PURPOSE: To evaluate the concordance of cancer location of the tissue mapping from a mechanical pressure transducer with magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: A total of 60 indentations were performed on 5 prostate specimens obtained after radical prostatectomy utilizing a robotic indentation system. The mechanical elastic moduli of suspected malignant lesions were calculated and mapped, and their locations were compared with suspicious areas of malignancy on MRI scans. RESULTS: The concordance rate between the location mapping from the robotic indentation system and MRI scans results was 90.0% (54/60). The sensitivity and specificity of the robotic indentation system were 87.9% (29/33) and 92.6% (25/27), respectively. The positive predictive value and negative predictive value were 93.5% (29/31) and 93.1% (27/29), respectively. CONCLUSION: The locations of malignant lesions derived from our robotic indentation system correlated strongly with the locations of suspected areas of malignancy on MRI scans. Our robotic system may provide a more targeted biopsy of the prostate than conventional non-targeted systemic biopsy, possibly improving the diagnostic accuracy of prostatic biopsies for cancer.
Aged ; Biopsy/methods ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Predictive Value of Tests ; Prostatectomy ; Prostatic Neoplasms/*diagnosis/pathology/surgery ; Robotics/instrumentation/*methods ; Sensitivity and Specificity

A 33-year old male was admitted due to continuous high spiking fever for 2 months via local clinic. He had been diagnosed pulmonary tuberculosis at local clinic. However, spiking fever had not been controlled by anti-tuberculous medications. Chest PA showed confluent consolidation on right upper & mid-lung field. 5 anti-tuberculous regimens (Streptomycin, Isoniazid, Rifampin, Ethambutol, Pyrazinamaide) were administered initially and steroid therapy was followed for relieving toxic symptoms Very slowly resolved chest X-ray lesion and continuous fever suggested the possibility of misdiagnosis. After 60th hospital day, the chest X-ray lesion was resolved gradually and fever subsided almost completely. He was discharged on 76th hospital day with anti-tuberculous drugs and steroid(prednisolon), without any other problems except sustained mild fever.
Diagnostic Errors ; Ethambutol ; Fever* ; Humans ; Isoniazid ; Male ; Pneumonia* ; Rifampin ; Thorax ; Tuberculosis, Pulmonary

Fitz-Hugh-Curtis syndrome, a kind of perihepatitis, occurs approximately in 3 to 10 percent of patients with pelvic inflammatory disease. It is not easy to detect in clinical settings due to requirement of invasive methods for diagnosis, for example, like a laparoscopic examination. Now, it has become possible to recognize it easily with the aid of non-invasive methods including an abdominal dynamic CT scan and laboratory tests. Moreover, it can be improved after the oral administration of antibiotics. Therefore, noninvasive diagnosis is desirable. Herein, clinical characteristics of ten cases of Fitz-Hugh-Curtis syndrome are reported, with a review of the literature.
Adolescent ; Adult ; Chlamydia Infections/diagnosis ; Chlamydia trachomatis ; Diagnosis, Differential ; Female ; Humans ; Laparoscopy ; Liver/pathology/radiography ; Pelvic Inflammatory Disease/*diagnosis/drug therapy/etiology ; Peritonitis/*diagnosis/drug therapy ; Syndrome ; Tomography, X-Ray Computed

No abstract available.
Carcinoma, Transitional Cell* ; Hematuria* ; Humans ; Urinary Bladder*

Purpose: This study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines. Methods: From June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines. Results: Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%). Conclusion The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

PURPOSE: Hematuria is a frequently encountered clinical problem in kidney graft recipients. The causes are variable, may be benign or malignant, but imperative to affect long- term graft function and survival. We have evaluated renal recipients who had hematuria using a newly defined algorithm. METHODS: We evaluated 1060 renal transplant recipients from March 1, 1992 to February 28, 2000. In 93 recipients, hematuria was transitory and spontaneously resolved within 3 months. We tried to identify the cause of persistent hematuria in 126 recipients. Patients were evaluated with plain x-ray, sonography, cystoscopic examination and/or graft biopsy. RESULTS: The mean duration of hematuria onset after transplantation was 17.81+/-14.6 months (4-70 months). The causes of gross hematuria were urolithiasis (n= 15), benign bladder mucosal bleeding (n=3), bladder cancer (n=2) and kidney cancer from an original kidney (n=1). Graft kidney biopsies were performed in 96 patients and the results were as follows: chronic rejection in 18, IgA nephropathy in 16, cyclosporine toxicity in 8, acute rejection in 5, focal segmental glomerulosclerosis in 3, the other glomerulonephritis in 2, and tubular atrophy and interstitial fibrosis in 19 patients. Combined pathologic findings were detected in 15 patients. In 8 patients, no pathological diagnoses were made. We were unable to evaluate 9 patients due to patient's refusal. CONCLUSION: The causes of hematuria after kidney transplantation are variable from benign to malignant disease. If the cause of hematuria is uncertain on ultrasonographic examination, cystoscopic examination and/or graft biopsy should be performed for making a definite diagnosis.
Atrophy ; Biopsy ; Cyclosporine ; Diagnosis ; Disulfiram ; Fibrosis ; Glomerulonephritis ; Glomerulonephritis, IGA ; Glomerulosclerosis, Focal Segmental ; Hematuria* ; Hemorrhage ; Humans ; Kidney ; Kidney Neoplasms ; Kidney Transplantation ; Transplantation ; Transplants ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urolithiasis

PURPOSE: Laparoscopic living donor nephrectomy has recently been emerged as a very attractive measure to the standard open surgical procedure for kidney transplantation (KTx) because of many advantages. But it also has some disadvantages such as technical difficulty, impaired early graft function and expensiveness. To overcome this shortcomings, we developed a new surgical method of retroperitoneoscopy assisted live donor nephrectomy. The method has been reported as an attractive surgical methods with many advantages to donor. But, recipient`s outcome is also equally important in living donor kidney transplantation. METHODS: We retrospectively studied recipient`s outcome between patients who received living donor kidneys from conventional open nephrectomies (Group I, n=247) and retroperitoneoscopy assisted nephrectomies (Group II, n=82) at our institution from March 1, 1997 and July 30, 2000. We compared postoperative complication, patient and graft survival and graft function between two groups for 12 months retrospectively. RESULTS: Demographic data such as age, sex, kidney weight/body weight ratio; ABO compatibility; degree of HLA matching and method of immunosuppression were not different between two groups (p>0.05). Complications, such as delayed graft function, acute rejection, ureter complication, graft failure, patients motality were not different. For the evaluation of graft function, we measured serum creatinine level for 12 months after trasplantation. There also was no difference of graft function between two groups. CONCLUSION: Recipient's outcome in patient received kidney by retroperitoneoscopy assisted live donor nephrectomy was similar to those of patient received kidney by conventional operation.
Creatinine ; Delayed Graft Function ; Graft Survival ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Living Donors* ; Nephrectomy* ; Postoperative Complications ; Retrospective Studies ; Tissue Donors ; Transplants ; Ureter

Prolonged ingestion of licorice can cause hypermineralocorticoidism, with sodium retention, potassium loss and hypertension. Nevertheless, its initial presentation with a very severe degree of hypokalemic paralysis and rhabdomyolysis are exceedingly rare. We describe a patient who experienced hypokalemic paralysis and rhabdomyolysis after licorice ingestion. The patient's initial blood pressure was 160/80mmHg. The major biochemical abnormalities included; hypokalemia(K+ 1.3mEq/L), metabolic alkalosis, with a pH of 7.64, and urine myoglobin > 3000ng/mL. The plasma rennin activity and aldosterone level were suppressed. The 24 hour urine cortisol concentration was normal. The patients, over a 1 month period, had ingested 500g of licorice boiled in water. After quitting the licorice, the hypokalemia and muscle paralysis gradually improved and blood pressure returned to normal
Aldosterone ; Alkalosis ; Blood Pressure ; Chymosin ; Eating ; Glycyrrhiza* ; Glycyrrhizic Acid ; Humans ; Hydrocortisone ; Hydrogen-Ion Concentration ; Hypertension ; Hypokalemia ; Myoglobin ; Paralysis* ; Plasma ; Potassium ; Rhabdomyolysis* ; Sodium ; Water

PURPOSE: To determine the ability of a novel palpation device to differentiate between benign and malignant tissues of the kidney and bladder by measuring tissue elasticity. MATERIALS AND METHODS: A novel palpation device was developed, mainly composed of a micromotor, a linear position sensor, a force transducer, and a hemisphere tip and cylindrical body probe. Motion calibration as well as performance validation was done. The tissue elasticity of both benign and malignant tissues of the kidney and bladder was measured using this device. A single investigator performed the ex-vivo palpation experiment in twelve kidneys and four bladder specimens. Malignant tissues were made available from partial nephrectomy specimens and radical cystectomy specimens. Palpations for benign renal parenchyma tissue were carried out on nephroureterectomy specimens while non-involved areas in the radical cystectomy specimens were used for benign bladder samples. Elastic modulus (Young's modulus) of tissues was estimated using the Hertz-Sneddon equation from the experimental results. These were then compared using a t-test for independent samples. RESULTS: Renal cell carcinoma tissues appear to be softer than normal kidney tissues, whereas tissues from urothelial carcinoma of the bladder appear to be harder than normal bladder tissues. The results from renal cell carcinoma differed significantly from those of normal kidney tissues (p=0.002), as did urothelial carcinoma of the bladder from normal bladder tissues (p=0.003). CONCLUSION: Our novel palpation device can potentially differentiate between malignant and benign kidney and bladder tissues. Further studies are necessary to verify our results and define its true clinical utility.
Adult ; Aged ; Elastic Modulus ; Elasticity Imaging Techniques/*instrumentation ; Equipment Design ; Female ; Humans ; Kidney/physiology ; Kidney Neoplasms/*diagnosis/physiopathology ; Male ; Middle Aged ; Palpation/*instrumentation ; Phantoms, Imaging ; Pilot Projects ; Urinary Bladder/physiology ; Urinary Bladder Neoplasms/*diagnosis/physiopathology

Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot-assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer.
Carcinoma, Renal Cell ; Humans ; Nephrectomy* ; Prostatectomy* ; Prostatic Neoplasms