Postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux

PURPOSE: We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR). MATERIALS AND METHODS: Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0+/-2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2+/-8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment. RESULTS: The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction. CONCLUSIONS: In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration.

Hybrid Granular Cell Tumor/Perineurioma

No abstract available.

Intravascular Papillary Endothelial Hyperplasia of the Chest Wall Misdiagnosed as a Malignancy on Fine Needle Aspiration

No abstract available.

Sudden Unexpected Death of Epileptic Patient with Dendriform Pulmonary Ossification / 대한법의학회지

Sudden unexpected death in epilepsy (SUDEP) is a devastating complication in patient with epilepsy. The mechanism of SUDEP is unclear, but several risk factors are reported and various studies are ongoing. Cerebral cavernous hemangioma (CCH) is a kind of vascular malformation that can cause seizure. Seizure caused by CCH is usually progress to intractable epilepsy. Dendriform pulmonary ossification (DPO) is an uncommon and rarely diagnosed disease during life, and there have been no reports of SUDEP with DPO. We recently experienced an autopsy case of a young woman dying suddenly and unexpectedly, who had suffered from epilepsy caused by CCH and in one of them DPO was identified. Herein we report that case and provide a literature review.

HPV Genotyping in Squamous Cell Carcinoma of Upper Aerodigestive Tract

BACKGROUND: Smoking and alcohol consumption are the main risk factors for squamous cell carcinoma of the upper aerodigestive tract (SCCUAT). However, human papillomavirus (HPV) has been etiologically linked with tonsillar squamous cell carcinoma (TSCC). Therefore, we investigated the etiologic role of HPV in the context of SCCUAT in Korea. METHODS: Archival paraffin block samples from 136 cases previously diagnosed as SCCUAT were randomly selected. A commercial HPV DNA chip was used for HPV genotyping. RESULTS: One hundred and seventeen cases were available after checking beta-globin (47 cases of tonsil and 70 of non-tonsil). A HPV-positive result (HPV 16 and 18) occurred in 13 cases of SCCUAT, and 12 cases were tonsil (25.5%, 12/47). Among the 12 HPV-positive patients with TSCC, nine were non-smokers and non-drinkers. Most HPV-negative patients with TSCC had a history of alcohol drinking and smoking (32/35, 91.4%). HPV infection status was not significantly associated with histological grade, clinical stage, or survival in patients with TSCC. CONCLUSIONS: HPV infection was significantly higher in patients with TSCC among those with SCCUAT. HPV may be independent risk factor in development of TSCC, such as smoking and alcohol drinking.

Prognostic Value of Phosphorylated Akt and Survivin Expression in Gastric Adenocarcinoma

BACKGROUND: pAkt (the phosphorylated form of the proto-oncogene protein c-akt) and survivin (human BIRC5 protein) are candidate apoptosis-related molecules that may be responsible for cancer progression. The aim of this study was to determine the expression of pAkt and survivin in malignant stomach neoplasm, and their value as prognostic indicators of cancer. METHODS: The expression of pAkt and survivin in 144 cases of gastric cancer was detected by immunohistochemistry and compared with established clinicopathological parameters and prognosis of this disease. RESULTS: Expression of pAkt showed significant correlations with depth of invasion, lymph node and distant metastasis, as well as the stage (p < 0.05 for all three correlations), but not with the Lauren classification. Survivin expression closely correlated with histological type, Lauren classification, depth of invasion, metastasis, and stage (p < 0.05 for all). The overall survival of patients with pAkt/survivin expression was inferior to that of patients with loss of pAkt/survivin expression. Cox multivariate analysis demonstrated a significant correlation between stage (p = 0.04), survivin expression (p = 0.02), and prognosis. CONCLUSIONS: Patients with pAkt/survivin expression in gastric cancer are at increased risk of cancer-related mortality via the apoptosis resistance pathway. Expression of pAkt and survivin could be used as a prognostic indicator for gastric cancer.

Cowper's Syringocele in an Adult / 대한남성과학회지

Cowper's syringocele is cystic dilatation of the main duct of Cowper's glands. Cowper's syringocele is usually diagnosed in male infants and children and is rarely found in adults. We present a case of Cowper's syringocele causing lower abdominal discomfort in an adult male.

The Clinical Significance of the Estrogen Receptor beta Expression for Endocrine Therapy in Patients with ERalpha-negative and Progesterone Receptor-positive Breast Carcinoma / 한국유방암학회지

PURPOSE: Estrogen receptor (ER) is the key therapeutic target in breast cancer. ERbeta has recently been identified to be distinct from ERalpha. In contrast to ERalpha, the functions of ERbeta in breast cancer are still unclear. We sought to determine whether the expression of ERbeta can be used as a predictive marker for endocrine therapy for patients with ERalpha-negative breast cancer. METHODS: Formalin-fixed, paraffin-embedded tumor specimens from 52 patients with ER-/PR+ invasive breast cancer were immunostained for their ERbeta expression. These patients were treated with adjuvant tamoxifen. The results were correlated with various clinicopathological variables and the follow-up data. The expressions of p53 and HER-2/neu were also analyzed and correlated with the ERbeta status. RESULTS: An ERbeta expression was observed in 53.8% (28/52) of the breast cancer samples. There was no correlation between the ERbeta expression and the other clinicopathologic factors (age, tumor size, histologic type, nodal status, histological grade, stage, therapeutic modality, progesterone receptor (PR) expression, p53 expression and HER-2/neu expression). Recurrence was present in 7.7% (2/26) of the patients whose tumors had an ERbeta expression, as compared to the presence of recurrence in 36.4% (8/22) of the patients whose tumors had no ERbeta expression (p<0.05). The patients with ERbeta negative-tumors revealed lower disease free survival rate than those with ERbeta positive-tumors (p<0.05). Of the 52 patients, 10 (19.2%) were p53 positive, and 11 (21.2%) were HER-2/neu positive. No significant correlations were observed between ERbeta and p53 or HER-2/neu. CONCLUSION: These results suggest that ERbeta might be a predictive marker of a response to endocrine therapy in patients with ER-/PR+ invasive breast cancer, although this needs to be confirmed by additional studies.

Expression of Survivin in Gastric Carcinoma and its Relation to Tumor Cell Proliferation and Apoptosis

BACKGROUND: Survivin, a novel antiapoptotic gene has been linked with tumor development and progression in various human carcinomas including gastric carcinomas. The aim of this study was to evaluate the expression of survivin in gastric carcinoma and its correlation with tumor cell proliferation and apoptosis. METHODS: Expression of survivin was evaluated immunohistochemically in 84 surgically resected gastric carcinomas. Tumor cell apoptosis was evaluated with terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and Ki-67 immunostaining was used for evaluation of tumor cell proliferation. RESULTS: Expression of survivin was noted in 53.6% of the gastric carcinomas, and was significantly associated with depth of invasion, status of lymph node metastasis or tumor stage (p=0.022, 0.034, 0.040, respectively). There was an inverse correlation between survivin expression and apoptotic index (p=0.015). But there was no significant correlation between survivin expression and Ki-67 labeling index (p=0.430). CONCLUSIONS: These results suggest that survivin expression may contribute to tumor development and progression by inhibiting apoptosis in human gastric carcinoma.

Metastatic Osteosarcoma to the Prostate: A Case Report

The most common site for the metastasis of osteosarcoma is the lung, and other sites of metastases include the bone, lymph node, pleura and liver. Although unusual extrapulmonary metastases have been reported with the improvement of the therapeutic results for the primary lesions, they are exceptionally rare. We report here on a case of prostatic metastasis of an osteosarcoma of the proximal tibia, and this developed seven years after successful resection, and four years after resection of a pulmonary metastasis. Radical prostatectomy was performed, and histological examination demonstrated metastatic osteosarcoma. To the best of our knowledge, this is the first case of prostatic metastasis of osteosarcoma in the medical literature.

Analysis of HPV-other Samples by Performing HPV DNA Sequencing

BACKGROUND: HPV-other samples are designated as being positive on HPV-PCR, but negative when using specific HPV hybridization probes. We wanted to determine the types on the HPV-other samples by performing sequencing, and to know the pathologic status of the uterine cervix according to the HPV type detected on sequencing. METHODS: For HPV genotying, we used the commercially available HPV DNA Chip test, which contains 15 types of high-risk HPV and 9 types of low-risk HPV. The HPV DNA sequencing was performed for the HPV-other samples of 209 patients who subsequently underwent cervical biopsy. RESULTS: For 204 of the 209 samples, the HPV types detected by sequencing were absent types at used HPV DNA chip. For the remaining 5 samples, sequencing was impossible due to mixed peaks. HPV-81 (19.6%), HPV-61 (18.6%), HPV-62 (16.7%) and HPV-84 (13.9%) were frequently detected. For the HPV-81, -62, -71, and -72 samples, most of the samples displayed normal or LSIL. However, HPV-84 and -61 were more associated with HSIL or worse, as compared to the other types. Conclusion: HPV-81, -61, -62 and -84 were frequently found on sequencing analysis of the HPV-other samples. The pathologic status was diverse, according to the HPV type detected on sequencing.

Clinical Characteristics of Wilms' Tumor according to Age

PURPOSE: Wilms' tumor typically affects young children, with more than 80% of patients identified before 5 years of age. We evaluated the clinical features of Wilms' tumor according to age. MATERIALS AND METHODS: According to their age, 27 patients with Wilms' tumor who underwent radical nephrectomy were classified into group I (under 24 months: n=15), group II (24-48 months: n=4), and group III (over 48 months: n=8), respectively. We retrospectively reviewed tumor size, pathologic features, renal vein invasion, renal capsule invasion, bilaterality, lymphovascular invasion, stage, complete resection, and survival rate. RESULTS: The mean age of groups I, II, and III was 12.5+/-7.0 (range, 1-20), 33.3+/-5.7 (range, 24-39) and 126.9+/-89.1 (range, 54-300) months, respectively. Bilaterality (p<0.001) and male sexuality (p=0.039) were significantly related to early diagnostic age. Tumor stage (p=0.036) and blastema component (p=0.027) increased with age. Bilaterality and incomplete resection of Wilms' tumor were related to larger size (p<0.001) and vessel/lymph node invasion (p=0.02), respectively. There were no significant differences in tumor volume, anaplasia, capsule invasion, lymph node invasion, vessel invasion, complete resection, laterality, or recurrence according to age. There was also no significant difference in the survival rate according to age. CONCLUSIONS: Tumor stage and blastema component of Wilm's tumor increased with age. Bilaterality and male sexuality were related to an early diagnostic age. There was no significant difference in the survival rate according to age.

Correlation Between Duration of Varicocele and Testicular Damage in an Experimental Rat Model / 대한남성과학회지

PURPOSE: The aim of this study was to evaluate the damage to the testicles caused by a varicocele over time with using an experimental varicocele rat model and by measuring the testicular weight, the status of oxidative stress, the hormonal changes and the degeneration of the tubules. MATERIALS AND METHODS: Thirty male Sprague-Dawley white rats, 10 weeks old, weighing 350-360g each, had experimentally induced left varicoceles; 30 rats of the same age were used as a control group. All rats in the varicocele and control groups were sacrificed at 2, 4 and 8 weeks after surgery. The testicular weight, the levels of serum reactive oxygen species, serum testosterone, LH and FSH, as well as the degenerative changes of the tubules were measured. Statistical analyses for comparisons between the two groups were performed using the Mann-Whitney U test; probability values of less than 0.05 were considered significant. RESULTS: Degenerative changes of the tubules on H-E stain and the testicular weight loss were observed 4 weeks after surgery. There was a significant difference in the serum ROS between the varicocele group and the control group at eight weeks after surgery. However, there were no significant differences found in the serum testosterone, LH or FSH. CONCLUSIONS: The results of this study with using a rat model showed that a varicocele may cause progression of the testicular damage that induced by the varicocele over time. If a further study shows that this damage can be reversed, then there may be a critical period for treatment of men before infertility develops.

Influence of Metabolic Syndrome on Late-onset Male Hypogonadism Symptoms and Serum Total Testosterone Level / 대한남성과학회지

Purpose: Although concern about the health disorders in aging men have been growing, the association has not been elucidated in relation to the late onset male hypogonadism(LOH) and metabolic syndrome(MS). In this background, we evaluated the clinical impact of MS on LOH symptoms and serum total testosterone level. Materials and Methods: 100 patients with LOH symptoms who visited to the urology clinic between May, 2004 and October, 2006 were analyzed. Of all object, 48 patients were associated with MS(Group I) and 52 patients were not(Group II), based on the NCEP-ATP III(2001) guidelines. We compared the LOH status with Saint Louis University Androgen Deficiency in Aging Males(ADAM) questionnaire, serum total testosterone level, as well as prevalence of MS components between the two groups. Results: The overall prevalence of MS was 48% among LOH patients. The average age of group I and II were 57.7+/-10.5 and 58.6+/-11.2 years, respectively. Positivity for ADAM questionnaire was 83.3% in group I and 76.9% in group II, respectively(p<0.05). Serum total testosterone level decreased according to number of components of MS(p<0.05). The obesity group had significantly decreased serum total testosterone level(3.41+/-1.34 ng/ml) comparing to control group(4.41+/-2.23 ng/ml)(p<0.05). Conclusions: MS and its risk factors were significantly associated with LOH symptoms and positively correlated with the severity of disease. The evaluation of MS are required for the diagnosis and treatment of the patients with LOH.

Male Patients with the Diagnoses of Synchronous Prostate and Breast Cancer / 대한비뇨기과학회지

Prostate cancer and male breast cancer are similar in many ways, including the potential role of steroidal hormones in their pathogenesis and shared genetic abnormalities. However, the combination of these cancers in the same patient is rare. Herein, the case of a male patient, diagnosed with synchronous prostate and breast cancers, is reported.

Expression of c-FLIP in Gastric Cancer and its Relation to Tumor Cell Proliferation and Apoptosis

BACKGROUND: The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 beta-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. METHDOS: Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. RESULTS: The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4+/-15.7. The mean KI value of the c-FLIP positive tumors was 54.1+/-15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4+/-2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). CONCLUSIONS: These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.

Progressive Multifocal Leukoencephalopathy in the Immunocompromised Patients - 3 Cases Report

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease resulting from infection of oligodendrocytes with JC virus. PML was a rare disease, but nowadays not uncommon as AIDS prevailed. Histopathologic features of the affected lesion shows infiltrations of foamy macrophages and hyperchromatic, pleomorphic, reactive astrocytes that may raise the suspicion of a brain tumor. We recently met with 3 cases of PML. Two of the patients had AIDS and the other had been treated for lymphoma. All cases were diagnosed by histopathologic examination in stereotactic brain biopsies.

Case Review of Small Cell Carcinoma of the Urinary Bladder in Korea / 대한비뇨기과학회지

Although it is known that small cell carcinoma most commonly occurs in the lung, it may also originate outside the thorax. Primary extrapulmonary small cell carcinoma has been reported in various organs, including the pharynx, larynx, esophagus, stomach, small intestine, salivary glands, pancreas, skin, breast, cervix, vagina, kidneys, ureter, prostate and urinary bladder. Primary pure small cell neuroendocrine carcinoma of the bladder is a rare condition. It is an aggressive tumor with an average five-year survival rate of less than 10%, as cited by multiple case reports. The mean age of these patients is 67.8 years. The prognosis of small cell carcinoma of the urinary bladder is poor because its behavior is more aggressive than bladder transitional cell carcinoma. We review here 4 cases with small cell carcinoma of the urinary bladder, including our own patient who we treated.

Tetranucleotide Repeat Microsatellite Instability in Uterine Cervical Carcinomas

BACKGROUND: Elevated levels of microsatellite alterations at selected tetranucleotide repeat regions (EMAST) have been recently described, and they are a distinct type of microsatellite instability (MSI). We investigated the prevalence of EMAST in squamous cell carcinoma (SCC) of the uterine cervix and we determined the correlation between EMAST and the clinicopathologic parameters, HPV infection and the p53 mutation. METHODS: We examined the 3 mono-, 3 di-, and 5 tetranucleotide repeat markers in 47 cases of SCC, and we performed immunohistochemical staining for p53. HPV detection and genotyping was performed using a commercially available HPV DNA chip. RESULTS: Thirteen out of 47 cases (27.7%) were EMAST(+) with at least one of five tetranucleotide repeat markers. However, MSI at mono- and dinucleo- tide markers was noted in only one case (2.1%). EMAST was not related with stage, size, lymph node metastasis, vascular/lymphatic invasion or the depth of invasion. Positive immunostaining for p53 was significantly more common in EMAST(+) tumors than in the EMAST(-) tumors (p=0.04). HPV-infection was positive in 32 cases. EMAST was not correlated with the state of HPV infection state or the HPV genotype. CONCLUSIONS: 27.7% of the invasive SCCs of the uterine cervix exhibited EMAST, and EMAST in the SCC of the uterine cervix was significantly associated with the p53 mutation.

5 Year Follow-up Results of Endoscopic Primary Realignment in Urethral Injury / 대한비뇨기과학회지

PURPOSE: The standard management of posterior urethral injury is controversial with regard to immediate primary realignment versus delayed urethroplasty. We analyzed the long-term results of treatment for urethral injury with performing immediate primary realignment. MATERIALS AND METHODS: 19 patients with urethral injury were treated by endoscopic primary realignment from March 2000 to March 2002. Anterior and posterior urethral injuries were classified into the A and P groups, respectively, and the A and P groups had 11 and 8 patients, respectively. We investigated 5-years of follow-up complications, which were composed of urethral stricture, incontinence and impotence. The mean follow-up period was 69.8 months after injury, and the follow-up status was obtained from a patient questionnaire or a telephone interview. RESULTS: 6(75%) of the P group had post-realignment stricture. However, 2 patients(25%) were considered to have mild strictures that were easily managed with a urethral sound, and 4(50%) had more significant stricture that required visual internal urethrotomy(VIU). 2(18%) of the A group needed only a sound and 4(36%) were managed via VIU. 1(13%) of the P group reported mild stress incontinence, but the patient did not need padding. 6(75%) of the P group had no erectile dysfunction, 1(13%) reported a decreased quality of erection that required only oral phosphodiesterase 5 inhibitor and 1(13%) required intracavernosal injection therapy. CONCLUSIONS: Endoscopic primary realignment of urethral injury is a simple, safe, rapid and nontraumatic technique. It reduces the incidence and extent of the complications such as stricture, erectile dysfunction and incontinence. Therefore, we recommend this endoscopic primary realignment for the initial management of posterior urethral injury, as well as for anterior urethral injury.