PURPOSE: There is a trend towards early catheter removal after radical retropubic prostatectomy (RRP). Therefore, the feasibility of early catheter removal after RRP was explored. MATERIALS AND METHODS: Twenty-four consecutive patients having undergone a RRP performed by one surgeon were divided into two groups. Groups A and B comprised the patients who had their cystography taken either 6 or 14 days after surgery, respectively. Voiding symptoms in the immediate (after catheter removal) and late postoperative (1 month after catheter removal) periods were assessed. The mean patient ages were 68.8, ranging from 59 to 76 and 66.8, ranging from 61 to 73 years in groups A and B (p=0.37), respectively. The Mean follow-up was 4.3 months (1-9). RESULTS: One patient in each group showed significant urine leakage on cystography, which required a further week of catheter indwelling. In group A, 8 patients (72.7%) needed pads for their incontinence immediately after catheter removal and 3 (27.3%) required pads continuously 1 month after catheter removal. In group B, incontinence that required pads developed in 9 patients (81.8%) immediately after catheter removal, and in 3 (27.3%) 1 month after catheter removal. One patient in group A required a 3-day Foley catheter indwelling for urinary retention. There were 4 (36.4%) and 2 (18.2%) patients in groups A and B, respectively, with weak urinary stream (Qmax<15ml/sec). CONCLUSIONS: A catheter can be safely removed, with caution, 6 days after a radical retropubic prostatectomy for the development of urinary retention and weak stream, which might be caused by anastomotic edema and transiently decreased bladder contractility.
Catheters* ; Edema ; Follow-Up Studies ; Humans ; Prostatectomy* ; Rivers ; Urinary Bladder ; Urinary Catheterization ; Urinary Retention

PURPOSE: To assess the prognostic factors for recurrence-free survival after salvage radiotherapy (RT). MATERIALS AND METHODS: Between 1990 and 2003, 20 patients underwent RT for biochemical failure after a radical prostatectomy (prostate-specific antigen; PSA>0.2ng/ml). The biochemical failure developed at a mean of 17.3 months (3-58) after the RP, and the mean PSA level at failure was 0.62ng/ml (0.4-1.0). All patients received curative radiation (mean dosage 64.5Gy); with a mean follow-up of 42.7 months after the RT. The pre-RT clinical and pathological parameters were evaluated to find prognostic factors affecting the biochemical recurrence-free survival (bRFS) after RT. RESULTS: The mean time to RT from biochemical failure was 5.1 months (1-21), with a mean PSA level at the commencement of RT of 1.39ng/ml (0.36-6.70). In 18 patients, the serum PSA declined to an undetectable level, at a mean of 4.9 months (1-12) after RT. Of these, 8 (44.4%) showed a biochemical relapse, at a mean of 19.3 months (1-38). The actuarial 1, 3 and 5-year bRFS were 75.0, 48.5 and 39.0%, respectively. The bRFS was significantly increased with an interval to RT after failure of within 3 months (p=0.002) and the PSA level at RT was below 0.7ng/ml (p=0.036). No other clinicopathological factors had a significant influence. CONCLUSIONS: Salvage RT for biochemical failure provides effective local tumor control, with a modest durable biochemical response. A more favorable outcome may be expected when the RT is instituted earlier, with a lower PSA level after failure.
Biochemistry ; Follow-Up Studies ; Humans ; Prostatectomy* ; Prostatic Neoplasms ; Radiotherapy* ; Recurrence ; Treatment Failure

We analyzed the prostate cancer data of 317 Korean men with clinically localized prostate cancer who underwent radical prostatectomy at Asan Medical Center between June 1990 and November 2003 to construct nomograms predicting the pathologic stage of these tumors, and compared the outcome with preexisting nomograms. Multinomial log-linear regression was performed for the simultaneous prediction of organ-confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node metastasis (LNM) using serum prostate-specific antigen (PSA), Gleason score and clinical stage. Nomograms representing percent probabilities were constructed and compared with those presented by Partin et al. by calculating areas under the receiver operating characteristics (ROC) curves. Median serum PSA at surgery was 10.8 ng/mL, and median biopsy Gleason score was 7. Overall OCD, ECE, SVI and LNM rates were 59.6%, 20.5%, 11.7% and 8.2%, respectively, and areas under the curves were 0.724, 0.626, 0.662, and 0.794, respectively. Pathologic stage of localized prostate cancer in Korean men may be predicted using the Partin table, with acceptable accuracy for OCD and LNM, but less so for ECE and SVI.
Adult ; Aged ; Aged, 80 and over ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prostate-Specific Antigen/blood ; Prostatic Neoplasms/blood/ethnology/*pathology ; ROC Curve

Ovarian cancer is one of the leading causes of cancer-related deaths in gynecological malignancies. Over 70% of ovarian cancer cases are high-grade serous ovarian cancers and have high death rates due to their resistance to chemotherapy. Despite advances in surgical and pharmaceutical therapies, overall survival rates are not good, and making an accurate prediction of the prognosis is not easy because of the highly heterogeneous nature of ovarian cancer. To improve the patient's prognosis through proper treatment, we present a prognostic prediction model by integrating high-dimensional RNA sequencing data with their clinical data through the following steps: gene filtration, pre-screening, gene marker selection, integrated study of selected gene markers and prediction model building. These steps of the prognostic prediction model can be applied to other types of cancer besides ovarian cancer.
Drug Therapy ; Filtration ; Mortality ; Ovarian Neoplasms ; Prognosis ; RNA ; Sequence Analysis, RNA ; Survival Rate

Mainly due to the slanted focus on the mechanism and regulation of neuronal aging, research on astrocyte aging and its modulation during brain aging is scarce. In this study, we established aged astrocyte culture model by long-term culturing. Cellular senescence was confirmed through SA-β-gal staining as well as through the examination of morphological, molecular, and functional markers. RNA sequencing and functional analysis of astrocytes were performed to further investigate the detailed characteristics of the aged astrocyte model. Along with aged phenotypes, decreased astrocytic proliferation, migration, mitochondrial energetic function and support for neuronal survival and differentiation has been observed in aged astrocytes. In addition, increased expression of cytokines and chemokine-related factors including plasminogen activator inhibitor -1 (PAI-1) was observed in aged astrocytes. Using the RNA sequencing results, we searched potential drugs that can normalize the dysregulated gene expression pattern observed in long-term cultured aged astrocytes. Among several candidates, minoxidil, a pyrimidine-derived anti-hypertensive and anti-pattern hair loss drug, normalized the increased number of SA-β-gal positive cells and nuclear size in aged astrocytes. In addition, minoxidil restored up-regulated activity of PAI-1 and increased mitochondrial superoxide production in aged astrocytes.We concluded that long term culture of astrocytes can be used as a reliable model for the study of astrocyte senescence and minoxidil can be a plausible candidate for the regulation of brain aging.

PURPOSE: We mapped the location of prostate cancer in Korean men, and investigated the volume and tumor distribution in relation to clinicopathological variables. MATERIALS AND METHODS: The volume of cancer and the anatomic location of each tumor foci were determined from 186 radical prostatectomy specimens, which were digitized to fit into a prototype prostate model. Using the computer-based digital images, the zonal cancer volume and distributional frequency were analyzed with respect to the clinical and pathological parameters, which were demonstrated in gray scales. RESULTS: The preoperative serum prostate-specific antigen (PSA) level ranged from 2.0 to 38.9ng/ml. The mean cancer volume of the 186 specimens was 4.5ml (median 1.9ml, range 0.01-37.7). The impalpable cancers were located more anteriorly and in the transition zone, and were also were smaller in volume (2.7ml vs. 5.5ml, p=0.004) than the palpable cancers. Cancers with seminal vesicle invasion were located more medially in the peripheral zone, and were larger in volume than organ-confined cancers or cancers with extracapsular extension (13.2ml vs. 3.0ml, p<0.001). For Gleason scores of 2-6, 7, and 8-10, the mean cancer volumes were 2.2, 3.7 and 8.2ml, respectively (p<0.001). High grade cancers were located more medially in the peripheral zone, especially when approaching the apex. CONCLUSIONS: T1c cancers are located more anteriorly and in the transition zone; therefore, inclusion of these areas for targeted biopsy may help to improve the detection of cancer in patients with elevated PSA levels and impalpable prostate cancer. A medial location of seminal vesicle invasive cancers may imply an ejaculatory ducts route of invasion rather than a direct extracapsular extension.
Biopsy ; Ejaculatory Ducts ; Fluconazole ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Seminal Vesicles ; Tumor Burden ; Weights and Measures

PURPOSE: In this multi institutional study, the data of 604 men with clinically localized prostate cancer, who underwent radical prostatectomy, with updated nomograms predicting the pathological stage, were analyzed. MATERIALS AND METHODS: Prostate biopsies and prostatectomy specimens from men treated with radical prostatectomy, obtained between 1990 and 2003, were included. The patient distribution with respect to clinical stage, serum prostate-specific antigen (PSA) and biopsy Gleason score, as well as final pathological findings, including organ-confined disease (OCD), extracapsular extension (ECE), seminal vesicle invasion (SVI), and lymph node metastasis (LNM), were analyzed for the construction of nomograms representing the percent probabilities of each respective pathological outcome. RESULTS: The median serum PSA at the time of surgery and biopsy Gleason score were 9.9ng/ml and 7, respectively. The preoperative serum PSA was 4ng/ml or less in 38 (6.3%) patients and the tumor was impalpable in 292 (48.2%) of patients. The biopsy Gleason scores were 7 and 8 or higher in 186 (30.7%) and 169 (27.9%), respectively. Throughout the clinical stages and PSA ranges, the Gleason score was 7 or higher in more than 50% of patients, but 8-10 in 20-30%. The overall OCD, ECE, SVI and LNM rates were 57.1, 27.8, 10.9 and 4.2%, respectively. CONCLISIONS: A significantly high proportion of prostate cancers arising in Korean men exhibited poor differentiation, with Gleason scores of 7 or higher, regardless of the clinical stage or initial serum PSA. Updated nomograms acknowledging such characteristics have been developed, which may aid in the treatment planning of these individuals.
Biopsy ; Humans ; Lymph Nodes ; Male ; Neoplasm Grading ; Neoplasm Metastasis ; Nomograms* ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Seminal Vesicles

BACKGROUND: Several studies reported that sub-clinical rejection (SCR) detected by a protocol biopsy soon after renal transplantation does permanent damage to a renal allograft, contributing to chronic allograft nephropathy (CAN). This article investigated the risk factors involved in SCR and the effects of treating SCR, and evaluated the clinical significance of a protocol biopsy soon after renal transplantation. METHODS: From January 2007 to June 2010, 253 patients received renal transplantation. Patients were divided into two groups according to whether or not they had undergone a protocol biopsy. To analyze the effect of SCR treatments, patients who were diagnosed with SCR were divided into two groups according to whether or not they had been treated with SCR. The patients who did not undertake a protocol biopsy were included in the untreated groups. RESULTS: Among 138 patients who undertook protocol biopsies, 65 patients (47.1%) showed SCR. In univariate analysis, both the number of HLA-DR mismatches (P=0.003) and not using Simulect (P=0.01) were identified as risk factors of SCR. In multivariate analysis, not using Simulect (P=0.006) was identified as an risk factor independent of SCR. deltaGFR, subtracting GFR at 1 week from GFR at that point, showed significant differences between SCR-treated patients and untreated patients at 1, 3, 6, 9, 12, 24, and 36 months with a P value of less than 0.05. CONCLUSIONS: A protocol biopsy can detect SCR, especially in patients with risk factors such as a high number of HLA mismatches or not using Simulect. Treatment of SCR detected by protocol biopsy will help to improve long-term renal function.
Antibodies, Monoclonal ; Biopsy ; HLA-DR Antigens ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Risk Factors ; Transplantation, Homologous

BACKGROUND: Several studies reported that sub-clinical rejection (SCR) detected by a protocol biopsy soon after renal transplantation does permanent damage to a renal allograft, contributing to chronic allograft nephropathy (CAN). This article investigated the risk factors involved in SCR and the effects of treating SCR, and evaluated the clinical significance of a protocol biopsy soon after renal transplantation. METHODS: From January 2007 to June 2010, 253 patients received renal transplantation. Patients were divided into two groups according to whether or not they had undergone a protocol biopsy. To analyze the effect of SCR treatments, patients who were diagnosed with SCR were divided into two groups according to whether or not they had been treated with SCR. The patients who did not undertake a protocol biopsy were included in the untreated groups. RESULTS: Among 138 patients who undertook protocol biopsies, 65 patients (47.1%) showed SCR. In univariate analysis, both the number of HLA-DR mismatches (P=0.003) and not using Simulect (P=0.01) were identified as risk factors of SCR. In multivariate analysis, not using Simulect (P=0.006) was identified as an risk factor independent of SCR. deltaGFR, subtracting GFR at 1 week from GFR at that point, showed significant differences between SCR-treated patients and untreated patients at 1, 3, 6, 9, 12, 24, and 36 months with a P value of less than 0.05. CONCLUSIONS: A protocol biopsy can detect SCR, especially in patients with risk factors such as a high number of HLA mismatches or not using Simulect. Treatment of SCR detected by protocol biopsy will help to improve long-term renal function.
Antibodies, Monoclonal ; Biopsy ; HLA-DR Antigens ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Risk Factors ; Transplantation, Homologous

This study was designed to compare the hospital-related costs of elective abdominal aortic aneurysm (AAA) treatment and cost structure between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in Korean health care system. One hundred five primary elective AAA repairs (79 OSRs and 26 EVARs) performed in the Seoul National University Hospital from 2005 to 2009 were included. Patient characteristics were similar between two groups except for older age (P = 0.004) and more frequent history of malignancy (P = 0.031) in EVAR group. Thirty-day mortality rate was similar between two groups and there was no AAA-related mortality in both groups for 5 yr after repair. The total in-hospital costs for the index admission were significantly higher in EVAR patients (mean, KRW19,857,119) than OSR patients (mean KRW12,395,507) (P < 0.001). The reimbursement was also significantly higher in EVAR patients than OSR patients (mean, KRW14,071,081 vs KRW6,238,895, P < 0.001) while patients payments was comparable between two groups. EVAR patients showed higher follow-up cost up to 2 yr due to more frequent imaging studies and reinterventions for type II endoleaks (15.4%). In the perspective of cost-effectiveness, this study suggests that the determination of which method to be used in AAA treatment be more finely trimmed and be individualized.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/economics/mortality/*surgery ; Blood Vessel Prosthesis Implantation/*economics ; Cost-Benefit Analysis ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Insurance, Health, Reimbursement ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Republic of Korea ; Survival Analysis ; Treatment Outcome ; Vascular Surgical Procedures/*economics