The bilateral vanishing testes syndrome is a rare condition in which the vanishing testes were once present but atrophied due to compromise in blood supply. We present a case of bilateral vanishing testes syndrome which was confirmed with laparoscopy and exploratory laparotomy following hormonal therapy The diagnosis of vanishing testes syndrome can be established by following criteria without surgical exploration. These criteria include a normal male phenotype with XY karyotype, absence of Mullerian structures on rectal examination or ultrasonography, elevated gonadotropins(FSH alone or FSH and LH), and no significant increase in serum testosterone after hCG stimulation. However, patients who do not fit these criteria should have laparoscopy or exploration to look for occult gonadal tissue and spermatic vessels.
Diagnosis ; Gonads ; Humans ; Karyotype ; Laparoscopy ; Laparotomy ; Male ; Phenotype ; Testis* ; Testosterone ; Ultrasonography

One hundred fifty seven patients with benign prostatic hypertrophy(BPH) under going trans. urethral resection of prostate( TUR - P) entered in this study in order to search for factors predictive of a successful outcome. In the follow-up period of 3 months to 7 years, a strictly successful result was achieved in 122 patients(78% ). On analysis of the success rate, 5 favorable factors and 8 unfavorable factors were noted. A symptomatic large prostatic adenoma proven by IVU, TRUS will imply a higher success rate. On uroflowmetry, obstructive BPH proven by maximal flow rate of less than l0 ml/sec and constrictive obstructive flow pattern can also predict a satisfactory outcome. The unfavorable factors always come from a small adenoma, uncertain irritative symptoms and detrusor underactivity. Patients with more than 2 unfavorable factors should be investigated carefully before surgery. The presence of 2 favorable factors without unfavorable factor will usually predict the best surgical outcome.
Adenoma ; Follow-Up Studies ; Humans ; Prostatic Hyperplasia*

We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.
Biopsy ; Digital Rectal Examination* ; Humans ; Male ; Mass Screening ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Ultrasonography* ; Urologic Diseases

PURPOSE: The aim of this study was to evaluate the safety of the nonoperative management of traumatic liver injuries. METHODS: The medical records of 67 patients, with traumatic liver injury, between January 1998 and December 2001, were reviewed retrospectively, with respect to the cause of injury, combined injury, hemodynamic stability, amount of transfusion, liver injury grade, length of hospital stay and complications. RESULTS: Of the 67 patients, 30 were treated operatively (Group A), and 37 nonoperatively (Group B). The initial systolic blood pressure in Group A was significantly lower than that in Group B (81.33+/-23.00 vs 108.10+/-20.66 mmHg, P<0.001). The amount of transfusion for hemodynamic stability were 2.83 and 0.89 units (P<0.01), and the mean total transfusion requirement and injury grade were 10.30 and 1.29 units (P<0.001). 3.63+/-0.99 and 2.48+/-1.12 (P<0.001) for Groups A and B. The duration of intensive care unit stay in Group A was significantly shorter than that of Group B (6.70+/-6.12 vs. 3.13+/-4.00 days, P<0.01), but there was no difference in total length of hospital stay. The complication rates in Groups A and B were 63.3 and 21.8%, respectively (P<0.01), and the most common complications were respiratory problems, such as pleural effusion, pneumonia, atelectasis and pulmonary edema. Five patients in Group A died, 2 from hypovolemic shock, and one each from disseminated intravascular coagulation, multiple organ failure, and respiratory failure, but no patients in Group B died. CONCLUSION: Nonoperative management is safe for hemodynamically stable patients with traumatic liver injury, regardless of the injury severity, but close observation and frequent physical examinations must be adhered to.
Blood Pressure ; Disseminated Intravascular Coagulation ; Hemodynamics ; Humans ; Intensive Care Units ; Length of Stay ; Liver* ; Medical Records ; Multiple Organ Failure ; Physical Examination ; Pleural Effusion ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Insufficiency ; Retrospective Studies ; Shock

Vesicoureteric reflux into the transplanted kidney has been described, but in general it has been disregarded and is not mentioned as a complication in recent reviews. But it may be harmful to the renal function in the long-term and has high incidence of symptomatic pyelonephritis with urinary tract infection in other studies. We studied prospectively 37 patients, who received living renal transplantation without complete antireflux surgery, out of 45 patients during the period from June 1991 to September 1992. Voiding cystourethrogram and urine culture were obtained all least once in 37 of 45 patients (82.2%) and serum BUN/creatinine and urinalysis were checked following surgery, weekly. These patients did not demonstrate an increased incidence of reflux, urinary tract infection or abnormalities of renal function. We conclude that a simple direct implantation of a normal ureter into a normal bladder is safe and should be considered the procedure of choice in renal transplantation and recommend that all functioning transplants be studied at yearly intervals with an IVP and VCUG to determine the true incidence of urologic complications.
Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Prospective Studies ; Pyelonephritis ; Ureter ; Urinalysis ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract*

The present study was attempted to investigate the characteristics of epibatidine on secretion of catecholamines (CA) from the isolated perfused model of the rat adrenal gland, and to establish the mechanism of action. Epibatidine (3X10(-8) M) injected into an adrenal vein produced a great inhibition in secretory response of CA from the perfused rat adrenal gland. However, upon the repeated injection of epibatidine (3X10(-8) M) at 15 min-intervals, CA secretion was rapidly decreased after second injection of epibatidine. However, there was no statistical difference between CA secretory responses of both 1st and 2nd periods by the successive administration of epibatidine at 120 min-intervals. Tachyphylaxis to releasing effects of CA evoked by epibatidine was observed by the repeated administration. Therefore, in all subsequent experiments, epibatidine was not administered successively more than twice only 120 min-intervals. The epibatidine-induced CA secretion was markedly inhibited by the pretreatment with atropine, chlorisondamine, pirenzepine, nicardipine, TMB-8, and perfusion of Ca2+/-free Krebs solution containing EGTA, while was not affected by diphenhydramine. Moreover, the CA secretion evoked by ACh for 1st period (0apprx4 min) was greatly potentiated by the simultaneous perfusion of epibatidine (1.5X10(-8) M), but followed by time-dependently gradual reduction after 2nd period. The CA release evoked by high potassium (5.6+/-10(-8) M) for 1st period (0apprx4 min) was also enhanced by the simultaneous perfusion of epibatidine, but those after 2nd period were not affected. Taken together, these experimental data suggest that epibatidine causes catecholamine secretion in a calcium dependent fashion from the perfused rat adrenal gland through activation of neuronal cholinergic (nicotinic and muscarinic) receptors located in adrenomedullary chromaffin cells. It also seems that epibatidine-evoked catecholamine release is not relevant to stimulation of histaminergic receptors.
Adrenal Glands* ; Animals ; Atropine ; Calcium ; Catecholamines ; Chlorisondamine ; Chromaffin Cells ; Diphenhydramine ; Egtazic Acid ; Neurons ; Nicardipine ; Perfusion ; Pirenzepine ; Potassium ; Rats* ; Tachyphylaxis ; Veins