PURPOSE: Increasing clinical importance is being placed on the role of differential renal function (DRF) for the management of congenital ureteropelvic junction obstructions. Supranormal DRF of a hydronephrotic kidney, on a renal scan, is hypothesized to be due to an increase in single nephron filtration or nephron volume. However, the etiology of this paradoxical phenomenon still remains to be elucidated. We studied the histopathological changes of hydronephrotic kidneys with a supranormal DRF. MATERIALS AND METHODS: 35 children with unilateral congenital hydronephrosis and supranormal DRF (>55%), on preoperative renal scans, who had undergone pyeloplasty, were retrospectively evaluated. There were 3 female and 32 male patients. The mean age at the time of the operation was 12.6 months, ranging from 0.1 to 144 months. Needle biopsies, from 3 different sites at the lower pole of the kidney, were performed during surgery. To evaluate the presence of glomerular hypertrophy, the maximal planar area of the glomeruli was measured under light microscopy. Tissue samples were obtained in same manner from kidneys with no history of urinary tract disease on autopsy, and used as controls. The mean glomerular areas of the patient and control groups were plotted according to the patient's age. RESULTS: The mean glomerular area in the patient group was smaller than in the control group, with the exception of 4 patients. According to the logistical regression, the probability of larger renal glomeruli increased with decreasing DRF (p=0.1155). CONCLUSIONS: The glomerular area of a hydronephrotic kidney, with a supranormal renal function on a renal scan, was not significantly larger than the normal controls. Therefore, we believe that the theory of increased nephron volume as a cause of a supranormal DRF can be excluded.
Autopsy ; Biopsy, Needle ; Child ; Female ; Filtration ; Humans ; Hydronephrosis ; Hypertrophy* ; Kidney ; Male ; Microscopy ; Nephrons ; Retrospective Studies ; Urologic Diseases

PURPOSE: Increasing clinical importance is being placed on the role of differential renal function (DRF) for the management of congenital ureteropelvic junction obstructions. Supranormal DRF of a hydronephrotic kidney, on a renal scan, is hypothesized to be due to an increase in single nephron filtration or nephron volume. However, the etiology of this paradoxical phenomenon still remains to be elucidated. We studied the histopathological changes of hydronephrotic kidneys with a supranormal DRF. MATERIALS AND METHODS: 35 children with unilateral congenital hydronephrosis and supranormal DRF (>55%), on preoperative renal scans, who had undergone pyeloplasty, were retrospectively evaluated. There were 3 female and 32 male patients. The mean age at the time of the operation was 12.6 months, ranging from 0.1 to 144 months. Needle biopsies, from 3 different sites at the lower pole of the kidney, were performed during surgery. To evaluate the presence of glomerular hypertrophy, the maximal planar area of the glomeruli was measured under light microscopy. Tissue samples were obtained in same manner from kidneys with no history of urinary tract disease on autopsy, and used as controls. The mean glomerular areas of the patient and control groups were plotted according to the patient's age. RESULTS: The mean glomerular area in the patient group was smaller than in the control group, with the exception of 4 patients. According to the logistical regression, the probability of larger renal glomeruli increased with decreasing DRF (p=0.1155). CONCLUSIONS: The glomerular area of a hydronephrotic kidney, with a supranormal renal function on a renal scan, was not significantly larger than the normal controls. Therefore, we believe that the theory of increased nephron volume as a cause of a supranormal DRF can be excluded.
Autopsy ; Biopsy, Needle ; Child ; Female ; Filtration ; Humans ; Hydronephrosis ; Hypertrophy* ; Kidney ; Male ; Microscopy ; Nephrons ; Retrospective Studies ; Urologic Diseases

OBJECTIVES: To investigate the work-relation of the asthma of a 51-year old aircraft maintenance worker and his working environment METHODS: For 2 weeks, the patient went back into his workplace. The pulmonary function test including FEV1 was performed every other day morning in the hospital and peak expiratory flow rate(PEFR) self-monitoring was done 6 times a day. RESULTS: The patient has been worked as aircraft maintenance worker in line maintenance department since 1968. The pulmonary function test(PFT) with bronchodilator confirmed the asthma of the patient. He showed positive response to 2-weeks workplace challenge test. On 3rd day after stopping challenge exposure, FEV 1.0 was 1.04 L(55 % of baseline measurement). The result of PEFR self-monitoring showed progressively deteriorating pattern, baseline PEFR was 6.02 L/min but PEFR on 3rd day after stopping exposure was 2.43 L/min. CONCLUSIONS: The present case could be occupational asthma based on positive results of PEFR monitoring. Further research will be needed to find the specific agent to cause asthma in aircraft maintenance workers exposed to aviation fuel and jet stream exhausts.
Aircraft ; Asthma* ; Asthma, Occupational ; Aviation ; Formaldehyde ; Humans ; Kerosene ; Middle Aged ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Rivers

OBJECTIVE: Total disc replacement (TDR) is frequently performed anterior approaching method for the patients diagnosed with cervical disc herniation. This study aimed to assess the degree of ossification of the posterior longitudinal ligament (OPLL) progression after cervical TDR. METHODS: Twenty-two male soldiers who underwent cervical TDR surgery from 2009 to 2016 and were followed-up for more than 12 months were enrolled. The enrolled patients were classified as; 1) patients with pre-existing OPLL and without; and 2) patient showing progression of OPLL or not. RESULTS: Twenty-two men were included in the analysis. The mean follow-up period from the surgery was 41.4 months (range, 12–114 months). The mean age of all patients was 40.7 years (range, 31–52 years). TDR-only was used in 7 cases, and the hybrid surgery (TDR+ACDF) was used in 15 cases. The incidence of progression or newly development of OPLL was significantly higher in pre-existing OPLL group (p=0.01). In 11 cases showing the progression of the OPLL, the mean size of OPLL progression was 4.16 mm (range, 0.34–18.87 mm) in the longitudinal height and 1.57 mm (range, 0.54–3.91 mm) in thickness. CONCLUSION: The progression of OPLL after cervical TDR was more frequent in patients with pre-existing OPLL than in patients without OPLL. Even though TDR is a major alternative to the treatment of cervical lesions to preserve vertebral segmental motion, careful attention should be paid to whether TDR should be used in patients with OPLL and this should be fully explained to the patient.
Cervical Vertebrae ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Longitudinal Ligaments ; Male ; Methods ; Military Personnel ; Ossification of Posterior Longitudinal Ligament ; Total Disc Replacement

BACKGROUND: The possibility of developing pulmonary tuberculosis usually increases with increasing age. Therefore, the incidence of endobronchial tuberculosis in older people may increase. We evaluated the clinical characteristics in patients with endobronchial tuberculosis above the age of 70 years. METHODS: We enrolled 74 patients (12 males and 62 females; mean age 64.6+/-16.2 years) that were diagnosed with endobronchial tuberculosis from March 2003 to July 2006 at Gyeongsang University Hospital. We retrospectively evaluated the clinical characteristics of endobronchial tuberculosis for patients 70 years or older (older group) and for patients below the age of 70 years (younger group). RESULTS: The number of patients in the older group was 41 (55%). Cough was the most common symptom in the two groups of patients and dyspnea on exertion was more common in the older group of patients than in the younger group of patients (31.7% vs. 12.1%). The actively caesating type of disease was more common in the younger group of patients than in the older group of patients (66.7% vs. 39%). The edematous type of disease was more common in the older group of patients than in the younger group of patients (53.7% vs. 27.2%) (p<0.05). Tracheal and main bronchial involvement of lesions were more common for the younger group of patients than for the older group of patients (30.3% vs. 9.7%) (p<0.05). CONCLUSION: Endobronchial tuberculosis was commonly observed in patients older than 70 years and this group of patients had some clinical characteristics that were different from the younger group of patients.
Cough ; Dyspnea ; Female ; Humans ; Incidence ; Male ; Retrospective Studies ; Tuberculosis* ; Tuberculosis, Pulmonary

PURPOSE: The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality. MATERIALS AND METHODS: Between March 1998 and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria, suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed. RESULTS: Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%) radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions. CONCLUSION: Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.
Adult ; Angiomyolipoma/*pathology/*surgery/therapy ; Female ; Humans ; Kidney Neoplasms/*pathology/*surgery/therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical Systemtrade mark, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy.
*Equipment Failure ; Humans ; Male ; Middle Aged ; Prostatectomy/*instrumentation ; Robotics/*instrumentation

PURPOSE: We compared the efficacy of urine cytology, nuclear matrix protein 22 (NMP22), and fluorescence in situ hybridization (FISH) for the detection of bladder cancer. MATERIALS AND METHODS: Washing urine samples from 156 patients were evaluated for the detection of bladder cancer. Patients were divided into 3 groups. Group 1 was 106 patients with bladder cancer, group 2 was 30 patients with benign prostatic hyperplasia who underwent transurethral resection of the prostate without bladder cancer, and group 3 had gross hematuria without bladder cancer. The sensitivity and specificity of cytology, NMP22, and FISH were compared. NMP22 positivity was defined as > or =10U/ml. FISH was done with the UroVysion(R) system and FISH positivity was defined as > or =2 abnormal urothelial cells with an abnormal signal from any out of 4 probes. RESULTS: The overall sensitivity of urine cytology, NMP22, and FISH was 60.4%, 75.5%, and 84.9%, respectively (p<0.001). The overall specificity of cytology, NMP22, and FISH was 96.7%, 83.3%, and 93.3%, respectively (p=0.168). In group 3, the false-positive rates of cytology, NMP22, and FISH were 20.0%, 55.0%, and 10.0%, respectively. In these patients with gross hematuria, the false-positive rate with NMP22 was significantly higher than with cytology or FISH (p=0.004). The sensitivity of cytology, NMP22, and FISH in low-grade bladder cancer patients was 25.9%, 51.9%, and 77.8%, respectively, and that in pTa-1 bladder cancer patients was 40.6%, 65.6%, and 78.1%, respectively. In low-grade or in pTa-1 patients, the sensitivity of the three diagnostic tools was significantly different (low grade; p<0.001, pTa-1; p<0.001). CONCLUSIONS: FISH is more sensitive in low-grade bladder cancer than is urine cytology and can be used as a diagnostic tool for the detection of primary and recurrent bladder cancer. NMP22 was affected by gross hematuria and thus has limitations for screening of bladder cancer. However, it can be used to follow-up bladder cancer.
Carcinoma, Transitional Cell ; Fluorescence ; Hematuria ; Humans ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Mass Screening ; Nuclear Matrix ; Nuclear Proteins ; Prostate ; Prostatic Hyperplasia ; Sensitivity and Specificity ; Urinary Bladder ; Urinary Bladder Neoplasms

Sexual dysfunction is a common problem in patients with end stage renal disease. The pathogenesis of this problem is complex, and includes psychological factors, vascular, and neurological disorders, drug therapy, uremic intoxication and hormonal disturbances. However, we don't have any valid report because pathogenesis and physiologic significance is not proved clearly. With the questionnaire that we provided to our patients, we evaluated the sexual dysfunction in patients with end stage renal disease, and we treated our patient with antidepressants for males and estrogen for females. The results are as follows: 1) Sixty patients among 70 answered the sexual question. Among these, 46 patients (76%) complained of sexual dysfunction, 75% of male patients and 58% of female patients complained of impotence and mensturation disturbance, respectively. Especially, female patients complained of loss of libido as a whole. Also they said that they never tried to do anything to recover their sexual dysfunction. 2) After starting dialysis, 57% of patients showed decrease in coital frequency than before. 58% of patients showed no significant change in subjective sezual symptoms after dialysis. 18% of patients showed significant change in sexual function after anemia treatment. 3) Eighty-eight percents of males and one hundred percents of females treated with antidepressants and estrogen, respectively showed no effect. Finally, we found that sexual dysfunction is a common problem in chronic renal failure, but they never try to recover their conditions. Our therapeutic approach was not effective, but dialysis in CRF patient must be used for lifting the value of life, not by way of life extension. In addition we can make more effective treatment through objective study and psychological examination.
Anemia ; Antidepressive Agents ; Coitus ; Dialysis ; Drug Therapy ; Erectile Dysfunction ; Estrogens ; Female ; Humans ; Kidney Failure, Chronic* ; Libido ; Life Expectancy ; Lifting ; Male ; Nervous System Diseases ; Psychology ; Value of Life ; Surveys and Questionnaires

PURPOSE: We evaluated the pathologic characteristics and prognosis of pathologic T0 (pT0) prostate cancer (PC). MATERIALS AND METHODS: Of 1,196 consecutive men who underwent radical prostatectomy (RP) between January 1992 and November 2008, 34 patients (mean age, 68.8+/-7.9 years; range, 48-85) had pT0 PC. They were categorized into 4 groups according to neoadjuvant hormone therapy (NHT) and diagnostic methods. The initial PSA, 5 alpha-reductase inhibitor (5alphaRI), Gleason score of prostatic needle biopsy (PNB) or transurethral resection of the prostate (TURP), clinical stage, and presence of high-grade prostatic intraepithelial neoplasia were evaluated. Clinical and biochemical progression were also evaluated. RESULTS: 34 patients were categorized into 4 groups (Group I: 9 without NHT, diagnosed by PNB [1.1%]; Group II: 8 without NHT, diagnosed by TURP [11.3%]; Group III: 16 with NHT, diagnosed by PNB [5.5%]; Group IV: 1 with NHT, diagnosed by TURP [3.8%]). Group I had serum prostate-specific antigen (PSA)<15.0 ng/ml, one positive biopsy core, and a Gleason score< or =7. Group II had serum PSA<10.1 ng/ml, chips involved with cancer<10.0%, and a Gleason score< or =6. There were more patients taking 5alphaRI and high-grade PIN among patients without NHT. None of patients with pathologic pT0 PC had clinical or biochemical progression during follow-up, except 3 patients with NHT (mean, 22 months; range, 2-105 months). CONCLUSIONS: Patients without NHT had more favorable clinical and pathologic results. In our study, except for 3 patients with NHT, all patients had undetectable PSA levels after RP. We need more time for follow-up to conclude whether the prognosis of pT0 PC is favorable.
Biopsy ; Biopsy, Needle ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms ; Transurethral Resection of Prostate