Identification of Small GTPases That Phosphorylate IRF3 through TBK1 Activation Using an Active Mutant Library Screen

Interferon regulatory factor 3 (IRF3) integrates both immunological and non-immunological inputs to control cell survival and death. Small GTPases are versatile functional switches that lie on the very upstream in signal transduction pathways, of which duration of activation is very transient. The large number of homologous proteins and the requirement for site-directed mutagenesis have hindered attempts to investigate the link between small GTPases and IRF3. Here, we constructed a constitutively active mutant expression library for small GTPase expression using Gibson assembly cloning. Small-scale screening identified multiple GTPases capable of promoting IRF3 phosphorylation. Intriguingly, 27 of 152 GTPases, including ARF1, RHEB, RHEBL1, and RAN, were found to increase IRF3 phosphorylation. Unbiased screening enabled us to investigate the sequence-activity relationship between the GTPases and IRF3. We found that the regulation of IRF3 by small GTPases was dependent on TBK1. Our work reveals the significant contribution of GTPases in IRF3 signaling and the potential role of IRF3 in GTPase function, providing a novel therapeutic approach against diseases with GTPase overexpression or active mutations, such as cancer.

dNP2-ctCTLA-4 inhibits German cockroach extract-induced allergic airway inflammation and hyper-responsiveness via inhibition of Th2 responses

German cockroaches are major household allergens that can trigger allergic airway inflammatory diseases with sensitive T-cell responses. Although the use of immune modulatory biologics, such as antibodies, to mediate allergic responses has recently been examined, only systemic administration is available because of the size limitations on intranasal administration. Here we utilized a cell-permeable peptide, dNP2, to deliver the cytoplasmic domain of cytotoxic T-lymphocyte antigen-4 (ctCTLA-4) through the airway epithelium to modulate Th2 responses in a German cockroach extract (GCE)-induced allergic airway inflammation model. The intranasal delivery efficiency of the dNP2-dTomato protein to the lungs was higher in GCE-induced asthmatic lung parenchymal cells compared to the sham cells. Intranasal administration of the dNP2-ctCTLA-4 protein inhibited airway hyper-responsiveness and reduced airway inflammation and remodeling, including goblet cell metaplasia and collagen deposition around the bronchi. The number of infiltrated cells, including eosinophils, and the levels of IL-4, IL-5, IL-13 and IFN-γ in the lungs were significantly reduced, presumably owing to inhibition of Th2 differentiation. However, intranasal administration of CTLA4-Ig did not inhibit airway inflammation. These results collectively suggest that dNP2-ctCTLA-4 is an efficient intranasally applicable candidate biologic for treating allergic asthma.

Use of Cell-Penetrating Peptides in Dendritic Cell-Based Vaccination

Cell-penetrating peptides (CPPs) are short amino acids that have been widely used to deliver macromolecules such as proteins, peptides, DNA, or RNA, to control cellular behavior for therapeutic purposes. CPPs have been used to treat immunological diseases through the delivery of immune modulatory molecules in vivo. Their intracellular delivery efficiency is highly synergistic with the cellular characteristics of the dendritic cells (DCs), which actively uptake foreign antigens. DC-based vaccines are primarily generated by pulsing DCs ex vivo with various immunomodulatory antigens. CPP conjugation to antigens would increase DC uptake as well as antigen processing and presentation on both MHC class II and MHC class I molecules, leading to antigen specific CD4+ and CD8+ T cell responses. CPP-antigen based DC vaccination is considered a promising tool for cancer immunotherapy due to the enhanced CTL response. In this review, we discuss the various applications of CPPs in immune modulation and DC vaccination, and highlight the advantages and limitations of the current CPP-based DC vaccination.

Public Attitudes toward Development of National Program for Cancer Survivorship / 한국호스피스완화의료학회지

PURPOSE: This study aimed to explore the public attitude toward the development of national health program for cancer survivorship. Based on the results of this survey suggest the necessity of national health program for cancer survivorship. METHODS: We surveyed 1,015 adults who were over 20 years of age from the sixteen cities and local districts of Korea. We conducted a telephone survey with a structured questionnaire on the post-treatment care at the nation and on the permission as the handicapped for cancer. RESULTS: Fifty-six percent of respondents answered that post-treatment program at the national level is very necessary and twenty-seven percent replied that it is necessary. Respondents emphasized 'Expanding insurance coverage for post-treatment care' (29.8%) and 'Systematic education and rehabilitation programs after treatment' (25.6%). This study found that a lower educational level [adjusted odds ratio (aOR)=1.36; 95% confidence interval (CI)=1.04~1.77], earning under 300 per month [aOR=1.36; 95% CI=1.04~1.77], being married (60.2%) [aOR=1.79; 95% CI=1.34~2.37] and thought higher level of cancer treatment in Korea than the advanced (64.4%) [aOR=1.56; 95% CI=1.15~2.12] influenced the positive attitude toward a national health program. Sixty-eight percent of respondents answered 'Strongly agree' or 'agree' to permission for cancer survivors as the handicapped. People who have been married (72.4%) [aOR=1.89; 95% CI=1.41~2.53] and who have had a lower educational level [aOR=1.35; 95% CI=1.03~1.78] responded that they agree more to permission for cancer survivors as the handicapped. CONCLUSION: This study shows the positive public attitude of the public toward the national health program for the cancer survivors.

Surgical Treatment of Delayed Traumatic Anuerysm of the Innominate Artery : A case report / 대한흉부외과학회지

The innominate artery aneurysm is an uncommon entity. A 36-year-old man was transferred to our hospital because of incidental finding of right superior mediastinal mass. He had a history of blunt chest trauma due to automobile accident 16 years earlier. Computed tomography scanning demonstrated 5-cm sized sacular aneurysm with thrombus at the innominate artery. The prosthetic bifurcated bypass grafting from the ascending aorta to the right common carotid artery and right subclavian artery was performed under the moderate hypothermic cardioplumonary bypass. We report a successful surgical treatment for a rare case of the innominate artery aneurysm.

A case of sparganosis mimicking a varicose vein

Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.

The Effect of Simultaneous Catheter Removal and Replacement for Recurrent Peritonitis and Catheter-related Infections in Peritoneal Dialysis Patients / 대한신장학회잡지

BACKGOUND: Recurrent peritonitis and catheter-related infection, in which removal of the PD catheter and temporary hemodialysis are required, are the main cause of limited technical survival in peritoneal dialysis (PD). The aim of this study was to verify whether the simultaneous catheter removal and replacement (SRR) is feasible and safe in patients with recurrent peritonitis and catheter-related infection. METHODS: From January 2001 to December 2004, We performed 47 SRR in 42 PD patients for the treatment of recurrent peritonitis and catheter-related infection to avoid the interruption of PD. RESULTS: Indications for SRR were recurrent peritonitis in 16 (34.0%), catheter infection without peritonitis in 16 (34.0%), catheter infection with peritonitis in 11 (23.5%) and peritonitis with dialysate leakage in 4 (8.5%). SRR was successful in 89.4%. However, SRR was failed in 10.6% due to persistent tunnel infection in three, drainage failure and hernia in each one. PD was continued after SRR during 14.5+/-11.8 months and subsequent catheter longevity ranged from 3 to 47 months. The most common causative organism of recurrent peritonitis and catheter-related infection was MRSA (25.5%). Subsequent peritonitis occurred in 52.4% of patients with the mean of 10.5+/-9.6 months after SRR. However, 81.8% of subsequent peritonitis were due to new organisms. Postoperative complications occurred in 16 cases (34.0%) including five cases with dialysate leakage, four with persistent tunnel infection, four with early peritonitis, two with drainage failure and one with bleeding. CONCLUSION: We conclude that SRR is a safe and effective procedure in patients with recurrent peritonitis and catheter-related infection without the interruption of PD.

Kidney Transplantation in Patients with Focal Segmental Glomerulosclerosis / 대한이식학회지

Purpose: Kidney transplantation (KT) is one of the important treatment modality for the patients with focal segmental glomerulosclerosis (FSGS), but high recurrence rate and resulting graft failure is still a great obstacle. In order to compare the results of transplantation for recipient with FSGS, we reviewed our cases retrospectively. Methods: Thirty-six biopsy proven FSGS were reviewed and compared their clinical characteristics according to their recurrence status, retrospectively. Patient with significant proteinuria after KT was re-biopsied and light- and electron-microscopic study were done to confirm the recurrence of original disease. Results: Recurrence of FSGS was confirmed histologically in 13 (36%) recipients. Among 15 failed grafts, 9 grafts lost their function by recurrence of FSGS. Higher rate of acute rejection associated in recurred group (53% vs 39%). Five-year graft survival of recurred group was significantly lower than non-recurred group (65% vs 78%, P=0.0071). Cyclosporin group showed more frequent recurrence of FSGS after transplantation than tacrolimus group but no statistical significance (P>0.05). Plasmapheresis (PP) was done in 8 patients with early recurred FSGS and was effective in reducing the grade of proteinuria. Their long-term graft survival, however, was poor even though half of the recurred patients maintain their graft function until 5 years after PP. Conclusion: Our data showed that the recurred FSGS group showed higher rate of graft loss and poor graft survival. Since the FSGS recurrence is directly related with graft survival, large data analysis will be necessary to analyze the risk factor of recurrence and prevent adverse effect of recurrence of FSGS after KT.

Trapping of Massive Thrombus in an Inferior Vena Cava Filter: Treatment with Additional Filter Placement and Aspiration Thrombectomy

For the patients suffering from extensive deep vein thrombosis (DVT), the placement of an inferior vena cava (IVC) filter in conjunction with anticoagulant therapy has been used to prevent pulmonary embolisms. However, for the patients who anticoagulant is contraindicated or if this is complicated, the use of an IVC filter without concurrent anticoagulation may become the sole treatment for pulmonary embolisms. In this situation, the thrombi trapped in the IVC filter may cause significant clinical problems. We report here on a case of IVC filter thrombosis that was successfully treated by aspiration thrombectomy after placing another filter proximal to the previous filter.

Spontaneous Rupture of the Left Common Iliac Vein: Management with Surgical Repair and Endovascular Stent

We report here on a case of spontaneous rupture of the left common iliac vein that was diagnosed preoperatively with computed tomography (CT), and the patient was successfully treated with surgery and stent placement. A 60-year-old woman was referred to our emergency room because of sudden left lower abdominal pain and swelling of the left lower extremity. CT revealed a huge retroperitoneal hematoma and extrinsic compression of the left common iliac vein with acute thrombosis of the deep veins of the left lower extremity. Venous patch angioplasty was performed at the site of spontaneous rupture. After performing thrombectomy with using a Forgaty catheter, a stent was placed at the occluded segment of the left common iliac vein under C-arm fluoroscopic guidance. The follow-up CT scans taken at 10 days and 8 months after the initial examination demonstrated a venous stent with preserved luminal patency and the striking resolution of the deep vein thrombosis of the left lower extremity.

Comparison of Tacrolimus Versus Cyclosporin on Cardiovascular Risk in Renal Allograft Recipient / 대한이식학회지

PURPOSE: Hyperlipidemia and diabetes mellitus are common metabolic disorders associated with transplantation and also are risk factors of cardiovascular disease which is leading cause of patient death in kidney transplant recipients. We compared blood lipid and glucose levels of patients receiving tacrolimus (Tac) with those of patients receiving cyclosporine (CyA). METHODS: Patients were grouped as Tac (n=124) or CyA (n=77). Minimal follow up duration was 18 months. Both groups have no difference in age, sex, HLA match, numbers of transplantation and proportion of the patients with pretransplant hypercholesterolemia (>220 mg/dL) or diabetes. Prevalence of hypercholesterolemia and diabetes in Tac and CyA groups were compared at posttransplant 1, 3, 6, and 12 months. RESULTS: Prevalence of diabetes in CyA versus Tac group were 18.9 vs. 13.8% (P=0.348), 8.6% vs. 18.8% (P=0.060), 5.9% vs. 18.6% (P=0.016), and 10.4% vs. 21.1% (P=0.067) at 1, 3, 6 and 12 months after transplantation respectively. Prevalence of hypercholesterolemia in CyA versus Tac group were 52.5% vs. 16.9% (P=0.000), 37.7% vs. 8.3% (P=0.000), 30.3% vs. 7.4% (P= 0.000) and 22.6% vs. 8.3% (P=0.001) at 1, 3, 6, and 12 months after transplantation. CONCLUSION: CyA group was more prone to develop hypercholesterolemia than Tac group, whereas incidence of diabetes in Tac group was not different from CyA group. In terms of cardiovascular risk, there was no significant difference between CyA treated group and Tac treated group in renal allograft recipients.

Inflammatory Abdominal Aortic Aneurysms, 3 Cases

An inflammatory abdominal aortic aneurysm (IAAA) is a unique abdominal aortic aneurysm (AAA) subtype, which shows severe inflammatory adhesion to adjacent structures. An IAAA is usually symptomatic; back pain, hydronephrosis, fever and weight loss are common manifestations. Recently, the operative mortality of IAAAs has been reported as being indifferent from that of non-inflammatory AAAs. However, as the technical difficulty of the operation is directly related to the complications and mortality, the operation for an IAAA is usually challenging to the vascular surgeons. Herein, we present our experience of three IAAA patients, who were successfully treated by surgical repairs. Cases: The 1st patient was a 62-year-old male with severe back pain and 8 kg of weight loss over a 3-month period. The IAAA was diagnosed by a CT scan. A Dacron Y graft was successfully placed via a retroperitoneal approach. After the operation, his back pain had been completely resolved. The 2nd and 3rd patients were 71 and 67-year-old males with left flank pain. The preoperative CT scans showed infrarenal IAAAs, with hydronephrosis of left kidney and ureter. After placing a ureteral catheter through the cystoscope, the aneurysms were repaired using Dacron Y-grafts via a transperitoneal approach. After the operations, the symptoms of these two patients completely disappeared. The 2nd patient showed complete resolution of the perianeurysmal inflammation and hydronephrosis on a follow up CT scan four months after surgery. The 3rd patient's hydronephrosis had not resolved on the follow up ultrasonogram two months after the surgery, but he was symptom free. All three patients are doing well at the 16th, 8th and 3rd postoperative months.

Placement and Retrieval of a Gunther Tulip Filter in Patients with a Free Floating Thrombus in Inferior Vena Cava

PURPOSE: We wanted to assess the technical feasibility and clinical efficacy of the placement and retrieval of a Gunther Tulip filter for the prevention of fatal pulmonary embolism during the management of patients with a free floating thrombus in their inferior vena cava (IVC). MATERIALS AND METHODS: Six patients having a free floating thrombus in their IVC (three patients with an isolated free floating thrombus in the IVC that resulted from immobilization due to traumatic liver injury or cerebral infarction, two patients with coexisting deep vein thrombosis in the left lower extremity that was caused by May-Thurner syndrome, and one patient with coexisting deep vein thrombosis in the right lower extremity that was due to nephrotic syndrome and immobilization after hip joint replacement) underwent placement and retrieval of a Gunther Tulip filter. The placement of the filter was performed through the right internal jugular vein to prevent the risk of detachment of the thrombus during the procedure. Retrieval of filter was performed after the free floating thrombus of the IVC had disappeared on follow-up CT because of anticoagulation therapy, aspiration thrombectomy or catheter directed Urokinase thrombolysis. RESULTS: The Gunther Tulip filter was successfully placed in the IVC in all six patients and it was retrieved after the management of the free floating thrombus. The mean duration of the placement of the filter was 11 days (range: 7-25 days). Two patients underwent placement of an iliac vein stent for the management of May-Thurner syndrome. Detachment of the free floating thrombus in the IVC and the subsequent thrombus entrapment in the filter were documented during aspiration thrombectomy or Urokinase thrombolysis in four patients. Recurrent thrombus didn't occur during the follow-up period (range: 3-20 months) in five of the six patients. In one patient, a recurrent thrombus due to the discontinuance of anticoagulation therapy was identified at the filter detachment site of the IVC on the follow-up CT 10 days after the filter retrieval, but it disappeared 15 days after proper anticoagulation therapy was done. CONCLUSION: Temporary Gunther Tulip filter placement is technically feasible and efficacious for the prophylaxis of pulmonary embolism in those patients with a free floating thrombus in the IVC, and particularly in those patients who will have subsequent aspiration thrombectomy or catheter directed Urokinase thrombolyis performed.

Central Vein Stenosis in Hemodialysis Patients

PURPOSE: Central vein stenosis (CVS) is a common problem for the patients on chronic hemodialysis. It is primarily a result of previous catheterization of a central vein. This study investigated the characteristics of this problem and the effect following treatment different modalities. METHOD: We reviewed the medical records of 23 dialysis patients who had diagnosed with central venous stenosis from January 2001 to March 2005. We reviewed the characteristics, clinical manifestations and effects of treatment. RESULT: Of the total 23 patients, 9 patients had no past history of central vein catheterization ipsilateral to the vascular access. The most common site of venous lesion was the left innominate vein (n=12). A total of 20 patients underwent treatment. Of these 20 patients, 14 (20%) underwent balloon angioplasty, 5 underwent percutaneous transluminal angioplasty (PTA) with stent insertion and 1 underwent bypass surgery. The primary patency rate was 57% for the balloon angioplasty and 40% for the PTA with stent insertion. The numbers of patients in need of repeat treatment following the initial endovascular treatment were 2 of 14 patients (14%) for balloon angioplasty and 2 of 5 (40%) for the PTA with stenting. CONCLUSION: The primary goal of diagnosis and therapy for CVS is to maintaining the functionality of the access and to relieve the symptoms. Radiogical intervention is a gold standard. The long term patency after angioplasty, with or without stents, remains unproven.

Retrospective Study Comparing Cyclosporine Microemulsion and Tacrolimus in Living Donor Renal Transplant Recipient / 대한이식학회지

PURPOSE: In order to achieve an adequate immunosuppression and avoid side effects of immunosuppressant, various combination of immunosuppressant have been tried. METHODS: To review the result of living donor renal transplantation according to the type of calcineurin inhibitor (group 1: microemulsion cyclosporine with mycophenolate mofetil and steroid (n=53) / group 2: tacrolimus with mycophenolate mofetil and steroid (n=44)), we retrospectively reviewed renal transplant recipients between January 1997 through December 2001 in Dongsan medical center. RESULTS: The biopsy proven acute rejection rate were 30.2% in cyclosporine group, while 20.5% in tacrolimus group. Among the 9 cases of acute rejection in tacrolimus group, four cases were associated with BK virus infection. The response rate of acute rejection to steroid pulse therapy was 75.0% and 66.7% in group 1 and 2 respectively. There were no statistical difference in serial changes of serum creatinine after transplantation, number of recipients whose serum creatinine more than 2.0 mg% and proteinuria more than 100 mg/dL, checked at one year. To treat the side effect and intractable acute rejection, calcineurin inhibitors were exchanged each other in 5 recipients. Average steroid daily dosage at one year was 7.10+/-2.82 mg in cyclosporine group while 5.27+/-1.45 mg in tacrolimus group. Overall graft survival were no significant difference between groups up to 24 months but in recipients who developed acute rejection showed better graft survival in cyclosporine group while recipients without acute rejection had better survival in tacrolimus group. CONCLUSIONS: Tacrolimus based immunosuppression showed lower incidence of acute rejection and better steroid sparing effect but developed more polyoma virus infection which eventually deteriorate graft function and survival up to two years.

Cadaveric Renal Transplantation, before and after KONOS System (Single Center Report) / 대한이식학회지

INTRODUCTION: Comparing with living donor renal transplantation, cadaveric renal transplantation is usually performed as an emergency procedure and has prolonged preservation time and increased incidence of delayed graft function. Korean Network for Organ Sharing (KONOS) was launched from February 2000 to manage the organ transplantation in Korea and expected to increase donor organs supply and an effective organ allocation. PURPOSE: In order to compare the result of cadaveric renal transplantation before and after KONOS system, 108 cadaveric renal transplants performed in Dongsan hospital until October 2003 were reviewed and analyzed. METHODS: Donors and recipients were divided into two groups (group 1; transplantation performed before KONOS, group 2; transplantation after KONOS) and their characteristics and results were analyzed retrospectively. RESULTS: Among donor factors, number of multi-organ procurement increased (23.1% vs 78.6%), and use of inotrophic agent decreased (63% vs 46%) significantly after KONOS, however cold preservation time was not changed even after KONOS system. Procured organs per one donor in our hospital was increased from 2.25 to 2.65. Increased recipient age (from 30.1 to 41.9 years old), more chance to diabetic patient and decreasing number of HLA mismatching (4.6 to 3.9) were considered as a result of KONOS allocation system. However, early results including incidence of acute rejection episode and delayed graft function, and serum creatinine level at the end of one year were no statistic differences. The number of early graft loss were decreased up to 2 years after transplantation. CONCLUSION: Renal transplantation from cadaveric donor after KONOS resulted in lower early graft loss but increased waiting time due to organ shortage is a serious problem to be solved in the future.

Detection of circulating tumor cells in patients with gastrointestinal tract cancer using RT-PCR and its clinical implications

To investigate the relationship between the presence of circulating tumor cells in different stages of gastrointestinal tract cancer and the subsequent relapse or distant metastasis, circulating levels of CEA mRNA was serially examined at an interval of 10.6+/-4.5 or 13.7+/-3.0 months in gastric or colorectal cancer patients, respectively. CEA mRNA was measured by means of RT-PCR amplification as an indicator for micrometastatic malignant cells. Seven of twenty-nine respectable gastric cancer patients (24.1%) [EGC: 2/9 (22.2%), AGC IIIa: 1/5 (20.0%), AGC IIIb: 4/15 (26.6%)] were positive for CEA mRNA on the initial test and 10 of 29 patients (34.4%) [EGC: 2/ 9 (22.2%), AGC IIIa: 1/5 (20.0%), AGC IIIb: 7/15 (46.7%)] were positive on a follow-up test. Only in AGC IIIb, the positive rate for CEA mRNA increased about twice and 6 of 7 positive cases (85.7%) relapsed within 2.6+/-2.4 months after the follow-up test. In colorectal cancer, 4 of 19 patients (21.1%) [B2: 1/6 (16.7%), C2: 3/13 (23.0%)] were positive on the initial test and 10 of 19 patients (52.6%) [B2: 4/6 (66.7%), C2: 6/13 (46.2%)] were positive on a follow-up test showing an increase in positive rates during a follow-up, however, no significant correlation between CEA mRNA positivity and subsequent relapse was demonstrated. These results suggest that an early tumor cell dissemination may occur in gastrointestinal tract cancer without subsequent relapse, however, the serial regular examination of CEA mRNA level may contribute to predicting a subsequent relapse in AGC IIIb in gastric cancer.

An Experimental Trial of Web-based Problem Based Learning / 한국의학교육

In this paper, we present some results from an experimental web-based Problem-Based Learning(PBL) course, which was offered to 64 medical students in the first grade at Konkuk university for 7 weeks. For the course, we developed a web-based PBL module, which is composed of three sections. The first section includes the 8 stages of problem probing and solving in patient's care. In every stage, the students can browse all the data for the problem solving. The second section contains some problems for evaluating the academic achievement of the students who successfully passed in the first section. In the third section, some questionnaires are presented to survey the students response. The followings are the results. 1. Average score of the first section was 64.1+/-13.2. Most students participated in the course with integrity, and especially seven students(11%) were remarkable in their clinical reasoning. 2.The student's computer skill did not largely affect their academic achievements. However, it is desirable for the students to learn basic computer usage in advance. 3.A few students attended to the discussion through bulletin board facilities. Considering the importance of discussion in PBL, we need to devise a new way of attracting students in the discussion. 4. The survey showed that sixty five percent of the students thought that the lecture was effective and ninety one percent of them that it would be better if it is offered as a regular course during summer or winter vacations. Seventy five percent of students became to realize the importance of basic sciences such as biochemistry and physiology after this course. 5. There were many students who complained about the malfunctioning of the system. The system should be modified to be more reliable and robust. In conclusion, the web-based PBL course provided an effective way of learning in medical education. It also turned out to be used as an alternative of traditional PBL and especially useful for self study.

Seven Cases of Desmoid Tumor of Trunk

BACKGROUND: A desmoid tumor is a rare neoplasm of a mature fibroblast within an extensive collagen matrix. These tumors are classified pathologically as aggressive fibromatosis with local invasiveness, showing recurrences after surgical treatment, although they do not metastasize. Complete surgical excision without leaving a remnant tumor seems to be the primary treatment option, but these tumors often recur after resection. Therefore, alternative treatment strategies, including radiation therapy, nonsteroidal anti-inflammatory agents, anti-estrogen compounds, and cytotoxic chemotherapy, have been employed. METHOD: The authors report the clinical characteristics and prognoses after treatment for seven patients who were diagnosed as having desmoid tumors and who underwent surgical excision for therapy during the ten-year period from 1986 to 1997 at Keimyung University Dongsan Medical Center. RESULTS: There were two males and five females. The most common chief complaint was a slowly growing painless mass. The duration of the symptom before diagnosis was quite different from patient to patient. The locations in the trunk were scattered diffusely: the shoulder, the chest wall, the abdominal wall, the retroperitoneum, and the pelvic cavity. The tumors were well visualized by imaging techniques such as ultrasonograms, CT scans, and MRI. Four of the seven patients experienced recurrent tumors after surgical excision; two are dead. The tumors in the recurrent patients were excised incompletely at initial surgery. CONCLUSION: Although the uncommon, solid desmoid tumors which develop in the musculoaponeurosis of the trunk are benign pathologically, they were recurrent after surgical excision when the resection margin is incomplete. Therefore, complete excision is the only curative therapeutic modality.

A Foreign Body in the Urethra: A Case Report / 대한비뇨기과학회지

Most foreign bodies in the lower genitourinary tract are self-inserted through the urethra for masturbation. It can be diagnosed by clinical histories and physical examinations of the patient, endoscopy and radiologic evaluations. Extraction should be tailored as the surgery, endoscopic manipulation and dissolution according to the nature of the foreign body and should minimize bladder and urethral injury. We report a case of a long wire in the bladder and urethra with brief review of literatures.