Evaluation of Obstructive Pulmonary Function Impairment Risks in Pulmonary Emphysema Detected by Low-Dose CT: Compared with Simple Digital Radiography / 결핵및호흡기질환

BACKGROUND: Pulmonary emphysema (PE) is major cause of obstructive pulmonary function impairment (OPFI), which is diagnosed by spirometry. PE by high resolution CT is known to be correlated with OPFI. Recently, low dose CT (LDCT) has been increasingly used for screening interstitial lung diseases including PE. The aim of this study was to evaluate OPFI risks of subjects with PE detected by LDCT compared with those detected by simple digital radiography (SDR). METHODS: LDCT and spirometry were administered to 266 inorganic dust exposed retired workers, from May 30, 2007 to August 31, 2008. This study was approved by our institutional review board and informed consent was obtained. OPFI risk was defined as less than 0.7 of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC), and relative risk (RR) of OPFI of PE was calculated by multiple logistic regression analysis. RESULTS: Of the 266 subjects, PE was found in 28 subjects (10.5%) by LDCT and in 11 subjects (4.1%) by SDR; agreement was relatively low (kappa value=0.32, p<0.001). FEV1 and FEV1/FVC were significantly different between PE and no PE groups determined by either SDR or LDCT. The differences between groups were larger when the groups were divided by the findings of SDR. When PE was present in either LDCT or SDR assays, the RRs of OPFI were 2.34 and 8.65, respectively. CONCLUSION: LDCT showed significantly higher sensitivity than SDR for detecting PE, especially low grade PE, in which pulmonary function is not affected. As a result, the OPFI risks in the PE group by LDCT was lower than that in the PE group by SDR.

Changes and Implications of Serum Uric Acid Levels After Living-Donor Nephrectomy

PURPOSE: The aim of this study was to investigate the changes in and implications of preoperative and postoperative serum uric acid levels in patients with living donor nephrectomy. MATERIALS AND METHODS: We studied 207 patients between 1998 and 2007 at our hospital undergoing living-donor nephrectomy for kidney transplantation. The serum uric acid level and estimated glomerular filtration rate (eGFR) were measured preoperatively and at 1 year postoperatively. We also analyzed multiple independent variables such as age, sex, blood pressure, body mass index (BMI), serum total cholesterol, hemoglobin, hematocrit, total protein, albumin, calcium, and phosphorus. RESULTS: The mean age of the study patients was 38.3+/-10.8 years. The mean serum uric acid concentration at 1 year after kidney donation was higher than preoperatively (5.05+/-1.39 mg/dl preoperatively vs. 5.85+/-1.14 mg/dl postoperatively) and was significantly greater in patients with hyperuricemia (uric acid> or =6.8 mg/dl) than in patients without hyperuricemia (uric acid or =5.7 mg/dl) require careful observation before and after living-donor nephrectomy.

Long Term Effectiveness of Doxazosin in Men with Lower Urinary Tract Symptoms Suggesting of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the efficacy of doxazosin over 6 years in men with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: This retrospective study enrolled 33 patients with symptomatic BPH who were prescribed an alpha-blocker from January 1999 to December 2000. We evaluated the changes of International Prostate Symptom Score(IPSS), maximal flow rate(Qmax), quality of life(QoL) and residual urine volume(RUV) between before and after 6-year of treatment. RESULTS: The percentages of improvement were 40.2% in total IPSS, 40.6% in obstructive symptom, 39.4% in irritative symptom, 44.7% in QoL, 124.8% in Qmax, 33.5% in RUV(p<0.05). Three patients(9.1%) experienced acute urinary retention and BPH-related surgery was performed in 6 patients (18.2%). CONCLUSIONS: Our study revealed that long-term treatment over 6 years with alpha-blocker resulted in significant improvements in the IPSS, QoL, Qmax and RUV.

Myxofibrosarcoma of Bladder / 대한비뇨기과학회지

Myxofibrosarcoma is also known as a myxoid variant of malignant fibrous histiocytoma, and this is one of the most common sarcomas in the extremities of elderly people; it is characterized by a high frequency of local recurrence. We herein report on a case of myxofibrosarcoma of the bladder. A 58-year-old man was referred to our hospital because of microscopic hematuria. Computed tomography(CT) and intravenous pyelography(IVP) showed a 12x7cm sized bladder mass in the pelvic cavity. The cystoscopic finding shows a protruding mass at the dome and posterior wall of the bladder. After exploratory laparotomy and tissue frozen biopsy were done, radical cystectomy and uretero-ileo-cutaneous anastomosis were then carried out. The diagnosis of the tumor was confirmed by histopathological examination. The myxofibrosarcoma of the bladder was completely excised, and there was no evidence of recurrence after 10 months of follow-up.

The Use of Dual Energy X-ray Absorptiometry in the Prediction of Stone Fragility in Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Purpose: The aim of this study was to determine whether the stone mineral content (SMC) and stone mineral density (SMD), as measured by dual energy X-ray absorptiometry, can predict the stone fragility in extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: In the experimental study, the stone size, weight, SMC and SMD of 111 urinary calculi, obtained by open surgery, were measured. The SMC and SMD were measured using dual energy X-ray absorptiometry, which is the gold standard for measuring the bone mineral content and density. The number of shock waves necessary for full fragmentation was accepted as a measure of the stone fragility in ESWL (EDAP-sonolith Praktis). In the clinical study, the stone size, SMC and SMD were measured in a total of 48 patients with a solitary renal stone of less than 3cm. Prior to ESWL all patients underwent dual energy X-ray absorptiometry to calculate the SMC and SMD. The correlations between the number of total shock waves and the stone size, SMC and SMD were analyzed. Results: In the experimental study, the stone size, stone weight, SMC and SMD values correlated with total shock waves, with a correlation coefficients (R) of 0.79, 0.95, 0.99 and 0.86, respectively (n=111). In the clinical study, the mean stone size, mean MC and MD values differed significantly between the clinically successful and failed ESWL (n=36 and n=12), respectively (p=0.0002, p=0.004, p=0.004). On a simple regression analysis, the SMC (R2=0.74), SMD (R2=0.56) and stone size (R2=0.51) were significant factors in predicting the number of shock waves. Using the receiver operating characteristic curves for comparing the stone size, SMC and SMD in relation to the number of shock waves, the areas under the respective curves were 0.79, 0.84 and 0.81 with cut-off values of 1.8, 1.4 and 1.8. Conclusions: The stone size, SMC and SMD measured by dual energy x-ray absorptiometry may provide a prediction of the outcome of patients prior to ESWL treatment. Patients with high SMC (greater than 1.4gm) could be recommended for percutaneous nephrolithotripsy or another treatment modality, thus, avoiding the unnecessary cost of prior ESWL.

Penile Expression of Nitric Oxide Synthase Isoforms in the Type II Diabetic Rat / 대한남성과학회지

PURPOSE: Erectile dysfunction commonly occurs in men with diabetes mellitus. Nitric oxide synthase (NOS) is essential for regulation of penile erection, and the isoforms of NOS have significance in a variety of complications of diabetes. However, little is known about the localization, abundance, and changes in NOS in diabetes. Therefore, we characterized the localization and abundance of NOS isoforms and explored their relationships and how they are altered in diabetes. MATERIALS AND METHODS: The Otsuka Long-Evans Tokushima Fatty (OLETF) rat, which models type II diabetes mellitus, and the non-diabetic control Long-Evans Tokushima Otsuka (LETO) rat were used. We analyzed the distribution of NOS isoforms in the isolated corupus cavernosum of both LETO and OLETF rats by immunohistochemistry (IHC). The mRNA expression of NOS isoforms was also analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: The concentration of nitrite/nitrate in cavernosal homogenate was higher in diabetic rats than non-diabetic rats, but the difference was not statistically significant. There was a reduction of immunoreactivity for nNOS and eNOS as well as nNOS and eNOS mRNA expression (p<0.05) in diabetic rats, compared to non-diabetic rats. In contrast, the IHC stain showed that iNOS increased in both the endothelium and vascular smooth muscle in the diabetic rats, and the mRNA expression of iNOS gene was also up-regulated (p<0.05). CONCLUSIONS: Change in the activity levels of NOS isoforms within the corpus cavernosum could be a major source of pathogenesis of erectile dysfunction in diabetes mellitus.

Ectopic Prostate Tissue in the Posterior Wall of the Bladder / 대한비뇨기과학회지

We herein report a case of ectopic prostate tissue involving the posterior wall of the bladder. A 33-year-old man was referred to our hospital because of a bladder tumor that was incidentally discovered on abdominal ultrasonography (US). US and computed tomography (CT) showed a 1.5x2.0cm sized tumor in the posterior wall of the bladder. Cystoscopic examination revealed a sessile tumor, covered with normal bladder mucosa in the posterior wall of the bladder. Transurethral resection of the bladder tumor was carried out and the origin of the tissue was confirmed by immunohistochemical staining for prostate specific antigen. The histopathological examination revealed benign prostate tissue that was situated ectopically.

The Renal Function and the Preoperative Predictive Factors Influencing Renal Function after Living Donor Nephrectomy / 대한비뇨기과학회지

PURPOSE: The aim of this study is to identify postoperative renal function and preoperative factors that can predict renal impairment after living donor nephrectomy. MATERIALS AND METHODS: We studied 172 patients undergoing living donor nephrectomy for kidney transplantation (115 males, 57 females). We analyzed the renal function measured by serum creatinine and the 99mTc- diethylenetriamine penta-acetic acid (DTPA) renal scan. Using a univariate and multivariate analysis, we also analyzed multiple independent variables for the remaining renal function following living donor nephrectomy, such as serum creatinine, glomerular filtration rate (GFR), age, sex, duration of follow-up, blood pressure, body mass index (BMI), serum calcium, serum phosphate, serum uric acid. RESULTS: The mean age of the donors was 34 years, and the mean duration of the follow-ups was 11 months. The mean serum creatinine at 11 months after kidney donation was increased compared to preoperative creatinine (1.26mg/dl vs. 0.93mg/dl), and significantly greater in the males than in the females (1.36mg/dl vs. 1.09mg/dl). Mean GFR measured by the 99mTc- DTPA renal scan at 11 months after kidney donation was 69.2 ml/min/ 1.73m2 and similar for men and women (72.3ml/min/1.73m2 vs. 68.3ml/ min/1.73m2). The univariate analysis showed that preoperative creatinine was significantly associated with postoperative creatinine only (p<0.001), and age and sex were associated with the change in creatinine (p=0.046, p<0.001). The univariate analysis also showed that preoperative GFR and age were significantly associated with postoperative GFR (p<0.001, p<0.001), and age was associated with compensatory change in GFR (p= 0.008). The multivariate analysis showed that preoperative GFR was the primary predictive factor of postoperative GFR (r=0.73, p<0.001), and age was an independent secondary predictive factor (r= 0.67, p<0.001). CONCLUSIONS: These results suggest that postoperative renal function has been preserved in kidney donors, and preoperative creatinine, preoperative GFR, and age at donation were the important predictive factors of renal function after living donor nephrectomy.

PSAD and TZ-PSAD as Predictors of the Response to Alpha-adrenergic Blocker in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To determine whether prostate-specific antigen density(PSAD) and transition zone prostate-specific antigen density(TZ-PSAD) can predict the clinical response of patients with benign prostatic hyperplasia(BPH) to alpha-adrenergic blocker(terazosin). MATERIALS AND METHODS: From January 2000 to June 2002, 202 patients with BPH who were treated with alpha-adrenergic blocker(terazosin) were enrolled in this study. The peak flow rate(Qmax) and the International Prostate Symptom Score(IPSS) were compared prior to and 3 months following medication. We analyzed total prostate volume(TPV), transition zone volume(TZV), transition zone index(transition zone volume/total prostate volume, TZI), PSAD(PSA/total prostate volume), and TZ-PSAD (PSA/transition zone volume) as predictors of the response to alpha-adrenergic blocker (terazosin). RESULTS: At 3 months following medication with terazosin, a statistically significant improvement was shown in the IPSS and Qmax. There was no significant correlation between pretreatment TPV, TZV, TZI and the percent change in the IPSS and Qmax. However, there was a significant negative correlation between pretreatment PSAD (r=-0.632, p<0.001), TZ-PSAD (r=-0.599, p<0.001) and the percentage change in Qmax, while there was a positive correlation between pretreatment PSAD (r=0.620, p<0.001), TZ-PSAD(r=0.604, p<0.001) and the percentage change in the IPSS. Using the receiver operating characteristic curves to compare PSAD and TZ-PSAD for IPSS, the areas under the respective curves were 0.867 and 0.874(cut-off values were 0.04 and 0.1), and for the Qmax, the areas under the respective curves were 0.876 and 0.873(cut-off values were 0.04 and 0.1). CONCLUSIONS: Patients with a lower pretreatment PSAD and TZ-PSAD responded better to alpha-adrenergic blocker than those with a higher pretreatment PSAD and TZ-PSAD. PSAD and TZ-PSAD were predictors of the response to alpha-adrenergic blocker (terazosin) in patients with BPH.

A Case of Adrenal Cavernous Hemangioma / 대한비뇨기과학회지

No abstract available.

Transitional Zone Index: a Predictor of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To investigate the efficacy of age, International Prostate Symptom Score(I-PSS), quality of life(QOL) score, various parameters obtained by transrectal ultrasonography(TRUS) as predictors of the onset of acute urinary retention in patients with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: From January 1996 to December 1997, 101 men(mean age 70years, range 52-92) with symptoms of BPH were enrolled in this study. Among them, 36 patients had suffered from acute urinary retention. TRUS was used to calculate the total prostate(TP) volume, the transitional zone(TZ) volume, the transitional zone index(TZ index=TZ volume/TP volume). To compare the usefulness of various indices, the area under the receiver-operator characteristic(ROC) curve was calculated for each index. RESULTS: There were significant differences in age, TP volume, TZ volume, TZ index between patients with and without acute urinary retention, but no significant differences in I-PSS and QOL score. In patients with acute urinary retention, the area under the ROC curve was 0.911 for the TZ index, 0.892 for the TZ volume, 0.769 for the TP volume and 0.660 for the age. CONCLUSIONS: The TZ index is a useful predictor of acute urinary retention in patients with BPH and may be a useful parameter for decision of surgical intervention.

An Experience of Vaginoplasty with Rectos Abdominis Myocutaneous Flap for Testicular Feminization Syndrome / 대한비뇨기과학회지

Testicular feminization syndrome is characterized by 46,XY karyotype, bilateral testes, absent or hypoplastic wolffian duct, female appearing external genitalia, blind vaginal pouch, and absent or rudimentary muillerian derivatives. We experienced vaginoplasty using rictus abdominis myocutaneous flap with modified Burch bladder neck suspension in a 51-year-old patient with testicular feminization syndrome combined with stress urinary incontinence.