Stress urinary incontinence (SUI) is a highly prevalent health condition that significantly impacts the quality of life. Traditional methods of treatment for SUI, such as pubovaginal sling and Burch colposuspension, have been replaced by the midurethral sling because of its high efficacy, low complication and morbidity rates, and short learning curve. Although multiple behavioral and operative treatments exist, midurethral slings are the gold standard for the treatment of SUI in women. However, several reports have raised concerns about complications caused by the synthetic mesh used in midurethral slings. Therefore, surgical treatment for SUI in women must be chosen with care, taking into account potential complications. Herein, we review the current safety issues pertaining to the use of meshes, the efficacy of traditional surgeries, old and new midurethral slings, and recent data comparing the efficacy and safety of different surgical options. This review is aimed at developing practical guidelines for choosing surgical options for women with SUI.

Breast conserving surgery is increasingly performed in early stage breast cancer patients. A certain propotion of these patients are at substantial risk for systemic metastasis. However, there is no valid consensus about optimal sequencing of chemotherapy and radiation therapy. We conducted a randomized prospective study to investigate whether concurrent chemotherapy and radiation therapy after breast conservation surgery are associated with increased toxicity. Fifty-seven patients with stage I or II breast cancer were randomly assigned to receive CMF chemotherapy either simultaneously (n=37) or before (n=20) radiation therapy. Moist desquamation was the most common adverse effect which occurred in 46% (16/37) treated with concurrent chemotherapy and radiation therapy while 8 patients (38%) treated with sequential regimen had the finding. Difference between two groups was not statistically significant. Incidence of severe neutropenia (WBC>1,800) or abnormal elevation of liver enzymes was also not influenced by sequencing of adjuvant therapies. Arm edema was observed in 2 patients of concurrent group and was observed in 2 patients treated with sequential regimen. Two patients treated with concurrent regimen did not complete 6 cycles of chemotherapy while one patient with sequential regimen did not complete. Incidence of toxicity during chemotherapy was not altered by timing of radiation therapy. In conclusion, chemotherapy and radiation therapy can be given concurrently after breast conservation surgery in stage I or II breast cancer patients without increase of serious toxicity.
Arm ; Breast Neoplasms* ; Breast* ; Consensus ; Drug Therapy* ; Edema ; Humans ; Incidence ; Liver ; Mastectomy, Segmental ; Neoplasm Metastasis ; Neutropenia ; Prospective Studies

Purpose: Current guidelines recommend clean intermittent catheterization (CIC) at regular time intervals for patients with spinal cord injuries; however, many patients experience difficulties. Performing time-based CIC outside the home is a significant burden for patients. In this study, we aimed to overcome the limitations of the current guidelines by developing a digital device to monitor bladder urine volume in real-time. Methods: The optode sensor is a near-infrared spectroscopy (NIRS)-based wearable device intended to be attached to the skin of the lower abdomen where the bladder is located. The sensor’s primary function is to detect changes in urine volume within the bladder. An in vitro study was conducted using a bladder phantom that mimicked the optical properties of the lower abdomen. To validate the data in the human body at the proof-of-concept level, one volunteer attached the device to the lower abdomen to measure the light intensity between the first voiding and immediately before the second voiding. Results: The degree of attenuation at the maximum test volume was equivalent across experiments, and the optode sensor with multiplex measurements demonstrated robust performance for patient diversity. Moreover, the symmetric feature of the matrix was deemed a potential parameter for identifying the accuracy of sensor localization in a deep-learning model. The validated feasibility of the sensor showed almost the same results as an ultrasound scanner, which is routinely used in the clinical field. Conclusions The optode sensor of the NIRS-based wearable device can measure the urine volume in the bladder in real-time.

Solid and papillary epithelial neoplasm of the pancreas(SPENP) is an uncommon low grade malignant tumor histologically distinct from the usual ductal adenocarcinoma and amenable to cure by surgical excision. The main features of SPENP are a peculiar morphology, favorable prognosis, and prediction for women 10 and 40 years of age. In men, the occurrence of SPENP seems to be exceedingly rare. The tumor is usually large at the time of presentation, and surgical excision is the treatment of choice. Gross pathologic examination revealed apparent encapsulation, cystic degeneration, and hemorrhagic necrosis. Microscopically, the tumor was characterized by distinctive solid and papillary patterns. This benign or low-grade malignant epithelial tumor is composed of monomorphous cells variably expressing epithelial, mesenchymal, and endocrine markers. The tumor is known to have good prognosis; although local invasion and infiltration of the capsule may occur. Despite growing recognition of this tumor, its histogenesis remains a matter of controversy i.e. pancreatic ductal cell origin, acinar cell origin, pluripotential cell origin. A 44-year-old male presented with an one-year history of postprandial abdominal pain. Following abdominal ultrasonography, computed axial tomography and angiography, a SPENP suspected. The patient underwent exploratory laparotomy. The tumor was located in the head of pancreas. And thus the patient underwent a pylorus-preserving pancreaticoduodenectomy. His postoperative course was uneventful, and he remains well.
Abdominal Pain ; Acinar Cells ; Adenocarcinoma ; Adult* ; Angiography ; Carcinoma ; Female ; Head ; Humans ; Laparotomy ; Male* ; Necrosis ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Prognosis ; Ultrasonography

Objectives: : The purpose of this study was to develop a cognitive-behavioral intervention for college students at high risk for mental health and to investigate its effect on mental health outcomes. Methods: : The program was developed to reduce depressive symptoms and adverse outcomes while promoting resilience and positive effects. It consisted of eight sessions in a small group format for eight weeks. Thirty subjects at high risk for mental health participated in the program. Outcomes on the depressive symptoms, resilience, satisfaction with life, negative affect, and positive affect were evaluated at pre-and post-intervention. Results: : Depressive symptom scores reduced significantly post-intervention compared to pre-intervention (t=3.51, p=0.002). Resilience scores (t=-3.65, p=0.001) and satisfaction with life scores (t=-3.00, p=0.006) increased after intervention than pre-intervention. Positive affect scores decreased post-intervention (t=2.28, p=0.031). There was no significant difference between pre-and post-intervention negative affect scores (t=-0.94, p=0.356). Conclusions : Present study demonstrated that group-based cognitive-behavioral intervention could be helpful for college students at high risk for mental health to reduce mental health symptoms and improve healthy protective factors.

PURPOSE: Breast mass - the most common occurences in the breast must be managed by a method that provides both the best medical and cosmetic results. METHODS: Two hundred seventy-eight patients evaluated and managed for breast mass at our center between January 1998 and December 1999 were analysed. In this study, we compare the results of the triple test score (TTS; sum of physical examination, mammography, and fine needle aspiration cytology) with those from each separate diagnostic test according to a standard formula incorporating sensitivity, specificity, positive predictive value, and negative predictive value. The TTS was modified to substitute sonography for mammography-TTSs. The TTS was also compared to the TTS-2 that double weighted the results of fine needle aspiration (FNA), but was otherwise the same as the TTS. RESULTS: The sensitivity and specificity of breast sonography were 90% and 84% whereas those of mammography were 84% and 73%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the TTSm (triple test score-mammography) were 99%, 97%, 99% and 97% respectively. The scores of the TTSm-2 were 99%, 100%, 100% and 97%. And those of the TTSs were 100%, 100%, 100% and 100%. CONCLUSION: The TTS was more accurate than each of the elements separately in evaluating breast masses. The TTSs was also more effective than the TTSm. The TTS-2 was more useful than the TTS, being less likely to miss malignancy due to the high accuracy of FNA.
Biopsy, Fine-Needle ; Breast* ; Diagnostic Tests, Routine ; Humans ; Mammography ; Physical Examination ; Sensitivity and Specificity

PURPOSE: The aim of the present study was to evaluate the clinical utility of Ki 67 labelling index and proliferative indices measured by flow cytometry in breast carcinomas. METHODS: We conducted immunohistochemical assay for Ki 67 and analyzed the DNA content and S-phase fraction by flow cytometry in 113 cases of primary breast carcinomas. Relationship between proliferative indices measured by two method and clinical biological parameters was also analyzed. RESULTS: Ki 67 labelling index than average was increased in 53 tumors (46.9%) and demonstrated a significant correlation with S-phase fraction. Higher Ki 67 labelling index was found in 28 (59.6%) of 47 tumors with high S-phase fraction whereas it was found in only 8 tumors (30.8%) with low S-phase fraction. Concordance between Ki 67 labelling index and S-phase fraction was 63.1% (p=0.017). Tumor with high S-phase fraction had a tendency to have an aneuploid. Ki 67 labelling index correlated significantly with histologic grade (p=0.001) and nuclear grade (p=0.001). An inverse correlation was found between Ki 67 and estrogen receptor expression (p=0.004). CONCLUSION: Ki 67 labelling index significantly correlated with S-phase fraction measured by flow cytometry. Ki 67 labelling index seems to be a clinically useful method because it is rapid, practical and easily performed by immunohistchemical assay.
Aneuploidy ; Breast Neoplasms* ; Breast* ; DNA ; Estrogens ; Flow Cytometry*

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and are particularly prevalent in women. Recurrent UTIs significantly diminish quality of life due to their symptoms and frequent relapses. Patients often experience immediate relapse following slightly strenuous activities or intense psychological stress. In this review, we explore why infections persist despite the advent of various treatments and suggest strategies to manage recurrent cystitis by targeting the mechanisms of adhesion and infection. Vitamin D levels and the expression of neutrophil gelatinase-associated lipocalin are linked to the recurrence of UTIs. During a UTI, bacteria employ adhesins to invade the urinary tract, adhere to urothelial cells, and then penetrate these cells, where they rapidly multiply to establish intracellular bacterial communities. Bacteria can also form quiescent intracellular reservoirs that escape immune responses and antibiotic treatments, leading to recurrence under certain conditions. The surface proteins of bacteria and D-mannose are crucial in the adhesion of bacteria to the urothelium. Understanding these processes provides valuable insights into potential therapeutic approaches that focus on preventing bacterial attachment and cluster formation. By disrupting the ability of bacteria to adhere to and form clusters on cells, we can better manage recurrent UTIs and improve patient outcomes.

Histologically, the diagnosis of a pure follicular carcinoma of the thyroid is difficult. It is generally not possible to distinguish between a follicular adenoma and a follicular carcinoma without examining the removed specimen, although follicular neoplasms can be identified on cytologic specimens from fine needle aspiration cytology(FNAC). The purpose of the present study is to evaluate the diagnostic accuracy of preoperative FNAC. A total of 42 cases were diagnosed as follicular neoplasms by FNAC while 50 cases were confirmed as follicular tumors after histologic examinations of removed specimens; follicular carcinoma 34, follicular adenoma 10, Hurthle cell carcinoma 3, Hurthle cell adenoma 3. When we compared the postoperative histologic diagnosis of the 42 cases which had been thought to be follicular neoplasms based on FNAC, 31(74.6%) had true follicular tumor; 20 carcinomas, 5 adenomas, and 6 Hurthle cell tumors. The other 11 cases were comprised of 6 follicular variant papillary carcinomas, 4 adenomatous goiters, and 1 instance of Hashimoto's disease. The 34 preoperative diagnoses of follicular carcinomas which were confirmed postoperatively were as follows; follicular neoplasm 20, adenoma 6, papillary carcinoma 5, and Hurthle cell tumor 3. Diagnosis of 10 follicular adenoma was made preoperatively as follicular neoplasm in 5 cases, adenomatous goiter in 3, and Hurthle cell tumor in 2 cases. It was impossible to distinguish a follicular carcinoma from a benign adenoma in 9 cases by using FNAC. Three patients with follicular carcinoma, who underwent a unilateral lobectomy because of inaccurate diagnosis, experienced recurrent disease, 2 with pulmonary metastasis and 1 with bone metastasis, with median follow-up period of 38 months(range: 6~71 months). There are no reliable diagnostic tools to dicriminate between follicular carcinoma and follicular adenoma preoperatively. In conclusion, the best way to establish a diagnosis and to predict prognosis is to surgically remove the tumor for a proper histopathologic examination.
Adenoma ; Adenoma, Oxyphilic ; Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Diagnosis* ; Follow-Up Studies ; Goiter ; Hashimoto Disease ; Humans ; Neoplasm Metastasis ; Prognosis ; Thyroid Gland*

BACKGROUND: Periampullary cancer is a relatively common malignancy, and its incidence is increasing. Prognosis in these patients depends upon resection of the tumor because surgery is the only effective treatment for irradicating the disease. There has, therefore, been a renewed interest in the role of serological markers early diagnostic tools for periampullary cancer. The potential role of serological markers is not limited only to early detection, but may also be of assistance in the difficult clinical dilemma of differentiating periampullary cancer from other diseases. Furthermore, serological markers of periampullary cancer might be used in follow-up patients after treatment, particularly after surgical resection, in order to select those with minimal disease likely to respond better to adjuvant treatment and/or radiotherapy. METHODS: From March 1989 to May 1997, 54 patients were admitted to Sanggye Paik Hospital, InJe University, and had pathologically confirmed periampullary cancer. Of those, 28 patients underwent a biliary bypass or a drainage procedure [Group I], and the others received resection procedures (Whipple's operation or pylorus-preserving pancreatoduodenectomy)[Group II]. Preoperative and postoperative serum levels of bilirubin, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9(CA19-9) were measured in all patients. We evaluated the relation of the postoperative increase or decrease in those tumor markers to survival, and we discuss the usefulness of those markers as prognostic indicators in periampullary cancer. In this study, we focused on the changes in the CEA and the CA19-9 levels as function of the serum bilirubin concentration change. RESULTS: The bilirubin, CEA, and CA19-9 concentrations decreased significantly in Groups I and II after operation. The correlation between the decreases of the bilirubin and the CEA levels was statistically significant, but that between the bilirubin and CA19-9 had no statistical significance, in spite of the fact that the preoperative and the postoperative tumor marker concentrations had changed markedly. The reason for the statistical insignificance of the CA19-9 result may be the its relatively small sample size and the wide standard variation. The overall median and mean survival time of Group I were 4 months and 11 months, respectively, and those of Group II were 17 months and 21 months. CONCLUSION: We found that the serum the CEA and the CA19-9 levels could be used as a useful prognostic indicator change according to the serum bilirubin concentration even after a biliary drainage procedure and a biliary bypass. We conclude that various biliary bypass and drainage procedures can be effective treatments in periampullary cancer. However, because it is thought that many tumor markers are greatly affected by hyperbilirubinemia, liver dysfunction or cholestasis, further studies of the exact mechanism for the decrease or the increase in the tumor marker level as a function of the serum bilirubin concentration are mandatory. Precise information obtained by using multivariate analysis of large samples is essential for more accurate evaluation.
Biomarkers, Tumor ; Bilirubin* ; Carcinoembryonic Antigen ; Cholestasis ; Drainage* ; Humans ; Hyperbilirubinemia ; Incidence ; Liver Diseases ; Multivariate Analysis ; Pancreaticoduodenectomy* ; Prognosis ; Pylorus* ; Radiotherapy ; Sample Size ; Survival Rate