A Case of Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Submucosal Resection / 대한소화기내시경학회지

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.

A Case of Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Submucosal Resection / 대한소화기내시경학회지

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.

Development of Enzyme Linked Immunosorbent Assay for Erythropoietin / 대한진단검사의학회지

BACKGROUND: The aim of our study was to optimize and establish erythropoietin (EPO) enzyme linked immunosorbent assay (ELISA) system. METHODS: We prepared several monoclonal and polyclonal antibodies specific to human-EPO. The best combinations of antibodies for coating and detecting antibodies were selected for the establishment of ELISA. We tested several methods such as a competitive EIA and a sandwich ELISA. RESULTS: The best sandwich ELISA was optimized compared to competitive EIA when purified polyclonal antibody (PoAb) was used as a coating antibody and biotinylated PoAb as a detecting antibody. This sandwich ELISA easily detected EPO when PoAb pairs were used compared to the ELISA using monoclonal antibody and PoAb. There were no significant differences between the effects of various blocking solutions on the performance of sandwich ELISA using biotinylated antibody. The ELISA system using PBST containing 3% BSA as a blocking solution can sensitively detect EPO (10 mU/mL) in a broad range of EPO concentrations (10-2,000 mU/mL) and there were cross-reactions with other cytokines). CONCLUSIONS: EPO can be easily determined by using biotinylated PoAb as a detecting antibody and another PoAb as a coating antibody.

Endovascular Management of Immediate Procedure-Related Complications of Failed Hemodialysis Access Recanalization

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.

Three Cases of Sclerosing Lymphangitis of the Penis / 대한남성과학회지

Sclerosing lymphangitis of the penis is a rare condition involving the distal lymphatics that is characterized by cord-like lesions on the shaft or coronal sulcus. Although the etiology is unknown, its association with mechanical trauma, anatomic variants, or infection has been shown. Clinically, the patient notices a painless, firm, cord-like lesion just proximal to the sulcus. Histologic study reveals hypertrophy and sclerosis of lymphatic vessel walls and, in some cases, thrombus formation within the dilated vessels. Most cases are self-limited, and conservative management is indicated, but surgical excision is warranted for persistently symptomatic lesions. We report three cases of sclerosing lymphangitis of the penis that required treatment by surgical excision.

Initial Experience of Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: A retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is useful as an approach to urological surgery. Here, our initial experience of retroperitoneal laparoscopic radical nephrectomies, in 18 consecutive patients with renal cell carcinomas, is reported. MATERIALS AND METHODS: The records of 18 consecutive patients, with renal cell carcinomas, that underwent a retroperitoneal laparoscopic radical nephrectomy between June 2000 and September 2002, were reviewed. RESULTS: The retroperitoneal laparoscopic radical nephrectomies, for the renal cell carcinomas, were successfully performed in all but 3 patients. These 3 were converted to an open technique due to severe adhesion in 1 and bleeding in the other 2. Of the 15 renal cell carcinomas, the final pathological stages were pT1N0M0 in 14 and pT2N0M0 in 1. The mean tumor size and specimen weight were 4.3cm, ranging from 2 to 7.5cm and 258gm, ranging from 203 to 372gm, respectively. The tumors involved the upper pole, the mid pole and the lower pole in 5, 6 and 4 cases, respectively. The mean operative time and estimated blood loss were 195 minutes, ranging from 160 to 260 minutes, and 181.3cc, ranging from 50 to 500cc, respectively. In 4 of the 15 patients, Patient-Controlled Analgesia (PCA) were used for the control of post operative pain, the other 11 required minimal postoperative analgesics. The mean interval to resuming oral intake and hospital stay were 2.3 days, ranging from 2 to 3 days, 5.4 days, ranging from 4 to 7 days, respectively. Complications occurred in 2 patients, and included partial atelectasis in 1 and pulmonary edema in the other. Neither local recurrence nor distant dissemination was observed during the mean follow-up of 13.6 months (range 4 to 25). CONCLUSIONS: A retroperitoneal laparoscopic radical nephrectomy is a safe and effective alternative, to an open radical nephrectomy, in patients with a localized renal cell carcinoma.

Clinical Significance of the Urinary Bladder Cancer Antigen (UBCTM) Test in the Diagnosis of Bladder Cancer / 대한비뇨기과학회지

PURPOSE: A new quantitative tumor marker, based on the combined measurement of urinary fragments of cytokeratin 8 and 18, namely the urinary bladder cancer antigen (UBCTM) test, has been proposed for the detection of bladder cancer. We compared the results of the UBC test, with voided urine cytology, for the diagnosis of bladder cancer to evaluate its diagnostic performance. MATERIALS AND METHODS: The UBC concentrations were measured, using an immunoradiometric assay, in the urine of 15 healthy subjects (group I), 26 patients with other urological disease except bladder cancer (group II), 40 patients with active bladder cancer (group III) and 17 patients free of bladder cancer, as confirmed by cystoscopy at follow-up (group IV). The differences in the UBC test, with regard to stage, grade, tumor size, focality and history of recurrence, were also evaluated. RESULTS: The mean UBC concentrations were 3.52micro gram/l, 45.76micro gram/l, 92.80micro gram/l and 20.51micro gram/l, for group I to IV, respectively, which were statistically different (p<0.05). There were significant differences regarding stage (p=0.044) and tumor size (p=0.036). However, no differences were founded in relation to the grade, shape, focality or history of recurrence. The optimal threshold for the UBC test, and the area under the ROC curve, were 12.8micro gram//l and 0.684, respectively. The sensitivity, specificity, positive and negative predictive values for the UBC test and urine cytology in groups III and IV were 50.0 and 30.0%, 88.2 and 100%, 90.9 and 100%, and 42.9 and 37.0%, respectively. CONCLUSIONS: The UBC test appears to be useful for the detection of bladder cancer in terms of its superior sensitivity and negative predictive value over those of urine cytology. Further studies will be required for the clinical utility of the UBC test in the diagnosis and follow-up of bladder cancer.

Polypoid Cystitis Managed by Bladder Substitution / 대한비뇨기과학회지

Polypoid cystitis is an unusual benign lesion characterized by the edema, congestion and inflammation elevating the vesical mucosa into papillary projections. It is rare in the absence of one of the following 3 recognizable causes: indwelling catheters, vesical fistula or chronic bladder irritation. We report a case of a rapidly growing, huge polypoid cystitis without identifiable cause in a 17-year-old female, who was managed by cystectomy with uterus preservation and orthotopic bladder substitution.