Laparoscopic finding and imaging of the iatrogenic duodenal intramural hematoma

Intramural duodenal hematoma is rarely seen in adults and may occur as an iatrogenic complication of endoscopic injection for peptic ulcer treatment. In the appropriate clinical setting, the diagnosis is easy with its ultrasonography and computed tomography characteristic findings. In one of our patients, UGI study revealed duodenal obstruction, bowel related lesion in sonography and hyperdense mass lesion in computed tomography. Clinical presentation of severe vomiting and epigastralgia were noted. Laparoscopy confirmed the location of the hematoma and subsequent evacuation was performed. The symptoms were relieved after the operation and a follow-up sonography demonstrated the regression of the duodenal hematoma.

[Furcation entrance dimension, divergent angle and length of CEJ to furcation entrance relate to periodontal therapy]

In previous studies we have investigated the furcation entrance dimension (FED), furcation entrance angle (FEA) and the distance between cementoenamel junction and furcation entrance (CEJ-FE) of the first and second molars and compared the Chinese with the Caucasians. The aim of the present study was to relate the FED, FEA, and distance of CEJ-FE to the clinical significance of periodontal therapy of molar furcations. All the FEDs, FEAs, and distance of CEJ-FEs of the molars were measured by a stereomicroscope equipped with a Bioscan OPTIMAS Image Analyzer and statistically analyzed by Student's paired t-test, multiple regression of ANOVA and correlation analysis. The results are summarized below. (1) There is a significant relationship between FEA and location of buccal, mesial, and distal furcations of maxillary first and second molars (16& 26, p < 0.001; 17&27, p < 0.01). (2) There exists a significant relationship between FEA and FED in the mandibular first and second molars. (3) There exists a significant relationship between FED and FEA in the mandibular second molar (r = 0.370, p < 0.05). (4) The prevalence of mean FED and FEA (type D, FED < or = 0.75 mm and FEA < or = 90 degree) of the maxillary first molar (45%) is twice as high as the maxillary first molar (24%). (5) The prevalence of type D of the buccal (32%) and lingual (37%) furcations on the mandibular second molar is markedly higher than the first molar (buccal = 12%; lingual = 4%, respectively). These results reveal that those topographics of the FED, FEA, and distance of CEJ-FE in second molars have poor prognosis in periodontal therapy when compared with first molars.

[A cross-sectional radiographic study of proximal alveolar bone loss in molars with adult periodontitis]

The purpose of the present study was to document the mean proximal alveolar bone loss of molars. The samples consisted of 219 subjects receiving of full mouth radiographs by standardized paralleling technique from Jan, 1992 to Jun, 1994. All the radiographs of 219 individuals suffered from adult periodontitis at age between 20 and 65 years old were measured, and were assessed mean proximal alveolar bone loss of molars and associated contributing factors. The main results indicated that (1) the mean proximal alveolar bone loss of the maxillary first and second molars accounted for 38. 4% and 33.5%, respectively, whereas the mandibular first and second molars were 34.8% and 31.6%, respectively; (2) within the same dental arch, mean proximal alveolar bone loss of the first molars was significant greater than that of the second molars, while the bone loss in the maxillary first molars was significant greater than that of the mandibular first molars. There was no difference between mean proximal bone loss of the maxillary and mandibular second molars; (3) mean alveolar bone loss of the first molars was significant greater than second molars in the same side of the dental arch. There was no significant difference in the mean proximal alveolar bone loss between right and left side molars. (4) average bone loss was the greatest (39.4%) at the mesial surfaces of maxillary first molars, whereas the least mean alveolar bone loss appeared at the distal surfaces of mandibular second molars. A significant difference of mean proximal alveolar bone loss was found between mesial and distal surfaces in mandibular first molars.

Idiopathic pulmonary artery aneurysm

The purpose of this article is to report two cases of pulmonary artery (PA) aneurysm in patients who had no evidence of left-to-right intracardiac shunting or other known relevant etiologies. One patient, a 52-year-old woman, was admitted to the hospital due to exertional palpitation, while the other patient, a 73-year-old woman, came to the hospital because of fever and cough. In both women, chest radiographic findings of a hugely dilated PA were confirmed by computed tomography (CT). In both cases, a ventriculogram showed fusiform dilatation of the main PA without evidence of pulmonary valve stenosis. The results of chest radiography, two-dimensional echocardiography, CT of the thorax, including pulmonary angiography in one patient, were compatible with the diagnosis of PA aneurysm. No specific drug regimen was administered nor was any surgical intervention performed in either patient. Both patients were asymptomatic as of the last telephone follow-up. Idiopathic PA aneurysm is a benign condition with better survival than PA aneurysms of other etiologies, because of the absence of left-to-right intracardiac shunting and significant pulmonary hypertension. PA aneurysm must be considered as part of the differential diagnosis in an enlarged pulmonary trunk seen on chest radiogram, and two-dimensional echocardiography should be performed initially.

Photoelastic stress analysis of mandibular posterior cantilevered pontic

The quasi-3D technique of photoelastic stress analysis was used to evaluate the stresses of mandibular posterior cantilevers for distal terminal abutments at various levels of periodontal support. The stress concentration index was selected to compare each model. The periodontal support of terminal abutment and the length of pontic must be considered, when a cantilever fixed partial denture is anticipated.

Clinical efficacy of prostate-specific antigen testing in patients with prostate disease

Prostate-specific antigen (PSA) has become the most commonly used marker for the detection of prostatic adenocarcinoma (PCa) in recent years. To understand the clinical value of PSA testing in patients with prostate disease, the preoperative serum PSA values of 562 patients who underwent prostatic surgery from April 1993 to December 1995 were correlated with histologic findings in samples taken during surgery. Histopathologic findings revealed 93 cases of PCa and 469 cases of benign prostatic hyperplasia (BPH). Of the 220 patients with a serum PSA level within the normal range (0-4 ng/mL), PCa was diagnosed in six (2.7%) cases. However, among the 342 patients (61%) who had serum PSA > 4.0 ng/mL, BPH was diagnosed in 225 (75%) patients. With a PSA cutoff value of 4.0 ng/mL, the sensitivity, specificity and positive predictive value of PSA in distinguishing PCa from BPH were 94%, 45% and 25%, respectively. Raising the cutoff value to 10 ng/mL enhanced the specificity (76%) and positive predictive value (42%) with a slight compromise in sensitivity (85%). Of the 469 patients with BPH, 255 (54%) had a serum PSA > 4.0 ng/mL and 107 (24%) had a serum PSA > 10.0 ng/mL. Prostate volume, histologically documented prostatic inflammation and history of urinary retention prior to PSA determination may partly explain the abnormal elevation of serum PSA in patients with BPH. Our data confirmed the sensitivity of PSA in the detection of PCa in a country with a low incidence of PCa. However, a considerable proportion of patients with BPH had elevated serum PSA levels caused by factors unrelated to malignancy. Raising the cutoff value of PSA or employing adjunct parameters derived from PSA determination may be helpful in improving the diagnostic efficacy of PSA.

[The study of molar furcation involvements in adult periodontitis. II. Age, sex, location and prevalence]

The purposes of the study were as follows: (1) to evaluate the molar furcation involvement and number of molar correlated with age and sex; and (2) to study the relationship between the means of alveolar bone loss and associated factors of molar furcation involvements (FIs). 1102 molars (703 males and 399 females) were measured in 219 individuals (136 males and 83 females) for the alveolar bone loss and associated factors of molar furcation involvements. Based on the results, we conclude the following: (1) the higher prevalence of FI was in the mandibular first molar (94.6%), whereas the lowest prevalence of FI was in maxillary second molar; (2) except for the mandibular first molar, the prevalence of molar FI markedly increased with an increased age group (16 & 26, r = 0.335, p < 0.01; 17 & 27, r = 0.345, p < 0.01; 37 & 47, r = 0.239, p < 0.01); (3) the prevalence of molar FI was significantly higher in males than in females (p < 0.05); (4) the mean number of molar FI was significant greater in males (mean = 3.45) than in females (mean = 2.69); (5) factors such as age (r = 0.222, p < 0.01), sex, (r = 0.145, p < 0.05), number of remaining teeth (r = -0.330, p < 0.01) and molar FI (r = 0.471, p < 0.01) are strongly associated with the mean alveolar bone loss of molars.

[Evaluation of the biosynthesis of mono-HETES and leukotrienes in diseased periodontal tissues]

Many arachidonic metabolites have been shown to have marked potent biological effects in animals. The cyclooxygenase and lipoxygenase products of arachidonate metabolism are known to play a key role in the development of inflammatory symptoms and signs. Reports published during past decades indicate that cyclooxygenase products of arachidonic acid metabolism are present in much higher concentrations in inflamed than in healthy periodontal tissues. Since information about the role of lipoxygenase products of arachidonic acid metabolism in human periodontal disease is lacking, the objective of this study was to determine the ability of diseased and non-diseased gingival tissue to synthesize lipoxygenase products from the precursor arachidonic acid. Twenty-six samples of diseased tissue and nine samples of non-diseased tissue were included in our data analysis. After incubation of the tissue with 100,000 cpm [3H]-arachidonic acid, lipoxygenase products were separated by high performance liquid chromatography (HPLC) and identified by comparison with cochromatographed standards. Our results showed that inflamed gingival tissue synthesized significantly larger amounts, of LTB4(p < 0.01), LTC4(p < 0.01), LTD4(p < 0.01), LTE4(p < 0.01), 5-HETE(p < 0.05), 12-HETE(p < 0.01), and 15-HETE(p < 0.01), compared to non-diseased tissue. The lipoxygenases are more active in inflamed gingival tissue than in non-diseased gingival tissue. 12-HETE and 15-HETE were the the major metabolites formed by lipoxygenases in diseased and non-diseased human gingiva. Since we did not functionally determine the fractions separated by HPLC, our present data may only provided indirect evidence for the existence of lipoxygenase products in periodontal tissue. However, our study did establish a research model for the investigation of arachidonic acid metabolism in the pathogenesis of periodontal disease.

Concomitant fracture of the coracoid and acromion after direct shoulder trauma

Fractures of the acromial process or coracoid process of the scapula are rare. We present a combined fracture of the coracoid and acromion after direct trauma to the shoulder. An anteroposterior radiography with the central x-ray beam angled 25 degrees cephalad or an axillary lateral radiograph may be needed to detect these fractures.

Comparison of hysterosalpingography and hysteroscopy in female infertility

STUDY OBJECTIVE

To determine the diagnostic value of hysterosalpingography (HSG) and diagnostic hysteroscopy in infertility evaluations.

DESIGN

Comparative 2-year study.

SETTING

Outpatient infertility clinic of a tertiary medical center.

PATIENTS

Two hundred sixteen women being investigated for infertility.

INTERVENTIONS

An HSG was followed by a diagnostic hysteroscopy.

MEASUREMENTS AND MAIN RESULTS

The HSGs were interpreted as normal in 79 (36.9%) women and as showing some abnormalities of the uterine cavity in 135 (63.1%). In the former group, 51 patients had a normal uterine cavity, but 28 had abnormal findings on hysteroscopy, a false negative rate of 35.4%. Of 135 women with an abnormal HSG, hysteroscopy found a normal uterine cavity in 21, a false positive rate of 15.6%. The sensitivity of HSG was 80.3% in revealing intrauterine abnormality and its specificity was 70.1%. Although some abnormalities were identified by both methods in 114 women, findings of both procedures were similar in only 88 (77.2%). In 75 (35.0%), the findings of HSG differed from those of hysteroscopy. In only 139 (65%) patients were the findings (normal and abnormal) similar for both methods.

CONCLUSIONS

We advocate hysteroscopy in the investigation of female infertility for its accuracy, safety, simplicity, and convenience.

Surgical treatment of hepatocellular carcinoma with biliary tumor thrombi

Treatment is always abandoned in those HCC with jaundice, because it is usually attributed to the underlying liver cirrhosis and extensive tumor. In this series, 7 cases (0.8%) of HCC with jaundice were caused by bile duct invasion and tumor thrombi (BTT). 57% of cases showed Charcot's triad. 57% of BTT were small HCC, significantly higher than the 1.7% of total cases (p<0.05). The growth pattern of BTT was all spreading type, significantly higher than the 42% of total operation cases (p<0.05). The DNA ploidy of BTT was all aneuploid. 57% of BTT had AFP level higher than 400 IU/ml, but it was 27% in total cases. The prognosis is poor in those treated with palliative tube drainage. Aggressive hepatic resection was proved to be safe and achieved the best results in our limited experience. Choledochotomy to remove tumor thrombi is contraindicated because it easily causes tumor seeding. It is advocated to search BTT for resection from the group of HCC with jaundice.

Management of perineal endometriosis

OBJECTIVE

To demonstrate the appropriate diagnosis and management of perineal endometriosis.

METHOD

Six patients with perineal endometriosis were diagnosed according to their clinical symptoms and signs which included cyclic perineal pain and a tender perineal mass coinciding with the menstrual cycle. Diagnostic tools used included ultrasonography, computerized tomography, fine needle aspiration cytology and laparoscopy. Management comprised both surgical and medical treatment. Postoperative follow-up was carried out at 3-monthly intervals.

RESULTS

All six patients were cured following surgical excision of the endometrioma.

CONCLUSION

A detailed history, thorough pelvic examination and sonographic investigation are essential in diagnosing perineal endometriosis. The role of other diagnostic tools remains controversial. Treatment of extrapelvic endometriosis includes surgical intervention and hormonal suppression. If hormonal suppression fails, surgical excision of the perineal endometrioma should be carried out.

Ovarian Sertoli-Leydig cell tumor in an amenorrheic hirsute patient

As ovarian Sertoli-Leydig cell tumors are extremely rare, it appears worthwhile to report cases with uncommon clinical and/or laboratory findings. A 37-year-old nulligravida female was referred because of secondary amenorrhea and hirsutism for 11 years. She appeared virilized with a male body habitus. The highest plasma testosterone (T) level was 1,070 ng/dl. A laparotomy with salpingo-oophorectomy was performed and the pathological report confirmed the presence of Sertoli-Leydig cell tumor of intermediate differentiation. Ovarian venous T value was 5,690 ng/dl. The patient was alive and well with improved hirsutism 4 years after the operation. The duration of symptoms and T level in our patient were among the highest values ever recorded in the literature. This supports the slowly progressive nature of the tumor and emphasizes that Sertoli-Leydig cell tumors should be included in the differential diagnosis of patients with elevated T level regardless of the duration of clinical symptoms.

Early discontinuation of gonadotropin-releasing hormone agonist in controlled ovarian hyperstimulation: a preliminary report

The purpose of this study was to evaluate the applicability of continuing daily injectable GnRHa, after pituitary desensitization, for the first 4 or 5 days of ovarian stimulation. We proposed a new calculation and estimated that it took as early as 6 to 7 days for pituitary and gonadotropin release to return after cessation of daily administered leuprolide acetate. A modified regimen based on this new calculation, i.e. Daily administered GnRHa continued for the first 4 or 5 days with ovarian stimulation after pituitary desensitization had been achieved was applied to patients undergoing assisted reproductive technology (ART). Thirty-five patients prospectively assigned to use this early discontinuation regimen were analyzed with respect to age, indications, duration of ovarian stimulation, dose of exogenous gonadotropin required, ovarian response and oocytes obtained, rate of fertilization, and rates of pregnancy. There was no spontaneous LH surge occurred. Premature luteinization occurred in one patient. We concluded that, after pituitary desensitization, there was no spontaneous LH surge when daily administered GnRHa continued for 4 or 5 days only with ovarian stimulation. Impacts on the ART outcome required further evaluation in a prospectively randomized study. Based on theoretical estimation, cessation of GnRHa at the beginning of ovarian stimulation might eliminate most, but not all, spontaneous LH surges.

Primary nonkeratinized epithelial (conjunctival) orbital cyst: a case report

We report a 24-year-old male patient with the chief complaint of a slowly progressive tumor-growth over the supero-nasal quadrant of his left orbit over the previous 3 years. Physical examination disclosed negative systemic abnormality except ocular finding. Ophthalmological check-up revealed a firm mass palpable over the medial portion of left upper eyelid. CT scan was performed and revealed a well-defined cystic mass without involvement of adjacent bony structure. Finally, he underwent superior orbitotomy and the specimen was sent for histopathological studies. Histological sections showed a cystic structure lined with nonkeratinized squamous epithelium in which some goblet cells were present. This is the first case report of primary conjunctival orbital cyst in Taiwan, also, we believe, the first case in Asia.

A case-control study of oral cancer in Changhua County, Taiwan

Forty oral cancer patients identified consecutively in Changhua Christian Hospital between 1990 and 1992 were compared with 160 population-based controls, matched for sex, age, area of residence, and educational background. Betel quid chewing was positively associated with the risk of oral cancer with adjusted odds ratio of 58.4 (95% CI: 7.6-447.6). The greater the number of years of chewing betel quid, the higher the risk of oral cancer; the adjusted odds rations were 12.9, 93.7 and 397.5 for < 21, 21-40, and > 40 years of betel chewing as compared with the non-users. The risk also increased with the quantity chewed per day; the odds ratios for those chewing < 10, 10-20 and > 20 quids/day were 26.4, 51.2 and 275.6, respectively. These odds ratio estimates were all statistically significantly different from the null value of unity.

Early diagnosis of necrotizing fasciitis by utilization of ultrasonography

Necrotizing fasciitis is a rare and rapid progression soft tissue infection. The only identifiable feature is tissue necrosis along a single fascia plane. Because the skin is initially spared, it is difficult for early recognition prior to extensive tissue destruction. Ultrasonography was used for early diagnosis of this infection in five cases. All 5 patients presented with severe cellulitis. Under the suspicion of necrotizing fasciitis, ultrasonography was performed before surgical debridement. Tissue biopsy was done for histological confirmation of the diagnosis. Three patients were proven to have necrotizing fasciitis and two cellulitis only. The ultrasonographic findings of necrotizing fasciitis included: 1) irregularity of the fascia; 2) abnormal fluid collections along the fascia plane; and 3) diffuse thickening of the fascia when compared with the control site in the normal limb. However, in severe infectious cellulitis, the above mentioned findings were not observed. Our results indicate the usefulness of the ultrasonography for early diagnosis of necrotizing fasciitis.

Self-expandable metallic stents in the management of malignant biliary obstruction

To overcome problems with conventional plastic endoprostheses, a study was conducted to determine the clinical efficacy of self-expandable metallic stents in the palliative treatment of malignant biliary obstruction. From May 1994 to March 1995, 19 self-expandable metallic stents were implanted in 13 consecutive patients with malignant obstructive jaundice due to cholangiocarcinoma (four patients), ampullary carcinoma (six), pancreatic carcinoma (one), and hepatic hilar lymph node metastasis (two). All patients underwent percutaneous transhepatic biliary drainage followed by stent insertion, except for two patients where the T-tube tract was used as access and another with previous placement of a polyethylene internal-external drainage catheter for more than 6 months. When both lobes of the biliary system were to be drained, stents were placed either side by side through punctured, separate hepatic ducts or, using a T configuration, through a single transhepatic tract. Percutaneous transhepatic stent placement was technically successful in all patients. After a mean follow-up of 5.9 months (range, 1-10 mo), 10 of 13 patients were still alive while three had died of nonprocedure-related causes. In 10 patients, total serum bilirubin levels decreased significantly (from 136.8 +/- 157 mumol/L to 34.2 +/- 22.2 mumol/L), while it increased in three patients. Two patients had stent occlusions at 2 and 3 months after stent placement, which required intervention. The overall patency period ranged from 1 to 9 months (mean, 5.1 mo). Our results confirm that the use of metallic stents is effective in the palliative treatment of malignant jaundice.

Expression of Epstein-Barr virus in carcinomas of major salivary glands: a strong association with lymphoepithelioma-like carcinoma

To elucidate the role of Epstein-Barr virus (EBV) in salivary gland carcinomas, 56 cases of carcinomas of major salivary glands were investigated. These included 14 mucoepidermoid carcinomas, 13 adenoid cystic carcinomas, seven malignant mixed tumors, four adenocarcinomas, four salivary duct carcinomas, two acinic cell carcinomas, two undifferentiated carcinomas without lymphoid stroma, seven lymphoepithelioma-like carcinomas (LELCs), two squamous cell carcinomas, and one small cell carcinoma. EBV transcripts were examined by in situ hybridization using digoxigenin-labeled oligonucleotide antisense probe for EBV-encoded RNA 1 (EBER1) on formalin-fixed paraffin-embedded tissue sections. EBER1 was detected in the malignant epithelial cells in all seven cases of LELC, but not in any of the other carcinomas and the neighboring normal salivary gland tissue. Because all the EBV-negative cases showed satisfactory labeling with the poly d(T) probe, the negative reaction with EBER1 was unlikely to be caused by poor RNA preservation in the tissues. The seven cases of LELC, which were histologically indistinguishable from undifferentiated nasopharyngeal carcinoma (NPC), had a disease-free 4-year survival rate of 85.7%. The results suggest that LELC of the salivary gland in Taiwanese Chinese may share similar EBV-related pathogenesis with that of NPC.

The expression of cytokines by an established basal cell carcinoma cell line (BCC-1/KMC) compared with cultured normal keratinocytes

A basal cell carcinoma (BCC) cell line (BCC-1/KMC) has recently been successfully established from a patient. The production of interleukin-1 alpha (IL-1 alpha), IL-1 beta, IL-6 and IL-8 was assessed in comparison with that of cultured normal keratinocytes. The mRNA expression of these cytokines was measured by a reverse transcriptase-polymerase chain reaction (RT-PCR) method and the protein production by an ELISA. The cultured BCC cells spontaneously secreted more IL-6 and IL-8 but less IL-1 than the keratinocytes after culture for 24 h at 37 degrees C. It is suggested that the increased expression of IL-6 and IL-8 may indicate the transformation of normal keratinocytes to locally aggressive BCC.

Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome

PURPOSE

To correlate imaging findings of types I and II emphysematous pyelonephritis (EPN) with clinical course and prognosis.

MATERIALS AND METHODS

The imaging studies and clinical outcome in 38 patients with EPN were retrospectively studied. The imaging studies performed included radiography (n = 33), computed tomography (n = 31), and ultrasonography (n = 35).

RESULTS

Two types of EPN were identified. Type I EPN was characterized by parenchymal destruction with either absence of fluid collection or presence of streaky or mottled gas. Type II EPN was characterized as either renal or perirenal fluid collections with bubbly or loculated gas or gas in the collecting system. The mortality rate for type I EPN (69%) was higher than that for type II (18%). Type I EPN tended to have a more fulminant course with a significantly shorter interval from clinical onset to death (P < .001).

CONCLUSION

Two distinct types of EPN can be seen radiologically, and the differentiation is important due to the prognostic difference.

Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis

BACKGROUND/AIMS

Laparoscopic cholecystectomy is the standard treatment for symptomatic cholecystolithiasis; however, there is debate on the management of patients with concomitant common bile duct stones. Several options have been suggested; endoscopic sphincterotomy and laparoscopic common bile duct exploration seemed to be the preferred methods at this moment.

MATERIALS AND METHODS

We performed endoscopic sphincterotomy prior to laparoscopic cholecystectomy in 51 cases of acute symptomatic cholelithiasis.

RESULTS

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy procedure-related complication rate was 5.4%, including 1 pancreatitis, 1 cholangitis, and 2 major bleeds. After follow up period of 15-42 months, recurrent stones were found in 2 patients.

CONCLUSION

Endoscopic sphincterotomy combined with laparoscopic cholecystectomy is a safe and effective therapy for symptomatic cholecystolithiasis with concomitant choledocholithiasis. Recurrent stones did occur, but further studies are needed to compare the incidence of recurrent stones after endoscopic sphincterotomy and after laparoscopic common bile duct exploration.

Xanthogranulomatous cholecystitis: a complication of metallic biliary stent placement

We present a case of 70-year-old female patient who was admitted due to progressive jaundice. Our clinical impression of cholangiocarcinoma (Klatskin tumor), was confirmed by ultrasound, abdominal CT scan, and percutaneous transhepatic cholangiography. Two self-expanding metallic stents were placed in both intrahepatic ducts through a single transhepatic tract. After successful biliary stenting, the jaundice subsided and she was discharged as improved. However, progressive right upper quadrant pain was noted a few days after discharge and persisted for about 5 months, thus the was readmitted. During admission, she was febrile, exhibiting leukocytosis, with clinical signs of impending septic shock. Gallbladder empyema with hilar cholangiocarcinoma were diagnosed. Percutaneous transhepatic cholecystotomy and drainage (PTCCD) was done to alleviate the symptoms and cholecystectomy was performed thereafter. Pathologic report was compatible with xanthogranulomatous cholecystitis. Post-operative recovery was fair at follow-up examination.