PURPOSE: Erectile dysfunction has variety of etiologic factors and it has been a common medical disorder with an estimated prevalence of about 50%. It has been confirmed that sildenafil improved impaired erectile responses in men. We evaluated the efficacy and safety of oral sildenafil for the patients with erectile dysfunction in Korea. MATERIALS AND METHODS: 583 patients were administered sildenafil for erectile dysfunction and 256 of them have been followed up over one month. The initial usual dosage was 50mg and the dosage was titrated based on efficacy and tolerance at every visit. Sexual function was measured before and during the therapy using International Index of Erectile Function (IIEF). RESULTS: Mean IIEF score changed significantly from 27.93+/-18.52 at baseline to 44.57+/-16.56 after treatment with sildenafil (p<0.001) and the mean scores of each IIEF domain (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) also improved (p<0.001). Q3 (penetration ability) and Q4 (maintenance ability) scores changed from 2.08+/-1.69 to 3.21+/-1.50 (p<0.001) and from 1.77+/-1.50 to 2.96+/-1.44 (p<0.001), respectively. In response to the global efficacy question, 73.4% of patients reported that treatment had improved their erections. With respect to the etiology, IIEF was changed significantly in DM group and no specific underlying disease group (p<0.001), but in radical prostatectomy or cystectomy group no significant change was observed. Side effects were reported in 56 patients (21.9%), including facial flushing (11.7%), headache (7.0%), dyspepsia (2.0%), altered vision (1.6%), nasal congestion (1.6%), conjunctival injection (1.2%), dyspnea (0.8%), dizziness (0.8%), and palpitation (0.8%). Only 4 patients (1.6%) discontinued treatment due to the side effects. CONCLUSIONS: Sildenafil citrate is a highly effective and well-tolerated oral agent for the treatment of erectile dysfunction in Korean men.
Citric Acid ; Cystectomy ; Dizziness ; Dyspepsia ; Dyspnea ; Erectile Dysfunction* ; Estrogens, Conjugated (USP) ; Flushing ; Headache ; Humans ; Korea* ; Male ; Orgasm ; Prevalence ; Prostatectomy ; Sildenafil Citrate

PURPOSE: Poor living conditions such as overcrowding and sharing a bed are reported to be significant risk factors for H. pylori infection throughout childhood. We investigated the prevalence of Helicobacter pylori infection in Korean athletes who are obliged to live together in training camps over six months a year. METHODS: Blood sampling and surveying through questionnaire were performed on 440 regular high school students (228 boys and 212 girls) and 220 athletes (148 boys and 72 girls) of a physical education high school. We measured serum IgG Ab to H. pylori in order to compare the prevalence of H. pylori infection between normal adolescents and athletes. In addition, we conducted a nutritional analysis and questionnaire survey for socioeconomic status in order to compare other risk factors that might influence H. pylori infection between groups. RESULTS: The prevalence (43.2%) of H. pylori infection in athletes was higher than that (22.7%) in the controls. No significant differences in the nutritional factors or socioeconomic status, such as Hollingshead index, type of house, and crowding index, were found between the groups. Multivariate analysis showed that crowding and the difference in school type were the significant predictors of H. pylori seropositivity after controlling for dietary and socioeconomic factors. CONCLUSION: Living together in training camps might be a significant risk factor for H. pylori infection in athletes.
Adolescent* ; Athletes* ; Crowding ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Multivariate Analysis ; Physical Education and Training ; Prevalence ; Surveys and Questionnaires ; Risk Factors ; Seroepidemiologic Studies* ; Social Class ; Social Conditions ; Socioeconomic Factors

PURPOSE: Helicobacter pylori has been known to have diverse vacA allelic types. The purpose of the study was to identify vacA diversity in Korea and design new primers for signal sequence alleles indigenous to Korea. METHODS: Fifty antral biopsy specimens, which had been proven to be H. pylori-positive, were examined for vacA status; signal sequence and mid-region. After PCR amplification and DNA sequencing, vacA alleles of Korean H. pylori strains were compared with those from other countries. RESULTS: Among Korean H. pylori strains vacA alleles with all combinations of signal sequence and mid-region were found, with the exception of s1b or s2. vacA genotype s1c/m1 was predominant in Korea. We found that GGGAGCGTTR in s1a and GGGGYTATTG in s1c were the indigenous sequences to Korea and constructed the new Korean specific primers for the vacA signal sequence; VASK-F, VASK-R, S1AK-F, and S1CK-F. CONCLUSION: This study showed that s1c/m1 is the predominant type of vacA allele in Korea. We designed new primers for the vacA signal sequence.
Alleles ; Biopsy ; Genotype ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Mosaicism* ; Polymerase Chain Reaction ; Protein Sorting Signals* ; Sequence Analysis, DNA

OBJECTIVE: Left ventricular (LV) filling pressure can be estimated using echocardiographic measurements, including the ratio of transmitral early peak flow velocity to tissue Doppler mitral annular motion velocity (E/e′) during sinus rhythm. However, non-invasive echocardiographic estimation is complicated in patients with atrial fibrillation (AF). AF is associated with reduced survival in patients with heart failure with preserved LV ejection fraction (LVEF). The aim of this study was to investigate echocardiographic parameters for predicting LV filling pressure and diastolic function in chronic AF patients with preserved LVEF. METHODS: Clinical data, echocardiographic findings, and laboratory data were assessed retrospectively in 90 chronic AF patients with preserved LVEF who underwent diagnostic left-heart catheterization between January 2011 and September 2015. LV end-diastolic pressure (LVEDP) assessment and standard echocardiographic measurements were performed. RESULTS: The E/e′ ratio was significantly correlated with LVEDP (r=0.449, P < 0.001). Receiver operating characteristic analysis defined the optimal cut-off for E/e′ as 13 (sensitivity, 88%; specificity, 67%) to predict elevated LVEDP (>15 mm Hg). E (r=0.463, P < 0.001) and E/propagation velocity (Vp; r=0.471, P < 0.001) were also correlated with LVEDP. E >90 cm/sec predicted elevated LVEDP with a sensitivity of 84% and a specificity of 70%. Also, an E/Vp >1.6 predicted elevated LVEDP with a sensitivity of 80% and a specificity of 72%. CONCLUSION: E >90 cm/sec, E/e′>13 and E/Vp >1.6 were suggestive of elevated LVEDP in these patients. Therefore, E, E/e′, and E/Vp provide significant predictive value for LVEDP in chronic AF with preserved LVEF.
Atrial Fibrillation* ; Catheterization ; Catheters ; Echocardiography* ; Heart Failure ; Humans ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume*

PURPOSE: A proper patient-physician interaction (PPI) creates rapport between doctors and patients and improves medical outcomes. The importance of PPI evaluation items was evaluated in each medical student in grades 3 and 4, before and after their clinical clerkship. METHODS: Six PPI evaluation guidelines (SEGUE, Kalamazoo Consensus, Calgary-Cambridge Guide, Macy guideline, 2 Korean Consortium guidelines) were selected and importance of each guideline was evaluated through the structured questionnaire in 73 pre-clinical clerkship (3rd-grade) and 78 post-clinical clerkship (4th-grade) medical students. RESULTS: The importance of medical communication items among total clinical performance, students-rated PPI portion was 21+/-9.7%. In SEGUE recommendations, 'Elicit information' was evaluated to be most important items before (58.3%) and after (65.8%) clinical clerkship. In Kalamazoo Consensus, 'Gathering information' was evaluated to be most important (49.3%/42.3%), same as in Calgary-Cambridge Guide (52.1%/56.4%) and Daegu Gyeongbuk Consortium (47.9%/43.6%). In the Macy guideline, 'Listening' was evaluated to be most important (28.8%/33.3%). In the Seoul Gyeonggi Consortium, 'Buidling relationships' was evaluated to be most important (23.3%/28.2%). CONCLUSION: In the 4th-grade post-clerkship medical students after clinical clerkship, importance of 'Gathering information' was evaluated to be less important, however, 'Giving information' and 'Understanding the patient perspective' was evaluated to be more important, compared to pre-clerkship students 3rd-grade students.
Clinical Clerkship ; Consensus ; Humans ; Students, Medical ; Surveys and Questionnaires

Strongyloides stercoralis is an intestinal nematode that infects a large portion of the world's population, especially in tropical climates, where the warm, moist soil offers an environment suited to the development of the larvae. In immuno-compromised hosts, receiving corticosteroids, immunosuppressive drugs or radiotherapy, especially in those with AIDS, large numbers of invasive strongyloides larvae can disseminate widely, which can be fatal. In Korea, several cases of strongyloides hyperinfection have been reported since 1959, and a case of strongyloides hyperinfection, accompanied with metastatic stomach cancer, was reported recently. We experienced a case of strongyloides infection, accompanied with early gastric cancer, and also suffering from bronchial asthma. The patient was treated with albendazole, 200 mg, twice-a-day for 3 days, 1 month after a radical gastric cancer operation. Thereafter, the respiratory symptoms of the patient, including asthmatic attacks, improved.
Adrenal Cortex Hormones ; Albendazole ; Asthma ; Humans ; Korea ; Larva ; Radiotherapy ; Soil ; Stomach Neoplasms* ; Strongyloides ; Strongyloides stercoralis* ; Tropical Climate

PURPOSE: This study was implemented to investigate the prevalence of proteinuria and its combined morbidity in apparently normal adults. METHODS: We examined the mass screening data of Health Promotion Center in Seoul National University Hospital from May 1, 1995 to February 11, 2000. The random urine samples of all screenees were examined by dipstick test. Among them 22,595 adults(men 11,737 and women 10,858) who didn't take anti- hypertensive medication and whose fasting blood sugar <126 mg/dL were included in this analysis. RESULTS: The prevalence of proteinuria was 6.7% in men and 3.6% in women. Risk factors for proteinuria by simple correlation analysis were age, sex, body weight, systolic blood pressure, diastolic blood pressure, fasting blood sugar, blood urea nitrogen, serum creatinine, total cholesterol and smoking. As the degree of proteinuria increased, the systolic and diastolic blood pressures also increased significantly and creatinine clearance significantly decreased above the '++' level of proteinuria. Probability of proteinuria was calculated at each blood pressure level graded by JNC VI. With the increase of the level of blood pressure, the probability of proteinuria increased significantly between normal and high normal, high normal and hypertension1, and hypertension 2 and hypertension 3 level. Creatinine clearance and blood pressure level showed negative correlation. When total screenees were divided to proteinuria and no proteinuria groups, proteinuria group showed significant decrease of creatinine clearance in high normal and hypertension 1 level. CONCLUSION: Our results suggest that proteinuria in the apparently normal adults is not a benign condition, and it can be accompanied by significantly increased blood pressures and decreased renal function.
Adult* ; Blood Glucose ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Cholesterol ; Creatinine ; Fasting ; Female ; Health Promotion ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence* ; Proteinuria* ; Risk Factors ; Seoul ; Smoke ; Smoking

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilatation and recurrent lower respiratory tract infections. It is thought to be due to a congenital anomaly. A diagnosis is typically made using computed tomography (CT) and bronchoscopy. Symptoms can range from minimal with preserved lung function to severe respiratory failure. Here, we present the case of a 50-year-old male who was referred to our hospital for chronic cough, sputum, and dyspnea. In addition, the patient showed tracheobronchomegaly with bronchomalacia on CT and bronchoscopy. This report describes a rare case of Mounier-Kuhn syndrome with a literature review.
Bronchomalacia ; Bronchoscopy ; Cough ; Dilatation ; Dyspnea ; Humans ; Lung ; Male ; Middle Aged ; Respiratory Insufficiency ; Respiratory Tract Infections ; Sputum ; Tracheobronchomegaly

Background: The optimal dose of radioactive iodine (RAI) therapy for N1b papillary thyroid carcinoma (PTC) is controversial. We evaluated the clinical outcome of N1b PTC patients treated with either 100 or 150 mCi of RAI. Methods: We retrospectively analyzed N1b PTC patients who underwent total thyroidectomy and postoperative RAI therapy at a tertiary referral center between 2012 and 2017. As the baseline characteristics differed between treatment groups, we performed exact matching for various pathological factors according to RAI dose. We evaluated the response to therapy and recurrence-free survival (RFS) in the matched patients. Structural recurrent/persistent disease was defined as new structural disease detected after initial therapy, which was confirmed by cytology or pathology. Results: Of the total 436 patients, 37 (8.5%) received 100 mCi of RAI and 399 (91.5%) received 150 mCi of RAI. After an exact 1:3 matching, 34 patients in the 100 mCi group and 100 patients in the 150 mCi group remained. There was no significant difference in response to therapy between the groups in the matched population (P=0.63). An excellent response was achieved in 70.6% (n=24) of patients in the 100 mCi group and 76.0% (n=76) in the 150 mCi group. Two (5.9%) patients in the 100 mCi group and four (4.0%) in the 150 mCi group had recurrence and there was no significant difference in RFS between the groups in the matched population (P=0.351). Conclusion There were no differences in response to therapy and RFS in N1b PTC patients according to RAI dose.

PURPOSE: C1q nephropathy (C1qN) is a rare glomerulonephritis characterized by mesangial deposits, predominantly C1q, without the evidence of systemic lupus erythematosus (SLE). It showed various clinical courses, however, the clinicopathologic features of C1qN have not been well defined as yet. METHODS: We retrospectively reviewed the clinicopathologic features of 11 patients (0.8%) diagnosed as C1qN among 1,403 patients aged > or = 18 years who had undergone renal biopsy due to primary glomerular disease from Jan. 2000 to Jan. 2009. Diagnostic criteria of C1qN were as follows; 1) the presence of dominant or co-dominant immunofluorescence staining for C1q in the mesangium, 2) corresponding mesangial dense deposit by electron microscopy, and 3) lack of clinical evidence of SLE. RESULTS: The male-to-female ratio was 6:5 and their mean age was 41.1+/-22.6 yrs (range, 19-69 yrs). Eight patients presented with urinary abnormalities and three with nephrotic syndrome. At the time of biopsy, three patients had hypertension. The mean value of 24-hour urine protein was 4.4+/-5.5 g/day (range, 0.5-18.5 g/day). On light microscopy, normal glomerular architecture (4/11) and segmental sclerosis (7/11) were observed. Complete or partial remission was achieved in six of the seven patients treated with immunosuppressive agents (steroid and/or immunosuppressants). Among these patients, two using steroid monotherapy had relapsed. The mean follow-up duration was 14+/-11 months (range, 2-31 months) and renal function deterioration was observed in three patients. CONCLUSION: C1qN showed various clinical manifestations and prognosis. Therefore, additional studies are needed to fully define the clinicopathologic features.
Aged ; Biopsy ; Fluorescent Antibody Technique ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Hypertension ; Immunosuppressive Agents ; Light ; Lupus Erythematosus, Systemic ; Microscopy ; Microscopy, Electron ; Nephrotic Syndrome ; Prognosis ; Retrospective Studies ; Sclerosis