PURPOSE: Laparoscopic nephrectomy has become accepted as a method of simple nephrectomy replacing with open nephrectomy in patients in whom a kidney requires removal for benign disease. Laparoscopic nephrecto my is widely performed and extends its indications. We evaluated our experience with the laparoscopic nephrectomy to assess the clinical efficacy. MATERIALS AND METHODS: Between April 1996 and September 1999, 23 patients (7 men and 16 women, mean age 44.1 years old) underwent laparoscopic nephrectomy, 16 by women, mean age 44.1 years old) underwent laparoscopic nephrectomy, 16 by the transperitoneal approach and 7 by the retroperitoneal approach. Operative and clinical records were reviewed. The underlying pathological conditions included 20 cases of non-functioning kidney, 2 cases of hypoplastic kidney with complete duplication and ectopic ureter, and 1 case of ureter tumor. Four ports (21 cases, two 12mm ports and two 5mm ports) or 5 posts ( 2 cases, two 12mm ports and three 5mm ports) were used. RESULTS: The laparoscopic procedure were successful in 20 cases (87%). Three patients had open conversion due to unclear anatomy, severe adhesion, and adrenal bleeding. In successful cases, mean operative time was 253+/-83 minutes (range 140-545), mean hospital stay was postoperative 5.2 days. Intraoperative and perioperative complications were noted in 6 patients, including bleeding requiring transfusion in 3, wound infection in 1, severe subcutaneous emphysema in 1, diarrhea in 1. CONCLUSIONS: Laparoscopic simple nephrectomy is feasible, effective, and safe treatment option. It is a less invasive alternative to open surgery providing a more rapid recuperation and superior cosmetic effect.
Diarrhea ; Female ; Hemorrhage ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Male ; Nephrectomy* ; Operative Time ; Subcutaneous Emphysema ; Ureter ; Wound Infection

No abstract available.
Kidney Calculi*

PURPOSE: recent studies have reported that the expression of Drg-1 is up-regulated by androgen. It has been suggested that Drg-1 gene be used as a molecular marker for prostate cancer therapies like PSA. To de termine the role of Drg-1 gene as a molecular marker during intermittent androgen deprivation(IAD) therapy, we investigated the expression of Drg-1 and compared it with PSA expression in human prostate cancer cell lines treated with dihydrotestosterone (DHT) continuously or intermittently. MATERIALS AND METHODS: Two prostate cancer cells having different status of androgen receptor [LNCaP (androgen dependent) and PC-3 (androgen independent)] were used in this study. To know the change in PSA and Drg-1 expression after DHT treatment the cells were cultured in steroid-free RPMI media for 24 hours. 10(-7) and 10(-8)M of DHT and 10(-7)M bicalutimide was added into the cells and then cultured for 72 hours. And we established in vitro IAD model using LNCaP cells. Northern analyses were performed to determine the expression level of both PSA and Drg-1genes. Also, western analyses were performed to determine the protein level of proliferating cellular nuclear antigen and androgen receptor. RESULTS: Transcripts of Drg-1 were detected in both LNCaP and PC-3 cells but PSA was not expressed in PC-3 cells. The expression of Drg-1gene in LNCaP cells was up-regulated by 10(-8)M of DHT like PSA gene and down-regulated by 10(-7)M bicalutamide. In the treatment of intermittent androgen deprivation, the expression pattern of Drg-1was similar to that of PSA. However, up-regulation of PSA was detected earlier than of Drg-1. CONCLUSIONS: Based on observation, Drg-1 was up-regulated by androgen and down-regulated by anti-androgen. This suggests that Drg-1gene is useful for determining the androgen independency of prostate cancer during IAD.
Cell Line ; Dihydrotestosterone ; Humans ; Prostate* ; Prostatic Neoplasms* ; Receptors, Androgen ; Up-Regulation

There are many epidemiologic studies to find the relationship between disease occurrence and categorized exposure variables which are measured in continuous scales. Recently, it has been found that the differential misclassification can arise when exposure variables are observed with measurement errors and categorized for the analysis. Even though the differential misclassification leads to serious misclassification bias, there is no theoretical attempt to correct the misclassification bias occuring in these circumstances. In this paper, we propose a new statistical method to reduce the misclassification bias due to dichotomizing continuous exposure variables. Since the exposure values are more likely to be misclassified when the true exposure values are close to the cutoff point, the method proposed here gives smaller weights in these case and more weights when these values are far from cutoff point. Simulation studies are performed to compare the bias and the power of the proposed method compared to other methods. Main results are as follows: 1. The proposed method produces the smaller bias and the higher power than the simple method which modifies misclassified data using sensitivity and specificity of exposure misclassification. 2. When the standard deviation of the measurement error are moderately large, the bias and the power of the proposed estimate are somewhat better than those of the modified estimate which excluding the misclassified observations in the analysis. In conclusion, the method proposed here is found to be useful in epidemiologic studies when continuous exposure variables are obtained with measurement error and categorized in the analysis.
Bias (Epidemiology) ; Sensitivity and Specificity ; Weights and Measures

Serum alkaline phosphatase (AP) activity is elevated in hepatobiliary disease, bone disease, pregnancy and certain neoplasms. Recently we experienced marked elevation of serum AP activity after administration of albumin preparation in nephrotic patients who suffered from hypovolemic symptoms. So serum AP activity and the isoenzymes in the albumin preparations & patient's serum after the administration of albumin preparation were studied. Serum AP activity was significantly higher after administration of albumin preparation (318+/-101 IU/L) then before (123+/-43 IU/L). The predominant isoenzyme after administration of albumin was placental type, while liver and bone type was predominant before administration. AP activity in albumin preparation was high (2,133+/-1,410 IU/L) and the isoenzyme was mostly placental type. So we concluded that marked elevation of serum AP activity after administration of albumin was traced to the placental type AP isoenzyme in some albumin preparations which was manufactured from the plasma of placental origin. Elevated serum AP activity like these may lead to erroneous interpretation. Manufactures should notify alkaline phosphatase activity in albumin preparations of placental origin.
Administration, Intravenous* ; Alkaline Phosphatase* ; Bone Diseases ; Humans ; Hypovolemia ; Isoenzymes ; Liver ; Plasma ; Pregnancy

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus*

No abstract available in English.
Female ; Humans ; Urinary Incontinence*

Magnetic resonance (MR) imaging was performed in 41 patients with compression fracture of the spine. MR images of 14 patients with acute spinal trauma (within recent 1 month), eight patients with chronic trauma (over 1 month), and 19 patients with malignant cause without history of trauma were analyzed, retrospectively. Low signal intencities on T1-weighted images and high signal intensities on T2-weighted images were noted in 86% (12/14) of patients with acute trauma, Iso-signal intensities on all pulse sequences were noted in 50%(4/8) of patients with chronic trauma. Low signal intensities on T1-weighted images and high signal intensities on T2-weighted images were noted in 100%(19/19) of patients with metastatic compression fracture. Contrast enhancement was observed in all the cases of acute trauma(4/4) and metastases(18/18), whereas only 20% (1/5) of chronic trauma showed enhancement. Fragmentation was seen in 35% (5/14) of patients with acute trauma, in 25%(2/8) with chronic trauma, and not seen in the patients with metastasis. In conclusion, acute traumatic compression fracture can not be differentiated from malignant cause by MR signal intensity or contrast enhancement, but chronic compression fracture can be distinguished from metasasis. Fragmentation may suggest traumatic compression fracture. So MRI could be a useful method in differentiating the benign compression fractures from the pathologic ones caused by malignancy.
Fractures, Compression* ; Humans ; Magnetic Resonance Imaging ; Methods ; Neoplasm Metastasis* ; Retrospective Studies ; Spine

We reviewed the clinical features, histrologic patterns and clinical courses of 30 children with lupus nephritis retrospectively, and the results were summerized as follows; 1) The male to female ratio was 1:2.8, and the mean age at the onset was 10 8/12 years. 2) The clinical symptoms were diverse, and malaise, weight loss, anorexia, fever and malar rash were the most frequent findings. 3) Among the immunologic tests, FANA and anti-ds-DNA test revealed the highest sensitivity with positive rates of 97% and 87%, respectively. 4) Clinically, 57% of patients had active nephrotic syndrome at the onset, and 33% showed (?) was the most common findings (70%). 5) During the follow-up period, one children with Class IV lupus nephritis expired. And 8 out of 9 cases with renal insufficiency at the onset showed improvement of renal function after treatment with corticosteroid and cytotoxic agents. In conclusion, the clinical features and histologic findings of lupus nephritis in children were diverse. Early diagnosis and proper treatment can prevent rapid deterioration of renal function and improve long-term survival rate.
Anorexia ; Child* ; Cytotoxins ; Early Diagnosis ; Exanthema ; Female ; Fever ; Follow-Up Studies ; Humans ; Immunologic Tests ; Lupus Nephritis* ; Male ; Nephrotic Syndrome ; Renal Insufficiency ; Retrospective Studies ; Survival Rate ; Weight Loss

There had been total 20 patients with early onset(4 months~2 years) primary nephrotic syndrome in the Department of Pediatrics, Seoul National University Children's Hospital, during the period from March 1987 to February 1993. We analysed clinical courses, response to treatment, pathological findings and prognosis of the patients And the results were as follows; 1) The initial responders to steroid treatment were 10(50%), of whom 3 became late nonresponders. Of the 10 initial nonresponders, 8 revealed continuing nonresponsiveness. 2) Incidence of hypertension was significantly higher in the intial nonresponders than in the initial responders. 3) Renal biopsies were performed in 9 initial nonresponders and 2 late nonresponders. And the results were 6 with minimal change lesion, 4 with focal segmental glomerulosclerosis and 1 with mesangiocapillary glomerulonephritis. 4) Six continuing or late nonresponders received methylprednisolone pulse therapy or cyclophosphamide. And partial remission was induced in 4 of them. 5) The overall 3 year maintenance rate of normal renal function was 81%(100% in the initial responders and 64% in the initial nonresponders). In conclusion, the initial steroid responsiveness and prognosis were poorer in patients with early onset nephrotic syndrome than in patients with usual childhood nephrotic syndrome.
Biopsy ; Cyclophosphamide ; Glomerulonephritis, Membranoproliferative ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Incidence ; Methylprednisolone ; Nephrotic Syndrome* ; Pediatrics ; Prognosis ; Seoul