PURPOSE: Some authors have suggested that erectile dysfunction correlates with the level of glycemic control and glycosylated hemoglobin can be used to predict erectile dysfunction in diabetic patients. This study evaluated whether or not glycosylated hemoglobin level can predict the effectiveness of sildenafil citrate, which is a first line therapy for erectile dysfunction. MATERIALS AND METHODS: A consecutive sample of 32 men with type 2 diabetes and erectile dysfunction completed the International Index of Erectile Function (IIEF) and had their glycosylated hemoglobin levels measured. 50mg of sildenafil citrate was prescribed at the first visit, which was then increased to 100mg if the symptom persisted. According to the response, the patients were divided into responders and nonresponders. The pretreatment clinical parameters (age, diabetic duration, erectile dysfunction duration, glycosylated hemoglobin level, body mass index, IIEF, diabetic complications, smoking, alcohol drinking) were recorded. The patients were divided into 3 groups according to the drug dosage (group 1 was 50mg responders, group 2 was 100mg responders, group 3 was nonresponders in any dosage) and the clinical parameters were compared and analyzed. RESULTS: The mean hemoglobin A1c level was 8.68 0.74% and 7.64 1.67% in the nonresponders and responders (p < 0.05), respectively. Diabetic neuropathy and diabetic retinopathy were significantly higher in the nonresponders (p < 0.05). The mean hemoglobin A1c levels of the three groups were 7.36 1.01, 7.78 0.98, and 8.64 0.44%, respectively and group 3 was significantly higher than the other groups (p < 0.05). CONCLUSIONS: High levels of glycosylated hemoglobin suggests a poor response to sildenafil citrate in diabetic patients with erectile dysfunction. Diabetic patients with neuropathy or retinopathy may have a low response for sildenafil citrate.
Body Mass Index ; Citric Acid* ; Diabetes Complications ; Diabetic Neuropathies ; Diabetic Retinopathy ; Erectile Dysfunction* ; Hemoglobin A, Glycosylated* ; Humans ; Male ; Smoke ; Smoking ; Sildenafil Citrate

Sparganosis usually means the plerocercoid larval infection of Spirometra species. It is endemic mainly in countries where the habit of eating raw snake or frog, or the habit of poulticing with snake skin exists. The most common endemic area is Korea, Japan and China, and the most common localizations are subcutaneous connective tissue and superficial muscles. We experienced a case of scrotal sparganosis in a 32-year-old man presenting with painless hard masses in left scrotum. He underwent by serum Enzyme Linked Immunosorbent Assay (ELISA) and was treated by surgical excision.
Adult ; China ; Connective Tissue ; Eating ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Japan ; Korea ; Muscles ; Scrotum ; Skin ; Snakes ; Sparganosis* ; Spirometra

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.
Abscess ; Appendicitis ; Appendix ; Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Humans ; Mass Screening ; Police ; Retrospective Studies ; Sensitivity and Specificity ; Unnecessary Procedures

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Diagnosis, Differential* ; Elasticity Imaging Techniques* ; Hardness ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

PURPOSE: The aim of this study was to compare three methods of hernioplasty: high ligation (HL), tissue repair (TR), and tension free (TF) and to determine the usefulness of high ligation for repair of indirect inguinal hernia in young adults. METHODS: One hundred thirty two patients who were under the age of 25 and who underwent repair of their inguinal hernia between January 2001 and December 2005 were reviewed retrospectively by using their inpatient and outpatient records and phone calls. Sixty seven, 23 and 42 patients underwent HL, TR and TF, respectively. The clinical features that were analyzed included location, type, signs and symptoms, operation method, complications and recurrence. RESULTS: The operation times were (mean+/-SD) 46.2+/-19.1, 56.0+/-11.5, and 61.8+/-14.9 minutes for HL, TR and TF, respectively. For the post-operative complications, there was 1 case of wound infection (1.5%) and 1 case of scrotal hematoma (1.5%) for HL; 1 case of wound infection (4.4%) and 1 case of scrotal swelling (4.4%) for TR; 3 cases of wound infection (7.0%), 2 cases of scrotal swelling (4.7%), 1 cases of intermittent pain (2.3%) and 1 case of scrotal hematoma (2.3%) for TF. Two patients in the HL group had recurrences, but there was no recurrence in the TR and TF groups. CONCLUSION: High ligation hernioplasty in young adults showed a shorter operation time, but there were no differences in the rate of complications between the methods. In the case of recurrence, it can be corrected by performing tissue repair or tension free hernioplasty because the normal anatomy may be preserved even after operation. Therefore, high ligation hernioplasty proved to be a useful method for repair of indirect inguinal hernia in young adults. In contrast, for the recurred or older age patients, tissue repair or tension free hernioplasty may be a more useful method.
Hematoma ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inpatients ; Ligation* ; Outpatients ; Recurrence ; Retrospective Studies ; Wound Infection ; Young Adult*

PURPOSE: Colonic diverticulitis is an uncommon disease in Korea, but the incidence of the disease is increasing. The right colon is the more preferred site for diverticulitis in Korea, but the incidence of left diverticulitis is increasing. Therefore, comparing the clinical features and treatments for right diverticulitis with those for left diverticulitis may help us to treat the disease more properly. METHODS: This study was performed retrospectively by reviewing the medical records of 96 patients with colonic diverticulitis, in whom either conservative or operative treatments were performed. RESULTS: Eighty-six patients had right diverticulitis (RD), and 10 patients had left diverticulitis (LD). The mean age of the patients was older for LD. Sixteen patients (18.6%) with RD had complications, and 7 patients (8.1%) underwent operations. On the other hand, 4 patients (40%) with LD had complications, and 3 patients (30%) underwent operations. The rates of complications and operations among old-aged patients were higher. The operations for 7 patients with RD who underwent surgery were 6 ileocecectomies and 1 diverticulectomy. On the other hand, the operations for the 3 patients with LD who underwent surgery were 2 resections and anastomoses and 1 diverticulectomy. The reasons for the operations were abscess formation, recurrence, perforation, and development of generalized peritonitis without response to conservative treatment. CONCLUSION: The incidence of LD is lower than that of RD in Korea, but the rate of complications and operations seems higher in LD. Therefore, patients who complain of left lower abdominal pain need to be thoroughly examined for LD.
Abdominal Pain ; Abscess ; Colon ; Diverticulitis ; Diverticulitis, Colonic ; Hand ; Humans ; Incidence ; Korea ; Medical Records ; Peritonitis ; Recurrence ; Retrospective Studies

BACKGROUND/AIMS: Abdominal bloating is a troublesome complaint due to insufficient understanding of the pathophysiology. The aim of this study was to evaluate the efficacy of rifaximin in reducing bloating associated with functional gastrointestinal disorders (FGIDs). METHODS: A total of 63 patients were treated with rifaximin for FGIDs with bloating or gas-related symptoms between 2007 and 2013 at Seoul National University Bundang Hospital. Rifaximin was administered at a dose between 800 mg/day and 1,200 mg/day for 5 to 14 days. The proportion of patients who had adequate relief of global FGID symptoms and FGID-related bloating was retrospectively assessed. The response was recorded when the symptoms were reduced by at least 50% at the follow-up after treatment cessation. RESULTS: The mean age was 56.8±14.2 years; 49.2% were females. According to Rome III criteria, 20.6% (13/63) had irritable bowel syndrome (IBS) with constipation, 9.5% (6/63) had IBS with diarrhea, 4.8% (3/63) had mixed IBS, 23.8% (15/63) had functional dyspepsia, and 12.7% (8/63) had functional bloating. Of the 51 subjects who were followed-up, 30 (58.8%) had adequate relief of global FGID symptoms and 26 (51.0%) experienced improvement of abdominal bloating after rifaximin treatment. The proportion of female was slightly higher in non-response group than in the response group (60.0% vs. 34.6%, p=0.069). Otherwise, there was no difference between the two groups. CONCLUSIONS: Despite the limitations of this retrospective study, our data confirms that rifaximin may be beneficial for abdominal bloating. Further prospective clinical trial with a larger cohort is needed.
Cohort Studies ; Constipation ; Diarrhea ; Dyspepsia ; Female ; Follow-Up Studies ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Prospective Studies ; Retrospective Studies ; Seoul ; Withholding Treatment

Melanosis ilei is a condition that's characterized by gross greyish-black or brownish-black pigmentation of the mucosa of the terminal ileum. There were several substances that produce gastrointestinal tract pigmentation such as lipofuscin, iron sulphide (FeS), Hemosiderin and exogenous material such as silicates and titanium. We report here on a case of a 58-year-old female who ingested charcoal for a long time, and she was diagnosed with melanosis ilei by colonoscopy. Her condition improved after she stopped ingesting the charcoal.
Charcoal ; Colonoscopy ; Female ; Gastrointestinal Tract ; Hemosiderin ; Humans ; Ileum ; Iron ; Lipofuscin ; Melanosis* ; Middle Aged ; Mucous Membrane ; Pigmentation ; Silicates ; Titanium

BACKGROUND: Prosthetic valve thrombosis is an uncommon but serious complication. Thrombolytic therapy has recently been proposed as an alternative to surgical methods in treating this condition and is used increasingly. However, the indications for thrombolytic treatment in prosthetic valve thrombosis have not been well defined and differential diagnosis of thrombosis is still difficult. METHODS: Four symptomatic patients with prosthetic valve thrombosis underwent 9 thrombolytic sessions for 7 distinct episodes. Transthoracic or transesophageal echocardiography and cinefluoroscopy were performed and repeated after each thrombolytic session. Urokinase or rt-PA (recombinant tissue-type plasminogen activator) was used and repeated dose was given if necessary. Recurrent thrombosis was treated also either with urokinase or rt-PA. RESULTS: All patients were female and mean age was 38.5 years old. Two valves were in mitral position and the other two were in tricuspid position. The anticoagulation status was inadequate in three patients. The initial success after first dose was 43% (3/7), which increased to 54% (4/7) after repeated thrombolytic therapy. Thrombolytic therapy was failed in three episodes; two thromboses and one ingrowths of pannus. Operations were needed in these cases. No complication was seen. CONCLUSION: Thrombolytic treatment can be used as an alternative to surgical therapy with a low risk of complications. But guideline of thrombolytic therapy for the recurrent thrombosis and education for the patients about the adequate anticoagulation were needed.
Diagnosis, Differential ; Echocardiography, Transesophageal ; Education ; Female ; Humans ; Plasminogen ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

Hemorrhagic radiation-induced gastritis is a rare but serious complication of upper gastrointestinal radiation treatment, and no simple and effective treatment method has yet been developed. Studies on effective treatment methods for achieving hemostasis in patients with hemorrhagic radiation-induced gastritis are necessary, because the new indications for upper gastrointestinal radiotherapy in the field digestive oncology can potentially lead to an increased incidence of radiation-induced gastric vasculopathy. For the first time in Korea and to the best of our knowledge, we report here on a 59-years-old male patient with hemorrhagic gastritis that was induced by external radiotherapy for ampullary adenocarcinoma. This was all well-treated using Argon plasma coagulation (APC).
Adenocarcinoma ; Argon ; Argon Plasma Coagulation ; Gastritis ; Hemostasis ; Humans ; Incidence ; Korea ; Male