Postoperative Ureteral Leak Treated Using a Silicone-Covered Nitinol Stent / 대한배뇨장애요실금학회지

Ureteral fistula is a serious complication of abdomino-pelvic surgeries, often resulting in poor outcomes owing to lack of proper treatment. We report the case of a 49-year-old woman who underwent placement of a silicone-covered ureteral occlusion stent in her right ureter for the management of ureteral leakage after pelvic surgery. A ureterogram obtained 18 months following the stent placement confirmed that there was no stent migration or additional urine leakage. We propose that the silicone-covered ureteral occlusion stent is practical, fast, and safe for the management of ureteral leakage.

The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome / 대한비뇨기과학회지

PURPOSE: We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping. MATERIALS AND METHODS: Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning. RESULTS: Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006). CONCLUSIONS: Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function.

Involvement of mitogen-activated protein kinases and p21Waf1 in hydroxyurea-induced G1 arrest and senescence of McA-RH7777 rat hepatoma cell line

Hydroxyurea is commonly used to treat hematologic disorders and some type of solid tumors, but the mechanism for its therapeutic effect is not clearly known. In this study, we examined the effect of hydroxyurea on rat hepatoma McA-RH7777 cells, specifically, on the role of mitogen-activated protein (MAP) kinase signal transduction pathways and p21Waf1, p27Kip1 and p53. Rat hepatoma McA-RH7777 cells treated with hydroxyurea for 7 days, caused the inhibition of cell growth in a dose-dependent manner. But, this growth inhibition was not caused by necrosis or apoptosis but instead was associated with cell senescence-like change as evidenced by senescence associated-beta-galactosidase staining, and cells arrest at G1 phase of cell cycle. Phosphorylation of MAP kinases, such as ERK, JNK, and p38, was found to be decreased after treatment of cells with hydroxyurea. But, the expression of p21Waf1 was increased, while p27Kip1 and p53 were not detected in hydroxyurea treated rat hepatoma cells. Hydroxyurea treatment induced G1 arrest and a senescence-like changes in rat hepatoma McA-RH7777 cells may be the likely results of signal disruption of MAP kinases (ERK, JNK, and p38 MAP kinase) and p21Waf1 over-expression.

Risk Factors Related to Immediate Urinary Retention after Tension-free Vaginal Tape Procedure / 대한비뇨기과학회지

PURPOSE: This study was performed to evaluate factors related to an immediate urinary retention, following the tension-free vaginal tape (TVT) procedure, which are embarrassing to both the patient and surgeon. MATERIALS AND METHODS: The records of 375 women, with a follow-up of at least 6 months, among patients that underwent the TVT procedure, between May 1999 and May 2002, were retrospectively reviewed. Of the 375 patients, 32 (8.5%) developed a urinary retention (retention group) that required at least 3 days of intermittent catheterization following the procedure. Multiple parameters, with regard to the patients characteristics, symptoms, and urodynamic studies, were analyzed using univariate and multivariate regression analyses between the non-retention (n=343) and the retention (n=32) groups. All the patients, in both groups, answered the global satisfaction question. RESULTS: Ninety percents of the patients (338/375) answered favorably toward the procedure on the global satisfaction question. The univariate analysis demonstrated that the patient's mean age, peak urinary flow rate, and parity, could predict the immediate urinary retention. However, in the multivariate analysis, the peak urinary flow rate was the only significant independent predictive factor (p=0.007). While 28 (87.5%) of the retention group regained normal voiding, with no specific procedure, 4 had to undergone releasing or cutting of the tape within 3 month of the surgery. The global satisfaction question showed a significant difference between the non-retention and retention groups (91.5% satisfaction versus 75% satisfaction, p=0.030). CONCLUSIONS: An accurate measurement of the peak urinary flow rate could predict the women at risk of postoperative urinary retention and compromise the patient's global satisfaction after a highly curative TVT procedure.

The Treatment of Humeral Shaft Fracture by Functional Bracing / 대한정형외과학회잡지

The recent trend in method of long bone fracture had been toward bracing or closed medullary nailing except for certain fractures that fall within well-established surigcal criteria. Functional bracing is gaining widespread acceptance in management of tibial, femoral, and forearm fractures and is well suited to humeral shaft fractures. Twenty four cases of humeral shaft fractures were treated with functional brace and early mobiliza tion from October 19S2 to June 1984 at Busan National University Hospital and the results were as follows. 1. The fracture sites were composed of middle third in 15 cases, distal third in 6 cases, and proximal third in 3 cases and the fracture shapes were transverse in 10 cases, oblique and spiral in 5 cases respectively, and comminuted in 4 cases. 2. The average time from injury to functional bracing was 13.0 days and to discontinuance of the functional brace was 9.0 weeks. 3. Nonunions have not been encountered in all cases. The residual angulation was under 20degrees in all but one and the most common deformity was varus in 20 cases. Minimum limitation of motion, mostly a loss of the last few degrees of external rotation, was detected after follow-up of 2 months but did not present any clinical problem. 4. The achievement of rapid and uninterrupted osteogenesis without undesirable functional or cos- metic deficit could be listed as the advantage.