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*

The Beckwith-Wiedemann syndrome, which included congenital anomalies such as macroglossia, exomphalos, postnatal somatic gigantism, have a substantially increased risk for the development of tumor. We report a case of testicular yolk sac tumor associated with Beckwith-Wiedemann syndrome, a previously unreported association. Pathologic examination showed Schiller-Duval body with evidence of testicular yolk sac tumor. This finding appears to represent a previously unreported association between Beckwith-Wiedemann syndrome and testicular yolk sac tumor.
Beckwith-Wiedemann Syndrome* ; Endodermal Sinus Tumor* ; Gigantism ; Hernia, Umbilical ; Macroglossia ; Testis ; Yolk Sac*

PURPOSE: The cornea of the keratoconus patient that is one of the contraindications in refractive surgery shows severe topographic asymmetry and the lower curvature is much steeper than the upper one. In this study, we evaluated whether the mild to moderate topographic asymmetry which does not fall under the Rabinowitz-McDonnell's keratoconus criteria(I-S value>3.0 D) would affect the LASIK results. METHODS: The maximal diopter difference in central 3 mm-zone(MDD-3) of the pre-LASIK topography, the postoperative best uncorrected visual acuity(UCVA) and the postoperative best corrected visual acuity(BCVA) were analyzed in 248 eyes of 124 patients retrospectively. We divided the patients into 2 groups according to the magnitude of MDD-3(MDD-3<1.0 D in group 1 and MDD-3> OR =1.0 D in group 2). In the same manner, the patients were divided into 2 groups according to the magnitude of MDD-5(MDD-5<1.0 D in group A and MDD-5> OR =1.0 D in group B) using 5 mm-zone. RESULTS: Between group 1 and 2, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05). Between group A and B, statistically significant difference was not observed in postoperative UCVA and BCVA(p>0.05), either. CONCLUSIONS: This suggests that the mild pre-LASIK topographic asymmetry would not affect the visual acuity after LASIK.
Cornea ; Humans ; Keratoconus ; Keratomileusis, Laser In Situ* ; Refractive Surgical Procedures ; Retrospective Studies ; Visual Acuity

PURPOSE: The purpose of this article is to assess the efficacy of a bioabsorbable polylactide (PLA) plate and screw for treating injuries of ankle fractures. MATERIALS AND METHODS:24 patients who underwent an open reduction and internal fixation operation for ankle fractures from July 2005 to March 2007 were enrolled into the study. There were 15 men and 9 women. The average age of the patients was 44 years and the average follow-up period was 16 years and two months (16.2 months). All cases were divided into low grade fracture patient (11) who belongs in type A and B of Danis-Weber classification and high grade fracture patient (13) who belongs in type C1, C2 of Danis-Weber classification, and each groups were analyzed by clinical (Meyer score) and radiological finding at the time of their last follow-up evaluation. RESULTS:The clinical results according to Meyer scoring system, showed that all patient with low grade fracture had good to excellent result, but only 54% of patient with high grade fracture had good to excellent result. According to Cedell's radiologic finding, there were 91% cases above fair in low grade fracture. But there were 62% of patient above fair result in high grade fracture, the reduction losses were seen in 38% of patient with high grade fracture. CONCLUSION: Bioabsorbable PLA plate and screw is good internal fixation device which doesn't have additional operation for removal of implant because of slow absorption within the human body. It showed sufficient strength for acquisition and maintenance of reduction in low grade fracture, but need attention to use because of many cases of reduction loss in high grade fracture. So, it seems to be safe and effective when used in heeling of low grade fracture under considering about type of fracture sufficiently.
Absorption ; Animals ; Ankle ; Female ; Follow-Up Studies ; Heel ; Human Body ; Humans ; Internal Fixators ; Male ; Polyesters

OBJECTIVE: To elucidate interhemispheric asymmetry of the neural generators of somatosensory evoked potential (SEP). METHOD: Median nerve SEP was recorded over 5 sites of each hemisphere in 20 healthy subjects and 23 stroke patients. One electrode was placed over C3'/C4' (position B) and two electrodes were located 2 cm medial (position A) and lateral (position C) to position B, respectively. Additional two electrodes were positioned at 3 cm anterior (position F) and posterior (position P) to position B. The common reference electrode was placed at Fz. RESULTS: In healthy subjects, P22 was more frequently evoked than P27 in position F of the nondominant hemisphere and P27 in position P of the dominant hemisphere. In stroke subjects, fourteen patients demonstrated SEP waveforms over the affected hemisphere. In them, SEP amplitude significantly correlated with proprioception. However, distribution of the recording position showing significant correlation between SEP amplitude and proprioception was different according to dominancy of the affected hemisphere. CONCLUSION: P22 was more dominant in the nondominant hemisphere and P27 in the dominant hemisphere of normal group. Furthermore, clinical correlation of SEP amplitude was affected by the injured hemisphere dominancy in stroke group. These results demonstrate that asymmetry of neural generator distribution can be presumed.
Electrodes ; Evoked Potentials, Somatosensory* ; Humans ; Median Nerve* ; Proprioception ; Stroke

Percutaneous endoscopic gastrostomy is used for long-term nutritional support to the patients who cannot maintain the adequate oral intake and can be performed with relatively few complications. Among the complications, migration of the internal bumper into the abdominal wall, so called "buried bumper syndrome" has been described more recently. We decribed a case of buried bumper syndrome in stroke patient with percutaneous endoscopic gastrostomy. He experienced peritubular leakage, resistance of tubal feeding, and abdominal pain which were developed 4 weeks after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen coud not be found. The gastrostomy tube was replaced with careful manual traction and replaced to new one with endoscopic technique. No complication was occurred and the function of tube has been well preserved.
Abdominal Pain ; Abdominal Wall ; Gastrostomy ; Humans ; Nutritional Support ; Stroke ; Traction

OBJECTIVE: To observe histological changes of the intervertebral disc injected with intradiscal steroid and mollification of discogenic pain. METHOD: A study group of 25 Sprague-Dawely rats was divided into five subgroups. A control group of 10 Sprague-Dawely rats was divided into five subgroups. The rats' intervertebral discs were exposed by an anterior surgical approach. For study group, the rats were injected intradiscally methylprednisolone acetate 4 mg (Depomedrol, 40 mg/ml) to the L4-L5 intervertebral disc, methylprednisolone sodium succinate 4 mg (Solumedrol, 40 mg/ml) to the L5-L6 intervertebral disc, and triamcinolone acetonide 4 mg (Triamcinolone, 40 mg/ml) to the L6-S1 intervertebral disc. For control group, the rats were injected intradiscally 0.1 ml of saline to the L5-L6 intervertebral disc and a needle was inserted in the L6-S1 intervertebral disc. The intervertebral discs were extracted after 1 week, 2 weeks, 3 weeks, 4 weeks, and 16 weeks. The extracted intervertebral discs were stained with Hematoxylin-Eosin and examined histomorphometrically. RESULTS: There is no significant histological change in either group until 4 weeks after the different types of steroid were injected. Focal fibrotic change was present in the Solumedrol and Triamcinolone injection subgroups after 16 weeks. CONCLUSION: We concluded that rapid mollification of discogenic pain following intradiscal steroid injection may not result from histological change of the disc. Further biochemical study will be neccessary to clarify mollification mechanism of discogenic pain by intradiscal steroid injection.
Animals ; Intervertebral Disc* ; Methylprednisolone ; Methylprednisolone Hemisuccinate ; Needles ; Rats ; Triamcinolone ; Triamcinolone Acetonide

OBJECTIVE: A warfarin-baclofen interaction has been postulated, but has not been documented in the literature. The purpose of this study is to investigate the drug interaction between warfarin and baclofen in rats. METHOD: Twenty Sprague-Dawley rats (250-300 gm), divided into a control and a study group were used. 0.02 mg/day of warfarin was administered intraperitoneally without baclofen for the first three days. Daily blood samples were drawn after six hours of warfarin adminstration for measurement of prothrombin time (PT) and International Normalized Ratio (INR). On the fourth day, the rats in the study group were given 0.02 mg of warfarin and 0.6 mg of baclofen intraperitoneally. For the control group, 0.02 mg of warfarin was administered on all four days. PT and INR measurements were taken at 3 hours, 6 hours, and 24 hours after the administration of warfarin with or without baclofen. RESULTS: Mean INR value was significantly increased by concomitant baclofen administration after 6 hours, resulting in 1.72 for the control group with warfarin alone and 2.74 for the study group with warfarin and baclofen (p<0.05). CONCLUSION: The concomitant administration of warfarin and baclofen affects the anticoagulant effect of warfarin. Physicians should be aware of the risk for increased anticoagulant effect of warfarin when baclofen is also administered.
Animals ; Baclofen* ; Drug Interactions* ; International Normalized Ratio ; Prothrombin Time ; Rats ; Rats, Sprague-Dawley ; Warfarin*

Myotonic dystrophy (MD) is a systemic disease that affects any level of the gastrointestinal tract. Due to its rare occurrence, achalasia could be misdiagnosed due to symptoms being similar to gastroesophageal reflux (GERD). Moreover, there is no known appropriate treatment for achalasia in patients with MD. A 58-year-old man was diagnosed with type 1 MD. He complained of dyspepsia and chest pain, which showed no improvement even after administering GERD medication. Secondary achalasia was subsequently diagnosed after examining the lower esophageal sphincter by performing a video fluoroscopic-swallowing study (VFSS) and high-resolution manometry. Thereafter, the patient was successfully treated with balloon dilatation, and showed significant improvements in the symptoms. The patient remained well for 1 year. We report a rare case of secondary achalasia in an MD patient. Our study validates that VFSS might be useful for the early diagnosis of achalasia, and esophageal intervention (such as balloon dilatation) should be considered on confirmation of the affliction.

No abstract available.
Animals ; Female ; In Situ Hybridization ; Mice* ; Ovary*