PURPOSE: We present our experience of a retroperitoneoscopic nephrectomy for a benign renal disease, and evaluate the clinical efficacy and safety of a retroperitoneoscopic nephrectomy. MATERIALS AND METHODS: The clinical results of 20 retroperitoneoscopic nephrectomies (RN) were compared with 20 open nephrectomies (ON). The surgery time, hospital stay, analgesic requirements, and complications were analysed. RESULTS: The mean operative time was 255.2 +/- 72.5 minutes for the RN patients and 161.1 +/- 22.7 minutes for the ON patients (p< 0.05). The mean hospital stay was 4.2 +/- 1.1 days for the RN patients and 9.0 +/- 1.1 days for the ON patients (p< 0.05). The analgesic dose was 80.0 +/- 23.4mg of piroxicam for RN and 240.0 +/- 26.8mg of piroxicam for the ON patients (p< 0.05). Minor and major complications occurred in 4 (20%) patients who underwent a RN and 12 (60%) patients who underwent an ON (p< 0.05). Of the 23 retoroperitoneoscopic nephrectomies, an open conversion was necessary in 3 (13%) patients. CONCLUSIONS: While operative time is longer in RN patients than ON patients, the postoperative hospital stay, analgesic requirement and complication rate are significantly lower than in ON patients. Retroperitoneoscopic nephrectomy appears to be a safe and effective alternative to a traditional open nephrectomy.
Humans ; Length of Stay ; Nephrectomy* ; Operative Time ; Piroxicam

PURPOSE: We present our experience of a retroperitoneoscopic nephrectomy for a benign renal disease, and evaluate the clinical efficacy and safety of a retroperitoneoscopic nephrectomy. MATERIALS AND METHODS: The clinical results of 20 retroperitoneoscopic nephrectomies (RN) were compared with 20 open nephrectomies (ON). The surgery time, hospital stay, analgesic requirements, and complications were analysed. RESULTS: The mean operative time was 255.2 +/- 72.5 minutes for the RN patients and 161.1 +/- 22.7 minutes for the ON patients (p< 0.05). The mean hospital stay was 4.2 +/- 1.1 days for the RN patients and 9.0 +/- 1.1 days for the ON patients (p< 0.05). The analgesic dose was 80.0 +/- 23.4mg of piroxicam for RN and 240.0 +/- 26.8mg of piroxicam for the ON patients (p< 0.05). Minor and major complications occurred in 4 (20%) patients who underwent a RN and 12 (60%) patients who underwent an ON (p< 0.05). Of the 23 retoroperitoneoscopic nephrectomies, an open conversion was necessary in 3 (13%) patients. CONCLUSIONS: While operative time is longer in RN patients than ON patients, the postoperative hospital stay, analgesic requirement and complication rate are significantly lower than in ON patients. Retroperitoneoscopic nephrectomy appears to be a safe and effective alternative to a traditional open nephrectomy.
Humans ; Length of Stay ; Nephrectomy* ; Operative Time ; Piroxicam

Twenty-five isolates of Pythium species were identi6ed and classified on the basis of RFLP(restriction fragment length polymorphism) of ITS(internal transcribed spacer) region in ribosomal DNA. and M-13 PCR markers. Eight restriction endonucleases were used to investigate the genetic relatedness among isolates P. graminicola and P. arrhenomanes as well as P. aphanidermatum and P. delience produced identical band patterns with all restriction endonucleases used and M-13 markers. P. myriotylum and P. catenulatum also formed tight cluster on the basis of RFLP of ribosomal DNA but produced distinct band pattern with M-13 PCR markers. No intraspecitic variations were observed with RFLP of ITS region in ribosomal DNA. Molecular analysis based on M-13 marker demonstrated that each species produced distinct band patterns. Intraspecific variation of P. ultimum and P. torulosum was observed with M-13 markers.
DNA Restriction Enzymes ; DNA, Ribosomal* ; Polymerase Chain Reaction* ; Polymorphism, Restriction Fragment Length* ; Pythium*

Three hundred and sixty five samples of avian droppings, collected from parks and zoo, were investigated for the occurrence of Cryptococcus neoformans in Korea. Thirteen samples were positive for C. neoformans. All isolates were obtained from withered pigeon droppings. Identification and serotyping of isolates were determined by means of serological test and polymerase chain reaction (PCR) fingerprinting. All isolates belonged to C. neoformans var. grubbi (serotype A).
Columbidae* ; Cryptococcus neoformans* ; Cryptococcus* ; Dermatoglyphics ; Korea* ; Polymerase Chain Reaction ; Serologic Tests ; Serotyping

PURPOSE: Graves' disease presenting concurrently with thyroid cancer is a rare condition. The clinical behaviors and the extent of surgery in this condition is still controversial. This study examined the prognostic factors influencing the long-term outcomes as well as the appropriate treatment modalities in patients with Graves' disease presenting concurrently with thyroid cancer. METHODS: Forty nine patients who underwent surgery for thyroid cancer with Graves' disease were enrolled in this study. The outcomes of various types of surgical treatments as well as the factors associated with the long-term outcome were retrospectively analyzed. RESULTS: There were 42 women and 7 men with a median age 39 years (15~70 years). The surgical procedures included a bilateral subtotal thyroidectomy (n=17), a bilateral total thyroidectomy (n=16), and a total and contralateral subtotal thyroidectomy (n=16). The mean follow-up period was 83 months (4~218 months) after surgery. Disease-free survival at 5 and 10 years were 97.6% and 88.9%, respectively. Univariate log-rank survival analyses revealed that the age at diagnosis, the size of the thyroid cancer, capsular invasion, multiplicity, lymph node involvement, and clinical cancer to be poor prognostic factors. However, the extent of the surgical treatment was not significant for survival. CONCLUSION: The prognosis is expected to be poor when thyroid cancer presenting concurrently with Graves' disease is clinically apparent or has invaded the thyroid capsule. Patients with Graves' disease should be screened with ultrasonography to detect thyroid cancer. A total thyroidectomy or completion total thyroidectomy is not necessary in patients who do not have any of the poor prognostic factors, such as incidentally detected microcarcinoma postoperatively.
Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Lymph Nodes ; Male ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

PURPOSE: The aims of this study were to introduce an alternative surgical technique using a ballooning catheter and assess the outcomes of its use in patients with an upper mediastinal mass originated from the thyroid gland. METHODS: Between May 2001 and April 2004, 8 patients undewent an operation via a cervical approach using a ballooning catheter were enrolled in this study. The study group was reviewed by their clinical characteristics, diagnostic methods, postoperative results, histopathological findings and prognosis. Instead of a sternotomy, a ballooning catheter technique was used to assist in the transcervical delivery and extraction of these huge or deep mediastinal masses. The ballooning catheter was placed at the base of the mediastinal mass via a narrow plane which could not be reached by the surgeon's fingers. When the mediastinal mass was freed up by careful dissection with traction using an inflated ballooning catheter, could the mass was able to be delivered without injury to the surrounding tissues. RESULTS: There were 3, 2 and 3 cases of substernal goiters, substernal goiters combined with a papillary microcarcinoma and metastatic papillary carcinoma from thyroid cancer, respectively. The mean operation time and period of hospitalization were 121 minutes, (ranging from 70 to 195 minutes), and 6 days, (ranging from 3 to 10 days), respectively. In the 5 cases with a substernal goiter, the average size of the resected specimen was 9.9 cm, (ranging from 5.5 to 17.6 cm), with an average weight of 100.2 g, (ranging from 45 to 172.2 g). In the 3 cases of metastatic mediastinal lymph nodes, the postoperative 131I scan and serum thyroglobulin level showed no evidence of remnant metastatic tissue or cancer spillage. The median follow up duration was 24.8 months (ranging from 13 to 42 months). No major complications were documented, and no evidence of recurrence was encountered. CONCLUSION: The use of the ballooning catheter was found to be helpful in the transcervical removal of an upper mediastinal mass, and useful for substernal goiters. Furthermore, for mediastinal lymph node metastasis, this technique can be adopted as an alternative method in carefully selected cases.
Carcinoma, Papillary ; Catheters* ; Fingers ; Follow-Up Studies ; Goiter, Substernal ; Hospitalization ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Sternotomy ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Traction

The use of mesenchymal stem cells (MSCs) has emerged as a potential new treatment for myocardial infarction. However, the poor viability of MSCs after transplantation critically limits the efficacy of this new strategy. The expression of microRNA-210 (miR-210) is induced by hypoxia and is important for cell survival under hypoxic conditions. Hypoxia increases the levels of hypoxia inducible factor-1 (HIF-1) protein and miR-210 in human MSCs (hMSCs). miR-210 positively regulates HIF-1alpha activity. Furthermore, miR-210 expression is also induced by hypoxia through the regulation of HIF-1alpha. To investigate the effect of miR-210 on hMSC survival under hypoxic conditions, survival rates along with signaling related to cell survival were evaluated in hMSCs over-expressing miR-210 or ones that lacked HIF-1alpha expression. Elevated miR-210 expression increased survival rates along with Akt and ERK activity in hMSCs with hypoxia. These data demonstrated that a positive feedback loop involving miR-210 and HIF-1alpha was important for MSC survival under hypoxic conditions.
Cell Survival ; Cobalt ; Gene Expression Regulation/*physiology ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit/genetics/*metabolism ; Mesenchymal Stromal Cells/drug effects/metabolism/*physiology ; MicroRNAs/*metabolism ; Oxygen/pharmacology ; *Oxygen Consumption ; RNA, Small Interfering/metabolism

OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of mirtazapine treatment in multicenter population consisting of Korean patients suffering from moderate-to-severe depression. METHODS: Total 163 of in and outpatients with a diagnosis of major depressive disorder (DSM-IV) and 18 or over scores of 17-items Hamilton Rating Scale for Depression (HAMD) received treatment with mirtazapine (15-45 mg/day) for 6 weeks. Efficacy was assessed by HAMD, Montgomery and Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI), and Clinical Global Impression (CGI) scales and statistical analyses were performed on the intent-to-treat sample (143 patients) using the last-observation-carried-forward method. In addition, reported adverse events, routine laboratory parameters, and vital signs were investigated to evaluate the safety of mirtazapine. RESULTS: Mean daily dose of mirtazapine was 28.4 mg. At the end of the study, the response rate (50% or more reduction from baseline in HAMD scores) was 75.5% and the remission rate (7 or less in HAMD score) was 42.7%. Mirtazapine treatment induced significant reduction in depressive symptoms at the 4(th) day and substantial reduction along the treatment period, as assessed by changes in HAMD, MADRS, BDI, and CGI scales. At the 4(th) day and first week of mirtazapine treatment, the mean HAMD-17 total score was significantly reduced compared that of the baseline and the response rates were 11.9% and 28.7%, respectively. Mirtazapine was well tolerated in general, and somnolence and sedation were the most common adverse events reported. In addition, there were no clinically relevant changes in laboratory parameters and vital signs, although body weight was increased. CONCLUSION: Although this trial had many limitations of open non-comparative study, mirtazapine was demonstrated to an effective treatment for moderate to severe major depressive disorder and was well tolerated. A potentially rapid onset of overall therapeutic efficacy of mirtazapine was suggested by significant changes in all major variables of efficacy after 4(th) day of treatment.
Body Weight ; Depression ; Depressive Disorder, Major ; Diagnosis ; Humans ; Outpatients ; Vital Signs ; Weights and Measures

OBJECTIVES: The purpose of this study was to evaluate the long-term efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open label study included 116 schizophrenic patients drawn from 19 university hospitals. After a wash-out period of 1 week, the patients were treated with risperidone for 56 weeks and evaluated at 8 points:at baseline, and the 8th, 16th, 24th, 32nd, 40th, 48th, 56th weeks of treatment. The dose was started at 2mg of risperidone on day 1, and increased to 4mg on day 2, and 6mg on day 3,7 and adjusted to a maximum of 16mg/day according to the individual's clinical response. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: Eighty-seven(75%) of 116 patients completed the 56-week trial of risperidone. Clinical improvement(as defined by a 20% of reduction in total PANSS score at end point) was shown by 92.0% of the patients. The mean dose of risperidone was 5.0mg/day in the 56 week follow-up. PANSS total scores showed significant improvements between consecutive two points at baseline, 8th, 16th, 24th, 32nd, and 48th week of treatment. CGI scores showed significant reductions between consecutive two points at baseline, 8th, 16th, 24th, and 48th week of treatment. Three PANSS factors(positive, negative, general) showed a significant improvement from the 8th week of treatment, and, after then, remained improved in the rest of the study period. ESRS showed no significant change during the 56 week trial. Laboratory parameters showed no significant changes during the course of treatment. CONCLUSIONS: This multicenter long-term open study suggests that risperidone is a antipsychotic drug with long term efficacy and safety in the treatment of schizophrenic patients.
Follow-Up Studies* ; Hospitals, University ; Humans ; Risperidone* ; Schizophrenia* ; Weights and Measures

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.
Dyskinesias ; Dystonia ; Electrocardiography ; Hospitalization ; Hospitals, University ; Humans ; Parkinsonian Disorders ; Risperidone* ; Schizophrenia* ; Vital Signs ; Weights and Measures