Prevalence of Obesity in Ambulatory Patients with Cerebral Palsy in the Korean Population: A Single Institution's Experience

BACKGROUND: There is a worldwide tendency of an increasing prevalence of obesity. Therefore, this study aimed at determining whether such a trend exists among cerebral palsy (CP) patients. We also tried to compare this trend with the trend in the general population. We also discuss the importance of obesity trends in CP patients. METHODS: This retrospective study was performed on 766 ambulatory patients who were diagnosed with CP since 1996 in our institution. The associations among the prevalence of obesity and the body mass index, age, gender, the type of CP, the gross motor function classification system and the time of survey were investigated. RESULTS: The overall prevalence of obesity was 5.7%, and the overall prevalence of obesity together with being overweight was 14.6% for the ambulatory patients with CP. The prevalence of obesity and of obesity together with being overweight did not show a statistically significant temporal increase. On the other hand, age and gender were found to affect the body mass index of the ambulatory CP patients (p < 0.001 and 0.003, respectively). CONCLUSIONS: The extent of obesity and being overweight in the ambulatory patients with CP in this study was far less than that reported in the United States (US). In addition, it appears that the differences of the prevalence of obesity in children and adolescents between those with and without CP are disappearing in the US, whereas the differences of the prevalence of obesity in children and adolescents between those with and without CP seem to be becoming more obvious in Korea. Accordingly, care should be taken when adopting the data originating from the US because this data might be affected by the greater prevalence of obesity and the generally higher body mass indices of the US.

Effects of Spinal and Peripheral Injection of alpha1A or alpha1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction / 대한배뇨장애요실금학회지

PURPOSE: Antagonists of alpha1-adrenergic receptors (alpha1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of alpha1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in alpha1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an alpha1A/D-selective AR), naftopidil (an alpha1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. METHODS: A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. RESULTS: After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of alpha1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different alpha1ARs. CONCLUSIONS: Up-regulations of the alpha1ARs in BOO were observed by the greater increases of BC after alpha1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the alpha1ARs in functional parameters of bladder activity. In addition, alpha1ARs also act on the lumbosacral cord which implies that the sensitivity of alpha1ARs is increased in pathologic models such as BOO. Further evaluation including differential expression of alpha1ARs in BOO models are need.

A Comparison of Outcomes between Transurethral Resection of the Prostate and High Power Potassium-titanyl-phosphate Laser Vaporization of the Prostate / 대한남성과학회지

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard for the surgical treatment for benign prostatic hyperplasia (BPH), but the procedure's limitations are its invasiveness and the high prevalence of complications. Photoselective vaporization of the prostate (PVP) using an 80w high power potassium-titanyl-phosphate (KTP) laser has recently been developed as a less invasive treatment. We assessed the efficacy of PVP as an alternative to TURP for the treatment of BPH. MATERIALS AND METHODS: The medical records of 324 patients who were surgically treated for BPH from July 2005 to December 2007 were retrospectively reviewed. Among the 324 patients, 190 patients of Group I were treated by TURP and 134 patients of Group II were treated by PVP. Before treatment, assessing the serum PSA level transrectal ultrasound and urodynamic study were done. The primary efficacy parameters were the postoperative international prostatic symptom score and the uroflow parametersat 6 months after the operation. The secondary efficacy parameters were perioperative factors such as the duration of the hospital stay, the operative time and the catheter-indwelling period. Any adverse reactions were monitored. RESULTS: There was no significant difference in the basal characteristics of the study subjects between both the groups. The primary efficacy parameters, the IPSS, the Qmax and thepostvoid residual urine volume were significantly improved in both groups, but there were no significant differences between both the groups. In group II, the perioperative parameters such as the operation time, the hospitalization day and the catheter-indwelling periodwere significantly shorter than those of group I (p<0.05). But the urethral complications such as urethral stricture, dysuria and bladder neck contracture were more common in group II. CONCLUSIONS: These results suggest that PVP using an 80w high power KTP could be an alternative for TURP in terms of efficacy. For the general, safe use of PVP, PVP should be carefully done until the causes of the urethral complications of PVP are determined.

The Feasibility of Robot-Assisted Laparoscopic Radical Cystectomy with Pelvic Lymphadenectomy: from the Viewpoint of Extended Pelvic Lymphadenectomy

PURPOSE: We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. MATERIALS AND METHODS: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. RESULTS: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5+/-145.1 minutes, and the mean estimated blood loss was 346.8+/-205.9 ml. The mean time for PLND was 106.7+/-25.2 minutes in patients with ePLND and 72.1+/-14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5+/-12.8 (range, 8-50) in all patients: 38.6+/-10.8 (range, 29-50) in ePLND and 15.7+/-12.2 (range, 8-21) in sPLND. CONCLUSIONS: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND.

Metastatic Tumor of Tunica Vaginalis Testis with Hydrocele in a Patient with Gastric Cancer / 대한비뇨기과학회지

Metastatic tumors of the tunica vaginalis testis from gastric cancer are extremely rare. We report here on a case of a 48-year-old man who had undergone total gastrectomy due to advanced gastric cancer 23 months previously, and he presented with right painless scrotal swelling. A hard mass was palpated along the right spermatic cord and there was an associated hydrocele around the mass. Ultrasonography showed homegenous hypoechoic lesions in the spermatic cord and anechoic lesion superior to the right testis, which was suggestive of hydrocele of the testis. Exploration was performed via inguinal incision. Multiple hemorrhagic small nodules were noted on the surface of the tunica vaginalis. Also, a tumor in the spermatic cord was present beyond the inner inguinal ring. On microscopic examination, adenocarcinoma cell nests, which were consistent with primary gastric cancer, were found in the tunica vaginalis testis, spermatic cord and peritesticular soft tissue, but not within the parenchyme of the testis or epididymis.

Attitude of Korean Males toward Late-Onset Hypogonadism: Survey of Males in Their 40s and Above / 대한남성과학회지

PURPOSE: To investigate the frequency of symptoms of late onset hypogonadism(LOH) and the intention for testosterone replacement therapy in Korean males in their 40s and above. MATERIALS AND METHODS: Korean males over age 40 were given a detailed explanation of LOH and the Korean version of Androgen Deficiency in Aging Male(ADAM) questionnaire(Saint Louis University) by e-mail. Positive for ADAM was defined as answering 'yes' to Q3 or Q7 which estimate the decline of sexual desire and erectile dysfunction or answering 'yes' to more than 3 other questions. The men's intention to take testosterone replacement therapy when recommended for symptoms of LOH was also queried. RESULTS: Among 38,502 people who opened the e-mail, 15.1%(5,795) of men responded to the survey. The largest fraction of respondents was males in their 40s(60%). The ADAM questionnaire revealed 64.6% of respondents as positive for LOH. More than 50% of respondents complained of decline in erection, endurance, or sexual desire. When asked about their intention to take testosterone replacement therapy, 96% of those positive for LOH answered that they would accept the treatment. CONCLUSIONS: Although the response ratio was low, 96% of screened LOH men showed high interest in LOH and a positive attitude toward testosterone replacement therapy. Urologists should thoroughly investigate the symptoms of LOH in men in their 40s and above and conduct testosterone replacement therapy as indicated, in order to improve the quality of life for Korean men.

Simple Quantification and DNA Profiling from Degraded Low Copy Number DNA Samples / 대한법의학회지

DNA quantification is important to ensure the consistency and the reliability in the interpretation of degraded low copy number DNA typing. We applied the simple PCR quantification method using fluo-rescently labeled primers for the amplification of mtDNA and amelogenin gene in 50 year old skeletal remains (e.g. bone and tooth). K562 DNA was serially diluted and used as a standard for concentration marker to gauge the amount of DNA from PCR versus the peak area. The quantities of DNA extracted from bones and teeth did not show significant difference in the analyses both using mtDNA and amelo-genin gene as an amplification target. To test the efficiency of DNA profiling of degraded low copy number DNA samples, mtDNA PCR quality evaluation and DNA typing for 16 autosomal STR and 9 Y chromosomal STR loci were per-formed and the correlation between DNA quantities and PCR amplification efficiencies of the samples was analyzed. The DNA quantities assayed by the simple method suggested in the present study could be good indicator for mtDNA and STR analysis. As the allele drop-out was observed in less than 0.050ng DNA samples, at least 0.100ng of DNA is required to produce informative STR profiles. Also, STRs with less than 200bp amplification sizes produce efficient DNA profiles in most cases. Therefore, the develop-ment of mini-STRs with less than 200bp amplification sizes is expected to improve DNA typing in degraded low copy number DNA. Y-STRs are easy to detect allele drop-out or drop-in, and accordingly the efficiency test of Y-STRs as well as autosomal STRs for profiling of degraded low copy number DNA samples is thought to be important.

A Case of Rudimentary Uterine Horn Pregnancy with clinical review / 대한산부인과학회잡지

The pregnancy on the rudimentary uterine horn is uncommon condition, its incidence is reported nearly as 1 case per 100,000 normal pregnancy. We experienced a case of noncommunicating uterine horn pregnancy at 10-gestational week. Here we present the case with brief review of literatures.

Clinical Study of cornual pregnancy and comparative Study of Laparoscopic surgery versus Laparotomy / 대한산부인과학회잡지

Most of treatments have been performed laparotomy, but the rapid advances in laparoscopic operative and laboratory techniques and instrument allowed to apply laparoscopic surgery to this disease. We have reviewed 342 cases of ectopic pregnancy from march 1994 to march 2001.The cornual pregnancies were 21 case (6.1%), and the laparoscopic management in 11 cases. The mean gestational age at the time of laparoscopic surgery was 9.1 1.2 (n=11) weeks, and laparotomy was 9.4 1.3 (n=10) weeks. There were no significant difference. The mean operation time of laparoscopic surgery was 72.8 25.5minutes, and laparotomy was 68.3 24.3minutes. The mean hospital days of laparoscopic surgery were 4.9 2.4days, and laparotomy were 6.6 2.3days. In conclusion, laparoscopic surgery can be used as effective and safe as laparotomy for cornual pregnancy.

A Case of Air Embolism during Diagnostic Hysteroscopy / 대한산부인과학회잡지

Complications from hysteroscopy are relatively rare events. They occur more frequently with operative hysteroscopy than with diagnostic hysteroscopy. Air embolism is a rare but devastating complication of hysteroscopy that rightly receives attention as a frightening, sudden, and potentially fatal hazard in otherwise healthy women. We experienced one case of air embolism during diagnostic hysteroscopy for abnormal uterine bleeding under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevention of catastrophic outcomes and the hysteroscopists must understand the pathophysiology of air embolism to prevent, diagnose, and manage this potentially disastrous problem effectively.

Two-dimensional gel electrophoresis of Helicobacter pylori for proteomic analysis

Two-dimensional gel electrophoresis (2-DE) is an essential tool of proteomics to analyse the entire set of proteins of an organism and its variation between organisms. Helicobacter pylori was tried to identify differences between strains. As the first step, whole H. pylori was lysed using high concentration urea contained lysis buffer (9.5 M Urea, 4% CHAPS, 35 mM Tris, 65 mM DTT, 0.01% SDS and 0.5% Ampholite (Bio-Rad, pH 3-10)). The extract (10 mug) was rehydrated to commercially available immobilised pH gradient (IPG) strips, then the proteins were separated according to their charges as the first dimensional separation. The IPG strips were placed on Sodium Dodecyl Sulfate-Polyacrylamide Gel Electrophoresis (SDS-PAGE) to separate according to molecular mass of the proteins as the second dimension. The separated protein spots were visualised by silver staining in order to compare different expression of proteins between strains. Approximately 120 spots were identified in each mini-protein electrophoresised gel, furthermore about 65 to 75 spots were regarded as identical proteins in terms of pI value and molecular weight between strains used. In addition, distinct differences were found between strains, such as 219-1, Y7 and Y14, CH150. Two representative strains were examined using strips which had pH range from 4 to 7. This strips showed a number of isoforms which were considered large spots on pH range 3-10. Furthermore, the rest of spots on pH 4-7 IPG strips appeared very distinctive compared to broad range IPG strips. 2-DE seems to be an excellent tool for analysing and identifying variations between H. pylori strains.

A Case of Pelvic Actinomycosis / 대한산부인과학회잡지

Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.