A Faster and Wider Skin Incision Technique for Decompressive Craniectomy: n-Shaped Incision for Decompressive Craniectomy / 대한신경손상학회지

OBJECTIVE: Decompressive craniectomy (DC) is a useful surgical method to achieve adequate decompression in hypertensive intracranial patients. This study suggested a new skin incision for DC, and analyzed its efficacy and safety. METHODS: In the retrograde reviews, 15 patients underwent a newly suggested surgical approach using n-shape skin incision technique (Group A) and 23 patients were treated with conventional question mark skin incision technique (Group B). Two groups were compared in the terms of the decompressed area of the craniectomy, protruded brain volume out of the skull layer, the operation time from skin incision to bone flap removal, and modified Rankin Scale (mRS) which was evaluated for 3 months after surgery. RESULTS: The decompressed area of craniectomy (389.1 cm² vs. 318.7 cm², p=0.041) and the protruded brain volume (151.8 cm³ vs. 116.2 cm³, p=0.045) were significantly larger in Group A compared to the area and the volume in Group B. The time interval between skin incision and bone flap removal was much shorter in Group A (23.3 minutes vs. 29.5 minutes, p=0.013). But, the clinical results were similar between 2 groups. Group A showed more favorable outcome proportion (mRS 0-3, 6/15 patients vs. 5/23 patients, p=0.225) and lesser mortality cases proportion 1/15 patients vs. 4/23 patients, but these differences were not significantly observed (p=0.225 and 0.339). CONCLUSION: DC using n-shaped skin incision was a feasible and safe surgical technique. It may be an easier and faster method for the purpose of training neurosurgeons.

Extracorporeal shock wave lithotripsy experience with wolf piezolith 2300 device in 500 patients with upper urinary tract calculi / 대한비뇨기과학회지

An experience of extracorporeal shock wave lithotripsy (ESWL) using the Wolf Piezolith 2300 lithotriptor in 500 patients with upper urinary tract calculi is presented. Between April 1990 and April 1992, 500 patients (526 renal units) 8 to 78 years old were treated and followed up for at least 3 months. Of 526 renal units, 199 (37.8 per cent) had renal, 275 (52.3 per cent) ureteral and 52 (9.9 per cent) multiple stones. Of these cases 50.4 per cent had stones smaller than 1cm, 33.7 per cent from 1 to 2cm, 8.5 per cent from 2 to 3cm and 7.4 per cent larger than 3cm, including staghorn or multiple stones. The success rate ranged from 100 per cent for stones smaller than 1.0cm in diameter to 71.8 per cent for stones larger than 3.0cm, with a 94.5 per cent of overall success rate. For auxiliary measures, push back procedure was done in 19 patients, Double J stents placed in 3 and nephrostomy performed in 6 patients. There were no significant complications. Stone street developed in 74 patients. Of these, stone fragments passed spontaneously in 37 and treated successfully with repeat ESWL in 24 and with manipulation by ureteral catheter in 12. Only 1 patient required percutaneous nephrostomy because of ureteral obstruction by stone fragments. Therefore. extracorporeal shock wave lithotripsy with piezoelectric lithotriptor is considered to be a safe and efficient outpatient procedure for the initial treatment of upper urinary tract calculi.

Transitional cell carcinoma of the renal pelvis and ureter / 대한비뇨기과학회지

Thirty-two patients with transitional cell carcinoma of the renal pelvis and ureter were analyzed to determine whether there was any correlation between tumor characteristics and patient survival. The patients consisted of 26 male and 6 female. Patient age ranged from 12 to 80 years with a mean of 53.6 years. Of these patients. 28 were followed for 1 to 10 years. The most common presenting symptom was hematuria (87.5% ). Excretory urogram demonstrated NVK (nonvisualization or the kidney) in 16 patients and filling defect in 10. Pathologically. 31% of the patients were stage T1. 46% stage T2, 12% stage T3 and l6% stage T4. Histologically, 16% of the patients had grade I . 47% grade II and 37% grade III disease. Recently 6 patients, of whom 5 presented with stage T2 and 1 with stage T4. were treated postoperatively with adjuvant M-VAC (methotrexate, vinblastine. adriamycin and cisplantin) chemotherapy. H these 6 patients, 3 had subsequently recurrent tumor and their mean survival was 15 months. The 2 years survival rates of 28 patients follow-up were 90.0, 45.5, 33.3 and 0% for stage T1, T2, T3 and T4 disease, respectively, and 100, 66.7 and 10% for grade I to III disease, respectively. Overall 2 years and 5 years survival rates were 53.6% and 23.1% respectively. It is concluded from this study that age, sex. NVK on excretory urogram. synchronous or metachronous bladder tumors seem to have no influence on patient survival while patient survival correlates with stage and grade of tumor.