We report a case of renoduodenal fistula resulting from papillary renal cell carcinoma. A 72-year-old woman presented with nausea, diarrhea and abdominal discomfort. Abdominal CT, UGI and sinography revealed fistula between the right renal mass and the duodenum. Radical nephrectomy and duodenal wedge resection was performed and a friable mass with a fistula between the lower pole mass of the right kidney and second portion of the duodenum was found. Histologic evaluation for renal mass showed papillary renal cell carcinoma. We describe this case and review the previously reports of renoduodenal fistulae.
Aged ; Carcinoma, Renal Cell* ; Diarrhea ; Duodenum ; Female ; Fistula* ; Humans ; Kidney ; Nausea ; Nephrectomy ; Tomography, X-Ray Computed

PURPOSE: We hypothesized that the deletion of Y-chromosome specific genes is associated with testicular tumors. To test this hypothesis, we analyzed the expressions of five Y-chromosome specific genes in testicular tumor samples. MATERIALS AND METHODS: Thirty-five human testicular tumor specimens were processed for the micro-dissection of pure epithelial cells. The DNA was extracted, and polymerase chain reactions performed using five different specific primers (ZFY, DYS203, SMCYM45, GDB187507 and RH38676). These primers were designed based on sequences available in the public genome data bank. RESULTS: Deletion was observed in 88.6% of the testicular tumor specimens with at least one Y-chromosome specific gene. The losses of DYS203, ZFY, SMCYM45, RH38676 and GDB187507 were shown in 51.4, 42.9, 40, 28.6 and 20% of cases, respectively. There was a different pattern of loss of the Y-chromosome specific genes according to the histologic types of germ cell tumor. The losses of the DYS203 and GDB187507 genes were seen more frequently in the advanced stages. CONCLUSIONS: There was a significant loss of the Y-chromosome specific genes in testicular germ cell tumors. The loss of the DYS203 gene was observed in about half the cases, and was more frequent in the higher stages of testicular tumor. The loss of Y-chromosome specific genes is associated with testicular tumors, suggesting their role in the pathogenesis of this disease.
DNA ; Epithelial Cells ; Genome ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Polymerase Chain Reaction ; Testicular Neoplasms

PURPOSE: To determine the clinical and pathological risk factors for subsequent bladder tumor in patients with primary upper tract urothelial tumor, we retrospectively analyzed patients with upper tract urothelial tumor, focusing on the clinicopathological features of subsequent bladder tumor. MATERIALS AND METHODS: Risk factors, disease free rate and survival were assessed with clinicopathological features in 56 patients with upper tract urothelial tumor operated between 1989 and 1998. We excluded the patients with lymph node metastasis or distant metastasis, those with a short period of follow-up, and those having a previous history of bladder tumor. Risk factors such as sex, age, location of tumor, size of tumor, number of tumor, synchronous bladder tumor, preoperative urine cytology, stage, grade, operation method, and adjuvant chemotherapy were investigated. RESULTS: Initial subsequent bladder tumor was found in 36 patients (53.6%) during follow-up period of 44 months (range 13 to 111). Among several clinicopathological factors examined, only urine cytology was significantly correlated with the incidence of subsequent bladder tumor (p<0.05). Sex, age, location of tumor, size of tumor, number of tumor, synchronous bladder tumor, stage, grade, operation method, or adjuvant chemotherapy did not affect subsequent bladder tumor recurrence. There was no significant difference in survival rates between the patients with and without subsequent bladder tumor. CONCLUSIONS: Of the clinical and pathological risk factors for subsequent bladder tumor in patients with primary upper tract urothelial tumor, only preoperative urine cytology was significantly correlated with subsequent bladder tumor.
Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Risk Factors* ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Important advances in the treatment of acute myelogenous leukemia have been made with the introduction of cytosine arabinoside(ara-C) and anthracycline(daunorubicin) over the past 20 years. Currently, 50 to 85% of patients with acute myelogenous leukemia achieve complete remission with induction chemotherapy consisting of ara-C and daunorubicin. About 25% of complete responders will have extended long-term survival and may be cured. Therefore we treated patients having acute myelogenous leukemia with AD(7+3) regimen and analyzed factors complete remission rate, remission duration, and survival duration. MATERIALS AND METHODS: Induction therapy; Thirty seven patients with previously untreated acute myelogenous leukemia treated with AD(7+ 3) regimen(ara-C, 200 mg/m2/d by continuous infusion for seven days, and daunorubicin, 45 mg/m2/d for 3 days). The second course of therapy was AD(5+2), if the patients failed to enter remission. Consolidation therapy; three cycles of consolidation chemotherapy were administrated with at least 4 week interval following remission. Course 1; ara-C at 100 mg/m2 by continuous infusion every 12 hour for five days, 6-thioguanine at 100 mg/m2/day orally for 5 days. Course 2; ara-C is same as course 1, vincristine at 1.2 mg/m2(maximum 2 mg) by bolus injection for 1 day, prednisolone at 40 mg/m'(maximum 60 mg) orally for 5 days. Course 3; ara-C is same as course 1, daunorubicin at 45 mg/m2 by 1 hour infusion for 2 days. RESULT: 62.2 percent of the 37 patients entered complete remission. The remission duration for all patients in complete remission ranged from 2 months to 63+ months, with the median of 15.1 months. The median duration of survival in complete responder group was 23.3 months. Among various prognostic factors, females and groups with normal chromosome and t(8;21) or t(15;17) had significantly higher complete remission rate than males and groups with other chromosomal abnormalities, respectively. Factors influencing on survival duration were female, normal chromosome, t(8;21) or t(15;17), Auer rod-positive, and peripheral blast % less than 50% at diagonosis. Groups with Auer rod-positive, normal chromosome, and t(8;21) or t(15;17) also had significantly longer remission duration. CONCLUSION: Combination chemotherapy with cytosine arabinoside and daunorubicin is a effective regimen for acute myelogenous leukemia as much as other regimen for acute myelogenous leukemia. Further clinical trials for effective treatment regimen are necessary to increase the complete remissioin rate.
Chromosome Aberrations ; Consolidation Chemotherapy ; Cytarabine* ; Cytosine* ; Daunorubicin ; Drug Therapy, Combination* ; Female ; Humans ; Induction Chemotherapy ; Leukemia* ; Leukemia, Myeloid, Acute ; Male ; Prednisolone ; Thioguanine ; Vincristine

Hepatocellular carcinoma (HCC) is one of the major cancers with a high incidence and mortality in Korea. A Korean multidisciplinary collaborative committee consisting of hepatologists, radiologists, epidemiologists and family medicine doctors systematically reviewed clinical practice guidelines in the world and literatures. The level of evidence for each recommendation was assessed and discussed to reach a consensus. Meta-analysis was also conducted to evaluate the grade of recommendation for the five key questions. Several randomized controlled studies and cohort studies showed a survival gain associated with surveillance for those at risk of developing HCC. The target populations for HCC surveillance were identified as hepatitis B virus or hepatitis C virus carriers and cirrhotic patients, since numerous studies revealed that these patients have significantly higher risk of HCC compared with non-infected or non-cirrhotic controls. Individual surveillance strategy according to treatment history or degree of fibrosis in patients with viral hepatitis remains to be settled. Based on several cohort and randomized studies, a surveillance interval of six months was recommend. The starting age of surveillance was determined as 40 years from the epidemiologic data. Although ultrasonography (US) is the mainstay for detection of HCC, its sensitivity is not fully accepted. Measurement of serum alpha-fetoprotein can complement US examination, increasing the sensitivity of HCC detection. The recommendation for HCC surveillance is that those with hepatitis B virus (or hepatitis C virus) infection or cirrhosis should have liver US and serum alpha-fetoprotein measurement every six months from 40 years of age or at the time of diagnosis of cirrhosis.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cohort Studies ; Complement System Proteins ; Consensus ; Diagnosis ; Fibrosis ; Health Services Needs and Demand ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Hepatitis C ; Humans ; Incidence ; Korea ; Liver ; Mortality ; Ultrasonography