Urachal anomalies are very rare. Since Cabrolius' report of patent urachus in 1550, only 315 cases have been collected in the literature. Failure of the urachal lumen to close and completely obliterate causes one of several anomalies. These have been classified into four distinct entities by Blichert-Tott and Neilsen, Who also tabulated the incidence of each variant in the 315 reported cases : patent urachus , 48 per cent ; urachal cyst , 31 percent ; urachal sinus or alternating sinus, 18 per cent , and vesicourachal diverticulum, per cent . A brief discussion of embryology, symptoms , histopathology , diagnosis and treatment is made and a case of congenital patent urachus is reported here at Korea General Hospital.
Diagnosis ; Diverticulum ; Embryology ; Hospitals, General ; Incidence ; Korea ; Urachal Cyst ; Urachus*

Craniofacial reconstructive procedures are frequently peformed with rigid fixation of the bone. During the period of active bone growth such manipulation may influence bone development. The purpose of this study was to determine the effects of metal plating of the mandible on the growth and morphology of the mandibulofacial skeleton. New Zealand white rabbits, 6 to7 weeks of age, were divided into 5 groups. They were designated as group I(nonoperated control, n=10), group II (rigid fixation of mandibular body after vertical osteotomy, n=10), group III(rigid fixation without osteotomy, n=10), group IV (interosseous wire fixation after osteotomy, n=10), and group V(rigid fixation and removal of plates and screws 4 weeks after osteotomy, n=7). Rabbits were sacrificed 12 weeks after operation and dry skull preparations were grossly measured and analyzed by direct measurement and by dorsoventral skull x-rays. Measurements taken were length, thickness, angle, and area of the mandibulofacial skeleton. Three-dimensional CT was used for volumetric measurement of the mandible. The data wee compared between the operated and nonoperated sides and significant differences between groups were evaluated using the paired t-test, the ANOVA test, and Dunn's test. The following results were obtained: 1. The length of the whole mandible and the anterior mandibular segment was decreased in groups II and III, compared with group I(p>0.05). These results show growth restriction of the plated mandible regardless of osteotomy. 2. The maxillary alveolus of the operated side was more anteriorly placed in groups II and III, compared with group I (p>0.05). 3. The thickness of the operated mandibular body showed a significant increase in groups II and III, compared with group I(p>0.05). 4. The length of the zygomatic arch of the operated side in all the experimental groups showed a significant decrease, compared with group I(p>0.05). The angular divergence of the mandibular ramus from the sagittal midline of the skull was increased in the operated side of groups II and III, compared with the nonoperated side (p>0.05). 5. Volume measurements of the mandible in groups II and III showed a significant reduction of the volume on the operated sides in the anterior mandibular segment, compared with group I(p>0.05). The volume of the operated mandibular body showed a significant increase in groups II and III, compared with group I(p>0.05). All gruops showed no significant difference in total hemiman dibular volume of the operated side compared with the nonoperated side. These results show that rigid fixation of mandibular fractures during the growth period causes a more severe growth restriction than either osteotomy or interosseous wiring.
Bone Development ; Electroplating ; Mandible ; Mandibular Fractures ; Osteotomy ; Rabbits* ; Skeleton ; Skull ; Zygoma

This animal experimental study reports one case of hybrid transvaginal natural orifice transluminal endoscopic surgery (NOTES) for nephrectomy. We performed a nephrectomy through a transvaginal access and 2 additional 5 mm trocars in the abdomen by using the keyhole technique. The specimen was removed through the vaginal tract. The total procedure time was 102 minutes. There were no intraoperative complications.
Abdomen ; Animal Experimentation ; Chimera ; Gastroscopy ; Intraoperative Complications ; Laparoscopy ; Natural Orifice Endoscopic Surgery ; Nephrectomy ; Surgical Instruments ; Vagina

The enzyme telomerase maintains a constant telomere length in immortalized cells, allowing unlimited cell proliferation. Almost all cancer cells express telomerase activity. However, little data is available regarding the role of telomerase activity in the detection of bladder cancer with a bladder wash specimen. We detected telomerase activity in a bladder wash specimen of bladder cancer and normal tissues, and compared them with final pathologic diagnosis. Twenty-three patients with transitional cell carcinoma (TCC) of the bladder were enrolled in our study. A bladder wash specimen was obtained before transurethral resection of the bladder (TURB) and normal and cancer tissues from the same patients during TURB. Telomerase activity was analyzed in each specimen a using telomeric repeat amplification protocol (TRAP) assay based on polymerase chain reaction (PCR) technique. Cytologic diagnosis was performed using Papanicolaou's stain with cytocentrifuged cytology preparation. We observed telomerase activity in 95.7% (22/23) of bath cancer tissues and bladder wash specimens; only one case did not express telomerase activity. Telomerase activity was undetected in all normal tissues except one, which was obtained from a patient with carcinoma in situ. A total of 69.6% (16/23) of wash specimens were positive in cytopathologic diagnosis. The accuracy of cytopathologic diagnosis in pathologic grade 2 or 3 was relatively high (83.3%, 15/18). However, in five cases of grade 1 TCC only 20% (1/5) of cytologic diagnosis was positive whereas the telomerase activity of wash specimens was detected in 80% (4/5). Our data demonstrates that not only the majority of human bladder cancer tissues, but also the bladder wash specimens obtained from patients with TCC, expressed telomerase activity. It indicates that telomerase activity may be a reliable marker in detecting bladder cancer especially in cases with a low grade that bladder wash cytology can miss.
Aged ; Aged, 80 and over ; Bladder Neoplasms/enzymology* ; Carcinoma, Transitional Cell/metabolism* ; Female ; Human ; Irrigation ; Male ; Middle Age ; Telomerase/metabolism* ; Tumor Markers, Biological

PURPOSE: We assessed the impact of using a porcine model on the training of laparoscopic partial nephrectomy(LPN) and compared the training effectiveness between surgeons with and without previous laparoscopic experience. MATERIALS AND METHODS: Surgeon A had previous laparoscopic experience, with the exception of LPN, while surgeon B had no prior laparoscopic experience. A tumor model was created by subcapsular injection of liquid plastic(Smooth-Cast 320) in the kidney. We recorded the total operation time, the bowel dissection time, the renal pedicle dissection time, the warm ischemic time, the mass resection time, the suture time, and the presence of major complications for each surgeon. RESULTS: The mean operation time was significantly shorter for surgeon A compared to surgeon B(49.1+/-4.5 and 63.6+/-8.4 minutes, respectively, p<0.001). Although the mass resection time was significantly shorter for surgeon A as well, there were no significant differences between the two surgeons in terms of warm ischemia time and suture time. As the training progressed, surgeon B improved in all surgical steps and surgeon A showed improvement in time for warm ischemia and suturing the defect. Five complications occurred(two cases by surgeon A and three cases by surgeon B). CONCLUSIONS: A porcine model improved the skills needed for LPN, including shortening the warm ischemia and suture times. LPN is a procedure requiring technically-demanding skills that can be improved by training using a animal model, regardless of the previous laparoscopic experiences.
Animals

Telomeres are the specialized structures at the end of all eukaryotic chromosomes that are thought to give important functions in protecting genomic DNA from degradation and deleterious recombination events. The enzyme telomerase maintains a constant telomere length observed in immortalized cells, allowing unlimited cell proliferation. Various cancer cells express telomerase activity. We analyzed telomerase activity in bladder tumors and normal tissues. Bladder tumor tissues and normal mucosa of 25 patients were obtained during transurethral resection of bladder (TURB) or after radical cystectomy. Telomerase activity was analyzed using telomeric repeat amplification protocol (TRAP) assay which is based on polymerase chain reaction (PCR) technique. Twenty-three of 25 bladder tumor tissue were transitional cell carcinomas and remains were urothelial hyperplasia and inverted papilloma, respectively. We observed telomerase activity in 22 of 23 bladder cancer tissues (95.7%); only one did not express telomerase activity. Telomerase activity was not detected in all normal tissues except one, which was obtained from a patient with carcinoma in situ. Urothelial hyperplasia and inverted papilloma did not express telomerase activity. Our data demonstrates that the majority of human bladder cancers obtained from patients with transitional cell carcinoma expressed telomerase activity whereas urothelial hyperplasia and inverted papilloma did not. It indicates that telomerase activity may be a important role in carcinogenesis.
Carcinogenesis ; Carcinoma in Situ ; Carcinoma, Transitional Cell* ; Cell Proliferation ; Cystectomy ; DNA ; Humans ; Hyperplasia ; Mucous Membrane ; Papilloma, Inverted ; Polymerase Chain Reaction ; Recombination, Genetic ; Telomerase* ; Telomere ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: To perform a prospective analysis of the clinical outcomes of prophylactic antibiotic treatment before the standard surgical modality of living donor nephrectomy (LDN) without postoperative antibiotic treatment. MATERIALS AND METHODS: From November 2005 to June 2010, a total of 470 patients underwent LDN at our medical institution, and 280 of these patients were injected with 1 g cephalosporin 30 minutes before the operation. The group receiving prophylactic antibiotics was compared with a control group composed of 190 patients who received injections of 2 g cephalosporin per day for 5 days after the operation. The presence of fever, incidence of blood transfusion, and period of drainage use were compared between the two groups. RESULTS: There were no significant differences in gender, age, body mass index, incidence of blood transfusion after the operation, fever over 38degrees C 3 days after the operation, or period of drain insertion between the single-dose group and the control group. The follow-up was conducted for 1 month after the operation, and 1 case of surgical site infection (SSI) was observed in each group (p=0.783). CONCLUSIONS: Of 280 patients in the single-dose group, 1 contracted SSI. In comparison with the control group, which was dosed with prophylactic antibiotics for 5 days after the operation, the single-dose group did not have a significantly different occurrence of SSI. We found that the incidence rate of SSI did not increase, even though prophylactic antibiotics were not used after standard and conventional open surgeries, such as video-assisted minilaparotomy surgery.
Anti-Bacterial Agents ; Antibiotic Prophylaxis ; Blood Transfusion ; Body Mass Index ; Contracts ; Drainage ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Laparotomy ; Living Donors ; Nephrectomy ; Prospective Studies ; Surgical Wound Infection ; Tissue Donors ; Video-Assisted Surgery

PURPOSE: We reviewed clinical features and survival rates of nonseminomatous germ cell testicular tumors(NSGCTs) and analyzed pathological risk factors of relapse in stage I group under surveillance program. MATERIALS AND METHODS: Forty one patients were treated for primary NSGCTs from February 1983 to April 1998. 20(48.8%) patients were stage I and 19 of them were followed up under surveillance program after orchiectomy and 1 underwent orchiectomy and adjuvant therapy(RPLND and PVB chemotherapy). 11(26.8%) were stage II and 10(24.4%) stage III and all stage II and III patients underwent orchiectomy and adjuvant therapy. Statistical analysis with Fisher`s exact test was performed to identify that pathological risk factors affected relapse rate. RESULTS: Mean age at diagnosis was 26 years(range 16-47) and mean follow-up period was 58 months(range 5-163). According to histopathological types, embryonal carcinoma, teratoma, teratocarcinoma and mixed type represented 19.5%, 26.8%, 7.3% and 46.3%, respectively. Among 41 patients, 33 showed significant elevation of tumor markers at diagnosis. The 5-year survival rates of stage I, II and III were 95%, 80% and 56%, respectively and overall 5-year survival rate was 82%. Among stage I patients under surveillance program, there was statistically significant increase of relapse rate in the patients with pathological risk factors(presence of embryonal elements, local stage T2 or higher, presence of lymphovascular invasion) as compared to those without. CONCLUSIONS: In stage I NSGCT patients, if there are pathological risk factors after orchiectomy, aggressive therapy such as early retroperitoneal lymph node dissection or chemotherapy is selectively needed.
Carcinoma, Embryonal ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Humans ; Lymph Node Excision ; Orchiectomy ; Recurrence ; Risk Factors* ; Survival Rate* ; Teratocarcinoma ; Teratoma ; Biomarkers, Tumor

OBJECTIVES: Purpose of this study is investigation the influence of intravenous and oral bisphosphonate to bone union and clinical results in patient treated with plate fixation in an osteoporotic distal radius fracture. MATERIALS AND METHODS: The medical records of 160 patients with an osteoporotic distal radius fracture treated with plate fixation in our hospital between January 2008 and April 2012 were reviewed retrospectively. The patients were classified by 3 groups; who did not administrate bisphosphonate after surgery as Group I (n=69), administrated oral bisphosphonate after surgery as Group II (n=44), and administrated intravenous bisphosphonate as Group III (n=47). After surgery, bone union, radiologic parameters, disabilities of the DASH score and range of motion of wrist were assessed. RESULTS: Mean time of bone union was 6.7 weeks in Group I, 6.8 weeks in Group II, and 7.1 weeks in Group III. There was no significant difference between three groups (P=0.571). Bone union rate on 6weeks shows no significant differences between three groups (P=0.16). Three groups also have no significant differences in all radiologic and clinical parameters. CONCLUSION: This study shows that early initiation of oral and Intravenous bisphosphonate did not affect bone union and clinical results compared to group who did not administrate bisphosphonate result in patient treated with plate fixation in an osteoporotic distal radius fracture.
Humans ; Medical Records ; Osteoporosis ; Radius Fractures ; Radius ; Range of Motion, Articular ; Retrospective Studies ; Wrist

Renal pelvic transitional cell carcinoma (TCC), which invades beyond muscularis into peripelvic fat or the renal parenchyma, is diagnosed as stage pT3 despite its structural complexity. We evaluated the prognostic impact of peripelvic fat invasion in pT3 renal pelvic TCC. Between 1986 and 2004, the medical records on 128 patients who were surgically treated for renal pelvic TCC were retrospectively reviewed. Sixty patients with pT3 disease were eligible for the main analysis. The prognostic impact of various clinicopathological factors was analyzed using univariate and multivariate analyses. On univariate analysis, sex, age, concomitant bladder tumors, concomitant ureter tumors, lymphadenectomy, adjuvant chemotherapy, tumor grade, multiplicity, renal parenchymal invasion, and carcinoma in situ did not influence the disease-specific survival (p>0.05). By contrast, peripelvic fat invasion, lymph node invasion, and lymphovascular invasion were each significantly associated with disease-specific survival (p<0.05). Multivariate analysis showed that peripelvic fat invasion (p=0.012) and lymph node invasion (p=0.004) were independent prognostic factors. In conclusion, peripelvic fat invasion is a strong prognostic factor in pT3 renal pelvic TCC. Thus, systemic adjuvant therapy should be considered in the presence of peripelvic fat invasion, even if the lymph nodes are not involved.
Adipose Tissue/*pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell/mortality/*pathology/surgery ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/mortality/*pathology/surgery ; Lymph Nodes/pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pelvis ; Prognosis ; Retrospective Studies ; Survival Analysis