PURPOSE: The advisability of early ureteral reimplantation in infants is controversial, and to our knowledge no long-term results are available. Whether early ureteral reimplantation in infants increases surgical morbidity, compared to ureteral reimplantation after the age of 1 year, was investigated, and the long-term voiding function after ureteral reimplantation evaluated. MATERIALS AND METHODS: Between 1993 and 1999, 130 children underwent ureteral reimplantation at our institution. The diagnosis was a primary vesicoureteral reflux, obstructed megaureter and an ectopic ureter. Two groups of 64 children that underwent ureteral reimplantation were compared. Group 1 included children younger than 12 months at surgery and group 2 children those between 1 and 2 years. The long term results were evaluated with regard to surgical outcome, voiding function and urinary tract infection. An analysis of the voiding function included family interviews, uroflowmetry and post-void residual urine measurements. RESULTS: Complete long-term data were available for 47 boys and 17 girls. In Group 1, there were no complications in 50 renal units(96%), while two had postoperative reflux, and underwent macroplastique injection. In Group 2, there were no complications in 35 renal units(97.1%), while one patient had postoperative reflux, which resolved spontaneously. No significant difference was noted in the postoperative post-void residual urine volumes between the two groups. CONCLUSIONS: In our samples, early ureteral reimplantation resulted in a technical success rate of greater than 95% and low postoperative morbidity, with the exception of urinary tract infection. Our data show satisfactory bladder emptying and normal uroflowmetry. When indicated, ureteral reimplantation can be performed safely in young children, without fear of damaging bladder function.
Child* ; Diagnosis ; Female ; Humans ; Infant* ; Replantation* ; Ureter* ; Urinary Bladder ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Candida albicans keratitis was established in rabbits by intrastromal injection of a suspension containing 1.2 X 10(4) spores. After a 48-hour incubation period, the animals were treated with oral ketoconazole(10mg/kg daily) alone and in combination with topical ketoconazole(2% solution ten times a day) for 2 weeks. Clinical scores were significantly lower in both treated groups than in the control group. But there was no significant difference between the two treated groups.
Animals ; Candida albicans* ; Candida* ; Keratitis* ; Ketoconazole* ; Rabbits* ; Spores

Objectives : The purpose of this study is to know the shisho constitutional distribution of outpatients at the Center for Kampo Medicine, Keio University School of Medicine (the Keio Kampo Center, herein) and to find out if there are differences in the type of diseases and symptoms according to shisho constitution.
Methods : We collected data from 366 outpatients at the Keio Kampo Center. All did a SSCQ-P (shisho Constitution Questionnaire for Patients) to obtain a shisho constitution diagnosis. We then classified their shisho constitutions and surveyed disease and symptom prevalence according to same.
Results : 1 : Among the 366 outpatients, distribution rates for Taiyojin, Syoyojin, Taiinjin, and Syoinjin were 0.8%, 27.3%, 28.7%, and 43.2% respectively. 2 : And the prevalence of V. Mental and behavioral disorders, XI. Diseases of the digestive system, XV. Pregnancy, childbirth and the puerperium, and Feeling of coldness (under XVIII. Symptoms, signs and abnormal clinical and laboratory findings, NEC) items for Shoinjin were significantly higher than those for the other constitutions. (p < 0.05)
Conclusions : The distribution rate for shisho in 366 outpatients at the Keio Kampo Center was different from that in Korea, with the rate for shoinjin in these outpatients at the Center especially, being significantly higher than that for Koreans. There were also significant differences in the prevalence of some diseases and symptoms in shoinjin group.

PURPOSE: Vascular endothelial growth factor (VEGF) stimulates angiogenesis and vascular permeability. Tissue damage is related to angiogenesis, and induced by a delay in neutrophil apoptosis. This study was performed to investigate the effect of VEGF on the spontaneous neutrophil apoptosis via the activation of VEGFR-1 and phosphorylation of the p38-MAPK pathway. METHODS: Neutrophils were prepared from 10 healthy young donors, cultured for 20 h, and the apoptosis measured by the morphological changes and flow cytometry. The VEGF receptor expression and phosphorylation of mitogen activated protein kinase (MAPK) were measured using a Western blotting method. RESULTS: VEGF dose-dependently delayed the spontaneous neutrophil apoptosis, but this effect was blocked by pre-treatment of the cells with a VEGF receptor antagonist. VEGF increased the phosphorylated forms of the extracellular stress related kinase (Erk) and p38-MAPK. However, the VEGF-induced delay in apoptosis was not affected by the Erk inhibitor, PD98059 but was affected by the p38- MAPK inhibitor, SB203580. The VEGF receptor-1, but not the VEGF receptor-2, was detected in neutrophils, but its level was reduced in cultured neutrophils. CONCLUSION: VEGF delays neutrophil apoptosis through p38- MAPK activation.
Apoptosis* ; Blotting, Western ; Capillary Permeability ; Flow Cytometry ; Humans ; Neutrophils* ; Phosphorylation ; Phosphotransferases ; Protein Kinases ; Receptors, Vascular Endothelial Growth Factor ; Tissue Donors ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factor Receptor-1

PURPOSE: We evaluated the clinical significance of simultaneous transurethral resection of bladder tumor(TURB) and the prostate(TURP) in patients who have superficial bladder cancer with bladder outlet obstruction. MATERIALS AND METHODS: Between April 1997 to April 2006, 213 patients with superficial bladder cancer were included in this study. The patients were treated with TURB only(n=107, Group I) or TURB with TURP (n=106, Group II). Bladder cancer recurrence was observed by performing cystoscopy and urine cytology. Uroflowmetry was performed three months after surgery. RESULTS: There were no significant differences in age, the tumor size or the number of tumors between groups I and II. There was no evidence of cancer implantation where TURP was applied. The recurrence rate of group II was significantly lower than that of group I(p=0.044), and the time to recurrence was longer for group II than for group I(p=0.026). There was no significant difference in the progression rate between the two groups(p=0.788). Three months after surgery, the mean residual urine volume was lower for group II(7.9ml) than that for group I(21.7ml). CONCLUSIONS: For superficial bladder cancer patients with bladder outlet obstruction, simultaneous TURB and TURP may help reduce the bladder cancer recurrence rate and delay the time to recurrence without the risk of cancer implantation at the site where TURP is applied.
Cystoscopy ; Humans ; Prostate ; Recurrence ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder Neoplasms

No abstract available.
Diabetic Ketoacidosis* ; Lung Abscess* ; Lung* ; Mucormycosis*

Gastrointestinal symptoms of Churg-Strauss syndrome (CSS) are common, but intestinal perforation is very unusual and occurred during steroid therapy in the previous case. We report a CSS showing intestinal perforation, which was caused by a complication of vasculitis.
Churg-Strauss Syndrome ; Intestinal Perforation* ; Vasculitis

PURPOSE: The ureter can be a very effective tissue for bladder augmentation, but the indications for ureterocystoplasty are still evolving, with the main problem being the limited number of patients with a nonfunctioning or poor functioning kidney. Recently, ureterocystoplasty, with preservation of ipsilateral renal function, has been reported by several authors. We reported our experience and follow-up results of ureterocystoplasty. MATERIALS AND METHODS: Between December 2000 and February 2003, 4 girls, aged 3 to 13 (mean age 7.2), with a low capacity, poorly compliant bladder underwent ureterocystoplasty using a single dilated ureter. Three patients had a dilated ureter due to high grade VUR (vesicoureteric reflux) and the other due to bilateral reflux. An urodynamic study showed an areflexic neurogenic bladder, with low compliance, in all patients. The technique was performed intraperitoneally using a midline abdominal incision. The distal parts of both detubularized magaureters were used for augmentation. The dilated proximal ureter was anastomosed to the longitudinally incised contralateral ureter, in an end to side fashion. RESULTS: The mean follow-up was 21 months (6-41). In a video-urodynamic study, the mean preoperative bladder capacity and post operative volume were 140cc (67-23) and 223cc (140-320), respectively, with an average increase of 17 to 113% (mean 71). The postoperative bladder compliance was normalized in all cases. Postoperative cystography showed excellent bladder configuration, with no vesicoureteral reflux. There were no surgical complications, such as bladder perforation, stone formation and bowel problem. The serum creatinine levels remained stable in all cases (0.3 to 0.6mg/dl). CONCLUSIONS: Although an increase in bladder capacity is not always optimal with the use of a distal ureter, it is good enough to ensure a good clinical outcome and allow an adequate catheterization interval, with a low complication rate.
Catheterization ; Catheters ; Compliance ; Creatinine ; Female ; Follow-Up Studies ; Humans ; Kidney ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic* ; Urinary Diversion ; Urodynamics ; Vesico-Ureteral Reflux

Torsion of the fallopian tube is an uncommon cause for acute low abdominal pain in female that is difficult to diagnose. Because it has no pathognomonic clinical symptoms or laboratory findings, a high index of suspicion is important when there is history of pelvic pathologic conditions or surgery. The early diagnosis and surgical treatment of the disease are mandatory to preserve oviduct.
Abdominal Pain ; Adolescent* ; Animals ; Early Diagnosis ; Fallopian Tubes* ; Female ; Humans ; Oviducts

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides