Leukemoid Reaction, a Rare Paraneoplastic Syndrome in Urothelial Cell Carcinoma: Is It an Indicator of a Poor Prognosis?

A leukemoid reaction is usually associated with malignancies of the lung, stomach, and thyroid. In contrast, urothelial cell carcinoma is rarely associated with leukemoid reactions, with few cases reported over the past 30 years. Here, we describe a patient with urothelial cell carcinoma who exhibited a leukemoid reaction. The patient had an elevated white blood cell count and experienced a rapid and aggressive clinical course, terminating in death. For urothelial cell carcinoma patients exhibiting a leukemoid reaction, removal of the inciting tumor is the definitive treatment. However, considering the aggressive nature of these tumors, if the patient is unsuitable for radical surgical management, palliative chemotherapy should be considered.

Persistent Genital Swelling after Hydrocele Ligation in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis / 대한배뇨장애요실금학회지

We report a case of genital swelling in a patient receiving continuous ambulatory peritoneal dialysis. A physical examination did not identify any defect. Ultrasonography revealed a large hydrocele, and surgical repair brought resolution of the genital swelling. Two months later, however, the genital swelling had recurred and was not improved until peritoneal dialysis was replaced by hemodialysis 3 months later.

Is a Decreased Serum Testosterone Level a Risk Factor for Prostate Cancer? A Cohort Study of Korean Men

PURPOSE: To investigate patients who had transrectal ultrasonography (TRUS)-guided prostate biopsy to define the role of the serum testosterone level in predicting prostate cancer risk and its association with a high Gleason score. MATERIALS AND METHODS: A total of 568 patients who underwent prostate biopsy were entered in this study. We divided the patients into two groups according to serum testosterone level (median level, 3.85 ng/ml): the high-testosterone group (n=285) and the low-testosterone group (n=283). Multivariate regression analysis was used to define the effect of age, prostate volume, serum prostate-specific antigen (PSA) level and PSA density, and serum testosterone level on the risk of prostate cancer and a high Gleason score. RESULTS: Baseline characteristics did not differ significantly between the two groups. Compared with the high-testosterone group, the low-testosterone group had a significantly higher prostate cancer incidence (38.9% vs. 29.5%, p=0.018). Factors associated with an increased risk of prostate cancer were increased age (odds ratio [OR]=1.08, 95% confidence interval [CI]=1.25-3.16, p=0.001), a high serum PSA level (OR=3.35, 95% CI=2.63-4.25, p=0.001), a low prostate volume (OR=0.183, 95% CI=0.11-0.30, p=0.001), and a low serum testosterone level (OR=1.99, 95% CI=1.25-3.16, p=0.001). Among these, only the serum PSA level was a strong predictor of high-grade prostate cancer (Gleason score > or =7) (OR=2.19, 95% CI=1.57-2.95, p=0.001). CONCLUSIONS: Patients with lower levels of serum testosterone had a higher risk of prostate cancer than did patients with high serum testosterone. Even though a lower serum testosterone level was a predictor of prostate cancer risk, it was not associated with an increased risk of high-grade prostate cancer.

The Patient Characteristics and Birth Outcomes of Vasovasostomy / 대한남성과학회지

PURPOSE: The purpose of this study was to investigate the characteristics of the patients who had undergone vasovasostomy and to analyze the reasons for an increase in the number of these operations. MATERIALS AND METHODS: From January 1999 to April 2007, 105 patients were analyzed by examining their medical records and conducting telephone surveys. The patients were divided into two groups before and after insurance payments for a vasovasostomy. Analysis of the differences between the two groups was performed by grouping the patients who had a vasovasostomy before July 2004 and those who had a vasovasostomy after July 2004. RESULTS: Among the 105 patients, 35 patients (0.58/month) had a vasovasostomy before receiving their insurance payment. However, the number of operations increased by more than 4 times (70 patients, 2.33/month) after insurance repayment (p<0.05). After the payment, the proportion of patients willing to have a vasovasostomy due to changing their mind increased, whereas the proportion of patients willing to have a vasovasostomy for remarriage and loss of a child decreased (p<0.05). The overall patency and birth rates were 87.6% and 76.1%, respectively (43 boys and 37 girls). Among such factors as the age of the patient and his spouse, the duration of ligation and the presence of seminal fluid and sperm, the duration of ligation was the only factor that showed relevance to the anatomical patency (p<0.05). There were no variables that showed significant relevance to the pregnancy rate. CONCLUSIONS: The main reason of vasectomy reversal was to have another child. The numbers of vasovasostomies were influenced by the medical insurance payment. The duration of ligation affected the anatomical patency rate. The overall patency rate was 87.6% and the birth rate was 76.1% in this study.