PURPOSE: We tried to find out the urodynamic features of the male patients suffering with lower urinary tract symptoms (LUTS) and we wanted to know the effects of the preoperative parameters on the outcome of transurethral resection of the prostate (TURP). MATERIALS AND METHODS: One hundred ninety four patients who had LUTS and who had undergone urodynamic study were available for analysis. The history taking and physical examination, urinalysis, International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA) level check and urodynamic study were performed for all the patients. Also, the postoperative IPSS and satisfaction level were accessed for the patients who had undergone TURP for bladder outlet obstruction (BOO), and the preoperative factors such as age, prostate volume, PSA and urodynamic findings were analyzed. RESULTS: For the total 194 patients, there were 123 BOO patients (63.4%), 62 detrusor overactivity patients (13.4%) and 19 detrusor underactivity patients (9.8%). For the patients who had undergone TURP, the IPSS was decreased from a preoperative value of 20.5 to a postoperative value of 9.0. We divided the patients into two groups in accordance with the level of satisfaction after the operation. Within the two groups, the dissatisfied group showed a preponderance of preoperative detrusor overactivity. When performing IPSS, both groups showed a decreased score with each having a different range: from 20.8 to 6.1 in the satisfied group, and from 23.2 to 14.8 in the dissatisfied group. CONCLUSIONS: BOO is most common cause among the male patients who have LUTS and who are more than 50 years old, but other causes should be considered. Moreover, if BOO accompanies detrusor overactivity, the importance of the preoperative urodynamic findings deserves emphasis, and it will help to predict the results of performing TURP.
Humans ; Lower Urinary Tract Symptoms ; Male* ; Middle Aged ; Physical Examination ; Prostate* ; Prostate-Specific Antigen ; Transurethral Resection of Prostate ; Ultrasonography ; Urinalysis ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics*

PURPOSE: The prevalence of female bladder outlet obstruction(BOO) is not well known and the diagnostic criteria is uncertain. We attempted to find out the features of urodynamic and clinical findings of bladder outlet obstruction in female patients with lower urinary tract symptom. MATERIALS AND METHODS: A total of 251 patients who were referred to urodynamic study for lower urinary tract symptom was available for analysis. Patients who had previous pelvic surgery history or neurologic causes were excluded. History taking, physical examination, voiding diary, urodynamic study were performed. Urodynamic study consisted of free uroflow, urethral pressure profile, cystometry, and pressure flow studies. The criteria of bladder outlet obstruction was peak flow rate at free uroflow less than 12ml/s and detrusor pressure at a maximum flow rate of more than 20cmH2O. Among the patients who were revealed as stress urinary incontinence, but with no other abnormalities at urodynamic study, 30 served as the controls. RESULTS: In 251 patients, 42(16.7%) were BOO patients. There were no significant differences in the clinical features of the two groups, such as age, parity, surgical history. In the urodynamic study, the first voiding sense and maximal bladder capacity were similar in the two groups. Peak flow rate was 24.0+/-10.9ml/s in the control and 7.9+/-1.7ml/s in BOO, the detrusor pressure of maximum flow was 25.8+/-10.4cmH2O and 62.6+/-33.1cmH2O, maximal urethral closing pressure was 55.3+/-20.3cmH2O and 79.5+/-46.8cmH2O, voiding volume was 377.2+/-85.0ml/s and 281.0+/-104.3ml/s, and residual volume was 19.3+/-76.9ml/s and 48.7+/-80.0ml/s, respectively. CONCLUSIONS: Among the female patients who had low urinary tract symptoms, numerous patients were revealed as BOO. BOO must be considered for female patients who have low urinary tract symptoms, and urodynamic studies may play an important role for the diagnosis and treatment of BOO.
Diagnosis ; Female* ; Humans ; Parity ; Physical Examination ; Prevalence ; Residual Volume ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Incontinence ; Urinary Tract* ; Urodynamics

Apoptosis ; Bone Regeneration ; Calcium ; Calcium Phosphates ; Cell Cycle ; Cell Proliferation ; Ceramics ; Durapatite ; Gene Expression ; Microarray Analysis ; Oligonucleotide Array Sequence Analysis ; Osteoblasts ; Osteogenesis ; Signal Transduction

OBJECTIVE: The Purpose of the study was to investigate the bone morphogenic protein expression of rhBMP-2(recombinant human bone morphogenic protein-2) as singnaling molecule and beta-TCP(Tricalcium phosphate) as a bone substitute and carrier medium of rhBMP-2. MATERIALS AND METHODS: 16 rabbits divided into 2 group of each 8 rabbit. Two standardized bone defect, round bilateral defect was made in the cranium of the 8 rabbit of first group, and was grafted with 150~500micrometer diameter beta-TCP 0.25g in one side, which was soaked with rhBMP-2, and autogenous bone was grafted on another side as a positive control. Second group of 8 rabbit, only beta-TCP was grafted with same size and same manner. After 2, 4, 8, and 12 weeks, specimen was taken for microscopic immunohiostochemical and histomorphometric analysis. RESULT: Grafting beta-TCP with rhBMP show the early formation of the bone regenerative factor (BMP-4) and more quantity of new bone formation than only use of beta-TCP (8,12 week), even show less new bone formation than autogenous bone. CONCLUSION: The experimental study result that beta-TCP graft combination with rhBMP-2 as a delivery system is an effective with osteoinductive capacity and biodegradable properties, so that provide clinical availibility of composite use in reconstruction of bony defect.
Bone Substitutes ; Calcium Phosphates ; Humans ; Immunohistochemistry ; Osteogenesis ; Rabbits ; Skull ; Transplants

PURPOSE: Cyclosporine A (CsA) is a versatile immunosuppresive agent used to prevent graft rejection syndrome and treat autoimmune disease. One of the major side effects associated with CsA is the abnormal gingival hyperplasia. The purpose of this study was to investigate the relationship between the mRNA expression of the MMP-1, TIMP-1, and TGF-beta1 and the concentration of CsA in cultured human gingival keratinocytes. MATERIALS AND METHODS: Gingival keratocytes were obtained from gingival tissues of 4 healthy donors. The cultured gingival keratocytes were incubated with increasing concentrations of CsA (0-2000 ng/ml) for 24 hours and the expression of MMP-1, TIMP-1, and TGF-beta1 were determined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: The expressions of MMP-1 and TGF-beta1 were not significantly different according to the concentrations of CsA. The expression of TIMP-1 was significantly increased at the CsA concentration of 500 ng/ml. CONCLUSION: We concluded that the gingival hyperplasia induced by CsA was more related with TIMP-1 than MMP-1 or TGF-beta1 on gingival collagen metabolism in patients treated with CsA.
Autoimmune Diseases ; Collagen ; Cyclosporine ; Gingival Hyperplasia ; Graft Rejection ; Humans ; Keratinocytes ; RNA, Messenger ; Tissue Donors ; Tissue Inhibitor of Metalloproteinase-1 ; Transforming Growth Factor beta1

OBJECTIVE: Outcome of gamma knife radiosurgery (GKS) in the consecutive 100 cases with cerebral arteriovenous malformations (AVMs) was analyzed. METHODS: Data from initial 100 patients treated with GKS in the authors' institute were reviewed retrospectively. Spetzler-Martin grade at diagnosis were I in 18 patients, II in 27, III in 36, IV in 11, and V in 8. Thirty-five patients had experienced previous bleeding, 27 patients presented with seizure, and 31 patients presented with headache. The mean volume of the lesion was 4.3 cm3 (0.1-29.3 cm3). The median radiation dose delivered to the margin was 20.0 Gy (13-32 Gy). Mean follow-up period was 37.5 months (5-63 months). RESULTS: Angiographic follow-up was performed in 48 patients at least 2 years after GKS. Sixteen patients were lost in follow up following 2 years from GKS. Twenty-eight of 48 patients (58%) showed complete obliteration and 20 patients (42%) showed partial obliteration. Seven patients presented with post-GKS hemorrhage. Adverse radiation effect (ARE) was observed at follow-up MRI in 25 of 76 patients, and it was symptomatic in 5 patients. Complete obliteration was confirmed in 24 of 31 (77%) patients with volume less than 4 cm3, meanwhile only 4 of 17 (24%) patients with volume of 4 cm3 or more showed complete obliteration. Complete obliteration rate was 67% with 20 Gy or higher marginal dose, 63% with 15-20 Gy, and 17% with less than 15 Gy. CONCLUSION: GKS can provide high rates of obliteration with acceptable risk of morbidity in a subgroup of small AVMs. However, overall outcome in whole spectrum of AVMs, in which large proportion of cases have unfavorable characteristics for radiosurgery, is much worse. More effective therapeutic strategy needs to be developed for large AVMs that are difficult to be managed with current available treatment modalities.
Arteriovenous Malformations ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations ; Radiosurgery ; Retrospective Studies ; Seizures

We described a 65-year-old female of 45,X/46,XX Turner's syndrome associated with patent ductus arteriosus who was admitted due to exertional dyspnea and palpitation. This patient had not spontaneous mensturation and had a short stature without webbed neck and a sexual infantilism. Chromosomal aberrations cause primarily structural defects of cardiovascular system, and a variety of structural aberrations involving the X chromosome can cause partial or complete Turner's syndrome. In Turner's syndrome, bicuspid aortic valve or coarctation of aorta is frequently combined, also aortic root dilatation, partial anomalous venous drainage, hypoplastic left heart, ventricular septal defect, atrial septal defect has been reported. However, this patient had not abnormality in aortic valve and whole aorta. Patent ductus arteriosus in 45,X/46,XX Turner's syndrome have not been reported in Korea. We report this case with a brief review of the literature.
Aged ; Aorta ; Aortic Coarctation ; Aortic Valve ; Bicuspid ; Cardiovascular System ; Chromosome Aberrations ; Dilatation ; Drainage ; Ductus Arteriosus, Patent* ; Dyspnea ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Korea ; Neck ; Sexual Infantilism ; Turner Syndrome ; X Chromosome

BACKGROUND: Dry and cold anesthetic gas deteriorates patient's respiratory function and body heat balance. We examined whether a humidifier with heated wire circuit might maintain core temperature and humidity of inspired gas in patient undergoing general anesthesia. METHODS: We enrolled forty ASA physical status I, II patients under general anesthesia for this study. We allocated the patients randomly into two groups with (experimental group) or without (control group) Humitube(R) anesthesia circuit, which delivered heated and humidified inspired anesthetic gases. We recorded the temperatures and humidity of the inspired gases throughout the surgery. RESULTS: The temperatures and relative humidity of the inspired gases in experimental group were significantly greater compared to control group (36.2 +/- 0.9degrees C, 89.5 +/- 4.8% vs. 30.4 +/- 1.8degrees C, 37.9 +/- 5.9%, P < 0.05) during anesthesia. The core temperatures in experimental group were significantly greater compared to control group (36.1 +/- 0.3degrees C vs. 35.7 +/- 0.1degrees C, P < 0.05) during anesthesia. CONCLUSIONS: A humidifier with heated wire system for anesthesia breathing circuit is helpful to maintain core temperature and adequate humidity.
Anesthesia ; Anesthesia, General ; Anesthetics, Inhalation ; Body Temperature ; Cold Temperature ; Gases ; Hot Temperature ; Humans ; Humidity ; Respiration

PURPOSE: This study examined the changes in intracavernous pressure, expression of nitric oxide synthase(NOS), and content of penile smooth muscle in castrated rats and testosterone-supplied castrated rats. MATERIALS AND METHODS: Sprague Dawley rats were used for this study and divided into control, castrated, and testosterone-supplied castrated groups. Castration was performed by bilateral orchietomy under general anesthesia, and testosterone propionate 3 mg/kg was injected subcutaneously daily for a week beginning 4 weeks after orchiectomy. Intracavernous pressure was measured by stimulating the cavernous nerve at 10 volts, 2.4 mA. Expression of NOS was measured by immunohistochemical staining for NADPH diaphorase, and content of penile smooth muscle was measured by H&E staining of the corpus cavernosum. The stained area-to-tissue ratio was calculated by computer scanning for each case. RESULTS: Compared with the control group(3.45+/-0.25 ng/ml), the serum testosterone level of the castrated group (0.78+/-0.34 ng/ml) was lower. Serum testosterone level was restored in the testosterone-supplied castrated group. Compared with the(67.2+/-14.3 cmH2O) was decreased (p <0.05). There was no significant difference between the testosterone-supplied group(94.7+/-11.4 cmH2O) and control group, so intracavernosal pressure was restored by testosterone treatment. Immunohistochemical staining for NOS showed that NADPH diaphorase was stained as brown nerve fiber. Compared with the control group(37.5+/-2.8%), the NOS activity of the castrated group(7.5+/-2.1%) was significantly decreased(p <0.05). NOS activity was slightly increased in the testosterone-supplied group(47.5+/-2.4%) compared with the control group, but the difference was not statistically significant. Thus, testosterone treatment restored NOS activity after castration. By H&E staining, the content of penile smooth muscle was 76.5+/-2.8% in the control group, but significantly lower in the castrated group(46.2+/-3.4% p <0.05). Smooth muscle content was slightly decreased in the testosterone-supplied group(63.8+/-4.7%) compared with control group, but the difference was not statistically significant. Thus, smooth muscle content was restored by testosterone treatment after castration. CONCLUSIONS: Decline of factors involved in erectile function can be restored by testosterone replacement after castration.
Anesthesia, General ; Animals ; Castration ; Male ; Muscle, Smooth ; NADPH Dehydrogenase ; Nerve Fibers ; Nitric Oxide ; Orchiectomy ; Penile Erection* ; Rats* ; Rats, Sprague-Dawley ; Testosterone Propionate ; Testosterone*

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) refers to dilatation of the colon and decreased bowel motility without evidence of mechanical obstruction. Neostigmine, an acetylcholinesterase inhibitor, has been used in patients in whom supportive therapy failed to resolve ACPO. Here, we report the results of administering neostigmine to treat ACPO in children with hematologic malignancies. METHODS: Between September 2005 and December 2009, 10 patients (8 male and 2 female) were diagnosed with ACPO at the Department of Pediatrics, Catholic University of Korea. Diagnosis of ACPO was based on typical clinical features as well as colonic dilatation found on abdominal CT imaging. Neostigmine was administered subcutaneously at a dosage of 0.01 mg/kg/dose (maximum 0.5 mg) twice daily for a maximum of 5 total doses. ACPO was determined to be responsive to neostigmine if the patient showed both stool passage and improvement of clinical symptoms. RESULTS: The study group included 8 acute lymphoblastic leukemia patients, 1 patient with malignant lymphoma, and 1 patient with juvenile myelomonocytic leukemia. The median age at ACPO diagnosis was 8.5 years (range, 3-14). Overall, 8 patients (80%) showed therapeutic response to neostigmine at a median of 29 hours after the initial administration (range, 1-70). Two patients (20%) showed side effects of grade 2 or above, but none complained of cardiovascular symptoms that required treatment. CONCLUSION: In this study, ACPO was diagnosed most often in late-childhood ALL patients. Subcutaneous neostigmine can be used to effectively treat ACPO diagnosed in children with hematologic malignancies without major cardiovascular complications.
Acetylcholinesterase ; Child ; Colon ; Colonic Pseudo-Obstruction ; Dilatation ; Hematologic Neoplasms ; Humans ; Korea ; Leukemia, Myelomonocytic, Juvenile ; Lymphoma ; Male ; Neostigmine ; Pediatrics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma