PURPOSE: We evaluated if VEGF (Vascular Endothelial Growth Factor)-immunoreactivity is associated with tumor stage or grade in RCC (renal cell carcinoma), and specifically, if it could serve as a prognostic i ndicator in terms of survival. MATERIALS AND METHODS: Histologic samples of 54 patients in whom radical nephrectomy due to RCC (clear cell type exclusively) from January 1995 to July 1999 were included in this study. VEGF-immunoreactivity was classified as 0 to 3+ according to the ratio of VEGF-positive cells in randomly selected multiple tumor areas. Histologic differentiation was classified according to Fuhrmann's classification and staging was made with TNM classification. RESULTS: The correlation between grade and VEGF-positivity was statistically significant using chi-square analysis. Among the 3 patients with grade I, showed 2, 1, 0 for VEGF 1+, 2+, 3+ respectively. In grade II the cases were 11, 7, 3 respectively. In grade III the cases were 3, 10, 11, and in grade IV the cases were 1, 2, 3 respectively. The correlation between stage and VEGF-positivity didn't show statistical significance. The survival rate for VEGF during the period was 100%, 90%, 76.5% for VEGF 1+, 2+, 3+ respectively. The survival rate for grade was 100%, 100%, 83.3%, 66.7% for grade I, II, III, IV respectively. The survival rate for stage was 95.2%, 85.7%, 87.5%, 66.7% FOR STAGE I, II, III, IV respectively. In the same grade, survival rate decreased apparently according to the increase of VEGF-positivity. For example, in the same grade III, the survival rae was 100%, 90%, 72.7% for VEGF 1+, 2+, 3+ respectively. CONCLUSIONS: The results of this study is that VEGF is correlated with tumor grade and the higher VEGF expression, the lower the survival rate, so we can predict the prognosis by VEGF immunohistochemical staining for supplement of grading system. VEGF alone can be a good predictor for survival, and importantly in the same grade, we can differentiate patient's prognosis with VEGF.
Carcinoma, Renal Cell ; Classification ; Humans ; Nephrectomy ; Prognosis ; Survival Rate ; Vascular Endothelial Growth Factor A

Adrenal Cortex Hormones* ; Prospective Studies* ; Stents*

PURPOSE: Benign prostatic hyperplasia(BPH) patients usually accompanies overactive bladder(OAB) symptoms. Adding anticholinergics in these patients evokes us worrying about deterioration of obstructive symptoms. We evaluated the relative benefit of anticholinergics compared with alpha-blocker only group in terms of emptying efficiency and storing symptoms. MATERIALS AND METHODS: From October 2000 to February 2006, male LUTS(lower urinary tract symptoms) patients with more than 8 IPSS(international prostate symptom score) and more than 2 score in IPSS urgency question(question 4) were selected. 168 patients were eligible without exclusion criteria or drop-out and with follow-up. In 109 patients, alpha-blocker plus anti-cholinergic were used(group I) and in 59 patients alpha-blocker only(group II). Used anti-cholinergics were tolterodine 1 mg, 2 mg and propiverine 10 mg, 20 mg. After mean 15.3 months, follow up evaluation was done. IPSS score was divided as emptying domain(question 1,3,5,6) and storing domain(question 2,4,7). Between the 2 groups the amount of change in each domain of IPSS, urgency question score, total IPSS, QoL, uroflowmetry and RU were compared. According to used anticholinergic and dosage 4 divided groups were also compared as the same methods. RESULTS: The mean age was 64.7+/-9.8 years. Baseline characteristics between the 2 groups were not different in all parameters. After mean 15.3 months later, the changes of storing symptom domain score were -3.3+/-2.7, -2.4+/-2.5 for group I and group II respectively(p=0.041) and urgency question score -1.6+/-1.4, -1.1+/-1.2 (p=0.046) and quality of life score -0.7+/-1.2, -0.4+/-0.8(p=0.028). But the changes of all other parameters were not different between 2 groups. Subdivided 4 cholinergic groups didn't show any differences among groups. CONCLUSIONS: Combination of alpha-blockers with anticholinergics in benign prostatic hyperplasia with overactive bladder patients seems not to lower emptying efficiency significantly but improve storing symptoms significantly.
Cholinergic Antagonists* ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Urinary Bladder, Overactive* ; Urinary Tract ; Tolterodine Tartrate

PURPOSE: We evaluated the correlation of the pathologic diagnosis, including the grade or location of the inflammation on a prostate biopsy specimen, to the serum prostate-specific antigen(PSA) level. MATERIALS AND METHODS: 172 patients(the patients' PSA was> or=4ng/ml) who received prostate biopsy at our department from January 2000 to August 2003 were retrospectively studied. The pre-biopsy PSA and pathology, including the diagnoses and inflammatory patterns, were analyzed. The pathologic patterns of inflammation were divided as acute or chronic by the predominant inflammatory cell type; especially, the chronic inflammation was divided by grade or location, and then this was reviewed by 1 pathologist. Chronic Inflammation was graded as I, II or III according to the severity of inflammation. The PSA levels were compared among the grades. The presence or absence of chronic inflammation was checked in the periglandular, stromal and perivascular areas, respectively. The PSA levels were compared between the presence and absence of inflammation at each location. RESULTS: Among 172 patients, the number of patients with prostate cancer was 37(21.5%), and 68 patients had only BPH(39.5%), 27 had only prostatitis(15.7%) and 40 patients had benign prostatic hyperplasia(BPH) with prostatitis(23.3%). The number of patients with any prostatitis was 67(39.0%). The age of the patients was 68.4+/-8.7 years(45-91), the serum PSA was 13.30+/-14.38ng/ml(4.30-102.48), and the prostate size was 49.5+/-21.1ml(20-126). One case of BPH with prostatitis had a PSA level above 100ng/ml. Among the 67 specimens that showed prostatitis, 16 patients had histologically acute inflammation(23.9%) and 51 patients had chronic inflammation(76.1%). The PSA levels of the acute or chronic inflammation patients were 24.04+/-25.95ng/ml(4.46-102.48) and 9.93+/-4.73ng/ml(4.3-21.12, p=0.047), respectively. The PSA levels were not different among the 3 grades of chronic inflammation. In periglandular, stromal and perivascular locations, the PSA levels were not different between the presence and absence of chronic inflammation. CONCLUSIONS: About 39% of the prostate biopsy specimens showed prostatitis. The PSA level was higher for the acute inflammation than for the chronic inflammation. However, there was no difference in PSA levels among the each of the grades or locations of chronic prostatic inflammation.
Biopsy ; Diagnosis ; Humans ; Inflammation* ; Pathology* ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Prostatitis* ; Retrospective Studies

PURPOSE: Lower urinary tract symptoms (LUTS) usually co-exist with erectile dysfunction. Although the mechanisms for this are still unknown, there seems to be a correlation between the two diseases. We evaluated the effect of lower urinary tract symptoms on the erectile function and the frequency of sexual intercourse. MATERIALS AND METHODS: 1,216 patients, who visited our hospital due to LUTS from January 2000 to April 2006, were evaluated for their erectile function with using International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, frequency of sexual intercourse per month during the last 3 months, prostate volume, International Prostate Symptom Score (IPSS) and quality of life (QoL). The patients were divided into five groups according to age: younger than 40, 40-49, 50-59, 60-69 and older than 70. The patients were again divided into three group according to IPSS: mild (0-7), moderate (8-19) and severe (20-35). Multiple regression analysis and two-way ANOVA were used to analyze the data. RESULTS: 772 patients were eligible for the analysis. The mean patient age was 53.6+/-12.6 years, the mean IPSS was 13.8 9.2 and the mean IIEF-EF score was 17.0+/-9.4. Among the age and LUTS parameters, only age and IPSS had significant effect on the erectile function (p<0.01). The IIEF-EF domain score showed significant differences among the each age group and also among the age-adjusted IPSS groups (p<0.01, p=0.023). The frequency of sexual intercourse per month during the last 3 months showed a significant difference among the each age group (p<0.01). CONCLUSIONS: Erectile function declines with the age-adjusted LUTS severity as well as with age. The frequency of sexual intercourse per month during the last 3 months declines with age, but not with the age-adjusted LUTS severity.
Coitus* ; Erectile Dysfunction ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate ; Quality of Life ; Sexual Behavior ; Urinary Tract

PURPOSE: After correction of stress incontinence, some patients experience the improvement of overactive bladder symptoms. During urodynamic study of some patients, the leak point pressure has a tendency to decrease at increasing vesical volumes. We evaluated the possibility of a correlation between stress incontinence parameters and bladder capacity or compliance. MATERIALS AND METHODS: 113 stress incontinence patients who received urodynamic study from February 2000 to August 2005, were reviewed retrospectively for this study. In these patients, urodynamic stress incontinence parameters(abdominal leak point pressure: ALPP, maximum urethral closure pressure: MUCP), Q-tip angle and Stamey symptom grade and age were analyzed for a correlation with urodynamic cystometric capacity or compliance. We also compared the cystometric capacity of each symptom grade group to assess the difference among the groups. RESULTS: The mean age of the patients was 49.5+/-10.4 years(29~75), symptom grade was I(37), II(27), III(19), Q-tip angle was 33.6+/-14.0 degrees(10~60), cystometric capacity was 390.2+/-109.7 ml(121~641), compliance was 51.6+/-30.4 ml/cmH2O(9.2~142.5), ALPP was 83.2+/-31.0 cmH2O(24~200), MUCP was 55.4+/-29.3 cmH2O(7~142). In the correlation analysis, cystometric capacity had a correlation of -0.207 with age (p=0.029) and -0.215 with symptom grade(p=0.031). However, bladder compliance had no significant correlation with any of the parameters studied. In each symptom grade, cystometric capacity was 407.0+/-103.1 cc(I), 395.8+/-103.0 cc(II), 324.5+/-124.0 cc(III)(p=0.04) and the age for each symptom grade was 48.5+/-9.7(I), 48.1+/-10.1 (II), 57.3+/-10.1(III)(p=0.005). CONCLUSION: As cystometric capacity decreased, symptom grade of stress incontinence increased and age also increased. However, there were no other correlations between cystometric capacity or compliance and stress incontinence parameters.
Compliance* ; Humans ; Retrospective Studies ; Urinary Bladder* ; Urinary Bladder, Overactive ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

Fractures, Comminuted ; Humans ; Immobilization ; Incidence ; Mandibular Fractures ; Wounds and Injuries

PURPOSE: To determine the effect of intraluminal brachytherapy on stent patency and survival after metallic stent placement in patients with primary bile duct carcinoma. MATERIALS AND METHODS: Twenty-seven patients with primary bile duct carcinoma underwent metallic stent placement; in 16 of the 27 intraluminal brachytherapy with an iridium-192 source (dose, 25 Gy) was the performed. Obstruction was due to either hilar (n=14) or non-hilar involvement (n=13). For statistical comparison of patients who underwent/did not undergo intraluminal brachytherapy, stent patency and survival were calculated using the Kaplan-Meier method and an independent t test. RESULTS: The mean durations of stent patency and survival were 9.1 and 10.0 months respectively in patients who underwent intraluminal brachytherapy, and 4.2 and 5.0 months in those who did not undergo this procedure (p<0.05). The mean durations of stent patency and survival among the 22 patients who died were 7.6 (range, 0.8 -16.1) and 8.3 (range, 0.8-17.3) months, respectively, in the eleven patients who underwent intraluminal brachytherapy, and 4.2 (range, 0.9-8.0) and 5.0 (range, 0.9-8.4) months in those whom the procedure was not performed (p<0.05). CONCLUSION: Intraluminal brachytherapy after stent placement extended both stent patency and survival in patients with primary bile duct carcinoma.
Bile Ducts* ; Bile* ; Brachytherapy* ; Humans ; Stents*

Purpose: The greatest concern in the androgen replacement therapy (ART) is the possible side effects to the prostate. We evaluated the effects of ART focusing on the prostate specific antigen (PSA). Materials and Methods: From 2003 to 2006, 47 patients 44 to 75 years old (mean age 60.1) received ART. At baseline and after ART, digital rectal examination, serum testosterone and PSA measurement and transrectal ultrasonography were evaluated. Mean follow-up was 7.9 months (range 1 to 41). Patients were classified into two groups based on the initial PSA level, as PSA levels of 2.5 ng/ml or greater (group 1) (n=29) and PSA levels of less than 2.5 ng/ml (group 2) (n=18). Results: ART significantly increased serum testosterone, PSA and free PSA levels. However, prostate volume did not change significantly. When serum PSA was compared, the increase of PSA levels was greater than in high PSA group (group 1) than in group 2, although the ratio between the two groups in PSA increase was 38.3% for group 2 and 18.2% for group 1, respectively. A total of 4 patients (16.7% of group 1 and 3.4% of group 2) with a serum PSA level greater than 4 ng/ml after ART underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusions: Rates of PSA elevation (>4 ng/ml) and prostate biopsies were higher in patients with high baseline PSA level (> or =2.5 ng/ml) than in those with PSA level less than 2.5 ng/ml who received ART. However, our findings suggest that an increased risk of prostate cancer was not associated with ART.
Biopsy ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Testosterone

Two cases of cavernous hemangioma of the cauda equina are presented. Cavernous hemangioma of the cauda equina is rare vascular malformation. This is the fifth and sixth case of cavernous hemangioma of the cauda equina in the literature. These cases are female patients. MRI is more sensitive method than spinal myelography and CT in diagnosis of cavernous hemangioma of the cauda equina. Total removal was possible without immediate post-operative complication.
Cauda Equina* ; Diagnosis ; Female ; Hemangioma, Cavernous* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Vascular Malformations