ABSTRACT
Primary vesical actinomycosis is an extremely rare disease. In most cases it is misdiagnosed as vesical or urachal tumor and usually diagnosed through post-operative pathologic confirmation. Here we report a case of primary vesical actinomycosis confirmed by preoperative repeated multiple transabdominal biopsies. The patient was a 49-yr-old woman who presented with frequency, dysuria, and intermittent gross hematuria for 2 months. Computed tomography and cystoscopic examination showed broad-based, edematous, and protruding mass at the dome and anterior portion of the bladder. The clinical and imaging findings of the patient initially suggested vesical malignancy. Transurethral resection and multiple biopsies of the mass were performed. Pathologic examination demonstrated fibrosis with chronic inflammation. We performed repeated transabdominal multiple needle biopsies for further pathologic confirmation. Histopathologic examination demonstrated typical sulfur granules, which were consistent with actinomycosis.
Subject(s)
Female , Humans , Middle Aged , Abdomen , Actinomycosis/drug therapy , Biopsy, Needle/methods , Follow-Up Studies , Penicillins/therapeutic use , Treatment Outcome , Urinary Bladder/pathology , Urinary Bladder Diseases/drug therapyABSTRACT
PURPOSE: Prostate volume has been poorly correlated with various parameters used to assess benign prostate hyperplasia (BPH), including symptom score, total prostate volume, peak flow rate and postvoid residual urine. The purpose of this study is to determine if measurement of the volume and the index of transition zone of the prostate correlated well with other clinical parameters in predicting the degree of obstruction. MATERIALS AND METHODS: 121 men with lower urinary tract symptoms were prospectively evaluated using international prostate symptom score, transrectal ultrasonography, and urodynamic investigation with pressure-flow studies for BPH. Bladder outlet obstruction was defined as the maximal detrusor pressure was greater than 40cmH2O at peak flow and peak flow rate was less than 10ml/sec. Patients were then divided into obstructive and non-obstructive groups. Correlations were evaluated among the total prostatic volume (TPV), transition zone volume (TZV), transition zone index (TZI=TZV/TPV) and other clinical and urodynamically obstructive parameters. RESULTS: Age, IPSS, peak flow rate and PVR were not significantly different between obstructive (n=69) and non-obstructive (n=52) groups. Among the transrectal sonographic parameters, TZV and TZI correlated better with urodynamically obstructive parameters such as detrusor pressure at peak flow rate (r=0.551, 0.544), Abrams Griffiths number (r=0.576, 0.506) and linear passive urethral resistance relation (r=0.560, 0.580) than with TPV. There were no correlations between clinical and volume parameters. All the volume parameters of the prostate were larger in obstructive than in non- obstructive group. CONCLUSIONS: In patients with BPH symptoms, TZV and TZI correlates better with urodynamically obstructive parameters than did the total prostate volume. TZV or TZI may serve as more useful method for evaluating obstruction.
Subject(s)
Humans , Male , Hyperplasia , Lower Urinary Tract Symptoms , Prospective Studies , Prostate , Prostatic Hyperplasia , Ultrasonography , Urinary Bladder Neck Obstruction , Urinary Bladder , UrodynamicsABSTRACT
High-flow priapism is caused by sustained arterial inflow into the spaces from a lacerated cavernosal artery. This typically follows perineal trauma. Iatrogenic high-flow priapism occasionally follows the treatment of low-flow priapism and is a diagnostic and therapeutic challenge. Herein, we reported a case of iatrogenic high-flow priapism which developed after treatment of-flow priapism.
Subject(s)
Arteries , PriapismABSTRACT
PURPOSE: E-cadherin(E-CD) is a family of Ca++-dependent intercellular adhesion molecules, plays essential roles in organogenesis and in the maintenance of normal structure and function. Decreased expression of E-CD correlates with tumor aggressiveness, advanced stage and metastasis. In renal cell carcinoma(RCC), however, this correlation is not well established and prevalence of negative expression of E-CD is higher than in other carcinomas. We focused our interest on E-CD expression in RCC and its clinicopathological implications. MATERIALS AND METHODS: Retrospectively, we reviewed 34 cases with RCC that were reclassified according to Mainz classification. Tumor stage, grade were determined according to the Robson method and Fuhrmann`s grading system. We detected E-CD expression in RCC by immunohistochemical staining and investigated the relationship between E-CD expression and clinicopathological features including prognosis. RESULTS: Thirty four cases of RCC were consisted of 21 cases(61%) of non-papillary clear cell type, 2 cases(6%) of chromophil type, 3 cases(9%) of spindle cell type and 8 cases(24%) of chromophobe type by Mainz classification. Especially, E-CD expression showed a strong positive reaction along the cell membranes in all 8 cases of chromophobe type. Our immunohistochemical study of E-CD expression in 34 RCC specimens showed 73% of positive expression and 27% of negative expression. Absence of E-CD expression was correlated with the high tumor stage and grade( stage & grade 3 or 4. p<0.05 in chi-squar test). All of metastatic cases showed a negative expression of E-CD. CONCLUSIONS: The differential expression of E-cadherin in renal cell carcinomas suggest that the tumor cell origin and differentiation. Especially, chromophobe cell type may have different biologic characteristics from other types of renal cell carcinoma. In this study, E-CD expression was seemed to be lost in RCC with a high stage and grade. In addition, preserved E-CD expression was associated with better prognosis than reduced E-CD expression.
Subject(s)
Humans , Cadherins , Carcinoma, Renal Cell , Cell Adhesion Molecules , Cell Membrane , Classification , Neoplasm Metastasis , Organogenesis , Population Characteristics , Prevalence , Prognosis , Retrospective StudiesABSTRACT
PURPOSE: Although PSA(prostate specific antigen) is an excellent tumor marker, it is not prostate cancer-specific but organ-specific. The objective of this study is to assess the efficacy of prostate specific antigen adjusted for the transition zone voume(PSATZ) in diagnosing prostate cancer in men with intermediate PSA levels of 4.1 to 10.0 ng/ml. MATERIALS AND METHODS: Between March 1997 and September 1998, PSATZ was obtained from 67 patients who underwent ultrasound-guided systemic sextant biopsies and had a PSA of 4.1-10.0ng/ml. PSATZ was compared with PSA, PSAD(PSA density) and free-to-total PSA ratio(F/T ratio) via receiver operating characteristic(ROC) curves. RESULTS: Of 67 patients, 22(32.8%) had prostate cancer and 45(67.2%) had benign prostatic hyperplasia on pathologic examination. Mean PSA, F/T ratio, PSAD and PSATZ were 7.96+/-2.01ng/ml 0.10+/-0.06, 0.28+/-0.14ng/ml/cc and 0.70+/-0.28ng/ml/cc in patients with prostate cancer and 6.39+/-1.68ng/ml, 0.15+/-0.05, 0.16+/-0.06ng/ml/cc and 0.29+/-0.11ng/ml/cc in patients with benign prostatic hyperplasia, respectively. ROC curve analysis demonstrated that PSATZ, F/T ratio and PSAD predicted the biopsy outcome significantly better than PSA in all 67 patients(p<0.01, respectively). In a subset of 45 men with normal digital rectal examination, PSATZ predicted the biopsy outcome better than PSAD or F/T ratio significantly(p<0.01, respectively). With cutoff value of 0.35ng/ml/cc, PSATZ had a sensitivity of 86% and a specificity of 89% for predicting prostate cancer. With cutoff value of 0.12, F/T ratio had a sensitivity of 73% and a specificity of 71% for predicting prostate cancer. CONCLUSIONS: These results suggest that PSATZ is more specific and more accurate than PSA, PSAD or F/T ratio in distinguishing benign prostatic disease from prostatic cancer in men with intermediate PSA levels of 4.1 to 10 ng/ml. But large prospective studies are requested to assess the precise role of PSATZ in early prostate cancer detection.