Long-term Transanal Excision Outcomes in Patients With T1 Rectal Cancer: Comparative Analysis of Radical Resection

PURPOSE: Transanal excision (TAE) is an alternative surgical procedure for early rectal cancer. This study compared long-term TAE outcomes, in terms of survival and local recurrence (LR), with total mesorectal excision (TME) in patients with pathologically confirmed T1 rectal cancer. METHODS: T1 rectal adenocarcinoma patients who underwent surgery from 1990 to 2011 were retrospectively reviewed. Patients that were suspected to have preoperative lymph node metastasis were excluded. Demographics, recurrence, and survival were analyzed based on TAE and TME surgery. RESULTS: Of 268 individuals, 61 patients (26%) underwent TAE, which was characterized by proximity to the anus, submucosal invasion depth, and lesion infiltration, compared with TME patients (P < 0.001–0.033). During a median follow-up of 10.4 years, 12 patients had systemic and/or LR. Ten-year cancer-specific survival in the TAE and TME groups was not significantly different (98% vs. 100%). However, the 10-year LR rate in the TAE group was greater than that of TME group (10% vs. 0%, P < 0.001). Although 5 of the 6 TAE patients with LR underwent salvage surgery, one of the patients eventually died. The TAE surgical procedure (hazard ratio, 19.066; P = 0.007) was the only independent risk factor for LR. CONCLUSION: Although long-term survival after TAE was comparable to that after TME, TAE had a greater recurrence risk than TME. Thus, TAE should only be considered as an alternative surgical option for early rectal cancer in selected patients.

Comparison of post-surgery follow-up methods in patients aged 80 years or older with non-metastatic colorectal cancer

PURPOSE: Studies investigating the appropriate post-surgery follow-up method for elderly patients with colorectal cancer are limited. Thus, the purpose of this study was to compare survival rates between two follow-up methods in patients aged 80 years or older who underwent surgery for colorectal cancer.METHODS: Between January 1, 2002 and December 31, 2010, 165 patients aged 80 years or older underwent curative resection for non-metastatic colorectal cancer at the Department of Surgery, Seoul National University Hospital. Sixty-six of these patients were excluded due to the lack of follow-up, while the remaining 99 were included in our study. These 99 patients were divided into the following two groups depending on their post-surgery follow-up method. Patients who underwent follow-up on a regular basis, which was defined as once every six months to one year, with carcinoembryonic antigen (CEA) and computed tomography (CT) comprised the Regular group, and those who received follow-up with CEA alone or underwent CT procedures once every two years or more comprised the Minimal group. Overall survival was analyzed with the log-rank test and Cox regression analysis.RESULTS: Of the 99 patients, 62 were in Regular group and 37 were in Minimal group. There was no difference in overall survival rate between the two post-surgery follow-up methods (regular group vs. minimal group: 51.6% vs. 50.9% [5-year overall survival rate], P=0.819). Additionally, no significant differences was detected between the groups following multivariate analysis (harzard ratio=0.907; 95% confidence interval=0.460–1.788, P=0.777).CONCLUSION: A significant survival gain was not observed between Regular and Minimal group. To draw a more definite conclusion, a multi-center randomized research study should be conducted.

Influence of Propofol and Fentanyl on Deep Brain Stimulation of the Subthalamic Nucleus

We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7+/-16.8 spikes/sec, n=78) and the right side MERs (35.5+/-17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.

Analysis of Risk Factors for the Development of Incisional and Parastomal Hernias in Patients after Colorectal Surgery

PURPOSE: The purpose of this study was to evaluate the overall rate and risk factors for the development of an incisional hernia and a parastomal hernia after colorectal surgery. METHODS: The study cohort consisted of 795 consecutive patients who underwent open colorectal surgery between 2005 and 2007 by a single surgeon. A retrospective analysis of prospectively collected data was performed. RESULTS: The overall incidence of incisional hernias was 2% (14/690). This study revealed that the cumulative incidences of incisional hernia were 1% at 12 months and 3% after 36 months. Eighty-six percent of all incisional hernias developed within 3 years after a colectomy. The overall rate of parastomal hernias in patients with a stoma was 6.7% (7/105). The incidence of parastomal hernias was significantly higher in the colostomy group than in the ileostomy group (11.9% vs. 0%; P = 0.007). Obesity, abdominal aortic aneurysm, American Society of Anesthesiologists score, serum albumin level, emergency surgery and postoperative ileus did not influence the incidence of incisional or parastomal hernias. However, the multivariate analysis revealed that female gender and wound infection were significant risk factors for the development of incisional hernias female: P = 0.009, wound infection: P = 0.041). There were no significant factors related to the development of parastomal hernias. CONCLUSION: Our results indicate that most incisional hernias develop within 3 years after a colectomy. Female gender and wound infection were risk factors for the development of an incisional hernia after colorectal surgery. In contrast, no significant factors were found to be associated with the development of a parastomal hernia.

High-intensity Focused Ultrasound Treatment (HIFU) for the Advanced Pancreatic Cancer

PURPOSE: We wanted to evaluate the levels of effect and safety of high-intensity focused ultrasound ablation (HIFU) for treating patients with advanced pancreatic cancer. MATERIALS AND METHODS: Nineteen sessions of HIFU, with the patients under general anesthesia, were performed in 18 patients with advanced pancreatic cancer. The change of the gray-scale of the target lesion was analyzed during HIFU, and MRI was performed before and after HIFU. We assessed the extent of coagulative necrosis, the change of pain and the complications after HIFU. The change of tumor size and the survival of patients were also evaluated. RESULTS: The average size of tumor was 4 cm in diameter. Eighty nine percent of the target tumors showed increased echogenicity. On MRI, necrosis of the entire target tumor occurred in 79% of the patients. After treatment, effective pain relief was noted in 89% of the patients. There were no major complications. No size increase of the treated tumor was noted during 24 weeks of follow-up for 10 patients. Six patients among 12 patients who were available for follow-up are still alive and they are receiving chemotherapy. Six patients expired due to other disease or progression of metastasis. CONCLUSION: HIFU is a safe method without any major complications, and it is effective for inducing tumor necrosis and achieving pain control for patients with advanced pancreatic cancer.

The Proteomics Approaches to Find Bio-Markers in Serum of Locally Advanced Breast Cancer Patients / 한국유방암학회지

PURPOSE: Breast cancer continues to be a major cause of death, despite the advances in the study of many prognostic factors. Although many prognostic factors have been studied, none reliably predict the response to treatment. This uncertainty in the prognostic factors could be overcome by defining the changes, occurring in patients at either the gene or protein level. Herein, attempts were made to examine the protein repertoire of patients using Proteomics. MATERIALS AND METHODS: Using conventional Proteomics, the high resolution 2-D electrophoresis followed by computational image analysis(Melanie program) and protein identification with mass spectrometry (MALDI-TOF), the serum of locally advanced breast cancer patients (stage III) was analyzed, and attempts were made to define the differences between recurred (or metastasis) patients ,and disease free patients of more than 4-years duration after surgery. RESULTS: In the 2-D electrophoresis of serum, about 1,000 spots were gained in each gel, with the up and down expressed protein spots compared to the normal control protein map. Six of seven patients had Cytokeratin 9 in their peripheral blood. In the serum of recurred patients (one of two), no Haptoglobin-related proteins were detected. All five un-recurred patients had normal or elevated levl of serum Haptoglobin-related proteins. CONCLUSIONS: The reduction of Haptoglobin-related proteins indicated the humoral immuno-depression in recurred patients. These findings may suggest the continuation of proper humoral immunity was important in the prevention of cancer recurrences or metastasis after surgery, especially in locally advanced breast cancer patients, which may suggests the value of immunotherapy in breast cancer patients to obtain good results.

The Proteomics Approaches to Find Bio-Markers in Serum of Locally Advanced Breast Cancer Patients / 한국유방암학회지

PURPOSE: Breast cancer continues to be a major cause of death, despite the advances in the study of many prognostic factors. Although many prognostic factors have been studied, none reliably predict the response to treatment. This uncertainty in the prognostic factors could be overcome by defining the changes, occurring in patients at either the gene or protein level. Herein, attempts were made to examine the protein repertoire of patients using Proteomics. MATERIALS AND METHODS: Using conventional Proteomics, the high resolution 2-D electrophoresis followed by computational image analysis(Melanie program) and protein identification with mass spectrometry (MALDI-TOF), the serum of locally advanced breast cancer patients (stage III) was analyzed, and attempts were made to define the differences between recurred (or metastasis) patients ,and disease free patients of more than 4-years duration after surgery. RESULTS: In the 2-D electrophoresis of serum, about 1,000 spots were gained in each gel, with the up and down expressed protein spots compared to the normal control protein map. Six of seven patients had Cytokeratin 9 in their peripheral blood. In the serum of recurred patients (one of two), no Haptoglobin-related proteins were detected. All five un-recurred patients had normal or elevated levl of serum Haptoglobin-related proteins. CONCLUSIONS: The reduction of Haptoglobin-related proteins indicated the humoral immuno-depression in recurred patients. These findings may suggest the continuation of proper humoral immunity was important in the prevention of cancer recurrences or metastasis after surgery, especially in locally advanced breast cancer patients, which may suggests the value of immunotherapy in breast cancer patients to obtain good results.

The Role of Urinary Sodium at Transient Renal Acidification Defect during Acute Infantile Acute Gastroenteritis

The pupose of this study is to verify the role of urinary sodium in transient renal acidification defect which frequently combine acute infantile gastroenteritis. We studied on twenty-five infants, 2month to 36 month of age, during the 4 month period, from August, 1991 to December, 1991. The patients had acidosis for a mean of 3 days and sixty urine samples were collected during this period. The mean pH of 23 rine samples with sodium concentration<10 mmol/L was significantly higher than pH of 37 samples with sodium concentration<10 mmol/L, We separately analyzed 15 urine samples collected during metabolic acidosis after completion. of rehydration. The result was that a urinary acidification defent was observed in the urine samples with low sodium concentration but not in the sodium rich samples. We concluded that impaired urinary acidification defect is frequently during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tublur acidosis.

The significance of nucleated red blood cell counts in low birth weight neonates

We studied to assess the relationship between intrauterine growth retardation and theincreased nucleated red blood cell counts (NRBC) in small for gestational age (SGA) and appropriatefor gestational age (AGA) neonates with low birth weight. We also evaluated the nucleated red blood cell counts in low birth weight neonates who had either perinatal asphyzia or hyaline membrane disease (HMD) or died within 7 days after birth. The results were as follows: 1) In low birth weight neonates, the mean value for NRBC counts was 9.02/100 WBCs and the mean absolute value for NRBC counts was 0.9210E9/L. 2) The mean values for NRBC counts were 13.4/100 WBCs in SGA and 6.4/100WBCs in AGA. The mean absolute values for NRBC were 1.32x10E9/L in AGA neonates 3) In SGA neonates with low birth weight, the mean NRBC counts wers 19.6/100WBCs in asphyxiated group and 4.5/100WBCs in control group. The mean absolute NRBC counts were 1.9810E9/L in control group. 4) In AGA neonates with low birth weight, the mean NRBC countswere 9.1/100WBCs in asphyxiated group and 2.4/100WBCs in control group. The meanabsolute NRBC counts were 0.98x10E9/L in asphyxiated group and o.23x10E9/L in controlroup. 5) The mean NRBC counts were 13.8/100WBCs in neonates with HMD and 7.1/100WBCs in control group. The mean absolute NRBC counts were 1.50x10E9/L in neonates withHMD and 0.70x10E9/L in control group. 6) The mean NRBC counts were 19.9/100 WBCs in expired group and 6.8/100WBCs in suvived group. The mean absolute NRBC counts were 2.1810E9/L in expired group and 0.66x10E9/L in survived group. 7) The NRBC counts of SGA neonates were significantly higher than that of AGA neonates with low birth weight. 8) The NRBC counts of asphyxiated neonates were significantly higher than that of the control group. 9) The NABC counts of expired neonates were significantly higher than that of the control group. 10) The NRBC counts of expired neonates were significantly higher than that of the survived neonates.

The relationship between neonatal hypoglycemia and newborn iron status in hypoglycemic large-for-gestational age infants

No abstract available.

A Case Report of Urethral Fistula due to Vesical Calculi / 대한비뇨기과학회지

Urethral fistula due to vesical calculi is very rare in urological field.We are presenting a case of urethral fistula due to vesical calcula along with article review.

Canine Renal Homotransplantation / 대한비뇨기과학회지

No abstract available.

Two Cases of Ureterocele / 대한비뇨기과학회지

No abstract available.

Asymptomatic Prostatitis / 대한비뇨기과학회지

From 128 young men who had no subjective symptoms during recent six months, prostatic secretions were collected on two slide glasses it each. Both slide glasses were examined microscopically for cytology. One of them was stained with Sternheimer and Malbin method for cytology and the other was stained with Gramts method for bacteriology. But no cultures were done, The results were as follows: Microscopic findings : Of 128 prostatic secretions examined microscopically, 73.4 per cent showed less than 10 W.B.C. per H.P.F. (normal); 12.5 per cent 11~20 W.B.C. per H.P.F. (grade 1); 7. 8 per cent 21~30 W.B.C per H.P.F.(grade 2); 3. 9 per cent 31~50 W.B.C. per H.P.F.(grade 3) and 2. 4 per cent more than 51 W.B,C. per H.P.F.(grade 4). Bacteriology: Regardless of microscopic findings microorganisms were found in 61.7 per cent of 128 prostatic secretions. Among the found microorganisms, Gram negative rod was the most common, and Gram positive coccus, Gram positive rod and Gram negative coccus followed in that order. There appeared no relation between the microscopic findings and the present of microorganisms.

A Case Report of Retroperitoneal Teratoma / 대한비뇨기과학회지

A case of retroperitoneal teratoma was presented in a 40-year-old Korean Male. The radiologic studies were evaluated a space occupying mass containing tooth like a density in the retroperitoneal region. Surgical removal of mass wag performed and histological finding was conformed the benign teratoma.

A Case Report of Giant Hydronephosis / 대한비뇨기과학회지

A case of giant hydronephrosis containing 9,500 cc, simulating ascites due to 'cirrhotic liver in a twenty. three year old male, is presented. The differential diagnosis and the important clinical, laboratory and X-ray features are discussed with brief literatual review.