PURPOSE: The cause of erectile dysfunction (ED) is mostly organic in nature and is associated with cardiovascular disease. Therefore, the presence of ED has been shown to be related to cardiovascular risk factors such as coronary artery disease, hypertension, diabetes mellitus (DM), and hyperlipidemia. This study evaluated the correlation between cardiovascular risk factors and penile hemodynamic parameters in men with ED. MATERIALS AND METHODS: The relationship between vascular risk factors and penile hemodynamic parameters were evaluated in a total of 149 men with ED. The patients were stratified according to the type and number of risk factors present. Each patient underwent a penile duplex Doppler ultrasound study after injections of intracavernous prostaglandin E1 to evaluate penile blood flow parameters. The rates of arterial insufficiency, venoocclusive dysfunction, and nonvascular etiologies were also evaluated. These results were statistically compared with those from patients with ED without vascular risk factors. RESULTS: The poorest blood flow was found in patients with ED with DM. Arterial insufficiency was most prevalent in patients with coronary artery disease and DM (p<0.05). Venoocclusive dysfunction was observed most often in hypertensive patients with ED. Abnormal penile blood flow parameters correlated with the number of vascular risk factors present. CONCLUSIONS: This study shows that cardiovascular risk factors are associated with abnormal penile blood flow. In addition, the number of risk factors is correlated with an increased probability of having abnormal blood flow parameters.
Alprostadil ; Cardiovascular Diseases ; Coronary Artery Disease ; Diabetes Mellitus ; Erectile Dysfunction ; Hemodynamics ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Risk Factors ; Ultrasonography, Doppler, Color

Henoch-Schoenlein purpura is predominantly a childhood disease with good prognosis. It is characterized by nonthrombocytopenic purpura, arthritis, arthralgia, gastrointestinal symptoms and glomerulonephritis. Abdominal pain is the most common gastrointestinal symptom, however, some patient with Henoch-Schoenlein purpura have gastrointestinal major surgical complication such as intussusception, bowel infarction, necrosis, stricture and perforation. We report a case of duodenal perforation in a 6-year-old boy with Henoch-Schoenlein purpura, being treated with corticosteroids.
Abdominal Pain ; Adrenal Cortex Hormones ; Arthralgia ; Arthritis ; Child* ; Constriction, Pathologic ; Glomerulonephritis ; Humans ; Infarction ; Intussusception ; Male ; Necrosis ; Prognosis ; Purpura* ; Purpura, Schoenlein-Henoch

PURPOSE: A lateral neck node metastasis is common in patients with papillary thyroid carcinoma. If a preoperative diagnosis is not made or is uncertain, an intraoperative biopsy for a frozen examination should be considered. The aims of this study were to evaluate the factors predicting a lateral neck node metastasis and to suggest guidelines for an intraoperative neck node biopsy. METHODS: From March 2003 to January 2006, 79 patients (7 males, 72 females) with 89 intraoperatively biopsied lateral neck nodes were enrolled in this study. The median age was 45 years. Among these patients, two or more lateral neck nodes were biopsied intraoperatively in 9 patients and one node was biopsied in the others. The clinicopathological features and radiological findings were reviewed. RESULTS: Among the 79 patients with 89 lateral neck nodes, 25 patients with 26 lateral neck nodes (29%) showed a metastasis. Univariate analysis revealed the computed tomography (CT) findings of lateral neck nodes such as a longitudinal size >1 cm (P=0.001), postcontrast Hounsefield Unit (HU) >110 (P<0.001), presence of necrosis (P<0.001), absence of hilum (P<0.001), and irregular margin (P<0.001) were found to be significant predicting factors. The pathologic findings of tumors such as multifocality (P= 0.006), bilaterality (P=0.001), tumor size >2 cm (P=0.008), extracapsular invasion (P=0.005) had significant impact on a lateral neck node metastasis. Multivariate analysis revealed a longitudinal size >1 cm (P=0.039), postcontrast HU >110 (P<0.001), and bilaterality of the tumor (P= 0.001) with a suspiciously enlarged lateral neck node in CT to have a significant impact on node metastasis. However, bilateral tumor with lymph nodes >110 HU were the most important factors. CONCLUSION: The most significant factors influencing lateral neck node metastasis were multifocal, bilateral, large size (2 cm < or = ), extracapsular invasion of the primary tumor, and the CT findings of lymph nodes such as a large longitudinal size (1 cm < or =), necrosis, the absence of hilum, irregular margin and increased postcontrast HU (110 < or =).
Biopsy ; Carcinoma, Papillary ; Diagnosis ; Humans ; Lymph Nodes ; Male ; Multivariate Analysis ; Neck* ; Necrosis ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications. MATERIALS AND METHODS: This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change. RESULTS: At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed. CONCLUSIONS: The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.
Anticoagulants ; Follow-Up Studies ; Hemoglobins ; Humans ; Laser Therapy ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Volatilization

PURPOSE: We retrospectively investigated the changes of prostate cancer detection rate according to patients prostate volume, age with prostate-specific antigen (PSA) levels of above 4.0ng/ml. MATERIAL AND METHODS: Data were collected from 663 patients who underwent 10 core prostate biopsy for elevated PSA above 4.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. Prostate cancer detection rate was calculated according to prostate volume (less than 40 vs 40 or more 40ml) and age (less than 60, 60-69, 70-79, 80 or more years old). Also we compared prostate cancer detection rate according to PSA levels (4-10 vs 10-20ng/ml). RESULTS: Among the 663 patients who underwent prostate biopsy, prostate cancer was detected in 134 patients (20.2%). There were no stastically difference in mean age, mean prostate volume, and mean PSAD except mean PSA (13.9 vs 11.9ng/ml) between cancer and non-cancer groups. The cancer detection rate in small prostate was significantly higher than large prostate (23.5% vs 16.0%). The cancer detection rate was significantly increased with age: from 14.5% for below 60 year-old patients to 30.3% for the 80 or more year-old patients. There was no significant difference in cancer detection rate between the two PSA groups (19.0 vs 20.5%). CONCLUSION: Prostate cancer detection rate was higher in old patients and patients with small prostate volume. The older age group and the patients with small prostate volume was considered as the important factors to decide whether biopsy of prostate is needed.
Biopsy ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies

PURPOSE: Many centers rely on radiologists to detect prostate cancer by transrectal ultrasound guided prostate biopsy. In this study we evaluated transrectal ultrasound guided prostate biopsy by radiologist or urologist, and compared prostate cancer detection rate, pathologic results and pain scrore. MATERIAL AND METHODS: In all, 259 consecutive patients had transrectal ultrasound guided prostate biopsy by one radiologist (group 1) and one urologist (group 2). The indication for prostate biopsies were a raised or rising prostate specific antigen (PSA) level or abnormal digital rectal examination (DRE). All data were collected prospectively. RESULTS: Both group showed comparable demographic data in age, PSA, prostate volume. But pain score showed higher in urologist group (p<0.05). Prostate cancer was detected in 73 patients (28.1%). Radiologist detected prostate cancer in 38 patients (29.2%) and urologist detected prostate cancer in 35 patients (27.1%) (p=0.70). Both groups showed comparable cancer detection rates in PSA of <4, 4-10 and >10 ng/ml. Both groups had similar Gleason score (6.8+/-0.7 vs 6.7+/-0.8) and number of cancer cores (3.0+/-1.7 vs 3.9+/-2.3). Group 1 showed significantly low visual analogue pain scale compared with Group 2 (2.9+/-1.9 vs 4.0+/-2.1)(p<0.05). CONCLUSION: Transrectal ultrasound guided prostate biopsy showed equally reliable datas whether performed by radiologist or urologist. The urologist can effectively perform transrectal ultrasound guided prostate biopsy like radiologist in detecting prostate cancer. Also we recommend to perform anesthesia to relieve pain before prostate biopsy and furthermore future studies with more patients with more datas are needed.
Anesthesia ; Biopsy ; Digital Rectal Examination ; Humans ; Neoplasm Grading ; Pain Measurement ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Urology

Pulmonary thromboembolism (PTE) increases the pressure of the right ventricle and leads to symptoms and signs, such as dyspnea and hypoxia. If PTE causes hemodynamic instability, thrombolytic therapy should be considered. A mechanical thrombectomy is an alternative treatment to thrombolytic therapy and should be considered when thrombolytic therapy is contraindicated. Various devices are used in mechanical maceration and catheter-directed thrombolysis, but there is no standard mechanical device for PTE as yet. We report here on 2 clinical experiences of mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombolytic device to remove residual clots after systemic thrombolysis in patients with massive PTE.
Anoxia ; Dyspnea ; Heart Ventricles ; Hemodynamics ; Humans ; Pulmonary Embolism* ; Thrombectomy ; Thrombolytic Therapy

PURPOSE: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). METHODS: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. RESULTS: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was 0.504+/-0.037 mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). CONCLUSION: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.
Cohort Studies* ; Emergencies* ; Emergency Medical Services ; Emergency Medical Technicians ; Hospitals, Urban ; Humans ; Occupational Exposure ; Prospective Studies ; Radiation Dosage ; Thorax

PURPOSE: To determine the efficacy and safety of endoscopic resection and ablation of superficial varicose vein using a powered vein resector and irrigated illuminator. METHODS: Forty-three limbs in 29 patients were involved in our hospital study. The clinical records between August 2002 and February 2004 were reviewed. All patients were treated with a minimally invasive, powered vein resecting device, using cutaneous transillumination and tumescent fluid under general or spinal anesthesia. RESULTS: The 29 varicose vein patients were composed, (19 men (65.5%) and 10 women (34.5%), with a mean age of 56.9 years. The most common symptom or sign of varicose vein was an unsightly vein (15 patients, 51.7%). Fifteen unilateral (5: right, 10: left) and 14 bilateral operation for varicose veins were performed. The mean operative time, number of skin incisions and length of hospital stay were 34.2 minutes, (ranging from 26 to 58, 3.2 sites, (ranging form 2 to 6) and 3.3 days, (ranging from 2 to 6). Postoperative complications occurred in 12 limbs (27.9%), including skin perforation (1 limb, 2.3%), wound abscess (1 limb, 2.3%), cellulitis (1 limb, 2.3%), lower limb pain (4 limbs, 9.3%), edema (2 limbs, 4.7%), hematoma (1 limb, 2.3%), remaining varicose vein (1 limb, 2.3%) and paresthesia (1 limb, 2.3%). CONCLUSION: This study showed that the TIPP (TriVexTM) technique for varicose vein removal was swift and efficacious. When performed by trained surgeons the complication rates of the technique were comparable with those of conventional surgery, with the advantages of a trend toward reduced operating times in extensive varicose vein, and significantly fewer incisions.
Abscess ; Anesthesia, Spinal ; Cellulitis ; Edema ; Extremities ; Female ; Hematoma ; Humans ; Length of Stay ; Lower Extremity* ; Male ; Operative Time ; Paresthesia ; Postoperative Complications ; Skin ; Transillumination ; Varicose Veins* ; Veins ; Wounds and Injuries

A gastrocolic fistula is a fistulous communication between a segment of colon and the stomach. It is a rare complication and is caused most commonly by a carcinoma of the colon or the stomach. Among the less common causes of a gastrocolic fistula are a benign gastric ulcer, chronic ulcerative colitis, Crohn's disease, a carcinoid tumor, syphillis, an intraabdominal abscess, a lymphoma, trauma, intestinal tuberculosis, and iatrogenic factors. Recently, the incidence of gastrocolic fistulas has decreased due to earlier diagnosis and treatment of stomach and colon cancer. The classic triad of symptoms are lienteric diarrhea, feculent vomiting, and foul eructations, but all patients do not necessarily present with these symptoms. A gastrocolic fistula is usually diagnosed by using a barium enema, but occasionally can be detected by using an upper gastrointestinal series or endoscopy. Here, we report experience with a fistula between a cancerous transverse colon and the stomach and give a review of the literature.
Abscess ; Barium ; Carcinoid Tumor ; Colitis, Ulcerative ; Colon* ; Colon, Transverse ; Colonic Neoplasms* ; Crohn Disease ; Diagnosis ; Diarrhea ; Endoscopy ; Enema ; Eructation ; Fistula* ; Humans ; Incidence ; Lymphoma ; Stomach ; Stomach Ulcer ; Tuberculosis ; Vomiting