This report attempts to explain the (i) implications of comorbidity for research and practice in the fieldo of oncology, (ii) the approach for dosing of anti-cancer drugs in the presence of comorbidity, as an example of its clinical application, and finally (iii) the dosing guidelines for the anticancer drugs clinically active in gastric cancer in the presence of renal or liver dysfunction. This has resulted from the idea of approaching comorbidity in a systematic way and of integrating it with oncologic decisions. Various methods have been used to assess comorbidity. However, significant work remains to be done to analyze how various diseases combine to influence the oncologic outcome. The main end-point explored so far has been mortality, but a largely open challenge remains to correlate comorbidity with treatment tolerance and functional and quality of life, as well as to integrate it in clinical decision-making. Cancer chemotherapy in comorbidity should be considered as an example of the need for dose optimization in individual patients, and it should be determined by considering the basic principles of the pharmacokinetics and the pharmacodynamics of the agents. This review analyzes the available data on the pharmacokinetics and the toxicities of anti-cancer agents in the comorbidity population.
Comorbidity* ; Drug Therapy* ; Humans ; Liver Diseases ; Mortality ; Pharmacokinetics ; Quality of Life ; Stomach Neoplasms

PURPOSE: A new quantitative tumor marker, based on the combined measurement of urinary fragments of cytokeratin 8 and 18, namely the urinary bladder cancer antigen (UBCTM) test, has been proposed for the detection of bladder cancer. We compared the results of the UBC test, with voided urine cytology, for the diagnosis of bladder cancer to evaluate its diagnostic performance. MATERIALS AND METHODS: The UBC concentrations were measured, using an immunoradiometric assay, in the urine of 15 healthy subjects (group I), 26 patients with other urological disease except bladder cancer (group II), 40 patients with active bladder cancer (group III) and 17 patients free of bladder cancer, as confirmed by cystoscopy at follow-up (group IV). The differences in the UBC test, with regard to stage, grade, tumor size, focality and history of recurrence, were also evaluated. RESULTS: The mean UBC concentrations were 3.52micro gram/l, 45.76micro gram/l, 92.80micro gram/l and 20.51micro gram/l, for group I to IV, respectively, which were statistically different (p<0.05). There were significant differences regarding stage (p=0.044) and tumor size (p=0.036). However, no differences were founded in relation to the grade, shape, focality or history of recurrence. The optimal threshold for the UBC test, and the area under the ROC curve, were 12.8micro gram//l and 0.684, respectively. The sensitivity, specificity, positive and negative predictive values for the UBC test and urine cytology in groups III and IV were 50.0 and 30.0%, 88.2 and 100%, 90.9 and 100%, and 42.9 and 37.0%, respectively. CONCLUSIONS: The UBC test appears to be useful for the detection of bladder cancer in terms of its superior sensitivity and negative predictive value over those of urine cytology. Further studies will be required for the clinical utility of the UBC test in the diagnosis and follow-up of bladder cancer.
Cystoscopy ; Diagnosis* ; Follow-Up Studies ; Humans ; Immunoradiometric Assay ; Keratin-8 ; Recurrence ; ROC Curve ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urologic Diseases

Polypoid cystitis is an unusual benign lesion characterized by the edema, congestion and inflammation elevating the vesical mucosa into papillary projections. It is rare in the absence of one of the following 3 recognizable causes: indwelling catheters, vesical fistula or chronic bladder irritation. We report a case of a rapidly growing, huge polypoid cystitis without identifiable cause in a 17-year-old female, who was managed by cystectomy with uterus preservation and orthotopic bladder substitution.
Adolescent ; Catheters, Indwelling ; Cystectomy ; Cystitis* ; Edema ; Estrogens, Conjugated (USP) ; Female ; Humans ; Inflammation ; Mucous Membrane ; Urinary Bladder Fistula ; Urinary Bladder* ; Uterus

PURPOSE: To evaluate the efficacy of a modified small bowel follow-through (SBFT) and to optimize this technique. MATERIALS AND METHODS: Ninety-nine subjects without small bowel pathology underwent modified SBFT using oral administration of methylcellulose after taking 100ml of 120% or 100, 150, or 200ml of 70% barium. Thirty-three and 39 normal subjects undergoing enteroclysis or conventional SBFT, respectively, were also evaluated for comparison of image qualities and transit time. RESULTS: Enteroclysis was the most successful ofthree types of small bowel examination for obtaining the best quality of bowel transradiency and distension. Modified SBFT was, however much superior to the conventional series for obtaining good bowel transradiency and rapid transity time (mean, 37-49 minutes). The use of 150ml of 70% barium was better than the other three modified techniques in achieving good bowel transradiency, rapid transit time, and less flocculation. CONCLUSION: Our modified SBFT is a simple and safe method for easily improving bowel transradiency and transit time.
Administration, Oral ; Barium ; Flocculation ; Methylcellulose* ; Pathology

BACKGROUND: The pathophysiology of acute respiratory distress syndrome with sepsis is acute lung injury (ALI) that's' caused by endotoxin (LPS). We evaluate effects of moxifloxacin on LPS-induced ALI in a rat model. MATERIAL AND METHOD: The rats were divided into 3 groups as the control group (C), the LPS insult group (L), and the LPS+moxifloxacin treated group (L-M). ALI was induced by endotracheal instillation of E.coli LPS, then moxifloxacin was given in 30 minutes. Five hours later, we checked the lung weight/body weight ratio(the L/BW ratio), the protein & neutrophils in the bronchoalveolar lavage fluid (BALF), the myeloperoxidase (MPO) activity & the malondialdehyde (MDA) content, the expressions of cytosolic and secretory phospholipase A2 (c, sPLA2), and the morphology of the lung with using a light microscope. RESULT: The L/BW ratio, the protein content and the neutrophil count in the BALF, and the MPO activity and the MDA content in lung were significantly increased in group L compared to group C, and these factors were markedly decreased in group L-M compare to group L. The cPLA2 expression and the sPLA2 expression were increased in group L and the cPLA2 expression was decreased in group L-M. Yet the sPLA2 expression was not changed in group L-M. Morphologically, many inflammatory findings were observed in group L, but not in group L-M. CONCLUSION: Many of the inflammatory changes of ALI that were caused by LPS insult were ameliorated by moxifloxacin treatment.
Acute Lung Injury ; Animals ; Aza Compounds ; Bronchoalveolar Lavage Fluid ; Cytosol ; Light ; Lung ; Malondialdehyde ; Neutrophils ; Peroxidase ; Phospholipases A2, Secretory ; Quinolines ; Rats ; Respiratory Distress Syndrome, Adult ; Sepsis

BACKGROUND: This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease(>75 % stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction<35 %). MATERIAL AND METHOD: One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. RESULT: There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5+/-0.9 vs 3.4+/-0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. CONCLUSION: IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Hemodynamics ; Humans ; Length of Stay ; Mortality ; Transplants* ; Ventilators, Mechanical ; Ventricular Dysfunction, Left

Sclerosing lymphangitis of the penis is a rare condition involving the distal lymphatics that is characterized by cord-like lesions on the shaft or coronal sulcus. Although the etiology is unknown, its association with mechanical trauma, anatomic variants, or infection has been shown. Clinically, the patient notices a painless, firm, cord-like lesion just proximal to the sulcus. Histologic study reveals hypertrophy and sclerosis of lymphatic vessel walls and, in some cases, thrombus formation within the dilated vessels. Most cases are self-limited, and conservative management is indicated, but surgical excision is warranted for persistently symptomatic lesions. We report three cases of sclerosing lymphangitis of the penis that required treatment by surgical excision.
Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

PURPOSE: A retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is useful as an approach to urological surgery. Here, our initial experience of retroperitoneal laparoscopic radical nephrectomies, in 18 consecutive patients with renal cell carcinomas, is reported. MATERIALS AND METHODS: The records of 18 consecutive patients, with renal cell carcinomas, that underwent a retroperitoneal laparoscopic radical nephrectomy between June 2000 and September 2002, were reviewed. RESULTS: The retroperitoneal laparoscopic radical nephrectomies, for the renal cell carcinomas, were successfully performed in all but 3 patients. These 3 were converted to an open technique due to severe adhesion in 1 and bleeding in the other 2. Of the 15 renal cell carcinomas, the final pathological stages were pT1N0M0 in 14 and pT2N0M0 in 1. The mean tumor size and specimen weight were 4.3cm, ranging from 2 to 7.5cm and 258gm, ranging from 203 to 372gm, respectively. The tumors involved the upper pole, the mid pole and the lower pole in 5, 6 and 4 cases, respectively. The mean operative time and estimated blood loss were 195 minutes, ranging from 160 to 260 minutes, and 181.3cc, ranging from 50 to 500cc, respectively. In 4 of the 15 patients, Patient-Controlled Analgesia (PCA) were used for the control of post operative pain, the other 11 required minimal postoperative analgesics. The mean interval to resuming oral intake and hospital stay were 2.3 days, ranging from 2 to 3 days, 5.4 days, ranging from 4 to 7 days, respectively. Complications occurred in 2 patients, and included partial atelectasis in 1 and pulmonary edema in the other. Neither local recurrence nor distant dissemination was observed during the mean follow-up of 13.6 months (range 4 to 25). CONCLUSIONS: A retroperitoneal laparoscopic radical nephrectomy is a safe and effective alternative, to an open radical nephrectomy, in patients with a localized renal cell carcinoma.
Analgesia, Patient-Controlled ; Analgesics ; Carcinoma, Renal Cell* ; Follow-Up Studies ; Hemorrhage ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Nephrectomy* ; Operative Time ; Pulmonary Atelectasis ; Pulmonary Edema ; Recurrence

OBJECTIVE: To explore the incidence of fragile X premutation in patients with idiopathic premature ovarian failure, particularly in the Korean population. DESIGN: A prospective study. MATERIALS AND METHODS: Eighty-three women affected by idiopathic premature ovarian failure were recruited for this study. Patient with known causes of premature ovarian failure were excluded: cytogenetic abnormalities, prior chemotherapy, prior bilateral oophorectomy. DNA was extracted from peripheral blood. Fragile X (FRAXA) premutation was evaluated by PCR amplification of and Southern blot analysis for FMR1 gene. RESULTS: The FRAXA premutation was detected in three (3.6%) out of 83 patients with idiopathic premature ovarian failure. CONCLUSION: This result suggests that fragile X premutation screening is indicated in patients with idiopathic premature ovarian failure, particularly in the Korean population.
Blotting, Southern ; Chromosome Aberrations ; DNA ; Drug Therapy ; Female ; Fragile X Syndrome ; Humans ; Incidence ; Mass Screening ; Ovariectomy ; Polymerase Chain Reaction ; Primary Ovarian Insufficiency* ; Prospective Studies

OBJECTIVE: The birth weight distributions are obtained to be classified according to the duration of pregnancy, and then compared with other results already published in literature to verify the difference. METHODS: A total of 17,291 deliveries in Gachon medical center hospital from January 1996 to December 1999 is retrospectively reviewed. The data of 28~42th week of gestation are analysed, and the 10th, 25th, 50th, 75th and 90th percentiles of birth weight are determined for each week and also according to sex and parity. Furthermore the 10th, 50th, 90th percentiles are compared with those from other reports. RESULTS: 1. The 10th, 50th, 90th percentiles of birth weight classifed according to gestational age are as follow : in 28th week of pregnancy, 1,068, 1,240 and 1,812 g; in 32th week, 1,470, 1,890 and 2,266 g; in 36th week, 2,170, 2,720 and 3,240 g; in 40th week, 2,910, 3,370 and 3,870 g; in 42th week, 2,977, 3,475 and 4,023 g.2. The mean birth weight of the male neonates is greater than that of the female ones from 37th week to 41th week (p<0.01).3. Comparisons of 10th, 50th, 90th percentiles of birth weight with Park groups show that there is an increase of birth weight by 100~144 g. CONCLUSION: Comparison of the birth weight-gestational age table with ones published by other groups shows that infants tend to be heavier.
Birth Weight ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Male ; Parity ; Parturition* ; Pregnancy ; Retrospective Studies