PURPOSE: Some recent studies have demonstrated that finasteride, a well- known 5alpha-reductase inhibitor, can decrease prostate specific antigen (PSA) by approximately 50% during the first 1 year of treatment. We investigated how long-term treatment with finasteride and alpha-blockers impacts on the serum PSA level of men whose final diagnosis was benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In a retrospective trial, we evaluated a total of 293 men with lower urinary tract symptoms (LUTS) that were suggestive of BPH. These men were divided into two treatment groups: group A was treated with alpha-blockers and group C was treated with a combination of finasteride and alpha-blocker. Comparisons of the two groups were performed by using independent t-tests. The changes in the PSA concentrations from baseline to the time of the final measurements were determined by repeated measures of ANOVA. RESULTS: There was no significant difference in the baseline PSA between the two groups. A statistically significant reduction in the PSA levels was observed at 2 years in C group (p<0.05), whereas any significant increase were not observed in group A (p>0.05). In group A, the repeatedly measured PSA levels were 2.67, 2.40, 2.41 and 2.42, respectively. In C group, these were 3.22, 2.09, 1.81 and 1.71 respectively. CONCLUSIONS: Our data showed that there was no clinically significant effect of long term treatment with alpha-blocker on the PSA levels. However, finasteride had significant effect on the serum PSA level during first two years of treatment.
Adrenergic Antagonists ; Diagnosis ; Finasteride* ; Follow-Up Studies* ; Humans ; Lower Urinary Tract Symptoms ; Male ; Oxidoreductases ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia* ; Retrospective Studies

We experienced a 61-year old man with Pneumocystis carinii pneumonia who had been diagnosed as having relapsed acute myelogenous leukemia(AML). He developed severe dyspnea in the nadir state after reinduction chemotherapy. His chest X-ray showed bilateral interstitial pneumonia in both lung fields. We started ventilator therapy and obtained sputum through the endotracheal tube. Typical P. carinii cysts were found in the sputum by Giemsa stain. No other organisms were found in thelavage sediments. From clinical observation and the presence of typical P. carinii cysts, the patient was diagnosed as having P. carinii pneumonia and was treated with sulfamethoxazole/trimethoprim and glucocorticoid. This was the first reported case of P. carinii pneumonia in an AML patient undergoing chemotherapy in Korea.
Azure Stains ; Drug Therapy ; Dyspnea ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid, Acute* ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Sputum ; Thorax ; Ventilators, Mechanical

PURPOSE: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. MATERIALS AND METHODS: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared. RESULTS: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups. CONCLUSION: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Colectomy/*adverse effects/methods ; Female ; Humans ; Inflammation/etiology/metabolism ; Insulin-Like Growth Factor Binding Protein 3/blood ; Interleukin-6/blood ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Period ; Sigmoid Neoplasms/*surgery ; Treatment Outcome ; Vascular Endothelial Growth Factor A/blood

PURPOSE: We aimed to assess the influence of the clinical and pathological factors on the multifocality of renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 467 patients (mean age: 54.6 years) who underwent operation for renal cell carcinoma at this hospital between June 1995 and April 2004. We evaluated the pathologic stage, grade, cell type, the histological pattern, tumor necrosis, the tumor size and the features of multifocality. To determine the clinical significant factors related with multifocality in renal cell carcinoma, we used the chi square test and multiple logistic regression analysis. RESULTS: Of the 467 renal cell carcinomas, 27 cases (5.8%) had multifocal malignant nodules. The average size of the multifocal renal lesions was 17x12x9 mm. The incidence of multifocality was statistically higher in the patients with stage pT3 disease than in those patients with stage pT1 or pT2 disease (p<0.001), and it was also higher for those patients with nuclear grade 3 or 4 than for those patients with nuclear grade 1 and 2 (p=0.005). Only the stage had significant correlation with multifocal disease when performing multiple logistic regression analysis. CONCLUSIONS: Our results suggest that the primary tumor stage is a risk factor for multifocality in the patients with renal cell carcinoma. Therefore, more precise preoperative staging of the primary tumor is required in case of performing nephron sparing surgery.
Carcinoma, Renal Cell* ; Humans ; Incidence* ; Logistic Models ; Necrosis ; Nephrectomy* ; Nephrons ; Retrospective Studies ; Risk Factors

PURPOSE: As the first-line pharmacotherapy for erectile dysfunction (ED), phosphodiesterase type 5 (PDE5) inhibitors are widely used and their clinical efficacy is well established. But up to now, most of these comparative studies have been based on questionnaires, and Udenafil and Mirodenafil, which have recently been developed in South Korea, have not yet to be compared in clinical studies. We compared and analyzed the efficacy of five PDE5 inhibitors using the sexual stimulated (SS)-Penogram. MATERIALS AND METHODS: A total of 347 patients taking PDE5 inhibitors for the treatment of ED and underwent SS-Penogram was enrolled in this study. AUC (area under the curve) of SS-Penogram was compared in each PDE5 inhibitors. Differences in AUC according to age, combined disorders, serum testostereone and prolactin, cholesterol and IIEF were also analysed using Chi-square and Kruskal-Wallis test. P-value less than 0.05 was considered as statistically insignificant. RESULTS: Ratios of Type I curves in medication groups with normal erection were not statistically different before and after medication. Ratios of the excellent response (>50 % increase in area under the curve) and non-response groups (no increase or even decrease in area under the curve) in each medication group were not statistically different. CONCLUSIONS: In this clinical comparative study of the efficacy of PDE5 inhibitors using the SS-Penogram, there were no definite differences in efficacy among PDE5 inhibitors.
Area Under Curve ; Cholesterol ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Erectile Dysfunction ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; Prolactin ; Pyrimidines ; Pyrimidinones ; Surveys and Questionnaires ; Republic of Korea ; Sulfonamides

PURPOSE: We assessed the impact of using a porcine model on the training of laparoscopic partial nephrectomy(LPN) and compared the training effectiveness between surgeons with and without previous laparoscopic experience. MATERIALS AND METHODS: Surgeon A had previous laparoscopic experience, with the exception of LPN, while surgeon B had no prior laparoscopic experience. A tumor model was created by subcapsular injection of liquid plastic(Smooth-Cast 320) in the kidney. We recorded the total operation time, the bowel dissection time, the renal pedicle dissection time, the warm ischemic time, the mass resection time, the suture time, and the presence of major complications for each surgeon. RESULTS: The mean operation time was significantly shorter for surgeon A compared to surgeon B(49.1+/-4.5 and 63.6+/-8.4 minutes, respectively, p<0.001). Although the mass resection time was significantly shorter for surgeon A as well, there were no significant differences between the two surgeons in terms of warm ischemia time and suture time. As the training progressed, surgeon B improved in all surgical steps and surgeon A showed improvement in time for warm ischemia and suturing the defect. Five complications occurred(two cases by surgeon A and three cases by surgeon B). CONCLUSIONS: A porcine model improved the skills needed for LPN, including shortening the warm ischemia and suture times. LPN is a procedure requiring technically-demanding skills that can be improved by training using a animal model, regardless of the previous laparoscopic experiences.
Animals

Extraskeletal osteosarcoma is a rare malignant tumor of the soft tissue. In addition, there are only several reported cases of osteosarcoma of the retroperitoneum as a primary site. We report here on a case of extraskeletal osteosarcoma arising in the retroperitoneum. An 80-year-old man visited our hospital because of a known renal mass. Abdominal computed tomography showed a 10cm sized huge renal mass. We then performed radical nephrectomy. The mass revealed a solid and ivory-colored cut surface with multifocally ovoid cystic spaces and hemorrhage. Microscopically, the tumor consisted of polygonal stromal cells, giant cells and varying amounts of neoplastic new bone; mitotic figures were frequently observed. There was no distant metastasis or regional lymph node involvement.
Aged, 80 and over ; Giant Cells ; Hemorrhage ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Nephrectomy ; Osteosarcoma* ; Stromal Cells

Inflammatory myofibroblastic tumor (IMT) is a very rare benign mass lesion. Inflammatory myofibroblastic tumor of genitourinary tract most frequently involves the urinary bladder. Renal inflammatory myofibroblastic tumor is rare. Renal inflammatory myofibroblastic tumor usually remain asymtomatic until the tumor occurs obstructive uropathy. We experienced a case of right renal inflammatory myofibroblastic tumor.
Granuloma, Plasma Cell ; Kidney* ; Myofibroblasts* ; Myofibroma ; Urinary Bladder

A 48-year-old man, with a history of advanced gastric cancer, underwent computed tomography (CT) for a postoperative 5 year follow-up. The CT scan showed a small bladder tumor. Pelvic magnetic resonance imaging and cystoscopy were performed consecutively, which revealed a small, ovoid and well-demarcated submucosal tumor at the anterior bladder, but without mucosal abnormality. The patient underwent a mass enucleation, which was 2x1.5x1cm in size, and light-pinkish, multi-lobulated and encapsulated. On the cut section, it was revealed to be a unilocular cyst, filled with brownish mucoid material. A histological examination showed focal stratified mucinous epithelium, without cellular atypia, which was admixed with mucinous pool formation. There was no evidence of a metastatic tumor or a tumor of urachal origin. Thus, it was diagnosed as a primary mucinous cystic neoplasm in the submucosa of the bladder, as initially thought, which has never been reported in the literature.
Cystoscopy ; Epithelium ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mucins* ; Stomach Neoplasms ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: The aim of this study was to evaluate the usefulness of a method for positioning the femoral stem in neutral position refer to the measured value of "lateral distance" in pre-operative templating and the femoral stem position post-operatively. MATERIALS AND METHODS: A total of 81 hips in 76 patients underwent cementless total hip arthroplasty between March 2008 and April 2012 using the C2 stem (Lima Corporate S.P.A, Udine, Italy). We measured the perpendicular distance from the lateral outermost part of the greater trochanter to the lateral outermost part of the femoral stem (lateral distance, LD) in pre-operative templating. We aimed to insert the femoral stem in neutral position by comparing LD measured intra-operatively. We evaluated the position of the femoral stem on post-operative plain radiography. We compared the result of post-operative re-measurement of the LD with that of pre-operative measurement. RESULTS: In all of the 81 cases, the femoral stem was inserted in neutral position, defined as the femoral stem position within 3degreesvalgus or varus. The average angle of the inserted femoral stem was 1.20degrees(0.003-2.85degrees). LD measured in preoperative templating was 15.6 mm(10-21.5 mm), and it showed no correlation ratio with LD; LD re-measured post-operatively was 15.9 mm(10.3-23.5 mm) (P=0.781). CONCLUSION: Measuring LD pre-operatively and using the value intra-operatively is an effective method for insertion of the femoral stem in neutral position.
Arthroplasty ; Femur ; Hip ; Humans