PURPOSE: Numerous methods exist for diagnosing nonpalpable testis in treatment of cryptochidism. However, there is no clinically established data for the rational diagnostic tool of nonpalpable testis in terms of expenses. We tried to establish a current conventional diagnostic course of nonpalpable testis. We then evaluated the efficacy of ultrasonography, physical examination under general anesthesia and laparoscopy for diagnosing nonpalpable testis. METHODS: Between March 2000 and February 2005, 103 boys(129 testes) with undescended testes were treated in our department. There were 31 testes(24.0%) that were not palpable at physical examination. These patients were evaluated with ultrasonography and repeated physical examination under general anesthesia. In the cases where testes could not be detected with ultrasonography and physical examination under general anesthesia, laparoscopy was performed to diagnose nonpalpable testis. RESULTS: In 31 cases of nonpalpable testis, 13 testes were detected with ultrasonography and 15 testes became palpable with physical examination under general anesthesia. All of the remaining 16 nonpalpable testes were confirmed with laparoscopy. CONCLUSION: Physical examination under general anesthesia was superior to ultrasonography in making a diagnosis of nonpalpable testis. Ultrasonography and physical examination under general anesthesia could reduce the incidence of diagnostic laparoscopy. Therefore, it is recommended that ultrasonography, physical examination under general anesthesia and laparoscopy must be performed conventionally in order to diagnose nonpalpable testis.
Anesthesia, General ; Child* ; Cryptorchidism* ; Diagnosis ; Humans ; Incidence ; Laparoscopy ; Male ; Physical Examination ; Testis ; Ultrasonography

BACKGROUND: Valve replacement in children has many problems such as the durability of prosthetic valve, thomboembolism and hemorrhage. But recently, the necessity of valve replacement in children increased and the above problems were solved party. So the number of valve replacement in children increased progressively. RESULTS: Valve replacement in 47 children were done at Seooul National University Chidren's Hospital from March 1986 to July 1991. The patients were composed of 25 males and 33 females. 25 patients had congenital heart disease and 22 patients rheumatic heart disease. 45 patients received single valve repalcement, 2 patients double valve repalcement, and among all of them, 2 patients redo-replacement. The major valve lesion was mitral insufficiency and post-operative status in view of NYHA functinonal class was improved in most patients. The mechanical valves were applied to 45 patients and tissue valves to 2 patients. The indication of valve replacement were progressive increase in ventricular volume, major regurgitant fraction over grade III decrease in exercise tolerance and vegetation. The overall early mortality was 8.5% and late mortality 0%. There were post-operative complication rate of 30% and late complication rate 14%, and among the later, valve faliure was reported in 2 pantients and thromboembolism in 1 patient. The complication-free rate was 97.7% at post-operative 1 month, 91.3% at 12 months, 90% at 36 months and 60% at 48 months. 43 patients received anticoagulation and/or antiplatelet therapy, but there was no critical indication for this. CONCLUSION: These results suggest that cardiac valve replacement in children have been effective therapeutic modality even though various problems still remain, but we propose that sufficient long-term follow-up and clinical research be needed.
Child* ; Exercise Tolerance ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Valves* ; Hemorrhage ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Rheumatic Heart Disease ; Thromboembolism

The adenocarcinoma of appendix and fallopian tube are both very rare. The incidence rate for fallopian tube is less than 1% of all genital malignancies. Fallopian tubes have been very rarely associated with synchronous tumorigenesis, and to the authors knowledge, the combination of mucinous adenocarcinoma of appendix has never been previously reported. The authors experienced a extremely rare case of synchronous adenocarcinoma of appendix and fallopian tube in 56 years old female patient who has suffered for 10days from RLQ abdominal pain. Pathologic examination of the resected specimen revealed a synchronous mucinous type adenocarcinoma of vermiform appendix and fallopian tube.
Abdominal Pain ; Adenocarcinoma* ; Adenocarcinoma, Mucinous ; Appendiceal Neoplasms ; Appendix* ; Carcinogenesis ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Incidence ; Middle Aged ; Mucins

BACKGROUND: Adenocarcinoma arising in the body or tail of the pancreas tends to be metastasized at the time of diagnosis, is mostly in inoperable stage, and poor in prognosis. In this study, we evaluated the adenocarcinoma arising in the body or tail of the pancreas and investigated the prognostic factors and ideal treatment. MATERIAL AND METHODS: We retrospectively analyzed 33 patients who were cytologically or histologically confirmed as adenocarcinoma in the body or tail of the pancreas at Samsung Medical Center from October 1994 to December 1999. RESULTS: The mean age of the patients in the resectable and unresectable groups were 63.4 and 60.6 year-old, respectively. The mean CA19-9 level was higher in unresectable group (5166.2u/ml), compared to the resectable group (964.7u/ml).(p=0.039) In the resectable group, the body was the most common location of the tumor, and in the unresectable patient group, the tail was more prevalent.(p= 0.021) The mean survival time of the resectable group was 15.1months. The univariate analysis of the resectale group showed that the age, sex, lymph node metastasis, chemotheraeutic modalities, radiotherapeutic modalities, and the location of tumor were not significantly related with the prognosis. In unresetable group, the mean survival time was 6.4months. The mean survival time were 3.3 months in patients over 60 year-old and 9.9 months in patients less than 60, showing statistically significant difference.( p=0.007) The mean survival time were 12.2 months and 3.4 months in patients who received the chemotherapy and who did not, respetively.(p=0.004) Evaluating the relationship between the extent of metastasis and survival, the mean survival length of single metastasis was 9.3 months, showing significantly higher survival length compared that of multiple metastasis.(p=0.027) Patient's sex, radiotherapeutic modality and location of the tumor were not significantly related with the prognosis. Multivariate analysis of prognostic factor showed that the patietnt's age (p=0,842), the extent of metastasis( p=0.458), and chemotherapeutic modality (p=0.078) were unrelated with prognosis. CONCLUSION: In adenocarcinoma arising in the body and tail of the pancreas, the CA19-9 level and tumor location could be utilized as indicating factors of the operability of the tumor. Age, sex, lymph node metastasis, and location of the adenocarcinoma are not significantly related with the survival length in both the resectable and unresectable groups. Also, in both groups, the chemotherapeutic and radiotherapeutic modalities were not related with the survival length.
Adenocarcinoma* ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Pancreas ; Prognosis* ; Retrospective Studies ; Survival Rate

No abstract available.
Lithotripsy* ; Shock* ; Ureter*

A 70-year old man presented with postprandial upper abdominal pain of two months duration, accompanied by indigestion, weight loss, and anorexia. There was no abnormality noted in the lab results. Abdominal CT showed a 3-cm round cystic mass in the tail of the pancreas. A distal pancreatectomy was done. The patient was discharged in 9 days. The cystic wall was composed of a keratinizing squamous epithelium surrounded by subepithelial, dense lymphoid tissue. Some clusters of the sebaceous gland were noted but there was no sweat gland or hair follicle. These findings were consistent with a lymphoepiethelial cyst with sebaceous differentiation. The patient was followed up for 12 months post operatively, and no recurrence was noted.
Abdominal Pain ; Aged ; Anorexia ; Dermoid Cyst* ; Dyspepsia ; Epithelium ; Hair Follicle ; Humans ; Lymphoid Tissue ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Recurrence ; Sebaceous Glands ; Sweat Glands ; Tomography, X-Ray Computed ; Weight Loss

A 70-year old man presented with postprandial upper abdominal pain of two months duration, accompanied by indigestion, weight loss, and anorexia. There was no abnormality noted in the lab results. Abdominal CT showed a 3-cm round cystic mass in the tail of the pancreas. A distal pancreatectomy was done. The patient was discharged in 9 days. The cystic wall was composed of a keratinizing squamous epithelium surrounded by subepithelial, dense lymphoid tissue. Some clusters of the sebaceous gland were noted but there was no sweat gland or hair follicle. These findings were consistent with a lymphoepiethelial cyst with sebaceous differentiation. The patient was followed up for 12 months post operatively, and no recurrence was noted.
Abdominal Pain ; Aged ; Anorexia ; Dermoid Cyst* ; Dyspepsia ; Epithelium ; Hair Follicle ; Humans ; Lymphoid Tissue ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Recurrence ; Sebaceous Glands ; Sweat Glands ; Tomography, X-Ray Computed ; Weight Loss

The incidence of tuberculosis (TB) had gradually been declining all over the world, but in recent years, TB has been increasing due to the spread of the human immunodeficiency virus (HIV). When immune-suppression status deteriorates further, extrapulmonary TB generally appears more often. Abdominal TB is one type of extra-pulmonary TB, which may involve the gastrointestinal tract, peritoneum, lymph nodes or solid viscera. We encountered a case who had initially been diagnosed as having abdominal TB, had progressed to acute respiratory distress syndrome and was eventually confirmed as having developed acquired immune deficiency syndrome. In cases of coinfection of TB and HIV, it is reported that immunological responses become poor and complications with higher morbidity frequently occur. Therefore, the Korean guidelines for TB should be revised to ensure whether HIV infection exists in TB patients.
Acquired Immunodeficiency Syndrome* ; Coinfection ; Gastrointestinal Tract ; HIV ; HIV Infections ; Humans ; Incidence ; Lymph Nodes ; Peritoneum ; Respiratory Distress Syndrome, Adult ; Tuberculosis* ; Viscera

PURPOSE: In spite of higher incidence of stroke in end-stage renal disease (ESRD) patients compared to general population, the risk factor for stroke which is specific to ESRD is not fully understood. The ESRD patients who develop stroke may have certain additional risk factors compared to ESRD patients without stroke. We used registered data of Hallym Stroke Registry to elucidate the factors which affect development of ischemic stroke among the dialysis patients. MATERIALS AND METHODS: We recruited patients with acute ischemic stroke in ESRD patients undergoing maintenance dialysis. Dialysis patients without stroke were selected as control group with age and gender matching. We compared the demographic features, stroke risk factors, and laboratory findings in ESRD patients with or without ischemic stroke. RESULTS: The total of 25 patients with ESRD developed ischemic stroke. Fifty ESRD patients without stroke were chosen as the control group. The mean age of acute ischemic stroke patients was 59.80+/-9.94 and male gender was 48%. The most common ischemic stroke subtype was small vessel occlusion (n=12), followed by large artery atherosclerosis (n=7). The patients with stroke had more frequent history of hypertension and higher systolic/diastolic blood pressure at the time of admission than the ESRD patients without stroke. Total cholesterol and LDL-cholesterol levels were significantly lower in the stroke group. In multivariate analysis, LDL-cholesterol was found to be the only risk factor for ischemic stroke. CONCLUSION: The results of our study reveal that LDL-cholesterol is associated with greater risk for ischemic stroke in the patients on dialysis.
Arteries ; Atherosclerosis ; Blood Pressure ; Cholesterol ; Dialysis* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Male ; Multivariate Analysis ; Risk Factors ; Stroke*

Urethral prolapse is rarely diagnosed. We have reported a case of urethral prolapse that was successfully managed by a simple ligation of prolapsed urethra over a Foley catheter in a postmenopausal woman who was suffering from advanced lung cancer.
Catheters* ; Female* ; Humans ; Ligation* ; Lung Neoplasms ; Prolapse* ; Urethra