Gastrointestinal Metastasis from a Primary Adenocarcinoma of the Lung Presenting with Acute Abdominal Pain / 대한소화기학회지

Symptomatic gastro-intestinal metastasis in lung cancer is extremely rare and only a few case reports have been published. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain, nausea and vomiting due to duodenum, jejunum, and colon obstruction by the gastro-intestinal metastasis. The patient underwent colonoscopy and the pathologic report was adenocarcinoma. When there are similar histologic findings in both colon and pulmonary lesion, the question is whether both lesions are primary cancer or the colon lesions are metastases from lung cancer. Microscopic examination of a conventional pathologic section was not sufficient to make this determination. Immunohistochemistry was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7), and negative for cytokeratin 20 (CK20) and caudal-related homeobox transcription factor-2 (CDX-2) on colon mucosa specimen. Accordingly, we used immunohistochemical marker for differential diagnosis of primary adenocarcinoma of the lung with gastro-intestinal metastasis.

Prostate-Specific Antigen Density as a Powerful Predictor of Extracapsular Extension and Positive Surgical Margin in Radical Prostatectomy Patients with Prostate-Specific Antigen Levels of Less than 10 ng/ml

PURPOSE: To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. MATERIALS AND METHODS: From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. RESULTS: The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. CONCLUSIONS: PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.

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.

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.