We experienced one case of renal arteriovenous fistula that was treated with superselective transcatheter arterial embolization of the renal artery. The patient presented with colicky pain, gross hematuria, and acute urinary retention. At that time, we suspected renal stone because of a radio-opaque density on the right renal area of excretory urography. However, an acoustic shadow could not identified by renal ultrasonogram. When gross hematuria reappeared one week later, selective renal angiography was performed, and arteriovenous fistula was found on the right kidney. We used superselective tanscatheter arterial embolization with a Gelfoam fragment on right arterial branch as the treatment modality.
Acoustics ; Angiography ; Arteriovenous Fistula* ; Abdominal Pain ; Gelatin Sponge, Absorbable ; Hematuria ; Humans ; Kidney ; Renal Artery ; Ultrasonography ; Urinary Retention ; Urography

No abstract available.
Female ; Ovary*

We performed a retrospective analysis of 25 patients presenting with confirmed renal pelvis tumor to examine factors predictive of survival outcome. Follow-up duration was from 11 to 133 months (mean 39 months). The analysis of prognostic factors was performed on 26 cases with available clinical data, testing the following parameters : age, symptom duration, IVP finding, urine cytology, concomitant tumor, histopathological grade, stage, treatment modality and also correlation between each factors was examined. The analysis showed that grade (p <0.001) and stage (p =0.001) were the only two parameters having a statistically significant impact on prognosis, multifocality also had some influence on survival(p<0.05 ). In cases of low-stage, low-grade tumor (stage I-II according to Bennington and Bechkwith classification and grade I - II according to Broder's classification) the probability of survival was 90%. 86% at 5 years, but in high-stage, high-grade tumor, 5 year survival rates were 28 % and 0% respectively. In 20 of total 25 cases nephroureterectomy with bladder cuff excision was performed, simple nephrectomy in 2 cases, radical or palliative nephrectomy in 3 cases, but no survival difference was observed in treatment modality. This finding suggests that early diagnosis and surgical excision of the pelvis tumor will result in excellent outcome but the survival of patients with high stage and high grade tumor probably can not be improved without the development of effective adjuvant therapy.
Classification ; Early Diagnosis ; Follow-Up Studies ; Humans ; Kidney Pelvis* ; Nephrectomy ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Rate ; Urinary Bladder

We experienced with 3 cases of penile fractures for recent 2 years, one occurred during masturbation and the others occurred during coitus(one case was associated with urethral injury). While the former was treated with conservative management, the latters were treated with surgical intervention that was immediate removal of hematoma and primary closure of ruptured corpus cavernosum. Penile deformity end decrease in rigidity occurred in conservatively treated case. However, two cases of immediate surgical treatment had a excellent result without complication. Even though we describe only 3 cases and could not compare the degree of injury. our short experiences suggest that immediate surgical intervention is better than conservative management in initial treatment of penile fracture.
Congenital Abnormalities ; Hematoma ; Masturbation

Fatal air embolism can occur during a variety of surgical procedures. We experienced a case of cardiac arrest due to venous air embolism during spinal fusion. A 63-year-old woman underwent spinal fusion for compression fracture on L1 and scolio-kyphosis. Anesthetic induction and initial intraoperative course were completely uneventful until precipitous blood pressure drop occurred, and accompanied by a significant decrease in heart rate and cardiac arrest after use of bone cement. Although more common intraoperative events were presumed and treatment initiated, venous air embolism was considered the etiology of these events when whirring noise was detected by esophageal sthetoscope and a transient decrease in end-tidal carbon dioxide tension was noted by capnometer. We performed cardiac resuscitation with external cardiac compression, various cardiotonic drugs, and removal of air through the right internal jugular venous catheter, but the result was unsuccessful.
Blood Pressure ; Carbon Dioxide ; Cardiotonic Agents ; Catheters ; Embolism, Air* ; Female ; Fractures, Compression ; Heart Arrest ; Heart Rate ; Humans ; Middle Aged ; Noise ; Resuscitation ; Spinal Fusion*

BACKGROUND: The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. METHODS: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0 microgram/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injection of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after arrival in the recovery room. RESULTS: There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2 +/- 1.8%, for the second group 97.9 +/- 2.6%, and for the third group 92.4 +/- 2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group CONCLUSIONS: We concluded that oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia.
Analgesics* ; Anesthesia, Spinal* ; Anoxia* ; Fentanyl ; Humans ; Hypnotics and Sedatives* ; Incidence* ; Injections, Intravenous ; Midazolam ; Oximetry ; Oxygen ; Recovery Room

BACKGROUND: Ischemic preconditioning (IPC) and some volatile anesthetics have been shown to attenuate ischemia-reperfusion injury in an isolated-heart model. The aim of this study was to determine whether sevoflurane has a cardioprotective effect on isolated-heart models when given before prolonged periods of global ischemia. METHODS: 48 male Sprague-Dawley rat hearts were randomly subdivided into four groups. Rats were anesthetized with 25 mg ketamine. After hearts had been removed, and perfused with a modified Krebs solution gassed with 5% CO2 balanced O2 at a constant temperature (37oC) and pressure (55 mmHg), a latex balloon was placed into the left ventricle to obtain isovolumetric contraction. After 20 min of equilibration, hearts were randomly allocated to 1) a control group, 2) an IPC group, two 5 min ischemic periods interspersed with 5 min normal perfusion, 3) an SPC (sevoflurane preconditioning) group, two 5 min sevoflurane periods interspersed with 5 min normal perfusion, 4) an SPC with Glibenclamide group. All groups were subjected to 30 min of global ischemia and 75 min of reperfusion. Left ventricular pressure, dP/dt max, and coronary flow were measured. Also flow responses to bradykinin were tested 15 min before IPC or SPC and 60 min after reperfusion. RESULTS: Sevoflurane administration before global ischemia was found to have protective effects like IPC on functional recovery, to reduce infarct size, and to conserve coronary endothelial function. LVP was less depressed in the SPC and IPC groups. dP/dt max in both the IPC and SPC groups recovered after global ischemia. Coronary flow was depressed in the control and in the SPC with Glibenclamide groups, but it was slightly depressed in the IPC and SPC groups. Smaller infarct sizes were observed in IPC and SPC groups. Flow increases due to bradykinin were greater after SPC and IPC. Moreover, these beneficial effects of sevoflurane were blocked by glibenclamide administration. CONCLUSIONS: Preconditioning with sevoflurane, like IPC, improves post ischemic contractility basal flow, and bradykinin-induced flow increases. Moreover, the protective effects of SPC and IPC were reversed by KATP channel antagonism.
Anesthetics ; Animals ; Bradykinin ; Glyburide ; Heart ; Heart Ventricles ; Humans ; Ischemia ; Ischemic Preconditioning ; Ketamine ; Latex ; Male ; Models, Animal* ; Myocardial Ischemia ; Perfusion ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; Ventricular Pressure

PURPOSE: Skin-sparing mastectomy (SSM) involves the resection of the nipple-areolar complex (NAC) along with the breast parenchyma, and this improves aesthetic outcome for breast cancer patients. Yet most patients desire preservation of the NAC. The purpose of this study was to determine the associated risk factors of NAC involvement and to identify the value of preoperative breast magnetic resonance imaging (MRI) for measuring the tumor-nipple distance (TND). METHODS: This prospective study was carried out in 92 breast cancer (3 patients with bilateral breast cancer) patients who underwent MRI and they had undergone modified radical mastectomy or SSM at the Department of Surgery in Soonchunhyang University Hospital from November of 2003 to March of 2006. The patients were divided into two groups: nipple-positive for malignancy (group 1; n=9) and nipple-negative for malignancy (group 2; n=86). We analyzed the risk factors of NAC involvement, including tumor size, nuclear grade, lymph node invasion, muticentricity, TND, the hormone recepor status, and lymphovascular invasion. The TND was measured by preoperative breast MRI (the imaging distance) in all patients and by the distance of specimens which were obtained postoperatively (the real distance) in 31 patients. RESULTS: The overall frequency of malignant nipple involvement was 9 of 95 (9.4%). There were no differences in tumor size, nuclear grade, lymph node invasion, muticentricity, the hormone recepor status and lymphovascular invasion between the two groups. The TND was identified as an independent predictor of malignant NAC involvement: the mean TND by breast MRI was 0.7 cm in group 1 and 2.7 cm in group 2 (p=0.01) the mean TND by pathologic measuring the specimen was 0.7 cm in group 1 and 3.2 cm in group 2 (p=0.02). In all the nipple involved cases, the tumor was within 2 cm of the nipple. In measuring the TND, there was no significant difference between the imaging distance of MRI and real distance of the sepcimen (p=0.166). CONCLUSION: The only predictive factor for malignant NAC invasion was TND in our study. NAC preservation would be appropriate for the patients with tumor located more than 2 cm away from the nipple. The TND as determined by preoperative MRI is considered to be helpful when deciding whether to preserve the NAC.
Breast Neoplasms* ; Breast* ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging ; Mastectomy ; Mastectomy, Modified Radical ; Nipples* ; Prospective Studies ; Risk Factors

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.
Breast ; Breast Diseases ; Follow-Up Studies ; Granulomatous Mastitis ; Humans ; Prospective Studies ; Recurrence

This study made a descriptive analysis of the cumulative amount and rate of sports medical care utilization during the 24th Seoul Olympic Games by the participating athletes, officials, etc. The sports medical care utilization was a component of the total medical care use and was basically caused by the prevention and treatment of sports injuries. The analytic data were derived from the Olympic Health Management Information System (OHMIS) of the SLOOC and the Korea Athlete Trainer Association(KATA). These were analyzed according to the., quantity of physician visits and the utilization rate, which was the amount of utilization divided by the total number of participating persons. The results were as follows: Firstly, the sports medical care utilization by the persons participating in the Seoul Olympics amounted to 17.9 % of the total medical care utilization. The venue medical services utilization accounted for 54.7 % of the total physician visits, which was larger than the village medical center's utilization. The number of physician visits per hundred persons during the 2 week period in the venue clinic was 3.03 and that of the village medical center was 2.51, therefore, the total was 5.54. Secondly, athletes accounted for 82.3% and officials 12.2% in the sports medical care utilization by participants. These results were because athletes, who were directly related to the games, called extremely often on the physicians. The utilization rate of sports medical care by athletes was 34.29. Thirdly, the sports medical demand according to type of therapy could be ranked from high to low in the following order: sports massage, thermal therapy, and electrical stimulation treatment, etc. The department of physical therapy in the village medical center was used a great deal. Fourthly, the trend of daily sports medical care utilization by the athletes showed a bell shape centering around the opening day of the Seoul Olympic Games. The utilization rate of athletes was 2.3; however, that of officials was 0.6. Lastly, the sports medical demand was calculated according to the continents, and Central America, Africa and Middle-East Asia proved to have a higher rate of sports medical care utilization than the more powerful and industrialized continent or regions.
Africa ; Asia ; Athletes ; Athletic Injuries ; Central America ; Electric Stimulation ; Humans ; Korea ; Management Information Systems ; Massage ; Seoul* ; Sports*