Assessment of Di (2-ethylhexyl) Phthalate Exposure by Urinary Metabolites as a Function of Sampling Time / 예방의학회지

OBJECTIVES: In most DEHP exposure assessment studies, single spot urine sample was used. It could not compare the exposure level among studies. Therefore, we are going to represent the necessity of selection of proper sampling time of spot urine for assessing the environmental DEHP exposure, and the association urinary DEHP metabolites with steroid hormones. METHODS: We collected urine and plasma from 25 men. The urine sampling times were at the end of the shift (post-shift) and the next morning before the beginning of the shift (pre-shift). Three metabolites of DEHP {mono(2-ethylhexyl) phthalate [MEHP], mono-(2-ethyl-5-hydroxyhexyl)phthalate [MEHHP], and mono(2-ethyl-5-oxohexyl)phthalate [MEOHP]} in urine were analyzed by HPLC/MS/MS. Plasma luteinzing hormone, follicle stimulating hormone, testosterone, and 17beta-estradiol were measured at pre-shift using a ELISA kit. A log-transformed creatinine-adjusted urinary MEHP, MEHHP, and MEOHP concentration were compared between the post- and pre-shift. The Pearson's correlation was calculated to assess the relationships between log-transformed urinary MEHP concentrations in pre-shift urine and hormone levels. RESULTS: The three urinary metabolite concentrations at post-shift were significantly higher than the concentrations in the pre-shift (p<0.0001). The plasma hormones were not significantly correlated with log-transformed creatinine - adjusted DEHP metabolites. CONCLUSIONS: To assess the environmental DEHP exposure, it is necessary to select the urine sampling time according to the study object. There were no correlation between the concentration of urinary DEHP metabolites and serum hormone levels.

Determination of Appropriate Sampling Time for Job Stress Assessment: the Salivary Chromogranin A and Cortisol in Adult Females / 예방의학회지

OBJECTIVES: This study was conducted to determine the appropriate sampling time of the salivary stress markers, chromogranin A (CgA) and cortisol as objective indices of job stress assessment in adult females. METHODS: The subjects were 20~39-year-old women (13 office workers, 11 sales-service workers, and 11 college students) who were eligible for the study and free of acute and chronic medical conditions. Salivary CgA and cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA). Saliva samples were collected (2ml each) at 7:00, 8:00, 10:30, 12:00, 17:30, and 22:30 on a typical day. Salivary CgA and cortisol levels, according to sampling time, were compared among the three groups using general linear model. The full version of the Korean Occupational Stress Scale (KOSS), which includes socioeconomic characteristics, health behavior, work-related characteristics, and BMI, was used to access the subjects' job stress. Multiple regression analysis of the job stressors identified by the KOSS was performed on salivary CgA and cortisol levels. RESULTS: The salivary CgA level peaked at 7:00 (time of awakening), then decreased and were maintained at a low level throughout the day, and increased slightly at 17:30. The salivary cortisol level increased steeply within the 1st hour after awakening, followed by a gradual decrease by 12:00, and was then maintained at a low level throughout the day. The salivary cortisol levels of subjects who worked < or =5 days per week and graduated from the university were significantly lower at 8:00 (p=0.006). The salivary cortisol levels of non-smokers were significantly lower at 7:00 (p=0.040) and 8:00 (p=0.003) compared to smokers. There were no significant differences in salivary CgA and cortisol levels at 10:30 and 12:00 in general characteristics. The regression coefficients on salivary CgA level were significant with interpersonal conflict at 17:30 and job insecurity at 22:30. Regression coefficients on salivary cortisol level were significant with organizational system and total job stressors at 17:30. CONCLUSIONS: We suggest that the appropriate sampling times for the salivary stress markers, CgA and cortisol, are at 7:00 (time of awakening), 8:00 (1 hour after awakening), 17:30 (early evening), and 22:30 (before sleep).

Clinical Efficacy and Safety of Sildenafil in the Men with Erectile Dysfunction in Korea / 대한비뇨기과학회지

PURPOSE: Erectile dysfunction has variety of etiologic factors and it has been a common medical disorder with an estimated prevalence of about 50%. It has been confirmed that sildenafil improved impaired erectile responses in men. We evaluated the efficacy and safety of oral sildenafil for the patients with erectile dysfunction in Korea. MATERIALS AND METHODS: 583 patients were administered sildenafil for erectile dysfunction and 256 of them have been followed up over one month. The initial usual dosage was 50mg and the dosage was titrated based on efficacy and tolerance at every visit. Sexual function was measured before and during the therapy using International Index of Erectile Function (IIEF). RESULTS: Mean IIEF score changed significantly from 27.93+/-18.52 at baseline to 44.57+/-16.56 after treatment with sildenafil (p<0.001) and the mean scores of each IIEF domain (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) also improved (p<0.001). Q3 (penetration ability) and Q4 (maintenance ability) scores changed from 2.08+/-1.69 to 3.21+/-1.50 (p<0.001) and from 1.77+/-1.50 to 2.96+/-1.44 (p<0.001), respectively. In response to the global efficacy question, 73.4% of patients reported that treatment had improved their erections. With respect to the etiology, IIEF was changed significantly in DM group and no specific underlying disease group (p<0.001), but in radical prostatectomy or cystectomy group no significant change was observed. Side effects were reported in 56 patients (21.9%), including facial flushing (11.7%), headache (7.0%), dyspepsia (2.0%), altered vision (1.6%), nasal congestion (1.6%), conjunctival injection (1.2%), dyspnea (0.8%), dizziness (0.8%), and palpitation (0.8%). Only 4 patients (1.6%) discontinued treatment due to the side effects. CONCLUSIONS: Sildenafil citrate is a highly effective and well-tolerated oral agent for the treatment of erectile dysfunction in Korean men.

Comparison of Extraperitoneal Laparoscopic Versus Open Burch Colposuspension for Treatment of Stress Urinary Incontinence: Long Term Follow-up / 대한비뇨기과학회지

PURPOSE: Laparoscopic Burch colposuspension has been described as an alternative method to the surgical correction of stress urinary incontinence. We attempt to compare long-term results of laparoscopic and open Burch colposuspension in women with stress urinary incontinence. MATERIALS AND METHODS: We retrospectively reviewed 51 consecutive cases of extra peritoneal laparoscopic (n=31) and open Burch colposuspension (n=20). Success rate was assessed by telephone interview and clinical data. RESULTS: Preoperative data of the two groups were not different statistically. The suc cess rate of laparoscopic group was 74.2% with a mean follow-up of 48.1 months and that of open Burch group was 80.0% with a mean follow-up of 43.1 months. On comparing extraperitoneal laparoscopic and open Burch procedure, laparoscopic group significantly required shorter operating time (110 minutes versus 138 minutes; p <0.05), shorter length of hospitalization (3.6 days versus 7.4 days; 0.01) and shorter catheter indwelling time (2.5 days versus 4.2 days; 0.01). CONCLUSIONS: Extraperitoneal laparoscopic Burch colposuspension offers a less in vasive and effective approach to the surgical correction of stress urinary incontinence in terms of success rate, hospital stay and catheter indwelling time in properly selected patients.

Pediatric Urolithiasis during the Past 10 Years: Retrospective Analysis / 대한비뇨기과학회지

PURPOSE: For better understanding of the clinical characteristics and outcomes of management in pediatric urolithiasis, we report our experience with pediatric urolithiasis during the past 10 years. MATERIALS AND METHODS: We retrospectively reviewed the records of 56 pediatric patients with urolithiasis between May 1990 and May 2000. The mean age of the patients was 8.4 years (3 months-18 years) with sex ratio of 1.2:1.0 (male:female). We described initial symptoms, risk factors, location and size of stones, stone composition, treatment outcomes and complications. Metabolic evaluations were performed in 26 patients. RESUTLS: Metabolic abnormalities were found in 13 (23%) and all of them had hypercalciuria. In 3 of these patients, hyperuricosuria was also detected. Urinary tract anomalies were discovered in 10 (18%), all of whom were under age of 10 and underwent surgical reconstruction except for 1 patient who had horseshoe kidney and was lost during follow-up. For the treatment, 28 patients (50%) were treated by SWL. Other treatment modalities consisted of ureteroscopic lithotripsy in 3, pyelolithotomy in 2 who had large staghorn stone (>5cm), and cystolitholapaxy in 2. Spontaneous stone passage was observed in 8 patients (14%). For those who underwent SWL, stone free rates of the first, second and third session were 78%, 96% and 100% respectively. There were no major complications. CONCLUSIONS: Pediatric patients with urolithiasis requires evaluation for metabolic and structural abnormalities. Most of the urinary stone disease in the pediatric age group without structural anomalies could be effectively treated by SWL with minimal morbidity whereas those with structural anomalies necessitating surgical reconstruction are the best candidates for open surgery.