Effect of Transurethral Resection With Hydrodistention for the Treatment of Ulcerative Interstitial Cystitis

PURPOSE: Many treatment options to help relieve the symptoms of interstitial cystitis (IC) are available, but none are effective. Because no reports of transurethral ulcer resection with hydrodistention are available, we assessed the effects of such combined surgery for ulcerative IC. MATERIALS AND METHODS: Between June 2006 and June 2011, 87 female patients with IC who underwent transurethral resection with hydrodistention and were followed up for at least 12 months were included. Improvements in patients' voiding symptoms and pain were analyzed retrospectively by using a 3-day micturition chart and a 10-point visual analogue scale (VAS) before and after the operation. The global response assessment (GRA) was used to assess treatment satisfaction. RESULTS: The mean age of the 87 female patients was 59.1+/-10.1 years, and the mean follow-up period was 26.7+/-14.4 months. Mean maximum functional bladder capacity increased from 168.4+/-92.4 mL to 276.3+/-105.4 mL (1 month) and to 227.3+/-91.7 mL (12 months). The mean frequency of voiding decreased from 17.2+/-8.5 before to 10.6+/-5.3 after (1 month) surgery; however, it increased again to 13.3+/-4.8 at 12 months. The 10-point VAS score decreased from 9.1+/-0.8 to 1.2+/-0.3 (1 month); however, it increased again to 2.5+/-0.4 (3 months), 3.2+/-0.4 (6 months), and 5.3+/-0.5 (12 months) (p<0.001). Symptom improvement based on the GRA was observed in 83 of the 87 patients (95.4%) at 1 month and in 55 of 87 patients (63.2%) at 12 months. CONCLUSIONS: Transurethral resection with hydrodistention is an effective treatment option for ulcerative IC because it provides improvements in voiding symptoms and pain.

Spontaneously Ruptured Renal Cell Carcinoma During Hemodialysis in Two Patients with End-Stage Renal Disease

Spontaneously ruptured renal cell carcinoma (RCC) in end-stage kidney disease is very rare. Preoperative diagnosis is difficult because of the relatively small tumor size, associated hematoma, and surrounding acquired cysts. Two middle-aged men who were maintained on hemodialysis (HD) for over 10 years suddenly developed flank pain during HD. Computed tomography scans revealed an enhancing ruptured renal mass in one patient, and no obvious tumor lesion except for a hematoma in the other, both of which were later confirmed as RCCs by pathologic specimens.

Effect of Intrathecal Morphine on Tourniquet Pain / 대한마취과학회지

In order to study the effect of spinal morphine on the tourniquet pain, 40 patients scheduled for orthopedic surgery on the lower extremity under spinal anesthesia were allocated randomly to two groups. In the experimental group, 20 patients received hyperbaric T-cain 10 mg and morphine 0.3 mg (0. 15 ml). In the control group, 20 patients received T-cain 10 mg and saline 0.15 ml. The levels of analgesia and motor block were similar in both groups. During surgery, patients in both groups did not complain of tourniquet pain, whereas one patient in the control group required general anesthesia for surgical pain although the sensory block extended to T(7). In the recovery room, when the sensory block had regressed to the Tdermatomal level, the pain response was checked on the contralateral unoperated thigh in a 60 min tourniquet pressure experiment (350 mmHg for 20 min, 0 mmHg for 20 min, 350 mmHg for 20 min). Seventeen patients in the experimental group experimenced no pain in this test, compared with four patients in the control group. From this study, it is suggested that intrathecal morphine prevents tourniquet pain and it may have some inhibitory effect on tourniquet pain transmission at the spinal cord level.