To compare the efficacy of Stamey with that of Raz procedure in the correction of stress urinary incontinence, we studied retrospectively 43 patients who underwent either procedure at our institution between January, 1989 and June, 1994. Of 43 Patients were 23 underwent Stamey and 20 underwent Raz procedures. Patient's characteristics of the 2 groups were similar, but mean operative time was 107 minutes in Stamey and 76 minutes in Raz procedure(P<0.05), a care rate was obtained postoperatively in 65y. of the patient in Stamey and in 85% in Raz procedure(P<0.05). Postoperative complications were similar in 13.5% of the patients in Stamey and in 12.5% in Raz procedure. Although most predictive factors were not associated with cure or failure in our series, the postoperative cure rate was significantly higher in the group with urinary retention of more than a week. It is thought that Raz procedure is more safe and accurate than Stamey procedure by its shorter operation time and higher success rate(P<0.05). although patient's satisfaction with postoperative morbidity is similar between Stamey and Raz procedure.
Humans ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Urinary Incontinence* ; Urinary Retention

No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Angiodysplasia of small bowel is uncommon and frequently undiagnosed and presents a taxing surgical problem. It is usually diagnosed for unexplained gastrointestinal bleeding. For the surgeon, the main technical problem is that the lesion is impalpable, and invisible to the naked eye, so it usually cannot be identified unless bleeds actively at the time of surgery. Arteriography gives a little information about wax and wane pattern of bleeding in the lesion. Endoscopy is often unfruitful because the majority of lesions are submucosal and rarely exceed a few millimeters in diameter. Transillumination of the intestinal wall from inside of the lumen to the outside in a dark room can define the precise vascular anatomy of the wall. The delicate lesion of the angiodysplasia can be identified by this transillumination method. We described a simple intraoperstive endoscopic translllumination technique used successfully to identify an angiodysplasia in the small bovwel prior to the bowel resecion. This report summarized our experience and review of literature.
Angiodysplasia* ; Angiography ; Endoscopy ; Hemorrhage ; Taxes ; Transillumination*

PURPOSE: Bacillus Calmette-Guerin (BCG) is the most effective intravesical agent for patients with superficial bladder cancer, but the long-term efficacy of BCG has not been established. We report our long-term experience of intravesical BCG therapy in the recurrence and progression for superficial bladder cancer. PATIENTS AND METHODS: Between 1985 and 1993. high risk patients with superficial bladder cancer were received complete TURB plus intravesical BCG (n=77). 120mg Tice-Chicago strain BCG was administered weekly for 6 weeks and then monthly for 3 months. Patients were considered treatment failure if either urinary cytology or biopsy results were positive for tumor on every 3 to 6 months followup examination. All patients reported have had a minimum 2-year followup, with the mean of 63 months. RESULTS: The 1st course of BCG was successful in 47 (6696) of 71 patients treated for prophylaxis and 3 (50%) of 6 treated for carcinoma in situ. Subsequent progression of disease occurred in 6 patients (8%) and cystectomy was performed in 2 patients (3%). The response rate for the total patients population treated with the 1st course was 65% (50 of 77). Of 27 patients who failed the 1st treatment course 21 patients were given the 2nd BCG treatment course. Of the 2nd BCG course, subsequent progression of disease occurred in 3 patients (14%), and cystectomy was performed in 2 patients (9%). Thirteen (68%) had complete response and 5 (26%) had new tumors, who had rendered free of disease after TURB plus intravesical therapy (mitomycin and/ or BCG). Although serious BCG complications (hepatitis, miliary Tbc, sepsis) were observed in 2 patients, side-effects were self-limiting and well controlled in the majority of patients (fever, bladder irritability, and hematuria). CONCLUSIONS: Intravesical BCG therapy seems to be effective to prevent recurrence and progression of superficial bladder cancer with long-term follow-up. However, we must note the possibility of fatal generalized complications in patients with grossly trauma of lower urinary tract.
Bacillus* ; Biopsy ; Carcinoma in Situ ; Cystectomy ; Follow-Up Studies* ; Humans ; Mycobacterium bovis ; Recurrence ; Treatment Failure ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract

From 1986 to 1993, we analyzed experiences in clean intermittent catheterization(CIC) of 62 patients with neurogenic bladder who were closely follow up for averaging 25months. Initial urodynamic study revealed hyperreflexic bladder in 21patients: 11 with detrusor sphincter dyssynergia. Areflexic bladder was found in 41patients: l5 with low compliance. Although positive urine culture were relatively frequent(61%), febrile urinary tract infections were rare(3%) and upper urinary tract function was stable. Other complications of CIC(29%) were burning sensation, resist on urethral catheter, epididymitis, scrotal abscess, bladder stone, etc. Although minor complications are not rare, we can conclude that preservation of renal function and improvement of urinary incontinence can achieved with intermittent catheterization and that patient must be well motivated and cooperative and be able to use their hands for continuation of CIC.
Abscess ; Ataxia ; Burns ; Catheterization ; Catheters ; Compliance ; Epididymitis ; Follow-Up Studies* ; Hand ; Humans ; Intermittent Urethral Catheterization* ; Male ; Sensation ; Urinary Bladder ; Urinary Bladder Calculi ; Urinary Bladder, Neurogenic* ; Urinary Catheters ; Urinary Incontinence ; Urinary Tract ; Urinary Tract Infections ; Urodynamics

No abstract available.
DNA* ; Ploidies* ; Stomach Neoplasms*

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p<0.005) and inflammation (3%, p<.05) were significantly associated with elevated serum PSA concentrations (>4.0 ng/ml) than control group (< or = 4.0 ng/ml) and age echogenecity on ultrasound and calculi were statistically less significant (p> or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.
Biopsy ; Calculi ; Humans ; Inflammation ; Male ; Prostate ; Prostatic Neoplasms ; Ultrasonography

Valproic acid-induced hyperammonemic encephalopathy (VHE) is a very rare but serious complication. Discontinuation of valproic acid is the first and critical step for treatment. VHE can occur in people with normal liver function, despite normal doses and serum levels of valproic acid, therefore it is very hard to predict. Recently, we experienced a case of VHE. Here we will present the clinical, laboratory and electroencephalography findings in this patient.
Electroencephalography ; Epilepsy ; Humans ; Liver ; Status Epilepticus ; Valproic Acid

Storz Modulith SLX represents a newly developed third generation lithotriptor with an electromagnetic cylinder as shock wave source and a dual localization system consisting of inline ultrasound and an integrated fluoroscope C-arm. We report our initial experience with in situ ESWL treatment of renal and ureteral stones with Modulith SLX. 282 patients with urinary stones were treated. Stones were located in calices or the renal pelvis in 21.4%, in the upper ureter in 50.5%. in the midureter in 6.1% and in the lower ureter in 22.0%. The age range of the patients was 18 to 73 years (mean of 43.8 years). The male to female ratio was 1.6: 1. The size of the stones ranged from 3 to 48mm (mean of 11.6mm). No general or regional anesthesia was required. The average number of shock waves was 3,250 shock/session and the total number of treatment session was 535 (mean of 1.9/person). The success rate was 84.1% in kidney, 92.6% in upper ureter. 83.3% in midureter and 95.4% in lower ureter respectively (overall 90.8%). The success rate was decreased in accordance with increment of stones size : 93.996 for stones of 1- 10mm, 86.2% for 11-20mm, 44.4% for stones larger than 20mm. There was no significant complications. In conclusion, ESWL with Storz Modulith SLX is the first choice of management for urinary stones less than 20mm in diameter regardless of the stone location. And it is an efficient and safe lithotriptor which allows anesthesia-free lithotripsy and treatment for outpatient basis.
Anesthesia, Conduction ; Female ; Humans ; Kidney ; Kidney Pelvis ; Lithotripsy* ; Magnets ; Male ; Outpatients ; Shock* ; Ultrasonography ; Ureter ; Urinary Calculi

Medullary thyroid carcinoma (MTC) is a rare and challenging malignancy. In patients with residual MTC, the tumor detection rate is generally low for most of the currently available imaging techniques. Various imaging methods have already been used for the detection of residual tumor, but no modality has been shown to be superior to others. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has recently been proposed to identify residual MTC, but this procedure also has limitations as small masses are rarely detected. So, a multimodality imaging approach is recommended for detecting residual MTC. We report here on a case of residual MTC that was detected by 18F-FDG PET/CT in a patient with persistent hypercalcitoninemia after total thyroidectomy and bilateral lymph node dissection.
Calcitonin ; Electrons ; Fluorodeoxyglucose F18 ; Humans ; Lymph Node Excision ; Neoplasm, Residual ; Positron-Emission Tomography ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy