Percutaneous endoscopic surgery for the treatment of upper urinary tract stone or stricture has proved less invasive, reliable and safe with results comparable to open surgery. Because this contains many procedures, however, one can expect complications at some extents. Between 1987 and 1994, 410 percutaneous endoscopic procedures - PNL (330 cases), endopyelotomy (40 cases), endoinfundibulotomy (24 cases), endoureterotomy (10 cases), nephropexy (6 cases) - were performed by three operators in one hospital. The incidence of complication was evaluated and compared statistically. Overall complication rates were 23.6% and there was no mortality. Bleeding necessitating transfusion (7.6%) and fever (7.1%) were the most frequent complications. Other complications included renal pelvis or ureteral perforation (6.8%), paralytic ileus (2.9%), sepsis (0.7%), pneumothorax (0.7%), stent migration (0.7%), atelectasis (0.2%), ureteral stricture (0.2%), colon perforation (0.2%). Surgical interventions for the management of complication included nephrectomy (2 cases) for uncontrolled bleeding, and open repair for colon perforation (1 case). Renal artery embolization stopped the delayed bleeding in one case. Data on complications occurring before and after the first 50 cases indicated a statistically significant decrease in complications (p<0.005). These complications could be attributed to inexperience, improper technique, underlying pathologic conditions, and anatomic variants. As might be expected, the complication rate was much lower on later cases according to the increasing experience and improved technique. Based on our accumulated experience, the experience with more than 50 procedures could be needed to minimize complications.
Colon ; Constriction, Pathologic ; Endoscopy ; Fever ; Hemorrhage ; Incidence ; Intestinal Pseudo-Obstruction ; Kidney Pelvis ; Mortality ; Nephrectomy ; Pneumothorax ; Pulmonary Atelectasis ; Renal Artery ; Sepsis ; Stents ; Ureter ; Urinary Calculi

Biometric measurements were made by ultrasonography in 30 eyes of 25 patients (18 Women and 7 men, mean 67.9 yrs) with acute angle closure glaucoma against 52 eyes of 26 age-matched normal persons (20 women and 6 men, mean 65.1 yrs) in order to analyze an affecting factor of lens in acute primary angle closure glaucoma. The 26 eyes of 30 patients' eyes was subjects older than 60 years of age and mean intraocular pressure was 57.06 +/- 16.764 mmHg The mean anterior chamber depth of these patients (1.895 +/- 0.193 mm) was 0.95mm shallower than one of controls (2.840 +/- 0.324 mm). The mean lens thickness was slgmtlCantly larger tor pal1ents (patients 5.024 +/- 0.498 mm, controls 4.168 +/- 0.524 mm, p=0.001). The mean axial length was 0.6 mm shorter for patients (patients 22.385 +/- 0.840 mm, controls 22.985 +/- 0.838 mm, p<0.01). The relative lens position was significantly smaller for patients (patients 0.194, controls 0.214, p=0.0001), but relative posterior capsule position was similar in two groups. The study suggested that the increased thickness and forward positioning of lens was one of important factors for anterior chamber angle closure in primary angle closure glaucoma.
Anterior Chamber ; Female ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure ; Male ; Ultrasonography

BACKGROUND: In the Far East, it is well known that hepatic resection is a best form of treatment for complicated intrahepatic stones (IHS). However, many investigators have reported that the associated intrahepatic biliary stricture is the main cause of treatment failure, requiring additional management because of recurrent cholangitis. PURPOSE: A retrospective comparative study was undertaken to clarify the long term efficacy of hepatic resection in IHS and to investigate the clinical significance of intrahepatic biliary stricture affected on treatment failure after hepatic resection. Patient and METHOD: The clinical records of 44 among 51 consecutive patients with symptomatic IHS who underwent hepatic segmentectomy or lobectomy between July 1986 and October 1996 were reviewed. We excluded 7 patients from study group because of postoperative death or incomplete follow- up. Patients were divided into two study groups: group A with intrahepatic biliary stricture (n=28) and group B without stricture (n=16). Residual or recurrent stones, recurrence of intrahepatic biliary stricture, late cholangitis, and final outcomes were analyzed and compared statistically between group A and B. Patients were followed up for a median duration of 65 months after hepatectomy. RESULTS: The overall incidence of residual or recurrent stones were 36% and 11%, respectively. The initial treatment failure rate was 50% in group A and 31% in group B. Intrahepatic biliary stricture was recurred in 46% of group A, but in none of group B (P=0.001). More than two thirds of restrictures were identified on the primary site. The incidence of late cholangitis was higher in group A (54%) than in group B (6%)(p=0.002). The late cholangitis was severe, recurrent and related to stones and strictures in 11 of the 15patients in group A. Twelve patients (ten in group A and two in group B) needed additional secondary multiple procedures at a median of 12 months after hepatectomy. These consisted of percutaneous fluoroscopic stone retrieval (n=6), postoperative cholangioscopy (POC) or percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL)(n=3), balloon dilatation (n=7)choledochotomy (n=3), S4 segmentectomy (n=1), Sphincteroplasty (n=1), drainage of the delayed subphrenic or liver abscess (n=2), and repair of prolonged biliary fistula (n=1). The final outcomes after hepatectomy with or without secondary management were good in 80%, fair in 16%, and poor in 4% of the cases. CONCLUSION: The majority of the recurrent cholangitis after hepatectomy in IHS were related to recurrent intrahepatic ductal strictures. Therefore, hepatic resection should be included the strictured duct. However, with hepatectomy alone, it is difficult to clean the IHS and relieve the ductal strictures completely, particularly in cases of bilateral IHS, so a perioperative team approaches, including both radiologic and cholangioscopic interventions, should be used for effective management of IHS.
Biliary Fistula ; Cholangitis ; Constriction, Pathologic* ; Dilatation ; Drainage ; Far East ; Hepatectomy ; Humans ; Incidence ; Lithotripsy ; Liver Abscess ; Mastectomy, Segmental ; Recurrence ; Research Personnel ; Retrospective Studies ; Treatment Failure

A 52 year old female patient was operated under the diagnosis of stomach cancer. She was very obese; her body weight and height were 95.5 kg and 161.5 cm, respectively. Radical subtotal gastrectomy was performed and the operation time was 4 hour and 40 minutes. The day following surgery, signs of right radial nerve palsy including wrist drop were noted. Neurologic examination revealed O-l/5 power of the wrist and finger extensor muscles of the right arm with reduced sensation in the radial aspects of the dorsum of the hand. The electromyography & nerve conduction test revealed incomplete right radial nerve injury above elbow level. During surgery, the patient was in the supine position, the right arm fully adducted to the lateral side of the trunk, and the left arm was 90 degree abducted from the trunk. The blood pressure cuff had been applied to the right upper arm and automated sequential blood pressure measurements performed every 5 minutes during the operation. Thirty minutes into the procedure, a Kent retractor had been applied, the side frame of which contacted the patients right upper arm. We hypothesize that firm pressure from the retractor frame against radial nerve where it passes superficially in the upper arm was responsible for the injury. No abnormalities in function of the automatic cuff were discovered. The patient was discharged 19 days after operation with partial recovery of the radial nerve palsy. Two months later the radial nerve palsy had completly resolved.
Arm ; Blood Pressure ; Body Weight ; Diagnosis ; Elbow ; Electromyography ; Female ; Fingers ; Gastrectomy ; Hand ; Humans ; Hypesthesia ; Middle Aged ; Muscles ; Neural Conduction ; Neurologic Examination ; Paralysis* ; Radial Nerve* ; Stomach Neoplasms ; Supine Position ; Wrist

No abstract available.
Vibrio vulnificus* ; Vibrio*

BACKGROUND: Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, however, this method had the complications of compensatory hyperhidrosis and facial anhidrosis. Therefore, a more limited and modified methods for T2 sympathicotomies were introduced and comparative analysis of the modified upper and lower T2 sympathicotomy were made in the treatment of palmar hyperhidrosis. MATERIAL AND METHOD: From January 1997 to December 1998, 41 patients with palmar hyperhidrosis had been treated by modified T2 sympathicotomy at the Kon-Kuk University Seoul Hospital. Twenty-four patients underwent a modified upper T2 sympathicotomy(Group A), and seventeen patients underwent a modified lower sympathicotomy(Group B). A comparison between groups A and B were made according to the medical records and interview results. RESULT: All patients showed symptomatic improvements after the operation. The anisocoria, facial anhidrosis and dissatisfaction for compensatory hyperhidrosis were more common in Group A and the individual satisfaction for the operations were higher in Group B. CONCLUSION: The modified lower T2 sympathicotomy might be a more effective and less complicated method than the modified upper T2 sympathicotomy.
Anisocoria ; Humans ; Hyperhidrosis* ; Hypohidrosis ; Medical Records ; Seoul

No abstract available.

PURPOSE: Percutaneous nephroureterolithotripsy is one of alternative methods for the treatment of upper ureteral stones which are impacted in ureter or unresponsive to repeated extracorporeal shock wave lithotripsy(SWL). We evaluated the factors influencing the success rate of percutaneous nephroureterolithotripsy based on clinical data. MATERIALS AND METHODS: 107 patients(2 with bilateral) were included in this study. We reviewed the medical records and analyzed the factors ; stone size, laterality, location, site of percutaneous puncture, presence of pyuria, body weight, previous procedure(open surgery or SWL), and the experience of operator. RESULTS: The overall success rate of percutaneous nephroureterolithotripsy was 85.3%(93 of 109 cases). The location of stone and the experience of operator influenced the success rate of operation. The stones located above the lower pole level were obviously more successful than those located below it(57/62, 91.9% versus 36/47, 76.6%, p<0.05). In the late period of the operator`s experience, the success rate was significantly increased than that in the early period(51/58, 87.9% versus 40/51, 78.4%, p<0.05). But the stone size, laterality, site of percutaneous puncture, presence of pyuria, body weight and previous procedure didn`t influence the success rate. The average operation time was 93 minutes, average radiation exposure time was 2.2 minutes, and average hospital stay was 5.4 days. Most of the complications such as bleeding, urinary tract infection and pneumothorax were managed successfully with conservative treatments. CONCLUSIONS: Upper ureteral stones, which are impacted in ureter or unresponsive to repeated SWL can be successfully managed with percutaneous procedures. The stone location and the experience of operator are considered to be the major factors influencing the success rate.
Body Weight ; Hemorrhage ; Length of Stay ; Medical Records ; Pneumothorax ; Punctures ; Pyuria ; Shock ; Ureter ; Urinary Tract Infections

A case of pituitary tuberculoma in a 53-year-old male is reported. His clinical complaints included headache and right ptosis. Endocrinological studies showed hypopituitarism. Radiologic studies showed enlargement of the sellar turcica. Removal of the tumor resulted in resolution of his neurological symptoms and signs.
Headache ; Humans ; Hypopituitarism ; Male ; Middle Aged ; Tuberculoma*

BACKGROUND: The effects of various concentrations (10, 25 micrometer) of azumolene, an analogue of dantrolene, were studied in isolated guinea pig ventricular papillary muscles by measuring the effects on myocardial contractility and electrophysiologic parameters. METHODS: Isometric forces were studied in normal and 26 mM K Tyrode's solution. Rapid cooling contracture, an index of SR Ca2 content, was performed. Normal and slow action potentials (APs) were evaluated by using conventional microelectrode technique. RESULTS: Ten and 25 micrometer azumolene depressed peak force and maximum rate of force development ( 30 40%). Dose-dependent depression was shown at 2 and 3 Hz stimulation rate. Rapid cooling contractures following 10 and 25 micrometer azumolene was not altered compared to control while peak force at 2 Hz stimulation rate just prior to cooling was depressed similarly to normal Tyrode's solution. In 26 mM K Tyrode's solution, 10 and 25 micrometer azumolene caused depression of early (10 micrometer: 20%) and late (10 micrometer: 50%) force development. In slow APs, shortening of AP duration at 20, 50, and 90% of the repolarization phase, as well as a small but significant reduction of dV/dt-max ( 20%) were shown at 0.25 Hz stimulation rate. There was no alteration in AP parameters in normal APs. CONCLUSIONS: The direct myocardial depressant action of azumolene seems to be at least in part caused by inhibition of Ca2 influx via the Ca2 channel in sarcolemma. It seems likely that azumolene does not alter the sarcoplasmic reticulum function such as Ca2 uptake and release in cardiac muscle.
Action Potentials ; Animals ; Contracture ; Dantrolene ; Depression ; Guinea Pigs ; Malignant Hyperthermia ; Microelectrodes ; Myocardium* ; Papillary Muscles ; Sarcolemma ; Sarcoplasmic Reticulum