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BACKGROUND: To present the clinical characteristics of neuroretinitis in Korea. METHODS: Twelve patients with neuroretinitis between January 2009 and September 2020 were retrospectively reviewed. Neuroretinitis was diagnosed based on fundus findings, optical coherence tomography, and fluorescein angiography. The serological findings of each patient were reviewed. RESULTS: Fifteen eyes of 12 patients (9 male and 3 female), with a mean age of 46.0 ± 10.7 years were included. Of the nine patients who underwent serological testing for Toxocara antibodies, six (66.6%) were positive. One patient had high titers of Toxoplasma immunoglobulins M and G. One patient diagnosed with dengue fever was suspected to have neuroretinitis in both eyes. There were no related abnormalities in the serological findings in four patients (33.3%) out of 12 patients. There were no suspected cases of cat-scratch disease. The six patients who were positive for Toxocara antibodies were older (mean age: 54.5 ± 9.1 years) than the others (mean age: 37.5 ± 4.4 years, p = 0.004). The four patients without any abnormal serological findings were relatively younger (mean age: 35.7 ± 3.0 years) than the other 8 patients (mean age: 51.1 ± 10.1 years, p = 0.008). CONCLUSIONS: Two-thirds of neuroretinitis patients were seropositive for Toxocara in the current cohort from Koreans. Causative factors in cases of neuroretinitis may vary according to age and region.
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Enfermedad por Rasguño de Gato , Coriorretinitis , Retinitis , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Retinitis/diagnóstico , Enfermedad por Rasguño de Gato/diagnóstico , República de Corea/epidemiologíaRESUMEN
Background and objectives: Renal arteriovenous malformation (AVM) is a rare disease and is difficult to be diagnosed by conventional methods because of its rarity. In this study, we investigated the diagnostic clues, and made an algorithm for the better diagnosis of renal AVM. Materials and Methods: We reviewed 13 patients who were diagnosed with AVM by using renal angiography from 1986 to 2020 at our institutes. We evaluated clinical features, diagnostic tools, treatment modalities, and outcomes after the treatment of patients. Results: All patients were female, and the mean age was 36.9 years (range 19 to 54 years). Twelve (92.3%) patients complained of gross hematuria. Four (30.8%) patients showed symptoms in relation with pregnancy and delivery. Angiographic findings demonstrated cirsoid type in 10 patients and aneurysmal type in 3 patients. Among the 11 patients who underwent computed tomography, AVMs were detected in 3 (27.3%) patients. Renal duplex Doppler was performed in 6 patients, and all of these patients were diagnosed with AVM, demonstrating a vascular turbulence or blood-rich area. Twelve patients were initially treated with transarterial embolization. Nephrectomy was performed in two patients due to persistent bleeding with hypovolemic shock. Conclusions: We should consider possible AVMs in patients who were not detected by conventional work up for hematuria, especially in mid-aged, pregnant, or recently delivered women. Renal duplex Doppler might be the optimal diagnostic modality in these patients. Our diagnostic algorithm could be aid to diagnosis and treatment for renal AVM patients.
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Malformaciones Arteriovenosas , Embolización Terapéutica , Adulto , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/terapia , Femenino , Hematuria/terapia , Humanos , Riñón/diagnóstico por imagen , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Resultado del Tratamiento , Adulto JovenRESUMEN
Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52-100) vs. 70.0 (26.5) years (range: 28-97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251; 95% CI, 2.254-17.250; p < 0.001), CKD (OR, 18.439; 95% CI, 3.421-99.404; p = 0.001), NB (OR, 7.374; 95% CI, 1.993-27.285; p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.
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Cistitis , Enfisema , Anciano , Anciano de 80 o más Años , Cistitis/complicaciones , Cistitis/epidemiología , Enfisema/complicaciones , Enfisema/diagnóstico por imagen , Enfisema/epidemiología , Análisis Factorial , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Here we assessed the influence of androgen deprivation therapy (ADT) during and/or after post-prostatectomy radiotherapy (RT) on biochemical recurrence (BCR) and radiographic progression in patients with prostate cancer. METHODS: Patients with prostate cancer who underwent post-prostatectomy RT were analyzed. BCR and radiographic progression after RT were compared according to the concurrent or salvage ADT. Cox regression analyses were used to identify risk factors for BCR and radiographic progression. RESULTS: Of the 227 patients who underwent post-prostatectomy RT, 95 (41.9%) received concurrent ADT for a median of 17.0 months. Despite more aggressive disease characteristics in the concurrent ADT group than in the RT-only group, the former had a better 5-year BCR-free survival rate than the latter (66.1 vs. 53.9%; p = 0.016), whereas the radiographic progression rate was not significantly different between two groups. On the other hand, salvage ADT after post-RT BCR significantly delayed radiographic progression (5-year radiographic progression-free survival; 75.2 vs. 44.5%; p = 0.002). CONCLUSIONS: Concurrent ADT improved BCR-free survival, and salvage ADT after post-RT BCR improved radiographic progression-free survival. To maximize the oncological benefit, ADT of sufficient duration should be implemented.
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Antagonistas de Andrógenos/uso terapéutico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Prostatectomía , Neoplasias de la Próstata/tratamiento farmacológico , Terapia Recuperativa , Anciano , Estudios de Casos y Controles , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Dosificación Radioterapéutica , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The objectives of this study were to investigate patients treated for scrotal trauma at our institute for the last three decades to describe our experience with an emphasis on the etiologies and ultrasonographic findings in these patients. We reviewed medical records of patients who underwent scrotal ultrasonography for evaluation of testicular trauma at our institutes from 1986 to 2015. Trends regarding the etiology of scrotal trauma were evaluated during each decade. The echo pattern and contour definition of the testicular parenchyma and the pattern of hematoma development were recorded to evaluate radiographic findings of testicular injury. The correlation between ultrasonographic and intraoperative findings was assessed. A total of 115 patients were analyzed. Most patients (92.2%) presented with blunt trauma. The most common etiology of testicular trauma was assault during the first and second decades, while injury related to a fall was most common during the third decade. Of the 77 patients (67.0%) who underwent urgent exploration, 46 patients (59.7%) had testicular rupture. Loss of contour definition, heterogeneous echo pattern of the testicular parenchyma, and testicular hematoma showed a moderate to strong degree of correlation with testicular rupture (Spearman correlation co-efficient: 0.5-0.8). Over the past 30 years, the etiology of testicular injury changed from assault to falls or athletic injury and the severity of injury has decreased. Our findings demonstrate the importance of ultrasonography for determining an appropriate management strategy in scrotal trauma. Surgical exploration should be considered in patients with abnormal ultrasonographic findings.
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Testículo/lesiones , Adolescente , Adulto , Hematoma/etiología , Humanos , Masculino , República de Corea , Escroto/patología , Testículo/diagnóstico por imagen , Testículo/patología , Ultrasonografía , Adulto JovenRESUMEN
PURPOSE: We analyzed the pathological and oncologic characteristics of anteriorly located prostate cancer and assessed the usefulness of magnetic resonance imaging to detect anterior prostate cancer. MATERIALS AND METHODS: We analyzed the records of 728 consecutive patients treated with radical prostatectomy. Patients were categorized with anterior or prostate cancer or tumors involving the anterior and posterior prostate according to the dominant tumor location on whole mount section. RESULTS: The anterior and posterior prostate cancer groups and the group with cancer at both locations represented 31.0%, 46.7% and 22.3% of the total number of patients, respectively. Anterior prostate cancer was less commonly palpable (p <0.001) and needed more frequent repeat biopsy (p = 0.012) than posterior prostate cancer. Moreover, the anterior group had fewer positive cores than the posterior group (p <0.001) despite comparable tumor volumes. Gleason score upgrading was more frequently observed in anterior than in posterior prostate cancer (p = 0.003). However, final pathological features did not significantly differ. Only the seminal vesicle involvement rate was lower in anterior than in posterior prostate cancer (p <0.001). Estimated 5-year biochemical recurrence-free survival in patients with anterior prostate cancer was 87.5%, significantly higher than in patients with posterior prostate cancer (77.4%, p = 0.001) and patients with anterior plus posterior involvement (74.4%, p <0.001). Multivariate analysis revealed that anterior location was an independent prognostic factor for biochemical recurrence (HR 0.403) along with other well-known prognostic factors. To detect anterior prostate tumors the sensitivity and specificity of magnetic resonance imaging were 78.1% and 58.2%, respectively. CONCLUSIONS: Anterior prostate cancer had pathological features and favorable oncologic outcomes comparable to those of posterior prostate cancer but also more frequent Gleason score upgrading. Magnetic resonance imaging had moderate diagnostic performance for detecting lesions in the anterior prostate.
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Imagen por Resonancia Magnética , Neoplasias de la Próstata/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Prostatectomía , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Sensibilidad y Especificidad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
PURPOSE: We investigated the prognostic significance of tumor location at the renal hilum near the sinus structure on the recurrence in T1 renal cell carcinoma (RCC). METHODS: A total of 1,818 T1 RCC patients who underwent radical (RN) or partial nephrectomy (PN) from 1997 to 2011 were retrospectively reviewed. A hilar tumor was defined as a tumor abutting the main renal artery and/or vein or its segmental branches, without invasion. We compared the recurrence-free survival (RFS) rates between hilar and nonhilar T1 RCC and analyzed predictors of RFS after nephrectomy. RESULTS: Patients with hilar tumors showed a poorer 5-year RFS compared with nonhilar tumors both in T1a (89.7 vs. 98.5 %, p < 0.001) and T1b (81.6 vs. 95.1 %, p < 0.001) RCCs. Among patients who underwent RN and PN, hilar tumors were associated with lower 5-year RFS (87.6 vs. 97.2 % for RN, 78.1 vs. 98.2 % for PN, both p < 0.001). In T1a hilar tumor, PN was associated with poorer 5-year RFS than RN (79.5 vs. 93.0 %, p < 0.001). In multivariate analysis, a hilar location remained as an independent predictor of recurrence in both T1a and T1b tumors (both p = 0.001). CONCLUSIONS: Hilar tumors show a higher recurrence rate than nonhilar counterparts in T1 RCC. In T1a hilar tumors, PN demonstrated poorer RFS than RN. Potential intrinsic renal anatomical or lymphovascular structural differences as well as differences in cancer characteristics need further investigations.
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Adenocarcinoma de Células Claras/patología , Carcinoma Papilar/patología , Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Recurrencia Local de Neoplasia/patología , Nefrectomía , Adenocarcinoma de Células Claras/cirugía , Carcinoma Papilar/cirugía , Carcinoma de Células Renales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Invasividad Neoplásica , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. METHODS: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). RESULTS: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6%) were up-staged based on the pathologic analysis of PAFP and eight (9.1%) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8-10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7%) nodes were located in the middle portion of the PAFP. CONCLUSIONS: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.
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Tejido Adiposo/patología , Ganglios Linfáticos/patología , Pelvis/patología , Próstata/patología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/patología , Supervivencia sin Enfermedad , Humanos , Incidencia , Internacionalidad , Metástasis Linfática , Masculino , Pronóstico , Neoplasias de la Próstata/cirugía , República de Corea/epidemiología , Factores de Riesgo , Análisis de Supervivencia , Taiwán/epidemiología , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: To describe the development of multiple retinal hemorrhages after uncomplicated macular hole (MH) surgery, and to determine the associated factors. METHODS: The medical records of 163 patients (167 eyes) diagnosed with idiopathic MHs and who underwent surgery at Pusan National University Hospital between March 2016 and July 2018 were retrospectively reviewed. The development of retinal hemorrhages was evaluated using ultra-widefield fundus photographs. Multiple retinal hemorrhages were defined as three or more dot or blot hemorrhages that had not been observed before and during the surgery. The patients were divided into two groups according to the presence of multiple retinal hemorrhages. The variable parameters were compared between the two groups to find the risk factors. The associated factors were evaluated further for the independent factor using multiple logistic regression analysis. RESULTS: Multiple retinal hemorrhages were observed in 31 eyes (18.6%) after MH surgery. The associated factors were the surgical induction of posterior vitreous detachment (PVD) (p = 0.003), use of the internal limiting membrane flap technique (p = 0.028), and staining with Brilliant Blue G (BBG) (p = 0.003). Retinal hemorrhages were exclusively observed in eyes in which BBG was used. Surgical PVD induction was the only independent risk factor (odds ratio, 13.099; p = 0.013). No statistically significant differences were observed between the two groups in the postoperative visual outcomes and MH closure rate. Additionally, patients who underwent surgery for idiopathic epiretinal membrane during the study period were reviewed to validate the above findings. Multiple retinal hemorrhages were noted in only one case (0.4%) in which BBG was used after surgical induction of PVD. CONCLUSIONS: Multiple retinal hemorrhages after MH surgery appear to be related to the intravitreal use of BBG in eyes that sustained mechanical damage because of surgical induction of PVD; however, they did not affect surgical outcomes.
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Perforaciones de la Retina , Humanos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/epidemiología , Hemorragia Retiniana/etiología , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/cirugía , Estudios Retrospectivos , Colorantes de Rosanilina , Tomografía de Coherencia Óptica , Agudeza Visual , VitrectomíaRESUMEN
PURPOSE: This study aimed to compare refractive deviations between in-the-bag insertion, trans-scleral ciliary sulcus fixation, ciliary sulcus insertion, and ciliary sulcus insertion with optic capture after phacovitrectomy. STUDY DESIGN: Single-unit, single-surgeon, retrospective study. METHODS: Consecutive patients who underwent phacovitrectomy and intraocular lens (IOL) out-of-the-bag insertion simultaneously were retrospectively reviewed. Patients who underwent phacovitrectomy with IOL in-the-bag insertion were also included for comparison with those who underwent phacovitrectomy with out-of-the-bag insertion. Patients were classified into four groups based on the IOL insertion method. The average difference from the target spherical equivalent (SE) to postoperative SE was defined as the refractive deviation. Refractive deviations of the groups were compared. RESULTS: The refractive deviation for the in-the-bag insertion (43 eyes) was -0.18 ± 0.50 Df, -0.84 ± 0.81 D for the trans-scleral ciliary sulcus fixation (43 eyes), -0.93 ± 0.68 D for the ciliary sulcus insertion (25 eyes), and -0.27 ± 0.50 D for the ciliary sulcus insertion with optic capture group (24 eyes). The trans-scleral ciliary sulcus fixation and ciliary sulcus insertion groups had significantly different deviations than the in-the-bag group (p < 0.001). There was no significant difference between the ciliary sulcus insertion with optic capture and the in-the-bag insertion groups (p = 0.100). CONCLUSION: Refractive deviation was significantly different between the eyes that underwent trans-scleral ciliary sulcus fixation or ciliary sulcus insertion and the eyes that underwent in-the-bag insertion. However, there was no significant deviation among the eyes that underwent ciliary sulcus insertion with optic capture.
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Implantación de Lentes Intraoculares , Lentes Intraoculares , Humanos , Refracción Ocular , Estudios Retrospectivos , EscleróticaRESUMEN
BACKGROUND: The applicability of the sphincter complex integral theory to robotic-assisted radical prostatectomy (RARP) is unclear, with little known about the long-term effect of sphincter complex integrity on continence. OBJECTIVE: To determine whether the preoperative anatomical and functional features of the sphincter complex and the degree of nerve-sparing affect long-term continence after RARP. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 529 patients who underwent RARP at a single tertiary center. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Anatomical factors, including membranous urethral length (MUL) and pelvic diaphragm length (PDL), were assessed using sagittal views of preoperative magnetic resonance imaging. MUL was defined as the distance from the posterior prostate apex to the urethra level at the penile bulb, and PDL was defined as the length of the urethra that met the planes created by the pelvic floor muscles. Functional parameters including maximum urethral closure pressure (MUCP) and functional urethral length were evaluated using preoperative measurements of the urethral pressure profiles. The degree of nerve-sparing was stratified as bilateral, unilateral, or none. Continence (pad-free status) was assessed according to anatomical and functional factors and nerve-sparing. We used binary logistic regression to assess factors predicting continence return 12 mo after RARP. RESULTS AND LIMITATIONS: Continence return rates 1, 3, 6, and 12 mo after RARP were 39.7%, 66.0%, 80.2%, and 87.0%, respectively. Continence return rates at 12 mo differed significantly in patients with MUL ≥11.7mm (91.9%) and <11.7mm (79.9%), PDL ≥9.9mm (96.7%) and <9.9mm (74.5%), and MUCP ≥66 cmH2O (89.7%) and <66 cmH2O (79.4%). The continence return rate was significantly higher in patients with bilateral (93.0%) than in patients with unilateral (78.1%) or no (76.7%) nerve-sparing. Multivariate analysis showed that PDL (odds ratio [OR]=2.187 per mm), MUCP (OR=1.037 per cmH2O), and bilateral nerve-sparing (OR=3.671) were independently associated with continence return 12 mo after RALP. CONCLUSIONS: The anatomical length and static pressure of the sphincter complex affected continence after RARP. Bilateral nerve-sparing was independently associated with long-term continence. PATIENT SUMMARY: Predisposing length and static pressure of the urinary sphincter affect continence after robotic-assisted radical prostatectomy. Nerve bundle preservation during surgery enhances postoperative return of continence.
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Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Procedimientos Quirúrgicos Robotizados , Uretra , Anciano , Humanos , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Uretra/anatomía & histología , Uretra/inervación , Uretra/fisiología , Incontinencia Urinaria/prevención & controlRESUMEN
PURPOSE: To evaluate the better risk stratification based on surgical pathology, and to predict oncologic outcomes after radical prostatectomy (RP) with a better scoring system in high-risk prostate cancer (PCa) patients. METHODS: We evaluated high-risk PCa patients (PSA >20 ng/ml, ≥cT3a, or Gleason score 8-10) who underwent RP between 2007 and 2013 at our institute. We classified patients into three groups according to their pathologic outcomes: favorable (pT2, Gleason score ≤7, and node negative), intermediate (specimen-confined disease (pT2-3a, node negative PCa with negative surgical margins) but not in the favorable group), and unfavorable (the remaining patients). We developed a risk stratification scoring system to predict prognostic outcomes after RP and validated our scoring system to estimate its predictive accuracy. RESULTS: Among a total of 356 patients, 95 (26.7%), 115 (32.3%), and 146 (41%) were in the favorable, intermediate, and unfavorable prognostic groups, respectively. The 5-year biochemical recurrence-free survival rates of the patients in each group were 87.8, 64.6, and 41.4%, respectively. We developed a scoring system based on preoperative PSA, clinical stage, percentage of tumor positive core, and percentage of cores with a Gleason score 8-10. This demonstrated internally and externally validated concordance indices of 0.733 and 0.772, respectively. CONCLUSIONS: Using our scoring system, we can predict which patients with high-risk PCa would benefit more from RP. Thus, this system can be used in patient counseling to determine an optimal treatment strategy for high-risk PCa.
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Patología Quirúrgica/métodos , Neoplasias de la Próstata/clasificación , Neoplasias de la Próstata/cirugía , Adulto , Anciano , Supervivencia sin Enfermedad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prostatectomía , Neoplasias de la Próstata/patología , Factores de Riesgo , Resultado del TratamientoRESUMEN
The prognostic value of the expression of vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR2), platelet-derived growth factor (PDGF)-ß, and PDGF receptor (PDGFR)-ß in papillary renal cell carcinoma (pRCC) is unknown. A total of 145 patients, who were confirmed to have pRCC, were analyzed. Expression levels of molecular markers were assessed via immunohistochemistry. The median follow-up period for all patients was 52.0 (interquartile range, 34.5-90.5) months. Among the cohort of 145 patients, high VEGF expression was observed in 100 (69.0%) patients, whereas high expression of VEGFR2, PDGF-ß, and PDGFR-ß was observed in 64 (44.1%), 42 (29.0%), and 30 (20.7%) patients, respectively. Only patients with high VEGFR2 expression exhibited improved 10-year recurrence-free survival (85.3% versus 58.1%; P=.005) and cancer-specific survival (86.4% versus 70.1%; P=.014) rates compared with individuals who exhibited low expression. Multivariate analysis revealed that high VEGFR2 expression was an independent prognostic factor for recurrence (hazard ratio, 0.326; P=.006) and cancer-specific mortality (hazard ratio, 0.334; P=.046). During follow-up, 17 patients received targeted drug therapy. Patients with high VEGFR2 expression showed a better initial response (partial response, 40%; stable disease, 20%; progressive disease, 40%) than patients with low expression did (partial response, 0%; stable disease, 58.3%; progressive disease, 41.7%; P=.052). pRCC with high VEGFR2 expression seems to be associated with a better initial response to targeted drug therapy and a better prognostic outcome.
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Biomarcadores de Tumor/análisis , Carcinoma de Células Renales/química , Neoplasias Renales/química , Proteínas Proto-Oncogénicas c-sis/análisis , Receptor beta de Factor de Crecimiento Derivado de Plaquetas/análisis , Factor A de Crecimiento Endotelial Vascular/análisis , Receptor 2 de Factores de Crecimiento Endotelial Vascular/análisis , Adulto , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Biopsia , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/terapia , Quimioterapia Adyuvante , Distribución de Chi-Cuadrado , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunohistoquímica , Estimación de Kaplan-Meier , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Neoplasias Renales/terapia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Terapia Molecular Dirigida , Análisis Multivariante , Nefrectomía , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the changes in corneal higher-order aberration (HOA) during amblyopia treatment and the correlation between HOA and astigmatism in hyperopic amblyopia children. METHODS: In this retrospective study, a total of 72 eyes from 72 patients ranging in age from 38 to 161 months were included. Patients were divided into two groups based on the degree of astigmatism. Corneal HOA was measured using a KR-1W aberrometer at the initial visit and at 3-, 6-, and 12-month follow-ups. Correlation analysis was performed to assess the association between HOA and astigmatism. RESULTS: A total of 72 patients were enrolled in this study, 37 of which were classified as belonging to the higher astigmatism group, while 35 were assigned to the lower astigmatism group. There was a statistically significant difference in success rate between the higher and lower astigmatism groups. In both groups, all corneal HOAs were significantly reduced during amblyopia treatment. When comparing the two groups, a significant difference in coma HOA at the 12-month follow-up was detected (p = 0.043). In the Pearson correlation test, coma HOA at the 12-month follow-up demonstrated a statistically significant correlation with astigmatism and a stronger correlation with astigmatism in the higher astigmatism group than in the lower astigmatism group (coefficient values, 0.383 and 0.284 as well as p = 0.021 and p = 0.038, respectively). CONCLUSIONS: HOA, particularly coma HOA, correlated with astigmatism and could exert effects in cases involving hyperopic amblyopia.
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Ambliopía/fisiopatología , Astigmatismo/fisiopatología , Aberración de Frente de Onda Corneal/fisiopatología , Hiperopía/fisiopatología , Aberrometría , Adolescente , Niño , Preescolar , Topografía de la Córnea , Aberración de Frente de Onda Corneal/diagnóstico , Anteojos , Estudios de Seguimiento , Humanos , Hiperopía/terapia , Estudios Retrospectivos , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To investigate whether preoperative urodynamic detrusor overactivity (DO) contributes to post-prostatectomy incontinence (PPI). METHODS: We systematically searched the online PubMed, Embase, and Cochrane Library databases spanning the period of January 1989 to December 2014. RESULTS: A total of nine articles met the eligibility criteria for this systematic review. The eligible studies included a total of 457 patients with a median number of 58 patients per study (range 17-92). Of the nine studies, five conducted open retropubic radical prostatectomy (RRP), two performed robot-assisted laparoscopic prostatectomy (RALP), and two others utilized multiple modalities. PPI was more likely to occur in patients with preoperative DO [pooled odds ratio (OR) 2.30; 95 % confidence interval (CI) 1.39-3.82; studies 9; participants 419], as compared to patients who were DO negative. Sensitivity analysis using the subgroups of RRP (OR 2.32; 95 % CI 1.11-4.85), RALP (OR 3.41; 95 % CI 1.55-7.47), DO defined as any amplitude of involuntary contraction (OR 2.32; 95 % CI 1.11-4.85), no postoperative intervention (OR 2.32; 95 % CI 1.11-4.85), and outcome evaluation after 6 months (OR 2.32; 95 % CI 1.11-4.85) demonstrated consistent results. Although some comparisons showed inter-study heterogeneity, there was no clear evidence of publication bias in this meta-analysis. CONCLUSIONS: Our meta-analysis results suggest that preoperative DO is another possible underlying mechanism for PPI.
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Prostatectomía/métodos , Vejiga Urinaria Hiperactiva/fisiopatología , Incontinencia Urinaria/fisiopatología , Humanos , Masculino , Vejiga Urinaria Hiperactiva/complicaciones , Incontinencia Urinaria/etiología , UrodinámicaRESUMEN
Urinary incontinence after robot-assisted radical prostatectomy (RARP) is one of the most bothersome complications affecting patients' daily lives. The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013. Patients were randomized 1:1 to undergo surgery with (n = 79) or without (n = 79) the bladder neck plication stitch, and their time to recovery from incontinence, defined as being pad free, was compared. Recovery from incontinence at 1, 3, and 6 months were observed in 22 (27.8%), 42 (53.2%), and 57 (72.2%) patients, respectively, treated with, and 23 (29.1%), 47 (59.5%), and 59 (74.7%) patients, respectively, treated without the bladder neck plication stitch, with no significant difference in time to recovery from incontinence between the two groups. Multivariate analysis showed that age, membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP. The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP.
Asunto(s)
Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Procedimientos Quirúrgicos Robotizados/efectos adversos , Incontinencia Urinaria/etiología , Incontinencia Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Anciano , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Prospectivos , Próstata/cirugía , Recuperación de la Función , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate whether anticholinergic medication contributes to early recovery of continence and improvement of other voiding symptoms after radical prostatectomy (RP). PATIENTS AND METHODS: A total of 78 patients with clinically localized prostate cancer who had incontinence at 1 week after RP were enrolled prospectively. The patients were allocated to one of the 2 groups: group 1 (α-adrenergic agonist [midodrine] plus an anticholinergic [solifenacin]) or group 2 (α-adrenergic agonist only). A urodynamic study and the International Continence Society male Short Form questionnaire were completed preoperatively and 4 months after RP. One-hour pad test and 3-day frequency volume chart at 1 and 4 months after medication were also analyzed. RESULTS: The rate of continence, defined as being pad free, did not differ between the groups at 4 months (both 71.8%; P >.05). However, the decreased value of mean weight of daily pads worn by groups 1 and 2 were 51.5 vs 11.7 g, respectively (P = .005). The incontinence (P = .008) and quality of life (P = .044) subscale scores significantly worsened in group 2, whereas they remained unchanged in group 1. Maximal detrusor pressure and maximal urethral closure pressure significantly decreased in both groups, whereas maximal cystometric capacity increased significantly in group 1 only (290.8-332.0 cm H2O; P <.001). CONCLUSION: Anticholinergics may facilitate early recovery from incontinence and prevent worsening of quality of life, which might be attributed to increased cystometric capacity after their use.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Midodrina/uso terapéutico , Antagonistas Muscarínicos/uso terapéutico , Prostatectomía , Neoplasias de la Próstata/cirugía , Quinuclidinas/uso terapéutico , Recuperación de la Función/efectos de los fármacos , Tetrahidroisoquinolinas/uso terapéutico , Incontinencia Urinaria/tratamiento farmacológico , Anciano , Quimioterapia Combinada , Humanos , Masculino , Estudios Prospectivos , Prostatectomía/efectos adversos , Método Simple Ciego , Succinato de Solifenacina , Incontinencia Urinaria/etiologíaRESUMEN
PURPOSE: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (α-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). MATERIALS AND METHODS: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. RESULTS: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95±2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. CONCLUSIONS: Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.
Asunto(s)
Complicaciones de la Diabetes/terapia , Cálculos Ureterales/terapia , Espera Vigilante , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Remisión Espontánea , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Cálculos Ureterales/diagnóstico por imagen , Cálculos Ureterales/patologíaRESUMEN
OBJECTIVE: To investigate the prevalence of high-grade or insignificant prostate cancer in Korean men with prostate-specific antigen (PSA) levels of 3.0-4.0 ng/mL. METHODS: The medical records of 4233 consecutive men with PSA levels of 3.0-10.0 ng/mL, who underwent prostate biopsy between 2007 and 2012 at our institute, were reviewed. The clinicopathologic characteristics were compared between patients with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL. Predictive factors for high-grade (Gleason score ≥7) or insignificant cancer (defined according to the Epstein criteria) in men with a PSA level of 3.0-4.0 ng/mL were assessed. RESULTS: The high-grade disease rates were similar between men with a PSA level of 3.0-4.0 ng/mL and those with a PSA level of 4.0-10.0 ng/mL (50.5% and 53.1%, respectively). The rates of clinically insignificant cancer were higher in men with a PSA level of 3.0-4.0 ng/mL than in those with a PSA level of 4.0-10.0 ng/mL (28.4% vs 12.5%; P <.001). However, among patients with clinically insignificant cancer who underwent radical prostatectomy, only 20% of those with a PSA level of 3.0-4.0 ng/mL and 16% of those with a PSA level of 4.0-10.0 ng/mL showed pathologically insignificant cancer. Prostate volume was an independent predictor of high-grade disease in men with PSA levels of 3.0-4.0 ng/mL. CONCLUSION: More than half of the cancer patients had high-grade disease in men with a PSA level of 3.0-4.0 ng/mL, and most cases of clinically insignificant cancer were diagnosed as significant cancer on prostatectomy specimens, suggesting that the optimal PSA threshold for prostate biopsy in Korean men is 3.0 ng/mL.
Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/epidemiología , Anciano , Pueblo Asiatico , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Valor Predictivo de las Pruebas , Prevalencia , Neoplasias de la Próstata/patología , Estudios RetrospectivosRESUMEN
PURPOSE: We investigated the expression status of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)-B and their receptors in organ-confined clear cell renal cell carcinoma (ccRCC) to evaluate their prognostic significance after radical surgery. METHODS: In 758 consecutive patients diagnosed with pT1-2N0 ccRCC between 2007 and 2012, we prospectively investigated the expression levels of VEGF, PDGF-B, VEGF receptor (VEGFR) and PDGF receptor (PDGFR)-ß via immunohistochemistry. Clinicopathologic parameters and expression of the angiogenic factors were analyzed with respect to recurrence-free survival (RFS) after nephrectomy. The median follow-up was 29.5 months (IQR 21.5, 39.6) after surgery. RESULTS: Partial nephrectomy had been performed in 48.5 % of the patients, and tumors were staged as pT1a in 514 (67.8 %), pT1b in 192 (25.3 %) and pT2 in 52 (6.9 %). VEGF, PDGF and their receptors were identified in the cytoplasm and membranes of the tumor cells. Expression level of VEGFR inversely correlated with both tumor size (r = -0.076, p = 0.014) and nuclear grade (r = -0.297, p = 0.004). As for PDGF-B, the expression level showed an inverse correlation with tumor size (r = -0.216, p < 0.001) while PDGFR-ß inversely correlated with nuclear grade (r = -0.341, p = 0.001). On multivariate analysis, age, pathologic stage, nuclear grade and PDGFR-ß expression (high vs. low or none, HR 3.121 95 % CI 1.300-7.493, p = 0.011) were independently prognostic of RFS after nephrectomy. CONCLUSIONS: In organ-confined ccRCC, high expression of PDGFR-ß was independently predictive of poorer RFS after nephrectomy.