Recurrent Urinary Tract Obstruction Due to Long-Coiled Transplant Ureter and Extrinsic Ureteric Compression

Urinary tract complications, manifesting as leakage or obstruction, generally occur in 3.0~13% of renal recipients. Most complications occur at the ureterovesical anastomosis and are secondary to technical causes and ureteric ischemia. Ultrasound and computed tomographic images are described in a recipient who underwent oversea deceased donor renal transplantation and presented with recurrent ureteral obstruction and hydronephrosis secondary to combination of unusually located transplant kidney, long-coiled ureter, ureteric compression and ischemia of the transplant ureterope

부분 신절제술 후 발생한 신동맥 가성동맥류의 자연 치유: 증례 보고

A partial nephrectomy is being used increasingly for the removal of renal cell carcinomas. A renal artery pseudoaneurysm (RAP) is a rare, potentially life threatening complication after a partial nephrectomy. This paper presents a case of spontaneous thrombosis of RAP after a partial nephrectomy. The presented case is believed to be the largest in diameter (59 mm) among the reported cases of spontaneous treatment of RAP by complete thrombosisope

Physiochemical Properties of Binary Pluronic Systems for Reversal of Multi-drug Resistant (MDR) Cancers

Pluronic as pharmaceutical excipients are listed in the US and British Pharmacopoeia. In particular, Pluronics exist as different compositions and display abundant phases as self-assembling into polymeric micelles with various morphologies depending on the aqueous solvent quality, the composition of structure, and hydrophilic-lipophilic balance (HLB). Pluronics were also known as a P-gp modulator, which was exploited as a reversal molecule of multi-drug resistant (MDR) cancers. We selected a lamella forming Pluronic L92 which has high hydrophobicity and relatively long PEO block among L series of Pluronics. The dispersion of L92 showed great size particles and low stability. To increase the stability and to decrease the particle size, secondary Pluronics (F68, F88, F98, F127, P85, P105, and P123) with relatively long PEO chain were added into 0.1 wt% Pluronic L92 dispersion. The stability of binary systems was increased due to incorporated long PEO chain. Their particle sizes slightly decreased to over 200~400 nm and their solubilization capacity of binary systems didn't change except Pluronic L92/P123 mixtures. The L92/P123 systems showed ca. 100 nm sizes and lowest turbidity among the all systems. The solubilization capacity of 0.1 wt% L92/0.1 wt% P123 was slightly increased compared to 0.1 wt% L92 mono system and other binary systems. These nano-sized binary systems may have potential as alternative drug delivery systems with simple preparation method and overcome the drawbacks of mono systems such as low stability and loading capacity.ope

경직장 초음파 검사를 통한 전립선 조직 검사 시 마취제 주사 방법의 비교

PURPOSE: To compare the effectiveness of 2 injection methods of lidocaine during a transrectal ultrasound (TRUS)-guided prostate biopsy for pain control and complication rates. MATERIALS AND METHODS: We retrospectively evaluated patients who underwent a TRUS-guided prostate biopsy from March 2005 to March 2006. One hundred patients were categorized into two groups based on injection method. For group 1, 10 mL of 1% lidocaine was injected bilaterally at the junction of the seminal vesicle and prostate and for group 2, into Denonvilliers' fascia. Pain scores using a visual analog scale (VAS) as well as immediate and delayed complication rates were evaluated. RESULTS: The mean VAS score showed no significant differences between the groups (group 1, 3.4+/-1.78; group 2, 2.8+/-1.3; p = 0.062). The difference in delayed complication rates and incidence of hematuria, hemospermia, and blood via the rectum was not significant between groups. However, two patients in group 1 complained of symptoms immediately after local anesthesia; one of tinnitus and the other of mild dizziness. CONCLUSION: There were no significant differences between pain control and complication rates between the 2 lidocaine injection methods. However, injection into Denonvilliers' fascia is thought to have less potential risk.ope

Focal Liver Lesions: Computer-aided Diagnosis by Using Contrast-enhanced US Cine Recordings

Purpose To assess the performance of computer-aided diagnosis (CAD) systems and to determine the dominant ultrasonographic (US) features when classifying benign versus malignant focal liver lesions (FLLs) by using contrast material-enhanced US cine clips. Materials and Methods One hundred six US data sets in all subjects enrolled by three centers from a multicenter trial that included 54 malignant, 51 benign, and one indeterminate FLL were retrospectively analyzed. The 105 benign or malignant lesions were confirmed at histologic examination, contrast-enhanced computed tomography (CT), dynamic contrast-enhanced magnetic resonance (MR) imaging, and/or 6 or more months of clinical follow-up. Data sets included 3-minute cine clips that were automatically corrected for in-plane motion and automatically filtered out frames acquired off plane. B-mode and contrast-specific features were automatically extracted on a pixel-by-pixel basis and analyzed by using an artificial neural network (ANN) and a support vector machine (SVM). Areas under the receiver operating characteristic curve (AUCs) for CAD were compared with those for one experienced and one inexperienced blinded reader. A third observer graded cine quality to assess its effects on CAD performance. Results CAD, the inexperienced observer, and the experienced observer were able to analyze 95, 100, and 102 cine clips, respectively. The AUCs for the SVM, ANN, and experienced and inexperienced observers were 0.883 (95% confidence interval [CI]: 0.793, 0.940), 0.829 (95% CI: 0.724, 0.901), 0.843 (95% CI: 0.756, 0.903), and 0.702 (95% CI: 0.586, 0.782), respectively; only the difference between SVM and the inexperienced observer was statistically significant. Accuracy improved from 71.3% (67 of 94; 95% CI: 60.6%, 79.8%) to 87.7% (57 of 65; 95% CI: 78.5%, 93.8%) and from 80.9% (76 of 94; 95% CI: 72.3%, 88.3%) to 90.3% (65 of 72; 95% CI: 80.6%, 95.8%) when CAD was in agreement with the inexperienced reader and when it was in agreement with the experienced reader, respectively. B-mode heterogeneity and contrast material washout were the most discriminating features selected by CAD for all iterations. CAD selected time-based time-intensity curve (TIC) features 99.0% (207 of 209) of the time to classify FLLs, versus 1.0% (two of 209) of the time for intensity-based features. None of the 15 video-quality criteria had a statistically significant effect on CAD accuracy-all P values were greater than the Holm-Sidak α-level correction for multiple comparisons. Conclusion CAD systems classified benign and malignant FLLs with an accuracy similar to that of an expert reader. CAD improved the accuracy of both readers. Time-based features of TIC were more discriminating than intensity-based features.ope

In Vivo Tracking of Mesenchymal Stem Cell in Rat Genitalia with Erectile Dysfunction Labeled by Superparamagnetic Iron Oxide Using Magnetic Resonance Imaging and Its Therapeutic Effect

Background: Molecular imaging with nanoparticles makes non-invasive monitoring of target cells without sacrifice of subjects and repeated evaluation possible. Objectives: To evaluate the imaging feasibility of a rat animal model with erectile dysfunction (ED) by bilateral cavernosal nerve injury using human mesenchymal stem cells (MSCs) labeled with superparamagnetic iron oxide (SPIO) and simultaneously to evaluate the beneficial effect of MSCs on ED. Materials and Methods: Thirty-six rats were injected with MSCs labeled with SPIO particle into the corpus cavernosum after bilateral cavernosal nerve injury. In vivo MR imaging was serially performed up to 16 weeks using 1.5 T clinical scanner. After MR imaging, the penile specimens were evaluated for the expression of transforming growth factor-β1 (TGF-β1) by polymerase chain reaction. Results: MR imaging showed a drop in signal intensity at the injection site in the stem cell-injected group. The size of hypointensity was decreased in MSC-injected group in a time-dependent manner; whereas, signal void was not detected at the injection site in the control group. In addition, polymeric chain reaction (PCR) analyses of penile tissues from both groups revealed that the mRNA expression of TGF-β1 was significantly decreased in MSC-injected groups after 4 weeks of injection compared to the control group. Conclusion: MSCs’ beneficial effects on ED was monitored with MR imaging, which might be a valuable tool for tracking and therapeutic monitoring in the future clinical study of stem cell therapy in ED.ope

Laparoscopic Excision of a Retroperitoneal Cystic Lymphangioma Encasing the Renal Vessels

A 55-year-old woman, with a retroperitoneal cystic mass, incidentally found during evaluation for the cause of right upper quadrant pain, was referred to our hospital from a local clinic. Computed tomography, performed at our hospital, revealed a multilobulated cystic lesion in the right perinephric space, encasing the renal vessels, suggestive of a cystic lymphangioma. A cystic abdominal lymphangioma is a rare tumor in adults, which is difficult to diagnose preoperatively. Surgical excision is known as the treatment of choice; however, only three cases of laparoscopic excision have been reported. We report a case of a successful laparoscopic excision of a retroperitoneal cystic lymphangioma encasing the renal vessels of the renal hilum.ope

Contralateral Testicular Single Metastasis from Renal Cell Carcinoma

Approximately one-third of all patients with renal cell carcinoma have metastases at the time of diagnosis. Metastasis of renal cell carcinoma (RCC) to the testis is a rare finding. The cases of testicular metastasis from renal cell carcinoma that have been reported in the literature are predominantly ipsilateral, and they are invariably found on the left side through the retrograde venous spread along the gonadal artery. We experienced a case of contralateral testicular metastasis from a right side renal cell carcinoma, so we discuss the clinical feature and pathophysiology of this case with a review of the related literature.ope

CT-Based Fagotti Scoring System for Non-Invasive Prediction of Cytoreduction Surgery Outcome in Patients with Advanced Ovarian Cancer

Objective: To construct a CT-based Fagotti scoring system by analyzing the correlations between laparoscopic findings and CT features in patients with advanced ovarian cancer. Materials and methods: This retrospective cohort study included patients diagnosed with stage III/IV ovarian cancer who underwent diagnostic laparoscopy and debulking surgery between January 2010 and June 2018. Two radiologists independently reviewed preoperative CT scans and assessed ten CT features known as predictors of suboptimal cytoreduction. Correlation analysis between ten CT features and seven laparoscopic parameters based on the Fagotti scoring system was performed using Spearman's correlation. Variable selection and model construction were performed by logistic regression with the least absolute shrinkage and selection operator method using a predictive index value (PIV) ≥ 8 as an indicator of suboptimal cytoreduction. The final CT-based scoring system was internally validated using 5-fold cross-validation. Results: A total of 157 patients (median age, 56 years; range, 27-79 years) were evaluated. Among 120 (76.4%) patients with a PIV ≥ 8, 105 patients received neoadjuvant chemotherapy followed by interval debulking surgery, and the optimal cytoreduction rate was 90.5% (95 of 105). Among 37 (23.6%) patients with PIV < 8, 29 patients underwent primary debulking surgery, and the optimal cytoreduction rate was 93.1% (27 of 29). CT features showing significant correlations with PIV ≥ 8 were mesenteric involvement, gastro-transverse mesocolon-splenic space involvement, diaphragmatic involvement, and para-aortic lymphadenopathy. The area under the receiver operating curve of the final model for prediction of PIV ≥ 8 was 0.72 (95% confidence interval: 0.62-0.82). Conclusion: Central tumor burden and upper abdominal spread features on preoperative CT were identified as distinct predictive factors for high PIV on diagnostic laparoscopy. The CT-based PIV prediction model might be useful for patient stratification before cytoreduction surgery for advanced ovarian cancer.ope

음낭 종양의 영상 소견

Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a high-frequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.ope