PURPOSE: Laparoscopic radical nephrectomy is a standard treatment for localized renal cell carcinoma. Although it is less invasiveness than open surgery, it has a steeper learning curve compared with open surgery. We analyzed the results of laparosopic radical nephrectomy that was performed by 3 surgeons who had finished a 1-year laparoscopy educational program. MATERIALS AND METHODS: A total of 103 cases of laparoscopic radical nephrectomy that were performed from June 2003 to July 2007 were enrolled in this study. These cases were performed via a transperitoneal, pure laparoscopic approach. We analyzed each surgeon's operative time, their operative blood loss and the complication rate, and then we examined a sequential transition after dividing the cases into three groups. RESULTS: The average tumor size was 4.69+/-2.21cm. The tumor stage distribution was T1 in 74 cases, T2 in 14 cases, T3a in 13 cases and T3b in 2 cases. The average operative time and calculated operative blood loss were 211.6+/-73.4 min and 553.6+/-466.9ml, respectively. Intraoperative complications occurred in 13 cases(12.6%). There were 2 cases of open conversion due to vascular injury. Surgeon A did a total of 50 cases during 4 years and his average operative time and estimated blood loss 170.8+/- 61.7 min and 577.4+/-457.5ml, respectively. Surgeon B did a total of 29 cases during 3 years and his results were 259+/-74.8 min and 434.8+/-468.1ml, respectively. Surgeon C did 24 cases during 2 years and his results were 239.1+/-45.5 min and 604.3+/-489.7ml, respectively. Sequential analysis of each surgeon's data after dividing the cases into three groups showed that operative time decreased significantly for surgeons A & B. However, the operative blood loss and complication rates did not significantly differ. CONCLUSIONS: This intensified 1-year educational program was successful enough to allow an inexperienced surgeon to complete laparoscopic radical nephrectomy without supervision.
Carcinoma, Renal Cell ; Intraoperative Complications ; Laparoscopy ; Learning Curve ; Nephrectomy ; Operative Time ; Vascular System Injuries

We report a 20-year-old female patient who developed clozapine-induced agranulocytosis on the 29th day of clozapine treatment. She recovered from the agranulocytosis on the 8th day of progression after treatment with G-CSE, GM-CSF, antibiotics and associated aseptic procedures. The cause of clozapine-induced agranulocytosis is still un known and it is proposed that the dominant gene of major histocompatibility complex region and the reactive metabolites which suppress the myeloid system may be responsible. We recommend that careful attentions such as the selection of patient, evaluation of the risk factors, and the thorough control of CPMS should be paid. If the agranulocytosis happens, it is helpful to consult to the department of medicine immediately.
Agranulocytosis* ; Anti-Bacterial Agents ; Attention ; Clozapine ; Female ; Genes, Dominant ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Major Histocompatibility Complex ; Risk Factors ; United Nations ; Young Adult

The authors report a case of renal cell carcinoma in a right malrotated (horizontal axis) kidney. The patient was treated by hand-assisted laparoscopic radical nephrectomy. This is the first report of a horizontal axis malrotated kidney with renal cell carcinoma.
Axis, Cervical Vertebra ; Carcinoma, Renal Cell ; Humans ; Kidney ; Nephrectomy

OBJECTIVES: This Study examined the relationship of depressive tendency in postpartum women with psychosocial factors such as infant temperament, parental stress and coping style. METHODS: The subjects consisted of 105 postpartum women, each of whom had an infant aged 4 to 12 months. They were assessed on demographic variables and on measures of the depressive symptomatology, infant temperament, parental stress and the coping style using Beck Depression Inventory(BDI), the EAS temperamental survey, Parenting Stress Index(PSI), the Way of Coping Checklist(WCC). And then we assessed the relationship of depressive tendency in postpartum women with psychosocial factors. RESULTS: The results were as follows: 1) Depressive tendency in postpartum women had significant relationship with emotionality(r=.26 p<0.05) and activity(r=.22 p<0.05) of infant temperament. 2) Depressive tendency in postpartum women had significant relationship with parenting stress(r=.44 p<0.001). 3) Depressive tendency in postpartum women had no significant relationship with coping style. 4) Parental stress had significant relationship with emotionality(r=.49 p<0.001) but did not have any relationship with sociability and activity of infant temperament. Parenting stress had no significant relationship with coping style. CONCLUSION: These results suggest that depressive tendency in postpartum women correlated with emotionality and activity of infant temperament correlated with parenting stress but not correlated with coping style. Infant temperament and parenting stress to child rearing are more significantly correlated with depressive tendency in postpartum women than coping style of postpartum women.
Child ; Child Rearing ; Depression ; Depression, Postpartum ; Female ; Humans ; Infant* ; Parenting ; Parents ; Postpartum Period* ; Psychology ; Temperament*

BACKGROUND AND OBJECTIVES: Otohematoma is a fairly common disease in otolaryngologic clinics. The principle treatment is composed of removal of the hematoma and compression. But this method is inconvenient both to the patient and doctor. To find another alternative that is simple and easy, we tried steroid injection in otohematoma. Steroid is used in various kinds of hemangioma, and if it is effective in hemangioma it also can be speculated that same phenomenon can be happened to otohematoma. MATERIALS AND METHODS: One hundred otohematoma patients were treated with triamcinolone injection on the lesion sites after aspiration of hematoma or seroma. The injection was repeated as necessary. RESULT: Among the 100 otohematoma patients 96 patients(96%) were healed without any complications. The numbers of injection needed were usually within 3 times(81%) : 1 time(42%), 2 times (20%), 3 times(19%). CONCLUSION: Steroid injection is a very good alternative in the treatment of otohematoma. It is easy to perform, convenient to the patients and usually results in complete resolution. The proposed mechanisms are vasoconstricting and anti-inflammatory action of steroid.
Hemangioma ; Hematoma ; Humans ; Seroma ; Triamcinolone

PURPOSE: We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs). MATERIALS AND METHODS: From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes. RESULTS: The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8). CONCLUSIONS: The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.
Carcinoma, Renal Cell* ; Cohort Studies ; Demography ; Follow-Up Studies ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Ischemia ; Kidney Neoplasms ; Korea ; Nephrectomy* ; Outcome Assessment (Health Care)

PURPOSE: We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs). MATERIALS AND METHODS: From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes. RESULTS: The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8). CONCLUSIONS: The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.
Carcinoma, Renal Cell* ; Cohort Studies ; Demography ; Follow-Up Studies ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Ischemia ; Kidney Neoplasms ; Korea ; Nephrectomy* ; Outcome Assessment (Health Care)