Comparison of Effectiveness between Abdominal Vibration Stimulation and Walking Exercise for Bowel Cleansing before Therapeutic Colonoscopy

Background/Aims@#Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. @*Methods@#A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. @*Results@#Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. @*Conclusions@#This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

Impact of previous metronidazole exposure on metronidazole-based second-line quadrupletherapy for Helicobacter pylori infection

Background/Aims@#The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However,whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection. Methods: Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori . @*Results@#The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use ( p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval,1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure. @*Conclusions@#Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.

Effect of PTEN Polymorphism on the Development of Hepatitis B Virus-associated Hepatocellular Carcinoma

BACKGROUND/AIMS: Phosphatase and tensin homolog (PTEN) is a known tumor suppressor gene that is downregulated in hepatocellular carcinoma (HCC). Here, we investigated the association between single nucleotide polymorphisms (SNPs) of PTEN and HCC development in patients with hepatitis B virus (HBV) infection. METHODS: Six SNPs of PTEN at positions rs1234221, rs1903860, rs1234220, rs1903858, rs2299941, and rs17431184 were analyzed in a development population (417 chronic HBV carriers without HCC and 281 chronic HBV carriers with HCC). PTEN rs1903858, rs1903860, and rs2299941 SNPs were further assessed for the development of HCC in a validation population of 200 patients with HBV-related liver cirrhosis. RESULTS: In the development population, PTEN rs1903860 C allele, rs1903858 G allele, and rs2299941 G allele were associated with a low risk of HCC. The haplotype A-T-A-A-A was associated with an increased risk of HCC (recessive model; odds ratio=2.277, 95% confidence interval [CI] =1.144-4.532, P=0.019). In the validation population, PTEN rs2299941 G allele was the only significant protective genetic polymorphism related to HCC development after adjustment for age and sex (hazard ratio=0.582, 95% CI =0.353–0.962, P=0.035). CONCLUSIONS: These findings suggest that genetic polymorphisms in PTEN may affect HCC development in patients with chronic HBV infection.

Renal Artery Embolization in Patients with Polycystic Kidney Disease / 대한내과학회지

Polycystic kidney disease (PCKD) is the most common life-threatening genetic disease that causes kidney failure worldwide. Patients with autosomal dominant PCKD notice an increase in abdominal size as the kidney cysts grow and present with gastrointestinal and pulmonary symptoms. Surgical therapy, percutaneous drainage, sclerotherapy, cyst decompression, and laparoscopic fenestration have been used to treat the symptoms, but the results are often unsatisfactory. We recruited five patients with PCKD. Each patient complained of severe abdominal discomfort, and had a poor quality of life. In these patients, we performed renal artery embolization. After the procedure, all of the patients were discharged without severe complications. Follow-up abdominal computed tomography was performed 3-6 months after the procedure, and we were able to confirm a reduction in the size of both kidneys. In addition, the clinical symptoms improved in all five patients.

Rupture of a Superior Mesenteric Artery Pseudoaneurysm Presenting with Asymptomatic Anemia / 대한내과학회지

Anemia is a common cause of referrals to gastroenterologists. Only a small number of anemia cases result from vascular abnormalities. Visceral artery aneurysms and pseudoaneurysms are rare forms of vascular disease that have significant potential for rupture, resulting in potentially life-threatening hemorrhaging. We present the case of a 70-year-old female patient with a pseudoaneurysm of the superior mesenteric artery complicated with rupture, who had no abdominal pain and only anemia.

An Unusual Presentation of Diabetic Ketoacidosis in Familial Hajdu-Cheney Syndrome: A Case Report

A 21-year-old man with diabetic ketoacidosis (DKA) displayed short and clubbed fingers and marked eyebrow, which are typical of Hajdu-Cheney Syndrome (HCS). Laboratory findings confirmed type 1 diabetes mellitus (DM). After conservative care with hydration and insulin supply, metabolic impairment was improved. Examinations of bone and metabolism revealed osteoporosis and craniofacial abnormalities. The mutation (c.6443T>G) of the NOTCH2 gene was found. The patient was diagnosed with HCS and DM. There may be a relationship between HCS and DM, with development of pancreatic symptoms related to the NOTCH2 gene mutation.

Prader-Willi Syndrome with Hypogonadism / 대한남성과학회지

Prader-Willi syndrome (PWS) is a rare genetic disease caused by a deletion or disruption of genes in chromosome 15. Commonly associated characteristics of this disorder include obesity, mental retardation, short stature, and hypogonadotropic hypogonadism. A 3-year-old-boy who initially presented hypoplastic scotum, small penis and bilateral cryptorchism was confirmed the diagnosis of PWS using of with genetic tests. Finally, he was taken bilateral orchiopexy.

Cystic Embryonal Sarcoma of the Kidney: Report of a Case with US and CT Findings

Here we report a case in a 41-year-old woman histologically proven cystic embryonal sarcoma of the kidney, with emphasis on the imaging findings and pathological features. A large lobulated solid mass in the cystically dilated pelvocalyceal region was accompanied with hydroureter as depicted on both ultrasound and contrast-enhanced CT images.

Uroplakin mRNA Expression in the Micro-dissected Mouse Prostate / 대한남성과학회지

PURPOSE: Prostatitis is a common condition with a significant effect on quality of life. Even though the etiology of chronic prostatitis remains unclear, certain bacterial infections may play a major role. In recent studies, E. coli, one important etiology of urinary tract infection, was found to mediate invasion into the bladder epithelium after binding uroplakin Ia in the apical membrane of the urinary bladder. Because E. coli is also an important pathogen for bacterial prostatitis, we investigated the uroplakin mRNA expression in micro-dissected mouse prostates. MATERIALS AND METHODS: We harvested the urinary bladder, ventral prostate, dorso-lateral prostate, and coagulating gland from 3 male imprinting control region (ICR) mice. The total RNA was extracted, cDNA was prepared, and finally the five target genes--uroplakin Ia, Ib, II, III, and beta-actin were amplified. We also examined the expressed sequence tags (EST) about above four uroplakin genes from mouse EST data. RESULTS: Uroplakin Ia, Ib, II, and III were expressed in the urinary bladder. However, only uroplakin Ia was definitively expressed in the ventral prostate. Uroplakin Ib and II were weakly expressed in the ventral, dorso-lateral, and coagulating prostate. Uroplakin III was not expressed in the prostate tissue. The mouse RNA transcripts in the EST data also showed similar results to uroplakin expression in the prostate. CONCLUSIONS: These results suggest that the mouse ventral prostate may be an adequate locus for acute or chronic bacterial prostatitis study. Further in-vitro bacteriologic studies of the ventral prostate will help reveal the mechanisms of chronic bacterial prostatitis.

The Effect of Dutasteride on Serum Prostate-specific Antigen (PSA) in Patients with Benign Prostate Hypertrophy

PURPOSE: 5alpha reductase, dutasteride, has widely used to treat enlarged prostate (BPH). By suppressing the conversion of testosterone to dihydrotestosterone it decreases serum prostate-specific antigen (PSA) which is very important screening marker for prostate cancer. We evaluate the early serum PSA changes after dutasteride treatment to Korean BPH patients. MATERIALS AND METHODS: A total 159 men with a clinical diagnosis of BPH and no evidence of prostate cancer were enrolled. They were treated with dutasteride 0.5mg daily for 12 months. Serum PSA was evaluated at 2, 6, and 12 months after the medication. RESULT: Dutasteride statistically significantly reduced serum PSA to 0.70+/-0.52, 0.64+/-0.35, and 0.59+/-0.49 from baseline level at 2, 6, and 12 months after the medication, respectively. However, there was no statistical significance among the three groups in serum PSA changes after dutasteride. There were statistically significant correlations between a high pre-treatment serum PSA level and a large reduction of follow-up PSA levels at 2, 6, and 12 months after dutasteride treatment. CONCLUSIONS: The reduction of serum PSA is variable in patients to patients at 2, 6, and 12 months after dutasteride treatment. The patient with high initial serum PSA revealed a large reduction of serum PSA level after treatment. The traditional concept that follow-up serum PSA level should be doubled for prostate cancer screening may overestimate real serum PSA level within 12 months in Korean men receiving 5alpha reductase inhibitors.

A Semi-Nested Polymerase Chain Reaction for Amplification of Chlamydia trachomatis Omp1 Gene / 대한비뇨기과학회지

PURPOSE: Chlamydia trachomatis(CT) infection is the most common bacterial sexually transmitted disease. Because of vague symptoms and delayed diagnosis, untreated infection can be transmitted to sexual partners and progress to infertility, pelvic inflammatory disease and ectopic pregnancy. Genotyping and serotyping for CT are very important to establish contact networks and for epidemiological and evolutionary studies. Cryptic plasmid and omp1 genes are targets for the detection of CT. Although the plasmid is a good target for amplification, it is very difficult to analyze sequences from the plasmid amplicons. The omp1 gene is an ideal target for sequence analysis because of large and publicized data deposits on the internet. However, very few studies have been published using a polymerase chain reaction(PCR) for the detection of the chlamydial omp1 gene in Korea. The purpose of this study was to detect CT infection with semi-nested amplification of the chlamydial omp1 gene. MATERIALS AND METHODS: Genomic DNA was extracted from the urethral swabs of 20 patients with urethritis or idiopathic chronic prostatitis, and from the vaginal swabs of 80 patients attending the gynecology clinic due to various vaginal symptoms. The primers were designed on omp1 genes from 12 CT and 2 sequences of lymphogranuloma venereum. The estimated products from the first and second rounds of PCR were 656 and 100 bp, respectively. RESULTS: With the 1st PCR bands there were confusing and non-specific bands, but all the specific PCR products from the 1st and 2nd amplifications with new primer sets were identified. CT was identified in 2 of 20 male patients (10%) and 4 of 80 female patients (5%). CONCLUSIONS: CT infections were detected from patients with semi-nested amplifications of the chlamydial omp1 gene. The semi-nested PCR method may be a more sensitive and specific test than first round PCR.

Prokaryotic 16S rDNAs from Various Prokaryotes That Are Suggested as Etiologies of Idiopathic Chronic Prostatitis / 대한비뇨기과학회지

PURPOSE: Specific microorganisms, such as C trachomatis, Mycoplasma and T vaginalis, are rarely detected in idiopathic chronic prostatitis. However, fastidious and nonculturable microorganisms may be important in the etiology of idiopathic chronic prostatitis. The object of this study was to test a new PCR primer set to detect 16S rDNA from various prokaryotes suggestive of the etiologies of idiopathic chronic prostatitis. MATERIALS AND METHODS: A new 16S rDNA primer set was designed from common prokaryotic genetic sequences using bioinformatic tools. The genomic DNAs from E-coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Actinobacter baumanmii, coagulase negative Staphylococcus, Corynebacterium, Serratia marcescens, Proteus mirabilis and Staphylococcus aureus were extracted by boiling colonies from their plated cultures. The template DNAs from the above microorganisms were amplified using this new 16S rDNA primer set. RESULTS: The correct PCR product, 470 bp, was obtained from E-coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Actinobactrer baumanmii, Corynebacterium spp, Serratia marcescens and Proteus mirabilis. However, a constant result from gram positive bacteria, such as Stapylococci, could not be obtained. CONCLUSIONS: A new PCR primer set, which can detect various prokaryotes suggestive of the etiologies of idiopathic chronic prostatitis, was obtained.

Use of Consensus Primer Set, GP5+ and GP6+, to Detect Human Papillomavirus within Genital Lesions / 대한비뇨기과학회지

PURPOSE: The human papillomavirus (HPV) group comprises over 90 different genotypes, of which more than 30 are mucosotropic. HPV types 16 and 18 are considered the major cause of invasive carcinomas and their related precursors. However, other types are also responsible for the development of carcinomas, condylomas acuminatas and genital warts. The prevalence of the different HPV genotypes in the general population shows heterogeneity and geographical variations. Therefore, a consensus primer set was evaluated to detect HPV in patients with genital lesions. MATERIALS AND METHODS: Genomic DNA was extracted from 2 penile squamous cell carcinomas, 2 verrucous carcinomas, 11 condyloma acuminatas and 2 suspicious lesions. A general primer GP5+ /GP6+ mediated PCR was performed. RESULTS: All the condyloma acuminata, carcinoma and suspicious lesions showed a 150 bp PCR products with the consensus primer GP5+ /GP6+ . CONCLUSIONS: The PCR method, with a general primer set, GP5+ /GP6+ , can detect mucosotropic HPV from various genital lesions. It may be a broad spectrum PCR method, but it can also detect small amounts HPV from suspicious lesions.

The Change of Histologic Features and Eicosanoids Level in Rat Testicular Ischemia-Reperfusion Injury / 대한비뇨기과학회지

PURPOSE: It has been suggested that prostaglandins (PGs) play an important role in ischemia-reperfusion (IR) organ injury. However, the significance of PGs is not well documented for a testicular IR injury. The purpose of this study was to assess the potential role of PGs in rat testicular ischemia and IR injury MATERIALS AND METHODS: Sprague-Dawley male rats were divided into 7 groups, each containing 7 rats. The right spermatic cord was clamped with vascular clamps for 30 minute (group B, C), 90 minute (D, E) and 240 minute (F, G). Groups B, D, and F were ischemia groups and the group C, E, and G were reperfusion groups. Reperfusion was carried out after ischemia lasting 30, 90 and 240 min. The levels of thromboxane B2 (TxB2), 6-keto-PGF1alpha and prostaglandins E2 (PGE2) were measured using High-Performance Liquid Chromatography (HPLC). RESULTS: The levels of TxB2 were significantly elevated in groups D, E, F, and G than in the controls (p<0.05, each group). The TxB2 levels in the ischemia group F were significantly decreased compared to that of group D (p<0.05). The histological features shown in groups D, and F were typical ischemic changes, but atypical in groups B, and C. The most severe damage was noted in group G. These features were well matched with the changes of TxB2 in testicular ischemia and IR injury. The levels of 6-keto-PGF1alpha were significantly elevated in all the ischemia and IR groups compared to that of the controls (p<0.05). CONCLUSIONS: These results suggested that TxB2 might have an active role in testicular IR injury, although PGE2 and 6-keto-PGF1alpha seemed not to have an active role.

The Harmful Effects of Superoxide Radical and the Protective Effect of Ginseng Saponin on Rat Whole Bladder Contractility / 대한비뇨기과학회지

PURPOSE: We investigated the effects of the superoxide radical on rat whole bladder contractility with duroquinone (superoxide radical generator, Dq) and diethyldithiocarbamate (superoxide dismutase inhibitor, DETCA), and the effects of ginseng saponin (GS) against superoxide radical injury. MATERIALS AND METHODS: Isometric tension changes of isolated rat whole bladders were recorded in an organ bath using a force transducer. The acute effects of Dq and Dq preincubated with DETCA were assessed on resting tension, electrical field stimulation, and bethanechol-, ATP-, and KCl-induced contraction. The effects of Dq and Dq preincubated with DETCA in the presence of sodium nitroprusside and GS were investigated. RESULTS: The resting tension of the muscle was not changed by Dq and Dq preincubated with DETCA. Dq had a harmful effect on only ATP- and KCl-induced detrusor contraction, whereas Dq pretreated with DETCA attenuated the induction of detrusor contraction which was reduced in response to the exogenous NO including GS. In the presence of L-NAME, the effects of GS reduced the Dq-induced inhibition on the detrusor contractility. CONCLUSIONS: It is suggested that the superoxide radical may be the cause of voiding difficulty. GS, as a NO synthesis stimulator, seems to act as a scavenger of the superoxide anion. However further study on the effect of each subfraction of GS is needed for clinical application.

Chemopreventive Effect of Aspirin on N-Butyl-N-(4-hydroxybutyl) Nitrosamine Induced Preneoplastic Lesions in Rat Bladder / 대한비뇨기과학회지

PURPOSE: We investigated the possible inhibitory effect of aspirin during the initiation and post initiating stages on N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) induced bladder carcinogenesis in female rats. MATERIALS AND METHODS: Forty-five female Sprague-Dawley rats were divided into three groups. Group A received 0.05% BBN in drinking water for 12 weeks. Group B re ceived 0.05% BBN in drinking water with 0.5% aspirin in the diet for 12 weeks. Group C received control diet without added chemicals. The rats were sacrificed after 12 weeks. For identification of chemopreventive effect of aspirin, apoptosis was detected by in situ cell death detection method. The apoptotic index (AI) was calculated from the ratio of typical apoptotic cells relative to the total cells from observation of at least 1000 cells in each preneoplastic lesion among the groups. RESULTS: All cases of group A showed multiple lesions of simple and focal hyperplasia. The incidence of papilloma was 80% in group A. All cases of group B also showed multiple lesions of simple and focal hyperplasia but the incidence of papilloma was decreased to 20%. The total numbers counted of focal hyperplasia and papilloma lesions were significantly reduced in group B than in group A (p<0.001 and p<0.001, respectively). The mean AI in group A and B sequentially increased in preneoplastic lesions, as compared to that in the normal epithelium of the rat bladder. Significant differences in AI in the lesions of simple and focal hyperplasia between group A and B were noted (p<0.001 and p<0.001, respectively). CONCLUSIONS: The result suggests that aspirin significantly decreases the incidence of precancerous lesions and it can act as a chemopreventive agent for precancerous lesions of urinary bladder.

Clinical Significance of Surgical Exploration on acute scrotum / 대한비뇨기과학회지

PURPOSE: Acute scrotum is a clinical syndrome that is defined as an acute painful swelling of the scrotum. It is well known that early surgical exploration is needed to prevent the testicular loss when testicu lar torsion breakouts. But most of reports were only focused on testicular torsion of prepubertal age group. This fact let us examine the acute scrotum with all age group and the significance of surgical exploration. MATERIALS AND METHODS: We retrospectively reviewed the results collected from 112 patients (131 cases) with acute scrotum who had been admitted to our hospital between June 1994 and November 1999 with the exception of scrotal trauma. RESULTS: The incidence of acute scrotum over 20 years old was 72.4% of total acute scrotum patients. The most common disease was acute epididymitis giving the rate of 71.8% (94 cases). In adult the incidence of testicular torsion was low (3 cases). Surgical torsion was 12 cases and acute epididymitis was 12 cases as the cause of acute scrotum. CONCLUSIONS: Most cases of testicular torsion have been below 20 years old and only 3 cases have been over 20 years old. Although the incidence of testicular torsion over 20 years old has been low. There were severe infectious diseases needing surgical approach in the cases of aged patient. this research shows that the treatment of acute scrotum goes with the need of surgical therapy.

The Effects of Superoxide Radical on Rat Detrusor Contractility / 대한비뇨기과학회지

No abstract available.

Acute Effects of Nicotine on Rat Detrusor Contractitity

No abstract available in English.

Significance of Scrotal Ultrasonography on Blunt Scrotal Trauma

BACKGROUND: Testicular rupture is a surgical emergency which command immediate repair. If surgery is delayed, a hematoma causes severe pain and loss of spermatogenesis as well as hormonal functions. Scrotal ultrasonography has been helpful in early diagnosis of testicular rupture. But disadvantage of ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Also the diagnostic accuracy, sensitivity or specificity of scrotal ultrasonography was variable in regard to authors. And so, a diagnostic accuracy of scrotal ultrasonography was evaluated in scrotal trauma. METHODS: We reviewed 38 patients of scrotal trauma from May, 1994 to March, 1998. 6 patients were treated conservatively following scrotal sonography and 10 patients treated only surgical exploration without ultrasonography. Surgical exploration was performed in 22 case, which were evaluated by ultrasound before surgical treatment. In a such 22 cases, diagnostic accuracy of scrotal ultrasonography was evaluated. RESULTS: We compared ultrasound before treatment with surgical exploration finding in a such 22 cases. The ultrasonographic features in 7(31.8%) out of 22 cases, which showed testicular ruptured, but surgical exploration revealed testicular rupture in 5 and epididymal rupture in 1, simple hematocele in 1. In 15(68.2%) out of 22 cases the simple hematocele was diagnosed by ultrasonography, but surgical finding feature in of the 7 cases revealed testicular rupture, epididymal rupture in 1, simple hematocele in 7. The sensitivity and specificity for the ultrasonography are 42.9% and 87.5%, and the positive and negative predictive values are 86.5% and 46.7%, respectively. Ultrasonography is low sensitive in identifying testicular rupture. CONCLUSION: Ultrasonography include a relatively low signal-to-noise level, tissue nonspecificity, lack of contrast media, a small field of view, and dependence on the operators skill and the patients physique. Therefore, early surgical exploration for saving the testis should be performed that sonographically by seeing hypoehoic peripheral lesions and disappearance of normal ovoid form of testis, hematocele in scrotal sac.