ABSTRACT
Complete urethral loss with vesicovaginal fistula is very infrequently encountered by the urologist. Urethral reconstruction may be accomplished with either bladder or vaginal wall flap. Moreover, it usually is necessary to reinforce the continence of reconstructed urethra with a well-vascularized pedicle flap from either the Martius labial flap, gracilis, perineum, or rectus. We report a case of the complete urethral loss with vesicovaginal fistula treated successfully with bilateral Martius labial fat graft.
Subject(s)
Female , Humans , Perineum , Transplants , Urethra , Urinary Bladder , Vesicovaginal FistulaABSTRACT
BACKGROUND: Detection of extended-spectrum beta-lactamase (ESBL) expression is difficult in ordinary clinical laboratories. The Etest has been introduced into clinical settings for the rapid identification of ESBL. The principle behind the Etest is to compare the minimal inhibitory concentration (MIC) of ceftazidime alone with the MIC of ceftazidime with clavulanic acid. The aim of this study was to evaluate the efficiency of the Etest for the detection of ESBL in Korea, where antimicrobial resistance rates are high. METHODS: The double disk synergy test and the Etest were performed simultaneously. The results of the clinical isolates were compared to those of strains producing TEM-1, TEM-2, and SHV-1 as negative controls. The results of the double disk synergy test and the E-test were confirmed by isoelectric focusing of beta-lactamase extracted from suspicious ESBL-producing strains. RESULTS: MIC determination using the standard agar dilution method according to the National Committee for Clinical Laboratory Standards revealed that a total of 48 strains were resistant or intermediate against one or more antibiotics of the third generation cephalosporins. These strains included five strains of E. coli, 14 of S. marcescens, seven of K. pneumoniae, 18 of Enterobacter spp., and four of Citrobacter spp. Sixteen (33%) of the strains, including five strains of E. coli, three of S. marcescens, five of K. pneumoniae, and three of Enterobacter spp. were ESBL- producing strains that were confirmed by double disk synergy test. Thirteen (81%) of the strains of ESBL- producing organisms were detected by Etest, but the remaining three strains (19%) were undetectable by Etest alone. CONCLUSION: The accuracy of Etest for the detection of ESBL was not high, but the efficiency of Etest as the primary screening method of a large number of clinical isolates was appreciable regarding efficiency and rapidity.
Subject(s)
Agar , Anti-Bacterial Agents , beta-Lactamases , Ceftazidime , Cephalosporins , Citrobacter , Clavulanic Acid , Enterobacter , Gram-Negative Bacteria , Isoelectric Focusing , Korea , Mass Screening , PneumoniaABSTRACT
BACKGROUND: Detection of extended-spectrum beta-lactamase (ESBL) expression is difficult in ordinary clinical laboratories. The Etest has been introduced into clinical settings for the rapid identification of ESBL. The principle behind the Etest is to compare the minimal inhibitory concentration (MIC) of ceftazidime alone with the MIC of ceftazidime with clavulanic acid. The aim of this study was to evaluate the efficiency of the Etest for the detection of ESBL in Korea, where antimicrobial resistance rates are high. METHODS: The double disk synergy test and the Etest were performed simultaneously. The results of the clinical isolates were compared to those of strains producing TEM-1, TEM-2, and SHV-1 as negative controls. The results of the double disk synergy test and the E-test were confirmed by isoelectric focusing of beta-lactamase extracted from suspicious ESBL-producing strains. RESULTS: MIC determination using the standard agar dilution method according to the National Committee for Clinical Laboratory Standards revealed that a total of 48 strains were resistant or intermediate against one or more antibiotics of the third generation cephalosporins. These strains included five strains of E. coli, 14 of S. marcescens, seven of K. pneumoniae, 18 of Enterobacter spp., and four of Citrobacter spp. Sixteen (33%) of the strains, including five strains of E. coli, three of S. marcescens, five of K. pneumoniae, and three of Enterobacter spp. were ESBL- producing strains that were confirmed by double disk synergy test. Thirteen (81%) of the strains of ESBL- producing organisms were detected by Etest, but the remaining three strains (19%) were undetectable by Etest alone. CONCLUSION: The accuracy of Etest for the detection of ESBL was not high, but the efficiency of Etest as the primary screening method of a large number of clinical isolates was appreciable regarding efficiency and rapidity.
Subject(s)
Agar , Anti-Bacterial Agents , beta-Lactamases , Ceftazidime , Cephalosporins , Citrobacter , Clavulanic Acid , Enterobacter , Gram-Negative Bacteria , Isoelectric Focusing , Korea , Mass Screening , PneumoniaABSTRACT
PURPOSE: To study the cellular events occuring during bladder development and regeneration, we used the human Dura mater (Tutoplast(R)) for augmenting the rat bladder. We compared their intravesical threshold pressure and volume, and observed the regenerative capacity of urothelium and smooth muscle cell within Tutoplast(R). MATERIALS AND METHODS: Among a total of 67 rats, 11 normal rats were checked their intravesical threshold pressure and volume(Group 1). 9 rats underwent only vesicotomy(Sham operation) and were checked their threshold pressure and volume at 2 months and 3 months postoperatively(Group 2). 47 rats underwent augmentation cystoplasty with Tutoplast(R) after partial cystectomy, which were checked pressure and volume at 1 day, 3-7 days, 2-4 weeks, 2-6 months postoperatively(Group 3). Specimens were examined histologically to assess the regeneration of urothelium and smooth muscle cell on the graft. RESULTS: There was a significant increase in intravesical volume of group 3 compared with group 1 and 2. There was a significant decrease in intravesical pressure of group 3 compared with group 2, but there was no significant difference between group 1 and 3. The specimens of 1 day postopratively showed inflammatory findings. Epithelialization on the graft margin was noted at 3 days postoperatively. At 7 days postoperatively, there was epithelial hyperplasia on the graft site. At 2 weeks postoperatively, there was a partial absorption of Tutoplast(R) as well as favorable progression of epithelialization. Smooth muscle regeneration and complete epithelialization were shown at 3 months postoperatively and absorption of Tutoplast(R) was completed thereafter. CONCLUSIONS: The regeneration of bladder cellular constituents within Tutoplast(R) will be valuable for further understanding the mechanism controlling bladder development and regeneration. Further studies will be necessary for using this method as an alternative strategy to the classical bladder augmentation.
Subject(s)
Animals , Humans , Rats , Absorption , Cystectomy , Dura Mater , Hyperplasia , Muscle, Smooth , Myocytes, Smooth Muscle , Regeneration , Transplants , Urinary Bladder , UrotheliumABSTRACT
PURPOSE: We did electrovaporization to reduce the absorbed volume of irrigant and bleeding during TURP, and compared the effects on intraoperative and postoperative serum electrolyte, osmolality, and blood loss between this method and the classic TURP. MATERIALS AND METHOD: Of the 45 BPH patients, 21 patients underwent TURP (Group l), while the other 24 patients were electrovaporized with vaportrode(Group ll). They were followed preoperatively, 30 min intraoperatively, immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, potassium, glucose and BUN. The amount of absorbed irrigant, serum osmolality, effective osmolality, blood loss were calculated and compared between the two groups. RESULTS: Although the group ll showed a longer operation time and used a larger amount of irrigant than the group l, there was not a significant difference in the amount of blood loss between the two groups and lesser amount of irrigant was absorbed than the group l. There was not a significant decrease in postoperative serum Hb and Hct level compared with preoperative level in the group ll. Serum sodium level were significantly decreased during postoperative period every patients in the group l. The serum osmolality and effective osmolality levels were significantly decreased postoperatively as compared with the preoperative levels in the group l, but were not in the group ll. CONCLUSIONS: These results show that electrovaporization may be the effective method in preventing complications such as hyponatremia and hypoosmolality during perioperative period. This method may also be helpful in reducing blood loss.
Subject(s)
Humans , Glucose , Hemorrhage , Hyponatremia , Osmolar Concentration , Perioperative Period , Postoperative Period , Potassium , Prostatic Hyperplasia , Sodium , Transurethral Resection of ProstateABSTRACT
The Beckwith-Wiedemann syndrome, which included congenital anomalies such as macroglossia, exomphalos, postnatal somatic gigantism, have a substantially increased risk for the development of tumor. We report a case of testicular yolk sac tumor associated with Beckwith-Wiedemann syndrome, a previously unreported association. Pathologic examination showed Schiller-Duval body with evidence of testicular yolk sac tumor. This finding appears to represent a previously unreported association between Beckwith-Wiedemann syndrome and testicular yolk sac tumor.
Subject(s)
Beckwith-Wiedemann Syndrome , Endodermal Sinus Tumor , Gigantism , Hernia, Umbilical , Macroglossia , Testis , Yolk SacABSTRACT
Multilocular renal cyst is an uncommon lesion which has various terminologies and controversial criteria of definition. Recently, it is said that these can be divided into cystic nephroma(CN) and cystic partially differentiated nephroblastoma(CPDN) based on the presence or absence of blastemal tissue and differentiation of the tissue within the septa of the cyst. We experienced a case of multilocular renal cyst(CN) which contains mature tubular and glomerular structures in the septa without evidence of blastema or embryonal elements and we are going to discuss the significance of this blastemal or embryonal tissue with regard to nature, classification, and prognosis with literatures.