The research for the utilization of mechanical chest compression device for emergency medical center in Korea: a survey-based study

Objective@#During the coronavirus disease 2019 (COVID-19) pandemic, the use of mechanical chest compression (meCC) devices for cardiopulmonary resuscitation (CPR) in emergency departments might have increased. However, there are few reports yet of such an increase in use. This study aimed to assess the current status of meCC device utilization in emergency medical institutions nationwide through a survey. @*Methods@#This cross-sectional study conducted a survey from August 20, 2022 to September 29, 2022, using emails and text messages to target 287 out of a total of 409 emergency medical institutions nationwide for which contact information was obtained. @*Results@#Of the 287 emergency medical institutions, 127 responded (44.2% response rate). Of these, 74 (58.3%) reported using meCC devices. The utilization rates were highest in the regional emergency medical center, followed by local emergency medical centers and local emergency medical agencies (93.3% vs. 67.3% vs. 27.1%, respectively; P<0.001). The most common reason for device purchases was to reduce rescuer fatigue and ensure high-quality CPR. The second reason was personnel shortages, while the regional emergency medical center gave a higher priority to the protection of medical staff from COVID-19. The meCC device group reported significantly higher cases of CPR (100 or more cases per year) compared to the non-meCC device group (64.9% vs. 24.6%; P<0.001) although no difference was shown in the total number of medical staff participated in CPR between the groups. Also, 90.5% of the meCC group expressed satisfaction with using the device. @*Conclusion@#More than 50% of emergency medical institutions used meCC devices in CPR, citing reasons such as reducing rescuer fatigue and ensuring high-quality CPR.

Comparison of Vendor-Provided Volumetry Software and NeuroQuant Using 3D T1-Weighted Images in Subjects with Cognitive Impairment: How Large is the Inter-Method Discrepancy?

Background@#Determination of inter-method differences between clinically available volumetry methods are essential for the clinical application of brain volumetry in a wider context.Purpose: The purpose of this study was to examine the inter-method reliability and differences between the Siemens morphometry (SM) software and the NeuroQuant (NQ) software. @*Materials and Methods@#MR images of 86 subjects with subjective or objective cognitive impairment were included in this retrospective study. For this study, 3D T1 volume images were obtained in all subjects using a 3T MR scanner (Skyra 3T, Siemens). Volumetric analysis of the 3D T1 volume images was performed using SM and NQ. To analyze the inter-method difference, correlation, and reliability, we used the paired t-test, Bland-Altman plot, Pearson’s correlation coefficient, intraclass correlation coefficient (ICC), and effect size (ES) using the MedCalc and SPSS software. @*Results@#SM and NQ showed excellent reliability for cortical gray matter, cerebral white matter, and cerebrospinal fluid; and good reliability for intracranial volume, whole brain volume, both thalami, and both hippocampi. In contrast, poor reliability was observed for both basal ganglia including the caudate nucleus, putamen, and pallidum. Paired comparison revealed that while the mean volume of the right hippocampus was not different between the two software, the mean difference in the left hippocampus volume between the two methods was 0.17 ml (P < 0.001). The other brain regions showed significant differences in terms of measured volumes between the two software. @*Conclusion@#SM and NQ provided good-to-excellent reliability in evaluating most brain structures, except for the basal ganglia in patients with cognitive impairment.Researchers and clinicians should be aware of the potential differences in the measured volumes when using these two different software interchangeably.

Risk of injury after emergency department visit for acute peripheral vertigo: a matched-cohort study

Objective@#Peripheral vertigo is one of the most common causes of the emergency department (ED) visits. It can impair balance and might predispose patients to injuries after discharge. The purpose of this study was to determine whether peripheral vertigo is associated with an increased risk of trauma. @*Methods@#This matched-cohort study used the nationally representative dataset of de-identified claim information of 1 million randomly sampled individuals from a real Korean population, from 2002 to 2013. The exposure cohort included patients who visited EDs for new-onset peripheral vertigo without prior or concurrent injury. Each patient was randomly matched to five unexposed individuals (also without previous injury) by incidence density sampling. The primary outcome was a new injury within 1 year. The secondary outcomes were various injury subtypes. The time-dependent effect of the exposure was modeled using the extended Cox model. Age, sex, comorbidities, and household income level were included as covariates. @*Results@#A total of 776 and 3,880 individuals were included as the exposure and comparison cohorts, respectively. The risks of trunk injury and upper extremity injury were significantly higher in the exposure cohort. Extended Cox models with multivariable adjustment showed significantly increased risk for up to 1 year, with the first 1-month; 1 month to 3 months; and 3 months to 1 year hazard ratios of 5.23 (95% confidence interval [CI], 2.83–9.64); 1.50 (95% CI, 1.02–2.20); and 1.37 (95% CI, 1.11–1.68), respectively. @*Conclusion@#Patients visiting EDs for acute peripheral vertigo are at a higher risk of a new injury for up to a year.

Korean Guideline for the Prevention and Treatment of Glucocorticoid-induced Osteoporosis

OBJECTIVE: To develop guidelines and recommendations to prevent and treat glucocorticoid-induced osteoporosis (GIOP) in Korea. METHODS: The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology developed this guideline based on Guidance for the Development of Clinical Practice Guidelines version 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously-published guidelines, and a systematic review and quality assessment were conducted. RESULTS: This guideline applies to adults aged 19 years or older who are using or plan to use glucocorticoids (GCs), but does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using FRAX (Fracture Risk Assessment Tool) with adjustments for GC dose, previous osteoporotic fracture history, and bone mineral density (BMD) results. All patients taking more than 2.5 mg/day prednisolone or equivalent for more than 3 months are recommended to take adequate calcium and vitamin D. Patients at moderate to high fracture risk should be treated with additional osteoporosis medication. All patients continuing GC therapy should receive an annual BMD measurement, vertebral X-ray, and fracture risk assessment using FRAX. When a treatment failure is suspected, switching to another drug should be considered. CONCLUSION: This guideline is intended to provide guidance for clinicians in prevention and treatment of GIOP.

Influence of Donor's Renal Function on the Outcome of Living Kidney Transplantation: 10-Year Follow-up

PURPOSE: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor's renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. MATERIALS AND METHODS: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. RESULTS: Mean follow-up duration of recipients after living kidney transplantation was 115.0+/-39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8+/-6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor's mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8+/-21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor's Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor's Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). CONCLUSIONS: Donor's 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation.

Effect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder

PURPOSE: The aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB). MATERIALS AND METHODS: We included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups. RESULTS: Groups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume. CONCLUSIONS: Desmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.

Efficacy and Safety of Tamsulosin for the Treatment of Non-neurogenic Voiding Dysfunction in Females: A 8-Week Prospective Study

We evaluated the therapeutic effects of tamsulosin for women with non-neurogenic voiding dysfunction. Women who had voiding dysfunctions for at least 3 months were included. Inclusion criteria were age > or =18 yr, International Prostate Symptom Score (IPSS) of > or =15, and maximum flow rate (Q(max)) of > or =12 mL/sec and/or postvoid residuals (PVR) of > or =150 mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram as having no or mild obstruction (group A) or moderate or severe obstruction (group B). After 8 weeks of treatment, treatment outcomes and adverse effects were evaluated. One hundred and six patients were evaluable (70 in group A, 36 in group B). After treatments, mean IPSS, bother scores, Q(max), PVR, diurnal and nocturnal micturition frequencies and scored form of the Bristol Female Lower Urinary Tract Symptoms questionnaire (BFLUTS-SF) were changed significantly. Eighty-nine patients (84%) reported that the treatment was beneficial. The proportion of patients reported that their bladder symptoms caused "moderate to many severe problems" were significantly decreased. No significant difference were observed between the groups in terms of IPSS, bother score, Q(max), PVR, micturition frequency, and BFLUTS-SF changes. Adverse effects related to medication were dizziness (n=3), de novo stress urinary incontinence (SUI) (n=3), aggravation of underlying SUI (n=1), fatigue (n=1). Tamsulosin was found to be effective in female patients with voiding dysfunction regardless of obstruction grade.

A Study of Minimal Change in Nocturia Affecting Quality of Life

PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding or =4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia ( or =4 times/night) are needed to improve the QoL.

Expression Changes of the Phosphodiesterase 5 isoform in the Penis of Type 2 Diabetic Rat / 대한남성과학회지

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.

Expression Changes of the Phosphodiesterase 5 isoform in the Penis of Type 2 Diabetic Rat / 대한남성과학회지

PURPOSE: To investigate the tissue distribution of PDE5 isoforms in type 2 diabetic rat penile tissues. MATERIALS AND METHODS: We prepared ten male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which develop NIDDM naturally, and ten control male Long-Evans Tokushima Fatty (LETO) rats. An oral glucose tolerance test confirmed diabetes development in OLETF rats at 26 weeks. At 42 weeks, we checked serum glucose, testosterone, triglyceride, insulin, and adiponectin before sacrifice. We performed semi-quantitative multiplex RT-PCR for rat PDE5, PDE5A1, and PDE5A2. Immunohistochemistry was performed using mouse monoclonal anti-cGB-PDE5 and anti-smooth muscle alpha-actin. RESULTS: OLETF rats were significantly more hyperglycemic, hypogonadal, hyperinsulinemic, hypercholesterolemic, hypertriglycemic, and had lower adiponectin levels than LETO rats. Levels of PDE5 mRNA were decreased in OLETF rats, but there were no changes in PDE5A1 or PDE5A2 mRNA levels. CONCLUSION: Diabetes may contribute to decreased expression of PDE5 mRNA, but not PDE5A1 or PDE5A2, in rat penile tissue. Furthermore, serum free testosterone was decreased in diabetic rats. PDE5 has an important role in the development of diabetic erectile dysfunction, but it is not clear whether PDE5A1 and PDE5A2 gene have specific roles.

Clear Cell Papillary Cystadenoma of the Epididymis Associated with Multiple Renal and Pancreatic Cysts / 대한남성과학회지

Papillary cystadenoma of the epididymis is a rare benign tumor that accounts for only 5% of all epididymal tumors. A case of epididymal cystadenoma was presented in a 25 year old man. The patient was hospitalized initially because of infertility and bilateral painless palpable scrotal masses. He had multiple renal cysts and pancreatic cysts. He had no renal, adrenal, cerebellar or retinal lesion as cardinal manifestation of the Von Hippel-Lindau Syndrome (VHL). The VHL gene mutation in this case was not identified. For evaluation and management, we planned left epididymovasostomy and left testicular biopsy. However, due to a cystic change on the left epididymis and left tunica albuginea, we instead performed a left partial epididymectomy for the cystic lesion, excision of the cystic mass from the left tunica albuginea, and diagnostic left testicular biopsy. The pathologic evaluation revealed a papillary cystadenoma of the epididymis and tunica albuginea, but with normal spermatogenesis.

The Meaning of Polysomnographic Indexes in Patients with Obstructive Sleep Apnea and Erectile Dysfunction / 대한남성과학회지

PURPOSE: The purpose of this study was to correlate erectile function with polysomnographic indexes of obstructive sleep apnea(OSA) and other associated factors. MATERIALS AND METHODS: Among the 42 patients who visited our sleep clinic, we enrolled 32 patients who scored lower than 22 on the IIEF-5(International Index of Erectile Function-5). Polysomnography(PSG) was performed for OSA evaluation. Apnea-hypopnea index(AHI), AHI during REM sleep, AHI during non-REM sleep, arousal index(AI), and sleep efficacy(SE) were used as PSG indexes. Obesity was quantified by body mass index(BMI). The patients were divided into 2 groups according to AHI: group A 10(n=19). BMI and erectile function scores were compared between the 2 groups. The correlations among erectile function scores, PSG indexes, and BMI were analyzed. RESULTS: IIEF-5 score was negatively correlated with AHI(r=-0.372, p <0.05) and AI(r=-0.472, p <0.05), and there was a positive correlation with SE(r=0.372, p <0.05) of PSG. Between the 2 AIH groups, the low AHI group had a statistically higher mean erectile function score, especially in the EF domain and in the total IIEF score compared to the high AHI group. CONCLUSIONS: Indexes for penile rigidity were negatively correlated with AHI and AI. These findings suggest that AHI, AI, and SE of PSG are meaningful indexes of erectile function and support the hypothesis that hypoxia induced by sleep apnea plays a role in poor rigidity. Further studies in larger groups, including analysis of PSG indexes and erectile function changes before and after the treatment of sleep apnea, would be necessary to confirm this hypothesis.

The Comparison of the Abdominal Leak Point Pressure and the 1-Hour Pad Test in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The aim of this study was to determine whether or not the 1-hour pad test demonstrates the objective severity of female stress urinary incontinence. MATERIALS AND METHODS: One hundred eighteen female patients with stress urinary incontinence symptom were prospectively evaluated with a 1-hour pad test as recommended by the International Continent Society and they also underwent videourodynamics to determine the ALPP. The patients were divided into 2 groups by the ALPP: group A (n=94) was the low leak point pressure group (ALPP100cmH2O or no leakage). A pad gain < or=2g was considered a negative pad test. Student's t-test was done to evaluate the difference of urine leakage between the two groups. RESULTS: The mean amount of urine leakage measured by the 1-hour pad test for groups A and B were 53.4+/-47.2 and 50.9+/-53.9g, respectively, and there was no statistically significant differences between two groups (p=0.839). Eighteen (15.2%) women did not leak during the ALPP measurement and 6 (5.1%) women had a negative pad test. Among the 18 women with no leakage on the ALPP, 15 had a positive pad test and 3 had a negative pad test. Among the 6 women with a negative pad test, 3 had leakage and 3 had no leakage during the ALPP measurement. One hundred fifteen patients received an operation for stress urinary incontinence. The three patients who had no leak on the ALPP and who also had a negative pad test did not receive the operation. CONCLUSIONS: These data suggest that the 1-hour pad test did not demonstrate the objective severity of stress urinary incontinence. However, the 1-hour pad test was more sensitive to demonstrate leakage than the ALPP; therefore, in the case of no leakage during the ALPP measurement, the 1-hour pad test is needed to check the leakage.

Sleep-Related Erections(SREs) in Chronic Vegetative State Patients / 대한남성과학회지

PURPOSE: To determine whether sleep-related erections(SREs) occur during chronic vegetative state and if so, to investigate what factors are involved. MATERIALS AND METHODS: Twenty-six men in a vegetative state aged 16~65 were selected. Exclusion criteria were the lack of informed consent, mean blood pressure under 90/60 mmHg during last 3 days, erectile dysfunction before brain injury, and a history of any anti-androgen treatment. Serum testosterone, albumin, sex hormone binding globulin(SHBG), and dehydroepiandrosterone sulfate(DHEAS) were assayed, and bioavailable testosterone(cBT) and free testosterone(cFT) were calculated. Nocturnal penile erections were counted and evaluated using the Rigiscan device for72 hours. Data on the number of erections, erection duration, minimal and maximal base tumescence, minimal and maximal tip tumescence, and base and tip rigidity were taken. RESULTS: SREs were noted in 25 patients. The mean erection number was 4.65+/-3.93(1~15), and the mean erection duration was 128.85+/-46.86 minutes(0~478.5). SREs were negatively correlated with age(r=-0.445, p<0.05), systolic BP(r=-0.394, p<0.05) and diastolic BP(r=-0.403, p<0.05), but positively correlated with DHEAS(r=0.395, p<0.05). SREs were not correlated with total testosterone, cBT or cFT. CONCLUSIONS: These preliminary findings suggest that SREs are a normal occurrence in vegetative patients. They contribute to penile blood perfusion if the supraspinal erection control center is intact and serum testosterone level is above the minimum required for SREs.

Expression of Hypoxia-inducible Factor-1alpha and Vascular Endothelial Growth Factor in Corpus Cavernosum of the Type 2 Diabetes Mellitus Rat / 대한남성과학회지

PURPOSE: The expression of hypoxia-inducible factor-1alpha(HIF-1alpha) and vascular endothelial growth factor(VEGF) has been known as important factor of vascular complications in diabetes mellitus. The penile tumescence has variable degree according to vascularity. The aims of this study were to investigate erectile function and cavernosal expression of HIF-1alpha and VEGF in Otsuka Long-Evans Tokushima Fatty(OLETF) rats, which develop NIDDM naturally. MATERIALS AND METHODS: Ten male OLETF rats and ten control male Long-Evans Tokushima Fatty(LETO) rats were included in this study. The development of diabetes mellitus for OLETF were defined by glucose tolerance test at 26 weeks. After 72 weeks, OLETF rats, LETO rats and ten twenty-week male Sprague-Dawley rats were studied. Intracavernosal pressure were measured after cavernous nerve stimulation. Immunohistochemical stain and Western blot analysis were done for HIF-1alpha and VEGF in corpus cavernosum. RESULTS: Cavernous nerve stimulation-induced mean intracavernosal pressure(mmHg) was significantly decreased in the OLETF group(21.6+/-6.7 mmHg) compared to LETO(32.8+/-16.0 mmHg) group and in the LETO group compared to Sprague-Dawley group(47.2+/-11.7 mmHg)(p <0.05). With Western blot analysis, HIF-1alpha and VEGF expressions were higher in the OLETF group compared to other groups. With immunohistochemical stain, HIF-1alpha and VEGF were mainly expressed in corpus cavernosum and endothelium. CONCLUSIONS: We propose that increased HIF-1alpha and VEGF expressions in OLETF rat penile tissue can be found at microvascular injury in corpus cavernosum and are presumed to be associated with vasculogenic erectile dysfunction.

The Usefulness of Ice-water Test in the Patients with Symptomatic Benign Prostatic Hyperplasia (BPH) Associated with Overactive Bladder / 대한비뇨기과학회지

Purpose: A video-urodynamic study is known as the most accurate test to differentiate between benign prostatic hyperplasia (BPH) with overactive bladder and detrusor instability but requires expensive equipment and an expert technique, so is not commonly available. We performed a video- urodynamic study and ice-water test which is easily performed for the diagnosis of a neurogenic bladder in the patients with symptomatic BPH associated with overactive bladder and compared the results. Materials and Methods: The video-urodynamic study using a 10-Fr triple lumen urodynamic catheter was performed in 36 patients with symptomatic BPH associated with overactive bladder that had frequency, weak stream, nocturia, urgency, urge incontinence, dysuria and no clinical neurogenic defect. After the video-urodynamic study, the ice-water test was performed by instilling 4degreesC sterilized water through a catheter at 200ml/ min in the supine position. The volume instilled was about 30% of the bladder capacity. The ice-water test was positive if there was an efflux of water around the catheter during or after water instillation. Results: Thirty two of the 36 symptomatic BPH patients with an overactive bladder were negative on the ice-water test. All 32 patients who had a negative ice-water test were BPH with overactive bladder on the video- urodynamic study. Four of the 36 symptomatic BPH patients with an overactive bladder were positive on the ice-water test. Two of the 4 patients who had a positive ice-water test were BPH with overactive bladder and the other two were detrusor instability on the video-urodynamic study. Conclusions: Therefore, in case of a positive ice water test, a video-urodynamic study is needed to differentiate between BPH with overactive bladder and detrusor instability in patients with symptomatic BPH associated with overactive bladder.

Increased Expression of Hypoxia-Inducible Factor-1alpha in Castrated Rat Penile Tissue / 대한남성과학회지

PURPOSE: Hypoxia-inducible factor 1(HIF-1) is a transcriptional activator of genes whose products are involved in systemic, local, and cellular responses to hypoxia. We investigated the effect of androgen deprivation on the expression of HIF-1alpha and related proteins in the penile corpus cavernosum of castrated rat. MATERIALS AND METHODS: Thirty adult male Sprague-Dawley rats(250~350 gm) were divided into 3 groups of 10 each: sham operation(group 1), bilateral orchiectomy(group 2), and bilateral orchiectomy plus hormone replacement(group 3). Testosterone propionate(2 mg/day for 4 weeks) was used for hormone replacement. At 4 weeks after surgery, serum testosterone and erythropoietin were measured, and the expression of HIF-1alpha and VEGF were examined by immunohistochemical staining and Western blot of corpus cavernosum. RESULTS: There was no significant change in serum erythropoietin among the three groups. HIF-1alpha and VEGF immuno-positive cells were dense in vascular endothelium and cavernosal smooth muscle and showed more intense staining in the orchiectomy group compared with the control and sham operation groups. The amount of HIF-1alpha and VEGF proteins detected by Western blot were also increased in the orchiectomy group compared with the control and sham operation groups. CONCLUSIONS: These results suggest that increased HIF-1alpha expression in the penile tissue of castrated rat results from adaptive responses to hypoxia, and testosterone deprivation may contribute to hypoxic injury in the cavernosal microenvironment.

In-situ Extracorporeal Shock Wave Lithotripsy (ESWL) Using an Ultrasonographic Localization System for Mid-Ureteral Stones / 대한비뇨기과학회지

PURPOSE: In situ ESWL is the most attractive treatment for mid-ureteral stones as it is non-invasive and effective. X-ray fluoroscopy is usually used to localize the mid-ureteral stones for in-situ ESWL, since it is easy to manipulate, although a radiation hazard and high maintenance costs are involved. We report our experience of in-situ ESWL, using an ultrasonographic localization system, for the treatment of mid-ureteral stones. MATERIALS AND METHODS: Between June 1992 and June 2001, the mid-ureteral stones overlying the pelvic bone were treated with a Siemens Lithostar Ultra lithotriptor using a Sonoline SL-1 (Siemens, Germany) ultrasonographic localization system, with no anesthesia nor pain control. The mid-ureteral stones, located at the upper half of the pelvic bone, were treated in the prone position, with the shock waves delivered through the back wall using the kidney, renal pelvis and ureter, as landmarks for targeting. The mid-ureteral stones, located at the lower half of the pelvic bone, were treated in supine position, with the shock waves delivered through the abdominal wall using a filled bladder as the landmark for targeting. The localization success, stone free, ESWL success rates, and complications, were evaluated. RESULTS: Of the 96 patients, with mid-ureteral stones, we failed to localize the stone in only 2 patients. Therefore, the success rate for the stone localization was 97.9% (94/96). The stone free rate at 3 months after completion of the in-situ ESWL was 97.9% (92/94). Therefore, in-situ ESWL success rate was 95.8% (92/96). The mean ESWL sessions needed to be free of stones were 1.3+/-0.8 (126 sessions/92 patients). Some patients had hematuria and colicky pain, but serious complications, such as febrile UTI or severe hematuria requiring a transfusion were not encountered. CONCLUSIONS: In-situ ESWL, using an ultrasonographic localization system, is a non- invasive and effective treatment for mid-ureteral stones.

Primary Carcinoid Tumor of the Testis / 대한남성과학회지

Primary testicular carcinoid is a rare disease, accounting for less than 1% of all testicular neoplasms, with the potential for distant metastasis. We report a case of primary testicular carcinoid in a 44-year-old-man who presented with a painless, palpable mass in the left testis. Preoperative testicular ultrasound examination revealed a solid mass. Radical orchiectomy was performed, and pathologic examination showed a carcinoid tumor confined to the testis. There was no evidence of carcinoid syndrome, and a 24-hour urinary 5-HIAA assay was normal. Abdominopelvic CT scan and gastrointestinal contrast study showed no evidence of carcinoid in other organ. At 12 months postoperatively, the patient was without evidence of tumor recurrence.

The Effect of Irrigating Fluid Absorption on Myocardial Damage in TURP / 대한비뇨기과학회지

PURPOSE: TURP(transurethral resection of prostate) is the standard surgical treatment for BPH. However, myocardial damage is the most serious complication and has been postulated to develop as a result of irrigating fluid absorption during TURP. The aim of this study is to evaluate the relationship between the amount of irrigating fluid absorption and myocardial damage, and the factors that affect irrigating fluid absorption. MATERIALS AND METHODS: From March 2002 to January 2003, 52 patients who had undergone TURP were evaluated. TURP was performed under epidural anesthesia and URIONE(R) solution was used as the irrigating fluid. The amount of absorbed irrigating fluid was measured and serum troponin I was checked as a marker of perioperative myocardial damage. Resection time, weight of resected prostatic tissue, and the amount of blood loss were evaluated as the factors that affect the irrigating fluid absorption. RESULTS: Weight of resected prostatic tissue(r=0.566, p=0.001) and blood loss(r=0.339, p=0.01) were found to have moderate correlation with the amount of absorbed irrigating fluid, whereas the amount of irrigating fluid(r=0.293, p=0.11) and resection time(r=0.296, p=0.062) had no correlation. Myocardial damage was observed in 2 out of the 52 patients(3.8%), whosepostoperative serum troponin I was higher than 0.4microgram/L, and absorbed irrigating fluid being more than 1,000ml. CONCLUSIONS: Therefore, in the case of large prostate volume and excessive blood loss, the use of diuretics during TURP is recommended to reduce the incidence of myocardial damage.