No abstract available.
Intestine, Small ; Ischemia ; Urokinase-Type Plasminogen Activator

PURPOSE: To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. MATERIALS AND METHODS: A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (<48 hours, n=153) and dESWL (> or =48 hours, n=126). Success was defined as stone-free status as shown on a plain radiograph within 1 month of the first session. RESULTS: For all patients, the success rate in the eESWL group was significantly higher than that in the dESWL group. The eESWL group required significantly fewer ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones <10 mm, all treatment outcomes in the former group were superior to those in the latter group, but not for 38 patients with stones sized 10 to 20 mm. The superiority of eESWL over dESWL in the treatment outcomes was more pronounced for proximal ureteral stones than for mid-to-distal ureteral stones. Post-ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success. CONCLUSIONS: Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance.
Colic ; Humans ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Shock ; Ureter ; Ureteral Calculi

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.
Ampulla of Vater ; Biliary Tract ; Choledochal Cyst ; Duodenum ; Endoscopy, Digestive System ; Endosonography ; Enteritis ; Epithelium ; Female ; Humans ; Ileum ; Intestinal Diseases ; Intestine, Small ; Jejunum ; Rare Diseases ; SNARE Proteins

Vesicoureteric reflux into the transplanted kidney has been described, but in general it has been disregarded and is not mentioned as a complication in recent reviews. But it may be harmful to the renal function in the long-term and has high incidence of symptomatic pyelonephritis with urinary tract infection in other studies. We studied prospectively 37 patients, who received living renal transplantation without complete antireflux surgery, out of 45 patients during the period from June 1991 to September 1992. Voiding cystourethrogram and urine culture were obtained all least once in 37 of 45 patients (82.2%) and serum BUN/creatinine and urinalysis were checked following surgery, weekly. These patients did not demonstrate an increased incidence of reflux, urinary tract infection or abnormalities of renal function. We conclude that a simple direct implantation of a normal ureter into a normal bladder is safe and should be considered the procedure of choice in renal transplantation and recommend that all functioning transplants be studied at yearly intervals with an IVP and VCUG to determine the true incidence of urologic complications.
Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Prospective Studies ; Pyelonephritis ; Ureter ; Urinalysis ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract*

Parovarian cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, treatment and prognosis of these tumors. Parovarian borderline malignancy mostly occur in young women, main complaints are abdominal enlargement and pelvic pain. we experienced one case of parovarian borderline malignancy and report this case with a brief review of literature.
Echinococcosis ; Female ; Humans ; Parovarian Cyst ; Pelvic Pain ; Prognosis

BACKGROUND: Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS: This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS: According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
Critical Illness ; Enteral Nutrition ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Lymphocyte Count ; Malnutrition ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prevalence ; Prognosis ; Respiration, Artificial ; Retrospective Studies

PURPOSE: To investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC. METHODS: A total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society. RESULTS: The mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR. CONCLUSIONS: Our data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors.
Catheterization ; Catheters ; Catheters, Indwelling ; Female ; Humans ; Logistic Models ; Male ; Postoperative Care ; Prone Position ; Retrospective Studies ; Risk Factors ; Urinary Retention ; Urination ; Urology

BACKGROUND: Understanding lung sound is important physical examination of chest. We studied to identify the state of the understanding, the education and the self-learning experience for lung sound's interpretation during the residentship training period. METHODS: Data were collected from 45 family medicine residents who had trained in Daegu and Gyeongbuk from April 1st to May 31th 2008. Residents completed self-administered questionnaire about the education and the self-learning experience for lung sound's interpretation and had been estimated the understanding of lung sound by using the audio file of five lung sounds. RESULTS: The median score (inter-quartile range, IQR) of lung sound's interpretation was 2 (1, 3) between 0 and 5 range. The number of residents who were educated for the interpretation of lung sounds during the training period were 10 (22.2%). Twenty-four (53.3%) had the self-learning experience for lung sounds. CONCLUSION: The understanding for lung sounds of family medicine residents in Daegu, Gyeungbuk was not high and the majority of residents were not educated the interpretation of lung sounds during the training period. Directors of family medicine should consider to make the regular education program for interpretation of lung sound during the training period.
Comprehension ; Humans ; Lung ; Physical Examination ; Respiratory Sounds ; Thorax ; Surveys and Questionnaires

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.
Abdominal Pain ; Appendectomy ; Appendicitis* ; Appendix ; Cecum ; Delayed Diagnosis ; Humans ; Inflammation ; Middle Aged

Signet-ring cell carcinoma of the ampulla of Vater is so rare that only 16 cases have been reported. Here we report a case of a 47-year-old man with signet-ring cell carcinoma in the ampulla of Vater. The patient was hospitalized for right upper quadrant abdominal pain and jaundice which had developed 10 days prior. Computed tomography (CT) and ultrasonography (US) revealed dilatation of the common bile duct and the intrahepatic bile duct. On duodenoscopy, a bulging mass with an irregular margin in the major papilla was noted. Histologic findings showed a signet-ring cell carcinoma. Surgical resection was not done because lymph node metastasis was noted during the operation. Hence, conservative treatment including chemotherapy and bile drainage was done.
Abdominal Pain ; Ampulla of Vater ; Bile ; Bile Ducts, Intrahepatic ; Common Bile Duct ; Dilatation ; Drainage ; Duodenoscopy ; Humans ; Jaundice ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis