PURPOSE: This study evaluated the prognostic differences in invasive cancer that progressed from a superficial transitional cell carcinoma (TCC) compared to an already invasive TCC at the time of the initial presentation. MATERIALS AND METHODS: Seventy-one patients who had a radical cystectomy performed for an invasive TCC were enrolled in this study. They were divided into two groups. In the first group, the patients were diagnosed as a superficial TCC at initially, which progressed to an invasive tumor. The second group consisted of patients who were diagnosed with invasive TCC at the time of the initial diagnosis. Two groups were compared with regard to the TNM stage, Ash grade, presence of accompanying carcinoma in-situ and survival rate. RESULTS: The group with invasive cancer at the time of the initial presentation had a significantly higher grade than the progressed group. The five-year survival rate was lower in the progressed group. Moreover, Kaplan-Meier analysis showed it was statistically significant (p=0.04). CONCLUSIONS: The grade was higher and the five-year survival rate was lower in the group with invasive cancer at the time of the initial presentation. Therefore, the invasive TCC at the initial diagnosis might take a more aggressive nature than the progressed group.
Carcinoma, Transitional Cell ; Cystectomy ; Diagnosis* ; Humans ; Kaplan-Meier Estimate ; Prognosis ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Classification* ; Female ; Hydatidiform Mole* ; Pregnancy ; Risk Factors*

No abstract available.
Classification* ; Female ; Hydatidiform Mole* ; Pregnancy ; Risk Factors*

BACKGROUND: Many disinfectants have been used clinically in both single and combination applications, but there have been few studies on disinfective power according to sterilization sequence when using a combination of disinfectants. The purpose of this study was to evaluate the disinfective power of a combination of 70% isopropyl alcohol and 10% povidone-iodine (PVP-I) according to sterilization sequence. METHODS: Two hundred healthy volunteers were recruited. Subjects were disinfected with a combination of 70% isopropyl alcohol and 10% PVP-I on both forearms, in varying sequence. The AP group included disinfections on the left forearm with isopropyl alcohol first followed by 10% PVP-I, while the PA group included disinfections on the right forearm with same disinfectants in reverse order. Skin cultures were obtained using cotton swabs 3 min after application of each disinfectant, and then were inoculated on blood agar plates for bacterial culture. Cultures were incubated at 37degrees C under aerobic conditions for 48 hours. RESULTS: There was no significant difference in the number of positive cultures after the 1st disinfection (AP, 45; PA, 36, P = 0.262) or the 2nd disinfection (AP, 6; PA, 13, P = 0.157), suggesting that there is no relationship between disinfective power and the sequence of the disinfectants used. The number of positive cultures significantly decreased after the 2nd disinfection (P < 0.01), however. CONCLUSIONS: There was no significant difference in disinfective power according to sterilization sequence with 70% isopropyl alcohol and 10% PVP-I in healthy volunteers. The combination of 70% isopropyl alcohol and 10% PVP-I was more effective than disinfection with a single agent regardless of sterilization sequence.
2-Propanol* ; Agar ; Disinfectants ; Disinfection ; Forearm ; Healthy Volunteers ; Povidone-Iodine* ; Skin ; Sterilization

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.
Biliary Tract ; Choledocholithiasis ; Needles ; Pancreas ; Sphincterotomy, Endoscopic* ; Urinary Bladder

PURPOSE: It is difficult to obtain biopsies from gastrointestinal stromal tumors (GISTs) prior to surgery because GISTs are submucoal tumors, despite being the most common nonepithelial neoplasms of the gastrointestinal tract. Unlike anatomic imaging techniques, PET-CT, which is a molecular imaging tool, can be a useful technique for assessing tumor activity and predicting the malignant potential of certain tumors. Thus, we aimed to evaluate the usefulness of PET-CT as a pre-operative prognostic factor for GISTs by analyzing the correlation between the existing post-operative prognostic factors and the maximum SUV uptake (SUVmax) of pre-operative 18F-fluoro-2-deoxyglucose (FDG) PET-CT. MATERIALS AND METHODS: The study was conducted on 26 patients who were diagnosed with gastric GISTs and underwent surgery after being examined with pre-operative FDG PET-CT. An analysis of the correlation bewteen (i) NIH risk classfication and the Ki-67 proliferation index, which are post-operative prognostic factors, and (ii) the SUVmax of PET-CT, which is a pre-operative prognostic factor, was performed. RESULTS: There were significant correlations between (i) SUVmax and (ii) Ki-67 index, tumor size, mitotic count, and NIH risk group (r=0.854, 0.888, 0.791, and 0.756, respectively). The optimal cut-off value for SUVmax was 3.94 between "low-risk malignancy" and "high-risk malignancy" groups. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7% and 94.7%, respectively. CONCLUSIONS: The SUVmax of PET-CT is associated with Ki-67 index, tumor size, mitotic count, and NIH classification. Therefore, it is believed that PET-CT is a relatively safe, non-invasive diagnostic tool for assessing malignant potential pre-operatively.
Biopsy ; Electrons ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Molecular Imaging ; Positron-Emission Tomography ; Sensitivity and Specificity

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.
Abdomen ; Actinomycosis/drug therapy/*pathology/surgery/ultrasonography ; Biopsy, Needle/methods ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Penicillins/therapeutic use ; Treatment Outcome ; Urinary Bladder/*pathology/surgery/ultrasonography ; Urinary Bladder Diseases/drug therapy/*pathology/surgery/ultrasonography

BACKGROUND: Kidney transplantation from cadaveric donor is increasing in KOREA. Knowledge of donor factors that can influence early graft function should be an important guideline in determining the suitability of a donor kidney for transplantation. METHOD: From June 1989 to August 1995, sixty patients with end-stage renal disease underwent kidney transplantation from thirty-two cadaver donors in Asan Medical Center. In this study, we reviewed the clinical characteristics of the cadaver donors including vital sign, urine output, serum creatinine, amounts of vasopressor needed, as well as the cause of brain death and evaluated the effect of these parameters on the early post-transplantation graft function (up to 6 months). RESULTS: The data are given as median (range). The donors had been admitted for 40 hours (12-177) before nephrectomy. During admission, the lowest systolic blood pressure was 85mmHg (60-130). Platelet count was 112 X 10(3)/L (11-270 X 10(3)). Hour urine output was 447ml/h (212-937). These parameters did not have significant effects on the early post-transplantation graft function of our patients. Fifteen of thirty two donors had peak serum creatinine higher than 1.4mg/dl (mean 1.9mg/dl, range 1.5-3.6mg/dl) with serum creatinine 1.5mg/dl (1.5-2.0) at the time of nephrectomy. The declining tendency and lowest level of serum creatinine after renal transplantation in patients who received kidneys from donor with peak serum creatinine higher than 1.4mg/dl was not different from those in patients who received kidney with normal function. CONCLUSION: The transient hypotension or acute reversible mild to moderate deterioration of renal function in cadaver donor does not seem to have significant effect on the early post-transplantation graft function if underlying organic renal disease could be ruled out by careful history taking and clinical evaluation.
Blood Pressure ; Brain Death ; Cadaver* ; Chungcheongnam-do ; Creatinine ; Humans ; Hypotension ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Korea ; Nephrectomy ; Platelet Count ; Tissue Donors* ; Transplants* ; Vital Signs

A 54-year-old man presented with primary position upbeat nystagmus and wall-eyed bilateral internuclear ophthalmoplegia. He also showed bilateral limb ataxia and impaired horizontal gaze. Upbeat nystagmus obeyed Alexander's law and attenuated by visual fixation and disappeared by convergence. Brain magnetic resonance imaging showed acute infarction in the bilateral paramedian midbrain involving the crossing of brachium conjunctivum. Multiple mechanisms including the interruption of central vestibulo-ocular projections from anterior canal may be postulated in upbeat nystagmus of this patient.
Ataxia ; Brain ; Cerebral Infarction ; Humans ; Infarction ; Jurisprudence ; Magnetic Resonance Imaging ; Mesencephalon ; Middle Aged ; Ocular Motility Disorders ; Ophthalmoplegia

We report a 43-year old woman patient presented with contralateral trigeminal neuralgia induced by tactile stimulation and mastication after Bell's palsy. Trigeminal neuralgia is characterized by recurrent episodes of intense lancinating pain affecting the face localized to the sensory supply areas of the trigeminal nerve. Increased excitability of facial motor neurons and bainstem interneurons which mediate trigemio-facial reflex are thought to be the cause of contralateral trigeminal neuralgia after Bell's palsy.
Bell Palsy ; Female ; Humans ; Interneurons ; Mastication ; Motor Neurons ; Reflex ; Trigeminal Nerve ; Trigeminal Neuralgia