BACKGROUND AND PURPOSE: Laser induced prostatectomy(LIP) has recently been considered as safe alternative to conventional transurethral resection of the prostate(TURP) in the surgical treatment of BPH. However, the value of LIP remains incompletely defined. We herein have performed a prospective study to compare TURP and LIP in treatment efficacy, safety and costs to define the value of LIP. MATERIALS AND METHODS: 113 patients with BPH who were candidates of TURP were randomized to undergo TURP or LIP and were adequately followed up for more than 1 year. There were no significant differences in preoperative clinical characteristics between 55 patients who underwent TURP and 58 patients who underwent LIP. For the LIP procedure, Nd:YAG was used in 42 patients and diode laser in 16 patients, respectively. 37 patients were treated by contact LIP only, and 21 with hybrid procedures of contact LIP and noncontact LIP using side firing laser fiber or interstitial laser fiber. Seven patients underwent LIP under local anesthesia at the outpatient department. RESULTS: International prostate symptom score(IPSS) and peak urinary flow rate(Qmax) were significantly improved at 3 months, 6 months, and 1 year after LIP as well as after TURP. There were no significant difference between TURP group(85.4%) and LIP group(87.9%) in treatment success rate as defined by improvement of IPSS and Qmax as well as patient's content for the surgical outcome. Nine(16.4%) and two(3.6%) of the patients who underwent TURP and none of the patients who LIP underwent developed ignificant bleeding and electrolyte imbalance, respectively. There were no significant difference in postoperative incidence of retrograde ejaculation, infection and urethral stricture between the two groups. Compared to TURP, the LIP procedure required significantly shorter hospitalization(6.8 vs 4.5 days) and catheterization(4.1 vs 2.6 days, all p<0.0l). There was no significant difference in total treatment cost between the two groups. CONCLUSIONS: LIP may be comparable to TURP in terms of short term treatment efficacy and cost effectiveness. LIP may be better than TURP in terms of safety and shortened hospitalization and catheterization. Further studies are necessary on long-term outcomes of LIP."
Anesthesia, Local ; Catheterization ; Catheters ; Cost-Benefit Analysis ; Ejaculation ; Fires ; Health Care Costs ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Lasers, Semiconductor ; Lip ; Male ; Outpatients ; Prospective Studies ; Prostate* ; Prostatectomy* ; Transurethral Resection of Prostate ; Treatment Outcome ; Urethral Stricture

Translational initiation is regulated in response to nutrient availabilty and growth stimuli and is coupled with cell cycle progression and cell growth. There is now growing body of evidence which suggests links between translational regulation and the disruption of cell behavior that results in the development and progression of cancer. mRNA translation can be overactivated in breast cancer through eIF4E overexpression or abnormal activation of signal transduction pathways. Among them, rapamycin-sensitive signal transduction pathway (mTOR signaling pathway) is now being studied as a novel target for cancer therapy. In this article, the basic principles of translational control, the alterations encountered in cancer and selected therapy targeting mTOR signaling pathway are reviewed and the preclinical study regarding the determinants of rapamycin sensitivity in breast cancer is presented in order to help elucidate new avenues for breast cancer therapy.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Eukaryotic Initiation Factor-4E ; Protein Biosynthesis ; Signal Transduction ; Sirolimus

Breast cancer is one of the most common malignancies of lethal potential for women in the developed world. Over the past two decades, we have witnessed dramatic advances in the treatment of breast cancer. The golden age of adjuvant systemic therapy for breast cancer began in early 1970s. The early results of the intial clinical trials raised both hopes and innumerable controversies. More importantly, they stimulated many physicians to set up further prospective trials to confirm or rule out the validity of different hypotheses. The initial adjuvant therapy trials used chemotherapy to treat women with lympy node positive cancer. These trials clearly demonstrated a disease-free and overall survival benefit for women receiving combination chemotherapy in the adjuvant setting. These benefits were subsequently extended to women with lymph node negative disease and to women with steroid receptor positive breast cancer. More than 100 randomized clinical trials of breast cancer adjuvant therapy have now been completed. Many of these studies have had more than 20 years of patients follow-up, and firm conclusion can be drawn about the value of treatment in different patients subsets. Although many questions remain to be answered regarding the dose intensity of chemotherapy, the appropriate sequencing of chemotherapy agents, and the use of novel chemotherapy agents such as taxanes, sufficient information is available to conclude that appropriately adminstered adjuvant treatment does improve survival of patients with early-stage disease.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant* ; Drug Therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Hope ; Humans ; Lymph Nodes ; Prospective Studies ; Receptors, Steroid ; Taxoids

Deposition of basement membrane extracellular matrix is influenced by adjacent tumor cells, and in some cases, the pattern of type IV collagen deposit is characteristic in malignant tumors. In this report, we analyzed the difference in type IV collagen deposition patterns between benign and malignant phyllodes tumors (PTs) of the breast. Of the 15 cases of PTs, 8 cases were benign PTs and 7 cases were malignant PTs. Three cases of other primary sarcomas of the breast (stromal sarcoma, angiosarcoma and osteosarcoma) and 2 cases of fibroadenomas were studied for comparison. The malignant PTs were distinguished from benign ones by increased mitotic figures, cellular atypism, and a higher proliferation index of stromal cells. Immunohistochemical staining against type IV collagen in malignant PTs revealed extensive to moderate deposition of type IV collagen around the small blood vessels in duplicate or multilayering pattern, while benign PTs showed minimal deposition in a single linear pattern. All of the three cases of other sarcomas revealed multilayering or meshwork pattern of type IV collagen around the blood vessels. The deposition of type IV collagen around the blood vessels may reflect the malignant behavior of the stromal tumors of the breast.
Adult ; Breast Neoplasms/blood supply/*metabolism ; Collagen/*metabolism ; Female ; Humans ; Middle Aged ; Retrospective Studies

PURPOSE: Tamoxifen has been well known as an effective anti-tumor agent against breast cancer. The important role of bcl-2 and p53 proteins in tamoxifen-induced apoptosis of breast cancer cells has been suggested. However, the paradoxical fact that bcl-2 over-expression is assdegrees Ciated with better prognosis in clinic has not yet been clearly explained. To investigate this paradox, we analyzed the effect and dynamics of bcl-2 and p53 on the apoptosis after treatment of breast cancer cells with tamoxifen. MATERIALS AND METHODS: The human breast cancer cell lines MCF-7 and MB MDA-468 were treated with 17-betaestradiol (E2) and tamoxifen. RESULTS: Following tamoxifen treatment, MCF-7 cells underwent apoptosis accompanied by reduced bcl-2 expression. E2 pre-treatment led to the inhibition of tamoxifen-mediated apoptosis and bcl-2 down-regulation. When MB MDA-468 cells were treated with E2 or tamoxifen, bcl-2 and p53 protein expression did not change and apoptosis did not develop. CONCLUSION: We observed that the down-regulation of bcl-2 by tamoxifen treatment can facilitate the apoptosis of breast cancer cells without p53 mutations. This finding was consistent with clinical experiences in which bcl-2 positive tumors were assdegrees Ciated with more indolent phenotypes in breast cancer.
Apoptosis* ; Breast Neoplasms* ; Breast* ; Cell Line* ; Down-Regulation ; Humans* ; MCF-7 Cells ; Phenotype ; Prognosis ; Tamoxifen

OBJECTIVE: Although anterior cervical discectomy and fusion (ACDF) is the standard treatment for degenerative cervical disc disease, concerns regarding adjacent level degeneration and loss of motion have suggested that arthroplasty may be a better alternative. We have compared clinical and radiological results in patients with cervical disc herniations treated with arthroplasty and ACDF. METHODS: We evaluated 53 patients treated for cervical disc herniations with radiculopathy, 21 of whom underwent arthroplasty and 32 of whom underwent ACDF. Clinical results included the Visual Analogue Scale (VAS) score for upper extremity radiculopathy, neck disability index (NDI), duration of hospital stay and convalescence time. All patients were assessed radiologically by measuring cervical lordosis, segmental lordosis and segmental range-of-movement (ROM) of operated and adjacent disc levels. RESULTS: Mean hospital stay (5.62 vs. 6.26 days, p<0.05) and interval between surgery and return to work (1.10 vs. 2.92 weeks, p<0.05) were significantly shorter in the arthroplasty than in the fusion group. Mean NDI and extremity VAS score improved after 12 months in both groups. Although it was not significant, segmental ROM of adjacent levels was higher in the fusion group than in the arthroplasty group. And, segmental motion of operated levels in arthroplasty group maintained more than preoperative value at last follow up. CONCLUSION: Although clinical results were similar in the two groups, postoperative recovery was significantly shorter in the arthroplasty group. Although it was not significant, ROM of adjacent segments was less in the arthroplasty group. Motion of operated levels in arthroplasty group was preserved at last follow up.
Animals ; Arthroplasty ; Convalescence ; Diskectomy ; Extremities ; Follow-Up Studies ; Humans ; Length of Stay ; Lordosis ; Neck ; Radiculopathy ; Return to Work ; Upper Extremity

For the physical characterization of neutron beam, dosimetric measurements had been performed to obtain physical data of KCCH cyclotron-produced neutrons for clinical use. The results are presented and compared with the data of other institutions from the literatures. The central aixs percent depth dose, build-up curves and open and wedge isodose curve values are intermediate between that of a 4 and 6 MV X-ray. The build-up level of maximum dose was at 1.35 cm and entrance dose was approximately 40%. Flatness of the beam was 9% at Dmax and less than+/-3% at the depth of 80% isodose line. Penumbra begond the 20% line is wider than corresponding photon beam. The output factors ranged 0.894 for 6 x 6 cm field to 1.187 for 30 x 30 cm field. gamma contamination of neutron beam was 4.9% at 2 cm depth in 10 x10 cm field.
Cyclotrons ; Neutrons*

Breast cancer is the most common cancer in Korean women since 2001 and needs national interests. The incidence of breast cancer is increasing with new breast cancer cases reaching more than 10,000 cases annually. But, there are some difficulties in breast cancer control; first, the National Cancer Screening Program is ineffective and of low quality, second, the lack of psychosocial care for mastectomized patients, third, the lack of national care for terminal cancer patients. For effective breast cancer control, we need special support for breast cancer awareness campaign, activation of breast cancer registry, development of clinical practice guideline, development of hospice program, breast cancer research, and upgrading its guarantee on breast cancer treatment. The Korean Breast Cancer Society should have the leading role in solving the current problems, but moreover, we cannot overemphasize the need for national support.
Breast Neoplasms* ; Breast* ; Early Detection of Cancer ; Female ; Hospice Care ; Humans ; Incidence

BACKGROUND: Small deep cerebral infarct can be associated with small-vessel occlusive disease, largevessel disease, low-flow or thrombo-embolic mechanism. This study is designed to investigate ralationship between symptomatic single small deep infarcts ahd vascular diseases. METHODS: We studied 154 patients who had symptomatic, small-sized(<20 mm), single, subcortical infarction(basal ganglia, corona rediata, centrum semiovale) who were admitted to our hospital from jund, 1996 to September, 1999. They were evaluated about the lesion site and vascular status of the carotid system and middle cerebral artery, using MRI, MRA and cervical duplex sonography or conventional angiography. RESULTS: Among 154 patients with single small deep infarction, 100 were related with small artery disease(64.9%), 38 with middle cerebral artery disease(26.7%) and 16 with carotid artery disease(10.4%). The basal ganglia or basal ganglia with corona radiata area were more frequently responsible lesion sites in both small artery disease(n=59, 59%) and middle cerebral artery disese(n=28, 73.7%) than in carotid artery disease(n=1, 6.3%). The centrum ovale or centrum ovale with corona radiata area were frequently involved lesion sites in carotid artery disease (n=10, 67.5%). CONCLUSION: Single small deep infarcts of th basal ganglia with corona radiata were mostly seen in the middle cerebral artery disease or small artery disease, and small deep infarcts of the centrum semiovale with corona radiata were usually assoicated with internal carotid artery disease. In occurrence of single small deep infarcts, middle cerebral artery disease was more frequent than carotid artery disease, which might be associated with intracranial occlusive disease known to be more common in Asians than in Caucasians.
Angiography ; Arteries ; Asian Continental Ancestry Group ; Basal Ganglia ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Artery, Internal ; Cerebral Infarction* ; Ganglia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Vascular Diseases

BACKGROUND: The deleterious cardiopulmonary side effects immediately after positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy are well tolerated in healthy patients but can lead to serious morbidity and mortality in patients with a limited cardiopulmonary reserve. Using a continuous and non-invasive cardiac output monitor based on partial CO2 rebreathing method, we investigated the immediate cardiopulmonary changes caused by positioning in reverse Trendelenburg and CO2 intra-abdominal insufflation during a laparoscopic cholecystectomy, and assessed the applicability of the partial CO2 rebreathing method for the measurement of cardiac output in a laparoscopic cholecystectomy. METHODS: The investigation was carried out on 11 patients undergoing a laparoscopic cholesystectomy. The control values of cardiac index (CI), cardiac output (CO), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), systemic vascular resistance (SVR), dynamic compliance (Cdyn), airway resistance (Raw), peak inspiratory pressure (PIP) and end tidal CO2 partial pressure (PETCO2) were measured in the supine position after induction with target-controlled infusion of propofol (5 microgram/ ml). Five minutes after positioning in reverse Trendelenburg and CO2 insufflation, the same cardiopulmonay variables were measured and compared with the control values. RESULTS: CI, CO and CVP were reduced 33.3%, 31.9% and 29.0%, respectively (P < 0.05). MAP and SVR were increased 39.8% and 154.1%, respectively (P < 0.05). Cdyn was reduced 38.0% (P < 0.05). Raw and PIP were increased 22.8%, and 34.8%, respectively (P < 0.05), whereas HR and PETCO2 remained unchanged. CONCLUSIONS: The non-invasive cardiopulmonary monitor using partial CO2 rebreathing method, could be used with ease and safety in a laparoscopic cholecystectomy.
Airway Resistance ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Cholecystectomy, Laparoscopic ; Compliance ; Heart Rate ; Humans ; Insufflation ; Mortality ; Partial Pressure ; Propofol ; Respiratory System* ; Supine Position ; Vascular Resistance