We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.
Biopsy ; Digital Rectal Examination* ; Humans ; Male ; Mass Screening ; Prostate* ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Ultrasonography* ; Urologic Diseases

One hundred fifty seven patients with benign prostatic hypertrophy(BPH) under going trans. urethral resection of prostate( TUR - P) entered in this study in order to search for factors predictive of a successful outcome. In the follow-up period of 3 months to 7 years, a strictly successful result was achieved in 122 patients(78% ). On analysis of the success rate, 5 favorable factors and 8 unfavorable factors were noted. A symptomatic large prostatic adenoma proven by IVU, TRUS will imply a higher success rate. On uroflowmetry, obstructive BPH proven by maximal flow rate of less than l0 ml/sec and constrictive obstructive flow pattern can also predict a satisfactory outcome. The unfavorable factors always come from a small adenoma, uncertain irritative symptoms and detrusor underactivity. Patients with more than 2 unfavorable factors should be investigated carefully before surgery. The presence of 2 favorable factors without unfavorable factor will usually predict the best surgical outcome.
Adenoma ; Follow-Up Studies ; Humans ; Prostatic Hyperplasia*

PURPOSE: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation (Vf). However, although it is well known that the cardiac arrest due to non-Vf is associated with poorer neurologic outcome that Vf, there is no study that evaluates the effect of mild hypothermia on the cardiac arrests due to non-Vf. So, we intend whether mild hypothermia would improve the neurologic outcome of them saftly. METHODS: We retrospectively analyzed the patients with cardiac arrest due to asystole or pulseless electrical activity who was presented at hopsital and successfully showed the return of spontaneous circulation. We divided the patients to two groups according to implementation of hypothermia and statistically compared the complication and neurologic outcome at discharge. RESULTS: A total of sixty one patients were analyzed in this study. Baseline clinical and physiological characteristic were similar between patients treated with mild hypothermia or with conservative treatment. The complication rate did not differ significantly between the two groups. However, the good outcome at hospital discharge was observed in 13 of 41 patients treated with mild hypothermia compared with 0 of 27 patients treated with conservative treatment. CONCLUSION: Mild therapeutic hypothermia for the treatment of postcardiac arrest due to non-Vf can be saftly implemented with a major benefit on patient outcome.
Coma ; Heart Arrest ; Humans ; Hypothermia ; Resuscitation ; Retrospective Studies ; Ventricular Fibrillation

Vesicoureteric reflux into the transplanted kidney has been described, but in general it has been disregarded and is not mentioned as a complication in recent reviews. But it may be harmful to the renal function in the long-term and has high incidence of symptomatic pyelonephritis with urinary tract infection in other studies. We studied prospectively 37 patients, who received living renal transplantation without complete antireflux surgery, out of 45 patients during the period from June 1991 to September 1992. Voiding cystourethrogram and urine culture were obtained all least once in 37 of 45 patients (82.2%) and serum BUN/creatinine and urinalysis were checked following surgery, weekly. These patients did not demonstrate an increased incidence of reflux, urinary tract infection or abnormalities of renal function. We conclude that a simple direct implantation of a normal ureter into a normal bladder is safe and should be considered the procedure of choice in renal transplantation and recommend that all functioning transplants be studied at yearly intervals with an IVP and VCUG to determine the true incidence of urologic complications.
Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Prospective Studies ; Pyelonephritis ; Ureter ; Urinalysis ; Urinary Bladder ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest. METHODS: A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups. RESULTS: Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%). CONCLUSIONS: The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.
Adult ; Asphyxia ; Blood Gas Analysis ; Cardiopulmonary Resuscitation ; Electrolytes ; Emergencies ; Gases ; Hand ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Oxygen ; Potassium ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

BACKGROUND: The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH. METHODS: The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality. RESULTS: One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622-42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003-1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0-228.0) mg/dl, 128.0 (102.0-165.0) mg/dl, and 105.0 (87.5-129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180-309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133-242) mg/dl of the maximal median blood glucose value during the cooling phase (p < 0.001). CONCLUSIONS: High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.
Blood Glucose ; Glucose ; Heart Arrest ; Hospital Mortality ; Humans ; Hypothermia ; Hypothermia, Induced ; Insulin ; Out-of-Hospital Cardiac Arrest ; Resuscitation ; Rewarming ; Survivors