BACKGROUND: The term 'ischemic preconditioning', which implies the first, brief, sublethal ischemia before the next ischemia, is widely accepted to have protective effect in the myocardium, and recently with a specified circumstances, in the brain also. However, the existence of this 'ischemic tolerance' phenomenon is not yet clarified in the repeated transient focal cerebral ischemia model. This study was performed to test whether the ischemic preconditiong has protective effect also in this TIA-mimicking condition. METHODS: Using intraluminar suture technique, initial transient focal ischemia was maintained for 30 minutes in the rat brain. After this ischemic preconditioning, second ischemia of 120 minutes duration was performed using the same method at 1, 3, 5, and 7 days after the 1st ischemia (n=20). The resulting brain infarct volume was assessed and compared to that of previously sham-operated paired controls(n=20). RESULTS: Using the infarct volume as parameters, there was no significant difference between the ischemia and control group in all pairs. But when the percent of infarct volume compared to the hemispheric volume was used instead, neocortical infarct percent was significantly smaller at day 3 after preconditiong (p<0.05). But such difference was not found at 1, 5, and 7th day in the neocotex. Neither the percent of total infarct nor the subcortical infarct showed any statistical difference. CONCLUSION: It could be concluded that transient focal cerebral ischemic preconditioning have neuroprotective effect. The optimal interval between ischemia for this 'ischemic tolerance' to happen is 3 days, and this phenomenon seems to be the function of cerebral cortex, but not the subcortex.
Animals* ; Brain ; Brain Ischemia ; Cerebral Cortex ; Ischemia* ; Ischemic Preconditioning* ; Models, Animal* ; Myocardium ; Neuroprotective Agents* ; Rats ; Suture Techniques

PURPOSE: The developments and advances in extracorporeal shock wave lithotripsy and endourological procedures have greatly diminished the need for open surgery in the treatment of renal and ureteral stones. We reviewed our experience of open stone surgery to determine current indications and efficacy of this treatment modality. MATERIALS AND METHODS: We undertook a review of hospital and office charts, operative records, and pertinent radiographic studies of all patients that had undergone open stone surgery from May 1986 to June 2001 at a single tertiary university hospital. Of 5,533 procedures performed for stone removal, 355 were open surgical procedures (6.4%), these included ureterolithotomy in 215 (60.6%), pyelolithotomy in 50 (14.1%), anatrophic nephrolithotomy in 43 (12.1%), and nephrectomy in 47 (13.2%). RESULTS: The indications for open surgery were complex stone burden (61%), failure of extracorporeal shock wave lithotripsy or endourological treatment (9%), other co- operation (10.4%) and anatomical abnormalities, such as: ureteropelvic junction obstruction, infundibular stenosis and/or renal caliceal diverticulum (6.5%). Stone free rate, following surgery, was 90.7%. All patients had minor postoperative complications that were resolved with appropriate therapy. CONCLUSIONS: Open stone surgery continues to be a reasonable alternative modality for a small proportion of patients with urinary stones. Those patients with large urinary stone, failed less invasive method, anatomical abnormality and serious medical diseases would be recommended for open stone surgical correction.
Constriction, Pathologic ; Diverticulum ; Humans ; Lithotripsy ; Nephrectomy ; Postoperative Complications ; Shock ; Ureter* ; Ureteral Calculi* ; Urinary Calculi

PURPOSE: To evaluate the usefulness of real-time ultrasound-guided biopsy as an aid in diagnosing pleural attached lung lesions. MATERIALS AND METHODS: Over a 2-year period (March 1992 through February 1994), 52 US-guided diagnostic biopsies were performed in 50 patients with peripheral lung lesions in contact with chest wall. 15 cases were performed with gun biospy and 37 cases with fine needles. Final diagnosis was confirmed by surgery and clinical follow-up. RESULTS: In 44 of 52 cases(84.6%), we obtained histologic or cytologic material by US-guided biopsy. Diagnostic accuracy and tissue type specific accuracy for malignancy were 83.9%(26/31) and 67.7% (21/31), respectively. Eighteen case% were reported to be benign and one of them was proven to be metastatic lesion. We could not find any complications such as hemoptysis or pneumothorax. CONCLUSION: Ultrasound-guided biopsy is a simple, safe and accurate diagnostic procedure for evaluation of peripheral lung lesion attached to the pleura.
Biopsy* ; Diagnosis ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung* ; Needles ; Pleura ; Pneumothorax ; Thoracic Wall

PURPOSE: It is presumed that lower urinary tract symptom(LUTS) and hypertension are related to the age-dependent sympathetic activity. Thus, the attempt to elucidate a correlation between these two conditions can be important in their management. We investigated the relationship between LUTS and hypertension. MATERIALS AND METHODS: From 1995 to 1997, 1011 men(422 from routine physical checkup, 288 benign prostatic hyperplasia(BPH) patients, 301 hypertension patients) over 50 years were enrolled. The international prostate symptom score(IPSS) and blood pressure were recorded in all. 422 men from physical checkup were grouped into 4 categories according to the presence of LUTS(IPSS> or =8) or hypertension(systolic> or =140mmHg, diastolic> or =90mmHg). The prevalence of hypertension, and the degree of LUTS were evaluated. Statistical analysis was performed with t-test, chi-square test and Mantel-Haenszel test. RESULTS: The prevalence of hypertension was not significantly different between the LUTS(n=177) and non-LUTS groups(n=245)(38.4% vs 35.9%, p=0.600) in men from physical checkup. There was no difference according to age(p=0.513). The prevalence of hypertension was 39.6% in the BPH group(N=288) and was not different compared to the non-LUTS group(n=245)(p=0.385). No significant difference in the prevalence of LUTS was seen between hypertensives(n=156) and normotensives(n=266)(53.2% vs 48.2%, p=0.447) in the physical checkup group. However, their mean IPSS (8.9+/-6.5 vs 7.6+/-5.6) were significantly different(p=0.030). The mean IPSS between hypertensives(15.21+/-4.5) and normotensives(12.75+/-5.0) from the LUTS group(n=178) were significantly different(p=0.002). The mean IPSS of the patients with hypertension(n=301, 9.6+/-5.9) was significantly higher than normotensive men(n=266, 7.6+/-5.6) from physical checkup(p=0.001). CONCLUSIONS: Hypertension and LUTS including BPH do not correlate prevalence-wise, however, hypertension may affect the degree of IPSS.
Blood Pressure ; Humans ; Hypertension* ; Male ; Prevalence ; Prostate ; Urinary Tract*

Ovarian hyperstimulation syndrome is a serious complication of ovulation induction and has a diverse clinical spectrum from edema to thromboembolism. Antiphospholipid antibody syndrome, one of the well known hypercoagulable states, can be also manifested as an arterial or venous thrombosis and recurrent spontaneous abortion. Sometimes a patient with antiphospholipid antibodies might not notice a miscarriage and seek for assisted reproduction treatment, which harbors a chance of developing ovarian hyperstimulation syndrome. If this happens, the ovarian hyperstimulation syndrome can exacerbate the thrombotic complication of underlying antiphospholipid antibody syndrome, resulting in a catastrophic vascular event. The authors experienced a case of middle cerebral artery infarct, which developed during ovarian hyperstimulation syndrome in a 33-yr-old woman with a previous history of fetal loss. An elevated titer of anticardiolipin antibodies was noticed and persisted thereafter. The authors suggest screening tests for the presence of antiphospholipid antibodies before controlled ovarian hyperstimulation.
Adult ; Antibodies, Anticardiolipin/blood ; Antiphospholipid Syndrome/*complications/pathology ; Female ; Humans ; Iatrogenic Disease ; Infarction, Middle Cerebral Artery/*etiology/pathology ; Magnetic Resonance Angiography ; Ovarian Hyperstimulation Syndrome/*complications/pathology ; Ovulation Induction ; Pregnancy ; *Pregnancy Complications/pathology

PURPOSE: To evaluate the concordance of cancer location of the tissue mapping from a mechanical pressure transducer with magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: A total of 60 indentations were performed on 5 prostate specimens obtained after radical prostatectomy utilizing a robotic indentation system. The mechanical elastic moduli of suspected malignant lesions were calculated and mapped, and their locations were compared with suspicious areas of malignancy on MRI scans. RESULTS: The concordance rate between the location mapping from the robotic indentation system and MRI scans results was 90.0% (54/60). The sensitivity and specificity of the robotic indentation system were 87.9% (29/33) and 92.6% (25/27), respectively. The positive predictive value and negative predictive value were 93.5% (29/31) and 93.1% (27/29), respectively. CONCLUSION: The locations of malignant lesions derived from our robotic indentation system correlated strongly with the locations of suspected areas of malignancy on MRI scans. Our robotic system may provide a more targeted biopsy of the prostate than conventional non-targeted systemic biopsy, possibly improving the diagnostic accuracy of prostatic biopsies for cancer.
Aged ; Biopsy/methods ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Predictive Value of Tests ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; Robotics/instrumentation/*methods ; Sensitivity and Specificity

Flail arm syndrome (FAS), an atypical presentation of amyotrophic lateral sclerosis (ALS), is characterized by progressive, predominantly proximal, weakness of upper limbs, without involvement of the lower limb, bulbar, or respiratory muscles. When encountering a patient who presents with this symptomatic profile, possible diagnoses include upper limb onset ALS (UL-ALS), and FAS. The lack of information regarding FAS may make differential diagnosis between FAS and UL-ALS difficult in clinical settings. The aim of this study was to compare clinical and electromyographic findings from patients diagnosed with FAS with those from patients diagnosed with UL-ALS. To accomplish this, 18 patients with FAS and 56 patients with UL-ALS were examined. Significant differences were observed between the 2 groups pertaining to the rate of fasciculation, patterns of predominantly affected muscles, and the Medical Research Council scale of the weakest muscle. The presence of upper motor neuron signs and lower motor neuron involvement evidenced through electromyography showed no significant between-group differences.
Amyotrophic Lateral Sclerosis* ; Arm* ; Diagnosis ; Diagnosis, Differential ; Electromyography ; Fasciculation ; Humans ; Lower Extremity ; Motor Neuron Disease ; Motor Neurons ; Muscles ; Respiratory Muscles ; Upper Extremity*

Isolated small bowel intussusception accounts for 10% of all pediatric intussusception. It is more common in children older than 2 years of age. Presentation usually is with vomiting and abdominal pain. Currant jelly stool and palpable mass are less frequent than typical intussusception. There are few reported cases of children with transient small bowel intussusception. We describe 3-year-old boy presented with intermittent cyclic crampy abdominal pain for 6 months was diagnosed as having recurrent transient small bowel intussusception by abdominal ultrasonography and small bowel series.
Abdominal Pain ; Child ; Child, Preschool ; Humans ; Intussusception* ; Male ; Ultrasonography ; Vomiting

We report one case of adenoma malignum of the cervix. Adenoma malignum is an extremely well-differentiated form of adenocarcinoma in which the branching glandular pattern strongly simulates that of the normal endocervical glands. This term has been used to describe a very well-differentiated adenocarcinoma characterized histologically by distorted and architecturally irregular endocervical glands which penetrate deeply into the wall of the cervix, but with minimal and focal evidence of glandular cell stratification, anaplasia, or mitotic activity. Despite this innocuous histologic appearance, these tumors have classically been thought to be clinically highly malignant, with an almost invariably rapid lethal outcome. The diagnosis of minimal deviation adenocarcinoma (adenoma malignum) of the endocervix may be difficult. The diagnosis was adenocarcinoma on the Pap Smear treatment has been hysterectomy.
Adenocarcinoma ; Adenoma* ; Anaplasia ; Cervix Uteri* ; Diagnosis ; Female ; Hysterectomy

Ganglioneuroma is generally considered to be a benign tumor arising from neural crest tissue. An adrenal ganglioneuroma is located within the substance of the adrenal medulla or along the sympathetic chain, thus may secrete catecholamines, and present with endocrine symptoms. However, nonfunctional growths remain silent until they reach a large size, and are usually discovered incidentally. Complete surgical excision of adrenal ganglioneuroma is the treatment of choice, and especially a laparoscopic adrenalectomy can be performed safely, and is an ideal substitute to an open procedure, with the added benefits associated with minimally invasive surgery. Herein, we report a case of an incidentally discovered adrenal ganglioneuroma.
Adrenal Gland Neoplasms ; Adrenal Medulla ; Adrenalectomy ; Catecholamines ; Ganglioneuroma* ; Laparoscopy ; Neural Crest ; Surgical Procedures, Minimally Invasive