PURPOSE: Promoter methylation provides an alternative pathway for the loss of tumor suppressor gene functions. This epigenetic change is a new marker for human cancers. We herein investigated the aberrant methylation profile of bladder cancer to identify the epigenetic markers that are useful for the diagnosis of bladder cancer. MATERIALS AND METHODS: Gene promoter methylation was analyzed in 50 bladder transitional cell cancer (TCC) tissues and 30 nonmalignant bladder mucosal tissues including 21 tissue samples with normal histology and 9 tissue samples with inflammation. The methylation status of 13 tumor suppressor genes was analyzed by methylation specific polymerase chain reaction and bisulfite genomic sequencing. The methylation frequency and methylation index were comparatively analyzed in each group of tissues. RESULTS: Bladder TCC showed a high frequency of promoter hypermethylation for RASSF1A(62.0%), RARbeta2(54.0%), E-cadherin(48.0%), p16INK4A(46.0%), p14ARF(34.0%) and H-cadherin(32.0%), whereas, methylation was less common for MGMT(18.0%), DAPK(14.0%) and p15INK4B(10.0%), and methylation was rare for GSTP1(4.0%), FHIT(2.0%), APC(2.0%) and MLH1(2.0%). Benign bladder mucosa rarely showed aberrant methylation except for E-cadherin (10.0%) and RARbeta2(10.0%). The methylation index of bladder TCC(0.25) was significantly higher than that of the benign bladder mucosal tissues(0.03, p<0.01). Remarkably, all of the bladder cancer tissues showed aberrant methylation of at least one of 6 genes including RASSF1A, RARbeta2, p16INK4A, p14ARF, E-cadherin and H-cadherin, whereas only 5 of 30 (16.7%) benign bladder mucosa tissues showed the same findings. CONCLUSIONS: Aberrant promoter methylation of tumor suppressor genes may be a critical step in the development of bladder TCC. Aberrant promoter methylations of RASSF1A, RARbeta2, p16INK4A, p14ARF, E-cadherin and H-cadherin may be promising epigenetic markers for the diagnosis and follow up of bladder cancer.
Cadherins ; Diagnosis ; Epigenomics* ; Follow-Up Studies ; Genes, Tumor Suppressor ; Humans ; Inflammation ; Methylation ; Mucous Membrane ; Polymerase Chain Reaction ; Tumor Suppressor Protein p14ARF ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: This study aimed to characterize the autonomic and chaotic control of heart rate and circadian rhythm in asymptomatic patients with postoperative tetralogy of Fallot (pTOF). METHODS: Twenty-four-hour electrocardiogram recordings were obtained in 30 asymptomatic pTOF patients and in 30 age-and sex-matched controls, aged between 6 and 11 years. The data was digitized and partitioned into sections of 30- minute'durations. For each section, time-domain and frequency-domain measures (low- and high- frequency component) of heart rate variability and three measures based on chaotic dynamics- approximate entropy, correlation dimension and Lyapunov exponent-were calculated. RESULTS: In pTOF patients, 24-hour mean values of the time domain measures, high-frequency component, and all chaotic measures were significantly lower, while 24-hour mean value and all 6-hour mean values of the low-frequency component were significantly higher; all 6- hour mean values of high-frequency component, except from 6am to midday, were significantly lower. In pTOF patients, all 6-hour mean values of all three chaotic measures were significantly lower. In pTOF patients, the day- night circadian variation seen in controls was diminished (time- domain measures) or absent (low- and high- frequency component). CONCLUSION: Even in asymptomatic patients with pTOF, who are thought to be at minimal risk of fatal arrhythmia, a sustained increase in sympathetic activity and decrease in vagal activity, abnormal circadian rhythm of the autonomic activity, and decreased cardiac chaos were found. When other arrhythminogenic risk factors are superimposed, these abnormalities may contribute to the development of fatal arrhythmia and sudden death.
Arrhythmias, Cardiac ; Child* ; Circadian Rhythm* ; Death, Sudden ; Electrocardiography ; Entropy ; Heart Rate ; Humans ; Risk Factors ; Tetralogy of Fallot*

PURPOSE: The formation of a liposarcoma is Known to be associated with a mutation of the p53 and MDM2 genes, and the histopathological subtypes of a liposarcoma are related to the prognosis of the patient. This study was performd to examine the relationship between the histopathological subtypes, the type of p53 mutation, and the proliferative rate. METHODS: Immunohistochemistry was used to measure the p53 protein and Ki-67 (Mib-1 labeling index) expression levels in 24 liposarcomas cases in which the liposarcoma developed primarily in the abdominal cavity. RESULTS: p53 expression was observed in 11.1% of the well- differentiated liposarcoma cases, 27.3% of the myxoid and round cell liposarcoma cases, and 50% of the pleomorphic liposarcoma cases. There were significant differences between the Ki-67 expression level according to the histopathological subtypes. There were significant differences between p53 positive or negative group and the Ki-67 expression level, and there was a quantitative correlation between them. CONCLUSION: The p53 protein was expressed in 25% of all liposarcomas, particularly in pleomorphic liposarcomas because it was expressed more frequently than in the other liposarcoma subtypes (in 2 cases out of 4 cases). The survival rate was much higher in the mucinous round cell liposarcomas which had high p53 and Ki-67 expression levels. The p53 expression level might be a prognostic predictor of a liposarcoma.
Abdominal Cavity ; Humans ; Immunohistochemistry ; Liposarcoma* ; Mucins ; Prognosis ; Survival Rate

STUDY DESIGN: A retrospective study OBJECTIVES: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results. SUMMARY OF LITERATURE REVIEW: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner. MATERIALS AND METHODS: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated. RESULTS: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms. CONCLUSIONS: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques.
Anti-Bacterial Agents ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Retrospective Studies ; Soft Tissue Injuries ; Spinal Stenosis ; Spondylitis ; Spondylolisthesis

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A 77-year-old man was referred for the evaluation of general weakness and leukocytosis. Computed tomography showed a 9.5×6.5-cm cavitary lesion with an air-fluid level near the stomach, which was thought to be a perigastric abscess. Upper endoscopy revealed a fistula on the greater curvature at the mid body of the stomach. The margin of the fistula opening was clearly demarcated, and yellow turbid fluid oozing from the fistula was seen. Laparoscopic wedge resection was performed at the perforated area of the stomach. Immunohistochemistry revealed CD117 expression. A diagnosis of intermediate-risk GIST was made. No recurrence was identified within 18 months after the operation. The final diagnosis was perforated gastric GIST communicating with the gastric lumen and presenting as an intra-abdominal abscess.
Abdominal Abscess ; Abscess* ; Aged ; Diagnosis ; Endoscopy ; Fistula ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Laparoscopy ; Leukocytosis ; Recurrence ; Stomach*

Neuroendocrine tumors (NETs) are a group of malignancies arising from neuroendocrine cells and frequently originate in the gastrointestinal tract and pancreas. Although curative resection is the main treatment for localized disease, systemic therapy is needed for relapsed or metastatic/unresectable gastroenteropancreatic NETs (GEP-NETs). Although there are several NET treatment guidelines from various countries, the geographical discrepancies between patient clinical characteristics, the regulatory approval status for therapeutic agents, and medical practices necessitate specific guidelines for Korean patients. We here provide a consensus review of the diagnosis, staging and systemic treatment of Korean GEP-NET patients. Systemic therapy options and the current Korean expert consensus on these treatments, including somatostatin analogs, targeted therapies such as everolimus and sunitinib, peptide receptor radionuclide treatments, and cytotoxic chemotherapies are addressed.

Neuroendocrine tumors (NETs) are a group of malignancies arising from neuroendocrine cells and frequently originate in the gastrointestinal tract and pancreas. Although curative resection is the main treatment for localized disease, systemic therapy is needed for relapsed or metastatic/unresectable gastroenteropancreatic NETs (GEP-NETs). Although there are several NET treatment guidelines from various countries, the geographical discrepancies between patient clinical characteristics, the regulatory approval status for therapeutic agents, and medical practices necessitate specific guidelines for Korean patients. We here provide a consensus review of the diagnosis, staging and systemic treatment of Korean GEP-NET patients. Systemic therapy options and the current Korean expert consensus on these treatments, including somatostatin analogs, targeted therapies such as everolimus and sunitinib, peptide receptor radionuclide treatments, and cytotoxic chemotherapies are addressed.

Subclavian and internal jugular vein catheters are widely employed for temporary hemodialysis access. Placement of subclavian venous catheter has many complications such as pneumothorax and hemothorax, etc. Incidence of subclavian vein obstruction due to thrombosis is probably greater than is commonly appreciated. Subclavian vein obstruction may cause no specific complaints, but thrombosis in the presence of an arteriovenous fistula may produce severe symptoms such as massive edema and pain. This is report of one patient, who developed massive edema of upper extremity and in whom proximal subclavian vein occlusion developed after previous percutaneous dialysis catheter. Right internal jugular vein to axillary vein bypass with 8mm PTFE provided prompt and effective venous outflow, with complete resolution of venous engorgement of the affected limb and preservation of the dialysis fistula.
Arteriovenous Fistula ; Axillary Vein ; Catheters ; Dialysis ; Edema ; Extremities ; Fistula ; Hemothorax ; Humans ; Hyperemia ; Incidence ; Jugular Veins ; Pneumothorax ; Polytetrafluoroethylene ; Renal Dialysis* ; Subclavian Vein* ; Thrombosis ; Upper Extremity

PURPOSE: To evaluate the long-term efficacy and safety of tamsulosin 0.2 mg once daily in Korean patients with lower urinary tract symptoms(LUTS) suggestive of benign prostatic obstruction(BPO) treated for up to 1 year. MATERIALS AND METHODS: Two hundred eleven patients were enrolled from 6 centers and 146 patients were included in the analysis. The primary efficacy parameters were improvements in the total, obstructive and irritative International Prostate Symptom Score(IPSS) and maximal urinary flow rate(Qmax). The secondary efficacy parameters were a decrease of >or=30% in IPSS and an increase of >or=30% in Qmax from baseline. Changes in parameters between baseline and 52 weeks were assessed using Student's paired t-test. RESULTS: Statistically significant, gradual improvements in all efficacy parameters were observed over the 1-year period. Tamsulosin 0.2 mg/day produced progressive improvements in total IPSS(41.1%) and Qmax(39.6%, 4.56 ml/sec)(p<0.001). Tamsulosin was well tolerated. The incidence of adverse events was only 6.2%. And There were no withdrawals as a result of adverse events. There were no significant changes in blood pressure or pulse rate during the study. CONCLUSION: Long-term 1-year treatment with tamsulosin 0.2 mg once daily in Korean BPO patients is safe, well tolerated and effective in improving LUTS and urinary flow. The effect on symptoms was apparent after 12 weeks of treatment, and symptom improvement was achieved for up to 1 year at every follow-up period respectively.
Blood Pressure ; Follow-Up Studies ; Heart Rate ; Humans ; Incidence ; Lower Urinary Tract Symptoms* ; Prostate ; Single-Blind Method* ; Urinary Tract

OBJECTIVES: We studied the circadian rhythm of nonlinear heart rate dynamics in healthy subjects. BACKGROUND: The frequency of sudden cardiac death increases in the morning. The relationship between decreased complexity of heart rate dynamics and sudden cardiac death has been documented. An understanding of the circadian variation in the complexity of cardiac dynamics may be important and to predict and prevent this sudden cardiac death. METHODS: Dynamic 24-hour electrocardiographic recordings were obtained from 30 healthy ambulant subjects aged 41 to 50 years and the digitized data was partitioned into sections of 30 minutes' duration. For each section, four indexes obtained from separate algorithms of nonlinear dynamics of RR interval - correlation dimension, Lyapunov exponent, approximate entropy, and fractal dimension - were calculated. Normalized low- (0.04-0.1 hertz) and high-frequency (>0.15 hertz) components were also calculated. RESULTS: All the four indexes of nonlinear dynamics showed a remarkably similar circadian rhythm: a prominent morning dip preceded by a steep decline during the late night, a recovery during the evening and a peak around midnight. In the morning, the low frequency component rose rapidly with concomitant withdrawal of the high frequency component. CONCLUSION: The complexity of cardiac dynamics decreases significantly in the morning, and this may contribute to the ominously increased rate of cardiac death in the morning hours.
Circadian Rhythm* ; Death ; Death, Sudden, Cardiac ; Electrocardiography ; Entropy ; Fractals ; Heart Rate ; Nonlinear Dynamics