The hyperimmunoglobulin E syndrome is a primary immunodificiency disorder characterized by recurrent staphylococcal infections and markedly elevated serum IgE level. Clinical features are coarse face and severe infections of the skin-furunculosis or chronically pruritic dermatitis and sinopulmonary tract infection from infancy by coagulase positive Staphylococcus aureus, or Candida albicans etc. The patients's serum IgE level is elevated but the basic immunologic pathogenesis not fully understood. We have experienced a case of hyperimmunoglobulin E syndrome in a 26/12-year-old who had suffered from recurrent staphylococcal pneumonias and abscesses and chronically pruritic dermatitis from 1 month of age with elevated serum IgE level. A brief review of the related literature is presented.
Abscess ; Candida albicans ; Coagulase ; Dermatitis ; Immunoglobulin E ; Pneumonia, Staphylococcal ; Staphylococcal Infections ; Staphylococcus aureus

PURPOSE: We analyzed the efficacy and safety of laparoscopic radical cystectomy (LRC) compared with open radical cystectomy (ORC). MATERIALS AND METHODS: Between November 2007 and April 2009, we performed LRC to treat bladder cancer in 23 patients and ORC in 64 patients. Data including the patients' clinical characteristics, peri-operative parameters, clinical outcomes, and oncologic outcomes were collected retrospectively and analyzed by use of the Mann-Whitney U test and chi-square test. RESULTS: There were no significant differences in demographic data between the two groups. Operative time was longer (595.2 min vs. 453.1 min; p<0.01) in the LRC group but blood loss was less (634.8 ml vs. 1,415.9 ml; p<0.01) and fewer transfusions were required (13.0% vs. 50.0%; p=0.002) in the LRC group. Days to oral intake (5.7 days vs. 7.3 days; p<0.01), days to drain removal (10.9 days vs. 13.9 days; p=0.014), and length of hospital stay (15.2 days vs. 22.3 days; p<0.01) were shorter in the LRC group. Postoperative complications occurred in 4 cases in the LRC group and 28 cases in the ORC group (17.4% vs. 43.8%, p<0.01). There were no cases with a positive surgical margin in the LRC group and 3 cases in the ORC group. There was no significant difference in the number of lymph nodes excised (17.4 vs. 19.6; p=0.132) between groups. CONCLUSIONS: These short-term clinical and oncological results suggest that LRC is a safe and effective method for the treatment of invasive bladder cancer.
Cystectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Diversion

Pulmonary blastoma is a rare type of malignant lung tumor comprised of epithelial and mesenchymal elements reminiscent of fetal lung. Mesenchymal element may show various patterns of differentiation toward mature tissue, such as cartilage, smooth muscle, and bone. Rhabdomyoblastic differentiation in pulmonary blastoma is quite rare. Our case of pulmonary blastoma with rhabdomyoblastic differentiation documented by electron microscopy and immunohistochemistry. Usually it has been treated with surgery, but both chemotherapy and radiotherapy have been used against the metastatic disease, and as the adjuvant setting. A 28/12-year-old girl is described who was presented with pulmonary blastoma. She underwent surgical excision of the tumor, followed by the T2protocol, a 8 cycles of combination chemotherapy consisting of actinomycin-D, adriamycin, vincristine and cyclophosphamide with the radiation therapy to the left chest cage(180cGyx11 times). The patient has been off therapy without any evidence of relapse for 24 months. We report a case of pulmonary blastoma with brief review of related literatures.
Cartilage ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Female ; Humans ; Immunohistochemistry ; Lung ; Microscopy, Electron ; Muscle, Smooth ; Pulmonary Blastoma* ; Radiotherapy ; Recurrence ; Thorax ; Vincristine

We evaluated the role of retroperitoneal laparoscopic ureterolithotomy (RPLU) for upper ureter stones. Between February 1998 and July 2004, 12 patients (10 men and 2 women) underwent RPLU for upper ureter stones (mean size 18.1 mm, range 10-25). RPLU was carried out in 5 patients as a salvage treatment after failed shock wave lithotripsy (SWL) (3) and both of failed SWL and ureteroscopy (URS) (2), and in 7 patients as primary treatment for large impacted stones. Total 6 of 12 cases were converted to open surgery. The reason of open conversion was failure of locating ureter due to severe adhesion in 5 cases and vascular injury in 1 case. In 6 successful cases, mean operation time, mean estimated blood loss, and mean postoperative hospital stay were respectively 109 min (90-120 min), 50 mL (10-100 mL), 4.6 days (2-7 days). There was no serious postoperative complication except for one patient who showed delayed urinary leakage but was cured with conservative management. Our experience suggested that RPLU was not easy to perform simply because it was indicated mainly in ureter stones with severe adhesion or after failed SWL and/or URS. Nevertheless, it can be considered as a primary procedure before open ureterolithotomy.
Urologic Surgical Procedures/*methods ; Ureteral Calculi/*therapy ; Ureter/pathology ; Treatment Outcome ; Time Factors ; Sex Factors ; Retroperitoneal Space/pathology ; Peritoneum ; Middle Aged ; Male ; Lithotripsy/*methods ; Laparoscopy/*methods ; Humans ; Female ; Adult

PURPOSE: Recently, the whole DNA sequence of Bacillus subtilis (B. subtilis) was identified, revealing the existence of the YvrK gene encoding a 43 kD oxalate decarboxylase (OXDC), which degrades oxalate by a simple pathway. The objective of this study was to develop recombinant Escherichia coli (E. coli) expressing the Yvrk gene from B. subtilis. MATERIALS AND METHODS: After the extraction of total DNA from B. subtilis, the YvrK gene was cloned by polymerase chain reaction. The cloned DNA encoding OXDC was inserted into the pBAD/gIII-A vector, downstream of the L-arabinose promotor. The plasmid vector was transformed into TOP 10 E. coli, and the transformants were selected with ampicillin. The recombinant E. coli, named pBy, was then analyzed by DNA sequencing and Western blot. To evaluate the oxalate-degrading function of pBy, pBy was cultured in LB broth containing oxalate, and then the amount of oxalate in the medium was assessed. The oxalate-degrading activity of homogenates of pBy was evaluated. RESULTS: DNA sequencing showed the successful transformation of the YvrK gene into TOP 10 E. coli. Western blot analyses showed that pBy expressed OXDC. pBy removed oxalate during the overnight culture in oxalate-containing LB broth, and the homogenate of pBy degraded 90% of oxalate under acidic conditions. CONCLUSIONS: A recombinant E. coli expressing the YvrK gene was successfully produced. The bacteria showed potent oxalate-degrading activity. The results of this study will provide a solution to the treatment of calcium oxalate stones and hyperoxaluria, for which there are few medical treatment modalities.
Ampicillin ; Arabinose ; Bacillus subtilis ; Bacteria ; Base Sequence ; Blotting, Western ; Calcium Oxalate ; Carboxy-Lyases ; Clone Cells ; DNA ; Escherichia coli ; Hyperoxaluria ; Oxalates ; Plasmids ; Polymerase Chain Reaction ; Sequence Analysis, DNA

PURPOSE: Nanobacteria have been reported to induce various pathologic calcifications like atherosclerosis and nephrolithiasis, and they do so by forming an apatite envelope, however, this concept is still controversial. We tried to elucidate whether nanobacteria might be related with urinary calcium stone by performing comparative study. MATERIALS AND METHODS: This study included 38 urinary stone patients who were proved to have calcium-containing stones and 37 healthy adults without urinary stone disease as controls. The subjects' age and gender were well matched between both groups. For the detection of nanobacteria, the serum and urine of all subjects were collected and western blotting for the samples was performed. RESULTS: There was no significant difference in the positive rate of nanobacteria from the serum samples between stone and control groups (52.6% vs 48.6%, respectively, p=0.465). But on the urine samples, the stone group showed a significantly higher positive rate than the control group (71.1% vs 21.6%, respectively, p<0.05). CONCLUSIONS: Nanobacteria might have a relation with urinary calcium stone disease.
Adult ; Atherosclerosis ; Bacteria ; Blotting, Western ; Calcifying Nanoparticles* ; Calcium* ; Humans ; Nephrolithiasis ; Urinary Calculi ; Urolithiasis

PURPOSE: After successful launches of a 120 W high-power system for photoselective vaporization of the prostate (HPS-PVP), several studies in the United States and Europe have reported good short-term data. Here we report the initial efficacy and side effects of the 120 W HPS-PVP in Korea. MATERIALS AND METHODS: Between January 2008 and January 2009, we performed a retrospective clinical analysis of 133 patients treated by HPS-PVP. RESULTS: The mean age at surgery was 68.4+/-8.0 years. The mean prostate size was 44.2+/-22.6 ml. The mean operation time was 58.9+/-33.5 minutes, and the mean total applied energy was 103,108+/-74,362 J. The mean duration of catheterization was 21.5+/-10.8 hours. The blood loss was minimal, and there were no transfusions. The baseline mean peak urinary flow rate (Qmax) was 10.4+/-5.0 ml/s, mean postvoid residual volume (PVR) was 77+/-91.3 ml, the mean International Prostate Symptom Score (IPSS) was 20.7+/-9.0, and the mean quality of life (QoL) score was 4.2+/-1.3. At 6 months, Qmax was 17.5+/-9.9 ml/sec, PVR was 49.0+/-56.0 ml, the IPSS was 8.0+/-9.0, and the QoL score was 1.6+/-1.5. During the first postoperative month, irritative urinary symptoms were reported in 18 cases, urge incontinence in 7, mild hematuria in 5, urinary tract infection in 2, and temporary recatheterization in 13. CONCLUSIONS: The new 120 W HPS-PVP showed good short-term safety and efficacy for the treatment of Korean patients with benign prostatic hyperplasia.
Catheterization ; Catheters ; Europe ; Hematuria ; Humans ; Korea ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Residual Volume ; Retrospective Studies ; United States ; Urinary Incontinence, Urge ; Urinary Tract Infections ; Volatilization

PURPOSE: We wanted to evaluate the safety and efficacy of standard laparoscopic radical nephrectomy (LRN) as compared to hand-assisted laparoscopic radical nephrectomy (HALS) and open radical nephrectomy (ORN) when the three different procedures were all performed by a single experienced surgeon. MATERIALS AND METHODS: Between May 2000 and September 2005, 62 consecutive patients with renal tumor underwent LRN (16 patients), HALS (18 patients), or ORN (32 patients) by a single surgeon who had performed more than 100 laparoscopic surgeries. The surgical results such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesia requirement, hospital stay and complications, and pathologic results were reviewed retrospectively. RESULTS: The LRNs and HALSs were successfully performed for all patients without open conversion. The final pathologic reports showed renal cell carcinomas in 65 cases and oncocytoma in 1 case. There were no significant differences of demographic data between the three groups. For the LRN, HALS, and ORN patients, the mean tumor size was 2.8cm (1.3-8.5), 4.5cm (1.5-13.5) and 5.6cm (1.0-12.5), respectively, the mean weight of the removed kidney was 200.6g (63-375), 214.5g (122-444.3) and 367.0g (122-823), respectively, the mean operation time was 174.8 min. (125-232), 196.4 min. (150-350) and 157.7 min. (110-265), respectively, the EBL was 140ml (50- 400), 108ml (50-600) and 297ml (50-700), respectively, the transfusion rate was 0%, 5.6% and 15.6%, respectively, the narcotic analgesia requirement was 20mg, 15mg and 43mg of morphine sulfate, respectively, the postoperative hospital stay was 4.8 days, 5.2 days and 10.5 days respectively, and the number of complication was 1/16 cases (6.3%), 1/18 cases (5.6%) and 4/32 cases (12.5%) respectively. The surgical and pathological parameters of LRN showed no significant difference compared to those of the HALS. CONCLUSIONS: LRN for renal tumors was less invasive than ORN and it showed similar surgical results to HALS. Therefore standard laparoscopic radical nephrectomy is considered to be an effective and safe treatment modality for renal tumors.
Adenoma, Oxyphilic ; Analgesia ; Carcinoma, Renal Cell ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Morphine ; Nephrectomy* ; Retrospective Studies

PURPOSE: The critical pathway (CP) for radical retropubic prostatectomy (RRP), which is the efficient standardized guideline of clinical practice, was established for all the medical staff, nurses, patients and hospital managers for managing patients with RRP. The aim of this study was to evaluate the usefulness of this CP for RRP. MATERIALS AND METHODS: Our series consisted of 256 consecutive patients who had undergone RRP at a single institution from March 1, 2002 till May 31, 2005. The CP of RRP was implemented January 1, 2004. The patients were subdivided into two groups: (1) the non critical pathway (NCP) group that was made of 91 patients who were treated other than by the CP (from March, 2002 through December, 2003) and (2) the CP group of 134 patients who were placed on CP (from January, 2004 through May, 2005). The factors compared in this study included the average length of stay (LOS), the average hospital charges, the postoperative complications and the patient satisfaction between the two groups. RESULTS: There were no significant differences in the parameters between the two groups including age, the prostate-specific antigen (PSA) level, the Gleason score and the stage. The average LOS decreased significantly after implementation of CP without increasing the incidence of postoperative complications. The average hospital charges were significantly lower for the CP group than for the group without CP. The patients in the CP group were more satisfied than the other patients. CONCLUSIONS: The CP for RRP seems to be effective practical guidelines for managing radical retropubic prostatectomy patients.
Critical Pathways* ; Hospital Charges ; Humans ; Incidence ; Length of Stay ; Medical Staff ; Neoplasm Grading ; Patient Satisfaction ; Postoperative Complications ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms

PURPOSE: We present a single surgeon experience of 52 cases of transperitoneal laparoscopic adrenalectomy for various adrenal diseases. MATERIALS AND METHODS: Transperitoneal laparoscopic adrenalectomy (n= 52) for various adrenal diseases was performed by a single surgeon from February 1998 to December 2004. Clinical diagnosis of the subjects included 17 cases of primary aldosteronism, 11 of adrenal adenoma causing Cushing's syndrome, 3 of pheochromocytoma and 21 of nonfunctioning adenoma. The 52 patients were divided into 3 groups according to the time when operations were performed: early group of 18 patients, intermediate group of 17 patients, and late group of 17 patients. The mean operative time, mean estimated blood loss (EBL) and complication of each group were investigated to analyze the single surgeon's learning curve. RESULTS: All laparoscopic adrenalectomies were successfully completed in all 52 patients. The mean operative time, mean EBL, mean tumor size, and mean postoperative hospital stay were 124 minutes (60-360), 56cc (30-300), 2.7cm (1-4.7), and 3.8 days (3-8), respectively. The mean time to solid diet and ambulation were 1.5 days and 1 day, respectively. There was no serious intraoperative or postoperative complication. Statistically, the mean operative time and estimated blood loss showed a significant reduction in the intermediate and late group compared with the early group. CONCLUSIONS: Our results showed that transperitoneal laparoscopic adrenalectomy is a safe and effective surgical treatment modality in adrenal diseases.
Adenoma ; Adrenal Gland Diseases ; Adrenalectomy* ; Cushing Syndrome ; Diagnosis ; Diet ; Humans ; Hyperaldosteronism ; Laparoscopy ; Learning Curve ; Length of Stay ; Operative Time ; Pheochromocytoma ; Postoperative Complications ; Walking