Renal cell carcinoma has been recognized for several years as a relatively common cause of paraneoplastic syndromes. Fever, polycythemia, hypercalcemia, amyloidosis, abnormal liver function, Cushing's syndrome and neuropathy have been ostm frequently reported in association with renal cell carcinoma, but leukemoid reactions have been reported only rarely with this tumor. Recently we experienced a leukemoid reaction in a 64-year old female patient who presented with an advanced case of renal cell carcinoma. According to the literature the mortality is 100% with leukemoid reactions in renal cell carcinoma, and indeed this patient expired. We therefore, consider this reaction as a late manifestation of a bizzare presentation of renal cell carcinoma.
Amyloidosis ; Carcinoma, Renal Cell* ; Cushing Syndrome ; Female ; Fever ; Humans ; Hypercalcemia ; Leukemoid Reaction* ; Liver ; Middle Aged ; Mortality ; Paraneoplastic Syndromes ; Polycythemia

Although transurethral prostatectomy is the most common treatment method of benign prostatic hyperplasia, the exact indication and efficacy of this method is variable and controversial. We performed this study to determine the efficacy of transurethral prostatectomy on men with moderate symptoms or benign prostatic hyperplasia. The efficacy parameters evaluated included the change of maximal flow rate, Boyarsky symptom score and the global assessment of voiding symptom by the patient after transurethral prostatectomy. The mean maximal flow rate improved 204% after transurethral prostatectomy, and the mean obstructive and irritative symptom scores decreased 84% and 59% respectively. But the irritative symptom score of unsatisfied patients decreased only. 41%. Over all, 80% of the patients were satisfied with the result of the operations. The improvement of the irritative symptoms is not expected after a transurethral prostatectomy, and therefore, the operative procedure is not indicated. But the symptoms of the unsatisfied patients were similar to the comparative group (healthy men over 50 years of age). Although this comparative group had nocturia (11%), frequency (32%), urgency (29%), they felt no necessity for special medical attention, but hesitancy, intermittency, terminal dribbling and dysuria led the patient to seek help in a hospital.
Dysuria ; Humans ; Male ; Nocturia ; Prostatic Hyperplasia* ; Surgical Procedures, Operative ; Transurethral Resection of Prostate*

A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue.
Adult ; Amylases ; Epithelium ; Female ; Fibrosis ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic

A 38-year-old woman was admitted for evaluation of cyst-like lesion of the pancreas, which was incidentally found on physical check up. She has been well until the lesion was found except epigastric pain. On endoscopic retrograde pancreatogram, pancreatic head portion revealed a 2 x 2 cm sized cystic mass with marginal calcification. There was no definitive communication between pancreatic duct and cyatic mass, but amylase level of cystic content was increased. Surgical excision was performed, Microspically, the cystic wall showed flat lining epithelium with dense fibrosis and dysplastic calcification accompanied by chronic pancreatitis of adjacent pancreatic tissue.
Adult ; Amylases ; Epithelium ; Female ; Fibrosis ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatitis, Chronic

We report a case of vesico-sigmoido-appendiceal fistula from unknown origin in a 29 years old female who was presented with the chief complaints of fecaluria and bladder irritation symptoms The diagnostic procedure such as excretory urography, cystography, barium enema, cystoscopy and proctoscopy were performed, and the vesico-recto-appendiceal or vesico-sigmoido-appendiceal fistula was suspected. On operation, the tip of appendix was communicated with the sigmoid fistulous tract and opened into the bladder in a common pathway. The patient underwent appendectomy, sigmoid fistulectomy, and partial cystectomy and the postoperative course was uneventful.
Adult ; Appendectomy ; Appendix ; Barium ; Colon, Sigmoid ; Cystectomy ; Cystoscopy ; Enema ; Female ; Fistula* ; Humans ; Proctoscopy ; Urinary Bladder ; Urography

To evaluate the nutritional status according to the degree of metabolic acidosis(MA) and determine that MA is a risk factor for malnutrition, we screened the laboratory data of 37 hemodialysis(HD) patients who were clinically stable for more than 6 months and taken bioelectrical impedence analysis(BIA) twice 6 months apart to check lean body mass (LBM). Mean age of patients was 49.1+/-15.0 years and sex ratio 1:2.4. Mean serum albumin level was 3.97+/-0.36g/dl and weekly Kt/V and normalized protein catabolic rate(nPCR) were 3.04+/-0.85 and 0.99+/-0.21g/kg/day. According to mean total CO2 content during the periods between BIA, the patients were divided to three groups[group 1(n=16):&18mEq/L, group 2(n=9):18< or =tCO2&21mEq/L, group 3(n=12):> or =21mEq/L). Group 1 had significantly higher body weight gain than group 2 and 3(1.82+/-1.62 vs. 0.77+/-3.13 and 1.35+/-3.85kg, P<0.05), and higher LBM gain(1.99+/-4.38 vs. 3.35+/-7.99kg, P<0.05), nPCR(1.05+/-0.20 vs. 0.91+/-0.13g/kg/day, P<0.05), intact parathyroid hormone(88.4+/-78.7 vs. 32.0+/-26.5pg/ml, P< 0.05), and phosphate(5.4+/-1.3 vs. 3.9+/-1.3mg/dl, P< 0.05) than group 3. There were no differences in age, serum albumin, BUN, creatinine and weekly Kt/V among three groups. Mean total CO2 level was inversely correlated with body weight gain and LBM gain. In conclusion, metabolic acidosis in stable HD patients may be the result of high protein intake and not related to decrease of body weight by protein catabolism.
Acidosis* ; Body Weight ; Creatinine ; Humans ; Malnutrition ; Metabolism ; Nutritional Status ; Renal Dialysis* ; Risk Factors ; Serum Albumin ; Sex Ratio

PURPOSE: We aimed to assess whether nerve-sparing radical prostatectomy (nsRP) is associated with improved recovery of urinary continence compared to non-nerve-sparing radical prostatectomy (nnsRP) in patients with localized prostate cancer and preoperative erectile dysfunction. METHODS: A total of 360 patients with organ-confined prostate cancer and an International Index of Erectile Function score of less than 17 were treated with nsRP or nnsRP in Seoul St. Mary's Hospital. Patients who received neoadjuvant or adjuvant androgen deprivation therapy or had a history of prostate-related surgery were excluded. Recovery of urinary continence was assessed at 0, 1, 3, 6, and 12 months. Postoperative recovery of continence was defined as zero pad usage. The association between nerve-sparing status and urinary continence was assessed by using univariate and multivariate Cox regression analyses after controlling for known predictive factors. RESULTS: Urinary continence recovered in 279 patients (77.5%) within the mean follow-up period of 22.5 months (range, 6-123 months). Recovery of urinary continence was reported in 74.6% and 86.4% of patients after nnsRP and nsRP, respectively, at 12 months (P=0.022). All groups had comparable perioperative criteria and had no significant preoperative morbidities. Age, American Society of Anesthesiologists score, and nerve-sparing status were significantly associated with recovery of urinary continence on univariate analysis. On multivariate analysis, age (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.002-1.478; P=0.026) and nerve-sparing status (HR, 0.713; 95% CI, 0.548-0.929; P=0.012) were independently associated with recovery of urinary continence. CONCLUSIONS: nsRP, as compared to nnsRP, improves recovery rates of urinary incontinence and decreases surgical morbidity without compromising pathologic outcomes.
Erectile Dysfunction* ; Follow-Up Studies ; Humans ; Male ; Multivariate Analysis ; Prostatectomy* ; Prostatic Neoplasms ; Seoul ; Urinary Incontinence

Although intussusception is primarily a disease of children, about 5 to 10 percent of cases occur in adults. The underlying causes of adult intussusception are tumor, postoperative complication, local bowel ischemia, abnormal motility and rarely intestinal tuberculosis. Recently, we experienced a 62-year-old man with intussusception underlying pulmonary tuberculosis. The postoperative pathologic finding was intestinal tuberculosis. For its rarity, we report this case with review of literatures.
Adult ; Child ; Humans ; Intussusception* ; Ischemia ; Middle Aged ; Postoperative Complications ; Tuberculosis* ; Tuberculosis, Pulmonary

Double primary cancer of the stomach and esophagus has been revealed a very low incidence in the world except Japan and reported only 6 cases in Korea. Furthermore, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency to early metastasis. This paper is concerned with a case of double primary cancer, which we have synchroniously confi~rmed esophageal squamous cell carcinoma and gastric adenocarcinoma with gastrofiberscopic biopsy, and then treated them by radical resec tion and systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Carcinoma, Squamous Cell ; Drug Therapy* ; Esophageal Neoplasms ; Esophagus ; Incidence ; Japan ; Korea ; Neoplasm Metastasis ; Stomach Neoplasms

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.
Carcinoma, Renal Cell* ; Cohort Studies ; Diagnosis* ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Nephrectomy ; Recurrence ; Survival Rate