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A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.
Acetabulum ; Arthroscopy ; Biopsy ; Femoracetabular Impingement ; Femur Neck ; Follow-Up Studies ; Hip ; Hip Joint* ; Humans ; Male ; Osteochondroma* ; Physical Examination ; Recurrence

BACKGROUND: The inhibitory effects of nitric oxide(NO) on platelet adhesion and vascular smooth muscle cell(VSMC) proliferation may have a possible role inhibiting development of neointima following balloon catheter induced injury. We tested the hypothesis that L-arginine, the precursor of NO, would attenuate neointima formation following balloon catheter induced injury via regulation of antagonistic balance between proliferation and apoptosis of VSMC. METHODS: Adult, male Sprague-Dawley rats(300 to 400g) were anesthetized with ketamine (100mg/kg intraperitoneally). The left common and external carotid artery were exposed. For endothelial denudation, 2mm angioplasty catheter was introduced through the left external carotid artery into the left common carotid artery. The catheter was inflated at I atm. and withdrawn three times. Animals were randomized to receive 2.25% L-arginine in their drinking water(n=14) or placebo(n=16) from 2 days prior to and 9 days following denudation. VSMC proliferation was quantified by immunohistochemical staining with an antibody to the proliferating cell nuclear antigen(PCNA). The cells undergoing apoptosis were identified by terminal nucleotidyl transferase-mediated nick end labeling(TUNEL) method and morphologic changes by computerized planimetry and transmission electron microscopy. RESULTS: 1) The neointimal area in injured arteries were significantly reduced in L-arginine supplemented animals compared with placebo group(p<0.05). 2) L-arginine administration significantly reduced the number of PCNA positive cells in neointima when compared with placebo at 9 days(p<0.05). 3) Positive TUNEL cells were not influenced by L-arginine supplementation. 4) On transmission electron microscopy, there were no cells showing characteristics of apoptosis in neointima. CONCLUSION: These results suggested that the inhibitory effect of L-arginine on neointima formation is due to reduced VSMC proliferation, but is not due to increased VSMC apoptosis at the early time period after initmal injur .
Adult ; Angioplasty ; Animals ; Apoptosis ; Arginine* ; Arteries ; Blood Platelets ; Carotid Artery, Common ; Carotid Artery, External ; Catheters ; Drinking ; Humans ; In Situ Nick-End Labeling ; Ketamine ; Male ; Microscopy, Electron, Transmission ; Muscle, Smooth, Vascular ; Neointima* ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Vascular System Injuries*

Bilateral tubal pregnancy is the least common type of all extrauterine pregnancies, 1:725-1:1580 of pregnancies are bilateral. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, assisted reproductive techniques. The high incidence of ectopic pregnancy assisted with ovulation induction continues to be a problem. Bilateral tubal pregnancy associated with the ovulation induction has been reported few cases of 3.0% to 6.0% in frequency. This paper describes a case of simultaneous bilateral tubal pregnancy after ovulation induction and intrauterine insemination in a 27 year old patient. The diagnosis was confirmed by laparoscopy performed 30 days after intrauterine insemination, which revealed bilateral tubal pregnancy and mild hyperstimulated ovaries. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspect and incidence and treatment options are discussed.
Adult ; Diagnosis ; Female ; Humans ; Incidence ; Insemination* ; Laparoscopy ; Ovary ; Ovulation Induction* ; Ovulation* ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Reproductive Techniques, Assisted ; Salpingectomy

PURPOSE: Retinoic acid (RA) is well known as a potent teratogenic agent in both deficiency and excess. Cellular retinoic acid binding proteins (CRABPs) are involved in RA. We carried this study in order to determine the possible relations of CRABPs with RA-induced teratogenesis through observation of the expression patterns of CRABP l and ll in developing rats. METHODS: 35S-labeled RNA probes were synthesized using SP6-RNA polymerase in CRABP l and T7-polymerase in CRABP ll. The distribution of CRABP l and ll transcripts analyzed by in situ hybridization of rat embryosections from day 12 to 19, and postnatal brains from day 1 to 14. RESULTS: The CRABP ll transcripts were more widely distributed than CRABPl distribution, however, the relative level of CRABPl transcripts were higher than CRABP ll. The CRABP l mRNA transcripts showed its highest expression on the 16th day of gestation and these distribution correlated well with structures known to be targets of RA-induced teratogenesis. CRABP ll transcripts were expressed in brain vesicle, spinal cord, head, face, tongue and genital tubercle and also found in the structures which are not involved in RA-induced teratogenesis. CONCLUSION: These results suggest the possible involvement of both CRABPs in the RA-induced teratogenesis. However, CRABP l may have more specific roles than CRABP ll which may play a role through a different mechanism.
Animals ; Brain ; Carrier Proteins* ; Head ; In Situ Hybridization ; Pregnancy ; Rats* ; Receptors, Retinoic Acid ; RNA Probes ; RNA, Messenger* ; Spinal Cord ; Teratogenesis ; Tongue ; Tretinoin*

BACKGROUND: Therapeutic approaches to brain metastases include surgery, whole-brain radiotherapy, stereotactic radiosurgery (SRS), and combination therapy. Recently, postoperative or preoperative SRS draws more attention to reduce postoperative recurrence in brain metastases. The goal of this study is to review surgical outcome of patients who had been treated by SRS, and to discuss the effectiveness of preoperative SRS. METHODS: From 2009 to 2015, 174 patients were treated by SRS for brain metastases, and among these 50 patients underwent surgery. Eighteen patients underwent surgery after SRS, and 14 had oligometastases. The patients' median age at the time of surgery was 56 years (range, 34–84 years). The median follow-up duration was 16.5 months (range, 4–47 months). Pathological findings were classified as follows; radiation necrosis (Group I, n=3), mixed type (Group II, n=2), and tumor-dominant group (Group III, n=9). We compared surgical outcome in respect of steroid, mannitol dosage, Karnofsky performance scale, and pathological subgroups. RESULTS: The median overall survival was 11 months (range, 2–40 months). Six, 12 and 24 months survival rate was 64.3, 42.9, and 28.6%, respectively. Improvement of Karnofsky performance score was achieved in 50% after surgery. The overall survival of Group I (26.6 months) was longer than the other groups (11.5 months). Additionally the patients were able to be weaned from medications, such as steroid administration after surgery was reduced in 10 cases, and mannitol dosage was reduced in 6 cases. Time interval within 3 months between SRS and surgery seemed to be related with better local control. CONCLUSION: Surgical resection after radiologically and symptomatically progressed brain metastases previously treated with SRS seems to be effective in rapid symptom relief and provides an improvement in the quality of life. A short time interval between SRS and surgical resection seems to be associated with good local tumor control.
Brain Neoplasms* ; Brain* ; Follow-Up Studies ; Humans ; Mannitol ; Necrosis ; Neoplasm Metastasis ; Quality of Life ; Radiosurgery* ; Radiotherapy ; Recurrence ; Survival Rate

PURPOSE: We compared renal function outcomes in patients undergoing open or laparoscopic radical nephrectomy. MATERIALS AND METHODS: Seventy-one patients undergoing open or laparoscopic radical nephrectomy for kidney disease with a normal contralateral kidney were identified between January 2004 and December 2007. Renal function was calculated by using the Cockcroft-Gault formula. Serial renal functions were checked from the day before surgery to 1 year after surgery. Exclusion criteria were preexisting renal insufficiency, urinary stone disease, and pancreatic and liver disorders. RESULTS: Forty-one and 30 patients were treated with open radical nephrectomy or laparoscopic radical nephrectomy, respectively. The operative time and urine output of patients who underwent open and laparoscopic radical nephrectomy were 211.7+/-5.8 and 330.8+/-15.6 and 196.4+/-19.6 and 130.7+/-12.1, respectively (p=0.001, p=0.013). The glomerular filtration rates of patients who underwent open or laparoscopic radical nephrectomy were insignificant from baseline to postoperative day 360 (p>0.05). CONCLUSIONS: No significant differences in renal function were detected in the groups of patients who underwent open or laparoscopic radical nephrectomy from baseline to long-term follow-up.
Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Diseases ; Laparoscopy ; Liver ; Nephrectomy ; Operative Time ; Renal Insufficiency ; Urinary Calculi

Pneumothorax, pneumomediastinum and pneumopericardium usually develop during emergency situations and these conditions may result in cardiopulmonary compromise, so an early and accurate diagnosis is seen as crucial for proper treatment. For diagnosis of pneumothorax, pneumomediastinum and pneumopericardium, chest radiography is a primary modality and CT can help for diagnosing them earlier and detecting associated abnormalities. The purpose of this pictorial essay is to describe the pathophysiology, various radiographic signs and diagnostic pitfalls of pneumothorax, pneumomediastinum and peumopericardium on chest radiographs that are correlated with CTs, and to aid the physician in the radiographic diagnosis.
Diagnosis ; Emergencies ; Mediastinal Emphysema* ; Pneumopericardium* ; Pneumothorax* ; Radiography ; Radiography, Thoracic ; Thorax

Repeated concussion is common among football players; however, these minor blunt head trauma rarely result in serious complications. We report a case of a young college football player who presented acute subdural hematoma, cerebral edema, and seizure due to pseudoaneurysm rupture. The pseudoaneurysm, located at the cortical branch of the middle cerebral artery, was speculated to be formed by dural calcification and adhesion with the underlying brain, possibly due to repeated concussions. Following successful excision of the pseudoaneurysm and control of brain swelling, the patient recovered without sequelae and was discharged after a short while.
Aneurysm, False* ; Athletic Injuries ; Brain ; Brain Edema ; Craniocerebral Trauma ; Dura Mater* ; Football* ; Hematoma, Subdural, Acute ; Humans ; Middle Cerebral Artery ; Rupture ; Seizures

PURPOSE: Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. METHODS: The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. RESULTS: Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). CONCLUSION: Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications.
Age Distribution ; Anesthesia ; Body Mass Index ; Cystectomy ; Humans ; Ileus ; Incidence ; Laparoscopy ; Linear Models ; Medical Records ; Postoperative Complications ; Risk Factors ; Urology