Association between Smoking and the Progression of Computed Tomography Findings in Chronic Pancreatitis

BACKGROUND/AIMS: Smoking and alcohol intake are two well-known risk factors for chronic pancreatitis. However, there are few studies examining the association between smoking and changes in computed tomography (CT) findings in chronic pancreatitis. The authors evaluated associations between smoking, drinking and the progression of calcification on CT in chronic pancreatitis. METHODS: In this retrospective study, 59 patients with chronic pancreatitis who had undergone initial and follow-up CT between January 2002 and September 2010 were included. Progression of calcification among CT findings was compared according to the amount of alcohol intake and smoking. RESULTS: The median duration of follow-up was 51.6 months (range, 17.1 to 112.7 months). At initial CT findings, there was pancreatic calcification in 35 patients (59.3%). In the follow-up CT, progression of calcification was observed in 37 patients (62.7%). Progression of calcification was more common in smokers according to the multivariate analysis (odds ratio [OR], 9.987; p=0.006). The amount of smoking was a significant predictor for progression of calcification in the multivariate analysis (OR, 6.051 in less than 1 pack per day smokers; OR, 36.562 in more than 1 pack per day smokers; p=0.008). CONCLUSIONS: Continued smoking accelerates pancreatic calcification, and the amount of smoking is associated with the progression of calcification in chronic pancreatitis.

The Effects of 5-alpha Reductase Inhibitor on Contr action of Erectile Tissue and Secretion of Seminal Fluid in Male Rabbits: Preliminary Study / 대한남성과학회지

PURPOSE: Adverse sexual experiences such as erectile dysfunction (ED), loss of libido, and ejaculation disorders have been consistent side effects of 5-alpha reductase inhibitors (5ARI). The aim of this study was to evaluate the effects of 5ARI (finasteride) treatment on semen parameters and contraction of the corpus cavernosum and seminal vesicles in male rabbits. MATERIALS AND METHODS: Adult male New Zealand White rabbits (n=10) were randomized into 2 groups: finasteride-treatment (5ARI) group and vehicle-treatment (control) group. The 5ARI group received daily oral finasteride (10 mg/day) by gavage for 4~6 weeks, and the control group received the same concentration of the vehicle. The semen volume and semen parameters between the 2 groups were compared; thereafter, contraction or relaxation responses of smooth muscle strips of the corpus cavernosum and seminal vesicles were observed in an organ bath. RESULTS: Semen magnesium (14.2 vs 5.1 mg/dl) and protein (2.2 vs 1.6 g/dl) concentrations were significantly lower in the 5ARI group than in the control group. The concentrations of other parameters such as electrolytes (Na/K/Cl), fructose, and citrate did not differ between the 2 groups. The contractile responses to norepinephrine (NE) significantly increased in the 5ARI group compared to the control group and the relaxation responses to acetylcholine (ACh) or sodium nitroprusside (SNP) also increased in the 5ARI group. The contractile responses of the seminal vesicular strips to NE significantly decreased in the 5ARI group compared with the control group. CONCLUSIONS: The results suggest that finasteride may decrease contraction of seminal vesicle tissue and alter semen parameters. The effect of finasteride on erectile tissue was double-faced; enhancing both contraction and relaxation. Further study is needed in this respect.

Outcome of Radical Prostatectomy in Prostate Cancer Patients with Prostate-Specific Antigen (PSA) Level Equal to or More Than 20 ng/ml and No Distant Metastasis Preoperatively

PURPOSE: We assessed the efficacy of radical prostatectomy (RP) in prostate cancer patients with preoperative prostate-specific antigen (PSA) levels > or = 20 ng/ml and no distant metastases. MATERIALS AND METHODS: The records of 132 prostate cancer patients undergoing RP with preoperative PSA levels > or =20 ng/ml and no distant metastases were reviewed. Sixty-six patients received preoperative neoadjuvant hormonal therapy. Pathologic and clinical outcomes were compared between the groups with PSA of 20-40 ng/ml and > or =40 ng/ml. RESULTS: There were no statistical differences in age, prostate volume, or the frequency of neoadjuvant hormonal therapy between the two groups. The PSA > or =40 ng/ml group had a higher RP Gleason score, tumor stage, and extracapsular extension. After a mean follow-up of 47.0 months, 73 (55.3%) patients had PSA progression with a median time of 37.0 months. Fifty-six patients received adjuvant hormonal therapy, and 19 received salvage external beam radiation therapy. Clinical disease progression developed in 10 patients (7.6%). During follow-up, 8 patients died, 1 of prostate cancer and 7 of other causes. Preoperative PSA was a significant predictor of PSA progression and time to PSA progression after RP, whereas there were no differences in distant metastasis, local recurrence, hormone-refractory prostate cancer progression, and overall or prostate cancer-specific death between the 2 groups. CONCLUSIONS: On the basis of the favorable postoperative outcomes of RP in patients with preoperative PSA > or =20 ng/ml and no distant metastases, we suggest that RP has a role in treating these high-risk prostate cancer patients and that preoperative PSA is a significant predictor of postoperative PSA progression.

Long-term Follow up of Augmentation Ileocystoplasty with Goodwin's Ileal Cup Patched Bladder / 대한비뇨기과학회지

PURPOSE: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin(')s ileal cup patched bladder. MATERIALS AND METHODS: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. RESULTS: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. CONCLUSIONS: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladders.

Robot-assisted Laparoscopic Nephroureterectomy with a Bladder Cuff Excision / 대한비뇨기과학회지

We report here on our technique and outcomes of the first two cases of robot-assisted laparoscopic nephroureterectomy with a bladder cuff excision(RLNU). RLNU was performed on two female patients who both had a muscle invasive lower ureter tumor. For the first step, nephroureterectomy was performed in the lateral flank position. For the second step, bladder cuff excision and bladder repair were performed in a steep Trendelenburg position. The specimen was extracted through a 6 cm sized incision in the umbilical trocar site. Both procedures were successfully completed with using the robot without conversion to open surgery. The total operative time, including the lymphadenectomy and the robot docking times, was 320 and 241 minutes, respectively, for the 2 patients. The estimated blood loss was 40 and 200 ml, respectively. The pathological examinations showed stage T3 and T2 invasive transitional cell carcinoma of the ureter. The patients' postoperative recoveries were uneventful and the bladder cuff was free of tumor. RLNU may have potential advantages over open and laparosopic surgery due to its minimal invasiveness. This approach can be an alternative to open surgery or laparoscopic technique.

A Case of McCune-Albright Syndrome with Associated Multiple Endocrinopathies

McCune-Albright syndrome (MAS) is a rare disorder that develops from an activating mutation in the Gs gene. It is characterized by an association with Polyostotic fibrous dysplasia, and precocious puberty, Caf-au-lait pigmentation, and other endocrinopathies that result from the hyperactivity of a variety of endocrine glands. Recently we encountered a patient with MAS with fibrous dysplasia, skin pigmentation, acromegaly, hyperprolactinemia and a thyroid nodule. A 23-year-old male presented for an evaluation of a change in his facial structures. Fibrous dysplasia was diagnosed by a bone biopsy and radiographic studies. The GH level increased paradoxically after an oral glucose load. The plasma prolactin, IGF-1 and alkaline phosphatase were high. Thyroid ultrasonography revealed multiple nodules. The brain MRI demonstrated a mass in the left pituitary gland. Genetic analysis identified a change from Arg (CGT) at codon 201 to Cys (TGT).

Analysis of Human V-erbA Related EAR-3 Gene Expression between Transitional Cell Carcinoma and Normal Tissue in Bladder Cancer / 대한비뇨기과학회지

PURPOSE: The prognosis of bladder cancer is related to tumor grade and stage. Because these pathological changes are preceded by molecular alterations, new molecular markers are needed in early diagnosis. New target molecular biomarkers can be differentially expressed genes(DEGs) between normal and cancer tissues. We tried to find a new DEG and demonstrated that it may be related to the development of the bladder cancer. MATERIALS AND METHODS: Cancer tissues were obtained from 39 patients with urothelial cell carcinoma, treated by transurethral resection of tumor (TURB) since 2002. Normal bladder tissues were obtained from the same patients during TURB. We compared the mRNA profiles between normal and cancer tissues using annealing control primer(ACP)-based Genefishing(TM) PCR to identify the DEGs in normal and cancer tissues of one same patient. To validate the result of ACP-based GeneFishing(TM) PCR, reverse transcription-polymerase chain reaction(RT-PCR) was performed on those of 39 patients. RESULTS: According to the result of ACP-based Genefishing(TM) PCR, EAR-3 gene was only present or markedly upregulated in normal tissue, compared with cancer tissues. The expression pattern that EAR-3 gene was downregulated in cancer tissues, irrespective of the clinicopathologic parameters was confirmed by RT-PCR in 39 patients. CONCLUSIONS: EAR-3 gene was downregulated in cancer tissues, irrespective of clinicopathologic parameters, compared with normal tissues in the bladder of the same patient. Therefore, we suggested that EAR-3 gene may be also play a role in bladder cancer development.

Remission of Refractory Intestinal Behcet's Disease with Infliximab / 대한류마티스학회지

Behcet's disease is a chronic, relapsing vasculitis of unknown origin that affects nearly all organs. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal lesion and the colon. The lesions are typically resistant to medical treatment and frequently recur with surgical treatment. We describe a patient who had intestinal Behcet's disease complicated perforation and enterocutanous fistula with a good response to infliximab.

A Case of Biliary Cast Syndrome after Cadaveric Liver Transplantation / 대한소화기학회지

We experienced one fatal case of biliary cast syndrome after cadaveric liver transplantation involving both intrahepatic ducts. A 58-year-old man underwent cadaveric liver transplantation because of hepatitis B virus related liver cirrhosis and concomitant hepatocellular carcinoma. Five weeks after the liver transplantation, postoperative course was complicated by development of acute cholangitis. Subsequent endoscopic retrograde cholangiography revealed diffuse intrahepatic bile duct strictures without filling defects. Percutaneous liver biopsy, which was done to exclude rejection, revealed biliary cast. Successful endoscopic removal was precluded due to its diffuse involvement. Because of the deterioration of patient's condition by refractory biliary obstruction and cholangitis, retransplantation from cadaveric donor was performed. Debridement of the biliary tree after graft removal yielded a near-complete cast of the intrahepatic ductal system. Biliary cast syndrome should be suspected when jaundice or cholangitis is associated with dilated ducts on abdominal imaging studies in cadaveric liver transplantation recipients. Initial therapeutic options include removal of biliary cast after endoscopic or percutaneous cholangiography. Although endoscopic retrieval of biliary cast by endoscopic retrograde cholangiopancreatography could be employed as a first-line management, other modalities such as endoscopic nasobiliary drainage, percutaneous transhepatic drainage, or retransplantation should be considered when complete removal is not feasible and the condition of the recipient deteriorates.

The Design of Subjective Visual Vertical and Horizontal Measurement Method in Normal Peoples

BACKGROUND AND OBJECTIVES:Subjective visual vertical and horizontal presented as test that evaluate otolithic organ. However, was not discussed about condition that is factor influencing in examination or position at examination. Therefore, we wished to evaluate effect of subjective visual vertical and horizontal in each test condition and find repletion item. MATERIALS AND METHOD:Measured subjective visual vertical and horizontal dividing by gender and three age group to 45 normal persons. Do so that there may be axis of rotation of 0.3x0 cm size candlepin on center of screen and lower part of screen to 18 inch LCD monitor at subjective visual vertical. Do so that may be center of screen and left middle at subjective visual horizontal and gave change length and axis of rotation of candlepin. Measured subjective visual vertical and horizontal each 3 times in standing, sitting, supine position in darkroom. RESULTS:There are no statistical differences in each positions and distinction of gender and axis of rotation. But there are statistical differences in age groups. CONCLUSION:Difference in age groups means that examination method or control of number of test, preliminary education of patients, assistance need rather than is caused change or abnormality of otolithic organ. Therefore, is thought to be representative test that evaluate function of otolithic organ as clinical test.

The Relationship between Tobacco Price Rises and Willingness to Quit Smoking among University Students / 한국역학회지

BACKGROUND: The smoking rate of adult male is 68.2% in Korea and that of adolescent and women has risen recently. Ministry of Health and Welfare plans to raise the price of cigarettes by 1,000 Won per pack this year in hopes of securing funds to aid the underprivileged and discourage excessive smoking. In this study, we tried to find the relationship between tobacco price increase and willingness to quit smoking among university students, and the factors associated with willingness to quit smoking. METHOD: The data were collected by questionnaire survey from 225 university students living in Seoul. The questionnaire contained items on age, sex, smoking history, economical status and the intention to quit smoking when the tobacco price be raised. RESULT: The proportion of smokers who has the intention to quit smoking if the price of tobacco be raised by 3,000 Won was 46.2%. The factors associated with willingness to quit smoking were age of initiating smoking, opinion for price of cigarette, self efficacy scores, current plans to quit smoking, and viewpoint of changes in the rate of smokers. CONCLUSION: The results showed that tobacco price rises will increase willingness to quit smoking among university students.