A new method of urinary diversion via Skinner`s modification of Koch continent ileal reservoir was tried. With this method continence with storage of urine under low pressure is well maintained so that no external applicances are necessary. Ileorenal reflux is also prevented with this nipple forming technique. From May l986 to September l986, 4 patients underwent urinary diversion that included creation of a modified Koch pouch by Skinner. Previous urinary diversion was by ureterocutaneous diversion in 1 patient. A total of 3 patients underwent radical cystectomies for bladder cancer In 1 patient, simultaneous urethrectomy was done because of carcinoma in situ in the urethra. There were no operative mortalities. All patients are continent and without reflux to the upper urinary tract. The volume capacity of pouch is more than 400ml. The pouch is emptied by self-catheterization every 4 to 6 hours during the day and once at night. Postoperative follow-up presently is short and it is impossible to check late complications. Although preliminary, this clinical trial suggests that the quality of life for patients can be improved markedly by the modified Koch continent ileal reservoir.
Carcinoma in Situ ; Colonic Pouches* ; Cystectomy ; Follow-Up Studies ; Humans ; Mortality ; Nipples ; Quality of Life ; Urethra ; Urinary Bladder Neoplasms ; Urinary Diversion ; Urinary Tract

OBJECTIVE: To identify the location and formation of the sural nerve and its contributing nerves. METHOD: Fourteen lower limbs of 7 adult cadavers were anatomically dissected. The location and formation of the sural nerve (SN) in relation to the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN) were investigated. The length and diameter of the SN and contributing nerves were measured and the differences of the results were analyzed. RESULTS: Twelve SNs were formed by the union of the MSCNs and LSCNs, and 2 SNs were direct extensions of the MSCNs. The point of formation of the SN by union of the MSCN and LSCN was found in the middle third of the legs in 66.7% of SNs examined. The union sites of the SNs were located at 40.58+/-13.97% of the length of lower leg from the tip of lateral malleolus and 55.84+/-6.48% of the calf width from the medial border of the calf. There were significant statistical differences of diameter among nerves (p<0.05) and no significant difference of length between MSCN and LSCN. CONCLUSION: The results of this cadaveric study would increase the accuracy of the sural nerve conduction study and provide the locational information for precise surgical approach.
Adult ; Cadaver ; Humans ; Leg ; Lower Extremity ; Sural Nerve*

PURPOSE: Although prostate specific antigen(PSA) is an excellent tumor marker, it is not prostate cancer-specific but organ-specific. The objectives of this study is to identify the correlation between the nonmalignant elevation of PSA and the characteristics of DRE, TRUS, and histologic features. MATERIALS AND METHOD: Ninety nine patients with elevated PSA were divided into 3 groups of prostatic cancer(46), benign prostatic hyperplasia(46), and infectious prostatic disease(10) according to their clinical history and histology of prostate. RESULTS: There was significant elevation of PSA in order of prostate cancer, infectious disease, prostatic intraepithelial neoplasia(PIN), and benign prostatic hyperplasia(p > 0.01). Episodes of acute urinary retention and pyuria more frequently induced nonmalignant elevation of PSA(p > 0.05). There was no specific correlation between the findings of TRUS and elevation of PSA except intraprostatic calculi and cyst. Irregularity of margin and seminal vesicle on TRUS highly suggested prostatic cancer. On microscopic examination, high grade PIN, enlarged nucleus, prominent nucleoli and perineural invasion were highly correlated with prostatic cancer. CONCLUSIONS: These results suggest that nonmalignant elevation of PSA has following clinical characteristics: episodes of urinary retention, bladder calculi, urinary tract infection, prostatic calculi or cyst, and histologically benign. And the values of PSA in nonmalignant condition is not so elevated as malignancy.
Calculi ; Communicable Diseases ; Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Pyuria ; Seminal Vesicles ; Urinary Bladder Calculi ; Urinary Retention

PURPOSE: To evaluate the effects of oral Tamoxifen only versus L-Carnitine plus Tamoxifen in patients with Peyronie's disease. MATERIALS AND METHODS: All 45 patients with Peyronie's disease, diagnosed using accepted definitions, were randomized into two groups and treated for 3 months with Tamoxifen only(40 mg/day)(n=17) or a combination ofL-Carnitine(2 g/day) and Tamoxifen(40 mg/day)(n=28). A medical history was obtained, and a physical examination was performed. Plaque size, pain, erectile function(IIEF score), and penile curvature were assessed. Both before and after therapy, the differences between the 2 groups were compared using independent-sample t-test with p<0.05 considered significant. RESULTS: The mean age of the 45 patients was 52.1 years, and no severe adverse events occurred in either group. In the Tamoxifen only group, the mean decrease of plaque-length was 0.46+/-0.88 mm, and mean reduction in the pain rating scale was 0.44+/-0.53. In the L-Carnitine and Tamoxifen group, mean decrease of plaque-length was 1.57+/-0.92 mm, and mean reduction in the pain rating scale was 1.27+/-0.96. Based on IIEF scores, the improvement of erectile function was 0.88+/-0.64 in the Tamoxifen only group and 1.56+/-0.75 in the L-Carnitine and Tamoxifen group. The degree of penile curvature was also measured, and the reduction of curvature angle was 9.17+/-4.92 degrees in the Tamoxifen only group and 9.55+/-6.50 degrees in the L-Carnitine and Tamoxifen group. CONCLUSIONS: This study showed significantly greater improvements in plaque size, pain, erectile function, and curvature in patients with Peyronie's disease who were treated with L-Carnitine and Tamoxifen compared with those treated with Tamoxifen only.
Carnitine* ; Humans ; Male ; Penile Induration* ; Physical Examination ; Tamoxifen*

PURPOSE: To evaluate the causative factors of the false positive CT findings of parametrial invasions of cervial cancer. MATERIALS AND METHODS: we analysed 17 parametria of 14 patients with the diseases staged over lib on CT, but confirmed to be under stage Ila on pathology. The CT findings were retrospectively reviewed, and compared with pathologic findings. RESULTS: The causes of false postive diagnosis of parametrial invasions on CT were prominent cardinal ligaments (n=12), vaginal fornix(n=3), and prominent uterine vessels(n=2). CONCLUSION: Familiarity with these CT finding may be helpful in avoiding false positive diagnosis of parametrial invasion in patients with uterine cervical carcinoma.
Diagnosis ; Humans ; Ligaments ; Pathology ; Recognition (Psychology) ; Retrospective Studies

No abstract available.

Maligant melanomas of the oral or nasal cavity, and the vulvovaginal area are relatively common among the melanomas of non-ocular mucosa. But, primary malignant melanoma arising in the mucosa of the palatine tonsil is rare. We present a case of primary malignant melanoma arising in the mucosa of the palatine tonsil. A 36-year-old male was admitted for evaluation of a recurrent sore throat. Tonsillectomy was performed on the basis of clinical suspicion of chronic tonsillitis. Grossly, the left tonsil was focally dark. Microscopically, the tonsillar mucosa was diffusely infiltrated with tumor cells. Tumor cells revealed numerous melanin pigments. Intraepithelial nests of tumor cells were noted, but pagetoid spread of tumor cells was not found. Tumor cells were positive for S-100 protein and HMB45 stain. There was no evidence of melanoma in the skin or eye.
Male ; Humans

BACKGROUND: Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. SUBJECTS AND METHOD: In this retrospective study, subject is limited to transferred outborn babies with age less than 24 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. RESULTS: There were 84 cases(39.6%) hypothermia(<36degrees C> among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. CONCLUSION: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.
Birth Weight ; Body Temperature ; Emergency Service, Hospital ; Gestational Age ; Hospitals, Private ; Humans ; Hypothermia* ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn* ; Logistic Models ; Mortality ; Parturition ; Reference Values ; Retrospective Studies ; Transportation*

Actinic reticuloid as a manifestation of chronic actinic dermatitis (CAD) is a rare dermatosis whose clinical and histologic features resemble other types of pseudolymphomas including mycosis fungoides and Jessner's lymphocytic infiltration, and it is regarded as an eventual stage of various photodermatoses like photosensitive eczema or persistent light reaction or chronic photoallergic contact dermatitis and so on. Phototests in the patients with actinic reticuloid usually reveal hypersensitivity to UVB, UVA, and sometimes to visible light. We present a case of actinic reticuloid in a 65-year-old male, whose skin lesions developed as erythematous lichenified infiltrating plaques on the face at first, and then spread themselves onto the upper trunk later. Histologically those skin lesions showed the aggregation of atypical lymphocytes and photobiologically the results of phototests revealed photosensitivity to UVB and UVA.
Actins* ; Aged ; Dermatitis, Photoallergic ; Eczema ; Humans ; Hypersensitivity ; Light ; Lymphocytes ; Male ; Mycosis Fungoides ; Photosensitivity Disorders ; Pseudolymphoma ; Skin ; Skin Diseases

PURPOSE: The purpose of this study is to find helpful MR findings for predicting a naplastic oligodendrogl lomas. MATERIALS AND METHODS: Retrospective analysis of 46 MR images and 37 CT scans was performed for 46 patients with pathologically-proven cerebral oligodendrogliomas. A neuropathologist graded the tumors as one of low-grade (n=16), intermediate-grade (n=l2), or anaplastic oligodendroglioma (n=18). MR imaging features were retrospectively analysed with respect to histologic grading of the tumors. RESULTS: Contrast enhancement was observed always in anaplastic group (17 /17), in a portion of intermediate-grade group (4/10) but not in low-grade group (0/14). Peritumoral edema was observed infrequently in anaplastic group (4/18) or intermediate-grade group (1/12). Cystic changes (25/46) or calcifications on CT Scans (14/37) were not related with histologic grading. Grossly identifiable hemorrhage was rare in this series (2/46). Among the various imaging features, only tumor enhancement and peritumoral edema were statistically significant for trend test (p<0.05). CONCLUSION: When considering the diagnosis of oligodendrogliomas, the presence of contrast enhancement or peritumoral edema is a helpful features suggesting anaplastic oligodendrogliomas.
Diagnosis ; Edema ; Hemorrhage ; Humans ; Loma ; Magnetic Resonance Imaging ; Oligodendroglioma* ; Retrospective Studies ; Tomography, X-Ray Computed