PURPOSE: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. MATERIALS AND METHODS: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. RESULTS: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. CONCLUSIONS: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated.
Biopsy ; Delivery of Health Care ; Digital Rectal Examination ; Humans ; Inflammation ; Male ; Mass Screening ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Prostatitis ; Young Adult

PURPOSE: To evaluate the efficacy and safety of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence (UI) after prostate surgery. MATERIALS AND METHODS: We performed a retrospective chart review of 19 patients who underwent AUS implantation from July 2003 to November 2008. Efficacy was evaluated in terms of the postoperative changes in daily pad use, incontinence visual analogue scale (I-VAS), International Continence Society male-Short Form questionnaire (ICS-male SF), Incontinence Quality of Life questionnaire (I-QoL), and patients' satisfaction postoperatively. No pad use was defined as cure, and use of 1 pad or fewer per day as improvement. Cure and improvement were regarded as success. Complications and durability of the AUS were evaluated. RESULTS: The median age of the patients was 70.0 years (range, 47-76 years). With a median follow-up period of 11.8 months (range, 6.2-48.1 months), the success rate was 68.4% (13/19; cure in 12 and improvement in 1). I-VAS, subscale scores of ICS-male SF (incontinence and QoL), and total and subscale scores of I-QoL (psychosocial impact, social embarrassment, avoidance, and limiting behaviors) were significantly improved. Fifteen (78.9%) patients reported being satisfied. Six (31.5%) patients required revision: volume adjustment for 2, second cuff implantation for 2, pump reposition for 1, and pump reposition, volume adjustment, and second cuff implantation for 1. One of the patients who had a second cuff implantation had the sphincter explanted for infection. CONCLUSIONS: Despite the high rate of revision, the satisfaction rate was high and the quality of life was significantly improved after AUS implantation for urinary incontinence after prostate surgery.
Follow-Up Studies ; Humans ; Prostate ; Quality of Life ; Retrospective Studies ; Social Change ; Urinary Incontinence ; Urinary Sphincter, Artificial

The signal intensity of paranasal sinus mucocele is highly variable, ranging from high to low on both T1 weighted and T2 weighted sequence, This variation is likely due to the combined effects of decreased free water concentration, cross-linking and polymerization of the macromolecular mucus glycoprotein, and increased viscosity. We have experienced three cases of the paranasal sinus mucocele with different signal intensity on Magnetic Resonance Imaging. We describe MR characteristics of the paranasal sinus mucocele and compare with MR characteristics for other paranasal sinus disease.
Glycoproteins ; Magnetic Resonance Imaging ; Mucocele* ; Mucus ; Paranasal Sinus Diseases ; Polymerization ; Polymers ; Viscosity ; Water

Although stress-induced cardiomyopathy (SCMP) is a reversible disease and the prognosis is usually excellent, several complications can occur and can result in fatal adverse events. The formation of left ventricular (LV) thrombus is one of these critical complications of SCMP. This report describes a case of SCMP complicated by formation of a LV thrombus that became increasingly mobile as LV contractility recovered, and for which surgical removal was performed. Here, we report a case of SCMP complicated by LV thrombus and review the literature regarding this topic.
Cardiomyopathies* ; Echocardiography ; Humans ; Prognosis ; Takotsubo Cardiomyopathy ; Thrombosis*

No abstract available.
Alcoholics* ; Aldehyde Dehydrogenase* ; Humans ; Liver Diseases, Alcoholic*

OBJECTIVE: To investigate the frequency of gut inflammation in the ankylosing spondylitis and the role of gut lesion in the pathogenesis of the ankylosing spondylitis. METHODS: Ileocolonoscopy and biopsy were performed in 24 patients with. ankylosing spondylitis. RESULTS: 1) Endoscopic lesions were observed in 7 patients(29.2%) of 24 patients and more often in the terminal ileum(6/7) than in the colon(I/7). Among 7 patients with endoscopic lesions, 5 patients were presented as juvenile chronic arthritis. 2) Histologic signs of gut inflammation were detected in 14 patients(58. 3%). Actue lesions were seen in 2 patients (8. 3%) and chronic lesions were seen in 12 patients (50%). 3) In 12 patients without the involvement of peripheral joints, acute lesion was not seen(0%), and chronic lesions were seen in 6 patients(50%). In 12 patients with the involvement of peripheral joints, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 6 patients(50%). Gut inflammations were more frequent in patients with the involvement of peripheral joints than in those without the involvement of peripheral joints. 4) In 12 patients without the administration of sulfasalazine, acute lesion was not seen(0%), and chronic lesions were seen in 7 patients(58.7%) In 12 patients with the administration of sulfasalazine, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 5 patients(41.6%). The frequency of gut lesions in patients without the administration of sulfasalazine was not different from that in patients with the administration. of sulfasalazine (p<0.05). CONCLUSION: Gut inflammation was frequently found in patients with ankylosing spondylitis. Chronic gut inflammation could play a role in the pathogenesis of the ankylosing spondylitis.
Arthritis, Juvenile ; Biopsy ; Humans ; Inflammation ; Joints ; Spondylitis, Ankylosing* ; Sulfasalazine

The necessity of routine prostate biopsy prior to transurethral resection of the prostate (TURP) in elderly comorbid patients with a high prostate specific antigen (PSA) level remains controversial. We assessed the role of TURP in prostate cancer diagnosis in these individuals. A total of 197 patients underwent TURP in conjunction with prostatic needle biopsy. Pathologic reviews of specimens of TUR chips and biopsy cores were analyzed. Overall, prostate cancer (CaP) was detected in 114 patients (57.6%). Ninety-eight cancers (86%) were detected with TURP and biopsy, and seven cancers (6.1%) with only TURP. The Gleason score of a TUR-specimen was identical to that of the biopsy-core in 43.9% of cases. Variables associated with diagnostic accuracy in the TUR-specimens included the prebiopsy PSA level, prostate specific antigen density (PSAD), and the Gleason score in biopsy cores. In patients with a PSA level and a PSAD that was greater than 15.4 ng/mL and 0.69 ng/mL/g, respectively, 100% of the cancers were detected in the TUR-specimens. Our results suggest that a prostatic biopsy might be omitted prior to TURP in elderly patients with significant co-morbidity and levels for PSA of >15.4 ng/mL.
Aged ; Aged, 80 and over ; Area Under Curve ; Biopsy, Needle ; Comorbidity ; Humans ; Male ; Neoplasm Grading ; Prostate/*surgery ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/*diagnosis/epidemiology/*pathology/surgery ; ROC Curve ; Transurethral Resection of Prostate

Adenoma is a benign epithelial lesion with malignant potential and can be found at any site of the gastrointestinal tract. Adenoma of the common bile duct is a rare and unusual cause of bile duct obstruction. We report a case of tubulovillous adenoma of the common bile duct at the cystic duct opening. A 1.8X1.2X1 cm sized, round and lobulated mass was noted on abdominal sonogram, CT scan and endoscopic retrograde cholangiogram, and it was confirmed and treated by surgical resection.
Adenoma* ; Cholestasis ; Common Bile Duct* ; Cystic Duct* ; Gastrointestinal Tract ; Tomography, X-Ray Computed

The HeartWare Ventricular Assist Device (HVAD) was widely used for mechanical circulatory support in patients with end-stage heart failure. However, there have been reports of a critical issue with HVAD pumps failing to restart, or experiencing delays in restarting, after being stopped. This case report describes 2 instances of HVAD failure-to-restart during heart transplantation surgery and routine outpatient care. Despite multiple attempts to restart the pump using various controllers and extensions, the HVAD failed to restart, triggering a hazard alarm for pump stoppage. In one case, the patient survived after receiving a heart transplantation, while in the other, the patient died immediately following the controller exchange. These cases highlight the rare but life-threatening complication of HVAD failure-to-restart, underscoring the importance of awareness among clinicians, patients, and caregivers, and adherence to the manufacturer’s guidelines and recommendations for HVAD management.

The HeartWare Ventricular Assist Device (HVAD) was widely used for mechanical circulatory support in patients with end-stage heart failure. However, there have been reports of a critical issue with HVAD pumps failing to restart, or experiencing delays in restarting, after being stopped. This case report describes 2 instances of HVAD failure-to-restart during heart transplantation surgery and routine outpatient care. Despite multiple attempts to restart the pump using various controllers and extensions, the HVAD failed to restart, triggering a hazard alarm for pump stoppage. In one case, the patient survived after receiving a heart transplantation, while in the other, the patient died immediately following the controller exchange. These cases highlight the rare but life-threatening complication of HVAD failure-to-restart, underscoring the importance of awareness among clinicians, patients, and caregivers, and adherence to the manufacturer’s guidelines and recommendations for HVAD management.