PURPOSE: Recent studies have shown the benefits of the use of methotrexate, vinblastine, doxorubicin and cisplatin(M-VAC) in the treatment of advanced transitional cell carcinoma of the bladder. Although the overall and complete response rates and survival is improved from the use of M-VAC, more than 90% of the patients with metastatic disease still die of the disease, with a median survival of approximately 1 year. MATERIALS AND METHODS: To evaulate the long-term results of M-VAC chemotherapy, we reviewed 51 patients with advanced transitional cell carcinoma of the bladder who were treated with standard dose M-VAC(30mg/m2 methotrexate on day 1, 15, and 22, 3mg/m2 vinblastine on day 3, 15, and 22, 30mg/m2 doxorubicin on day 3 and 70mg/m2 cisplatin on day 2). There were 43 men and 8 women. The age of the patients ranged from 31 to 74 years(mean 60.8) and the duration of follow up ranged from 2.4 to 79.5 months(mean 23.8). RESULTS: Of the 51 patients, 10(19.6%) had a complete and 15(29.4%) had a partial response, giving an overall response rate of 49%. The median duration of response was 11.2 months for the 10 patients with a complete response and of these, eight relapsed at a median of 10.4 months after complete response. Survival of patients with a complete response differed significantly from those with no response at 1 year after the start of treatment, but not subsequently. Toxicity included moderated to severe myelosuppression that resulted in sepsis in 2 patients and mild to moderate anorexia, vomiting, alopecia and renal dysfunction. CONCLUSIONS: Long-term follow up revealed a high relapse rate and poor prognosis in patients with a complete response who received the M-VAC as induction therapy. Therefore, more effective new adjunctive regimens are needed for patients with locally unresectable or metastatic transitional cell carcinoma.
Alopecia ; Anorexia ; Carcinoma, Transitional Cell* ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Male ; Methotrexate ; Prognosis ; Recurrence ; Sepsis ; Urinary Bladder* ; Vinblastine ; Vomiting

Hemangiomas of the genitalia are extremely rare. A hemangioma is self-limited and usually resolves spontaneously, therefore conservative treatment is generally recommended. However, genital hemangiomas may require surgical treatment for either functional or cosmetic problems. Herein we report a case of cavernous hemangioma of the dorsum of the penis In 36 year old man which was treated with surgical excision.
Adult ; Genitalia ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Male ; Penis*

OBJECTIVE: The aim of this study is to investigate the effects of Behcet's disease (BD) on pregnancy outcome. METHODS: We evaluated pregnancies in women who had been diagnosed as BD prior to pregnancy. The medical records of 39 pregnancies in 27 women from May, 1991 to July, 2007 with underlying BD and 499 randomly selected normal pregnancies not associated with BD were retrospectively reviewed. Women with other connective tissue disorders like systemic lupus erythematosus or rheumatoid arthritis and medical illnesses such as diabetes mellitus or hypertension were excluded from the study. The statistical significance was defined as P<0.05. RESULTS: The influence of BD on pregnancy and its outcome were studied in comparison with the normal group. The age, parity, spontaneous abortion rates, delivery weeks, cesarean section rates, premature rupture of membranes, preterm birth, fetal birth weights, APGAR scores, and intrauterine fetal death were compared. Majority of the women with BD were primiparae (P<0.001), and intrauterine fetal death rates (P<0.001) were significantly higher in the study group. The 1-minute APGAR score (P<0.005) of 4 or less and 5-minute APGAR score (P<0.039) of 7 or less appeared more in Behcet's group. The incidences of pregnancy complications including spontaneous abortion, premature rupture of membranes, preterm birth, and small for gestational age did not show statistically significant differences between the two groups. CONCLUSION: The results show higher rates of primiparity, lower APGAR scores, and higher intrauterine fetal death rates in patients with BD which implies that the disease may adversely affect pregnancy. Therefore, it is important for pregnant women with BD to receive proper antenatal care and preconception counseling prior to pregnancy.
Abortion, Spontaneous ; Apgar Score ; Arthritis, Rheumatoid ; Birth Weight ; Cesarean Section ; Connective Tissue ; Counseling ; Diabetes Mellitus ; Female ; Fetal Death ; Gestational Age ; Humans ; Hypertension ; Incidence ; Lupus Erythematosus, Systemic ; Medical Records ; Membranes ; Parity ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Rupture

Idiopathic pulmonary arterial hypertension eventually leads to right-sided heart failure and sudden death. Its mortality rate in children is still high, despite improvements in pharmacological therapy, and therefore novel treatments are necessary. The Potts shunt, which creates an anastomosis between the left pulmonary artery and the descending aorta, has been proposed as a theoretically promising palliative surgical technique to decompress the right ventricle. We report the case of a 12-year-old girl with suprasystemic idiopathic pulmonary hypertension and right ventricular failure who underwent a Potts shunt for palliation with good short-term results.
Aorta, Thoracic ; Child ; Death, Sudden ; Female ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Pulmonary Artery

Acupuncture is one of the most popular complimentary therapies these days not only in Asia, but also in USA and Europe. Acupuncture is generally regarded as a safe procedure in the general public. However, acupuncture is not free of risk; complications of acupuncture have been repeatedly reported in the medical literatures. The authors report a rare case of hemorrhage in the cisterna magna after acupuncture. Acute frontal headache, dizziness, neck pain, neck stiffness, and paresthesia or tingling discomfort at arms and legs developed immediately after an acupuncture treatment that had been performed to treat her chronic posterior neck pain. Computerized tomography scans and magnetic resonance images(MRI) showed a 1.2x0.8cm-sized high density and high signal mass within the cisterna magna. It is probable that the acupuncture needle had been inserted deep enough to enter the cisterna magna and provoked a small hemorrhage in the cistern. She gradually recovered from the symptoms. Physicians and acupuncture therapists should be aware of the adverse events associated with acupuncture.
Acupuncture* ; Arm ; Asia ; Cisterna Magna* ; Dizziness ; Europe ; Headache ; Hemorrhage* ; Leg ; Neck ; Neck Pain ; Needles ; Paresthesia

Anemia is a common and significant complication of chronic kidney disease (CKD). However, its prevalence and current management status has not been studied thoroughly in Korea. We examined the prevalence of anemia, its association with clinical and laboratory factors, and utilization of iron agents and erythropoiesis stimulating agents using the baseline data from the large-scale CKD cohort in Korea. We defined anemia when hemoglobin level was lower than 13.0 g/dL in males and 12.0 g/dL in females, or received by erythropoiesis stimulating agents. Overall prevalence of anemia was 45.0% among 2,198 non-dialysis CKD patients from stage 1 to 5. Diabetic nephropathy (DN) as a cause, CKD stages, body mass index (BMI), smoking, leukocyte count, serum albumin, iron markers, calcium, and phosphorus concentration were identified as independent risk factors for anemia. Considering the current coverage of Korean National Health Insurance System, only 7.9% among applicable patients were managed by intravenous iron agents, and 42.7% were managed by erythropoiesis stimulating agents.
Anemia* ; Body Mass Index ; Calcium ; Cohort Studies* ; Diabetic Nephropathies ; Female ; Hematinics ; Humans ; Iron ; Korea ; Leukocyte Count ; Male ; National Health Programs ; Phosphorus ; Prevalence* ; Renal Insufficiency, Chronic* ; Risk Factors ; Serum Albumin ; Smoke ; Smoking

We present four cases of the recently characterized chromophobe cell renal carcinoma. Gross hematuria, palpable flank mass and flank pain were the main symptoms of patients. With chromophobe cell renal carcinoma all tumors were solitary pale brown or beige colored mass, ranging from 6.0 to 10.5cm in diameter. Microscopically two cases were typical type and the other two cases were eosiophilic type. All of them showed strong reactivity for Hale's colloidal iron stain, cytokeratin and epithelial membrane antigen, but negative for vimentin. Ultrastructually characteristic invaginated microvesicles, 180-440nm in diameter, were identified in the cytoplasm. DNA ploidy studies revealed an aneuploid cell population in two cases of eosinophilic type. No patients showed recurrent tumor during the follow up periods, ranging from 5 to 92months.
Aneuploidy ; Colloids ; Cytoplasm ; DNA* ; Eosinophils ; Flank Pain ; Flow Cytometry ; Follow-Up Studies ; Hematuria ; Humans ; Iron ; Keratins ; Microscopy, Electron ; Mucin-1 ; Ploidies* ; Vimentin

BACKGROUN: Despite improvements in immunosuppressive therapy for use in renal transplantation, acute graft rejection remains a risk factor of chronic rejection and a major cause of graft loss and patient death. Recently, daclizumab, an anti IL-2 receptor monoclonal antibody has been shown to reduce the incidence of acute rejection. METHODS: To investigate the immunosuppressive effect of daclizumab and the incidence of acute rejection, we administered daclizumab intravenously (1 mg/kg of body weight within 24 hours before transplantation and once every other week afterward, for a total of 5 doses) in combination with cyclosporine microemulsion (CsA), steroid and mycophenolate mofetil (MMF) to 68 transplant recipients RESULTS: Among them 62 were undergoing their first transplantation and 6 were undergoing their second transplantation. 32 patients received living-related transplants and 36 patients received living-unrelated transplants: their HLA match were as follows:1 case with 1 Ag match, 13 cases with 2 Ag matches, 18 cases with 3 Ag matches, 3 cases with 4 Ag matches, 1 case with 5 Ag matches. The clinical characteristics of patients treated with daclizumab were as follows: 42 were male, 26 were female; the mean age of recipients was 42.94 +/- 11.2 years and that of donor was 34.1 +/- 9.9 years. The underlying renal diseases were glomerulonephritis (n=47), reflux nephropathy (n=6), diabetic nephropathy (n=12), polycystic kidney disease (n=2) and acute renal failure (n=1). During the observed period (17.41 +/- 4.34 months; min. 6 months, max. 26 months), 2 cases had acute rejection in the third month after transplantation and 1 case in the 6th month after transplantation, 1 case in the 24th month after transplantation (4/68, 5.8%). In the historical control, 20.8% of acute rejection (10/48) were noted in CsA, MMF and steroid regimen group and 36% of acute rejection (22/60) in CsA, azathioprine and steroid group. Serum creatinine level was 1.21 +/- 0.23, 1.31 +/- 0.25, 1.35 +/- 0.28 and 1.34 +/- 0.31 (mg/dL) during the 1st, 3rd, 6th month and 1 year after transplantation respectively. 10 patients developed herpes-zoster infection and 6 patients had CMV infection. 1 patient expired due to CMV pneumonitis on the 3 months after transplantation. The 2-year graft survival rate was 98.5% with daclizumab and 45 months graft survival rates were 92.9% and 89.3% for MMF group and azathioprine group respectively. CONCLUSION: Daclizumab, used in combination with CsA, MMF and steroid, reduced acute rejection episodes without serious short term side effects. Further observation is needed to evaluate the graft survival rate and uncover any long-term side effects.
Acute Kidney Injury ; Azathioprine ; Body Weight ; Creatinine ; Cyclosporine ; Diabetic Nephropathies ; Female ; Glomerulonephritis ; Graft Rejection ; Graft Survival ; Humans ; Incidence ; Kidney Transplantation* ; Male ; Pneumonia ; Polycystic Kidney Diseases ; Receptors, Interleukin-2 ; Risk Factors ; Tissue Donors ; Transplantation ; Transplants

Polyoma virus (PV) nephropathy is a known cause of graft loss after renal transplantation. In a renal transplant patient suspected of graft rejection, it is important to discriminate between PV induced interstitial nephritis and acute cellular rejection, because of similar pathologic findings. After the loss of the first allograft secondary to PV nephropathy, transplant graft nephroureterectomy before retransplantaton may have an influence in the recurrence of PV nephropathy. However, this question has not been completely resolved. Case: A 23-year-old male underwent first renal transplantation from his HLA haploidentical 25 year-old-sister. His renal function had been good with cyclosporine, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2 mg/dL. A renal biopsy revealed features of tubulitis and we confirmed PV nephropathy through a positive PV monoclonal antibody reaction to inclusion body. After gradual loss of graft function, he underwent hemodialysis. After 48 months of hemodialysis, the patient underwent cadaveric renal retransplantation without transplant graft nephroureterectomy. Thrombocytopenia and suspected delayed graft function occurred after 2 days of transplantation. A graft biopsy revealed thrombotic microangiopathy. Improved graft function was attained after a temporary stop of tacrolimus and ATGAM(R) bridging therapy. The patient is maintaining satisfactory graft function 33 months after retransplantation without clinical and serological evidence of recurrent PV infection.
Allografts ; Azathioprine ; Biopsy ; Cadaver ; Creatinine ; Cyclosporine ; Delayed Graft Function ; Graft Rejection ; Humans ; Inclusion Bodies ; Kidney Transplantation ; Male ; Nephritis, Interstitial ; Polyomavirus* ; Recurrence ; Renal Dialysis ; Tacrolimus ; Thrombocytopenia ; Thrombotic Microangiopathies ; Transplants* ; Young Adult

Raoultella ornithinolytica (formerly Klebsiella ornithinolytica ) is a Gram-negative aerobic bacillus which belongs to the family Enterobacteriaceae. However, human infections caused by bacteria of the genus Raoultella are uncommon and their pathogenicity is not well known yet. Herein, we report a case of necrotizing fasciitis caused by R. ornithinolytica in a 51 years old female patient who presented with erythematous swelling after a plantar puncture wound from a thumbtack.
Bacillus ; Bacteria ; Enterobacteriaceae ; Fasciitis, Necrotizing ; Female ; Humans ; Klebsiella ; Punctures