Outcomes of men aged ≤50 years treated with radical prostatectomy: a retrospective analysis / 亚洲男科学杂志(英文版)

Previous studies investigating prostate cancer (PCa) features in younger men have reported conflicting findings. This study aimed to investigate pathologic outcomes and biochemical recurrence (BCR) status in younger men who underwent radical prostatectomy (RP) for PCa. Records of 2057 patients who underwent RP at Seoul National University Bundang Hospital (Seongnam, Korea) between 2006 and 2015 were reviewed; patients were divided according to age into the younger and older groups (men aged ≤50 and >50 years, respectively). Postoperative BCR status and functional outcomes and clinicopathologic features were compared between both groups. All analyses were repeated after propensity score matching. Younger men were more likely to have low-risk disease (P < 0.001), lower pathologic Gleason score (P < 0.001) and pathologic stages (P < 0.001) than older men. The pathologic Gleason score (P = 0.002) and rates of extracapsular extension (P = 0.004) were lower in younger men after propensity score matching. In multivariate analysis, age at RP was not an independent predictor of BCR-free survival after RP (P = 0.669). Moreover, at 1 year after RP, younger men with preoperative 5-item International Index of Erectile Function score ≥22 (n = 228) showed more favorable results for urinary continence (defined as nonuse of pads daily) (99.4% vs 95%, P = 0.009) and erections sufficient for vaginal intercourse (81.8% vs 55.5%, P = 0.001). Younger men had more favorable clinicopathologic features at RP than their older counterparts. Although age was not an independent predictor of BCR status outcome, younger men had better functional outcomes following RP.

The Effect of Age on the Cardiovascular Responses Induced by High Concentration of Isoflurane / 대한마취과학회지

BACKGROUND: The inhalation of a high concentration of isoflurane transiently increases heart rate (HR) and blood pressure. The current study examined the effects of age on isoflurane-induced circulatory responses. METHODS: One hundred-ten patients were randomly allocated into one of four groups according to age: under 10 years (Group 1), 20 - 40 years (Group 2), 41 - 60 years (Group 3), and over 65 years (Group 4). In each group, the inspired concentration of isoflurane via mask was increased to 5.0 vol% abruptly. The target was to produce an end-tidal concentration of isoflurane (ETisof) of 2.6 vol% which was maintained until the end of the study by adjusting the vaporizer setting when necessary. HR, mean arterial pressure (MAP), ETisof, and end-tidal concentration of carbon dioxide were measured at baseline and every 30 seconds for 5 minutes after inhalation of isoflurane and for 2 minutes after intubation. RESULTS: HR and MAP significantly increased after inhalation of isoflurane in all four groups compared with the baseline. The time from administration of isoflurane to the maximal HR was less than that for MAP. However, there were no significant differences among the groups for ETisof at the maximal HR and MAP. In Groups 1 and 4, the times for maximal HR were shorter than in Groups 2 and 3. In aged patients (Group 4), the isoflurane-induced HR increase was less than in the other three groups. There were no significant differences among the groups in increases of MAP. CONCLUSIONS: The high concentration of isoflurane transiently increases HR and MAP during inhaled anesthesia induction. In aged patients, the increase in HR is less than in younger-aged patients.

Comparison of General Anesthesia and Thoracic Epidural Anesthesia for Breast Mass Excision Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. METHODS: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). RESULTS: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 +/- 3956.9 vs 32,284.8 +/- 1209.4 won) were significantly lower in the TEA group than in the GA group. CONCLUSIONS: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.