PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.
Classification* ; Compliance ; Female* ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Neck ; Prevalence ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urodynamics*

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.
Classification* ; Compliance ; Female* ; Humans ; Incidence ; Lower Urinary Tract Symptoms ; Neck ; Prevalence ; Retrospective Studies ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence ; Urodynamics*

Malignant rhabdoid tumor (MRT) is a rare but distinctive neoplasm of unknown histogenesis, occurring primarily in children. It has a characteristic histologic pattern and aggressive clinical behavior, and was originally thought to be a malignant sarcomatous variant of Wilms tumor; numerous cases of MRT arising from extrarenal sites have, however, been reported. We describe the radiologic findings of two cases of malignant extrarenal rhabdoid tumor that arose in the pelvic paravertebral region of two children. Both were confirmed by surgical excision and pathologic examination.
Child ; Humans ; Rhabdoid Tumor* ; Wilms Tumor

PURPOSE: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. RESULTS: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23+/-0.3ml, while that for the conventional STING was 0.95+/-0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects.
Child ; Male ; Female ; Humans ; Bites and Sting

Adrenocortical carcinoma is a rare tumor in children. This tumor is more likely to be hormonally active in children than in adults and tends to cause a variety of symptoms. These tumors are usually diagnosed at the advanced stages and have a dismal prognosis. Here we report a case of a functioning adrenocortical carcinoma in a child with a review of the relevant literature.
Adrenocortical Carcinoma* ; Adult ; Child* ; Humans ; Prognosis ; Virilism

Purpose: This study was done to assess the therapeutic effect of trazodone, an antidepressant agent in combination with sildenafil in patients with erectile dysfunction (ED) and decreased libido with normal serum testosterone level. Materials and Methods: From March 2005 to February 2006, 90 patients with ED complaining of decreased libido but whose serum testosterone level was within normal range were screened and enrolled in this study. The subjects were randomly treated by sildenafil only (group 1) and combination of sildenafil with trazodone (group 2). Patients received trazodone for at least 3 consecutive months, with daily doses starting at 50 mg. By intention-to-treat basis, the period of study was extended by 9 month. The intention-to-treat population included 39 sildenafil recipients and 35 sildenafil with trazodone recipients. The patients were asked to make up two questions, Q1: 'Did you experience improvement of erection after treatment?' and Q2: 'Did you experience improvement of libido after treatment?' and the change of International index of erectile function (IIEF) scores before and after the treatment were analyzed to assess the efficacy of treatment. Results: After 3 month treatment period, 70% of group 1 and group 2 answered 'yes' to Q1. Twenty seven percents of group 1 and 51% of group 2 answered 'yes' to Q2 and 20% of group 1 and 24% of group 2 answered 'yes' to both Q1 and Q2. In the intention-to-treat population, seventy-two percents of group 1 and 71% of group 2 answered 'yes' to Q1 and 28% of group 1 and 52% of group 2 answered 'yes' to Q2, 21% of group 1 and 26% of group 2 answered 'yes' to both Q1 and Q2. The change of IIEF scores before and after the treatment at 3 month and 9 month showed similar results. Both group 1 and group 2 showed significant improvement on scores of IIEF-5 and question 15 of IIEF after treatment (p<0.01). Meanwhile, only group 2 showed significant improvement on question 11 and 13 of IIEF after the treatment compared to group 1 (p<0.05). Two patients with high dose of trazodone complained of headache and drowsiness, but the symptoms disappeared by dose reduction. Conclusions: The combination therapy of trazodone with sildenafil increased libido and sexual satisfaction on patients with ED. Therefore, combination of trazodone with sildenafil might be considered in ED patients of decreased libido with normal serum testosterone level rather than sildenafil monotherapy.
Erectile Dysfunction ; Headache ; Humans ; Libido ; Male ; Piperazines ; Purines ; Reference Values ; Sleep Stages ; Sulfones ; Testosterone ; Trazodone ; Sildenafil Citrate

The widespread application of coronary angiography and poen heart surgery have resulted in more frequent detection of patients with coronary artery anomaly. In 0.6 to 1.2 percent of individials, the coronary arteries arise aberrantly from the aorta. Anomalous origin of the left coronary artery from the fight coronary sinus with subsequent coursing between the aorta and pulmonary artery is a rare and sometimes fatal coronary amonaly. This anomaly has been reported in young and healthy men who died suddenly during or immediately forllowing vigorous physical exercise. The exact mechanism of sudden death is unclear. It is believed to be related to either extrinsic compression of the left coronary artery or distorsion of the vessel orifice, with resultant global ischemia and ventricular fibrllation. A 13-years old healthy boy, who was completely asymptomatic until he had sudden chest pain after running, arrived at hospital with typical clinical picture of acute myocardial infarction. The electrocardiography taken on admission demonstrated pathologic Q wave changes on lead I, aVL, V2, V3 and V4. Cardiac enzymes were elevated. The selective coronary angiography demonstrated that left coronary artery arose from the right coronary sinus. The anomalous left coronary artery passed posterioly around aortic root to reach its normal position in the interventricular groove. We report the patient with anomalous origined left coronary artery which causes the acute myocardial infarction.
Adolescent ; Aorta ; Chest Pain ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessels* ; Death, Sudden ; Electrocardiography ; Exercise ; Humans ; Ischemia ; Male ; Myocardial Infarction* ; Pulmonary Artery ; Running ; Thoracic Surgery

Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an uncommon, idiopathic and generally self-limited disease, characterized by cervical lymphadenopathy. It can present systemic symptoms and signs, but ocular involvement is unusual. We report a 35-year-old woman who presented sudden decreased visual acuity and a swollen lymph node on the left side of her neck. On laboratory findings, there were no evidences of infection, autoimmune disease and systemic vasculitis. She was diagnosed with Kikuchi disease and bilateral retinal vasculitis by histologic analysis of lymph node, fundoscopy and fluorescein angiography.
Adult ; Autoimmune Diseases ; Female ; Fluorescein Angiography ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Neck ; Retinal Vasculitis ; Retinaldehyde ; Systemic Vasculitis ; Visual Acuity

Polycythemia is a condition in which the red blood cell count is increased due to an inherited or acquired mutation, a physiologic response to hypoxia, autonomous erythropoietin production, or deliberate erythropoietin administration. Higher testosterone levels appear to act as a stimulus for erythropoiesis and testosterone replacement therapies have rarely been reported as causes of polycythemia. We report here a case of a 51-year-old man with polycythemia that was caused by long-acting testosterone undecanoate (Nebido(R)).
Anoxia ; Erythrocyte Count ; Erythropoiesis ; Erythropoietin ; Humans ; Middle Aged ; Polycythemia ; Testosterone

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.
Male ; Humans ; Cysts