Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms / 대한남성과학회지

PURPOSE: We compared the efficacy and safety profiles of dose increase, traditional combination methods, and combining different alpha blockers in hypertensive males with lower urinary tract symptom (LUTS) refractory to an initial dose of 4 mg doxazosin. MATERIALS AND METHODS: Between 2000 and 2005, 374 male patients with LUTS and hypertension unresponsive to 4 weeks of 4 mg doxazosin were enrolled. The subjects were randomly classified into 3 groups, 8 mg/day of doxazosin (D group), 4 mg of doxazosin plus 0.2 mg/day of tamsulosin (DT group), and 4 mg doxazosin plus 5 mg/day finasteride (DF group). Patients were evaluated based on their International Prostate Symptom Score (IPSS), quality of life (QOL), uroflowmetry and blood pressure (BP) and adverse events (AEs) at the baseline and 3 and 12 months after treatment. RESULTS: The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p<0.05). Sitting systolic and diastolic BP of the D group decreased larger than those of the other 2 groups (p<0.05). At least one of the AEs was reported by 29.0%, 19.3%, and 17.3% of patients in the D, DT, and DF groups, respectively. In particular, vasodilatory AEs of the D group (28.2%) were higher than those of other groups (p<0.05), and sexual function AEs of the DF group (10.9%) were higher than those of other groups (p<0.05). CONCLUSIONS: Doxazosin 4 mg plus tamsulosin 0.2 mg has comparable efficacy but less vasodilatory AEs than doxazosin 8 mg, and has superior efficacy to but comparable vasodilatory AEs to 4 mg doxazosin plus 5 mg finasteride in hypertensive male LUTS patients.

A Treatment for Incurved Toenails Using a K-D(R)

Treatments of severely incurved toenails cause anatomical changes and cosmetic problems, even though they provide adequate symptom relief. Incurved toenail patients treated with a K-D(R)(S&C Biotech, Seoul, South Korea) the new device for correcting curved nail deformity were investigated retrospectively. This study surveyed 12 patients(18 cases) who had been treated for severe ingrown toenails using K-D(R) from May 2008 to March 2009, and examined their subjective satisfaction before and after the treatment. The average age of the participants was 39(ranging from 27 to 52), and 8 of them were male and 4 female. The treatment was applied after the patients were given a thorough explanation about the tool and the treatment, and questionnaire surveys were conducted before the treatment and after 3 months on the average from the treatment. In the survey, the respondents were asked about pain, restriction on activities, and the selection of shoes. For each item, symptoms with a given point were presented, and the respondents' scores were compared between the surveys before and after the treatment. According to the results of the questionnaire survey, pain increased from 14 out of 40 before the treatment to 39 after, activity restriction increased from 11 to 30, and shoe selection increased from 20 to 30. The average total score increased from 45 to 98, and this suggests a considerable enhancement in the patients' subjective satisfaction. The average period of the application of K-D(R) was 20.3+/-9.4 days, and in all the cases, ingrown toenails were corrected within three weeks.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

A Prostate Neoplasm Distantly Metastasized to the Unilateral Ureter / 대한비뇨기과학회지

Neoplasms of the prostate usually metastasize to pelvic lymph nodes or bone, or directly invade the adjacent pelvic organs. Ureteral metastasis of a prostatic carcinoma, without ascending spread along the ureter, is very rare, with only a few having been reported from autopsy series. Herein, the case of a prostatic carcinoma, distantly metastasized to the unilateral ureter, is reported.

Cutis Verticis Gyrata : A Case Report

PURPOSE: Cutis verticis gyrata(CVG) is a morphologic syndrome, typically occurring on the scalp, characterized by varing development of permanent folds and furrows conferring a corrugated or convoluted appearance which resembles the outer surface of the cerebrum. Cutis verticis gyrata can be categorized into primary and secondary types according to various etiologic factors and associated conditions which cause disease process. METHODS: We report a case of essential primary cutis verticis gyrata in a 24-year-old male who did not have any other underlying or associated conditions. RESULTS: After we made an incision to the galea aponeurotica of patient's scalp four times under local anesthesia, we dissected along the subapponeurotic layer and adjusted the flaps each other, and then sutured the flap. CONCLUSION: After the operation, the clear margin disappeared and it did not recur.

The Efficacy of Terazosin in the Management of Chronic Pelvic Pain Syndrome (CPPS): Comparison between Category IIIa and IIIb / 대한비뇨기과학회지

Purpose: To evaluate the efficacy of terazosin in chronic pelvic pain syndrome (CPPS) and compare the effect of terazosin between CPPS IIIa and IIIb. Materials end Methods: Between January 2004 and February 2005, CPPS patients, aged 45 or below, with a small size prostate (0.05). In category IIIb (n=56), the T group (n=29) showed significant improvements in all NIH-CPSI domains and the Qmax (p0.05). Comparing both category IIIb groups, the T group showed a greater improvement in the pain score in the NIH-CPSI domains and the Qmax than the non-T group. Conclusions: Terazosin was effective in all domains of the symptom score and in the Qmax for CPPS.

Valproic Acid Effect in Nerve Regeneration Using Gore-Tex(R) Tube Filled with Skeletal Muscle

As the large defect of peripheral nerve occurs, the autologous nerve graft is the most ideal method but it has many limitations due to donor site morbidities. Various materials have been developed for the nerve defect as the conduits, but none of these materials is satisfactory. Among them, Gore-Tex(R) tube seems to be one of the most ideal nerve conduit materials at peripheral nerve defect. Many researches have focused on finding the neurotrophic factors. It is recently demonstrated that Valproic acid(VPA) has an effect of axonal regeneration as a neurotrophic factor without enzymatic degradation and toxicity problems. The purpose of this study is to evaluate the effect of VPA on the nerve regeneration at the peripheral nerve defect. A 10 mm gap of rat sciatic nerve was made and Gore-Tex(R) tube filled with biceps femoris muscle was placed at the nerve defect site. We let the rat take VPA as drinking water in experimental group and did not give VPA to the control group. We estimated the results as electrophysiologic and histological aspects for 16 weeks after the surgery. The nerve conduction velocity, total myelinated axon count, myelin sheath thickness and mean nerve fiber diameter significantly increased in VPA-treated experimental group when compared to the control (p < 0.05). From the above results, we conclude that VPA promotes the nerve regeneration at the peripheral nerve defect site. It is suggested that Gore-Tex(R) tube filled with skeletal muscle and VPA administration may be a good substitute for autologous nerve graft.

A Study of the Correlation between Bladder Capacity or Compliance and Stress Urinary Incontinence Parameters

PURPOSE: After correction of stress incontinence, some patients experience the improvement of overactive bladder symptoms. During urodynamic study of some patients, the leak point pressure has a tendency to decrease at increasing vesical volumes. We evaluated the possibility of a correlation between stress incontinence parameters and bladder capacity or compliance. MATERIALS AND METHODS: 113 stress incontinence patients who received urodynamic study from February 2000 to August 2005, were reviewed retrospectively for this study. In these patients, urodynamic stress incontinence parameters(abdominal leak point pressure: ALPP, maximum urethral closure pressure: MUCP), Q-tip angle and Stamey symptom grade and age were analyzed for a correlation with urodynamic cystometric capacity or compliance. We also compared the cystometric capacity of each symptom grade group to assess the difference among the groups. RESULTS: The mean age of the patients was 49.5+/-10.4 years(29~75), symptom grade was I(37), II(27), III(19), Q-tip angle was 33.6+/-14.0 degrees(10~60), cystometric capacity was 390.2+/-109.7 ml(121~641), compliance was 51.6+/-30.4 ml/cmH2O(9.2~142.5), ALPP was 83.2+/-31.0 cmH2O(24~200), MUCP was 55.4+/-29.3 cmH2O(7~142). In the correlation analysis, cystometric capacity had a correlation of -0.207 with age (p=0.029) and -0.215 with symptom grade(p=0.031). However, bladder compliance had no significant correlation with any of the parameters studied. In each symptom grade, cystometric capacity was 407.0+/-103.1 cc(I), 395.8+/-103.0 cc(II), 324.5+/-124.0 cc(III)(p=0.04) and the age for each symptom grade was 48.5+/-9.7(I), 48.1+/-10.1 (II), 57.3+/-10.1(III)(p=0.005). CONCLUSION: As cystometric capacity decreased, symptom grade of stress incontinence increased and age also increased. However, there were no other correlations between cystometric capacity or compliance and stress incontinence parameters.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Reconstruction of Scalp Defects using Bilobed Flap

The bilobed flap is often used when the primary closure of a skin defect is difficult. We applied a simple and rational method to design a bilobed flap for closure of scalp defect that reconstruction was comparatively difficult. In our method, two triangle flaps are designed; the angle of the first flap is three-fourths the angle of a rhombus at the defect site, and the angle of the second flap is also three-fourth that of the first flap. We applied it to five patients with scalp defect and obtained favorable result. The location of the defect was the parietal region in two cases. the occipital region in two cases. the frontal region in one case. We found that the alopecia by scar formation could be minimized with the designed bilobed flap. The suture line, being "Z" shape, was unnoticeable due to hair line stream. There are several advantages of this method for use in reconstruction of scalp defect such as, easy design and elevation of the flap and short operation time.

A Case of Scalp Angiosarcoma

Angiosarcoma is very rare but highly malignant soft tissue tumor derived from the vascular endothelium. This tumor is most commonly found in the skin and subcutaneous tissues. Angiosarcoma is known to cause early and widespread metastasis leading to a very poor prognosis of less than 24 months. We report a case of angiosarcoma developed in the temporoparietal scalp of a 84-year-old man. The patient was referred for us consultation after failed systemic antibiotic treatment, incision drainage treatment for "cellulitis" by the general physician. We performed excision and biopsy. The histologic finding of the lesion showed that irregular, complex vascular channels in dermis. The tumor cells were positive for Factor VIII-related antigen. The lesion was confirmed as cutaneous angiosarcoma. We recommended a radical surgery and reconstruction followed by adjuvant radiation, but the patient refused. The patient was expired 2 months thereafter because of a massive hemorrhagic pleural effusion by suspicious distant metastasis. Authors reported important aspects of clinical findings, histologic features and therapeutic options of the scalp angiosarcoma.

A Clinical Study On The Dental Emergency Patients Visiting Wonkwang Univ-Hospital Emergency Room

Prostate Specific Antigen Velocity in Healthy Men with Initial PSA Levels of 4.0ng/ml or Less / 대한비뇨기과학회지

PURPOSE: We evaluated the relative long-term longitudinal changes in the levels of serial prostate specific antigen in healthy men without urinary tract infection and initial PSA of 4.0ng/ml or less. MATERIALS AND METHODS: Between February 1996 and June 2000, the rate of PSA change (PSAV) in 1,132 healthy men with an initial PSA of 4.0ng/ml or less who were clinically free of urinary tract infection and known prostate disease were analyzed. In all cases, a minimum of 2 PSA levels were measured at intervals of at least 12month. The influence of age, initial PSA and interval between measurements were assessed. RESULTS: The mean age, initial PSA, interval between measurements, change in PSA and PSAV were 45.2 (24-80) years, 1.05 (0.04-4.0)ng/ml, 19.2 (12-39) month, 0.13 ( 1.0-3.1)ng/ml and 0.08 ( 0.8-1.22)ng/ml/year. A cumulative frequency plot of PSAV demonstrated that 50%, 95% and 97% of subjects had PSAV 0.06ng/ml/year, 0.55 ng/ml/year and 0.60ng/ml/year or less, respectively. PSAV was correlated with age (r=0.090, p=0.002) and initial PSA (r=0.331, p 0.05) when adjusted by the initial PSA level. Percentage of the men with PSAV of great than 0.75ng/ml/year was 1.8% (20/1,132); 0.6% (4/708) for those whose initial PSA were less than 1.0ng/ml, 1.7% (6/358) for 1.1-2.0ng/ml and 15.1% (10/66) for 2.1-4.0ng/ml. CONCLUSIONS: Among men with normal PSA whose PSA is sampled over relatively long-term interval, PSAV is directly correlated with initial PSA but not with age and interval between measurements. Men with a PSA of 2.0ng/ml or less are at low risk for abnormal PSAV and annual PSA monitoring may not be necessary, but the annual longitudinal monitoring may be clinically useful in men with an initial PSA of 2.1-4.0ng/ml. Large prospective studies are required to assess the precise cut-off point of PSAV for Korean men in the early detection of prostate cancer.

A comparison of Modified One Layer Vasovasostomy with Optical Loupe and Microscope / 대한불임학회지

OBJECTIVE: The objective of this study was to compare results of the macroscopic one-layer vasovasostomy with those of microscopic one-layer vasovasostomy and to analyze the change of semen parameters according to the interval of vasal obstruction. METHOD AND MATERIALS: Between March 1987 and December 1997, we performed 121 vasovasostomies using modified one-layer technique with loupe magnification (macroscopic vasovasostomy) or microscope. Among the 68 could be followed post-operatively, 37 patients were treated by macroscopic technique with loupe, and 31 patients by microscopic technique. We compared rates of anatomical patency (sperm count above than 10x106/ml) and pregnancy of macroscopic vasovasotomy with those of microscopic vasovasostomy. Patency and pregnancy fates according to vasal obstructive interval were also examined. RESULTS: The patency rates of macroscopic and microscopic technique were 86.5% and 87.1%, and pregnancy rates of macroscopic and microscopic technique were 64.9% and 67.7%. There was no statistical significance between these two methods (p>0.05). The pregnancy rates and sperm motility were decreased if more than 10 years had elapsed following vasectomy(p<0.05). CONCLUSION: We found little difference in success rates resulting from macroscopic and microscopic vasovasostomy and the former had the advantage of reduced cost and a lower operator skill level. in post-operative semen analysis, the sperm motility was the most probable factor associated with vasal obstructive interval.

Therapeutic Effect of Minocycline on Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: Confluent and reticulate papillomatosis(CRP) of Gougerot and Carteaud is an uncommon disorder of unknown cause for which a variety of treatments have been proposed. OBJECTIVE: We attempted to evaluate the therapeutic effect of oral minocycline for CRP. METHOD: Nine patients(age range, 14 to 38; mean age, 21years) with CRP were included in this study. They took minocycline 100mg daily. The therapeutic effect was evaluated weekly by 5 scoring systems according to the percentage clearing of the skin lesion: poor (score 1), 95%. RESULTS: Two out of 9 patients showed complete clearing(score 5) of the skin lesions within 2 weeks. Seven patients revealed incomplete clearing(score 4) within 3 to 8 weeks. The mean scoring for 9 CRP patients was 4.2. Recurrences were noted in two patients at 24 and 26 months, respectively, but they responded to re-treatment with minocycline. The patients did not show any adverse reactions apart from two patients who developed mild pruritus. CONCLUSION: We recommend minocycline as the first choice of treatment for CRP because minocycline is safe, economic and effective.

Infantile Acute Hemorrhagic Edema of the Skin / 대한피부과학회지

Infantile acute hemorrhagic edema of the skin(IAHE) is a benign disease which affects infants between 4 months and 2 years of age and is characterized by palpable ecchymotic purpura and edema on the limb and face. We report a typical case of IAHE, which was presenting a cockade, annular, reticulated, and iris-like purpura and edema on the face and extremities in a 19-month-old male infant. We consider it to be a new disease category because its characteristics different markedly from HenochSchoenlein purpura in several clinical and histopathologic findings.

Effects of Mycobacterium leprae , M . leprae Phenolic Glycolipid - 1 and Cytokines on the Nitric Oxide Generation of RAW 264 . 7 Macrophages / 대한피부과학회지

Background: Nitric oxide(NO) has been reproted to play an important role in macrophage-mediated microbicidal capacity for a variety of intracellular pathogens. NO generation is used as an indicator of microbicidal function of macrophages. OBJECTIVE: Our purpose is to investigate the production of NO rom macrophages phagocytized with Mycobacterium leprae or M. leprae phenolic glycolipid-1(PGL-1) for the purpose of elucidating the pathogenesis of leprosy. METHODS: We used a murine macrophage cell line, RAW 264.7. Macrophages were incubated with dead M. leprae or PGL-1, respectively and then treated with interfer n-gamma(IFN-r) and/or tumor necrosis factor-alpha(TNF-a). The release of NO was determined spectrophotometrically by measuring nitrite. RESULTS: M. Leprae and PGL-1 failed to stimulnte NO secretion execept at high bacteria-to-cell rations(50:1)and at the higheat concentrat,ion(100pg/ml) of PGL-1. IFN-r or IFN-r plus TNF-a markedly stimulated macrophages phagocyt,ized with M. leprae or PGL-1 to release NO . CONCLUSION: Defective IFN-r-dependent NO production of macrophages may be an important factor in the pathogenesis of leprosy.