No abstract available.
Aneurysm* ; Renal Artery*

BACKGROUND/AIMS: The growing volume and the diversity of clinical research has led to related laws and regulations as well as the Institutional Review Board (IRB) approval process becoming more stringent. To conduct clinical research efficiently and while following regulations, information about the IRB approval process and feedback is important for investigators. This has yet to be studied. METHODS: We included 381 gastrointestinal disease research proposals (79 with inflammatory bowel disease [IBD], and 302 with non-IBD) reviewed by the IRB of Severance Hospital between January 2009 and December 2013. We retrospectively analyzed research characteristics including research risk levels, results of initial reviews, frequencies of continuing review, numbers of IRB comments, frequencies of IRB comments, and durations from submission to approval. RESULTS: Investigators' decisions on risk level were higher in the IBD group than in the non-IBD group (P<0.05). Results of initial reviews, frequencies of continuing reviews, the numbers of IRB review comments, and durations from submission to approval were not different between the two groups, but IRB decisions on risk level were higher in the IBD group (P<0.05). In subgroup analysis, the number of IRB comments from initial review on informed consent forms and procedures as well were quest of more information were significantly higher in the IBD group than in the non-IBD group (P<0.001 and 0.01, respectively). CONCLUSIONS: In Korea, rare diseases such as IBD require more information for the IRB process due to their distinct characteristics. IBD researchers should develop research protocols more carefully and make their research as subject-friendly as possible.
Consent Forms ; Ethics Committees, Research ; Gastrointestinal Diseases ; Humans ; Inflammatory Bowel Diseases* ; Jurisprudence ; Korea ; Rare Diseases ; Research Design ; Research Personnel ; Retrospective Studies ; Social Control, Formal

A 41-year-old heterosexual African man was evaluated for persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. The differential diagnosis of an acquired rectourethral fistula and the significance of AIDS are discussed.
Acquired Immunodeficiency Syndrome/*complications ; Adult ; Case Report ; Diverticulum/*complications/diagnosis ; Human ; Male ; Rectal Fistula/*complications/diagnosis ; Urethral Diseases/*complications/diagnosis

BACKGROUND: Liver transplantation (orthotopic) is considered as an important therapy for the end stage liver diseases, but because of the coagulopathies of these patients, the massive bleeding during the operation has been a disturbing problem. So, the role of blood bank has increasingly been important for the appropriate blood products supply for the operation. METHODS: The authors reviewed retrospectively the hospital records of 9 patients who had taken orthotopic liver transplantations (OLT) at the Seoul Paik Hospital from March, 1992 to November, 1994. RESULTS AND CONCLUSION: The mean operation time and hospitalization duration was 14.1 hours and 35.3 days, respectively. Intraoperatively, the operations required a mean of 2.4 units of whole blood (WB), 29.4 of red cells (RBCs), 32.0 of fresh frozen plasma (FFP), 17.5 of platelet concentrates (PLTs), and 4.1 of cryoprecipitates (CRYOs). During the entire hospital stay, a mean of 9.3 units of WB, 56.1 of RBCs, 108.3 of FFP, 210.8 of PLTs, and 5.6 of CRYOs were transfused.
Blood Banks ; Blood Platelets ; Hemorrhage ; Hospital Records ; Hospitalization ; Humans ; Length of Stay ; Liver Diseases ; Liver Transplantation* ; Liver* ; Plasma ; Retrospective Studies ; Seoul

Primary intracranial melanoma is uncommon. These tumors most commonly occur at the temporal lobe, cerebellum and cerebellopontine angle. We report a case of intracranial malignant melanoma of the occipital lobe in a 60-year-old man who presented with headache and visual disturbance. The mass showed hyperintensity on T1-weighted images and hypointensity on T2-weighted magnetic resonance images. He underwent gross total removal of tumor and received radiotherapy. Followup imaging studies showed neither recurrence nor any signs of residual disease for 4 months.
Cerebellopontine Angle ; Cerebellum ; Follow-Up Studies ; Headache ; Humans ; Melanoma* ; Middle Aged ; Occipital Lobe ; Radiotherapy ; Recurrence ; Temporal Lobe

PURPOSE: We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution. MATERIALS AND METHODS: Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases. RESULTS: Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma. CONCLUSIONS: Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.
Adrenalectomy ; Cystectomy ; Follow-Up Studies ; Gloves, Surgical ; Humans ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time ; Orchiectomy ; Postoperative Complications ; Prospective Studies ; Robotics ; Surgical Procedures, Minimally Invasive ; Ureter ; Urologic Diseases

PURPOSE: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen (PSA) levels, where the initial biopsies were negative for cancer. MATERIALS AND METHODS: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218 (29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104 (19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26 (4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. RESULTS: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result (12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients (p<0.05). CONCLUSIONS: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patients.
Biopsy* ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Reference Values ; Ultrasonography

OBJECTIVE: Prenatal cytogenetic diagnosis is limited to metaphase karyotype analysis of cultured cells obtained by amniocentesis or chorionic villus sampling. Moreover, genome wide analysis cannot be performed by FISH analysis using specific probe. Array comparative genomic hybridization (CGH) offers a number of advantages over conventional cytogenetic analysis and FISH. Microarray CGH can be highly comprehensive, amenable to very high resolution, sensitive and fast. The objective of this study was to determine the clinical use of cDNA microarray CGH for detection of fetal aneuploidy. METHODS: 21 amniotic fluid samples and 6 chorionic villi samples were obtained from 27 pregnant women in 9-19 gestational weeks. Genomic DNA was extracted from each sample and amplified. For cDNA microarray CGH analysis, test DNA sample and reference DNA sample were labeled with Cy3-dUTP and Cy5-dUTP, respectively. Each sample of labeled test and reference DNA was hybridized to microarray. The result was analysed with axon scanner and compared with cytogenetic analysis and FISH. RESULTS: In 27 cases, 3 cases with trisomy 21 and 1 case with trisomy 18 had increased hybridization signals on chromosome 21 and chromosome 18. One case with 45,X had decreased signals on chromosome X. One case with 46,X,i(Xq) had decreased signal on short arm of chromosome X and increased signal on long arm. And one case with 47,XYY had two fold increased signal on Y chromosome. cDNA microarray based CGH correctly identified fetal aneuploidy in all of the 7 cases with aneuploid fetuses. CONCLUSION: Prenatal genetic diagnosis by cDNA microarray-based CGH is an useful, innovative, rapid and accurate method. It is promising technique allowing rapid screening for whole chromosomal changes including aneuploidy, and may augment standard karyotyping techniques for prenatal genetic diagnosis by providing additional molecular information. This method may aid the discovery and description of minor genetic aberration, potentially enhancing future prenatal genetic diagnostic application.
Amniocentesis ; Amniotic Fluid ; Aneuploidy* ; Arm ; Axons ; Cells, Cultured ; Chorionic Villi ; Chorionic Villi Sampling ; Chromosomes, Human, Pair 18 ; Chromosomes, Human, Pair 21 ; Comparative Genomic Hybridization* ; Cytogenetic Analysis ; Cytogenetics ; Diagnosis ; DNA ; DNA, Complementary* ; Down Syndrome ; Female ; Fetus ; Genome ; Humans ; Karyotype ; Karyotyping ; Mass Screening ; Metaphase ; Oligonucleotide Array Sequence Analysis ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Trisomy ; Y Chromosome

BACKGROUND: Progressing stroke (PS) variably develops from initially the same size and severity, and is most frequently observed in lacunar infarctions. We investigated fractional anisotrophy (FA), mean diffusivity (MD) and infarct volume by using diffusion tensor imaging during the acute phase of ischemic stroke to determine whether these parameters are useful in characterizing and predicting PS. METHODS: In this study, 55 consecutive patients admitted within 24 hours of the onset of their first ischemic stroke were included. NIH stroke scale (NIHSS) and Canadian Neurological scale (CNS) were performed upon admission, twice a day, and at discharge. Modified Rankin scale and Barthel index were also evaluated. PS was defined as a 2-point drop in NIHSS and a 1-point drop in CNS from admission to day 3. A correlation analysis was performed between clinical scale scores and imaging parameters, and the distribution of those values was compared between the two groups with and without PS. RESULTS: Significant correlations were observed between clinical scale scores and infarct volumes. The FA ratio in 14 patients with PS was lower than the patients without PS (p=0.004). Other characteristics including infarct volume and MD ratio were not different. The FA ratio remained as an independent predictor of PS (OR, 1.055; p=0.011). CONCLUSIONS: In acute ischemic stroke within the first 24 hours, only infarct volume was correlated with clinical status. However, patients with PS showed lower FA values, which accounts for rapid and severe vasogenic edema involving the disruption of the cell membrane and axonal fibers. Moreover, FA may be a predictor of PS.
Anisotropy* ; Axons ; Cell Membrane ; Diffusion Tensor Imaging* ; Diffusion* ; Edema ; Humans ; Stroke* ; Stroke, Lacunar

PURPOSE: Penile and scrotal involvements in extramammary Paget's disease (EMPD) are exceedingly rare, with only small series or case reports having been reported in the literature. Our study was undertaken to clarify the uncertainty of the clinical outcome of this disease. MATERIALS AND METHODS: Between 1995 and 2003, 32 patients with penile or scrotal EMPD were treated and followed up. Local wide excision was performed in all patients, with or without an intraoperative frozen biopsy. RESULTS: Of the 32 patients, 12 (37.5%) underwent local wide excision with an intraoperative frozen biopsy; 1 patient (8.3%) had a positive surgical margin. Conversely, 20 (62.5%) underwent local wide excision with an excessive surgical margin of upto 1 to 2cm only due to the gross findings, but 15 (75.0%) had a positive surgical margin (p<0.001). 8 of the 16 patients with a positive surgical margin had a local recurrence at the 8 month follow-up (p<0.05). One patient with invasion to the subcutaneous tissue had died of metastatic EMPD and internal malignancy (renal cell carcinoma) at the 17 month postoperative follow-up. There was no underlying adnexal carcinoma in any case. CONCLUSIONS: Local wide excision with intraoperative frozen biopsy was essential for the complete treatment of EMPD. There was no associated internal malignancy or underlying adnexal carcinoma at the initial diagnoses.
Biopsy ; Diagnosis* ; Follow-Up Studies ; Humans ; Male ; Paget Disease, Extramammary* ; Penis* ; Prognosis* ; Recurrence ; Scrotum* ; Subcutaneous Tissue ; Uncertainty