PURPOSE: Since the first description of multiple primary malignant neoplasms(MPNs) by Billroth, numerous studies concerning MPNs have been reported. We analyzed variable characteristics of MPNs in urologic tumor patients and try to offer useful clinical informations. MATERIALS AND METHODS: From January 1994 to September 1998, we have treated 1,230 patients who had at least one primary urologic cancer; 459 transitional cell carcinomas, 366 renal cell carcinomas, 325 prostatic cancers, 128 others. Among those patients, 99 patients(8.0%) had genitourinary multiple primary neoplasms(GU-MPNs). We reviewed the medical and pathologic records of these 99 patients with GU-MPNs. RESULTS: The incidence of MPNs was especially high in patients with renal cell carcinoma and bladder cancer than any other GU tract cancers. Renal cell carcinoma plus gastrointestinal malignancy and urothelial cancer plus cervix cancer were common combinations of MPNs in this study. Incidences of counterpart cancers were similar to the ranks of relative frequency of cancers in Korea except genitourinary cancers that were more common than the relative frequency of their own. 55 cases were synchronous and mean diagnostic interval was one month and eleven days. 36 cases of 44 metachronous MPNs developed within 5 years after the diagnosis of the first tumor. In synchronous MPNs, 29 second tumors(52.7%) were diagnosed by staging workup or during operation of the first tumor and 34 second tumors(77.3%) of metachronous MPNs were diagnosed by their own symptoms. CONCLUSIONS: Due to the improvements in the techniques for diagnosis and treatment of cancer and the prolonged average life span, occurrence of MPNs is no longer rare. Therefore importance of early diagnosis of MPNs is increasing. We recommend to keep in mind the possibility of MPNs especially in RCC and bladder cancers. We think further study is needed to delimitate the risk factors of MPNs.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Early Diagnosis ; Humans ; Incidence ; Korea ; Neoplasms, Multiple Primary* ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder Neoplasms ; Urogenital Neoplasms ; Urologic Neoplasms ; Uterine Cervical Neoplasms

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and aggressive form of primary gastrointestinal T-cell lymphoma. Symptoms can vary but often include fever, abdominal pain, weight loss, diarrhea, obstruction, and perforation.Disease-specific symptoms rarely present before patients reach an advanced stage, which contributes to delayed diagnosis and poor survival outcomes. Approximately half of the patients with MEITL undergo emergency surgery for acute intestinal obstruction or perforation, leading to peritonitis, septic shock, and multiple organ failure. These factors contribute to treatment delays, which are associated with a worse prognosis, particularly in the case of chemotherapy. This paper reports two fatal cases of patients with MEITL who deteriorated rapidly after emergency surgery for intestinal perforation. Patient 1 complained of persistent diarrhea, but a delayed diagnosis led to bowel perforation, and the subsequent chemotherapy treatment was canceled. Patient 2 was diagnosed relatively early, but treatment was delayed due to intestinal perforation. Despite its rarity, MEITL should be considered through a “high index of suspicion” approach when a patient complains of unexplained abdominal pain and diarrhea. This is expected to improve early diagnosis and ultimately patient prognosis.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare and aggressive form of primary gastrointestinal T-cell lymphoma. Symptoms can vary but often include fever, abdominal pain, weight loss, diarrhea, obstruction, and perforation.Disease-specific symptoms rarely present before patients reach an advanced stage, which contributes to delayed diagnosis and poor survival outcomes. Approximately half of the patients with MEITL undergo emergency surgery for acute intestinal obstruction or perforation, leading to peritonitis, septic shock, and multiple organ failure. These factors contribute to treatment delays, which are associated with a worse prognosis, particularly in the case of chemotherapy. This paper reports two fatal cases of patients with MEITL who deteriorated rapidly after emergency surgery for intestinal perforation. Patient 1 complained of persistent diarrhea, but a delayed diagnosis led to bowel perforation, and the subsequent chemotherapy treatment was canceled. Patient 2 was diagnosed relatively early, but treatment was delayed due to intestinal perforation. Despite its rarity, MEITL should be considered through a “high index of suspicion” approach when a patient complains of unexplained abdominal pain and diarrhea. This is expected to improve early diagnosis and ultimately patient prognosis.

Congenital syphilis is a rare disease nowadays because of prenatal screening test and early treatment. In the absence of proper maternal therapy, infection can result in stillbirth, prematurity, or a wide spectrum of clinical manifestations involving multiple organ systems. We took care of a preterm infant with apnea, desquamation on the palms of hands and thrombocytopenia at birth, and the serologic tests revealed congenital syphilis. We present a fatal case of early congenital syphilis of preterm newborn delivered by an untreated mother, with a brief review of literature.
Apnea ; Hand ; Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Parturition ; Prenatal Care ; Prenatal Diagnosis ; Rare Diseases ; Serologic Tests ; Stillbirth ; Syphilis, Congenital ; Thrombocytopenia

Distraction osteogenesis with an Ilizarov external fixator is one of the most successful treatment options for large segmental bone defects after extensive debridement of chronic osteomyelitis in the tibial shaft. Its complications include skin irritation, pin tract infection, and non-union due to infection. There are few case reports on chronic osteomyelitis occurring in the distraction osteogenesis area. The authors experienced a chronic osteomyelitis in the distraction osteogenesis area of the tibial shaft and report this case with references.
Debridement ; External Fixators ; Osteogenesis, Distraction* ; Osteomyelitis* ; Skin

PURPOSE: The international index of erectile function(IIEF) is a multidimensional scale for assessment of erectile function and detecting treatment-related changes in patients with erectile dysfunction. It was developed by Dr. Rosen in 1997 and composed of 15-item questionnaire of five relevant domains of sexual function(that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction). The IIEF currently is available in more than 30 languages for use in multinational clinical trials, and demonstrates adequate sensitivity and specificity for detecting treatment-related changes in erectile function in patients with erectile dysfunction. For application of the IIEF to Korean, it is inevitable to demonstrate the reliability and validity of Korean version of IIEF, since the cultural background is one of the most important factors which often results in misinterpretation of the questionnaire. MATERIALS AND METHODS: From May 13th to July 20th 1998, a total of 39 patients aged over 30 who visited Andrology Clinic with the complaint of erectile dysfunction were enrolled for the patient group and 40 age-matched volunteers who visited the Department of Family Medicine without erectile dysfunction were enrolled for a control group. Self administered questionnaire survey was performed with linguistically valid Korean version of IIEF for all study subjects and was repeated with the inteval of 10-25 days(between the first and second survey). The results were analyzed statistically by PC-SAS version 6.12. RESULTS: Two separate aspects of scale reliability were evaluated, namely, internal consistency and test-retest repeatability. Internal consistency(Cronbach`s alpha) was computed separately for the five domains in patient and control group. Responses in overall satisfaction was highly consistent with alpha value of 0.96. A satisfactory degree of consistency also was observed for items in the other domains(alpha values greater than 0.70). Test-retest repeatability was assessed by computing correlations between the domain score and total scale scores at the first and the second survey. There was no significant difference in the domain scores and total scale scores between the first and the second survey; nevertheless, test-retest repeatability was relatively low for the orgasmic function(r=0.67) and intercourse satisfaction(r=0.70) domains. Relatively high correlations were observed for the other domains(r value of 0.73 to 0.85), as well as for the total scale scores(r=0.88)(p<0.01). To demonstrate validity, domain scores were compared with the monthly frequency of sexual intercourse(convergent validity) and with scales that measure occupational satisfaction(divergent validity). Siginificant positive correlations were observed between the monthly frequency of sexual intercourse and subscale scores for all five domains. In contrast, none of the correlations between domain scores and measure of occupational satisfaction reached statistical significance. Discriminant validity was assessed by comparing the responses for patients with erectile dysfunction with control group by repeated measures ANOVA. Highly significant differences were observed between the patients with erectile dysfunction and age-matched controls. CONCLUSIONS: Based on the results of this study, the Korean version of IIEF was verified in its reliability and validity. This can be used as a brief and reliable self-administered scale for assessing erectile function and for detecting treatment-related changes in patients with erectile dysfunction. Furthermore, this can be used as universal and objective scale in multinational clinical trial and research field.
Andrology ; Coitus ; Erectile Dysfunction ; Humans ; Male ; Orgasm ; Surveys and Questionnaires ; Reproducibility of Results ; Sensitivity and Specificity ; Volunteers ; Weights and Measures

PURPOSE: The bicoronal incision, traditional procedure to correct the frontal sinus fracture, could remain a long scar, alopecia etc. Hence, the authors introduce the procedure to fix the outer table fracture of the frontal sinus through the upper eyelid incision as a concealed scar. MATERIAL & METHODS: From November, 2007 to December, 2010, five patients who suffered from outer table fracture of frontal sinus fracture underwent operation to correct the depressed contour of forehead. Instead of the reduction of depressed outer wall, autogenous bone was grafted trough the upper eyelid incision. The result of operation was evaluated with VAS score system(score arrange 0 to 5). VAS score was taken from patients as well as 4 plastic surgeons. RESULTS: Both patients and surgeons were satisfied about result of operation. The overall average score from plastic surgeon was 4.2. Especially to the scar of upper eyelid incision, the score was 4.7. Average score from the patients was 4.1. And there were no other complications as follow-up periods. CONCLUSION: This technique could be one of good options to correct the depression after the outer table fracture of the frontal sinus. And this technique has some benefits to overcome the disadvantage of previous introduced methods.
Alopecia ; Bone Transplantation ; Cicatrix ; Depression ; Eyelids ; Follow-Up Studies ; Forehead ; Fractures, Closed ; Frontal Sinus ; Humans ; Transplants

Objective: The endothelial inflammatory response plays an important role in atherogenesis by inducing nuclear factor (NF)κB-dependent cell adhesion molecule expression and monocyte recruitment. Here, we screened for natural ligands and investigated the ability of shinjulactone A to inhibit interleukin-1β (IL-1β)-induced endothelial inflammatory signaling. Methods: The natural compound library included 880 single compounds isolated from medicinal plants by the Korean Medicinal Material Bank. Primary endothelial cells were pretreated with single compounds before stimulation with IL-1β to induce endothelial inflammation. Endothelial inflammation was measured by assaying NFκB activation and monocyte adhesion. The endothelial-mesenchymal transition (EndMT) was evaluated using cell type-specific marker protein expression and morphology. Results: Shinjulactone A was identified as an efficient blocker of IL-1β -induced NFκB activation, with a half-maximal inhibitory concentration of approximately 1 µM, and monocyte recruitment in endothelial cells. However, it did not affect lipopolysaccharideinduced NFκB activation in macrophages. Compared to Bay 11-782, a well-known NFκB inhibitor that shows considerable cytotoxicity during long-term treatment, shinjulactone A did not affect endothelial cell viability. Furthermore, it also significantly inhibited the EndMT, which is known to promote atherosclerosis and plaque instability. Conclusion We suggest that shinjulactone A may be an effective and safe drug candidate for atherosclerosis because it targets and inhibits both endothelial inflammation and the EndMT, without impairing NFκB-dependent innate immunity in macrophages.

Background: Allografts are preferred in certain cases of revision anterior cruciate ligament reconstructions to avoid additional graft harvesting and to fill in enlarged tunnels. The clinical outcomes of quadriceps tendon-patellar bone allograft in revision anterior cruciate ligament reconstruction are not well-known. This study was performed to evaluate the clinical outcomes of revision anterior cruciate ligament reconstructions using quadriceps tendon-patellar bone allografts. Methods: Patients who underwent revision anterior cruciate ligament reconstructions with quadriceps tendon-patellar bone allografts with a minimum follow-up of 2 years were retrospectively reviewed. Their mean follow-up length was 33.5 ± 19.5 months.Outcomes including clinical scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner scale, and Knee injury and Osteoarthritis Outcome Score [KOOS]), knee stability (physical examinations and knee arthrometer), return to sports, and any associated complications were assessed. Degrees of graft synovialization were also evaluated using arthroscopy. Results: A total of 38 patients were reviewed and their age at the time of surgery and follow-up length were 37.2 ± 12.5 years (range, 17–66 years) and 2.8 ± 1.6 years, respectively. All clinical scores including KOOS, IKDC, Lysholm, and Tegner scale significantly improved at 2 years after surgery and 92.1% of the patients returned to sports. The mean preoperative side-to-side difference in knee arthrometer decreased from 4.5 ± 2.3 mm before surgery to 2.6 ± 1.5 mm after surgery (p < 0.001). Graft synovialization was observed in 13 of 16 patients (81.3%) who underwent second-look arthroscopy. Complication rate was 10.5% (n = 4). All complications were graft re-rupture and occurred at an average of 18 months after revision surgery. Conclusions Quadriceps tendon-patellar bone allograft showed satisfactory clinical outcomes in revision anterior cruciate ligament reconstruction and thus could be a good alternative when autograft harvesting is not optimal.

Background: Allografts are preferred in certain cases of revision anterior cruciate ligament reconstructions to avoid additional graft harvesting and to fill in enlarged tunnels. The clinical outcomes of quadriceps tendon-patellar bone allograft in revision anterior cruciate ligament reconstruction are not well-known. This study was performed to evaluate the clinical outcomes of revision anterior cruciate ligament reconstructions using quadriceps tendon-patellar bone allografts. Methods: Patients who underwent revision anterior cruciate ligament reconstructions with quadriceps tendon-patellar bone allografts with a minimum follow-up of 2 years were retrospectively reviewed. Their mean follow-up length was 33.5 ± 19.5 months.Outcomes including clinical scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner scale, and Knee injury and Osteoarthritis Outcome Score [KOOS]), knee stability (physical examinations and knee arthrometer), return to sports, and any associated complications were assessed. Degrees of graft synovialization were also evaluated using arthroscopy. Results: A total of 38 patients were reviewed and their age at the time of surgery and follow-up length were 37.2 ± 12.5 years (range, 17–66 years) and 2.8 ± 1.6 years, respectively. All clinical scores including KOOS, IKDC, Lysholm, and Tegner scale significantly improved at 2 years after surgery and 92.1% of the patients returned to sports. The mean preoperative side-to-side difference in knee arthrometer decreased from 4.5 ± 2.3 mm before surgery to 2.6 ± 1.5 mm after surgery (p < 0.001). Graft synovialization was observed in 13 of 16 patients (81.3%) who underwent second-look arthroscopy. Complication rate was 10.5% (n = 4). All complications were graft re-rupture and occurred at an average of 18 months after revision surgery. Conclusions Quadriceps tendon-patellar bone allograft showed satisfactory clinical outcomes in revision anterior cruciate ligament reconstruction and thus could be a good alternative when autograft harvesting is not optimal.