Middle aortic syndrome diagnosed at 51 years of age / 대한내과학회지

A 51-year old woman was admitted to our hospital because of Exertional dyspnea, Palpitation, Headache, upper-limb hypertension, and lower-limb claudication. A loud systolic bruit was audible along Lt. carotid artery. Upper limb hypertension was responsed to drug moderately (included ACEI, alpha, beta-blocker, Ca++-channel blocker), but claudication of lower limb was aggravated, also on exertion, Blood Pressure of upper-limb was elevated to 180 mmHg. So, chest CT and Aortogram was performed, we confirmed long segmental stenosis from thorasic Aorta to the renal a. bifurcation level. Finally, We performed after axillo-femoral bypass surgery. After surgery, upper limb hypertension and lower limb claudication was improved.

Clinical Experience of Hydrodistension in Men Diagnosed as Prostatodynia / 대한비뇨기과학회지

PURPOSE: This study was designed to investigate that men with prostatodynia have petechiae in the bladder and improvement of symptoms after hydrodistension. MATERIALS AND METHODS: A total of 14 men with the diagnosis of prostatodynia underwent cystoscopy and hydrodistension under a general or regional anesthetic. Their charts were retrospectively reviewed. RESULTS: Of the 14 men 5(36%) had moderate to severe petechiae similar in appearance to women with interstitial cystitis after hydrodistension. Men with moderate to severe bladder petechiae had fewer leukocytes in expressed prostatic secretions and smaller bladder capacities than men with more normal appearing bladders after hydrodistension. Symptomatic improvement 2 to 6 weeks after hydrodistension was more common in men with moderate to severe petechiae than in those with fewer petechiae. CONCLUSIONS: We suggest that bladder petechiae after hydrodistension may be a diagnostic finding in men with prostatodynia as well as women with interstitial cystitis. Therefore, the diagnosis of interstitial cystitis should be considered in patients with prostatodynia.

Timing of Penile Color Flow Duplex Ultrasonography Using a PGE1 / 대한비뇨기과학회지

Duplex ultrasonography (USG) is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. Between August 1994 and May 1996, 24 normal males (control group) and 45 impotent patients (impotence group) underwent penile doppler sonography, and their records were reviewed. Scans were performed at 1, 3, 5, 10, 15, 20 and 30 minutes after intracavernous injection of PGE1 (10 pg) in all subjects. Any subject not having a full erection at 15 minutes performed private self-stimulation for at least 5 minutes before the 30 minute scan. If we define normal arterial inflow as a peak systolic velocity (PSV) of 30 cm. per second or greater in the best artery, 46% of control group and 55% of impotence group achieved this velocity until 5 minutes. One (4%) of control group and three (6%) of impotence group achieved maximum velocity at 1 or 3 minutes but continually PSV of 30 cm. per second or greater after 5 minutes, so any subject may not have had an incorrect diagnosis. When we calculated maximum velocity in the best artery in relation to percentage tumescence, maximum velocity were recorded most often at 10% tumescence (46% of control group and 51% of impotence group). If we define normal arterial inflow as PSV of 30 cm. per second or greater in best artery, the cumulative percentage of patients who achieved this velocity at 1, 3, 5, 10, 15, 20 and 30 minutes were 4, 34, 46, 88, 96, 96 and 100% in control group and 6, 28, 55, 90, 92, 94 and 96% in impotence group. In conclusion, we support delaying the initial scan until 5 minutes, performing the additional scans until 30 minutes and self-stimulation when necessary. We believe all efforts should be made to have studies performed in the setting of least anxiety to the patient.

A Case of Papillary Type of Renal Cell Carcinoma after Renal Injury in a Child / 대한비뇨기과학회지

Renal cell carcinoma is an uncommon tumor in children and only 3-5 percent of the renal cell carcinoma occur under age of twenty. Interestingly, some of the patients had a history of trauma occurring shortly before the onset of symptom calling attention to the tumor. In histology of renal cell carcinoma, clear cell type is most common and papillary type is 10-15 percent. The papillary type of renal cell carcinoma is characterized by better prognosis than non-papillary types. We report a case of papillary type of renal cell carcinoma which was detected incidentally after trauma in 13-year-old male patient.

A Case of Lymphangioleiomyomatosis Looked Like Miliary Tuberculosis / 결핵

We experienced one case of pulmonary lymphangioleiomyomatosis in 26-year-old female patient. She had taken antituberculous medication under the impression of miliary tuberculosis on simple chest X-ray at peripartum period. On outpatient follow-up she complained of progressive exertional dyspnea in spite of medication. Through careful history taking and physical examination, high resolutional CT, and open lung biopsy she was diagnosed as pulmonary lymphangioleiomyomatosis combined with incomplete type of tuberous sclerosis. So, we presented the case with the brief review the literatures.

The Effect of Pleurodesis with Doxycycline in the Rabbit / 결핵

BACKGROUND: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. METHOD: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were divided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. RESULTS: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. CONCLUSION: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.