Gonadal and Sexual Dysfunction in Childhood Cancer Survivors / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Few studies have addressed gonadal and sexual dysfunctions in childhood cancer survivors. We evaluated the prevalence rates and risk factors for gonadal failure among adolescent/young adult childhood cancer survivors and their sexual function. MATERIALS AND METHODS: Subjects were childhood cancer survivors aged 15-29 years who had completed therapy more than 2 years ago. Demographic and medical characteristics were obtained from the patients’ medical records. In addition, hormonal evaluation and semen analysis were performed and sexual function was evaluated via questionnaire. RESULTS: The study included 105 survivors (57 males, 48 females), of which 61 were adults (age > 19 years) and 44 were adolescents. In both males and females, the proportion of survivors with low sex hormone levels did not differ among age groups or follow-up period. Thirteen female subjects (27.1%) needed sex hormone replacement, while five males subjects (8.8%) were suspected of having hypogonadism, but none were receiving sex hormone replacement. Of 27 semen samples, 14 showed azospermia or oligospermia. The proportion of normospermia was lower in the high cyclophosphamide equivalent dose (CED) group (CED ≥ 8,000 mg/m2) than the low CED group (27.3% vs. 62.5%, p=0.047). Among adults, none were married and only 10 men (35.7%) and eight women (34.3%) were in a romantic relationship. Though a significant proportion (12.0% of males and 5.3% of females) of adolescent survivors had experienced sexual activity, 13.6% had not experienced sex education. CONCLUSION: The childhood cancer survivors in this study showed a high prevalence of gonadal/sexual dysfunction; accordingly, proper strategies are needed to manage these complications.

Asymptomatic Synchronous Tuberculosis Involving Stomach and Small Bowel in Immunocompetent Patient / 대한소화기학회지

Gastrointestinal tuberculosis that is not an unusual form of extrapulmonary tuberculosis and it is usually associated with immunocompromised condition that may present with clinical symptoms including fever, weight loss or pain. Terminal ileum and cecum are the common sites of involvement, but involvement of the stomach is rare. Furthermore, synchronous tuberculosis involving both the stomach and lower gastrointestinal tract has been reported in very few cases. Herein, we report a case of incidentally detected synchronous tuberculosis involving both the stomach and terminal ileum that was successfully treated by antituberculosis therapy in an asymptomatic immunocompetent patient.

The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population: Could It Be Explained?: A Multi-center Prospective Study

BACKGROUND/AIMS: Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. METHODS: A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. RESULTS: The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (> or = 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P or = 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level > or = 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. CONCLUSIONS: The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.

Usefulness of Gastroscope in Patients with Incomplete Colonoscopy

BACKGROUND/AIMS: Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. METHODS: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. RESULTS: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). CONCLUSIONS: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy.

Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

Post-extubation Negative Pressure Pulmonary Edema Complicating ESD under General Anesthesia / 대한소화기내시경학회지

Negative pressure pulmonary edema is a recognized complication of airway obstruction, particularly after endotracheal extubation. The application of oxygen therapy and continuous positive airway pressure with the administration of diuretics under a rapid diagnosis usually clears pulmonary edema. We report a case of 61-year-old man who developed negative pressure pulmonary edema following extubation after an endoscopic submucosal dissection under general anesthesia.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

An Intramural Gastric Hematoma after Epinephrine Injection for Gastric Ulcer Bleeding in Patient with Liver Cirrhosis / 대한소화기내시경학회지

Intramural hematoma of the gastrointestinal tract is an uncommon occurrence with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is very rare, and has been reported most commonly in association with coagulopathy, trauma, hematologic disease, and therapeutic endoscopy. Here we describe a case of intramural gastric hematoma after epinephrine injection therapy for a gastric ulcer with underlying liver cirrhosis that was successfully managed with conservative therapy.

Cytomegalovirus Induced Gastric Ulcer as a Principal Manifestation in the Initial Stage of Hodgkin's Disease / 대한소화기학회지

Cytomegalovirus (CMV) is an important cause of opportunistic infection in immunocompromised patients. CMV infection occurs as a result of the cell-mediated immunity change in lymphoma patients. Although CMV can cause ulceration anywhere in the gastrointestinal (GI) tract in immunocompromised patients, only a few case reports about CMV GI infection in malignant lymphoma have been documented in literature. Furthermore, it was rare that CMV gastric ulcer with massive bleeding presented as an initial manifestation in a patient who has been not diagnosed lymphoma. We report a case of CMV induced gastric ulcer as an initial manifestation in patient with Hodgkin's disease.

The Outcome of TRUS-guided Sextant Biopsy According to Prostate Volume / 대한비뇨기과학회지

No abstract available.

Nephron Sparing Sugery in the Management of Renal Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Natural History of Refluxign Distal Stumps following Upper Tract Sugery in Children with Ectopic Ureter or Ureterocele / 대한비뇨기과학회지

No abstract available.

Ureteroscopic Management of Ureteral Calculi: Comparisons of Stone Basket Electrohydraulic Lithotripsy Swiss Lithoclast and Holmium:YAG Laser / 대한비뇨기과학회지

No abstract available.

Adult Testicular Germ Cell Tumor: Clinical Characteristics and Risk Factors for Recurrence / 대한비뇨기과학회지

PURPOSE: We reviewed clinical characteristics and prognostic factors in testicular germ cell tumor in adults. MATERIALS AND METHODS: We reviewed the records of 42 patients with testicular germ cell tumors managed at Seoul National University Hospital between January 1985 and May 1997. Patients were followed regularly to determine clinical outcome with tumor markers, chest X-ray and abdominal CT. Mean follow-up was 5.75 years ranging from 3months to 238months. RESULTS: Painless testiscular enlargement(86%) was the most common presenting symptom and history of cryptorchidism was noted in 6 patients. Among 21 seminoma patients, 11 were stage I, 9 were stage II, and 1 was unknown and among 21 nonseminomatous germ cell tumor(NSGCT) patients, 14 were stage I, 1 was stage II, 5 were stage III, and 1 was unknown. Of the 11 patients with stage I seminoma, there was no recurrence in 7 patients who received retroperitoneal low-dose radiation therapy after orchiectomy, but 2(50%) of 4 patients who had surveillance after orchiectomy, showed relapse at retroperitoneal lymph nodes. One of 3 patients who had elevated level of serum beta-HCG at initial presentation showed tumor relapse at retroperitoneal lymph node. Among 11 patients with stage I NSGCT under surveillance after radical orchiectomy, 7 patients(63.6%) had relapse. Vascular invasion of tumor was noted in orchiectomy specimens in 3 cases of the 7 relapsed cases compared to no vascular invasion in 4 non-relapsed cases. Also, 4 of 7 patients with elevation of tumor marker resulted in relapse. Although primary pathologic stage T2 was noted in 2 patients with clinical stage I NSGCT, no recurrence occurred after adjuvant combined chemotherapy. Fifteen patients with stage II or stage III were treated with systemic combination chemotherapy after radical orchiectomy and 7 of these patients had residual retroperitoneal mass. Of these patients, salvage chemotherpy was done in 2 patients, salvage RPLND and salvage chemotherapy with RPLND was performed in 1 patient respectively. Of the patients with stage II or III, One patient with stage IIB seminoma died despite of salvage chemotherapy with RPLND. The remaining 3 patients with residual mass were followed regulary without further treatment. They had no evidence of recurrence which was evaluated by tumor marker, chest X-ray and abdominal CT. The marked reduction of residual mass after adjuvant therapy were found in this group. The overall survival rate in total patients was 98% at 5.75 years from initial diagnosis. CONCLUSIONS: Adjuvant low-dose radiation therapy after radical orchiectomy was recommended to reduce recurrence rates in stage I seminoma. The vascular invasion, pre-orchiectomy elevation of tumor markers, or pathologic T2 or more stage were risk factors for relapse in stage I NSGCT. In advanced staged germ cell tumor, high survival rate was achieved by cis-platin based combination chemotherapy. Especially, in the patients with marked reduction of tumor mass after chemotherapy, close surveillance might be adequate in stead of second look operation for the retroperitoneal mass. Irrelevant of its histopathologic finding and stage, the testicular germ cell tumor showed excellent therapeutic end-results. Further studies should be directed at developing therapeutic modalities that could achieve better therapeutic results with least therapeutic complication and sequelae.

Patterns of Tumor Recurrence after Nephron Sparing Surgery for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.

The Study for Chromosome 3p Loss in Renal Cell Carcinoma by Fluorescence in Situ Hybridization Using Paraffin-Embedded Tissue / 대한비뇨기과학회지

PURPOSE: Conventional pathologic classifications of human renal cell carcinoma give little insight into oncogenesis and little assistance in predicting the clinical behavior of this disease. For genetic classification, deletion of the short arm of chromosome 3(3p), the hallmark of nonpapillary/clear cell RCC, is a major diagnostic criterion. Because of the limited routine applicability of cytogenetics and molecular genetic techniques we investigated fluorescence in situ hybridization(FISH) for the detection of this aberration in RCC. MATERIALS AND METHODS: Isolated nuclei from 8 human RCC paraffin embedded tissue sections were examined with a dual color FISH technique for loss of chromosome 3p. Telomeric DNA probe from 3p and an internal ploidy control probe, centromeric probe of chromosome 2, were applied to the isolated nuclei of RCC. RESULTS: 87.5% of the patients(7) lost chromosome 3p. The loss of 3p in the samples tested was unrelated to patient age, gender, tumor stage, and grade. CONCLUSIONS: FISH for the detection of loss in 3p from paraffin embedded tissue sections provides a sensitive and feasible methods for the genetic classification of kidney tumors and FISH is a very useful diagnostic tool for detection of the genetic aberrations of the tumors.

Age-specific Reference Ranges for Prostate-specific Antigen from a Community-based Study / 대한비뇨기과학회지

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.

The Significance of Atypical Cell in Urinary Cytology / 대한비뇨기과학회지

PURPOSE: Atypical cells in urinary cytology are frequently observed in patients who have history of urothelial cancer A study was made to evaluate the significance of atypical cell in urinary cytology for the detection and surveillance of urothelial cancer. MATERIALS AND METHODS: We studied retrospectively 100 patients with atypical cell in urinary cytology. A bladder washing specimen was used for cytology Four groups of subjects were participated in this study. Group I - patients who showed gross hematuria, or lower urinary tract symptoms, but no history of the urothelial cancer. Group II - patients with urinary tract surgery for urothelial cancers. Group III - patients with intravesical therapy due to transitional cell carcinoma of the bladder. Group IV - patients with history of urothelial cancers, but no recurrence for l year or more. RESULTS: Mean follow up was 39 months. Cystoscopy and radiography showed urothelial cancer in 72 patients(72%) with atypical cytology. The bladder cancer was found in If of 27(63%) in group I, 26 of 26(100%) in group II, 4 of 5(80%) in group III and 13 of 14(93%) in group IV respectively. The interval from atypical cytology to the detection of urothelial cancer was 4 months. Upper tract tumors developed in 11 patients and prostatic urothelial recurrence in l patient. CONCLUSIONS: These data demonstrate the clinical importance of atypical cytology and emphasize the search for urothelial cancer. Patients with history of transitional cell carcinoma who showed atypical cells are likely to have a overt transitional cell carcinoma, and require further evaluation of intravesical and extravesical sites to detect the urothelial cancer.

The Change of Clinical Characteristics of Prostatic Cancer before and after the Introduction of Prostate Specific Antigen Assay / 대한비뇨기과학회지

OBJECTIVE: To evaluate the change of clinical characteristics of prostatic cancer after the introduction of PSA (Prostate specific antigen) assay and TRUS (Transrectal ultrasonography), we retrospectively reviewed the medical records of 155 patients with prostatic adenocarcinoma who were managed at Seoul National University Hospital from January 1985 to December 1994. MATERIALS AND METHODS: Patients were stratified into 2 groups (Group I: 45pts{1985-1989} and Group II: 110pts{1990-1994}) by the year 1990 when our hospital began to use PSA assay and TRUS to detect prostatic cancer. PSA was measured by monoclonal radioimmunometric assay (ELSA-PSA). Tumor staging consisted of DRE (digital rectal. examination), TRUS, CT, MRI, simple bone X-ray and radionuclide bone scan. Clinical characteristics of 2 groups were compared. RESULT: Proportion of younger pts increased in group II but this was not statistically significant (p>0.05 by chi-square test). Number of pts were annually increasing , especially after the year 1990 when PSA assay and TRUS were introduced into clinical practice. Despite use of PSA and TRUS, the number of clinically localized pts did not differ between 2 groups. There was no difference in distribution of chief complaints between 2 groups. There were 3 pts who were detected by increased PSA alone. CONCLUSION: Prostate cancer incidence is increasing and will substantially increase in the future on the basis of increasing tendency to the old population, improved cancer detection and improved public awareness. More than 70% of pts have metastases or regional extension (Stage C or D). These dismal statistics constitute the main reason for early detection programs in the population at large.