PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding <4 times per night, and Group II had severe nocturia with voiding > or =4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia (<4 times/night) and of 2 times in patients with severe nocturia (> or =4 times/night) are needed to improve the QoL.
Deamino Arginine Vasopressin ; Humans ; Nocturia ; Quality of Life

BACKGROUND: Mortality and morbidity of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux symptoms after esophagogastrostomy continue to be a burden jeopardizing the quality of life. In the present study, we evaluated the quality of esophagogastrostomy by analyzing anastomotic stenosis and reflux esophagitis. MATERIAL AND METHOD: A retrospective analysis was made in 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. 53 patients of them received endoscopic examination during follow-up (29+/-23.6 months, range 5~111 months). Reflux esophagitis and stenosis at anastomostic site were analyzed according to the techniques and locations of esophagogastrostomy. RESULT: The median age at the time of repair was 60.3+/-8.87 years (range 39~81 years). 23 patients received a hand-sewn esophagogastric anastomosis and 30 patients a circular stapled one. There was no significant statistical difference in terms of anastomotic stenosis (p=0.64) and reflux esophagitis (p=0.41) between the two groups. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in anastomotic stenosis between the two groups was found (p=0.44), but reflux esophagitis was noted in 3 patients in the cervical anastomosis group and 14 patients in the intrathoracic anastomosis group (p=0.003). CONCLUSION: Cervical anastomosis was supposed to have a better quality of esophagogastrostomy by lowering the risk of reflux esophagitis. In the future, the comprehensive study including a patient's subjective symptom and Barrett's metaplasia should be performed in larger cases.
Anastomosis, Surgical ; Constriction, Pathologic ; Deglutition ; Endoscopy ; Esophageal Neoplasms ; Esophagectomy ; Esophagitis, Peptic ; Follow-Up Studies ; Humans ; Metaplasia ; Mortality ; Quality of Life ; Retrospective Studies

PURPOSE: We evaluated indications for chorionic villus sampling (CVS), the positive predictive value of CVS for fetal chromosomal abnormalities, and the fetal loss rate after CVS at CHA Medical Center. MATERIALS AND METHODS: We reviewed the medical records of 511 cases of CVS performed between 67 and 120 days of gestation for prenatal cytogenetic diagnosis from April 2000 to April 2010. Fetal karyotypes were obtained by direct and indirect culture methods. RESULTS: The most common indications for CVS were abnormal ultrasonic findings including increased nuchal translucency (294/635, 46.3%). The positive predictive value of abnormal karyotyping according to indication for CVS was highest in cases with abnormal parental karyotypes (14/21, 66.7%). Mosaicism revealed by CVS comprised 3.1% of the sample (16/509). Amniocentesis revealed two cases of true mosaicism and 11 cases of confined placental mosaicism. The fetal loss rate within 4 weeks of the procedure was 1.2% (6/511). CONCLUSION: If CVS is performed by an expert clinician, it is a feasible and reliable procedure for prenatal genetic diagnosis. When CVS indicates mosaicism, the finding should be confirmed by amniocentesis to distinguish true mosaicism from confined placental mosaicism.
Amniocentesis ; Chorion ; Chorionic Villi ; Chorionic Villi Sampling ; Chromosome Aberrations ; Cytogenetics ; Female ; Humans ; Karyotype ; Karyotyping ; Medical Records ; Mosaicism ; Nuchal Translucency Measurement ; Parents ; Pregnancy ; Ultrasonics

Osteogenesis imperfect (OI) is a generalized connective tissue disorder. We report the female neonate case with OI type III who showed severe bone deformities and fractures in utero. At birth, she showed multiple fractures in the clavicle, rib, femur, and wormian bone in the skull X-ray. We initiated pamidronate disodium infusion 30 mg/m2 in cycles of 3 consecutive days from when she was 4 days old, monthly for the first 3 months and every 2 months thereafter without adverse effects.
Bone Density ; Clavicle ; Congenital Abnormalities ; Connective Tissue ; Diphosphonates ; Female ; Femur ; Fractures, Bone ; Humans ; Infant ; Infant, Newborn ; Osteogenesis ; Osteogenesis Imperfecta ; Parturition ; Ribs ; Skull

Osteogenesis imperfect (OI) is a generalized connective tissue disorder. We report the female neonate case with OI type III who showed severe bone deformities and fractures in utero. At birth, she showed multiple fractures in the clavicle, rib, femur, and wormian bone in the skull X-ray. We initiated pamidronate disodium infusion 30 mg/m2 in cycles of 3 consecutive days from when she was 4 days old, monthly for the first 3 months and every 2 months thereafter without adverse effects.
Bone Density ; Clavicle ; Congenital Abnormalities ; Connective Tissue ; Diphosphonates ; Female ; Femur ; Fractures, Bone ; Humans ; Infant ; Infant, Newborn ; Osteogenesis ; Osteogenesis Imperfecta ; Parturition ; Ribs ; Skull

PURPOSE: To evaluate usefulness of volume rendering technique using 3D visualization software on PC in patients with suspected intracranial aneurysm on brain MRA. MATERIALS AND METHODS: We analyzed prospectively 21 patients with suspected aneurysms on the routine MIP images which were obtained 15 degree increment along axial and sagittal plane, among 135 patients in whom brain MRA was done due to stroke symptoms for recent 5 months. The locations were the anterior communicating artery (A-com) in 8 patients, the posterior communicating artery (P-com) in 3, the ICA bifurcation in 5, the MCA bifurcation in 4, and the basilar tip in one. Male to female ratio was 14:7 and mean age was 62 years. MRA source images were sent to PC through LAN, and the existence of aneurysm was evaluated with volume rendering technique using 3D visualization software on PC. The presence or absence of aneurysm on MIP and volume rendering images was decided by the consensus of two radiologists. RESULTS: We found the aneurysms with volume rendering technique, from 1 patient among 8 patients with suspected aneurysm at A-com and also 1 patient among 3 patients with suspected aneurysm at P-com on routine MIP images. Confirmative angiography and interventional procedures were done in these 2 patients. The causes for mimicking the aneurysm on MIP were flow displacement artifact in 9, normal P-com infundibulum in 2, and overlapped or narrowed vessels in 8 patients, and among them confirmative angiography was done in 2 patients. CONCLUSION: Volume rendering technique using visualization software on PC is useful to scrutinize the suspected aneurysm on routine MIP images and to avoid further invasive angiography.
Aneurysm* ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Artifacts ; Brain* ; Consensus ; Female ; Humans ; Intracranial Aneurysm ; Local Area Networks ; Male ; Prospective Studies ; Stroke

PURPOSE: The phosphodiesterases (PDEs) are critical components in the cyclic AMP/protein kinase A and the cyclic GMP/phosphokinase G signaling pathways. The cAMP and cGMP pathways are regulated by activation and dissolution of PDEs. Benfotiamine, a lipophilic derivation of thiamine is known an activator of transketolase, is reported to prevent diabetic nephropathy by decreasing proteinuria and reducing oxidative stress. We did this study to investigate the effect of benfotiamine in type 2 diabetic rat kidneys. MATERIALS AND METHODS: We prepared 10 male Long-Evans Tokushima Fatty (LETO: control) and 20 male Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which developed non-insulin-dependent diabetes mellitus (NIDDM) naturally. An oral glucose tolerance test confirmed diabetic development in the OLETF rats at 26 weeks. We classified 10 of the OLETF rats into Group I, the no treatment group and the other 10 into Group II, the treatment group. Group II received 100 mg/kg benfotiamine after developing DM. At 44 weeks, we checked kidney weight, serum glucose, free testosterone, insulin, total cholesterol, and triglyceride before sacrifice. We designed the primers for rat PDE5, PDE5A1, and PDE5A2 genes were carried out semiquantitive multiplex RT-PCR. Immunohistochemical staining was performed for monoclonal mouse anti-cGB-PDE5 and mouse monoclonal anti-smooth muscle alpha-actin. RESULTS: For the Control Group, Group I, and Group II, kidney weight was 2.13+/-0.23, 2.08+/-0.22, and 1.94+/-0.44 g; serum glucose was 279.50+/-56.79, 338.00+/-55.00, and 314.71+/-139.1 mg/dl; free testosterone was 1.46+/-1.08, 1.05+/- 0.42, and 0.72+/-0.56 pg/dl; insulin was 1.03+/-0.43, 1.09+/-0.83, and 1.15+/-1.08 ng/ml; total cholesterol was 86.83+/-4.79, 132.00+/-7.69, and 118.14+/-30.93 mg/dl; and triglyceride was 78.83+/-16.47, 177.83+/-75.62, and 194.57+/-92.57 mg/dl, respectively. All three groups expressed PDE5, PDE5A1, PDE5A2 mRNA, but Group I PDE5 mRNA expression was lower than that of Group C, II. However, the expression of PDE5A1 and PDE5A2 mRNA was not significantly different among the three groups. CONCLUSIONS: Serum cholesterol, triglyceride, and glucose were significantly higher in OLETF than in LETO rats. The PDEs were lower in diabetic rat (OLETF) kidneys and PDEs may play a significant role in the development of diabetic renal complications. Benfotiamine is suggested to increase expression of PDE5 mRNA in the type 2 diabetes rat kidney, but the difference in expression levels between PDE5A1 and PDE5A2 was not significant. These findings suggest that benfotiamine may play a specific role in diabetic changes of the rat kidney via a PDE5-related pathway, but it is not clear whether subtype PDE5A1 and PDE5A2 genes play a specific role.
Actins ; Animals ; Cholesterol ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diethylstilbestrol ; Glucose ; Glucose Tolerance Test ; Humans ; Insulin ; Kidney ; Male ; Mice ; Muscles ; Oxidative Stress ; Phosphoric Diester Hydrolases ; Phosphotransferases ; Protein Isoforms ; Proteinuria ; Rats ; Rats, Inbred OLETF ; RNA, Messenger ; Testosterone ; Thiamine ; Transketolase

Cases of coexistent lichen sclerosus et artrophicus and morphea have been reported. It is controversial that both diseases are single disease-spectrum or entirely separated. We encounterd a forty five year old female with a hypopigmented firm plaque on the left neck. Its histologic feature showed compact orthokeratosis, follicular plugging, atrophy of the stratum malpighii with vacuolar alteration of basal layer, and homogenization of the collagen in the upper dermis (lichen sclerosus et atrophicus). Increased thick collagen bundles were seen in the lower dermis (morphea).
Atrophy ; Collagen ; Dermis ; Female ; Humans ; Lichen Sclerosus et Atrophicus* ; Lichens* ; Neck ; Scleroderma, Localized*

BACKGROUND: The aim of this study was to investigate the effects of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass graft surgery (OPCAB) in patients with elevated serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: Of the 492 patients who underwent multivessel OPCAB from March 2007 to February 2009, the records of 144 patients whose baseline hs-CRP level > 2 mg/L were reviewed. According to the history of preoperative statin therapy for at least one week, patients were classified as either statin group or control group (72 subjects each). Preoperative and operative characteristics and postoperative data including troponin (Tn)-T level and major morbidity endpoints were obtained and compared. Major morbidity endpoints were defined as permanent stroke, renal dysfunction, hemostatic re-exploration, deep sternal wound infection, and the number of patients requiring prolonged ventilation. RESULTS: Preoperative and operative characteristics were similar between the two groups. There were no significant differences in the incidence of morbidity endpoints between the two groups, except for the number of patients requiring dialysis, which was significantly lower in the statin group (8 vs. 1, P = 0.033). Tn-T level at 24 h after surgery was also significantly lower in the statin group. CONCLUSIONS: In this study, we observed beneficial effects of preoperative statin therapy for at least one week in terms of less myocardial enzyme release and fewer patients requiring dialysis following OPCAB in patients whose preoperative hs-CRP was elevated.
C-Reactive Protein ; Dialysis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Stroke ; Transplants ; Troponin ; Ventilation ; Wound Infection

BACKGROUND: The aim of this study was to investigate the effects of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass graft surgery (OPCAB) in patients with elevated serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: Of the 492 patients who underwent multivessel OPCAB from March 2007 to February 2009, the records of 144 patients whose baseline hs-CRP level > 2 mg/L were reviewed. According to the history of preoperative statin therapy for at least one week, patients were classified as either statin group or control group (72 subjects each). Preoperative and operative characteristics and postoperative data including troponin (Tn)-T level and major morbidity endpoints were obtained and compared. Major morbidity endpoints were defined as permanent stroke, renal dysfunction, hemostatic re-exploration, deep sternal wound infection, and the number of patients requiring prolonged ventilation. RESULTS: Preoperative and operative characteristics were similar between the two groups. There were no significant differences in the incidence of morbidity endpoints between the two groups, except for the number of patients requiring dialysis, which was significantly lower in the statin group (8 vs. 1, P = 0.033). Tn-T level at 24 h after surgery was also significantly lower in the statin group. CONCLUSIONS: In this study, we observed beneficial effects of preoperative statin therapy for at least one week in terms of less myocardial enzyme release and fewer patients requiring dialysis following OPCAB in patients whose preoperative hs-CRP was elevated.
C-Reactive Protein ; Dialysis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Stroke ; Transplants ; Troponin ; Ventilation ; Wound Infection