PURPOSE: Hand-assisted laparoscopic live donor nephrectomy (HALDN) are being performed at our institution in an attempt to make live donor more attractive to the potential donor. We review the results of HALD N retrospectively and compare them with those obtained using the standard open approach. MATERIALS AND METHODS: 9 consecutive HALDN were performed from February 2000 through June 2000. The control group consisted of the 22 open donor nephrectomy at the same institution from January 1999 through December 1999 immediately before the initiation of HALDN. Live donors were considered candidates for HALDN if they possessed left normal renal anatomy with single renal vessels and ureter. Among 9 HALDN patients, one patient had two main renal arteries and another one patient had a polar artery. We evaluated sex, age, body weight, BMI (Body Mass Index) basically. And we evaluated renal ischemic time, operation time, to normal activities, postoperative serum creatinine level, and postoperative complications. RESULTS: There was no significant difference in male-female ratio, age distribution and weight-height ratio between two groups. Warm ischemic time for HALDN group was 3 to 4 min and it was not different with open surgery. Operation time was prolonged in HALDN group (284.4+/-72.8 min) compared to open group (193.1+/-26.7 min) (p Age Distribution ; Arteries ; Body Weight ; Chylous Ascites ; Creatinine ; Humans ; Kidney Transplantation ; Length of Stay ; Nephrectomy* ; Pneumothorax ; Postoperative Complications ; Renal Artery ; Retrospective Studies ; Tissue Donors* ; Ureter ; Warm Ischemia

STUDY DESIGN: A retrospective study of functional outcome after surgical correction of neuromuscular scoliosis. OBJECTIVES: To assess functional outcomes and their significances after the surgical correction of neuromuscular scoliosis. SUMMARY OF LITERATURE REVIEW: The surgical correction of neuromuscular scoliosis has been used to stabilize the trunk for balanced sitting, to improve cardiopulmonary function, and the function of the upper extremities. Many authors have reported favorable surgical results, but few studies have been undertaken on functional assessment after surgery. MATERIALS AND METHODS: Eighteen adult patients with neuromuscular scoliosis underwent surgical correction. Functional assessments were performed in terms of impairments, disabilities, and handicaps. The impairments included sitting ability, coronal Cobb's angle, pain after surgery, and cosmesis after surgery. The disabilities included dressing, feeding, toilet/bathing, locomotion, and the use of both hands, and the handicaps included the effort and time to care for patients. Each parameter was checked preoperatively, 6 months after surgery, and at the last follow-up. RESULTS: In terms of impairments, sitting ability, coronal Cobb's angle, pain, and cosmesis were improved by surgery. In terms of disabilities, dressing, toilet/bathing, and locomotion were not improved after surgical correction. However, the feeding and use of both hands were significantly improved. And, in terms of handicaps, both the effort and the time required for care were reduced post-surgically. CONCLUSIONS: We conclude that impairments, handicaps, and the functions of the upper extremities were improved after surgical intervention to stabilize the trunk and spine in cases of neuromuscular scoliosis, but that overall disabilities were unaffected. This latter apparent shortcoming is attributed to the inability of surgery to treat previous systemic disease affecting physical disabilities of lower extremities. However, surgical correction of neuromuscular scoliosis was found to be clinically significant in terms of improving the functions of the trunk and of the upper extremities.
Adult ; Bandages ; Follow-Up Studies ; Hand ; Humans ; Locomotion ; Lower Extremity ; Retrospective Studies ; Scoliosis* ; Spine ; Upper Extremity

The Mainz classification for renal cell tumors was introduced in 1986 and it's utility has been reported in several histogenetic and genetic studies of renal cell tumors. We present a study of 127 cases of renal cell tumors with clinicopathologic correlation, DNA content analysis, and histogenesis studied by histochemical and immunohistochemical staining. The 127 renal cell tumors classified by the Mainz classification were 87 clear cell, 17 chromophilic, 13 chromophobe and 3 sarcomatoid renal cell carcinomas, 5 oncocytomas and 2 adenomas. These subtypes showed significant correlation not with age, sex, Robson's stage, DNA ploidy or tumor recurrence but with nuclear grade (p=0.001) and tumor size (p=0.001). Hall's colloidal iron (p=0.002) and carbonic anhydrase II (p=0.013) stains, representing the origin of distal nephron especially of collecting duct, were significantly correlated with specific subtypes of renal cell tumors, especially chromophobe cell renal carcinoma. This study demonstrates that the Mainz classification suggests several morphologically different subtypes and variants of renal cell tumors and that some of them may have originated from the distal nephron, particularly from the collecting duct.
Adenoma ; Adenoma, Oxyphilic ; Carbonic Anhydrase II ; Carcinoma, Renal Cell ; Classification* ; Colloids ; Coloring Agents ; DNA* ; Iron ; Nephrons ; Ploidies ; Recurrence

We report 13 chromophobe renal cell carcinomas (10.8%) observed among 120 renal cell carcinomas in adults. The average age was 53 (range: 34-72) years old, and 6 were males and 7 females. The mean tumor size was 10 (range: 5-17) cm, mean nuclear grade 2.4, and mean Robson's stage was 1.9. There were two distinct histologic variants; typical variant (n=9) and eosinophilic variant (n=4). Both of them showed typical light microscopic features and positive reaction with Hale's colloidal iron and carbonic anhydrase II, a marker protein of intercalated cells of renal collecting ducts. A strong positive immunoreactivity for epithelial membrane antigen was noted in the cytoplasm in 12 of 13 tumors. Numerous microvesicles, 180~440 nm in diameter, were identified ultrastructurally. DNA aneuploidy was found in 3 out of 10 cases. Neither local recurrence nor metastasis have been identified during the following period of 4~144 (mean 48) months.
Adult ; Aneuploidy ; Carbonic Anhydrase II ; Carcinoma, Renal Cell* ; Colloids ; Cytoplasm ; DNA ; Eosinophils ; Female ; Humans ; Iron ; Male ; Mucin-1 ; Neoplasm Metastasis ; Recurrence

Prostatic intraepithelial neoplasia (PIN), which is divided into low and high grade, has different clinicopathologic significance. We reviewed 158 prostatic tissues, which consisted of 144 cases of nodular hyperplasias and 14 cases of adenocarcinomas, to evaluate incidence of PIN, its histologic finding, and its clinical significance. Ten cases of PIN, 4 low grade and 6 high grade, were found. Four cases of low grade PIN (LPIN) and five cases of high grade PIN (HPIN) were associated with nodular hyperplasia. Only one case of HPIN occurred in carcinoma. The constant histologic findings of LPIN were nuclear stratification and nucleomegaly. The most prominent characteristics of HPIN were hyperchromasia and prominent nucleoli. Anisonucleosis was not so helpful for differential diagnosis between LPIN and HPIN. Basal layer disruption was present in one case of high grade PIN associated with adenocarcinoma, and important for the differentiatial diagnosis of cribriform HPIN from the cribriform adenocarcinoma. There was no significant difference in age incidence between the two groups with the mean age of 70.9 years in nodular hyperplasia and 69.4 years in adenocarcinoma. Serum PSA level was significantly different between the two group with the mean PSA value of 11.03 ng/ml in nodular hyperplasia and that of 73.76 ng/ml in carcinoma (p=0.000). However, PSA values between "nodular hyperplasia only" group and "PIN associated nodular hyperplasia" group were not significantly different. PIN association changed neither age distribution nor serum PSA level. During the follow up period, no adenocacinoma has occurred in the cases having PIN although serum PSA level has elevated in some cases. One case of adenocarcinoma associated with HPIN developed in the nodular hyperplasia patient. Although PIN did not increase the possibility of subsequent prostatic adenocarcinoma in transurethral resection specimens, it could not be excluded that PIN was a precursor of prostatic adenocarcinoma.
Adenocarcinoma ; Age Distribution ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Hyperplasia ; Incidence ; Prostate-Specific Antigen ; Prostatic Intraepithelial Neoplasia*

Obturator hernia is a rare type of pelvic hernia and occurs most commonly in elderly and debilitated women. It is still a challenge for surgeons to diagnose precisely in early stages because of its nonspecific symptoms and consequently delayed diagnosis could lead to high morbidity and mortality. We experienced a 92-year old patient who was diagnosed as obturator hernia which was confirmed by computed tomography scan of the abdomen and pelvis. The operation was delayed due to the refusal of family members but eventually done after 12 days from initial diagnosis. After manual reduction of small bowel impacted into right obturator foramen, segmental resection of impacted small bowel and anastomosis was done. The hernial defect was closed by primary closure with Dexon suture material. After the operation, the patient was discharged without significant complications. We report here successful results of delayed operation for obturator hernia.
Abdomen ; Aged ; Benzenesulfonates ; Delayed Diagnosis ; Disulfiram ; Female ; Hernia ; Hernia, Obturator ; Humans ; Pelvis ; Sutures

PURPOSE: Transfusion transmitted virus (TTV) is a newly discovered virus and to date the contribution of TTV to liver disease remains unclear. Little is known about the frequency of TTV infection in children in Korea. The purpose of this study was to investigate the prevalence and genotypic distribution of TTV carried by healthy children and patients with hepatitis in Korea. METHODS: Eighty eight of healthy children and three groups of patients with hepatitis-14 patients with chronic hepatitis B, 12 patients with chronic hepatitis C and 25 patients with hepatitis of unknown etiology-were tested. TTV DNA was detected by semi-nested PCR using primer sets generated from N-22 region and from 5' noncoding region (NCR) of the viral genome. PCR products derived from 8 patients with hepatitis and from 11 healthy children were sequenced and a phylogenetic tree was constructed. RESULTS: TTV was found by PCR with N22 primer in 11.3% of healthy children, 28.5% of children with hepatitis B, 25% of children with hepatitis C, 24% of children with hepatitis of unknown etiology. TTV DNA was found by PCR with 5'NCR primer in 32.9% of healthy children, 71.4% of patients with chronic hepatitis B, in 50% of patients with hepatitis C and in 48% of patients with hepatitis of unknown etiology. TLMV DNA was found in 48.9% of healthy children, 21.4% of patients with hepatitis B, 16.6% of patients with hepatitis C, 40% of patients with hepatitis of unknown etiology. Among the sequenced isolates, 10(52%) belonged to genotype 1 (G1) and others belonged to genotype 2 (G2) or genotype 3 (G3). Among the G1 sequences, 7 were grouped as G1a. CONCLUSION: TTV infection was common in healthy children and in patients with hepatitis. But, the prevalence of TTV DNA by 5'NCR primer was relatively high in patients with hepatitis B and there may be some association between TTV and hepatitis B virus infection. G1 was the major genotype of the studied population.
Child* ; DNA ; Genome, Viral ; Genotype* ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis* ; Humans ; Korea ; Liver Diseases ; Polymerase Chain Reaction ; Prevalence* ; Torque teno virus*

About a third of the patients with decompensated liver cirrhosis have reduced arterial oxygen saturation and are sometimes cyanosed in the absence of any apparent lung or heart disease; There is a reduction of diffusing capacity without a restrictive ventilatory defect. The aim of this study was to determine diffusing capacities in patients with chronic liver- diseases. The diffusing capacities and arterial oxygen saturations were measured in 25 patients with chronic active hepatitis(CAH), 9 early cirrhotics (early LC), 36 cirrhotics(Child's class A) and 11 cirrhotics(Child's class B). The anterior tibial area was observed for pitting edema, and Thallium-201 test per rectum(shunt index) was done. Hypoxemia was not observed in all subjects. The number of cases with decreased pulmonary diffusing capacity (DLco) is 3/25(12.0%) for CAH, 3/9(33.3%) for CAH with early liver cirrhosis(LC), 17/36(47.2%) for LC(Child's class A) and 6/11(54.5%) for LC(Child's class B). The mean+/-standard deviation of Dlco(% predicred) are 93.1+/-12.1 for CAH, 85.7+/-12.3 for CAH with early LC, 82.2+/-14.7 for LC(Child's class A) and 80.4+/-6.9 for LC(Child's class B), There is a significant difference between DLco in CAH and that in LC(Child's class A)(p<0.01). Patients with higher shunt index(>0.3) had significantly lower DLco than these with lower shunt index(<0.3)(76.4+/-9.7% vs. 89.3+/-13.3%)(p<0.01). The DLco was also lower in patients with pitting edema(77.3+/-10.2%) than in those without pitting edema(85.5+/-13.8%) (p<0.01). These results summarized that the DLco was low in patients with cirrhosis and with higher shunt index(>0.3) or pitting edema. This may be due to an increased systemic blood flow shunt and an increased generalized interstitial edema. Pulmonary function tests including diffusing capacity may be useful as prognostic parameters in patients with chronic liver disease, especially in those with CAH or early LC.
Anoxia ; Edema ; Fibrosis ; Heart Diseases ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Oxygen ; Pulmonary Diffusing Capacity* ; Respiratory Function Tests

We report a case of renal hemangiopericytoma occurring in renal sinus and expanding to the renal hilum. This unusual presentation caused misinterpretation of this tumor as transitional cell carcinoma of the renal pelvis clinically. The patient who was a 30-year-old woman had a relatively well demarcated solid tumor, 8 x 6 cm, in the renal sinus of the left kidney.
Adult ; Case Report ; Female ; Follow-Up Studies ; Hemangiopericytoma/*pathology/radiography ; Human ; Kidney Neoplasms/*pathology/radiography ; Tomography Scanners, X-Ray Computed

Recently, the use of acupuncture has been increasing for the management of low back pain and herniated nucleus pulposus. There are many debates on its usefulness and associated complications. Complications such as hemorrhage, infection, direct internal organ or nerve injury and disease transmission have been reported. We report a case of dural sac and nerve root compression caused by chronic inflammatory granuloma. This chronic inflammatory granuloma, which might have been formed by local hemorrhage or low-grade infection after acupuncture is highly suspected to produce the symptoms of spinal stenosis; moreover, after surgical excision of the granuloma the patient's symptoms were eliminated. Hence, we report this case and discuss the possibility of the acupuncture as a cause.
Acupuncture* ; Constriction, Pathologic ; Granuloma* ; Hemorrhage ; Low Back Pain ; Radiculopathy ; Spinal Stenosis*