PURPOSE: It is well known that smoking is one of the most important etiologic factor in bladder cancer and mutations of p53 tumor suppressor gene are the important step in carcinogenesis of urinary bladder. In this study, we investigated the difference in pattern and rate of p53 gene mutation between smoker and non-smoker MATERIALS AND METHODS: Of 26 bladder transitional cell carcinoma, 16 cases were smoker and 10 cases were non-smoker. We evaluated mutation of the p53 gene concentrated on axon 5 through 8, using polymerase chain reaction- single strand conformation polymorphism(PCR-SSCP) with radioisotope. RESULTS: 3 cases(18.7%) of 16 smoker were found to have p53 gene mutation, but none of 10 non-smoker was found. 2 of 3 cases of p53 gene mutation were found in exon 5 and 1 in exon 7. The pattern of p53 gene mutation was different in 3 cases. CONCLUSIONS: Although the more cases will be needed in this study, we think that a mutation of p53 in bladder cancer may be associated with cigarette smoking.
Axons ; Carcinogenesis ; Carcinoma, Transitional Cell ; Exons ; Genes, p53* ; Genes, Tumor Suppressor ; Humans ; Smoke* ; Smoking* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Classification* ; Humans ; Spinal Cord* ; Urodynamics*

PURPOSE: Resistance to anticancer chemotherapeutic drug remains a major obstacle in cancer chemotherapy. Multidrug-resistance(MDR) gene overexpression and detoxification by glutathione are believed to be involved in adriamycin and cisplatin resistance. We investigated change of p-glycoprotein(MDR gene product) expression, cellular glutathione content and glutathione peroxidase and glutathione transferase activities by hyperthermia to elucidate the synergistic mechanism of hyperthermia with chemotherapeutic agent. MATERIALS AND METHODS: Human renal cell carcinoma cell lines, Caki-1 and A-498 were used. Control temperature was 37OC and hyperthermia of 43OC was applied in 2 and 4 hours durations. P-glycoprotein expression was measured by flowcytometric examination using monoclonal antibody to p-glycoprotein. Glutathione content and activities of glutathione peroxidase and transferase were measured by biochemical methods. RESULTS: Glutathione content and activities of glutathione peroxidase and transferase were not changed by hyperthermia. However, p-glycoprotein expression was reduced by hyperthermia of 43OC. CONCLUSIONS: These results suggest that reduced p-glycoprotein expression by hyperthermia causes increased intracellular accumulation of chemotherapeutic agent by decreasing drug efflux mechanism and plays an important role in synergistic effect with adriamycin and cisplatin cytotoxicities.
Carcinoma, Renal Cell* ; Cell Line ; Cisplatin ; Doxorubicin ; Drug Therapy ; Fever* ; Glutathione Peroxidase ; Glutathione Transferase ; Glutathione* ; Humans* ; P-Glycoprotein* ; Transferases

PURPOSE: We investigated if there are some differences in characteristic of recent renal infection from the past one and evaluated the need of ultrasonography in acute renal infection and the efficiency of antibiotics that have been used primarily in treatment of past renal infection. MATERIALS AND METHODS: We reviewed charts of 232 patients with acute renal infection retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The laboratory tests such as complete blood count, urinalysis and urine culture with sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory urography or voiding cystourethrography were performed. RESULTS: The most common age groups were 3rd decade(26.7%) and 4th decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal ultrasonography was done in 90.5%, but 74.8% of them were completely normal and most of abnormal findings at abdominal ultrasonography were clinically insignificant. Result of ultrasonography did not affect the outcome of the disease or the treatment plan. The significant bacterial isolation(more than 10(5)CFU/ml) in urine culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to some drugs such as ampicillin or bactrim which have been usually used for urinary tract infection. CONCLUSIONS: Routine ultrasonography in renal infections without urinary tract obstruction was not helpful in treatment plan or outcome of this disease and selection of antibiotics in treatment of recent renal infection should be changed from the past one.
Ampicillin ; Anti-Bacterial Agents ; Blood Cell Count ; Enterobacter ; Female ; Humans ; Klebsiella ; Pseudomonas ; Pyelonephritis ; Retrospective Studies ; Trimethoprim, Sulfamethoxazole Drug Combination ; Ultrasonography* ; Urinalysis ; Urinary Tract ; Urinary Tract Infections ; Urography ; Vesico-Ureteral Reflux

BACKGROUND: The role of ultrasound in the thoracic spine has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and the limitation of imaging through the narrow acoustic windows produced by the bony framework of thoracic spine. The aim of this study was to make a comparison between the 12th rib and the spinous process of C7 as a landmark for effective ultrasound-guided target segment identification in the thoracic spine. METHODS: Ultrasonography of 44 thoracic spines was performed and the same procedure was carried out 1 week later again. The target segments (T3–4, T7–8, and T10–11) were identified using the 12th rib (group 1) or the spinous process of C7 (group 2) as a starting landmark. Ultrasound scanning was done proximally (group 1) or distally (group 2) toward the target transverse process and further medially and slightly superior to the target thoracic facet. Then, a metal marker was placed on the T3–4, T7–8, and T10–11 and the location of each marker was confirmed by fluoroscopy. RESULTS: In the total 132 segments, sonographic identification was confirmed to be successful with fluoroscopy in 84.1% in group 1 and 56.8% in group 2. Group 1 had a greater success rate in ultrasound-guided target segment identification than group 2 (p = 0.001), especially in T10–11 (group 1, 93.2%; group 2, 43.2%; p = 0.001) and T7–8 (group 1, 86.4%; group 2, 56.8%; p = 0.002). The intrarater reliability of ultrasound-guided target segment identification was good (group 1, r = 0.76; group 2, r = 0.82), showing no difference between right and left sides. Ultrasound-guided target segment identification was more effective in the non-obese subjects (p = 0.001), especially in group 1. CONCLUSIONS: Ultrasound-guided detection using the 12th rib as a starting landmark for scanning could be a promising technique for successful target segment identification in the thoracic spine.
Acoustics ; Fluoroscopy* ; Nerve Block ; Ribs ; Spine* ; Ultrasonography

Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinizing desquamative squamous metaplasia (KDSM). Until now about 80 cases including one case from Korea have been reported. Cholesteatoma shows microscopic features of squamous metaplasia of the transitional epithelium and keratinization. These changes with subsequent desquamation of the superficial epithelial layers explain clinical manifestations of the disease. Flank pain, passage of cornified material in the urine and a filling defect on the IVP constitute the characteristic triad. Most cases were managed by extensive ablative surgery for fear of malignant potential. We report a case of renal cholesteatoma which was misdiagnosed as renal stone in 58 year-old female patient who had been suffered from intermittent left flank pain.
Cholesteatoma* ; Epithelium ; Female ; Flank Pain ; Humans ; Korea ; Metaplasia ; Middle Aged ; Urinary Tract

This is a study on the dose-decreasing effect of the first reversed laser beam collimator (RLBC) for C-arm type angiographic equipment. A laser beam was located at the center of each plane at an oblique angle to the angiographic equipment detector. A field of view, which could be seen with the naked eye, was made by focusing the laser beam in the direction of the X-ray source. The height of the table was fixed at 75 cm and the iron balls were located within 2 mm of the top, bottom, left, and right edges of the output image. The time needed for location fixing, fluoroscopy, and measurement of dose area product (DAP) were compared by having 30 radiologists perform location fixing by looking at the fluoroscopic image while performing location fixing (no radiation) and while the RLBC was turned on. In the next test, the time needed for location fixing, fluoroscopy, and DAP were compared when varying the location of the iron balls from 2 to 10 mm from the edges of the output image. The results showed that the time needed for location fixing, the time needed for fluoroscopy, and DAP decreased, both in the first test and the second test. This study confirmed that the use of a RLBC for C-arm type angiographic equipment decreases both the time needed to perform the procedure and the radiation dose received. It is expected that continuous advancement of RLBC technology will contribute greatly to decreasing the dose of radiation needed and improving convenience during angiography.
Angiography ; Fluoroscopy ; Iron

PURPOSE: The diagnosis and treatment of insulinoma are very important because the tumor can induce critical and permanent neurological deficit. The purpose of this study was to gain an understanding of the clinical features of insulinomas and to establish the diagnostic and therapeutic strategies. METHODS: 17 patients, preoperatively diagnosed with insulinomas and who had undergone surgical management between January, 1998 and March 2004, at the Department of Surgery, Samsung Medical Center, were analyzed. RESULTS: After the operation the 17 patients were diagnosed pathologically; 13 insulinoma, 2 nesidioblastosis, 1 endocrine tumor and 1 endocrine carcinoma. The male to female ratio was 7: 10, with a mean age of 52.3 years. All the patients had symptoms of Whipple triad. The mean duration of symptoms to surgery was 18 months. The preoperative mean blood sugar, plasma insulin, C-peptide and insulin to glucose ratio were 39.6 mg/dl, 47.4muU/ml, 4.8 ng/ml and 1.02 respectively. Preoperative localization was achieved in 15 patients by combining ultrasonography, angiography, abdominal CT and intra-arterial calcium stimulated venous sampling and sensitivity of those examinations were 60, 61.5, 73.3 and 91.7%, respectively. Intraoperative localization was also performed by a combination of manual palpation and intraoperative ultrasonography in 15 patients, with retrospective sensitivities of 86.6 and 100% respectively. The frequenies of head, body and tail were 6: 3: 6. In 2 nesidioblastosis patients, the localization failed both pre- and intraperatively. The types of operations included 11 enucleations, 3 distal pancreatectomies, 2 blind subtotal pancreatectomies and a distal pancreatectomy combined with an extended left hemihepatectomy and intraoperative radiofrequency ablation (RFA) for one patient accompanied by multiple liver metastase. 13 insulinomas were benign, small (mean diameter 1.5 cm, maximum 2.3 cm) and solitary, with the exception of one patient with MEN I. The symptoms of hypoglycemia and the laboratory values were improved in all patients after the operation. CONCLUSION: Insulinomas may be readily localized using sensitive diagnostic tools, such as intra-arterial stimulated venous sampling or intraoperative ultrasonography with manual palpation. If possible, enucleation may be a curative and feasible procedure for benign insulinomas. However, in the case of a highly suspicious nesidioblastosis, a blind partial pancreatectomy may be used as a trail method.
Angiography ; Blood Glucose ; C-Peptide ; Calcium ; Catheter Ablation ; Diagnosis ; Female ; Glucose ; Head ; Humans ; Hypoglycemia ; Insulin ; Insulinoma* ; Liver ; Male ; Multiple Endocrine Neoplasia Type 1 ; Nesidioblastosis ; Palpation ; Pancreas* ; Pancreatectomy ; Plasma ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

Zoletil is a non-opioid, non-barbiturate animal anesthetic and proprietary combination of two drugs, a dissociative anesthetic drug, tiletamine, with the benzodiazepine anxiolytic drug, zolazepam. Zoletil has greater potency than ketamine. Zoletil is abused for recreational purposes, especially by people with easy access to medicine. However, in Korea, it is available over-the-counter. Here we report on a case of an 83-year-old woman who received injection of seven vials of "Zoletil 50" by her daughter and presented with an altered mental change. Her mental state was stupor and vital sign was hypotension, bradycardia. Her blood tests indicated metabolic and respiratory acidosis and hyperkalemia. She was treated with intravenous naloxone and flumazenil but was not responsive. She was admitted to the ICU and treated with supportive therapy. Her mental state showed transient recovery, however, her clinical manifestation worsened and she expired.
Acidosis, Respiratory ; Aged, 80 and over ; Animals ; Benzodiazepines ; Bradycardia ; Drug Combinations ; Female ; Flumazenil ; Hematologic Tests ; Humans ; Hyperkalemia ; Hypotension ; Ketamine ; Korea ; Naloxone ; Nuclear Family ; Stupor ; Tiletamine ; Vital Signs ; Zolazepam

Background: The objective of this study was to investigate whether alcohol consumption might affect the quality of life (QOL), depressive mood, and metabolic syndrome in patients with obstructive lung disease (OLD). Methods: Data were obtained from the Korean National Health and Nutrition Examination Survey from 2014 and 2016. OLD was defined as spirometry of forced expiratory volume in 1 second/forced vital capacity <0.7 in those aged more than 40 years. QOL was evaluated using the European Quality of Life Questionnaire-5D (EQ-5D) index. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive mood. Alcohol consumption was based on a history of alcohol ingestion during the previous month. Results: A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled. The EQ-5D index was significantly higher in alcohol drinkers (n=525) than in non-alcohol drinkers (n=459) (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ- 9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.013). However, multiple logistic regression analysis showed that alcohol consumption was not associated with EQ-5D index or PHQ-9 score. Body mass index ≥25 kg/m2, triglyceride ≥150 mg/dL, high-density lipoprotein <40 mg/dL in men and <50 mg/dL in women, and blood pressure ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (all p<0.05). Conclusion Alcohol consumption did not change the QOL or depressive mood of OLD patients. However, metabolic syndrome-related factors were more common in alcohol drinkers than in non-alcohol drinkers.