TNM-Based Head-to-Head Comparison of Urachal Carcinoma and Urothelial Bladder Cancer: Stage-Matched Analysis of a Large Multicenter National Cohort / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. @*Materials and Methods@#Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. @*Results@#UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. @*Conclusion@#Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

Multiple Metachronous Malignancies: One Patient with Five Primary Malignancies / 대한내과학회지

We report a case of a 73-year-old male with multiple, metachronous primary malignancies. He presented with adenocarcinoma of the stomach with transverse colon invasion followed by bladder cancer, hypopharyngeal cancer, urothelial cancer, and hepatocellular carcinoma, in that order, over 10 years. While these multiples malignancies were separate entities, they shared several etiologic factors, including smoking. To the best of our knowledge, this is the first description of five metachronous malignancies in a Korean patient.

Multiple Metachronous Malignancies: One Patient with Five Primary Malignancies / 대한내과학회지

We report a case of a 73-year-old male with multiple, metachronous primary malignancies. He presented with adenocarcinoma of the stomach with transverse colon invasion followed by bladder cancer, hypopharyngeal cancer, urothelial cancer, and hepatocellular carcinoma, in that order, over 10 years. While these multiples malignancies were separate entities, they shared several etiologic factors, including smoking. To the best of our knowledge, this is the first description of five metachronous malignancies in a Korean patient.

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Elevated red cell distribution width is associated with advanced fibrosis in NAFLD

BACKGROUND/AIMS: The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. METHODS: This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. RESULTS: After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of or =2.67, respectively (P or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. CONCLUSIONS: Elevated RDW is independently associated with advanced fibrosis in NAFLD.

Burnt-out Metastatic Prostate Cancer / 영남의대학술지

A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

Impact of Treatment With Statins on Prostate-Specific Antigen and Prostate Volume in Patients With Benign Prostatic Hyperplasia

PURPOSE: We investigated the impact on prostate-specific antigen (PSA) and prostate volume (PV) of statin medication for 1 year in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We retrospectively investigated 791 patients in whom BPH was diagnosed. For analysis, the patients were divided into four groups according to their medications: group A, alpha-blocker; group B, alpha-blocker+statin; group C, alpha-blocker+dutasteride; group D, alpha-blockers+statin+dutasteride. To investigate changes in serum PSA, PV, and total cholesterol, we analyzed the data at the time of initial treatment and after 1 year of medication. RESULTS: After 1 year, group A showed a 1.3% increase in PSA and a 1.0% increase in PV. Group B showed a 4.3% decrease in PSA and a 1.8% decrease in PV. The difference in PV reduction between groups A and B was statistically significant (p<0.001). Group C showed a 49.1% reduction in PSA and a 22.9% reduction in PV. Group D showed a 51.6% reduction in PSA and a 24.5% reduction in PV. The difference in PV reduction between groups C and D was not statistically significant (p=0.762). By use of a multivariate logistic regression model, we found that the probability of PV reduction after 1 year was more than 14.8 times in statin users than in statin nonusers (95% confidence interval, 5.8% to 37.6%; p<0.001). CONCLUSIONS: Statin administration reduced PSA and PV in BPH patients. This finding may imply the improvement of lower urinary tract symptoms and prevention of cardiovascular disease and chemoprevention of prostate cancer with statin treatment.

Effect of Nonalcoholic Fatty Liver Disease on the Development of Type 2 Diabetes in Nonobese, Nondiabetic Korean Men

BACKGROUND/AIMS: We have a limited understanding of the effect of nonalcoholic fatty liver disease (NAFLD) on the development of type 2 diabetes. METHODS: The study subjects included male who had received biennial medical check-ups between 2005 and 2009 and who had been diagnosed with fatty liver disease. The subjects with sustained NAFLD (FL, n=107) and sustained non-NAFLD (NFL, n=1,054) were followed to determine the development of type 2 diabetes. RESULTS: In the FL group, there were more subjects with impaired fasting glucose (IFG), type 2 diabetes and high HOMA-IR than there were in the NFL group during the 5-year follow-up period (32.7 vs. 17.6%, 1.9 vs. 0.3%, 17.9 vs. 5.2% respectively, p<0.05). The FL group showed a higher risk than NFL group for abnormal glucose metabolism as determined using IFG (odds ratio [OR], 2.13; confidence interval [CI], 1.36 to 3.35), type 2 diabetes (OR, 7.63; 95% CI, 1.03 to 56.79) and high HOMA-IR (OR, 3.25; 95% CI, 1.79 to 5.91) and metabolic parameters such as body mass index (OR, 3.35; 95% CI, 1.87 to 6.02), triglyceride (OR, 3.05; 95% CI, 1.92 to 4.86) and fasting blood sugar (OR, 2.18; 95% CI, 1.39 to 3.41). CONCLUSIONS: Sustained NAFLD appears to be associated with an increased risk for the development of type 2 diabetes and deterioration of metabolic parameters in non-obese, non-diabetic Korean men.

Tumor Establishment Features of Orthotopic Murine Bladder Cancer Models

PURPOSE: Animal tumor models are important for the evaluation of novel therapeutic modalities. Since the initial report of an orthotopic bladder tumor model, several modifications have been proposed to improve the tumor take rate. Here we compared the HCl-pretreated and electrocauterization-pretreated orthotopic murine bladder tumor models. MATERIALS AND METHODS: MBT-2 murine bladder cancer cells were transurethrally implanted in the bladder of syngeneic C3H/He mice. The mice were divided into three groups according to pretreatment methods (electrocautery, HCl, and control group) and were subjected to pretreatment before instillation of MBT-2 tumor cells into the bladder. Mice were sacrificed on day 21, and bladders were harvested, weighed, and examined histopathologically. RESULTS: The tumor take rate of the control, electrocautery, and HCl groups was 0%, 54%, and 100%, respectively. The tumor take rate of the HCl group was significantly higher than that of the control group (p<0.01) and the electrocautery group (p=0.01). Pathologic reports revealed that all established bladder tumors were high-grade papillary urothelial carcinomas. CONCLUSIONS: The HCl pretreatment model was a preferable murine bladder tumor model for evaluating further therapeutic interventions.

Wilms' Tumor in a Horseshoe Kidney

The incidence of horseshoe kidney is about 1 in 400 cases. The presence of Wilms' tumor with a horseshoe kidney is unusual, and the occurrence of Wilms' tumor in a horseshoe kidney is estimated at 0.4 to 0.9% of all Wilms' tumors. We report the case of a 5-year-old boy who presented with a stage IV Wilms' tumor in a horseshoe kidney. The patient was treated with preoperative chemotherapy followed by surgical resection and adjuvant chemotherapy. This case illustrates the role of preoperative chemotherapy for preserving renal function and aims to highlight the multimodality treatment of Wilms' tumor.

Heart Rate Variability in Men with Erectile dysfunction / 대한배뇨장애요실금학회지

PURPOSE: The objective of this study is to investigate alteration of autonomic nervous system (ANS) activity in patients suffering from erectile dysfunction (ED) by comparing parameters of heart rate variability (HRV) between men with ED and healthy subjects. METHODS: A retrospective review was performed on 40 ED patients (mean age, 46.0+/-8.49 years) without any disease and 180 healthy control people (mean age, 44.4+/-7.83 years) without ED in our institution from June 2008 to July 2010. And electrocardiographic signals were obtained to measure HRV parameters for both patients and controls in a resting state. RESULTS: For the time domain analysis, square root of the mean differences between successive RR intervals (RMSSD) representing parasympathetic activity was lower in patients than controls although P-value was not statistically significant (P=0.060). For the frequency domain analysis, high frequency (HF) representing parasympathetic activity was lower in patients than controls (P=0.232) and low frequency (LF) representing mainly sympathetic activity was higher in patients than controls (P=0.416). Lastly, LF/HF ratio reflecting sympathetic/parasympathetic activity ratio was statistically higher in patients than controls (P=0.027). CONCLUSIONS: Patients with ED exhibited different HRV parameters compared with normal controls. This suggests that the patients with ED may have some kind of imbalance in the ANS and it may be possible that general imbalance of the ANS is one of the causes of ED. Thus, HRV analysis may give valuable diagnostic information and serve as a rapid screening tool to evaluate altered ANS activity in patients with ED.

Role of Clusterin and Tumor Necrosis Factor Receptors on the Apoptosis of Prostate Cancer Cells / 대한남성과학회지

PURPOSE: In prostate cancer, the anti-apoptotic mechanism of sulfated glycoprotein-2 (clusterin) against tumor necrosis factor-alpha (TNF-alpha) receptors and the action of type 2 TNF-alpha receptor (TNFR2) were investigated. MATERIALS AND METHODS: TNF-alpha, agonistic-TNF type 1 receptor (TNFR1) antibody, agonistic-TNF-R2 antibody and their combination were treated in PC3 cell line with or without anti-clusterin. Cytotoxicity was assessed by trypan blue dye exclusion assay. By using flowcytometric analysis, the exact amount of apoptosis and their changes were assessed. RESULTS: Apoptosis was significantly increased in both agonistic-TNFR1 antibody and TNF-alpha treated cases after blocking the activity of clusterin. The more the anti-clusterin antibody added, the more the apoptosis occurred. The increase of total apoptosis was greater in TNF-alpha treated cells than in agonistic-TNFR1 antibody treated ones. However, there was no increase of apoptosis in agonistic-TNFR2 antibody and TNF-alpha with agonistic-TNFR2 antibody treated cases, respectively. CONCLUSIONS: Clusterin prevents TNF-alpha induced apoptosis by affecting TNFR1. The difference in degree of apoptosis between agonistic-TNFR1 antibody treated cells and TNF-alpha treated ones suggests the possibility of the action of TNFR2. It may be associated with affinity of TNF-alpha to the tumor cell surface.

Relationship between Metabolic Syndrome and Prostate Volume in Korean Men under 50 Years of Age

PURPOSE: The metabolic syndrome (MS) has been accepted as an important cause of benign prostatic hyperplasia (BPH) in old age. However, there are no studies of the influence of MS on prostate volume in relatively young adults. We evaluated the relationship between parameters of MS and prostate volume in men under 50 years of age who visited our health promotion center. MATERIALS AND METHODS: A total of 968 men aged 30 to 49 years were enrolled from March 2009 to June 2010. Prostate volume by transrectal ultrasonography of the prostate, serum prostate-specific antigen, digital rectal examination, urinalysis, and MS-related parameters were investigated. We evaluated the correlations of prostate volume with MS and MS-related parameters. RESULTS: Prostate volume was not significantly larger in the MS group (18.4 cc; range: 14.3-23.1 cc) than in the non-MS group (17.8 cc; range, 13.6-21.6 cc). The prostate volumes in subjects with abnormal fasting plasma glucose (FPG) (18.9 cc; range, 14.3-22.7 cc) and abnormal waist circumference (WC) (19.5 cc; range, 15.6-23.7 cc) were significantly larger than those of subjects with normal parameters (16.9 [range, 12.7-20.4] cc and 17.5 [range, 13.3-21.2] cc, respectively; p=0.001). The logistic regression analysis showed the FPG level and WC to have a significantly positive correlation with the prostate volume (odds ratios: 1.441 [95% CI: 1.303-1.643] and 2.305 [95% CI: 1.470-3.614], respectively). CONCLUSIONS: Groups with abnormal FPG and WC had larger prostate volumes than did normal groups. The abnormal FPG and WC could be more important factors than MS in prostate volume enlargement in relatively young adults.

Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy / 대한남성과학회지

PURPOSE: We investigated the predictive factors in patient with prostate cancer diagnosed by repeat prostate biopsy, where initial prostate biopsy results were negative for malignancy. MATERIALS AND METHODS: Between March 2000 and June 2007, 1280 men with suspected prostatic cancer underwent transrectal ultrasound guided needle biopsy of the prostate, with 148 (11.6%) diagnosed as having prostate cancer. Of 1132 men whose biopsy results were negative for malignancy, 655 whose prostate specific antigen (PSA) was elevated persistently underwent second biopsy, and 462 underwent third biopsy as the same course. Twelve core biopsies were performed in the majority of patients. To determine predictive factors, we evaluated prostate volume, serum PSA, percent free PSA, PSA density (PSAD), transition zone PSAD, PSA velocity (PSAV) and pathological report of previous biopsy between the men with cancer detection and the men with negative biopsy in second and third biopsy. RESULTS: Overall cancer detection rate was 16.3% (208/1280). From the first, second and third biopsies, the cancer detection rate were 11.6, 5.5 and 5.2%, respectively. There were significant differences in percent free PSA, transition zone PSAD, PSAV between cancer and negative biopsy groups after serial repeat biopsies (p<0.05). Multivariate logistic regression analysis revealed that the transition zone PSAD, PSAV, and presence of either atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in initial biopsy specimen were significant predictors for prostate cancer diagnosed by repeat biopsy. CONCLUSIONS: Of the men with negative results on the first biopsy, 60 (5.4%) were diagnosed prostate cancer after serial biopsies. The transition zone PSAD, PSAV, and presence of either ASAP or HGPIN in initial biopsy specimen are predictable factors for prostate cancer detection on repeat biopsy.

Serum Uric Acid as a Predictor for the Development of Nonalcoholic Fatty Liver Disease in Apparently Healthy Subjects: A 5-Year Retrospective Cohort Study

BACKGROUND/AIMS: This study evaluated the relationship between hyperuricemia and nonalcoholic fatty liver disease (NAFLD) by comparing the incidence rates of NAFLD in relation to serum uric acid levels in apparently healthy subjects during a 5-year period. METHODS: Among 15,638 healthy Korean subjects who participated in a health-screening program in 2003 and 2008, respectively, 4954 subjects without other risk factors were enrolled in this study. We compared the incidence rates of NAFLD in 2008 with respect to baseline uric acid levels. RESULTS: In 2003, serum uric acid levels were categorized into the following quartiles: 0.6-3.9, 3.9-4.8, 4.8-5.9, and 5.9-12.6 mg/dL. The incidence of NAFLD in 2008 increased with the level of baseline uric acid (5.6%, 9.8%, 16.2%, and 20.9%, respectively; p<0.05). Multiple logistic regression analysis demonstrated that hyperuricemia was associated with the development of NAFLD. When compared to the subjects in quartile 1, the odds ratio (OR) for the incidence of NAFLD for quartiles 2, 3, and 4 were 1.53 (95% confidence interval [CI], 1.09-2.16; p=0.014], 1.69 (95% CI, 1.17-2.44; p=0.005), and 1.84 (95% CI, 1.25-2.71; p=0.002), respectively. CONCLUSIONS: High serum uric acid levels appear to be associated with an increased risk of the development of NAFLD.

Alteration of Autonomic Function in Female Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) have different mechanisms of action. We believe that alteration of autonomic nervous system (ANS) activity may contribute to UUI because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) allows measurement of autonomic nervous function, therefore we measured and compared HRV parameters in women with urinary incontinence. METHODS: From March 2008 to March 2010, we evaluated all patients who visited 2 university hospitals for treatment of urinary incontinence. Theywere performed 3-day voiding diary, urodynamic study, physical examination and routine laboratory examination. We excluded subjects who had diabetes, cardiovascular problems, or other condition that affect ANS. Patients with mixed urinary incontinence (MUI) were also excluded. Finally 47 women with SUI (group 1) and 29 women with UUI (group 2) were enrolled according to their symptoms and voiding diary. We compared their HRV parameters. And excluding 11 patients who had detrusor underactivity, we divided them again into group A, 53 women without detrusor overactivity (DO) and group B, 12 women with DO. We compared HRV parameters between DO and non-DO group. RESULTS: Older women had a higher incidence of UUI and DO. In HRV parameters, only the ratio of low frequency (LF) and high frequency (HF) was significantly higher in group 2 than group 1 (3.5+/-3.6 vs. 1.6+/-1.1, P<0.05). Also group A had higher mean LF/HF ratio than group B (4.3+/-3.8 vs. 1.9+/-1.9, P<0.05). CONCLUSIONS: Increased LF/HF values indicate relative sympathetic hyperactivity over parasympathetic activity. Changes in ANS activity could indicate the presence of UUI and potentially DO.

Association of Prostate Specific Antigen (PSA) Velocity with Age and Initial PSA in Healthy Korean Men / 대한남성과학회지

PURPOSE: Prostate specific antigen (PSA) is a test with relatively low specificity used for determination of risk for prostate cancer. PSA velocity (PSAV) has been used as a complimentary test. We investigated the association of PSAV with age and an initial PSA. MATERIALS AND METHODS: We enrolled 989 healthy men with initial PSA of 4.0ng/ml or lower. The PSA levels were measured at intervals of at least 12 months. We analyzed the influence of age and initial PSA on the PSAV. RESULTS: PSAV was directly correlated with age and the initial PSA. The initial PSA was not correlated with the PSAV when adjusted by age (r=0.009, p=0.773); age was correlated with PSAV when adjusted by initial PSA level (r=0.276, p<0.001). The mean PSAV in cases with initial PSA of 2.1-4.0 ng/ml was significantly greater compared to the cases with an initial PSA of 0-2.0 ng/ml (p<0.01). The ratio of the men with a PSAV greater than 0.75 ng/ml/year was significantly higher in cases with an initial PSA of 2.1-4.0 ng/ml (p<0.05). CONCLUSIONS: PSAV is associated with age and an initial PSA level in healthy Korean men. Men with initial PSA of 2.1-4.0 ng/ml had an abnormal PSAV in high proportion, and therefore annual follow up PSA would be useful for the early detection of prostate cancer in these cases.

What is the best Treatment of Penile Fractures? Conservative or Surgical?: Experience in 34 cases / 대한남성과학회지

PURPOSE: Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis. In this study, we aimed to compare conservative and surgical treatment modalities. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 34 patients who visited our hospital with penile fracture and two treatment modalities were compared: conservative (Group I) and surgical (Group II). The five men who refused surgical treatment were treated conservatively, and the other 29 patients underwent surgical treatment. RESULTS: The most common cause of fracture was sexual intercourse (21/34, 61.8%). The most common sites of fracture were the right (67.6%), ventral (67.6%), and proximal (47.1%) parts of the penis. In Group II, only complication was painful erection (2/29, 6.9%), whereas in group I, 80% (4/5) suffered complications such as wound infection, painful erection, penile nodules with curvature, and erectile dysfunction. All patients treated with surgery successfully recovered without erectile dysfunction. CONCLUSIONS: Because surgical management gives excellent results, shorter hospitalization, less morbidity, surgical treatment is more effective approach than conservative treatment.

Effects of Tadalafil on the Cerebral Ischemia-induced Apoptotic Neuronal Cell Death in Motor Cortex of Gerbils / 대한남성과학회지

PURPOSE: Cerebral ischemia leads to neuronal cell death, and eventually causes neurological impairments. Tadalafil is a long-acting phosphodiesterase type-5 (PDE-5) inhibitor, and it has been used for the treatment of erectile dysfunction. In the present study, we investigated whether tadalafil has the protective effect on apoptotic neuronal cell death in the motor cortex following transient global ischemia in gerbils. MATERIALS AND METHODS: For this study, Mongolian gerbils were used for the experimental animals, and transient global ischemia was induced to the gerbils by occlusion of both common carotid arteries for 7 min. Gerbils were randomly divided into five groups (n=8 in each group): the sham-operation group, the cerebral ischemia-induced group, the cerebral ischemia-induced and 0.1 mg/kg tadalafil-treated group, the cerebral ischemia-induced and 1 mg/kg tadalafil-treated group, the cerebral ischemia-induced and 10 mg/kg tadalafil-treated group. Tadalafil-treated groups received tadalafil orally once a day for a 7 consecutive days, starting one day after surgery. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay and immunohistochemistry for caspase-3 were performed for the detection of apoptotic neuronal cell death in the motor cortex. RESULTS: The number of TUNEL-positive cells was 21.45+/-3.69/section in the sham-operation group, 771.66+/-97.25/section in the cerebral ischemia-induced group, 688.44+/-81.35/section in the cerebral ischemia-induced and 0.1 mg/kg tadalafil-treated group, 295.66+/-36.34/section in the cerebral ischemia-induced and 1 mg/kg tadalafil-treated group, and 198.47+/-25.25/section in the cerebral ischemia-induced and 10 mg/kg tadalafil-treated group. In the present results, induction of ischemic injury increased apoptotic neuronal cell death in the motor cortex of gerbils. However, tadalafil treatment suppressed the cerebral ischemia-induced apoptotic neuronal cell death in the motor cortex as dose-dependently. CONCLUSIONS: Here in this study, we showed that tadalafil has protective effect on the cerebral ischemia-induced apoptotic neuronal cell death, and thus this drug may facilitate the recovery following ischemic cerebral injury.

The Effects of Anthropometric Factors and Serologic Factors of the Metabolic Syndrome on Prostate-Specific Antigen Levels in Korean Men

PURPOSE: We evaluated the effects of anthropometric and serological parameters on serum prostate-specific antigen (PSA) in Korean men. MATERIALS AND METHODS: This study included 92,891 healthy Korean men who visited our health promotion center for a general health checkup. The mean age of the participants was 42.6 years (range, 20-77 years). Exclusion criteria were a serum PSA level over 4.0 ng/dl or pyuria on urinalysis (>5 white blood cells/high power field). All participants were evaluated for several anthropometric factors (height, weight, systolic blood pressure, diastolic blood pressure, body mass index [BMI], body surface area [BSA], fat mass, body fat percentage, and lean body mass) and for serologic parameters including components of the metabolic syndrome (fasting blood sugar, triglyceride [TG], and high-density lipoprotein cholesterol) biochemically. We analyzed the relationship between serum PSA levels and the various anthropometric and serologic parameters. RESULTS: In the univariate analysis, serum PSA levels were significantly positively correlated with age and with low-density lipoprotein (LDL) cholesterol after adjustment for age. On the other hand, serum PSA levels were negatively correlated with height, weight, BMI, BSA, fat mass, body fat percentage, lean body mass, aspartate aminotransferase, alanine aminotransferase, and TG. In the multivariate analysis, age and LDL-cholesterol had positive correlations with serum PSA levels, but BMI, BSA, fat mass, lean body mass, and TG were negatively correlated with PSA levels. CONCLUSIONS: These results suggest that the serum PSA level is significantly influenced by age, the components of metabolic syndrome (BMI, TG), and serologic parameters such as LDL-cholesterol. The normal range of serum PSA should be considered in association with metabolic syndrome and anthropometric factors as well as age.