PURPOSE: Caliceal diverticular calculi are mostly asymptomatic. In certain cases they may be associated with chronic or recurrent pain, recurrent urinary tract infections, progressive renal damage and hematur ia. The treatment of symptomatic caliceal diverticular calculi has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy (SWL), percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. Percutaneous techniques are frequently used to address the diverticular stone burden, to fulgurate the diverticular wall, to dilated the diverticular neck and improve drainage. For this reason, we reviewed 33 patients with caliceal diverticular calculi to determine whether they could be treated successfully by percutaneous nephrolithotomy (PCNL) as the initial treatment. MATERIALS AND METHODS: A total of 33 patients with caliceal diverticular calculi underwent PCNL between February 1990 and February 2000. The majority of diverticula were located at the upper pole. Access was gained via a direct target puncture. After sequential dilatation of the tract, stones were removed and the diverticular wall was fulgurated. The diverticular neck was dilated with the Amplatz dilator upto 24-30 Fr. and a 20 Fr. nephrostomy catheter was placed. RESULTS: PCNL was performed successfully in 30 patients (90.9%), but puncture was failed in 3. Mean operative time was 105 minutes and mean hospital stay was 4.5 days. All patients who were treated successfully with PCNL became stone-free without any complication. Mean follow-up was 20 months (ranged from 1 to 108 months). Of the 26 patients with symptoms preoperatively, 25 patients were rendered symptom-free (96.2%). Twenty-four patients were assessed with an intravenous urogram at 1 or 3 months and 6, 12 months and there was no stone recurrence. The diverticula were obliterated or had improved drainage in 95.8% (23/24) of assessable cases. CONCLUSIONS: We confirmed that PCNL is a safe, less invasive and effective procedure and should be considered an acceptable form of primary management of patients with caliceal diverticular stone.
Calculi ; Catheters ; Dilatation ; Diverticulum ; Drainage ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Lithotripsy ; Neck ; Nephrostomy, Percutaneous ; Operative Time ; Punctures ; Recurrence ; Shock ; Ureteroscopy ; Urinary Tract Infections

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.
Constriction, Pathologic ; Humans ; Pelvis ; Shoulder ; Stents ; Tuberculosis ; Ureter*

No abstract available.
Animals ; Apoptosis* ; Collagen* ; Insulin* ; Rats* ; Streptozocin*

The diagnosis of soft tissue osteochondroma should be considered when a well-defined osseous mass is located in the soft tissues. The differential diagnosis includes myositis ossificans, tumoral calcinosis, synovial chondromatosis, and soft tissue osteosarcoma, true osteochondroma which arises from bone. One case of soft tissue osteochondroma in the knee, a lesion of uncertain pathogenesis is reported.
Calcinosis ; Chondromatosis, Synovial ; Diagnosis ; Diagnosis, Differential ; Knee ; Myositis Ossificans ; Osteochondroma* ; Osteosarcoma

Panner's disease, osteonecrosis of the capitellum of the elbow, was first reported by Panner in 1927. The disease occurs mainly in boys between 6 and 15 years old and shows unilateral distribution. Pain, stiffness, localized tenderness over the lateral condyle of the elbow, and decreased range of motion are the typical clinical symptoms. Conservative treatment is generally recommended for patients in the early stage of this disease. A few cases of Panner's disease have been reported and few are related to long-term follow-up results. To the best of our knowledge, all reported cases were over six years. Therefore, we report on a five-year-old boy diagnosed as Panner's disease that showed resorption and regeneration of the humeral capitellum with no limitation of motion over three years. The current study was exempted from review by the institutional review board because it was a single retrospective case report. Informed consent was obtained from the patient's guardian.
Child* ; Elbow ; Ethics Committees, Research ; Follow-Up Studies ; Humans ; Informed Consent ; Male ; Osteochondrosis ; Osteonecrosis ; Range of Motion, Articular ; Regeneration ; Retrospective Studies

One patient with bilateral staghorn calculi was managed by partial nephrectomy of lower pole in one kidney and nephrolithotomy combined with partial nephrectomy in the other kidney.
Calculi* ; Humans ; Kidney ; Nephrectomy

Subarachnoid hemorrhage (SAH) is less frequent than ischemic stroke, but has a high public health relevance because it can affect young and middle-age adults, has considerable mortality and morbidity, it is treatable and preventable. Despite stable incidence, the mortality of SAH has decreased in the last two decades due to better neurosurgical techniques and neurocritical care and to advances in neuroendovascular treatment. Sudden headache is the cardinal feature. Rebleeding is the most imminent danger; a first aim is therefore occlusion of the aneurysms. Complications such as vasospasm/delayed cerebral ischemia, hydrocephalus, increased intracranial pressure, and seizures must be considered in the management of SAH. The authors reviewed the recent advances in the clinical aspects of SAH and grading system of the available evidence is included.
Adult ; Aneurysm ; Brain Ischemia ; Headache ; Humans ; Hydrocephalus ; Incidence ; Intracranial Pressure ; Mortality ; Public Health ; Seizures ; Stroke ; Subarachnoid Hemorrhage*

PURPOSE: To present initial and follow-up HRCT findings of lymphangitic carcinomatosis of the lung. MATERIALS AND METHODS: Both initial and follow-up HRCT scans were obtained in 18 patients with lymphangitic carcinomatosis of the lung. After dividing the patients into two groups (with anticancer chemotherapy (n=12) and without chemotherapy (n=6), changes of pulmonary parenchymal abnormalities (percentile increase or decrease in the extent of each pattern) were assessed and compared on initial and follow-up HRCTs. RESULTS: Findings on initial CT were interlobular septal thickening (n=18) (smooth in 15 and mixed smooth and nodular in three), thickening of bronchovascular bundles (n=17), areas of ground-glass opacity (n=15), polygonal lines (n=15), and nodules (n=10). With chemotherapy, the finding of polygonal lines decreased by 20/3%, while findings of ground-glass opacity, bronchovascular bundle thickening, septal thickening, and nodules remained stable. Without chemotherapy, all CT patterns of abnormalities except nodules increased by 45-88%. In three patients who did not undergo chemotherapy, smooth interlobular septal thickening changed to nodular thickening. CONCLUSION: Lymphangitic carcinomatosis of the lung manifests initially as smooth thickening of the interlobular septae, bronchovascular bundle thickening,areas of ground-glass opacity, and polygonal lines, as seen on HRCT. Without chemotherapy, the extent of CT findings increases and there is a tendency for smooth septal thickening to change to nodular thickening. Chemotherapy induces improvement or cessation of the progression of CT findings.
Carcinoma* ; Drug Therapy ; Follow-Up Studies ; Humans ; Lung*

BACKGROUNDS: Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is not always intractable to antiepileptic drugs (AEDs). To identify the responsiveness to AEDs and related clinical factors in TLE-HS, we performed this study. METHODS: Consecutive 100 (51 men, mean age=30.2+/-6.6, age range=19-50) patients with TLE-HS were divided into two groups by their responsiveness to AEDs. Intractable TLE-HS was defined if they had any seizures for the preceding year with at least two AEDs. Clinical factors were analyzed to find the association of the responsiveness to AEDs. RESULTS: Intractable TLE-HS was found in 68% of patients. The younger age of onset (12+/-4 vs. 31+/-8 years, p<0.0001), longer duration of epilepsy (17+/-6 vs. 2+/-1 years, p<0.0001), more than five tonic-clonic seizures (GTCs) with secondary generalization (29.4 vs. 6.3%, p=0.0009) and bilateral epileptiform abnormalities on EEG (30.9 vs 6.3%, p=0.0054) were significantly correlated with the intractable TLE-HS. According to multiple logistic regression analysis, bilateral epileptiform abnormalities on EEG (adjusted OR=9.4, 95% CI: 1.98~44.76) and more than five GTC (adjusted OR=7.7, 95% CI: 1.60~33.39) were independently related with poor responsiveness to AEDs in TLE-HS. CONCLUSIONS: The presence of hippocampal sclerosis does not necessarily mean intractability to AEDs. The clinical variables related with the poor response to ADEs in TLE-HS are more than five GTCs and bilateral epileptiform abnormalities on EEG.
Age of Onset ; Anticonvulsants ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Generalization (Psychology) ; Humans ; Logistic Models ; Male ; Sclerosis ; Seizures ; Temporal Lobe

PURPOSE: Most men with benign prostatic hyperplasia (BPH) have bothersome lower urinary tract symptoms (LUTS). This study aimed to investigate the safety and efficacy of high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) for the treatment of BPH in men with detrusor underactivity (DU). MATERIALS AND METHODS: From March 2009, 371 patients with BPH were divided into 2 groups according to the findings of preoperative urodynamic study: 239 (64.4%) patients with bladder outlet obstruction (BOO) and 132 (35.6%) patients with bladder outlet obstruction with detrusor underactivity (BOO+DU). 120 W HPS laser PVP was performed to resolve the BOO. The perioperative data and postoperative results at 1 month and 12 months, including the International Prostate Symptom Score (IPSS), maximum urinary flow (Qmax), and postvoid residual urine (PVR) values, were evaluated. RESULTS: Compared with the preoperative parameters, significant improvements in IPSS, Qmax, and PVR were observed in each group at 1 and 12 months after the operation. In addition, IPSS, Qmax, and PVR were not significantly different between the BOO and BOO+DU groups at 1 and 12 months after the operation. CONCLUSIONS: Surgery to relieve BOO in the patients with BPH seems to be an appropriate treatment modality regardless of the existence of DU.
Humans ; Laser Therapy ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostatic Hyperplasia ; Urinary Bladder Neck Obstruction ; Urodynamics ; Volatilization