ABSTRACT
Purpose@#In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). @*Materials and Methods@#We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bähren system. @*Results@#One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). @*Conclusion@#Remnant collateral veins of the internal spermatic vein (ISV) (Bähren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bähren type 4) and is unidentifiable without venography.
ABSTRACT
Purpose@#In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). @*Materials and Methods@#We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bähren system. @*Results@#One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). @*Conclusion@#Remnant collateral veins of the internal spermatic vein (ISV) (Bähren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bähren type 4) and is unidentifiable without venography.
ABSTRACT
Bladder urothelial carcinoma typically occurs in individuals in their sixties or seventies: it rarely occurs in persons <20 years old. Moreover, in young patients, bladder urothelial carcinoma lesions are reported to be solitary and nonmuscle invasive, with low malignant potential. However, 13% of lesions in this age group are reported to be noninvasive high-grade papillary urothelial carcinoma but these are extremely rare in children <15 years. There is no specific consensus regarding treatment of bladder urothelial carcinoma in children and adolescent. In particular, method has been suggested for follow-up of high-grade bladder urothelial carcinoma. Therefore we report our experience of one case the, discuss surveillance methods, and provide a brief review of the literature.
Subject(s)
Adolescent , Child , Humans , Consensus , Follow-Up Studies , Methods , Pediatrics , Urinary BladderABSTRACT
A 28 year-old man visited our hospital for left periorbital painful swelling. He had no diabetic symptoms and no specific medical histories. We could diagnose the orbital cellulitis by CT scan of orbit and diabetes mellitus by fasting hyperglycemia. Streptococcus viridans species were identified from blood culture. The symptoms of periorbital swelling were improved after administration of broad-spectrum antibiotics and excision and drainage but small intraorbital abscess was remained after intravenous antibiotics for 6 weeks. The visual acuity and the function of extraocular muscles were intact. We experienced a case of newly diagnosed diabetes mellitus by orbital cellulitis without any other diabetic symptoms. Thus, we report the case with reviews of other literatures.
Subject(s)
Adult , Humans , Abscess , Anti-Bacterial Agents , Diabetes Mellitus , Drainage , Fasting , Hyperglycemia , Muscles , Orbit , Orbital Cellulitis , Tomography, X-Ray Computed , Viridans Streptococci , Visual AcuityABSTRACT
PURPOSE: The balance between cell death and proliferation is a key step in cellular homeostasis. Inhibition of apoptosis could trigger an abnormal malignant change. Survivin is a recently reported anti-apoptotic molecule that inhibits the caspase system along the apoptosis pathway. It is expressed in fetal tissue and transformed tissue, but not in normal tissues except durung the mitosis period. Some authors have described abnormal survivin expression in various cancer tissues. We performed western blotting in colorectal cancer to assess the expression pattern of survivin. METHODS: Thirty-four colorectal cancer tissues and adjacent normal colonic epithelia of patients operated an at KCCH from June 1998 were assessed. We used the common western blotting method with the polyclonal anti-survivin antibody. RESULTS: Survivin was expressed in all cases (34 cases, 100%) of cancer tissues and two cases (5.8%) of normal tissue. Seven of 34 cases showed a strong positive result. Univariate analysis of sex, age, stage, original site, lymphatic invasion, neural invasion, and vessel invasion between the positive group and the strongly positive group revealed no significant relationship except for neural invasion. CONCLUSIONS: Survivin should be a good tumor marker of colorectal cancer.
Subject(s)
Humans , Apoptosis , Blotting, Western , Cell Death , Colon , Colorectal Neoplasms , Fetus , Homeostasis , MitosisABSTRACT
BACKGROUND: It has been reported that many peripheral vasodilating drugs might improve insulin resistance. Cilostazol, a antithrombotic agent, increases peripheral blood flow in non-insulin dependent diabetic patients. The effect of cilostazol treatment on insulin resistance in streptozotocin (STZ)-induced non-insulin dependent diabetic Wistar rats was examined. METHODS: About a half of two-day old neonate siblings were injected intraperitoneally with STZ and maintained for six months, at which time they were compared with age-matched control rats for intraperitoneal glucose tolerance test (IPGTT) and for glucose infusion rate (GINF) in a euglycemic hyperinsulinemic glucose-clamp study. After that, these studies were also performed after feeding rat chow containing cilostazol (100 mg/kg/day) to rats with STZ-induced non-insulin dependent diabetes mellitus for four-weeks and compared with those of age-matched control rats. RESULTS: In the intraperitoneal glucose tolerance test studies, plasma glucose levels of STZ-induced non-insulin dependent diabetic rats were significantly higher and plasma insulin levels significantly lower than those of age-matched control rats in the age of six months. Glucose infusion rate was lower in STZ-induced non-insulin dependent diabetic rats than those of age-matched control rats. However, after a four-week cilostazol treatment, glucose infusion rate of STZ-induced non-insulin dependent diabetic rats was not significantly different from that of control rats. CONCLUSION: These findings suggested that cilostazol may improve insulin resistance in STZ-induced non-insulin dependent diabetic rats.
Subject(s)
Male , Rats , Animals , Animals, Newborn , Blood Glucose/drug effects , Comparative Study , Diabetes Mellitus, Type 2/chemically induced , Disease Models, Animal , Glucose Tolerance Test , Insulin Resistance , Probability , Rats, Wistar , Reference Values , Sensitivity and Specificity , Streptozocin , Tetrazoles/pharmacology , Vasodilator Agents/pharmacologyABSTRACT
BACKGROUND: To compare the 1997 American Diabetes Association (ADA) criteria with the 1985 World Health Organization (WHO) criteria in categorization of the diabetes diagnostic status of Koreans and to define clinical characteristics of subjects diagnosed differently by the two criteria. METHODS: In 810 Korean subjects, we analyzed blood glucose and insulin response during 75 g oral glucose tolerance test (OGTT). According to current WHO criteria, the cutoff values of FPG which distinguish normal and IGT from diabetes were determined. Then the subjects were categorized according to both WHO and ADA criteria. The clinical characteristics of the subjects with different diagnostic categories by the two criteria were defined. RESULTS: The FPG cut point distinguishing diabetes from IGT was 117 mg/dl, and from normal was 110 mg/dl. The overall agreement between the ADA criteria and the WHO criteria was moderate, as reflected in the kappa of 0.45. 141 of subjects categorized diabetes by WHO criteria were not diagnosed with ADA criteria. These discordant subjects were older in age and showed blunted early insulin response than concordant normal subjects. CONCLUSION: These results suggest that mild diabetes by the WHO criteria, especially in the elderly, would not be diagnosed as diabetes by the ADA FPG criteria only. Thus, in a group at high risk for developing diabetes or in a relatively older age group, we should continue using the OGTT.
Subject(s)
Adult , Aged , Female , Humans , Male , Adolescent , Age Factors , Blood Glucose/analysis , Diabetes Mellitus/diagnosis , Fasting , Middle Aged , Retrospective Studies , World Health OrganizationABSTRACT
OBJECTIVES: Oxidized LDL is thought to play a key role in atherogenesis. Among their wide variety of biological properties, oxidized LDL injures the endothelium as an early event of atherogenesis. However, the mechanisms by which oxidized LDL injures endothelial cells are not definitely known. In order to evaluate the involvement of GTP-binding protein on the mechanism of apoptosis, we studied the effects of pertussis and cholera toxin on oxidized LDL-induced apoptosis in bovine aortic endothelial cells(BAECs). METHODS: Oxidized LDL elicited apoptosis in cultured BAECs as shown by characteristic morphological and biochemical changes. Chromatin condensation and nucleus fragmentation were visualized by using fluorescence microscopy of intact cells staining by acridine orange/ ethidium bromide. DNA fragmentation was quantified by an ELISA with specific antibody for bromodeoxyuridine- labelled DNA fragments and confirmed with DNA ladder formation. RESULTS: Studies using a combination of bacterial toxins which change the function of GTP-binding protein suggest that oxidized LDL-induced apoptosis was regulated by GTP-binding protein. Oxidized LDL-induced apoptosis was not changed by pretreatment of BAECs with pertussis toxin. In contrast, pretreatment with cholera toxin completely prevented the oxidized LDL- induced apoptosis. CONCLUSION: These results show that oxidized LDL induces apoptosis of BAECs and suggest that cholera toxin-sensitive G-proteins are involved in signal transduction of oxidized LDL-induced apoptosis of BAEC.
Subject(s)
Apoptosis , Atherosclerosis , Bacterial Toxins , Cholera Toxin , Cholera , Chromatin , DNA , DNA Fragmentation , Endothelial Cells , Endothelium , Enzyme-Linked Immunosorbent Assay , Ethidium , GTP-Binding Proteins , Lipoproteins , Microscopy, Fluorescence , Pertussis Toxin , Signal Transduction , Whooping CoughABSTRACT
BACKGROUND: Hyperhomocysteinemia is an independent risk factor for cardiovascualr disease. Recently, a mutation (677C-->T) was identified in the methylenetetrahydrofolate reductase gene leading to the substitution of valine(V) for alanine(A). This mutation causes a reduced folate-dependent enzyme activity which leads to increased homocysteine. In this study, we examined the association between the V allele of the methylenetetrahydrofolate reductase gen and serum total homocysteine and folate concentrations in Korean healthy subjects. METHODS: In 198 healthy subjects, the methylenetetrahydrofolate reductase genotypes were analyzed by polymerase chain reaction followed by HinfI digestion. Serum total homocysteine and folate concentrations were measured in age- and sex-matched 14 healthy subjects in each of three methylenetetrahydrofolate reductase genotypes. RESULTS: Homozygosity for 677C-->T mutation in the methylenetetrahydrofolate reductase gene was found in 31 (15.7%) of 198 healthy subjects. In healthy subjects, those bearing the VV genotype tend to have higher serum total homocysteine concentrations 1.5 micromol/L(18.6%) than AA genotype but this was not statistically significant. Correlation between serum total homocysteine concentrations and other clinical variables showed that serum folate and creatinine were significant. CONCLUSION: We conclude that although the frequency of VV genotype in Korean healthy subjects is higher than that of other reports, this mutation is not associated with increased serum total homocysteine concentrations in Korean healthy subjects.
Subject(s)
Alleles , Creatinine , Digestion , Folic Acid , Genotype , Homocysteine , Hyperhomocysteinemia , Methylenetetrahydrofolate Reductase (NADPH2) , Polymerase Chain Reaction , Risk FactorsABSTRACT
Primary hyperparathyroidism is characterized by hypercalcemia and increased intact parathyroid hormone, and associated with reduced bone density and bony change. We experienced the case of a 18-year-old man presenting as fracture of brown tumor. And then ectopic superior mediastinal parathyroid adenoma was detected by preoperative localization studies (Tc-99m sestamibi scan, neck CT). The patient presented with fracture of the right 5th proximal phalanx which was brown tumor, and was diagnosed as having primary hyperparathyroidism due to elevated serum calcium level (12.1 mg/dl) and intact parathyroid hormone levels (1631.8 pg/ml). Ultrasonography, Tl-201/Tc-99m subtraction scan, Tc-99m sestamibi scan, computed tomography was performed, and then revealed an enlarged parathyroid gland in the superior mediastinum. Tumor was removed via a transcervical approach. Pathologically, the tumor was confirmed to be a parathyroid adenoma. After his operation, his calcium level rapidly returned to within normal ranges, and increased bone density and some remineralization of brown tumor has occurred after eight months.
Subject(s)
Adolescent , Humans , Bone Density , Calcium , Hypercalcemia , Hyperparathyroidism, Primary , Mediastinum , Neck , Parathyroid Glands , Parathyroid Hormone , Parathyroid Neoplasms , Reference Values , UltrasonographyABSTRACT
OBJECTIVES: The thyroid disease is the common form of endocrine diseases, which often requires surgical management. Recently, fine needle aspiration biopsy is widely used preoperatively. As a result, some studies show that numbers of thyroid operation have decreased significantly. We performed this study to analyze the clinical features of thyroid diseases and the trend of thyroid operation in Korea. METHODS: We reviewed medical records of 1787 cases with thyroid diseases who were managed surgically in Catholic Medical Center, Korea from 1988 to 1992. RESULTS: 1) The percentage of thyroid diseases in total cases undergoing operation in Department of General Surgery was 3%, which tended to decrease with time.2) 72.9% of thyroid diseases was benign. Among them, the frequency of nodular hyperplasia and follicular adenoma were 67.5% and 18.4%, respectively.3) The percentage of thyroid cancers in thyroid diseases was 27.1%, which tended to increase with time. The frequency of papillary adenocarcinoma was 78.6%, follicular adenocarcinoma 18.2% and medullary carcinoma 1.5%.4) Thyroid cancers were most commonly found in the forty and sixty decades. Male:female ratio was 1:8.5.5) 7.6% of thyroid cancers was accompanied by benign thyroid diseases which were mostly nodular hyperplasia and follicular adenoma.6) The most common type of operation was lobectomy (82.5%) in benign thyroid diseases, and total thyroidectomy (47.1%) and lobectomy (41.1%) in thyroid cancers.7) Fine needle aspiration biopsy was performed in 51.7% of thyroid nodules, the frequency of which tended to increase with time. The sensitivity, specificity, false negative rate and false positive rate of this test were 78.3%, 89.4%, 13.7% and 17.2%, respectively. CONCLUSION: With the use of fine needle aspiration biopsy, numbers of thyroid operation decreased and the percentage of thyroid cancers in thyroid operation increased.
Subject(s)
Adenocarcinoma, Follicular , Adenocarcinoma, Papillary , Adenoma , Biopsy , Biopsy, Fine-Needle , Carcinoma, Medullary , Endocrine System Diseases , Hyperplasia , Korea , Medical Records , Sensitivity and Specificity , Thyroid Diseases , Thyroid Gland , Thyroid Nodule , ThyroidectomyABSTRACT
Although cryptococcosis complicated with steroid therapy is well described, cryptococcosis has been rarely reported in the presence of Cushing's syndrome characterized by endogenous steroid excess. We experienced two cases of cryptococcosis in patients with Cushing's syndrome and diabetes mellitus. We describe a case of cryptococcal meningitis complicatiog Cushing's syndrome, secondary to pituitary adenoma. And another case of cryptococcal pneumonia complicatiog Cushing's syndrome, secondary to bilateral nodular adrenal hyperplasia. Before Cryptococcosis, two patients were suffered from diabetes mellitus, and they have got both adrenalectomy.
Subject(s)
Humans , Adrenalectomy , Cryptococcosis , Cushing Syndrome , Diabetes Mellitus , Hyperplasia , Meningitis, Cryptococcal , Pituitary Neoplasms , PneumoniaABSTRACT
No abstract available.