The authors attempted to choose what has the best reproducibility and predictability for prognosis of the prostatic adenocarcinoma among four most widely used gradings methods; the Gleason's Mostofi's, Bocking and MD Anderson hospital systems. According to these gradings systems, each of two pathologists made histologic gradings of 40 consecutive prostatic adenocarcinomas which had been diagnosed with the surgically resected specimens. Correlation between the histological grades and the clinical stages was studied and a comparison was made among each system. For the comparison, the Gleason's and MDAH systems were revised as 3 grades and adjusted to the other gradings systems. In this study, MDAH grading system yielded the highest reproducibility as represented by 90% agreement, as compared with the other systems which showed 82.5~87.5% agreement. By the Gleason's, Mostofi's and Bocking's systems, 46.2%, 23.1% and 46.2% of grade 3 tumors respectively fell under the clinical stage A. On the contrary, there were no cases of grade 3 in stage A and no cases of grade 1 in stage D, by MDAH gradings system. These results suggest that MDAH gradings system is superior to the other systems in reproducibility and for predicting the biological behavior.
Adenocarcinoma

Primary extranodal lymphoma of the liver is very rare, approximately thirty-one cases having been reported in the literature. We report one case of primary malignant lymphoma of the liver in a 26-year-old female, who was presented with palpable abdominal mass on the epigastrium for about 40 days. Laboratory findings revealed no specific abnormalities. Peripheral lymph nodes or spleen were not palpable. An abdominal ultrasonogram revealed a huge mass involving the entire left lobe of the liver. Left lateral segmentectomy of the liver was done. The resected lateral portion of left lobe of the liver showed a large solitary mass, 12 cm in the greatest dimension, with a yellowish gray fleshy solid cut surface. Though light microscopic feature was compatible with primary malignant lymphoma, diffuse large cell type, intermediate grade by the working formulation, undifferentiated carcinomas including hepatocellular carcinoma, plasmacytoma, and pleomorphic sarcomas could not be completely ruled out. Thus, marker studies and electron microscopic examination were performed. Immunoperoxidase stains for common leukocyte antigen was positive, and the Leder stain for myeloid granule was negative. Electron microscopic stuids revealed findings of neoplastic lymphoid cells, consistent with malignant lymphoma. Primary lymphoma of the liver has only rarely been reported, and its natural history is unclear. Many of the reported cases have been large cell lymphomas, as in this case.
Female ; Humans ; Carcinoma, Hepatocellular

PURPOSE: We performed this prospective randomized study to evaluate the efficacy and the complications of radiotherapy for Subfoveal CNV in ARMD and to compare the treatment results at two dosages (14.4 Gy and 19.8 Gy). MATERIALS AND METHODS: 60 eyes of 55 patients were enrolled, and randomized into 14.4 Gy (31 eyes) or 19.8 Gy (29 eyes) groups. CT was used to plan the radiotherapy. All patients received radiotherapy with a 1.8 Gy daily dose using 4 MV photon. We categorized treatment results as improved, stable, or deteriorated based on visual acuity changes of more than 2 lines on the ETDRS chart. RESULTS: Median follow-up period was 33.5 months. At 12 months, visual acuity improved in 9 (16.7%), stable in 41 (75.9%), and aggravated in 4 (7.4%) of 54 evaluated eyes. At 24 months, 49 eyes (81.7%) were evaluated. Visual acuity improved in 6 (12.2%), was stable in 33 (67.4%), and deteriorated in 10 (20.4%). At 36 months, 37 eyes were evaluated. Six (16.2%) eyes were improved, 21 (56.8%) stable, and 10 (27.0%) deteriorated. No significant difference in response was observed between the 14.4 Gy and 19.8 Gy groups (Mantel-Haenszel chi-square=0.4756). The proportion of eyes with a vision of 20/100< or =increased from 28.3% initially to 32.7% after 24 months of radiotherapy. There were no severe acute or chronic complications. CONCLUSION: External beam radiotherapy with doses of 14.4 or 19.8 Gy may be an effective treatment for subfoveal CNV in ARMD. No dose-response relationships with respect to treatment response or toxicity were observed between the 14.4 Gy and 19.8 Gy groups.
Choroid* ; Choroidal Neovascularization* ; Follow-Up Studies ; Humans ; Macular Degeneration* ; Prospective Studies ; Radiotherapy* ; Visual Acuity

PURPOSE: This study was conducted to determine the effects of a fall prevention program on knowledge, efficacy, and prevention behavior of falls among the low-income elderly. METHODS: This study used a nonequivalent control group pre and post test quasi-experimental research design. The study was conducted from August to October, 2008 with 20 subjects in the experimental group and 22 in the control group who were registered at the public health center of S District in D City. RESULTS: Hypothesis 1 "The experimental group that participated in the fall prevention program will show a higher degree of knowledge about falls than the control group" was supported. Hypothesis 2 "The experimental group will have a higher degree of self-efficacy of falls than the control group" was not supported. Hypothesis 3 "The experimental group will report fall prevention behavior more frequently than the control group" was supported. CONCLUSION: It was verified that the fall prevention program in this study was an effective intervention to improve knowledge about falls and fall prevention behaviors among the low-income elderly. The results can be used as part of an intervention to prevent falls for the vulnerable elderly such as the low-income elderly.
Accidental Falls ; Aged* ; Humans ; Public Health ; Research Design ; Self Efficacy

OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.
Brain Injuries ; Diagnosis ; Humans ; Inpatients* ; Length of Stay ; Medical Records ; Rehabilitation* ; Retrospective Studies ; Spinal Cord Injuries ; Stroke ; Tertiary Care Centers*

OBJECTIVE: To determine whether there is a difference in nerve conduction studies depend on the body mass index (BMI) of subjects METHOD: Twenty normal healthy volunteers were enrolled for the study. A routine usual sensory and motor nerve conduction study and a sensory nerve conduction study using the near nerve needle technique were performed. BMI was calculated as weight (kg) divided by height (m) squared. In order to evaluate the effect of BMI on the various measure ments of the nerve conduction study, one-way analysis of variance (ANOVA) was used. RESULTS: The sensory nerve amplitudes of median, ulnar and sural nerves correlated significantly (p<0.05) with BMI. However, no correlation was noted between BMI and sensory nerve amplitude by near nerve needle technique. There was no statistical differences noted in the measurements of latency of examined motor and sensory nerves neither the velocity of examined motor nerves. CONCLUSION: In clinical practice, the effect of BMI should be taken into account when the interpretation of abnormal sensory nerve study has to be soli.
Body Mass Index* ; Healthy Volunteers ; Needles ; Neural Conduction* ; Obesity ; Sural Nerve ; Weights and Measures

Application of robotic surgery in the field of general surgery has been increasing. This paper is an overview of the current uses and future perspectives of robotic surgery in four major divisions—endocrine, upper gastrointestinal, hepato-biliary-pancreatic (HBP), and colorectal surgery.Current Concepts: In endocrine surgery, cosmetic advantage is the highest priority when selecting a surgical approach for thyroidectomy. Currently, the transaxillary route is the most common approach. The introduction of the single-port system could maximize the advantages of this technique. In upper gastrointestinal surgery, the use of robots has the advantage of better retrieval of lymph nodes, less bleeding, earlier discharge, and less complications than the laparoscopic approach. However, a more prospective comparative trial is required to confirm those findings. In the HBP field, the indications of robotic surgery have expanded, starting with cholecystectomy to more challenging procedures, such as donor hepatectomy and pancreaticoduodenectomy. Meticulous dissection using robots could provide benefits to patients. In colorectal surgery, robotic surgery is an excellent technical tool for minimally invasive surgeries for rectal cancers, especially in male patients with narrow, deep pelvises. However, further studies are required to confirm the impact of robotic surgery on rectal cancers.Discussion and Conclusion: Robots are used to provide optimal surgical outcomes. Investigating new technologies and innovative surgical procedures is the highly important for a surgeon in the era of minimally invasive surgery.

PURPOSE: Anti-p185HER2/neu monoclonal antibody (mAb) that can induce phenotypic reversion and monoclonal antibodies specific for the p185HER2/neu growth factor receptor that are able to diminish its kinase-signaling properties represent a specific advance in the therapy for p185HER2/neu-expressing human cancers. With mAb treatment, down-regulation of p185HER2/neu surface receptors and attenuation of the kinase-signaling properties have been observed and regarded as a basic phenomenon; however, the mechanisms for mAb-induced phenotypic reversion are not clear. METHODS: We used human tumor-cell lines of SK-BR-3, T6-17, and U373MG. With immunoprecipitation and Western blotting, we investigated the changes in p185HER2/neu receptor phosphorylation and the expression of signal-regulatory proteins (SIRPs) after mAb treatment. To identify the proteins interacting with Tat-binding protein-1 (TBP1), we used the Clonotech Gal4 matchmaker two-hybrid system. RESULTS: Minimal to moderate reduction in phosphotyrosine (pTyr) content was observed in SK-BR-3 and T6-17 cells with short-term (10-30 minutes) incubation after mAb treatment, but that did not alter total p185HER2/neu receptor density. SIRPs phosphorylation after peptide treatment was increased. With mAb treatment, three proteins were shown to interact with TBP1, and all of the interacting proteins are subunits of proteasome 26S. Collectively, anti- p185HER2/neu mAb or peptide down-regulates the surface receptors and attenuates the kinase signaling, which then both induces higher proteasome activity through increased TBP1 and increases SIRPs expres sion. CONCLUSION: Increased proteasomal activity may degrade abnormal proteins and increased SIRPs may regulate signal transduction toward the norm. Therefore, activation of a protein-degradation pathway and induction of signal-regulatory proteins may be possible mechanisms for the ultimate anti-tumor effects of the anti-p185HER2/neu mAb or peptide.
Antibodies, Monoclonal ; Blotting, Western ; Down-Regulation ; Humans ; Immunoprecipitation ; Phosphorylation ; Phosphotransferases ; Phosphotyrosine ; Proteasome Endopeptidase Complex ; Signal Transduction

A 24 year-old woman with a ventriculoperitoneal shunt is presented, who showed repeated episodes of shunt malfunction before and during pregnancy. Daily pumping of the flushing device relieved the symptoms at first, but reattack during the third trimester of pregnancy was managed with revision of the shunt to ventriculoatrial system. She delivered a healthy female baby successfully at term.
Female ; Flushing ; Humans ; Hydrocephalus ; Pregnancy Trimester, Third ; Pregnancy* ; Ventriculoperitoneal Shunt* ; Young Adult

PURPOSE: To evaluate the prognostic value of the S-phase fraction (SPF) and the correlation with other clinicopathologic factors in node negative breast cancer. METHODS: From 1995 to 1998, seventy one breast carcinoma tumors with T1-2N0M0 staging were prospectively sampled as fresh tumors for flow cytometric DNA analysis. We determined the nuclear DNA content, and the SPF was calculated from DNA histograms. We evaluated the relationship between the SPF and other clinicopathologic factors (age, tumor size, tumor grade and, steroid receptor status). The five year distant relapse free survival (DRFS) and overall survival (OS), according to the SPF, were determined. RESULTS: The SPF ranged from 0.1 to 50.9% (median: 13.4%). The SPF was dichotomized using the median value to divide patients into 38 patients (53.5%) having tumors with the low SPF and 33 patients (46.5%) having tumors with the high SPF. The patient's age and the tumor size were not significantly associated with the SPF. High SPF was associated with high tumor grade, but this did not reach statistical significance. There was a significant correlation between high SPF and estrogen receptor negativity; 34.4% of ER positive tumor had high SPF, whereas 58.3% of ER negative tumor had high SPF(p = 0.042). The mean follow up duration was 65.0 months (median: 62.3). Among 71 patients, there were 4 (5.6%) cases of local recurrence, 7 (9.9%) cases of systemic recurrence and 10 (14.1%) cases of disease related death. The patients with high SPF showed a poorer 5 years DRFS and OS than did the patients with low SPF (87.9% vs. 91.2%; 80.4% vs. 94.5%, respectively), but the difference had no statistical significance. CONCLUSION: The present data was insufficient to use SPF information for the selection of the type of adjuvant therapy, but SPF is a promising prognostic factor for node negative breast cancer. Further study with a sufficient number of patients is needed and this should lead to a better understanding of SPF in node negative breast cancer.
Breast Neoplasms* ; Breast* ; DNA ; Estrogens ; Flow Cytometry ; Follow-Up Studies ; Humans ; Prognosis ; Prospective Studies ; Receptors, Steroid ; Recurrence