Urge incontinence with uninhibited detrusor contraction has been known to be a typical findings observed in the supraspinal neurologic disorders such as cerebrovascular accident(CVA). However, voiding difficulty with significant amounts of residual urine are frequently noted in the patients with organic brain diseases. Also, little is known about the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik at all have identified a specific physiological abnormality-detrusor hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the symptoms and urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outlet obstruction or, pathologies in the brain. Of the 50 patients with parenchymal brain disease, 41 had CVA, 6 had Parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH (detrusor hyperreflexia) in 24, DH with obstructive pattern in 8, ID (impaired detrusor contractility) in 5, normal findings in 5 patients. Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were noted in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in 7 and, senile dementia in 1 cases. Of the 5 patients with IDC, CVA was present in 2 and, normal aged peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC complained obstructive symptoms more frequently than irritative symptoms. On the contrary, DH patients complained irritative symptoms more frequently than obstructive symptoms. Mean fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41 patients(53%). The fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile function of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without any pathologies exhibited abnormal findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contractility. Urge incontinence due to DH has been known to be the most common findings in supraspinal lesion. However, these results showed that the impairment of detrusor contractility was also commonly found in the patients with supraspinal lesions and, in aged peoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and it may need emptying of residual urine in addition to the administration of anticholinergics or smooth muscle relaxants.
Aged ; Aging ; Alzheimer Disease ; Brain ; Brain Diseases ; Cholinergic Antagonists ; Humans ; Muscle, Smooth ; Nervous System Diseases ; Parkinson Disease ; Pathology ; Reflex, Abnormal* ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Incontinence, Urge ; Urodynamics

Subcutaneous metastasis from colorectal cancer is an unusual presentation. Most perineal subcutaneous metastases are found in extensive involvements of multiorgan metastases or local recurrences of rectal cancer. Subcutaneous metastasis from colon cancer is considered as a distant metastasis with poor prognosis. We report an unusual case of solitary subcutaneous metastasis beneath the perineum without solid organ involvement after a curative anterior resection for sigmoid colon cancer. The patient underwent a perineal resection, and chemotherapy with the FOLFOX (fluorouracil, leucovorin, and oxaliplatin) regimen was instituted. Eight months later, multiple lung metastases were found, and chemotherapy was restarted with the FOLFIRI (fluorouracil, leucovorin, and irinotecan) regimen. However, lung metastases progressed, and new metastases appeared at the adrenal glands, the kidneys and the cerebellum. The patient died 30 months after the diagnosis of perineal subcutaneous metastasis. He lived relatively long in comparison with patients in previous reports.
Adrenal Glands ; Cerebellum ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Kidney ; Leucovorin ; Lung ; Neoplasm Metastasis ; Perineum ; Prognosis ; Rectal Neoplasms ; Recurrence ; Sigmoid Neoplasms

Rectourethral fistulas (RUFs) in adults are rare and could result from complicated trauma, and prostatic or rectal surgery. RUFs have been treated initially by using primary repair and omental interposition with or without a colostomy during surgery. Recurrent RUFs require complex surgery, such as a low rectal resection and coloanal anastomosis, an interposition flap of the datos muscle or gracilis muscle, and others. Recently, transanal rectal flap advancement and fibrin glue injection have provided an effective occlusion of RUFs. However, no reports about this technique exist for cases of recurrent RUFs. We report a case of a recurrent RUF successfully repaired by using transanal rectal flap advancement combined with fibrin glue injection into the fistula tract. The postoperative course was uneventful without complications. At the 1-year follow-up, no complications such as urethral stricture or recurrence existed, and voiding was normal without anal incontinence.
Adult ; Colostomy ; Fibrin ; Fibrin Tissue Adhesive ; Fistula ; Follow-Up Studies ; Humans ; Muscles ; Recurrence ; Urethral Stricture

Spontaneous regression of an intracranial lesion, as seen in sequential CT or MRI images, does not necessarily indicate a self-limiting process such as trauma or vascular disease. This report describes two cases of intracranial enhancing lesions which, on follow-up, showed complete resolution of the changes seen on MRI, without any treatment other than the administration of corticosteroid for a short period. We review several reports of "disappearing CT lesions", and discuss the possible mechanism of disappearance of intracranial lesions.
Follow-Up Studies ; Magnetic Resonance Imaging ; Vascular Diseases

PURPOSE: Peritoneal irrigation and drain insertion were traditionally performed following major abdominal surgery, as routine procedures The aim of this retrospective study was to evaluate the usefulness of peritoneal irrigation and drain insertion following elective gastric cancer surgery. METHODS: Between December 2000 and Feburary 2002, 184 patients having undergone surgery for gastric cancer were divided into two groups, a comparative group (86 patients with peritoneal irrigation and drainage) and an experimental group (98 patient without peritoneal irrigation and drainage). The demographics, histopathological classification, range of dissection, comorbid disease, first passage of flatus, start of soft diet, operation time, anesthesia time and operative complication were analyzed retrospectively in consecutive patients. The data were analyzed by student's t-tests with the level of significance set at P<0.05. RESULTS: No significance differences were found between the two groups in regard to demographics, range of dissection, comorbid disease or complications. However the mean length of hospitalization, operation time and anesthesia time and the first passage of flatus, and start of soft diet in the experimental group were significantly shorter than those in the comparative group. CONCLUSION: The result shows that routine peritoneal irrigation and drain insertion following elective gastric cancer surgery are ineffective in reducing postoperative complications. We think these procedures are unnecessary and offer no considerable advantages.
Anesthesia ; Classification ; Demography ; Diet ; Drainage* ; Flatulence ; Hospitalization ; Humans ; Peritoneal Lavage* ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms*

A perineal hernia (PH) is formed by a protrusion of intra-abdominal viscera through a defect in the pelvic floor. This is a rare complication after a conventional abdominoperineal resection (APR). However, the risk of a PH may be increased after a laparoscopic resection because this technique can cause fewer postoperative adhesions, predisposing the small bowel to sliding down toward the pelvis. However, only a few case reports describe the transperineal approach for the repair of a PH after a laparoscopic APR. We present a case of a PH after a laparoscopic APR; the PH was repaired with synthetic mesh by using a transperineal approach. A transperineal approach using a mesh to reconstruct the pelvic floor is less invasive and more effective. We suggest that this technique should probably be the first choice for treating an uncomplicated PH that occurs after a laparoscopic APR.
Hernia* ; Hydrogen-Ion Concentration ; Pelvic Floor ; Pelvis ; Viscera

A patient is described who was presented with a little finger tip sized palpable nodular mass on left calf muscle for 2 years of duration. The pathologic result of the biopsy specimen for nodular mass showed a clear cell carcinoma. The full metastatic work up demonstrated tumor in the right kidney, with no other detectable primary focus. Result of the radical nephrectomy exhibited renal cell carcinoma confined within renal parenchyme. The patient was treated with IFN-alpha-2b as adjuvant therapy and now is on close observation without the evidence of tumor recurrence.
Biopsy ; Carcinoma, Renal Cell* ; Fingers ; Humans ; Kidney ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence

No abstract available.
Trigger Finger Disorder*

Colorectal large-cell neuroendocrine carcinomas (NECs) are extremely rare and have very poor prognosis compared to adenocarcinomas. A 74-year-old man presented with abdominal pain, diarrhea and hematochezia. The histopathologic report of colonoscopic biopsy performed at a local clinic was a poorly differentiated carcinoma. An abdominopelvic computed scan revealed irregularly enhanced wall thickening at the sigmoid colon with regional fat stranding and lymphnode enlargement. He underwent a laparoscopic high anterior resection with selective peritonectomy for peritoneal carcinomatosis, intraoperative peritoneal irrigation chemotherapy, and early postoperative intraperitoneal chemotherapy for 5 days. The tumor had a high proliferation rate (mitotic count > 50/10 HPFs and 90% of the Ki-67 index) and lymph-node metastases had occurred. On immunohistochemistry, the tumor cells expressed CD56 and synaptophysin. Large-cell NEC was confirmed. Systemic chemotherapy with cisplatin/etoposide was done. The patient is still alive after 3 years with no evidence of recurrence.
Abdominal Pain ; Adenocarcinoma ; Aged ; Biopsy ; Carcinoma* ; Carcinoma, Neuroendocrine* ; Colon* ; Colon, Sigmoid ; Diarrhea ; Drug Therapy ; Gastrointestinal Hemorrhage ; Humans ; Immunohistochemistry ; Neoplasm Metastasis ; Peritoneal Lavage ; Prognosis ; Recurrence ; Synaptophysin

Intramedullary spinal cord metastasis is rare, but is being encountered with increasing frequency with the availability of more sensitive imaging techniques. RI is the most sensitive of these techniques, though it cannot differentiate between intramedullary spinal cord metastasis and other cord pathologies. Occasionally, therefore, surgical biopsy is indicated though optimal treatment after diagnosis remains controversial. Radical resection, radiation and chemotherapy significantly prolong survival, but many patients survive less than one year. The authors have encountered two cases of intramedullary spinal cord metastasis of small cell carcinoma of the lung. These are reviewed, together with literature describing adequate evaluation and management.
Biopsy ; Carcinoma, Small Cell ; Diagnosis ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis* ; Pathology ; Spinal Cord*