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*

OBJECTIVE: Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. METHODS: From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. RESULTS: The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). CONCLUSION: GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG and the group without SDG. Analysis of radiological factors indicated that a midline shifting exceeding 5 mm, SAH, delayed hydrocephalus, compression of basal cisterns, and tearing of the arachnoid membrane were significantly more common in patients with SDG.
Arachnoid ; Brain Injuries ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Membranes ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion

The interaction between Lipiodol and cells was studied by treating Lipiodol in a human hepatocellular carcinoma cell line(Hep) and mouse fibroblast cell line (L929). Irregular, sustained radioactivity was released from both cell lines shortly after incubation in the radioiodinated Lipiodol mixed media. Lipiodol droplets were found to be firmly attached to the cells following the incubation and these cells were strongly positive for fat stains. The radioiodinated Lipiodol demonstrated the same behavior of accumulation within the cell and on the cell membrane. Although the amount of Lipiodol attached was almost equal in both of the cell lines, the final amount accumulated in the cells was larger in the Hep cells. The accumulation of Lipiodol within the cell and on the cell membrane may play a significant role for its selective targeting and its prolonged retention in the solid tumor.
Carcinoma, Hepatocellular/*pathology/therapy ; Human ; Iodine Radioisotopes/diagnostic use/therapeutic use ; Iodized Oil/pharmacokinetics/*pharmacology/therapeutic use ; Liver Neoplasms/*pathology/therapy ; Support, Non-U.S. Gov't ; Tumor Cells, Cultured/drug effects

PURPOSE: We evaluated the incidence and duration of voiding dysfunction following bilateral detrusorrhaphy to correct vesicoureteral reflux (VUR), and we also evaluated the factors that influence the development of voiding dysfunction and recovery from voiding function. MATERIALS AND METHODS: We performed a retrospective review on 36 children, 27 boys and 9 girls, who showed normal voiding function on preoperative video-urodynamic study and for whom data on post-void residual urine volume (PVR) were available postoperatively. The mean age and duration of follow-up were 3.1 2.6 years and 17.5 10.4 months, respectively. Postoperative voiding dysfunction included urinary retention and incomplete bladder emptying. RESULTS: The overall success rate was 97.2%. The urethral catheter was kept in for a mean period of 4.0 3.6 days. After urethral catheter removal, postoperative voiding dysfunction developed in 24 children and urinary retention developed in 5 children. The differences in age, grade of VUR or sex did not have significant influence on the development of voiding dysfunction. 35 children achieved normal PVR during the postoperative follow-up. The mean time to recovery of voiding function was 34.1 37.9 days. The differences in age, sex or grade of VUR did not have any significant influence on the recovery rate of voiding function. The time to recovery of the voiding function was significantly longer in the patients aged less than 2 years or those patients with bilateral high-grade VUR. However, sex did not significantly influence the time to recovery of voiding function. CONCLUSIONS: The development of postoperative voiding dysfunction is frequent, but temporary. However, it is necessary to consider a longer period of catheterization for the group of patients aged less than 2 years or those patients with bilateral high grade VUR.
Catheterization ; Catheters ; Child* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Replantation ; Retrospective Studies ; Urinary Bladder ; Urinary Catheters ; Urinary Retention ; Vesico-Ureteral Reflux*

Propofol, a GABA-mediated inhibitor of excitatory neurotransmitter, is a popular intravenous agent for general anesthesia and sedation. Its side effects reportedly include opisthotonus, seizures, and myoclonus, and are usually manageable. We present a patient who developed propofol-induced delayed-onset refractory myoclonic seizures that resisted antiepileptic drugs.
Anesthesia, General ; Anticonvulsants ; Humans ; Myoclonus ; Neurotransmitter Agents ; Propofol ; Seizures* ; Status Epilepticus