Comparison of the prevalence and histology between primary benign bladder tumors and recurrent benign lesions after transurethral resection of malignant bladder tumors / 고신대학교의과대학학술지

Background@#Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years. @*Methods@#We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated. @*Results@#The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86). @*Conclusions@#The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Purpose@#We compared the effectiveness of narrow-band imaging (NBI) cystoscopy and white light cystoscopy (WLC) for detection of intravesical recurrence of bladder cancer. @*Materials and Methods@#We studied the positive predictive value (PPV) in the recurrent suspicious lesions in patients with nonmuscle invasive bladder cancer (NMIBC) for the 13 months of the follow-up from July 2016 to June 2017 with WLC and another 13 months from July 2017 to July 2018 with NBI, respectively. We also studied the second transurethral resection of bladder tumor (TURBT) free survival (STFS) and cancer-specific recurrence-free survival (CSRFS) with WLC and NBI in the 12 months of short-term follow-up. @*Results@#The total number of first TURBT patients in the follow-up was 164. Eighty patients were excluded. Among the 84 patients with NMIBC, WLC group was 43, NBI group was 41. Thirty-six patients had more than second TURBT. In 48 cases of patients with more than second TURBT, PPV of WLC and NBI was 81.8% and 61.5%, respectively. There was no statistically significance of PPV between the 2 groups (p=0.124). There were no pathological differences between the results about 1 year of follow-up patients with one of WLC or NBI (p=0.288). STFS was statistically significantly shorter in NBI (p=0.002), but there were no statistically significant difference in CSRFS. @*Conclusions@#NBI had made the bladder lesions detected early but had a low PPV for cancer recurrence within the bladder and there is no survival benefit.

Postoperative Recurrent Bladder Tumors Detection by Narrow-Band Imaging Cystoscopy

Purpose@#We compared the effectiveness of narrow-band imaging (NBI) cystoscopy and white light cystoscopy (WLC) for detection of intravesical recurrence of bladder cancer. @*Materials and Methods@#We studied the positive predictive value (PPV) in the recurrent suspicious lesions in patients with nonmuscle invasive bladder cancer (NMIBC) for the 13 months of the follow-up from July 2016 to June 2017 with WLC and another 13 months from July 2017 to July 2018 with NBI, respectively. We also studied the second transurethral resection of bladder tumor (TURBT) free survival (STFS) and cancer-specific recurrence-free survival (CSRFS) with WLC and NBI in the 12 months of short-term follow-up. @*Results@#The total number of first TURBT patients in the follow-up was 164. Eighty patients were excluded. Among the 84 patients with NMIBC, WLC group was 43, NBI group was 41. Thirty-six patients had more than second TURBT. In 48 cases of patients with more than second TURBT, PPV of WLC and NBI was 81.8% and 61.5%, respectively. There was no statistically significance of PPV between the 2 groups (p=0.124). There were no pathological differences between the results about 1 year of follow-up patients with one of WLC or NBI (p=0.288). STFS was statistically significantly shorter in NBI (p=0.002), but there were no statistically significant difference in CSRFS. @*Conclusions@#NBI had made the bladder lesions detected early but had a low PPV for cancer recurrence within the bladder and there is no survival benefit.

Effect of Sildenafil on Esophageal Motor Function in Healthy Volunteers / 대한소화관운동학회지

BACKGROUND/AIM: Nitric oxide (NO), the nonadrenergic, noncholinergic inhibitory neurotransmitter, plays a role in controlling esophageal motor function by causing guanosine 3', 5'-cyclic monophosphate (cGMP) accumulation in circular smooth muscle of the esophagus and lower esophageal sphincter (LES). Increase in the intracellular concentration of cGMP as a second messenger produces relaxation of smooth muscle. It is metabolized by phosphodiesterase (PDE). Sildenafil, a drug used to improve the functional impotence, shows an inhibitory effect on the smooth muscle cells of the human corpus cavernosum by blocking type V PDE that destroys cGMP. The aim of this study was to investigate the effects of sildenafil on the esophageal motility. METHODS: Eight male subjects without any evidence of esophageal motor dysfunction were enrolled in this study. On first day, 20 ml of distilled water (placebo) was infused into the stomach. On second day, 0.8 mg/kg of sildenafil powder dissolved in water was infused into the stomach. We measured the amplitude of esophageal body contractions and LES pressure at each day. In addition, plasma cGMP levels were assayed by ELISA method. RESULTS: There were no significant differences in esophageal manometric findings in the placebo group, but significant decreases in LES pressure as well as amplitude of peristaltic contractions at smooth muscle portion of esophagus were noted in sildenafil group. Sildenafil showed its maximum effect in lowering LES pressure on 30 minutes after ingestion, and also in decreasing the amplitude of peristaltic contractions at smooth muscle portion of esophagus on 15 minutes after ingestion. There was no difference in the propagation velocity of peristalsis and plasma cGMP levels after sildenafil treatment. CONCLUSION: Sildenafil showed inhibitory effects on smooth muscle of esophageal body and LES in human.

Efficacy of Cisapride in Patients with Functional Dyspepsia Resistant to Dopamine Antagonists / 대한소화관운동학회지

BACKGROUND/AIMS: Prokinetics are commonly used for the treatment of functional dyspesia, but their methods of action are different. First, we compared the efficacy and safety of the dopamine receptor antagonists, which were domperidone maleate and levosulpiride, in a 2 week treatment in functional dyspepsia, then investigated the efficacy and safety of cisapride tartrate in a 2 week treatment in those who were resistant to domperidone maleate or levosulpiride. METHODS: One hundred Forty-nine patients, who were diagnosed with functional dyspepsia, were selected. The subjects were randomly divided into two groups, domperidone maleate (75) and levosupiride (74). Daily they took 30mg of domperidone maleate (DOM) or 75mg of levosulpiride (LEV) for 2 weeks. Then the subjects who didn't respond to these treatments took 30mg of cisapride tartrate for the following 2 weeks. RESULTS: At week 0, the total symptom scores of the DOM group and LEV group were 8.01+/-2.57 and 8.14+/-2.65 respectively, which were not statistically different. At week 2, the total symptom scores of the DOM and LEV groups were significantly reduced to 4.28+/-3.30 and 4.85+/-3.53(p=0.0001). The efficacy rates of the DOM and LEV groups at week 2 were 50.8% vs. 44.1%. The rate of adverse events in the LEV groups was much higher than in the DOM group(17.7% vs. 8.0%). In addition the rate of change from normal to abnomal in prolactin level was markedly higher in the LEV than that of the DOM group(80.0% vs. 8.3%). After 2 weeks of treatment with cisapride tartrate, the total symptom score was significantly reduced to 3.77+/-2.49(p=0.0001), and the efficacy rate was 75.0%. The satisfaction of the resistant subjects in efficacy of cisapride compared with the previous treatment was 73.3%. The rate of adverse events of cisapride tartrate was 5.0%. CONCLUSIONS: Considering efficacy and safety of domperidone maleate and levosulpiride, domperidone maleate was the safer drug for the treatment of functional dyspepsia, and cisapride tartrate can be a useful drug in those patients who are resistant to dopamine antagonists like domperidone maleate and levosulpiride.

A Case of Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Sphincterotomy / 대한소화기내시경학회지

Perforation complicates endoscopic sphincterotomy (EST) in approximately 1% of cases. However, pneunomediastinum and/or subcutaneous emphysema due to duodenal perforation after EST have rarely been reported. The management strategy of this awkward complication of EST remains controversial. Conservative treatment with antibiotics and nasogastric and/or biliary drainage has been reported to be adequate, but some authors still advocate early surgery for all perforations. Therefore, it seems necessary to accumulate more data in order to set up a management algorithm in these cases. Recently, we experienced a case of pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema developed after EST and stone removal in which recovery was achieved with conservative treatment in a 87-year-old woman with previous Billroth II partial gastrectomy. We herein report this rare complication of EST and a management algorithm is suggested based on a literature review.

A Case of Intraductal Papillary Mucinous Tumor of the Pancreas Accompanied by Gastric Cancer / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a distinct entity characterized by intraductal papillary growth and thick mucin secretion. Prolonged postoperative survival can be anticipated in many IPMT cases. However, IPMT of the pancreas was reported to be associated with a high incidence of nonpancreatic neoplasms and these nonpancreatic neoplasms have potential prognostic significance in patients with IPMT. Recently, we experienced a case of IPMT of the pancreas accompanied by gastric cancer in a 72-year-old woman. The main pancreatic duct was incidentally found to be dilated on an abdominal computed tomography performed for staging of gastric cancer. A subtotal gastrectomy and near-total pancreatectomy were carried out. Histopathologic examinations of the resected specimens confirmed the diagnosis of early gastric cancer (T1N1M0) and IPMT of the pancreas, carcinoma in situ, combined type. We report this interesting case with a review of the literature.

A case of pulmonary epithelioid hemangioendothelioma / 대한내과학회지

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.

Primary Lymphoma of Bone Combined with Pancytopenia / 대한혈액학회지

Primary lymphoma of bone, first described by Parker and Jackson in 1939, is derived from bone marrow reticuloendothelial systems. It is uncommon neoplasm representing only 5% of all extranodal non-Hodgkin's lymphoma. Primary bone non-Hodgkin's lymphoma is characterized by initial symptoms of bone pain with associated single or multiple radiological bone lesions, with or without local soft tissue swelling, pathologic fractures,or regional/distant metastasis. Isolated bone marrow non-Hodgkin's lymphoma is rare, and determining the diagnosis difficult. The common features are fever, abnormal liver function, pancytopenia, polyserositis, neurologic symptoms, opportunistic infections, and a short, fatal course. Treatment includes surgery, radiotherapy, and chemotherapy depending on multiple factors, including histopathologic type of tumor, stage of disease, location of the lesion, and extent of osseous involvement. Five year survival rate is above 80%, when treated by combined radiation & chemotherapy. We experienced a patient who admitted to our department of Internal Medicine. She had mutiple bone pain, general weakness and diagnosed as primary lymphoma of the bone with severe pancytopenia. Her presentation, treatment, and clinical progress were discussed.

Circadian and Seasonal Variations in the Frequency of Onset of Acute Myocardial Infarction / 대한내과학회지

BACKGROUND: The onset of acute myocardial infarctin varies in a circadian and seasonal pattern, with a morning and winter peak. The purpose of this study was to determine whether the frequency of onset of acute myocardial infarction varies circadianly and seasonally in Korean patients. METHODS: We analyzed the time of onset of chest pain in 409 patients with myocardial infarction admitted to our hospital over the past 30 years according to a 24-hour and 12 month period. RESULTS: There notel marked circadian variations in the frequency of onset, with the primary peak from 6 a.m. to noon and the secondary peak from 6 p.m. to midnight (p<0.001). Circadian bimodal rhythmicity of myocardial infarction was demonstrated in this study. By the sex analysis, circadian variations of frequency of acute myocardial infarction were also similar to those of total patients. Interestingly, circadian variations were slightly different in the patients below 50 years of age, showing the highest frequency of onset in the time between 6 pm and midnight (p<0.062). And we also analyzed the frequency of onset of AMI by seasons. The notel a peak incidence in autumn, and followed by winter and spring. But we didn't find any statistical significance (p<0.059). However, comparing summer to other seasons, summer showed the lowest incidence of myocardial infarction with statistical significance (p<0.001). CONCLUSIONS: Ever though the study population in small, this study showed that the frequency of acute myocardial infarction had a circadian and a seasonal variation in Korean patients.

A Study on positive rate of HBs Ag, HBs Ab and anti-HCV in Korean adults / 대한수혈학회지

BACKGROUND: It is well known that Korea is one of endemic area for viral hepatitis B(HBV). The prevalence of HBsAg in general population has been reported as high as 5-12% before vaccination plan began in 1983, 7-9% after vaccination for HBV in 80th, 3-6% in 90th. The hepatitis C(HCV) is now known to be the chief cause of tranfusion-associated non-A, non-B hepatitis. As there are not sufficient information about the prevalence rate of HBV, HCV in 90th, this study was designed to investigate the positive rate of HBV, HCV and the mean prevalence rate of HBV, HCV by sex, age, year in 90th. METHODS: From January 1993 to October 1998, HBsAg and HBsAb were checked by Radioimmunoassay technique in 132,367 adults. and from January 1995 to October 1998, anti-HCV were checked by the same technique in 86,384 adults. We have studied the positive rate of HBsAg, HBsAb and anti-HCV, which were checked by sex, age, year. Then, we have studied coinfection rate of HBV and HCV, association of blood type with HBV and HCV. RESULTS: The positive rate of HBsAg and anti-HCV were 6.0% and 0.46%. The sex distribution of positive HBsAg showed higher in male than female. The sex distribution of positive anti-HCV showed higher in female than male. HBsAg positive rate decreased from 6.5% of 1993 to 5.2% of 1998 and anti-HCV positive rate decreased from 0.6% of 1995 to 0.2% of 1998. The positive rate of HBsAg and anti-HCV steadily decreased by years from 1993 through 1998 and from 1995 through 1998, respectively. The age distribution of positive HBsAg was higher in 4th, 5th decade and anti-HCV in 7th decade. The positive rate of anti-HCV steadily increased with age. The positive rate of HBsAb was 63.9%. Positive rate of later group(1996-1998) was lower when compared with positive rate of first half(1993-1995). In the group of positive HBsAg, the positive rate of anti-HCV was 0.35% but, in the group of negative HBsAg, the positive rate of anti-HCV was 0.41%. So, the relationship between the positive rate of HBsAg and anti-HCV were not noted. The positive rate of HBsAg and anti-HCV were not differ regarding to ABO blood type. CONCLUSIONS: The positive rate of HBsAg and anti-HCV steadily decreased by years. This suggest that Government continues effort for control of HBV such as HBV vaccination and for control of transfusion associated HCV infection Also, this suggest that general population increase concerns in sanitation and public health.

A Case of Hyperparathyroidism induced from Cystic Parathyroid Adenoma / 대한내분비학회지

Cystic parathyroid adenoma is one of the rare causes of hyperparathyroidism, and is usually located in neck and mediastinum. This type of adenoma tends to cause increased serum level of parathyroid hormone and alkaline phosphatase, similar serum calcium level when compared to those of solid adenoma. Thanks to current radioimmunoassay and easy accessibility to serum autoanalyzer, serum calcium level and parathyroid hormone level are more easily measured, which in turn lead to more easier diagnosis of hyperparathyroidism. Also improvement in imaging and nuclear diagnostic method of parathyroid lesion are suggested to enable easy diagnosis of cystic parathyroid adenoma. A 35-year-old male presented with easy fatigability for 12 months. The serum calcium, phosphate, alkaline phosphotase were 11.5mg/dL, 1.4mg/dL, 194IU/L respectively and his parathyroid hormone level in serum was 126.42pg/mL. Neck CT showed enlargement of right lobe of thyroid gland with well defined inhomogenously enhanced density inside the right thyroid gland. The patient was diagnosed of hyperparathyroidim due to parathyroid adenoma and was surgically removed. The surgical biopsy showed cystic parathyroid adenoma. After operation his general condition was improved and serum calcium, phosphate, parathyroid hormone level were normalizd. We report a case of hyperparathyroidism caused by cystic parathyroid adenoma with brief review of literature.