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: Currently many clinicians have recommendsprostate biopsy when the level of prostate specific antigen (PSA) is higher than 4.0 ng/ml. However, recently the prostate cancer detection rates werereported to be about 20% at PSA level 2.5 to 4.0 ng/ml. Therefore, an increasing amount of hospitals have recommends lowering the PSA cut off level to 2.5 ng/ml. We retrospectively evaluated the prostate cancer detection rate and pathologic characteristics of patients with PSA level of 2.5 to 4.0 ng/ml and we compared this with the patients who had PSA level in the range of 4.1 to 10.0 ng/ml. MATERIAL AND METHODS: We analyzed the data of 515 patients who received prostate biopsy in the range of PSA level 2.5 to 10 ng/ml. The clinical characteristics, cancer detection rate and pathologic findings of the biopsy were compared between the PSA 2.5-4.0 ng/ml group and PSA 4.1-10.0 ng/ml group. RESULTS: Cancer detection rates in patients who underwent biopsy were 18.1% and 22.4% at PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. Mean Gleason scores were found 6.4+/-0.5 and 6.6+/-0.7 and high grade cancers with Gleason score 7 or more were found in 50% and 58.4% of patients with cancer with PSA 2.5 to 4.0 and 4.1 to 10.0 ng/ml, respectively. There were no significant difference between the 2 groups in cancer detection rates and pathologic findings on biopsy including mean Gleason score and high grade cancers with Gleason score 7 or more between two groups. CONCLUSION: There were no significant difference in cancer detection rates and pathologic findings between PSA 2.5-4 ng/ml group and PSA 4.1-10 ng/ml group. These results suggest that a lower PSA cutoff should be considered as an indication for prostate biopsy in the Korean population.
Biopsy ; Humans ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies

BACKGROUND: The purpose of this study was to identify the factors that influence mortality in organophosphate intoxication and the differences between the elderly (> or =65 years) and younger adults (18-64 years) looking at vital sign, length of admission, cholinesterase activity, complications, and prognosis. METHODS: All patients visiting one Emergency Department (ED) with organophophate intoxication between January 2000 and December 2011 were reviewed retrospectively. We divided the patients into two groups, geriatric adults (> or = 65 years) and nongeriatric adults (18-64 years). RESULTS: During the study period, 155 patients (45 patients, > or =65 years; 110 patients, 18-64 years) presented to the ED with organophosphate intoxication. Thirty-six elderly patients (80.0%) vs. 63 younger adult patients (57.3%) were intubated endotracheally, with the analysis showing a clear distinction between the two groups (p=0.026). Twenty-two elderly patients (48.9%) vs. 23 younger adult patients (20.9%) went into shock, displaying a significant gap (p=0.008). Thirtyfive elderly patients (81.4%) vs. 62 younger adult patients (59.0%) developed respiratory complications and 20 elderly patients (46.5%) vs. 19 younger adult patients (18.1%) developed central nervous system complications, with obvious differences seen in each of the comparison at (p=0.031) and (p=0.005), respectively. Comparing plasma cholinesterase levels at 1st, 3rd, 5th, 10th, 15th, and 20th days, the rate of increase was faster in the younger adults (p=0.022). CONCLUSION: With organophosphate intoxication, elderly patients tended to be intubated endotracheally, went into shock, developed central nervous system complications, were more severe, and showed a slower increase in cholinesterase level.
Adult ; Aged ; Central Nervous System ; Cholinesterases ; Emergencies ; Humans ; Mortality ; Organophosphate Poisoning ; Plasma ; Prognosis* ; Retrospective Studies ; Shock ; Vital Signs

A stercoral perforation of the colon is a very rare condition, which results from stercoral ulcers due to severe, prolonged constipation, and has a very high mortality rate. Herein is presented four cases of stercoral perforation of the sigmoid colon. All the patients were female. They had long standing and severe constipation, with peritonitis, prior to admission. Plain chest or abdominal X-rays revealed the presence of abdominal free air in all cases, and so emergent operations were undertaken. Fecalomas were found in the colon or abdominal cavity, with round and spherical shaped perforated sites. Microscopically, the edges of the ulcers were compressed with the accumulation of lymphocytes. A resection of the perforated colon with a proximal colostomy was performed in one case, a primary closure of the perforated colon and a proximal colostomy in another and a Hartmann's colostomy in the remaining two cases.
Abdominal Cavity ; Colon* ; Colon, Sigmoid ; Colostomy ; Constipation ; Female ; Humans ; Lymphocytes ; Mortality ; Peritonitis ; Thorax ; Ulcer

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: 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: 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

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