PURPOSE: Sildenafil citrate(Viagra(R)) has been accepted as a primary treatment of erectile dysfunction(ED). We performed this study to assess the determinants of sildenafil failure and the status of secondary treatment in sildenafil failure patients. MATERIALS AND METHODS: We reviewed the medical records of 1,023 erectile dysfunction patients who were prescribed sildenafil from September 2001 to June 2003. A specially designed sildenafil failure questionnaire was asked in 236 patients of sildenafil failure(Group I) and 127 of 787 patients with sildenafil success as a control(Group II). RESULTS: Sildenafil failure rate was 23%(236/1023). In Group I, the etiology of ED was psychogenic in 14%, organic in 36%, mixed in 32% and un-classified in 18%. Number of total medication(more than 6 times) was 47% in Group I and 61.4% in Group II. Presence of sexual stimulation after medication was 47% in Group I and 61.4% in Group II. There was no difference in time to intercourse after medication and interval of meal to medication between both groups(p>0.05). The secondary treatment in Group I was intracavernous injection(11.3%), vacuum device(7.2%), penile prosthesis(1.3%) and 81.2% of no further treatment. CONCLUSIONS: Although precise education of taking sildenafil may enhance the response rate, the best predictors for long-term use of sildenafil are the severity and cause of ED and the effectiveness of sildenafil. Due to the high dropout rate of patients who suffer sildenafil failure, precise public education and secondary treatment options should be recommended.
Education ; Erectile Dysfunction* ; Humans ; Male ; Meals ; Medical Records ; Patient Dropouts ; Sildenafil Citrate ; Vacuum

In the past, physical castration was adopted to punish sex offenders and prevent the recurrence of sexual crimes. However, it was abrogated because of human right issues and the irreversibility of fertility. Chemical castration of depot injection with hormones was introduced as an alternative method of physical castration. Antiandrogen is the most frequently used hormonal agents. Although there are several positive results such as changes of sexual behaviors and decrease of the recurrence rate of sexual crime after hormonal treatment, it also has serious limitations; difficulties in academic evaluation for control group and placebo effect; difficulties in the assessment of the therapeutic effect; and difficulties to decide the proper duration of treatment. Although the law for chemical castration to control sexual impulses in sex offenders was enforced since July, 2011 in Korea, there are not enough resources for treatment. We reviewed the appropriate references and suggested continuous long-term follow-up studies.
Castration ; Child ; Crime ; Criminals ; Fertility ; Follow-Up Studies ; Human Rights ; Humans ; Jurisprudence ; Korea ; Pedophilia ; Recurrence ; Sexual Behavior

PURPOSE: Intracavernous injection of PGE1 or papaverine is widely used in the diagnosis and treatment of erectile dysfunction. However, these drugs have several side effects such as pain, priapism, and fibrotic lesions. In this study, we assessed the effects of pinacidil (a K+ -ATP - channel opener) as an alternative for inducing penile erection. METHODS: Using a feline model, the magnitude of penile erection caused by pinacicil was compared with that caused by other drugs, namely acetylcholine, PGE1 and L-arginine. The effects of K+ -channel blockers(4-aminopyridine, glibenclamide, and tetraethylammonium; TEA) and pinacidil on the induced erections were investigated. RESULTS: Intra-arterial injection of pinacicil increased the intracavernous pressure (ICP) in a dose-dependent fashion, and the increase in ICP induced by pinacicil plus acetylcholine, PGE1 or L-arginine was more pronounced than that induced by any of these drugs alone. Furthermore, pinacicil (10(-3)M/mL) effectively reversed the inhibitory effects of the K+-channel blockers on cavernous relaxation induced by acetylcholine, PGE1 or L-arginine (P<0.01). Notably, pinacidil induced cavernous relaxation even in cases refractory to a higher concentration <10(-1) M/mL) of erectics (n = 11; p<0.01). CONCLUSIONS: These results suggest that pinacidil is effective in relaxing feline erectile tissue in vivo, probably via increased K+ permeability and subsequent hyperpolarization. Further comparative studies with human erectile tissue and clinical testing are required to show whether K+-channel openers can be used in the diagnosis and treatment of erectile dysfunction.
Acetylcholine ; Alprostadil ; Arginine ; Diagnosis ; Erectile Dysfunction* ; Glyburide ; Humans ; Injections, Intra-Arterial ; Male ; Papaverine ; Penile Erection ; Permeability ; Pinacidil ; Priapism ; Relaxation ; Tetraethylammonium

PURPOSE: Intracavernous injection of PGE1 or papaverine is widely used in the diagnosis and treatment of erectile dysfunction. However, these drugs have several side effects such as pain, priapism, and fibrotic lesions. In this study, we assessed the effects of pinacidil (a K+ -ATP - channel opener) as an alternative for inducing penile erection. METHODS: Using a feline model, the magnitude of penile erection caused by pinacicil was compared with that caused by other drugs, namely acetylcholine, PGE1 and L-arginine. The effects of K+ -channel blockers(4-aminopyridine, glibenclamide, and tetraethylammonium; TEA) and pinacidil on the induced erections were investigated. RESULTS: Intra-arterial injection of pinacicil increased the intracavernous pressure (ICP) in a dose-dependent fashion, and the increase in ICP induced by pinacicil plus acetylcholine, PGE1 or L-arginine was more pronounced than that induced by any of these drugs alone. Furthermore, pinacicil (10(-3)M/mL) effectively reversed the inhibitory effects of the K+-channel blockers on cavernous relaxation induced by acetylcholine, PGE1 or L-arginine (P<0.01). Notably, pinacidil induced cavernous relaxation even in cases refractory to a higher concentration <10(-1) M/mL) of erectics (n = 11; p<0.01). CONCLUSIONS: These results suggest that pinacidil is effective in relaxing feline erectile tissue in vivo, probably via increased K+ permeability and subsequent hyperpolarization. Further comparative studies with human erectile tissue and clinical testing are required to show whether K+-channel openers can be used in the diagnosis and treatment of erectile dysfunction.
Acetylcholine ; Alprostadil ; Arginine ; Diagnosis ; Erectile Dysfunction* ; Glyburide ; Humans ; Injections, Intra-Arterial ; Male ; Papaverine ; Penile Erection ; Permeability ; Pinacidil ; Priapism ; Relaxation ; Tetraethylammonium

Xanthogranulomatous pyelonephritis (XGP) is a rare type of chronic bacterial nephritis, which rarely involves the invasion of adjacent organs or the formation of fistulas due to tissue-destructive granulomatous reactions. Although the invasions of various adjacent organs have been reported in several cases of XGP, MRI data on their features are limited. MRI has a better soft-tissue resolution than CT. Thus, it can identify the extent of extrarenal involvement in advanced XGP, and the findings can be used in treatment planning. Herein, we report a rare case of XGP with nephropleural fistula formation diagnosed using CT and MRI.

Xanthogranulomatous pyelonephritis (XGP) is a rare type of chronic bacterial nephritis, which rarely involves the invasion of adjacent organs or the formation of fistulas due to tissue-destructive granulomatous reactions. Although the invasions of various adjacent organs have been reported in several cases of XGP, MRI data on their features are limited. MRI has a better soft-tissue resolution than CT. Thus, it can identify the extent of extrarenal involvement in advanced XGP, and the findings can be used in treatment planning. Herein, we report a rare case of XGP with nephropleural fistula formation diagnosed using CT and MRI.

OBJECTIVES: 'Taegyo,' prenatal education, is steeped into Korean culture. Although there has been a traditional focus on providing education and care for the fetus in Korea, there is a lack of medical evidence for its effectiveness. METHODS: The authors assessed the scientific basis for 'Taegyo' by reviewing the evidences. RESULTS: 'Taegyo' in Korea began with the spread of Buddhist culture from China, and transmitted by word-of-mouth. The first 'Taegyo' book, the Tae-gyo-shin-gi, was published on 1803. Modern prenatal education is very diverse. However, only a few studies on its effect have been conducted. Development of medicine, especially obstetrics, fetology, pediatrics, psychiatry, and etc., has learned that many factors, including bad environmental conditions and maternal stress, influenced against the fetus and mother. As for the paternal side, occupation, smoking, and stress were also revealed to have consequences for the development of the fetus. On the contrary, adequate maternal nutrition, exercise, and music stimulation positively impact the fetal development and healthy birth. CONCLUSION: Traditional contents of 'Taegyo' were proved to have effectiveness from evidence-based medicine and animal experiments. We need further studies to explore the impact of prenatal education for the fetal development and maternal health.
Animal Experimentation ; China ; Education ; Evidence-Based Medicine ; Female ; Fetal Development ; Fetus ; Humans ; Korea ; Maternal Health ; Mothers ; Music ; Obstetrics ; Occupations ; Parturition ; Pediatrics ; Pregnant Women ; Prenatal Care ; Prenatal Education* ; Smoke ; Smoking ; Stress, Psychological

Uterus didelphys with unilateral obstructed hemivagina is indeed a very rare congenital anomaly due to M llerian duct malformation. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An accurate and prompt diagnosis is of importance to permit treatment and to assure the future fertility of the patient. The simple and adequate treatment of the condition is incision of the obstructed vaginal septum providing adequate drainage of the retained blood. We report a case of uterus didelphys with obstructed hemivagina with brief review of the literature.
Diagnosis ; Drainage ; Dysmenorrhea ; Female ; Fertility ; Humans ; Menarche ; Pelvic Pain ; Uterus*

The aim of this study was to investigate whether the omega-3 fatty acids help to improve erectile function in an atherosclerosis-induced erectile dysfunction rat model. A total of 20 male Sprague-Dawley rats at age 8 weeks were divided into three groups: Control group (n = 6, untreated sham operated rats), Pathologic group (n = 7, untreated rats with chronic pelvic ischemia [CPI]), and Treatment group (n = 7, CPI rats treated with omega-3 fatty acids). For the in vivo study, electrical stimulation of the cavernosal nerve was performed and erectile function was measured in all groups. Immunohistochemical antibody staining was performed for transforming growth factor beta-1 (TGF-β1), endothelial nitric oxide synthase (eNOS), and hypoxia inducible factor 1-alpha (HIF-1α). In vivo measurement of erectile function in the Pathologic group showed significantly lower values than those in the Control group, whereas the Treatment group showed significantly improved values in comparison with those in the Pathologic group. The results of western blot analysis revealed that systemically administered omega-3 fatty acids ameliorated the cavernosal molecular environment. Our study suggests that omega-3 fatty acids improve intracavernosal pressure and have a beneficial role against pathophysiological consequences such as fibrosis or hypoxic damage on a CPI rat model, which represents a structural erectile dysfunction model.
Animals ; Atherosclerosis/*complications ; Blotting, Western ; Carotid Arteries/physiology ; Chronic Disease ; Disease Models, Animal ; Electric Stimulation ; Fatty Acids, Omega-3/*pharmacology ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism ; Ischemia/etiology/*pathology ; Male ; Nitric Oxide Synthase Type III/metabolism ; Penile Erection/*drug effects ; Penis/metabolism/pathology ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1/metabolism

BACKGROUND: Endotoxins play important roles in the pathophysiologic alterations associated with sepsis so we examined the effects of volatile anesthetics on vascular smooth muscle contractile function in LPS-treated rat aorta. METHODS: Fifty male Sprague-Dawley rats(250~300 gm) were made septic by intraperitoneal injection of lipopolysaccharide(1.5 mg/kg). Cumulative doses of phenylephrine and norepinephrine(10 -8~10 -5M) were added to construct a contraction response curve. Two percent of volatile anesthetics, IBMX (3-isobutyl-1-methylxanthine, phosphodiesterase inhibitor) or L-NAME(Ng-nitro-L-arginine-methylester, Nitric oxide synthase inhibitor) was added and those contractile responses were observed respectively. We also measured nitric oxide synthase (NOS) activity of liver, lung and adrenal gland after 18 hours in the LPS-treated rats. Individual values between the control rats and LPS-treated rats were compared by unpaired t-test. A p-value less than 0.05 was considered statistically significant. RESULTS: Contractile response of 2% halothane to norepinephrine was significantly decreased both in the control rats and LPS-treated rats. The NOS inhibitor enhanced the contractile responses to phenylephrine and norephinephrine in the vessels from LPS-treated rats more significantly than those of control rats. CONCLUSIONS: These results suggest that LPS-treatment impairs vasopressor-induced contractility and doesn't alter the contractile responses during administration of volatile anesthetics.
1-Methyl-3-isobutylxanthine ; Adrenal Glands ; Anesthetics* ; Animals ; Aorta ; Endotoxins ; Halothane ; Humans ; Injections, Intraperitoneal ; Liver ; Lung ; Male ; Muscle, Smooth, Vascular ; Nitric Oxide ; Nitric Oxide Synthase ; Norepinephrine ; Phenylephrine ; Rats* ; Rats, Sprague-Dawley ; Sepsis