This study aimed to describe the initial experience of laparoscopic radical cystectomy (LRC) with total intracorporeal urinary diversion (ICUD). The procedure was performed in a male patient using a 5-port transperitoneal approach. Radical cystoprostatectomy and bilateral pelvic lymphadenectomy were performed laparoscopically. A 40-cm segment of the ileum 20 cm from the ileocecal junction was then isolated, and ileo-ileal continuity was restored using Endo- GIA staplers. Bilateral ureteroileal anastomoses were individually performed using the modified Studer chimney. Running urethroileal anastomosis was performed at the midpoint of the remaining distal 30 cm of the ileal segment. The distal 30 cm of the isolated ileal segment was detubularized, and a modified Studer neobladder was constructed. The total operative time was 465 minutes, and the estimated blood loss was 890 mL. The patient resumed ambulation on postoperative day 2, and oral liquids were resumed on postoperative day 8. The surgical margins of bladder specimens were negative for cancer. LRC with ICUD performed completely intracorporeally was feasible. Large-scale studies are needed to define these benefits and corroborate these findings.

Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.

This study aimed to describe the initial experience of laparoscopic radical cystectomy (LRC) with total intracorporeal urinary diversion (ICUD). The procedure was performed in a male patient using a 5-port transperitoneal approach. Radical cystoprostatectomy and bilateral pelvic lymphadenectomy were performed laparoscopically. A 40-cm segment of the ileum 20 cm from the ileocecal junction was then isolated, and ileo-ileal continuity was restored using Endo- GIA staplers. Bilateral ureteroileal anastomoses were individually performed using the modified Studer chimney. Running urethroileal anastomosis was performed at the midpoint of the remaining distal 30 cm of the ileal segment. The distal 30 cm of the isolated ileal segment was detubularized, and a modified Studer neobladder was constructed. The total operative time was 465 minutes, and the estimated blood loss was 890 mL. The patient resumed ambulation on postoperative day 2, and oral liquids were resumed on postoperative day 8. The surgical margins of bladder specimens were negative for cancer. LRC with ICUD performed completely intracorporeally was feasible. Large-scale studies are needed to define these benefits and corroborate these findings.

Pyometra is a rare condition that is defined as the accumulation of purulent material in the uterine cavity caused by an occlusion to the natural drainage of the uterus. Pyometra cases are seldom reported. The symptoms of pyometra may be non-specific, resulting in a delay or misdiagnosis that may subsequently increase the risk of perforation of the pyometra. Once a pyometra ruptures, the patient develops acute abdominal and generalized peritonitis. This case report describes diffuse peritonitis caused by the spontaneous perforation of a pyometra in a woman who was diagnosed preoperatively and treated successfully by emergency laparotomy.

Ovarian hilus cells (OHCs), a counterpart of testicular Leydig cells, are usually found in the ovarian poles and produce androstenedione. Their origin remains a matter of debate, although OHCs are assumed to come from the adrenogenital primordium. OHCs are rarely observed around the poles of the ovary, including the mesoovarium, stroma (perisalpinx) of the salpinx, and the wall of paratubal cysts. Their clinical and pathological characteristics are not well-known because of their rarity. Herein, we present a case of ectopic OHCs in a 48-year-old woman. The patient underwent total hysterectomy and bilateral salpingectomy for vaginal bleeding due to multiple leiomyomas. We incidentally found OHCs in the stroma of the infundibulum of the salpinx, just beneath the tubal epithelium. Their size was less than 1 mm, and they were composed of large cells with central round nuclei and abundant clear or granular cytoplasm. OHCs share morphological and immunohistochemical profiles with ectopic adrenal glands, and the differential diagnosis is sometimes difficult. They do not exhibit microscopic encapsulation or the normal adrenal cortex zonation pattern. The patient was discharged and did not show any abnormal findings during 19 months of follow-up. Analyzing the characteristics of testicular Leydig cells will help understand how OHCs develop and why heterotopic OHCs occur in and around the salpinges.

PURPOSE: This study examined the health status among elderly in community. METHOD: This is a survey using cross-sectional design. The subjects were 531 elders who were 65 and over in Pusan, Korea. Data were collected by 17 trained interviewers from April 10 to August 26, 2000. Functional status for physical health status, depression, loneliness, self-esteem for psychological health status, and social support for social health status were measured. RESULT: About forty three percent of the subjects were found as the elderly who need support in physical status. About fifty six percent of the subjects were depressed. The mean score on the Loneliness scale was 40.4, which means relatively higher. For self-esteem, its score was lower than that of elderly who were examined in other studies. The subjects were living in the state of lower social support. The risk factors for vulnerable health status were being female, becoming older, lower income and education, and living alone. CONCLUSION: This finding indicates that the elderly subjects in Korean community were in poor health status in physical, psychological and social aspects.

No abstract available.