PURPOSE: Forty percent of the newly diagnosed bladder cancer patients are over the age of 70 years, but it is said that over 75% of them are excluded from active programs of management. This study was to evaluate the usefulness of M-VAC(methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy for invasive bladder cancer patients over the age of 70 years compared with that of patients under the age of 70 years. MATERIALS AND METHODS: Sixty patients with invasive bladder cancer were treated with M-VAC chemotherapy. We divided the patients into group 1- 20 patients over the age of 70 years and group 2- 40 patients under the age of 70 years. We compared cycle length, toxicity and clinical response of M-VAC chemotherapy in group 1 with those of group 2. RESULTS: The Karnofsky performance score was 85.5% in group 1 and 96.3% in group 2. The cycle length needed for 2 cycle of M-VAC chemotherapy was 67.2(range, 56-92) days in Group 1 and 61.5(range, 56-78) days in Group 2(p>0.05). Hematologic toxicities had not significant difference between two groups. Vomiting and stomatitis occurred more common in group 1. In 3 patients of group 1, the serum creatinine level rose to more than 3 mg/dl. The clinical response was 50% in Group 1 and 67% in Group 2(p>0.05). CONCLUSIONS: The bladder cancer patients over the age of 70 years had much more toxicity, longer cycle length and lower response rate, but these differences had not statistical significance. These results suggest that M-VAC chemotherapy in patients over the age of 70 years will achieves the therapeutic effects when the patients have a good physical condition and toxicities to chemotheraphy are monitored closely.
Aged* ; Creatinine ; Doxorubicin ; Drug Therapy* ; Humans ; Stomatitis ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vinblastine ; Vomiting

OBJECTIVE: The safety and efficacy of various fusion substitutes in pyogenic osteomyelitis has not been investigated. We evaluated and compared the cadaveric allograft and titanium cages used to reconstruct, maintain alignment and achieve fusion in the management of pyogenic spinal infection. METHODS: There were 33 patients with pyogenic osteomyelitis underwent fusion in this study. Fifteen of the 33 patients were operated on by fusion with allografts (cadaveric patella bones) and 18 of those were operated with titanium mesh cages filled with autologous cancellous iliac bone. After the affected disc and vertebral body resection with pus drainage, cadaveric allograft or titanium cages were inserted into the resected space. Posterior transpedicular screw fixation and rod compression in resected space, where cadaveric allograft or titanium cages were inserted, was performed to prevent the malposition in all patients except in 1 case. Recurrent infection was identified by serial erythrocyte sedimentation rate and cross reactive protein follow-up. Osseous union and recurred infection available at a minimum of 2 years following operation was identified. The amount of kyphosis correction and the subsidence were measured radiographically. RESULTS: Spinal fusion was achieved in 29 of 33 patients. In the cadaveric allograft group, 93.3% of patient (14 of 15) showed the osseous union while 83.3% of patient (15 of 18) in the titanium cage group showed union. Subsidence was noted in 12 of the patients. Twelve patients (36.3%) showed unsettling amounts of subsidence postoperatively whereas 46.6% of patients in the cadaveric allograft group and 37.7% of patients in the titanium cage group showed similar subsidence, respectively. There were statistical difference in the fusion rate (p=0.397) and subsidence rate (p=0.276) between the two groups. There was significant statistical difference in the postoperative improvement of segmental kyphosis between the two groups (p=0.022), that is the improvement in sagittal alignment was greater in the titanium cage group than in the cadaveric allograft group. There was no case of recurred infection. CONCLUSION: The cadaveric allograft and titanium cages are effective and safe in restoring and maintaining sagittal plane alignment without increased incidence in infection recurrence in pyogenic osteomyelitis. The postoperative improvement of segmental kyphosis was better in the cage group.
Blood Sedimentation ; Cadaver ; Drainage ; Follow-Up Studies ; Humans ; Incidence ; Kyphosis ; Osteomyelitis ; Patella ; Recurrence ; Spinal Fusion ; Suppuration ; Titanium ; Transplantation, Homologous

No abstract available.
Breech Presentation* ; Female ; Fetus* ; Pregnancy

PURPOSE: The detection of bladder cancers by noninvasive techniques remains an unsolved problem. We evaluate the availability of an immunoassay for urinary nuclear matrix protein, NMP 22, as an indicator for transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Three groups of subjects participated in this trial of NMP 22: 22 patients with transitional cell carcinoma (group 1), 12 patients with urinary tract infection (group 2) and 31 healthy volunteers (group 3). NMP 22 was determined by ELISA using a commercial test kit (NMP 22 Test Kit, Matritech Inc., USA), We compared urinary NMP 22 levels to the grade, stage, cytology and DNA flowcytometry of transitional cell carcinoma of bladder. RESULTS: NMP 22 values in these 3 groups were significantly different (group 1, median 24.81 U/mL; group 2, median 8.41 U/mL; and group 3, median 5.12 U/mL; Mann-Whitney U test for differences between 3 medians, p < 0.05). The patients with transitional cell carcinoma had significantly greater urinary NMP 22 levels than those with no evidence of tumor (Mann-Whitney U test for differences between 2 medians, p<0.01). There was no zelationship between the urinary NMP 22 levels and tumor grade, stage, cytology or DNA flowcytometry. CONCLUSIONS: It is possible that urinary NMP 22 could improve the detection of bladder transitional cell carcinoma.
Carcinoma, Transitional Cell* ; DNA ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Immunoassay ; Nuclear Matrix* ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections

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: Sexual dysfunction has been reported to be frequent in patients with acute myocardial infarction. One aim was to correlates the erectile function with the severity of coronary arterial disease in the acute myocardial infarction patients. MATERIALS AND METHODS: A total of 57 men, median age 55.7 years (range 29 to 81), with acute myocardial infarction who had received coronary angiography were evaluated about their erectile function with 15-item questionnaire, the International Index of Erectile Function (IIEF). History of vascular risk factors such as smoking, diabetes mellitus, and hypercholesterolemia were obtained. We compared the erectile function score to the number of occluded coronary vessels or patients age. RESULTS: One coronary vessel was involves in 16 patients (28.1%), more than 2 coronary vessels were involved in 25 patients (43,9%) while 16 patients (28.1%) showed free of occlusion. Seventy-four percent of patients claimed abnormal erectile function, mild erectile dysfunction in 19 patients (33.3%), moderate in 9 patients (15.8%), severe in 14 patients (24.6%). Erectile function score decreased significantly according to increasing in the number of coronary vessels involved (p<0.05) and in patients age (p<0.01). CONCLUSIONS: There was a significant correlation between erectile function and the severity of the coronary arterial disease in acute myocardial infarction patients. The age of patients also had a negative effects on the erectile function.
Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Erectile Dysfunction ; Humans ; Hypercholesterolemia ; Male ; Myocardial Infarction* ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking

Esophageal carcinoma rarely metastasizes to the brain. Although some studies have mentioned esophageal cancer with solitary brain metastasis or with meningocerebral metastasis or with skull metastasis, multiple meningocerebral metastasis and extensive skull metastasis from squamous cell carcinoma of esophagus has not been reported in the literature. We encountered a case of an extensive osteolytic change of the skull and multiple meningocerebral metastases from esophageal carcinoma.
Brain ; Carcinoma, Squamous Cell* ; Epithelial Cells* ; Esophageal Neoplasms ; Esophagus* ; Neoplasm Metastasis* ; Skull*

OBJECTIVE: Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. METHODS: We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. RESULTS: The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was 13.6±7.0 years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). CONCLUSION: The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.
Arthritis, Rheumatoid* ; C-Reactive Protein ; Diagnosis* ; Hand ; Humans ; Joints ; Methotrexate ; Propensity Score ; Retrospective Studies ; Rheumatoid Factor ; Rheumatology ; Risk Factors* ; Spine

OBJECTIVE: A common cause of failure in laminectomy surgery is when epidural, peridural, or perineural adhesion occurs postoperatively. The purpose of this study is to examine the efficacy of a temperature-sensitive, anti-adhesive agent (TSAA agent), Guardix-SG®, as a mechanical barrier for the prevention or reduction of peridural scar adhesion in a rabbit laminectomy model. METHODS: Twenty-six mature rabbits were used for this study. Each rabbit underwent two separate laminectomies at lumbar vertebrae L3 and L6, left empty (the control group) and applied 2 mL of the TSAA agent (the experimental group), respectively. Invasive scar formation or inflammation after laminectomy was quantitatively evaluated by measuring the thickness of the dura, the distance from the surface of dura to the scar tissues, the number of inflammatory cells in the scar tissues at the laminectomy site, and the concentration of collagen in histological sections. RESULTS: At 6 weeks postsurgery, the dura was significantly thinner and the distance from the surface of dura to the scar tissues was greater in the experimental group than in the control group (p=0.04 and p=0.01). The number of inflammatory cells was not significantly different in the two groups (p=0.08), although the mean number of inflammatory cells was relatively lower in the experimental group than in the control group. CONCLUSION: The current study suggests that the TSAA agent, Guardix-SG®, could be useful as an interpositional physical barrier after laminectomy for the prevention or reduction of adhesion.
Cicatrix ; Collagen ; Inflammation ; Laminectomy* ; Lumbar Vertebrae ; Rabbits

The most common neurologic manifestations of polycythemia vera (PV) are cerebral infarction and transient ischemic attacks, while cerebral hemorrhage or intracranial dissection has been rarely associated with PV. Here we report the first case of a 59-year-old patient with intracranial supraclinoid internal carotid artery (ICA) dissection causing cerebral infarction and concomitant subarachnoid hemorrhage due to pseudoaneurysm rupture as clinical onset of PV. This case report discusses the possible mechanism and treatment of this extremely rare condition.
Aneurysm, False* ; Carotid Artery, Internal* ; Cerebral Hemorrhage ; Cerebral Infarction* ; Humans ; Ischemic Attack, Transient ; Middle Aged ; Neurologic Manifestations ; Polycythemia Vera* ; Polycythemia* ; Rupture ; Subarachnoid Hemorrhage