, Jun Hyeok Song Moyamoya disease is a cerebrovascular disease that features stenosis or occlusion at the distal internal carotid artery and proximal portion of the anterior and middle cerebal arteries. Before reversible changes occur to the brain revascularization surgery for patients of moyamoya disease is believed to prevent cerebral ischemic attacks by increasing and improving cerebral blood flow. The authors present the experiences of surgery for patents with ischemic or hemorrhage.
Revascularization surgeries were performed in 10 patents with episode of ischemic, seizure and hemorrhage between 1994 and 1999. There were 3 male and 7 female, aged 5 to 54(mean32.4 years) and 6 patients with ischemic, 3 patients with hemorrhage and 1 patient with seizure. Procedure of EDAS was performed in 4 patients with ischemic and 1 patient with hemorrhage. EMS was performed in 3 patients with hemorrhage and 1 patient with seizure. Combined EDAS and EMS was performed in 1 patients with ischemic. One superior cerebellar artery aneurysm was demonstrated and clipped and pseudoaneurysms was obseved in one patient. The authors studies the relationship between efficasy and outcome of surgical treatments.
All patients except one patient who died were followed up >3 years, from onset untill 1999. Improved and no recurred of symptoms and signs were observed in all patients who underwent EDAS procedure. Rebleeding was observed in 1 among 4 patients who underwent EMS procedure and the patient died of rebleeding 1 patient who underwent combined procedures EDAS and EMS resulted in improved and no recurrence of ischemic symptom. 1 superior cerebellar aneurysmal clipping was performed successfully. The pseudaneurysms arising dilating perforating moyamoya vessels in patient with hemorrhage were source of the hemorrhage and rebleeding.
The surgically treated patient seems to have good results, but long term study of large numbers of patient needs further investigation. Although the procedure of EDAS and EMS were successful in producing effective indirect arterial anastomoses and improvement in symptoms, superficial temporal artery middle cerebral artery(STA-MCA) anastomosis combined with indirect arterial anastomotic procedures were recommended as the appropriate surgical treatment for refracting cases of moyamoya disease.
, Jae Jin Han There have been many parameters that determined the results of radiocephalic ffisutla. However, few reliable intraoperative parameters have been suggested until now. The purpose of this study was to find the correlation between intra-operative blood flow and early patency of radiocephalic fistula.
Between March 1998 and October 1999, 45 radiocephalic arteriovenous fistulas were constructed in 38 patients. Intra-operative blood flow measurements were made 10 minutes after complection of the vascular anastomoses with 3-4mm handheld flow probes. Patients were followed until failure of fistula or 3months after first hemodialysis with these fistulas. Intraoperative blood flow as well as age, sex, presence of diabetes, size of cephalic vein, thrill on the fistula and flow of radial artery were correlated with early patency.
The mean intraoperative blood flow was 195.9±16.7 mL/min ranged from 50 to 500 mL/min, and it was the only significant parameter that determined early patency of radiocephalic fistula. Fistulas with flow less than 150 ml/min(10 of 18) revealed higher failure rate than those of flow more than 150 ml/min(1 of 27), which was statistically significant(p<0.01). All of the patients with flow less than 70 ml/min(5 of 5) failed in maintaining patency within a month. However, the other variables were not correlated with early patency.
In conclusion intra-operative blood flow measurements can be performed with ease and intraoperative blood flow in radiocephalic fistula is well correlated with early patency of the fistula. And we rocommend that radio-cephalic fistula of flow less than 150mL/min should be observed carefully and that of flow less than 70mL/min must be abandoned intraoperatively.
, Kyung Hun Kim, Ji Seok Leem, Sung Han Lee, Bong Suk Shim, Young Yo Park, Sung Won Kwon We retrospectively reviewed the cases of ureteroscopic stone removal at our hospital from January, 1994 to August, 1999 and defined the efficiency and complications of ureteroscopic stone removal.
Ureteroscopic stone removal was in 255 cases of ureteral stone from January, 1994 to August, 1999. Patients were 142 males and 113 females, and mean age was 42.5 years. 20 stones were located in the upper ureter, 29 stone in the mid ureter, 206 stones in the lower ureter. The stone size was less than 5mm in 95 cases, from 5 to 10mm in 117 cases and more than 10mm in 43 cases. Ureteroscpic stone ramoval was performed with 7.5Fr, 9.5Fr rigid ureteroscope under general, spinal, and epidural anesthesia.
255 cases of ureteroscopic stone removal were performed and over all success rate of ureteroscopic stone removal was 97 percent. The success rates of upper, mid and lower ureteral stones were 85, 93 and 99 percent. According to the size, the success rate was 99 percent in stones less than 5mm, 98 percent in stones of 5 to 10mm and 90 percent in stones more than 10mm. There were 8 cases of complication and over all complication rate was 3.1 percent. Complications consisted of severe mucosal injury(3 cases), ureteral perforation(3 cases), gross hematuria(1 case), urinary tract infecion(1 case). Complications were treated successfully with conservative treatment except 1 case of severe mucosal injury that required ureteral reimplantaton.
Ureteroscopic stone removal could provide rapid resolution of obstruction and colic due to ureteral calculi with high seccess rate and minimal complications.
Citations
I investigated the relationships among International prostate symptom score(IPSS), prostatic size and other factors, and look into the possibility of the expert system for benign prostatic hyperplasia in symptomatic prostatism.
Through the prostate awareness program, 349 men had undergone IPSS questionnaire, uroflownetry and transrectal ultrasonography. I analyzed the correlation coefficient to revel the relationship among age, maximal flow rate(MFR), and prostatic size, according to the several parameters.
The relationships among the age, MFR and prostatic size were statistically significant. When the all men were classified according to the height, weight, educational course and resident place, the relationships were not significant different.
, Sang Hyu No, Jung Whan Son, Chang Gu Han, Sung Han Lee, Ha Na Yoon, Jae Yup Hong Primary transitional cell carcinoma(TCC) of the bladder is a rare during child-bearing age and only 10 such cases have been reported in the literature1-6). The patients presented with gross hematuria which was initially mistaken as vaginal bleeding. Initial diagnosis was made with sonography. Diagnosis was easily confirmed by cystoscopy with biopsy. Transurethral resection of the bladder tumor was performed as usual manner and postoperative course was uneventful. We experienced transitional cell carcinoma of bladder in a 26 year-old in the 21 week of pregnancy.
, Youn-Jin Kim, Hyun-Joo Kim, Soyun Cho, Kyu-Kwang Whang, Jeong-Hee Hahm We report a case of type III hyperlipoproteinemia associated with tuberous xanthoma, which is improved by treatment with lovastatin and bezafibrate. A 34-year-old female patient visited our clinic for evaluation of multiple yellowish-brown papulonodules on the kness, elbows and palms. Serum lipid examination showed an abnormal elevation of serum cholesterol and triglyceride. Lipoprotein electrophoresis showed a single peak at pre-β and β portion without separation. The biopsh specimen from a nodule on the knee and a papule on the palm revealed characteristic findings of xanthoma. We diagnosed the case as type III hyperlipoprotei-nemia. After 3 months of treatment with diet restriction, lovastatin and bezafibrate, the serum levels of cholesterol and triglyceride were reduced to normal level. The skin lesion of the palm showed complete regression and ones on both knees and elbows were moderate improvement.
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