We treated 160 patients with ureteral stones using extracorporeal shock wave lithotripsy (Siemens Lithostar, Germany) and evaluated many factors which influence the results of ESWL such as stone size, location, degree of ureteral obstruction. duration of impaction and adjuvant procedure. Our results showed that. in case of large stones (more than 1 cm in diameter), mid-ureteral stones, long-standing impacted stones or in-situ treatment, the success rates of ESWL were relatively poor. Therefore in cases accompanying the above-mentioned factors, in is necestary to recognize that the patients may be required to repeat ESWL. The results also suggest that the use of an ureteral catheter or stent may contribute to a slightly higher success rate. But we prefer in-situ extracorporeal shock wave lithotripsy to an ureteral stent because it is an invasive procedure.
Humans ; Lithotripsy* ; Shock* ; Stents ; Ureter* ; Ureteral Obstruction ; Urinary Catheters

This study was designed to investigate the clinical availability of topographic auditory event related potential P300 as a biological marker in patients with schizophrenia. The subjects were composed of normal controls(N=30) and patients(N=30) with schizophrenia by DSM-IV. Topographic auditory event related potential P300 and N100 were measured by "oddball paradigm", which was known as a standard method. Schizophrenics were evaluated twice, initial and follow-up, by 4 week interval. P300 latency and N100 latency were deter-mined by Global Field Power. At this time point the maximum amplitude and its location, according to X-Y coordinates, were determined in brain topography. Clinical symptoms were evaluated by Positive and Negative Syndrome Scale(PANSS). P300 latencies of normal controls, initial group of schizophrenics, and follow-up group of schizophrenics were 315.8+/-24.2msec, 403.8+/-42.3msec, and 364.7+/-43.2msec, respectively. P300 amplitudes of normal controls, initial group of schizophrenics, and follow-up group of schizophrenics were 8.8+/-2.7microV, 4.4+/-1.9microV, and 4.4+/-2.5microV, respectively. They had significantly different P300 latencies one another by measuring ANCOVA, of which covariables were N100 latency, age, and CCP(correct counted percent)(p<0.01). X-Y coordinates was not significant. In P300, there were some different characters between normal controls and schizophrenics even though excluding N100, which was supposed to be exogeneous component by external stimuli. When clinical symptoms were improved, P300 latency was decreased. However, P300 amplitude was not changed. These results suggest that P300 woald be available clinically as a biological marker, P300 latency be a state marker, and P300 amplitude be a trait marker in schizophrenia.
Biomarkers* ; Brain ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Schizophrenia*

BACKGROUND: Although the first coronary Wallstent implantation ushered in a new era in interventional cordiology with the purpose of circumventing the two major limitations of coronary balloon angioplasty, early acute occlusion and late restenosis, the previous investigators have reported a high rate of subacute occlusion after Wallstent implantation. However, recent studies have reported a low incidence rate of subacute closure and restenosis using the newly modified coronary Less Shortening in aortocoronary vein grafts. The present study reports the immediate results of the Less Shortening Wallstent Implantation for 21 diffuse native coronary lesions in 20 patients. METHODS: Twenty patients were enrolled at the Yonsei Univ. Cardiovasular Center of medical College, Yonsei University in Seoul, Korea from March 1996 through May 1996. The specific angiographic criteria for enrollment included at least 75% diameter stenosis, according to the estimate of two investigatior ; a lesion that was 20mm or more in lenght and a vessel diameter of at least 2.5mm. Bail-out procedure was performed in the case of abrupt closure or threatened closure, defined as a dissection and over 50% residual stenosis of the artery. RESULTS: The coronary Less Shortening Wallstents were successfully implanted in the 21 diffuse coronary lesions(more than 20mm in length) of the 20 patients(pts), including 7 pts of acute myocardial infarction, 11 pts of unstable angina, and 2 pts of stable angina. Angiographic results after Less Shortening Wallstent were 3.0+/-0.3mm in minimal luminal diameter(MLD), 6.7+/-10.8% diameter stenosis(DS) comparing with pre-stent implantation MLD and DS, respectively, 0.3+/-0.4mm and 89.9+/-8.4%. During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The peristent spasms were observed in 11 among 21 lesions, although long term significance of peristent spasm is not defined. The relative risk for peristent spasm were 10 times higher when larger stents(expanded stent diameter/reference artery diameter>1.7) were implanted. There was no peristent spasm when stents of which expanded stent diameter 1.4 times smaller than reference artery size ware used. CONCLUSION: The results of this introductory study suggest that new Less Shortening Wallstent may reduce the requirement of multiple stent in the long lesion and a lower rate of thrombotic occusion in comparison to its prototype. Further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease* ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Myocardial Infarction ; Phenobarbital ; Research Personnel ; Seoul ; Spasm ; Stents ; Thrombosis ; Transplants ; Veins

PURPOSE: Diffusion-weighted magnetic resonance imaging (DWI) has been known to visualize hyperacute ischemic stroke. And it takes only a few minutes to do. Moreover only a small amount of time and little cost is required to add T2-weighted imaging (T2WI) to DWI. The purpose of this study is to determine the usefulness of T2WI in addition to DWI as a primary imaging modality for patients with suspected ischemic stroke. METHODS: DWI plus T2WI was performed from January to May 2001 on the patients with suspected ischemic stroke. Two emergency physicians reviewed the films and medical records. The sensitivity and the specificity of DWI and T2WI for acute ischemic stroke were calculated. The agreement between DWI and T2WI was calculated using kappa statistics. RESULTS: A total of 241 patients were enrolled. Acute ischemic stroke was confirmed in 86 (35.7%) patients. The sensitivity and the specificity of DWI for acute ischemic stroke were 94.2% and 98.7%, and those for T2WI were 60.5% and 94.2%, respectively. The kappa value was 0.721 (p<0.01). Among the 86 acute ischemic stroke patients, the number of cases who presented less than 6 hours after symptom onset was significantly lower in the T2WI positive group (31% vs. 68.7%, p<0.05). CONCLUSION: This study suggests that the addition of T2WI to DWI as a primary imaging modality for acute ischemic stroke has little benefit compared to DWI alone, especially, when the symptom duration has been less than 6 hours.
Emergencies ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Sensitivity and Specificity ; Stroke*

BACKGROUND AND OBJECTIVE: The long-term effects of beta-irradiation on intimal hyperplasia (IH) within the stented segment and vessel, and the lumen dimensions of non-stented adjacent segments, have not been sufficiently evaluated in patients with ISR. The long-term (24 months) effects of beta-irradiation ((188)Re-MAG3-filled balloon) were evaluated using intravascular ultrasound (IVUS) in patients with in-stent restenosis (ISR). SUCJECTS AND METHODS: A two-year follow-up IVUS was performed in 30 patients with patent ISR segments at the 6-monthly follow-up angiography. Serial IVUS images were acquired at 5 equidistant intra-stent sites and 3 different reference segment sites (1, 2 and 4 mm from stent margin). RESULTS: The mean intra-stent IH area and IH burden significantly increased between 6 and 24 months-from 2.1+/-1.1 to 2.6+/-1.4 mm2 (p<0.001) and from 26+/-10 to 33+/-14% (p<0.001), respectively. There were significant decreases in the mean external elastic membrane (from 10.1+/-3.9 to 9.7+/-3.9 mm2, p=0.015) and lumen area (from 5.6+/-2.3 to 5.1+/-2.3mm2, p=0.021) within the distal reference segments between 6 and 24 months. Target lesion revascularization (TLR) was performed between 6 and 24 months in 6 patients (20%) following the beta-irradiation therapy. There were no significant differences between the TLR and non-TLR groups, with the exception of a smaller minimum lumen CSA at 24 months in the TLR group. CONCLUSION: Because of a small amount of late loss between 6 and 24 months, most irradiated ISR vessel segments remained stable for up to 2 years. However, quantitative evidence of late catch-up was evident in most patients and was significantly associated with 24-month TLR in some patients with a smaller minimum lumen area.
Angiography ; Brachytherapy* ; Follow-Up Studies ; Humans ; Hyperplasia ; Membranes ; Stents ; Ultrasonography*

No abstract available.

PURPOSE: We estimated scattered radiation doses to the patients and medical practitioneer and revealed risk factors associated with increasing radiation doses during extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: At first, we measured radiation doses 2 times using thermoluminescence dosimeter to simulative patients and medical practitioneer without any shield during 10 minutes of ESWL and determined mean radiation dose/minute. From June to August 2007 at our institution, we prospectively measured radiation exposured time during respective ESWL for treatment of urinary stones. Thereafter, we calculated practical radiation doses to patients and medical practitioneer from respective mean radiation dose/minute. We also analyzed which factors were associated with increasing radiation doses. RESULTS: A total of 50 ESWL were analyzed from 38 patients. Mean radiation dose/minute to simulative patients and medical practitioneer was 16.20, 0.006mSv respectively. At 1 time ESWL, median radiation exposured time was 360 seconds(130-980), therefore, median radiation dose to patients and medical practitioneer was calculated as 97.20mSv(35.10-264.60), and 0.04mSv(0.01-0.08) respectively. Larger stone size had a correlation with increasing radiation dose and additional pain control group had higher radiation dose than otherwise. CONCLUSIONS: During ESWL, patients were relatively exposed to high radiation which were roughly corresponded to that of 3 times of computed tomography. But the radiation dose to medical practitioneer was insignificant consider international guideline. Medical practitioneer should be aware of radiation hazard and try to minimize radiation dose to the patients at the time of ESWL.
Humans ; Lithotripsy ; Prospective Studies ; Risk Factors ; Shock ; Urinary Calculi

PURPOSE: We investigated the effects of obesity on prostate volume (PV) and lower urinary tract symptoms (LUTS) in Korean men. MATERIALS AND METHODS: From December 2007 to 2009, a total of 10,383 ostensibly healthy Korean men aged > or =50 years visited our health promotion center for a routine check-up. Among them, 872 men who wanted a prostate evaluation were enrolled in this study. All men underwent detailed clinical evaluations with the International Prostate Symptom Score (IPSS) questionnaire. Anthropometric measurements, including height, weight, and waist and hip circumferences, were determined. A blood sample was obtained for serum prostate-specific antigen (PSA) measurement. Thereafter, a digital rectal examination and transrectal ultrasound were performed. RESULTS: In total, 465 men with moderate to severe LUTS (IPSS> or =8 points) were included in this prospective study. The participants' mean age was 57.2 years. Multivariate analysis demonstrated that only waist circumference was a significant factor in predicting PV besides age and serum PSA. The univariate analysis showed no statistically significant relations between any of the obesity-related parameters and LUTS. The PV was also not correlated with LUTS. CONCLUSIONS: Central obesity is the more important predictor of PV than overall obesity. There are no significant relations between obesity-related parameters and LUTS.
Aged ; Digital Rectal Examination ; Health Promotion ; Hip ; Humans ; Lower Urinary Tract Symptoms ; Male ; Multivariate Analysis ; Obesity ; Obesity, Abdominal ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Waist Circumference

Hypertensive encephalopathy is a medical emergency that is usually presented with manifestating headache, nausea, and visual disturbance. The disease predominantly involves the parieto-occipital white matter. Although cerebellar lesion accompanying hydrocephalus has been occasionally described in the literature, medical management has been sufficient for relieving the posterior fossa hypertension. In the present case, we report a patient who was diagnosed with primary hypertensive cerebellar encephalopathy refractory to medical management and who was successfully treated by surgical decompression of the posterior fossa. A pathologic microscopic inspection of the tissue specimen confirmed hypertensive vascular change.
Decompression* ; Decompression, Surgical ; Emergencies ; Headache ; Humans ; Hydrocephalus ; Hypertension ; Hypertensive Encephalopathy ; Nausea

OBJECTIVES: This study was carried out to investigate the clinical availability of topographic auditory event related potential P300 as a biological marker in children with attention deficit hyperactivity disorder(ADHD). METHODS: The subjects were composed of children with ADHD(n=22:16 boys, 6 girl s:mean age=89.8+/-17.1months) and normal controls(n=20:12 boys, 8 girls:mean age=90.6+/-16.8months). Topographic auditory event related potential was measured by "oddball paradigm", and the latencies and amplitudes of P300 of both groups were determined by Global Field Power Measurement. After 8 weeks treatment with methylphenidate, P300 of ADHD children were also measured. RESULTS: Both P300 latency and amplitude were not different between ADHD children after treatment and normal controls, but significantly different between ADHD children before treatment and normal controls, and between before and after treatment of ADHD children. CONCLUSIONS: The results implicate that the latency and amplitude of P300 may be considered as state markers of ADHD.
Attention Deficit Disorder with Hyperactivity* ; Biomarkers ; Child* ; Evoked Potentials* ; Female ; Humans ; Methylphenidate