The formation of urinary calculi following renal transplantation is rare event with a frequency of less than 5%. Although infection, renal tubular acidosis and cyclosporine-induced hyperuricosuria can predispose toward stone formation in a renal allograft. The modalities of treatment used, were percutaneous nephrolithotripsy, shock wave lithotripsy and chemolysis. We report a case in which a double-J ureteral stent that had been forgotten for 10 years induced staghorn calculi in allograft. The stone was successfully removed by percutaneous ultrasonic nephrolithotripsy through graft renal pelvis.
Acidosis, Renal Tubular ; Allografts* ; Calculi* ; Kidney Calculi ; Kidney Pelvis* ; Kidney Transplantation ; Lithotripsy ; Shock ; Stents ; Transplants* ; Ultrasonics ; Ureter ; Urinary Calculi

Aphasia as clinical manifestation of cerebral multiple sclerosis is a rarity. We report here a clinical case of multiple sclerosis complicated by striking motor aphasia. A 11 year old male was admitted with sudden onset of aphasia and quadriparesis following appendectomy under the general anesthesia. A few hour after operation, above symptoms and bilateral pyramidal signs were developed. These findings were fluctuated but slowly remitted. Two weeks later second bout of multiple sclerosis developed, characterized by absent spontaneous speech, quadriparesis, multiple cranial nerve palsies internuclear ophthalmoplegia and bilateral pyramidal signs. The finding of E.E.G. disclosed paroxysmal slow waves in high amplitude on frontal region. Patient was treated with steroids and conservative management. Eleven weeks later, he was discharged with relatively good results.
Anesthesia, General ; Aphasia* ; Aphasia, Broca ; Appendectomy ; Child ; Cranial Nerve Diseases ; Humans ; Male ; Multiple Sclerosis* ; Ocular Motility Disorders ; Quadriplegia ; Steroids ; Strikes, Employee

PURPOSE: The incidence of stage T1c prostate cancer has been reported to have increased more than any other prostate cancer. To evaluate whether a sextant biopsy is useful for the detection of stage T1c prostate cancer, the detection rates were compared between the sextant and 12-sample needle biopsies, in relation to the prostate volume (PV) and serum prostate specific antigen (PSA) level. MATERIALS AND METHODS: Between January, 1986 and December, 2002, 123 patients who were found to be normal upon digital rectal examination, with negative findings on a transrectal ultra sonography (TRUS) examination and elevated serum PSA (>4ng/ml), underwent either a sextant or 12-sample needle biopsy, under local anesthesia, to detect the presence of prostate cancer. RESULTS: There was no statistically significant difference in the cancer detection rate between the sextant (11/41) and 12-sample (24/82) needle biopsies of the prostate. According to the total PSA level, the detection rates of prostate cancer for the 6 and 12 core groups were 31.6 (6/19) and 22.8% (8/35), respectively, (PSA: 4.1-9.9ng/ml), 23.1 (3/13) and 32.0% (8/25) (PSA: 10.0-19.9ng/ml), and 22.2 (2/9) and 36.4% (8/22) (PSA >or=20.0ng/ml). According to the prostate volume, the detection rates of prostate cancer for the 6 and 12 core groups were 28.6 (2/7) and 31.0% (9/29), respectively (PVor=60ml). Our study did not have the statistical power required to rule out small differences. CONCLUSIONS: These findings imply that a sextant biopsy constitutes a useful method for the detection of prostate cancer.
Anesthesia, Local ; Biopsy* ; Biopsy, Needle* ; Digital Rectal Examination ; Humans ; Incidence ; Needles* ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

To observe the role of oxygen free radical and enzymatic scavengers in cerebral ischemia, an infarction model was made using transorbital occlusion of the middle cerebral artery in cats. The changes of the superoxide radical production and the activities of superoxide dismutase and catalase were measured. The results were as follows ; 1) The infarction of the left middle cerebral artery(MCA) territory was identified with intracardiac perfusion of a TTC solution after transorbital occlusion. 2) The superoxide radical activities after occlusion of the left MCA were not changed in all groups except for the decrease in 6 hours group of the right side compared to the control group(p<0.05). 3) The Mn-superoxide dismutase activities of the left side in the 12 hours group were significantly higher than those of the right side(p<0.01) and those in the control group(p<0.05). 4) The Cu, Zn-superoxide dismutase activities of the left side in the 3 hours group after occlusion of the left MCA were significantly higher than those in the control group(p<0.05). 5) The catalase activities of the left side in the 3 hours, 6 hours and 12 hours groups after occlusion of the left MCA were significantly higher than those of the right side(p<0.05). 6) The catalase activities of the left side in the 12 hours group after occlusion of the left MCA were significantly higher than those in the control group(p<0.05). The authors suggest that the enzymatic scavangers such as Mn-SOD, Cu, Zn-SOD and catalase increased in the infarcted brain, which means an involvement of free radicals in cerebral infarction.
Animals ; Brain ; Brain Ischemia ; Catalase* ; Cats ; Cerebral Infarction* ; Free Radicals ; Infarction ; Middle Cerebral Artery ; Oxygen ; Perfusion ; Superoxide Dismutase* ; Superoxides*

To determine whether the relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostatic hyperplasia, we measured the percentage of stroma and gland by quantitative morphometric analysis in the prostate adenomas from men with symptomatic and asymptomatic BPH. Prostate adenomas were obtained from 9 men with asymptomatic BPH undergoing cysto-prostatectomy for invasive transitional cell carcinoma of the bladder (group 1), 15 with symptomatic BPH undergoing transurethral resection of the prostate and 5 with symptomatic BPH undergoing open prostatectomy( <60g : group 2a), and 15 with symptomatic BPH undergoing open prostatectomy( >= 60g: group 2b). The results obtained were as follows. 1. The prostate adenomas from group 1, 2a and 2b contained 57.1 %, 68.2% and 68.8% of stroma and 19.69t, 14.3% and 13.2% of epithelium and 23.3%, 17.5% and 18.0% of glandular lumen, respectively. The difference in percentage of stroma, epithelium and glandular lumen in the prostate adenoma from men with symptomatic and asymptomatic BPH were statistically significant(P <0.05). 2. The prostate adenomas from 24 men with modified Boyarsky obstructive symptom scoring over 10 were compared with 11 men with scores less than 10. The results were 68.2% vs. 69.3%, 13.8% vs. 13.5% and 18.0% vs. 17.2% of stroma, epithelium and glandular lumen, respectively ( P>0.1). 3. The prostate adenomas from 19 men with modified Boyarsky irritative symptom scoring over 7 were compared with 16 men with scores less than 7. The results were 67.6% vs. 69.9%, l3.8% vs. 14.1% and l8.0% vs. 16.2% of stroma, epithelium and glandular lumen, respectively ( P>0.1) . In conclusion, the prostate adenomas from men with symptomatic BPH were composed of more proportion of stroma and lesser proportion of epithelium and glandular lumen than those from men with symptomatic BPH. The histological composition of prostate adenomas were not related to the severity of obstructive or irritative symptom.
Adenoma ; Carcinoma, Transitional Cell ; Epithelium ; Humans ; Hyperplasia ; Male ; Prostate ; Prostatic Hyperplasia* ; Urinary Bladder

The pre-transplantation goal of the urologist is the optimization of urinary tract condition. Therefore, urologic surgery may be needed before or after renal transplantation. We analyzed the results of urologic surgery performed because of de novo urologic diseases. Between January 1986 and January 2001, 281 patients underwent renal transplantation, and 23 urologic surgical procedures were performed on 21 transplant recipients before or after renal transplantation because of de novo urologic diseases. By review the major reasons for urologic surgery in recipients were polycystic kidney diseases, vesicoureteral reflux, and dysfunctional voiding disorders. Nineteen surgical corrective procedures were done average 2.9 months before transplantation. The mortality rate was 10.5%. Four patients underwent urologic surgery at an average 57.5 months after transplantation. We highlight the fact that patients with uremia are vulnerable to surgical complications, and conclude that more intensive longterm urologic follow-ups should be conducted on recipients.
Adult ; Child ; Female ; Follow-Up Studies ; Humans ; Kidney/abnormalities ; Kidney Diseases/surgery/*therapy ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Nephrectomy ; Polycystic Kidney Diseases/pathology/therapy ; Postoperative Complications ; Preoperative Care ; Research Support, Non-U.S. Gov't ; Time Factors ; Urologic Diseases/surgery ; Urologic Surgical Procedures/*methods ; Vesico-Ureteral Reflux/therapy

Of the case of malignant astrocytoma, spontaneous transdural extension is very rare. Only several cases of transdural extension of primary intracranial tumor are reported. However, these cases are through the foramina of the skull base. We have experienced a case of malignant astrocytoma which directly extended out through the dura and calvarium near the pterion of the left side.
Astrocytoma* ; Skull ; Skull Base

We have experienced 3 cases of localized cervical adhesive arachnoiditis. 2 of them had history of operation under spinal anesthesia. Paresthetic pain and weakness are the commonest presenting symptoms and signs in our cases. Myelographically, findings are simulating the intramedullary lesion in 2 cases. With surgical intervention, 2 cases have good results.
Adhesives* ; Anesthesia, Spinal ; Arachnoid* ; Arachnoiditis*

PURPOSE: We wanted to determine and report on the outcome of combined gemcitabine/cisplatin chemotherapy for patients suffering with locally advanced or metastatic urothelial cancer. MATERIALS AND METHODS: Between July 1999 and December 2004, 43 selected patients were enrolled in this study. Group 1 (the adjuvant chemotherapy group) had undergone radical surgery with removal of evident tumor from the following primary sites: bladder (n=8), renal pelvis (n=7) and ureter (n=3). Group 2 (the salvage chemotherapy group) had undergone palliative surgery with a remnant tumor at the following primary sites; bladder (n=23) and renal pelvis (n=2). All the patients were given gemcitabine/ciplatin and they evaluated for the therapeutic effect and toxicity. The patients were initially treated with gemcitabine 1000 mg/m2 intravenously for 30 minutes on days 1, 8 and 15 of a 28-day cycle, and cisplatin 70 mg/m2 was administered intravenously on day 1 using prehydration measures. RESULTS: Group 1: The median follow-up period was 16.5 months. The mean age was 63 years (males: 15 cases, females: 3 cases), and eleven patients (61%) remained alive. The estimated median relapse-free survival period and 2-year survival rate were 24 months and 63%, respectively. Group 2: the median follow-up period was 20 months, the mean patient age was 63.8 years (males: 22 cases, females: 3 cases), and nine patients (36%) remained alive. The overall response and 2-year survival rates were 36% and 43%, respectively. Toxicities: Grade 3 toxicities developed in 14 cycles during the total 232 cycles. Grade 4 toxicity did not occur. CONCLUSIONS: The results of this study confirm that adjuvant and salvage chemotherapy with using gemcitabine and cisplatin is tolerable and safe.
Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Kidney Pelvis ; Palliative Care ; Survival Rate ; Ureter ; Urinary Bladder ; Urologic Neoplasms

For surgical stabilization of thoracolumbar instability either posterior transpedicular fixation or anterior interbody fixation is commonly performed. On some occasions, however, combined ventral and dorsal stabilization is needed, in which case surgery is usually performed in separate stages. To achieve this goal in a single operation, the authors used the crossed-screw fixation technique, with the pedicle screw-rod system, in eight patients. Their thoracolumbar instabilities were caused by trauma(n=6), tumor(n=1), and congenital deformity(n=1). In all patients, signs of myelo- and/or radiculopathy were present, and as this required extensive ventral and dorsal decompression, combined ventral and dorsal stabilizations was considered necessary. Surgery involved the lateral extracavitary approach: for dorsal stabilization, the conventional transpedicular fixation method, with pedicle screws of 5.5-mm diameter, was used. For ventral stabilization, interbody struts were grafted, using rib autograft or in the case of tumor fibula allograft, supplemented with transverse fixation of the vertebral body with pedicle screws of 7.5-mm diameter. The two stabilization systems, ventral and dorsal, were interconnected with cross-linking plates. Follow-up 12 to 26 (average 18) months after surgery revealed no hardware failures, and all patients showed improvement in their neurological functions during this period. Due to congenital deformity, graft dislodgement occurred in one patient. On the basis of these results the authors believe that the crossed-screw fixation technique is a viable option for three-dimensional stabilization of the thoracolumbar spine.
Allografts ; Autografts ; Congenital Abnormalities ; Decompression ; Fibula ; Follow-Up Studies ; Humans ; Radiculopathy ; Ribs ; Spine* ; Transplants