Effect of the Sodium-Glucose Cotransporter 2 Inhibitor, Dapagliflozin, on Genitourinary Infection in an Animal Model of Type 2 Diabetes / 대한배뇨장애요실금학회지

Purpose@#To investigate the effect of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on inflammatory cytokines of urogenital tissue in a rat model of type 2 diabetes (T2DM) to infer pharmaceutical influence of dapagliflozin on genitourinary infection or inflammation. @*Methods@#Study animals were divided into the following 4 groups of 10 animals each: (1) the Otsuka Long-Evans Tokushima Fatty (OLETF)-DA group treated with dapagliflozin at 1.0 mg/kg/day, (2) the OLETF-VO group treated with voglibose at 0.6 mg/kg/day, (3) the control group (OLETF-CO) given water, and (4) the Long-Evans Tokushima Otsuka (LETO) rats were included as nondiabetic control group. Changes in blood glucose, 24-hour urine volume, and urine glucose were measured. The interleukin-1β (IL-1β) and interleukin-18 (IL-18) levels in the bladder and the urethra were quantified, respectively. @*Results@#The urine glucose level and the 24-hour urine volume at 12 weeks of treatment were significantly higher in the OLETF-DA group than that in any other group (P<0.05). The cytokine analysis of the bladder and urethra showed higher IL18 and IL-1β in the OLETF-DA and the OLETF-CO groups than that in the OLETF-VO and LETO groups (P<0.05). The cytokine levels did not differ between the OLETF-DA and the OLETF-CO groups, and the level of IL-18 in the OLETF-DA group was higher in the urethra than in the bladder. @*Conclusions@#This study revealed that dapagliflozin increased the urine glucose concentration, resulting in an inflammatory response remain in the urogenital tract as the untreated diabetic rats. Therefore, when treating patients with T2DM with dapagliflozin, careful attention should be paid to genitourinary infection or inflammation.

Case Reports of Tectal Plate Gliomas Showing Indolent Course

From 2004 to 2020, we studied three pediatric patients (age: 9-13 years, all male) and one adult patient (age: 29 years, female) with tectal plate glioma with obstructing hydrocephalus on MRI. One patient had neurofibromatosis type 1. All patients complained about headaches and vomiting, and one patient had diplopia. Endoscopic third ventriculostomy (ETV) was underwent in all patients and a biopsy was obtained from two patients. Pathologic diagnoses were a pilocytic astrocytoma and a lowgrade glioma. After ETV with or without biopsy, neurological symptoms were improved in all patients.Three patients did the clinical and radiological follow-up without adjuvant treatment. One patient underwent gamma knife radiosurgery. In two pediatric patients and the adult patient, there was no clinical and radiological progression after 6.2, 6.9, and 8.0 years, respectively. One pediatric patient whose lesion had focal enhancement had radiologic progression without any neurologic symptoms after 5.1 years. Without adjuvant treatment for this lesion, there was no clinical deterioration neither further radiological progression for 6.2 years after radiological aggravation. Tectal plate gliomas showed indolent clinical courses, even after radiologic tumor progression. After the treatment of obstructing hydrocephalus, clinical and radiologic follow-up can be recommended for indolent tectal plate gliomas.

A Case of Diabetic Mastopathy

Diabetic mastopathy is an unusual fibroinflammatory breast lesion that is characteristically presented in premenopausal women with long-standing diabetes with multiple microvascular complications. This patient was a 49-year-old postmenopausal woman with diabetic nephropathy, neuropathy, and retinopathy. Although palpable mass was detected on the left breast, an ultrasonography could not distinguish it from breast cancer. Excisional biopsy was conducted. Histological findings indicated diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. After excision, there has been no recurrence until now.

The Factors Influencing to the Results of Pneumatic Retinopexy

PURPOSE: To evaluate the preoperative factors influencing results of pneumatic retinopexy in patients with rhegmatogenous retinal detachment. METHODS: We analyzed retrospectively the preoperative and postoperative retinal findings, visual results, postoperative complications in 98 eyes of 98 patients who had undergone pneumatic retinopexy and followed for at least 3 months. RESULTS: Postoperatively visual acuity improved in 46 out of 59 patients whose preoperative visual acuity was equal to or less than 0.08, and in 20 out of 27 patients whose preoperative visual acuity was equal to or less than 0.5. The success rate of initial surgery was 75.5% and the final reattachment rate 99.0%. The anatomic success rate of each group did not differ in terms of the duration of retinal detachment, the size or quadrantal location of retinal break. The success rate was decreased when retinal detachment was broader or retinal breaks were multiple, although the difference was not statistically significant. The success rate was significantly lower when retinal break was located posterior to the equator than when retinal break was located on or anterior to the equator (40.0% vs 80.3%, 70.4%) (p=0.02). The main causes of failure in primary retinal reattachment were as follows: reopened retinal break in 8 eyes, new retinal break in 7 eyes, delayed absorption or shift of subretinal fluid in 5 eyes, proliferative vitreoretinopathy in 2 eyes, subretinal gas in 1 eye and endophthalmitis in 1 eye. CONCLUSIONS: Our results showed that the axial location of retinal break was the only preoperative factor influencing the success rate of pneumatic retinopexy. However, other factors may not be completely ruled out as influence factors for success rate considering the small number of patients in our study. Further study including larger series will be needed.

A Case of Chronic Myelogenous Leukemia Involving Retina and Optic Nerve

PURPOSE: We report a case of chronic myelogenous leukemia(CML) involving the retina and optic nerve, in which visual acuity had been improved after radiation therapy combined with steroid pulse therapy. METHODS: In a 44-year-old CML patient with central nervous system involvement who presented with retinal infiltration, initial uncorrected visual acuity was 1.0 in the right eye, 0.9 in the left eye. The patient was given 1% prednisolone acetate eye drops 4 times a day and 40mg of oral prednisolone a day. One month later, papilledema and exudative retinal detachment was developed in the left eye and we raised oral prednisolone dosage to 90mg a day. In spite of those kinds of treatment, papilledema in left eye and retinal infiltration in both eyes were much more aggravated at two months. So we used high-dose steroid(solumedrol 125mg qid) parenterally for initial 3 days followed by tapered oral dosage(prednisolone 60mg/day for 11 days, tapered with 10mg/day and maintain with 10mg/day) and performed simultaneously radiation therapy (total 2340 rads, 13 times) on both eyes through 2 weeks. RESULTS: Uncorrected visual acuity was decreased to 0.3 in the left eye at one month and to 0.6 in the right eye and 0.08 in the left eye at two months, and improved to 1.0 in the right eye and 0.5 in the left eye. Gradual resolution was noted in retinal and optic disc abnormalities at one month after high-dose steroid therapy combined with radiation therapy. CONCLUSIONS: This case suggests that visual acuity in CML patient with the retinal and optic nerve involvement can be improved by using radiation therapy combined with steroid pulse therapy.

The Efficacy of Primary Silicone Oil Tamponade in Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the clinical efficacy for primary application of the silicone oil tamponade in vitrectomy for severe proliferative diabetic retinopathy. METHODS: We did retrospective clinical analysis on the preoperative and postoperative fundus findings, visual results, postoperative complications in 26 patients (30 eyes) with severe proliferative diabetic retinopathy who vitrectomy and intravitreal silicone oil injection were performed simultaneously as initial operation. RESULTS: Vitrectomy with silicone oil injection was performed in 14 eyes (46.7%) with severe traction retinal detachment involving macula, 10 eyes (33.3%) showed severe intraoperative hemorrhage among the cases that iatrogenic retinal tear was developed in the eyes with traction retinal detachment and 6 eyes (20.0%) with combined tractional and rhegmatogenous retinal detachment, and silicone oil was removed postoperatively on mean 2.7months (1.4~6.0 months) in 28 eyes of the total of 30 eyes. Final anatomic success was obtained in 26 eyes (86.7%) and functional success in 23 eyes (76.7%), and there was visual improvement of mean 2.8, 1.9 lines and improvement over 2 lines in 17 (56.7%), 11 (36.7%) eyes for best and final visual acuity comparing to preoperative visual acuity, respectively. Postoperative complications included cataract formation and aggravation in 24 or 25 phakic eyes(96.0%), recurrent preretinal membrane in 10 eyes (33.3%), retinal detachment in 10 eyes (33.3%), neovascular glaucoma in 5 eyes (16.7%), vitreous hemorrhage in 3 eyes (10.0%), and phthisis, band keratopathy, endophthalmitis in 1 eye (3.3%) respectively. CONCLUSIONS: In the proliferative diabetic retinopathy that difficulty in the retinal reattachment is predicted or that has high risk of the rebleeding, early application of the silicone oil tamponade is expected to be a useful tool for primary vitrectomy.

Corneal Endothelial Changes in Patients with Traumatic Hyphema

PURPOSE: In patients with traumatic hyphema, we investigated the changes of corneal endothelium and the associated ocular complications that might attribute to endothelial damage. MATERIALS & METHODS: We reviewed the medical records of 67 patients(67 eyes) who had been admitted and treated for blunt ocular trauma with hyphema between February 1997 and June 2000. One month after injury, endothelial photographs of both eyes of each patient were taken with specular microscope to compare the endothelium of the injured eyes with that of the normal fellow eyes. The endothelial parameters were studied in relationship to various complications to see the relationship between the complications and the endothelial damage. RESULTS: Compared with the fellow uninjured eyes, the injured eyes had a mean decrease in endothelial cell density (ECD) of 5.6% (P=0.015). Nine patients had significant corneal edema with epithelial defect on initial admission, which was defined as corneal impact lesion. In the group with the corneal impact lesion, the mean ECD decrease was 23.1% (P=0.016) and the mean coefficient of variation (COV) increase was 24.8% (P=0.01). With other variables such as the amount of hyphema and the degree of angle recession, statistically significant results could not be obtained. In 20 patients on long-term follow-up examination (mean 36.7 months after the injury), the injured eyes had a mean increase in ECD of 2.5% compared to the result on initial examination. This change was minimal and statistically not significant. CONCLUSION: In patients with traumatic hyphema, this study showed reduced endothelial cell densities in the injured eyes compared to the normal fellow eyes. In particular, statistically significant decrease in ECD was noted to be associated with corneal impact lesion.

A case of uterine tumor resembling ovarian sex-cord tumor with clinical review / 대한산부인과학회잡지

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) were first described by Clemen and Scully in 1976. They are a heterogenous group of uterine neoplasm characterised by pure or predominant histological patterns that resembled sex cord tumors of ovary. Clemen and Scully divide the tumors into two groups according to sex-cord-like structures within tumors (the so-called group I tumors with 50% of sex-cord elements, the so-called group II tumors with almost completely sex-cord-like structures). The histogensis of the sex-cord-like elements is uncertain, the group I tumor appears to be more malignant. We experienced a case of UTROSCT in a 44 years old woman underwent LAVH under tantative diagnosis of uterine myoma and report the case with brief review of literature.

Percutaneous Treatment of Caliceal Diverticular Stone / 대한비뇨기과학회지

PURPOSE: Caliceal diverticular calculi are mostly asymptomatic. In certain cases they may be associated with chronic or recurrent pain, recurrent urinary tract infections, progressive renal damage and hematur ia. The treatment of symptomatic caliceal diverticular calculi has evolved from open surgery to less invasive procedures, such as extracorporeal shock wave lithotripsy (SWL), percutaneous techniques, retrograde ureteroscopy and laparoscopy, but it remains controversial. Percutaneous techniques are frequently used to address the diverticular stone burden, to fulgurate the diverticular wall, to dilated the diverticular neck and improve drainage. For this reason, we reviewed 33 patients with caliceal diverticular calculi to determine whether they could be treated successfully by percutaneous nephrolithotomy (PCNL) as the initial treatment. MATERIALS AND METHODS: A total of 33 patients with caliceal diverticular calculi underwent PCNL between February 1990 and February 2000. The majority of diverticula were located at the upper pole. Access was gained via a direct target puncture. After sequential dilatation of the tract, stones were removed and the diverticular wall was fulgurated. The diverticular neck was dilated with the Amplatz dilator upto 24-30 Fr. and a 20 Fr. nephrostomy catheter was placed. RESULTS: PCNL was performed successfully in 30 patients (90.9%), but puncture was failed in 3. Mean operative time was 105 minutes and mean hospital stay was 4.5 days. All patients who were treated successfully with PCNL became stone-free without any complication. Mean follow-up was 20 months (ranged from 1 to 108 months). Of the 26 patients with symptoms preoperatively, 25 patients were rendered symptom-free (96.2%). Twenty-four patients were assessed with an intravenous urogram at 1 or 3 months and 6, 12 months and there was no stone recurrence. The diverticula were obliterated or had improved drainage in 95.8% (23/24) of assessable cases. CONCLUSIONS: We confirmed that PCNL is a safe, less invasive and effective procedure and should be considered an acceptable form of primary management of patients with caliceal diverticular stone.

Lateral Lithotomy Position for Simultaneous Retrograde and Antegrade Approach to the Ureter / 대한비뇨기과학회지

PURPOSE: We applied lateral lithotomy position to the severe ureteral stricture cases supposed to fail with only retrograde approach. MATERIAL AND METHODS: From October 1997 to April 1999, 13 patients with severe ureteral stricture (lenghth>2cm or complete obstruction) supposed to fail with only retrograde approach and one patient with study. The causes of ureteral strictures were pelvic malignancy in 5, tuberculosis in 4, trauma in 2 and others in 2. The patient's ipsilateral shoulder was rotated and fixed like lateral position. And ipsilateral pelvis was elevated with sandbag or pad and rotated about 45 degrees, too. The retrograde approach was tried at first, if fail, antegrade approach was combined. RESULTS: We could insert ureteral stent via retrograde approach only in 3 patients and we needed aid of antegrade approach for passage through ureteral stricture in the other 11 patients (79%). Percutaneous antegrade approaches were combined in those 11 patients and we could pass the guide wire and indwell the stent in 10 of 11 patients (91%) using this position. CONCLUSIONS: The lateral lithotomy position was very helpful to the simultaneous retrograde and antegrade approach in severe fibrotic or malignant ureteral strictures.

Epidermoid Cyst of Testis / 대한비뇨기과학회지

A 24-year-old man visited our hospital with painless scrotal mass 2 weeks in duration. Physical examination revealed about 3cm in diameter, ovoid, hard, movable and painless mass in the left side of the scrotum. He had no history of trauma, voiding difficulty or infection sign. CBC, blood chemistry and tumor marker were normal. Left orchiectomy was done. Tumor was a well encapsulated white-gray ovoid mass filled with yellowish gray material and histogically diagnosed as epidermoid cyst. Benign tumors of testis are rare, acounting for less than 1% of all testicular tumors. Herein we report a case of epidermoid cyst of testis and review the literatures.