No abstract available.
Aneurysm* ; Renal Artery*

Objective: Physiologically, the vastus medialis muscle is the first muscle to undergo muscle atrophy, and it was thought that pain in patients with knee osteoarthritis could be reduced if this muscle could be strengthened and stabilized. The purpose of this study was to prove the effectiveness in knee osteoarthritis using polydioxanone sutures that have been tried in other musculoskeletal areas. Method: Forty knee osteoarthritis patients voluntarily participated in the study, and divided into 30 polydioxanone suture needle (MEST-B2375 produced by Ovmedi Co.) and 10 sham needle (without suture). And the needles were inserted into the vastus medialis muscle. In all patients, safety evaluation including blood tests and ultrasonography as well as efficacy evaluation including isometric maximal contractile strength of quadriceps muscle, weight bearing pain, impression of change, quadriceps angle, rescue drug intake were evaluated up to 30 weeks after the procedure. Results: Isometric maximal contractile strength showed a significant improvement at 4 weeks after the procedure in the polydioxanone suture group, and the weight-bearing pain showed a significant improvement at every visit in the polydioxanone suture group compared with baseline values. Patient global impression of change score showed significant improvement at 20 and 30 weeks, and clinical score showed improvement at every visit. Conclusion Insertion of polydioxanone sutures showed improvement in muscle strength and knee pain by supporting and fixation of the vastus medialis muscle in patients with degenerative knee osteoarthritis. Insertion of polydioxanone sutures is considered to have a therapeutic effect in knee osteoarthritis patients.

PURPOSE: Shock wave lithotripsy (SWL) and ureteroscopy are used to successfully manage the majority of ureteral stones. However, some large and impacted ureteral stones still require surgery. Laparoscopic ureterolithotomy has emerged as a feasible treatment option for the patients with large and impacted ureteral stone. MATERIALS AND METHODS: Between December 2004 and October 2005, laparoscopic ureterolithotomy was performed in 12 patients who required surgical treatment. In four patients, laparoscopy was carried as a salvage procedure after failed SWL, and laparoscopy was performed in seven patients as a primary procedure for treating large and impacted stones. The mean stone size was 16mm (range: 8-28). RESULTS: All the procedures were completely laparoscopically, and all the patients were rendered stone-free after a single procedure; no complications were encountered. The mean operative time was 132.5 minutes (range: 60-220), and the mean estimated blood loss was 100ml (range: 50- 150). The mean postoperative hospital stay was 4.3 days (range: 2-7). CONCLUSIONS: Laparoscopic ureterolithotomy can be a safe and effective treatment for large and impacted stones. In selected cases, it should be considered as a primary procedure for large and impacted ureteral stones that are located at the mid and upper levels of the ureter, including renal pelvic stones.
Humans ; Laparoscopy ; Length of Stay ; Lithotripsy ; Operative Time ; Shock ; Ureter* ; Ureteroscopy ; Urinary Calculi

PURPOSE: The presence of histologic coagulative necrosis in the primary tumors of patients with renal cell carcinoma has been suggested to be an important predictor of survival. This study aimed to evaluate the relationship of tumor necrosis and tumor location as compared to the other clinical features. MATERIALS AND METHODS: From June 1995 to April 2004 we retrospectively reviewed the records of 204 patients who underwent unilateral radical nephrectomy for stage T1a renal cell carcinoma. The presence of histologic coagulative necrosis in the primary tumors was recorded and the location of tumor was classified based on the computed tomography (CT) scan. Overall survival was estimated using the Kaplan-Meier method and the log-rank test, and the prognostic factors that influenced on survival were estimated using the Cox proportional hazard regression model. RESULTS: In this study, radical nephrectomy was performed in 148 men and 56 women with a mean age of 54.9 years (age range: 23 to 77). The mean follow-up was 31.3 months (range: 6 to 106 months). The average size of the renal cell carcinoma was 3.0cm (range: 1 to 4). The tumor locations were categorized into 2 types according to the centrality and verticality. The incidence of necrosis in T1a renal cell carcinoma was 8.7% (n=18). On the analysis of the overall survival using the log rank test, tumor necrosis (p=0.01) was a statistically significant factor. CONCLUSIONS: For the patients with T1a renal cell carcinoma (2002 TNM stage), the presence of tumor necrosis was significantly associated with overall survival.
Carcinoma, Renal Cell* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Necrosis* ; Nephrectomy ; Retrospective Studies

OBJECTIVE: To know when we can identify fetal Y chromosome SRY gene by using fetal DNA in maternal plasma. METHODS: DNA from maternal plasma of 62 pregnant women (48: inpatients, 14: outpatients) underwent a sensitive Y-PCR assay to identify SRY gene of Y chromosome. RESULTS: Of the patients, fetus-derived Y sequences were detected in 37 (88.1%) of the 42 maternal plasma samples from women bearing male fetuses. One of the 20 women bearing female fetuses had positive result from plasma DNA. Seventh gestational week was the earliest gestation of gender identification. CONCLUSION: We could identify fetal gender using fetal DNA in maternal plasma (sensitivity 88.1%). The earlist to detect was 7th gestational week.
DNA* ; Female ; Fetus ; Genes, sry ; Humans ; Inpatients ; Male* ; Plasma* ; Pregnancy ; Pregnant Women ; Y Chromosome

BACKGROUND: The occurrence of an outbreak of food-borne infectious disease requires a hospital to do extended role. There has been no report of an outbreak and an outbreak management of food-borne infectious diseases in a hospital. Therefore, this report of an outbreak and management of Shigellosis in the hospital would help others to manage further cases. METHODS: This was a descriptive study for an infection control program for food-borne infectious diseases in a hospital. RESULTS: There was a shigellosis outbreak at a university hospital in Seoul between December 3 and 30, 2001, Five hundred eighty four were affected, of which 81 cases were suspected and 86 cases were confirmed Shigella sonnei in fetal culture. The source of infection was identified as a lunch box or seaweed rolled rice that was contaminated and was supplied from the S-catering facility. The infection control team had developed the various strategies to control the outbreak and implemented them. The strategies included an epidemiology investigation, the removal of infection sources, medical treatment and isolation of patients, education and management of public relationship, environmental control, withdrawal of medical students' training, prevention and control of asymptomatic cases, intensive care unit strong financial support, analysis and management various data and the construction of cooperation and reporting system with the public health system CONCLUSION: This outbreak was controlled by effective team approach. The effective management of an outbreak of food-borne infectious diseases requires a systematic infection control, public relationship strategies for the reputation of the hospital, and the cooperation with a public health system.
Communicable Diseases ; Dysentery, Bacillary* ; Education ; Epidemiology ; Financial Support ; Humans ; Infection Control* ; Intensive Care Units ; Lunch ; Public Health ; Seaweed ; Seoul ; Shigella sonnei

PURPOSE: Vesicoureteral reflux (VUR) in a transplanted kidney may affect the function of a grafted kidney with a recurrent urinary tract infection (UTI), and is a factor of graft failure. Our experience of surgical correction was investigated by performing transvesical ureteral reimplantation in VUR recipients. MATERIALS AND METHODS: Among 2,265 recipients, who had received a living kidney transplantation at Yonsei University Severance Hospital between April 1979 and October 2003, and 29 VUR recipients (7 Men, 22 Women), diagnosed with VCUG after recurrent UTI, were retrospectively analyzed. The mean age of the patients was 43.9, ranging from 24 to 61 years, with a mean follow up of 3.6, ranging from 0.7 to 8.0 years. The changes in the serum creatinine and complications after a transvesical ureteral reimplantation were analyzed. RESULTS: The incidence of VUR was 1.28% (29/2,265) and the mean diagnosis was made after 5.0, ranging from 0.8 to 13.4 years. The grades of VUR were 2 (I), 2 (II), 20 (III) and 5 (IV). Twenty-five recipients underwent a transvesical ureteral reimplantation. The mean serum creatinine decreased from 2.5+/-2.2 to 1.8+/-1.4mg/dl (p=0.14) 1 year after surgical correction, and was significantly decreased from 2.5+/-2.2 to 1.4+/-0.7mg/dl (p=0.017) 3 years after surgical correction. There were no UTI and acute pyelonephritis after a ureteral reimplantation. CONCLUSIONS: VUR, with recurrent UTI, in recipients administered an immunosuppressive agent may cause deterioration of the graft function. The suspicion of VUR should be borne in mind for renal recipients with recurrent UTI, which can be safely corrected by a transvesical ureteral reimplantation.
Creatinine ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Pyelonephritis ; Replantation ; Retrospective Studies ; Transplantation* ; Transplants ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

PURPOSE: To investigate the incidence and histopathological factors of perirenal fat invasion (pT3a) in cT1a renal cell carcinomas. The implication for postoperative perirenal fat invasion, as a prognostic factor in patients with tumors less than 4cm tumor in size is also discussed. MATERIALS AND METHODS: Of 503 patients who underwent an operation for a renal cell carcinoma at our institution, between June 1995 and April 2004, we retrospectively reviewed the records of 176 with T1a renal cell carcinomas. We evaluated the pathological grade, cell type, tumor size, location and incidence of perirenal fat invasion using the Fisher's exact test. The overall survival was estimated using the Kaplan-Meier method and log-rank test, and the prognostic factors influencing the survival were estimated using the Cox proportional hazard regression model. RESULTS: In this study, a radical nephrectomy was performed in 128 men and 48 women, with a mean age of 54.6 years, ranging from 23 to 77. The mean follow-up was 31.3 months, ranging from 6 to 106 months. The average size of the renal cell carcinomas was 3.0cm, ranging from 1 to 4cm. The incidence of perirenal fat invasion in the T1a renal cell carcinomas was 5.7% (n=10). The nuclear grade (p<0.001) was a statistically significant factor in the incidence of postoperative perirenal fat invasion. CONCLUSIONS: In the patients with a renal cell carcinoma less than 4cm in size (cT1a), those in the postoperative perirenal fat invasion group had a significantly poorer prognosis. The tumor size and Fuhrman nuclear grade were implicated in the incidence of perirenal fat invasion in the T1a renal cell carcinomas. Therefore, in the case of nephron sparing surgery, more precise preoperative staging of the primary tumor is required.
Carcinoma, Renal Cell* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Neoplasm Staging ; Nephrectomy ; Nephrons ; Prognosis ; Retrospective Studies

A rare primary segmental omental infarction in an adult. Infarction of a part of the greater omentum has been recognized as an uncommon condition that may mimic other acute abdominal conditions, particularly acute appendicitis and acute cholecystitis. The presentation and course are seldom typical of appendicitis or cholecystitis. A greater omental infarction may occur without a recognizable cause, and may be termed "primary" (idiopathic), but in some cases, a cause is discovered, such as; mechanical interference with the blood supply to the omentum secondary to torsion, or systemic disorders such as cardiac, vascular, and hematological disease. The inflammatory necrotic mass resulting from the infarction produces somatic pain at its location in the abdomen. For unknown reasons the infarction occurs most commonly in the right half of the abdomen, especially the lower quadrant. An sign of peritoneal irritation, tenderness, and muscle guarding are the principal findings elicited on palpitation of the abdomen. Occasionally, a point of exquisite tenderness may be detected; this usually corresponds to the site of the infarction. Recognizing the typical imaging featuresan ovoid or cake-like mass in the omental fat with surrouding inflammatory changesof this condition is important, as most cases can be managed without surgery. We report a case of an adult patient with acute abdominal pain who was diagnosed with a right-sided segmental omental infarction.
Abdomen ; Abdominal Pain ; Adult* ; Appendicitis ; Cholecystitis ; Cholecystitis, Acute ; Hematologic Diseases ; Humans ; Infarction* ; Nociceptive Pain ; Omentum

PURPOSE: To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS: Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS: With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION: Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.
Adult ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Radiotherapy, Adjuvant/adverse effects ; Seminoma/*radiotherapy ; Testicular Neoplasms/*radiotherapy ; Treatment Outcome ; Young Adult