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1.
J Int Med Res ; 51(5): 3000605231172469, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37198972

RESUMO

Primary retroperitoneal mucinous cystic neoplasms are rare retroperitoneal tumors, which are histologically similar to mucinous cystic neoplasms of the ovaries. Only 31 cases of primary retroperitoneal mucinous cystic neoplasm with borderline malignancy (PRMCN-BM) have been reported (26 in women and five in men). We describe an additional male patient with PRMCN-BM. A 39-year-old man presented to our hospital with back pain. Twelve years earlier, he had undergone an orchiectomy for a germ cell tumor. Computed tomography showed a 6.9- × 4.4-cm cystic mass in the left pararenal space. Laparoscopic mass excision was performed, and a unilocular cystic mass was found in the pararenal space near the lower pole of the left kidney. A histopathological examination showed a cyst lined by atypical mucinous intestinal epithelium without stromal invasion. Targeted next-generation sequencing identified two hotspot mutations, with one each in the KRAS and GNAS genes. Outpatient follow-up 10 months after surgery showed no evidence of tumor recurrence. PRMCNs are extremely rare retroperitoneal neoplasms, especially in men. These neoplasms are rarely considered in the differential diagnosis of retroperitoneal masses, and their preoperative diagnosis is difficult. Evaluation of additional patients is required to better determine the prognosis of PRMCNs and the optimal postoperative follow-up.


Assuntos
Cistadenoma Mucinoso , Cistos , Neoplasias Císticas, Mucinosas e Serosas , Neoplasias Retroperitoneais , Adulto , Humanos , Masculino , Cromograninas/genética , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Mucinoso/patologia , Cistadenoma Mucinoso/cirurgia , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Mutação , Recidiva Local de Neoplasia , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/genética , Neoplasias Retroperitoneais/cirurgia
2.
Yonsei Med J ; 61(3): 262-266, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102128

RESUMO

The World Health Organization 2016 edition assigned anaplastic lymphoma kinase (ALK) rearrangement-associated renal cell carcinoma (ALK-RCC) as an emerging renal tumor entity. Identifying ALK-RCC is important because ALK inhibitors have been shown to be effective in treatment. Here, we report the case of a 14-year-old young man with ALK-RCC. Computed tomography revealed a well-demarcated 5.3-cm enhancing mass at the upper pole of the left kidney. There was no further history or symptoms of the sickle-cell trait. The patient underwent left radical nephrectomy. Pathologically, the mass was diagnosed as an unclassified RCC. Targeted next-generation sequencing identified a TPM3-ALK fusion gene. The present report and literature review demonstrate that TPM3-ALK RCC may be associated with distinct clinicopathological features. Microscopically, the tumors showed diffuse growth and tubulocystic changes with inflammatory cell infiltration. Tumor cells were dis-cohesive and epithelioid with abundant eosinophilic cytoplasm and cytoplasmic vacuoles. If morphological features and TFE3 expression are present in adolescent and young patients, molecular tests for ALK translocation should be performed. This awareness is critically important, because ALK rearrangement confers sensitivity to ALK inhibitors.


Assuntos
Carcinoma de Células Renais/metabolismo , Neoplasias Renais/metabolismo , Proteínas de Fusão Oncogênica/metabolismo , Adolescente , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/genética , Carcinoma de Células Renais/patologia , Criança , Feminino , Rearranjo Gênico , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/genética , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Proteínas de Fusão Oncogênica/genética , Tomografia Computadorizada por Raios X
3.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-203009

RESUMO

Seminal vesicle cyst (SVC) with ipsilateral renal agenesis is a rare congenital anomaly. When the patient is symptomatic, surgical treatment may be necessary. The open surgical approach, traditionally considered the definite form of treatment, has been associated with a high rate of morbidity. The laparoscopic approach for the management of SVCs has recently been described. A 18-year-old man presented with a 2-year history of dysuria and perineal pain. The diagnostic evaluation revealed a 45x35x48 mm sized left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with left renal agenesis. Transperitoneal laparoscopic excision of the cyst was performed successfully. The patient was discharged from the hospital on the fourth postoperative day and did not present with any complaints or complications.


Assuntos
Adolescente , Humanos , Anormalidades Congênitas , Disuria , Rim , Nefropatias , Glândulas Seminais
4.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-92241

RESUMO

Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT). The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected.


Assuntos
Angiografia , Artérias , Glicosaminoglicanos , Incidência , Complicações Pós-Operatórias , Slings Suburetrais , Incontinência Urinária
5.
Korean Journal of Urology ; : 260-265, 2010.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-63142

RESUMO

PURPOSE: With growing interest in early imaging, the aim of our study was to define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). We compared the sensitivity of enhanced computerized tomography (CT), dimercaptosuccinic acid (DMSA) scintigraphy, and Doppler ultrasonography (DUS) by using clinical findings as the standard of reference. MATERIALS AND METHODS: A total of 207 APN patients (191 women, 16 men; mean age, 49.4 years; range, 17-88 years) were enrolled in this study. All the patients underwent imaging modalities during hospitalization. SPECT images were obtained 4 hours after injection of (99m)Tc-DMSA. Transverse and coronary CT images were obtained before and after injection of the contrast agent. DUS was performed in the longitudinal, transverse, and coronal planes. All the images were read independently by a single radiologist and a nuclear medicine specialist. The sensitivity of each modality for detecting APN was compared. RESULTS: CT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163). CONCLUSIONS: For cases of clinically suspected APN, CT and DMSA scintigraphy appear to be equally sensitive and reliable for detecting APN, although CT is more practical in various fields. DUS was significantly less sensitive.


Assuntos
Feminino , Humanos , Diagnóstico por Imagem , Hospitalização , Medicina Nuclear , Pielonefrite , Especialização , Succímero , Tomografia Computadorizada de Emissão de Fóton Único , Ultrassonografia Doppler
6.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-218063

RESUMO

BACKGROUND: Umbilical cord blood (UCB) is generally stored overnight and it undergoes a CD34 positive selection process the next day for reducing the cost and due to the convenience. We intended to determine whether overnight storage of cord blood cells affects the short and long-term repopulating capacity. METHODS: Five individuals' UCB samples were analyzed by colony assay, apoptotic cell counts and long term bone marrow culture. All the samples were divided to four groups, which were the fresh group (immediate use of harvest), the overnight storage group (overnight storage at room temperature after harvest), the immediate cryopreservation group (immediate cryopreservation after harvest) and the overnight cryo group (cryopreservaton after overnight storage at room temperature after harvest). RESULTS: The number of colony forming units-granulocyte macrophage (CFU-GM) was 116.2+/-20.1 in the fresh group and 90.8+/-15.8 in the overnight storage group (P=0.07). The number of CFUs-GM was similar between the immediate and overnight cryo groups (P=0.79). The immediate cryo group showed a significantly lower number of CFUs-GM as compared to that of the fresh group (P=0.03). The apoptotic cells were detected at 21+/-6.8% in the fresh group and this was 24.2+/-2.4% in the overnight storage group (P=0.32), and this was similar between immediate and overnight cryo groups (P=0.80). The fresh group had a significantly lower number of apoptotic cells compared to that of the immediate cryo group (P=0.02). After long term stromal-based culture, the mean production of CFU-GM colonies was similar between all the groups (P>0.05). CONCLUSION: These results support the continue use of overnight storage of UCB before cryopreservation as a convenient, cost reducing measure.


Assuntos
Medula Óssea , Contagem de Células , Criopreservação , Sangue Fetal , Células Progenitoras de Granulócitos e Macrófagos , Macrófagos
7.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-28800

RESUMO

Churg-Strauss syndrome (CSS) or allergic granulomatous angiitis is a rare syndrome that is characterized by hypereosinophilic systemic necrotizing vasculitis affecting small- to medium-sized arteries and veins. In general, it occurs in individuals with pre-existing allergic asthma. When CSS appears in patients, it has the following characteristics: eosinophilia of more than 10% in peripheral blood, paranasal sinusitis, pulmonary infiltrates, histological proof of vasculitis with extravascular eosinophils, and mononeuritis multiplex or polyneuropathy. Therapeutic trials dedicated to Churg-Strauss syndrome have been limited due to the rarity of this disorder and the difficulty in making a histological diagnosis. Proper treatment of patients with CSS is not widely known. In this case study, we report on our experience with an unusual patient case, characterized by purpura and a perforation of the small intestine after inadequate steroid therapy.


Assuntos
Humanos , Artérias , Asma , Síndrome de Churg-Strauss , Eosinofilia , Eosinófilos , Perfuração Intestinal , Intestino Delgado , Mononeuropatias , Polineuropatias , Púrpura , Sinusite , Vasculite , Veias
8.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-722375

RESUMO

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.


Assuntos
Humanos , Bacteriemia , Toxinas Bacterianas , Ciprofloxacina , Clindamicina , Atenção à Saúde , Exotoxinas , Gentamicinas , Incidência , Leucocidinas , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Fatores de Risco , Tetraciclina , Combinação Trimetoprima e Sulfametoxazol
9.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-721870

RESUMO

Recent reports have described an increasing incidence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in patients who do not exhibit established risk factors for healthcare exposure. We report two cases of CA-MRSA bacteremia complicated by vertebral osteomyelitis. Both of CA-MRSA isolates were resistant to beta-lactam agents, but susceptible to clindamycin, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, and tetracycline. Both isolates carried staphylococcal cassette chromosome mec (SCCmec) type IVA, and were identified as sequence type (ST) 72 by mlultilocus sequence typing (MLST). However, the Panton-Valentine leukocidin (PVL) gene was not identified.


Assuntos
Humanos , Bacteriemia , Toxinas Bacterianas , Ciprofloxacina , Clindamicina , Atenção à Saúde , Exotoxinas , Gentamicinas , Incidência , Leucocidinas , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Fatores de Risco , Tetraciclina , Combinação Trimetoprima e Sulfametoxazol
10.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-61118

RESUMO

Purpose: To determine the clinical differences between prostate cancer detected on initial biopsy and repeated biopsy Materials and Methods: Between January 2003 and December 2006, 67 patients were evaluated in this study who were diagnosed prostate cancer by transrectal ultrasound-guided biopsies and their prostate specific antigen (PSA) were below 20 ng/ml and clinical stages were less than T2. Among 67 patients, 43 patients were diagnosed at the first biopsies (group A) and others were diagnosed at the repeate biopsies (group B). We retrospectively characterized differences in clinical features such as age, digital rectal examination (DRE), prostate volume, the number of biopsy core, rate of positive core, PSA, % free PSA, Gleason score and rate of insignificant cancer. Results: There were no significant differences in age, PSA, % free PSA, rate of insignificant cancer between groups A and B. However, positive rate of DRE, prostate volume and rate of patients whose PSA were 7 ng/ml or higher in group A were significantly higher than those in group B. Despite the number of biopsy core was higher in group A, there were no differences in the number of positive biopsy core. Conclusions: Compared to the patients who were diagnosed as prostate cancer in the initial biopsies, prostate volume, positive rate of DRE and rate of Gleason score 7 or more were significantly lower in repeated biopsy group. From now on we are planning to include more patients and compare these characteristics of biopsies with the final pathological features after radical prostatectomy.


Assuntos
Humanos , Biópsia , Exame Retal Digital , Gradação de Tumores , Próstata , Antígeno Prostático Específico , Neoplasias da Próstata , Estudos Retrospectivos
11.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-205677

RESUMO

PURPOSE: Tension-free vaginal tape(TVT) procedure is an effective surgical procedure for the treatment of female urinary stress incontinence. The purpose of this study was to evaluate the changes of pelvic floor MR imaging findings after tension-free vaginal tape procedure on stress urinary incontinent women. MATERIALS AND METHODS: Thirty two women with complaint of stress urinary incontinence(mean age, 56 years; age range 32~73 years) were included in this study. Pelvic floor MR imaging were performed preoperatively and one month after surgery. The position of the bladder neck in relation to the pubococcygeal line, the position of the bladder neck in relation to a perpendicular line through the posterior edge of symphysis pubis, the angle of urethral inclination were measured. We also measured the position of anterior wall of the urethra in relation to posterior edge of the symphysis pubis and cystocele during resting and pelvic straining and thickness of the anterior wall. We compared all parameters between resting and stress. RESULTS: Twenty nine patients(91%) had normal voiding pattern after TVT procedure. three patients(9%) had voiding difficulty. The position and mobility of the bladder neck during straining showed significant improvement after surgery(p<0.01). During straining, the length between the urethra and the inferior edge of the pubic symphysis with mid-urethra angulation was shorten in twenty eight patients(88%). There is no significant difference among three groups in all parameters. However, 3 patients with voiding difficulty had the significant high bladder neck and moderate cystocele. CONCLUSION: The TVT procedure provides decrease of urethral hypermobility and increase of mid-urethral angulation. MR imaging demonstrate well that urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed at stress. Postoperative voiding difficulty may be related to remaining cystocele and high bladder neck.


Assuntos
Feminino , Humanos , Cistocele , Joelho , Imageamento por Ressonância Magnética , Pescoço , Diafragma da Pelve , Sínfise Pubiana , Slings Suburetrais , Uretra , Bexiga Urinária , Incontinência Urinária , Incontinência Urinária por Estresse
12.
Korean Journal of Urology ; : 965-970, 2007.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-78522

RESUMO

PURPOSE: We compared the clinical and urodynamic findings of patients suffering with lower urinary tract symptoms(LUTS)/benign prostatic hyperplasia(BPH) and who underwent transurethral resection of the prostate, and we tried to determine the effect of urodynamical obstruction and the bladder function on the result of this operation. MATERIALS AND METHODS: 101 patients with LUTS/BPH were categorized in four groups based on the findings of the preoperative urodynamic study: 15(14.8%) patients without bladder outlet obstruction[(BOO(-)], 50 (49.5%), patients with BOO[(BOO(+)], 12 patients(11.8%) with BOO and with detrusor underactivity(BOO+DU), and 24 patients(23.7%) with BOO and with detrusor overactivity(BOO+DO). The outcomes and satisfaction were analyzed by the changes of the International Prostate Symptom Score(IPSS) and the quality of life(QoL) index before and after transurethral resection of the prostate(TURP), respectively. RESULTS: The Qmax was significantly high and residual urine was significantly low in group BOO(-). The PdetQmax was significantly high in group BOO(+) and also in the BOO+DO group. In group BOO(-), the decrease of the total IPSS was smaller than that noted in the other groups. There were significant decreases of the IPSS after TURP in groups BOO (+), BOO+DU and BOO+DO each voiding and storage subscore were decreased,but in group BOO+DO, the improvement was not as much as that in the other groups. The QoL was improved significantly in group BOO compared to the other groups. CONCLUSIONS: Performing urodynamics preoperatively helps to predict the degree of symptom relief, and a higherbaseline BOO positively predicts the postoperative improvement of the IPSS and the QoL. The outcome of the BOO+DU group was satisfactory, but storage symptoms still existed for the BOO+DO group.


Assuntos
Humanos , Próstata , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Obstrução do Colo da Bexiga Urinária , Bexiga Urinária , Sistema Urinário , Urodinâmica
13.
Korean Journal of Urology ; : 440-442, 2006.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-99392

RESUMO

Fibrotic lesions occurring in the corpus cavernosum are usually cases of Peyronie's disease that originate from the tunica albuginea, or they are the fibrotic result of inflammatory processes. The lesion involving the corpus cavernosum, but not tunica albuginea is rare. We present here a case of fibrotic nodule arising in the corpus cavernosum with the sonographic and magnetic resonance imaging features. A 38-year-old man complained a small nodular mass in the left corpus cavernosum at the level of penoscrotal junction without abnormal curvature of the organ. We performed ultrasonography and magnetic resonance imaging to determine exactly what the lesion was. The lesion was removed and it was pathologically found to be a localized fibrotic nodule of the corpus cavernosum with some narrow-channeled vascular structures.


Assuntos
Adulto , Humanos , Masculino , Fibrose , Imageamento por Ressonância Magnética , Induração Peniana , Pênis , Ultrassonografia
14.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-105673

RESUMO

Leber's hereditary optic neuropathy(LHON) is an optic nerve disease that causes blindness and is associated with maternally inherited mitochondrial DNA(mt DNA) mutations. The most common mitochondrial DNA mutation among LHON patients is a point mutation at the nucleotide 11778 in the subunit 4 of complex I. In one 45-year old male LHON patient with bilateral optic neuropathy, we investigated the presence of a point mutation of mitochondrial DNA and identified a single guanine to adenine transition mutation in the mitochondrial DNA at nucleotide point 11778.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Adenina , Cegueira , DNA Mitocondrial , Guanina , Atrofia Óptica Hereditária de Leber , Doenças do Nervo Óptico , Mutação Puntual
15.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-228313

RESUMO

BACKGROUND AND OBJECTIVES: Local compression of the ulnar nerve occurs most commonly at the elbow and optimal surgical intervention should be directed at the specific site of involvement. This study is designed to localize the more discrete region by using the method of short segment stimulation in ulnar neuropathy at the elbow. METHODS: Thirty seven patients who were diagnosed as entrapment ulnar neuropathy at the elbow by routine nerve conduction studies were investigated. Latency changes and amplitude changes including conduction block were determined by stimulating the ulnar nerve at 2cm intervals across the elbow. Six of these patients had orthopedic surgery after undergoing short segment stimulation studies. RESULT: All patients had significant latency changes(> OR =0.7msec) in specific segments by short segment stimulation and 6 patients of them showed conduction block. The most frequently involved segments were between medial epicondyle and 2cm proximal(20 patients) and between medial epicondyle and 2cm distal(9 patients). Only two patients exhibited significant latency changes between 2 and 4cm distal to the medial epicondyle, suggesting cubital tunnel syndrome. Lesions, as identified by surgery, proved to be accurately predicted by preoperative short segment stimulation in 5 of 6 patients. CONCLUSION: Short segment stimulation studies are helpful in localizing more accurate involved segment in ulnar neuropathy at the elbow. And the most commonly involved site is within 2cm of the medial epicondyle suggesting tardy ulnar nerve palsy.


Assuntos
Humanos , Síndrome do Túnel Ulnar , Cotovelo , Condução Nervosa , Ortopedia , Nervo Ulnar , Síndromes de Compressão do Nervo Ulnar , Neuropatias Ulnares
16.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-173327

RESUMO

Antiphospholipid antibody syndrome(APS) is a well-known clinical syndrome characterized by recurrent arterial or venous thromboses, recurrent fetal loss, thrombocytopenia, together with high titers of sustained anticardiolipin antibody(aCL) or lupus anticoagulant(LA). Although systemic lupus erythematosus(SLE) and APS may coexist, a high proportion of patients manifesting the APS do not suffer from classical lupus or other connective tissue disease. The patient has been defined as having a primary antiphospholipid antibody syndrome. We experienced one case of primary APS with recurrent fetal loss, recurrent cerebral infarctions, positive anticardiolipin antibody IgG and fluttering vegetation on the mitral valve, without other connective tissue diseases including SLE. Forty-three old female had 2 out of 11 criteria for the diagnosis of SLE, such as thrombocytopenia and positive antinuclear antibody, but did not meet whole criteria. The patient was treated with ticlopidine, and anticoagulant therapy was recommended.


Assuntos
Feminino , Humanos , Anticorpos Anticardiolipina , Anticorpos Antinucleares , Anticorpos Antifosfolipídeos , Síndrome Antifosfolipídica , Infarto Cerebral , Doenças do Tecido Conjuntivo , Diagnóstico , Ecocardiografia , Imunoglobulina G , Valva Mitral , Trombocitopenia , Ticlopidina , Trombose Venosa
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