Intracavernous self-injection of vasoactive agents for erectile dysfunction has been widely used in recent years due to its effectiveness and low rate of complications. Intracorporeal needle breakage during intracavernous self-injection represents an unusual complication. We report a case of intracorporeal needle breakage during self-injection of prostaglandin E1 in a 61-year-old man.
Alprostadil ; Erectile Dysfunction ; Humans ; Male ; Middle Aged ; Needles*

Penile strangulation developed by wearing metallic or non-metallic objects is unusual but potentially serious. We report a case of 33-year-old man who presented with penile strangulation after applying the device for self-circumcision. The device was removed and after debridement of the infected necrotic tissues and antibiotic therapy, conventional circumcision was performed. It is stressed that circumcision should be performed by urologists.
Adult ; Circumcision, Male ; Debridement ; Female ; Humans ; Male ; Penis*

PURPOSE: This study was performed to evaluate the impact of microvessel density (MVD), a reflection of tumor angiogenesis, and microvascular invasion (MVI) on the prognosis of patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue sections of RCC from 81 patients who had undergone radical nephrectomy were stained immunohistochemically for CD34, which decorate endothelial cells, in order to assess MVD and MVI. The immunostaining results of MVD and MVI were compared with the clinicopathological variables. RESULTS: Twenty-two patients had either synchronous or metachronous metastases and fourteen patients died during the follow-up. MVD was significantly correlated with only metastasis (synchronous or metachronous; p=0.020). MVI was significantly correlated with tumor size (p=0.005), TNM stage (p<0.001), T stage (p<0.001), M stage (p=0.001), and metastasis (synchronous or metachronous; p=0.007). MVD was not significantly associated with MVI (p=0.232). The survival rate of patients with higher MVD or MVI-positive tumors was significantly lower than that of patients with lower MVD or MVI-negative tumors, respectively (p<0.0001, p=0.0002). Multivariate analyses indicated that tumor size, M stage and MVI were independent prognostic factors for cancer-specific survival. MVD was not an independent factor. CONCLUSIONS: MVD and MVI were associated with metastasis and a worse prognosis in RCC, which suggests that tumor angiogenesis and MVI may play an important role in the progression of RCC. MVI was an independent prognostic factor for cancer-specific survival.
Carcinoma, Renal Cell* ; Endothelial Cells ; Follow-Up Studies ; Humans ; Microvessels ; Multivariate Analysis ; Neoplasm Metastasis ; Nephrectomy ; Prognosis ; Survival Rate ; Veins

BACKGROUND/AIMS: Ambulatory blood pressure (BP) monitoring has been widely recommended for evaluating the status of BP, but is lacking in practicality. Determination of the specific time points for BP measurement that are representative of 24-hour mean BP could be useful and convenient in hypertensive patients with chronic kidney disease (CKD). METHODS: A total of 1,317 patients for whom 24-hour ambulatory BP monitoring was performed were enrolled in a multicenter study on hypertensive CKD. We analyzed the time points at which systolic blood pressure (SBP) values exhibited the smallest differences from 24-hour mean SBP (mSBP). We included office mSBP and analyzed the relationships between SBPs at the office and the time points with the smallest differences from 24-hour mSBP using several methods. RESULTS: The time points with the smallest differences from 24-hour mSBP were 7:00 AM, 2:00 PM, and 9:30 PM. In regression analysis, SBPs at 7:00 AM and 9:30 PM were better correlated with 24-hour mSBP than SBPs at 2:00 PM and the office. The proportions of patients with SBPs within 30% of 24-hour mSBP were higher at 7:00 AM and 9:30 PM. The best consistency between the uncontrolled hypertensive groups, defined as > or = 135 mmHg of 24-hour mSBP and higher values of SBPs corresponding to 135 mmHg of 24-hour mSBP, were observed at the 7:00 AM and 9:30 PM time points. CONCLUSIONS: The specific time points for SBPs that correlated well with 24-hour mSBP in hypertensive CKD patients were 7:00 AM and 9:30 PM.
Adult ; Aged ; *Blood Pressure ; Blood Pressure Monitoring, Ambulatory/*methods ; Circadian Rhythm ; Cross-Sectional Studies ; Female ; Humans ; Hypertension/*diagnosis/physiopathology ; Male ; Middle Aged ; Office Visits ; Predictive Value of Tests ; Prospective Studies ; Renal Insufficiency, Chronic/*diagnosis/physiopathology ; Republic of Korea ; Time Factors ; Young Adult

PURPOSE:We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990. METHODS:We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate. RESULTS:The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p= 0.016; age> or =60: HR 7.397, p<0.001), diabetes (HR 1.973, p=0.001), and cardiovascular disease (HR 2.040, p<0.001) were the independent risk factors of mortality, while older age (age> or =60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure. CONCLUSION:The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.
Cardiovascular Diseases ; Cause of Death ; Comorbidity ; Follow-Up Studies ; Humans ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis ; Peritonitis ; Risk Factors ; Survival Rate

PURPOSE:We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990. METHODS:We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate. RESULTS:The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p= 0.016; age> or =60: HR 7.397, p<0.001), diabetes (HR 1.973, p=0.001), and cardiovascular disease (HR 2.040, p<0.001) were the independent risk factors of mortality, while older age (age> or =60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure. CONCLUSION:The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.
Cardiovascular Diseases ; Cause of Death ; Comorbidity ; Follow-Up Studies ; Humans ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis ; Peritonitis ; Risk Factors ; Survival Rate

The aim of this study was to investigate the relationship of cyclooxygenase (COX) -2 and p53 expression with prognosis in patients with conventional renal cell carcinoma (RCC). Formalin-fixed, paraffin-embedded tissue sections of conventional RCC from 92 patients, who had undergone radical nephrectomy, were examined for COX-2 and p53 expression by immunohistochemistry and compared with clinicopathological variables. The COX-2 expression significantly correlated only with tumor size (p=0.049), whereas the p53 expression profoundly correlated with the TNM stage (p=0.024), M stage (p=0.001), and metastasis (synchronous or metachronous; p= 0.004). The COX-2 overexpression did not significantly associate with p53 positivity (p=0.821). The survival rate of patients correlated with the p53 expression (p < 0.0001) but not with the COX-2 expression (p=0.7506). Multivariate analyses indicated that tumor size, M stage, and p53 expression were independent prognostic factors for cancer-specific survival. The COX-2 expression was not an independent factor. These results show that the increased expression of p53 was associated with metastasis and a worse prognosis in conventional RCC, which suggests that p53 might have played an important role in the progression of conventional RCC. The increased expression of COX-2 was associated only with tumor size, but may not be an important prognostic factor in conventional RCC. No association was observed between COX-2 overexpression and p53 positivity in conventional RCC.
Carcinoma, Renal Cell/*metabolism/mortality/pathology ; Humans ; Kidney Neoplasms/*metabolism/mortality/pathology ; Prognosis ; Prostaglandin-Endoperoxide Synthase/*metabolism ; Protein p53/*metabolism ; Tumor Markers, Biological/*metabolism

We evaluated the effect of cobalt chloride (CoCl2) on TNF-alpha and IFN-gamma-induced-inflammation and reactive oxygen species (ROS) in renal tubular epithelial cells (HK-2 cells). We treated HK-2 cells with CoCl2 before the administration of TNF-alpha/IFN-gamma. To regulate hemeoxygenase-1 (HO-1) expression, the cells were treated CoCl2 or HO-1 siRNA. CoCl2 reduced the generation of ROS induced by TNF-alpha/IFN-gamma. TNF-alpha/IFN-gamma-treated-cells showed an increase in the nuclear translocation of phosphorylated NF-kappaBp65 protein, the DNA-binding activity of NF-kappaBp50 and NF-kappaB transcriptional activity and a decrease in IkappaBalpha protein expression. These changes were restored by CoCl2. We noted an intense increase in monocyte chemoattractant protein-1 (MCP-1) and regulated on activation normal T cell expressed and secreted (RANTES) production in TNF-alpha/IFN-gamma-treated cells. We demonstrated that this effect was mediated through NF-kappaB signaling because an NF-kappaB inhibitor significantly reduced MCP-1 and RANTES production. CoCl2 effectively reduced MCP-1 and RANTES production. The expression of HO-1 was increased by CoCl2 and decreased by HO-1 siRNA. However, knockdown of HO-1 by RNA interference did not affect MCP-1 or RANTES production. We suggest that CoCl2 has a protective effect on TNF-alpha/IFN-gamma-induced inflammation through the inhibition of NF-kappaB and ROS in HK-2 cells. However, CoCl2 appears to act in an HO-1-independent manner.
Cell Line ; Chemokine CCL2/metabolism ; Chemokine CCL5/metabolism ; Cobalt/*pharmacology ; Epithelial Cells/cytology/metabolism ; Heme Oxygenase-1/antagonists & inhibitors/genetics/metabolism ; Humans ; *Inflammation ; Interferon-gamma/pharmacology ; Kidney Tubules, Proximal/cytology ; NF-kappa B/antagonists & inhibitors/genetics/*metabolism ; NF-kappa B p50 Subunit/genetics/metabolism ; Oxidative Stress/*drug effects ; Phosphorylation ; Protein Binding ; RNA Interference ; RNA, Small Interfering/metabolism ; Transcription Factor RelA/metabolism ; Tumor Necrosis Factor-alpha/pharmacology

PURPOSE: It has generally been accepted that the most common primary testicular tumor in the pediatric population is yolk sac tumor. Recently, there have been some reports that teratoma is the most common tumor in this age group. The histopathological distribution and clinical behavior of primary pediatric testicular tumors from three hospitals were retrospectively reviewed. MATERIALS AND METHODS: A retrospective review was performed on 30 pediatric patients, who had been treated for primary testicular tumors, at three hospitals. The records of the patients were reviewed with respect to age at diagnosis, affected sites, presentation, operation, pathology and prognosis. The mean age of the patients was 68.3 months (1-234). RESULTS: The most common presentation was a painless scrotal mass (86.7%). In patients younger than 15 years, the most common testicular tumor was teratoma at one hospital and yolk sac tumor at the other two hospitals. Totally, the most common testicular tumor was teratoma (52%), followed by yolk sac tumor (40%). In 5 patients, aged 15-20 years, the pathological distribution of the testicular tumor was the same as that observed in adults. No patients had had a recurrence after a mean follow- up of 30.6 months (3-109). CONCLUSIONS: Our results suggest that the prognosis for children with testicular tumors is favorable. The most common primary prepubertal testis tumor is teratoma, followed by yolk sac tumor, although yolk sac tumor was the most common tumor at two of the hospitals in this study. A large prospective multi-center study will be required to determine the pathological distribution of pediatric testicular tumors.
Adult ; Child* ; Diagnosis ; Endodermal Sinus Tumor ; Humans ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Teratoma ; Testicular Neoplasms* ; Testis

Hypersensitivity myocarditis may result from an allergic reaction to a variety of agents such as antibiotics, anticonvulsants and diuretics. A diagnosis of hypersensitivity myocarditis should be considered in any patient with an ongoing allergic reaction to a drug, evidence of peripheral eosinophilia, an appearance of new electrocardiographic changes, mildly elevated cardiac enzyme, mild cardiomegaly on chest X-ray or unexplained tachycardia. This condition is rarely recognized clinically although it is occasionally diagnosed on endomyocardial biopsy. We report a 25 year-old woman with hypersensitivity myocarditis, which was diagnosed by endomyo-cardial biopsy and successfully treated by immunosuppression therapy with corticosteroids.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Anticonvulsants ; Biopsy ; Cardiomegaly ; Diagnosis ; Diuretics ; Electrocardiography ; Eosinophilia ; Female ; Glucocorticoids ; Humans ; Hypersensitivity* ; Immunosuppression ; Myocarditis* ; Tachycardia ; Thorax