The Experience of Surgical Management for Parathyroid Hyperplasia / 대한내분비외과학회지

Parathyroid hyperplasia is a pathologic finding that can be found in hyperparathyroidism. Unlike parathyroid adenoma, treatment of parathyroid hyperplasia is still quite controversial. In addition, the relative merits of two alternative surgical approaches-subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation have not been clearyly elucidated. The records of 10 patients who had parathyroid hyperplaisa and who underwent parathyroid surgery at the Department of Surgery, Hanyang University Hospital, between April 1992 and April 2003 were retrospectively reviewed. The 10 patients were comprised of 3 males and 7 females. The age distribution was between 29 and 73 years. The presenting clinical manifestations were associated with bone pain in 8 patients, muscle weakness in 4, headache in 4, gastrointestinal symptoms in 3, renal symptoms in 3 and psychologic symptoms in 2. The serum parathyroid hormone level was elevated in all patients. The serum alkaline phosphatase level was elevated in seven among the ten patients. Histopathologic findings revealed chief cell hyperplasia in all patients. Postoperative transient hypocalcemia occurred in 5 patients and they were supplied with oral calcium and calcitriol for several months. There were no major complications. The results indicate that a subtotal parathyroidectomy can be performed without mortality or morbidity and provides good control of primary parathyroid hyperplasia, A total prathyroidectomy with autotransplantation can be performed without mortality or morbidity and provides good contril of secondary and tertiary parathyroid hyperplaisa.

Comparison of Complication of Anterior Urethral Injury by Initial Management Methods / 대한비뇨기과학회지

PURPOSE: We compared the results of immediate and conservative managements of anterior urethral injury by the degree of injury. MATERIALS AND METHODS: We reviewed the medical records of 95 cases of anterior urethral injury from May 1989 to January 1998. The age of these patients ranged from 2 to 67 years(mean age 39.6+/-3.1). The degree of anterior urethral injury was classified by the finding of retrograde urethrography. Type I was classified as contusion or urethral laceration, extravasation due to partial urethral rupture, and type II was classified as extravasation due to total urethral rupture. Both type I and type II are managed by immediate(urethral foley catheterization or primary realignment or end to end anastomosis) and conservative(observation or suprapubic cystostomy insertion)management. RESULTS: There were 47 cases(49.5%) in type I and 48 cases(50.5%) in type II. The associated injuries were 36 cases(37.9%). The duration of catheter indwelling in type I was 9.0+/-5.8 days in immediate management and 9.4+/-6.4 days in conservative management. That of type II was 21.7+/-9.5 days in immediate management and 27.6+/-8.5 days in conservative management. The complications of type I were 2 cases(6%) in immediate management and 1 case(7%) in conservative management. That of type II were 10 cases(31.3%) in immediate management and 11 cases(68.8%) in conservative management. CONCLUSIONS: Although conservative management is preferable in anterior urethral injury in general, we recommend immediate management regardless of the degree.

A Case of Malacoplakia of the Prostate / 대한비뇨기과학회지

Malacoplakia is an uncommon granulomatous inflammatory disease, which predomina- ntly affected the urinary tract, particularly the urinary bladder. The prostatic involve- ment of malacoplakia is extremely rare and may clinically mimic prostate cancer. A correct diagnosis of malacoplakia can be made by histopathologic findings characterized by accumulations of macrophages containing typical intracytoplasmic inclusions(Michael is-Gutmann bodies). We report a case of prostatic malacoplakia, which was incidentally found in prostate biopsy performed to confirm clinically suspected prostate cancer.

Change in the Concentration of Cholesterol and Phospholipid of Seminal Plasma in Patients with Chronic Prostatitis / 대한비뇨기과학회지

PURPOSE: The complaint of infertility are found in patients with chronic prostatits. In vitro studies tend to show that the addition of massive micro organisms to semen results in decreased viability. Because such massive concentrations of pathogens seldom occur in the secretory fluids of infected prostate gland and chronic non bacterial prostatitis is more common, it seems that the chronic prostatitis produces infertility on the basis of the change in composition of seminal plasma besides a direct effect of the pathogen on spermatozoa. There is evidence that fluids from the accessory genital glands play an important role in sperm viability and fertility. The plasma membrane of spermatozoa is composed of cholesterol and phospholipid. The correlation exists between cholesterol to pohospholipids membrane ratio and cholesterol to phospholipid ratio in seminal plasma. We examined the change in the concentration of cholesterol and phospholipid of seminal plasma in patients with chronic prostatitis. MATERIALS AND METHODS: Semen from 14 healthy males and 23 chronic prostatitis patients were evaluated for the concentration of cholesterol and phospholipid of seminal plasma. RESULTS: The ages(mean +/- standard error) of control and patients with chronic prostatitis were 28.0 +/- 1.4 year and 27.0 +/- 0.4 year(p>0.05). The concentrations(mean +/- standard error) of cholesterol in control and patients with chronic prostatitis were 26.4+/-3.gmg/dl and 23.3+/- 1.8mg/dl(p>0.05). The concentrations(mean +/- sandard error) of phospholipid in control and patients with chronic prostatitis were 858.1 +/-23.7mg/dl and 789.9+/-6.0mg/dl(p<0.05). CONCLUSIONS: The decreased concentration of phospholipid of seminal plasma in patients with chronic prostatitis was found and this fact is helpful to understand the causes of functional change of sperm in patients with chronic prostatitis.

A Case of Tension Pneumothorax during High Frequency Left Jet Ventilation in Laryngomicrosurgery / 대한마취과학회지

High frequency jet ventilation (HFJV) has advantage for laryngomicrosurgery that the transit of a small airway tube through the surgical field causes much less interference with surgery. We experienced a case of tension pneumothorax during high frequency jet ventilation. The possible cause of barotrauma in this case was obstruction of gas escape. It is recommened that meticulous care is taken to ensure and adequate pathway for expiration when HFJV is used.