PURPOSE: Orthotopic neobladder following radical cystectomy are currently preferred to the other urinary diversions. We have compared three different ureteroenteric anastomoses regarding change of the upper urinary tracts and evaluated correlation between the length of bowel used for bladder reconstruction and metabolic acidosis. MATERIALS AND METHODS: Between Sep. 92 and Jul. 97, 37 patient(range 34-69 yrs) with bladder cancer underwent an orthotopic Mainz pouch with antireflux submucosal tunnel(n=10), an ileal low-pressure bladder substitute with direct ureteroileal anastomosis(Stuffier, n=15) and an ileal W-neobladder with serouslined ertramural tunnel(Ghoneim, n=12) following radical cystectomy Mean follow up was 22 months(7-64 twos). IVP and VCUG were performed at 6, 12 months postoperatively and annually thereafter. The measurement of serum electrolyte and/or arterial blood gas analysis were carried out every 3-6 months. RESULTS: The vesicoureteral reflux occurred in 37%(11/30 renal unit) with Stuffier pouch, 10%(2/20) with Mainz pouch, and none with Ghoneim(p=0.01). Moderate to severe hydronephrosis resulting from reflux was noted in 4 renal units with Stuffier pouch, while an atrophic kidney due to obstruction at ureteroenteric anastomosis was noted with each Mainz pouch and Ghoneim. Metabolic acidosis was identified in 5 patients(33%) with an Stuffier pouch whereas it was noted in less than 10% with Mainz pouch and Ghoneim(p=0.07). Two patients with deteriorated renal function need bicarbonate replacement therapy for correction of metabolic acidosis. CONCLUSIONS: Although most patients with direct ureteroileal anastomosis preserved renal function, antireflux ureteroenteric anastomosis using submucosal tunnel or serous-lined extramural tunnel is better in terms of occurrence of hydronephrosis and vesicoureteral reflux. The length of bowel less than 45cm used for bladder reconstruction may avoid metabolic acidosis
Acidosis* ; Blood Gas Analysis ; Cystectomy ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion ; Urinary Tract* ; Vesico-Ureteral Reflux

According to the ophthalmic literature, the lack of epicanthus and termi-nal hairs at the medial side of punctum are unique features in most non-Asian eyelids.We wanted to examine the presence of terminal hairs at the medial side of punctum in Asian.A study was designed to examine 416 eyes of 208 patients who had visited our hospital between March 1999 and Sep-tember 1999.Physical examination included the presence of epicanthus, terminal hairs at the medial side of punctum, upper eyelid crease and pruritus in medial canthal area.The mean age of the patients was 56.5 years.Epi-canthus was seen in 256 eyes of 416 eyes (61.5%).The upper lid creases were detected in 242 eyes of 416 eyes (58.2%)and classified mostly as the medial tapering and lateral flaring type (83.5%).There were 250 eyes of 416 eyes (60.1%)who had terminal hairs at the medial side of punctum.Sixty eyes of 416 eyes (14.4%)complained of itching sensation in medial canthal area and had experienced once or two times per week (70.0%).They com-posed of 44 eyes of 60 eyes (73.3%)with epicanthus and terminal hairs, 10eyes of 60 eyes (16.7%)with only terminal hairs, and 6 eyes of 60eyes (10.0%)with only epicanthus.In our study, we found many patients had terminal hairs at the medial side of punctum in Asian and the presence of epicanthus and terminal hairs caused itching sensation at medial canthal area.
Asian Continental Ancestry Group ; Eyelids ; Hair ; Humans ; Pruritus* ; Sensation

This study investigated the effect of leuprolide acetate treatment on sex offenders' sexual fantasies and behaviors, as well as on their criminogenic psychological character and the risk of second conviction. The study participants consisted of 22 sex offenders who were confined to the National Institute of Forensic Psychiatry. Among them, 9 patients were given off-label leuprolide acetate for three months to inhibit sexual impulses, whereas the others were not given any medication. All sex offenders underwent two psychological evaluations; the first evaluation was conducted before starting medication, and the second was conducted after medication. Wilson's Sex Fantasy Questionnaire (WSFQ), the Rape Myth Acceptance Scale (RMAS), and the Endorsement of Violence Scale (EVS) were used for evaluation. Leuprolide acetate-treated sex offenders showed a statistically significant decline in the total WSFQ score (p < 0.05). However, the RMAS and EVS scores did not differ after leuprolide acetate treatment, indicating that cognitive distortions like rape myth acceptance and endorsement of violence were unchanged after leuprolide medication. Leuprolide acetate may reduce deviant sexual impulses and fantasies, as suggested by previous research form Korea and other countries. However, it probably cannot alter cognitive distortion. On the basis of these findings, we recommend a combination of leuprolide medication and other therapies, like cognitive behavioral therapy, for the treatment of paraphilic sex offenders.
Cognitive Therapy ; Criminals ; Fantasy ; Forensic Psychiatry ; Humans ; Korea ; Leuprolide ; Paraphilic Disorders ; Rape ; Violence ; Surveys and Questionnaires

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.
Alprostadil ; Diabetes Mellitus ; Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies* ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine ; Priapism ; Treatment Outcome

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.
Brain ; Carcinoma, Renal Cell* ; Chemistry ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Nephrons* ; Physical Examination ; Recurrence* ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.
Digital Rectal Examination ; Humans ; Jeollabuk-do ; Korea ; Male ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Reference Values*

Abnormal aggregation of α-synuclein is a key element in the pathogenesis of several neurodegenerative diseases, including Parkinson’s disease (PD), dementia with Lewy bodies, and multiple system atrophy. α-synuclein aggregation spreads through various brain regions during the course of disease progression, a propagation that is thought to be mediated by the secretion and subsequent uptake of extracellular α-synuclein aggregates between neuronal cells. Thus, aggregated forms of this protein have emerged as promising targets for disease-modifying therapy for PD and related diseases. Here, we generated and characterized conformation-specific antibodies that preferentially recognize aggregated forms of α-synuclein. These antibodies promoted phagocytosis of extracellular α-synuclein aggregates by microglial cells and interfered with cell-to-cell propagation of α-synuclein. In an α-synuclein transgenic model, passive immunization with aggregate-specific antibodies significantly ameliorated pathological phenotypes, reducing α-synuclein aggregation, gliosis, inflammation, and neuronal loss. These results suggest that conformation-specific antibodies targeting α-synuclein aggregates are promising therapeutic agents for PD and related synucleinopathies.

Purpose: This study assessed the relationship between newly developed normal-tension glaucoma (NTG) and androgen deprivation therapy (ADT) in patients with prostate cancer. Materials and Methods: A retrospective population-based cohort study was performed. During the period between 2008 and 2017, a total of 218203 prostate cancer patients were identified in a nationwide claims database in the Republic of Korea. The final analysis included 170874 patients (42909 in the ADT group, 127965 in the control group) after applying the inclusion and exclusion criteria. The incidences of NTG according to ADT duration were compared with controls. Exact matching was conducted to adjust comorbidities between cohorts. Cox proportional hazard regression models were performed after controlling for latent confounding factors, and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of NTG according to ADT were obtained. Results: In the matched cohort, the ADT group was associated with a significantly reduced risk of NTG in multivariable analysis compared to the control group. The risk of NTG decreased in patients who underwent ADT for less than 2 years (HR=0.824; 95% CI, 0.682–0.995; p=0.0440) and in those using ADT over 2 years (HR=0.796; 95% CI, 0.678–0.934; p=0.0051), compared to the controls. Conclusion Medical castrations for patients with prostate cancer results in a lower incidence of newly diagnosed NTG compared to no ADT. These findings suggest that testosterone may be involved in the pathogenesis of NTG.