PURPOSE: Bacillus Calmette-Guerin(BCG) therapy for superficial bladders carcinoma and carcinoma in situ is believed to exert its antitumor effects through immune mechanisms when BCG is instilled into the bladder, but its detail mechanisms are poorly understood. Recently, intravesical BCG instillation is known to induce nitric oxide(NO) which is revealed to be tumoricidal . This experiment was performed to determine the intravesical localization and alteration of expression of inducible nitric oxide synthase(iNOS) after BCG instillation. MATERIALS AND METHODS: Normal saline(0.85m1/kg, control group) and BCG(6mg/kg, experimental group) were instilled intravesically in fifty four female mice. After 2 hours, each mouse urinated after removal of urethral ligature, and was sacrificed at 6th, 12th, 18th hour, 1st day, 1.5th, 2th, 3th, 7th and 14th day, respectively. Immunohistochemistry was performed on paraffin embedded bladder tissue using anti-inducible NOS antibody(Transduction Labaratories, USA.). RESULTS: Inflammatory cells were infiltrated in the bladder wall in the BCG-treated group, but not in the control group. Number of inflammatory cells among BCG-treated group, was the highest in the 18th hour group and was reduced gradually with time elapse thereafter In the control group, immunoreactivity of iNOS to be positive in the all intermediate cell layer and a few basal cell layer of bladder transitional epithelium, which did not change as time passed. In the BCG-treated group, immunoreactivity of iNOS increased from 6 hours after BCG instillation, and gradually decreased from 7 days to restore to the level of the control group. However, some cells of transitional epithelium showed reduced immunoreactivity, focally. CONCLUSIONS: These results suggest that iNOS is tonically expressed in transitional epithelium of mouse bladder which is further induced by BCG instillation. Also, NOS-mediated NO production is supposed to be one of factors to induce tumoricidal erect by BCG instillation.
Animals ; Bacillus ; Carcinoma in Situ ; Epithelium ; Female ; Humans ; Immunohistochemistry ; Ligation ; Mice* ; Mycobacterium bovis* ; Nitric Oxide ; Nitric Oxide Synthase Type II* ; Paraffin ; Urinary Bladder

PURPOSE: This study was designed to determine the diagnostic availability of transperineal ultrasongraphy compared with chain cystourethrography for patients with stress urinary incontinence. MATERIALS AND METHOD: Twenty-seven outpatient women with stress urinary incontinence, who underwent both transperineal ultrasonography and chain cystourethrography for the last ten months, participated in this study. The mean age was 47 years(range 37 to 66 years). The posterior urethrovesical angle(PUVA) at lest and during strain, and both an increment of PUVA and bladder neck descent during strain were measured in the two methods, respectively. Wilcoxon Matched-Pairs Signed-Ranks test was used for the comparative analysis of the results. RESULTS: The mean of PUVAS at rest and during strain were 118.9 degrees and 142.3 degrees, respectively, and the mean of the increment of PUVAS during strain was 23.5 degreesin transperineal ultrasonography. The mean of PUVAS at rest and during strain were 130.7 degrees and 158,0 degrees, respectively, and the mean of the increment of PUVAS during strain was 27.3 in chain cystourethrography. There were statistically significant differences in PUVAS, but no significant differences in the increment of PUVAS during strain between the two methods. During strain condition, the mean descent of bladder neck was 11.8mm in transperineal ultrasonography and 13.7mm in chain cystourethrography, and there were no significant differences between the two methods. CONCLUSIONS: Compared with chain cystourethrography, the transperineal ultrasonography made no significant differences in the diagnosis of stress urinary incontinence using both the increment of PUVAS and the bladder neck descent caused by the increase of abdominal pressure during strain. In addition, the transperineal ultrasonography is considered to be replaceable for chain cystourethrography, as that is noninvasive, devoid of risks of irradiation, and removes the noticeable discomfort or embarrassment for the patient in the diagnosis of stress urinary incontinence.
Diagnosis ; Female ; Humans ; Neck ; Outpatients ; Ultrasonography* ; Urinary Bladder ; Urinary Incontinence

Here we present a rare case of an adolescent with hypertension, concurrently diagnosed with fibromuscular dysplasia of the renal artery and Graves’ disease. Although fibromuscular dysplasia and Graves’ disease have distinct pathogenic mechanisms, it is possible to infer the potential correlation between the two from the perspective of vascular involvement. It is believed that transforming growth factor-β, as the shared element of both diseases, may contribute to their development and progression. The overactivation of the sympathetic nervous system in Graves’ disease may induce hyperplasia of vascular smooth muscle cells, similar to that observed in fibromuscular dysplasia. In Graves’ disease, the excessive synthesis and secretion of angiotensin II due to the overactivation of the renin-angiotensin system, along with the up-regulation of angiotensin II receptors, may also induce pathological changes in the vasculature throughout the body. In this regard, exploring the correlation between fibromuscular dysplasia and Graves’ disease is of significant clinical importance.

We report two cases of bilateral renal angiomyolipoma with tuberous sclerosis who had skin lesions like butterfly shaped adenoma sebaceum on face, shagreen patch on back, leaf-shaped hypopigmented spot on both extremities, mental retardation, and seizure, which they are treated unilateral simple nephrectomy and selective arterial embolization, each other.
Angiomyolipoma* ; Butterflies ; Extremities ; Intellectual Disability ; Nephrectomy ; Seizures ; Skin ; Tuberous Sclerosis*

Purpose: To identify the discrepancies in the textbook of fundamentals of nursing in nutrition and elimination needs in terms of number, range, definition and etc. Methods: The 10 textbooks which are the most frequently used were selected and reviewed. After then compared it with the protocols of essential nursing skills of Korean Accreditation Board of Nursing Education and evidence-based clinical nursing practice guidelines of Korean Hospital Nurses’ Association. Results: The most significant discrepancies in nutrition domain were criteria of obesity, confirmation of nasogastric tube placement. In elimination domain, there were several mixed or miss uses of French and number unit in catheter size. And appropriate catheter size for urinary catheterization and enema is different to books and guidelines. Conclusion In order to conduct an effective resource in education of nursing, textbooks need to be revised constantly and contain the recent researches and guidelines.

Purpose: This study investigated changes in attitudes toward marriage and childbearing assuming a BRCA1/2 mutation carrier status among healthy, unmarried individuals in Korea. Methods: A nationally representative sample of healthy, unmarried individuals aged 20–39 years was surveyed. A questionnaire on marriage and childbearing intentions was administered to the participants before and after providing them with information on BRCA1/2 mutation carriers’ breast and ovarian cancer risks and their autosomal dominant inheritance pattern. The participants were asked about their attitudes toward childbearing through preimplantation genetic diagnosis (PGD). Results: Of the participants who initially wanted to marry, the assumption that they or their partners had BRCA1/2 mutation caused 25.3% to no longer want to get married and 36.2% to change their attitude from wanting to bear children to no longer wanting them. Females were more likely than males to change their attitudes toward marriage and childbearing. The participants who had negative attitudes toward genetic testing were more likely to change their attitudes regarding marriage and childbearing than those who were favorable toward both disclosure and testing. More than 50% of the participants who did not want children were willing to bear children through PGD when it was assumed that they were BRCA mutation carriers. Conclusion On the assumption of being carriers, general, young, and healthy females were more likely than males to negatively change their attitudes toward marriage and childbearing. Public education on the implications of living with mutation carriers and reproductive options may be required.

OBJECTIVE: This study was aimed to determine effectiveness and tolerability of Osmotic-controlled Release Oral delivery (OROS) methylphenidate (MPH) and its optimal dose administered openly over a period of up to 12 weeks in drug naive Korean children with ADHD. METHODS: Subjects (n=143), ages 6 to 18-years, with a clinical diagnosis of any subtype of ADHD were recruited from 7 medical centers in Korea. An individualized dose of OROS-MPH was determined for each subject depending on the response criteria. The subjects were assessed with several symptom rating scales in week 1, 3, 6, 9 and 12. RESULTS: 77 of 116 subjects (66.4%) achieved the criteria for response and the average of optimal daily dose for response was to 30.05+/-12.52 mg per day (0.90+/-0.31 mg/kg/d) at the end of the study. Optimal dose was not significantly different between ADHD subtypes, whereas, significant higher dose was needed in older aged groups than younger groups. The average of optimal daily dose for response for the subjects aged above 12 years old was 46.38+/-15.52 per day (0.81+/-0.28 mg/kg/d) compared to younger groups (p<0.01). No serious adverse effects were reported and the dose did not have a significant effect on adverse effects. CONCLUSION: Optimal mean dose of OROS-MPH was significantly different by age groups. Higher dose was needed in older aged groups than younger groups. Effectiveness and tolerability of OROS-MPH in symptoms of ADHD is sustained for up to 12 weeks.
Aged ; Child ; Humans ; Korea ; Methylphenidate ; Weights and Measures

This practice parameter for non-pharmacological treatment for attention-deficit hyperactivity disorder(ADHD) review the domestic and international literature on the psychosocial treatment of children and adolescents with ADHD. This parameter include the parental training & education, cognitive behavior therapy(group or individual), social skill training, family therapy, play therapy(individual psychotherapy) and non-traditional therapy(art therapy, herbal therapy et al). Among them, there is some proven evidence only in parental training & education and cognitive behavior therapy. So, this parameter describes some details only in the field of parental training & education and cognitive behavior therapy. The efficacy or effectiveness, especially, cost-effectiveness of specific psychosocial treatment method for ADHD cannot be fairly assessed due to the scarcity of controlled clinical data. Based on the clinical expert consensus and limited evidence, we cautiously suggest the practice recommendations about the non-pharmacological psychosocial treatment for children and adolescents with ADHD.
Adolescent ; Child ; Cognitive Therapy ; Consensus ; Education ; Family Therapy ; Humans ; Parents ; Phytotherapy

The objective of this review is to propose the Korean practice guideline for pharmacological treatment of attentiondeficit hyperactivity disorder(ADHD). For making the guideline, the authors used the evidence-base approaches derived from a detailed review of literature including wide range of controlled clinical trials, studies of side effects of drugs, toxicological reports, and meta-analyses published in United States and Europe, as well as inside Korea. The review committee composed of experts in ADHD in Korea has reviewed the parameter. The practice parameter for pharmacological treatment describes the use of stimulants, atomoxetine, modafinil, bupropion, tricyclic antidepressants, and alpha-adrenergic agonists and their side effects. The recommendations of pharmacological treatment are proposed at the end of the article.
Adrenergic alpha-Agonists ; Advisory Committees ; Antidepressive Agents, Tricyclic ; Bupropion ; Europe ; Korea ; United States ; Atomoxetine Hydrochloride

Probably the three most important components to a comprehensive evaluation of patients with attention-deficit hyperactivity disorder(ADHD) are the clinical interview, the medical examination, and the completion and scoring of behavior rating scales. Teachers and other school personnel are often the first to recognize that a child or adolescent might have ADHD, and often play an important role in the help-seeking/referral process. A diagnostic evaluation for ADHD should include questions about ADHD symptoms, other problems including alcohol and drug use, family history of ADHD, prior evaluation and treatment for ADHD. Screening interview or rating scales as well as interviews should be used. When it is feasible, clinicians may wish to supplement these components of the evaluation with objective assessments of the ADHD symptoms, such as psychological tests. These tests are not essential to reaching a diagnosis, however, or to treatment planning, but they may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD. Screening for intellectual ability and academic achievement skills is also important in determining the presence of comorbid developmental delay or learning disabilities. The number and type of symptoms required for a diagnosis of ADHD vary depending on the specific subtype. To receive a diagnosis of ADHD, the person must be experiencing significant distress or impairment in daily functioning, and must not meet criteria for other mental disorders which might better account for the observed symptoms such as mental retardation, autism or other pervasive developmental disorders, mood disorders, anxiety disorders. This report aims to suggest a practice guideline of assessment and diagnosis for children and adolescents with ADHD in Korea.
Adolescent ; Anxiety Disorders ; Autistic Disorder ; Child ; Diagnosis* ; Humans ; Intellectual Disability ; Korea ; Learning Disorders ; Mass Screening ; Mental Disorders ; Mood Disorders ; Psychological Tests ; Weights and Measures