PURPOSE: We evaluated the relative long-term longitudinal changes in the levels of serial prostate specific antigen in healthy men without urinary tract infection and initial PSA of 4.0ng/ml or less. MATERIALS AND METHODS: Between February 1996 and June 2000, the rate of PSA change (PSAV) in 1,132 healthy men with an initial PSA of 4.0ng/ml or less who were clinically free of urinary tract infection and known prostate disease were analyzed. In all cases, a minimum of 2 PSA levels were measured at intervals of at least 12month. The influence of age, initial PSA and interval between measurements were assessed. RESULTS: The mean age, initial PSA, interval between measurements, change in PSA and PSAV were 45.2 (24-80) years, 1.05 (0.04-4.0)ng/ml, 19.2 (12-39) month, 0.13 ( 1.0-3.1)ng/ml and 0.08 ( 0.8-1.22)ng/ml/year. A cumulative frequency plot of PSAV demonstrated that 50%, 95% and 97% of subjects had PSAV 0.06ng/ml/year, 0.55 ng/ml/year and 0.60ng/ml/year or less, respectively. PSAV was correlated with age (r=0.090, p=0.002) and initial PSA (r=0.331, p <0.001) but not with interval between measurements (r=0.046, p=0.132). Age was directly correlated with initial PSA (r=0.118, p<0.05). However, age was not correlated with PSAV (r=0.052, p>0.05) when adjusted by the initial PSA level. Percentage of the men with PSAV of great than 0.75ng/ml/year was 1.8% (20/1,132); 0.6% (4/708) for those whose initial PSA were less than 1.0ng/ml, 1.7% (6/358) for 1.1-2.0ng/ml and 15.1% (10/66) for 2.1-4.0ng/ml. CONCLUSIONS: Among men with normal PSA whose PSA is sampled over relatively long-term interval, PSAV is directly correlated with initial PSA but not with age and interval between measurements. Men with a PSA of 2.0ng/ml or less are at low risk for abnormal PSAV and annual PSA monitoring may not be necessary, but the annual longitudinal monitoring may be clinically useful in men with an initial PSA of 2.1-4.0ng/ml. Large prospective studies are required to assess the precise cut-off point of PSAV for Korean men in the early detection of prostate cancer.
Humans ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Urinary Tract Infections

To evaluate the etiology and treatment of options in patients with hemospermia, we retrospectively reviewed 21 patients who had both transrectal ultrasound and MRI and have been followed for more than 6 months after initiation of treatment. Mean age was 40 years (range 20 - 50 years) with duration of infliction being 24 months (range 1 week to 16 years). Among the 14 patients with prostatic cyst, 9 patients underwent transurethral unroofing (TUUR) of cyst. All 9 patients were completely cured, but one patient developed postoperative epididymitis. Among the 6 patients with prostatitis, hemospermia was resolved in 4 patients after mean treatment of 12 weeks with antibiotics. In DES (Diethylstilbestrol) group, 50 % showed resolution of symptoms among 6 patients after 4 weeks of treatment, and two patients complained breast discomfort which were developed after medication. In conclusion, the antibiotic treatment is advisable in hemospermia patients with prostatitis. Prostatic cystic lesion is believed to be a factor in hemospermia, thus TUUR of cyst wall and removal of stone and hematoma in cyst can be a viable option.
Anti-Bacterial Agents ; Breast ; Epididymitis ; Hematoma ; Hemospermia* ; Humans ; Magnetic Resonance Imaging ; Male ; Prostatitis ; Retrospective Studies ; Ultrasonography

Purpose: To evaluate the efficacy of terazosin in chronic pelvic pain syndrome (CPPS) and compare the effect of terazosin between CPPS IIIa and IIIb. Materials end Methods: Between January 2004 and February 2005, CPPS patients, aged 45 or below, with a small size prostate (0.05). In category IIIb (n=56), the T group (n=29) showed significant improvements in all NIH-CPSI domains and the Qmax (p<0.05), but the non-T group (n=27) showed no significant improvement in the NIH-CPSI domains or the Qmax (p>0.05). Comparing both category IIIb groups, the T group showed a greater improvement in the pain score in the NIH-CPSI domains and the Qmax than the non-T group. Conclusions: Terazosin was effective in all domains of the symptom score and in the Qmax for CPPS.
Humans ; Massage ; Pelvic Pain* ; Prostate ; Prostatitis ; Quality of Life ; Ultrasonography ; Urinalysis

OBJECTIVE: The objective of this study was to compare results of the macroscopic one-layer vasovasostomy with those of microscopic one-layer vasovasostomy and to analyze the change of semen parameters according to the interval of vasal obstruction. METHOD AND MATERIALS: Between March 1987 and December 1997, we performed 121 vasovasostomies using modified one-layer technique with loupe magnification (macroscopic vasovasostomy) or microscope. Among the 68 could be followed post-operatively, 37 patients were treated by macroscopic technique with loupe, and 31 patients by microscopic technique. We compared rates of anatomical patency (sperm count above than 10x106/ml) and pregnancy of macroscopic vasovasotomy with those of microscopic vasovasostomy. Patency and pregnancy fates according to vasal obstructive interval were also examined. RESULTS: The patency rates of macroscopic and microscopic technique were 86.5% and 87.1%, and pregnancy rates of macroscopic and microscopic technique were 64.9% and 67.7%. There was no statistical significance between these two methods (p>0.05). The pregnancy rates and sperm motility were decreased if more than 10 years had elapsed following vasectomy(p<0.05). CONCLUSION: We found little difference in success rates resulting from macroscopic and microscopic vasovasostomy and the former had the advantage of reduced cost and a lower operator skill level. in post-operative semen analysis, the sperm motility was the most probable factor associated with vasal obstructive interval.
Humans ; Pregnancy ; Pregnancy Rate ; Semen ; Semen Analysis ; Sperm Motility ; Vasovasostomy*

BACKGROUND: The Ivor-Lewis operation has been widely applied for treating thoracic esophageal cancer, but more acceptable results from three-field lymph node dissection have recently been reported. In this study the efficacy of the Ivor-Lewis operation was evaluated. MATERIAL AND METHOD: Among the 273 patients, who underwent operation for esophageal cancer between September 1994 and August 2004, we retrospectively studied 172 patients with esophageal squamous cell carcinoma and who had no other primary cancer and who underwent complete resection with an Ivor-Lewis operation. The postoperative complications, the short and long-term survival and the recurrence patterns were analyzed. RESULT: The postoperative staging was as follows: stage I in 40 cases, IIA in 48 cases, IIB in 18 cases, III in 55 cases, IVA in 5 cases and IVB in 6 cases. The operative mortality rate was 4% (7 of 172 pts). Postoperative complication occurred in 32 patients (18%) and tumor recurred in 55 patients (32%). The overall 5-year survival rate was 48%; it was 85.6% in stage I patients, 47.6% in IIA patients, 65% in IIB patients, 22.8% in III patients and 0% for those in IV (p<0.05). The 5-year survival rate according to the location of esophageal cancer was 26.5% for patients with tumor in the upper 1/3 of the esophagus and 52.4% for patients with tumor in the mid and lower 1/3 (p>0.05). CONCLUSION: The Ivor-Lewis operation is an acceptable surgical procedure for thoracic esophageal squamous cell carcinoma. Yet it is necessary to consider other surgical procedures, and especially three-field lymph node dissection for treating upper 1/3 esophageal cancer.
Carcinoma, Squamous Cell* ; Esophageal Neoplasms ; Esophagus ; Humans ; Lymph Node Excision ; Mortality ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate

The development of immunosuprressants has had a significant contribution to inhibition of acute allograft rejection. However, long-term graft survival has not been realized by immunosuppressants, probably because of their nonspecific suppression of T cell activity and nonimmune side effects. The ideal way to overcome the limitations of current immunosuppressants is to induce allograft-specific immune tolerance. Transplant immunologists are exerting their efforts in achieving transplantation tolerance using three different approaches; mixed hematopoietic chimerism, costimulatory blockade, and regulation by regulatory T cells. It is expected that transplantation tolerance will soon be established as a standard immunosuppressive regimen with little side effects in preventing and reversing allograft rejection.
Allografts* ; Chimerism ; Graft Survival ; Immune Tolerance* ; Immunosuppressive Agents ; T-Lymphocytes, Regulatory ; Transplantation Tolerance

Although heparin solution is widely used as an anticoagulant in blood gas analysis, alterations in blood gas measurements may occur when small sample volumes are diluted by heparin. Cook pressure tubing for infants and children and Gould pressure line for adults were applied to each of 10 adult patients whose cardiovascular fuction was normal. Arterial blood gases were measured serially after withdrawing 2,4,6,8,10 and 12 ml of flus-blood solutions from the Gould pressure connecting tubing, and 1,2,3,4,5 and 6 ml from the Cook pressure line, which were connected to a transducer through a 3way stopcock. In the Gould pressure tubing, the pH was unchanged from sample 2 and PaCO2, HCO3- and base excess were unchanged from sample 3. PaO2 did not change between the samples. In the Cook pressure line, the pH and base excess were unchanged from sample 2 and PaCO2, HCO3- and PaO2 from sample 3. We conclude that arterial blood should be withdrawn in volumes of at least 4ml by the Gould pressure connecting tubing and 3ml by the Cook pressure line to obtaine accurate results in blood gas analysis.
Adult ; Blood Gas Analysis ; Child ; Gases ; Heparin ; Humans ; Hydrogen-Ion Concentration ; Infant ; Transducers

The purpose of this study is to evaluate the use of high frequency percutaneous transtracheal ventilation and high frequency jet insufflation for laryngomicrosurgery performed under general anesthesia. Twenty patients were anesthetized with intermittent intravenous anesthetics and paralyzed with either d-tubercurarine or pancuronium. For the operations for 8 of them (group 1) ventilation was supplied through a 16 G Angiocatch introduced into the trachea through the cricothyroid membrane. For the operations for 12 remaining patients(group 2) ventilation was supplied through a 5 mm endotracheal catheter. A respiratory rate of 100 breaths/minute was used at an FiO2 1.0 using a solenoid valve-actuated ventilator. The inspiratory-expiratory ratio was 1:2. The driving pressure of oxygen was 10-45 psi. In neither group was there any significant change in the value of the pH, of PaCO2, or of PaO2. Cardiovascular parameters such as blood pressure and heart rate were slightly increased. Data obtained from these observations indicate that these techniques and devices when used properly, should provide adequate ventilation and improve the visibility of the operative field.
Adolescent ; Adult ; Aged ; Anesthesia, General* ; Child ; Child, Preschool ; Human ; Laryngeal Diseases/surgery* ; Microsurgery* ; Middle Age ; Respiration, Artificial

Changes in serum potassium concentration following administration of succinylcholine (1.5mg/kg) were evaluated in 15 cases of donors and 20 cases of reciepients in kidney transplantation.There were no changes prior to and follwing administration of succinrlcho-line in serum potassium levels in the donors and recipients. Changes in serum potassium concentration were also eyaluated in livining-related recipients, in which the donor kidney was flushed with cold Ringer's lactate solution with the amount of about 750 ml. The mean vascular clamping time was 39.5+/-71.8 minutes. There were no difference between before clamping and following release of the vascular clamp in spite of the interruption of blood flow to the clamped leg. We suggest that succinylcholine in this dose is not contraindicated in patients with chronic renal failure and in the living related recepients who received dornor kidnie which was flushed with Ringer's lactate solution and there is no risk of potassium elevation after relesaing vascular clamp.
Constriction ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Lactic Acid ; Leg ; Potassium* ; Succinylcholine* ; Tissue Donors

Thirty-six adult patients who received caudal anesthesia for perianal surgery were rando-mly agsigned to two grgups. Of these, 15 patients ingroup 1 were given 1.5 and 2% plain lidocaine in 18 and 7 ml doses, repectively. Twenty-one patients in group 2 were given lidooaine carbonated with 5% NaHCO3 0.1 ml per 1 ml-lidocaine in the same volume and concentration as in group 1. The time of onset of analgesia for the pin prick and scratch tests was significantly more rapid in group 2(2.04+/-0.63 and 4,69+/-1.12 min for the pin prick and scratch tests, respecti-vely-) than those in group 1(5.00+/-1.70 and 9.48+/-5.40 min for the pin prick and scratch test, respectively). However, the duration of anesthesia in both groups was not significantly different (111.80 +/-40.24 and 105.95+/-45.04 min in group 1 and 2, respectively). The mean pH of the 1.5 and 2% agents used in group 1 was 5.289+/-0.206 and 5.257+/-0.193, respectively, while the mean PH of the 1.5 and 2% carbonated lidocaine used in group 2 was 7.004+/-0.079 and 7.023+/-0.288, reapectively. The results iridicate that pH-adjusted lidocaine for caudal anesthesia has a more rapid onset than plain lidocaine hut that there is no difference in the length of duration of its effect.
Adult ; Analgesia ; Anesthesia ; Anesthesia, Caudal* ; Carbon* ; Humans ; Hydrogen-Ion Concentration ; Lidocaine*