Hinyokika kiyo. Acta urologica Japonica
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Comparative Study
[Examination of the anesthesia on transperineal prostate biopsy--saddle block versus caudal block].
We examined the anesthesia of transperineal prostate biopsy under saddle block or caudal block. Between July 2003 and September 2004, we performed transperineal prostate biopsy under saddle block and caudal block, in 59 and 78 patients, respectively. We evaluated the pain score with the FACES Pain Rating Scale (0-5) and examined side effects on each anesthesia. ⋯ Saddle block caused post-operative retention more frequently than caudal block and required the patient to rest in bed for several hours after prostate biopsy. Saddle block was useful for relieving the pain of biopsy. In future, we need to consider using a method with fewer side effects.
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We report a case of multifocal liposarcoma that showed rapid growth in a short term. A 65-year-old male was referred from a local doctor to our clinic with the chief complaint of abdominal fullness. Abdominal CT shows two huge tumors in the intraperitoneal and retroperitoneal space, and we diagnosed it as multifocal liposarcoma. ⋯ However, the tumor recurred 4 months later, and two additional operations were required because of rapid growth. The patient died at 7 months after the first admission. The clinical outcome of myxoid liposarcoma is known to be better than other histological types, but it is very poor when the tumor appears multifocally.
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We report two cases of retroperitoneal liposarcoma arisen from the perirenal fat tissue, which could not be diagnosed preoperatively. Case 1 is a 58-year-old male. He complained of left flank tumor. ⋯ He has stopped visiting our clinic due to aggravation of heart disease. The characteristics of the images of the two cases were different despite the histological resemblance. This difference was considered to be due to the difference in the distribution of lipomatous tissue in each patient.
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Case Reports
[Clinical experiences of endotoxin removal in urinary obstruction: report of two cases].
Clinical experiences of endotoxin removal using polymyxin B immobilized fiber column (PMX) in two septic shock patients are reported. Case 1: A 74-year-old man with bladder cancer received a total cystectomy and a ileal conduit 19 years before he was referred to our hospital with complaints of high fever and general fatigue. Physical examination and laboratory data revealed severe hypotension, and pyuria. ⋯ Right hydronephrosis due to retroperitoneal fibrosis were observed on CT. Diagnoses of septic shock were made. After right nephrostomy were performed, direct hemoperfusion using polymyxinB immobilized fiber column was carried out.
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Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal region. We treated four cases of Fournier's gangrene from July 2002 to April 2003. All patients were male, ranging in age from 73-92 years old (80.5 +/- 6.5). ⋯ Immediately, we started systemic chemotherapy with broad-spectrum antibiotics, and performed surgical debridements for all patients. Three patients made a full recovery, but one patient died of sepsis. These cases are presented with some notes on the relevant literature.