PURPOSE: To report the voiding pattern and continence stati in male patients having undergone a radical cystectomy and orthotopic bladder substitution. MATERIALS AND MATHODS: Between March 2000 and June 2005, 20 men with advanced bladder cancer had a radical cystoprostatectomy and urinary diversion via an ileal orthotopic bladder substitution. The voiding pattern and continence stati were assessed using patient interviews, frequency- volume charts and pad tests at 1, 3, 6, 9 and 12 months after catheter removal. RESULTS: The mean age and follow-up were 60.5 years (41-72) and 34.1 months (12-69), respectively. Neobladder substitution was performed with an ileum in all patients. 17 patients had reconstruction with a Studer neobladder and 3 with a W-pouch Hautmann. All patients had transitional cell carcinoma (TCC) and their tumor stages ranged from T1G3 to T4aN1M0. The frequency of voiding ranged from 4 to 12 times during the day, and 0 to 5 times during the night, with a mean maximum neobladder capacity of 336ml (200-620) and maximum flow rate of 24.6ml/sec (12-46) 12 months after removal of the catheter. No patient required intermittent self-catheterization. All-time continence rates were 15, 30, 65 and 85%, and all-time incontinence rates were 55, 25, 10 and 5% at 1, 3, 6 and 9 months after catheter removal, respectively. CONCLUSIONS: Orthotopic bladder substitution has an excellent functional outcome over time, resulting in high daytime and nighttime continence rates within 9 months of catheter removal.
Carcinoma, Transitional Cell ; Catheters ; Colonic Pouches ; Cystectomy ; Follow-Up Studies ; Humans ; Ileum ; Male* ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

No abstract available.
Blood Flow Velocity*

Segmental testicular infarction is an uncommon and usually idiopathic phenomenon. Some case reports have linked segmental infarction to sickle cell anemia, hypersensitivity angiitis, polycythemia, and an idiopathic cause. Magnetic resonance imaginge (MRI) might be of great diagnostic value as the ischemic lesions have a characteristic pattern. Nonetheless, as its clinical and radiological presentation may resemble testicular tumors, a definite diagnosis can only be established following surgery. We report a case of testicular infarction which presented as a malignancy even in the frozen biopsy.
Anemia, Sickle Cell ; Biopsy ; Diagnosis ; Infarction* ; Magnetic Resonance Imaging ; Polycythemia ; Testicular Neoplasms* ; Testis ; Vasculitis, Leukocytoclastic, Cutaneous

Migration of an intrauterine contraceptive device (IUD) into the urinary bladder is very rare. We experienced a case of a foreign-body migrating into the bladder of a 35-year-old women who has been suffering from frequency and dysuria for the recent 5 months. The IUD had originally been inserted 10 years ago. Removal of the IUD had been performed for achieving pregnancy, but the IUD was not detected at the correct site 7 years ago. One year later, the patient had given birth without complication. It is thought that it took less than 6 years for the IUD to invade the bladder wall.
Adult ; Dysuria ; Female ; Foreign-Body Migration ; Humans ; Intrauterine Devices* ; Parturition ; Pregnancy ; Urinary Bladder*

Involvement of the liver is very common in military tuberculosis, but despite this fact, jaundice and hepatocellular dysfunction very rarely occur in this disease. Here, we report the case of a 59-year-old male patient who presented with acute hepatitis. After being admitted for fever and right upper quadrant pain for a 3-day period, military tuberculosis was diagnosed and treated with antituberculosis medication. Despite treatment, which was based on laboratory results and radiologic findings suggestive of acute hepatitis, fever persisted, jaundice developed, and hepatic enzyme levels increased. Percutaneous liver biopsy was performed to assist in the differential diagnosis of acute hepatitis and findings from the biopsy specimen revealed typical hepatic tuberculosis. Antituberculosis treatment was initiated, and the fever gradually subsided and hepatic enzyme levels decreased.
Biopsy ; Diagnosis, Differential ; Fever ; Hepatitis ; Humans ; Jaundice ; Liver ; Male ; Middle Aged ; Military Personnel ; Tuberculosis ; Tuberculosis, Hepatic

PURPOSE: Tenofovir disoproxil fumarate (TDF) is commonly prescribed as a fixed-dose, co-formulated antiretroviral drug for HIV-1 infection. The major concern of long-term TDF use is renal dysfunction. However, little is known about the long-term patterns of changes in renal function in HIV-infected Koreans receiving TDF. MATERIALS AND METHODS: We prospectively followed 50 HIV-infected Koreans, performing laboratory tests every 3 months during the first year and every 6 months for the next 2 years. Urine N-acetyl-β-D-glucosaminidase (NAG) and plasma cystatin-C were measured using samples collected in the first year. Data on renal function were retrospectively collected on HIV-infected patients receiving first-line TDF (n=40) and in antiretroviral therapy (ART)-naïve patients (n=24) for 3 years. Renal function was evaluated as estimated glomerular filtration rate (eGFR) from serum creatinine [Modification of Diet in Renal Disease (MDRD)] and cystatin-C. RESULTS: The eGFR (cystatin-C) showed significant changes from 0 to 48 wks (p=0.002), with the lowest levels at 24 wks (84.3±18.8 mL/min vs. 90.3±22.5 mL/min, p=0.021 by post hoc test). Urine NAG levels did not differ at 0, 12, 24, and 48 wks, although eGFR (MDRD) significantly decreased from 0 (98.7±18.9 mL/min/1.73 m²) to 144 wks (89.0±14.7 mL/min/1.73 m²) (p=0.010). The first-line TDF group had significantly lower eGFR (MDRD) than the ART-naïve group at 144 wks (89.7 mL/min/1.73 m² vs. 98.4 mL/min/1.73 m², p=0.036). Thirteen (26%) participants experienced a decrease in renal impairment of 10 mL/min/1.73 m² in eGFR (MDRD) at 144 wks. CONCLUSION: These data suggest that clinically meaningful renal injury can develop in HIV-infected Koreans receiving long-term TDF.
Creatinine ; Diet ; Follow-Up Studies* ; Glomerular Filtration Rate ; HIV ; HIV-1 ; Humans ; Plasma ; Prospective Studies ; Retrospective Studies ; Tenofovir*

PURPOSE: HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. This study aimed to evaluate the risk factors of carotid plaque, and clinical factors associated with carotid atherosclerosis measured by carotid intima-medial thickness (cIMT) in HIV patients. MATERIALS AND METHODS: Clinical and cardiometabolic factors as well as cIMT were prospectively measured in 145 HIV-infected participants who had received combined antiretroviral therapy for > or =6 months. The mean value of the bilateral average cIMT level was used as Mean-IMT in the analysis, and the greatest value among the measured cIMT levels was used as Max-IMT. RESULTS: Among 145 patients, 34 (23.4%) had carotid plaque. Multivariate logistic regression analysis revealed three independent risk factors of carotid plaque: old age [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.09-34.88; p=0.040], hypertension (OR 12.62, 95% CI 1.72-92.49; p=0.013) and higher low-density lipoprotein cholesterol (LDL-C) (OR 1.08, 95% CI 1.01-1.16; p=0.039). Levels of estimated glomerular filtration rate were inversely associated with Mean-IMT (r=-0.379, p<0.001) and Max-IMT (r=-0.389, p<0.001). Stepwise multivariate regression analyses revealed that age, total cholesterol and fasting glucose were positively correlated with cIMT, independent of other risk factors. CONCLUSION: The presence of hypertension, old age and a higher level of LDL-C were independent risk factors of carotid plaque among HIV-infected subjects.
Adult ; Age Factors ; Blood Glucose/analysis ; Carotid Artery Diseases/*etiology/*ultrasonography ; Carotid Intima-Media Thickness ; Cholesterol, LDL/blood ; Female ; Glomerular Filtration Rate ; HIV Infections/*complications/drug therapy/physiopathology ; Humans ; Hypertension/complications/physiopathology ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Prospective Studies ; Risk Factors

Vancomycin is the primary antibiotic administered for treatment of methicillin-resistant S. aureus (MRSA) infection; however, treatment failure of vancomycin is currently not uncommon in patients with in vitro vancomycin susceptibile S. aureus (MIC < or = 2 microg/mL) infection. In this report, we describe a case of septic arthritis caused by persistent MRSA bacteremia and treated successfully with linezolid after failure of initial vancomycin therapy.
Acetamides ; Arthritis, Infectious ; Bacteremia ; Humans ; Linezolid ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxazolidinones ; Treatment Failure ; Vancomycin

An estrogen producing adrenocortical carcinoma is a rare, highly malignant tumor. Fewer than 100 cases of feminizing adrenocortical carcinomas in men have been reported. These tumors are usually large in size and show high levels of serum total estrogen and estradiol. Recently, two cases of estrogen producing adrenocortical carcinoma were experienced by our selves during in year. A unilateral adrenalectomy, with mass excision, was performed in both patients, with an ipsilateral nephrectomy performed in just one. Mitotane or cisplatin based adjuvant chemotherapy was also performed.
Adrenalectomy ; Adrenocortical Carcinoma* ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Estradiol ; Estrogens* ; Humans ; Male ; Mitotane ; Nephrectomy

Thyroid stimulating hormone (TSH)-secreting pituitary adenomas are rare tumors of the pituitary gland and represent 1~2% of all pituitary adenomas. A TSH-secreting pituitary adenoma shows as a normal or elevated thyrotropin level in a hyperthyroid patient. We present a 32-year-old woman who was diagnosed with a TSH-secreting pituitary microadenoma. She had a high free T4, with a normal TSH and alpha-subunit. Bilateral inferior petrosal sinus sampling (IPSS) was done to confirm the alpha-subunit secreting adenoma, and the concentration of the alpha-subunit was high on the tumor side. The pituitary microadenoma was removed, and her TSH and free T4 levels decreased to normal. IPSS may help give an accurate diagnosis in the patient with a normal alpha-subunit.
Adenoma ; Adult ; Female ; Humans ; Petrosal Sinus Sampling ; Pituitary Gland ; Pituitary Neoplasms ; Thyrotropin