PURPOSE: To compare the outcomes of endonasal dacryocystorhinostomy in patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy. METHODS: We retrospectively reviewed the clinical records of patients diagnosed with secondary lacrimal drainage obstruction after systemic chemotherapy or radioactive iodine therapy for thyroid disease and surgical treatment by endonasal dacryocystorhinostomy between January 2009 and January 2015. The control group included randomly selected patients who underwent endonasal dacryocystorhinostomy after diagnosis of primary lacrimal drainage obstruction. RESULTS: Patients were separated into a chemotherapy group (13 eyes of 9 patients), a radioactive iodine therapy group (44 eyes of 32 patients), and a control group (50 eyes of 40 patients). Duration from the onset of systemic chemotherapy or radioactive iodine to the first epiphora symptom was shorter in the chemotherapy group than the radioactive iodine therapy group (p < 0.001). There was no significant difference between the three groups in success rate of endonasal dacryocystorhinostomy. CONCLUSIONS: Most patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy had successful outcome of endonasal dacryocystorhinostomy. The success rate of dacryocystorhinostomy was comparable to that in patients with primary lacrimal drainage obstruction.
Dacryocystorhinostomy* ; Diagnosis ; Drainage* ; Drug Therapy* ; Humans ; Iodine* ; Lacrimal Apparatus Diseases ; Retrospective Studies ; Thyroid Diseases

PURPOSE: To analyze the morphologic differences in blowout fracture seen on preoperative CT images compared to intraoperative images. METHODS: The present study included 63 patients (63 eyes) with orbital fractures that were repaired by orbital reconstruction between January 2009 and April 2010. We assessed the medial, inferior, and inferomedial orbital fractures and excluded superior and lateral wall fractures. We captured intraoperative blowout fracture images using a camera or endoscope and compared the fracture type (fracture size, fracture surface) seen on intraoperative images with that observed on the preoperative CT images. RESULTS: The study consisted of patients between 20 and 50 years of age with a mean age of 27.76 years (men: 49 eyes, women: 14 eyes). The proportions of small fractures and medium fractures were similar on the preoperative CT images; however, large fractures were observed more frequently on the intraoperative images. The proportions of mono-fragment fractures and multi-fragment fractures were similar on the preoperative CT images, but multi-fragment fractures, especially inferior orbital fractures, were more frequent on the intraoperative images. Features of the trapdoor fracture differed most between images in terms of fracture size and surface. CONCLUSIONS: The morphology of blowout fractures, especially trapdoor fractures, differed between preoperative CT images and intraoperative images.
Endoscopes ; Eye ; Humans ; Orbit ; Orbital Fractures

We encountered a patient with cystoid macular edema (CME) secondary to paclitaxel use. A 57-year-old man presented with gradual decreased bilateral vision. His chemotherapeutic regimen consisted of bevacizumab, paclitaxel (175 mg/m2 for 5 months), and carboplatin. Optical coherence tomography imaging revealed bilateral CME greater than 500 microm. However, one year later, visual acuity was improved, best-corrected Snellen visual acuity was 40 / 80 in each eye, and CME was spontaneously improved. Our study confirmed that macular edema associated with paclitaxel use shows spontaneous resolution and improvement of visual acuity after a change of chemotherapeutic regimen.
Adenocarcinoma/drug therapy ; Antineoplastic Agents, Phytogenic/*adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Humans ; Lung Neoplasms/drug therapy ; Macular Edema/*chemically induced ; Male ; Middle Aged ; Paclitaxel/*adverse effects ; Remission, Spontaneous ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: We evaluated the clinical significance of simultaneous transurethral resection of bladder tumor(TURB) and the prostate(TURP) in patients who have superficial bladder cancer with bladder outlet obstruction. MATERIALS AND METHODS: Between April 1997 to April 2006, 213 patients with superficial bladder cancer were included in this study. The patients were treated with TURB only(n=107, Group I) or TURB with TURP (n=106, Group II). Bladder cancer recurrence was observed by performing cystoscopy and urine cytology. Uroflowmetry was performed three months after surgery. RESULTS: There were no significant differences in age, the tumor size or the number of tumors between groups I and II. There was no evidence of cancer implantation where TURP was applied. The recurrence rate of group II was significantly lower than that of group I(p=0.044), and the time to recurrence was longer for group II than for group I(p=0.026). There was no significant difference in the progression rate between the two groups(p=0.788). Three months after surgery, the mean residual urine volume was lower for group II(7.9ml) than that for group I(21.7ml). CONCLUSIONS: For superficial bladder cancer patients with bladder outlet obstruction, simultaneous TURB and TURP may help reduce the bladder cancer recurrence rate and delay the time to recurrence without the risk of cancer implantation at the site where TURP is applied.
Cystoscopy ; Humans ; Prostate ; Recurrence ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder Neoplasms

PURPOSE: To examine the trend, and investigated the possibilities as a prediction tool by choosing the trend score about male and urologic cancers have the high incidence rate. MATERIALS AND METHODS: We selected 5 major male and 3 major urologic cancers for past 3 years (from 2010 to 2012) and examined the incidence rate, and using Naver and Google trend, the rate of cancer incidence was compared with the trend score during the same period. RESULTS: From 2010 to 2012, the greatest occurrence of the cancer to males was the stomach cancer, followed by colon, lung, liver, and prostate cancer. In the urologic field, the prostate cancer was the first one, followed by kidney and bladder cancer. In 2010 to 2012, the Naver trend score was 32 for stomach and colon cancers, 31 for lung cancers, 20 for liver cancers, and 19 for prostate cancers, which index were corresponded with the order of incidence rate. Though the Google trend score for prostate cancer was not found, the average was 9 for stomach cancer, 8 for colon cancer, 6 for lung cancer, 4 for liver cancer, which index were corresponded with the order of incidence rate. In 2013 and 2014, the figure of prostate cancer was grown and exceeded liver cancer. CONCLUSIONS: In the trend score, the index of the prostate cancer shows continuing increase, and, from the results, urologists should recognize the importance of the study on the prostate cancer such as management, prevention, and treatment of the prostate cancer.
Colon ; Colonic Neoplasms ; Humans ; Incidence* ; Kidney ; Liver ; Liver Neoplasms ; Lung ; Lung Neoplasms ; Male* ; Prostatic Neoplasms ; Stomach ; Stomach Neoplasms ; Urinary Bladder Neoplasms ; Urologic Neoplasms* ; Urology

BACKGROUND: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. METHODS: A study design was used in 20 ASA physical status 1 and 2 patients aged from 18 to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 mg/kg/h was infused continuously after propofol 2 mg/kg as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 mg/kg/h was infused continuously after half-strength propofol 1 mg/kg as an intravenous bolus for IA preceded by 0.1 mg/kg midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 mg/kg) was given 3 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. RESULTS: The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. CONCLUSIONS: Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia.
Anesthesia* ; Anesthesia, Intravenous ; Anesthetics ; Blood Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Intubation, Intratracheal ; Midazolam* ; Oxygen ; Propofol* ; Vecuronium Bromide ; Ventilation

PURPOSE: Androgen deprivation therapy (ADT) is used as a salvage treatment for men with biochemical recurrence (BCR) of prostate cancer (PCa) following initial radical prostatectomy (RP). The optimal time at which to begin salvage ADT (sADT) remains controversial. In this retrospective study, we evaluated the efficacy of initiating sADT in patients before prostate-specific antigen (PSA) values met the clinical definition of BCR. MATERIALS AND METHODS: We identified 484 PCa patients who received sADT for BCR after RP. Median follow-up was 82 months. Propensity score matching was performed based on preoperative PSA level, pathologic T stage, and Gleason score. Patients were assigned to two groups of 169 patients each, based on PSA levels at the time of sADT: Group A (without meeting of the definition of BCR) and Group B (after BCR). Kaplan-Meier survival analyses and Cox regression analyses were performed. RESULTS: The median PSA level at sADT initiation was 0.12 ng/mL in group A and 0.42 ng/mL in group B. Kaplan-Meier analyses showed that group A had favorable disease progression-free survival (DPFS) and distant metastasis-free survival (DMFS), but did not have better cancer-specific survival (CSS) than group B. In subgroup analyses, group A showed better CSS rates in the non-organ confined PCa group. In Cox regression analyses, early sADT was associated significantly with DPFS and DMFS rates, however, did not correlate with CSS (p=0.107). CONCLUSION: Early sADT after RP improved DPFS and DMFS. Furthermore, early sADT patients demonstrated better CSS in non-organ confined PCa.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Passive Cutaneous Anaphylaxis ; Propensity Score* ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms* ; Recurrence ; Retrospective Studies ; Salvage Therapy

PURPOSE: To evaluate the efficacy and safety of robotic procedures performed using the da Vinci Robotic Surgical System at a single institute. MATERIALS AND METHODS: We analyzed all robotic procedures performed at Severance Hospital, Yonsei University Health System (Seoul, Korea). Reliability and mortality rates of the robotic surgeries were also investigated. RESULTS: From July 2005 to December 2013, 10267 da Vinci robotic procedures were performed in seven different departments by 47 surgeons at our institute. There were 5641 cases (54.9%) of general surgery, including endocrine (38.0%), upper (7.7%) and lower gastrointestinal tract (7.5%), hepato-biliary and pancreatic (1.2%), and pediatric (0.6%) surgeries. Urologic surgery (33.0%) was the second most common, followed by otorhinolaryngologic (7.0%), obstetric and gynecologic (3.2%), thoracic (1.5%), cardiac (0.3%), and neurosurgery (0.1%). Thyroid (40.8%) and prostate (27.4%) procedures accounted for more than half of all surgeries, followed by stomach (7.6%), colorectal (7.5%), kidney and ureter (5.1%), head and neck (4.0%), uterus (3.2%), thoracic (1.5%), and other (2.9%) surgeries. Most surgeries (94.5%) were performed for malignancies. General and urologic surgeries rapidly increased after 2005, whereas others increased slowly. Thyroid and prostate surgeries increased rapidly after 2007. Surgeries for benign conditions accounted for a small portion of all procedures, although the numbers thereof have been steadily increasing. System malfunctions and failures were reported in 185 (1.8%) cases. Mortality related to robotic surgery was observed for 12 (0.12%) cases. CONCLUSION: Robotic surgeries have increased steadily at our institution. The da Vinci Robotic Surgical System is effective and safe for use during surgery.
Head ; Kidney ; Korea* ; Lower Gastrointestinal Tract ; Mortality ; Neck ; Neurosurgery ; Prostate ; Robotic Surgical Procedures ; Stomach ; Surgeons ; Thyroid Gland ; Ureter ; Uterus

PURPOSE: Amplification and mutation of the epidermal growth factor receptor(EGFR) and HER-2 genes were analyzed in the tissues of hormone refractory prostate cancer(HRPC) patients. MATERIALS AND METHODS: Gene amplifications of the EGFR and HER-2 gene were analyzed by fluorescence in situ hybridization(FISH) with direct sequencing. Studies were performed on 10 patients; tissues were sampled at the time of initial diagnosis and after the conversion to HRPC(a total of 20 tissue samples). Direct sequencing was performed on exons 18-24 of the EGFR gene and exons 19 and 20 of the HER-2 gene. The amplifications and mutations were compared with the clinicopathologic features. RESULTS: Gene amplification of the EGFR gene was observed in 6(30%) out of 20 samples. A total of six EGFR mutations in exons 18 and 19 were detected in three pairs of tissues(three patients). One patient with a hormone refractory status had a novel deletion mutation in EGFR exon 19. EGFR mutations were associated with the acinar type of prostate cancer, but they were not associated with the ductal type. No significant correlation was found between mutation change and the hormone sensitive or refractory status. However, the time to convert to HRPC was significantly shorter in the patients with a mutation in the EGFR gene (p=0.017). There were no HER-2 gene amplifications or mutations found in any of the samples. CONCLUSONS: EGFR gene mutation and amplification occurred frequently in these advanced prostate cancer cases, but EGFR mutations do not appear to play a significant role in the hormone refractory pathway. However, EGFR gene mutation is closely associated with the time to convert to HRPC.
Epidermal Growth Factor ; Exons ; Fluorescence ; Gene Amplification ; Genes, erbB-1 ; Genes, erbB-2 ; Humans ; Prostate ; Prostatic Neoplasms ; Receptor, Epidermal Growth Factor ; Sequence Deletion

Sexual dysfunction is a common problem in patients with end stage renal disease. The pathogenesis of this problem is complex, and includes psychological factors, vascular, and neurological disorders, drug therapy, uremic intoxication and hormonal disturbances. However, we don't have any valid report because pathogenesis and physiologic significance is not proved clearly. With the questionnaire that we provided to our patients, we evaluated the sexual dysfunction in patients with end stage renal disease, and we treated our patient with antidepressants for males and estrogen for females. The results are as follows: 1) Sixty patients among 70 answered the sexual question. Among these, 46 patients (76%) complained of sexual dysfunction, 75% of male patients and 58% of female patients complained of impotence and mensturation disturbance, respectively. Especially, female patients complained of loss of libido as a whole. Also they said that they never tried to do anything to recover their sexual dysfunction. 2) After starting dialysis, 57% of patients showed decrease in coital frequency than before. 58% of patients showed no significant change in subjective sezual symptoms after dialysis. 18% of patients showed significant change in sexual function after anemia treatment. 3) Eighty-eight percents of males and one hundred percents of females treated with antidepressants and estrogen, respectively showed no effect. Finally, we found that sexual dysfunction is a common problem in chronic renal failure, but they never try to recover their conditions. Our therapeutic approach was not effective, but dialysis in CRF patient must be used for lifting the value of life, not by way of life extension. In addition we can make more effective treatment through objective study and psychological examination.
Anemia ; Antidepressive Agents ; Coitus ; Dialysis ; Drug Therapy ; Erectile Dysfunction ; Estrogens ; Female ; Humans ; Kidney Failure, Chronic* ; Libido ; Life Expectancy ; Lifting ; Male ; Nervous System Diseases ; Psychology ; Value of Life ; Surveys and Questionnaires