The Natural Course in Children with Unilateral Multicystic Dysplastic Kidney

Purpose: Advances in modern ultrasonography combined with a dimercaptosuccinic acid (DMSA) renal scan have permitted the diagnosis of a multicystic dysplastic kidney (MCDK) with a high degree of certainty. Most multicystic dysplastic kidneys undergo spontaneous involution during follow-up, as demonstrated by serial ultrasonography. The purpose of this study was to contribute to a better understanding of the natural history of a MCDK, and suggest guidelines for follow-up of a MCDK. Materials and Methods: Between November 1988 and May 2004, 142 children with a MCDK were diagnosed at our institute. A retrospective data analysis was carried out on 38 patients who were conservatively managed and followed for more than 6 months. Follow up ultrasonography examinations were performed every 6 months until patients were 5 years old, and annually thereafter. Patients were divided into simple and complex MCDK based on postnatal physical examination and renal ultrasonography. A simple MCDK was defined as unilateral renal dysplasia without genitourinary abnormalities. Complex MCDK included patients with unilateral renal dysplasia, but with other genitourinary abnormalities. Results: The follow-up periods ranged from 6 to 76 months, with a median of 21.5 months. Partial and complete involution of the affected kidney was observed in 6 (15.8%) and 8 (21.1%) patients, respectively. There was no significant difference in the median involution time between the groups. The median time to involution in all patients was 36 months. Conclusions: Conservative management for a MCDK appears to be a safe option. Because of a complex MCDK has a high incidence of UTI, prophylactic antibiotics may be required. We recommend the long-term follow-up of a MCDK using ultrasonography monitoring.ope

The Clinical Experience of the Ureterocystoplasty in Neurogenic Bladder

Purpose: The ureter can be a very effective tissue for bladder augmentation, but the indications for ureterocystoplasty are still evolving, with the main problem being the limited number of patients with a nonfunctioning or poor functioning kidney. Recently, ureterocystoplasty, with preservation of ipsilateral renal function, has been reported by several authors. We reported our experience and follow-up results of ureterocystoplasty. Materials and Methods: Between December 2000 and February 2003, 4 girls, aged 3 to 13 (mean age 7.2), with a low capacity, poorly compliant bladder underwent ureterocystoplasty using a single dilated ureter. Three patients had a dilated ureter due to high grade VUR (vesicoureteric reflux) and the other due to bilateral reflux. An urodynamic study showed an areflexic neurogenic bladder, with low compliance, in all patients. The technique was performed intraperitoneally using a midline abdominal incision. The distal parts of both detubularized magaureters were used for augmentation. The dilated proximal ureter was anastomosed to the longitudinally incised contralateral ureter, in an end to side fashion. Results: The mean follow-up was 21 months (6-41). In a video-urodynamic study, the mean preoperative bladder capacity and post operative volume were 140cc (67-23) and 223cc (140-320), respectively, with an average increase of 17 to 113% (mean 71). The postoperative bladder compliance was normalized in all cases. Postoperative cystography showed excellent bladder configuration, with no vesicoureteral reflux. There were no surgical complications, such as bladder perforation, stone formation and bowel problem. The serum creatinine levels remained stable in all cases (0.3 to 0.6mg/dl). Conclusions: Although an increase in bladder capacity is not always optimal with the use of a distal ureter, it is good enough to ensure a good clinical outcome and allow an adequate catheterization interval, with a low complication rate.ope

The Impact of Voiding Dysfunction on Vesicoureteral Reflux and Renal Scars

Purpose: To report the relationship between voiding dysfunction and reflux, renal scars and the common findings related to voiding dysfunction in patients with vesico-ureteral reflux (VUR). Materials and Methods: Between March 2002 and February 2004, 56 children underwent a video-urodynamic study (video-UDS) for evaluation of VUR. The grade of VUR, various findings of voiding dysfunction and the maximal intravesical pressure (maxPves) were assessed during voiding, and severity of renal scars were assessed via video-UDS and DMSA scans, respectively. Results: Voiding dysfunction was diagnosed in 30 patients (53.6%). The findings of voiding dysfunction were uninhibited contraction (14 patients), detrusor sphincter dyssynergia (15 patients) and bladder neck opening during the filling phase (17 patients). Urethrovaginal reflux and after contraction were noted in 6 and 8 patients, respectively. In the voiding dysfunction group, the mean VUR grade was 3.4, while this was 2.6 in 42 renal units of the normal voiding group (p=0.023). The mean maxPves values during voiding in the voiding dysfunction and normal voiding groups were 107.7 and 77cmH2O, respectively (p=0.002). On evaluation of the relationship between voiding dysfunction and the extent of renal scarring [no scar, single scar, multiple scars, reduced size], the existence of voiding dysfunction resulted in more severe forms of renal scarring (p=0.034). Conclusions: Voiding dysfunction can cause or aggravate VUR or urinary tract infection due to an increased intravesical pressure during voiding, which can ultimately cause permanent renal damage. Therefore, treatments, such as anticholinergic drugs or biofeedback, must be performed in patients with combined VUR and voiding dysfunction for a better treatment outcome.ope

Voiding Dysfunction after Bilateral Detrusorrhaphy to Correct Vesicoureteral Reflux in Children

Purpose: We evaluated the incidence and duration of voiding dysfunction following bilateral detrusorrhaphy to correct vesicoureteral reflux (VUR), and we also evaluated the factors that influence the development of voiding dysfunction and recovery from voiding function. Materials and Methods: We performed a retrospective review on 36 children, 27 boys and 9 girls, who showed normal voiding function on preoperative video-urodynamic study and for whom data on post-void residual urine volume (PVR) were available postoperatively. The mean age and duration of follow-up were 3.1 2.6 years and 17.5 10.4 months, respectively. Postoperative voiding dysfunction included urinary retention and incomplete bladder emptying. Results: The overall success rate was 97.2%. The urethral catheter was kept in for a mean period of 4.0 3.6 days. After urethral catheter removal, postoperative voiding dysfunction developed in 24 children and urinary retention developed in 5 children. The differences in age, grade of VUR or sex did not have significant influence on the development of voiding dysfunction. 35 children achieved normal PVR during the postoperative follow-up. The mean time to recovery of voiding function was 34.1 37.9 days. The differences in age, sex or grade of VUR did not have any significant influence on the recovery rate of voiding function. The time to recovery of the voiding function was significantly longer in the patients aged less than 2 years or those patients with bilateral high-grade VUR. However, sex did not significantly influence the time to recovery of voiding function. Conclusions: The development of postoperative voiding dysfunction is frequent, but temporary. However, it is necessary to consider a longer period of catheterization for the group of patients aged less than 2 years or those patients with bilateral high grade VUR.ope

The Significance of Simultaneous Transurethral Resection of Bladder Tumor and the Prostate in Patient who have Superficial Bladder Cancer with Bladder Outlet Obstruction.

PURPOSE: We evaluated the clinical significance of simultaneous transurethral resection of bladder tumor(TURB) and the prostate(TURP) in patients who have superficial bladder cancer with bladder outlet obstruction. MATERIALS AND METHODS: Between April 1997 to April 2006, 213 patients with superficial bladder cancer were included in this study. The patients were treated with TURB only(n=107, Group I) or TURB with TURP (n=106, Group II). Bladder cancer recurrence was observed by performing cystoscopy and urine cytology. Uroflowmetry was performed three months after surgery. RESULTS: There were no significant differences in age, the tumor size or the number of tumors between groups I and II. There was no evidence of cancer implantation where TURP was applied. The recurrence rate of group II was significantly lower than that of group I(p=0.044), and the time to recurrence was longer for group II than for group I(p=0.026). There was no significant difference in the progression rate between the two groups(p=0.788). Three months after surgery, the mean residual urine volume was lower for group II(7.9ml) than that for group I(21.7ml). CONCLUSIONS: For superficial bladder cancer patients with bladder outlet obstruction, simultaneous TURB and TURP may help reduce the bladder cancer recurrence rate and delay the time to recurrence without the risk of cancer implantation at the site where TURP is applied.ope

The Subdivision of the Spinal Neurons for Detrusor Function

Purpose: No ideal method for subdividing and assessing changes in neurons of the spinal cord during specific conditions has been established. We attempted to develop a method for subdividing spinal neurons using immunohistochemical and fluorescent staining, which is an important key towards understanding the mechanism of reflex voiding. Materials and Methods: Thirty Sprague-Dawley rats, weighting 200-300g, were divided into five groups. A cystometrogram was performed during saline or acetic acid instillation. We identified the neuronal pathway associated with the detrusor by injecting a pseudorabies virus (PRV) into the detrusor muscle and inspecting the changes in relation to different time sequences. An immunohistochemical staining method was used to stain the fos-protein encoded by the c-fos gene. Immunofluorescent staining was performed to evaluate changes in the neurons in relation to the voiding reflex, and the neurons then subdivided. Results: We confirmed pseudorabies virus (PRV) infection of the cells in the sacral parasympathetic nucleus through immunohistochemical staining two days after injection. On detection of an increase in c-fos positive cells after dividing the c-fos positive area of the L6 and S1 spinal cord into 4 sections, significant increases were observed in the sacral parasympathetic nucleus (SPN) and dorsal commissure (DCM). Double staining was performed to detect the neurons associated with the voiding reflex in the SPN and DCM areas showing overexpression of c-fos. Conclusions: The establishment of a method for detecting morphological changes, and subdividing neurons by immunohistochemical and fluorescent staining, may provide an important key towards understanding the mechanism of various neuromodulations of clinically applied treatments.ope

(The) subdivision of the spinal neuron for control of detrusor muscle

의학과/석사[한글] 척수의 감각신경은 중추신경계의 preganglionic neuron 및 운동신경원 등으로 정보를 제공하는 interneuron으로 전달되고 방광, 요도 및 요도괄약근 반사는 disynaptic이나 polysynaptic pathway를 통해 이루어지는데 이 과정에 하부요로기능을 조절하는 필수적인 역할을 interneuron이 담당하고 있다. C-fos는 중추신경계에서 배뇨반사에 관여하는 신경의 활성을 나타내는 중요한 표식인자로 알려져 있으나 뇌로 전달되는 projection neuron 뿐만 아니라 interneuron, preganglionic neuron이 모두 C-fos 양성으로 관찰되기 때문에 C-fos 단독으로 이러한 신경원을 구분하기에는 부족한 면이 많다. 현재까지 보고된 연구방법으로는 척수의 신경세포를 세분화하여 특정한 상태에서 각 신경세포의 변화를 연구할 수 없는 실정이다. 본 연구는 흰쥐 실험모델에서 배뇨근에 pseudorabies virus를 주입한 후 시간에 따른 변화를 관찰하여 배뇨근에 관여하는 신경로를 확인하였다. PRV virus 주입 2일에 면역조직화학염색을 시행하여 virus가 sacral parasympathetic neucleus에 분포하는 세포를 감염시킨 것을 확인하였고 이러한 세포의 분포는 choline acetyltransferase를 사용한 염색에서 확인한 preganglionic neuron이 분포하는 위치와 동일하다는 것을 알 수 있었다. virus 주입 2.5일 이후에는 2일에 virus 양성 세포가 관찰되던 SPN 영역의 뒤쪽 부위, DCM, dorsal horn의 superficial laminae에서 virus 양성 세포가 증가하는 양상이었다. 2시간동안 방광내 acetic acid를 주입하여 감각신경활성을 통한 배뇨반사를 유도하였으며 요역동학검사를 통하여 배뇨횟수가 증가하는 것을 확인하였다. 이러한 배뇨반사에 의한 신경원의 형태학적 변화 및 세분화를 위하여 면역조직화학염색 및 형광염색을 시행하였다. L6, S1 척수에서 C-fos 양성을 나타내는 부위를 4개의 영역으로 구분하였고 C-fos 단백질에 양성을 나타내는 세포의 증가를 관찰한 결과 SPN, MDH 영역에서 유의하게 증가하였다. C-fos 발현이 증가한 SPN 및 MDH 영역에서 배뇨반사에 관여하는 신경원을 분류하기 위해서 이중염색을 시행하였고 배뇨반사에 관여하는 preganglionic neuron은 C-fos 양성 및 ChAT 양성인 세포, interneuron은 C-fos 양성, PRV 양성인 세포, projection neuron은 C-fos 양성 및 PRV 음성인 세포로 구분할 수 있다. 이러한 면역조직화학염색 및 형광염색을 통한 신경원의 형태학적인 변화 및 세분화방법을 확립함으로써 현재 임상에 적용하고 있는 각종 neuromodulation 치료의 기전을 규명하는데 있어서 중요한 연구방법을 제시할 것으로 기대한다. [영문]Sensory neurons of the spinal cord transmit signals to the preganglionic neurons and interneurons which transmit then transmit signals to the motor nuclei of the CNS. Reflexes of the bladder, urethra and sphincter occur through disynaptic or polysynaptic pathways and interneurons play a major role in controlling the lower urinary tract function via such pathways. C-fos, although known as a significant factor expressed when nerves of the associated with voiding reflex are activated, is inadequate in identifying such activation per se since C-fos is expressed not only in projection neurons to the brain but also in interneurons and preganglionic neurons, as well. No ideal method for subdividing neurons of the spinal cord and assessing the changes in those neurons during specific conditions have been established yet. In this study we identified the neural pathway associated with the detrusor by injecting pseudorabies virus into the detrusor muscle of Sprague-Dawley rats and inspecting the change according to different time sequence. We confirmed infection of the cells in the sacral parasympathetic nucleus by PRV through immunohistochemical staining two days after injection and we could also know that the area infected correlated to the where the preganglionic neurons are distributed on staining using choline acetyltransferase. 2.5 days after virus injection, the virus positive cells tended to increase in the area beyond SPN which showed viral infected cells 2 days post-injection, DCM and in the superficial laminae of dorsal horn. Voiding reflex was triggered through activation of sensory neurons by intravesical instillation of acetic acid for 2 hours and urodynamic studies proved increase in the frequency of voiding. Immunohistochemical and fluorescent staining were performed to evaluate changes in neurons according to voiding reflex and subdivide those neurons. On detection of increase in C-fos positive cells after dividing the C-fos positive area in the L6 and S1 spine into 4 sections, a significant increase was observed in the SPN and MDH area. Double staining was performed to detect the neurons associated with voiding reflex in the SPN and MDH area showing overexpression of C-fos. As a result preganglionic neurons associated with voiding reflex were C-fos and ChAT positive, interneurons C-fos and PRV positive and projection neurons were C-fos positive and PRV negative. Establishment of a method detecting morphological changes and subdividing neurons by immunohistochemical and fluorescent staining may provide an important key towards the understanding of the treatment mechanism of various neuromodulations which are being clinically applied. Sensory neurons in the spinal cord transmit signals to the supraspinal neurons, preganglionic neurons and interneurons transmitting signals to the motor nuclei.ope

(The) effects of situational variables, personality, and leadership style on sailors` subjective well-being in the Navy

Thesis(masters) --서울대학교 대학원 :심리학과(성격심리전공),2010.2.Maste

A DCT coefficients error concealment by using adjacent blocks in spatial domain

학위논문(석사) - 한국과학기술원 : 전기 및 전자공학과, 1994.2, [ ii, 58 p. ]한국과학기술원 : 전기 및 전자공학과

Long-term outcome of simultaneous transurethral resection of bladder tumor and prostate in patients with nonmuscle invasive bladder tumor and bladder outlet obstruction.

PURPOSE: We evaluated the long-term outcome of simultaneous transurethral bladder tumor and prostate resection in patients with nonmuscle invasive bladder tumor and bladder outlet obstruction. MATERIALS AND METHODS: Between April 1997 and April 2006, 213 patients with nonmuscle invasive bladder tumor who had a minimum followup of 24 months were included in the study, including group 1-107 with transurethral resection of bladder tumor only and group 2-106 with transurethral bladder tumor and prostate resection. Simultaneous transurethral bladder tumor and prostate resection was performed at surgeon discretion. The records were retrospectively analyzed for clinicopathological parameters, recurrence and progression rates, time to recurrence and postoperative uroflowmetry results in the 2 groups. RESULTS: There were no significant differences in clinicopathological parameters between the 2 groups. At a mean followup of 54.3 and 50.1 months in groups 1 and 2, respectively, group 2 patients with a tumor less than 3 cm or a single tumor had a significantly lower recurrence rate than group 1 patients. None of the 31 patients with recurrence in group 2 had recurrence in the bladder neck or prostatic urethra where transurethral prostate resection had been done. There was no significant difference in the progression rate between the 2 groups. The 60-month recurrence-free probability in groups 1 and 2 was 43.4% and 52.0%, respectively. Three months after surgery the postvoid residual urine volume had significantly decreased in group 2. CONCLUSIONS: Simultaneous transurethral bladder tumor and prostate resection may help decrease bladder cancer recurrence and delay time to recurrence without the risk of cancer implantation when transurethral prostate resection is done, especially in patients with a papillary, solitary-appearing bladder lesion less than 3 cmope