Preoperative Lymphocyte-Monocyte Ratio Ameliorates the Accuracy of Differential Diagnosis in Non-Metastatic Infiltrative Renal Masses

PURPOSE: Distinguishing infiltrative renal cell carcinoma (RCC) from transitional cell carcinoma (TCC) is a challenging issue due to their radiologic similarities. We evaluated systemic inflammatory biomarkers as parameters for distinguishing tumor types. MATERIALS AND METHODS: A computerized search of medical records from November 2005 to October 2015 identified 116 patients with infiltrative renal masses who were difficult to diagnose confirmatively in radiological study. We investigated the diagnostic efficacy among these patients with their preoperative absolute neutrophil counts (ANC), absolute lymphocyte counts (ALC), absolute monocyte counts (AMC), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). RESULTS: The infiltrative RCC group demonstrated significantly lower ALC {1449/µL (1140–1896), median [interquartile range (IQR)]} than the TCC group [1860/µL (1433–2342), p=0.016]. LMR [median (IQR)] also was lower in the infiltrative RCC group [2.98 (2.32–4.14) vs. TCC group 4.10 (2.86–6.09); p=0.011]. In subgroup analysis, non-metastatic infiltrative RCC showed lower ALC and LMR and higher NLR than non-metastatic TCC. Within non-metastatic infiltrative renal masses, multivariate logistic regression analysis revealed that younger patient age and lower LMR were associated with infiltrative RCC [odds ratios (OR) 0.874, p=0.024 and OR 0.461, p=0.048, respectively]. Receiver operating characteristic curve analysis showed that younger age and lower LMR were highly predictive of non-metastatic RCC (area under the curve=0.919, p<0.001). CONCLUSION: Age and LMR were significantly different between patients with infiltrative renal mass. These are potential markers for distinguishing between infiltrative RCC and TCC without metastasis.

Clinical Significance of Periurethral Calcification According to the Location in Men With Lower Urinary Tract Symptoms and a Small Prostate Volume / 대한배뇨장애요실금학회지

PURPOSE: To assess the impact of periurethral calcification (PUC) according to its location on uroflowmetric parameters and urinary symptoms in patients with small prostate volume (PV). METHODS: Records were obtained from a prospectively maintained database of first-visit men with lower urinary tract symptoms (LUTS). Patients whose PV was >30 mL were excluded to elucidate more clearly the impact of PUC on LUTS. A total of 539 patients were enrolled in the study. The prostatic urethra was examined by transrectal ultrasonography for PUC, and the location of PUC was divided into 3 areas (proximal, mid, and distal). RESULTS: The characteristics according to the location of PUC were compared using a 1-way analysis of variance test. The Total International Prostate Symptom Score (IPSS), postmicturition symptoms, and overactive bladder symptom score (OABSS) differed significantly among the groups. In the propensity score matching analysis, the proximal- and distal-PUC groups did not have a significantly different urinary flow rate or symptom score when compared to their matched control groups. However, the mid-PUC group had significantly worse urinary symptoms than its matched control group (total IPSS [P=0.001], voiding symptoms [P=0.002], storage symptoms [P=0.041], and OABSS [P=0.015]). The peak urinary flow rate was also lower in the mid-PUC group with borderline significance (P=0.082). On multivariate linear regression analysis, mid-PUC was independently associated with IPSS and OABSS (P=0.035 and P=0.011, respectively). CONCLUSIONS: Only mid-PUC was associated with symptom severity in men with LUTS and a small PV. Our findings suggest that mid-PUC could be a potential causal factor of LUTS, and the midportion of the prostatic urethra might play a pivotal role in the process of micturition.

Seasonal Variation of Urinary Symptoms in Korean Men with Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

PURPOSE: To examine seasonal variations in urinary symptoms in Korean men with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS/BPH). MATERIALS AND METHODS: Records were obtained from a consecutive database of LUTS/BPH patients from March 2010 to February 2014. A total of 1,185 patients were suitable for analysis. The International Prostate Symptom Score (IPSS), uroflowmetric parameters, prostate volume-related parameters, and serum prostate-specific antigen levels were evaluated. RESULTS: Based on the month during which they were examined, patients were categorized into cold, hot, or intermediate season groups. The IPSS score was significantly different between the cold and the hot season groups (17.3+/-6.9 vs. 16.1+/-7.4, respectively; p=0.020). Storage symptom scores were significantly aggravated in the cold (6.8+/-3.3; p=0.030) and intermediate groups (6.9+/-3.5; p=0.032) compared with the hot season group (6.3+/-3.4), with this observation primarily driven by the individual scores for frequency and urgency. Quality of life (QOL) scores were worse in the cold compared with the hot season group (4.0+/-1.1 vs. 3.8+/-1.1, respectively; p=0.012). There were also significant differences between the cold and hot season groups in voided volume (278.7+/-148.5 vs. 255.9+/-145.1, respectively; p=0.034) and postvoid residual volume (26.4+/-37.6 vs. 32.2+/-41.0, respectively; p=0.039). CONCLUSIONS: Different urinary symptoms and uroflowmetric parameters were associated with changes in seasons. QOL and IPSS parameters might be worse in cold weather seasons compared with hot weather seasons.

A Spatial Index Analysis for Decision on the First Opening of Facial Recess in Posterior Tympanotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Temporal bone is a complicated structure anatomically. Highresolution computed tomography (HRCT) provides a good method for examination of the middle ear, inner ear anatomy and pathologic changes in the temporal bones. The purpose of this study is to evaluate the relations of facial nerve and other structures in temporal bone and factors influencing access to posterior tympanotomy according to the age, sex and degree of temporal bone pneumatizaton. SUBJECTS AND METHOD: A total of 133 ears of temporal bone computer tomograph (TBCT) were analyzed. We measured the distances and angle between important surgical landmarks, and compared the data according to the age, sex and mastoid pneumatization. RESULTS: We presented the angle between the posterior wall of external auditory canal and the facial nerve with the index for facial nerve preservation in posterior tympanotomy. This angle is 10.05 degrees other indices are not related statistically. CONCLUSION: This results may enable preoperative assessment and provide background knowledge to prevent facial nerve injury when performing a posterior tympanotomy.

Detection Rates of Bacteria in Chronic Otitis Media with Effusion in Children

This study was performed to investigate polymerase chain reaction-based detection of bacterial DNA in middle ear fluid and assess the correlation between the PCR-positive rate with several factors associated with middle ear effusion. The purpose was to gain a further understanding of bacterial infection as a major cause of otitis media with effusion. Of the 278 specimens of middle ear fluid, 39 (14%) tested positive by ordinary culture. The overall detection rate of bacterial DNA using the PCR method was 36.7% for middle ear effusion, and bacterial DNA detection rates of Hemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis in the middle ear effusion were 29.1%, 4.7% and 10.8%, respectively. The bacterial DNA detection rate was higher in ears with a history of acute otitis media than those without the history. High detection rates were observed in patients younger than 48 months who have had a higher tendency to present with acute otitis media. We concluded that PCR is a more sensitive method for the detection of bacteria in middle ear effusion than ordinary culture, and acute otitis media is a major contributor to the pathogenesis of otitis media with effusion.

Factors Influencing Access to Facial Recess in Temporal Bone according to the Pneumatization of Temporal Bone-Measurement of Important Structures on Temporal Bone Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Computed tomography of the temporal bone (TBCT) provides us many information about the status of temporal bone and middle ear, and is very important for surgical planning. We studied the relations of facial nerve and other structures in temporal bone and factors influencing access to facial recess according to the pneumatizaton of temporal bone. MATERIALS AND METHOD: A total 177 ears were analyzed. With the coronal section on the level just below the second genu of facial nerve, we measured the distances and angle between important surgical landmarks, and compared the data according to the mastoid pneumatization. RESULTS: The distance from sigmoid sinus to posterior wall of external auditory canal, and the distance from sigmoid sinus to line which was drawn at facial nerve parallel to posterior wall of external auditory canal were significantly influenced by temporal bone pneumatization (p<0.05). Temporal bone pnuematization gave no influence on the position of facial nerve, size of facial recess, and posterior fossa. CONCLUSION: Anterior projection of sigmoid sinus into mastoid antrum, which was influenced by pneumatization of mastoid antrum, was the most important factor influencing access to facial recess area.

Immunohistochemical Study on the Expression of Laminin-5 in the Oral Cavity and Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laminins are extracellular matrix proteins localized mainly in basement membranes. Currently there are at least ten different laminin chains and 11 heterotrimetric laminin variants. Laminin-5 is a heterotrimeric basement membrane molecule (alpha3beta3gamma2). It serves as an important adhesion protein for epithelial cells and it also plays an important role in cell migration during tumor invasion and tissue remodeling. This study was designed to investigate the relationship between laminin-5 expression and clinicopathologic variables in oral cavity and oropharynx squamous cell carcinomas using immunohistochemistry. MATERIALS AND METHOD: The expression of the laminin-5 around tumor cells was determined in 32 oral cavity and oropharyngeal carcinomas by immunohistochmical staining with antibody against laminin-5gamma2 chain. RESULTS: Statistical analysis showed that the frequency of laminin-5gamma2 chain expression was correlated with the lymph node metastasis (p<0.05). The poor differentiation of tumor cells, the large tumor size, advanced overall stage and the deep tumor invasion showed high expression of laminin-5, although it was not significant statistically. CONCLUSION: These results suggest that overexpression of laminin-5 in oral cavity and oropharyngeal squamous cell carcinoma might be a biomarker that can predict cervical lymph node metastasis.