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

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

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

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: 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

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

Nitric oxide (NO) seems to play a pivotal role in the vascular endothelial growth factor (VEGF)-induced endothelial cell proliferation. This study was designed to investigate the role and intracellular signal pathway of endothelial nitric oxide synthase (eNOS) activation induced by VEGF. ECV 304 cells were treated with betaVEGF(165) and then cell proliferation, eNOS protein and mRNA expression levels were analyzed to elucidate the functional role of eNOS in cell proliferation induced by VEGF. After exposure of cells to betaVEGF(165) , eNOS activity and cell growth were increased by approximately two-fold in the betaVEGF(165) -treated cells compared to the untreated cells. In addition, VEGF stimulated eNOS expression at both the mRNA and protein levels in a dose-dependent manner. Phosphatidylinositol-3 kinase (PI-3K) inhibitors were used to assess PI-3K involvement in eNOS regulation. LY294002 was found to attenuate VEGF-stimulated eNOS expression. Wortmannin was not as effective as LY294002, but the reduction effect was detectable. Cells activated by VEGF showed increased ERK1/2 levels. Moreover, the VEGF-induced eNOS expression was reduced by the PD98059, MAPK pathway inhibitor. This suggests that eNOS expression might be regulated by PI-3K and the ERK1/2 signaling pathway. In conclusion, betaVEGF(165) induces ECV 304 cell proliferation via the NO produced by eNOS. In addition, eNOS may be regulated by the PI-3K or mitogen-activated protein kinase pathway.
1-Phosphatidylinositol 3-Kinase/*antagonists & inhibitors ; Cell Division/drug effects ; Cell Line ; Endothelial Growth Factors/*metabolism/pharmacology ; Endothelium, Vascular/cytology ; *Gene Expression Regulation, Enzymologic ; Lymphokines/*metabolism/pharmacology ; MAP Kinase Signaling System ; Mitogen-Activated Protein Kinase 1/*antagonists & inhibitors ; Mitogen-Activated Protein Kinase 3 ; Mitogen-Activated Protein Kinases/*antagonists & inhibitors ; Nitric Oxide Synthase/*genetics/metabolism ; Nitric Oxide Synthase Type III ; Signal Transduction ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

PURPOSE: In Korea, neonatal clinical features and feeding pattern are not reported systematically. So we report the neonatal presentation of Prader-Willi syndrome. METHODS: This is a retrospective study of 14 neonate with Prader-Willi syndrome whose diagnosed in neonatal intensive care unit, Samsung Medical Center between January 1st 1997 and December 30th 2011. RESULTS: The birth characteristics of patients, maternal age was 31.5+/-4.5 years and 5 (35.7%) were primiparous. Oligohydramnios were reported in 2 cases (14.2%), polyhydramnios were reported in 4 cases (28.5%). 5 pregnancies (35.7%) had complained that decreased fetal movements. Mean gestational age were 38.1+/-2.2 weeks and 12 patients (85%) were term infants, one patient (7.1%) was post term infant, the other patient was preterm infants (7.1%). The average weight at birth were 2509.0+/-442.5 grams. All 14 patients (100%) had hypotonia and a weak cry at birth. 9 patients (64.5%) had the characteristic facial dysplasia. In all, nine male patients (100%) had cryptorchidism. All patients had weak sucking power, so they started to eat via nasogastric tube at birth. The mean duration of use nasogastric tube were 3.2+/-2.0 months. The median age of diagnosis were 1.5 months. 7 cases (50%) were diagnosed within one month of life. Median time of starting GH treatment was 2.0 years. The mean interval of from diagnosis to treatment of growth hormone were 2.2+/-2.0 years. CONCLUSION: Early diagnosis of Prader-Willi syndrome is a very important to improve long-term prognosis.
Cryptorchidism ; Early Diagnosis ; Feeding Behavior ; Female ; Fetal Movement ; Gestational Age ; Growth Hormone ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Korea ; Male ; Maternal Age ; Muscle Hypotonia ; Oligohydramnios ; Parturition ; Phenotype ; Polyhydramnios ; Prader-Willi Syndrome ; Pregnancy ; Prognosis ; Retrospective Studies

BACKGROUND: Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable. However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. MATERIAL AND METHOD: Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63 patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively. RESULT: Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0 % in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant. CONCLUSION: The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Esophagus ; Heart ; Humans ; Korea ; Lung ; Lung Neoplasms ; Medical Records ; Mortality ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Neoplasm Staging ; Pneumonectomy ; Retrospective Studies ; Vagus Nerve