Currently intracavernous pharmacotherapy is the second common therapeutic modality for erectile dysfunction after the introduction of Viagra. Nevertheless, intracavernous pharmacotherapy has increased in popularity for the past 15 years. While having an overwhelming safety after complete training in injection method, this treatment option can reveal unexpected complications related to self-injection. We report two cases of intracavernous needle breakage associated with alprostadil (Caverject , Pharmacia-Upjohn) and trimix self-injection therapy with a brief review of the literature.
Alprostadil ; Drug Therapy ; Erectile Dysfunction ; Male ; Needles* ; Sildenafil Citrate

Relaxation of penile cavernous smooth muscle is controlled by nerve and endothelium derived substances. Externally applied acetylcholine in human corpus cavernosum has been shown to cause endothelium dependent smooth muscle relaxation and nitric oxide(NO) is known as an endothelium derived relaxing factor(EDRF). NO has been identified as an endothelium derived relaxing factor in blood vessels. We tried to determine whether it is involved in the relaxation of the corpus cavernosum that allows penile erection. The changes of isometric tension in rabbit cavernous smooth muscle strips mounted in organ bath chambers after the addition of drugs were monitored on the biophysical recording system. Acetylcholine induced a dose-dependent relaxation and atropine at 5 x 10(-5) M almost abolished the effects of acetylcholine. N(c)-nitro-L-arginine (L-NOARG) at 5 x 10(-5) M almost abolished the effects of acetylcholine. The subsequent addition of L-arginine at 5 x 10(-5) M further restored to the effect of acetylcholine, but these effect did not occur if D -arginine was substituted for L-arginine. Methylene blue at 10-5 M markedly inhibited effects of acetylcholine. These data suggest that acetylcholine endothelial formation of NO via muscarinic receptor and NO from L-arginine leads to the relaxation of cavernous smooth muscle via activation of guanylate cyclase in rabbit.
Acetylcholine ; Arginine ; Atropine ; Baths ; Blood Vessels ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Guanylate Cyclase ; Humans ; Male ; Methylene Blue ; Muscle, Smooth* ; Nitric Oxide* ; Penile Erection ; Receptors, Muscarinic ; Relaxation*

A total of 92 men with impotence underwent a trial of intracavernous injection of papaverine 30mg. Underlying causes of impotence were psychogenic (26 Pts.), posterior urethral injury (28 Pts.), spinal cord injury (15 Pts.), pelvic surgery (14 Pts.) and eldly (9 Pts.). The results were as follows 1. The underlying causes of impotence in papaverine responders were psychogenic 23 (88.5%), posterior urethral injury 19 (67.9%), spinal cord injury 13(86.7%), Pelvic surgery 5 (35.7%) and eldly 3 (33.3%). 2. Fourteen patients of the moderate papaverine responders underwent intracavernous injection of papaverine 30mg with phentolamine 1mg and 8 of them attained full erection. 3. After injection, the erection started in an average of 2.6 minutes, rigidity of penis attained in an average of 7.3 minutes, and erection status sustained for an average of 42.6 minutes in 60 patients. 4. Normal nocturnal penile tumescence monitoring (NPTM) or stamp test was found in 19 of 40 patient and 18 of them (94.7%) were papaverine responders, while 21 had an abnormal NPTM or stamp test and 11 of them were papaverine non-respoders. 5. A penile brachial index (PBI) of 0.6 or more was found in 62 of 73 patients and 53 of them(85.5 %) were papaverine responders, while 11 had an index of less then 0.6 and all of them were papaverine non-responders. 6. Thitry patients had sexual intercourse. Twenty-seven of them had a satisfactory result and 23 of them had ejaculation. 7. Papaverine induced prolonged erection occurred as major complicatiun in 4 patients after trial injection. Erection was subsided after intracavernous phenylepinephrine injection. There were minor complications such as ecchymosis at the injected site on the prepuce but subsided spontaneously in a few days. We conclude that intracavernous papaverine injectiun currently is a good screening technique for the differential diagnosis of severe vasculosenic impotence and is a useful chemical prosthesis of non-vasculogenic impotence.
Coitus ; Diagnosis, Differential ; Ecchymosis ; Ejaculation ; Erectile Dysfunction ; Humans ; Male ; Mass Screening ; Papaverine* ; Penile Erection ; Penis ; Phentolamine ; Prostheses and Implants ; Spinal Cord Injuries

Continuous and simultaneous recording of nocturnal penile rigidity and tumescence is preferred than measuring tumescence alone to define the features of nocturnal penile erection and differentiate psychogenic from organic impotence. Rigiscan is suitable for this purpose. Authors studied to define the features of nocturnal penile erection by rigiscan in 24 normal Koreans and 18 patients with erectile dysfunction. The results were as follows : 1. In normal group, the number of normal erection was 4.2+/-0.9 times per night, duration was 21.1+/-7.4 minutes at tip and 26.3+/-9.8 minutes at base, tumescence change was 1.81+/-0.51 cm at tip and 2.23+/-0.72 cm at base, rigidity was 55.7+/-19.6 per cent at tip and 66.3+/-12.0 per cent at base. Maximal duration was 34.2+/-14.9 minutes at tip and 39.0+/-15.1 minutes at base, maximal tumescence change was 2.28+/-0.83 cm at tip and 2.64+/-0.78 cm at base, maximal rigidity was 65.4+/-11.8 per cent at tip and 75.8+/-12.5 per cent at base. The higher the age, the shorter the duration and number of events were(p<0.05). 2. In patient group, normal rigigram showed in 6 patients(3 of psychogenic, 3 of posterior urethral injury). Event and duration were shorter than normal group(p<0.05). The findings of flat trace or abnormal erection provide valuable information to screen the organic impotence.
Erectile Dysfunction ; Humans ; Male ; Penile Erection*

BACKGROUND: The serum total cholesterol is supposed to be increased as dietary pattern is Westernized recently in our country. We studied the longitudinal change of serum total cholesterol levels in normal Korean adult male workers and analyzed the influence of age, weight, blood pressure, fasting blood sugar, lifestyle (exercise, smoking, alcohol drinking habits) on change of serum total cholesterol levels. METHODS: The 6279 healthy adult male workers were studied during recent 10 Years (1992 and 2002). Those who suffered from hypertension, diabetes mellitus, ischemic heart disease, nephropathy, thyroid disease were excluded. Those who took antilipidemic drugs were also excluded. Blood sampling for serum total cholesterol and sugar was done after overnight fasting for more than 12 hours. Data on lifestyle were obtained using self administered questionnaires. RESULT: The serum total cholesterol levels had increased by 23.2 +/- 23.60 mg/dL (2.32 mg/dL per year) between 1992 and 2002 surveys. The increment of serum total cholesterol levels was most prominent in twenties (3.30 mg/dL per year) during 10 years and less prominent in thirties (2.80 mg/dL per year), forties (2.19 mg/dL per year) and fifties (1.55 mg/dL per year). The change of body mass index (BMI) was most significantly correlated with that of serum total cholesterol level (r=0.290, p=0.0001) (r2=0.084, p=0.0001). The change of serum total cholesterol levels was also significantly correlated with age, diastolic blood pressure change, fasting blood sugar change, exercise and smoking habits. However, it was not significantly correlated with the alcohol drinking habits among influencing variables. CONCLUSION: The serum total cholesterol levels were increased by 23.2 +/- 23.60 mg/dL (2.32 mg/dL per year) during recent 10 years. The increment of serum total cholesterol levels was most prominent in younger age group. The change of serum total cholesterol levels was most significantly correlated with that of body mass index (BMI) among influencing variables.
Adult* ; Aging ; Alcohol Drinking ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cholesterol* ; Diabetes Mellitus ; Fasting ; Follow-Up Studies* ; Gyeongsangbuk-do* ; Humans ; Hypertension ; Life Style ; Longitudinal Studies ; Male* ; Myocardial Ischemia ; Smoke ; Smoking ; Thyroid Diseases ; Surveys and Questionnaires

Dyslipidemia has significantly contributed to the increase of death and morbidity rates related to cardiovascular diseases. Clinical nutrition service provided by dietitians has been reported to have a positive effect on relief of medical symptoms or reducing the further medical costs. However, there is a lack of researches to identify key competencies and job standard for clinical dietitians to care patients with dyslipidemia. Therefore, the purpose of this study was to analyze the job components of clinical dietitian and develop the standard for professional practice to provide effective nutrition management for dyslipidemia patients. The current status of clinical nutrition therapy for dyslipidemia patients in hospitals with 300 or more beds was studied. After duty tasks and task elements of nutrition care process for dyslipidemia clinical dietitians were developed by developing a curriculum (DACUM) analysis method. The developed job standards were pretested in order to evaluate job performance, difficulty, and job standards. As a result, the job standard included four jobs, 18 tasks, and 53 task elements, and specific job description includes 73 basic services and 26 recommended services. When clinical dietitians managing dyslipidemia patients performed their practice according to this job standard for 30 patients the job performance rate was 68.3%. Therefore, the job standards of clinical dietitians for clinical nutrition service for dyslipidemia patients proposed in this study can be effectively used by hospitals.
Cardiovascular Diseases ; Curriculum ; Dyslipidemias* ; Humans ; Job Description ; Nutrition Therapy* ; Nutritionists ; Professional Practice

PURPOSE: Breast cancer is one of the most frequent malignant tumors in Korea. The major tumor suppressor genes (TSGs) such as p16, Rb, E-cadherin and p53 may play important roles in cell cycle regulation, apoptosis and the regulation of the expression of other genes as well as tumor suppression. Microsatellite alteration such as loss of heterozygosity (LOH) have been reported to be a novel mechanism of carcinogenesis and a useful prognostic factor for many malignant tumors. Also, LOH is also known to be related with allelic loss of various TSGs. This study evaluated LOH of 4 TSGs in invasive ductal carcinomas (IDCs) and we correlated these results with the clinicopathological factors. METHODS: LOH analysis was carried out using a polymerase chain reaction with 12 polymorphic microsatellite markers of 4 TSGs in 50 surgically resected tumors and their non-tumorous counterparts. RESULTS: There was no detectable LOH in the normal tissue. LOH was detected in 86% of the 50 cases of IDCs. LOH was detected on all chromosomes and this showed a statistical difference between benign tumor and malignant tumor. LOH of p16, Rb, E-cadherin and p53 TSGs was detected in 36%, 26%, 54% and 60% of the tumors, respectively. LOH of the p16 and Rb genes was inversely correlated with tumor grade 1. The low rate of detecting LOH on the E-cadherin gene was noted in T1 tumor and stage I disease. LOH of the p53 gene correlated well with the tumor size and stage. The LOH-High results correlate well with the tumor size and stage and the LOH-High results are similar to those of the p53 gene LOH. CONCLUSION: These results suggest that LOH of the 4 major TSGs may contribute to the development and invasion of IDCs. Also, the combined use of various LOH markers may help in deciding the prognosis of IDCs.
Apoptosis ; Breast Neoplasms ; Cadherins ; Carcinogenesis ; Carcinoma, Ductal* ; Cell Cycle ; Genes, p53 ; Genes, Retinoblastoma ; Genes, Tumor Suppressor* ; Korea ; Loss of Heterozygosity* ; Microsatellite Repeats ; Polymerase Chain Reaction ; Prognosis

This study was conducted to develop job standards for clinical dietitian administering clinical nutrition therapy to diabetic patients in hospitals. Based on DACUM (Developing A Curriculum) analysis of 17 members including clinical dietitians, professors majoring in clinical nutrition and researchers, information on duties, tasks and task elements of clinical dietitians for diabetes care were derived and applied to diabetes mellitus-specific clinical nutrition care in hospitals for evaluation. The final developed job standards for clinical dietitians for diabetes care included four duties, 19 tasks and 56 task elements. The duties consisted of nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring . evaluation. For application of diabetes mellitus-specific job standards in clinical nutrition care, 108 work activities were developed and classified into 90 basic and 18 recommended types. Performance rates of standardized jobs were 80.2% at nutrition assessment, 99.6% at nutrition diagnosis, 78.5% at nutrition intervention, and 32.9% at nutrition monitoring . evaluation. These results can be applied as guidelines to implement jobs for diabetes mellitus-specific clinical nutrition services in clinical settings. In addition, they would be useful for education standards in educational institutions for education and training of clinical dietitian.
Diabetes Mellitus ; Diagnosis ; Education ; Humans ; Job Description ; Nutrition Assessment ; Nutrition Therapy* ; Nutritionists*

The present study was conducted to provide the basis for improvement of clinical nutrition services through development of job standards of clinical dietitian for the clinical nutrition therapy to cancer patients in hospitals. Developing A Curriculum (DACUM) method was used for job analysis and development of job standards for clinical dietitians for cancer care. Based on DACUM analysis, information about duties, tasks, and task elements of clinical dietitians for cancer care was collected. Developed job standards were applied to clinical nutrition care for cancer patients in hospitals for evaluation. Based on DACUM analysis, consultations from professionals, and field application tests, the final job standards were composed of four duties, 18 tasks, and 56 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring.evaluation. For cancer nutrition care, 109 work activities were developed. They were composed of 75 basic and 34 recommended work activities. The application of developed job standards for clinical dietitians for cancer care at 10 hospitals showed a performance rate of 72.3%. In conclusion, job standards for clinical dietitians for cancer care developed in this study might be effectively used as guidelines for providing clinical nutrition services for cancer patients in hospitals.
Curriculum ; Diagnosis ; Humans ; Nutrition Assessment ; Nutrition Therapy* ; Nutritionists* ; Referral and Consultation

We report here on a case of a spinal extradural leiomyoma in a 67-year-old woman, and this tumor was in a very unusual location for a leiomyoma. Because the patient underwent hysterectomy for a uterine leiomyoma 20 years ago, we can speculate that the spinal lesion was a metastatic leiomyoma.
Aged ; Female ; Humans ; Hysterectomy ; Leiomyoma* ; Spinal Cord