Effect of Preoperative Chemotherapy on Outcome of Wilms Tumor / 임상소아혈액종양

BACKGROUND: Wilms tumor is the most common renal tumor in children. The aim of this study was to assess the effect of preoperative chemotherapy after needle biopsy on outcome of Wilms tumor and suggest an optimal treatment scheme on Wilms tumor.METHODS: We reviewed the medical records of 52 patients who were diagnosed with Wilms tumor from 1995 to 2010. Before 2000, primary nephrectomy was usually done. After 2000, preoperative chemotherapy was usually done.RESULTS: Preoperative chemotherapy was given to 39 cases while primary nephrectomy was done in 13 cases. Five year survival rate and five year event-free survival rate were 96.2+/-2.7% and 87.9+/-4.7%, respectively. Tumor spillage occurred more frequently in primary nephrectomy group than in preoperative chemotherapy after needle biopsy group (P=0.014). There was no significant difference in survival between the two groups (P=0.599).CONCLUSION: Preoperative chemotherapy after needle biopsy improved diagnostic accuracy and decreased tumor spillage while strengthened chemotherapy intensity. Further studies are needed to optimize chemotherapy intensity.

Laparoendoscopic Single-Site Pyeloplasty Using Additional 2 mm Instruments: A Comparison with Conventional Laparoscopic Pyeloplasty

PURPOSE: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P). MATERIALS AND METHODS: Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting. RESULTS: The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months). CONCLUSIONS: Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.

Effect of Preoperative Chemotherapy on Outcome of Wilms Tumor / 임상소아혈액종양

BACKGROUND: Wilms tumor is the most common renal tumor in children. The aim of this study was to assess the effect of preoperative chemotherapy after needle biopsy on outcome of Wilms tumor and suggest an optimal treatment scheme on Wilms tumor. METHODS: We reviewed the medical records of 52 patients who were diagnosed with Wilms tumor from 1995 to 2010. Before 2000, primary nephrectomy was usually done. After 2000, preoperative chemotherapy was usually done. RESULTS: Preoperative chemotherapy was given to 39 cases while primary nephrectomy was done in 13 cases. Five year survival rate and five year event-free survival rate were 96.2+/-2.7% and 87.9+/-4.7%, respectively. Tumor spillage occurred more frequently in primary nephrectomy group than in preoperative chemotherapy after needle biopsy group (P=0.014). There was no significant difference in survival between the two groups (P=0.599). CONCLUSION: Preoperative chemotherapy after needle biopsy improved diagnostic accuracy and decreased tumor spillage while strengthened chemotherapy intensity. Further studies are needed to optimize chemotherapy intensity.

The Prognostic Significance of Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To review the result of a radical nephrectomy for renal cell carcinomas and investigate whether an ipsilateral adrenalectomy, during a radical nephrectomy, has a favorable prognostic effect in patients with renal cell carcinomas. MATERIALS AND METHODS: The medical records of 365 patients, who underwent a radical nephrectomy, between January 1995 and December 1999, were retrospectively reviewed. All patients had unilateral renal cell carcinomas, and nephrectomies were performed either with (adrenalectomy group, 193 patients) or without (non-adrenalectomy group, 172 patients) an ipsilateral adrenalectomy. The survival rate was assessed using the Kaplan-Meier method. In conjunction with a univariate analysis, a multivariate analysis was performed, using a Cox regression analysis, to determine the independent prognostic factors. RESULTS: The ages of the adrenalectomy and non-adrenalectomy groups ranged from 21 to 78 (mean age: 54.7 years) and 28 to 77 years (mean age: 54.0 years), respectively. The durations of the follow-up periods in the adrenalectomy and non-drenalectomy groups were 62.4 and 62.6 months, respectively. There were no significant differences in the clinicopathological characteristics, including the T stage, between the two groups. The 3-year survival rates of the adrenalectomy and non-adrenalectomy group were 82.8 and 91.2%, respectively, and the 5-year survival rates were 75.4 and 85.3%, respectively (p=0.095). In the adrenalectomy group, distant metastasis, high T-stage and adrenal involvement were identified as prognostic factors by the multivariate statistical analysis (p=0.002, p=0.008 and p<0.001, respectively). CONCLUSIONS: Our results reveal that an ipsilateral adrenalectomy, during a radical nephrectomy, does not improve the prognosis of patients with renal cell carcinomas.

Expressions of Thrombospondin-1 and Vascular Endothelial Growth Factor and Their Relationship with p53 Status in Prostate Cancer and Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The precise role of angiogenesis in prostate cancer should be defined. Several reports suggest that thrombospondin-1 (TSP-1) possesses a tumor suppressor function, possibly through its ability to inhibit tumor neovascularization. The vascular endothelial growth factor (VEGF), one of the most important angiogenic factors in a solid tumor, has shown conflicting results on prostate cancer. Therefore, TSP-1 and VEGF expression in prostate cancer, and their relationship with the p53 status were analyzed. MATERIALS AND METHODS: Using immunohistochemistry, the expression of VEGF, TSP-1 and p53 was assessed in 75 archival tissues from 23 benign prostatic hyperplasia (BPH), 22 localized prostate cancer, and 30 metastatic prostate cancer patients. The relationship between VEGF and TSP-1, and the p53 status, tumor grade and stage was evaluated in patients with prostate cancer. RESULTS: The immunohistochemical analysis demonstrated a higher VEGF expression level (p<0.01) and a lower TSP-1 expression level (p<0.01) in prostate cancer compared to the BPH tissues. In addition, a higher VEGF expression level (p<0.05) and a lower TSP-1 expression level (p<0.05) in metastatic prostate cancer tissues were observed compared to the localized prostate cancer tissues. A significant inverse correlation was found between the TSP-1 and VEGF expression levels. There was a significant association between the VEGF expression level and the p53 status (p<0.05), but the TSP-1 expression level was not associated with the p53 status. CONCLUSIONS: These results show that angiogenic factors including VEGF and TSP-1 might play an important role in the development and progression of prostate cancer. These changes appear to be influenced by the p53 status.

Investigation of the Validity of an in vivo Experimental Model for the Evaluation of the Therapeutic Potentials of Drugs for the Treatment of Premature Ejaculation / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to investigate the validity of in vivo experimental models to evaluate the therapeutic potentials of drugs for the treatment of premature ejaculation. MATERIALS AND METHODS: Male Sprague-Dawley rats (250-300gm) were divided into 8 groups based on the experimental agent administered: serotonergic agents (serotonin, clomipramine, fluoxetine, sertraline, paroxetine) and alpha-adrenergic blockers (prazosin, terazosin, tamsulosin). Various concentrations of the agents were intravenously injected 20 minutes prior to the electrical stimulation of the hypogastric nerve. Intraluminal pressures of seminal vesicle and vas deferens were measured on each side in the same animal. The concentration-response curves for each drug were obtained, and the inhibitory effects of the drugs on the contractile response of the seminal vesicles and vasa deferentia to the electrical stimulation of the hypogastric nerve were compared. RESULTS: All the serotonergic agents resulted in dose-dependent inhibition of the intraluminal pressure of the seminal vesicle to electrical stimulation (clomipramine>serotonin>fluoxetine>sertraline>paroxetine). The vasal pressure responses were also effectively inhibited by serotonin, clomipramine and sertraline, in that order. Fluoxetine and paroxetine showed no inhibitory effects on the vasal pressure. The pressure responses of both the seminal vesicles and the vasa deferentia were inhibited in a dose-dependent manner by all the alpha-adrenergic blockers. CONCLUSIONS: This in vivo model was not able to demonstrate the established clinical effects of various serotonergic agents widely used in the treatment of premature ejaculation. Conversely, the alpha-adrenergic blockers showed marked dose-dependent inhibition of the seminal tract pressure responses. Therefore, this in vivo model has limitations for the proper evaluation of therapeutic potentials of drugs for the treatment of premature ejaculation.

Development of New Gene Therapy for Erectile Dysfunction Using Antisense cDNA for Type V Phosphodiesterase Gene / 대한남성과학회지

PURPOSE: We examined the feasibility of gene therapy for erectile dysfunction using cultured human corpus cavernosal smooth muscle cells. MATERIALS AND METHODS: The vector construct was designed to contain a fusion gene of enhanced green fluorescent protein (gfp) and beta-galactosidase (lacZ) which was under control of CMV promoter. Cells within the second passage were transfected with the vector DNA only and vector DNA containing a part of cDNA in an antisense orientation for human type V phosphodiesterase (PDE) gene using lipofection. Reporter gene expressions were investigated by fluorescence microscopy and X-gal staining at 24-hour interval. Effects of gene transfer of type V PDE antisense cDNA were investigated after 48 hours of gene transfection using the RT-PCR for type V PDE gene and measurement of intracellular cGMP level treated by sodium nitroprusside (SNP), NO-donor, of various concentrations. RESULTS: Expressions of gfp and lacZ were observed for upto 72 hours after gene transfection. Results from RT-PCR analysis also confirmed the gene expression at the transcriptional level. Type V PDE mRNA expression was significantly inhibited and magnitude of cGMP increase was significantly enhanced by gene transfer of antisense cDNA for type V PDE gene compared with non-transfectant control cells. CONCLUSIONS: Our results demonstrate that the liposome-mediated gene transfer was shown to be effective in corpus cavernosal smooth muscle cells. Gene transfer of antisense cDNA for type V PDE gene effectively inhibited the expression of type V PDE gene at the transcriptional and translational levels, suggesting that this newly developed gene transfer system may be a potential gene therapy in the treatment of erectile dysfunction.