Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage

Background@#The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages. @*Methods@#Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed. @*Results@#MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P< 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%. @*Conclusion@#MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

Preventive Effect on Inflammation and Anti-Inflammatory and Anti-Microbial Effects of Garlic Extract in a Rat Model of Chronic Bacterial Prostatitis

PURPOSE: Garlic has anti-microbial and anti-inflammatory effects. We investigated its actions and preventive effects on chronic bacterial prostatitis (CBP) using a rat model. MATERIALS AND METHODS: Bacterial suspension was inserted into the prostatic urethra of 75 rats. Then 15 were grouped as garlic group, and 60 as control group. Garlic and saline were given to each group for 4 weeks, respectively. After partial resection of the prostate, microbiological culture and histological examination were done. The incidence of CBP was compared between two groups. To evaluate the anti-microbial and anti-inflammatory effect of garlic, the 41 rats proved as CBP models among the control group were divided into 4 groups randomly: I, control; II, garlic; III, ciprofloxacin; IV, garlic plus ciprofloxacin. After 3 weeks of treatment, microbiological cultures of urine, prostate and histological examination of prostate were done. RESULTS: In study of the preventive effects, 5 rats in garlic treatment group and 41 rats in control group were shown to be CBP models. In anti-microbial and anti-inflammatory evaluation, positive urine culture rate and prostate tissue show no significant difference among four groups, but bacterial growth in urine and prostate tissue were lower in groups II, III, and IV than group I. Bacterial growth was the slowest in prostate tissue of group IV. Histologic findings were more improved in groups II, III and IV than group I, with Group IV being the most improved. CONCLUSIONS: These results show that garlic has preventive and therapeutic effects on CBP. Combination treatment with antibiotics may be considered in the future.

Changes in Causative Organisms and Antibiotic Sensitivity in Intensive Care Unit-Acquired Urinary Tract Infection

PURPOSE: Patients in the intensive care unit (ICU) are usually at greater risk for acquiring urinary tract infection (UTI). Few studies have focused on UTI specifically acquired within the ICU. We retrospectively studied and compared the microbiology and antibiotic sensitivity of UTI in ICU-admitted patients between 2001 and 2008. MATERIALS AND METHODS: We reviewed the medical records of a total of 1,818 ICU patients who had undergone a urine culture exam in 2001 and 2008 in a single hospital. Changes in causative organisms and their antibiotic sensitivity between 2001 and 2008 were analyzed. RESULTS: The common pathogens in 2008 were Escherichia coli (20.3%), Pseudomonas (19.5%), Enterococcus (18.0%), Klebsiella (7.8%), coagulase-negative Staphylococcus (CNS) (4.3%), and Staphylococcus (4.3%). Pseudomonas species significantly increased in 2008 compared with 2001 (p=0.002). Gram-negative organisms showed relatively higher sensitivities to amikacin, imipenem, and Tazocin (72.1%, 76.2%, and 74.6%, respectively), whereas they showed relatively lower sensitivities to third-generation cephalosporins and ciprofloxacin (43% to 59%). Gram-positive organisms showed high sensitivities to teicoplanin and vancomycin (91.2% and 86.8%, respectively), whereas they showed low sensitivities to ampicillin and ciprofloxacin (25% and 26.5%, respectively). The antibiotic resistance of Pseudomonas species was nearly double that of E. coli. CONCLUSIONS: E. coli, Pseudomonas, and Enterococcus were the three most common organisms in ICU-acquired UTI in our study. In particular, Pseudomonas species were found to have increased significantly in recent years. Pseudomonas species had a significantly lower susceptibility to antibiotic sensitivity than did the other organisms.

Effect of Aging on Androgen, Penile Structure and Nitric-oxide Synthase in Rat / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to investigate the changes of serum testosterone, intracavernous pressure, expression of nitric-oxide synthase (NOS) and content of penile smooth muscle in aged rat. MATERIALS AND METHODS: Sprague Dawley rats were used for this study and divided into control and aging groups. Intracavernous pressure was measured by stimulating the cavernous nerve with 10volt, 2.4mA. Expression of NOS was measured by immunohistochemical staining for NADPH (nicotinamide adenine dinucleotide phosphate) diaphorase and the content of penile smooth muscle was measured by Masson's trichrome staining for corpus cavernosum. In each case the stained area-tissue ratio was calculated by computer scanning. RESULTS: Compared with the control group (3.34-0.25ng/ml), the serum testosterone level of the aged group (1.41-0.37ng/ml) was decreased significantly. Compared with the control group (106.7-13.2cmH2O), the intracavernosal pressure of the aged group (71.2-12.3cmH2O) was decreased significantly. Immunohistochemical staining for NOS showed that NADPH diaphorase was stained as brown nerve fiber. Compared with the control group (40.5-3.1%), NOS activity of the aged group (9.5-2.5%) was decreased significantly. On Masson's trichrome staining, the content of penile smooth muscle was 62.8 3.9% in the control group. Compared with the control group, the smooth muscle content of the aged group (35.2-2.4%) was decreased significantly. CONCLUSIONS: In conclusion, the factors involved in erectile function were decreased in aged rats.

Expandable Metallic Stent Placement for Nutcracker Syndrome / 대한비뇨기과학회지

Herein, a new left renal vein stenting procedure (expandable metallic stent placement), which provided relief for an 18-year-old man incapacitated by an intermittent gross hematuria, is reported. The placement of an expandable metallic stent is a minimally invasive therapy, and a simpler and more physiological therapy than previous approaches to Nutcracker syndrome.

Intrascrotal Extratesticular Epidermal Cyst / 대한비뇨기과학회지

An epidermal cyst, presenting as an intrascrotal tumor, with no relation to the testicles or cord structures, is a rare benign tumor. Their etiology is unknown, but the most widely accepted theory on the histogenesis of testicular epidermal cysts is that they are the end result of a monolayer teratoma arising from germ cells; however, an extratesticular epidermoid cyst is believed to be an abnormal closure of the median raphe and urethral groove. An extratesticular epidermal cyst is normally subcutaneous, and can be localized anywhere along the median raphe, from the distal penis to the anus. To our knowledge, there has been no case reported in the Korean literature. A case of an intrascrotal epidermal cyst is reported in a 44-year-old man.