Pyuria, pain and hematuria are the predominant symptoms in urologic diseases. Among them hematuria is the most important complaint referable to the urinary tract in both children and adults Accordingly, hematuria should never be ignored, and no matter how trivial the bleeding a complete urologic investigation into itscause is mandatory. A statistical survey was made on hematuria of the in-patientsin the Department of Urology at ST. Mary's Hospital, during the two years from August 1966 to July 1968 and the following results were obtained. 1. During that period. out of 437 cases who were hospitalized, 246 cases(179 males and 67 females) had hematuria, giving a rate of 5t percent (gross: 24 percent, micro-hematuria: 30 percent) 2. More than 70 percent of all the cases of hematuria processed were found to be calculus, tumor and tuberculosis of the genitourinary tract. 3. Most frequent incidences of hematuria 'were shown to be trauma in children, while calculus, tuberculosis and tumor in young and middle aged group, and tumor in old aged group as well. 4. Among 141 cases of micro-hematuria, grade I showed 78 cases(55 percent) 5. The location of bleeding in 1O5 cases of gross hematuria was in the kidney by 40 percent, bladder, ureter and urethra in that order of frequency.
Adult ; Calculi ; Child ; Hematuria* ; Hemorrhage ; Humans ; Incidence ; Kidney ; Male ; Middle Aged ; Pyuria ; Tuberculosis ; Ureter ; Urethra ; Urinary Bladder ; Urinary Tract ; Urolithiasis ; Urologic Diseases* ; Urology

This study was done to investigate the effect volume overloading of right ventricle(RV) on the left ventricular(LV) volume and function in patients with isolated secundum type atrial septal defect(ASD) and to determine the hemodynamic indices affecting the postoperative reduction of RV size. Pre and postoperative echocardiogram and equilibrium radionuclide cardiac angiogram were analyzed in 39 patients of isolated secundum type ASD, who had their diagnosis confirmed by right heart catheterization and were operated at Seoul National University Hospital from January 1982 to July 1984. The ratio fo RV end-diastolic dimension to LV end-diastolic dimension(RVED/LVED), ratio of LV pre-ejection period and LV ejection time(PEP/LVET), ejection fraction(E.F.), fractional shortening(F.S.) mean velocity of circumferential fiber shortening(mVcf), peak ejection rate(PER) and peak filling rate(PFR) were measured in 24 normal control subjects and 39 patients with ASD before and after operation. The results obtained were as follows : 1) The postop. reduction of RV size could be correlated with age at operation, but showed no correlation with the degree of QP/Qs, main pulmonary arterial systolic, diastolic, mean pressure, RVEDP and previous RV size. 2) The ratio of postop. RVED/LVED(0.58+/-0.15) was significantly decreased, compared with the ratio of preop(0.96+/-0.28)(P<0.005)(Mean+/-1 S.D.). In preop and postop. status of ASD, the ratio of RVED/LVED was significantly larger than that of normal control subject(0.30+/-0.09)(P<0.005). 3) The ratio of preop PEP/LVET(0.33+/-0.02) was significantly decreased, compared with ratio of preop PEP/LVET(0.39+/-0.04)(P<0.005). There was significant difference between the ratio of preop. PEP/LVET and ratio of normal control subjects(0.33+/-0.05)(P<0.005), but no significant difference between the ratio of postop. PEP/LVET and ratio of normal control subjects(P>0.1). 4) There was no significant difference in LV systolic contractile functional indices between ASD group and normal control subjects and between pre and postop. status of ASD patients : LVEF was 63.5+/-6.1(%) in preop., 63.0+/-5.7(%) in postop and 62.4+/-6.6(%) in normal control subjects. F.S. was 27.3+/-5.7(%) in preop., 28.2+/-3.1(%) in postop. and 28.7+/-4.5(%) in normal control subjects. mVcf was 0.81+/-0.11(Cire/sec) in preop., 0.80+/-0.10(Circ/sec) in postop. and 0.82+/-0.14(Circ/sec) in normal control subjects. PER was 2.82+/-0.61(EDV/sec) in preop., 2.84+/-0.56(EDV/sec) in postop. and 2.84+/-0.45(EDV/sec) in normal control subjects. 5) The postop. PFR 3.34+/-0.46(EDV/sec) was significantly increased, compared with preop. PFR 2.51+/-0.46(EDV/sec)(P<0.005). There was significant difference between preop. PFR and normal control PFR 3.29+/-0.66(EDV/sec)(P<0.005), but no significant difference between postop. PFR and normal control PFR(P>0.1). 6) The postop. RVEF(51.4+/-6.3%) was significantly decreased, compared with preop. RVEF(54.5+/-9.9%)(P<0.005). Pre and postop. RVEF of ASD patient were significantly lower than RVEF of normal control group(60.3+/-3.1%)(P<0.01, P<0.005). The results indicate that postop. reduction of RV size could be correlated with age at operation. The effect of RV volume overloading on LV could not change systolic contractile functional indices, but diastolic filling index. There is many evidences suggesting that RV filling influences LV diastolic function which are occured by means of left ward shift of the interventricular septum and indirectly by linkage of filling of the two ventricules by common enclosure in the pericardium(underfilled LV volume and decreased LV compliance). Mildly diminished overall LV performance as shown by systolic time intervals appears to be related to the volume overload of the RV and to the concomitantly diminished volume of LV rather than to any myocardial contractility. LV systolic time inverval was non-invasive and sensitive index in assessing overall LV performance independent to LV geometric configuration and abnormal motion of regional ventricular wall.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Heart Septal Defects, Atrial* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Seoul ; Systole ; Ventricular Function, Left*

BACKGROUND: Isolated coronary ostial stenosis presumed to be atherosclerosis in origin is a rare condition reported to have peculiar characteristics-that occurs primarily in premenopausal women, low incidence of risk factors, severe symptoms of short duration with absence of collaterals suggesting rapid development. METHODS: From Feb. 1979 to May. 1991, 11 patients with isolated left coronary ostial stenosis were identified among 2520 coronary angiographies and they were presumed to be athreosclerosis in origin by excluding other alleged causes. RESULTS: There were 5 males and 6 females with mean ages of 47.8+/-9.5 and 51.5+/-7.9 respectively. Clinical presentations were stable angina in 4, unstable angina in 6 patients, and unstable angina after myocardial infarction in 1 patient.Number of risk factors per patient was 0.82+/-0.98. Majority showed a relatively short history of angina(mean 3.6+/-2.8 months). Coronary angiographic findings showed collateral circulation in 7 patients-grade III in 5 of them. There was 1 death related to coronary angiography. Coronary artery bypass surgeries were performed in 7 patients and 5 of them were followed for mean 22+/-8 months without coronary events. CONCLUSIONS: In contrast to the previous reports, isolated left coronary ostial stenosis presumed to be atherosclerosis in orign did not showed female predelication and although their symptom durations were relatively short coronary angiographies showed well developed collaterals in the majority of patients.We experienced one coronary angiography related death in this group of patients. Coronary artery bypass surgery is to be recommended in these patients otherwise contraindicated.
Angina, Stable ; Angina, Unstable ; Atherosclerosis* ; Collateral Circulation ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Bypass ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Risk Factors

We report a case of a ruptured triple hormone-secreting adrenal mass with hyperaldosteronism, hypercortisolism, and elevated normetanephrine levels, diagnosed as adrenal cortical carcinoma (ACC) by histology. A 53-year-old male patient who initially presented with abdominal pain was referred to our hospital for angiocoagulation of an adrenal mass rupture. Abdominal computed tomography revealed a heterogeneous 19×11×15 cm right adrenal mass with invasion into the right lobe of the liver, inferior vena cava, retrocaval lymph nodes, and aortocaval lymph nodes. Angiocoagulation was performed. Laboratory evaluation revealed excess cortisol via a positive 1-mg overnight dexamethasone suppression test, primary hyperaldosteronism via a positive saline infusion test, and plasma normetanephrine levels three times higher than normal. An adrenal mass biopsy was performed for pathological confirmation to commence palliative chemotherapy because surgical management was not deemed appropriate considering the extent of the tumor. Pathological examination revealed stage T4N1M1 ACC. The patient started the first cycle of adjuvant mitotane therapy along with adjuvant treatment with doxorubicin, cisplatin, and etoposide, and was discharged. Clinical cases of dual cortisol- and aldosterone-secreting ACCs or ACCs presenting as pheochromocytomas have occasionally been reported; however, both are rare. Moreover, to the best of our knowledge, a triple hormone-secreting ACC has not yet been reported. Here, we report a rare case and its management. This case report underscores the necessity of performing comprehensive clinical and biochemical hormone evaluations in patients with adrenal masses because ACC can present with multiple hormone elevations.

To evaluate the efficacy of pelviscopic surgery in gynecologic patient, we have reviewed 1196 patients treated pelviscopically from June 1992 to November 1996. The results of this study were summarized as follows; 1. The common indication were ectopic pregnancy(44.6%), ovarian cyst(14.0%), and myoma uteri(10.5%). 2. The major types of surgery were salpingectomy(24.8%), cystectomy(12.6%), salpingostomy(9.9%), adhesiolysis(6.5%),and myomectomy(5.8%). 3. The age of the patients ranged from 15 to 79 years and the mean age was 30.8 years. 4. the mean parity of the patients was 1.24. 5. The mean duration of hospitalization was 3.2 days. 6. The most common complication was hemorrhage at the trocar site, but it was controlled without difficulty.
Female ; Hemorrhage ; Hospitalization ; Humans ; Myoma ; Parity ; Surgical Instruments

To compare the first report of our anesthetic experiences with 16,457 Cases performed by the Department of Anerthesiology of Wonju Christian Hospital, Wonju Medical College, Yonsei University, from Nov. 1959 to Dec. 1977 which was published in 1980, the anesthetic experiences of 12,608 cases performed from Jan. 1978 to Dec. 1982 were analyzed, according to age, sex, department, physical status, emergency Procedureornotn, anesthetic agent, complication, and in addition, the ratio of medical insurance patients after enforcement of medical insurance patients. The results are as follows; 1) The number of cases receiving anesthesia tended, to increase year by year and the rate of increasi was remarkable for female patients. 2) Sexual distribution was 6049 males(48.0%), and 6559 females(52.0%). 3) 44.4% of patients were in the 2nd to 4th. decade of life and the patients over 60 years had increased markedly, 4) Among the departments General Surgery accounted for 30.7%, aner Obstetric sand Gynecology for 30.0%. 5) General anesthesia was use in 76.2% and regional anesthesia 23.8%. 6) The main anesthetic agent was halothane(47.9%). 7) Emergency operations were 37.6%, of the total. 8) Medical insurancs patients have increasied remarkably year by year. 9) Cardiac arrest in the operating room and the recovery room consisted of 4 cases. (0.032%).
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Emergencies ; Female ; Gangwon-do ; Gynecology ; Heart Arrest ; Humans ; Insurance ; Operating Rooms ; Recovery Room ; Silicon Dioxide

Purpose: To report a rare case of severe ocular hypertension following intravenous methylprednisolone treatment in a child with bilateral optic neuritis.Case summary: A 6-year-old girl presented with bilateral severe visual loss and disc swelling. Magnetic resonance imaging revealed optic nerve enhancement, and she received high-dose intravenous methylprednisolone for 3 days and oral prednisolone 30 mg/day for 2 weeks. Two weeks after initiating treatment, ophthalmologic examination revealed an intraocular pressure (IOP) of 46 mmHg in the right eye and 42 mmHg in the left eye. The best-corrected visual acuity was 1.0 in the right eye and 0.6 in the left eye. Relative afferent pupillary defect was noted in the left eye. Fundus examination showed normal cup-to-disc ratio (0.4) in both eyes. The iridocorneal angle was open in all directions. The treatment plan included the cessation of oral prednisolone and initiation of latanoprost and dorzolamide-timolol fixed combination agent. After 12 hours, the IOP decreased to 18 mmHg in the right eye and 14 mmHg in the left eye. Six months later, her visual acuity was 1.0 in both eyes, and IOP was maintained at 11 and 13 mmHg in the right and left eye, respectively. Optic disc examination showed no sign of glaucomatous change with normal cup-to disc ratio in both eyes. Conclusions Since steroid medication may cause asymptomatic IOP elevation, regular intraocular pressure measurements are required during steroid treatment for pediatric optic neuritis. The administration of IOP-lowering eyedrops returned IOP to the normal range without damaging the optic nerve.

PURPOSE: Rib and sternal fractures are common complications of chest compressions during cardiopulmonary resuscitation (CPR). The aim of this study is to investigate skeletal chest injuries following chest compressions and factors associated with skeletal chest injuries. METHODS: A retrospective study was conducted for 10 years from January 2005 to February 2015. Skeletal chest injuries in patients who underwent computerized tomography (CT) after return of spontaneous circulation (ROSC) were analyzed. The exclusion criteria were patients with insufficient medical records, under 18 years old, traumatic cardiac arrest, and out-of-hospital cardiac arrest. RESULTS: During the period 106 patients were included. The CT scan after ROSC showed that 47 patients (44.3%) had rib fractures, and 20 patients (18.9%) had sternal fractures. The rib fracture group showed higher age (73 vs 61, p<0.001), longer CPR time (10 vs 6 min, p<0.001), and higher incidence of sternal fracture (34% vs 6.8%, p<0.001). The sternal fracture group showed longer CPR time (10 vs 7, p<0.05) and higher incidence of rib fractures (80% vs 4.7%, p<0.001). In multivariate logistic regression analysis, age (OR 1.087; 95% CI 1.041 to 1.134, p<0.001), CPR time (OR 1.200; 95% CI 1.087 to 1.323, p<0.001), and sternal fracture (OR 4.524; 95% CI 1.259 to 16.697, p=0.021) showed significant association with rib fracture. CONCLUSION: Rib and sternal fractures are frequent complications in patients who underwent CPR. In hospital cardiac arrest patients with older age, longer CPR time, and sternal fracture needed more precaution for rib fractures and other complications.
Cardiopulmonary Resuscitation* ; Heart Arrest* ; Humans ; Incidence ; Logistic Models ; Medical Records ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Rib Fractures ; Ribs ; Thoracic Injuries* ; Thorax* ; Tomography, X-Ray Computed

Continuous epidural pain block with a local anesthetic agents is a commonly employed technique for pain relief after thoracotomy. In this study, we evaluated the effectiveness of the continuous epidural pain block in 19 patients undergoing elective lateral or posterolateral thoracotomy with control group(n=19) from November 1994 to July 1995. Epidural lidocaine and morphine mixtures were injected via an epidural catheter as a bolus after operation, and then bupivacaine and morphine mixtures were injected continuously following 5 or 6 days. The pain score, upper arm elevation(ROM score), and respiratory rate were significantly changed(P<0.05) from 30min after injection. The CO2 tension of arterial blood was decreased significantly(P<0.05) from 2hr after injection. The postoperative hospital days were decreased significantly(P<0.05). Side effects of the epidural pain block were urinary retention(n=10), urticaria(n=2) and a case of headache. There was no postoperative lung atelectasis. We conclude that the continuous epidural pain block is good for prevention of the postoperative lung complication and early recovery after thoracotomy.
Anesthesia, Epidural ; Anesthetics ; Arm ; Bupivacaine ; Catheters ; Headache ; Humans ; Lidocaine ; Lung ; Morphine ; Pulmonary Atelectasis ; Respiratory Rate ; Thoracotomy*

Angiodysplasia of the small bowel is an uncommon disorder in Korea, and is often found to be the cause of unexplained gastrointestinal bleeding. A 53-year-old male patient visited an emergeney room because of repeated melena and dizziness, He underwent selective superior mesenteric arterial angiography which revealed abnormal clusters of small arteries and early opacification of veins draining a segment of lower jejunum. An exploratory laparotomy was performed under the impression of angiodysplasia. An ulceration on the lower jejunum was found, and was resected. Subsequent jejunojejunostomy was performed. Histology of the resected specimen showed an irregularly dilated vessels in mucosa and submucosa.
Angiodysplasia* ; Angiography ; Arteries ; Dizziness ; Hemorrhage ; Humans ; Jejunum* ; Korea ; Laparotomy ; Male ; Melena ; Middle Aged ; Mucous Membrane ; Ulcer ; Veins