A Testicular Tumor Incidentally Found after Trauma / 대한비뇨기과학회지

A testis tumor is comparatively rare and most of them are discovered as a palpable asymptomatic mass. We recently experienced two cases of incidental testicular tumor during scrotal exploration for trauma. Pathologic study revealed a mixed germ cell tumor and mature teratoma, so we report here on these two cases with a review of the related literatures.

A Testicular Tumor Incidentally Found after Trauma / 대한비뇨기과학회지

A testis tumor is comparatively rare and most of them are discovered as a palpable asymptomatic mass. We recently experienced two cases of incidental testicular tumor during scrotal exploration for trauma. Pathologic study revealed a mixed germ cell tumor and mature teratoma, so we report here on these two cases with a review of the related literatures.

The Therapeutic Effect of TUNA for the Treatment of BPH Based on Pressure-flow Studies / 대한비뇨기과학회지

PURPOSE: We investigated the effects of transurethral needle ablation (TUNA) in men with benign prostatic hyperplasia (BPH) using a pressure-flow study. MATERIALS AND METHODS: A total of 25 patients with symptomatic BPH, and an obstructive pattern on urodynamics, were treated with TUNA. We evaluated the patients before TUNA treatment using the International Prostate Symptom Score (IPSS), quality of life scores (QOL), uroflowmetry, postvoid residual volume (PVR) and pressure-flow studies, for a mean of 6 months following treatment. RESULTS: At 6 months after TUNA, the IPSS decreased from a mean of 22.69 to 7.65 (p<0.01). The QOL scores improved from a mean of 4.65 to 2.13 (p<0.01). The peak flow rate and PVR improved from a mean of 8.13ml/sec to 13.79ml/sec and 98.52ml to 39.52ml (p<0.01), respectively. A reduction in the mean detrusor pressure at maximum flow rate (67.21cmH2O to 47.43cmH2O, p<0.01) and the Abrams-Griffiths number (51.39 to 20.65, p<0.01) indicated that TUNA can significantly lower bladder pressure. With the exception of one patient, no patient complained of any severe side effects. CONCLUSIONS: In patients with BPH, TUNA resulted significant clinical improvements, with no major complications, and slightly decreased the bladder outlet obstruction. We suggest that TUNA is a safe and effective method for treating bladder outlet obstructions due to BPH, especially, in patients at high risk of operative morbidity and mortality, and for aged patients afraid of sexual dysfunction and retrograde ejaculation.

The Therapeutic Effect of TUNA for the Treatment of BPH Based on Pressure-flow Studies / 대한비뇨기과학회지

PURPOSE: We investigated the effects of transurethral needle ablation (TUNA) in men with benign prostatic hyperplasia (BPH) using a pressure-flow study. MATERIALS AND METHODS: A total of 25 patients with symptomatic BPH, and an obstructive pattern on urodynamics, were treated with TUNA. We evaluated the patients before TUNA treatment using the International Prostate Symptom Score (IPSS), quality of life scores (QOL), uroflowmetry, postvoid residual volume (PVR) and pressure-flow studies, for a mean of 6 months following treatment. RESULTS: At 6 months after TUNA, the IPSS decreased from a mean of 22.69 to 7.65 (p<0.01). The QOL scores improved from a mean of 4.65 to 2.13 (p<0.01). The peak flow rate and PVR improved from a mean of 8.13ml/sec to 13.79ml/sec and 98.52ml to 39.52ml (p<0.01), respectively. A reduction in the mean detrusor pressure at maximum flow rate (67.21cmH2O to 47.43cmH2O, p<0.01) and the Abrams-Griffiths number (51.39 to 20.65, p<0.01) indicated that TUNA can significantly lower bladder pressure. With the exception of one patient, no patient complained of any severe side effects. CONCLUSIONS: In patients with BPH, TUNA resulted significant clinical improvements, with no major complications, and slightly decreased the bladder outlet obstruction. We suggest that TUNA is a safe and effective method for treating bladder outlet obstructions due to BPH, especially, in patients at high risk of operative morbidity and mortality, and for aged patients afraid of sexual dysfunction and retrograde ejaculation.

Distribution of HIV-1 Subtypes by Transmission Routes in Korea / 감염

BACKGROUND: Previous data have been reported that subtype B is prevalent in South Korea, but neither the extent nor the proportion of subtypes could be evaluated. This study was designed to analyze the distribution of HIV-1 subtypes, temporal instructions and transmission dynamics between epidemiological groups. METHODS: 1,280 Koreans had been diagnosed as HIV seropositive during the period 1985 to 2000. Among them, 134 individuals were selected for this molecular epidemiological study. 134 DNAs were isolated from uncultured or cultured peripheral blood mononuclear cells. V3-V5 (0.7 kb) fragment of HIV-1 env gene was amplified by nested polymerase chain reaction and was sequenced. RESULTS: HIV-1 isolates from thirty-seven homosexuals were all subtype B (100%). On the other hand, 66 isolates from 94 heterosexuals were subtype B (70%) and 28 were non B subtypes (30%:13 A, 4 C, 2 D, 8 E, 1 G). Only subtype B strains were isolated from 73 males who were infected with HIV inside Korea while 16 B and 20 non B subtype strains were isolated from 36 males who were HIV infected outside of Korea. However, B and non B strains were isolated half and half from females who were infected inside Korea except one. CONCLUSION: The HIV-1 subtype B strains are prevalent in Korea from the early HIV infection until present in both homo and heterosexuals. Non B strains have been transmitted from men who were infected outside Korea to their spouses and casual partners. So, we need further study to monitor subtype B and non B HIV transmission in epidemiological groups of Korea.

Immunologic Characterization of Newly Found Koreans as HIV Seropositives by the Year / 감염

BACKGROUND: Although HIV is introduced relatively late into Asia, the amount of HIV-positive population has been continuously growing in this area. UNAIDS/WHO estimate that 6.5 million people are living with HIV in the Asia/Pacific region at the end of 1999. To expect the HIV/AIDS epidemic in the 21st century in Korea, it is necessary to monitor the changes of the number of newly found HIV-infected individuals and their immune status by year including their epidemiological data. METHODS: We have selected 591 HIV-infected individuals whose first CD4 count was checked within 6 months from the time of diagnosis of HIV infection from 1990 to 1999. For the measurement of CD4+T and CD8+T cells, blood samples of HIV-1 infected individuals were collected into three potassium ethylene diamine tetra-acetic acid (K3EDTA)-treated tubes and stained within at least 24 hours after drawing and analysed by flow cytometer (FACStar or FACScount). The immune status were classified into 4 groups as follows: group I (> or =500 CD4+T cells/mm3), group II (201~499 CD4+T cells/mm3), group III (51~200 CD4+T cells/mm3), and group IV (< or =50 CD4+T cells/mm3). RESULTS: The mean of number of CD4+T cells of HIV-infected individuals at the time of HIV diagnosis was 677 cells/mm3 and the percentage of CD4+T cells was 22.5% in 1990~1991 but 350 cells/mm3 and 14.7% in 1999, respectively. The number of newly found HIV-infected individuals belong to Group III increased rapidly from 1997 to 1999. Also, the proportion of newly found HIV-infected individuals having the CD4+T cell counts of < or =50 cells/mm3 increased slowly by the time of diagnosis of HIV infection. The proportion of newly found HIV-infected individuals who were found in general hospitals increased during the second half of the 1990s. CONCLUSION: These results show that not only the number of newly found HIV-infected individuals has increased annually but also their immune status at the time of HIV diagnosis have been more depressed by the year. Therefore, we should enforce education for prevention of HIV/AIDS about general population as well as high risk groups.

Anterior Vaginal Wall Sling Operation with Bone Fixation using Self-made Titanium Screw for Stress Urinary Incontinence Associated with Intrinsic Sphincter Deficiency / 대한비뇨기과학회지

PURPOSE: Anterior vaginal wall sling operation (by Raz`s method )for the treatment of stress urinary incontinence(SUI) associated with intrinsic sphincter dysfunction(ISD) may produce postoperative suprapubic discomfort and suture related problem such as pull-through and loosening. Stabilization of the bladder neck to the pubic bone decreases the tension placed on the anterior rectus fascia and lessens the possibility of suture-related pain and the risk of entrapment of ilioinguinal neve branches. At present, bone anchoring system is available in Korea but its cost sometimes limit the use of the kit. Therfore, we developed self-made titanium screw which is anchored to pubic bone at the time of anterior vaginal wall sling operation and acquired good short-term results. MATERIALS AND METHODS: Total 16 women who had SUI with ISD were treated by in-situ anterior vaginal wall sling using self-made titanium screw anchored to pubic bone to support the bladder neck and midurethra. Postoperative results were analyzed for 16 patients who has been followed up for more than 3 months after surgery. RESULTS: Overall cure rate was 100% at 3 months of follow-up. Complication included anemia in 2 patients, mild dysuria in 2 patients and osteitis pubis in 1 patient. After resting and antibiotic therapy, complications were subsided. CONCLUSIONS: In short term follow-up, anterior vaginal wall sling using self-made titanium screw was shown to be very effective treatment of SUI with ISD with simple technique and had relatively low cost, low complication rates. Long-term followup will be necessary to define the efficacy of this method.

Development of Osteoporosis after Hormonal Treatment for Prostate Cancer Patient / 대한비뇨기과학회지

PURPOSE: Combined androgen blockade(CAB) is often used in the management of advanced adenocarcinoma of the prostate. Recent case reports indicated that hypogonadism from CAB therapy is associated with osteoporosis and related fracture. The effect of CAB on bone mineral density(BMD) has not been adequately studied in men with prostate cancer. In this study, the possibility, frequency and severity of osteoporosis following CAB in prostate cancer patient was investigated. MATERIALS AND METHODS: A total of 19 men with advanced prostate cancer receiving CAB were evaluated for the presence of osteoporosis defined as bone mass 2.5 standard deviation below peak bone mass of young normal men(T-score). The BMB of the femoral neck and lumbar spine were measured. The BMD was then compared to the age-matched control value and reported as the Z-score. BMD measurements were compared to duration of CAB and Gleason score. RESULTS: Osteoporosis occurred in 10 of 15 patients in lumbar spine, and 4 of 18 patients in femoral neck. Osteoporosis was unrelated to the type of the CAB(orchiectomy, or LHRH-agonist). CAB caused a decrease in mean BMD of lumbar spine and femoral neck. There is a negative linear relation between mean BMD and duration of CAB(lumber spine; R2=0.059, Y=-2.368-0.016X, p>0.05, femoral neck; R2=0.089, Y=-1.923-0.020x, p>0.05). There is a statistically significant negative linear relationship between Gleason score and mean T-score of femoral neck(lumbar spine; R2=0.391, Y=-0.08-0.371X, p<0.05, femoral neck; R2=0.517, Y=0.855-0.450x, p<0.005). CONCLUSIONS: Our study provide evidence for acceleration of osteoporosis among men whose prostate cancers were treated with CAB. This study indicates a need for bone mineral density determination at the onset of CAB and at periodic intervals there after to begin appropriate therapy, undefined at this point, for prevention of osteoporosis and its complications aggravated by this therapy.

Clinical Characteristics of Incidentally Detected Renal Cell Carcinoma / 대한비뇨기과학회지

In recent years, with the increasing use of ultrasonography and computed tomography (CT), a large number of renal cell carcinoma has been founded incidentally for a variety of occasions. We reviewed 107 cases of renal cell carcinoma treated surgically from 1988 to 1995, and compared symptomatically suspected group (62 cases) to incidentally detected group (45 cases). The groups were compared according to stage, grade, tumor size, age, sex, laterality and survival rate. The chief imaging methods of detection were ultrasonography (80%), IVP (11%), CT (9%). The main reasons for examination leading to the diagnosis in incidentally detected group were follow-up of other diseases (58%), general health check (31%), and follow-up of unrelated symptoms (11%). The frequency of incidentally detected renal cell carcinoma was increased from 29% (1988-1991) to 48% (1992-1995). The tumor stage and grade were lower in incidentally detected group than suspected group, and tumor size was smaller in incidentally detected group. The 2-year disease free survival rate in incidentally detected group tended to be better (95% vs 68%). So screening test with ultrasonography to detect renal cell carcinoma at an early stage, may be essential.