No abstract available.

About 80% of Bladder cancer is non muscle invasive bladder cancer (NMIBC). Despite of appropriate therapy, a lot of NMIBC recur as a superficial tumor or progress to muscle invasive disease. Several studies about prognostic factors of recurrence and progression have reported a single risk factor variously according to each study. These efforts were developed to predict the risk by scoring system and large-scale studies had been conducted. These studies had limitations that their patients did not receive BCG (bacillus Calmette-Guerin) immunotherapy, immediate intravesical chemotherapy, second-look TUR (transurethral resection) in high-risk group. Through studies to date, patients with NMIBC have showed heterogenous prognosis and a more sophisticated scoring system can give personalized treatment and exact prediction.
Drug Therapy ; Humans ; Immunotherapy ; Mycobacterium bovis ; Prognosis ; Recurrence* ; Research Design ; Risk Factors ; Urinary Bladder Neoplasms ; Urinary Bladder*

In a conservative treatment of lumbar disc herniation, authors customarily had included the flexion exercise untill 1991. Thereafter, the extension exercise started to be included for the selected patients and this study was designed to assess the clinical outcome of the extension exercise compared to the flexion exercise in the conservative treatments of lumbar disc herniations. 55 consecutive patients (31 males and 24 females having ages ranging from 19-68 years with a mean of 37.2) were included in this prospective study. Criteria for inclusion in this group were: 1. Contained herniations of a single lumbar disc, documented by CT or MRI; 2. no other concurrent spine pathology; 3. conservative treatments with an uniform program including the extension exercise; 4. follow-up for a minimum of one year. For comparison with this prospective group, another 62 consecutive patients (36 males and 26 females having ages ranging from 17-63 years with a mean of 35.7) were selected who were treated during 1991 with flexion exercise before this study was designed and who were matched with the designed criteria except for the direction of exercise. Apart from the therapeutic exercise, the conservative treatments also included medication, physiotheraphy, epidural injection, and back school in the both groups uniformly. The clinical outcome of the extension exercise group indicated that 28 (50.9%) patients excellent, 23 (41.8%) patients good, three (5.5%) patients fair, and one (1.8%) patient failed outcomes. In the flexion exercise group, there were 23 (37.1%) excellent, 27 (43.5%) good, seven (11.3%) fair, and five (8.1%) failed outcomes. From these results, it would seem to follow that the extension exercise group had superior clinical outcome compared to the flexion exercise, i.e. higher excellent and good outcomes (92.7% vs. 80.6%) and lower poor and failed outcomes (7.3% vs. 19.4%), respectively, Moreover, the excellent outcome in terms of full recovery without any pain and disability was more common in the extension exercise group (50.9% vs. 37.1%). A better clinical outcome was obtained in the extension exercise group of patients who were younger than 40 years and who had a history of three months or less compared with those who were older and had longer history of disease. The sizes of disc protrusion did not affect the clinical outcome. In conclusion, we would recommend that the extension exercise, instead of the flexion exercise, should be included in the conservative treatment of a contained herniation of lumbar disc for a better clinical outcome.
Female ; Follow-Up Studies ; Humans ; Injections, Epidural ; Magnetic Resonance Imaging ; Male ; Pathology ; Prospective Studies ; Spine

STUDY DESIGN: Case report. OBJECTIVES: To report the effectiveness of open reduction and internal (screw) fixation treatment performed to treat dislocation of the first coccygeal vertebra. SUMMARY OF LITERATURE REVIEW: Most treatment methods for coccygeal dislocation were conservative treatment for acute coccygodynia and coccygectomy for chronic coccygodynia. MATERIALS AND METHODS: A 18-year-old female presented with severe coccygodynia due to a fall down the stairs. Computed tomography showed dislocation of the first coccygeal vertebra. We performed open reduction and internal fixation with a 4.0-mm shortthread cancellous screw with a washer, with no additional procedure for bone union. RESULTS: Union was achieved 10 weeks postoperatively. CONCLUSIONS: Open reduction and internal (screw) fixation can be a useful method for coccygeal vertebra dislocation.
Adolescent ; Dislocations* ; Female ; Humans ; Methods ; Spine*

Medial medullary syndrome is a clinical disorder charactenzed by ipsilateral paralysis of tongue and contralateral hemiparalysis and contralateral hemisensory disturbance of vibration or position but face sparing. The syndrome is ususlly due to lesion of medial medulla oblongata. Involved structures are pyramid, hypoglossal nucleus, medial lemniscus and/or medial longitudinal fasciculus. We present 1 case of medial medullary syndrome with MRI finding, which showed infarction of left medial medulla oblongata.
Infarction ; Magnetic Resonance Imaging ; Medulla Oblongata ; Paralysis ; Tongue ; Vibration

PURPOSE: Numerous trials have been conducted to develop new treatment regimens for superficial and invasive bladder cancer, because there is an urgent need to identify novel agents to prevent the recurrence and progression of these cancers. We evaluated the prognostic and biological significance of mTOR pathway-related markers in patients with bladder cancer who had undergone transurethral resection of their bladder tumors and radical cystectomy. MATERIALS AND METHODS: We retrieved 208 bladder cancer specimens collected from patients between 1989 and 2007 and constructed a tissue microarray comprising 208 tumor samples and 25 benign urothelium samples. Immunohistochemical staining was performed for mTOR, phosphorylated (phos) S6, and phos4E-BP1. The pattern, percentage, and intensity of staining for all three markers were evaluated. RESULTS: The median age at diagnosis of the patient cohort was 67 years (range: 29-87 years), and the median follow-up was 72 months (range: 1-257 months). The expression of phos4E-BP1 was higher in the bladder cancer cohort than in the benign cohort, whereas phosS6 expression was lower in the bladder cancer cohort than in the benign cohort. The expression of phosS6 was significantly higher in high-grade bladder cancer (p<0.01). There was a significant positive correlation between the H-scores of mTOR and phos4E-BP1 (coefficient of correlation, r=0.37, p<0.01) as well as between the H-scores of mTOR and phosS6 (r=0.17, p<0.05). In the multivariate analysis, strong phosS6 expression predicted shorter progression (p<0.01; hazard ratio [HR], 2.516) and disease-specific survival (p<0.01; HR, 2.396) but not overall survival (p=0.112), whereas strong phos4E-BP1 expression was a predictor of disease-specific survival (p<0.05; HR, 2.105). Moreover, strong phosS6 expression predicted shorter recurrence-free (p<0.05) and progression-free (p<0.05) survival in the superficial bladder cancer cohort. CONCLUSIONS: Our results demonstrate that mTOR pathway activation, as assessed by phos4E-BP1 phosphorylation, is related to bladder cancer tumorigenesis and that S6 protein phosphorylation is associated with a high level of disease recurrence and progression and poor cancer-specific survival.
Cell Transformation, Neoplastic ; Cohort Studies ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Phosphorylation ; Recurrence ; TOR Serine-Threonine Kinases ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urothelium

To systematically review relevant literature on efficacy and safety of immune checkpoint inhibitors (ICIs) in patients with advanced and metastatic urothelial cell cancer (UCC), renal cell cancer (RCC), and prostate cancer. In platinum pretreated UCC, efficacy of pembrolizumab was superior to chemotherapy, with longer median overall survival (OS; 10.3 months vs. 7.4 months), a higher objective response rate (ORR; 21.1% vs. 11.4%, p=0.001), and a lower adverse event rate (60.9% vs. 90.2%). Three randomized controlled trials (RCTs) assessed the safety and efficacy of nivolumab in advanced RCC. The median OS (25.0 months vs. 19.6 months) and the ORR (25% vs. 5%) were higher in patients treated with nivolumab compared with second-line everolimus. In patients with metastatic castration-resistant prostate cancer, 2 RCTs were identified, which did not show significant benefits for ipilimumab over placebo. In UCC and RCC, there was no conclusive association between programmed cell death receptor ligand 1 (PD-L1) expression in tumor tissue and clinical outcome during pembrolizumab and nivolumab treatment, respectively. Therefore, in metastatic UCC and RCC, pembrolizumab and nivolumab have superior efficacy and safety to second-line chemotherapy and everolimus, respectively. No beneficial effect of ipilimumab was observed in prostate cancer patients. PD-L1 expression status is currently not suitable as a predictive marker for treatment outcome.
Carcinoma, Renal Cell ; Cell Death ; Drug Therapy ; Everolimus ; Humans ; Immunotherapy ; Platinum ; Prostatic Neoplasms ; Treatment Outcome ; Urologic Neoplasms

Unstable fractures of the proximal humerus should be treated with precise reduction and stable fixation, and early joint motion should be permitted. But stable fixation of the proximal humerus is frequently difficult to obtain in older patients due to osteoporosis and fracture comminution. We treated one case of a segmental comminuted fracture of the proximal humerus with severe osteoporosis with a method of inlay fibular autograft and fixation with a helical locking compression plate (LCP). Stable fixation was obtained, so early motion of the shoulder joint was permitted. The fracture was healed in 12 weeks after the operation without loss of fixation and there were no problems at the donor site of the fibula. Functional recovery of the shoulder was satisfactory. The result of Neer's functional score was 87 points (satisfactory) and Constant score was 83 points.
Autografts* ; Fibula ; Fractures, Comminuted* ; Humans ; Humerus* ; Inlays* ; Joints ; Osteoporosis ; Shoulder ; Shoulder Joint ; Tissue Donors

Lateral ankle sprains are one of the most common injuries to the lower extremity. Most of them well respond to conservative treatments. However, simultaneous peroneal nerve injuries may occur rarely following lateral ankle ligamentous injuries. We report a case presents superficial peroneal nerve injury with dorsal foot pain lasting for more than 2 months after lateral ankle sprain and review the literature.
Animals ; Ankle ; Foot ; Ligaments ; Lower Extremity ; Peroneal Nerve ; Sprains and Strains

PURPOSE: The purpose of this study was to evaluate the surgical outcomes of isolated greater tuberosity fractures of the proximal humerus fixed with the spring plates. MATERIALS AND METHODS: Fourteen patients who could be followed up at least 1 year after the surgical treatment of isolated greater tuberosity fracture were evaluated. Their mean age was 51 years (range, 25~73 years). The deltopectoral approach and fixation with the spring plate were performed in all cases. The spring plate was used in all cases. In some circumstances, sutures incorporating the rotator cuff, interfragmentary screw or tension band wire were added. We evaluated the clinical outcomes using UCLA scoring system and KSS (Korean Shoulder Score). RESULTS: The mean UCLA score was 29.8 and the mean KSS was 89.4. The average time of bony union was 10.2 weeks (range, 7~14 weeks) after the surgery, including 1 case that was performed the secondary operation due to metal failure. The shoulder stiffness were observed in 4 cases and one case of infection was treated well without operation. CONCLUSION: In the treatment of isolated greater tuberosity fractures of the proximal humerus, the spring plates fixation can be a good surgical option providing reliable functional results.
Humans ; Humerus ; Rotator Cuff ; Shoulder ; Sutures