PURPOSE: The effect of neoadjuvant hormonal therapy (NHT) on radical retropubic prostatectomy (RRP) for prostate cancer is various and remains a controversy for urologists. We conducted this study to comparatively evaluate whether NHT before RRP is indicated and beneficial in the aspects of postoperative complications, positive surgical margin, and biochemical recurrence. MATERIALS AND METHODS: Between September 2006 and December 2009, 69 men were scheduled for RRP as a treatment for clinically localized and locally advanced prostate cancer and were divided into two groups. Group 1 (n=31, 44.9%) was treated with RRP only, and group 2 (n=38, 55.1%) underwent RRP with preoperative NHT. We evaluated clinical parameters, surgical parameters, and the positive margin rate in surgical specimens and the biochemical recurrence rate. RESULTS: There were no statistical differences in age, body mass index (BMI), preoperative biopsy Gleason score, initial serum prostate-specific antigen (PSA) levels, International Prostate Symptom Score (IPSS), or quality of life (QoL) between the two groups (p>0.05). We also observed no differences in the transfusion rate, mean catheterization time, or positive margin rate (p>0.05). However, the mean operative time was significantly higher in the RRP with preoperative NHT group than in the other group (p=0.034). There was no significant difference in the biochemical recurrence rate during the last follow-up according to NHT (p=0.102) or positive surgical margin (p=0.473). CONCLUSIONS: These results suggest that there were no clinical benefits to the administration of NHT before RRP from the viewpoint of biochemical recurrence.
Biopsy ; Body Mass Index ; Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Grading ; Operative Time ; Postoperative Complications ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Quality of Life ; Recurrence

Drawing on our observation that many medical professionals have considerable difficulty in using what they know about ethics, we have developed a course for teaching the fifth year medical students a systematic approach to ethical reasoning and problem-solving, rather than teaching bioethical theories or prominent current ethical issues in developed countries. This course consisted of a series of guided group discussions and debates in classroom using over 50 cases classified under seven major headings. Responses and reactions from students and participating clinicians are encouraging. Several ideas for improving medical ethics curricula are discussed, including emphases on the thorough understanding of various aspects of human relations in medical practice, enhancing the ability of articulate the students own values, provoking the student to get involved in the ethical situation when studying the cases, and the need to introduce social science concepts in analyzing the ethical issues in the health care system.
Curriculum ; Delivery of Health Care ; Developed Countries ; Ethics ; Ethics, Medical* ; Head ; Humans ; Social Sciences ; Students, Medical

PURPOSE: Type III 5-alpha reductase (SRD5A3; steroid 5-alpha reductase 3) may be associated with the progression of prostate cancer (PCa). The aim of our study was to determine whether the length of AC repeats in the SRD5A3 gene is associated with the risk of PCa and the expression of androgen receptor (AR) protein in Korean men. MATERIALS AND METHODS: We compared the length of AC repeats in the short tandem repeat (STR) region of the SRD5A3 gene in 68 PCa patients and 81 control subjects by genotyping. A total of 55 patients in the PCa group underwent radical prostatectomy. We evaluated the expression of AR protein by using Western blotting and tested the association between the type of AC repeats in the SRD5A3 gene and AR protein expression and clinical and pathologic parameters. RESULTS: The short type of STR had less than 21 copies of AC repeats in the SRD5A3 gene. The SS type (short and short type) of STR of the SRD5A3 gene was 2.2 times as likely to occur in PCa patients as in controls (odds ratio, 2.21; 95% confidence interval, 1.14 to 4.31; p=0.019). However, AC repeats of the SRD5A3 gene were not associated with AR protein expression or clinical or pathologic parameters in PCa samples. CONCLUSIONS: These results suggest that the short AC repeats of SRD5A3 polymorphism are associated with an increased risk of PCa. SRD5A3 polymorphism may contribute to a genetic predisposition for PCa.
3-Oxo-5-alpha-Steroid 4-Dehydrogenase ; Blotting, Western ; Coat Protein Complex I ; Genetic Predisposition to Disease ; Humans ; Microsatellite Repeats ; Oxidoreductases ; Passive Cutaneous Anaphylaxis ; Polymorphism, Genetic ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Receptors, Androgen

BACKGROUND: It has been known that alveolar macrophage exposed to bacterial lipopolysaccharide (LPS) induces a lots of nitric oxide (NO) and inducible nitric oxide synthase (iNOS) mRNA expression. The Authors elucidated the effects of iNOS mRNA expression by inhalational anesthetics (isoflurane) on endotoxemic rats and positive pressure ventilation with and without LPS. METHODS: Fifty Sprague-Dawley rats (250 - 270 g) were anesthesized with urethane injected in the peritoneal cavity. Then the expression of iNOS mRNA in the alveolar macrophages of the rats were measured after injection of LPS, 2 hours of isoflurane (0.5 - 2.5%) anesthesia, and 2 hours of positive pressure ventilation. The activities of iNOS in macrophages were measured by analysing iNOS mRNA expression by Northern blot analysis with autoradiography using the polymerase chain reaction (PCR) method. RESULTS: The size and patterns of the iNOS mRNA band in the 0.5 - 2% isoflurane group were almost same as with the control group. The size of the iNOS mRNA band in the 2.5% isoflurane group increased more than in the control group. In the continous positive-pressure ventilation with LPS group, the iNOS mRNA band was slightly increased compared to the normal lung and the continous positive-pressure ventilation without LPS group. CONCLUSIONS: Higher concentrations of isoflurane anesthesia may evoke the expression of iNOS mRNA in a septic model. Positive pressure ventilation in sepsis may induce iNOS mRNA production.
Anesthesia ; Anesthetics ; Animals ; Autoradiography ; Blotting, Northern ; Isoflurane* ; Lung ; Macrophages ; Macrophages, Alveolar ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Peritoneal Cavity ; Polymerase Chain Reaction ; Positive-Pressure Respiration ; Rats* ; Rats, Sprague-Dawley ; RNA, Messenger* ; Sepsis ; Urethane

PURPOSE: Aquaporin (AQP), a protein located in the cellular membrane, allows rapid passage of water across the cell membrane. Various AQP subtypes have been associated with ureteral obstruction. In particular, AQP3 has two functions: water and glycerol transport. The aim of this study was to investigate the expression of AQP3 in the ipsilateral rat kidney in unilateral partial ureteral obstruction (UPUO). MATERIALS AND METHODS: Sprague-Dawley rats (n=30, 200-250 g) were divided into two groups. A sham operation was performed in the control group (n=10) and UPUO of the left upper ureter with a silicone tube was induced in the UPUO group (n=20). The left kidney was obtained from both groups 7 days after the operations. The kidney specimens underwent immunofluorescent staining with AQP3 monoclonal antibody, and the density of AQP3 in the tissue was measured with an image analyzer. RESULTS: In the UPUO group, thinning of the epithelial layer and infiltration of inflammatory cells was seen along with the localized expression of AQP3 in the basolateral aspect of the principal collecting duct cells. The mean optical density of AQP3 was significantly lower in the UPUO group than in the control group (100.9+/-17.5 compared with 131.7+/-16.9; p<0.001). CONCLUSIONS: These results suggest that a decrease in the expression of AQP3 may be the result of a urinary stasis reaction caused by UPUO in response to local and intrarenal factors. These changes suggest that AQP3 may have a pathophysiological role in UPUO.
Animals ; Aquaporin 3 ; Cell Membrane ; Glycerol ; Kidney ; Membranes ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Silicones ; Ureter ; Ureteral Obstruction

Hypoxemia is a common and potentially serious postoperative complication. Hypoxic encephalopahty may occur in prolonged hypoxemia. This condition needs brain protection. There are many brain protective methods. The primary cental nervous system protective mechanism of the barbiturates is attributed to their ability to decrease the cerebral metabolic rate, thus improving the ratio of oxygen (O2) supply to O2 demand. The electroencephalogram-derived bispectral index system (BIS) is a promising new method to predict probability of recovery of consciousness. We experienced two cases of hypoxic brain damage in recovery room. The patients were treated with thiopental and monitored with BIS. The use of thiopental as brain protection during complete global ischemia after cardiac arrest was not effective.
Anesthetics ; Anoxia ; Barbiturates ; Brain ; Consciousness ; Heart Arrest ; Humans ; Hypoxia, Brain* ; Ischemia ; Nervous System ; Oxygen ; Postoperative Complications ; Recovery Room ; Thiopental*

PURPOSE: We undertook this study to evaluate the usefullness of radiologic placement of subcutaneous infusion ports (SIP). MATERIALS AND METHODS: Between August 1999 and May 2000 we performed 45 implantations of SIP in radiologic suite. Both sonography and fluoroscopy were used for venipuncture and to guide port insertion. We prospectively evaluated 45 systems in 45 patients with solid tumors. RESULTS: Median follow-up time was 189 days (61~352 days). Technical success rate is 100% without any venipuncture-related complications. Early complication rate within 30 days of procedure was 4.4%, including wound dehiscence (n=1) and pocket hematoma and local infection (n=1). Catheter-related infection rate was 6.7% and catheter-related venous thrombosis rate was 4.4%. Mean duration of catheter use was 208 96 days (total, 9,381 days). Overall port survival rate was 38.5%, and four systems (8.9%) were prematurely removed because of catheter tunnel infection (n=1), pocket infection (n=1), and central venous thrombosis (n=2). CONCLUSION: Radiologic placement of SIP had higher success rate and equal or lower complication rate compared with reported conventional surgical technique using anatomical landmarks. Moreover, clinical convenience, resulting from ease of scheduling could make it replace surgical method.
Catheter-Related Infections ; Catheters ; Fluoroscopy ; Follow-Up Studies ; Hematoma ; Humans ; Infusions, Subcutaneous* ; Phlebotomy ; Prospective Studies ; Survival Rate ; Venous Thrombosis ; Wounds and Injuries

A 65-year-old man was admitted due to low grade fever, dry coughing, and dyspnea on exertion. The chest radiograph and CT scan showed diffuse ground glass opacities and small nodules in the both lung fields resulting in a diagnosis of severe interstitial pneumonia. Conservative treatment with antibiotics and bronchodilators decreased the symptoms, but the dyspnea and cough reappeared when he returned home. An inspection of his house revealed the presence of fungi under the wallpaper. His symptoms disappeared completely after these were removed. His clinical course raised the suspicion of hypersensitivity pneumonitis and these fungi believed to be the cause of hypersensitivity pneumonitis. The histological findings of a lung specimen by video-assisted thorachoscopy were compatible with hypersensitivity pneumonitis. The fungi were identified as Alternaria.
Aged ; Alternaria* ; Alveolitis, Extrinsic Allergic* ; Anti-Bacterial Agents ; Bronchodilator Agents ; Cough ; Diagnosis ; Dyspnea ; Fever ; Fungi ; Glass ; Humans ; Hypersensitivity* ; Lung ; Lung Diseases, Interstitial ; Radiography, Thoracic ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to evaluate changes in expressions of neuregulin (NRG)1 and erbB2 tyrosine kinase (ErbB2) in bladders of rats with cyclophosphamide (CYP)-induced interstitial cystitis (IC). METHODS: Twenty-four Sprague-Dawley rats were divided into the IC group (n=16) and the control group (n=8). After inducing IC with intraperitoneal CYP injection, expressions of NRG1 and ErbB2 were analyzed using western blotting and reverse transcriptase-polymerase chain reaction. RESULTS: In Western blotting, relative intensities and distributions of both NRG1 and ErbB2 were approximately 1.5- and 3.2-fold higher, respectively, in the IC group than in the control group (mean+/-standard deviation: 1.42+/-0.09 vs. 0.93+/-0.15 and 0.93+/-0.16 vs. 0.29+/-0.08, P<0.05). In the rat bladder samples, mRNA expression levels of NRG1 and ErbB2 were higher in the IC group than in the control group (P<0.05). CONCLUSIONS: Our study has demonstrated significant changes in mRNA expression and immunoreactivity of NRG1 and ErbB2 receptors in the urinary bladder after CYP-induced IC. These results suggest that the up-regulated NRG1 may play a role in inducing an overactive bladder and promoting regeneration in the inflammatory bladder with CYP-induced IC.
Animals ; Blotting, Western ; Cyclophosphamide ; Cystitis, Interstitial* ; Neuregulin-1* ; Protein-Tyrosine Kinases* ; Rats* ; Rats, Sprague-Dawley ; Receptor, erbB-2 ; Regeneration ; RNA, Messenger ; Tyrosine* ; Urinary Bladder* ; Urinary Bladder, Overactive

OBJECTIVES: To identify changes in relationships with superiors or colleagues at work and family members and social networks at home, based on occupational stress and psychological characteristics in during the process of restructuring some plants undergoing a long-term labor dispute. METHODS: This study invested 213 workers involved in a long-term labor dispute using the KOSS (Korean Occupational Stress Scale) and the MMPI-2 (Minnesota Multiphasic Personality Inventory) and questionnaires. The KOSS and MMPI-2 scores in accordance with aggressiveness of trade union activity and changes in human relationships were compared. In addition, the odds ratio of whether there were differences in health behavior (perception of health status, smoking, alcohol abuse, medical treatment) and the absenteeism rate was calculated by logistic regression analysis. RESULTS: For members of the aggressiveness of trade union activity group, the rate at which the relationship between superiors or colleagues deteriorated was high, as was the total KOSS score, occupational system and lack of reward score of KOSS subclass. The depression subclass score of MMPI-2 was generally high, while the score of hypochondriasis, hysteria, psychopathic deviate, hypomania was high, and social introversion was low in the active group. In cases in which there were high score of psychopathic deviate, hypomania and paranoia, there were also signs of negative health behavior. CONCLUSIONS: Occupational stress caused by a long-term labor dispute, accompanied with depression can result in an aggressive, hostile and vulnerable personalities and have a negative impact on health behavior.
Absenteeism ; Alcoholism ; Depression ; Dissent and Disputes ; Health Behavior ; Humans ; Hypochondriasis ; Hysteria ; Introversion (Psychology) ; Labor Unions ; Logistic Models ; Odds Ratio ; Paranoid Disorders ; Questionnaires ; Reward ; Smoke ; Smoking