Ubiquitous-Severance Hospital Project: Implementation and Results / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. METHODS: Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. RESULTS: The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. CONCLUSIONS: YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified.

Adenomatoid Tumor of the Testis / 대한비뇨기과학회지

Adenomatoid tumors arising in the parenchyma of the testes are extremely rare neoplasms, and they uniformly behave in a benign fashion. The long reorted history of these tumors and the absence of distant metastasis suggest a benign nature. Thus, the treatment is surgical excision. We report here on a case of an adenomatoid tumor of the testis. Radical orchiectomy was performed, and this revealed an adenomatoid tumor of the parenchyma of the testis.

Adenomatoid Tumor of the Testis / 대한비뇨기과학회지

Adenomatoid tumors arising in the parenchyma of the testes are extremely rare neoplasms, and they uniformly behave in a benign fashion. The long reorted history of these tumors and the absence of distant metastasis suggest a benign nature. Thus, the treatment is surgical excision. We report here on a case of an adenomatoid tumor of the testis. Radical orchiectomy was performed, and this revealed an adenomatoid tumor of the parenchyma of the testis.

Transient downregulation of protein O-N-acetylglucosaminylation by treatment of high-dose nicotinamide in human cells

Nicotinamide at millimolar concentrations affects cell survival in various conditions, and is being utilized therapeutically in many human diseases. However, the effect of an acute treatment of nicotinamide at such high dose on gene expression and cellular metabolism has rarely been determined previously. In this study, we found that levels of O-N-acetylglucosamin(O- GlcNAc)ylated proteins including Sp1 acutely decreased upon treatment of 10 mM nicotinamide. Concomitantly, Sp1 protein level decreased rapidly through accelerated proteasome-mediated proteolysis. Cotreatment of glucosamine or 2-deoxyglucose, which inhibits protein deGlcNAcylation, effectively blocked the decrease induced by nicotinamide. Interestingly, the decline in the levels of Sp1 and protein O- GlcNAcylation was only transient lasting for two days post treatment, and this pattern matched closely the rapid fluctuation of the cellular [NAD(+)]. Our results suggest a possible link between cellular nicotinamide metabolism and protein O-GlcNAcylation, and an existence of cellular [NAD(+)] homeostasis.

Changes in Corpus Cavernosum after Partial Bladder Outlet Obstruction in Rat / 대한비뇨기과학회지

PURPOSE: Abnormalities of the relaxation and contraction of the corpus cavernosum can lead to erectile dysfunction. Therefore, we induced a partial bladder outlet obstruction(PBOO) in male rats, and investigated the mechanisms of penile dysfunction with endothelial nitric oxide synthase(eNOS), vascular endothelial growth factor(VEGF), endothelin-1(ET-1), and apoptosis of peri-vascular smooth muscle and connective tissue cells in the corpus cavernosum. MATERIALS AND METHODS: PBOO was induced in 13 Sprague-Dawley rats by placing a 25 gauge needle sheath around the urethra, then ligating the bladder neck with a 3-0 suture. Three week after surgery, distal penile tissues were dissected for immunohistochemical staining, immunoblotting, and TUNEL staining. RESULTS: The expression of eNOS and VEGF were significantly decreased, whereas the expression of ET-1 and apoptosis of perivascular smooth muscle and connective tissue cells were significantly increased in the corpus cavernosum. CONCLUSIONS: The significant increase of ET-1 and apoptosis along with decreased eNOS and VEGF could mediate erectile dysfunction.

Mucinous Adenocarcinoma of Prostate / 대한비뇨기과학회지

It is not atypical for a small amount of mucin to be present in prostate adenocarcinoma. But true mucinous type of adenocarcinoma of prostate occurs rarely, with 88 cases reported in the literature. This has been histopathologically defined as containing lakes of extracellular mucin comprising at least 25% of the primary prostate tumor. The biologic behavior of this malignancy is not well known and the prognosis is considered to be poor compared with typical adenocarcinoma of the prostate. We experienced a case of mucinous adenocarcinoma of prostate that was developed in a 70 year-old man.

Induction of Apoptosis by alpha1-Adrenoceptor Antagonists in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Recent evidence has indicated that alpha1-adrenoceptor antagonists induce prostate apoptosis in patients with benign prostatic hyperplasia (BPH). In this study, the effects of different alpha1-adrenoceptor antagonists, on the apoptosis and cell proliferation in the prostatic glandular epithelium and stroma of patients with benign prostatic hyperplasia, were evaluated. MATERIALS AND METHODS: A retrospective analysis was performed on BPH patients for the relief of lower urinary tract symptoms; an untreated (control) group (n=28), and patients treated with terazosin (n=26), doxazosin (n=27) and tamsulosin (n=15) were included. Archival prostate specimens were selected on the basis of availability of previous TURP (transurethral resection of the prostate) specimens. Terazosin, doxazosin and tamsulosin (2-8mg/day) treatment periods ranged from 1 week to 6 years. Ki-67 immunostaining and the TUNEL assay were used to evaluate the proliferative and apoptotic indices for both the epithelial and stromal components of prostate specimens. RESULTS: A significant induction of apoptosis was observed in patients treated with the alpha1-adrenoceptor antagonists, terazosin and doxazosin, compared with the untreated control group (p0.05). CONCLUSIONS: Our findings demonstrated that alpha1-adrenoreceptor antagonists may regulate the prostate growth, by inducing apoptosis in both the epithelial and stromal cells, with little effect on the cell proliferation. Apoptosis-mediated prostate stromal regression appears as an additional molecular mechanism underlying the therapeutic response to alpha1-adrenoceptor antagonists in the treatment of BPH.

Comparison of International Erectile Function Index Scores and Penile Doppler Ultrasonographic Findings in Erectile Dysfunction Patients / 대한비뇨기과학회지

PURPOSE: Of the various methods for evaluating erectile dysfunction, International Index of Erectile Function (IIEF) questionnaires and penile color Doppler ultrasonography are commonly performed. In this study, the total IIEF scores and erectile function domain scores of the IIEF were compared with the etiology diagnosed from the indices of penile color Doppler ultrasonography. MATERIALS AND METHODS: A total of 54 patients, with erectile dysfunction, who underwent penile color Doppler ultrasonography and IIEF, were retrospectively examined. Various blood flow parameters, including the peak systolic velocity, end diastolic velocity, mean flow rate and resistive index, were observed and recorded for about 30 minutes following an intracorporeal injection of alprostadil and self stimulation. According to the causes of the erectile dysfunction, as diagnosed with penile color Doppler ultrasonography, the total IIEF and erectile function domain scores of the IIEF were compared. RESULTS: There was no statistically significant difference in the total IIEF and IIEF scores of the erectile function domain between the causes of erectile dysfunction as diagnosed by the penile color Doppler ultrasonography. CONCLUSIONS: The IIEF scores did not statistically differentiate the specific etiologies of erectile dysfunction determined by penile color Doppler ultrasonography. Therefore, it is believed that the IIEF score alone cannot predict the etiologies of erectile dysfunction.

Response characteristics of ventral posteromedial thalamic nociceptive neurons in the anesthetized rat / 대한치과보존학회지

Extracellular single unit recordings were made from the ventral posteromedial thalamic (VPM) nociceptive neurons to determine mechanoreceptive field (RF) and response properties. A total of 44 VPM thalamic nociceptive neurons were isolated from rats anesthetized with urethane-chloralose. Based on responses to various mechanical stimuli including touch, pressure and pinch applied to the RF, 32 of 44 neurons were classified as nociceptive specific (NS) neuron. The other 12 neurons, classified as wide dynamic range (WDR), showed a graded response to increasingly intense stimuli, with a maximum discharge to noxious pinch. The VPM nociceptive neurons showed various spontaneous activity ranged from 0-6 Hz. They were located throughout the VPM, and had an contralateral RF including mainly intraoral (and perioral) regions. The RF size was relatively small, and very few neurons had a receptive field involving 3 trigeminal divisions. The NS neurons activated only by pressure and pinch stimuli had high mechanical thresholds compared to WDR neurons activated also by touch stimuli. The VPM nociceptive neurons were tested with suprathershold graded mechanical stimuli. Most of 21 NS and 8 WDR neurons showed a progressive increase in number of spikes as mechanical stimulus intensity was increased. In some neurons, the responses reached a peak before the highest intensity was given. Application of 5 mM CoCl2 (10 microl) solution to the trigeminal subnucleus caudalis did not produce any significant changes in the spontaneous activity, RF size, mechanical threshold, and response to suprathresold mechanical stimuli of 9 VPM nociceptive neurons tested. 17 of 33 VPM nociceptive neurons responded to noxious heat as well as noxious mechanical stimuli applied to their RF. Application of the mustard oil, a small-fiber excitant and inflammatory irritant, to the right maxillary first molar tooth pulp induced an immediate but short-lasting neuronal discharges upto approximately 4 min in 16 of 42 VPM nociceptive neurons. These results suggest that VPM thalamic nucleus may contribute to the sensory discriminative aspect of orofacial nociception.

Retroperitoneal Gossypiboma / 대한비뇨기과학회지

Gossypiboma is the term used to describe a mass within the body composed of a non-absorbable surgical material involving a cotton matrix. Surgical sponges with radiopaque markers are easily recognized on plain radiographs, but foreign bodies retained in the body without such markers present a diagnostic problem. Gossypiboma should be differentiated from a hematoma, abscess, cyst or tumor. Here we report a case of Gossypiboma in a 60-year-old male patient who had undergone a ureterolithotomy for a right ureteral stone 30 years earlier.

Recurrent Priapism Associated with Splenectomy / 대한비뇨기과학회지

Priapism is a prolonged erection of the corpus cavernosum that is unaccompanied by sexual desire. It has been classified into 2 main groups: primary (idiopathic) or secondary. The common conditions associated with a secondary priapism include sickle cell anemia, trauma, leukemia, a cancerous invasion of the penis, drugs, alcohol ingestion, various venous thromboembolic diseases, intravenous fat for parenteral nutrition, and other less common disorders.1 A splenectomy has not been previously identified as a predisposing factor except for a report of 3 cases of priapism who underwent a splenectomy.2 We experienced a case of recurrent priapism following a splenectomy that developed in 30 years old man.

Recurrence According to Grade after BCG Intravesical Therapy in Stage T1 Bladder Cancer / 대한비뇨기과학회지

PURPOSE: We compared the recurrence rate and mean interval to recurrence according to tumor grade after complete transurethral resection and adjuvant intravesical instillation with bacillus Calmette-Guerin (BCG), in patients with stage T1 transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Between January 1994 and May 2000, 31 patients presenting to our hospital with T1 superficial bladder cancer received adjuvant intravesical instillation with BCG after complete transurethral resection of the bladder tumor. Tumors with CIS lesion or recurrent tumors were excluded. The recurrence rates, mean interval to recurrence, tumor size and number of tumors were compared according to tumor grade. RESULTS: Of the 31 patients, 5 presented with grade I tumor, 17 with grade II tumor and 9 with grade III tumor. Mean follow-up period was 22 months (range 6-58) and mean tumor sizes according to tumor grade were 1.6, 1.6 and 1.7cm in grade I, II and III, respectively. Twelve (38.7%) patients experienced tumor recurrence. The recurrence rates according to tumor grade were 20.0%, 41.2% and 44.4% in grade I, II and III, respectively. Mean interval to recurrence were 40, 11.4 and 7.5 months, respectively. CONCLUSIONS: Our results suggest that the recurrence rates were higher in grade II and III tumors than in grade I tumor. Therefore close follow-up is necessary in both grade II and III tumors.

Primary T Cell Lymphoma of the Testis / 대한비뇨기과학회지

Primary malignant lymphoma of the testis is an uncommon tumor, accounting for only 1 to 9% of all testicular neoplasms and 1% of all non-Hodgkin's lymphoma. Especially, T cell lymphoma of the testis is very rare. However, it is the most common testicular malignancy in the elderly. It has a propensity for extranodal spread to the skin, subcutaneous tissue, CNS and lung. Immunohistochemical studies of testicular lymphoma have showed that the majority of these are B cell lymphomas, with rare reports of T cell lymphomas. Given the rarity of this disease, treatment has not been standardized. However, there is universal agreement that orchiectomy is the initial treatment. Although excellent results with a doxorubicin-containing chemotherapy regimen have been achieved in early stage disease, most patients have relapse of disease and a grave prognosis. We experienced the primary T cell lymphoma of the testis that was developed in 41 year-old-man.