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

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

PURPOSE: Advances in modern ultrasonography combined with a dimercaptosuccinic acid (DMSA) renal scan have permitted the diagnosis of a multicystic dysplastic kidney (MCDK) with a high degree of certainty. Most multicystic dysplastic kidneys undergo spontaneous involution during follow-up, as demonstrated by serial ultrasonography. The purpose of this study was to contribute to a better understanding of the natural history of a MCDK, and suggest guidelines for follow-up of a MCDK. MATERIALS AND METHODS: Between November 1988 and May 2004, 142 children with a MCDK were diagnosed at our institute. A retrospective data analysis was carried out on 38 patients who were conservatively managed and followed for more than 6 months. Follow up ultrasonography examinations were performed every 6 months until patients were 5 years old, and annually thereafter. Patients were divided into simple and complex MCDK based on postnatal physical examination and renal ultrasonography. A simple MCDK was defined as unilateral renal dysplasia without genitourinary abnormalities. Complex MCDK included patients with unilateral renal dysplasia, but with other genitourinary abnormalities. RESULTS: The follow-up periods ranged from 6 to 76 months, with a median of 21.5 months. Partial and complete involution of the affected kidney was observed in 6 (15.8%) and 8 (21.1%) patients, respectively. There was no significant difference in the median involution time between the groups. The median time to involution in all patients was 36 months. CONCLUSIONS: Conservative management for a MCDK appears to be a safe option. Because of a complex MCDK has a high incidence of UTI, prophylactic antibiotics may be required. We recommend the long-term follow-up of a MCDK using ultrasonography monitoring.
Anti-Bacterial Agents ; Child* ; Child, Preschool ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Multicystic Dysplastic Kidney* ; Natural History ; Physical Examination ; Retrospective Studies ; Statistics as Topic ; Succimer ; Ultrasonography ; Urogenital Abnormalities

PURPOSE: To report the relationship between voiding dysfunction and reflux, renal scars and the common findings related to voiding dysfunction in patients with vesico-ureteral reflux (VUR). MATERIALS AND METHODS: Between March 2002 and February 2004, 56 children underwent a video-urodynamic study (video-UDS) for evaluation of VUR. The grade of VUR, various findings of voiding dysfunction and the maximal intravesical pressure (maxPves) were assessed during voiding, and severity of renal scars were assessed via video-UDS and DMSA scans, respectively. RESULTS: Voiding dysfunction was diagnosed in 30 patients (53.6%). The findings of voiding dysfunction were uninhibited contraction (14 patients), detrusor sphincter dyssynergia (15 patients) and bladder neck opening during the filling phase (17 patients). Urethrovaginal reflux and after contraction were noted in 6 and 8 patients, respectively. In the voiding dysfunction group, the mean VUR grade was 3.4, while this was 2.6 in 42 renal units of the normal voiding group (p=0.023). The mean maxPves values during voiding in the voiding dysfunction and normal voiding groups were 107.7 and 77cmH2O, respectively (p=0.002). On evaluation of the relationship between voiding dysfunction and the extent of renal scarring [no scar, single scar, multiple scars, reduced size], the existence of voiding dysfunction resulted in more severe forms of renal scarring (p=0.034). CONCLUSIONS: Voiding dysfunction can cause or aggravate VUR or urinary tract infection due to an increased intravesical pressure during voiding, which can ultimately cause permanent renal damage. Therefore, treatments, such as anticholinergic drugs or biofeedback, must be performed in patients with combined VUR and voiding dysfunction for a better treatment outcome.
Ataxia ; Biofeedback, Psychology ; Child ; Cicatrix* ; Humans ; Neck ; Succimer ; Treatment Outcome ; Urinary Bladder ; Urinary Tract Infections ; Urodynamics ; Vesico-Ureteral Reflux*

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: 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*