A New Formula for Optimal Pediatric Endotracheal Tube Depth by Magnetic Resonance Imaging: Limited Study

PURPOSE: The aim of this study is to propose a new, simplified formula using an upper incisor-sternal notch (UI-SN) to predict the airway length of optimal positioning of the endotracheal tube via a midsagittal magnetic resonance imaging (MRI) in pediatric patients. METHODS: Between August 2000 and September 2014, a total of 56 pediatric patients (under 8 years old) who underwent MRI for C-spine or whole spine were included for analysis. Variables, such as curved airway length from upper incisor to carina (UI-C), straight length from upper incisor to sternal notch (UI-SN), and from the clivus to sternal notch (C-SN), were measured. Linear regression was used to analyze the relationship among these variables. RESULTS: The average age was 3.5±2.6, and there were 30 (53.6%) males. The mean airway length for UI-C and UI-SN was 16.0±2.8 and 8.8±2.1 cm, respectively. There was a close linear correlation between UI-C and UI-SN (p<0.001). By linear regression, a formula was obtained as UI-C (cm)=1.26×UI-SN (cm)+5.0 (R²=0.873). CONCLUSION: The airway length from the upper incisor to the carina with the head placed in neutral position can be well predicted by a straight length from the upper incisor to the sternal notch. The proposed simplified formula (UI-C=1.26×UI-SN+5, cm) can provide good guidance in determining the optimal positioning of endotracheal tube in pediatric patients.

Hemodynamic Change and Hypoxic Inducible Factor-1alpha and Inducible Nitric Oxide Synthase Expression of Ipsilateral Kidney during Acute Stage of Ureteropelvic Junction Obstruction in Adult Rat / 대한비뇨기과학회지

Purpose: This study aimed to evaluate the expression of inducible nitric oxide synthase (iNOS) and hypoxic inducible factor-1alpha (HIF-1alpha) and the hemodynamic changes in the renal medulla and cortex, during the acute stages of an unilateral ureteropelvic junction obstruction (UPJO) in adult rats. Materials and Methods: Kidney specimens were aseptically removed from 35 Sprague- Dawley 8 week old adult rats, weighing 250-300gm, from a sham groups, 0, 6, 12 and 24 hours, and an experimental groups (UPJO 6, 12 and 24 hours). The renal blood flow of the ipsilateral kidney was measured at the left main renal artery using a laser flowmeter. The expressions of HIF-1alpha and iNOS, for the hypoxic changes to the ipsilateral kidney, were evaluated by immunohistochemical staining and a Western blot assay. Results: There were no significant differences in the blood flows of the main renal arteries immediately prior to the operations in any of the groups. However, there was a significant difference in the blood flows between the before an operation, and just before a nephrectomy, after a UPJO, in all the experimental groups. There was a significant decrease in the renal blood flow in the experimental group compared to those in the sham group. The expressions of iNOS and HIF-1alpha in the ipsilateral kidney, as shown by the immunohistochemical staining, were markedly increased in relation to the time of the obstruction, especially in medulla, and those shown by the Western blot assays were increased in the total renal tissue, medulla and cortex, compared to the sham groups. Conclusions: A decreased renal blood flow in the ipsilateral kidney, during the acute stages of the unilateral UPJO, generally enhanced the expressions of the iNOS and HIF-1alpha in the medulla. This study suggests that hypoxia of the ipsilateral kidney, after an UPJO, induces HIF-1alpha, and then enhances the production of NO by the activation of iNOS, which finally results in renal ischemic damage.

Patterns of Voiding Dysfunction of Stroke Patients during Rehabilitation

OBJECTIVE: The purpose of this study is to evaluate the patterns of voiding dysfunction of stroke patients during rehabilitation. METHOD: We evaluated 53 patients with complaints of voiding dysfunction following the strokes. After the comprehensive history and physical examination, all patients underwent cystometric study and males underwent the transrectal ultrasound. RESULTS: The incidences of detrusor hyperreflexia, detrusor areflexia, and normal finding on the cystometry were 50.9%, 32.1%, and 17.0%, respectively (p<0.05). There was a significantly high incidence of detrusor hyperreflexia in the groups of subcortical lesion, large lesion, and the over 3 months after stroke (p<0.05). However, there was no statistical difference on cystometric findings according to the other characteristics of the stroke such as the age, sex, type of stroke, cognition, aphasia, and diabetes mellitus. The incidences of irritative, obstructive, and mixed symptoms according to the presenting voiding complaints were 49.1%, 32.1%, and 18.9%, respectively (p<0.05). There was no significant statistical difference on the cystometric findings according to the 3 voiding symptom groups as well as none of significant statistical difference on prostate enlargement in males in according to the 3 voiding symptom groups. CONCLUSION: Only with the pattern of voiding, we could not predict the cystometric finding or the presence of bladder outlet obstruction. Thus, we recommend the further studies including cystometry and evaluation of the bladder outlet obstruction for the treatment of voiding dysfunction of stroke patients during rehabilitation.

Role of Clinical Stage, PSA and Gleason`s Score in Predicting Pathologic Outcome in Prostate Cancer / 대한비뇨기과학회지

Preoperative clinical staging in the prostate cancer does not always accurately predict the surgical-pathological outcome. We evaluated how the clinical staging, and other clinical parameters including preoperative PSA and Gleason`s score could reflect on the surgicopathological findings in 30 patients with prostate cancer, who underwent radical prostatectomy. Twelve of 24 patients with clinical T1 or T2 disease were understaged by clinical staging determined by digital rectal examination, bone scan, and radiologic studies including CT and MRI with endorectal coil. MRI with endorectal coil accurately reflected the extracapsular disease only in 59.1% of 22 patients studied. At the same time, it also showed low sensitivity (50%) with high specificity (100%) in detecting lymph node metastasis. Preoperative levels of PSA in patients with P2, P3, and N+ disease were 17.8 +/- 4.5, 47.9 +/- 11.3, 93.5 +/- 20.5ng/ml, respectively. The level of PSA was less than 20ng/ml in 9 of 12 patients with P2 disease, while they were greater than 20ng/ml in 9 of 12 patients with P3 disease. PSA may have a role to rule out lymph node metastasis when its level is less than 10ng/ml, although it did not reach the statistical significance because of small sample size. Gleason`s scores in patients with P2 disease were quite similar to those in patients with P3 disease (5.92 +/- 0.69 vs 5.67 +/- 0.56), whereas Gleason`s scores in all 6 patients with N+ disease were 9 or greater. Neoadjuvant hormonal therapy with LH-RH analogue and androgen receptor blocker for 1.5 to 3 months had no impact on the reduction of margin positivity or downstaging in 10 patients. PSA failure rate in patients with P2 and P3 disease was 25% at 1 year after operation. PSA is a good marker for differentiating between P2 and P3 disease (,p=0.0214) and can safely rule out N+ disease if its level is below 10ng/ml, while Gleason`s score may reflect the lymph node metastasis when it is 9 or greater (p=0.0012). Among the candidates for radical prostatectomy, selection of the patients on the basis of PSA and Gleason`s score might improve the surgical-pathological outcome.

Effects of Estrogen on the Urinary Symptoms and Urodynamic Parameters in Postmenopausal Women / 대한비뇨기과학회지

Effects of oral estrogen (Tibolone) on the urinary symptoms and urodynamics parameters were assessed by a double-blind prospective trial in 24 postmenopausal women. Patients were assessed subjectively and objectively before and after treatment by symptom score change, urethral pressure profiles and uroflow. There was statistical difference in the subjective response (symptom score) to treatment between the two groups (p 0.05). Although there was no significant urodynamic changes, estrogen treatment in postmenopausal women was effective to improve urinary symptoms. Careful observation with periodic follow up will be needed because of possible harmful side effects of estrogen.

Retroperitoneal Liposarcoma (Pleomorphic Type): A Case Report / 대한비뇨기과학회지

A 66-year-old woman was admitted to our hospital because of a mass in the left abdomen. Ultrasonography, aortography and computed tomographic (CF) scanning revealed the mass occupying the entire left abdominal cavity and the left kidney displaced by huge and avascular mass. Also CT guided needle biopsy demonstrated liposarcoma. At operation, a huge yellow-brownish tumor found in the retroperitoneal space, was removed incompletely due to severe adhesion to the left external iliac artery The tumor was 12x11x10cm and weighed 560gm. Histologically, it was a pleomorphic type liposarcoma. She bas received adjuvant radiotherapy but recurred 10 months later.

Fluoxetine as a Treatment for Premature Ejaculation: A Double-Blind, Randomized, Placebo-Controlled Study / 대한비뇨기과학회지

Premature ejaculation is the most common male sexual dysfunction and defined as persistent or recurrent occurrences of ejaculation before or shortly after penetration. But there has never been any effective oral agents for the patients with premature ejaculation. Recently, fluoxetine, a potent serotonin reuptake inhibitor, being used as antidepressant, has been suggested to be helpful for the patients with premature ejaculation. Twenty three male outpatients with premature ejaculation were randomly divided into fluoxetine (n=12) and placebo (n=11) group. In the fluoxetine group, the dose of fluoxetine was 20 mg/day for the first one week and 40 mg/day for the remaining 5 weeks. Patient and his female partner were interviewed separately before starting medication, three weeks and six weeks after medication. The mean intravaginal ejaculation latency time increased to 187.5 seconds after 3 weeks and 254.2 seconds after 6 weeks front 46.7 seconds before treatment (p<0.05). Only 1 out of 12 patients in the fluoxetine group was able to have thrusts over 30 times before treatment. After 3 weeks of Treatment, 8of 12 patients and after 6 weeks of treatment, 7 patients were able to have thrusts over 30 times. There was no significant improvement of intravaginal ejaculation latency time and number of thrusts in the placebo group. Symptomatic improvement was noticed in 75% with fluoxetine group and 18.2% with placebo group. Side reactions of fluoxetine, fatigue and yawning, were noticed in 41% of the patients, but they did not interfere with their daily activities. These findings suggest that fluoxetine can be safely used as a good pharmacotherapeutic treatment for the patients with premature ejaculation.

Effect of Protein Kinase C Inhibitor (Staurosporine) in Human Invasive Bladder Tumor Cells / 대한비뇨기과학회지

Protein Kinase C which is a Ca++ -activated, phospholipid - dependent enzyme phosphorylates numerous protein substrates and participates in intracellular signaling processes. Protein kinase C is associated with a wide range of biological effects including stimulus-secretion coupling, induction of cellular proliferation and differentiation, activation of nuclear transcription factors and cell surface receptors and tumor promotion. Programmed cell death, referred to apoptosis is an active, energy-dependent process in which the cell participates in its own destruction during apoptosis. There is condensation and fragmentation of nuclear chromatin, accompanied by a marked decline in total cell volume, dilation of the endoplasmic reticulum and general compacting of cellular organelles. Thereafter, there is fragmentation of both nucleus and cytoplasm to give rise to small membrane-bound vesicles known as apoptotic bodies. Protein kinase C may have the regulatory role in apoptosis. Staurosporine is a potent protein kinase C inhibitor. Staurosporine inhibited the growth of human invasive bladder tumor cells, T24 in MTT test. The survival fractions of human invasive bladder tumor cells T24 were 100.0%, 76.0%, 62.5% and 18.1% with staurosporine concentration 0nM, 10nM, 100nM and 1000nM, respectively. From the results we identified that staurosporine inhibited the growth of T24 cells markedly in a dose dependent manner(P<0.05). 12-hour exposure of T24 cells to staurosporine failed to induce DNA fragmentation at the concentrations of 0nM, 10nM and 100nM but promoted fragmentation at the concentration of 1000nM, showing typical ladder pattern on agarose gel electrophoresis. On the examination of cellular morphology, T24 cells showed the features of apoptosis such as cell shrinkage, nuclear condensation and formation of bleb and apoptotic bodies after exposure to staurosporine of 10nM, 100nM and 1000nM concentrations. These results suggest that staurosporine have remarkable cytotoxic effect against human invasive bladder tumor cells T 24 and the mechanism of cytotoxicity may be apoptosis.

Prostate Specific Antigen Density (PSAD) in the Detection of the Prostate Cancer / 대한비뇨기과학회지

Prostate specific antigen(PSA) is an extremely valuable tumor marker. However, its use in detection of prostate cancer is limited by low sensitivity and specificity. To enhance the accuracy of serum PSA we used the quotient of serum PSA and prostate volume, which is referred to as prostate specific antigen density(PSAD). Prostate volume in this study was calculated from transrectal ultrasonographic determinations using the formula, length x width x depth x 0.52 = volume. The serum PSA was analyzed using the Hybritech assay. Prostate biopsy was performed transperineally from at least six sites. The cancer detection rate was 3.3%(three out of 91 patients) in the group with PSA value of less than 4.0ng/ml and 11.3%(eight out of 71 patients) in the group with PSA value of 4.1 to 10. 0ng/ml. In the latter group, mean PSA value for the positive(n=8) and negative(n=63) biopsy group was 7.10+/-1.22 and 6.61+/-1.79ng/ml each(p=0.4630), but mean PSAD value was 0.275+/-0.089 and 0.187+/-0.078 each(p=0.0045). In the group of 38 patients with PSA value of 10.1 to 20.0ng/m1, the cancer detection rate was 15.8%(six patients) and the mean PSA value for the positive(n=6) and negative(n=32) biopsy group was 15.5+/-3.09 and 13.4+/-2.78ng/ml each(p=0. 1038), but the mean PSAD value was 0.535+/-0.082 and 0.334+/-0.182 each(p=0.0128). These results suggest that PSAD be useful in distinguishing BPH and prostate cancer in the patients with intermediate PSA values(4.1ng/ml to 20.0ng/ml).