PURPOSE: The location of renal cysts is related with the symptoms and signs. Parapelvic cysts are a rare form of simple renal cysts, and they are much more commonly associated with the symptoms of obstruction, pain, infection and stone formation. We evaluated the surgical outcomes of laparoscopic renal cyst marsupialization for treating the peripheral and parapelvic types of renal cysts. MATERIALS AND METHODS: Between November 1993 and April 2007, 87 patients(91 cases) who presented with symptomatic renal cysts underwent laparoscopic renal cyst marsupialization. There were 76 cases in the peripheral cyst group and 15 cases in the parapelvic cyst group. The mean age was 59.2 years(age range: 20-77) for the patients with peripheral renal cysts and 62.9 years(age range: 47-79) for the patients with parapelvic cysts. RESULTS: The mean operative time was 108 minutes(30-280) for the patients with peripheral renal cysts and 144 minutes(80-270) for the patients with parapelvic cysts, and there was a significant difference(p=0.031). However for the other factors, including the time for the first oral intake, the time to remove the drain and the length of the hospital stay, there were no significant differences(p=0.671, 0.088, 0.268, respectively). Complications, including bleeding and leakage, were detected in 11 patients(14.4%) of the peripheral cyst group and in 4 patients(26.6%) of the parapelvic cyst group; there was a statistical difference(p=0.035). Both groups had a high success rate, 98.7% in the peripheral cyst group and 100% in the parapelvic cyst group. CONCLUSIONS: We found that laparoscopic renal cyst marsupialization was a standard treatment with a high success rate and a fast recovery time. However, performing this for parapelvic cysts showed a longer operative time and a higher complication rate as compared with peripheral cysts.
Hemorrhage ; Humans ; Kidney Diseases, Cystic ; Laparoscopy ; Length of Stay ; Operative Time

Meningeal carcinomatosis in patients with prostate cancer is very rare. Recently, we experienced a case of meningeal carcinomatosis in a patient with prostate cancer. He had undergone a radical prostatectomy 11 years before presentation and had undergone chemotherapy 4 years before presentation due to bone metastases. This time, he visited the emergency department because of a seizure. Although cerebrospinal fluid (CSF) examinations did not reveal malignant cells, we diagnosed meningeal carcinomatosis based on positive CSF prostate-specific antigen and magnetic resonance imaging (MRI) findings. The diagnosis was confirmed pathologically. We treated the patient with whole brain radiotherapy and intrathecal chemotherapy. We report a case of prostate cancer with meningeal carcinomatosis with a literature review.
Brain ; Emergencies ; Humans ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Neoplasm Metastasis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Seizures

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.
Bronchial Fistula ; Carcinoma, Non-Small-Cell Lung ; Fistula ; Humans ; Lung Neoplasms ; Lymph Nodes ; Lymphatic Diseases ; Male ; Pneumonia ; Thoracic Cavity ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

OBJECTIVE: The synovium in rheumatoid arthritis(RA) is characterized by an increase in the thickness of lining layer and infiltration of cells into the sublining area. Histomorphologic studies of RA have indicated that initial destruction is more closely related to the presence of transformed appearing proliferating synovial cells than to the presence of subsynovial or periarticular inflammation. Based on the fact that synovial lining cells have some properties of transformed appearing cells, we examined the expressions of Fos, Jun and Myc oncoproteins in the synovial tissue from patients with rheumatoid arthritis and osteoarthritis. METHODS: Synovial tissues from 15 patients with RA and 15 with osteoarthritis(OA) were studied by the immunohistochemical staining technique. Nine of 15 RA specimen were from arthroscopic synovectomy and the other 6 were from total knee replacement arthroplasty. RESULT: In all specimen studied, Myc and Fos were expressed in the synovial lining cells and Myc, Fos and Jun were expressed in the sublining cells, including lymphocytes, other inflammatory cells and blood vessels. Lymphocytes in the diffuse infiltrates showed increased expression of three oncoproteins compared to lymphocytes in the nodular aggregates. When oncoprotein expressions in RA were compared to OA, Fos and Myc expressions in the synovial lining cell layer were significantly higher in RA than in OA and Jun, Fos and Myc expressions in inflammatory cells were significantly higher in RA than in OA. The expressions of Fos and Myc were significantly correlated with the degree of synovial hypercellularity. In RA, the expressions of all three oncoproteins were increased in synovectomy group than joint replacement group. CONCLUSION: We observe that there are increased expressions of Myc, Fos and Jun in RA synovium than OA. These changes are more prominent in synovectomy group than joint replacement group, which suggest the differential expression of oncoproteins according to disease progression.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Blood Vessels ; Disease Progression ; Humans ; Inflammation ; Joints ; Lymphocytes ; Oncogene Proteins ; Oncogenes ; Osteoarthritis ; Synovial Membrane*

OBJECTIVE: Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS. METHODS: After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors. RESULTS: Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions. CONCLUSION: NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
Constipation/epidemiology/etiology ; Female ; Humans ; Hysterectomy/adverse effects/*methods ; Intraoperative Complications/epidemiology ; *Organ Sparing Treatments/adverse effects/methods ; Pelvis/*innervation/surgery ; Rectum/*innervation/surgery ; Sexual Dysfunction, Physiological/epidemiology/etiology ; Urinary Bladder/*innervation/surgery ; Urinary Retention/epidemiology/etiology ; Uterine Cervical Neoplasms/epidemiology/*surgery ; Uterus/innervation/surgery ; Vagina/innervation/surgery

We report a case of Alport syndrome associated with esophageal leiomyomatosis, presenting as recurrent pneumonia. A 5-year old girl who had a history of cataract visited the out patient clinic with a complaint of recurrent wheezing and respiratory difficulty which had started five months previously. Chest magnetic resonance image(MRI) and esophagography, checked on the suspicion of achalasia, revealed esophageal leiomyomatosis and renal biopsy revealed Alport syndrome. In the pediatric population, this tumor is a rare cause of dysphagia and is often misdiagnosed as an esophageal motility disorder. Although a number of Alport syndrome associated with leiomyomatosis were reported in the literature, this is a second case report presented with recurrent pneumonia in Korea.
Biopsy ; Cataract ; Child, Preschool ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders ; Female ; Humans ; Korea ; Leiomyomatosis* ; Nephritis, Hereditary* ; Pneumonia ; Respiratory Sounds ; Thorax

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.
Diagnosis ; Extremities ; Humans ; Pain Measurement ; Severity of Illness Index ; Skin Temperature*

BACKGROUND: The diagnostic criteria of complex regional pain syndrome (CRPS) have mainly focused on dichotomous (yes/no) categorization, which makes it difficult to compare the inter-patient's condition and to evaluate the intra-patient's subtle severity over the course of time. To overcome this limitation, many efforts have been made to create laboratory methods or scoring systems to reflect the severity of CRPS; measurement of the skin temperature asymmetry is one of the former, and the CRPS severity score (CSS) is one of the latter. However, there has been no study on the correlations among the CSS, temperature asymmetry and subjective pain score. The purpose of this study was to evaluate whether there is any correlation between the CSS, skin temperature asymmetry and subjective pain score. METHODS: Patients affected with CRPS in a unilateral limb were included in this study. After making a diagnosis of CRPS according to the Budapest criteria, the CSS and skin temperature difference between the affected and unaffected limb (DeltaT) was measured in each patient. Finally, we conducted a correlation analysis among the CSS, DeltaT and visual analogue scale (VAS) score of the patients. RESULTS: A total of 42 patients were included in this study. There was no significant correlation between the DeltaT and VAS score (Spearman's rho = 0.066, P = 0.677). Also, the CSS and VAS score showed no significant correlation (Spearman's rho = 0.163, P = 0.303). CONCLUSIONS: The DeltaT and CSS do not seem to reflect the degree of subjective pain in CRPS patients.
Diagnosis ; Extremities ; Humans ; Pain Measurement ; Severity of Illness Index ; Skin Temperature

Purpose: This study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). Materials and Methods: Cancer incidence data were obtained from the Korean Central Cancer Registry, the NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program. Results: The operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. Conclusion Based on the NHIS data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively lower concordance by cancer type requires additional definitions such as treatment.