PURPOSE: To evaluate the safety and efficacy of the radiologic placement of implantable chest ports under intravenous sedation in pediatric patients with malignancy. MATERIALS AND METHODS: Between October 2001 and June 2002, 20 chest ports were placed in 19 pediatric patients [13 boys and six girls aged 1-11 (mean, 4.7) years] for the purpose of long-term chemotherapy. In three patients, tunneled central venous catheters had been removed because of catheter extraction, infection, and tearing. Under intravenous sedation, the right internal jugular vein was used for access in 19 cases, and the left internal jugular vein in one. Venipucture was performed using a micropuncture needle with real-time ultrasound guidance. A port chamber was created at the infraclavicular fossa, and to prevent catheter kinking, a smooth-angled tunnel was created between the venipuncture site and the subcutaneous pocket. The catheter tip was positioned under fluoroscopy at the junction of the superior vena cava and right atrium. We observed techincal success, complications arouse during and after the procedure, and duration of catheter use. RESULTS: Implantation of the port system was successful in all cases, though slight hematoma, treated with manual compression, occurred at a chamber pocket in one case. In addition, the port system was removed from one patient because of wound infection leading to dehiscence and catheter malpositiong. A new port system was implanted through the left internal jugular vein. The median period during which catheter use was followed up was 118 (range, 18-274) days. CONCLUSION: For long-term chemotherapy in pediatric patients with malignancy, radiologic placement of an implantable chest port under intravenous sedation shows a high technical success rate, with few complications. This method may thus be used instead of surgical port placement.
Catheters ; Central Venous Catheters ; Drug Therapy ; Female ; Fluoroscopy ; Heart Atria ; Hematoma ; Humans ; Jugular Veins ; Needles ; Phlebotomy ; Punctures ; Thorax* ; Ultrasonography ; Vena Cava, Superior ; Wound Infection

BACKGROUND: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. METHODS: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). RESULTS: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. CONCLUSIONS: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.
Elbow ; Follow-Up Studies ; Fracture Fixation* ; Humans ; Humeral Fractures ; Humerus* ; Muscles ; Peripheral Nervous System Diseases ; Traction ; Transplants ; Treatment Outcome

PURPOSE: To determine, when extracorporeal shockwave lithotripsy is contraindicated, the usefulness and safety of percutaneous management in the removal from the upper urinary tract of foreign bodies and calculi, or small remnants of these, retained affer percutaneous nephrolithotomy. MATERIALS AND METHODS: Between January 1996 and May 2001, we attempted to retrieve foreign bodies or calculi from the upper urinary tract of 20 patients, using various percutaneous techniques. There were eleven foreign bodies, namely fragmented nephrostomy catheters (n=2), migrated ureteric stents inaccessible to retrograde ureteroscopic management (n=8), and one metallic radiopaque marker which was separated from the pusher of the internal ureteral stent. Nine urinary tract calculi were present. These ranged in radiographically measured size from 4 to 8 mm in their largest diameter, and were found in the renal pelvis or calyx (n=5) and ureter (n=4). After percutaneous nephrostomy, all procedures involved the use of a 7-F to 14-F sheath, inserted under fluoroscopic guidance. Devices used for the retrieval of these objects include a stone basket retriever, loop snare, grasping forceps, and balloon catheter. RESULTS: In all cases except one, it was possible to retrieve calculi or other items from the upper urinary tract. No surgical procedure was required and no significant complications were encountered in any of the cases during or after the procedures. CONCLUSION: The percutaneous technique can be useful and safe in the management of foreign bodies or calculi present in the upper urinary tract.
Calculi* ; Catheters ; Foreign Bodies* ; Hand Strength ; Humans ; Kidney Pelvis ; Lithotripsy ; Nephrostomy, Percutaneous ; SNARE Proteins ; Stents ; Surgical Instruments ; Ureter ; Urinary Tract*

PURPOSE: To report the effectiveness of Minocin sclerotherapy in the treatment of renal cysts. MATERIALS AND METHODS: We performed minocin sclerotherapy to 19 patients with 21 renal cysts composed of 17 cases of solitary renal cyst and three cases of multiple renal cyst and one case of polycystic kidney comfirmed by ultrasound and CT. After aspiration of cyst fluid, if the amount was less than 50ml, 500mg of minocin was mixed with 3ml of normal saline,if more than 50ml, 1000mg of minocin mixed with 5ml of normal saline were injected, and each case was followed-up over 3 months by ultrasound. RESULTS: Of all 21 renal cysts, 14 cases were followed-up three months after minocin sclerotherapy. In 12 of 14 cases, the size of the cysts decreased by 10% or collapsed completely. Of the remaining two cases, one collapsed after 6 months while the other recurred after 6months. Three cases were followed up after 20 months and only one of them recurred. 19 of all 21 cases(91%) were cured, and two of 21 cases(9%) were recurred. Pain was the only complaint. and four of 10'cases needed analgesics. CONCLUSION: Sclerotherapy with minocin has low recurrence-rate and low complication, and relatively early high cure-rate.
Analgesics ; Cyst Fluid ; Humans ; Minocycline* ; Polycystic Kidney Diseases ; Sclerotherapy* ; Ultrasonography

OBJECTIVE: To determine the feasibility of transcaval transjugular intrahepatic portosystemic shunt (TIPS) in patients with occluded previous TIPS. MATERIALS AND METHODS: Between February 1996 and December 2000 we performed five transcaval TIPS procedures in four patients with recurrent gastric cardiac variceal bleeding. All four had occluded TIPS, which was between the hepatic and portal vein. The interval between initial TIPS placement and revisional procedures with transcaval TIPS varied between three and 31 months; one patient underwent transcaval TIPS twice, with a 31-month interval. After revision of the occluded shunt failed, direct cavoportal puncture at the retrohepatic segment of the IVC was attempted. RESULTS: Transcaval TIPS placement was technically successful in all cases. In three, tractography revealed slight leakage of contrast materials into hepatic subcapsular or subdiaphragmatic pericaval space. There was no evidence of propagation of extravasated contrast materials through the retroperitoneal space or spillage into the peritoneal space. After the tract was dilated by a bare stent, no patient experienced trans-stent bleeding and no serious procedure-related complications occurred. After successful shunt creation, variceal bleeding ceased in all patients. CONCLUSION: Transcaval TIPS placement is an effective and safe alternative treatment in patients with occluded previous TIPS and no hepatic veins suitable for new TIPS.
Esophageal and Gastric Varices/*surgery ; Feasibility Studies ; Gastrointestinal Hemorrhage/*surgery ; Human ; Male ; Middle Age ; Portal Vein/radiography/*surgery ; Portasystemic Shunt, Surgical/*methods ; *Portasystemic Shunt, Transjugular Intrahepatic ; Reoperation ; Stents ; Treatment Failure ; Vascular Patency ; Vena Cava, Inferior/radiography/*surgery

PURPOSE: Smoking reportedly exerts deleterious effects on renal function; however, its effects on histology have not been clarified in patients with IgA nephropathy (IgAN). MATERIALS AND METHODS: Renal histology was evaluated in a cohort of 397 patients diagnosed with IgAN according to smoking status and dose in relation to renal function. RESULTS: Among the study cohort, which was predominantly male (88.5%), 52 patients (13%) were current smokers. These current smokers demonstrated more frequent hypertension and higher serum creatinine levels than non/ex-smokers at the time of diagnosis, which was apparent with increased smoking dose. The percentages of global glomerulosclerosis and arteriolar hyalinosis increased with increased smoking dose, whereas tubulointerstitial fibrosis or arterial intimal thickening did not. Glomerular mesangial alpha-smooth muscle actin expression were similar between current and non/ex-smokers matched for age, gender, hypertension, and histologic severity, although the number of glomerular CD68+ cells was significantly fewer in smokers. Initial serum creatinine level, estimated glomerular filtration rate (eGFR), and global glomerulosclerosis were found to be risk factors of serum creatinine doubling in both smokers and non/ex-smokers by univariate analysis during a mean follow-up of 3.8 years. CONCLUSION: In addition to dose dependent renal functional decline and hypertension, smoking contributes to renal disease progression by eliciting microvascular injury in IgAN patients.
Adult ; Aged ; Case-Control Studies ; Cohort Studies ; Creatinine/blood ; Disease Progression ; Female ; Glomerulonephritis, IGA/blood/*diagnosis/epidemiology ; Humans ; Immunohistochemistry ; Kidney/*pathology ; Kidney Function Tests ; Kidney Glomerulus/*pathology ; Male ; Middle Aged ; Risk Factors ; Smoking/*adverse effects/epidemiology

PURPOSE: The purpose of this study was to determine the characteristics of hypoxic-ischemic encephalopathy (HIE) on diffusion-weighted imaging (DWI) and the role of DWI for the diagnosis of HIE. MATERIALS AND METHODS: Six patients with HIE underwent MRI including DWI. MR examinations were performed within 4 - 32 days (mean, 11.8 days) after hypoxic brain insult. We assessed the distribution of the lesions and compared the DWI and T2, FLAIR images for the subjective conspicuity of the lesions. RESULTS: In all patients, symmetrical hyperintense lesions were demonstrated in the bilateral basal ganglia on T2, FLAIR, and DWI. On ADC map image, the lesions were hypointense in four of six patients and isointense in other two patients. Lesion conspicuity on DWI was higher than on T2 and FLAIR images in four of six patients and similar in other two patients. For the involvement of the cortex and subcortical white matter, in five of six patients, bilateral symmetric hyperintense lesions were seen on T2, FLAIR, and DWI. Lesion conspicuity on DWI was higher than on T2 and FLAIR images in three of them and similar in other two patients. On ADC map image, the lesions showed hypointensity in three of five patients and isointensity in other two patients. For the involvement of the deep cerebral white matter, T2, FLAIR, and DWI showed bilateral symmetric hyperintense lesions in four of six patients. Among them, Lesion conspicuity on DWI was higher than on T2 and FLAIR images in only one patient. CONCLUSION: HIE is characterized by symmetrical hyperintense lesions in the bilateral basal ganglia, cerebral cortex, and white matter on DWI and the lesions are more conspicuously demonstrated on DWI than on T2 and FLAIR images.
Anoxia ; Basal Ganglia ; Brain ; Cerebral Cortex ; Humans ; Hypoxia-Ischemia, Brain