We present a rare case of urothelial carcinoma in situ (CIS), which invades the prostate and seminal vesicle (SV). A 70-year-old man underwent transurethral resection of bladder (TURB), and the pathologic examination revealed multiple CIS. Although the patient received intravesical bacillus Calmette-Guerin (BCG) therapy following TURB, recurrence of CIS was confirmed in the bladder and left distal ureter at 3 months following BCG. Radical cystectomy was performed due to BCG-refractory CIS. Microscopically, CIS was found throughout the mucosa of the bladder, left ureter, prostatic duct, and both SVs. Next-generation sequencing revealed significant differences in tumor clonality between bladder and SV CIS cells. Among 101 (bladder CIS) and 95 (SV CIS) somatic mutations, only two were shared, and only one gene (ARHGAP23) was common exon coding region gene. In conclusion, multicentric genetic changes, in line with the field-cancerization effect, may result in SV involvement by CIS of the bladder.

No abstract available.
Adenocarcinoma* ; Female* ; Humans ; Urethra*

No abstract available.
Nevus, Blue*

Objectives: ：The purpose of this study was to examine the clinical utility of the internalization and externalization higher-order scales of the Minnesota Multiphasic Personality Inventory-Adolescent Restructured Form (MMPI-A-RF), compared with those scales of the Korean Child Behavior Checklist (K-CBCL). Methods: ：43 adolescents with internalizing disorders and 44 adolescents with externalizing disorders and their parents were administered the MMPI-A-RF and K-CBCL each. To verify the difference between the internalization and externalization scales of the MMPI-A-RF and K-CBCL for each group, independent-sample t test was performed. To compare the agreement between the MMPI-A-RF and K-CBCL, correlation analysis was also conducted. Lastly, to identify which scales significantly best predict each of the internalizing and externalizing disorder, logistic regression analysis was conducted. Results: ：Internalization scales of the MMPI-A-RF and K-CBCL were significantly higher in the internalizing disorder group, and the externalization scales were significantly higher in the externalizing disorder group. The positive correlation was significant only for internalization problems between the two evaluation measures in both groups (each r=0.360, p<0.05, r=0.572, p<0.05). In addition, the scales significantly predicted internalizing and externalizing disorders were the internalization and externalization scales of the MMPI-A-RF, followed by the externalization scale of the K-CBCL (R2 =0.407, p<0.05). Conclusions ：The internalization and externalization higher-order scales of the MMPI-A-RF were found to reliably reflect the characteristics of each disorder in adolescents and be useful evaluative scales to differentiate dis-orders. Moreover, if adolescents show externalization problems, additional information from the K-CBCL can be more useful to differentiate disorders.

BACKGROUND: In an effort t enhance long term patency of coronary bypass grafts, utilization of arterial conduits have been on an icrease. With the same objective, we have been using the right gastroepiploic artery (RGEA) in coronary artery bypass procedures since 1998. The current paper has been undertaken with the aim of assessing the apropriateness, problems, and short term results of using the RGEA as an arterial graft conduit by studying the postoperative clinical results of 100 patients than received coronary artery bypass grafting (CARG) with this artery. MATERIAL AND METHOD: Between May of 1998 and May of 1999, an analysis of the mortality, postoperative myocardial infarction, and the need for IABP insertion as a result of low cardiac output were made between 100 consecutive patients undergoing CABG with the RGEA. There was one postoperative death due to cerebral infarction. Postoperative complications/morbidity comprised myocardial infarction in 2, cerebral infarct in 3, reoperation due to bleeding in 1, mediastinitis in 1, and low cardiac output syndrome necessitating IABP in 3 patients. Complicatons related to harvesting of the arterial grafts were not experienced in any of the patients. CONCLUSION: The results of the current data show that utilization of the RGEA in CABG is not associated with increased mortality/morbidity and demonstrates satisfactory short term results suggesting the usefulnessof this conduit as an arterial graft.
Arteries ; Cardiac Output, Low ; Cerebral Infarction ; Coronary Artery Bypass* ; Coronary Vessels* ; Gastroepiploic Artery* ; Hemorrhage ; Humans ; Mediastinitis ; Mortality ; Myocardial Infarction ; Reoperation ; Transplants

PURPOSE: The goal of reduction mammaplasty is breast with natural cone shape, minimizing scars, well-placed and sensate nipple-areolar area and maintaining breast physiology. In order to satisfy that goal, variable reduction mammaplasty methods are performed, however, two methods such as vertical reduction method and inverted T-scar method are currently most used. We compared indications and advantages of the two methods and set up useful guidlines. METHODS: For 15 years from 1995 to 2010, we experienced 84 patients(162 breasts). We performed vertical reduction method as Lejour's superior pedicle technique(45 patients) and inverted T-scar method as Goldwyn's inferior dermal flap technique(39 patients). We evaluated the result of the operation comparing patient's age, amount of resected tissue, complications and post-operative scars of the two methods. RESULTS: The mean age was 36 years and the vertical reduction group was 3 years younger than inverted T-scar group. The mean breast tissue resection amount per one breast, inverted T-scar group(712 gm) was lagger than vertical reduction group(395 gm). CONCLUSION: There is no ideal method for reduction mammaplasty until now. However, we suggest that guide line, the vertical reduction method is effective for minimal and moderate macromastia in young and middle aged women and inverted T-scar method is appropriate for severe macromastia with ptosis in elderly women. Recently, all procedures tried shorter and smaller scar on the vertical line as small I, J or L shape scar, and inframammary fold as short inverted T-scar.
Aged ; Breast ; Cicatrix ; Female ; Humans ; Hypertrophy ; Mammaplasty ; Middle Aged

The Urachus lies between the peritoneum and transversalis fascia and extends from the anterior dome of the bladder toward the umbilicus. During the 4th and 5th months of gestation, the urachus narrows to a small-calibered epitherial tube. During fetal development, as the bladder descends into the pelvis, its apical portion narrows progressively into a fibromuscular strand of urachus. Recently, we reviewed three cases of urachal anomalies with literatures.
Fascia ; Fetal Development ; Pelvis ; Peritoneum ; Pregnancy ; Umbilicus ; Urachus ; Urinary Bladder

OBJECTIVE: Our purpose was to determine normal amniotic fluid alpha-fetoprotein level in midtrimester Korean pregnant women whose neonatal outcomes were normal. METHODS: Amniotic fluid alpha-fetoprotein(AFAFP) levels were measured by specific radioimmunoassay (RIA) in midtrimester pregnant women for various indications of amniocentesis from May 1992 to July 1999 at Seoul National University Hospital. Normal ranges were obtained from 640 singleton pregnancies in which neonatal outcomes were normal. RESULTS: Median values of AFAFP in Korean pregnant women were 13,250ng/mL, 12,900ng/mL, 11,150ng/mL, 9,430ng/mL, 8,019ng/mL, 6,800ng/mL, 5,850ng/mL, 5,750ng/mL, 5,210ng/mL, 3,420ng/mL at 15 week, 16 week, 17 week, 18 week, 19 week, 20 week, 21 week, 22 week, 23 week, 24 week, respectively. CONCLUSION: This determination of the median values and the normal range of AFAFP level by each gestational week in uncomplicated Korean women could be used reference values for prenatal diagnosis of various disorders like open neural tube defect.
alpha-Fetoproteins* ; Amniocentesis ; Amniotic Fluid* ; Female ; Humans ; Neural Tube Defects ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnant Women* ; Prenatal Diagnosis ; Radioimmunoassay ; Reference Values* ; Seoul

OBJECTIVES: Our purpose was 1) to determine whether elevated maternal serum alpha- fetoprotein(MSAFP) predict increased risk of spontaneous preterm delivery and indicated preterm delivery; 2) to determine whether elevated maternal serum human chorionic gonadotropin(MSHCG) predict increased risk of preterm delivery. Methods: Between September 1995 and April 1998, 945 of 2105 pregnant women who received midtrimester MSAFP screening were identified and evaluated. 81 women with MSAFP levels of 2.0 MoM or more were included in the study group while 864 women with levels less than 2.0 MoM served as controls. Pregnancy outcome were obtained from hospital records and statistical analysis were performed. RESULTS: Women with elevated MSAFP levels showed an increased risk for preterm delivery(p<0.05), fetal growth restriction(p<0.05) and hypertensive disorders(p<0.05), but not for preterm premature rupture of membrane, fetal death in utero. There was a strong association between unexplained elevated MSAFP levels and spontaneous preterm delivery(p<0.05) but our study does not support an association between unexplained elevated MSAFP levels and indicated preterm delivery. There was no association between elevated MSHCG levels and preterm delivery regardless of MSAFP levels. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP were associated with an elevated risk of spontaneous preterm delivery but not with a risk of indicated preterm delivery. Elevated MSHCG levels were not associated with a risk of preterm delivery and spontaneous preterm birth.
alpha-Fetoproteins* ; Chorion ; Extraembryonic Membranes ; Female ; Fetal Development ; Hospital Records ; Humans ; Mass Screening ; Obstetric Labor, Premature ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Premature Birth* ; Rupture

PURPOSE: Since the laparoscopic cholecystectomy became an usual procedure, operative indications of the gallbladder polyps have had the tendency to enlarge. There are no precise management plan about the gallbladder polyps which is not included in the accepted operative indications. Therefore a management plan may be required for the patients who has gallbladder polyps which is not accepted operative indications. METHODS: We retrospectively analysed 106 patients with gallbladder polyps who were diagnosed preoperatively by ultrasound and CT from January 1991 to January 2005. Our operation indications are polyp above 10 mm, symptomatic polyp, sessile polyp, coincidence of stone, focal thickening of gallbladder wall, diffuse wall thickening and detection during other operations. The gallbladder polyps which were suspected to the gallbladder cancer strongly on radiologic studies and polyps above 20 mm size were excluded in this studies. RESULTS: Among the 106 patients, 87 patients underwent operation, and polypoid lesions disappeared during the follow-up period in 3 patients, and 16 patients are on regular follow up. Fifty-six cases received operation with accepted operative indications, and the thirty-one cases underwent operation by the patient's demand. Two groups showed significant difference in true polyp on pathological diagnosis (P < 0.001). There was 16.07% true polyp in opertive indication based 56 patients and no true polyp in patient's demanded 31 cases. The pathologic diagnoses were cholesterol polyp in 27 patients (87.15%), no polyp in 2 patients, adenomatous hyperplasia in 2 patients. The correlation of the polyp size and pathologic diagnosis was an inverse relation to the polyp size and incidence of pseudopolyp (P=0.014). CONCLUSION: We propose that the 6-month-interval follow-up observation is fully safe for polyps sized below 10 mm and not included in accepted operative indications.
Cholecystectomy, Laparoscopic ; Cholesterol ; Diagnosis ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Hyperplasia ; Incidence ; Polyps ; Retrospective Studies ; Surgical Procedures, Operative ; Ultrasonography