PURPOSE: Laparoscopic Burch colposuspension (LBC) is a feasible surgical procedure for stress urinary incontinence (SUI). Initially, transperitoneal laparoscopic Burch (TLBC) operation was performed, but lately, extraperitoneal laparoscopic Burch colposus pension (ELBC) has been developed as a minimally invasive procedure. The aim of this study is to compare the safety and efficacy of TLBC versus the ELBC in treating the women with SUI. MATERIALS AND METHODS: We retrospectively compared 13 cases TLBC with 30 cases ELBC performed between April 1995 and September 1998. Parameters of evaluation included operation time, length of postoperative hospital stay, postoperative catheter ization days, complications, and cure rate. RESULTS: There were no statistically significant differences between the two approaches in operation time and postoperative catheterization days. The postoperative hospital stay of ELBC was statistically shorter than that of TLBC. The mean times to follow-up were 51.2 months (TLBC) and 32.3 months (ELBC). At last follow-up, success rate were 11 of 13 (84.6%) of TLBC and 27 of 30 (90%) of ELBC. The postoperative complication rate were 8 of 13 of TLBC and 14 of 30 of ELBC. As results, ELBC and TLBC are considered as effective surgical method for stress urinary incontinence due to hypermobility. CONCLUSIONS: ELBC and TLBC are considered as effective surgical method for stress urinary incontinence due to hypermobility.
Catheterization ; Catheters ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Pensions ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome ; Urinary Incontinence*

PURPOSE: While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, this procedure remains challenging for pheochromocytoma. The purpose of our investigation was to assess the perioperative profiles of laparoscopic adrenalectomy (LA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. MATERIALS AND METHODS: Between January 1997 and October 2005, 31 patients with pheochromocytoma underwent surgical removal, including 15 LA and 16 OA. The LA was performed via a lateral decubitus transperitoneal approach. The mean tumor size was similar in both groups (LA 6.0cm vs. OA 5.7cm). All patients underwent extensive preoperative medical preparation with alpha-blockers. The intraoperative hemodynamic instabilities and perioperative profiles were retrospectively analyzed. RESULTS: No conversion to open surgery was required with either procedure and no mortality was observed. Hypertensive crisis (systolic blood pressure>200mmHg) and severe tachycardia (heart rate>100/min) were more common in the OA group (LA 13.3 and 26.7% vs. OA 56.3 and 62.5%). The mean operating times for both groups were similar (LA 182.0+/-47.0 min vs. OA 183.1+/-66.5 min), but the duration of hospitalization was shorter in the LA group (LA 5.3+/-2.2 days vs. OA 6.8+/-1.0 days). The estimated blood loss was greater in the OA group (LA 103.3+/-44.2ml vs. OA 159.4+/-66.8ml). Intravenous morphine was needed in 56.3% of the OA, but in only 13.3% of the LA group. There were no significant differences in the postoperative complications between the two groups. CONCLUSIONS: The laparoscopic resection of pheochromocytomas can be accomplished safely and effectively. A short hospital stay, with minimal perioperative morbidity and the eradication of endocrinopathy, support the minimally invasive approach for adrenalectomy in patients with pheochromocytoma.
Adrenalectomy* ; Conversion to Open Surgery ; Hemodynamics ; Hospitalization ; Humans ; Laparoscopy ; Length of Stay ; Morphine ; Mortality ; Pheochromocytoma* ; Postoperative Complications ; Retrospective Studies ; Tachycardia

STUDY DESIGN: We classified adult isthmic spondylolisthesis based on the findings of postmyelographic CT scanning. OBJECTIVES: To propose a new classification that could be used as a useful guideline when evaluating the patient with adult isthmic spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Morphologic changes of the spinal canal and its neural contents in the adult patient with isthmic spondylolisthesis and their relations to radiological variables have not been well described in literature. MATERIALS AND METHODS: 32 adult patients with one level isthmic spondylolisthesis underwent myelography followed by CT scanning. Based on these findings, we classified each patient with four morphologic criteria; 1. dural station I or ll by the location of dural sac, 2. non-compression or compression type by the existence of lateral compression of dural sac. 3. root station I or ll by the location of nerve root, 4. hook or smooth type by the shape of spinal canal. Subsequent statistical analyses to assess the relationships between our newly developed classification and clinical variables were tested by SPSS software. RESULTS: Dural station correlated positively with percent slip(rpb=0.39; p=0.026). Patient age was closely related to the lateral compression(rpb=0.54, p<0.01) which consequently decreased transverse diameter of dural sac(rpb=-0.68, p<0.01). Both dural station and lateral compression were important in the prediction of the extent of the dural involvement. Root station of the smooth type correlated positively with percent slip(reb=0.47: p=0.038), while that of the hook type did not. Consequently, nerve root of the hook type entered neural foramen under the pedicle, whereas that of the smooth type entered at various locations depending on the degrees of percent slip. Depth of lateral recess was significantly less in the hook type than in the smooth type(p<0.01). Stretching of the nerve root, produced by posterior migration of the nerve root, was observed only in the smooth type. CONCLUSIONS: We strongly recommend the use of our classification because it is easy to apply and has a high correlation with radiological variables.
Adult* ; Classification* ; Humans ; Myelography* ; Spinal Canal* ; Spondylolisthesis* ; Tomography, X-Ray Computed*

Angiosarcomas are rare tumors that are derived from vascular endothelial cells. They may occur in various sites, including the skin, breast, visceral organs and deep soft tissues. The pleura usually a metastatic site from angiosarcomas. However, thirty one cases of primary pleural angiosarcomas have been reported worldwide. Here, we report a 61-year-old man with a primary angiosarcoma of the pleura with a brief review of the literature.
Breast ; Endothelial Cells ; Hemangiosarcoma* ; Humans ; Middle Aged ; Pleura* ; Skin

Primary heterotopic ossification has been previously noted in abdominal laparotomy scars, but the presence of ectopic bone within the peritoneum is extremely rare and chracterized by new bone formation in a tissue which does not normally undergo ossification. Our patient in a 59-year-old man who underwent operation for acute cholecystitis had formation of heterotopic bone involving mesentery of intestine. The features of various types of ectopic calcification are discussed, and several theories concerning the pathogenesis and treatment of heterotopic ossification are examined.
Cholecystitis, Acute ; Cicatrix ; Humans ; Intestines* ; Laparotomy ; Mesentery* ; Middle Aged ; Ossification, Heterotopic* ; Osteogenesis ; Peritoneum

BACKGROUND: This study was conducted to investigate the pharmacodynamic interaction between rocuronium and cisatracurium using the response surface model, which is not subject to the limitations of traditional isobolographic analysis. METHODS: One hundred and twenty patients were randomly allocated to receive one of the fifteen predefined combinations of rocuronium and cisatracurium. To study single drugs, cisatracurium 0.2, 0.15, or 0.1 mg/kg or rocuronium 0.8, 0.6 or 0.4 mg/kg doses were administered alone. To study the pharmacodynamic interaction, drugs were applied in three types of combination ratio, i.e., half dose of each drug alone, 75% of each single dose of rocuronium and 25% of each single dose of cisatracurium, and vice versa. Train-of-four (TOF) ratio and T1% (first twitch of the TOF presented as percentage compared to the initial T1) were used as pharmacodynamic endpoints, and the Greco and Minto models were used as surface interaction models. RESULTS: The interaction term α of the Greco model for TOF ratio and T1% measurements showed synergism with values of 0.977 and 1.12, respectively. Application of the Minto model resulted in U₅₀ (θ) values (normalized unit of concentration that produces 50% of the maximal effect in the 0 <θ< 1 region) less than 1 for both TOF ratio and T1% measurements, indicating that rocuronium and cisatracurium exhibit synergism. CONCLUSIONS: Response surface modeling of the interaction between rocuronium and cisatracurium, based on considerations of their effects on muscle relaxation as measured by TOF ratio and T1%, indicated that the two drugs show considerable synergism.
Drug Interactions ; Humans ; Muscle Relaxation ; Pharmacology

Cystic mesothelioma of the peritoneum is a very rare tumor which has a clinically and histologically benign nature. It occurs predominantly in young to middle-ged women and tends to recur locally. It affects chiefly the pelvic peritoneum-articularly the cul-e-ac, uterus, and rectum. We report a case of cystic mesothelioma of the visceral peritoneum which was located anterior to the ascending colon. A 54-ear-ld female patient visited our hospital with a palpable tender mass in the right flank. A computed tomographic scan of the abdomen showed a multicystic mass with an enhancing wall and septum in front of the ascending colon. The patient underwent a right hemicolectomy, and the mass was completely removed. Grossly, the tumor consisted of a multilocular cyst containing clear, serous, or gelatinous fluid and partially solid areas. Microscopically, the solid areas were composed of fibrous tissue, and the lining cells varied from flattened to cuboidal cells with a strong positive reactivity for cytokeratin and mild positive reactivity for epithelial membrane antigen on immunohistochemical staining. These findings suggest that the tumor was mesothelial in origin.
Abdomen ; Colon* ; Colon, Ascending ; Female ; Gelatin ; Humans ; Keratins ; Mesothelioma, Cystic* ; Mucin-1 ; Peritoneal Neoplasms ; Peritoneum ; Rectum ; Uterus

Popliteal artery entrapment syndrome, capable of causing intermittent claudication or even critical ischemia of the lower leg, is a rare disease that usually affects young men. This syndrome arises due to an abnormally medially displaced popliteal artery which has been entrapped and/or occluded by the medial head of the gastrocnemius muscle, especially in knee hyperextension posture. This report summarizes our experience with popliteal entrapment syndrome in 6 limbs of 5 patients treated during a 3-year period. Popliteal entrapment syndrome is more prevalent than previously appreciated. On the basis of our experience, early surgical intervention is recommended in all cases of entrapment at the time of diagnosis to avoid occlusion as a result of continued arterial wall degeneration.
Diagnosis ; Extremities ; Head ; Humans ; Intermittent Claudication ; Ischemia ; Knee ; Leg ; Male ; Muscle, Skeletal ; Popliteal Artery ; Posture ; Rare Diseases

BACKGROUND: The advantages of addition of epinephrine to local anesthetics during caudal epidural anesthesia are core intense block, prolonged duration of anesthesia and reduction of systemic toxic effect of local anesthetics. The currently recommended concentration of epinephrine is 1 : 200,000, but absorbed epinephrines cause unwanted hemodynamic changes, so we attempted to ascertain the minimum effective concentrations of epinephrine during caudal epidural anesthesia. METHODS: Ninty patients classified ASA physical status I or II scheduled for perianal surgery were studied. These patients were divided into four groups who received 20 ml of 2% lidocaine with epinephrine concentrations of 1 : 100,000, 1 : 200,000, 1 : 400,000 or 1 : 800,000 respectively. Before and during anesthesia, patients' mean arterial pressure (MAP) and heart rate (HR) were measured. Caudal anesthesia was performed with patients in the jack-knife position. A 3 ml test dose was administered initially and then the remaining local anesthetics were injected slowly. The onset of analgesia, duration of analgesia, and other complications were observed. RESULTS: The onset of analgesia was slowest in the 1 : 800,000 group. The duration of analgesia was longest in the 1 : 100,000 group. There were no significant difference in MAP changes, but HR increased significantly in the 1 : 100,000 group compared to the 1 : 200,00 group. There were no systemic toxic symptoms for local anesthetics except that 1 patient, who was in the 1 : 100,000 group, had symptoms of palpitation and headache, considered to be the unwanted pharmacologic effects of epinephrine. CONCLUSION: We concluded that the 1 : 400,000 epinephrine concentration can be used during caudal epidural anesthesia.
Analgesia ; Anesthesia ; Anesthesia, Caudal ; Anesthesia, Epidural* ; Anesthetics, Local ; Arterial Pressure ; Epinephrine* ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Lidocaine

PURPOSE: Aortoiliac occlusve diseases are common disease of chronic artherosclerosis in patients in lower extremities. We compared the operative results of anatomic reconstruction with those of an extraanatomic bypass to evaluate the true benefit of one over other procedure. METHOD: 115 patients who underwent surgery from January 1995 to May 2001 were retorspectively reviewed. The patients were classified in two group: a direct anatomic reconstruction group and an extraanatomic bypass group. Operative risk were analyzed by the scoring system recommended by the Subcommittee on Reporting Standards for Lower Extremity Ischemia of International Society for Cardiovascular Surgery(ISCVS). Risk factor, graft patency were analyzed between two group. RESULT: Graft patiency was better in anatomic reconstruction but it was not statistically significant. The important risk factors in deciding the extraanatomic bypass were age and degree of the organ injury, especially heart disease. CONCLUSION: Preoperative evaluation of the risk factors was important in decision making but statistically not significant. Patency of the deep femoral artery was sufficient for runoff and extensive profundaplasty prevented the femorodistal bypass.
Decision Making ; Femoral Artery ; Heart Diseases ; Humans ; Ischemia ; Lower Extremity ; Risk Factors ; Transplants