Purpose: To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) and postoperative clinical outcome in patients with upper urinary tract carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) and adjuvant chemotherapy (ACH). Materials and Methods: We respectively analyzed the clinical and pathological data of 102 patients who underwent RNU and ACH for UTUC. Patients were divided into 2 groups, according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS) and overall survival (OS). Results: Mean survival time was 50.5±41.2 months. Mean age was 61.4±9.7years. Forty-one of the patients (46.5%) were in the high AST/ALT group. According to receiver operating characteristic analysis, the optimal AST/ALT ratio was 1.2. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in OS (p=0.007) and CSS (p=0.011). Using Cox regression models of clinical and pathological parameters to predict OS, high AST/ALT ratio (hazard ratio [HR], 5.428; 95% confidence interval [CI]; 1.803–16.334; p=0.002), pathological T3 (pT3) or higher (HR, 1.464; 95% CI; 1.156-1.857; p=0.002), and to predict CSS, high AST/ALT ratio (HR, 4.417; 95% CI; 1.545–12.632; p=0.005), and pT3 or higher (HR, 1.475; 95% CI; 1.172–1.904; p=0.002) were determined as independent prognostic factors. Conclusions Pretreatment AST/ALT ratio is a significant independent predictor of CSS and OS in advanced UTUC patients receiving systemic ACH after RNU.

PURPOSE: To report one case of unilateral intraocular involvement of the MALToma (Mucosa Associated Lymphoid Tissue Lymphoma) in the patient with bilateral conjunctival MALToma which was cured by radiation therapy 8 years ago. METHODS: A 64 year old woman who was in remission status after radiation therapy of the bilateral conjunctival MALToma presented with vitreous opacity, inflammatory reaction in anterior chamber, iris posterior synechiae and keratic precipitate in her left eye. Visual acuity of her left eye decreased from 20/33 to 20/100. Pars planar vitrectomy and cytologic analysis of the vitreous sample were performed. RESULTS: Cytologic analysis of the vitreous sample showed atypical lymphoid cells containing vacuolar nuclei which were stained positive at CD20 marker in the immunohistochemistry. So radiation therapy of the left eye was performed in the diagnosis of intraocular involvement of the MALToma. CONCLUSIONS: If severe panuveitis occurs in the patient with radiation therapy of the conjunctival MALToma, intraocular involvement of the MALToma should be considered as one of the differential diagnosis.
Anterior Chamber ; Conjunctiva ; Diagnosis ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Iris ; Lymphocytes ; Lymphoid Tissue ; Middle Aged ; Panuveitis ; Visual Acuity ; Vitrectomy

PURPOSE: Retisert(TM) (fluocinolone acetonide implant) has recently been approved for clinical use in patients with noninfectious posterior uveitis. We report a patient with intractable chronic Behcet's panuveitis who underwent Retisert(TM) implantation and showed a favorable outcome. METHODS: A 30-year-old male affected with intractable Behcet's uveitis of both eyes for over one year which did not respond to oral steroids and immunosuppressants; subcutaneous interferon injection caused undesirable side effects such as impotency and pyrexia. Initial visual acuities were 20/1000 in the right eye and 20/100 in the left eye, and both eyes showed severe panuveitis with posterior subcapsular cataract, especially in the right eye. The subtenon triamcinolone injection was performed in the right eye, which was only effective to anterior uveitis, and Retisert(TM) was implanted in the right eye after the cataract operation. Two months later the visual acuity increased to 20/25, and the inflammation was totally controlled. There were no ocular or systemic adverse events. CONCLUSIONS: Retiserttrade mark is a fast, effective, and safe treatment for chronic, non.infectious posterior uveitis.
Adult ; Cataract ; Eye ; Fever ; Fluocinolone Acetonide ; Humans ; Inflammation ; Interferons ; Male ; Panuveitis ; Steroids ; Triamcinolone ; Uveitis ; Uveitis, Anterior ; Uveitis, Posterior ; Visual Acuity

Through the use of intraoral scanners, it is possible to obtain intraoral scan impressions and produce prostheses. This approach isalso being attempted not only in dentate patients but also in edentulous patients. However, obtaining scans of edentulous areas can be more challenging than scanning dental areas, and there may be limitations, especially in capturing the details of the mucosal tissues. On the other hand, when obtaining impressions with intraoral scanners, simultaneous recording of the occlusal relationship of the maxilla and mandible can reduce the number of patient visits and expedite the restoration process. In this case, we aimed to combine the advantages of direct intraoral scanning and indirect digital impressions obtained after traditional impression-taking by merging two types of scan files. Consequently, in patients with partially edentulous arches, we sought to provide effective in-terim prostheses through direct and indirect digital model impressions and report our findings accordingly.

Through the use of intraoral scanners, it is possible to obtain intraoral scan impressions and produce prostheses. This approach isalso being attempted not only in dentate patients but also in edentulous patients. However, obtaining scans of edentulous areas can be more challenging than scanning dental areas, and there may be limitations, especially in capturing the details of the mucosal tissues. On the other hand, when obtaining impressions with intraoral scanners, simultaneous recording of the occlusal relationship of the maxilla and mandible can reduce the number of patient visits and expedite the restoration process. In this case, we aimed to combine the advantages of direct intraoral scanning and indirect digital impressions obtained after traditional impression-taking by merging two types of scan files. Consequently, in patients with partially edentulous arches, we sought to provide effective in-terim prostheses through direct and indirect digital model impressions and report our findings accordingly.

Through the use of intraoral scanners, it is possible to obtain intraoral scan impressions and produce prostheses. This approach isalso being attempted not only in dentate patients but also in edentulous patients. However, obtaining scans of edentulous areas can be more challenging than scanning dental areas, and there may be limitations, especially in capturing the details of the mucosal tissues. On the other hand, when obtaining impressions with intraoral scanners, simultaneous recording of the occlusal relationship of the maxilla and mandible can reduce the number of patient visits and expedite the restoration process. In this case, we aimed to combine the advantages of direct intraoral scanning and indirect digital impressions obtained after traditional impression-taking by merging two types of scan files. Consequently, in patients with partially edentulous arches, we sought to provide effective in-terim prostheses through direct and indirect digital model impressions and report our findings accordingly.

PURPOSE: The management of pediatric trauma is substantially derived from the results of adult trauma patient. Despite the increasing of pediatric renal trauma, the management of them still remains controversial. The aim of this study is to evaluate our experience with the expectant conservative management of blunt trauma in children. MATERIALS AND METHODS: We retrospectively studied 45 pediatric patients with renal trauma between 1995 and 2007. We reviewed medical records for clinical symptoms, mechanism of injury, assigned grade of renal injury, associated injuries, indication of surgery, and treatment outcomes. We graded renal injuries according to the American Association for the Surgery of Trauma Organ Injury Scale. RESULTS: All patients of grade I, II, III, and IV were managed conservatively at beginning, if the hemodynamic state is stable. Among them, 2 patients of grade IV were done delayed operation. One patient underwent delayed renorrhaphy for persistent anemia and hypotension, and the other patient needed delayed nephrectomy because of persistent fever and worsening abdominal pain with significant urinary extravasation. All patients of grade V were undergone early nephrectomy. CONCLUSIONS: Except for persistent fever with significant extravasation and grade V injury, initial conservative management of blunt renal trauma in children is effective and recommendable at beginning, if the hemodynamic state is stable. Prospective larger randomized controlled trials will be needed.
Abdominal Pain ; Adult ; Anemia ; Child ; Fever ; Hemodynamics ; Humans ; Hypotension ; Kidney ; Medical Records ; Nephrectomy ; Pediatrics ; Retrospective Studies ; Treatment Outcome

PURPOSE: The promotion of educators is challenged by the lack of accepted standards to evaluate the quality and impact of educational activities. Traditionally, promotion is related to research productivity. This study developed an evaluation tool for educational performance of medical school faculty using educator portfolios (EPs). METHODS: Design principles and quantitative items for EPs were developed in a consensus workshop. These principles were tested in a simulation and revised based on feedback. The changes of total educational activities following introduction of the system were analyzed. RESULTS: A total of 71% faculty members answered the simulation of the system and the score distributed widely (mean±standard deviation, 65.43±68.64). The introduction of new system significantly increased the total educational activities, especially in assistant professors. CONCLUSION: The authors offer comprehensive and practical tool for enhancing educational participation of faculty members. Further research for development of qualitative evaluation systems is needed.
Consensus Development Conferences as Topic ; Education ; Education, Medical ; Efficiency ; Evaluation Studies as Topic ; Schools, Medical*

PURPOSE: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast(R)) is effective regardless of the stones' composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast(R) alone or combined with ultrasonic lithotripsy. MATERIALS AND METHODS: Thirty-five (group A) and 39 (group B) patients underwent Lithoclast(R) PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates. RESULTS: The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181+/-50 vs. 221+/-65 min, respectively, p=0.004), number of hospital days (11.6+/-3.8 vs. 14.2+/-4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12+/-0.61 vs. 1.39+/-1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (Lithoclast(R) probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating). CONCLUSIONS: The combination of ultrasonic lithotripter and Lithoclast(R) is more effective than Lithoclast(R) alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast(R) and the ability to aspirate the debris during ultrasonic lithotripsy.
Hemoglobins ; Humans ; Kidney Calculi ; Length of Stay ; Lithotripsy ; Nephrostomy, Percutaneous ; Operative Time ; Suction ; Ultrasonics

PURPOSE: Penile fracture is a rare but serious urological condition. Immediate surgical repair is widely accepted as the treatment of choice in penile fracture. The aim of this study is to investigate the long-term outcome of immediate surgical treatment of penile fracture. MATERIALS AND METHODS: This is a retrospective study of 12 men with penile fracture who were treated in the Department of Urology, Sanggyepaik Hospital, Seoul, Korea from January 2000 to June 2005. Diagnosis was made clinically and was confirmed by cavernosography in all our patients. All patients underwent immediate surgical repair, within two days after trauma, using a degloving incision. The long term results of the immediate surgical repair were evaluated using questionnaire on outpatient department visiting or telephoning. RESULTS: The median patient age was 43 years (range, 18 to 57 years). The median follow-up was 32 months (range, 14 to 60 months). Of these patients, 8 (66.7%) patients were injured during sexual intercourse, whereas 4 (33.3%) patients were injured during masturbation. All patients were treated by immediate surgery. All patients reported satisfactory, painless erectile function; two developed penile curvature and one had a penile nodule. CONCLUSIONS: Immediate surgical repair of penile fracture is effective, restores erectile function, and the incidence of complications is low.
Coitus ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Masturbation ; Outpatients ; Penis ; Retrospective Studies ; Urology