We examined the nuclear overexpression of p53 protein by immunohistochemical analysis of the deparaffinized tumor tissue specimens from 45 patients with transitional cell carcinoma of the bladder. The data were then correlated with conventional prognostic variables such as histologic tumor grade, stage and DNA ploidy. In addition, we related the expression of the 53 protein to indicators of cellular proliferative activity, including proliferating cell nuclear antigen(PCNA), mean number of silver-binding nucleoar organizer regions(AgNORs) per nucleus, flow cytometric S-phase fraction(SPF) and proliferation index(PI). Survivals of the patients according to mutant p53 protein expression, stratified by histologic tumor grade and stage were analyzed.None of the urothelial cells from normal bladder specimens showed nuclear expression of mutant p53 protein. Mutant p53 protein expression was not associated with histologic tumor grade, stage, flow cytometric SPF and PI, but there was an association between mutant p53 protein expression and flow cytometric DNA ploidy with marginal statistical significance(p=0.0892) There was statistically significant difference of mutant p53 protein expression between low and high AgNORs counts per nucleus(p=0.0108), but here was no significant correlation between mutant p53 protein expression and PCNA expression rate. Using Kaplan-Meier analysis, we could not identify the statistically significant difference of survivorship between patients with and without mutant p53 expression. These results suggest that immunohistochemical analysis of bladder cancer specimens could be a good method of screening for the presence of mutant p53 protein, and mutant p53 protein expression may be an indicator of bladder cancer with more proliferative and/or aggressive activity, but it may not be an clinically useful prognostic factor in patients with bladder TCC.
Carcinoma, Transitional Cell ; DNA ; Humans ; Immunohistochemistry* ; Kaplan-Meier Estimate ; Mass Screening ; Mutant Proteins ; Nucleolus Organizer Region* ; Ploidies ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Survival Rate ; Urinary Bladder Neoplasms ; Urinary Bladder*

No abstract available.
Transplants* ; Urinary Incontinence*

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.
Accidental Falls ; Analgesia ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Early Ambulation ; Femoral Nerve ; Humans ; Knee ; Nerve Block ; Pain Management ; Peripheral Nerves ; Postoperative Complications ; Quadriceps Muscle ; Rehabilitation

No abstract available.
Asthma* ; Child* ; Humans ; Lymphadenitis*

To develop criteria for prostatic cancer patient care related to early diagnosis, treatment according to accurate staging and follow up in Korea, a clinical study was made on 49 patients with prostatic malignancy who were admitted to the Departrnent of Urology, Korea University College of Medicine between January 1981 and December 1985. The results were as follows 1. The incidence of prostatic malignancy was 1.6% of all inpatients, 2.2% of male inpatients and 10.1% of all male G-U tract tumors. 2. The age distribution ranged from 17 to 85 years with the highest incidence of 60 to 80 years (65%) and 3 of these 49 patients (6.1%) were men less than 40 years old. 3. The incidence of prostatic cancer has increased over the years with B.P.H. and the numbers of patients was comparable to the numbers of patients with B.P.H. during this period representing 49 and 214. 4. Prostatism (59%) and acute urinary retention (41%) were two common presenting symptoms, with symptom caused by metastasis such as persistent bone pain (14%) and pulmonary symptoms (4%). 5. On digital rectal examination at admission, 12 patients had a hard nodule in the prostate with 8 patients of multiple nodules, and 7 patients had soft, smooth prostate presumed B.P.H. 6. Of 9 tumors that extended over the prostate by Intraoperative palpation, 7 (78%) were identified by transrectal ultrasonography but only 2(22%) were identified correctly by digital rectal examination. Transrectal ultrasonography was especially useful in detecting and staging the prostatic cancer. 7. Perineal or transrectal prostatic needle biopsy was done in 29 patients. Adenocarcinoma was found in 26 patients and rhabdomyosarcoma in 3 patients. The histopathologic classification of 3 rhabdomyosarcomas was embryonal, alveolar and pleomorphic. 8. Distant metastasis was found in 28 patients (57%): The sites involved were bone in 24 patients, lymph node in 5 patients, lung in 3 patients and liver and skin in each 1 patient. The sites most frequently involved were pelvis (65%) and spine (50%) in the bony skeleton, and obturator lymph nodes (60%) in lymph node metastasis. 9. In 54% of the patients in which bone scans were positive for metastasis conventional radiographic surveys were negative. The nuclear bone scan was a highly sensitive means for detecting skeletal metastasis 50% more than the conventional bone radiography. 10. The patients were grouped according to American Urological system. 30(6l.2%) patients had stage D, 7(l4.3%) had stage C, 6(12.2%) had stage B and 6 had stage A. Of 6 patients with stage A 4 had histologically proved stage A1, 2 had stage A2. Grade III lesions made up to the largest group accounting for approximately half (47%) of the total patients. This study showed significant correlation between tumor grades and clinical stage of the disease, demonstrating a shift from lower to higher clinical stage with increasing tumor grades. 11. Patients with clinical stage B lesions were preferentially and best treated with prostatectomy, stage C with external beam radiation therapy, stage D with endocrine therapy. 3 patients with prostatic rhabdomyosarcoma were treated with radiation and systemic chemotherapy and one of these 3 patients was also treated with total cystoprostatectomy and urinary diversion. 12. Follow up study with serial measurements of acid phosphatase level and assessment of clinical status was made on 24 patients. (2l patients of adenocarcinoma, 3 patients of rhabdomyosarcoma, Of the 4 patients who had a response as determined by acid phosphates level 3 patients (75%) improved in clinical status and mean survival was more than 24 months. Of the 3 patients who had no change in acid phosphatase level 2 patients (67 %) deteriorated in clinical status and had a mean survival of 7 months. Of the 9 patients who had a progression in acid phosphatase level 7 patients (78 %) deteriorated in clinical status and had a mean survival of 10 months.
Acid Phosphatase ; Adenocarcinoma ; Adult ; Age Distribution ; Biopsy ; Biopsy, Needle ; Classification ; Digital Rectal Examination ; Drug Therapy ; Early Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Inpatients ; Korea ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Palpation ; Patient Care ; Pelvis ; Phosphates ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Prostatism ; Radiography ; Rhabdomyosarcoma ; Skeleton ; Skin ; Spine ; Ultrasonography ; Urinary Diversion ; Urinary Retention ; Urology

PURPOSE: The goal of this in vivo study is to determine the feasibility and efficacy of suicide gene therapy using adenovirus-mediated herpes simplex virus thymidine kinase (HSV-TK) and the prodrug acyclovir (ACV) system in animal model of human prostate cancer. MATERIALS AND METHODS: We used a replication-defective adenoviral vector containing the beta-galactosidase gene (Ad-CMV-beta-gal) as a control and Adenovirus-Cytomegalovirus-Thymidine Kinase (Ad-CMV-TK) as the therapeutic vector under the trascriptional control of the CMV promoter. Transduction efficiency was assessed in vitro by infection of LNCaP and PC-3 human prostate cancer cells with Ad-CMV-beta-gal utilizing X-gal staining. TK activity in LNCaP and PC-3 cells infected with Ad-CMV-TK was determined by measuring the TK-mediated [3H]-Ganciclovir (GCV) phosphorylation. Sensitivity of LNCaP and PC-3 cells to Ad-CMV-TK in vitro was determined after infection of therapeutic vector with or without ACV. Subcutaneous tumors were established in athymic nude(nu/nu) mice with PC-3 cells, and Ad-CMV-TK/ACV sucide gene therapeutic system-induced inhibition of tumor growth in vivo was determined in separate and controlled experiments. RESULTS: The mean TK activity was significantly higher in Ad-CMV-TK-infected LNCaP and PC-3 cells than in cells infected with Ad-CMV-beta-gal that was used as a control(P<0.05). The growth of human prostate cancer cells with Ad-CMV-TK was significantly inhibited by the addition of GCV in vitro(p<0.05). In vivo experiments using PC-3 human prostate cancer animal model demonstrated that tumor volume and growth at the conclusion of experiment was significantly attenuated in the suicide toxic gene therapy (Ad-CMV-TK / ACV) group compared with Ad-CMV-TK, ACV and no treatment control groups(p<0.05). CONCLUSIONS: Adenovirus-mediated suicide gene therapy using HSV-TK / ACV system provides an effective therapy in an experimental human prostate cancer animal model by significantly inhibiting tumor growth.
Acyclovir ; Adenoviridae ; Animals ; beta-Galactosidase ; Genetic Therapy* ; Herpes Simplex* ; Humans ; Mice ; Models, Animal ; Phosphorylation ; Phosphotransferases* ; Prostate* ; Prostatic Neoplasms* ; Simplexvirus* ; Suicide* ; Thymidine Kinase ; Tumor Burden

Tangential vitreoretinal traction around fovea is known to be the principal cause in the pathogenesis of idiopathic macular holes. According to the recent study, the internal limiting membrane(ILM) may provide a scaffold for fibroblast proliferation and contraction, therefore play an important role in the enlargement of macular hole. We removed the ILM during macular hole surgery and assessed the anatomical and functional outcome of the macular hole surgery. Twelve consecutive patients with full-thickness macular hole were enrolled in this study. They were examed for best-corrected vision, fundus photography, fluorescein angiography, Humphrey automated perimetry, focal eletroretinogram, before and after surgery. After surgery, vision was improved in 8 eyes(67%), hole was closed in 10 eyes(83%). Macular thresholds on visual field was increased in 8 eyes and peripheral scotomas developed in 3 eyes postoperatively. The amplitude increased in 7 eyes and the implicit time decreased in 8 eyes on focal electroretinograms postoperatively. Out results suggested that the complete removal of ILM should be attempted to improve vision and to close holes during the full-thickness macular hole surgery.
Fibroblasts ; Fluorescein Angiography ; Humans ; Membranes* ; Photography ; Retinal Perforations* ; Scotoma ; Traction ; Visual Field Tests ; Visual Fields

Recently, acute pseudomonas keratitis is reported to occur more frequently. If treatment is not adequate after the invasion of Pseudomonas into the cornea, corneal perforation ensues within 48 hours. Hence the rapid diagnosis and treatment is required, and the treatment mostly depends on the antibiotics. Pseudomonas keratitis induced in the rabbit cornea by inoculating Pseudomonas aeruginosa (lID 1210). Then the keratitis was treated with topical antibiotics available in Korea Chloramphenicol(R), Polyspectran(R), Tobra(R), Gentamicin(R), Tarivid(R). The effect of the antibiotics on Pseudomonas keratitis was evaluated clinically as well as bacteriologically and irritation of the antibiotics against the eye was also obsesved. 1. Polyspectran(R), tobra(R), gentamicin(R), tarivid(R) treated experimental Pseudomonas keratitis in the rabbit eyes but chloramphenicol(R) and saline did not inhibit the bacterial growth of the rabbit corneas. 2. Against the rabbit eyes, chloramphenicol(R) and polyspectran(R) were the most irritable aptibiotics, where as Gentamicin(R) and tarivid(R) were the moderate, and tobra(R) and saline were the least in the extent of irritation.
Anti-Bacterial Agents* ; Cornea ; Corneal Perforation ; Diagnosis ; Keratitis* ; Korea ; Pseudomonas aeruginosa ; Pseudomonas*

Spontaneous rupture of subcapsular liver hematoma in pregnancy is rare but potential life threatening complication of preeclampsia. We experienced a case of spontaneous rupture of subcapsular hematoma of liver that was treated with conservative method. So, we present the case with a brief review of literatures as first report in Korea.
Hematoma* ; Korea ; Liver* ; Pre-Eclampsia ; Pregnancy* ; Rupture, Spontaneous

No abstract available.
Aminosalicylic Acid* ; Cycloserine* ; Prothionamide* ; Retreatment* ; Tuberculosis, Pulmonary*