PURPOSE: We reviewed the incidence, causes, location, treatment and prognosis of the severe iatrogenic ureteral avulsions caused by ureteroscopy procedures. MATERIALS AND METHODS: We analyzed the records of eight patients with ureteral avulsion out of 683 patients treated with ureteroscopic procedures, retrospectively. The patients had surgical correction or ureteral double-J stenting for the iatrogenic ureteral avulsions. RESULTS: The incidence of ureteral avulsion was 1.17%. While seven cases occurred during ureteroscopic removal of a stone, five cases among them occurred during stone basketing and two cases occurred during insertion of the ureteroscope. Another case among eight avulsion cases occurred while removing the during an endopyelotomy for a ureteral stricture. Depending on the length of the ureteral avulsion, four cases were over 2cm, the patientsopen surgical repair for ureteral continuity restoration immediately; three cases, under 2cm, were treated with indwelling ureteral double J stents, and one case with an injury to the entire ureter was treated with a nephrectomy. The result of the surgical treatment as the initial treatment was good in all cases. On the other hand, among the three cases with an inserted ureteral double-J stent, one case had aresult and the other two developed hydronephrosis. CONCLUSION: Careful attention to surgical techniques and awareness of risk factors and types of potential injuries are essential to reduce severe iatrogenic ureteral avulsions. Our reports suggest that open surgical repair is better than an indwelling ureteral double-J stent for patients with a ureteral avulsion.
Constriction, Pathologic ; Hand ; Humans ; Hydronephrosis ; Incidence ; Nephrectomy ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents ; Ureter* ; Ureteroscopes ; Ureteroscopy

Objective: To determine the association of macrocalcification and rim calcification with malignancy and to stratify the malignancy risk of thyroid nodules with macrocalcification and rim calcification based on ultrasound (US) patterns. Materials and Methods: The study included a total of 3603 consecutive nodules (≥ 1 cm) with final diagnoses. The associations of macrocalcification and rim calcification with malignancy and malignancy risk of the nodules were assessed overall and in subgroups based on the US patterns of the nodules. The malignancy risk of the thyroid nodules was categorized as high (> 50%), intermediate (upper-intermediate: > 30%, ≤ 50%; lower-intermediate: > 10%, ≤ 30%), and low (≤ 10%). Results: Macrocalcification was independently associated with malignancy in all nodules and solid hypoechoic (SH) nodules (p < 0.001). Rim calcification was not associated with malignancy in all nodules (p = 0.802); however, it was independently associated with malignancy in partially cystic or isoechoic and hyperechoic (PCIH) nodules (p = 0.010). The malignancy risks of nodules with macrocalcification were classified as upper-intermediate and high in SH nodules, and as low and lowerintermediate in PCIH nodules based on suspicious US features. The malignancy risks of nodules with rim calcification were stratified as low and lower-intermediate based on suspicious US features. Conclusion Macrocalcification increased the malignancy risk in all and SH nodules with or without suspicious US features, with low to high malignancy risks depending on the US patterns. Rim calcification increased the malignancy risk in PCIH nodules, with low and lower-intermediate malignancy risks based on suspicious US features. However, the role of rim calcification in risk stratification of thyroid nodules remains uncertain.

Objective: To determine the association of macrocalcification and rim calcification with malignancy and to stratify the malignancy risk of thyroid nodules with macrocalcification and rim calcification based on ultrasound (US) patterns. Materials and Methods: The study included a total of 3603 consecutive nodules (≥ 1 cm) with final diagnoses. The associations of macrocalcification and rim calcification with malignancy and malignancy risk of the nodules were assessed overall and in subgroups based on the US patterns of the nodules. The malignancy risk of the thyroid nodules was categorized as high (> 50%), intermediate (upper-intermediate: > 30%, ≤ 50%; lower-intermediate: > 10%, ≤ 30%), and low (≤ 10%). Results: Macrocalcification was independently associated with malignancy in all nodules and solid hypoechoic (SH) nodules (p < 0.001). Rim calcification was not associated with malignancy in all nodules (p = 0.802); however, it was independently associated with malignancy in partially cystic or isoechoic and hyperechoic (PCIH) nodules (p = 0.010). The malignancy risks of nodules with macrocalcification were classified as upper-intermediate and high in SH nodules, and as low and lowerintermediate in PCIH nodules based on suspicious US features. The malignancy risks of nodules with rim calcification were stratified as low and lower-intermediate based on suspicious US features. Conclusion Macrocalcification increased the malignancy risk in all and SH nodules with or without suspicious US features, with low to high malignancy risks depending on the US patterns. Rim calcification increased the malignancy risk in PCIH nodules, with low and lower-intermediate malignancy risks based on suspicious US features. However, the role of rim calcification in risk stratification of thyroid nodules remains uncertain.

A meniscal ossicle is an ossified structure embedded in the meniscus of the knee, and it very rarely occurs in human. We present here two cases of meniscal ossicle. The two patients were men in their thirties. They had intrameniscal ossicles from the torn posterior horn of the medial meniscus without having any history of trauma. Both cases were treated by arthroscopic excision.
Animals ; Horns ; Humans ; Knee ; Male ; Menisci, Tibial

BACKGROUND: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). METHODS: Participants in this study consisted of 65 type 2 diabetes patients (M : F = 45 : 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 +/- 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. RESULTS: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 +/- 2.5 vs. 50.5 +/- 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 +/- 0.7 vs. 24.6 +/- 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 +/- 1.48 vs. 4.71 +/- 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). CONCLUSION: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.
Blood Pressure ; Body Mass Index ; Diabetes Mellitus ; Electrocardiography ; Fasting ; Glucose ; Heart Diseases ; Hemoglobins ; Humans ; Hypertension ; Insulin ; Myocardial Ischemia ; Risk Factors ; Smoke ; Smoking

BACKGROUND: There is an individual variation in the hepatic injuries following alcohol abuse, which may be partly caused by the diverse activities of enzymes participating in the degradation of alcohol. Polymorphism of cytochrome P450 2E1 (CYP2E1) gene has been reported to affect the degradating activity of the enzyme, which may be eventually associated with the severity of alcoholic liver disease. In this study we were to evaluate the effects of genetic polymorphism of CYP2E1 on hepatocellular injury or fibrosis. METHODS: We analyzed the relationship of CYP2E1 genotypes to the biochemical and clinical characteristics as well as TGFbeta1 expressions in a total of 33 patients (M:F=32:1) with advanced alcoholic liver cirrhosis. CYP2E1 genotypes were determined by RFLP using RsaI and PstI. The amounts of serum TGFbeta1 were measured by ELISA (TGFbetta1 ELISA system, Promega, USA). RESULTS: Out of 33, 23 (70%) had the CYP2E1 of genotype A and all of the remaining 10 (30%) were type B; there was no one who had type C. The serum albumin levels of patients with type A of CYP2E1 gene were lower than those with type B (p=0.01); the Child-Pugh scores were also higher in patients with type A than B (p=0.03). However, there was no difference between the two groups in the serum AST, ALT, gamma-GTP and bilirubin levels. The patients expressed similar amount of serum TGFbetta1 regardless of their CYP2E1 genotypes. CONCLUSION: Our data indicates that the most common genotype of CYP2E1 is type A (70%) in patients with advanced alcoholic liver cirrhosis in Korea. It is also suggested that patients with enotype A of CYP2E1 may be associated with more advanced alcoholic liver cirrhosis compared to those with type B.
Alcoholics* ; Alcoholism ; Bilirubin ; Cytochrome P-450 CYP2E1* ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Genotype ; Humans ; Korea ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Liver Diseases, Alcoholic ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Serum Albumin ; Transforming Growth Factor beta

Immunoglobulin G4-related disease (IgG4-RD) is characterized by extensive IgG4-positive plasma cells infiltration resulting in inflammation and fibrosis of the affected organs. Patient with IgG4-RD shows an excellent response to glucocorticoid therapy especially when given at early onset stages. IgG4-related sclerosing cholangitis (IgG4-SC) is considered biliary manifestation of IgG4-RD. The natural history and long-term prognosis of IgG4-SC is not well defined and most of the previous case series have reported short duration of follow-up. We present the case of development of decompensated liver cirrhosis from IgG4-related sclerosing cholangitis with a 6-year natural clinical course.
Cholangitis ; Cholangitis, Sclerosing* ; Fibrosis ; Follow-Up Studies ; Humans ; Immunoglobulins ; Inflammation ; Liver Cirrhosis* ; Liver* ; Natural History ; Plasma Cells ; Prognosis

STUDY DESIGN: A retrospective study on the outcomes of surgical treatment for pyogenic lumbar spondylodiscitis. OBJECTIVES: To report the clinical outcomes of the surgical treatment of pyogenic lumbar spondylodiscitis using a one stage posterior approach. SUMMARY OF LITERATURE REVIEW: There are few reports on the treatment of pyogenic lumbar spondylodiscitis through a one stage posterior approach. MATERIALS AND METHODS: Between June 1999 and June 2005, this study examined the history of 12 patients with pyogenic lumbar spondylodiscitis treated by simultaneous posterior debridement, autogenous iliac bone graft and pedicle screw fixation. The clinical outcomes were evaluated in terms of the pain level, neurological status, hematological parameters and radiology findings. RESULTS: The clinical symptoms improved in all cases after surgery. There was no case of the infection recurring. The mean time for postoperative antibiotics and hospitalization was 6 weeks and 41.6 days, respectively. Radiological bony fusion was observed at 5.5 months on average. The mean preoperative, immediate postoperative and final follow-up sagittal angles were 4.6, 8.6 and 6.9degrees. CONCLUSION: One stage posterior interbody fusion and instrumentation for the treatment of pyogenic lumbar spondylodiscitis can provide radical debridement, bone graft and immediate stability without prohibiting the control of infection. Therefore, it can be used in selected cases.
Anti-Bacterial Agents ; Debridement* ; Discitis* ; Follow-Up Studies ; Hospitalization ; Humans ; Retrospective Studies ; Transplants

OBJECTIVES: The ginsenoside Rg1 and Rb1, the major components of ginseng saponin, have neurotrophic and neuroprotective effects including promotion of neuronal survival and proliferation, facilitation of learning and memory, and protection from ischemic injury and apoptosis. In this study, to investigate the molecular basis of the effects of ginsenoside on neuron, we analyzed gene expression profiling of SH-SY5Y human neuroblastoma cells treated with ginsenoside Rg1 or Rb1. METHODS: SH-SY5Y cells were cultured and treated in triplicate with ginsenoside Rg1 or Rb1(80micrometer, 40micrometer, 20micrometer). The proliferation rates of SH-SY5Y cells were determined by MTT assay and microscopic examination. We used a high density cDNA microarray chip that contained 8K human genes to analyze the gene expression profiles in SH-SY5Y cells. We analyzed using the Significance Analysis of Microarray(SAM) method for identifying genes on a microarray with statistically significant changes in expression. RESULTS: Treatment of SH-SY5Y cells with 80microliter ginsenoside Rg1 or Rb1 for 36h showed maximal proliferation compared with other concentrations or control. The results of the microarray experiment yielded 96 genes were upregulated(> or =3 fold) in Rg1 treated cells and 40 genes were up-regulated(> or =2 fold) in Rb1 treated cells. Treatment with ginsenoside Rg1 for 36h induced the expression of some genes associated with protein biosynthesis, regulation of transcription or translation, cell proliferation and growth, neurogenesis and differentiation, regulation of cell cycle, energy transport and others. Genes associated with neurogenesis and neuronal differentiation such as SCG10 and MLP increased in ginsenoside Rg1 treated cells, but such changes did not occur in Rb1- group. CONCLUSION: Our data provide novel insights into the gene mechanisms involved in possible role for ginsenoside Rg1 or Rb1 in mediating neuronal proliferation or cell viability, which can elicit distinct patterns of gene expression in neuronal cell line. Ginsenoside Rg1 have more broad and strong effects than ginsenoside Rb1 in gene expression and related cellular physiology. In addition, we suggest that SCG10 gene, which is known to be expressed in neuronal differentiation during development and neuronal regeneration during adulthood, may have a role in enhancement of activity dependent synaptic plasticity or cytoskeletal regulation following treatment of ginsenoside Rg1. Further, ginsenoside Rg1 may have a possible role in regeneration of injured neuron, promotion of memory, and prevention from aging or neuronal degeneration.
Aging ; Apoptosis ; Cell Cycle ; Cell Line ; Cell Proliferation ; Cell Survival ; Gene Expression Profiling* ; Gene Expression* ; Humans* ; Learning ; Memory ; Negotiating ; Neuroblastoma* ; Neurogenesis ; Neurons ; Neuroprotective Agents ; Oligonucleotide Array Sequence Analysis ; Panax ; Physiology ; Plastics ; Protein Biosynthesis ; Regeneration ; Saponins ; Transcriptome

PURPOSE: The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS: A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival. RESULTS: The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). CONCLUSION: Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.
Carcinoma, Transitional Cell ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Prognosis* ; Retrospective Studies ; Treatment Outcome