Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.
Actinomycosis ; Aged ; B-Lymphocytes ; Biopsy ; Colon ; Colon, Ascending ; Colonic Neoplasms ; Colonoscopy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; Masks ; Penicillin G ; Sulfur ; Tomography, X-Ray Computed ; Weight Loss

A 54-year-old woman visited Gangnam Severance Hospital for left side flank pain. She had a history of total removal of malignant melanoma on the left eye ball 20 years prior. No evaluation had been performed since then. A paravertebral mass at thoracic ninth level (T9) was discovered on spinal magnetic resonance imaging, and pathology confirmed malignant melanoma. Following positron emission tomography-computed tomography, no other metastasis was discovered. After removal of the paravertebral mass, palliative chemotherapy (dacabarzine + tamoxifene) was administered in 3 cycles over 2 months. Radiotherapy with simultaneous integrated boost technique was performed at 4,350 cGy total over 15 days, 290 cGy per delivery, and was administered with the first cycle of palliative chemotherapy. Despite this treatment, multiple metastases developed throughout her body 7 months later, and the patient is continuing chemotherapy.
Choroid* ; Drug Therapy ; Electrons ; Female ; Flank Pain ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Pathology ; Radiotherapy ; Spine*

Background: Flail chest is a severe condition of thoracic trauma, and it requires diagnosis and treatment as soon as possible. From year 2000, we developed an improved technique of open fixation in order to adapt the situations of Vietnam health settings. Objectives: To report preliminary results of application of improved open fixation technique in Viet Duc Hospital from 2001 to 2006. Subjects and method: This descriptive, prospective and retrospective study involved 19 patients with flail chest due to closed thoracic trauma or multiple traumas, treated by open fixation technique. The parameters included features of patients, characteristics of this technique and postoperative progression.Results: Of 19 patients, there were 16 males and 3 females, mean age: 47.8 years. All patients presented obvious signs of flail chest preoperatively, but only 9 cases were treated by open fixation technique and pleural drainage immediately. This technique canbe applied in all sugical settings with single local anaesthesia, and any kind of common surgical threads. The most suitable initial pulled weight is 2000 g. All cases of flail chest required pleural drainage. All patients had good outcomes with open fixation technique, no death. There were 3 patients with postoperative complications, all were severe multiple trauma patients. Conclusion: Improved open fixation technique applied in Viet Duc Hospital is simple, effective and safe, and can be widely used in all surgical settings.
Flail Chest ; Flank Pain/ therapy ;

Renal vein thrombosis is a rare, renal disease in adults that is related to hypercoagulability. We experienced a case of renal vein thrombosis in a 30-years old woman who presented with fever, chills and left flank pain after delivery. She was treated with catheter-directed thrombolytic therapy and oral anticoagulants.
Adult ; Anticoagulants ; Chills ; Female ; Fever ; Flank Pain ; Humans ; Pregnancy ; Renal Veins* ; Thrombolytic Therapy ; Thrombophilia ; Thrombosis*

PURPOSE: The aim of this presentation is to analyze the factors influencing on retrograde insertion of double-J catheter in urethral obstruction due to malignancy and to predict the possibility of stunting with double-J catheter. MATERIALS AND METHODS: A retrospective analysis of 43 patients who had underwent retrograde double-J catheter insertion for urethral obstruction secondary to pelvic malignancy, from January 1993 to April 1997, was performed to evaluate the success rates of double-J ureteral stenting according to the factors such as age, sex, presence or absence of flank pain, degree of hydronephrosis, renal function, stage of tumor, laterality of ureter, past history of radiotherapy, operation and chemotherapy. RESULTS: According to the degree of hydronephrosis, the success rate was 100, 73.7 and 50% in grade I II and III, respectively(p<0.05). According to the renal function, the success rate was 81.3% in the group with normal renal function and 45.5% in the group with abnormal venal function(p<0.05) According to the stage of disease, the success rate was 100, 70.7 and 58.3% in stage I, II and III, respectively. According to the absence or presence of flank pain, the success rate was 56.3% in the group with flank pain and 81.5% in the group without flank pain. According to the past history of radiotherapy, the success rate was 65.6% in the group treated with radiotherapy and 90.9% in the group not treated with radiotherapy. The age, sex, laterality of ureter, past history of operation and chemotherapy were not significantly correlated to the success rates. CONCLUSIONS: The factors influencing on double-J ureteral slanting were the degree of hydronephrosis, renal function, absence or presence of flank pain, stage of disease and past history of radiotherapy Further study will be needed to demonstrate the accurate timing of urethral stenting with doublets ureteral catheter.
Catheters* ; Drug Therapy ; Flank Pain ; Humans ; Hydronephrosis ; Radiotherapy ; Retrospective Studies ; Stents ; Ureter* ; Ureteral Obstruction* ; Urethral Obstruction ; Urinary Catheters

A clinical observation was done in 72 patients with renal cell carcinoma admitted to Department of Urology, St. Mary's Hospital, Catholic University Medical College from Jan. 1980 to Jun. 1988 retrospectively. There were 52 men and 20 women, giving a ratio of 2.6 to 1, with the highest incidence in the sixth to seventh decades (66%). The most common symptom and sign were hematuria, flank pain and palpable mass in orders, but classic symptom triad of renal cell carcinoma was present in only 11% of the patients. Symptoms secondary to metastasis were only initial presentations in more than half of the patients with stage IV disease, initially 11% (12 pts.) of all the patients with renal cell carcinoma. CT scan showed a high diagnostic accuracy (78%) as compared to pathologic examination. So recently angiography is not done routinely. In one patient, tumor was not detected by CT scan, but by ultrasonography and angiography. Liver scan is not indicated unless there are 2 or more abnormal values among liver function test including alkaline phosphatase, GOT and GPT. Bone metastasis is not correlated with the elevation of alkaline phosphatase and bone scan is indicated only when bone pain and/or gait disturbance are present. Radical nephrectomy is the choice of treatment and adjunctive therapy including. irradiation, chemotherapy, hormone therapy and immunotherapy were not effective. The majority of distant metastasis (86%) occurred within the first 2 years following nephrectomy and metastatic sites were lung, lymph nodes, liver and bone in orders. Of the 72 patients, it was possible for 36 patients to follow up more than 3 years. Patients with stage 1 disease showed 90%. (9/10) 3 year survival and there were no significant differences in 3 year survival between stage II (50%) and stage III (44%) disease. No patients with stage IV disease survived more than 3 years.
Alkaline Phosphatase ; Angiography ; Carcinoma, Renal Cell* ; Drug Therapy ; Female ; Flank Pain ; Follow-Up Studies ; Gait ; Hematuria ; Humans ; Immunotherapy ; Incidence ; Liver ; Liver Function Tests ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Nephrectomy ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography ; Urology

A clinical observation was made on 46 cases of renal tuberculosis who were admitted to the Department of Urology, Eul Ji General Hospital, Seoul, Korea, during the period from January 1978 to December 1982. Following results were obtained. 1. The most common symptoms were urinary frequency (47.8%), gross hematuria (43.5%) flank pain (32.6%) and dysuria (21.7%). 2. Tubercle bacilli were demonstrated in 37% of patients by Ziehl-Neelson staining. The most common findings of urine were hematuria (73.9%), Pyuria (54.4%) and proteinuria (32.6%). 3. Excretory urographic findings in 46 cases of renal tuberculosis were non visualization (45.7%), calyectasis (28.3%), delayed visualization (15.2%), ureteral deformity (10.9%). 4. The most common finding of cystoscopy was hemorrhagic patches (44.4%), followed by sealed off ureteral orifice (s) in 30.6%, ulceration and tubercle formation in 25.0%. 5. Patients were managed by chemotherapy only in 47.8%, chemotherapy with nephrectomy in 43.5%, chemotherapy with reconstructive surgery in 8.7%.
Congenital Abnormalities ; Cystoscopy ; Drug Therapy ; Dysuria ; Flank Pain ; Hematuria ; Hospitals, General ; Humans ; Korea ; Nephrectomy ; Proteinuria ; Pyuria ; Seoul ; Tuberculosis, Renal* ; Ulcer ; Ureter ; Urology

A clinical observation was made on 20 patients with renal tumor who had been admitted to Department of Urology, Jeonbug National University Hospital during the period from January 1978 to March 1983. The following results were obtained. 1. The incidence of renal tumor among total 1892 inpatients was 1.1% and 5.1% among the 389 genitourinary tumors. The most prevalent age group was fifth decade. The sex ratio, male to female was 1.5:1. 2. Histopathological analysis showed renal cell carcinoma in 11 cases, transitional cell carcinoma in 2 cases, squamous cell carcinoma in I case, Wilms' tumor in 1 case, neuroblastoma in 1 case, hemangioma in I case and simple cyst in 3 cases. 3. The most frequent symptoms and signs were gross hematuria in 11 cases(55%), flank pain in 11 cases(55%) and palpable mass in 6 cases (30%), and these classical symptom triad were seen in 3 cases of renal cell carcinoma. 4. Renal angiography was performed in 9 patients with 6 cases of renal cell carcinoma, 1 case of transitional cell carcinoma, 1 case of hemangioma and 1 case of renal cyst. 5. At the time of diagnosis, distant metastasis were found in 2 cases with renal cell carcinoma to lung, spine and Virchow's node. 6. Treatment of renal tumors consisted of surgery, radiation and/or chemotherapy. Radical nephrectomy was performed in 10 cases, simple nephrectomy in 2 cases, nephroureterectomy with bladder cuff resection in 3 cases, renal cystectomy with marsupialization in 3 cases and only diagnosis in 2 cases.
Angiography ; Carcinoma, Renal Cell ; Carcinoma, Squamous Cell ; Carcinoma, Transitional Cell ; Cystectomy ; Diagnosis ; Drug Therapy ; Female ; Flank Pain ; Hemangioma ; Hematuria ; Humans ; Incidence ; Inpatients ; Jeollabuk-do ; Lung ; Male ; Neoplasm Metastasis ; Nephrectomy ; Neuroblastoma ; Sex Ratio ; Spine ; Urinary Bladder ; Urology ; Wilms Tumor

A clinical observation was made on 34 patients with renal tumor who had been admitted to the Department of Urology, Chonnam University Hospital during the period from Jan. 1977 to Dec. 1982. The following results were obtained: 1. During the period, the renal tumor was 1.6 percent of total urological in-patients and 7.5 percent of total genitourinary tract tumors. The mean age of patients with renal cell carcinoma was 49 years. Wilms' tumor 4 years, and transitional cell carcinoma 41 years. The male sex was favored by a ratio of 2.1 to 1 in the renal tumors. 2. The pathological classification of 34 patients with renal tumors revealed renal cell carcinoma in 16 cases (47.1%), Wilms' tumor in 9 cases (26.5%) and transitional cell carcinoma in 9 cases (26.5%). 3. The most common symptoms and signs were hematuria in 21 cases (61.7%), palpable mass in 18 cases (52.9%) and flank pain in 14 cases (46.2%) The classical triad of symptoms and signs including hematuria, flank pain and palpable mass was presented in only 5 cases (14.%). 4. Distant metastasis was found in 6 patients, of whom 3 had lung metastasis, 2 liver metastasis and 1 vertebral metastasis. 5. Treatment of renal tumors consisted of surgery and adjuvant radiation and/or chemotherapy. In 16 cases with renal cell carcinoma, 5 simple nephrectomies, 8 radical nephrectomies and 3 explorations with biopsy were done. Postoperative radiation and/or chemotherapy were performed in 2 cases. In 9 cases with Wilms' tumors, 3 simple nephrectomies, 5 radical nephrectomies and 1 exploration with biopsy were done. Postoperative radiation and/or chemotherapy were performed in 6 cases. In 9 cases with transitional cell carcinoma, 5 nephroureterectomies, 2 nephroureterectomies with partial cystectomy and 2 nephroureterectomies with total cystectomy and ileal conduit were done. Postoperative radiation and/or chemotherapy were performed in 1 cases. 6. The mean weight of resected kidneys with renal tumors was about 594 gm. The mean weight of resected kidneys with renal cell carcinoma was about 594 gm, that with transitional cell carcinoma 354 gm, and that with Wilms' tumor 440 gm. 7. The 1-year survival rate of the patients with malignant renal tumors was 71.4 percent. The 1-year survival rate of the patients with renal cell carcinoma was 63.6 percent, that with transitional cell carcinoma 83.3 percent, and that with Wilms' tumor 75 percent.
Biopsy ; Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Classification ; Cystectomy ; Drug Therapy ; Flank Pain ; Hematuria ; Humans ; Jeollanam-do ; Kidney ; Liver ; Lung ; Male ; Neoplasm Metastasis ; Nephrectomy ; Survival Rate ; Urinary Diversion ; Urology ; Wilms Tumor