Many symptoms of age related bladder dysfunction may be associated with urethral dysfunction. We compared the contractile responsiveness of urethral strips from young adults (6-9 months) and old (24-27 months) male Fisher 344 rats. Circularly and longitudinally oriented urethral strips from proximal (bladder neck) and distal urethra were obtained and suspended in organ baths containing Tyrodes buffer. Contractile responses to field stimulation (FS), phenylephrine, bethanechol and KC1 were recorded. Results were as followed: 1. Contractile responses of proximal urethral strips from old rats to FS, bethanechol, phenylephrine, KCI were greater than those of young rats. In young rats, general order of responsiveness was FS >KC1 = phenylephrine >bethanechol. In old rats, it became FS >bethanechol >KCI = phenylephrine. 2. Magnitude of the contractile responses for distal urethral strips were significantly lower than for proximal urethra and there were no significant differences of the responses between two age group. 3. For the circularly oriented strips, responses of old rats to FS, bethanechol, phenylephrine and KC1 also were greater than those of young rats. In young rats, general order of responsiveness was FS>KCl =phenylephrine =bethanechol. In old rats, it became FS>bethanechol >KC1 >phenylephrine. 4. For the longitudinally oriented strips, responsiveness to FS and bethanechol was similar between younger and old rats. However, responses to phenylephrine were greater for young rats than for old ones. For both young and old rats, general order of contractile responsiveness was FS>phenylephrine=KCl>bethanechol, In old rats contractile responses of proximal, circular urethral strips to various stimulation were greater than those in young ones. 5. Degree of field stimulated relaxant responses of the urethra precontracted by phenylephrine were similar between two age groups at higher frequencies(16-64 Hz.): whereas higher degrees of relaxation were observed in young rats at lower frequencies(1-8 Hz.). Circularly oriented urethral strips showed better relaxation with FS than did longitudinal ones. Relaxant responses were only partially (50%) blocked by preincubation of L-NAME. These results suggest that as male became older, their urethra responds to various stimulation with obstructive pattern than did the younger ones and also, lesser degree of urethral relaxation may causes obstructive voiding due to poor Opening of bladder outlet. Also it can be said that the ratio of the receptor density of cholinergic and adrenergic nerves varies as one become old.
Aging* ; Animals ; Baths ; Bethanechol ; Humans ; Male* ; NG-Nitroarginine Methyl Ester ; Phenylephrine ; Rats* ; Relaxation ; Urethra ; Urinary Bladder ; Young Adult

Many symptoms of age related bladder dysfunction may be associated with urethral dysfunction. We compared the contractile responsiveness of urethral strips from young adults (6-9 months) and old (24-27 months) male Fisher 344 rats. Circularly and longitudinally oriented urethral strips from proximal (bladder neck) and distal urethra were obtained and suspended in organ baths containing Tyrodes buffer. Contractile responses to field stimulation (FS), phenylephrine, bethanechol and KC1 were recorded. Results were as followed: 1. Contractile responses of proximal urethral strips from old rats to FS, bethanechol, phenylephrine, KCI were greater than those of young rats. In young rats, general order of responsiveness was FS >KC1 = phenylephrine >bethanechol. In old rats, it became FS >bethanechol >KCI = phenylephrine. 2. Magnitude of the contractile responses for distal urethral strips were significantly lower than for proximal urethra and there were no significant differences of the responses between two age group. 3. For the circularly oriented strips, responses of old rats to FS, bethanechol, phenylephrine and KC1 also were greater than those of young rats. In young rats, general order of responsiveness was FS>KCl =phenylephrine =bethanechol. In old rats, it became FS>bethanechol >KC1 >phenylephrine. 4. For the longitudinally oriented strips, responsiveness to FS and bethanechol was similar between younger and old rats. However, responses to phenylephrine were greater for young rats than for old ones. For both young and old rats, general order of contractile responsiveness was FS>phenylephrine=KCl>bethanechol, In old rats contractile responses of proximal, circular urethral strips to various stimulation were greater than those in young ones. 5. Degree of field stimulated relaxant responses of the urethra precontracted by phenylephrine were similar between two age groups at higher frequencies(16-64 Hz.): whereas higher degrees of relaxation were observed in young rats at lower frequencies(1-8 Hz.). Circularly oriented urethral strips showed better relaxation with FS than did longitudinal ones. Relaxant responses were only partially (50%) blocked by preincubation of L-NAME. These results suggest that as male became older, their urethra responds to various stimulation with obstructive pattern than did the younger ones and also, lesser degree of urethral relaxation may causes obstructive voiding due to poor Opening of bladder outlet. Also it can be said that the ratio of the receptor density of cholinergic and adrenergic nerves varies as one become old.
Aging* ; Animals ; Baths ; Bethanechol ; Humans ; Male* ; NG-Nitroarginine Methyl Ester ; Phenylephrine ; Rats* ; Relaxation ; Urethra ; Urinary Bladder ; Young Adult

Random biopsy of normal-looking mucosa of the bladder at the time of T.U.R.B. in the patients with bladder cancer have been used as a routine assessment of the tumor behavior. To investigate mucosal abnormalities of normal-looking mucosa in bladder cancer. we performed random mucosal biopsies during transurethral resection of the bladder cancer. The following results were obtained. 1. In Group 1 (Solitary, Stalk, Papillary ca). no CIS lesion was found in biopsy specimens. 2. In Group 2 (Solitary. Sessile. Papillary ca) and Group 3 (Solitary. Sessile. Non-papillary ca). some positive results were obtained. On the consideration of above results and the potentiality of implantation. we can raise an issue that the bladder cancer patients with a solitary, papillary shape do not necessarily undergo the mucosal biopsy during T.U.R.B. Instead, close follow up for the patients will be recommended.
Biopsy* ; Humans ; Mucous Membrane ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Cutaneous fistula of dental origin is the most common type of cutaneous fistula that is formed on the face and neck. This lesion can be a diagnostic challenge to clinicians who are not familiar with cutaneous fistula since many patients with cutaneous fistula of dental origin do not have any complaints such as toothache. Diagnostic errors may result in multiple excisions, biopsies, and ineffective long-term antibiotic therapy. However, if the lesion could be suspected of being of dental origin, the diagnosis can be easily confirmed by radiologic examinations. We report four cases of cutaneous fistula of dental origin. All four patients had a characteristic cutaneous findings with chronically draining, fixed, erythematous papule on their nasolabial fold or submental region. Ultrasonography, fistulography or plain roentgenography were needed to confirm the diagnosis of cutaneous fistula originating from dental problems.
Biopsy ; Cutaneous Fistula* ; Diagnosis ; Diagnostic Errors ; Humans ; Nasolabial Fold ; Neck ; Radiography ; Toothache ; Ultrasonography

BACKGROUND: Pneumonia is a common medical complication after acute stroke, and makes a considerable influence on the prognosis. It is potentially preventable or treatable if early recognized. Thus, the identification of which patients are at risk for the development of pneumonia is clinically significant. METHODS: A total of 240 patients with an acute stroke who were consecutively admitted to a Seoul National University Hospital were studied. The following prognostic factors were accounted for in the statistical analyses: age, sex, hypertension, diabetes, cardiac disease, smoking, recurrent stroke, NIHSS, modified Rankin scale (mRS), the presence of dysphagia, blood pressure, body temperature, white blood cell count, blood sugar, fibrinogen, Levin tube insertion, Foley catheter insertion, and subtype of stroke. RESULTS: Pneumonia was diagnosed in 36 (17.0%) patients during the acute stage of stroke, particularly within 2 weeks. Average admission stay of patients with pneumonia was 38.7 days, whereas it was 19.3 days for those without pneumonia. By multivariate analysis, Levin tube insertion, body temperature, recurrent stroke, and mRS were significant predictor of pneumonia development. Forty percent of patients with four or five points of mRS developed pneumonia, compared to 6% in less than four points. CONCLUSIONS: Our results show that the patients who have Levin tube, high mRS, or recurrent stroke tend to develop pneumonia after acute stroke. It is important for early detection and prevention of pneumonia in patients with high mRS.
Blood Glucose ; Blood Pressure ; Body Temperature ; Catheters ; Deglutition Disorders ; Fibrinogen ; Heart Diseases ; Humans ; Hypertension ; Leukocyte Count ; Multivariate Analysis ; Pneumonia* ; Prognosis ; Seoul ; Smoke ; Smoking ; Stroke*

OBJECTIVE: Magnetic resonance imaging (MRI) grading systems using sagittal images are useful for evaluation of lumbar foraminal stenosis. We evaluated whether such a grading system is useful as a diagnostic tool for surgery. METHODS: Between July 2014 and June 2015, 99 consecutive patients underwent unilateral lumbar foraminotomy for lumbar foraminal stenosis. Surgically confirmed foraminal stenosis and the contralateral, asymptomatic neuroforamen were assessed based on a 4-point MRI grading system. Two experienced researchers independently evaluated the MR sagittal images. Interobserver agreement and intraobserver agreement were analyzed using κ statistics. RESULTS: The mean age of patients (54 women, 45 men) was 62.5 years. A total of 101 levels (202 neuroforamens) were evaluated. MRI grades for operated neuroforamens were as follows: Grade 0 in 0.99%, Grade 1 in 5.28%, Grade 2 in 14.85%, and Grade 3 in 78.88%. Interobserver agreement was moderate for operated neuroforamens (κ=0.511) and good for asymptomatic neuroforamens (κ=0.696). Intraobserver agreement by reader 1 for operated neuroforamens was good (κ=0.776) and that for asymptomatic neuroforamens was very good (κ=0.831). In terms of lumbar level, interobserver agreement for L5–S1 (κ=0.313, fair) was relatively lower than the other level (κ=0.804, very good). CONCLUSION: MRI grading system for lumbar foraminal stenosis is thought to be useful as a diagnostic tool for surgery in the lumbar spine; however, it is less reliable for symptomatic L5–S1 foraminal stenosis than for other levels. Thus, various clinical factors as well as the MRI grading system are required for surgical decision-making.
Constriction, Pathologic* ; Female ; Foraminotomy ; Humans ; Lumbar Vertebrae ; Magnetic Resonance Imaging* ; Spinal Stenosis ; Spine

The purpose of this study was to assess the comorbid axis-II disorders of obsessive compulsive disorder(OCD) patients and to investigate the relationship between symptoms of OCD and the comorbid personality traits. The subjects were 59 patients who met DSM-IV criteria for obsessive-compulsive disorder and 32 normal controls. All subjects completed Personality Disorder Questionnaire-IV(PDQ-IV). The patients completed Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI), and were rated with Yale-Brown Obsessive Compulsive Scale(YBOCS). The results were as follows. 1) The OCD patients showed significantly higher prevalence of avoidant, depresssive and borderline personality disorder(p<0.01) compared to controls. 2) The BAI score had significant effect on the avoidant personality score(t=3.23, p<0.003). The BDI score had significant effect on the depressive personality score(t=3.08, p=0.004). The YBOCS(t=2.10, p=0.043) and BAI(t=2.60, p=0.014)scores had significant effects on the borderline personality score. We found that OCD patients had higher prevalence of avoidant, depressive, and borderline personality disorders. We also found that obsessive-compulsive symptoms have significant effect on the severity of borderline personalty traits. We suggest that it would be very helpful to consider Axis-II disorders for managing patients with obsessive-compulsive disorder.
Anxiety ; Borderline Personality Disorder ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Obsessive-Compulsive Disorder* ; Personality Disorders ; Prevalence

PURPOSE: Adenoid cystic carcinoma is a rare type of eccrine sweat gland carcinoma. Although it is mostly known as a neoplasm of the salivary gland, it could occur as a primary skin tumor. We present a patient with a primary cutaneous adenoid cystic carcinoma at the genital area. METHODS: A 60-year-old man had a slowly growing 1 cm sized single tender mass near the left scrotum and he underwent excisional biopsy at a local clinic. A diagnosis of adenoid cystic carcinoma was made and thus he was transferred to our hospital. In physical examination, other specific findings were not detected except a linear scar caused by a previous skin biopsy near the left scrotum. In CT scan, PET-CT scan and endoscopy, there was no evidence of neoplasm in other organs. It was diagnosed as the primary cutaneous adenoid cystic carcinoma and then wide excisions were performed including total 4.5cm margin of normal skin. RESULTS: Microscopic findings revealed proliferation of tumor cell islands with cribriform or tubular patterns containing several round, pseudocystic structures. The tumor cells showed basaloid cells with uniform and small nuclei. Tumor cells infiltrated into the dermis and upper portion of subcutaneous tissue. There was multifocal perineural invasion of tumor cells. In postoperative 6 months, we found no recurrence and other complications. CONCLUSION: Herein we found a rare case of primary cutaneous adenoid cystic carcinoma at the genital area.
Adenoids ; Biopsy ; Carcinoma, Adenoid Cystic ; Cicatrix ; Dermis ; Endoscopy ; Humans ; Islands ; Middle Aged ; Physical Examination ; Recurrence ; Salivary Glands ; Scrotum ; Skin ; Subcutaneous Tissue ; Sweat Glands

The paper by Lee YJ et al. [1] was printed with spelling errors.

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate