PURPOSE: Doxazosin has gained wide acceptance as a pharmacotherapeutic agents for the treatment of BPH. As a selective alpha-1 blocker, it is known to reduce symptom scores and improve flow rates. However, the correlation not been fully established. in this study we investigated that improvements of clinical parameters, such as the symptom score, storage symptom score, voiding symptom score, bother score, peak flow, post-voiding residuals and prostate volume, are statistically related to the subjective satisfaction in patients receiving doxazosin pharmacotherapy for the management of BPH. MATERIALS AND METHODS: Forty nine symptomatic BPH patients were evaluated prior to and at 3 months after the administration of recommended dose of doxazosin. The parameters evaluated were total symptom, storage symptom, voiding symptom and bother scores, peak flow rate (Qmax), post-voiding residuals (PVR) and prostate volume. The patients satisfaction to the treatment was determined by subjective responses to the questionnaires, and each response was categorized into one of the two groups; good (much improved, improved) or poor (slightly improved, no changes or getting worse). The subjective responses and the clinical parameters were compared and statistically analyzed. RESULTS: The total symptom, storage symptom, voiding symptom and bother scores decreased, and the Qmax increased significantly in all patients after doxazosin therapy. There was also significant mean posttherapeutic improvement for all individual questions. However, according to the patients subjective satisfaction for the treatment, patients with good result (23 patients) score then those with poor result group (26 patients; p<0.01). The changes of storage symptom score, Qmax, PVR and prostate volume were not significantly different in both groups. CONCLUSIONS: Doxazosin was effective in reducing symptoms and improving peak flow rates in the patients diagnosed clinically with BPH. Although the clinical parameters show significant improvements after doxazosin therapy, the patient satisfaction is more dependent on the severity of pre-treatment total and voiding symptom score. These findings suggest that pre-selecting patients prior to the initiation of doxazosin therapy could result in better treatment responses.
Doxazosin* ; Drug Therapy ; Humans ; Patient Satisfaction ; Patient Selection* ; Prostate ; Surveys and Questionnaires

No abstract available.
Biopsy, Fine-Needle* ; Diagnosis, Differential* ; Radionuclide Imaging* ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Recently, straight-wire appliance is widely used with great concern in clinical orthodontic field. The purpose of this study was to collect the information of the straight-wire appliance and to determine the crown inclination in clinical orthodontics. The author analyzed the study model of 78 individuals with normal occlusion. The obtained results were as follows. 1. Mean, maximum value, minimum value and standard deviation of crown inclination of upper and lower teeth were obtained. 2. The lingual crown inclination of upper tooth had constant value from first premolar through second molar, the lingual crown inclination of lower tooth progressively increased from canine through second molar 3. As Howes' ratio was decreased, the crown inclination of upper incisors was increased. 4. Narrowing the upper arch, the crown inclination of upper incisors was increased.
Bicuspid ; Crowns* ; Incisor ; Molar ; Orthodontics ; Tooth

Inappropriate treatment of the injury of the lateral collateral ligaments of the ankle produce residual instability, which causes serious disability. There is considerable divergence of opinion as to whether fresh rupture of the lateral ligaments of the ankle are best treated by conservative or opreative method. We have conducted a trial to analyze thirty patients, who were treated by immediate open surgical rupair of rupture of the lateral ligaments of the ankle between April 1991 and February 1992. The results were as follows: 1. All patients were active, young men, Injuries to left ankle were three times more than right side. The most common cause of injury is occurred during sports, especially association football. 2. The decision to operate was based on 1)Talar tilt angle of the injured ankle measures 8-10 degrees more than that of the stress uninjured ankle. 2)A positive arthrogram showing contrast leakage into peroneal tendon she-aths & anterolateral aspect of the lateral malleolus. 3. Diagnostic accuracy rate of arthrography is 94.5%, stress radiography 61.1 %. Arthrography is more reliable than stress radiography in the diagnosis of acute injuries to the lateral ligament of the ankle. 4. At operation, isolated rupture of anterior talofibular ligament was in 5 cases, isolated rupture of middle calcaneofibular ligament in 3 cases, concomittant ruptures of anterior talofibular and middle calcaneofibular ligements in 22 cases. 5. Location of tears of anterior talofibular ligament was mostly mid-portion, middle calcaneofibular ligament in mid-portion or distal portion. 6. On radiologic results, average angle of talar tilt was 14.4° preoperatively, 5.2 preoperatively. There was correction of talar tilt angle of average 9.2°. 7. Clinical results of treatment were excellent in 9 patients, good in 6 patients, fair in 4 patients, poor in 2 patients by authors rating system. The satisfactory result was achieved in 15 patients(71.4%). 8. Postoperative complication was reduced mobility in 4 cases, functional instability 1 case, neuroma in operation scar in 2 cases, minor sensory loss in 4 cases. 9. Primary surgical repair gave good results in the aspect of radiologic & fun ctional instability, but clinical results were not satisfactory, due to high incidence of postoperative complication.
Ankle ; Arthrography ; Cicatrix ; Collateral Ligaments ; Diagnosis ; Football ; Humans ; Incidence ; Lateral Ligament, Ankle ; Ligaments ; Male ; Methods ; Neuroma ; Postoperative Complications ; Radiography ; Rupture ; Sports ; Tears ; Tendons

PURPOSE: Although symptom score, peak flow rate(Qmax), postvoid residuals(PVR) and prostate volume are measured in the diagnosis of bladder outlet obstruction(BOO) caused by benign prostatic hyperplasia, pressure flow study is the most objective parameter in diagnosing BOO. To predict the degree of bladder outlet obstruction or detrusor contractility, correlations between clinical and urodynamic parameters such as linear passive urethral resistance relation(L-PURR) nomogram were estimated and also determined whether it is possible to predict the presence of BOO by non-invasive clinical variables in patients with lower urinary tract symptoms(LUTS). MATERIALS AND METHODS: The study was composed of 56 male patients referred for urodynamic study due to LUTS. Patients with disease that might directly or indirectly affect detrusor function and those undergone operation may affect bladder mechanics were excluded from the study. BPH was diagnosed by symptom score(IPSS), uroflowmetry, transrectal ultrasound and urodynamic study. Correlations between L-PURR nomogram grade and other clinical variables(symptom score, Qmax, PVR and prostate volume) were obtained. Predictive value of peak flow rate and prostate volume in diagnosing bladder outlet obstruction were also determined. Comparison of clinical and urodynamic parameters between obstructive(LPURR>3) and nonobstructive as well as those between normal and low contractility groups were performed. RESULTS: Grade of obstruction in urodynamic study correlated with symptom score(r=0.34, p<0.05) and peak flow rate(r=-0.36, p<0.01) but not with PVR and prostate volume. Contractility grade didn`t correlate well with other clinical parameters. Obstruction grade correlated with voiding symptom(question 1, 6) and bother score(r=0.34, p<0.05, r=0.42, p<0.01, r=0.49, p<0.01, respectively). Voiding symptoms(question 1, 5), bother and total symptom score were significantly greater in obstructive group than in nonobstructive one. Qmax was significantly lower in obstructive than in nonobstructive group(8.9+/-0.9 vs 14.0+/-1.0ml/sec, p<0.01). Detrusor pressure at peak flow was significantly greater in obstructive than in nonobstructive group (76.6+/-16.7 vs 42.2+/-3.1cmH2O, p<0.01). Positive predictive values of BOO were 86.2% if Qmax is less than 10ml/sec but 15.4% if Qmax is more than 15ml/sec(x2=16.6, p<0.01). CONCLUSIONS: Obstruction grade of L-PURR correlated well with obstructive symptom and negatively with peak flow rate. Obstructive symptoms in the obstructive group were significantly higher compared to those in the nonobstructive group. Peak flow rate combined with L-PURR seems to be effective parameters in predicting obstruction. Conclusively, L-PURR nomogram was thought to be a good parameter in predicting the presence and degree of bladder outlet obstruction caused by BPH.
Diagnosis ; Humans ; Male ; Mechanics ; Nomograms ; Prostate ; Prostatic Hyperplasia* ; Ultrasonography ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics*

PURPOSE: Our purpose was to deterrnine the efficacy of maternal corticosteroid therapy on the morbidity of premature infants between 26 and 31 weeks' gestation. METHOD: A total of 62 premature infants between 26 and 31 weeks gestation admitted to pediatric department of National Medical Center from Nov, 1990 to June 1996 were analyzed to evaluate the efficacy of prenatal corticosteroid therapy on the morbidity such as hyaline membrane disease, intreventricular hernorrhage, necrotizing enterocolitis, sepsis, neonatal death, days on ventilation and hospital days. RESULT: Among 62 women who delivered premature infants between 26 and 31 weeks, 22 received betamethasone before delivery and 40 did not. 1) The rate of hyaline membrane disease was less in the betamethasone group (41% vs. 70%, P<0.05). 2) The rate of intracranial hemorrhage was less in the betamethasone group (0 vs. 20%, P<0.05). 3) The days of ventilator care was less in the betamethasone group among survival cases (27+/-3.2 vs. 5.2+/-4.6, P<05). 4) Arnong 14 women who delivered at 26 to 28 weeks, 4 received betamethasone before delivery and 10 did not. The rate of neonatal death was less in the betamethasone group (o% vs. 80%, P<0.05). 5) Among 48 women who delivered at 29 to 31 weeks, 18 received betamethasone before delivery and 30 did not. The rate of hyaline membrane disease was less in the betamethasone group (39% vs. 73%, P<0.05). CONCLUSION: Betamethasone appears to reduce hyaline membrane disease, intraven- tricular hemorrhage, neonatal death and the morbidity significantly in premature infants between 26 and 31 weeks' gestation.
Betamethasone ; Enterocolitis, Necrotizing ; Female ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Infant, Newborn ; Infant, Premature* ; Intracranial Hemorrhages ; Pregnancy ; Sepsis ; Ventilation ; Ventilators, Mechanical

PURPOSE: The process of micturition is depend on the bladder contracton power and urethral resistance. The higher urethral resistance in the BPH, the greater power(W) is needed to open the urethra and keep it open during voiding. It has been known that the occurrence of unstable bladder did correlate with the degree of obstruction. Unstable detrusor will exhibit greater contraction power with more efficient voiding(evidenced by higher flow rate, less voiding time). We performed this study to define the differences of urodynamic voiding parameters including detrusor contractility between unstable and stable bladder in the BPH. MATERIALS AND METHODS: In all subjects bladder outlet obstruction was ascertained urodynamically and BPH was diagnosed by digital rectal examination and transrectal ultrasound. The patients were divided into 2 groups. Group 1 included 25 men chosen randomly among BPH patients with bladder outlet obstruction and detrusor instability. Group 2 consisted of 22 men chosen at random among BPH patients with stable obstructed bladders. For each subject a number of urodynamic parameters derived from pressure-flow study were evaluated. RESULTS: Obstructive findings were found in the pressure-flow study in the both groups. Patients ages were 64.1 in the unstable and 61.9 years old in the stable group. Peak flow rate, minimum urethral opening pressure, maximum detrusor pressure, detrusor pressure at peak flow, maximum external voiding power were 14.2ml/sec, 24.3cmH2O, 52.1cmH2O, 42.9cmH2O, 537.3mW, respectively in the unstable group and 11.6ml/sec, 17.5cmH2O, 45.3cmH2O, 34.1cmH2O, 388.2mWm in the stable group. Voiding time was shorter in the unstable group(41.9sec) than in the stable group(54.5sec). Maximum cystometric capacity was significantly greater in the stable group(434.2ml) than in the unstable group(287.5ml) (p<0.01). Maximum contraction power, peak flow detrusor power, opening contraction power were significantly greater in the unstable group(38.8+/-20.2microW/mm2, 34.0+/-18.5microW/mm2, 24.0+/-3.1microW/mm2, respectively) than in the stable group(14.2+/-7.4microW/mm2, 12.9+/-8.1microW/mm2, 11.2+/-1.6microW/mm2)(p<0.01). Voiding efficiency was significantly higher in the unstable population(68.6+/-28.9%) than in the stable one(47.5+/-31.3%)(p=0.02). There were significant positive correlations between opening contraction power with maximum detrusor pressure(r=0.45) and peak flow detrusor pressure (r=0.48) (p<0.01). CONCLUSIONS: In this study, there were more powerful micturition power and more efficient voiding in unstable bladder group. Conclusively, it seems that unstable bladder possibly works as an energy saving device thereby maintaining efficient voiding despite obstruction.
Digital Rectal Examination ; Humans ; Male ; Prostatic Hyperplasia* ; Ultrasonography ; Urethra ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urination ; Urodynamics

PURPOSE: Our experiments were done to determine the effects of alpha-1-adrenergic antagonists which have been commonly used in the treatment of BPH against the partially obstructed detrusor smooth muscle using in-vitro muscle strip study of female rat bladder. MATERIALS AND METHODS: Partial obstruction was created by means of partial ligation of the proximal urethra in 15 female Sprague-Dawley rats. After 6 weeks of obstruction, 1x0.5cm sized each bladder smooth muscle strip was stimulated by field stimulation(FS),(1-32Hz) and bethanechol administration(10(-7)-10(-4)M). After the control stimulations, each strip was pre-treated with doxazosin, tamsulosin, prazosin and atropine for 30 minutes, and then same stimulations were repeated. Seperate strip was pre-treated by propranolol for 30 minutes, and then was stimulated by norepinephrine(10(-4)M) or phenylephrine(10(-4)M). RESULTS: After the administration of doxazosin, percent decreases of maximal tension developed by FS was significantly greater in obstructed(26-50% of the control) than in normal rats(0-12% of the control)(p<0.05). Field stimulated tension were inhibited more in normal(32-40%) than in obstructed rats(p<0.05, 1-32Hz) after the administration of prazosin. Atropine inhibited field stimulated tension to a greater degree in normal(73-63%) than in obstructed(27-43%) rats(p<0.01, 1-32Hz). Complete inhibitory effects of atropine against bethanechol stimulation(10(-7)-10(-4)M) was achieved at 10(-5)M in normal rats. In obstructed rats, complete blockage was achieved at 10-4M of bethanechol. Norepinephrine decreased basal tension both in normal and obstructed rats. After pre-treatment of propranolol, phenylephrine and norepinephrine did not show any increase of basal tension. CONCLUSIONS: Our results suggest that changes of adrenoceptors may be the underlying cause of bladder instability secondary to outflow obstruction as evidenced by significant inhibition of the tension of the detrusor muscle by alpha-1-adrenoceptor blocker(doxazosin but not by tamsulosin) only in obstructed rat bladder. These results also suggest that non-cholinergic components of bladder contraction are much more in obstructed than in normal bladder. It also can be said that doxazosin may have additional effects against bladder instability caused by BPH.
Animals ; Atropine ; Bethanechol ; Doxazosin ; Female ; Humans ; Ligation ; Muscle, Smooth ; Norepinephrine ; Phenylephrine ; Prazosin ; Propranolol ; Rats* ; Rats, Sprague-Dawley ; Receptors, Adrenergic ; Urethra ; Urinary Bladder Neck Obstruction* ; Urinary Bladder*

Congenital adrenal hyperplasia is inherited disorder of adrenal steroidogenesis. 21-hydroxylase deficiency is the most commone enzymatic defect and is divided into classic and late-onset or nonclassic forms. Both classic non-classic 21-hydrozylase deficiencies are inherited in a recessive manner as allelic variants. But it is rare that happened in twin infants. Chief complaints of affected twins in our case were ambiguous genitalia, hyperpigmentation and dehydrations. They were revealed into hyponatremia, hyperkalemia and increased amount of serum progesterone, 17-hydroxyprogesterone and urinary 17-ketosteroid excretion and were administered with DOCA, 9alpha-fluorohydrocortisone, hydrocortisone to control the electrolyte imbalance. And now, both of them are going to normal ratio of weight gain and body growth.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital* ; Desoxycorticosterone Acetate ; Disorders of Sex Development ; Humans ; Hydrocortisone ; Hyperkalemia ; Hyperpigmentation ; Hyponatremia ; Infant ; Progesterone ; Steroid 21-Hydroxylase* ; Twins* ; Weight Gain

Coenzyme Q is concentrated in Golgi apparatus membranes and mitochondria, but not in other membranes. Although it is difficult to prove the metabolic action of coenzyme Q administered exogenously in clinical cases, the effect of this substance can be evaluated by criteria based on clinical findings. In an attempt to evaluate the effect of coenzyme Q for the treatment of 67 patients(male 26 cases, female 41 cases) of congestive heart failure, we administered Coenzyme Q1030mg daily for 4 to 8 weeks. Most of them were valvular heart disease(74.6%) and hypertension (14.9%). Clinical effects were evaluated at least 4 weeks later by the criteria using a scoring method of severity of congestive heart failure which was devised by Ishiyama, etc. In summary, a definite effect was found in 13 cases(19%) and a mild effect was observed in 46 cases(69%). During treatment there were no significant side effects, and also no significant changes in heart rate and blood pressure.
Blood Pressure ; Estrogens, Conjugated (USP)* ; Female ; Golgi Apparatus ; Heart ; Heart Failure* ; Heart Rate ; Humans ; Hypertension ; Membranes ; Mitochondria ; Research Design ; Ubiquinone