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

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

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

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

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

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

OBJECTIVE: Survivin is an inhibitor of apoptosis protein(IAP), which inhibits apoptosis through a pathway distinct from the Bcl-2 family members. Overexpression of survivin and Bcl-2 have been commonly reported in human neoplasms. The authors investigate whether there is a synergistic effect on the anti-apoptosis rate of primary brain tumors "in situ" based on the co-expression of survivin and Bcl-2. METHODS: One hundred and two brain tumor patients who had been resected were included in this study. Survivin and Bcl-2 were detected by Western blotting analysis, while apoptosis was examined by DNA fragmentation analysis. An anti-apoptotic rate was assessed in these brain tumor samples based on the expression of survivin and Bcl-2 or co-expression of both. RESULTS: Survivin and Bcl-2 were expressed in 57(55.9%) and 53(52.0%) of 102 brain tumor samples studied respectively, and co-expressed in 31(30.4%). The percentage of astrocytic and meningeal tumors expressing survivin was significantly correlated with histological grades; however, Bcl-2 was not correlated (p=0.106). The anti-apoptotic rate in primary brain tumors with survivin, Bcl-2, and both was detected in 49(86.0%) of 57 samples, 42(79.9%) of 53 samples, and 27(87.1%) of 31 samples, respectively. Their difference in the frequency of anti-apoptosis was not significant. CONCLUSION: Survivin or Bcl-2 is involved in the anti-apoptosis. However, it suggests that co-expression of survivin and Bcl-2, together, have no synergistic effect on the anti-apoptotic properties of the primary brain tumors.
Apoptosis ; Blotting, Western ; Brain Neoplasms* ; DNA Fragmentation ; Humans ; Meningeal Neoplasms

OBJECTIVE: The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. METHODS: From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan–Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. RESULTS: We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52–0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27–4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20–4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27–3.58; p=0.005) were positively associated with 30-day mortality. CONCLUSION: We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses.
Brain Injuries ; Comorbidity ; Diabetes Mellitus ; Glasgow Coma Scale ; Hematoma, Subdural* ; Hematoma, Subdural, Acute ; Humans ; Methods ; Mortality* ; Prognosis ; Subarachnoid Hemorrhage, Traumatic ; Survival Rate

OBJECTIVE: Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty. METHODS: A total of 162 patients who underwent cranioplasty following DC due to life-threatening elevated intracranial pressure between October 2003 and December 2012, were included in our investigation. Follow-up exceeded one year. RESULTS: BFR occurred as a long-term complication in 9 of the 162 patients (5.6%). The affected patients consisted of individuals who had undergone DC for traumatic brain injury (TBI; n=4), for subarachnoid hemorrhage (SAH; n=3), for cerebral infarction (n=1), and intracerebral hemorrhage (n=1). Logistic regression analysis identified no significant risk factors for BFR. CONCLUSION: TBI and SAH as initial diagnoses are more often associated with BFR than other diagnoses. This finding may influence future surgical decision making, especially in patients with possible risk factors for BFR. A prospective study with a large number of patients is needed to identify potential predictors of BFR such as bone flap sterilization and preservation.
Bone Resorption ; Brain Injuries ; Cerebral Hemorrhage ; Cerebral Infarction ; Decision Making ; Decompressive Craniectomy* ; Diagnosis ; Follow-Up Studies ; Humans ; Intracranial Hypertension ; Logistic Models ; Risk Factors ; Sterilization ; Subarachnoid Hemorrhage ; Transplants

Tuberculosis is a systemic disease with a world-wide distribution, and its occurance in the oral cavity is well documented in the literature. Disease of oral cavity and jaw caused by Mycobacterium tuberculosis is very rare, so it is often difficult to diagnose tuberculosis in the oral cavity. When granulomatous and ulcerative lesion persists in the oral cavity for a long time, it may be considered a tuberculosis. When differential diagnosis is needed, the most reliable indicators of mycobacterial infection are careful clinical evaluation, skin test, acid-fast staining, biopsy and culture. We report a case of tuberculous osteomyelitis which simultaneously occurred on the maxilla and mandible in a 85 years old man that proved diagnosis difficult, but which responded very well to surgical treatment and chemotherapy.
Aged, 80 and over ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Jaw ; Mandible* ; Maxilla* ; Mouth ; Mycobacterium tuberculosis ; Osteomyelitis* ; Skin Tests ; Tuberculosis ; Ulcer