Clinical Significance of Periurethral Calcification According to the Location in Men With Lower Urinary Tract Symptoms and a Small Prostate Volume / 대한배뇨장애요실금학회지

PURPOSE: To assess the impact of periurethral calcification (PUC) according to its location on uroflowmetric parameters and urinary symptoms in patients with small prostate volume (PV). METHODS: Records were obtained from a prospectively maintained database of first-visit men with lower urinary tract symptoms (LUTS). Patients whose PV was >30 mL were excluded to elucidate more clearly the impact of PUC on LUTS. A total of 539 patients were enrolled in the study. The prostatic urethra was examined by transrectal ultrasonography for PUC, and the location of PUC was divided into 3 areas (proximal, mid, and distal). RESULTS: The characteristics according to the location of PUC were compared using a 1-way analysis of variance test. The Total International Prostate Symptom Score (IPSS), postmicturition symptoms, and overactive bladder symptom score (OABSS) differed significantly among the groups. In the propensity score matching analysis, the proximal- and distal-PUC groups did not have a significantly different urinary flow rate or symptom score when compared to their matched control groups. However, the mid-PUC group had significantly worse urinary symptoms than its matched control group (total IPSS [P=0.001], voiding symptoms [P=0.002], storage symptoms [P=0.041], and OABSS [P=0.015]). The peak urinary flow rate was also lower in the mid-PUC group with borderline significance (P=0.082). On multivariate linear regression analysis, mid-PUC was independently associated with IPSS and OABSS (P=0.035 and P=0.011, respectively). CONCLUSIONS: Only mid-PUC was associated with symptom severity in men with LUTS and a small PV. Our findings suggest that mid-PUC could be a potential causal factor of LUTS, and the midportion of the prostatic urethra might play a pivotal role in the process of micturition.

Seasonal Variation of Urinary Symptoms in Korean Men with Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia

PURPOSE: To examine seasonal variations in urinary symptoms in Korean men with lower urinary tract symptoms and benign prostatic hyperplasia (LUTS/BPH). MATERIALS AND METHODS: Records were obtained from a consecutive database of LUTS/BPH patients from March 2010 to February 2014. A total of 1,185 patients were suitable for analysis. The International Prostate Symptom Score (IPSS), uroflowmetric parameters, prostate volume-related parameters, and serum prostate-specific antigen levels were evaluated. RESULTS: Based on the month during which they were examined, patients were categorized into cold, hot, or intermediate season groups. The IPSS score was significantly different between the cold and the hot season groups (17.3+/-6.9 vs. 16.1+/-7.4, respectively; p=0.020). Storage symptom scores were significantly aggravated in the cold (6.8+/-3.3; p=0.030) and intermediate groups (6.9+/-3.5; p=0.032) compared with the hot season group (6.3+/-3.4), with this observation primarily driven by the individual scores for frequency and urgency. Quality of life (QOL) scores were worse in the cold compared with the hot season group (4.0+/-1.1 vs. 3.8+/-1.1, respectively; p=0.012). There were also significant differences between the cold and hot season groups in voided volume (278.7+/-148.5 vs. 255.9+/-145.1, respectively; p=0.034) and postvoid residual volume (26.4+/-37.6 vs. 32.2+/-41.0, respectively; p=0.039). CONCLUSIONS: Different urinary symptoms and uroflowmetric parameters were associated with changes in seasons. QOL and IPSS parameters might be worse in cold weather seasons compared with hot weather seasons.

A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding / 대한소화기학회지

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

Two Cases of Xanthogranulomatous Cholecystitis and Gallbladder Cancer with Hemobilia / 대한소화기내시경학회지

Hemobilia is a rare upper gastrointestinal (GI) bleeding phenomenon usually caused by trauma but may occur due to various liver and pancreatobiliary diseases. Causes related to gallbladder disease include vascular disorders, malignancy, polyps, heterotopic GI mucosa, acalculous inflammation, and most commonly gallstones. Most cases are treated with a cholecystectomy. If hemobilia is detected, efforts must be made to exclude malignancy because hemobilia develops from both benign and malignant disease. Particularly in gallbladder disease with hemobilia, the possibility of gallbladder carcinoma should be considered. We report two cases of hemoblia by endoscopic retrograde cholangiopancreatography and duodenoscopy, with a review of the literature. The first case was xanthoglanulomatous cholesystitis and the second case was gallbladder cancer disclosed by cholecystectomy.

A Case of Pancreatic Cancer and Opioid Withdrawal after Endoscopic Ultrasound-guided Celiac Plexus Neurolysis / 대한소화기내시경학회지

Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.

A case of pneumococcal endocarditis complicated by meningitis / 대한내과학회지

pneumonia in the setting of chronic alcoholism and may be complicated by meningitis. Only one adult case of pneumococcal endocarditis (PE) has been reported in Korea. We report the case of a 73-year-old woman who suffered from PE complicated by embolic cerebral infarction and meningitis. This is the first Korean case of PE complicated with meningitis. The patient was treated medically and died from a cardiac complication. This case shows that PE is difficult to treat without surgery because its evolution is usually acute and very aggressive; it has a high rate of local and systemic complications despite the administration of appropriate antibiotics.

IgA Multiple Myeloma Presenting with Pathologic Fracture at Clavicle in a Patient with Ankylosing Spondylitis / 대한류마티스학회지

Multiple myeloma (MM) is a malignant monoclonal proliferation of plasma cells that commonly causes pathologic fractures in the vertebrae, femur, humerus and rib. Although the association of MM and ankylosing spondylitis (AS) has rarely been reported, most of MM patients with AS share the characteristic of IgA type paraproteinemia, which suggests the presence of mechanisms that possibly connect the two conditions. In this report, we describe a 47-year-old man with a 25-year history of AS, and he was diagnosed as having IgA kappa type MM with a pathologic fracture at the left clavicle. To the best of our knowledge, this is the first case of IgA myeloma presenting with a pathologic fracture in a patient with AS. We report here on this case along conducting a review of the relevant medical literature.

The Incidence and Clinical Implications of Congenital Defects of Atlantal Arch

OBJECTIVE: Atlantal arch defects are rare. Few cadaveric and imaging studies have been reported on the variations of such anomalies. Our goal in this study was to examine the incidence and review the clinical implications of this anomaly. METHODS: A retrospective review of 1,153 neck or cervical spine computed tomography (CT) scans was performed to identify patients with atlantal arch defects. Neck CT scans were performed in 650 patients and cervical spine CT scans were performed in 503 patients. Posterior arch defects of the atlas were grouped in accordance with the classification of Currarino et al. In patients exhibiting this anomaly, special attention was given to defining associated anomalies and neurological findings. RESULTS: Atlantal arch defects were found in 11 (11/1153, 0.95%) of the 1,153 patients. The type A posterior arch defect was found in nine patients and the type B posterior arch defect was found in two patients. No type C, D, or E defects were observed. One patient with a type A posterior arch defect had an anterior atlantal-arch midline cleft (1/1153, 0.087%). Associated cervical spine anomalies observed included one C6-7 fusion and two atlantal assimilations. None of the reviewed patients had neurological deficits because of atlantal arch anomalies. CONCLUSION: Most congenital anomalies of the atlantal arch are found incidentally during investigation of neck mass, neck pain, radiculopathy, and after trauma.

Calcifying Fibrous Pseudotumor of the Stomach That Was Diagnosed by Endoscopic Submucosal Dissection / 대한소화기내시경학회지

Calcifying fibrous pseudotumor (CFPT) is very rare and especially at an intrinsic visceral location such as the stomach. The CFPT is generally located in the subcutaneous or deep soft tissue and the subserosal area of organs and it is mainly diagnosed during childhood or young adulthood. The etiology and pathophysiology of CFPT are unclear. Herein we describe a case of gastric CFPT and we review the related literature. A thirty-year-old asymptomatic female patient visited our hospital for the evaluation of a submucosal tumor that was seen on previous endoscopy. On the endoscopic ultrasonography (EUS), a subepithelial lesion was found at the gastric angle and it was a slightly hypoechoic, homogenous mass located at the submucosal layer of the gastric wall. Endoscopic submucosal dissection was performed under the suspicion of carcinoid. On the microscopic findings, most of the tissue was composed of hyalinized collagenous tissue. Mild lymphocytic infiltration and several dystrophic calcifications were also seen. Immunohistochemically, bcl-2 and CD34 staining was negative, so we diagnosed the mass as CFPT.

Recovery Rate of Nontuberculous Mycobacteria and the Clinical Course of Nontuberculous Mycobacterial Pulmonary Disease at a Secondary Hospital / 결핵및호흡기질환

BACKGROUND: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. METHODS: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. RESULTS: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. CONCLUSION: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.

Persistent Proatlantal artery Type I Observed in a Patient with Subarachnoid Hemorrhage: Case Report / 대한뇌혈관외과학회지

We report here on a case of persistent proatlantal artery type I with the absence of the right vertebral artery's first, second and third segments. This rare anomaly was accidentally encountered when performing angiography in a patient with a ruptured aneurysm of the left anterior choroidal artery and an unruptured aneurysm of the right anterior choroidal artery. Both aneurysms were clipped via craniotomy. The angiography showed that the right proatlantal artery type I arose from the right internal carotid artery at the C2 level. The proatlantal artery joined the horizontal portion of the right vertebral artery. The absence of the right vertebral artery's first, second and third segments and a hypoplastic left vertebral artery were demonstrated. The anomalous artery was thought to have been unrelated to rupture of the aneurysm. We also reviewed the previous Korean reports about a persistent proatlantal artery, and we discuss the potential clinical implications of this anomalous vessel.

The Comparision of the Short Term Result of Transobturator and Retropubic Mid Urethral Slings in the Female Stress Urinary Incontinence

PURPOSE: Transobturator slings have become an alternative to retropubic slings for the surgical treatment of stress urinary incontinence (SUI). We aimed to compare the efficacy and outcome between transobturator and retropubic mid-urethral sling procedures. MATERIALS AND METHODS: We reviewed the chart of 186 consecutive women who had sling procedures with a follow-up of at least 1 year from 2001 to 2006. The retropubic sling procedure was perfomed on 76 women assigned to retropubic group. A total 110 women received transobturator slings assingned to transobturator group. The preoperative evaluations, the indices of voiding, and postoperative complications were analysed by Student's t-test and chi-square. RESULTS: Two groups were similar in their preoperative characteristics and the perioperative parameters except the period of hospitalization and operative time. There were significant difference between the 2 groups in terms of the postoperative obstructive and iatrogenic complications. Transobturator group had shorter hospitalization and operative time and lower complications than retropubic group. CONCLUSIONS: Because transobturator sling procedures showed better results and less complications than retropubic slings, it is a safe and efficient surgical treatment for female SUI.