Rapid and accurate management is necessary for the emergency patients, but there is a few comprehensive and analyzed references about them and still the definition and the criteria of the urologic emergency are not defined. So a clinical observation was made on 382 patients, admitted to the Department of Urology through the emergency room of the Severance hospital during 5 years from January, 1972 to December, 1976. They were observed as following orders; annual, age, sex, symptoms, emergency managements, diagnostic procedures, diagnoses, associated diseases, and mortality rate etc. The results are as follows: 1. Urologic emergency patients were 382 (male 265, female 117). They were 1.4 % of the patients admitted through the emergency room, and 19.3% of the in-patients of the Department of Urology. 2. Symptoms and signs of the urologic emergency were pain (209 cases), gross hematuria (48 cases), acute retention (42 cases), acute genitourinary infection (38 cases), genitourinary injury (66 cases), shock (13 cases), and uremia(24 cases). 3. I.V.P. was the most common diagnostic procedure, but bone X-ray and the cystourethrogram were more common in genitourinary injury. 4. Emergency managements were performed in 227 cases. Pain control was most common (52t), then indwelling of the Foley catheter and transfusion were next. 5. In pain, flank or abdominal pain was most common (191 cases) and the most common cause. was lower 1/3 ureteral stone. 6. The causes of the gross hematuria were genitourinary tumor (11 cases), calculi(10 cases), acute cystitis(9 cases), and acute pyelonephritis (7 cases). 7. Acute retentions were commonly developed in old aged men and the most common cause was B.P.H. (42. 9%), then urethral stricture (23. 8%). 8. Acute genitourinary infections were most common in 3rd decade women. 9. Genitourinary injuries were most commonly occurred in the spring (34. 8%). The most common cause was kick or blow (43.9%) and the most common organ was urethra (40%). The most common combined injury was pelvic bone fracture (36. 8%). 10. The causes of the shock were genitourinary injury(84.6%) and bladder tumor (15. 4%). 11. The most common cause of uremia was genitourinary tumor (25%), then ureteral stricture (20. 8%). 12. In 30 cases, the presumptive diagnoses were different from the definite diagnoses. 43.3% of them were suspected as urinary calculi, but confirmed as acute pyelonephritis, ureteral stricture and tumor etc. 13. Associated diseases were common in old aged patients and cardiovascular (33%) or respiratory diseases (28.4%) were common. 14. Conservative treatment was most commonly performed, but suprapubic transvesical prostatectomy was more common in acute retention. 15. 7 patients were died and the mortality rate was 1.8%.
Abdominal Pain ; Catheters ; Constriction, Pathologic ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Female ; Flank Pain ; Hematuria ; Humans ; Male ; Mortality ; Pelvic Bones ; Prostatectomy ; Pyelonephritis ; Shock ; Uremia ; Ureter ; Urethra ; Urethral Stricture ; Urinary Bladder Neoplasms ; Urinary Calculi ; Urology

Operations for benign prostatic hypertrophy was done on 48 cases during the last 3 years, 18 cases on suprapubic prostatectomy and 30 cases on transurethral of the resection prostate. A clinical comparative investigation was made between the suprapubic prostatectomy group and transurethral resection of the prostate group on the operation time, blood loss during or after the operation, the excised prostatic tissue weights , the duration of urethral catheter indwelling, the duration of hospitalization, complications, and the kinds or volume of irrigating solutions. The results were followed as; 1. The mean operation time was 89 minutes in transurethral resection of the prostate and 140 minutes in suprapubic prostatectomy. 2. The mean duration of the urethral catheter indwelling was 4 days in transurethral resection of the prostate and 6 days in suprapubic prostatectomy. The mean duration of hospitalization was 6 days in suprapubic prostatectomy. 3. Transfusion was done in 33.3% of transurethral resection of the prostate and 83.3% of suprapubic prostatectomy during or after the operation. The mean amount of trans fused blood was 1.4 pints in transurethral resection of the pro state and 3.7 pints in suprapubic prostatectomy. 4. Complication rates during the hospitalization was 26.7% in transurethral resection of the prostate and 38.9% in suprapubic prostatectomy. 5. The mean weights of excised tissue was 10.7gm. in transurethral resection of the prostate and 42.9gm. in suprapubic prostatectomy. 6. The mean amount of irrigating solution was 24,000cc in transurethral resection of the prostate.
Hospitalization ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate* ; Urinary Catheters ; Weights and Measures

A 71 years old housewife with epidermoid carcinoma of cervix was diagnosed as crossed renal ectopia (probably with fusion) incidentally by intravenous pyelography during baseline study of cervical carcinoma.
Aged ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Humans ; Urography

Prenephrectomy therapeutic renal artery embolization by injecting gelfoam into therenal artery was done in a 47 year-old female patient with hypernephroma. This technique facilitated nephrectomy and decreased blood loss. A post-infarction syndrome characterized by flank pain, fever and nausea also occurred in this patient. We report our experience herein with review of literature.
Arteries ; Carcinoma, Renal Cell* ; Female ; Fever ; Flank Pain ; Gelatin Sponge, Absorbable ; Humans ; Middle Aged ; Nausea ; Nephrectomy ; Renal Artery*

The great chain of sympathetic ganglia which extends from the base of the skull to the pelvis, including the suprarenal medulla, accounts for the origin of the ganglioneuroma which compound with the matured ganglion cells and neural elements. The ganglioneuroma is non-functioning tumor, but occasionally this tumor accompanies with hypertension and diarrhea and increased excretion of vanilmandelic acid in urine. Recently we experienced a housewife with the bilateral ganglioma which developed at both suprarenal medulla and after successful removal of the tumors hypertension was controlled.
Diarrhea ; Ganglia, Sympathetic ; Ganglion Cysts ; Ganglioneuroma* ; Hypertension ; Pelvis ; Skull ; Vanilmandelic Acid

Ultrasonography is a useful diagnostic modality in evaluating the non-visualized kidney on IVP because visualization by this technique depends only on the morphologic and acoustic characteristics of the kidney and is independent of renal function. This non-invasive technique can accurately guide percutaneous puncture of the collecting system, permitting antegrade localization of the obstructing lesion, and percutaneous nephrostomy under the ultrasonic guidance can be performed as a means for rapid, usually temporary, urinary diversion in patients with obstructive uropathy. Many causes of IVP non-visualization have a typical sonographic appearance. 35 patients with non-visualized kidney were examined ultrasonically and 13 AGP were carried out.
Acoustics ; Humans ; Kidney ; Nephrostomy, Percutaneous ; Punctures ; Ultrasonics* ; Ultrasonography ; Urinary Diversion

After the performance of 100 coronary cineangiographies in 100 paitents who were adminitted to Soonchunhyang University Hospital under the diagnosis of ischemic heart disease from July 1986 to October 1987, we observed the coronary collateral circulation and measured the ejection fraction, circumferential fiber shortening, left ventricular end-diastolic pressure and pulmonary artery wedge pressure in 52 paitents who had 50% or more stenosis in one or more coroanry arteries. The results were as follow : 1) The collaterall circulation was observed in 16 patients(30.8%) of the 52 patients and it was developed mainly(87.5) in patients with 90% or more coronary artery stenosis. In patients with stenosis of less than 90%, however, collateral circulation was observed rarely(12.5%). 2) The left ventricular wall motion abnormality was severe in the group without collateral circulation. 3) The collteral circulation was most frequently developed in patients with severe right coronary artery stenosis and most of the routes were supplied from contralateral coronary arteries. 4) There was no significant difference in ejection fraction, circumferential fiber shortening, left ventricular end-diastoic pressure and pulmonary artery wedge pressure between the 2 groups with and without coronary artery collateral circulation.
Arteries ; Cineangiography ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Diagnosis ; Humans ; Myocardial Ischemia ; Pulmonary Wedge Pressure ; Ventricular Function, Left*

To difine the relation between plasma atrial natriuertic peptide (ANP) levels and hemodynamic changes, we measured plasma concentration of atrial natriuertic peptide in 19 patients with heart disease undergoing cardiac catherization and in 15 normal subjects. The following results were obtained; 1) There were significantly increased plasma levels of atrial natriuertic peptide in patients with elevated mean pulmonary arterial wedge pressure. 2) A significant step-up in atrial natriuertic peptide concentration was seen between the femoral venous and right atrial plasma (P<0.01) and between the right atrial and pulmonary arterial plasma (P<0.05). 3) Peripheral venous atrial natriuretic peptide levels were significantly correlated with mean pulmonary arterial pressure and pulmonary wedge pressure (r=0.05, r=0.65, P<0.05). 4) Plasma atrial natriuretic peptide levels in pulmonary artery were significantly correlated with mean pulmonary arterial pressure (P<0.05).
Arterial Pressure ; Heart Diseases* ; Heart* ; Hemodynamics* ; Humans ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass is now an accepted technique of myocardial revasculization in terms of preventive method from various complications of cardiopulmonary bypass. Despite danger of myocardial ischemia, induced hypotension with bradycardia are sometimes necessary for the convenience of operative approach to beating heart. We report a case of induced hypotension with bradycardia during general anesthesia for CABG without cardiopulmonary bypass. After induction and maintenance of balanced anesthesia with fentanyl-midazolam-isofluranepiperocuronium for the 68 kg, 55 years old male stable angina patient, we induced controlled hypotension(systolic blood pressure: 70~80 mmHg) and bradycardia(heart rate: 50~60/min.) by bolus injections of verapamil 5 mg and esmolol 30 mg followed by continuous infusion of esmolol 0.1~0.3 mg/kg/min. during 50 minutes of main graft implantations without bypass. Any significant ischemic changes on EKG were not detected during induced hypotension and bradycardia. Patient was recovered without any signs of myocardial ischemia postoperativery and discharged 8 days after operation.
Anesthesia, General* ; Angina, Stable ; Arteries* ; Balanced Anesthesia ; Blood Pressure ; Bradycardia* ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Electrocardiography ; Heart ; Humans ; Hypotension* ; Male ; Middle Aged ; Myocardial Ischemia ; Transplants* ; Verapamil

Echocardiography has been the most widely applicable noninvasive cardiovascular imaging technique. Recent advances in this technique have extended its use into the operating room by development of transesophageal approach. Many anesthesiologists use transesophageal echocardiography (TEE) because it provides a more direct and rapid method of assessing cardiac anatomy and function. Intraoperative TEE done by anesthesiologists or cardiologists makes it possible for operation team to get useful informations such as cardiac filling, valvular function, cardiac contractility, intracardiac shunt, segmental wall motion abnormality and adequacy of coronary blood flow, etc. We analyzed our clinical experiences of forty six cases of TEE (6.0%) in 767 cases of anesthesia for open heart surgery at the Sejong General Hospital during the period from September 1993 to August 1994. 767 open heart surgical cases were divided into 4 groups by disease entity ; 498 cases of group I(congenital), 190 cases of group II(valvular), 63 cases of group III(ischemic) and 16 cases of group IV(miscellaneous). TEE was done for 22 cases of male patients and 24 cases of female patients. 32 cases of TEE were done for the age group between 21 to 30 years old. The number of TEE was 26 cases of group II, 11 cases of group I, 7 cases of group III and 2 cases of group IV, respectively. The main purpose of TEE in descending order was 27 cases for assessment of cardiac contractility, 18 cases for valvular function after valvuloplasty, 7 cases for the evaluation of low cardiac output syndrome(LCOS), and 7 cases for adequacy of coronary blood flow respectively. Two cases of Biopump in group I, 2 cases of Biopump in group II, 3 cases of intraaortic baloon pump(IABP) in group II, III and IV were applied after TEE. Two cases of mitral valvular replacement(MVR) were done immediately after confirmation of valvular insufficiency by TEE. These results have demonstrated that TEE is one of the useful monitoring devices for the anesthesia in open heart surgery by assessment of variable informations about patients' cardiac status.
Adult ; Anesthesia ; Cardiac Output, Low ; Echocardiography ; Echocardiography, Transesophageal* ; Female ; Heart* ; Hospitals, General ; Humans ; Male ; Operating Rooms ; Thoracic Surgery*