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: To describe the appearance and average thickness of the internal anal sphincter with anal endosonography in healthy Korean adults. MATERIAL AND METHODS: 184 subjects(male: 96, female: 88) with no history of anorectal disease or surgery were studied with anal endosonography. The average thickness of internal sphincter was meas ured at the mid-anal canal. For the internal sphincter, which is often asymmetric, the thickness of each 4 part(12, 3, 6 and 9 o'clock direction) were measured in left lateral decubitus position. RESULTS: The anal wall was well visualized in 5 layers(mucosa, submucosa, internal anal sphincter, intersphincteric plane, external anal sphincter) with anal endosonography. The anal endosonogram showed the internal anal sphincter as a homogenous, well-defined, hypoechoic, circular band, and slightly asymmetric. The average thickness of the internal anal sphincter in the area of mid-anal portion was 2.0 0.3 mm(range: 1~3 mm). There was no sexual difference; however, a significant positive correlation with age was found in average thickness of the internal anal sphincter. The correlation with lean body mass was not found. CONCLUSION: The internal anal sphincter is well-visualized, best defined structure by anal endosonography. Average thickeness of the sphincter in Korean appeared to be the same as in the Western.
Adult* ; Anal Canal* ; Endosonography ; Female ; Humans

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

Mesenteric lymphadenitis due to Yersinia enterocolitica infection is not common in Korea. Although most cases of Yersinia enterocolitica-induced mesenteric adenitis are self limited, cardinal features of Yersinia enterocolitica-induced mesenteric adenitis are so similar to those of acute appendicitis that some of the patients undergo laparotomy with suspected appendicitis. The findings on laparotomy in such patients are usually enlarged mesenteric nodes with a normal or slightly inflamed appendix. Because histologic examination of the removed mesenteric lymph nodes reveals reactive hyperplasia in most cases, it is usually difficult to suspect Yersinia enterocolitica infection on morphology of the resected nodes. But suppurative granulomata of mesenteric lymph nodes, uncommonly encountered in Yersinia enterocolitica infection, strongly suggest yersinial infection. We report a case of mesenteric lymphadenitis in a 10-year-old boy, who underwent laparotomy with suspected acute appendicitis. The removed lymph node showed several suppurative granulomata in the cortex, suggesting yersinial infection. Serologic study confirmed Yersinia enterocolitica serotype O:3 infection.
Appendicitis ; Appendix ; Child ; Humans ; Hyperplasia ; Korea ; Laparotomy ; Lymph Nodes ; Lymphadenitis ; Male ; Mesenteric Lymphadenitis* ; Yemen ; Yersinia enterocolitica* ; Yersinia*

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*

Imipramine(Tofranil(R)) is one of the tricyclic antidepressants commonly used in depressive symptoms or enuresis. An accidental or nonaccidental poisoning of imipramine is common today. A 16 years old girl was admitted to Seoul National university Hospital because of unocnsciousness and frequent attacks of seizure after the impulsive ingestion of 1.4gm of imipramine. She showed variable arrhythmias such as complete RBBB, secod degree AV block and ventricular tachycardia and recovered from poisoning without residual myocardial damage. We present a case of imipramine poisoning with cardiac arrhythmias with review of literatures.
Adolescent ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Depression ; Eating ; Enuresis ; Female ; Humans ; Imipramine ; Poisoning* ; Seizures ; Seoul ; Tachycardia, Ventricular