The Role of Alpha 1 (A) Adrenoceptor Antagonist Tamsulosin for the Treatment of Patients with Benign Prostatic Hyperplasia: The Effect on Lower Urinary Tract Symptoms and Nocturia / 대한비뇨기과학회지

PURPOSE: Nocturia is considered to be the main cause of disturbance of sleep maintenance and the quality of life for elderly men. We assessed the effectiveness of administering alpha 1 (A)-adrenoceptor antagonist tamsulosin for the patients with benign prostatic hyperplasia (BPH), and we measured the degree of improvement of the lower urinary tract symptoms and nocturia after treatment. MATERIALS AND METHODS: From May 2003 to October 2003, 268 patients with BPH were prospectively selected for this study. The patients were treated with tamsulosin at a dose of 0.2mg/day. The effectiveness of tamsulosin was assessed by analyzing the three day voiding diaries and the other parameters, including the International Prostatic Symptom Score (I-PSS), the Bother score, the maximal urinary flow rate (Qmax), and the postvoid residual urine. The data for these parameters were acquired at baseline and after 4 and 12 weeks of treatment. We investigated the differences in the improvement of noctuia in the BPH patients according to the type of nocturia. RESULTS: Of the 268 patients, 189 patients (70.5%) completed the study. The clinical parameters, including the I-PSS, the Bother score, the Qmax and the residual urine showed significant improvement from the baseline. The change of nocturnal frequency was 2.2 at baseline to 1.4 after 12 weeks of treatment. For the subgroups according to the type of nocturia, both the BPH only group and the nocturnal polyuria group showed improvement in the nocturnal frequency and the nocturnal urine volume. CONCLUSIONS: Alpha 1 (A) adrenoceptor antagonist, tamsulosin, significantly improved the nocturia as well as the lower urinary tract symptoms, which was confirmed by measuring the clinical parameters. To identify the role of tamsulosin for improving nocturia for patients with BPH, we need to prospective clinical studies according to the type of nocturia.

The Role of Alpha 1 (A) Adrenoceptor Antagonist Tamsulosin for the Treatment of Patients with Benign Prostatic Hyperplasia: The Effect on Lower Urinary Tract Symptoms and Nocturia / 대한비뇨기과학회지

PURPOSE: Nocturia is considered to be the main cause of disturbance of sleep maintenance and the quality of life for elderly men. We assessed the effectiveness of administering alpha 1 (A)-adrenoceptor antagonist tamsulosin for the patients with benign prostatic hyperplasia (BPH), and we measured the degree of improvement of the lower urinary tract symptoms and nocturia after treatment. MATERIALS AND METHODS: From May 2003 to October 2003, 268 patients with BPH were prospectively selected for this study. The patients were treated with tamsulosin at a dose of 0.2mg/day. The effectiveness of tamsulosin was assessed by analyzing the three day voiding diaries and the other parameters, including the International Prostatic Symptom Score (I-PSS), the Bother score, the maximal urinary flow rate (Qmax), and the postvoid residual urine. The data for these parameters were acquired at baseline and after 4 and 12 weeks of treatment. We investigated the differences in the improvement of noctuia in the BPH patients according to the type of nocturia. RESULTS: Of the 268 patients, 189 patients (70.5%) completed the study. The clinical parameters, including the I-PSS, the Bother score, the Qmax and the residual urine showed significant improvement from the baseline. The change of nocturnal frequency was 2.2 at baseline to 1.4 after 12 weeks of treatment. For the subgroups according to the type of nocturia, both the BPH only group and the nocturnal polyuria group showed improvement in the nocturnal frequency and the nocturnal urine volume. CONCLUSIONS: Alpha 1 (A) adrenoceptor antagonist, tamsulosin, significantly improved the nocturia as well as the lower urinary tract symptoms, which was confirmed by measuring the clinical parameters. To identify the role of tamsulosin for improving nocturia for patients with BPH, we need to prospective clinical studies according to the type of nocturia.

Effects of Alpha 1 Adrenoceptor Antagonist Tamsulosin on Sexual Function in Patients with Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: We evaluated the effectiveness of alpha 1 adrenoceptor antagonist tamsulosin on erectile function in the treatment of the patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We recruited 268 patients who had BPH with lower urinary tract symptoms in the period of June 2003 to September 2003. The study utilized an open-label approach. Patients were evaluated by physical examination, transrectal ultrasonography (TRUS), serum prostate specific antigen (PSA), uroflowmetry, international prostatic symptom score (IPSS), quality of life (QOL) assessment, voiding diary for 3 days, brief international index of erectile function (IIEF)-7 score, and the global efficacy assessment questionnaire (GEAQ)-2. All evaluations were performed before medication, and again at 4 and 12 weeks of treatment. The patients suspected to have prostatic carcinoma based on the digital rectal examination and/or PSA level above 4 ng/ml underwent transrectal ultrasonography guided biopsy of the prostate. The patients found to have prostate cancer were not included in the study. RESULTS: A total of 165 patients completed the study. Total IIEF scores did not change significantly. Question 10 of IIEF was significantly different between 4 and 12 weeks. There was a statistically significant difference in GEAQ-2 between 4 and 12 weeks of medication. Ejaculation volume decreased 14% and 22% at 4 and 12 weeks, respectively. However, orgasmic function significantly improved between 4 and 12 weeks. CONCLUSIONS: In patients with BPH, tamsulosin therapy improved sexual and orgasmic function, although it decreased ejaculation volume. We need a longer follow-up period and more patients to establish the effects of tamsulosin on erectile function in the patients with BPH.

Simultaneous duodenal and colon masses as late presentation of metastatic renal cell carcinoma

We report a case of pathologically proven simultaneous duodenal and colonic metastases about four years after nephrectomy for mixed clear and granular cell type renal cell carcinoma (RCC). A 76-year-old female patient who had undergone a left radical nephrectomy 4 years previously for RCC presented with a 1-month history of dyspepsia and pain in the right upper abdomen. An abdominopelvic CT scan showed circumferential wall thickening with high enhancement at the second portion of the duodenum and additional enhancement of an irregular protruding mass into the lumen of the ascending colon. A gastroscopy showed a large and ulcerative protruding mass nearly obstructing the second portion of the duodenum. A colonoscopy revealed a polypoid, nodular and purplish mass in the ascending colon. Microscopy of the biopsy specimen showed the features identical to those of the RCC which was resected 4 years earlier in this patient. We believe this to be the first case illustrating a metastatic renal cell carcinoma as simultaneous duodenal and colon masses.

Arteriovenous Malformation In Oral & Maxillofacial Region : A Case Report

In the field of oromaxillofacial surgery, it is not common to meet arteriovenous malformation(AVM) patients. AVMs are the result of congenital abnormality, or the result of trauma of adjacent vessels. This patients need special care in surgical procedure. Also, they need management include clinical, radiographic, and angiographic assessment. We report a case of the AVM in right maxillary artery, who embolized PVA and obtained good result.

A LATERAL RHINOTOMY INCISCON: CASE REPORTS AND REVIEW OF LITERATURES

The lateral rhinotomy signifies only an incision and not on operation and a lateral rhinotomy incision with osteotomy of the nasal bones provides access to the entire nasal cavity and maxillary, ethmoid, and sphenoid sinuses as well as the frontal sinus if the floor is removed, permitting removal of benign lesions at these sites and en bloc resection of the ethmoid labyrinth and the party wall between the nasal cavity and antrum with infiltrating tumors. The authors treated a tumor patient and a midfacial bone fracture patient via lateral rhinotomy approach and had a good result. So we report the cases with literature review.

A Case of Hepatic Biloma Following Endoscopic Retrograde Cholangiography / 대한소화기내시경학회지

Endoscopic retrograde cholangiography has now evolved into a highly sophisticated diagnostic and therapeutic tool in patients with hepatobiliary-pancreatic disorders. However, this procedure is associated with risks of significant complications such as cholangitis, pancreatitis, hemorrhage, and perforation which have been widely recognized. Hepatic subcapsular biloma is a very rare and less recognized complication of this procedure. Recently, we experienced a case of hepatic subcapsular biloma, developed after endoscopic removal of choledocholithiasis, managed with percutaneous drainage procedure and endoscopic stenting, and report with a review of literature.

Hypervascularity on palatal mass; Acinic cell carcinoma, a case report

Two Cases of Severe Neutropenia Associated with Ticlopidine

Ticlopidine is a powerful inhibitor of platelet aggregation which is induced by adenosine diphosphate. Ticlopidine has been shown to be effective in reducing combined stroke, myocardial infarction, reocclusion of coronary stent. The principal side effects of ticlopidine are severe neutropenia, rash and gastrointestinal upset. Recently, we experienced two cases of severe neutropenia associated with ticlopidine. One was administered ticlopidine to prevent subacute thrombosis after intracoronary stent implantation in unstable angina pectoris. Thirty days of therapy, her absolute neutrophil count (ANC) had dropped to 14/mm3 . The other patient was presented with recurrent episodes of cerebral infarction, for which he had undergone right carotid angiogram. The carotid angiogram demonstrated tight stenosis of right internal carotid artery. Carotid artery stenting was performed at right internal carotid artery without any complications. Twenty seven days of ticlopidine therapy, his ANC had dropped to 111/mm3. The ticlopidine was stopped, and they were given granulocyte-colony stim-ulating factor 250 microgram/day subcutaneous injection until their ANC was up to 1000/mm3. They were discharged with normal neutrophil count and no other complications.

Brain Metastasis from Papillary Thyroid Carcinoma: Report of 2 Cases / 대한내분비학회지

Papillary carcinoma, the commonest thyroid malignancy, has an indolent clinical course and carries a good prognosis. Metastasis usually occurs to regional lymph nodes, including cervical and upper mediastinal nodes. Distant metastasis is uncommon, lung and bone being the commonest sites. Brain metastasis from papillary thyroid cancer is rare, with a frequency of less than 1% in several reported series and an extremely poor prognosis. The first case was a 74-year-old female patient with papillary cancer who took total thyroidectomy followed by 131I therapy 1 month later. Two days after 131I therapy, she developed headache, vomiting and left hemiplegia. Brain MRI and 131I whole body scan showed solitary brain metastasis in right parietal lobe. After a few weeks her condition improved enough to maintain her usual daily activity despite mild motor weakness. The second one, a 64-year-old female patient presented with headache and vomiting. Two years previously, she had taken total thyroidectomy and 131I ablation therapy after diagnosis of thyroid papillary cancer. Eight months before, she had undergone radical neck dissection because of relapse in cervical lymph nodes. Brain MRI revealed multple metastatic lesions including cerebellum. This patient did not report for follow-up after 2 months of discharge.

A Case of Acute Respiratory Distress Syndrome with Pulmonary Embolism induced by Injection of Silicone at Vaginal Wall / 결핵

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.

Usefulness of Voiding Symptom Score and Uroflowmetry as the Screening Methods for Patients with Prostatitis Syndrome / 대한비뇨기과학회지

PURPOSE: Recently, urine reflux into prostate during abnormal micturition has been proved and suggested to be an important pathogenetic factor that evoked the symptoms of prostatitis syndrome. The evaluation of voiding dysfunction in these patients may give the useful information to select the treatment methods or the next step of study. The objectives of this study was to evaluate the usefulness of voiding symptom score and uroflowmetry as the screening methods for patients with nonbacterial prostatitis syndrome. MATERIALS AND METHODS: For patients with prostatitis syndrome, evaluations of urine, prostatic secretion, voiding symptom scores(IPSS: international prostate symptoms score), and uroflowmetry were performed. Patients were divided into 3 groups according to the patterns of uroflow curve[type N; normal bell shape with Qmax(maximal flow rate) > 20ml/sec, type I; irregular shape, regardless of Qmax, type P; plateau shape with Qmaxf15ml/sec]. For patients with cutie patterns of type I and p, G-blockers were tried initially for 1-2 months and the effectiveness of o-blockers according to the changes of IPSS, Qmax and patterns of uroflow cutie was estimated. Patients with the pattern of type N and non-responders to o-blockers were further investigated to rule out any other cause. RESULTS: Among total 64 patients, 55 patients(86%) showed the abnormal uroflow cuties(Type I or P). 34(61.8%) of these 55 patients responded to alpha-blockers with changes of IPSS from 18.3 to 8.1(p<0.001) and of Qmax from 13.gm1/sec to 20.0ml/sec(p<0.001). The response to o-blockers was expected highly in group of type I with more than 10m1/sec of Qmax and less than 20points of IPSS(14.7folds). Of the 9 of type N patients, 6 were revealed to have idiopathic detrusor instability and 18 of 21 non-responders to alpha-blockers were diagnosed to have the bladder neck obstruction. CONCLUSIONS: The results that the effectiveness to o-blockers and the possibility of other disease could be characterized by IPSS and uroflowmetry suggest IPSS and uroflowmetry may be the useful screening methods for patients with prostatitis syndrome.

Comparative Responses of Various Pharmacologic Agents on Contractility of the Smooth Muscle Strips of Rabbit Bladder / 대한비뇨기과학회지

Pharmacologic treatment of the detrusor hypocontractility(hyporeflexia) remains controversial issues. Clean intermittent self catheterization(CIC) alone, or combination with bethanechol chloride has been generally accepted as treatment modality. Until presently, bethanechol chloride is the only pharmacologic agent commonly used for bladder emptying without significant complication. However, the effectiveness of bethanechol seem to be episodic. The present study compared the contractile response of various pharmacologic agents including bethanechol chloride, ATP, PG E1, E2, F2-alpha on the smooth muscle strips of male rabbit bladder. In addition, effect of the gastrointestinal motility agents such as cisapride and metoclopramide on the contraction of rabbit bladder were assessed. Each bladder was divided into bladder body and bladder base for comparison of pharmacologic effects. FS at basal tension elicited a frequency dependent contraction which was greater in bladder body strips than in bladder base strips. The contractile responses to bethanechol, ATP, PG E1, E2 and PG F2-alpha were greater in bladder body than in bladder base.In the bladder body,magnitude of the contractile responses by ATP and PG F2-alpha were approximately 1/3 of those by bethanechol or FS.PG F2-alpha was consistently more potent to produce contraction than PG E1, E2. ATP induced contraction only consisted of initial phasic rise of tension. The contraction induced by PG developed slower than those caused by bethanechol. Cisapride(10uM) induced weak contractile responses comparable to those by PG E1 Metoclopramide had no contractile effects in this studies. Conclusively, differences exist in the response of the bladder body and base to FS and various pharmacologic agents. ATP, PG E2 and PG F2-alpha exhibited some notable contractile responses to the bladder body that were approximately 1/3 of those by bethanechol. Gastrointestinal motility agents were not shown to be effective in the mediation of contraction of rabbit bladder.

Effect of Epidural Steroid Injection in the Low Back Pain

In order to evaluate the effect of the lumbar epidural steroid injection in the low back pain and/or radicular pain. We studied 66 patients who were treated and followed for an average of 8.6 months. In the initial evaluation, main pain sites were as follows: low back pain in 41 patients, buttock pain in 7 patients, and leg pain. In 18 patients. Immediate response and delayed response in the patients were studied. Immediate response within 1 day after injection revealed the following : dramatic improvement in 3.0%;some improvement in 56.1%; no improvement in 27.3%; and more aggravated in 13.6%. Delayed response after 1 month revealed the following : 15.2% continuously maintained improvement; 9.1 showed progressive improvement;36.4% experienced recurring pain; 27.3% had no improvement; and 10.6% had aggravating pain. The effect of the lumbar epidural steroid injection was not affected by the severity of pain in the initial evaluation. Better improvements were noted in patients who suffered radicular pain than those who suffered low back or buttock pain. Good prognostic factors were young age and male. Complications that the patients suffered were transient injection pain(6), edema of the face or extremity(10), transient leg weakness(5) and dural puncture(1). The number of patients who wanted to recommend this procedure to others were 22(33.3%). In conclusion, epidural steroid injection was one of the methods in the management of the patients who suffered low back pain and/or radicular pain and had no effect by any other therapies.

Comparison of the Effect of Transurethral Resection of Prostate and Prostatic Laserthermia for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Benign prostatic hyperplasia is one of the most common afflictions in an aged man, but the surgery has been the only therapeutic option in the treatment of benign prostatic hyperplasia. Recently, other alternative therapeutic modalities such as pharmacological, hormonal, less invasive treatment(laser, stents, thermotherapy, etc.) were developed. The prostatic laserthermia is one of the new therapeutic tool being evaluated for the treatment of BPH. The aim of this study is that the prostatic laserthermia will be an alternative therapeutic modality for BPH as transurethral resection of prostate(TURP). A total of 92 patients(ages 49 to 90 years) who were diagnosed as BPH were included in the study, underwent uroflowmetry, transrectal ultrasound and AUA symptom scoring. 34 of 92 patients were treated with TURP. And 58 of the 92 patients were treated with prostatic laserthermia. After the treatments, each patients were followed by uroflowmetry and AUA symptom score at post operative 1, 3 and 6 months. In TURP group, the preoperative peak flow rate was changed from 8.33+/-4.5ml/sec, to 14.65+/-4.74 ml/sec, 14.67+/-4.08 ml/sec and 14.60+/-4.63 ml/sec, at postoperative lst, 3rd and 6th month respectively. The amount of average residual urine was decreased from 158.l+/-121.6 ml, to 41.9+/-22.3 ml, 43.3+/-27.1 ml and 58.2+/-27.5 ml, at 1st, 3rd and 6 month respectively. Also the AUA symptom score was decreased from 22.5+/-7.0, to 9+/-4.7, 9.3+/-4.3 and 9.5+/-5.2, at postoperative 1st, 3rd and 6th month. In prostatic laserthermia group, the preoperative average peak flow was 9.33+/-6.30 ml/sec, changed to 11.46+/-5.20 ml/sec, 11.67+/-5.40 ml/sec and 11.72+/-5.27 ml/sec at postoperative lst. 3rd and 6th month. The preoperative average mean flow was 4.75+/-2.87 ml/sec, increased to 5.47+/-2.69 ml/sec, 5.l8+/-2.69 ml/sec and 5.28+/-3.06 ml/ sec at 1st, 3rd and 6th month. The preoperative average residual urine was 130.9+/-154.7 ml/sec, decreased to 59.9+/-66.6 ml/sec, 50.6+/-57.0 ml/sec and 31.3+/-45.7 ml/sec at postoperative lst, 3rd and 6th month. The preoperative average AUA symptom score was 27.0+/-5.9, decreased 19.1+/-8.1, 18.4+/-8.7 and 17.5+/-9.1 at 1st, 3rd and 6th month. When comparing the parameters between two treatment groups, improvement of peak flow rate was greater in TURP than in Prostatic laserthermia group(p<0.01). Decrease of AUA symptom score and amount of residual urine also were greater in TURP than in prostatic laserthermia group. As the result TURP is more effective than prostatic laserthermia in peak flow rate at 1st month and AUA symptom score at lst, 3rd and 6th month t < 0.05). But laserthermia also appears to be as effective as TURP in the decrease of postvoid residuals. It could be suggested that prostatic laserthermia is an alternative therapeutic modality of BPH, especially old man who has some risk factors for operation. Key Word : transurethral resection, laserthermia.

Experience of Transvaginal Bladder Neck Suspension(Raz Procedure) for Stress Urinary Incontinence: 10 Cases / 대한비뇨기과학회지

Transvaginal bladder neck suspension by Raz is an acceptable procedure for the treatment of stress urinary incontinence with high cure rate, operative simplicity, short hospitalization and little morbidity. Recently we experienced 8 cases of stress urinary incontinence treated with Raz's procedure and 2 cases with coexisting cystocele were treated with 4-corner operation. All cases have been assessed prior to and following operation and the results were satisfactory. Herein, we report 10 cases of stress urinary incontinence treated by Raz's procedure and 4-corner operation with review of literatures.