PURPOSE: To determine the criteria that can be used to safely reduce unnecessary biopsies for patient found to be lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) negative on digital rectal examination (DRE) and transrectal ultrasound (TRUS), with a prostate specific antigen (PSA) level over 4.0ng/ml. MATERIALS AND METHODS: A retrospective data analysis of 157 patients, with a raised serum PSA level, over 4.0ng/ml, and negative DRE and TRUS findings was performed. The detection rates of prostate cancer according to the prostate volume were also investigated. All patients with one benign biopsy were followed with PSA determination over a 2 year period, and in the cases of men with a persistently elevated PSA, a re-biopsy was suggested. Patients were also classified according to the results of the first biopsy and the follow up PSA level. RESULTS: Of the 157 patients, the rate of prostate cancer was 14.6% (23 of 157), and that for a benign disease, including BPH, was 85.4% (134 of 157). The rates of prostate cancer according to prostate volume (PV) were 20.6 (22 of 107) and 2.0% (1 of 50) in those with a PV80ml, respectively. In the men with one benign biopsy, cancer was not found in 61 (23 with a prostatectomy and 38 with a re-biopsy) and 112/134 (83.6%) had normalized PSA after 1 year. CONCLUSIONS: A statistically significant difference was noted in the profile of a prostate biopsy for cancer according to the prostate volume. We concluded that the majority of LUTS/BPH men with a prostate volume over 80ml have PSA elevation due to BPH or another benign prostate disease, not related to cancer. For patients with negative DRE and TRUS findings, a large prostate (>80ml) and elevated prostate-specific antigen (PSA), over 4ng/ml, watchful waiting, with PSA follow up and BPH treatment, may be a suitable option.
Biopsy* ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatectomy ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Retrospective Studies ; Statistics as Topic ; Ultrasonography ; Watchful Waiting

PURPOSE: To make a histological study of a urethral plate using light and transmission electron microscopies to find evidence responsible for ventral curvature in hypospadias. MATERIALS AND METHODS: Full thickness biopsies of the urethral plate were obtained from 5 patients with proximal hypospadias; including 4 children and 1 adult. All specimens were examined with light and transmission electron microscopies. RESULTS: With the light microscope, all specimens demonstrated well vascularized connective tissue, comprised of smooth muscle and collagen. With the transmission electron microscope, all specimens demonstrated intact endothelial cells and fibroblasts, with dispersed chromatin distribution, intercellular loose collagen and a regular arrangement of collagen fibrils in intercellular spaces. No histological evidence of fibrous cord could be found in any of the specimens. CONCLUSIONS: No histological evidence of fibrous cord could be historically found that could be considered responsible for ventral penile curvature in hypospadias.
Adult ; Biopsy ; Child ; Chromatin ; Collagen ; Connective Tissue ; Endothelial Cells ; Extracellular Space ; Female ; Fibroblasts ; Humans ; Hypospadias ; Male ; Microscopy ; Microscopy, Electron ; Microscopy, Electron, Transmission* ; Muscle, Smooth ; Urethra

The simultaneous occurrence of renovascular hypertension and an aldosterone-producing adrenal adenoma is a rare entity. Here, we report the case of a 52-year-old female who had a coexisting aldosterone-producing adrenal adenoma and ipsilateral renal artery stenosis. She was diagnosed with the aldosterone-producing adrenal adenoma and then underwent a laparoscopic left adrenalectomy. Her blood pressure was uncontrolled after the adrenalectomy. Selective renal angiography showed left renal artery stenosis; thus, she underwent balloon angioplasty at the same sitting. Subsequently, her blood pressure returned to normal after administration of a single antihypertensive drug. This case suggests that it is important to recognize the possible coexistence of renal artery stenosis in a patient with an aldosterone-producing adrenal adenoma.
Adenoma* ; Adrenalectomy ; Adrenocortical Adenoma ; Angiography ; Angioplasty, Balloon ; Blood Pressure ; Female ; Humans ; Hyperaldosteronism ; Hypertension, Renovascular ; Middle Aged ; Renal Artery Obstruction*

BACKGROUND: We investigated the prevalence of electrolyte imbalance and the relationship between serum electrolyte and anterior pituitary hormone levels in patients with Sheehan's syndrome. METHODS: In a retrospective study, we investigated 78 patients with Sheehan's syndrome. We also included 95 normal control subjects who underwent a combined anterior pituitary hormone stimulation test and showed normal hormonal responses. RESULTS: In patients with Sheehan's syndrome, the serum levels of sodium, potassium, ionized calcium, magnesium, and inorganic phosphate were significantly lower than those in control subjects. The prevalence of hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and hypophosphatemia in patients with Sheehan's syndrome was 59.0% (n=46), 26.9% (n=21), 35.9% (n=28), 47.4% (n=37), and 23.1% (n=18), respectively. Levels of sodium and ionized calcium in serum were positively correlated with levels of all anterior pituitary hormones (all P<0.05). Levels of potassium in serum were positively correlated with adrenocorticotrophic hormone (ACTH) and growth hormone (GH) levels (all P<0.05). Levels of inorganic phosphate in serum were positively correlated with levels of thyroid-stimulating hormone, prolactin, and GH (all P<0.05), and levels of magnesium in serum were positively correlated with delta ACTH (P<0.01). CONCLUSION: Electrolyte imbalance was common in patients with Sheehan's syndrome. Furthermore, the degree of anterior pituitary hormone deficiency relates to the degree of electrolyte disturbance in patients with this disease.
Adrenocorticotropic Hormone ; Calcium ; Electrolytes ; Growth Hormone ; Humans ; Hypocalcemia ; Hypokalemia ; Hyponatremia ; Hypophosphatemia ; Hypopituitarism* ; Magnesium ; Pituitary Hormones, Anterior ; Potassium ; Prevalence ; Prolactin ; Retrospective Studies ; Sodium ; Thyrotropin

Here we determined which radiation-responsive genes were altered in radioresistant CEM/IR and FM3A/IR variants, which showed higher resistance to irradiation than parental human leukemia CEM and mouse mammary carcinoma FM3A cells, respectively and studied if radioresistance observed after radiotherapy could be restored by inhibition of protein kinase A. The expressions of DNA-PKcs, Ku70/80, Rad51 and Rad54 genes that related to DNA damage repair, and Bcl-2 and NF-kappaB genes that related to antiapoptosis, were up-regulated, but the expression of proapototic Bax gene was down-regulated in the radioresistant cells as compared to each parental counterpart. We also revealed that the combined treatment of radiation and the inhibitor of protein kinase A (PKA) to these radioresistant cells resulted in synergistic inhibition of DNA-PK, Rad51 and Bcl-2 expressions of the cells, and consequently restored radiosensitivity of the cells. Our results propose that combined treatment with radiotherapy and PKA inhibitor can be a novel therapeutic strategy to radioresistant cancers.
Animals ; Apoptosis/drug effects ; Cell Line, Tumor ; Cyclic AMP-Dependent Protein Kinases/*antagonists & inhibitors/metabolism ; DNA Damage/drug effects ; DNA Repair/drug effects ; Gamma Rays ; Gene Expression Regulation, Neoplastic/radiation effects ; Genes, bcl-2 ; Humans ; Mice ; Neoplasm Proteins/genetics/metabolism ; Neoplasms/enzymology/*genetics ; Radiation Tolerance/*genetics ; Research Support, Non-U.S. Gov't