Seasonal Variation of Overactive Bladder Symptoms in Female Patients / 대한배뇨장애요실금학회지

PURPOSE: To evaluate seasonal variations of overactive bladder (OAB) symptoms in women who visited hospital clinics.METHODS: Medical records of female patients treated for OAB symptoms from January 2011 to December 2017 were retrospectively reviewed. Patients with pyuria at the first visit, those who did not complete the questionnaire, and those with <3 overactive bladder symptom scores (OABSS) were excluded. Uroflowmetric parameters, 3-day micturition diary, and OABSS were analyzed.RESULTS: A total of 582 patients with OAB symptoms who visited the hospital were enrolled in this study. Patients were grouped into 1 of the 3 season groups (cold, intermediate, and hot) depending on the average temperature of the month that the patient first visited the urologic department outpatient clinic. The total OABSS was significantly different between the 3 season groups (cold [7.25±3.20] vs. intermediate [6.24±3.40] vs. hot [5.51±3.20], P=0.001). The proportion of patients who had moderate OAB symptoms (6≤OABSS) was higher in the cold season group (56.2%) than in the other season groups (intermediate, 42.1%; hot, 31.8%; P=0.002). Differences in the number of micturitions (12.12±4.56 vs. 10.95±4.39, P=0.021) and number of urgent urinary incontinence episodes (2.06±0.94 vs. 2.48±0.87, P=0.001) between the cold and hot season groups were also significant. However, differences in the nocturia episode, total daytime voided volume, and mean voided volume between season groups were not significant.CONCLUSIONS: Different urinary symptoms and uroflowmetric parameters were correlated with seasonal variation. OAB symptoms might be worse in cold season than in other seasons.

Differences in Urodynamic Parameters According to the Presence of a Hunner Lesion in Women With Interstitial Cystitis/Bladder Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Differences in the severity of subjective symptoms have been noted depending on whether a Hunner lesion is present in women with interstitial cystitis/bladder pain syndrome (IC/BPS). In this study, we aimed to identify differences in objective urodynamic parameters in women with IC/BPS according to the presence of a Hunner lesion. METHODS: This cross-sectional study included a total of 55 patients with IC/BPS. IC/BPS and the presence of a Hunner lesion on cystoscopy were diagnosed according to American Urological Association guidelines. The patients were categorized into a Hunner IC/BPS group and a non-Hunner IC/BPS group according to the presence of a Hunner lesion on cystoscopy. At the initial visit, a medical history was taken from all patients with IC/BPS, and they underwent symptom assessment using a 3-day voiding diary and laboratory tests. A urodynamic study was then performed before any treatment was performed. Baseline characteristics and urodynamic parameters were compared between the 2 groups. RESULTS: Of the 55 patients, 23 (41.8%) had a Hunner lesion on cystoscopy. As documented in the voiding diaries, the Hunner IC/BPS group had more frequent voids and a smaller maximal voided volume (P=0.045, P < 0.001, respectively). Regarding urodynamic parameters, the mean volume at the first desire to void, normal desire to void, strong desire to void (SDV), and maximum cystometric bladder capacity (MBC) was significantly lower in the Hunner IC/BPS group (P=0.001, P=0.004, P < 0.001, and P < 0.001, respectively). On receiver operating characteristic curve analysis, patients with an SDV≤210 mL (area under the curve [AUC]=0.838, P < 0.001) and an MBC≤234 mL (AUC=0.857, P < 0.001) were likely to be in the Hunner IC/BPS group. CONCLUSIONS: The differences in patients’ subjective symptoms between the Hunner IC/BPS and non-Hunner IC/BPS groups were confirmed to correspond to differences in objective urodynamic parameters.

The Efficacy of Medical Treatment of Peyronie's Disease: Potassium Para-Aminobenzoate Monotherapy vs. Combination Therapy with Tamoxifen, L-Carnitine, and Phosphodiesterase Type 5 Inhibitor

PURPOSE: This study was designed to evaluate the efficacy of medical treatment of Peyronie's disease. MATERIALS AND METHODS: A total of 109 patients with Peyronie's disease who had been treated from January 2011 to December 2014 were retrospectively reviewed in this study. Forty-four patients (Group 1) were treated with 12 mg of potassium para-aminobenzoate daily. Sixty-five patients (Group 2) were treated with combination therapy: tamoxifen (20 mg) and acetyl-L-carnitine (300 mg) twice daily in addition to a phosphodiesterase type 5 inhibitor. Ability to perform sexual intercourse, pain during erection, size of plaque, and penile curvature angle were assessed. RESULTS: In Group 1, 30 of 44 patients (68.2%) discontinued treatment within 12 weeks, while 5 patients (7.7%) in Group 2 discontinued treatment. Pain during erection and plaque size were improved in both groups but showed no statistical difference due to the high dropout rate in Group 1. In both groups, penile curvature was improved, but demonstrated no statistical difference between the treatment groups. However, combination therapy demonstrated a better response rate in patients whose penile curvature angle was less than 30° (44.4% vs. 79.1%, p=0.048). The rate of successful sexual intercourse was significantly higher in Group 2 (42.8% vs. 78.3%, p=0.034). The number of patients who underwent surgical correction despite medical treatment was significantly higher in Group 1 (35.7% vs. 13.3%, p=0.048). CONCLUSIONS: Early medical combination therapy in Peyronie's disease may present better results in patients whose curvature angle is less than 30°.

Prostate-Specific Antigen Mass and Free Prostate-Specific Antigen Mass for Predicting the Prostate Volume of Korean Men With Biopsy-Proven Benign Prostatic Hyperplasia

PURPOSE: It has been reported that prostate-specific antigen (PSA) correlates with prostate volume. Recently, some studies have reported that PSA mass (PSA adjusted for plasma volume) is more accurate than PSA at predicting prostate volume. In this study, we analyzed the accuracy of PSA and the related parameters of PSA mass, free PSA (fPSA), and fPSA mass in predicting prostate volume. MATERIALS AND METHODS: We retrospectively investigated 658 patients who underwent prostate biopsy from 2006 to 2012 and had a confirmed negative biopsy result. International Prostate Symptom Score (IPSS) questionnaire, PSA, fPSA, and prostate volume were investigated. PSA mass and fPSA mass were calculated by use of established formulas. The association between PSA-related parameters and IPSS and prostate volume was assessed by using Pearson correlation coefficient and receiver operating characteristic curves. RESULTS: There was no significant difference between PSA and PSA mass, fPSA, or fPSA mass in predicting prostate volume except in obese patients (p-value of PSA-PSA mass for 40 cm3, 0.54; p-value of fPSA-fPSA mass for 40 cm3, 0.34). fPSA performed significantly better than PSA at predicting prostate volume (p-value for 40 cm3, <0.001). IPSS and the aforementioned PSA-related parameters were not significantly correlated. CONCLUSIONS: PSA mass was not a better predictive value than PSA for estimating the prostate volume in Korean men except in obese men. This finding was also applicable to the relationship of fPSA and fPSA mass, which appeared to be more accurate predictors of prostate volume than either PSA or PSA mass.

Treatment Options of Metastatic Brain Tumors from Hepatocellular Carcinoma: Surgical Resection vs. Gamma Knife Radiosurgery vs. Whole Brain Radiation Therapy

OBJECTIVE: Although metastasis of hepatocellular carcinoma to the brain is uncommon, it is associated with a very high mortality rate and most patients usually expire within 1 year after brain metastasis. The aim of this study is to identify the effectiveness of the active interventions such as gamma knife radiosurgery or surgical intervention for these patients. METHODS: We retrospectively reviewed the medical records and imaging data of 59 patients with metastatic brain tumors from hepatocellular carcinoma from May 2004 to September 2012. The study included patients with available clinical and radiological data who had been diagnosed with metastatic hepatocellular carcinoma of the brain, confirmed by magnetic resonance imaging. The overall survival time was analyzed and compared according to each risk factor. RESULTS: The mean age at diagnosis of metastatic brain tumor was 52.2 years (14-77). The mean follow-up duration was 13.3 weeks (0.1-117.6). Overall median survival was 4.3 weeks (95% confidence interval, 2.2-6.4). The results from an analysis of clinical factors related to survival revealed that treatment modalities were significantly related to the patient's survival (log rank, p=0.006). Twenty patients (32.8%) experienced tumor bleeding, and the survival time of the patients with tumor bleeding tended to be shorter, although the result was not statistically significant (log rank, p=0.058). Hepatic reserve, by Child-Pugh classification, was grade A in 38 patients (64.4%), grade B in 16 patients (27.1%), and grade C in 5 patients (8.5%), and was significantly related to the patient's survival (log rank, p=0.000). CONCLUSION: Although patients with metastatic brain tumors from hepatocellular carcinoma showed poor survival, active intervention including surgical resection or gamma knife radiosurgery may result in better survival, especially if patients have preserved liver function.

Temporal Hollowing Augmentation with Titanium Mesh after Autologous Cranioplasty in Temporal Muscle Resected Case: A Case Report / 대한신경손상학회지

Temporal fossa hollowing can represent a serious cosmetic concern to patients after post-traumatic surgery, oncological resection, or surgical dissection for obtaining access to the temporal area. Various methods have been described to augment temporal fossa hollowing, such as use of autogenous bone and cartilage implants, high-density polyethylene implants, and dermal fat grafts. We report a case of 22-year-old man with temporal fossa hollowing after post-traumatic surgery, including temporal muscle resection, whose defect was augmented by using titanium mesh even though long after cranioplasty.

Temporal Hollowing Augmentation with Titanium Mesh after Autologous Cranioplasty in Temporal Muscle Resected Case: A Case Report / 대한신경손상학회지

Temporal fossa hollowing can represent a serious cosmetic concern to patients after post-traumatic surgery, oncological resection, or surgical dissection for obtaining access to the temporal area. Various methods have been described to augment temporal fossa hollowing, such as use of autogenous bone and cartilage implants, high-density polyethylene implants, and dermal fat grafts. We report a case of 22-year-old man with temporal fossa hollowing after post-traumatic surgery, including temporal muscle resection, whose defect was augmented by using titanium mesh even though long after cranioplasty.

Chuna therapy for musculoskeletal pain: a systematic review of randomized clinical trials in Korean literature / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of Chuna for the treatment of musculoskeletal pain as reported in Korean literature.</p><p><b>METHODS</b>We conducted an electronic literature search using seven Korean databases and manually searched six traditional Korean medicine journals. Risk of bias was assessed with the Cochrane criteria.</p><p><b>RESULTS</b>Six randomized controlled trials (RCTs) were included in the study. Compared with standard care, three RCTs suggested favorable effects of Chuna on neck pain due to a hypolordotic cervical spine, low back pain caused by traffic accidents, and low back pain. In contrast, compared with standard care, three RCTs failed to show positive effects on temporomandibular joint disorder, mandibular movement, and neck pain caused by traffic accidents.</p><p><b>CONCLUSIONS</b>Currently, the evidence of the effectiveness of Chuna for the treatment of musculoskeletal pain is not convincing. Further rigorously designed trials are warranted to determine its effectiveness.</p>

Progression of Peyronie's Disease during Tamoxifen Treatment / 대한남성과학회지

PURPOSE: Medical treatment of Peyronie's disease with tamoxifen has been initially proposed as acting upon the early phase of the disease. As recent reports show no significant benefit of tamoxifen, we review the long term results of tamoxifen treatment of Peyronie's disease. MATERIALS AND METHODS: Time to progression during tamoxifen treatment of patients showing acute disease and chronic disease was compared. The acute phase was identified by pain during erection. Progression was defined as enlargement of plaque size or appearance of calcification. RESULTS: The average treatment duration was 15.9+/-13.8 months (range: 3 to 48 months). The median time to progression was 7 months for acute patients and 20 months for chronic patients. Eighty percent of patients in the acute phase showed relief of pain; however, overall progression was 72.1% (78.0% for acute, 66.7% for chronic). Patient history, comorbidities, serum testosterone or initial plaque characteristics, and severity of curvature were not predictive of disease progression. CONCLUSIONS: Tamoxifen showed no significant benefit in slowing the progression of Peyronie's disease in the acute phase over the chronic phase. Peyronie's disease continued to progress, though at a dampened rate for patient's in the chronic phase.

Testicular Seminoma Incidentally Detected by Spermatic Cord Torsion / 대한남성과학회지

We recently encountered a very rare case of torsion of an intrascrotal testicular tumor in a 26-year-old male. Unlike the intra-abdominal undescended testis, intrascrotal spermatic cord torsion associated with a testicular tumor has rarely been reported. We write to report a case of intrascrotal spermatic cord torsion accompanied by a testicular tumor that had been overlooked preoperatively.

Effect of PDE5 Inhibitor in Nonsurgical Management of Peyronie's Disease: Preliminary Study / 대한남성과학회지

PURPOSE: This study was designed to evaluate the role of PDE5 inhibitors as combination therapy with conventional treatment of Peyronie's disease (PD). MATERIALS AND METHODS: From July 2007 to October 2010, 35 Patients were divided into two groups. Group I (N=14) received PDE5 inhibitors in addition to conventional treatment with tamoxifen and acetyl L-carnitine, while group II (N=21) received only conventional treatment. The follow-up duration was at least 12 weeks after the active therapy of PD. Outcomes were assessed by pain relief, successful attempts for sexual intercourse, resolution of the plaque and any occurring complications. RESULTS: In the efficacy of overall treatment of 35 patients, 94.3% patients experienced successful sexual intercourse, while 5.7% experienced pain on erection, and 25.7% showed a decrease in plaque size. The analysis of parameters before treatment showed no significant difference between groups in terms of successful attempt at sexual intercourse (p=0.583) and pain on erection (p=0.445). Furthermore, there was no difference between groups after treatment in terms of successful attempts at sexual intercourse (p=0.766), pain on erection (p=0.766) and change in plaque size (p=0.445). However, successful intercourse and pain relief after treatment showed significant change irrespective of groups (p<0.05). While the addition of a PDE5 inhibitor did not show any significant improvement in clinical outcome measures, the satisfaction of patient was higher in patients who received combination treatment (p=0.042). CONCLUSIONS: Although the effect of PDE5 inhibitor for pain relief, successful intercourse and resolution of plaque size was not significant, patients who received PDE5 inhibitors had a more satisfaction of treatment of PD. Further prospective studies on the effect of PDE5 inhibitor in PD will be needed.

Effect of Potassium Aminobezoate in Oral Therapy for Peyronie's Disease: Preliminary Study / 대한남성과학회지

PURPOSE: To evaluate the effect and improvement of potassium aminobenzoate (500 mg Peyron capsule) in oral therapy for Peyronie's disease. MATERIALS AND METHODS: From February 2011 to September 2011, 31 patients with Peyronie's disease received potassium aminobezoate (500 mg Peyron capsules) and were divided into two groups. Group 1 (N=10) received potassium aminobezoate (500 mg Peyron capsule) 3 g four times daily without previous treatment of Peyronie's disease, while group 2 (N=21) received the same drug with previous treatment of Peyronie's disease (10 mg Tamoxifen +300 mg L-carnitine two times daily). Outcomes were assessed by subjective symptom change, pain relief, resolutions of the plaque, and curvature. RESULTS: After 3 months, there were no significant improvements in clinical outcomes of either group and among all the patients, 23 stopped taking potassium aminobezoate (23/31, 74%). The reasons for ceasing the therapy were gastrointestinal trouble (8/23, 35%), too many doses to take (7/23, 30%), ineffectiveness (6/23, 26%), and high price (2/23, 9%). CONCLUSIONS: Athough the etiology of Peyronie's disease has not been elucidated, potassium aminobenzoate in therapy of Peyronie's disease has been used. The use of this medication has the limitations of gastrointestinal trouble, ineffectiveness, too many doses, and high price. Further evaluations of the effect and appropriate dosing of potassium aminobenzoate are needed.

Oral Testosterone Undecanoate Versus Transdermal Testosterone Gel for the Treatment of Testosterone Deficiency Syndrome: A Retrospective Comparative Study / 대한남성과학회지

PURPOSE: Oral testosterone undecanoate and transdermal testosterone gel are the testosterone formulas widely prescribed as hormonal replacement for tesosterone deficiency syndrome (TDS) in male patients. We evaluated the changes in serum testosterone level and the effects of these medicines. MATERIALS AND METHODS: The medical records of 162 patients who were diagnosed with TDS based on serum testosterone (0.05). The initial and final testosterone levels of the two groups were not significantly different. However, the peak level during treatment was significantly higher in group II (p<0.05). The maximal increment of testosterone level was also significantly higher in group II. Initially, group II reached its peak testosterone level earlier than group I. The final serum levels were not significantly different after adjustment of dosages in group I. Testosterone replacement significantly decreased the AMS scales in both groups. CONCLUSIONS: Both oral testosterone undecanoate and transdermal testosterone gel improved the serum testosterone level and symptom score for those with TDS. Transdermal testosterone gel may reach the peak serum testosterone level faster than oral testosterone undecanoate. Large prospective studies are required to assess the precise role of testosterone replacement therapy.

A Case of Small Cell Carcinoma in the Stomach / 대한소화기내시경학회지

Primary extrapulmonary small cell carcinoma(SCC) is appearing with increased frequency in the literature. These tumors have been described in the esophagus, stomach, pancreas, larynx, hypopharynx, salivary gland, nasal cavity & paranasal sinus, thymus, small & large bowel, uterine cervix, endometrium, breast, prostate, urinary bladder and skin. Small cell carcinoma of the stomach is extremely rare and a total 9 cases have been reported in the English literature. Like SCC in the lung, SCC in the alimentary tract has a aggresive behavior and prognosis of the patient is poor. We are reported a case of advanced gastric cancer diagnosed as small cell type by endoscopic biopsy. Grossly, the lesion of small cell carcinoma of the stomach, located in the upper body and gastric angle, is ulcerated with irregular margin and dirty surface covered with blodd clots and exudates.

A Case of Autonomously Functioning Thyroid Nodule Treated with Percutaneous / 대한내분비학회지

Autonomously functioning thyroid nodules(AFTNs) are so named because they presumably are independent of TSH for growth and function. In general, surgery and radioactive iodine are effective therapies but reluctant to use because of complications such as hypothyroidism or cosmetic problems.Percutaneous ethanol injection therapy(PEIT) under sonographic guidance has recently been introduced as alternative therapy. But its adverse effects such as severe local pain, subcutaneous hematoma or palsy of the recurrent nerve are not negligible, therefore sufficient skill is required.In this case, the levothyroxine therapy in reducing the size of colloid thyroid nodules was not apparent within three months. Therefore we selected another sclerosing therapeutic method such as percutaneous tetracycline injection(PTI) and followed up thyroid function test, thyroid scan, ultrasonographical size and volume of nodule. The results were as follows: 1) With 0.5-0.8 cc tetracycline injection for three times, the volume of nodule was reduced after PTI; About 2.3 X 1.7 X 0.7 cm sized nodule was reduced to about 1.3 X 1.0 X 0.5 cm sized nodule. 2) There were significant improvements of TFT(subclinical hyperthyroidism to euthyroidism) and thyroid scan(solitary hot nodule to completely ablated AFTN) during 9 months follow-up after PTI as compared with the base line study. In conclusion, we experienced good results in a 22-year-old woman suffered from AFTN treated with PTI and think that PTI could be the effective, safe, simple, well tolerable procedure in the treatment of AFTN.

VEP in Normal Eyes by Using Different Check-sizes

VEP is a gross electrical signal generated by the occipital region of the cortex in response to visual stimuli and it is useful in refraction, optic nerve disease, color blindness, amblyopia, field defect, macular disease, etc. We used Horizon computer with UTAS-E and normal VEP at different checksize was measured on 30 subjects(60 eyes) with visual acuity better than 1.0. The pattern reversal frequency was 2 Hz., analysis time was 250 msec., artifact reject threshold was 75 micro V., low-pass filter cut-off was 30Hz., high-pass filter cut-off was 1Hz. The check sizes used were 16 X 16(50min), 32 X 32(25min) and 64 X 64(12.5min). The results were as follows; 1. 16 X 16 (50min). amplitude: 8.18 +/- 3.55 micro V., latency: 106.78 +/- 4.28 msec. 2. 32 X 32(25min). amplitude: 8.48 +/- 5.99 micro V., latency: 106.68 +/- 3.82 msec. 3. 64 X 64(12.5min). amplitude: 7.79 +/- 3.68 micro V., latency: 109.73 +/- 5.15 msec. 4. The change of latency between 32 X 32 and 64 X 64 check-size was statistically significant(p0.05). 6. The latency was most increased in 64 X 64(12.5min.) check-size and it was statistically significant(p<0.001).

Three Cases of the Posterior Lenticonus

Posterior lenticonus is a circumscribed round or oval bulge of posterior lens capsule and cortex. About 100 cases have been reported since the first clinical description given in 1888 by Meyer. Most cases in the literature were unilateral and were not usually associated with other congenital anomaly. The authors have recently experienced a case of bilateral posterior lenticonus with left keratoconus in a 21 year-old male patient and two cases of characteristic posterior lenticonus not associated with other ocular anomalies in 22 year-old male patients.

A Case of Bilateral Macular Hole Caused by High-Tension Electric Current

A twenty-three year old korean officer was exposed accidentally to high-tension electric current(22,900 voltage). He lost consciousness for about three days. The point of entry was the palm area of the right hand and the point of exit was the lateral area of the right thigh. He sustained second and third degree burn on the exposed area and face, neck, anterior chest, abdomen, right thigh. He subsequently developed yellow-gray foveolar lesion and macular hole, cataract, and iritis with central visual-loss in both eyes. Fluorescein angiography demonstrated the area of retinal pigment epithelial disruption. We suspected that it was electric current induced full-thickness macular hole, not photochemical macular hole, because his companion did not seeing a bright flash light and successively central visual loss.