PURPOSE: We studied the crystallographic component of the prostatic calculi according to the location on the transrectal prostatic ultrasonography to know the mechanism of the formation of the calculus. MATERIALS AND METHODS: From August, 1995 until May, 1997, 33 prostatic calculi from 24 patients(mean age 59 years, mean size 3.1mm) operated on for prostatism were analyzed by polarization microscopy(ZeissR), X-ray diffraction(PW-1720R, Philips) and infrared spectrophotometer(FTIR-205R, Nicolet). Location of calculi was divided two groups under guide of transrectal prostatic ultrasonography; periurethral and periadenoma type. The periurethral type showed hyperechoic density around the prostatic urethra and the periadenoma type showed hyperechoic density between adenoma and false prostatic capsule(peripheral zone). RESULTS: 22 calculi were the periurethral type and 11 were periadenoma type. Thirty stones from 20 periurethral type and 10 periadenoma type consisted two or three of the following calcium phospate, calcium oxalate and tricalcium phospate. These are mixed by the endogenous origin formed from the prostatic fluid and the exogenous origin formed at least in part from urine. Three stones (2 calcium oxalate, 1 uric acid) contained only one compound which participitate from urine. All of 11 calculi of the pericapsular type had an oxalate component. CONCLUSIONS: The calculi around the periadenoma region may be formed from not only endogenous component(calcium apatite stone) but also exogenous component(calcium oxalate) or intraductal precipitation of oxalate component which has never found in the prostatic fluid. These results may suggest the necessity of reevaluation about oxalate component within the prostatic fluid.
Adenoma ; Calcium ; Calcium Oxalate ; Calculi* ; Prostatism ; Ultrasonography* ; Urethra

No abstract available.
Lymphangioma*

PURPOSE: We studied the therapeutic effect and safety of transurethral prostatectomy (TURP) performed with improved instruments by a moderately experienced resectionist. PATIENTS AND METHODS: Clinical data of the 95 consecutive patients who underwent TURP by one surgeon from March 1995 to June 1997 were analyzed. During this period, a continuous-irrigation 26F TUR sheath with a 30-degree lens attached to a monitor screen was used in most patients. RESULTS: The average weight of the resected adenoma was 10.8 7.4 gm, and the resection time was 47.2 21.2 minutes. The average weight of tissue resected per minute was 0.23 0.13 gm. Six patients required transfusion, and four suffered operative complications (one bladder perforation, one bladder neck injury, and two urethral injuries that enforced prolonged catheterization). Postoperative complications developed in seven cases. The duration of postoperative urethral catheterization averaged 2.8 days. The maximal flow rate was improved from 11.3 mL/sec to 20.6 mL/sec. Subjective satisfaction was mentioned by 95.6% of patients (91/95). In comparison with data from the first authors former report, all differences in terms of resection speed, safety, and morbidity were statistically significant. The therapeutic efficacy of the operation with the new equipment seems to be superior to that of other less invasive procedures, and even in terms of complications and duration of catheterization, these results are comparable to those of other procedures. CONCLUSIONS: We think that TURP deserves to be the primary treatment modality for the patients with benign prostatic hyperplasia who need surgical therapy if the procedure is performed by a properly trained surgeon equipped with modern TUR instruments.
Adenoma ; Catheterization ; Catheters ; Humans ; Neck Injuries ; Postoperative Complications ; Prostatic Hyperplasia ; Transurethral Resection of Prostate* ; Urinary Bladder ; Urinary Catheterization ; Urinary Catheters

Phrenic nerve palsy is a well-known complication following cardiac surgery in children. The incidence is approximately 1~2%. In infants and young children, it often causes a life-threatening respiratory distress. They must be treated with mechanical ventilation in the ICU. Many patients with phrenic nerve injury who is impossible to wean from a ventilator are candidates of diaphragmatic plication. Diaphragmatic plication is performed to restore the normal pulmonary parenchymal volume by replacing the diaphragm to its proper location. This is a case of 2-months-old infant who had phrenic nerve palsy after the removal of cavernous lymphangioma of the chest. He underwent 4 operations to remove the mass and to have pericardiotomy. We tried to wean him from the ventilator but failed several times in the ICU. After 4th operation, right diaphragmatic elevation was noted from the chest X ray. Phrenic nerve palsy was confirmed with fluoroscopy and he underwent diaphragmatic plication on 42 days after his 4th operation. Three days after the diaphragmatic plication, weaning was successfully carried out.
Child ; Diaphragm ; Fluoroscopy ; Humans ; Incidence ; Infant* ; Lymphangioma* ; Paralysis* ; Pericardiectomy ; Phrenic Nerve* ; Respiration, Artificial ; Thoracic Surgery ; Thorax ; Ventilators, Mechanical ; Weaning*

Backgrouad & Aims: Cyclophosphamide, adriamycin and cisplatin(CAP) combination chemo- therapy improved the response rate in the treatment of advanced epithelial ovarian cancer, and it has been the gold standard. However, adriamycin is a rather toxic drug, and there is still confusion concerning the choice of adriamycin to be included in optimal regimen. The present study was designed to compare the activity and toxicity of combination regimens in advanced epithelial ovarian cancer between CAP and CTP which substitutes adriamycin with pirarubicin(THP- adriamycin). PATIENTS AND METHODS: From March 1995 to December 1997, 47 patients with FIGO stage III-IV epithelial ovarian cancer who were diagnosed after initial cytoreductive surgery were divided into two groups at random: (1) The case group were treated with CTP(500/40/50 mg/m2) as a first line chemotherapy. (2) The control group were treated with CAP(500/50/50 mg/m2) as that of case group. Clinical characteristics, response rates and toxicities according to Gynecologic Oncology Group criteria were compared between those treated with CAP and CTP respectively. RESULTS: Forty one patients out of 47 were evaluable and the number of patients in case and control group was 22 and 19 respectively. There was no significant differences in patient characteristics such as age, stage, histologic type between two groups. Clinical complete response rate was 50.0%(11/22) in patients treated with CTP regimen and 47.4%(9/19) with CAP regimen and there was no significant difference between two groups. Second look operation was undergone in 10 patients of CTP group and 7 patients of CAP group who showed clinical complete response and the pathologic complete response rate was 27.3%(6/22) with CTP and 21.1%(4/19) with CAP. The incidence of leukocytopenia of grade 3 or 4 was more frequently occurred in CAP group(52.6%, 10/19) than CTP group(22.7%, 5/22). There was no significant difference in the incidence of other toxicitied such as hepatic, renal and G-I toxicities. Suspicious cardiac toxicity according to the finding of EKG was seen in 15.8%(3/19) only with CAP regimen and all of them showed decreased cardiac function in gated blood pool scan. There were no significant differences in risponse rates between two groups, but the incidence of cardiac toxicity and leukocytopenia o f grade 3 or 4 was more frequently occurred in CAP group than CTP group. CONCLUSION : CTP regimen has comparable response rates to CAP regimen, with lower incidence of hematolohic and cardiac toxicity.
Cyclophosphamide* ; Cytidine Triphosphate ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination* ; Electrocardiography ; Humans ; Incidence ; Leukopenia ; Ovarian Neoplasms*

We report a rare case of well differentiated paratesticular liposarcoma in a 72-year -old male. His chief complaint was left painless scrotal mass for about three years. The mass was composed of hard, soft, and rubbery components and its size was 20x5x5 cm in dimension. Scrotal ultrasonography showed huge highly echogenic multilobulated mass with some calcification and CT scan excluded the presence of nodal involvement. Left radical orchiectomy was performed as treatment and the patient has survived 24 months without evidence of recurrence. Paratesticular liposarcoma is very rare and most of them are low-grade malignancies and treatment is radical orchiectomy with wide local excision.
Humans ; Liposarcoma* ; Male ; Orchiectomy ; Recurrence ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVE: To investigate the response of back muscle, the flexion moment and the kinematic change of lumbar spine during sudden upper limb loading between expected and unexpected conditions. METHOD: 23 healthy young subjects (13 male and 10 female, mean age 26.6+/-3.3) were recruited. We measured the latency of paraspinal muscle contraction (erector spinae and lumbar multifidus), flexion moment of lumbar spine, and kinematic change of lumbar spine during sudden upper limb loading by using surface EMG system, motion analysis system, and force platform. 6 trials with 3 eye opened and 3 eye closed were performed randomly. RESULTS: The latency of paraspinal muscle contractions was significantly slower during eyes closed condition than during eyes opened condition after sudden upper limb loading (p<0.05). The flexion moment and the flexion change of lumbar spine increased significantly during eyes closed condition compared with eyes opened condition (p<0.05). CONCLUSION: The response of paraspinal muscle was significantly slower and the flexion moment and the flexion change of lumbar spine was higher during unexpected condition than during expected condition after sudden upper limb loading. Therefore, the spinal stability is more decreased during unexpected condition than expected condition.
Back Muscles ; Female ; Humans ; Male ; Paraspinal Muscles ; Spine* ; Upper Extremity* ; Weight-Bearing

PURPOSE: The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. MATERIALS AND METHODS: Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, 500 mg/m2) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. RESULTS: At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. CONCLUSION: Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.
Appointments and Schedules ; Cause of Death ; Fluorouracil ; Follow-Up Studies ; Head and Neck Neoplasms ; Humans ; Infusions, Intra-Arterial ; Maxillary Sinus ; Maxillary Sinus Neoplasms ; Orbit ; Recurrence

Background/Aims: The optimal treatment (Tx) for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains to be determined. Methods: A retrospective review was conducted on 77 NSCLC patients with synchronous BM who underwent first-line EGFR-tyrosine kinase inhibitor (TKI) Tx. The outcomes of patients were analyzed according to the clinicopathological characteristics including local Tx modalities. Results: Fifty-nine patients underwent local Tx for BM (gamma knife surgery [GKS], 37; whole brain radiotherapy [WBRT], 18; others, four) concurrently or sequentially with EGFR-TKI. Patients treated with TKI alone showed significantly lower incidence of central nervous system (CNS) symptoms. The median progression-free survival (PFS) and overall survival (OS) after the initiation of EGFR-TKI for all patients were 9 and 19 months, respectively. In 60 patients with follow-up brain imaging, the median time to CNS progression was 15 months. Patients with EGFR exon 19 deletion had a significantly longer median OS than those with other mutations including L858R (23 months vs. 17 months). Other clinical characteristics, including CNS symptoms, number of BM, and the use of local Tx were not associated with OS, as well as PFS. In terms of the local optimal Tx modality, no difference was found between GKS and WBRT in the OS and PFS. Conclusions This study suggests that EGFR-TKI may result in a favorable outcome in NSCLC patients with synchronous BM, especially in deletion 19 mutant, regardless of the extent of BM lesions or local Tx modalities. Patients with asymptomatic BM can be treated with EGFR-TKI and careful surveillance.