Alteration in plasma chemokine profile in a high-fat diet-induced obesity mouse model / 한국영양학회지

PURPOSE: Obesity is associated with a dysregulation of metabolic balance and is regarded as a low grade chronic inflammation. Western-style diet and physical inactivity are leading causes of obesity. This study examined the profiles of forty plasma cytokines and chemokines at the same time in the early stages of high-fat diet-induced obesity using a mouse model. METHODS: A total of 30 male CD1 mice, 12 ~ 14 weeks of age, were enrolled. The mice were fed a high-fat diet for 6 weeks to induce obesity. The plasma glucose and triglyceride concentrations were measured using a hexokinase colorimetric assay kit and a serum triglyceride determination kit, respectively. The relative levels of multiple cytokines and chemokines in the plasma were determined using a mouse cytokine array kit. RESULTS: The mice exhibited significant weight gain after 6 weeks of a high-fat diet. The genital fat depot was enlarged along with an increase in the number and the mean size of white adipocytes as early as 4 weeks after a high-fat diet. In addition, the plasma glucose and triglyceride levels increased significantly after 4 weeks of a high-fat diet. Cytokine array analysis revealed a remarkable increase in the expression of both CXCL12 and CXCL13, whereas the proinflammatory cytokines remained low after 4 weeks of a high-fat diet. CONCLUSION: A significant increase in plasma levels of CXCL12 and CXCL13 was observed after 4 weeks of a high-fat diet, which might induce the migration of B lymphocytes, T lymphocytes, and monocytes from the blood to expanding adipose tissue or fat associated lymphoid clusters, playing a key role in adipose tissue remodeling and local immunity during the early stages of high-fat diet-induced obesity.

Prognostic impact of preoperative statin use after radical nephroureterectomy for upper urinary tract urothelial carcinoma

PURPOSE: The objective was to investigate the impact of statin use on prognosis after radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: A retrospective review of medical records identified 277 patients who underwent radical nephroureterectomy for primary UTUC at Asan Medical Center between January 2006 and December 2011. Information on preoperative statin use was obtained from patient charts in an electronic database. We assessed the impact of statin use on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of these 277 patients, 62 (22.4%) were taking statin medications. Compared to the statin nonusers, the statin users were older, had a higher body mass index, and had higher rates of cardiovascular disease and diabetes. The 5-year RFS rates of statin users and nonusers were 78.5% and 72.5%, respectively (p=0.528); the 5-year CSS rates were 85.6% and 77.7%, respectively (p=0.516); and the 5-year OS rates were 74.5% and 71.4%, respectively (p=0.945). In the multivariate analysis, statin use was not an independent prognostic factor for RFS (hazard ratio, 0.47; p=0.056), CSS (hazard ratio, 0.46; p=0.093), or OS (hazard ratio, 0.59; p=0.144) in patients who underwent radical nephroureterectomy for UTUC. CONCLUSIONS: Statin use was not associated with improved RFS, CSS, or OS in the sample population of patients with UTUC.

Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

PURPOSE: To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP). MATERIALS AND METHODS: The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS: Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1+/-5.3 and 19.3+/-4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0+/-3.0 days vs. 12.9+/-6.4 days, p<0.01). The rate of urinary retention after catheter removal and the rate of bladder neck contracture were not significantly different between the two groups. The rate of urinary continence at 3, 6, 9, and 12 months after RP was also similar in both groups. CONCLUSIONS: Both anastomosis techniques provided similar functional results and a similar rate of postoperative urine extravasation. However, running vesicourethral anastomosis decreased the rate of intraoperative extravasation and time for anastomosis, without increasing the risk of urinary retention or bladder neck contracture.

Prognosis of Prostate Cancer With Other Primary Malignancies

PURPOSE: The objective was to investigate the clinicopathological characteristics and the prognosis of prostate cancer patients affected by other primary malignancies. MATERIALS AND METHODS: From 1990 to 2008, we retrospectively reviewed the medical records of 1,317 patients who underwent radical prostatectomy (RP) for prostate cancer. We assessed the effect of other primary malignancies on clinicopathological features, biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of 1,317 patients, at least one additional other primary malignancy was detected in 187 patients (14.2%). A comparison of patient groups according to the presence or absence of other primary malignancies showed no significant differences in preoperative serum prostate-specific antigen concentrations, pathological Gleason scores, or pathological staging. Prostate cancer patients with other primary malignancies were older than patients without other primary malignancies (p<0.001). No significant differences in 5-year BCR-free survival (80.2% compared with 77.7%; p=0.656) or CSS (98.9% compared with 98.5%; p=0.733) were found between these groups, respectively. Five-year OS was significantly lower in prostate cancer patients with than in those without other primary malignancies (89.3% compared with 95.4%; p<0.001). Multivariate analysis showed that other primary malignancies diagnosed after RP for prostate cancer were independent predictors of OS (hazard ratio, 4.10; p<0.001) but not of BCR-free survival or CSS. Conversely, other primary malignancies diagnosed before RP for prostate cancer did not independently predict BCR-free survival, OS, or CSS. CONCLUSIONS: Prostate cancer prognosis after RP is not dependent on the presence or absence of other primary malignancies. However, other primary malignancies diagnosed after RP for prostate cancer negatively affect OS.

External Validation of the Cancer of the Prostate Risk Assessment-S Score in Koreans Undergoing Radical Prostatectomy

PURPOSE: To evaluate the validity of the University of California San Francisco Cancer of the Prostate Risk Assessment-S score (CAPRA-S score), a biochemical indicator of recurrent prostate cancer that uses histopathologic data, in Korean prostate cancer patients. MATERIALS AND METHODS: A total of 203 prostate cancer patients who underwent radical prostatectomy between February 1997 and November 2010 were observed for longer than 6 months. The CAPRA-S score of 134 patients for whom records were available for preoperative prostate-specific antigen (PSA), pathologic specimen Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node invasion were calculated. Biochemical recurrence was defined as repetitive measurement of PSA > or =0.2 ng/mL at least 6 months after surgery with at least a 4-week interval. The Cox proportional hazard model and Kaplan-Meier analysis were used for the statistical testing. RESULTS: The CAPRA-S scores were divided into nine groups. The 5-year disease-free survival rate was reduced as the CAPRA-S score increased compared with the group with a CAPRA-S score of 0-1. The CAPRA-S score in this study was more sensitive to biochemical recurrence than was the CAPRA score conducted at this institution (CAPRA-S concordance index, 0.776; CAPRA concordance index, 0.728). CONCLUSIONS: The CAPRA-S score is judged to be a useful tool for predicting the disease-free survival rate of Korean prostate cancer patients and is thought to assist in establishing postoperative management.

Time-Dependent Expression Patterns of Cardiac Aquaporins Following Myocardial Infarction

Aquaporins (AQPs) are expressed in myocardium and the implication of AQPs in myocardial water balance has been suggested. We investigated the expression patterns of AQP subtypes in normal myocardium and their changes in the process of edema formation and cardiac dysfunction following myocardial infarction (MI). Immunostaining demonstrated abundant expression of AQP1, AQP4, and AQP6 in normal mouse heart; AQP1 in blood vessels and cardiac myocytes, AQP4 exclusively on the intercalated discs between cardiac myocytes and AQP6 inside the myocytes. However, neither AQP7 nor AQP9 proteins were expressed in CD1 mouse myocardium. Echocardiography revealed that cardiac function was reduced at 1 week and recovered at 4 weeks after MI, whereas myocardial water content determined by wet-to-dry weight ratio increased at 1 week and rather reduced below the normal at 4 weeks. The expression of cardiac AQPs was up-regulated in MI-induced groups compared with sham-operated control group, but their time-dependent patterns were different. The time course of AQP4 expression coincided with that of myocardial edema and cardiac dysfunction following MI. However, expression of both AQP1 and AQP6 increased persistently up to 4 weeks. Our findings suggest a different role for cardiac AQPs in the formation and reabsorption of myocardial edema after MI.

Changes in Prostate Cancer Aggressiveness over a 12-Year Period in Korea

PURPOSE: To investigate whether tumor aggressiveness in patients with prostate cancer has changed in Korea since the introduction of prostate-specific antigen (PSA) testing. MATERIALS AND METHODS: The data from 2,508 patients with pathologically confirmed prostate cancer who underwent radical prostatectomy at Asan Medical Center between 2000 and 2011 were reviewed. The patients were divided into four 3-year time series, and the changes between the groups in terms of serum PSA levels, pathological Gleason score (GS), and pathological stage were assessed. The change in GS over time in organ-confined disease and in patients whose PSA was below 10 ng/ml was also analyzed. RESULTS: The mean PSA levels dropped significantly over the 12-year period (p<0.001). The frequency of organ-confined disease increased (55.7% vs. 64.7% vs. 62.9% vs. 63.5%, p=0.043). The frequency of patients with a GS of 8 or more decreased (38.9% vs. 25.7% vs. 18.2% vs. 19.7%) and the frequency of patients with a GS of 6 or less increased (15.0% vs. 18.9% vs. 26.7% vs. 18.2%, p=0.003). However, the vast majority (more than 70%) of all cases had a high GS (7 or greater) at all time points. The GS distribution did not change over time in patients whose PSA levels were below 10 ng/ml or in those who had organ-confined disease. CONCLUSIONS: In 2000 to 2011, the preoperative PSA, pathological stage, and pathological GS dropped. However, the majority of the prostate cancers in Korean men were poorly differentiated, even when the patients had organ-confined disease or their PSA levels were less than 10 ng/ml.

Clinical Experience with Limited Lymph Node Dissection for Prostate Cancer in Korea: Single Center Comparison of 247 Open and 354 Robot-Assisted Laparoscopic Radical Prostatectomy Series

PURPOSE: There are limited data on the role of limited pelvic lymph node dissection (PLND) in patients with prostate cancer in Korea. The objective of this study was to demonstrate our clinical experience with limited PLND and the difference in its yield between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients in Korea. MATERIALS AND METHODS: We retrospectively analyzed 601 consecutive patients undergoing radical prostatectomy and bilateral limited PLND by either RRP (n=247) or RALP (n=354) in Asan Medical Center. All patients were divided into three groups according to the D'Amico's risk stratification method. Clinicopathologic data, including the yield of lymph nodes, were thoroughly reviewed and compared among the three risk groups or between the RRP and RALP subjects. RESULTS: The mean patient age was 64.9 years and the mean preoperative prostate-specific antigen was 9.8 ng/ml. The median number of removed lymph nodes per patient was 5 (range, 0 to 20). The numbers of patients of each risk group were 167, 199, and 238, and the numbers of patients with tumor-positive lymph nodes were 1 (0.6%), 4 (2.0%), and 17 (7.1%) in the low-, intermediate-, and high-risk groups, respectively. In the high-risk group, the lymph node-positive ratio was higher in RRP (14.9%) than in RALP subjects (2.4%). CONCLUSIONS: We speculate that limited PLND may help in prostate cancer staging in intermediate- and high-risk prostate cancer groups. RRP is a more effective surgical modality for PLND than is RALP, especially in high-risk prostate cancer groups.

Clinical Experience with Limited Lymph Node Dissection for Prostate Cancer in Korea: Single Center Comparison of 247 Open and 354 Robot-Assisted Laparoscopic Radical Prostatectomy Series

PURPOSE: There are limited data on the role of limited pelvic lymph node dissection (PLND) in patients with prostate cancer in Korea. The objective of this study was to demonstrate our clinical experience with limited PLND and the difference in its yield between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer patients in Korea. MATERIALS AND METHODS: We retrospectively analyzed 601 consecutive patients undergoing radical prostatectomy and bilateral limited PLND by either RRP (n=247) or RALP (n=354) in Asan Medical Center. All patients were divided into three groups according to the D'Amico's risk stratification method. Clinicopathologic data, including the yield of lymph nodes, were thoroughly reviewed and compared among the three risk groups or between the RRP and RALP subjects. RESULTS: The mean patient age was 64.9 years and the mean preoperative prostate-specific antigen was 9.8 ng/ml. The median number of removed lymph nodes per patient was 5 (range, 0 to 20). The numbers of patients of each risk group were 167, 199, and 238, and the numbers of patients with tumor-positive lymph nodes were 1 (0.6%), 4 (2.0%), and 17 (7.1%) in the low-, intermediate-, and high-risk groups, respectively. In the high-risk group, the lymph node-positive ratio was higher in RRP (14.9%) than in RALP subjects (2.4%). CONCLUSIONS: We speculate that limited PLND may help in prostate cancer staging in intermediate- and high-risk prostate cancer groups. RRP is a more effective surgical modality for PLND than is RALP, especially in high-risk prostate cancer groups.

Bladder Rupture during Voiding Cystourethrography / 대한비뇨기과학회지

A ruptured bladder, or extravasation from the bladder, is almost always associated with trauma. Spontaneous extravasation, or iatrogenic extravasation, is extremely rare, with only few reported cases. Herein, two cases of bladder rupture, which occurred during voiding cystourethrography (VCUG), one in an 18 month old patient and the other in a 6 week old patient, due to instill dye by high pressure, are presented.

The Changes of Serum Prostate-specific Antigen after Ejaculation / 대한비뇨기과학회지

PURPOSE: Prostatic manipulation and surgery have been shown to increase serum prostate-specific antigen (PSA). We studied the effect of ejaculation on the serum PSA levels. MATERIALS AND METHODS: We evaluated 131 men(16 to 64 years old) who had no history of surgery or inflammatory disease of the urogenital tract. The total serum PSA, free PSA, serum total testosterone, free testosterone, luteinizing hormone(LH), and follicular stimulating hormone(FSH) were evaluated 1 hour after ejaculation. RESULTS: A PSA level was detected in all the men. There were statistically significant changes of the serum PSA level before and after ejaculation. We compared the parameters between increased PSA group and the decreased PSA group. There were significant differences between the two groups on comparison of the total prostate volume(25.4+/-3.6g vs 15.1+/-4.2g, respectively) and the transition zone volume(7.1+/-2.7g vs 5.3+/-1.1g, respectively). CONCLUSIONS: Based on our data, ejaculation affects the serum PSA concentration in young men, and there seems to be a physiological relationship between ejaculation and the PSA level. The larger the prostate volume, the more ejaculation has an effect on the serum PSA level.

Analysis of Prognostic Factors in Patients with Fournier's Gangrene / 감염과화학요법

BACKGROUND: To evaluate prognostic factors such as age, associated disease, laboratory and clinical data, which can affect prognosis of patients with Fournier's gangrene. MATERIALS AND METHODS: 27 patients were included in this study. All underwent treatment during past 15-year in our department. Medical records were reviewed with respect to age at presentation, extent of disease, laboratory data and bacteriology, associated disease, and clinical course. Also involved surface area was measured by the rule used in burn patients. Statistical analysis was made by Mann Whitney U test and Fisher's exact test. RESULTS: Of 27 patients, 4 died and 23 survived. The mean age was 55.4+/-13.7. The most common underlying disease was diabetes mellitus. In comparison of survival and non-survival groups, there were significant differences in duration of symptom before hospitalization, total surface area involved, laboratory data including serum albumin, creatinine, and WBC count on CBC. However, there was no difference in hospital stay, age, underlying disease, serum BUN, infected organisms, and urinary or fecal diversion. CONCLUSION: We conclude that the unfavorable factors affecting survival are duration of symptom before hospitalization, total surface area involved, serum albumin and creatinine level, and WBC count on CBC. The survival was, however, not associated with bacteriological factors, hospital stay, age, urinary or fecal diversion, and underlying diseases such as diabetes, and cancer.

Analysis of Prognostic Factors in Patients with Fournier's Gangrene / 감염과화학요법

BACKGROUND: To evaluate prognostic factors such as age, associated disease, laboratory and clinical data, which can affect prognosis of patients with Fournier's gangrene. MATERIALS AND METHODS: 27 patients were included in this study. All underwent treatment during past 15-year in our department. Medical records were reviewed with respect to age at presentation, extent of disease, laboratory data and bacteriology, associated disease, and clinical course. Also involved surface area was measured by the rule used in burn patients. Statistical analysis was made by Mann Whitney U test and Fisher's exact test. RESULTS: Of 27 patients, 4 died and 23 survived. The mean age was 55.4+/-13.7. The most common underlying disease was diabetes mellitus. In comparison of survival and non-survival groups, there were significant differences in duration of symptom before hospitalization, total surface area involved, laboratory data including serum albumin, creatinine, and WBC count on CBC. However, there was no difference in hospital stay, age, underlying disease, serum BUN, infected organisms, and urinary or fecal diversion. CONCLUSION: We conclude that the unfavorable factors affecting survival are duration of symptom before hospitalization, total surface area involved, serum albumin and creatinine level, and WBC count on CBC. The survival was, however, not associated with bacteriological factors, hospital stay, age, urinary or fecal diversion, and underlying diseases such as diabetes, and cancer.

The Stone Risk Factors for Stone Patients with Hypertension / 대한비뇨기과학회지

Purpose: In order to identify the stone risk factors for stone patients with hypertension, we analyzed the stone metabolic studies of stone patients with hypertension and stone patients without hypertension. Materials and Methods: Between January 1998 and December 2005, we analyzed 92 urinary calculi patients with hypertension, and we also 210 urinary calculi patients who had no history of hypertension as a control group. Hypertension was defined as systolic blood pressure >140 mmHg or a diastolic pressure >90mmHg or both, or those patients who were on drug therapy for hypertension. We evaluated such metabolic risk factors as calcium, sodium, potassium, chloride, uric acid, oxalate, phosphorus, the total urine volume and urine citrate level of the 24-hour urine collection, and the uric acid, calcium, phosphorus, cholesterol, triglyceride from the serum. Results: The mean age was 53.2+/-11.2 in the hypertensive group and 48.4+/-14.0 in the normotensive group. There were significant differences between the hypertensive group and the normotensive group for the body mass index (BMI) (28.7+/-0.9kg/m2 vs 25.1+/-1.1kg/m2, respectively), weight (73.2+/-3.2kg vs 67.4+/-2.1kg respectively) and urine calcium (262.4+/-21.7 mg/day vs 205.2+/-22.3mg/day respectively), uric acid (662.7+/-184.3mg/ day vs 578.3+/-179.2 mg/day respectively). Moreover, there were significant differences between the two groups for total cholesterol (198.5+/-47.4mg/dl vs 167.1+/-42.5 mg/dl respectively) and triglyceride (207.5+/-109.5mg/dl vs 160.8+/-107.1 mg/dl respectively). Conclusions: Our results suggest that higher urinary calcium excretion and higher uric acid excretion appear to be the characteristic risk factors in the hypertensive group. Hypercholesterolemia, hypertriglyceridemia and an excessive BMI are also related to stone patients with hypertension.

A Prospective Randomized Trial Comparing Transobturator Vaginal Tape and Tension Free Vaginal Tape Obturator Inside-Out for Surgical Treatment of Stress Incontinence

PURPOSE: The aim of our study was to compare the outcomes of the transobturator vaginal tape(TOT) and tension free vaginal tape obturator inside-out(TVT-O) procedures in patients with stress urinary incontinence. MATERIALS AND METHODS: Between August 2004 and March 2005, 77 women with stress incontinence were randomly assigned to either TOT(n=36) or TVT-O(n=41). The preoperative evaluation included a careful history taking, physical examination, stress test, a quality of life questionnaire and a comprehensive urodynamic examination. Follow up evaluation was carried out after 1 month, 6 months. Patients assessment was made by a clinical examination in the first 1 month and satisfaction rate expressed and uroflowmetry with postvoid residual urine to compare voiding disorder suggesting bladder outlet obstruction after 6 months. RESULTS: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar between the 2 groups. Mean operative time was similar between the 2 groups(17 min vs 16 min). The rate of postoperative urinary retention was 8.3%(n=3) in the TOT group and 9.8%(n=4) in the TVT-O group. The cutting of tape was required to treat urinary retention in 2.8%(n=1) of the TOT group and 4.9%(n=2) of the TVT-O group at 14 days after the procedure. The rates of cure(66.7% vs 65.9%), improvement(27.8% vs 29.3%), and failure (5.6% vs 4.9%) were similar for the TOT and TVT-O groups, respectively. In terms of bladder outlet obstruction, no difference were found after TOT and TVT-O. CONCLUSION: Both procedures are equally a simple, safe and effective treatment for female stress urinary incontinence in terms of rate of cure, operation time and complications. However, further studies and long term follow-up are needed for the complications and cure rate.