Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: Early sonographic changes that correlate with a loss of differential renal function

PURPOSE: To evaluate changes in differential renal function (DRF), as a functional outcome, in children who underwent redo pyeloplasty for management of failed pyeloplasty and to examine the factors that affect functional outcomes. MATERIALS AND METHODS: Between January 2002 and November 2010, a total of 18 patients who underwent redo pyeloplasty for persistent ureteropelvic junction obstruction after failed pyeloplasty were enrolled in this study. We assessed perioperative factors and evaluated changes in renal cortical thickness (RCT), renal function, and hydronephrosis by use of serial ultrasound and diuretic renography. RESULTS: The mean follow-up period was 44.83+/-28.86 months. After redo pyeloplasty, prevention of further functional deterioration was observed in only 12 of the 18 patients. After dividing the patients according to this observation, we discovered significant differences in both change in DRF (dDRF) and change in RCT (dRCT) (difference between before and after initial pyeloplasty) between the two groups (p<0.001). Additionally, we noted a significant positive correlation between dRCT and dDRF. All patients showed improvements in hydronephrosis grade and relief of symptoms compared with before redo pyeloplasty. CONCLUSIONS: Redo pyeloplasty should be considered in cases of failed pyeloplasty to preserve renal function and obtain relief from symptoms. If patients show severe deterioration of DRF or a decrease in RCT after initial pyeloplasty, preservation of DRF in these patients after redo pyeloplasty could be difficult. Therefore, redo pyeloplasty should be performed before severe deterioration of DRF or decrease in RCT.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience / 전남의대학술지

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Clinical Experiences of Incidental Prostate Cancer after Transurethral Resection of Prostate (TURP) According to Initial Treatment: A Study of a Korean High Volume Center

PURPOSE: These are the clinical experiences of Korean incidental prostate cancer patients detected by transurethral resection of the prostate according to initial treatment: active surveillance (AS), radical prostatectomy (RP) and hormone therapy (HT). MATERIALS AND METHODS: We retrospectively reviewed the records of 156 incidental prostate cancer patients between 2001 and 2012. The clinicopathologic outcomes were reviewed and follow-up results were obtained. RESULTS: Among 156 patients, 97 (62.2%) had T1a and 59 (37.8%) had T1b. Forty-six (29.5%) received AS, 67 (42.9%) underwent RP, 34 (21.8%) received HT, 4 (2.6%) received radiotherapy, and 5 (3.2%) chose watchful waiting. Of 46 patients on AS, prostate-specific antigen (PSA) progression occurred in 12 (26.1%) patients. Among them, 3 patients refused treatment despite PSA progression. Five patients, who underwent RP as an intervention, all had organ-confined Gleason score < or =6 disease. In 67 patients who underwent RP, 50 (74.6%) patients had insignificant prostate cancer and 8 (11.9%) patients showed unfavorable features. During follow-up, biochemical recurrence occurred in 2 patients. Among 34 patients who received HT, 3 (8.8%) patients had PSA progression. Among 156 patients, 6 patients died due to other causes during follow-up. There were no patients who died due to prostate cancer. CONCLUSION: The clinical outcomes of incidental prostate cancer were satisfactory regardless of the initial treatment. However, according to recent researches and guidelines, immediate definite therapy should be avoided without a careful assessment. We also believe that improved clinical staging is needed for these patients.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience / 전남의대학술지

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Meta-Analysis of the Relationship between CXCR4 Expression and Metastasis in Prostate Cancer

PURPOSE: Experimental studies have suggested that the stromal-derived factor-1 (SDF-1)/CXCR4 axis is associated with tumor aggressiveness and metastasis in several malignancies. We performed a meta-analysis to elucidate the relationship between CXCR4 expression and the clinicopathological features of prostate cancer. MATERIALS AND METHODS: Data were collected from studies comparing Gleason score, T stage, and the presence of metastasis with CXCR4 levels in human prostate cancer samples. The studies were pooled, and the odds ratio (OR) of CXCR4 expression for clinical and pathological variables was calculated. RESULTS: Five articles were eligible for the current meta-analysis. We found no relationship between CXCR4 expression and Gleason score ( or =7). The forest plot using the fixed-effects model indicated an OR of 1.585 (95% confidence interval [CI]: 0.793~3.171; p=0.193). Further, CXCR4 expression was not associated with the T stage ( or =T3), and the relevant meta-analysis showed OR=1.803 (95% CI: 0.756~4.297, p=0.183). However, increased CXCR4 expression was strongly associated with metastatic disease with a fixed-effects pooled OR of 7.459 (95% CI: 2.665~20.878, p<0.001). CONCLUSIONS: Our meta-analysis showed that the higher CXCR4 protein expression in prostate cancer specimens is significantly associated with the presence of metastatic disease. This supports previous experimental data supporting the role played by the SDF-1/CXCR4 axis in metastasis.

Small bowel obstruction in early pregnancy: A case report / 대한산부인과학회지

Intestinal obstruction occurs rarely as a cause of acute abdominal pain during pregnancy. It is very difficult to make diagnosis, as nausea, vomiting and abdominal pain are commonly associated with pregnancy, and X-rays are avoided if possible. However, delayed diagnosis can cause intestinal strangulation, which results in a high incidence of maternal morbidity, mortality, premature labor, and fetal loss. The incidence of intestinal obstruction seems to increase at the time of rapid uterine size changes such as between 16~20 weeks, 32~36 weeks or even in the puerperium. The possibility of intestinal obstruction must always be kept in mind when a pregnant woman with an operation scar on her abdomen develops abdominal pain. We present a case of small bowel obstruction during early pregnancy with a brief review of the literature who had the history of right salpingo-oophorectomy and appendectomy operation

A case of heterotopic pregnancy: 16 weeks of intrauterine pregnancy with fetal Edwards syndrome and tubal pregnancy, following IVF-ET / 대한산부인과학회지

Heterotopic pregnancy is defined as coexistence of intrauterine and ectopic pregnancy. The reported incidence of heterotopic pregnancy, which is normally rare, is particularly high (1%) after IVF treatment. It is important to have a high index of suspicion for the occurrence of heterotopic pregnancies because only 40% to 84% of cases can be diagnosed with transvaginal ultrasound at the initial presentation. Edwards syndrome occurs in 8,000 newborns and the incidence is much higher in elderly gravidas. We report a case of heterotopic pregnancy following IVF-ET resulting in 16 weeks of intrauterine pregnancy with fetal Edwards syndrome, and tubal pregnancy with a brief review of literature.

A case of spontaneous ovarian hyperstimulation syndrome in consecutive pregnancies / 대한산부인과학회지

The ovarian hyperstimulation syndrome (OHSS) is one of the notorious complications of assisted reproduction procedure. Severe and moderate OHSS associated with a spontaneous pregnancy is rare. We experienced a case of two normal, spontaneously conceived pregnancies with OHSS and her past obstetric history included prior spontaneous OHSS in the first trimester and term vaginal delivery of normal baby.

Abdominal Wall Endometriosis after Cesarean Section: A Report of Two Cases / 대한산부인과학회지

Extrapelvic endometriosis remains quite rare phenomenon. The majority of extrapelvic endometriosis involve scar tissue following obstetric/gynecologic procedures. Endometriosis involving a cesarean section scar may be more common than previously recongnized. The classic symptom is a painful scar that became swollen and more tender during menstruation. The cause of surgical scar endometriosis is believed to be iatrogenic transplantation of endometrial tissue to the surgical wound. The surgical excision remains the treatment of choice for expected cures and presents the most appropriate diagnostic and therapeutic intervention. We present two cases of endometriosis appearing on the abdominal wall scar of cesarean section with a brief review of the concerned literatures.

A Case of Intracolonic Surgical Sponge misdiagnosed as Intraperitoneal Foreign Body / 대한산부인과학회잡지

Intraperitoneal foreign body is a rare but extremely troublesome condition. Such as forceps, rubber tubes, pieces of broken instruments can retained during surgery but most commonly foreign body is the surgical sponge. The retained foreign body produce intra-abdominal abscess, peritonitis, intestinal obstruction in the postoperative period or even after weeks, months or years and very uncommonly migrate into the bowel. We report a case of intracolonic surgical sponge misdiagnosed as retained intraperitoneal foreign body with brief review of literatures.

Thromboxane in Pregnancy-Induced Hypertension / 대한산부인과학회잡지

OBJECTIVE: High thromboxane level evidence supports pivotal involvement of TxA2 in pathophysiology of pregnancy induced hypertension and provides a strong rationale for pursuing TxA2-blocking strategies in drug development. METHODS: The stable metabolites of TXA2 (Thromboxane B2) in maternal blood of 12 patients with mild preeclampsia, 4 patients with severe preeclampsia and 14 normal parturients were measured by competitive enzyme immunoassay. RESULTS: TxB2 concentrations were not increased in mild preeclampsia (101 +/- 12 pg/mL, n=12) as compared with normal pregnancy (150 +/- 15 pg/mL, n=14), but they were significantly increased in severe preeclampsia (454 +/- 102 pg/mL, p<0.0001, n=4). CONCLUSION: Maternal plasma thromboxane is increased only in severe preeclampsia. Thus, increased thromboxane A2 biosynthesis correlates with disease severity and may have a pathogenetic role in pregnancy-induced hypertension. These findings provide a rationale for the use of aspirin in the treatment as well as in the prevention of this disorder.

A Case of Ruptured Noncommunicating Rudimentary Uterine Horn Twin Pregnancy / 대한산부인과학회잡지

The uterus with rudimentary horn occurs as a result of a lack of development during fetal life of the middle and lower part of one of the M llerian ducts, in which there is a failure of fusion of the two ducts. Pregnancy in the rudimentary uterine horn is very rare, its incidence is reported nearly as 1 case per 100,000 normal pregnancy. We experience a case of ruptured rudimentary uterine horn twin pregnancy at 29-gestational week and report the case with brief review of literatures.

A Case of Pelvic and Abdominal Actinomycosis Associated with Wearing an Intrauterine Device / 대한산부인과학회잡지

Actinomycosis, a rare disease entity in the upper genital tract, and caused by anaerobic bacteria, Actinomyces israelii, presents some difficulties in establishing a correct preoperative diagnosis. Pelvic actinomycosis has been reported more frequently in women with intrauterine device (IUD). Actinomycosis may be confused with malignancy and other inflammatory diseases due to its infiltrative nature and tendency to invade normal anatomic barriers. So, cervicovaginal smear is recommended for all women wearing IUDs, and actinomyosis should be suspected in such patients suffering pelvic infections. We experienced a case of pelvic and abdominal actionomycosis complicated by tuboovarian abscess in a 52 year-old woman wearing IUD and report it with a brief review of related literatures.

A study on the relationship of leptin concentrations in the maternal plasma and cord blood to fetal weight in term normal-pregnant and preeclampsia women / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to assess the relationships between maternal plasma and umbilical cord leptin concentrations and their effects on newborn birth weights, maternal body mass indices and fetal sex in term normotensive (NT) and preeclampsia (PE) women. METHODS: Blood samples were obtained at delivery from 20 NT group and another 20 from PE group of at least 36 weeks of gestation. And the umbilical cord samples were also taken from their newborns at birth. Plasma leptin levels were determined in both groups using a human recombinant leptin 125-I radioimmunoassay. RESULTS: Mean maternal plasma and umbilical cord leptin concentrations were 16.16+/-2.05 ng/ml and 7.11+/-1.01 ng/ml in NT group, 17.09+/-1.67 ng/ml and 8.55+/-6.63 ng/ml in PE group, and there was no statistical significances among them. The differences of leptin concentrations in maternal plasma and umbilical cord according to baby sex were not significant in both NT and PE groups. Plasma leptin concentrations were related with maternal weight gain and BMI in NT group and with body weight in PE group. The BMI and birth weights of the neonates have significant effects on the umbilical cord leptin concentrations in both NT and PE groups. CONCLUSION: In this study, no correlation was found between maternal plasma and umbilical cord leptin concentrations in both NT and PE groups. But maternal plasma leptin concentrations had positive correlations with maternal body weight, BMI, and body weight changes during pregnancy in both NT and PE groups. There were also positive correlations among umbilical cord leptin concentrations, BMI and birth weights of the neonates of NT and PE groups term. Therefore umbilical cord leptin is considered to be the index of fetal birth weight.

A study on the relationship of leptin concentrations in the maternal plasma and cord blood to fetal weight in term normal-pregnant and preeclampsia women / 대한산부인과학회잡지

OBJECTIVE: The aim of this study is to assess the relationships between maternal plasma and umbilical cord leptin concentrations and their effects on newborn birth weights, maternal body mass indices and fetal sex in term normotensive (NT) and preeclampsia (PE) women. METHODS: Blood samples were obtained at delivery from 20 NT group and another 20 from PE group of at least 36 weeks of gestation. And the umbilical cord samples were also taken from their newborns at birth. Plasma leptin levels were determined in both groups using a human recombinant leptin 125-I radioimmunoassay. RESULTS: Mean maternal plasma and umbilical cord leptin concentrations were 16.16+/-2.05 ng/ml and 7.11+/-1.01 ng/ml in NT group, 17.09+/-1.67 ng/ml and 8.55+/-6.63 ng/ml in PE group, and there was no statistical significances among them. The differences of leptin concentrations in maternal plasma and umbilical cord according to baby sex were not significant in both NT and PE groups. Plasma leptin concentrations were related with maternal weight gain and BMI in NT group and with body weight in PE group. The BMI and birth weights of the neonates have significant effects on the umbilical cord leptin concentrations in both NT and PE groups. CONCLUSION: In this study, no correlation was found between maternal plasma and umbilical cord leptin concentrations in both NT and PE groups. But maternal plasma leptin concentrations had positive correlations with maternal body weight, BMI, and body weight changes during pregnancy in both NT and PE groups. There were also positive correlations among umbilical cord leptin concentrations, BMI and birth weights of the neonates of NT and PE groups term. Therefore umbilical cord leptin is considered to be the index of fetal birth weight.

A study of the effects of epidural analgesia on the course of labor and delivery mode / 대한산부인과학회잡지

OBJECTIVE: This study was designed to evaluate the effect of epidural analgesia on the course of labor and delivery mode. METHOD: Three hundred eighteen term pregnant women with singleton fetus in vertex presentation were admitted for vaginal delivery at the Department of Obstetrics and Gynecology, medical center Chung-ju hospital from January 1, 1998 to December 31, 1998. They were divided into two groups: epidural analgesia group and non-epidural analgesia group. Epidural analgesia group was 106 women (79 primiparas and 27 multiparas). Non-epidural analgesia group was 212 women (138 primiparas and 74 multiparas). Course of labor and delivery mode were compared between the two groups. RESULTS: 1. The duration of the first stage of labor was not significantly different between two groups (primiparas: 672+/-110 min vs 625+/-134 min, multiparas: 458+/-152 min vs 422+/-184 min), and that of the second stage of labor in the primiparas was significantly longer in epidural analgesia group than non-epidural analgesia group (62+/-25 min vs 42+/-20 min, p=0.03), but did not differ significantly in the multiparas groups (36+/-12 min vs 31+/-20 min).2. Cesarean delivery rates were not significantly different between two groups (19.8% vs 15.1%).3. Cesarean delivery rates due to failure to progress were not significantly different between two groups (85.7% vs 78.1%).4. Oxytocin augmentation rates were significantly higher in epidural analgesia group than in non-epidural analgesia group (primiparas: 42.3% vs 20.1%, p=0.008, multiparas: 38.5% vs 19.7%, p=0.01).5. The newborn birthweight, Apgar score and the incidence of meconium-stained amnionic fluid were not significantly different between two groups.6. The complication of the epidural analgesia were back pain (10.4%), shivering (7.5%), nausea and vomiting (1.3%), hypotension (0.9%), and voiding difficulty (0.9%). CONCLUSION: Though epidural analgesia prolonged second stage of labor in the primiparas and increased oxytocin augmentation rates but did not increased the cesarean delivery rates. So intrapartum epidural analgesia provided safe and effective pain control without undesirable effects on labor outcomes.

A Case of Pelvic and Abdominal Actinomycosis Associated with wearing an Intrauterine Device / 대한산부인과학회잡지

Actinomycosis, rare in pelvic localization and a severe condition not well known to gynecologists, is an uncommon entity caused by anaerobic bacteria, Actinomycosis israelii. After trauma, surgery, or other infections that alter the host's mucosal barriers, these organisms advance to invade surrounding tissue and organs. The pelvic loculation of the disease generally presents as a pseudoneoplastic formation, so it is very difficult to make an accurate diagnosis initially. We experienced a pelvic and abdominal actinomycosis confirmed by pathology in a woman who had been wearing an IUD and complained fever, chill, headache for one month, and lower abdominal pain and palpable mass. This case illustrates the importance of considering the possibility of actinomycosis when we met a vague abdominal mass.

A case of thanatophoric dwarfism / 대한산부인과학회잡지

No abstract available.