Relapse of Neuromyelitis Optica Spectrum Disorder Presented with Suspected Bacterial Meningomyelitis

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory demyelinating disease. Anti-aquaporin-4 antibodies serve as a specific biomarker, while other factors including antecedent infection may also play a role in the development of NMOSD. Abnormal cerebrospinal fluid (CSF) findings such as leukocytosis with concentration >50/mm3 are one of the characteristics of NMOSD, but these were not specific for identifying other infective neurological diseases. Here we describe a rare case of NMOSD with CSF findings suggestive of bacterial meningomyelitis.

Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

PURPOSE: Systemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC). MATERIALS AND METHODS: We collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models. RESULTS: Overall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence. CONCLUSIONS: Our results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients.

Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

PURPOSE: To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. MATERIALS AND METHODS: We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. RESULTS: A univariate analysis indicted that hypoalbuminemia ( or =1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS > or =1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. CONCLUSIONS: A mid or lower ureteral obstruction, GPS > or =1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Effect of Finasteride on Male Pattern Baldness in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Finasteride, an inhibitor of 5alpha-reductase, is used for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness, by inhibiting the conversion of testosterone to dihydrotestosterone (DHT). We attempted to determine whether finasteride treatment led to a clinical improvement in BPH patients with male pattern baldness. MATERIALS AND METHODS: This was a one year, single blind, prospective study, conducted on BPH patients. Eighty two men participated in the study, and received either 5mg finasteride plus 0.2mg tamsulosin (group I, n=43) or 0.2mg tamsulosin alone (group II, n=39). The efficacies were evaluated, bimonthly, by baldness grade, international prostate symptom score (IPSS) and peak flow rate (PFR), for 12 months. The estimation of baldness grade was based on the modified Norwood's classification (from grades I to VII). Patients with grade IV or higher were categorized as having moderate to severe male pattern baldness. The numbers of moderate to severe male pattern baldness were 11 and 16 in groups I and II, respectively. RESULTS: At the baseline, there were no significant differences in the baldness grade, age and prostatic volume between the two groups. Group I exhibited a gradual and continuous improvement in the baldness grade at 10 and 12 months compared to baseline (p<0.05), while group II displayed no significant change in the baldness grade. Thirteen patients (30.2%) of group I manifested improvements in their baldness grade, whereas none of group II demonstrated an improvement. In group I, of the eleven patients with moderate to severe male pattern baldness, seven (63.6%) showed an improvement in their baldness grade, whereas of the thirty two mild grade patients, six (18.7%) showed an improvement. The improvement in baldness grade from the baseline to 10 and 12 months were statistically significant, but from the baseline to 8 months was insignificant. CONCLUSIONS: The combined treatment of 5mg finasteride and 0.2mg tamsulosin, for BPH patients, resulted in an improvement in male pattern baldness.

Deletion of Y-Chromosome Specific Genes in Testicular Germ Cell Tumor / 대한비뇨기과학회지

PURPOSE: We hypothesized that the deletion of Y-chromosome specific genes is associated with testicular tumors. To test this hypothesis, we analyzed the expressions of five Y-chromosome specific genes in testicular tumor samples. MATERIALS AND METHODS: Thirty-five human testicular tumor specimens were processed for the micro-dissection of pure epithelial cells. The DNA was extracted, and polymerase chain reactions performed using five different specific primers (ZFY, DYS203, SMCYM45, GDB187507 and RH38676). These primers were designed based on sequences available in the public genome data bank. RESULTS: Deletion was observed in 88.6% of the testicular tumor specimens with at least one Y-chromosome specific gene. The losses of DYS203, ZFY, SMCYM45, RH38676 and GDB187507 were shown in 51.4, 42.9, 40, 28.6 and 20% of cases, respectively. There was a different pattern of loss of the Y-chromosome specific genes according to the histologic types of germ cell tumor. The losses of the DYS203 and GDB187507 genes were seen more frequently in the advanced stages. CONCLUSIONS: There was a significant loss of the Y-chromosome specific genes in testicular germ cell tumors. The loss of the DYS203 gene was observed in about half the cases, and was more frequent in the higher stages of testicular tumor. The loss of Y-chromosome specific genes is associated with testicular tumors, suggesting their role in the pathogenesis of this disease.

Effects of Ginsenosides on Relaxation of Rabbit Vaginal Smooth Muscle / 대한남성과학회지

PURPOSE: Ginseng has been used throughout the Far East, including Korea and China, as a tonic and restorative agent to maintain physical vitality. The main pharmacoactive molecules of ginseng are ginsenosides. The present study was designed to investigate whether ginsenosides relax rabbit vaginal smooth muscle and whether this effect is modulated by nitric oxide(NO) and the cGMP pathway. MATERIALS AND METHODS: Strips of rabbit vagina were mounted in organ chambers to measure isometric tension. The strips were contracted with phenylephrine(5 X 10(-5) M), and the responses to acetylcholine, nitric oxide inhibitor, and ginsenosides were examined. The cGMP content of the strips was measured by radioimmunoassay after various doses of ginsenosides. RESULTS: Ginsenosides(100~500microgram/mL) relaxed vaginal smooth muscle in a dose-dependent manner(5~25%). Acetylcholine-induced relaxation was significantly increased in the presence of ginsenosides(100, 200microgram/mL)(p0.05). Ginsenosides(400microgram/mL for 7 min) increased the accumulation of cGMP. CONCLUSIONS: These data suggest that ginsenosides have a relaxing effect on rabbit vaginal smooth muscle. This effect is at least in part mediated by the NO-cGMP pathway.