PURPOSE: In 2004, a joint effort was undertaken between Dong-a University Hospital, Busan, Korea and Singapore General Hospital, Singapore, to promote laparoscopic radical prostatectomy (LRP) to yet another level by enhancing the human performance using a master-slave manipulator, the da VinciTM System. Herein, we report our initial experience of employing robotic telepresent technology to perform a LRP. MATERIALS AND METHODS: A 6-port modified transperitoneal approach was used. The da VinciTM System (Intuitive Surgical, Inc., California) consists of three components: a surgeon console, a robotic manipulator and a vision cart. Cable-driven mechanical "Endowrist" instruments are capable of delivering a complete range of motion at the instrument tips, allowing a total of 6 degrees of freedom. RESULTS: Five robotic-assisted LRP were performed. The mean patient age PSA and Gleason score were 65 years, 7.8ng/ml and 6.2, respectively. Overall, the system functioned well, without significant intraoperative errors. The mean operative time was 185 minutes in 2 patients with preservation of the neurovascular bundle, and 154 minutes in 2 patients with non-nerve sparing. In one patient, a bilateral pelvic lymphadenectomy was performed, with an operative time of 195 minutes. The mean blood loss and hospital stay were 245cc and 2.5 days, respectively. All patients maintained continence at 3 month follow-up. CONCLUSIONS: Intuitive hand-eye coordination, superb depth of perception and "Endowrist" instruments allowed tissue handling and suturing quite feasible during the LRP. Continuous effort is underway to further the surgical experience and advances in robotic technology. We believe robotic surgical systems will greatly facilitate and improve the LRP procedure.
Busan ; Follow-Up Studies ; Freedom ; Hospitals, General ; Humans ; Joints ; Korea ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Neoplasm Grading ; Operative Time ; Prostatectomy* ; Range of Motion, Articular ; Robotics ; Singapore

Congenital unilateral agenesis of pulmonary artery is a rare anomaly and it usually occurs in association with other cardiac anomaly such as tetralogy of Fallot. Since most patients affected by this defect without associated congenital cardiac anomaly or pulmonary infection are asymptomatic, the clinical diagnosis of this anomaly is first recognized by a characteristic pattern in chest roentgenogram taken as a routine checking; the findings on chest film sonsists of cardiac and mediastinal displacement, absence of the pulmonary arterial shadow, smaller hemithorax, and elevationof the hemidiaphragm, all on the affected side. We experienced right pulmonary artery agenesis in a 48 year-old male, who complained of massive hemoptysis, and it was diagnosed by digital subtraction pulmonary arteriogram and perfusin scan, and treated by right middle and lower lobe bi-lobectomy, and we report this case with the review of relevant literatures.
Diagnosis ; Hemoptysis ; Humans ; Male ; Middle Aged ; Pulmonary Artery* ; Tetralogy of Fallot ; Thorax

We present a case of coronary artery fistula originating from the proximal left anterior descending artery draining into the main pulmonary artery,which was associated with atrial septal defect.The patient was a 56 year old male who was admitted for exertional dyspnea and abdominal distension.Echocardiogram and selective coronary arteriogram revealed a atrial septal defect and fistulous connection.The patient underwent surgery under the cardiopulmonary bypass with fibrillating heart.The pericardial patch closure of atrial septal defect and internal obliteration of the fistula termination site in the main pulmonary artery were performed.Postoperative hospital courses were uneventful without any specific complication and the patient was discharged without problem.
Arteries ; Cardiopulmonary Bypass ; Coronary Vessels* ; Dyspnea ; Fistula* ; Heart Septal Defects, Atrial* ; Humans ; Male ; Middle Aged ; Pulmonary Artery

Glomus tumors, also called paragangliomas, originate from nonchromaffin cells. They are slow-growing benign lesions and represent the most common primary neoplasm of the middle ear. It is worth mentioning that the most common symptoms are pulsating tinnitus and hearing loss. Imaging studies (CT and MRI) are necessary for diagnosis. Although most of cases are limited to the middle ear, this article reports a glomus tumor presented with a polypoid mass in the external auditory canal.
Ear Canal ; Ear, Middle ; Glomus Tumor ; Hearing Loss ; Paraganglioma ; Tinnitus

PURPOSE: Cefodizime is a new third-generation cephalosporin which has a structure and immunomodutation properties similar to cefotaxime. Various studies on cefodizime have demonstrated the direct eradication of bacteria in cooperation with the host defense mechanism, particularly with phagocytosis. We evaluated the effects of cefodizime on the phagocytosis of COS-1 cells transfected with FcgammaRI/gammagamma or FcgammaRIIA cDNA. METHODS: Phagocytosis was measured using the in vitro COS-1 cell modeling system according to Schreiber's method. COS-1 cells, which lack endogenoous Fcgammareceptors but have phagocytic potential, were transfected with either FcgammaRI/gammagammaor FcgammaRIIA cDNA. COS-1 cells, as target cells, were treated with antibiotics for 1 or 24 hours and incubated for 30 min with IgG coated sheep RBCs. Adhered IgG coated sheep RBCs were removed after brief exposure to hypotonic phosphate buffered saline. Phagocytosis index (PI) was calculated as the number of ingested RBCs per 100 phagocytic cells after wright-Giemsa staining. RESULTS: COS-1 cells tranfected with FcgammaR (either FcgammaRI/gammagamma or FcgammaRIIA cDNA) showed the phagocytic activity against IgG coated sheep RBC, while untransfected COS-1 cells did not. After treatment with cefodizime, phagocytic activity of FcgammaRI/gammagammacDNA transfected COS-1 cells was significantly increased, while that of FcgammaRIIA cDNA transfected COS-1 cells did not. Marked enhancement of phagocytosis of COS-1 cells was observed after treatment with cefodizime, but was not observed with ceftriaxone or moxalactam. CONCLUSION: Cefodizime showed marked enhancement of phagocytic activity of FcgammaR transfected COS-1 cells. FcgammaRI seems to play an important role in the enhancement of phagocytosis. Further studies will be required.
Animals ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Ceftriaxone ; COS Cells ; DNA, Complementary ; Immunoglobulin G ; Moxalactam ; Phagocytes ; Phagocytosis* ; Sheep

From July 1983 to December 1993, total 112 consecutive mitral valve replacement in 107 patients were performed in patient with mitral valvular abnormalites. To estimate the risk factor related to operative death, all patient's perioperative data were reviewed retrospectively. Except 20 patients received concomitant aortic valve replacement and 2 patients had incomplete data, 85 patients were included in this study. Mean age was 37.3+/-13.1 years ranging from 13 to 72 years. Thirty-seven patients were male and fourty-eight patients were female. Mean follow-up durations were 51.1+/-33.8 months ranging from 6 months to 11 years. Patients in this study showed improvement in mean NYHA functional clssification, from 3.02+/-0.73 to 1.78+/-0.55, and also in cardiothoracic ratio, from 0.61+/-0.09 to 0.58+/-0.08 at 6 months follow-up after operation. Operative complications were detected in 23 patients(27.1%) and common postoperative complications were rhythm disturbance in 7 cases, pulmonary complications in 6 cases and low cardiac output syndrome in 6 cases. Early mortality was 10.6% ( n=9 ) and most common cause of death was congestive heart failure due to low cardiac output syndrome. Main cause of our higher operative mortality than other study was that operative mortality in the initial period of our mitral surgery was high (5 operative deaths among 19 mitral valve replacement from July 1983 to December 1985 ). Actuarial survival was 80.8% at 5 years, 71.8% at 11 years including operative deaths. Actuarial freedom from anticoagulant-related bleeding was 85.3% at 5 years, 78.3% at 11 years. 95.1% at 5 years and 88.8% at 11 years among the patient in this study were free from thromboembolism, and 97.5% at 5 years and 75.1% at 11 years were free from reoperation. Preoperative cardiothoracic ratio and patient's age were statistically significant operative risk factors.
Aortic Valve ; Cardiac Output, Low ; Cause of Death ; Female ; Follow-Up Studies ; Freedom ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mitral Valve* ; Mortality ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Risk Factors ; Thromboembolism

PURPOSE: To evaluate the clinical results between interlocking intramedullary nail with fibular fixation and nail only for treating distal tibiofibular diaphyseal fractures. MATERIALS AND METHODS: From March 2003 to September 2006, 19 distal tibiofibular fractures were antegrade nailed after anatomical reduction and fixation of fibular fractures, and another 37 fractures fixed with nails only. Average age of patients was 48.6 years. These two groups were compared by VAS (visual analogue scale)&ankle ROM according to degree of comminution and fracture configuration. The statistical analysis was evaluated by t-test. RESULTS: There was no statistical difference between fibular fixation group and non-fixation group in VAS score according to fracture comminution and configuration (p>0.05). However, compared according to fracture configuration, mean ankle eversion of fibular fixation group in oblique fractures was 18.3 degrees, and that of non-fixation group was 12.5 degrees (p<0.05). In addition, mean ankle plantar flexion, dorsiflexion, inversion and total ankle ROM of fibular fixation group in spiral fractures was 40.0, 20.0, 30.0 and 108.3 degrees of each and that of non-fixation group was 38.3, 18.5, 27.0 and 101.7 degrees (p<0.05). CONCLUSIONS: In oblique and spiral fractures of distal tibiofibular diaphysis, interlocking intramedullary nail with fibular fixation had the advantage in postoperative ankle ROM. So, it can be a worthy method for the treatment of distal tibiofibular diaphyseal fractures.
Animals ; Ankle ; Diaphyses ; Fracture Fixation, Intramedullary ; Humans ; Imidazoles ; Nails ; Nitro Compounds

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
Arteriovenous Fistula ; Central Nervous System Vascular Malformations* ; Humans ; Methods ; Middle Aged ; Radiosurgery ; Tinnitus*

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
Arteriovenous Fistula ; Central Nervous System Vascular Malformations* ; Humans ; Methods ; Middle Aged ; Radiosurgery ; Tinnitus*

PURPOSE: This study was conducted to analyze the efficacy of photoselective vaporization of the prostate (PVP) with the use of a 980 nm diode laser for benign prostatic hyperplasia (BPH) according to postoperative period. MATERIALS AND METHODS: Data were collected from 96 patients who were diagnosed with BPH and who underwent PVP with the 980 nm K2 diode laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean prostate volume was 45.3+/-15.6 g, the mean operative time (lasing time) was 22.9+/-18.3 minutes, the total amount of energy was 126+/-84 kJ, and the Foley catheter maintenance period after PVP was 24.8+/-5.6 hours. At 1 month, significant improvements were noted in IPSS (11.7+/-6.6), QoL score (2.3+/-1.1), Qmax (12.7+/-6.1 ml/sec), and PVR (41.9+/-30.5 ml). After 3 months, all follow-up parameters showed significant improvements that were sustained throughout a period of 6 months after PVP. CONCLUSIONS: PVP using a K2 diode laser is a minimally invasive and effective surgical method for improvement of BPH and is associated with minimal morbidity.
Catheters ; Follow-Up Studies ; Humans ; Lasers, Semiconductor ; Operative Time ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Urodynamics ; Volatilization