PURPOSE: Combined androgen blockade(CAB) is often used in the management of advanced adenocarcinoma of the prostate. Recent case reports indicated that hypogonadism from CAB therapy is associated with osteoporosis and related fracture. The effect of CAB on bone mineral density(BMD) has not been adequately studied in men with prostate cancer. In this study, the possibility, frequency and severity of osteoporosis following CAB in prostate cancer patient was investigated. MATERIALS AND METHODS: A total of 19 men with advanced prostate cancer receiving CAB were evaluated for the presence of osteoporosis defined as bone mass 2.5 standard deviation below peak bone mass of young normal men(T-score). The BMB of the femoral neck and lumbar spine were measured. The BMD was then compared to the age-matched control value and reported as the Z-score. BMD measurements were compared to duration of CAB and Gleason score. RESULTS: Osteoporosis occurred in 10 of 15 patients in lumbar spine, and 4 of 18 patients in femoral neck. Osteoporosis was unrelated to the type of the CAB(orchiectomy, or LHRH-agonist). CAB caused a decrease in mean BMD of lumbar spine and femoral neck. There is a negative linear relation between mean BMD and duration of CAB(lumber spine; R2=0.059, Y=-2.368-0.016X, p>0.05, femoral neck; R2=0.089, Y=-1.923-0.020x, p>0.05). There is a statistically significant negative linear relationship between Gleason score and mean T-score of femoral neck(lumbar spine; R2=0.391, Y=-0.08-0.371X, p<0.05, femoral neck; R2=0.517, Y=0.855-0.450x, p<0.005). CONCLUSIONS: Our study provide evidence for acceleration of osteoporosis among men whose prostate cancers were treated with CAB. This study indicates a need for bone mineral density determination at the onset of CAB and at periodic intervals there after to begin appropriate therapy, undefined at this point, for prevention of osteoporosis and its complications aggravated by this therapy.
Acceleration ; Adenocarcinoma ; Bone Density ; Femur Neck ; Humans ; Hypogonadism ; Male ; Neoplasm Grading ; Osteoporosis* ; Prostate* ; Prostatic Neoplasms* ; Spine

Antihypertensive effect of angiotensin converting enzyme(ACE) inhibitor Captopril was studied in 34 cases of essential hypertension. A single oral dose of 50mg Captopril was administered daily and blood pressure was followed every 2 weeks. Diuretics were added to patients who responded inadequately after 2 weeks of Captopril single treatment. Alpha-blocker, beta-blocker or calcium channel-blocker was added to patients who responded inadequately after another 2 weeks of Captopril and diuretics combined treatment. In 5 cases, Captopril was raised to 100mg and further antihypertensives were added to unresponded 3 cases. The resuts were as follows; 1) In 15 patients, blood pressure dropped from 170.3+/-10.5mmHg/108.7+/-6.1mmHg to 148.3+/-4.4mmHg/93.3+/-3.7mmHg after 8 weeks of Captopril 50mg single therapy. 2) Hydrochlorothiazide 25mg was added to non-responders, and blood pressure dropped from 180+/-6.7mmHg/111.1+/-6.2mmHg to 155.0+/-15.0mmHg/106.2+/-8.7mmHg in 9 of 19 patients after 8 weeks of combined treatment. 3) Alpha-blocker, Beta-blocker or calcium channel blocker was added to 10 non-responders to Captopril-hyprochlorothiazide combination therapy, and blood pressure dropped from 189.0+/-27mmHg/116+/-10mmHg to 137.8+/-15.5mmHg/88.5+/-10.2mmHg after 8 weeks. 4) Increase of captopril from 50mg to 100mg in 5 random nonresponder cases of Captopril single treatment lowered blood pressure from 168.0+/-13.6mmHg/107.1+/-6.4mmHg to 161+/-15.2mmHg/99+/-8.8mmHg after 2 weeks. 5) Heart rate, and serum creatinine, electrolytes and lipid levels showed no significant interval change. 6) Six patients complained of dry cough and one patient complained of poor appetite but no other clinically significant complications were noted during Captopril treatment.
Angiotensins ; Antihypertensive Agents ; Appetite ; Blood Pressure ; Calcium ; Calcium Channels ; Captopril* ; Cough ; Creatinine ; Diuretics ; Electrolytes ; Heart Rate ; Humans ; Hydrochlorothiazide ; Hypertension

BACKGROUND: Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. METHOD: Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. RESULTS: 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. CONCLUSION: In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.
Biopsy* ; Biopsy, Fine-Needle ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Lung* ; Pneumothorax

A 60-year old male patient admitted with complaints of dyspnea and pleuritic chest pain. The chest X-ray demonstrated right pleural effusion. We planed to do the conventional thoracentesis to evaluate the characteristics of pleural effusion and to relieve the symptom of the patient. Focal reexpansion pulmonary edema was seen on the follow-up chest X-ray. After the 5-day conservative management, the patient recovered without any complications.
Chest Pain ; Dyspnea ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pleural Effusion* ; Pulmonary Edema* ; Thorax

OBJECTIVES: A number of investigators have examined the possible pathophysiological mechanisms in patients who died from asthma, but the reasons for the increased incidence of death in patients with asthma are largely unknown. To elucidate the risk factors and possible causes of fatal asthma, we reviewed the clinical data of patients with potentially fatal asthma(PFA). METHODS: We retrospectively studied the clinical and laboratory profiles of 35 PFA patients(43 episodes) who had been admitted at the Kyungpook University Hospital and Taegu Fatima Hospital in recent 5 years(1989. 7-1994. 6). Our criteria of PFA were defined as either respiratory arrest or an arterial carbon dioxide tension(PaCO2) greater than 50 mmHg or an altered state of consciousness, due to acute asthma. RESULTS: 1) Twenty four patients with PFA were female and 11 male. At the time of PFA episode, age distribution was between 16-65 year (42% between 36-49). 2) Seasonal distribution was 13 episodes between March and May, 13 June and August, 6 September and November, 11 December and February. 3) Previous hospitalization history due to asthmatic attack was noted in 81 percent, and 75 percent were relatively compliant to their therapy. 5) At visiting emergency room, 81 percent satisfied the criteria of PFA, whereas 19 percent during hospitalizatoin. 77 percent required mechanical ventilation, and 52 percent of them within 30 minutes after visiting. 6) Initial arterial blood gas analysis at emergency room showed marked hypercapnia(75 +/- 29 mmHg), hypoxemia(50 +/- mmHg) and acidosis(pH 7.14 +/- 0.15). Serum potassium levels were within normal ranges in 75 percent. 7) All, except one, showed no significant cardiac arrthymias. 8) Possible precipitating factors leading to PFA were respiratory tract infection in 31 episodes, ingestion of NSAIDs in 2, emotional upsets in 2, irritant air pollutions in 2, withdrawal of anti-asthma drugs in 1, and unknown causes in 5. 9) Nine of 16 patients were atopic, and majority of them showed positive reaction to Dermatophagoides antigen. CONCLUSIONS: These results may suggest that PFA is mainly due to airway obstruction, and upper respiratory infection is an important precipitating factor leading to PFA. It is necessary to establish an appropriate plan for preventing PFA and related deaths.
Age Distribution ; Air Pollution ; Airway Obstruction ; Anti-Inflammatory Agents, Non-Steroidal ; Asthma* ; Blood Gas Analysis ; Carbon Dioxide ; Consciousness ; Daegu ; Eating ; Emergency Service, Hospital ; Female ; Gyeongsangbuk-do ; Hospitalization ; Humans ; Incidence ; Male ; Potassium ; Precipitating Factors ; Pyroglyphidae ; Reference Values ; Research Personnel ; Respiration, Artificial ; Respiratory Tract Infections ; Retrospective Studies* ; Risk Factors ; Seasons

PURPOSE: To evaluate the MR findings of a development of bony bridge within tunnels drilled across growth plates after injury in immature rabbits, and to correlate the MR and pathological findings. MATERIALS AND METHODS: In 19 young rabbits, a growth-plate injury model was constructed in the distal femur by longitudinal drilling with a 5-mm drill. Coronal scans with T1-weighted, T2-weighted fast spin-echo, gradient echo, and gadolinium enhanced T1-weighted sequences were obtained immediately, and at 1, 2, 3, and 4 weeks, and 3, 6 months, postoperatively. Each group underwent pathologic examination, and the signal intensity, shape, and enhancement pattern of the drill holes were assessed. All results were correlated with pathologic findings. RESULTS: During the early period, the signal intensity of the defect site varied due to hemorrhage and inflammatory reaction in the lesion, becoming isointense to that of metaphyseal marrow on all sequences during the late period (3 and 6 months). Pathologically, it corresponded to replacement of the osseous bridge with fatty marrow. The new bone formation shown by pathologic examination to be present in the periphery of the defect during the first week corresponded to the vertical dark rim seen on MR images. It appeared during that week and became more distinct, thickening gradually until the fourth week. Enhancement was absent or faint on follow-up immediately after surgery, inhomogenous and seen in half the rabbits at week 1, and maximal and homogenous at weeks 2 and 3. In had decreased by week 4, and was absent at months 3 and 6. These findings corresponded to the changes in transphyseal vascularity across the drill hole revealed by pathologic examination. CONCLUSION: The contrast enhancement demonstrated by defective growth plate may indicate the development of vascularity throughout the plate, a phenomenon which precedes the formation of a bony bridge after trauma.
Bone Marrow ; Femur ; Follow-Up Studies ; Gadolinium ; Growth Plate* ; Hemorrhage ; Magnetic Resonance Imaging* ; Osteogenesis ; Rabbits

OBJECTIVES: To determine effect of transforming growth factor-beta1 and bone morphogenetic protein-2 in matrix synthesis and expression of chondrogenic phenotype in human intervertebral disc cells. MATERIALS AND METHODS: The intervertebral disc cells were harvested and cultured from the surgical patients for the degenerative disc disease. TGF-beta1 was purchased from R&D and BMP-2 was produced by transfection of pcDNA3.1/Hygro/BMP-2 to CHO cell using Lipofectamine 2000. rhBMP-2 was separated by Heparin-Sepharose A chromatography. TGF-bata1 and BMP-2 were administered to culture. Proteoglycan synthesis was assessed by 35S incorporation and expression of matrix mRNA was analyzed by RT-PCR for collagen I, collagen II, aggrecan, and osteocalcin. RESULTS: TGF-bata1 and BMP-2 showed increased proteoglycan synthesis and expression of collagen I, collagen II and aggrecan mRNA in dose dependent manner respectively. There was no recognizable synergistic effect in matrix synthesis and matrix mRNA expression. Throughout dosage, expression of osteogenic phenotype (osteocalcin mRNA) was not noted. CONCLUSION: TGF-beta1 and BMP-2 proved to be effective anabolic agent for maximizing matrix synthesis without evidence of osteogenesis.
Aggrecans ; Animals ; CHO Cells ; Chromatography ; Collagen ; Cricetinae ; Humans ; Intervertebral Disc* ; Osteocalcin ; Osteogenesis ; Phenotype* ; Proteoglycans ; RNA, Messenger ; Transfection ; Transforming Growth Factor beta1

PURPOSE: Insistence that total regression of primary tumor would not represent long-term oncologic outcomes has been raised. Therefore, this study aimed to evaluate the outcomes of these patients after preoperative chemoradiotherapy (PCRT) and radical surgery and to evaluate the associated risk factors. METHODS: We included 189 patients with rectal cancer who showed total regression of the primary tumor after PCRT, followed by radical resection, between 2001 and 2012. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the results were compared with 77 patients with Tis rectal cancer who received only radical resection. Factors associated with RFS were evaluated using Cox regression analysis. RESULTS: Sphincter-saving resection was performed for 146 patients (77.2%). Adjuvant chemotherapy was administered to 168 patients (88.9%). During the follow-up period, recurrence occurred in 17 patients (9%). The 5-year RFS was 91.3%, which was significantly lower than that of patients with Tis rectal cancer without PCRT (P = 0.005). In univariate analysis, preoperative CEA and histologic differentiation were associated with RFS. However, no factors were found to be associated with RFS. CONCLUSION: RFS was lower in patients with total regression of primary rectal cancer after PCRT than in those with Tis rectal cancer without PCRT, and it would not be considered as the same entity with early rectal cancer or “disappeared tumor” status.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Follow-Up Studies ; Humans ; Methods ; Rectal Neoplasms ; Recurrence ; Risk Factors

PURPOSE: The level of serum prostate-specific antigen (PSA) varies according to both age and race. It is known that the level of PSA increases with age, and that Asians have a lower incidence of prostate cancer and levels of PSA than Caucasians. In this study, the variation in the serum PSA level in samples collected from general populations were used to find an actual standard age-specific PSA reference range for Koreans. MATERIALS AND METHODS: Patients who received serum PSA level check-ups, between November 1998 and July 2005, at 8 domestic hospitals, were selected for the investigation. The PSA levels of 120,439 adult males, aged between 30 and 80 years, were measured, and those lower than 10ng/ml were analyzed. To estimate the increase in the level of serum PSA according to age, a simple linear regression analysis was carried out. RESULTS: The mean PSA level reference ranges according to age were 1.88, 1.92, 2.37, 3.56 and 5.19ng/ml for those in their thirties, forties, fifties, sixties and seventies, respectively. The rates of PSA change were 0.0023, 0.0175 and 0.0499 for those in their forties, fifties and sixties, respectively, indicating the rates of PSA level change increase steady with age, but these increases are greater for those in their fifties and most severe after their sixties. The level of age-specific PSA reference in Korean men was lower than that of men from Western countries. CONCLUSIONS: The age-specific PSA reference levels, as found in pre-existing literature, showed differences between races, with the overall reference levels being low for domestic data. The standard reference level of age-specific PSA for the screening of prostate cancer may be lower in Korean men than those from Western countries.
Adult ; Asian Continental Ancestry Group ; Continental Population Groups ; Humans ; Incidence ; Linear Models ; Male ; Mass Screening ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Reference Values*

BACKGROUND: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. METHODS: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. RESULTS: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. CONCLUSION: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.
Bacteria ; Bronchi ; Coinfection ; Dyspnea ; Glass ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Lung ; Lymph Nodes ; Pandemics ; Pleural Effusion ; Pneumonia ; Pneumonia, Viral ; Pulmonary Atelectasis ; Thorax ; Tomography, X-Ray Computed