Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

A Case of Primary Mature Teratoma of the Rectum

A mature teratoma is a tumor composed of normal derivatives of all three germ layers, and usually occurs in ovaries, testes, or mediastinum. Mature teratoma of the gastrointestinal tract occurs less frequently, and case reports of primary mature teratoma of the rectum have not been published much. Here, we report a 65-year-old woman patient presented with lower abdominal discomfort. Colonoscopy revealed a pedunculated polypoid tumor arising from the rectum with hairs on its surface, and endoscopic ultrasound revealed an exophytic pattern bulging from the serosa. The tumor was removed surgically and confirmed histologically as a benign, primary mature teratoma of the rectum.

A patient with acquired hemophilia A induced by clopidogrel

Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies against factor VIII (FVIII). Treatment with clopidogrel is a cause of AHA, but its clinical course is unknown. Recently, we treated a 65-year-old man who was hospitalized for cerebellar infarction and had a prolonged activated partial thromboplastin time (aPTT) with soft tissue oozing after 3 weeks of clopidogrel use. We terminated clopidogrel administration and transfused the patient with fresh frozen plasma. However, the aPTT increased up to 98.8 seconds, and the FVIII and FVIII inhibitor levels were <1% and 5.4 Bethesda units/mL, respectively. Clopidogrel-associated AHA was considered, and we began steroid treatment. Two months later, FVIII, FVIII inhibitor, and aPTT values were normalized. No further bleeding or aPTT prolongation has been reported during the 2-year follow-up period. AHA should be considered in patients taking clopidogrel and experiencing bleeding, unless the platelet count and coagulation screen are normal.

Comparative Results of Extracorporeal Shock Wave Lithotripters with Three Kinds of Shock Wave Generator / 대한비뇨기과학회지

PURPOSE: To compare the results of extracorporeal shock wave lithotripters according to three shock wave energy sources; piezoelectric (EDAP LT 01+), electromagnetic (Storz Modulith SLX) and electroconductive (EDAP- TMS Sonolith VISION), for the treatment of urinary stones. METERIALS AND METHODS: Between February 1990 and March 2006, 1,504 patients (1,691 renal units) were treated with LT-01+(group A), 2,265 patients (2,500 renal units) with a Modulith SLX (group B) and 927 patients (946 renal units) with a Sonolith VISION (group C). The success rates, number of sessions and complications were examined. Statistical analyses were also conducted according to the size and location of the stones. RESULTS: There were no significant differences in the success rates between the three groups (group A, 97.8%; group B, 98.1%; group C, 97.1%). According to the stone size, the success rate for stones more than 1cm(2) was lower in group C than in groups A and B. According to the location, group C had a lower success rate than groups A and B for renal stones, while there were no differences between the three groups in the treatment of other stone locations. The number of treatment sessions for group A was greater than those for groups B and C (group A, 3.83; group B, 1.85; group C, 1.93). Many more sessions were required for group A in comparison with groups B and C in case of renal stones, ureteropelvic junction and upper ureteral stones. The number of sessions for group B was the least for lower ureteral stones. Complications, including steinstrasse, fever, perirenal hematoma and hematuria, were detected in groups A, B and group C at 10, 15.3 and 7.1%, respectively. CONCLUSIONS: There were no differences in the success rates between the three extracorporeal shock wave lithotripters using a shock wave generator. The mean number of treatment sessions was most with the piezoelectric type; whereas, complications were most prevalent with the electromagnetic type.

Early Experience of Retroperitoneoscopic Nephroureterectomy for Transitional Cell Carcinoma of Renal Pelvis and Ureter / 대한비뇨기과학회지

PUSPOSE: To evaluate the results of our experience with a retroperitoneoscopic nephroureterectomy, in patients with transitional cell carcinomas of the renal pelvis and ureter, compared to those treated by open nephroureterectomy. MATERIAL AND METHODS: Between August 2003 and February 2006, 17 patients with a transitional cell carcinoma of the upper urinary tract underwent retroperitoneoscopic nephroureterectomy. The distal ureter and bladder cuff was treated with a Gibson incision in 11 patients, with an endoscopic stapler employed in 6 patients. During the endoscopic stapler firing of the bladder cuff, complete removal of the ureteral orifice was confirmed using a flexible cystoscope. The patients' operative and clinical records were retrospectively reviewed, and compared to 16 patients with a transitional cell carcinoma of the upper urinary tract treated using an open nephroureterectomy. RESULTS: The retroperitoneoscopic nephroureterectomies were successfully performed in all patients. The mean operative time, transfusion rate and time to drain removal were not significantly different between the two groups. The initiations of the postoperative oral intake and ambulation, as well as the hospital stay were shorter in the retroperitoneoscopy than the open group. Complications were detected in 1 and 5 patients of the retroperitoneoscopy and open groups, respectively. With respect to the follow-up results, no statistical differences were seen in either bladder or extravesical recurrence between the two groups. CONCLUSIONS: A retroperitoneoscopic nephroureterectomy is a less invasive technique than an open nephroureterectomy for patients with a transitional cell carcinoma of the renal pelvis and ureter. Especially, using an endoscopic stapler for the lower ureter and bladder cuff may shorten the operative time. However, long term follow-up will be necessary to confirm the cancer control effects.

Can Serum PSA Predict Prostate Volume in Men with Benign Prostatic Hyperplasia? / 대한비뇨기과학회지

PURPOSE: To analyze the ability of serum prostate specific antigen (s-PSA) to predict the prostate volume by characterizing the relationship between the prostate volume and serum PSA in men with benign prostate hyperplasia. MATERIALS AND METHODS: We evaluated 1,254 patients, with lower urinary tract symptoms, who had visited our hospital between Jan. 2002 and Aug. 2004. All patients with prostate cancer, prostatitis, and a history of prostatic surgery and alpha-blocker or 5-alpha reductase inhibitor medication were excluded from the study. The baseline s-PSA and prostate volume were determined using standard techniques. Pearson's correlation coefficient was used to analyze the relationship between the s-PSA and prostate volume, and a linear regression model to estimate the prostate volume. Receiver operating characteristics (ROC) curves were constructed to evaluate the ability of the s-PSA to predict cut-off values for assessing prostate enlargement. RESULTS: The analyses included 959 patients, with mean age, baseline s-PSA and prostate volume of 68.2 years, 3.4ng/ml and 34.4ml, respectively. The s-PSA and prostate volume increased with age. The prostate volume correlated positively with s-PSA (r=0.292, p30ml and 2.0ng/ml to detect a prostate volume>40ml. CONCLUSIONS: The prostate volume is strongly related to the s-PSA and age in men with benign prostatic hyperplasia (BPH). Since treatment outcomes and the risk of long-term complications depend on the prostate volume, the serum PSA may sufficiently estimate prostate enlargement to be useful in therapeutic decision making in men with BPH.