PURPOSE: No consistent histo-pathological characteristics of cystic renal cell carcinomas have previously been determined. In this study, attempts were made at our hospital to evaluate the histopathological characteristics of this cancer. MATERIALS AND METHODS: The medical records of 451 patients with renal cell carcinomas, having undergone a radical nephrectomy, between January 1995 and April 2002, were retrospectively reviewed. The renal cell carcinomas were classified, according to the criteria of the World Health Organization, as a cystic renal cell carcinoma in 31 of these patients (6.8%). The tumor size, nuclear grade and pathological stage were investigated. RESULTS: The mean age of the patients was 52 years, ranging from 35 to 75. Cancer stages were T1, T2 and T3 in 26 (84%), 3 (10%) and 2 (6%) patients, respectively. The nuclear grade and pathological stage were lower in patients with a cystic renal cell carcinoma. CONCLUSIONS: 81% of the cystic renal cell carcinoma cases were diagnosed incidentally. The cystic renal cell carcinomas were usually detected at lower stages and grades, and therefore were associated with a better prognosis than the renal cell carcinomas.
Carcinoma, Renal Cell* ; Humans ; Medical Records ; Nephrectomy ; Prognosis ; Retrospective Studies ; World Health Organization

PURPOSE: The ureter can be a very effective tissue for bladder augmentation, but the indications for ureterocystoplasty are still evolving, with the main problem being the limited number of patients with a nonfunctioning or poor functioning kidney. Recently, ureterocystoplasty, with preservation of ipsilateral renal function, has been reported by several authors. We reported our experience and follow-up results of ureterocystoplasty. MATERIALS AND METHODS: Between December 2000 and February 2003, 4 girls, aged 3 to 13 (mean age 7.2), with a low capacity, poorly compliant bladder underwent ureterocystoplasty using a single dilated ureter. Three patients had a dilated ureter due to high grade VUR (vesicoureteric reflux) and the other due to bilateral reflux. An urodynamic study showed an areflexic neurogenic bladder, with low compliance, in all patients. The technique was performed intraperitoneally using a midline abdominal incision. The distal parts of both detubularized magaureters were used for augmentation. The dilated proximal ureter was anastomosed to the longitudinally incised contralateral ureter, in an end to side fashion. RESULTS: The mean follow-up was 21 months (6-41). In a video-urodynamic study, the mean preoperative bladder capacity and post operative volume were 140cc (67-23) and 223cc (140-320), respectively, with an average increase of 17 to 113% (mean 71). The postoperative bladder compliance was normalized in all cases. Postoperative cystography showed excellent bladder configuration, with no vesicoureteral reflux. There were no surgical complications, such as bladder perforation, stone formation and bowel problem. The serum creatinine levels remained stable in all cases (0.3 to 0.6mg/dl). CONCLUSIONS: Although an increase in bladder capacity is not always optimal with the use of a distal ureter, it is good enough to ensure a good clinical outcome and allow an adequate catheterization interval, with a low complication rate.
Catheterization ; Catheters ; Compliance ; Creatinine ; Female ; Follow-Up Studies ; Humans ; Kidney ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Diversion ; Urodynamics ; Vesico-Ureteral Reflux

PURPOSE: We wished to introduce the curative effect of biofeedback in children with urge syndrome and dysfunctional voiding, and examine the durability of effect and the difference in response to medication before and after biofeedback. MATERIALS AND METHODS: There were 15 patients with urge syndrome and 8 with dysfunctional voiding. Average age was 8.2 years old(range, 4-16 years). Pelvic floor relaxation biofeedback, voiding biofeedback, and intravesical biofeedback were enforced with 4-18 sessions(average, 7.4). We defined the patient with disappearance of more than 90% of symptoms as 'improved', disappearance of 50 to 90% as 'partially improved', and the rest as 'not improved'. We assessed the degree of improvement between groups, and changes in uroflowmetry, functional bladder capacity and response to medication after biofeedback. RESULTS: Nine(60%) of the 15 patients with urge syndrome and 4(50%) of the 8 patients with dysfunctional voiding showed improvement, and the overall response rate was 56%(13 of 23 patients). The mean follow-up period was 7.6 months, and the therapeutic effect lasted for 5.1 months. Among the 13 patients who were refractory to medical treatment, 8(61%) improved and 3 with partial improvement responded well to medication after biofeedback. There were significant improvements in uroflowmetry findings; the numbers of bell shape and discordant shape(fractionated, staccato) before and after biofeedback were 7, 14 and 19, 4, respectively. Functional bladder capacity was also improved significantly from 177ml to 236ml(p=0.014). CONCLUSIONS: Biofeedback is an effective and safe treatment modality in most patients with urge syndrome and dysfunctional voiding.
Biofeedback, Psychology* ; Child ; Follow-Up Studies ; Humans ; Pelvic Floor ; Relaxation ; Urinary Bladder

OBJECTIVE: To evaluate radiographic results of anterior fusion methods in two-level cervical disc disease : tricortical autograft and plate fixation (ACDF-AP), cage and plate fixation (ACDF-CP), stand-alone cage (ACDF-CA), and corpectomy and plate fixation (ACCF). METHODS: The numbers of patients were 70 with a minimum 6 month follow-up (ACDF-AP : 12, ACDF-CP : 27, ACDF-CA : 15, and ACCF : 16). Dynamic simple X-ray and computed tomography were evaluated preoperatively, postoperatively, 6 month, and at the final follow-up. The fusion and subsidence rates at the final were determined, and global cervical lordosis (GCL), cervical range of motion, fused segment angle (FSA), and fused segment height (FSH) were analyzed. RESULTS: Nonunion was observed in 4 (25%) patients with ACDF-CA, 1 (8%) patient with ACDF-AP, 1 (4%) patient with ACDF-CP. The number of loss of FSH (%) more than 3 mm were 2 patients (16%) in ACDF-AP, 3 patients (11%) in ACDF-CP, 5 patients (33%) in ACDF-CA, and 3 patients (20%) in ACCF. The GCL was decreased with ACDF-CA and increased with others. The FSA was increased with ACDF-AP, ACDF-CP, and ACCF, but ACDF-CA was decreased. At the final follow-up, the FSH was slightly decreased in ACDF-CP, ACDF-AP, and ACCF, but ACDF-CA was more decreased. Graft related complication were minimal. Screw loosening, plate fracture, cage subsidence and migration were not identified. CONCLUSION: ACDF-CP demonstrated a higher fusion rate and less minimal FSH loss than the other fusions in two-level cervical disc disease. The ACDF-AP and ACCF methods had a better outcome than the ACDF-CA with respect to GCL, FSA, and FSH.
Animals ; Follow-Up Studies ; Humans ; Lordosis ; Range of Motion, Articular ; Transplants

We report a case of a 25-year old man with chronic kidney disease with secondary hyperparathyroidism who had persistent elevation of serum parathyroid hormone level after the immediate total parathyroidectomy and autotransplantation. To localize supernumerary (ectopic) parathyroid gland, we checked Tc-99m MIBI scintigraphy, MDCT and PET-CT. Contrast-enhanced MDCT showed a small strong enhancing lesion over left bracheocephalic vein, and PET-CT showed multiple brown tumors. We removed the supernumerary parathyroid gland and got a rapid drop of parathyroid hormone level.
Hyperparathyroidism, Secondary ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroidectomy ; Renal Insufficiency, Chronic ; Technetium Tc 99m Sestamibi ; Veins

Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy.
Carcinoma, Hepatocellular* ; Disease Progression ; Humans ; Salvage Therapy ; Tegafur* ; Treatment Failure

Purpose: Trocar-site burns occurring during laparoscopic surgery have been reported in various cases, and several efforts to reduce them are underway. This study aimed to analyze the effect of capacitive coupling on trocar site by observing electrical and histological changes for electrical skin burn injury. Methods: To measure the electrical changes relating to capacitive coupling, the temperature, current, voltage, and impedance around the trocar were measured when an open circuit and a closed circuit were formed using insulation intact instruments and repeated after insulation failure. After the experiment, the tissue around the trocar was collected, and microscopic examination was performed. Results: When open circuits were formed with the intact insulation, the impedance was significantly reduced compared to the cases of closed circuits (142.0 Ω vs. 109.3 Ω, p = 0.040). When the power was 30 W and there was insulation failure, no significant difference was measured between the open circuit and the closed circuit (147.7 Ω vs. 130.7 Ω, p = 0.103). Collagen hyalinization, nuclear fragmentation, and coagulation necrosis suggesting burns were observed in the skin biopsy at the trocar insertion site. Conclusion This study demonstrated that even with a plastic trocar and electrosurgical instruments that have intact insulation, if an open circuit is formed, capacitive coupling increases, and trocar-site burn can occur. When using electrocautery, careful manipulation must be taken to avoid creating an open circuit to prevent capacitive coupling related to electrical skin burn.

Secondary hyperparathyroidism is one of the most common complications of patients with chronic kidney disease (CKD). Mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis are rare complications in these patients. The defect of calcium and phosphorus metabolism may precipitate pathologic calcification at diverse organs and soft tissue, and change bone architecture. In case of involving periarticular area, patients usually present with localized swelling, pain, and reduced mobility in affected sites. However, in case of organ involvement, except in an advanced stage of disease, there are no specific symptoms. Among these patients, treatment strategies include tight control of calcium and phosphate levels, parathyroidectomy for hyperparathyroidism, renal transplantation, and local excision of calcific lesions. We report a case of mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis due to CKD with improvement 3 months after medical and surgical treatment.
Calcinosis ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation ; Parathyroidectomy ; Phosphorus ; Renal Insufficiency, Chronic

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.
Cadaver ; Chungcheongnam-do ; Cold Ischemia ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Retrospective Studies ; Tissue Donors

Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.
Acute Kidney Injury ; Anti-Bacterial Agents ; Cadaver ; Comprehension ; Consciousness ; Diet ; Fibrinogen ; Hepatitis B ; Hepatorenal Syndrome ; Immunosuppression ; Infection Control ; Critical Care* ; Liver Diseases ; Liver Failure, Acute ; Liver Regeneration ; Liver Transplantation* ; Liver* ; Nutritional Support ; Pneumonia ; Recovery of Function ; Recurrence ; Transplants ; Vital Signs ; Water-Electrolyte Balance