ABSTRACT
BACKGROUND: Open reduction followed by internal fixation has been regarded as the most effective technique for the surgical repair of zygomatic fractures. However, the ideal number and locations of internal fixation points to maintain stable reduction remain controversial. Using 3-dimensional computed tomography, we aimed to compare the stability of 2-point and 3-point fixation among patients who had undergone surgical repair of zygomatic bone fractures. METHODS: The study included 22 patients (17 men, 5 women) with unilateral zygomatic bone fractures who had undergone open reduction with 2-point or three-point fixation using biodegradable materials (11 patients in each group). The authors measured the lateral projection and height of the zygoma at 2 landmark points (zygomaticofacial foramen and frontozygomatic suture). In each group, bony displacement was analyzed between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. Differences in stability between the 2 groups were analyzed by comparing values between the immediate postoperative and follow-up phases. RESULTS: The 2-point group exhibited a lower rate of complex fractures at the frontozygomatic suture than the 3-point group (18.2%, 63.6%, respectively). In both groups, the authors observed significant differences in the lateral projection of the zygomaticofacial foramen between the preoperative and immediate postoperative phases, and between the preoperative and follow-up phases. No significant differences in stability were observed between the groups. CONCLUSION: Our findings demonstrated that 2-point fixation of the zygoma with biodegradable materials is as stable as 3-point fixation. It could be initially considered when open reduction of frontozygomatic suture was not essential.
Subject(s)
Imaging, Three-Dimensional/methods , Open Fracture Reduction , Tomography, X-Ray Computed/methods , Zygoma , Zygomatic Fractures , Absorbable Implants , Adult , Bone Plates , Female , Fracture Fixation, Internal/instrumentation , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Open Fracture Reduction/methods , Outcome Assessment, Health Care/methods , Republic of Korea , Zygoma/diagnostic imaging , Zygoma/injuries , Zygoma/surgery , Zygomatic Fractures/diagnosis , Zygomatic Fractures/surgeryABSTRACT
Microsatellite-unstable (MSI) cancers have distinct genetic and clinical features from microsatellite-stable cancers, but the molecular functional differences between MSI cancers originating from different tissues or organs have not been well studied because the application of usual differentially expressed gene (DEG) analysis is error-prone, producing too many noncancer-specific normally functioning genes. To maximize therapeutic efficacy, biomarkers reflecting cancer-specific differences between MSI cancers of different tissue origins should be identified. To identify functional differences between MSI colon and endometrial cancers, we combined DEG analysis and biclustering instead of DEG analysis alone and refined functionally relevant biclusters reflecting genuine functional differences between the 2 tumors. Specifically, using The Cancer Genome Atlas and genome-tissue expression as data sources, gene ontology (GO) enrichment tests were performed after routinely identifying DEGs between the 2 tumors with the exclusion of DEGs identified in their normal counterparts. Cancer-specific biclusters and associated enriched GO terms were obtained by biclustering with enrichment tests for the preferences for cancer type (either colon or endometrium) and GO enrichment tests for each cancer-specific bicluster, respectively. A novel childness score was developed to select functionally relevant biclusters among cancer-specific biclusters based on the extent to which the enriched GO terms of the biclusters tended to be child terms of the enriched GO terms in DEGs. The selected biclusters were tested using survival analysis to validate their clinical significance. We performed multiple sequential analyses to produce functionally relevant biclusters from the RNA sequencing data of MSI colon and endometrial cancer samples and their normal counterparts. We identified 3066 cancer-specific DEGs. Biclustering analysis revealed 153 biclusters and 41 cancer-specific biclusters were selected using Fisher exact test. A mean childness score over 0.6 was applied as the threshold and yielded 8 functionally relevant biclusters from cancer-specific biclusters. Functional differences appear to include gland cavitation and the TGF-ß receptor, G protein, and cytokine pathways. In the survival analysis, 6 of the 8 functionally relevant biclusters were statistically significant. By attenuating noise and applying a synergistic contribution of DEG results, we refined candidate biomarkers to complement tissue-specific features of MSI tumors.
Subject(s)
Endometrial Neoplasms , Female , Child , Humans , Endometrial Neoplasms/genetics , Endometrial Neoplasms/pathology , Microsatellite Repeats , Colon/pathology , Gene Expression Profiling/methods , AlgorithmsABSTRACT
PURPOSE: We aimed to analyze the characteristics and management of bladder and urethral injuries in Korea by use of the National Health Insurance Service (NHIS) database. MATERIALS AND METHODS: Data from the NHIS database representative of all cases of Korean bladder injury (n=4,631) and urethral injury (n=17,858) reported between 2012 and 2016 were analyzed. We used the International Classification of Diseases, 10th revision, clinical modification codes to identify the diagnoses. RESULTS: A total of 491 males (1.97/100,000) and 590 females (2.39/100,000) experienced bladder injury in 2012, and 449 males (1.76/100,000) and 624 females (2.47/100,000) in 2016. The risk of bladder injury was higher in female than in male (hazard ratio [HR], 1.267; p<0.001). The annual incidence of bladder injury did not increase (HR, 0.992; p=0.409). A total of 2,886 (62.3%) patients were managed with conservative treatment, and 1,745 (37.7%) patients underwent surgical treatment. A total of 4,114 males (16.5/100,000) and 285 females (1.2/100,000) had urethral injury in 2012, while 4,465 males (17.5/100,000) and 303 females (1.2/100,000) had urethral injury in 2016. The incidence of urethral injury is increasing annually (HR, 1.010; p=0.036). CONCLUSIONS: The incidence of urethral injury increased continuously over the years studied, whereas that of bladder injury remained unchanged in Korea. The incidence of bladder injury was higher in females, and more than 90% of total urethral injuries were reported in males. This is the first study to evaluate the epidemiology of bladder and urethral injury using a nationwide population database.
Subject(s)
Urethra/injuries , Urinary Bladder/injuries , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Epidemiologic Studies , Female , Humans , Incidence , Infant , Male , Middle Aged , Republic of Korea/epidemiology , Wounds and Injuries/epidemiology , Young AdultABSTRACT
OBJECTIVE: ⢠To examine potential predictors of pathological outcomes for a single microfocal (≤3 mm) positive prostate cancer detected via contemporary biopsy scheme in patients presenting with prostate-specific antigen (PSA) ≤10 ng/mL. PATIENTS AND METHODS: ⢠We reviewed the data of 119 patients who had prebiopsy PSA ≤ 10 ng/mL and a single microfocal (≤3 mm) Gleason ≤6 prostate cancer identified via multicore (≥12) biopsy and who subsequently underwent radical prostatectomy (RP). ⢠We assessed the rates of insignificant prostate cancer (organ-confined and pathological Gleason ≤6 with tumour volume <0.5 mL) and unfavourable prostate cancer (upstaging and/or upgrading) by analysing pathological findings. ⢠Potential preoperative predictors of insignificant or unfavourable prostate cancer were analysed. Multivariable models for predicting insignificant and unfavourable tumours were devised and evaluated. RESULTS: ⢠Overall rates of insignificant and unfavourable prostate cancer were 44.5% and 24.4%, respectively. In multivariate analysis, only PSA density was an independent predictor of insignificant prostate cancer. ⢠Predictive accuracies of multivariable models for predicting insignificant prostate cancer did not exceed 68.2%. No significant predictor for pathologically unfavourable tumour was found in multivariate analysis. ⢠All versions of the multivariable model devised for prediction of unfavourable tumour showed predictive accuracies ≤66.9%. CONCLUSION: ⢠Although PSA density can be considered an independent predictor of pathologically insignificant tumour among patients with PSA ≤10 ng/mL and only a single microfocal tumour detected via multicore (≥12) biopsy, the clinical and biopsy-related parameters that are currently available have limited value in predicting pathologically insignificant or unfavourable prostate cancer in such patients.
Subject(s)
Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Aged , Biopsy/methods , Humans , Male , Predictive Value of Tests , Retrospective StudiesABSTRACT
AIM: This retrospective study was conducted to assess the relationship between renal functional parameters and histolopathological findings in patients with renal amyloidosis. METHODS: A total of 40 patients with biopsy-proven renal amyloidosis, which was diagnosed at the Department of Pathology, Hanyang University Hospital, between 1986 and 2010, were investigated. Renal biopsy specimens were evaluated in various histochemical and immunohistochemical stains using light, immunofluorescence and electron microscopes, and renal function was determined by estimated glomerular filtration rate (eGFR) (ml/min/1.73 m(2)) using the method proposed by the Modification of Diet in Renal Disease study. Glomerular amyloid deposits were classified into four groups: none, mild, segmental and diffuse types. The vascular, tubular and interstitial deposits were subdivided into the negative and positive groups. RESULTS: In simple regression analysis, 24-hour protein excretion, serum blood urea nitrogen and eGFR were found to significantly correlate with the increased extent of glomerular amyloid deposit. In multiple regression analysis, a decrease in eGFR was significantly associated with an increase in glomerular amyloid deposits (p=0.024), but there was no significant correlation with an increase in 24-hour protein excretion and blood urea nitrogen (p=0.119 and 0.184, respectively). CONCLUSION: The results of this study demonstrate that the increased extent of glomerular amyloid deposits may be associated with the decline of GFR in patients with renal amyloidosis.
Subject(s)
Amyloid/analysis , Amyloidosis/pathology , Kidney Diseases/pathology , Kidney Glomerulus/pathology , Kidney/physiology , Adult , Aged , Amyloidosis/complications , Amyloidosis/diagnosis , Biopsy , Female , Glomerular Filtration Rate/physiology , Humans , Kidney/blood supply , Kidney/metabolism , Kidney Diseases/complications , Kidney Diseases/diagnosis , Kidney Glomerulus/blood supply , Kidney Glomerulus/metabolism , Male , Middle Aged , Multivariate Analysis , Retrospective StudiesABSTRACT
ABSTRACT: To investigate the feasibility, safety, and outcomes of three-dimensional (3D) laparoscopic vaginoplasty with a rectosigmoid colon flap for vaginal reconstruction.Following appropriate preoperative patient counseling, 17 consecutive patients underwent vaginoplasty using a 3D laparoscopic system. Perioperative and postoperative outcomes were retrospectively evaluated.Between September 2016 and February 2020, 17 patients underwent 3D laparoscopic vaginoplasty with a rectosigmoid colon flap. Of them, 15 (88%) were transgender female patients, and 2 (12%) were cisgender female patients with congenital deformities. Among the 15 transgender patients, 12 (80%) underwent de novo surgeries and 3 (20%) underwent re-do surgeries. The mean age at the time of operation was 33.0âyears, and the mean total operation time was 529â±â128âminutes. The initial intraoperative mean vaginal depth was 15.2â±â1.3âcm, and the 30-day readmission rate was 5.9% (1/17 cases). The mean follow-up duration was 24.8âmonths.Perioperative and postoperative outcomes suggest that 3D laparoscopic rectosigmoid colon vaginoplasty is a potentially acceptable, effective, and safe method for vaginal reconstruction.
Subject(s)
Laparoscopy/methods , Sex Reassignment Surgery/methods , Surgical Flaps/surgery , Vagina/surgery , Adult , Female , Humans , Laparoscopy/statistics & numerical data , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Plastic Surgery Procedures/methods , Plastic Surgery Procedures/statistics & numerical data , Retrospective Studies , Sex Reassignment Surgery/statistics & numerical data , Transgender Persons/statistics & numerical data , Vagina/physiopathologyABSTRACT
AIMS: Tumour suppressor phosphatase and tensin homologue (PTEN) is an important negative regulator for the PIP3/Akt signalling pathway that promotes cell proliferation and inhibits apoptosis. Inactivation of PTEN by mutation, deletion and promoter hypermethylation has been demonstrated in a range of cancers. The aim was to investigate whether the loss of nuclear PTEN protein expression correlates with conventional clinicopathological parameters and patient survival. METHODS AND RESULTS: Immunohistochemistry staining for PTEN was performed on a tissue microarray of 19 samples of normal colonic mucosa, 14 adenomatous polyps, 482 adenocarcinomas and 56 metastatic lymph nodes. All 19 normal colonic mucosa samples (100%) were positive and 12 (85.7%) out of 14 adenomatous polyps were positive for PTEN. However, only 241 (50.0%) of the 482 colorectal adenocarcinomas and 26 (46.4%) of the 56 metastatic lymph nodes were positive for PTEN. Loss of PTEN expression was related to defective mismatch repair protein expression and colonic localization rather than rectal localization. On univariate survival analysis, patients with PTEN- adenocarcinoma revealed a poor overall and disease-free survival (P = 0.030 and P = 0.046, respectively). On multivariate analysis, a significant difference was observed in patients with stage II cancer that was not observed in other stages. CONCLUSIONS: Nuclear PTEN expression gradually decrease during the normal-adenoma-adenocarcinoma-metastasis sequence, which suggests an important role for PTEN in carcinogenesis. Moreover, loss of nuclear PTEN expression was a marker of poor clinical outcome in patients with stage II colorectal cancer.
Subject(s)
Adenocarcinoma/metabolism , Adenomatous Polyps/metabolism , Cell Nucleus/metabolism , Colon/metabolism , Colorectal Neoplasms/metabolism , Intestinal Mucosa/metabolism , Lymph Nodes/metabolism , PTEN Phosphohydrolase/metabolism , Rectum/metabolism , Adenocarcinoma/genetics , Adenocarcinoma/pathology , Adenomatous Polyps/genetics , Adenomatous Polyps/pathology , Antibodies, Monoclonal , Biomarkers, Tumor , Colon/pathology , Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , DNA Mismatch Repair , Disease-Free Survival , Female , Humans , Intestinal Mucosa/pathology , Lymph Nodes/pathology , Male , Multivariate Analysis , Neoplasm Metastasis , Neoplasm Staging , PTEN Phosphohydrolase/immunology , Rectum/pathologyABSTRACT
There is no conclusive evidence as to whether patients with testosterone deficiency (TD) who benefit from testosterone treatment (TRT) must continue the treatment for the rest of their lives. In some patients, the effect of TRT does not maintained after stopping TRT and, some patients show no significant TD symptoms, with normal testosterone levels after TRT cessation. Therefore, we investigated the predictive factors of response maintenance after TRT cessation. A total of 151 men with TD who responded to TRT were followed up for six months after TRT discontinuation. Ninety-two patients (Group I) failed to show response maintenance; 59 patients (Group II) had a maintained response. The groups did not differ in baseline characteristics or the type of TRT (oral, gel, short/long-acting injectables). However, TRT duration was significantly longer (10.7 vs. 5.2 months), and peak total testosterone (TT) level was significantly higher (713.7 vs. 546.1 ng/dL), in Group II than in Group I. More patients regularly exercised in Group II than in Group I (45.8% vs. 9.8%, p < 0.001). A multivariate logistic regression analysis revealed that exercise (B = 2.325, odds ratio = 10.231, p < 0.001) and TRT duration (B = 0.153, Exp(B) = 1.166, p < 0.001) were independent predictive factors of response maintenance. In men with TD who respond to TRT, longer treatment periods can improve the response durability after TRT cessation, regardless of the type of TRT. Additionally, regular exercise can increase the probability of maintaining the response after TRT cessation.
ABSTRACT
BACKGROUND: Three-quarters of aged men experience lower urinary tract symptoms with benign prostate hypertrophy (BPH). Transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) are standard endosurgical procedures in patients with BPH. Previous studies reported better results in patients undergoing HoLEP than in those undergoing TURP. METHODS: This study compared the efficiency and safety of conventional morcellation and morcellation performed after X-incision during enucleation, a newly added technique in HoLEP. Overall, 174 patients were selected as the final study population. The populations were stratified with respect to resected volumes. A t-test were used to compare the conventional morcellation and X-incision procedure groups. RESULTS: In morcellation times and rates, there were significant differences in stratified resected mass (g) between the groups. The results also showed a decreased incidence of bladder injury as a surgical complication. CONCLUSION: We believe morcellation performed after X-incision procedure during enucleation is efficient and safe for older adults with BPH.
ABSTRACT
Foreign body (FB) impaction in the maxillofacial area could be caused by knives, glass fragments, and vegetative materials. We present the rare case of a 62-year-old man with a large glass FB in the left cheek retained for over 40 years. He had traffic accident over 40 years ago and glass fragments impacted on his left cheek. Glass fragments were retained around the zygomatic arch with dimpled scar and unclear serous discharge, but other facial motor or sensory dysfunction was not observed. We confirmed three glass fragments with radiologic examination including plain radiograph and computed tomographic image. Under general anesthesia, impacted glass fragments were removed through the direct incision on the dimpled scar and the additional incision on the left lateral canthal area. Remnant FBs were not seen on an intraoperative C-arm radiograph. After 2 days of irrigation for inflammation control, the dimpled wound was sutured. The wound was healed without major complication and the original dimpled scar was much improved.
ABSTRACT
BACKGROUND: Apoptotic protease activating factor-1 (Apaf-1) is one of the key regulators in the mitochondrial apoptotic pathway, and the loss of Apaf-1 leads to cellular resistance against the apoptotic signals. We investigated the expression of Apaf-1 in colorectal tissues corresponding to the multistep carcinogenesis model to determine correlations between the clinicopathologic characteristics and the expression of this molecule and to evaluate the role of Apaf-1 in the development and progression of colorectal adenocarcinoma. METHODS: Immunohistochemistry for Apaf-1 was performed on the tissue microarray of 38 normal mucosal tissues, 46 adenomatous polyps, 529 colorectal adenocarcinomas, and 76 metastatic tumors. RESULTS: Normal colonic mucosa tissues and adenomas were positive for Apaf-1 with no exceptions (100%). However, in colorectal adenocarcinomas, 119 of 529 cases (22.5%) were positive and 410 cases (77.5%) were negative. Moreover, 67 of 76 metastatic cases (88.2 %) were negative and only nine cases (11.8%) were positive for Apaf-1 expression. In the analyses between Apaf-1 expression and clinicopathologic parameters, reduced expression of Apaf-1 correlated with left colon location (p < 0.001), deeper tumor invasion (p < 0.001), frequent lymph node metastasis (p = 0.021), higher American Joint Committee on Cancer (AJCC) and Dukes' stage (p = 0.02 and p = 0.001, respectively) and poorer differentiation (p < 0.001). The patient survival was significantly associated with age, histological grade, AJCC stage, and lymphovascular invasion, but not Apaf-1 expression (p = 0.478). CONCLUSIONS: The results suggest that the loss of Apaf-1 expression is a relatively frequent late event and the loss of Apaf-1 expression may play an important role in tumorigenesis and tumor progression in colorectal adenocarcinoma.
Subject(s)
Adenocarcinoma/metabolism , Apoptotic Protease-Activating Factor 1/metabolism , Biomarkers, Tumor/metabolism , Colorectal Neoplasms/metabolism , Adenocarcinoma/mortality , Adenocarcinoma/secondary , Adenoma/metabolism , Adenoma/pathology , Adult , Aged , Aged, 80 and over , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Disease Progression , Female , Humans , Immunoenzyme Techniques , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prognosis , Retrospective Studies , Survival Rate , Tissue Array AnalysisABSTRACT
Membranous lupus nephritis (MLN) and idiopathic membranous nephropathy (IMN) are kidney diseases with similar morphology, but distinct etiologies, both producing glomeruli with immune deposits. Immunoglobulins and complements, the main components of the deposits, can be detected by immunofluorescence (IF) microscopy. Previous researches characterized the immune deposits only individually, but not the interactions between them. To study these relationships we analyzed an IF profile of IgG subclasses and complements (IgG1, IgG2, IgG3, IgG4, C3, C1q, and C4) in 53 and 95 cases of biopsy-confirmed MLNs and IMNs, respectively, mainly using information theory and Bayesian networks. We identified significant entropy differences between MLN and IMN for all markers except C3 and IgG1, but mutual information (a measure of mutual dependence) were not significantly different for all the pairs of markers. The entropy differences between MLN and IMN, therefore, were not attributable to the mutual information. These findings suggest that disease type directly and/or indirectly influences the glomerular deposits of most of IgG subclasses and complements, and that the interactions between any pair of the markers were similar between the two diseases. A Markov chain of IgG subclasses was derived from the mutual information about each pair of IgG subclass. Finally we developed an integrated disease model, consistent with the previous findings, describing the glomerular immune deposits of the IgG subclasses and complements based on a Bayesian network using the Markov chain of IgG subclasses as seed. The relationships between the markers were effectively explored by information theory and Bayesian network. Although deposits of IgG subclasses and complements depended on both disease type and the other markers, the interaction between the markers appears conserved, independent from the disease type. The disease model provided an integrated and intuitive representation of the relationships of the IgG subclasses and complements in MLN and IMN.
Subject(s)
Complement System Proteins/immunology , Glomerulonephritis, Membranous/immunology , Immunoglobulin G/immunology , Kidney Glomerulus/immunology , Lupus Nephritis/immunology , Glomerulonephritis, Membranous/pathology , Humans , Kidney Glomerulus/pathology , Lupus Nephritis/pathology , Models, TheoreticalABSTRACT
PURPOSE: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. MATERIALS AND METHODS: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of -3.9 (range, -3.1 to -6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. RESULTS: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. CONCLUSION: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.
ABSTRACT
Beta tricalcium phosphate (ß-TCP) is one of allogenic bone substitute which is known to have interconnected pores that draws cell and nutrients for bone generation. It has been resulted in good outcomes for bone defect coverage or augmentation. However, several studies have also reported negative outcomes and associated complications including unexpected formation of cystic mass, continuous pain and secretion. We present the case of a 36-year-old man with a right cheek cystic mass who had a history of right zygomaticomaxillary (ZM) complex fracture and surgical correction with ß-TCP powder insertion to ZM bone defect. Excisional biopsy under local anesthesia revealed calcified mass in a sinus tract which was found to be connected to the ZM bone defect site in postoperative computed tomography image. Further excision under general anesthesia was performed to remove the sinus tract and fine granules which filled the original defect site. Pathologic report revealed bony spicules and calcification materials with chronic foreign body reaction. Postoperative complications and recurrence were not reported.
ABSTRACT
To evaluate the effect of naftopidil 75 mg once daily for ureteral double-J (DJ) stent-related discomfort after a ureteroscopic procedure using a multicenter, randomized, double-blinded, placebo-controlled study. 100 patients with indwelled retrograde DJ ureteral stents after ureteroscopic stone removal or retrograde intrarenal surgery (RIRS) were randomized 1:1 to receive either placebo or naftopidil during the stenting period. At the time of stent removal, the Ureteral Stent Symptom Questionnaire (USSQ), the International Prostate Symptom Score and the total amount of used analgesics were reported. Of the 92 patients who completed the study, 49 patients were enrolled in the placebo group, and 43 patients in the naftopidil group. USSQ urinary symptom scores (30.90 vs. 29.23, p = 0.299) and USSQ body pain scores (22.28 vs. 19.58, respectively, p = 0.286) were lower in the naftopidil group than in the placebo group, but the difference was not significant. Multivariate analysis showed that the use of a ureteral access sheath during RIRS was the only significant predictor of postoperative DJ-related pain (OR = 2.736, p = 0.031). The use of naftopidil once daily did not significantly reduce DJ ureteral stent-related discomfort. Larger-scaled prospective studies should be conducted to evaluate the effects of naftopidil on DJ stent-related symptoms and surgeries.
Subject(s)
Naphthalenes/pharmacology , Piperazines/pharmacology , Stents/adverse effects , Double-Blind Method , Endpoint Determination , Female , Humans , Male , Middle Aged , Multivariate Analysis , Placebos , Ureter/surgeryABSTRACT
OBJECTIVES: A prospective, multicenter, randomized, double-blind, placebo-controlled trial evaluated the effects of naftopidil 75 mg for medical expulsive therapy for a single ureter stone. MATERIALS AND METHODS: Patients diagnosed with a ureter stone were prescribed aceclofenac 100 mg or a combined medication of tramadol 37.5 mg and acetaminophen 325 mg. Patients then randomly received either naftopidil 75 mg or placebo. Primary endpoint was the stone passage rate at 14 days after medication. RESULTS: The 150 patients enrolled in 6 institutions randomly received either naftopidil (n = 75) or placebo (n = 75). The percentages of ureter stone passed spontaneously 14 days after medication was 60.9% in the naftopidil group and 53.3% in the placebo group. Stone-free rates and the total use of analgesics showed no significant differences between the two groups. Stone-free rates at 14 days after medication were decreased when maximal stone size was increased: 39.4% (≥ 5 mm), 15.5% (≥ 6 mm), and 7.0% (≥ 7 mm). CONCLUSIONS: The use of naftopidil 75 mg once daily was not effective in increasing spontaneous stone passage rates or reducing analgesic use. The maximal stone size < 6 mm and the follow-up for two weeks would be appropriate for applying medical expulsive therapy to patients with a single ureter stone.
Subject(s)
Naphthalenes/therapeutic use , Piperazines/therapeutic use , Ureteral Calculi/drug therapy , Adult , Double-Blind Method , Female , Humans , Male , Middle Aged , Placebos , Treatment OutcomeSubject(s)
Actinomyces/isolation & purification , Actinomycosis/diagnosis , Cystitis/diagnosis , Urinary Bladder/pathology , Actinomycosis/surgery , Actinomycosis/urine , Adult , Cystitis/surgery , Cystitis/urine , Cystoscopy , Female , Humans , Urinalysis , Urinary Bladder/microbiology , Urinary Bladder/surgerySubject(s)
Granuloma/diagnosis , Granuloma/pathology , Inflammation/diagnosis , Inflammation/pathology , Parotid Gland/pathology , Aged , Biopsy, Fine-Needle , Granuloma/complications , Humans , Inflammation/complications , Male , Parotid Gland/diagnostic imaging , Parotid Gland/surgery , RadiographyABSTRACT
PURPOSE: We attempted to evaluate the perioperative complications of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by using the modified Clavien classification system (MCCS). MATERIALS AND METHODS: Targeting 402 patients who underwent HoLEP for benign prostatic hyperplasia performed by a single surgeon between July 2008 and January 2011, we investigated complications that occurred during and within 1 month after surgery and classified them into grade I to grade V on the basis of the MCCS. If two or more complications occurred in one patient, each complication was graded and counted. RESULTS: The mean age, prostate volume, operation time, hospital stay, and average follow-up period of 402 patients who underwent HoLEP were 68.8 years (range, 52-84 years), 53.2 g (range, 23-228 g), 58.2 minutes (range, 20-230 minutes), 4.5 days (range, 2-7 days), and 9 months (range, 4-27 months), respectively; 78 complications occurred in 71 of the patients (morbidity rate, 17.6%). In MCCS grade I, complications occurred in 54 cases (69.2%); in grade II, complications occurred in 19 cases (24.3%); in grade III, complications occurred in 4 cases (5.1%); and in grade IV, 1 patient required intensive care unit care because of cerebral infarction (1.2%). There were no grade V complications. CONCLUSIONS: The HoLEP-based MCCS complications classification was performed very quickly. However, MCCS, when compared with other measures of endoscopic prostate surgery experiences, including HoLEP, exposed the lack of accuracy in low grade classification and the inability to include late complications.
ABSTRACT
PURPOSE: We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency. MATERIALS AND METHODS: From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique. RESULTS: There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups. CONCLUSIONS: In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.