Closure of Petersen's Space Lowers the Incidence of Gastric Food Retention after Distal Gastrectomy with Gastrojejunostomy in Gastric Cancer Patients

Purpose@#Delayed gastric emptying usually manifests as gastric food retention. This study aimed to evaluate the incidence of gastric food retention after distal gastrectomy with gastrojejunostomy in gastric cancer patients and identify the risk factors for its development. @*Materials and Methods@#We retrospectively enrolled 245 patients who underwent distal gastrectomy with gastrojejunostomy for gastric cancer at Boramae Medical Center between March 2017 and December 2019. We analyzed the presence of gastric food residue via computed tomography (CT) scans at 3 and 12 months postoperatively and analyzed the risk factors that may influence the development of gastric food retention. @*Results@#CT scans were performed on 235 patients at 3 months and on 217 patients at 12 months postoperatively. In the group that received closure of Petersen's space, the incidence of gastric food retention was significantly low as per the 3- and 12-month postoperative follow-up CT scans (P=0.028 and 0.003, respectively). In addition, hypertension was related to gastric food retention as per the 12-month postoperative follow-up CT scans (P=0.011). No other factors were related to the development of gastric food retention. In the multivariate analysis, non-closure of Petersen's space (hazard ratio [HR], 2.54; 95% confidence interval [CI], 1.20–5.38; P=0.010) was the only significant risk factor for gastric food retention at 3 months postoperatively, while non-closure of Petersen's space (HR, 2.81; 95% CI, 1.40-5.64;P=0.004) and hypertension (HR, 2.30; 95% CI, 1.14–4.63; P=0.020) were both significant risk factors for gastric food retention at 12 months postoperatively. @*Conclusions@#Closure of Petersen's space has an effect on decrease the incidence of gastric food retention after distal gastrectomy with gastrojejunostomy in gastric cancer patients.

Are the elderly patient’s changes in the health‑related quality of life one year after gastrectomy for stomach cancer different from those in young patients?

Purpose@#Gastrectomy for elderly patients can significantly deteriorate the health-related quality of life (HRQoL). There was no report comparing HRQoL of elderly patients with young patients after gastrectomy for gastric cancer. This study assessed the differences in the changes of HRQoL at one year after gastrectomy according to age. @*Methods@#From May 2014 to Feb 2016, we prospectively enrolled patients undergoing gastrectomy for gastric cancer. They completed the European Organization for Research and Treatment of Cancer and gastric questionnaires preoperatively and at postoperative 1, 3, 6, 9, and 12 months. @*Results@#We included 57 elderly patients (≥70 years old) and 74 younger patients. The elderly had similar demographic, surgical, and pathological characteristics with young patients except that elderly had more comorbidity, laparoscopic gastrectomies, and lesser postoperative chemotherapy. One month after gastrectomy, the score of global health status/ quality of life, physical, role, and social functioning were significantly impaired in elderly patients. Among them, physical and role functioning were more impaired than those of young patients. The scores of physical functioning, role functioning, cognitive functioning, and social functioning were not fully recovered till 1 year after surgery. There was a significant age group difference in the changes in physical function over the 1-year follow-up. @*Conclusion@#Elderly patients’ global health status/quality of life and social functioning significantly decreased at postoperative 1 month and recovered by 6 months after gastrectomy. There was a significant age-specific difference in physical functioning throughout the 1-year follow-up. Surgeons need to pay more attention to recovery of the elderly patients’ HRQoL after gastrectomy.

Comparing the surgical outcomes of dual-port laparoscopic distal gastrectomy and three-port laparoscopic distal gastrectomy for gastric cancer

Purpose@#Many studies have demonstrated that single-incision or reduced-port laparoscopic distal gastrectomy is a feasible method compared to conventional laparoscopic distal gastrectomy. Using rigid-type laparoscope and right-side approach, we could perform dual-port laparoscopic distal gastrectomy (DPLDG) for gastric cancer. This study aimed to compare the surgical outcomes of DPLDG to those of 3-port laparoscopic distal gastrectomy (TPLDG). @*Methods@#From March 2017 to December 2019, this retrospective study included 218 patients with gastric cancer who underwent DPLDG (106 patients) or TPLDG (112 patients) at SMG-SNU Boramae Medical Center. Surgical outcomes were compared between 2 operation methods. @*Results@#Operation time was similar between DPLDG and TPLDG (158.9 ± 33.4 minutes vs. 154.0 ± 31.1 min, P = 0.787). The number of retrieved lymph nodes was similar between the 2 groups (35.3 ± 14.6 vs. 37.0 ± 13.5, P = 0.415). The complication rate in DPLDG and TPLDG groups was 10.4% and 8.9%, respectively (P = 0.894). The time to first flatus, time to first diet, and postoperative hospital stay were similar between the 2 groups. There were no reoperation or mortality cases. The cost of trocars was 359.9 US dollars (USD) in DPLDG and 291–391.4 USD in TPLDG. @*Conclusion@#The surgical outcomes of DPLDG and TPLDG did not differ. Regarding fewer incisions, DPLDG can be an alternative option for TPLDG.

Risk factors of elderly patients with postoperative delirium following major abdominal surgery for cancer

Purpose@#Postoperative delirium (POD) is a common complication in elderly patients after major abdominal surgery for cancer. Although POD is related with a poor outcome, there have not been many reports about POD after abdominal surgery in Korea. The aims of study were to analyze the characteristics and surgical outcomes of elderly patients with POD and to identify the risk factors of POD. @*Methods@#From November 2016 to January 2019, we prospectively enrolled 63 patients who were aged ≥75 years and underwent major abdominal surgery for cancer. POD was daily assessed for up to 10 days postoperatively with the Confusion Assessment Method and a validated chart review. @*Results@#POD occurred in eight patients (12.7%). Univariate analysis showed that the occurrence of POD was related to sodium <135 mEq/L (P=0.037), combined resection (P=0.023), longer surgery/anesthesia time (P=0.023 and P=0.037, respectively), increased blood loss (P=0.004), postoperative admission to intensive care unit (ICU) (P=0.023), and duration of Foley catheter (P=0.011), however, multivariate analysis identified no significant risk factors of POD. There was no difference in postoperative outcomes such as hospital stay, mortality, reoperation, and morbidity between patients with POD and without POD. @*Conclusion@#Elderly patients with hyponatremia, combined resection, longer operation/anesthesia time and admission to ICU had tendencies to develop POD after major abdominal surgery. Surgeons should pay more attention to prevent POD, and a large-scale prospective study is needed to identify the risk factors of POD.

Risk factors of elderly patients with postoperative delirium following major abdominal surgery for cancer

Purpose@#Postoperative delirium (POD) is a common complication in elderly patients after major abdominal surgery for cancer. Although POD is related with a poor outcome, there have not been many reports about POD after abdominal surgery in Korea. The aims of study were to analyze the characteristics and surgical outcomes of elderly patients with POD and to identify the risk factors of POD. @*Methods@#From November 2016 to January 2019, we prospectively enrolled 63 patients who were aged ≥75 years and underwent major abdominal surgery for cancer. POD was daily assessed for up to 10 days postoperatively with the Confusion Assessment Method and a validated chart review. @*Results@#POD occurred in eight patients (12.7%). Univariate analysis showed that the occurrence of POD was related to sodium <135 mEq/L (P=0.037), combined resection (P=0.023), longer surgery/anesthesia time (P=0.023 and P=0.037, respectively), increased blood loss (P=0.004), postoperative admission to intensive care unit (ICU) (P=0.023), and duration of Foley catheter (P=0.011), however, multivariate analysis identified no significant risk factors of POD. There was no difference in postoperative outcomes such as hospital stay, mortality, reoperation, and morbidity between patients with POD and without POD. @*Conclusion@#Elderly patients with hyponatremia, combined resection, longer operation/anesthesia time and admission to ICU had tendencies to develop POD after major abdominal surgery. Surgeons should pay more attention to prevent POD, and a large-scale prospective study is needed to identify the risk factors of POD.

Choosing Wisely: The Korean Perspective and Launch of the ‘Right Decision in Cancer Care’ Initiative / Journal of the Korean Cancer Association, 대한암학회지

Government healthcare expenditure is rising in Korea, and the costs incurred by patients in Korea exceed those incurred by patients in other Organization for Economic Co-operation and Development countries. Despite the increasing health expenditure, patient demand for services is increasing as well, so it is now becoming recognized that cancer care needs to be balanced. The most important measure in cancer care optimization is to provide high-quality care while keeping costs sustainable. The Korean Cancer Association considers the current situation of cancer therapy in Korea the foremost issue, which has led to the implementation of the nationwide ‘Right Decisions in Cancer Care’ initiative. This initiative is based on the concepts of medical professionalism in that it should be led by physicians working in the field of oncology, that education should be offered to patients and clinicians, and that it should influence healthcare policy. In this article, we introduce the nationwide ‘Right Decision in Cancer Care’ initiative and highlight the five initial items on its agenda. The agenda is open to expansion and update as the medical environment evolves and additional clinical evidence becomes available.

Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018

The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.

External Validation of a Gastric Cancer Nomogram Derived from a Large-volume Center Using Dataset from a Medium-volume Center

PURPOSE: Recently, a nomogram predicting overall survival after gastric resection was developed and externally validated in Korea and Japan. However, this gastric cancer nomogram is derived from large-volume centers, and the applicability of the nomogram in smaller centers must be proven. The purpose of this study is to externally validate the gastric cancer nomogram using a dataset from a medium-volume center in Korea. MATERIALS AND METHODS: We retrospectively analyzed 610 patients who underwent radical gastrectomy for gastric cancer from August 1, 2005 to December 31, 2011. Age, sex, number of metastatic lymph nodes (LNs), number of examined LNs, depth of invasion, and location of the tumor were investigated as variables for validation of the nomogram. Both discrimination and calibration of the nomogram were evaluated. RESULTS: The discrimination was evaluated using Harrell's C-index. The Harrell's C-index was 0.83 and the discrimination of the gastric cancer nomogram was appropriate. Regarding calibration, the 95% confidence interval of predicted survival appeared to be on the ideal reference line except in the poorest survival group. However, we observed a tendency for actual survival to be constantly higher than predicted survival in this cohort. CONCLUSIONS: Although the discrimination power was good, actual survival was slightly higher than that predicted by the nomogram. This phenomenon might be explained by elongated life span in the recent patient cohort due to advances in adjuvant chemotherapy and improved nutritional status. Future gastric cancer nomograms should consider elongated life span with the passage of time.

Gastric carcinosarcoma

Gastric carcinosarcoma is an uncommon biphasic malignant tumor. We report the case of 59-year-old man with a history of melena and dizziness. Endoscopic findings showed a fungating mass that originated from the posterior wall of upper body. Radical total gastrectomy with Roux-en-Y esophagojejunostomy was performed. In the resected specimen, immunohistochemical studies for epithelial and mesenchymal markers showed positive reactions. The mass invaded the submucosa without regional lymph node metastasis. Adjuvant chemotherapy with TS-1 (Taiho Pharmaceutical Co. Ltd, Japan) was performed after surgery despite early clinical stage due to aggressive features of carcinosarcoma.

In which group of gastric cancer patients is the preoperative neutrophil-to-lymphocyte ratio a significant prognostic factor?

PURPOSE: Several recent studies have reported on the clinical importance and prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in gastric cancer. The objective of this study was to identify the subgroups of patients with gastric cancer for which the preoperative NLR was prognostically significant.METHODS: Data from 870 patients who were among those who had undergone surgery for gastric cancer between August 2005 and December 2013 were evaluated. Receiver operating characteristic curve analysis was used to determine the cut-off value for NLR. The patients were classified into high-NLR (NLR≥1.7) and low-NLR (NLR<1.7) groups, and survival analysis of subgroups of gastric cancer patients was performed.RESULTS: Univariate analysis identified age, gender, tumor location, tumor histology, tumor, node, metastasis (TNM) stage, and NLR as significant prognostic factors. Multivariate analysis identified age, TNM stage, and NLR as significant prognostic factors. In subgroup analysis, NLR was a significant prognostic factor except group of TNM stage I, II with age younger than 70 years.CONCLUSION: Except group of TNM stage I, II with age younger than 70 years, careful postoperative follow-up is warranted for those patients with elevated NLR.

Preoperative neutrophil-to-lymphocyte ratio is a prognostic factor for overall survival in patients with gastric cancer

PURPOSE: Preoperative neutrophil-to-lymphocyte ratio (NLR) reflects patients' inflammation status, clinical stage, and survival in various malignancies. However, only a limited amount of information on the clinical importance and prognostic significance of NLR in gastric cancer has been reported. The objective of this study is to assess the prognostic values of preoperative NLR in patients with gastric cancer. METHODS: During the period between August 1, 2005 and December 31, 2011, we collected data from 601 patients among those who had undergone surgery for gastric cancer at the Department of Surgery, Konkuk University Medical Center. We classified the subjects into high NLR (NLR > or = 1.7) group and low NLR (NLR or = 1.7), and old age (> or = 70 years) are significant, independent prognostic factor for overall survival in patients with gastric cancer.

Intra-abdominal fibromatosis after gastrectomy for gastric cancer

Intra-abdominal fibromatosis (IAF) may arise either sporadically or in association with familial adenomatous polyposis. The characteristics of fibromatosis are slow-growth, benign histological features, and aggressive local invasion. Surgery remains a reasonable first treatment option. Here, we report 2 cases of a phenomenon rarely described in published literature, IAF after gastrectomy for gastric cancer. Intra-abdominal masses were found during the routine follow-up period in a 50-year-old man who had received a radical subtotal gastrectomy for early gastric cancer. Two mesenteric masses were detected in the upper abdomen by CT and were excised completely along with segments of the jejunum. Another intra-abdominal mass was found in 60-year-old man who had received a radical total gastrectomy for advanced gastric cancer. A 4.2-cm-sized mass was detected in the periumbilical region by follow-up CT and was excised completely along with a segment of the ileum.

The Effect of Anthocyanin on the Prostate in an Andropause Animal Model: Rapid Prostatic Cell Death by Apoptosis Is Partially Prevented by Anthocyanin Supplementation

PURPOSE: To evaluate the anti-apoptotic effect of the antioxidant reaction of anthocyanin on the prostate in an andropause animal model. MATERIALS AND METHODS: Sprague-Dawley rats were divided into three groups (n=12 in each): control (Group I), andropause (Group II), andropause treated with anthocyanin (Group III). For induction of andropause, Group II and III underwent bilateral orchiectomy. Group III was treated with daily oral anthocyanin (160 mg/kg) for 8 weeks. After 8 weeks, the rats were sacrificed and their blood and prostates were examined pathohistologically and evaluated for oxidative stress and apoptosis. Oxidative stress was assessed by the activity of superoxide dismutase (SOD) and apoptosis in the prostate was identified by terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labelling assay. RESULTS: Group II showed markedly increased activity of SOD in serum over that observed in Group I, whereas the rats in Group III showed reduced oxidative stress compared to Group II. Despite no significant differences in prostate weight between Group II and III (p=0.078), the apoptotic index was significantly greater in Group II than Group I, and was significantly lesser in Group III than Group II. CONCLUSIONS: We suggest that the oxidative stress caused by low testosterone may be another inducer of apoptosis, and this apoptosis may partly contribute to the overall apoptosis of the prostate in the andropause animal model. Therefore, anthocyanin supplementation may contribute to preventing excessively rapid cell death by apoptosis in the prostate in an animal model of andropause.

The Changes of Testis and the Effects of Anthocyanin on Spermatogenesis in Rat Induced Varicocele / 대한남성과학회지

PURPOSE: Varicocele is known as a main cause of primary male infertility and it supposed to be associated with oxidative stress. Anthocyanin is known as a natural plant pigment and novel antioxidant. This study was designed to investigate the effects of anthocyanin on a rat model of varicocele. MATERIALS AND METHODS: Twenty four male rats, induced varicocele by partial obstruction of left renal vein, were divided into four experimental groups: the group induced varicocele for four weeks without anthocyanin, the group received anthocyanin (80 mg/kg) right after varicocele induction, group induced varicocele for eight weeks without anthocyanin, and the group received anthocyanin (80 mg/kg) after four weeks observation following varicocele induction. After anthocyanin treatment, testes from the rats in all groups were removed, weighed, and subjected to histological examination. Apoptosis in the testes was measured by the TUNEL assay. And the oxidative stress was evaluated by measurement of 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: Induction of varicocele led to decreasing left testis weight, decreasing spermatogenic cell density significantly (p<0.05). Also it led to increasing apoptotic body counts and increasing concentration of 8-OHdG significantly (p<0.05). However administration of anthocyanin right after varicocele induction prevent this change meaningfully (p<0.05). In group received anthocyanin after four weeks observation following varicocele induction, interestingly, there was no significant difference in testis weight, spermatogenic cell density, apoptotic body count and concentration of 8-OHdG compared to group induced varicocele for eight weeks without anthocyanin administration. CONCLUSIONS: These results suggest that anthocyanin is effective in decreasing the oxidative stress of testis in rat induced varicocele and may be effective in making a healthy sperm in patient of varicocele in early stage. However in patient under way in advanced stage, it is supposed that the anthocyanin cannot help having a protective effect from oxidative stress narrowly unless the condition of oxidative stress by varicocele is corrected. Further studies are needed to better understand the mechanisms and actions of anthocyanin and varicocele, and these studies may lead to the clinical application of anthocyanin in preventing male infertility by varicocele.

Comparison of knowledge, attitude, and experience about complementary and alternative medicine between primary care physicians and academic physicians in Korea

Despite the recent increase in the use of complementary and alternative medicine (CAM) among the general population and patients, little is known about Korean physicians' attitudes about and interest in CAM. We conducted a web-based survey of knowledge, attitude, and experience in CAM among primary care physicians (PCPs) and academic physicians (APs) in Korea. A total of 826 physicians (341 PCPs and 485 APs) responded. Respondents in both groups felt that they were not sufficiently knowledgeable about CAM. PCPs, however, had a significantly higher composite index score in CAM knowledge than that of APs. Although APs were more skeptical about the scientific evidence of CAM than PCPs, both groups had a positive attitude toward CAM. The level of experience in utilizing CAM in their practice was 23.2% among PCPs, which was much higher than that among APs (2.7%). Experience rates of referring patients to CAM were 11.7% in PCPs and 4.5% in APs (P<0.001). Despite the discrepant rates in CAM education between the two groups (58.7% in PCPs and 26.0% in APs, P<0.001), the majority of doctors in both groups (85.0% in PCPs and 70.0% in APs) expressed an intention to participate in authorized CAM coursework. In conclusion, despite the lack of scientific evidence, both PCPs and APs have an interest in incorporating CAM into their conventional medical practices. To meet physicians' increasing needs for CAM the Korean medical societies should promote education and research about CAM in the conventional medical system.

The Effects of Anthocyanin Extracted from Black Soybean on a Benign Prostatic Hyperplasia-induced Rat Model / 대한남성과학회지

PURPOSE: Anthocyanin is known as a water soluble natural pigment and potent antioxidant. We extracted anthocyanin mediating antioxidant reaction from black soybeans, administered the extract to rats induced prostatic hyperplasia, and evaluate the effect of anthocyanin. MATERIALS AND METHODS: Twenty four male rats were divided into 4 experimental groups: the control, BPH-induced, BPHinduced, and oral anthocyanin (40 mg/kg, 80 mg/kg)-administered groups. For exclusion of intrinsic testosterone influence, a bilateral orchiectomy was done on all except the control group. An experimental prostate hyperplasia was induced by the subcutaneous administration of 3 mg/kg testosterone propionate for 4 weeks to all except the control group. Anthocyanin administration was done in the last 4 weeks in the anthocyanin-administered groups. After 8 weeks, the prostates were removed and analyzed for their prostatic weight and histological examination. Then TUNEL staining was done on each group's specimens, and they were analyzed for their apoptotic body counts. RESULTS: The mean prostate weight was found to be 674.17+/-28.24 mg, 1,098.33+/-131.31 mg, 323.00+/-22.41 mg, and 324.00+/-26.80 mg in the control, BPH-induced, and oral anthocyanin-administered (40 mg/kg, 80 mg/kg) groups, respectively. The BPH-induced group showed statistically significant increases in their prostate weights compared with the control group (p<0.05) and the anthocyanin administered groups showed statistically significant decreases compared to the control and BPH-induced groups (p<0.05). Histologically injected testosterone led to prostatic hyperplasia, but anthocyanin-administered groups experienced this change to a lesser extent. Apoptotic body counts in 5x400/HPF were found to be 3.67+/-0.86, 1+/-0.94, 15.67+/-2.36, and 28.33+/-1.71 in each group. The anthocyanin-administered groups showed statistically significant increases in apoptotic body counts compared with the control and BPH induced groups (p<0.05). CONCLUSIONS: In a prostatic hyperplasia-induced rat model, administration of anthocyanin showed the reduction of prostate weight and the increase of apoptosis. We thought that such results were caused by antioxidant reactions of anthocyanin, and administration of the anthocyanin may be effective in benign prostatic hyperplasia, which is the representative geriatric disease of the urological system.

Early Experience of Prostate Cancer Treated with CyberKnife(TM) Radiotherapy

PURPOSE: We investigated the outcome in patients with prostatic cancer treated by means of CyberKnife(TM) radiotherapy. MATERIALS AND METHODS: Between July 2007 and April 2009, 16 patients with prostate cancer underwent CyberKnife(TM) radiotherapy. The histologic diagnosis was established by transrectal ultrasonography-guided biopsy. Radiotherapy was performed for a dose of 34 Gy at 8.5 Gy per day over 4 to 18 days. Nine patients were treated with hormone therapy. After treatment, prostate-specific antigen (PSA) relapse was evaluated with periodic PSA follow-up. RESULTS: The numbers of patients in clinical stages T2 and T3 were 13 and 3, respectively. Two patients had lymph node metastasis with no distant metastasis. The numbers of patients with a Gleason grade of 5, 6, 7, 8, and 9 were 1, 5, 4, 3, and 2, respectively. The mean time to PSA nadir and the mean PSA at nadir were 7 months and 0.43 ng/ml, respectively. To date, there has been no biochemical failure or clinical recurrence. No severe complications were observed in any patients; observed minor complications [n (%)] were perianal pain [2 (12.5%)] and defecation discomfort [2 (12.5%)]. CONCLUSIONS: Generally good responses were observed in patients treated with CyberKnife(TM) radiotherapy for prostate cancer. No severe complications were observed. More patients and a longer follow-up are required for further conclusions.

The Effect of Finasteride on Microvessel Density and Expression of Vascular Endothelial Growth Factor and 5alpha-Reductase in Prostatic Hyperplasia

PURPOSE: Vascular endothelial growth factor (VEGF), a potent stimulator of angiogenesis and microvessel density (MVD), which is an important indicator of neoangiogenesis, were independently evaluated to elucidate the mechanism of decreased bleeding observed in patients treated with finasteride, an inhibitor of 5alpha-reductase (5AR). We evaluated MVD and the expression of VEGF and 5AR type II in patients with benign prostatic hyperplasia (BPH) treated with finasteride. MATERIALS AND METHODS: The study included 61 patients undergoing transurethral prostatectomy (TURP) for BPH. Among these patients, 29 had well-preserved paraffin blocks, 13 of whom were given finasteride for a minimum of 3 weeks before surgery; the remaining 16 patients served as controls. MVD was calculated by counting the number of positively stained blood vessels on 5 random, high-power fields within the prostatic section. Expressions of VEGF and 5AR type II were analyzed with a confocal laser scanning microscope and an image analyzer. RESULTS: Prostatic MVD was significantly lower in the finasteride-treated group (p<0.05). The expression of VEGF and 5AR type II at the level of the prostatic glandular epithelium and stroma was not significantly different between the 2 groups. VEGF and 5AR type II were more strongly expressed in the epithelium of both groups than in stromal smooth cells (p<0.05). CONCLUSIONS: Finasteride treatment had no clear effect on the expression of VEGF or 5AR type II. It is possible, however, that finasteride improves blood loss after TURP and BPH-induced hematuria by reducing MVD. Further study on the mechanism of MVD reduction is needed.

The Effects of Estrogen on Detrusor Contraction and the Expression of Muscarinic Receptors in Ovariectomized Rats / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to evaluate the effects of estrogen on detrusor contraction and the expression of muscarinic receptors in ovariectomized rats. MATERIALS AND METHODS: 24 Sprague-Dawley female virgin rats(12 weeks old) were separated into three groups of 8 rats each. Group I served as a control group, group II was the ovariectomized only rats(Ovx group) and Group III was given estradiol benzoate(0.8mg/kg/day) subcutaneously for 7 consecutive days, beginning 1 week after ovariectomy(Ovx+E group). At the end of the experimental period, each rat was sacrificed and the urinary bladder was removed for contractile studies. The expressions of M2 and M3 receptors in the bladder epithelium and the muscle layer were investigated by performing immunofluorescent staining. RESULTS: The Ovx group showed a significantly decreased bladder contractile function on the KCl and carbachol-induced contractile tests, whereas the Ovx+E group showed increased contractility(p<0.05). The Ovx+E group showed an increase of smooth muscle compared to the other groups. Ovariectomy induced a significant increase in the M3 receptors density in the bladder body, as compared to the control group(p<0.05) but there was no significant difference between the Ovx group and the Ovx+E group. CONCLUSIONS: Bladder dysfunction of menopausal women is thought not to be related with the changes of muscarinic receptors. Our results suggest that the detrusor contractility of menopausal women might be improved after estrogen replacement therapy.

Effect of 5alpha-reductase Inhibitor (Finasteride) on Bleeding during Transurethral Resection of Prostate

PUROPOSE: The efficacy of finasteride in the treatment of hematuria associated with benign prostatic hyperplasia (BPH) is well known. Recent studies have also shown that finasteride reduce angiogenesis and prostatic bleeding associated with BPH. We evaluated that pretreatment with finasteride could decrease perioperative bleeding associated with transurethral resectrion of prostate (TURP) in this way. MATERIAL AND METHODS: A total of 56 patients who underwent TURP due to BPH between January 2004 and August 2006 were evaluated. Of the patients, 30 recieved pretreatment with finasteride 5mg daily (group 1) while 26 did not undergo any pretreatment (control group). In the group 1, 17 had pretreatment period of 3months or more (group 2). In all patients we evaluated the degree of perioperative bleeding, intended as a reduction tendency in hemoglobin (Hb) and hematocrit (Hct) value in the 24 h following TURP. Also, we evaluated the correlation of the preoperative factor and postoperative change of Hb and Hct. RESULTS: Difference of reduction tendency in Hb and Hct between group 1 and control group was not significant (p=0.86, 0.95, respectively). Difference between group 2 and control was not significant (p=0.56, 0.29, respectively). The change of Hb and Hct correlated with prostate volume, significantly (p=0.006, 0.010). Also, operation time was correlated with the change of Hb and Hct (p=0.006, 0.011). CONCLUSIONS: There were no significant difference of the perioperative bleeding according to finasteride medication or medication duration.