PURPOSE: We evaluated the differences in treatment outcomes between patients who complained of nocturia and patients who did not complain of nocturia after treatment with medication for benign prostatic hyperplasia(BPH) for >6 months. We also investigated the effectiveness of desmopressin on persistent nocturia after BPH medication. MATERIALS AND METHODS: One hundred forty-nine patients with 3 or more episodes of nocturia, despite treatment with BPH medications, were enrolled. Patients were divided into two groups according to complaints or absence of complaints of persistent nocturia. We compared differences of the International Prostate Symptom Score(IPSS), quality of life(QoL), and nocturia between the two groups. Patients who complained of persistent nocturia were subdivided into the following three groups after administration of desmopressin(0.2mg/day) with cessation of BPH medication: group I, decreased nocturia(>2 episodes per night) with desmopressin only; group II, decreased nocturia with desmopressin, but the BPH symptoms are aggravated, and the previous medication was added; group III, no change of nocturia despite desmopressin. We analyzed the differences in each group. RESULTS: Patients who complained of nocturia after BPH medication had a greater decrease in IPSS than those who did not complain of nocturia (p=0.047). Twenty percent(n=9) of the patients had decreased nocturia and were satisfied with desmopressin treatment, Twenty-four of the patients (53.3%) had decreased nocturia, but needed a combination with the previous BPH medication, while desmopressin was not effective in 26.7% (n=12) of the patients. The improvement of BPH after primary treatment was more evident in patients who experienced efficacy with desmopressin. CONCLUSIONS: Desmopressin can be an effective treatment for persistent nocturia in patients with nocturnal polyuria components. The more improvement in BPH after primary treatment, the better the effects of desmopressin can be expected. We cannot overemphasize the importance of a voiding diary and analysis of nocturia.

Fibrovascular polyp of the esophagus is a rare and benign pedunculated intraluminal tumor. The tumor consists of varying amount of vascular fibrous and adipose tissue that arises in the submucosa and is covered by squamous epithelium. We report the typical radiographic, CTand MR findings of a case of giant fibrovascular polyp of the esophagus.
Adipose Tissue ; Epithelium ; Esophagus* ; Polyps*

PURPOSE: To compare chest radiographic findings of pulmonary tuberculosis in non-AIDS immunocom- promised adult patients with those in immunocompetent patients. MATERIAL AND METHOD: Eighty six patients who had pulmonary tuberculosis were included in the study. Of these, 41 were non-AIDS immunocompromised adult patients and 45 were immunocompetent adult patients. Chest radiographs obtained from 86 patients were retrospectively evaluated with regard to the followings ;the anatomic distribution and extent of tuberculous lesions, typical or atypical patterns of radiographic findings. We then compared the results in non-AIDS immunocompromised adult patients with those in immunocompetent adult patients. RESULTS: The characteristic manifestation of pulmonary tuberculosis was a tendency of pulmonary lesions to localize in the apico-posterior segments of the upper lobe and the superior segment of the lower lobe in both groups but more wide distribution such as the anterior segment and the lingular segment of the upper lobe and the basal segments of the lower lobe was frequently identified in non-AIDS immunocompromised adult patients, and also bilateral, multisegmental and multilobular extents were common findings. in immunocompetent adult patients, more common findings were in local exudative and productive lesions and several cavities in preferential sites. Atypical plain radiographic findings were more common in non-AIDS immunocompromised adult patients, and which were multiple cavitary lesions, wide extent of bronchogenic spread and tuberculous pneumonia, and .miliary disseminations and mass like lesions. CONCLUSIONS: Pulmonary tuberculosis in non-AIDS immunocompromised adult patients is characterized by frequent bilateral distribution, wide pulmonary extent, and atypical radiographic findings.
Adult* ; Humans ; Pneumonia ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary*

Ovarian cysts are common incidental findings in term infants and, if unusually large, may result in dystocia, torsion, or rupture. We report the case in which serial sonographic examination revealed changing pattern of cystic ovarian mass from hypoechogenic to well defined multiseptated echogenic during pregnancy. Postnatal T2-weighted MR images revealed a multilocular with high signal density. After delivery a laparotomy was performed, and a twisted ovary measuring 6.7x5x4.5 cm was removed. Ovarian torsion was left-sided and had been almost autoamputated. The resected specimens were nontense, thin walled cysts, filled with hemorrhage like fluid. Histological examination demonstrated the presence of lymphangioma with widespread hemorrhage and necrosis. The neonate did well after the procedure.
Dystocia ; Female ; Hemorrhage ; Humans ; Incidental Findings ; Infant ; Infant, Newborn ; Laparotomy ; Lymphangioma ; Necrosis ; Ovarian Cysts* ; Ovary ; Pregnancy ; Rupture ; Ultrasonography*

PURPOSE: The supracostal access for percutanous nephrolithotomy (PCNL) is a more useful approach in certain situations according to the position of the kidney, location of the calculi, or configuration of the collecting system. We attempted to assess the availability of supracostal approach based on the experience with supracostal approach in treating the complex renal stone and upper ureteral stones at our institution. MATERIALS AND METHODS: The medical records of 26 patients who underwent sup racostal PCNL procedure, between April 1996 and January 2001 were reviewed retrospectively. Under the general anesthesia, 11th-12th intercostal space was selected for the puncture site. Before the needle was passed between the ribs, the lung was deflated completely to prevent thoracic injury. RESULTS: Mean operating time and hospital stay were 81 minutes and 6.7 days, respectively. The stone-free rate after supracostal PCNL was 73% (19 patients). Extra corporeal shock wave lithotripsy (ESWL) was needed to treat residual stones in 7 patients (26%). After supracostal PCNL followed by ESWL, the stone-free rate rose to 88% (23 patients). Three patients (11%) developed pleural effusion postoperatively, one of whom had chest tube placed, the others improved with conservative management. Except for the pleural effusion, there were no complications such as atelectasis, pnemothorax, hemothorax, or injury to the liver or spleen. CONCLUSIONS: Since the complication rate can be kept to minimum with strict precaution, there is no reason to hesitate supracosatal PCNL, when upper pole punc ture is needed and the desired puncture site is above 12th rib.
Anesthesia, General ; Calculi ; Chest Tubes ; Hemothorax ; Humans ; Kidney ; Length of Stay ; Lithotripsy ; Liver ; Lung ; Medical Records ; Needles ; Nephrostomy, Percutaneous ; Pleural Effusion ; Pulmonary Atelectasis ; Punctures ; Retrospective Studies ; Ribs ; Shock ; Spleen ; Thoracic Injuries ; Ureter

PURPOSE: We studied how to increase the detection rate of prostatic cancer in men with normal DRE and the diagnostic gray zone of PSA in whom transrectal prostate biopsies were done. MATERIALS AND METHODS: We analyzed 132 patients with normal DRE and serum PSA greater than 4ng/ml, in whom transrectal prostate biopsies were done between January 1, 1996 and July 31, 2000. These patients were divided into two groups, one group having normal DRE and serum PSA level between 4 and 10ng/ml, in whom transrectal prostate biopsies was done and another group having normal DRE and serum PSA level between upper limit of age-specific PSA reference ranges (APSA-R) and 10ng/ml, in whom transrectal prostate biopsies was done. We applied PSAD and F/T PSA ratio to each group. RESULTS: Eighty-one patients with serum PSA level between 4 and 10ng/ml and 67 patients with serum PSA level between upper limit of APSA-R and 10ng/ml, underwent prostate sextant biopsies. In each group, prostate cancer detection rates were 7.4% and 7.5%. When we applied F/T PSA ratio cut off of 0.15 in each group, prostate cancer detection rates were 19.4% and 22.7%, individually (p<0.05). CONCLUSIONS: Application of F/T PSA ratio can be used significantly to elevate the detection rate of prostate cancer and reduce safely the number of biopsies performed in patients with gray zone of serum PSA levels.
Biopsy ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Reference Values

Pelvic lymph node dissection (PLND) is the most accurate and reliable staging procedure for detecting lymph node invasion (LNI) in prostate cancer. Recently, [11C]-choline positron emission tomography imaging and magnetic resonance imaging with lymphotropic superpara-magnetic nanoparticles have shown potential for detecting LNI but are still under investigation. The risk of LNI in low-risk groups could be underestimated by use of the current nomograms, which rely on data collected from patients who underwent only limited PLND. Extended PLND (ePLND) shows higher lymph node yield, which leads to the removal of more positive nodes and fewer missed positive nodes. It may be possible to refrain from performing PLND on low-risk patients with a prostate-specific antigen value <10 ng/ml and a biopsy Gleason score < or =6, but the risk of biopsy-related understaging should be kept in mind. Theoretically, meticulous ePLND may also impact prostate cancer survival by clearing low-volume diseases and occult micrometastasis even in pN0. The therapeutic role of PLND in prostate cancer patients is still an open question, especially in individuals with low-risk disease. Patients with intermediate- to high-risk disease are more likely to benefit from ePLND.
Biopsy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Magnetic Resonance Imaging ; Nanoparticles ; Neoplasm Grading ; Neoplasm Micrometastasis ; Nomograms ; Positron-Emission Tomography ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms

The double pylorus-is a fistulous communication between the gastric antrum and duodenal bulb, usually extending from the lesser curvature of the stomach to the superior aspect of the duodenal bulb, and seperated by septum or bridge of normal mucosa. Although its incidence is rare, reports concerning double pylorus are increasing with the recent development of upper gastrointestinal endoscopy and more awareness of this abnormality. We recently experienced two cases of double pylorus; an aquired one in 72-year old male who had an another opening with healing ulcer at the superior aspect of the original pyloric channel, central erosion with clubbing and fusion of mucosal folds at the greater curvature of the lower body and a 3 x 4 cm sized ulcer at the lesser curvature of the lower body, and the other congenital one in 53-year old male who had an another opening at the superior aspect of the original pyloric channel with histologically intact muscularis mucosa in the pyloric septum with no evidence of chronic peptic ulcer scarring. We report here two cases of double pylorus, one-acquired, and the other-congenital, with a review of the literature.
Aged ; Cicatrix ; Endoscopy, Gastrointestinal ; Humans ; Incidence ; Male ; Middle Aged ; Mucous Membrane ; Peptic Ulcer ; Pyloric Antrum ; Pylorus ; Stomach ; Stomach Ulcer ; Ulcer

For the several decades, the treatment of clinically localized prostate cancers has been largely represented by surgery, radiotherapy, and observation. Until recently, this has not changed much. In particular, curative treatment through surgery or radiotherapy is considered to be of no great benefit in elderly patients with low-risk groups. Thus, these strategies are recommended only in moderate or high-risk patients with a life expectancy of 10 years or more. In general, surgery and radiotherapy have been reported to be similar in terms of oncologic outcomes, but the level 1 evidence was lacking to support this to date. Recent advances in imaging modalities have led to the introduction of treatments for the concept of focal therapy, such as high-intensity frequency ultrasound or cryotherapy. Subsequently, positive results have been reported in terms of functional outcomes. However, the level of evidence is not high due to the short follow-up period and the absence of large-scale prospective studies. For the reasons described above, counseling and decision-making were not straightforward. Consequently, the treatment strategy for each individual patient was determined mainly on the risk of incontinence, erectile dysfunction, or other adverse effects of radiotherapy. To overcome these limitations, substantial studies have been reported evaluating survival outcomes and complications following treatments of localized prostate cancer for the past several years. In this review, we aimed to summarize recent literatures on surgery, radiotherapy, and expectant management, which have been the mainstays of treatment for localized prostate cancer; and introduce several treatments for the concept of focal therapy.
Aged ; Counseling ; Cryotherapy ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Life Expectancy ; Male ; Prospective Studies ; Prostate ; Prostatic Neoplasms ; Radiotherapy ; Ultrasonography

This study was performed to investigate the relationship between diet quality and food cost and identify the effects of food cost on healthy diet among Korean adult. Among the subjects of 2001 National Health and Nutrition Survey 1,641 men and 1,765 women aged from 30 to 49 years were selected and their information of dietary intakes, socio-demographic information, and anthropometric data were analyzed. For the analysis, subjects were classified to quartile based on their daily food cost. Food guidelines provided by Korean Nutrition Society was regarded as a model of healthy diet. Subjects in the lowest quartile of food cost consumed inadequate amount of food from all food categories of the guidelines. Many subjects in the highest quartile not only satisfied the recommended amount of the Food Guide but also seemed to overeat high energy density foods. Even in the highest quartile, about 90% of subjects did not satisfied recommended amount of dairy products. According to the calculated cost of healthy diet, the average cost did not seem to be more expensive than the current mean food cost of the subjects, and most cost-sensitive food intake was observed in the meat . fish . beans . eggs category. The implications of study results were: 1) all the high cost diets did not indicate the high quality of diet, 2) most practical matter of healthy diet in low income group seemed whether they could afford the expense of meat and fish, 3) nutrition education was required to most subjects for healthy diet.
Adult ; Dairy Products ; Diet* ; Eating ; Education ; Eggs ; Fabaceae ; Female ; Humans ; Male ; Meat ; Nutrition Surveys ; Ovum