Translation and Linguistic Validation of Korean Version of the Expanded Prostate Cancer Index Composite for Clinical Practice for Patients With Prostate Cancer / 대한배뇨장애요실금학회지

Purpose@#Advances in the diagnosis and treatment of prostate cancer have increased the patients’ stress level and decreased the quality of life. A variety of instruments are currently available to evaluate patients with prostate cancer. However, only a few tools are available to assess Korean patients, and therefore we demonstrated a linguistic validation of Korean Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). @*Methods@#EPIC-CP was translated into Korean and the linguistic validation was evaluated. The evaluation process includes permission for translation, forward translation, reconciliation, backward translation, cognitive debriefing, and proofreading. Two bilingual translators independently translated the original questionnaire, discussed the feasibility and naturalness of initial translation, followed by revision to the reconciled version. Another translator then performed a backward translation into English. Ten patients with prostate cancer completed the translated questionnaire and performed cognitive debriefing. @*Results@#The original EPIC-CP was translated into 2 Korean versions. The different wording in both versions and the ordinary words in the initial translations were changed considering the nuances and meanings of medical terms. During the backward translation, the panels made slight changes to clarify the meaning and nuances of the translated questionnaire. During cognitive debriefing, 10 patients answered the questionnaire and offered their opinions regarding comprehensibility and naturalness. Most patients agreed that the translation was comprehensible in general. @*Conclusions@#Our study provides a successful linguistic validation of the EPIC-CP questionnaire. The translation is a helpful diagnostic tool to ensure the quality of life of patients with prostate cancer attending crowded clinics.

Predicting Factors for Death from Other Causes in Patients with Localized Renal Cell Carcinoma

PURPOSE: To identify the predictors of death from other causes in patients with localized renal cell carcinoma (RCC). MATERIALS AND METHODS: We identified 1,101 patients with pathologically confirmed T1 or T2 RCC with a follow-up duration of over 6 months. Survival according to the cause of death was evaluated by using the Kaplan-Meier analysis with log-rank test. Prognostic factors for death from other causes were assessed by multivariate analysis using the Cox proportional hazard regression model. Once the prognostic factors were identified, a risk-group variable was created by counting the number of unfavorable features present for each patient. RESULTS: The median follow-up was 62 months, and RCC-related death occurred in 50 patients (4.5%), whereas death from other causes occurred in 47 (4.3%). Patients who died from other causes had a higher American Society of Anesthesiologist (ASA) score (26.1% vs. 10.2%; p=0.044), older age (63.4 years vs. 55.0 years; p<0.001), smaller mass size (5.1 cm vs. 7.9 cm; p<0.001), and lower nuclear grade (p=0.003). In the multivariate Cox regression analysis, older age, higher ASA score, and lower body mass index were independent factors predicting death from other causes in patients with localized RCC. On the basis of the number of risk factors for death from other causes, the 5-year other-cause-specific survival was 98.3% (0 risk factors), 84.7% (1 risk factor), and 67.6% (2 or 3 risk factors), respectively (p<0.001). CONCLUSIONS: Older age, higher ASA score, and lower body mass index were independent predictors of death from other causes in patients with localized RCC.

Airway Obstruction Caused by Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion: A Case Report / 대한구급학회지

Acute airway obstruction after anterior cervical surgery is rare, but does occur. Airway obstruction due to prevertebral soft tissue swelling is unpredictable, but potentially lethal. We managed a 67-year-old male who developed acute airway obstruction caused by marked prevertebral soft tissue swelling on the first day after anterior cervical discectomy and fusion at the C4-C5 level.

Anaphylaxis Induced by Intravenous Ranitidine Injection: 2 Case Reports / 대한구급학회지

Histamine type 2 (H2) receptor antagonists are widely used for stress ulcer prophylaxis in critical and postoperative care. Though ranitidine is one of the most commonly used H2 receptor antagonists, with a low incidence of adverse reactions, a few anaphylactic reactions associated with ranitidine have been reported. This report describes 2 additional cases of anaphylaxis induced by ranitidine used for stress ulcer prophylaxis.

Targeted Therapy in Metastatic Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of targeted therapy in patients with metastatic renal cell carcinoma. MATERIALS AND METHODS: In this retrospective analysis, 43 consecutive patients with metastatic renal cell carcinoma received targeted therapy between December 2005 and December 2007. All patients underwent radical nephrectomy. Twenty-two patients received targeted therapy as a first-line treatment and 21 as a second-line treatment. RESULTS: The median follow-up duration after radical nephrectomy and after the initiation of targeted therapy was 87 and 14 months, respectively. The initial response rate was 74.4% (partial response 37.2%, stable disease 37.2%) and the last response rate was 34.9% (partial response 4.7%, stable disease 30.2%). The median survival was 17 months (95% confidence interval (CI), 11.6-22.4) and the median progression-free survival was 10 months (95% CI, 7.5-12.5). Eleven patients (50%) with synchronous metastasis and 3 (14.3%) with metachronous metastasis died from renal cell carcinoma (p=0.023), but there was no significant difference in terms of median survival (15 months vs. longer than 14 months, p=0.210). Also, there was a significant difference in the overall mortality of the MSKCC risk groups (13.3% vs. 44.4%, p=0.049), but no significant difference in median survival (longer than 14 months vs. 15 months, p=0.236). CONCLUSIONS: Targeted therapy shows promising clinical activity in patients with metastatic renal cell carcinoma. Time to metastasis and MSKCC risk group may be associated with overall survival, and the prognostic implications of those factors should be analyzed in further prospective studies.

Continuous epidural analgesia versus continuous intravenous analgesia with peri-articular infiltration following total knee arthroplasty in geriatric patients / 대한마취과학회지

BACKGROUND: Postoperative continuous intravenous analgesia may not provide effective postoperative analgesia following total knee arthroplasty. This study was conducted to determine if combined continuous intravenous analgesia and peri-articular infiltration provided a better quality of analgesia following total knee arthroplasty than epidural analgesia. METHODS: A prospective, double-blind study involving 50 patients who had undergone total knee arthroplasty was conducted. Patients were divided into control group and an experimental group. Patients in the control group (n = 25) received peri-articular infiltration with 47 mL normal saline prior to closure of the wound and postoperative epidural analgesia for 48 hours. Patients in the experimental group (n = 25) received a mixture of peri-articular infiltration of 16 mL of 0.75% ropivacaine, 6 mg morphine, 0.2 mg of epinephrine and 25 mL normal saline prior to closure of the wound and postoperative continuous intravenous analgesia for 48 hours. The analgesic efficacy was then evaluated using the verbal numeric rating scale at 1, 2, 6, 12, 24, and 48 hours postoperatively. The side effects and the dosage of rescue analgesics were then recorded. RESULTS: The experimental group showed a significantly higher pain score than the control group 2 and, 6 hours postoperatively at rest and 2 hours postoperatively following passive knee movement (P < 0.05). In addition, the rescue analgesic requirement was higher for the experimental group during the first 24 hours following surgery than for the control group (P < 0.05). CONCLUSIONS: We found that combined continuous intravenous analgesia and peri-articular infiltration of a mixture of ropivacaine and, morphine injected into the peri-articular tissue provided minimal benefits for pain control during the early postoperative period when compared to epidural analgesia after total knee arthroplasty.

A clinical comparison of vertical infraclavicular brachial plexus block using 0.75% or 0.5% ropivacaine for upper limb surgery / 대한마취과학회지

BACKGROUND: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. METHODS: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. RESULTS: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. CONCLUSIONS: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block.

The Learning Curve Analysis of Laparoscopic Radical Prostatectomy: Comparison with Retropubic Radical Prostatectomy / 대한비뇨기과학회지

PURPOSE: We wanted to compare the early outcome of laparoscopic radical prostatectomy(LRP) as performed by a laparoscopic surgeon without experience with retropubic prostatectomy(RRP), and open RRP as performed by an oncologic surgeon without experience with LRP. MATERIALS AND METHODS: We reviewed the clinical data on the initial 31 LRPs(group 1) and the 107 RRPs(group 2), as performed by two surgeons at our institution. The two different surgeons performed each type of operation, respectively. Although each surgeon was an expert of laparoscopic surgery and open surgery respectively, they were unfamiliar with radical prostatectomy. RESULTS: The mean operation time was longer in group 1 than in group 2(303 minutes vs. 207 minutes, respectively, p0.05), and no conversions or re-explorations were required and rectal injury did not occur in group 1. The histopathologic parameters of the two groups were comparable, especially in terms of the surgical margin positivity(37.9% vs. 43.4%, respectively, p>0.05). The continence rate and potency rate were also comparable between the two groups. CONCLUSIONS: Our findings suggest that early outcome of LRP is comparable to that of RRP. Especially the estimated blood loss and the rate of transfusions were lower in the LRP group. We believe that the surgical outcome of LRP will continue to improve at specialized centers as laparoscopic urologists gain experience, and even though an expert laparoscopic urologist may be a naive for prostate cancer surgery, the learning curve is overcome earlier than expected.

Correlation between Androgen Deficiency on the Aging Males Questionnaire and the Aging Males' Symptoms Scale and Their Relationship with Serum Testosterone / 대한비뇨기과학회지

PURPOSE: The aim of this study is to analyze the correlation between the Androgen Deficiency in Aging Males(ADAM) questionnaire and the Aging Males' Symptoms(AMS) scale and to determine their relationship with the serum testosterone level. MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients who took the self-administered ADAM questionnaire, the AMS scale and the International Index of Erectile Function(IIEF) questionnaire. We enrolled a total of 265 patients older than 40 years who presented a positive result for the ADAM questionnaire(defined as a 'yes' answer to question 1 or 7, or a 'yes' answer to at least three of the other questions). Blood tests were performed, including the total testosterone, prolactin, the lipid profiles and the fasting glucose level. RESULTS: The psychological subscale of the AMS scale was correlated with ADAM questions 2, 3, 5, 7, 8 and 10(p<0.005) and the somato-vegetative subscale was correlated with questions 2, 3, 5, 6, 8 and 10(p<0.05). The sexual subscale was correlated with questions 1, 2, 5, 6, 7, 8 and 10(p< 0.05). Statistically significant differences were found for the IIEF questionnaire scores between the patients with 'yes' and 'no' answer to ADAM question 1 and 7(p<0.05). The IIEF questionnaire scores were significantly lower for the men with a sexual subscale score 11-25 on the AMS scale (p<0.05). The total testosterone was not correlated with the ADAM, AMS and IIEF questionnaire but the total testosterone demonstrated a significantly negative correlation with weight, abdominal circumference, body mass index(BMI) and triglyceride(p<0.05). CONCLUSIONS: This analysis revealed that the ADAM questionnaire and the AMS scale have a significant relationship, and especially the sexual function domain of the two questionnaires showed correlation with the IIEF questionnaire. Serum testosterone was related with weight, abdominal circumference, BMI and triglyceride.

Risk Factors for Urinary Stone Formation in Male Patients with Spinal Cord Injury: A 17-Year Follow-Up Study / 대한비뇨기과학회지

PURPOSE: This study was initiated to establish the hazard ratios for risk of urinary stone formation in chronic spinal cord injury (SCI) patients. MATERIALS AND METHODS: A total of 140 male patients who were injured before 1987 were eligible for this investigation and they were followed up on a yearly basis from January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (27.9%) and 21 patients (15.0%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. On multivariate analysis, bladder stone was more common for the patients who were injured at 24 years old or older than is was for those patients who were injured at less than 24 years old (odds ratio [OR]: 2.490; 95% confidence interval [CI]: 1.092-5.677; p=0.030). In another model, the patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (OR: 4.095; 95% CI: 1.295-12.944; p=0.016). We also found that renal stone was more common for the patients with urethral catheterization (UC) than for the patients who could spontaneous void (OR: 5.668; 95% CI: 1.306-24.604; p=0.021), and for patients with bladder stone than for those without bladder stone (OR: 4.678; 95% CI: 1.447-15.126; p=0.010). CONCLUSIONS: Injury characteristics are important for the development of urinary stone in chronic traumatic SCI patients. In addition, our findings suggest that for the cases who cannot undergo intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than UC is regards to renal stone formation in this population.

Effect of Periprostatic Nerve Blockade for Transrectal Ultrasound Guided Biopsy of the Prostate / 대한비뇨기과학회지

PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.

Detection of tumor cell contamination in peripheral blood by RT-PCR in gastrointestinal cancer patients

We analyzed the peripheral blood of patients with gastrointestinal tract cancer at different stages to assess the presence of carcinoembryonic antigen (CEA) mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR), which we used as an indicator for micrometastatic malignant cells. A total of 35 gastric, 24 colorectal, 4 esophageal and 4 biliary tract cancer patients and nine normal healthy subjects were studied. No CEA mRNA was detected in the nine normal healthy volunteers. CEA mRNA was detected in 100% (10/10) of metastatic, 33.3% (3/9) of early gastric cancer (EGC), and 18.8% (3/16) resectable gastric cancer patients, respectively. In colorectal cancer, 55.6% (5/9) of metastatic cancers were positive for CEA mRNA, and 26.7% (4/15) Duke stage B/C showed positive. One patient with stage III gastric cancer who was negative CEA mRNA initially and turned positive during follow-up, developed multiple bone metastasis one month later. Another stage III patient, who was positive for CEA mRNA, preoperatively revealed early relapse in two months. These results suggest that the identification of circulating tumor cells using RT-PCR for the detection of CEA mRNA is feasible and this analysis may be a promising tool for early detection of micrometastatic circulating malignant cells in patients with gastrointestinal tract cancer.