PURPOSE: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. RESULTS: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. CONCLUSIONS: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL.
Humans ; Lithotripsy ; Prospective Studies ; Risk Factors ; Shock ; Urinary Calculi

No abstract available.
Aneurysm* ; Coronary Aneurysm ; Coronary Vessels* ; Drug-Eluting Stents ; Stents* ; Ultrasonography, Interventional

PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated alpha-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. RESULTS: Mean age and mean gestational weeks in the study were 30+/-4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.
alpha-Fetoproteins ; Biomarkers ; Chorion ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Logistic Models ; Mothers ; Multivariate Analysis* ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, Second ; Pregnancy* ; Radioimmunoassay ; Rupture

PURPOSE: We wanted to investigate the usefulness of Mycofast (MYCOFAST(R) Evolution 2, International Microbio, France) for Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) in association with nongonococcal genitourinary infections. MATERIALS AND METHODS: 530 patients visited our department for genitourinary infection symptoms or for the evaluation of sexually transmitted disease. The genital swabs were first vortexed in Mycofast transport broth. A volume of 100mul of liquid sample was innoculated to each well of the Mycofast broths and 0.5mul of liquid sample was innoculated to A7 agar culture media (International Microbio, France). The Mycofast broths were incubated at 35-37 degrees C for 36 hrs, and the A7 agar culture media was incubated for 4 days. We compaired Mycofast with A7 agar culture for the sensitivity, specificity, the positive and negative predictive values and the antibiotic susceptable profiles. RESULTS: Of the 530 samples submitted, 165 samples were positive by the A7 agar culture and 162 samples were positive by Mycofast. 157 samples were positive by both methods. Of the 365 samples that were negative by the A7 agar culture, 360 samples were also negative by the Mycofast. In this study, Mycofast had a sensitivity and specificity of 95% and 98%, respectively, and a positive and negative predictive value of 96% and 97%, respectively. The Mycofast drug susceptibility tests indicate a high susceptibility to doxycyclin as follows: U. urealyticum: 86.3%; M. hominis: 85.0% and both organisms with simultaneous isolation: 75.8%. CONCLUSIONS: Mycofast was an easy test to perform and it proved to be a practical and reliable method for isolating the Mycoplasma and Ureaplasma species for making the diagnosis of nongonococcal genitourinary infections, and it showed the added benefit of determining the limited susceptibilities of the isolated strains.
Agar ; Culture Media ; Diagnosis* ; Humans ; Mycoplasma ; Mycoplasma hominis ; Sensitivity and Specificity ; Sexually Transmitted Diseases ; Ureaplasma ; Ureaplasma urealyticum

STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
Adhesives ; Diagnosis ; Diskectomy ; Electromyography ; Fistula ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Nylons ; Pain, Intractable ; Tears

Treatment strategies for patients with coronary artery disease (CAD) should be based on objective evidence of inducible ischemia in the subtended myocardium to improve clinical outcomes, symptoms, and cost-effectiveness. Fractional flow reserve (FFR) is the most verified index to-date for invasively evaluating lesion-specific myocardial ischemia. Favorable results from large clinical trials that applied FFR-guided percutaneous coronary intervention (PCI) prompted changes in coronary revascularization guidelines to emphasize the importance of this ischemia-based strategy using invasive coronary physiology. However, the frequency of functional evaluations is lacking in daily practice, and visual assessment still dominates treatment decisions in CAD patients. Despite recent efforts to integrate functional and anatomical assessments for coronary stenosis, there is considerable discordance between the 2 modalities, and the diagnostic accuracy of simple parameters obtained from current imaging tools is not satisfactory to determine functional significance. Although evidence that supports or justifies anatomy-guided PCI is more limited, and FFR-guided PCI is currently recommended, it is important to be aware of conditions and factors that influence FFR for accurate interpretation and application. In this article, we review the limitations of the current anatomy-derived evaluation of the functional significance of coronary stenosis, detail considerations for the clinical utility of FFR, and discuss the importance of an integrated physiologic approach to determine treatment strategies for CAD patients.
Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Humans ; Ischemia ; Myocardial Ischemia ; Myocardium ; Percutaneous Coronary Intervention ; Physiology ; Ultrasonography, Interventional

Treatment strategies for patients with coronary artery disease (CAD) should be based on objective evidence of inducible ischemia in the subtended myocardium to improve clinical outcomes, symptoms, and cost-effectiveness. Fractional flow reserve (FFR) is the most verified index to-date for invasively evaluating lesion-specific myocardial ischemia. Favorable results from large clinical trials that applied FFR-guided percutaneous coronary intervention (PCI) prompted changes in coronary revascularization guidelines to emphasize the importance of this ischemia-based strategy using invasive coronary physiology. However, the frequency of functional evaluations is lacking in daily practice, and visual assessment still dominates treatment decisions in CAD patients. Despite recent efforts to integrate functional and anatomical assessments for coronary stenosis, there is considerable discordance between the 2 modalities, and the diagnostic accuracy of simple parameters obtained from current imaging tools is not satisfactory to determine functional significance. Although evidence that supports or justifies anatomy-guided PCI is more limited, and FFR-guided PCI is currently recommended, it is important to be aware of conditions and factors that influence FFR for accurate interpretation and application. In this article, we review the limitations of the current anatomy-derived evaluation of the functional significance of coronary stenosis, detail considerations for the clinical utility of FFR, and discuss the importance of an integrated physiologic approach to determine treatment strategies for CAD patients.

OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD).SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

STUDY DESIGN: A prospective study. OBJECTIVES: To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea. MATERIALS AND METHODS: Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period. RESULTS: Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2degrees(55-136) to 37.6degrees (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7degrees(12-101) and 38.3degrees(9-72) to 44.5degrees(12-75) and 18.8degrees(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period. CONCLUSIONS: New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.
Animals ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Male ; Osteochondrodysplasias ; Osteoporosis ; Preoperative Period ; Prospective Studies ; Scoliosis ; Soft Tissue Infections

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast. Only one case of metastatic esophageal cancer with a radiologic evidence that it was originated from the rectal cancer had been reported. We report an unusual case of a 80-year-old man with secondary esophageal carcinoma originated from the rectal cancer. It was diagnosed by histopathologic confirmation using immunohistochemical staining including CK20 and CK7 by comparing the histopathologic findings of surgical specimen of rectal cancer and endoscopic biopsy tissue from the esophagus. To the best of our knowledge, this is the first case of secondary esophageal cancer arising from rectum in Korea.
Aged, 80 and over ; Biopsy ; Breast ; Esophageal Neoplasms* ; Esophagus ; Humans ; Korea ; Lung ; Rectal Neoplasms* ; Rectum