The final degrees of education for the third and fourth authors were mutually misplaced.

PURPOSE: We compared the clinical efficacy of Therasonic LTS (piezoelectric type) with that of SDS-5000 (spark gap type) for the management of urinary stones. MATERIALS AND METHODS: We evaluated 516 patients treated with Therasonic LTS, between June 1996 and April 2001, and 314 treated with SDS-5000 between September 2001 and January 2003. We compared the average success rates and shock wave sessions according to the stone sizes and locations, and also verified the complications related to the therapies. RESULTS: The total success rates of Therasonic LTS and SDS-5000 were similar (92.6 and 94.6%, respectively), with no difference according to stone location and size. However, the average shock wave sessions were significantly lower in the group treated with SDS-5000 (2.5 1.8 sessions) compared to the group treated with Therasonic LTS (3.1 1.9 sessions) (p<0.05). The cumulative success rates were 64.3 and 77.1%, respectively, at the completion of session 3, and 82.2 and 88.2%, respectively, at the completion of session 5. The complication rates associated with the therapies were 8.9 and 6.9%, respectively, consisting of pain, gross hematuria, steinstrasse and acute pyelonephritis, most of which were successfully controlled by conservative treatment. CONCLUSIONS: SDS-5000 lithotripsy is more efficient than Therasonic LTS in terms of shock wave sessions.
Calculi ; Hematuria ; Humans ; Lithotripsy ; Pyelonephritis ; Shock ; Urinary Calculi* ; Urinary Tract

We report a case of cardiac arrest in a 71 year old male during the Valsalva maneuver that had been performed immediately after completing a pneumonectomy. The patient had a subclinical atrial septal defect (1.08 cm sized) and he previously undergone a left upper lobectomy of the lung without complications 11 months earlier. He underwent a left completion pneumonectomy due to recurrent lung cancer. After surgery a Valsalva maneuver was performed with 35 cmH2O to relocate the mediastinum. During this procedure, the patient experienced a cardiac arrest and was resuscitated with difficulty. It is believed that the cardiac arrest was due to pulmonary hypertension, right ventricular failure and right to left shunt caused by several factors, such as the pneumonectomy, subclinical atrial septal defect (1.08 cm sized), and Valsalva maneuver. In addition, the hypovolemia caused by fluid restriction and the epidural injection of local anesthetics might have contributed to this incident. Although it is a rare complication, it is suggested that subclinical ASD can cause severe hypoxemia, dyspnea even cardiac arrest after pneumonectomy. In order to avoid these complications, ASD should be treated with percutaneous closure or surgical intervention. If these are not possible, care must be taken when anesthetizing the patient, and anything that can increase the pulmonary vascular resistance and right to left shunt should be avoided.
Anesthetics, Local ; Anoxia ; Dyspnea ; Heart Arrest ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Hypovolemia ; Injections, Epidural ; Lung ; Lung Neoplasms ; Male ; Mediastinum ; Pneumonectomy ; Valsalva Maneuver ; Vascular Resistance

OBJECTIVE: The purpose of this study was to assess rotational patterns of dentofacial structures according to different vertical skeletal patterns by cone-beam computed tomography (CBCT) and analyze their influence on menton deviation in skeletal Class III deformity with mandibular asymmetry. METHODS: The control group consisted of 30 young adults (15 men, 15 women) without any severe skeletal deformity. The asymmetry group included 55 adults (28 men, 27 women) with skeletal Class III deformity and at least 3-mm menton deviation from the midsagittal plane; it was divided into the hyperdivergent and hypodivergent subgroups using a mandibular plane angle cutoff of 35degrees. Fourteen rotational variables of the dental arches and mandible were measured and compared among the groups. Correlations between menton deviation and the other variables were evaluated. RESULTS: The asymmetry group showed significantly larger measurements of roll and yaw in the mandible than the control group. The hypodivergent subgroup showed significant differences in maxillary posterior measurements of yaw (p < 0.01) and maxillary anterior shift (p < 0.05) compared with the hyperdivergent subgroup. All the mandibular measurements had significant correlations with menton deviation (p < 0.01). Most measurements of roll were positively correlated with one another (p < 0.01). Measurements of yaw and roll in the posterior regions were also positively correlated (p < 0.05). CONCLUSIONS: Menton deviation in skeletal Class III deformity with mandibular asymmetry is influenced by rotation of mandibular posterior dentofacial structures. The rotational patterns vary slightly according to the vertical skeletal pattern.
Adult ; Cone-Beam Computed Tomography* ; Congenital Abnormalities* ; Dental Arch ; Facial Asymmetry ; Humans ; Male ; Mandible ; Young Adult

We report an unusual case of multiple glomangioma showing the histopathologic findings of focal leiomyomatous component. A 23-year-old man complained of multiple, bluish, soft nodules, 0.5 to 2cm in diameter, which were distr ibuted on the back and both upper limbs. Histologic examination revealed some foci composed of spindle-shaped smooth muscle cells with abundant eosinophilic cytoplasm and blunt ended nuclei as well as cells with features intermediate between glomus cells and fully differentiated myocytes. It was confirmed by immunohistochemical and ultrastructural studies.
Cytoplasm ; Eosinophils ; Glomus Tumor* ; Humans ; Leiomyoma* ; Muscle Cells ; Myocytes, Smooth Muscle ; Upper Extremity ; Young Adult

In our previous study, we demonstrated that immobilization stress blocked estrogen-induced luteinizing hormone(LH) surge possibly by inhibiting the synthesis and release of gonadotropin-releasing hormone (GnRH) at the hypothalamic level and by blocking estrogen-induced prolactin (PRL) surge by increasing the synthesis of dopamine receptor at the pituitary level in ovariectomized rats. The present study was performed to determine whether immobilization stress affects pituitary LH responsiveness to GnRH, and whether endogenous opioid peptide (EOP) and dopamine systems are involved in blocking LH and PRL surges during immobilization stress. Immobilization stress was found to inhibit basal LH release and to completely abolish LH surge. However, the intravenous application of GnRH agonist completely restored immobilization-blocked LH surge and basal LH release. Treatment with naloxone did not exert any effect on immobilization-blocked LH surge but increased basal LH release during immobilization stress. Pimozide did not affect immobilization-blocked LH surge or basal LH release. Naloxone also decreased immobilization-induced basal PRL release, but had no effect on immobilization-blocked PRL surge. Immobilization-increased basal PRL levels were augmented by pimozide treatment and immobilization-blocked PRL surge was dramatically restored by pimozide. We conclude that immobilization stress does not impair pituitary LH response to GnRH, and that the immobilization stress-induced blockage of LH surge is probably not mediated by either the opioidergic or the dopaminergic system. However, immobilization-blockade of PRL surge may be partly mediated by the dopaminergic system.
Animal ; Estradiol/*pharmacology ; Female ; Gonadorelin/*pharmacology ; Immobilization ; Luteinizing Hormone/*secretion ; Naloxone/pharmacology ; Opioid Peptides/physiology ; Ovariectomy ; Prolactin/*secretion ; Rats ; Rats, Sprague-Dawley ; Receptors, Dopamine/physiology ; Stress/*metabolism

Hyponatremia, well known as a serious medical condition, is the most frequent electrolyte disorder in clinical medicine. The aim of this study is to bring to readers affecting factors in hyponatremia treatment and to suggest effective treatment guideline. We studied general characteristics, associated serum potassium change, relationship of sodium concentration in urine, and affecting factors on serum sodium correction in 76 hyponatremic patients who had admitted Hanyang University Kuri Hospital. These 73 hyponatremic patients were divided into 10 groups according to cause and treatment by retrospective analysis(1 group : G-I origin, 2 group : CRF, 3 group : CHF, 4 group: LC, 5 group : adrenal origin, 6 group : diuretics use, 7 group : CHF with di- uretics use, 8 group : LC with diuretics use, 9 group : polydypsia, 10 group : SIADH). Serum sodium were 124.2+/-6.9mEq/L in initial diagnosis, 125.6 +/-7.7mEq/L after 48 hour, and 129.8+/-6.3mEq/L in final evaluation. Among these hyponatremic patients, thirty patients' (41.1%) sodium correction rate were below 0.5mEq/L/hr during initial 48 hour and fifteen patients(20.5%) were corrected above 135mEq/l in serum sodium Initial serum potassium was average 4,07mEq/L, and 15 patients in 73 hyponatremic patients were hypokalemic feature. Eight patients of 15 hypokalemic patients were corrected to normal potassium level and in addition, four patients of 8 corrected patients were corrected to normal sodium level above 135mEq/L. The disease frequency were highest in GI origin (31.5%), followed by SIADH(20.5%) and LC(12.3%). In our study, hyponatremia correction was not related to patient sex, age, and initial serum sodium concentration. In conclusion, Hyponatremia prognosis was not related to initial serum sodium concentration and corection rate, but related to treatment of underlying disease. And hypokalemia acompanied by hyponetremia was corrected after correction of hyponatremia.
Clinical Medicine ; Diagnosis ; Diuretics ; Humans ; Hypokalemia ; Hyponatremia* ; Potassium ; Prognosis ; Retrospective Studies ; Sodium

PURPOSE: We assessed the usefulness of manual reduction in patients with an acute scrotum. MATERIALS AND METHODS: We retrospectively analyzed the data of 61 consecutive males who had undergone surgical exploration for an impression of testicular torsion, focusing on the incidence, duration of symptoms, direction of testicular torsion and results of manual reduction. Of the 61 explorations, there were 46 (75.4%) and 15 (24.6%) cases of testicular torsion and torsion of a testicular appendage, respectively. RESULTS: Of the 46 testicular torsions, the symptoms were localized to the left side in 37 and to the right side in 9. While the mean symptom duration of the 31 in the orchiectomy group (89 hours) was significantly longer than that in the 15 salvaged testes (10 hours, p=0.003), the mean degree of rotation between the two groups was not significant (p=0.196). Information on the direction of testicular rotation was available in 44 cases, with medial rotation having occurred in 31 (70.5%) and lateral rotation in 13 cases. The clinical symptoms were improved in 4 of the 20 patients in who manual reduction was attempted; residual torsion was identified in 2 patients. CONCLUSIONS: Manual detorsion, the fastest way to relieve testicular ischemia, should be performed at an early offstage following presentation. However, in attempting the manual reduction, the urologist should consider the possibility that a quarter of patients with an acute scrotum do not have testicular torsion, with 30% of testicular torsions occurring in the lateral direction. Surgical exploration remains necessary to confirm the causes of an acute scrotum and to correct any residual torsion.
Humans ; Incidence ; Ischemia ; Male ; Orchiectomy ; Retrospective Studies ; Scrotum* ; Spermatic Cord Torsion ; Testis

OBJECTIVE: The aim of this study was to evaluate the prognostic value of squamous cell carcinoma antigen (SCC-Ag) and the optimal cut-off value for predicting recurrence in cervical squamous cell carcinoma patients with complete remission after primary treatment. METHODS: We reviewed the records of 783 cervical squamous cell cancer patients who underwent primary therapy and showed complete remission at our institution between January 2000 and April 2014. A receiver operating characteristic curve was used to determine the optimal SCC-Ag threshold to predict recurrence. Cox regression model for disease free survival was used to assess differences in outcome. RESULTS: The median follow-up period was 41.2 months, and 154 patients (19.7%) had recurrent disease. The median pretreatment and posttreatment SCC-Ag level was 2.6 ng/mL (range, 0.1 to 532.0 ng/mL) and 0.7 ng/mL (range, 0.0 to 46.8 ng/mL), respectively. Both pretreatment and posttreatment SCC-Ag levels were higher in the recurrence group (P=0.017 and P=0.039). Optimal cut-off value of pretreatment and posttreatment SCC-Ag for predicting recurrence was 1.86 ng/mL (area under the curve, 0.663; P=0.000), and 0.9 ng/mL (area under the curve, 0.581; P=0.002), respectively. In the multivariate Cox regression model, pretreatment SCC-Ag >1.86 ng/mL (odds ratio, 2.11; 95% confidence interval, 1.38 to 3.22; P=0.001) and posttreatment SCC-Ag >0.9 ng/mL (odds ratio, 1.64; 95% confidence interval, 1.18 to 2.28; P=0.003) were significantly associated with poor disease free survival. CONCLUSION: Patients with pretreatment SCC-Ag >1.86 ng/mL or posttreatment SCC-Ag >0.9 ng/mL should be considered at high risk for cancer recurrence after complete remission, and therefore, closer surveillance is needed.
Carcinoma, Squamous Cell* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasms, Squamous Cell ; Recurrence* ; ROC Curve

Autosomal dominant polycystic kidney disease (ADPKD) is a common genetic disorder characterized by innumerable bilateral renal cysts. It has an prevalence rate of one in 200~1,000 individuals and is a relatively common cause of renal failure. As renal function deteriorates, overall renal size usually diminish in patients with chronic renal failure. However, renal size of patients with ADPKD usually continues to increase, even after the initiation of dialysis therapy, because numerous cysts replace renal mass. Attempted methods to reduce the size of enlarged kidneys have included needle aspiration and sclerotherapy, cyst decompression surgery, laparoscopic and surgical nephrectomy. The outcome of these therapy frequently has been suboptimal, and there is a need to develop a more effective therapy. We report a case of renal arterial embolization using 99% ethanol and lipiodol mixture for ADPKD in a hemodialysis pathient, which has not been previously reported.
Decompression ; Dialysis ; Ethanol* ; Ethiodized Oil* ; Humans ; Kidney ; Kidney Failure, Chronic ; Laparoscopy ; Needles ; Nephrectomy ; Polycystic Kidney, Autosomal Dominant* ; Prevalence ; Renal Dialysis* ; Renal Insufficiency ; Sclerotherapy