BACKGROUND: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. METHODS: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg + lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. RESULTS: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of 2.4 +/- 2.1 points, which was lower, with statistical significance, than the VAS score of group 2, which was 4.4 +/- 3.1 points (p<0.001). CONCLUSIONS: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
Bursitis* ; Follow-Up Studies ; Humans ; Joints ; Lidocaine ; Motion Therapy, Continuous Passive ; Prospective Studies ; Range of Motion, Articular ; Rehabilitation ; Shoulder ; Visual Analog Scale

Axial displacement of an implant-supported prosthesis is frequently reported in clinical and laboratory studies. However, limited information is available about the behavior of the axial displacement of implant-supported prostheses functioning in intraoral situations. The present case report evaluated the three-dimensional displacement of posterior single implant-supported prostheses in 2different patients. Internal connection type implants were placed, and screw and cement-retained prosthesis (SCRP) type prosthesis were delivered after an appropriate healing period. Intraoral digital scans were performed using an intraoral scanner (Cerec Omnicam, Dentsply Sirona, USA) on the day of crown delivery and one week, one month, and one year after delivery. The amount of 3-dimensional displacement of the prosthesis was evaluated by using a digital inspection software (Geomagic Control X, 3D systems, USA). The axial displacement of implant-supported prosthesis occurred in both patients. Furthermore, the amount of displacement increased over time.

PURPOSE: We report our experience using flexible ureteroscopy in diagnosing and treating upper urinary tract diseases. MATERIALS AND METHODS: Fifty six patients (male 35; female 21) who underwent flexible ureteroscopy for diagnostic purposes (n=24) or treatment (n=32) of upper urinary tract diseases from January 2000 to November 2001 were enrolled in this study. The primary indications for the ureteroscopy included stones (32), filling defects (10), stricture (8) and hematuria (6). A 7.5Fr flexible ureteroscope was used for observation and either an electrohydraulic lithotriptor (EHL) or Ho: YAG laser were used to remove the stones. RESULTS: The ureteroscopic procedures were performed under local (n=46) or general anesthesia (n=10). As a diagnostic procedure (n=24), clear underlying causes were found in 19 patients. As therapeutic purposes, the flexible ureteroscopic procedures were applied to 32 patients with urolithiasis (renal calyx, 14; renal pelvis, 6; proximal ureter, 7; and middle ureter, 5). Among them, an advancement in flexible ureteroscopy was possible in 24 patients. Of these, the stones in 20 (83%) had completely fragmented by the EHL or Ho: YAG laser lithotriptor without further treatment. In 4 patients (17%) who had residual stones, the adjuvant procedures including extracorporeal shock wave lithotripsy or a subsequent endoscopic procedure were performed for successful fragmentation. CONCLUSIONS: The flexible ureteroscopic procedure is one of the more effective and minimally traumatic diagnostic and therapeutic modalities for upper urinary tract diseases.
Anesthesia, General ; Constriction, Pathologic ; Female ; Hematuria ; Humans ; Kidney Pelvis ; Lasers, Solid-State ; Lithotripsy ; Shock ; Ureter ; Ureteroscopes ; Ureteroscopy ; Urinary Tract* ; Urolithiasis ; Urologic Diseases*

PURPOSE: We performed laparoendoscopic single-site (LESS) partial nephrectomy in a porcine model with the objectives of overcoming the technical challenges of this surgery and exploring its feasibility. MATERIALS AND METHODS: Six partial nephrectomies were performed on a pig aged 5 months, three cases on each kidney, by four surgeons: two urologists with much experience in laparoscopic surgery (E1, E2) and two less-experienced urologists (B1, B2). While under general anesthesia, the swine was placed in a lateral flank position. Umbilical placement of an Octoport was done with a 2.5 cm incision. After dissection of the renal hilum and Gerota's fascia, a bulldog clamp was applied on the renal artery and parenchymal resection was done. Renorrhaphy was then performed with interrupted sutures with the use of a sliding knot technique. RESULTS: All six partial nephrectomies were performed successfully after repair of the vascular and collecting system at the resection margin and renorrhaphy without the need to introduce any additional ports. There were no noticeable intra- or postoperative complications. The mean warm ischemic time was 42 minutes (range, 30-60 minutes). The shortest warm ischemic time, 30 minutes, was achieved by using the early unclamping technique during renorrhaphy. The longest warm ischemic time was 60 minutes. The average number of renorrhaphy stitches was 3.2 (range, 2-5). CONCLUSIONS: LESS partial nephrectomy was successfully performed in a porcine model but resulted in a longer ischemic time than that of conventional laparoscopic surgeries. Therefore, further laboratory disciplinary efforts are needed to decrease the warm ischemic time and to improve this surgical technique.
Aged ; Anesthesia, General ; Fascia ; Humans ; Kidney ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy ; Postoperative Complications ; Renal Artery ; Sutures ; Swine ; Warm Ischemia

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney Calculi/pathology/radiography/*surgery ; Laparoscopy/methods ; Male ; Middle Aged ; Nephrostomy, Percutaneous/*methods ; Retrospective Studies ; Treatment Outcome ; Ureteral Calculi/pathology/radiography/*surgery ; Young Adult

Tyrosine kinases have been implicated in vascular smooth muscle cell proliferation and contraction. The involvement of tyrosine kinases in 5-hydroxytryptamine (5-HT)-induced contractile response of the isolated aorta was examined in two-kidney, one clip (2K1C) hypertensive rats, 2141C hypertension was made by constricting the left renal artery and age-matched control rat received sham treatment. Thoracic aortic rings denuded of endotheliurn were mounted in tissue bath, for measurement of isometric contractile force. The putative tyrosine kinase inhibitor, genistein, shifted concentration-response curves to 5-HT toward the right in control rats The isometric force generation induced by 5-HT was also inhibited by genistein in aortic rings from 2K1C: hypertensivc rats, however genistein did not affect on the high concentration of 5-HT in hypertensive rat ;. Genistein-induced relaxations were more attenuated in aortae from hypertensive rats than those from control Genistein had no effect on contrartcion elicited by the direct protein kinase C activator, phorbol 12, 13 dibutyrate (PDBu) either in 2KlC hypertensive or in control Group. These findings indicate that genistein-sensitive tyrosine kinases paeticipate in 5-HT-induced contraction of rat aortic smooth muscle, of which role is apparent in 2K1C: hypertension.
Animals ; Aorta ; Baths ; Cell Proliferation ; Genistein ; Hypertension ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Phosphotransferases* ; Placebos ; Protein Kinase C ; Protein-Tyrosine Kinases ; Rats* ; Relaxation ; Renal Artery ; Serotonin ; Tyrosine*

BACKGROUND: Calcium plays a key role in vascular contraction and regulates receptor sensitivity to certain neurotransmitters. Calcium channel blockers are useful in the treatment of both clinical and experimental hypertension. The present study was designed to examine whether there is an alteration of the activity of calcium channels in association with the development of hypertension. METHODS: Deoxycorticosterone acetate(DOCA)-salt hypertension was made by subcutaneous implantation of DOCA(200mg/kg)strip plus saline drinking(1%) and 2-kidney, 1 clip(2KIC)hypertension by clipping the left renal artery with a silver clip(internal gap of 0.2mm). They were used 4 weeks later. Age-matched normal rats served as a control. Mean arterial pressure(MAP) and heart rate(HR) were continuously recorded from the right femoral artery. The drugs were administered intravenously. RESULTS: Vehicle alone was without effect on MAP or HR. In normotensive rats, nifedipine infusion(5 and 10ug/kg/min)caused a dose-dependent decrease in MAP without significant changes in HR, while Bay k 8644(Bay K, 5 and 10 ug/kg/min) increased MAP transiently. Both the depressor response to nifedipine and the pressor response to Bay k were more marked in DOCA-salt hypetensive rats than in normotensive rats. The maximal changes in MAP indced by nifedipine(5 and 50 ug/kg) or Bay K(5 and 50 ug/kg) were also enhanced in 2KIC hypertensive rats as compared with control rats. CONCLUSION: These results indicate that calcium channel inhibitors and activators can affect on the regulation of blood pressure in an opposite fashion. It is also suggested that the activity of calcium channels might be altered in the developement of experimental hypertension.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester* ; Animals ; Bays* ; Blood Pressure ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Desoxycorticosterone ; Femoral Artery ; Heart ; Hypertension ; Neurotransmitter Agents ; Nifedipine* ; Rats* ; Renal Artery ; Silver

Acute pancreatitis is occasionally caused by endoscopic treatments or radiologic interventions of the pancreatobiliary tract. However, no reports indicate that acute pancreatitis resulted from the insertion of a percutaneous transhepatic cholangiography (PTCS) catheter in the common bile duct (CBD). A 65-year-old woman visited our hospital with acute cholangitis due to about 3 cm-sized CBD stones. We planned to perform PTCS because of the large stones and altered anatomy (Billroth II). The patient was discharged after tract dilatation and insertion of a PTCS catheter in the distal CBD without manipulations of Ampulla of Vater (AOV). However, she visited the emergency room due to acute pancreatitis at three days after discharge. Computed tomography revealed upstream dilation of the main pancreatic duct following the compressed area of a large stone and catheter. Thus, we report a case that presented with acute pancreatitis induced by insertion of a PTCS catheter without manipulations of AOV.
Aged ; Ampulla of Vater ; Catheters* ; Cholangiography ; Cholangitis ; Common Bile Duct* ; Dilatation ; Emergency Service, Hospital ; Female ; Humans ; Pancreatic Ducts* ; Pancreatitis*

PURPOSE: A transurethral incision of the ureterocele offers several advantages. This study investigated the clinical efficacy of a transurethral incision in a ureterocele. MATERIALS AND METHODS: Twenty two children, 5 boys and 17 girls, received a transurethral incision as the primary treatment for their ureteroceles. Of the children, 12 had intravesical and 10 had ectopic ureteroceles. The initial presentations were abnormal findings in prenatal ultrasonography in 9 cases, fever in 7, UTI in 2, and others in 4. The median patient's age at the transurethral incision of the ureterocele was 3.3 months (range 0.2month to 4.1years). A cold knife or a 3-french Bugbee electrode was used. Their clinical courses were evaluated with a radiological and laboratory examinations. RESULTS: The transurethral incision resulted in the decompression of the ureterocele in 19 (86%), reflux to the upper moiety in 15 (68%), UTI in 2 (9%) and incontinence in 1 (4.5%). Eighteen patients (82%), 8 patients with an intravesical ureterocele and all 10 patients with an ectopic ureterocele, required secondary operations. A transurethral incision proved to be a definitive treatment for 4 (33.3%) patients with an intravesical ureterocele. Secondary operations were performed at 7.3 7.1months postoperatively. CONCLUSIONS: An endoscopic incision may be advocated as a definitive treatment modality for some patients with an intravesical ureterocele. Furthermore, by safely delaying reconstructive surgery, the majority of children can benefit from an endoscopic incision of the ureterocele.
Child ; Decompression ; Electrodes ; Female ; Fever ; Humans ; Ultrasonography, Prenatal ; Ureterocele*