BACKGROUND: Skeletal muscle is well established as a major target organ of insulin action, and is associated with the pathogenesis of type 2 diabetes. Therefore, we attempted to determine whether a variation in serum creatinine is related to the development of type 2 diabetes and other risk factors for diabetes. METHODS: A total of 2,676 nondiabetic subjects with stable and normal renal function (estimated glomerular filtration rate >60 mL/min/1.73 m2) were followed up for approximately 4.5 years. New onset diabetes was defined as fasting plasma glucose (FPG) > or =7.0 mmol/L, glycated hemoglobin (HbA1c) > or =6.5%, or subjects taking antidiabetic agents. Variation of serum creatinine (DeltaCre) was defined as a difference between follow-up and baseline creatinine. In subgroup analysis, body composition was examined by bioelectric impedance analysis method. RESULTS: A total of 106 subjects were diagnosed with new-onset diabetes during the follow-up period. Baseline serum creatinine was not different between the new-onset diabetes and no diabetes groups. Negative DeltaCre (DeltaCre <0) showed an association with increased risk of type 2 diabetes after adjusting for age, sex, body mass index, systolic blood pressure, FPG, HbA1c, triglyceride, high density lipoprotein cholesterol, and gamma-glutamyl transpeptidase (odds ratio, 1.885; 95% confidence interval, 1.127 to 3.153). Serum creatinine level demonstrated positive correlation with muscle mass and negative correlation with percentage of body fat in body composition analysis. CONCLUSION: Serum creatinine reflected body muscle mass and the decrease of serum creatinine might be regarded as a risk factor for type 2 diabetes.
Adipose Tissue ; Blood Pressure ; Body Composition ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Electric Impedance ; Fasting ; Follow-Up Studies ; gamma-Glutamyltransferase ; Glomerular Filtration Rate ; Glucose ; Hemoglobins ; Hypoglycemic Agents ; Insulin ; Lipoproteins ; Muscle, Skeletal ; Muscles ; Plasma ; Risk Factors

PURPOSE: In this study, we evaluated the extent of functional and histological axonal regeneration after resection of the sciatic nerve. The nerve was repaired with silicone tubes filled with human muscle derived stem cells(MDSCs) and neuronal progenitor cells(NPCs) in nude mice. MATERIALS AND METHODS: The human muscle samples were obtained from the rectus abdominis muscle of 12 patients that underwent a laparotomy. The MDSCs were isolated using a modified preplate technique. Using the MDSCs, neurogenic differentiation was induced by dissociating neurospheres produced in a neurosphere culture medium containing neuronal induction agents. A part of the sciatic nerve, approximately 7 mm in length, was excised bilaterally, and a 9mm long silicone tube guide was placed at the resulting gap in 40 nude mice. The transplanted sites were divided randomly into three groups according to the type of grafting cells: silicone tube guides filled with PBS(P group, n=20), silicone tube guides filled with MDSCs(M group, n=40) and silicone tube guides filled with NPCs(N group, n=20). Histological observations and a nerve conduction study were performed 12 weeks after the graft. RESULTS: The number and diameter of the myelinated axons were significantly increased in the M and N groups(p<0.001). In a nerve conduction study, the amplitude of the compound muscle action potential(CMAP) and motor latency of response were significantly higher and shorter in the M and N groups(p<0.001). Moreover, reaction with neuronal class beta-tubulin(Tuj1, a neuronal marker) and antiglial fibrillary acidic protein(GFAP, a glial marker) was observed in the regenerated nerve that originated from the M and N groups.onclusions: These results show that MDSCs can differentiate into NPCs and improve the peripheral nerve regeneration rate after transplantation into a nerve guide.
Animals ; Axons ; Humans ; Laparotomy ; Mice ; Mice, Nude ; Muscles ; Myelin Sheath ; Nerve Regeneration ; Neural Conduction ; Neurons ; Peripheral Nerves ; Rectus Abdominis ; Regeneration ; Sciatic Nerve ; Silicones ; Stem Cells ; Transplants

PURPOSE: The aim of this study was to investigate treatment results, toxicity and efficacy of hyperfractionated radiation therapy combined with paclitaxel for paraaortic node recurrence in cervix cancer. MATERIALS AND METHODS: Between September 1997 to March 1999, 12 patients with paraaortic node recurrence in cervix cancer who previously received radical or postoperative radiotherapy were treated with hyperfractionated radiation therapy combined with paclitaxel. Of these, 2 patients who irradiated less than 30 Gy were excluded, 10 patients were eligible for this study. Median age was 5 1 years. Initial FlGO stage was 1 stage IB1, 2 stage IIA, 7 stage IIB. For initial treatment, 7 patients received radical radiotherapy and 3 received postoperative radiotherapy. The paraaortic field encompassed the gross recur rent disease with superior margin at T 12, and inferior margin was between L5 and S 1 with gap for previously pelvic radiation field. The radiation field was initially anterior and posterior opposed field followed by both lateral field. The daily dose was 1.2 Gy, twice daily fractions, and total radiotherapy dose was between 50.4 and 60 Gy(median, 58.8 Gy). Concurrent chemotherapy was done with paclitaxel as a radiosensitizer. Dose range was from 20 mg/m to 30 mg/m (median, 25 mg/m'), and cycle of chemotherapy was from 3 to 6 (median, 4.5 cycle). Follow-up period ranged from 3 to 21 months. RESULTS: Interval between initial diagnosis and paraaortic node recurrence was range from 2 to 63 months (median, 8 months). The 1 year overall survival rate and median survival were 75% and 9.5 months, respectively. The 1 year disease free survival rate and median disease free survival were 30% and 3 7 months, respectively. At 1 month after treatment, 4 (40%) achieved a complete response and 6 (63%) experienced a partial response and all patients showed response above the partial response. There was distant metastasis in 6 patients and pelvic node recurrence in 2 patients after paraaortic node irradialion. There was 2 patients with grade 3 to 4 leukopenia and 8 patients with grade 1 to 2 nausea/ vom ting which was usually tolerable with antiemetic drug. There was no chronic complication in abdomen and pelvis during follow up period. CONCLUSION: Hyperfractionated radiation therapy combined with paclitaxel as a radiosensitizer showed high response rate and few complication rate in paraaortic node recurrence in cervix cancer. Therefore, present results suggest that hyperfractionated radiation therapy combined with paclitaxel chemotherapy can be used as optimal treatment modality in this patients.
Abdomen ; Cervix Uteri* ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; Neoplasm Metastasis ; Paclitaxel* ; Pelvis ; Radiotherapy ; Recurrence* ; Survival Rate ; Tolnaftate ; Uterine Cervical Neoplasms*

STUDY DESIGN: We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication OBJECTIVES: The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. SUMMARY OF LITERATURE REVIEW: Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. MATERIALS AND METHODS: Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination, postmyelography CT and MRI. RESULTS: Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. CONCLUSION: The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.
Adipose Tissue ; Back Pain ; Cauda Equina ; Diagnosis ; Epidural Space ; Humans ; Laminectomy ; Lipomatosis* ; Low Back Pain ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Physical Examination ; Radiculopathy ; Spinal Canal ; Spinal Cord ; Spinal Stenosis ; Spine

C-erbB-2 oncoprotein has been known to act as growth factor receptor responsible for the regulation of cellular growth, proliferation and differentiation and has been demonstrated in a number of cancers by immunohistochemical as well as matrix blotting techniques. Breast and ovarian cancer patients, whose tumor cells have amplification or overexpression of this oncoprotein, have been suggested to have worse prognosis. Yet, there are only a few studies on c-erbB-2 oncoprotein expression in transitional cell carcinoma(TCC) of the bladder. The aim of this study was to examine c-erbB-2 oncoprotein expression in bladder cancer to assess its potential as a useful prognostic marker in transitional cell carcinoma of the bladder. Deparaffinized tumor specimens from 42 patients with TCC of the bladder and 3 normal bladder tissue specimens were utilized. C-erbB-2 oncoprotein expression was detected by immunohistochemical analysis and then correlated with conventional prognostic variables such as histologic tumor grade, stage and DNA ploidy. In addition, we related the expression of c-erbB-2 oncoprotein to indicators of cellular proliferative activities such as proliferating cell nuclear antigen(PCNA), mean number of silver nucleolar organizer regions(AgNORs) per nucleus, flow cytometric S-phase fraction(CPF) and proliferation index(PI). The incidence of c-erbB-2 oncoprotein expression in Ash grade IV TCC of bladder was higher than that in Ash grade II and III (Chi-square test, p<0.05). The incidence of positive immunoreaction was higher in cases with muscle invasion and metastasis than in superficial tumors with statistical significance(p<0.05). In addition, statistical significant correlation was noted between c-erbB-2 oncoprotein expression and PCNA expression rate. But there were no significant differences in c-erbB-2 oncoprotein expression to DNA ploidy, PI nor SPF by flow cytometry and mean number of AgNORs per nucleus. The results of this study suggests that the c-erbB-2 oncoprotein together with other predictive parameters may serve to provide a phenotypic profile which permits more accurate forecasting of bladder cancer behavior and may prove to be useful in the future as an important guide to specific anti-tumor therapy.
Breast ; Carcinoma, Transitional Cell* ; DNA* ; Flow Cytometry ; Forecasting ; Humans ; Incidence ; Neoplasm Metastasis ; Nucleolus Organizer Region* ; Ovarian Neoplasms ; Ploidies* ; Prognosis ; Proliferating Cell Nuclear Antigen* ; Silver ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: The purpose of this study was to compare the radiation adaptive response (RAR) in peripheral lymphocytes (PL) of patients induced by Tc.-99m MDP and Tc-99m DTPA scintigraphies. MATERIALS AND METHODS: Lymphocytes from 45 patients (25 males, 20 females, mean age 44+/-18 years) were collected before and after scintigraphies using 740 MBq Tc-99m MDP (n=22) or Tc-99m L)TPA (n=23). Lympho-cytes from 20 controls (12 males, 8 females, mean age 43+/-7 years) were also callected. They were exposed to challenge dose of 2 Gy gamma-rays using a Cs-137 cell irradiator, Number of ring-form (R) and dicentric (D) chromosomes was counted under the light microscope. From them a representative score, Ydr, was calculated as Ydr=(D+R)/cells. Adaptation index (AI) was defined as difference of Ydr between unconditioned and conditioned lymphocytes. Ydr was also measured after an administration of cyclohexi-mide (CHM), a protein synthesis inhibitor, before challenge dose. RESULTS: RAR was induced in both groups of patients. CHM abolished the adaptive response in both groups. AI of Tc-99m MDP group was significantly higher than that of Tc-99m DTPA group. CONCLUSION: Tc-99m MDP induced RAR was more prominent than those induced by Tc-99m DTPA.
Chromosome Aberrations ; Female ; Humans ; Lymphocytes* ; Male ; Pentetic Acid* ; Technetium Tc 99m Medronate*

Complications of penile prosthesis include malfunction, infection and patient dissatisfaction. Herein, a rare complication of a retained reservoir having eroded into the bladder after the removal of the penile components of a three-piece penile prosthesis, is reported. A 39-year-old man complained of irritative voiding symptoms. The symptoms had developed 4 years after the removal of the penile components of the prosthesis. The erosion of the reservoir into the bladder was discovered incidentally during the treatment of bladder calculi. The reservoir was removed by an open vesicolithotomy.
Adult ; Calculi ; Cytochrome P-450 CYP1A1 ; Humans ; Penile Prosthesis* ; Prostheses and Implants ; Urinary Bladder Calculi* ; Urinary Bladder*

Objectives: This study used data from the seventh National Health and Nutrition Survey, a dataset which signifies that dental services in the country exhibit relatively low health insurance coverage and high copay rates compared to other medical healthcare services. We surveyed the utilization rate of dental care and the prevalence of untreated conditions among Korean elders aged over 65.Furthermore, we aimed to present policy implications to improve dental care accessibility and expand health insurance coverage for elders, especially vulnerable individuals who are bedridden or living alone. Methods: We used raw data from the seventh National Health and Nutrition Survey to investigate Korean elders’ dental service utilization and untreated conditions. We opted for elders aged over 65 and finalized 1,712 subjects for the analysis. Statistical analysis was performed using IBM SPSS 25.0 (IBM Corp., Chicago, IL, USA). Groups were detailed in terms of strata of variation estimation and elders aged over 65, cluster of district enumeration, and weighted oral survey. We generated a scheme file and employed complex sampling analysis with a statistical significance level of P<0.05. Results: This study intended to survey the rate of dental care use and untreated care of Korean elders over 65 using the seventh National Health and Nutrition Survey data which represents our country. 1. Dental care use rate based on general traits showed statistically significant relevance (P<0.01) with lower age, higher income, higher education level, residence of ‘Dong’, and ‘with’ private insurance. 2. In untreated rate of dental care by general traits showed the significant total of 26.1% with female, lower income, lower education level, ‘recipient’ of basic living, and subjectively poor status of oral health. 3. The multiple answers of the patients who went to the dentists over the past year showed dental care details of dental checkups 54.3%, prosthetic dentistry 32.1%, preventive treatment 30.9%, cavity of root canal treatment 25.7%, gum treatment 17.1%, and tooth extraction 14.7%. 4. The reasons for untreated dental care of those untreated subjects showed the highest 34.0% of economic reason, mild condition 32.3%, lack of time 8.2%, and scared of treatment 8.0% in order. Based on this analysis, we intended to suggest policy implications for the necessity of dental checkup expansion and the activation of prevention treatment. Conclusions To improve dental care accessibility for elders aged 65 and above, especially the vulnerable individuals who are bedridden or living alone, it is imperative to expand outpatient insurance coverage and tailor the dental services as per their specific needs. Shifting the focus from treatment-oriented health insurance to preventive measures and examination service expansion and invigoration is essential to improve dental health and overall quality of life. It is deduced that expansion of dental care health insurance coverage and checkup services is critical for vulnerable elders, such as those who are bedridden or living alone.

Primary ovarian pregnancy is comparatively rare in ectopic pregnancy. Ovarian pregnancy occurs in corpus luteum cyst and is usually accompanied with the rupture of ovary and a massive hemoperitoneum. It presents as a hemorrhagic ovary and frequently misdiagnosed as a ruptured corpus luteum. Spiegelberg's criteria should be fulfilled for the diagnosis of ovarian pregnancy. Two cases of ovarian pregnancy were presented with a brief review of the literatures.
Corpus Luteum ; Diagnosis ; Female ; Hemoperitoneum ; Ovarian Cysts ; Ovary ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

PURPOSE: The incidence of overactive bladder (OAB) and the efficacy of alpha blocker and tolterodine combination therapy were examined in patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Between March 2001 and December 2001, 144 BPH patients were subdivided into those with BPH, or BPH with OAB, based on urodynamic studies. All patients were treated with alpha blockers for 3 months. Patients with no symptomatic improvement were treated with alpha blockers and tolterodine for 2 months. An increase in the International prostate symptom scores (IPSS) of more than 3 points after medication was considered an improvement, but if not, as a failure. RESULTS: Of the 144 patients, 76 (53%) had BPH and 68 (47%) had BPH with OAB. The patients with BPH and OAB were older (p<0.05), but no differences were observed in the serum creatinine, IPSS, prostate volume, maximum flow rate or post-void residual urine (PVR) between the 2 groups. After 3 months treatment with alpha blockers, 79% (60/76) of the BPH and 35% (24/68) of the BPH with OAB patients had improved (p<0.05). Of the patients showing no improvement, 38% (6/16) with BPH and 73% (32/44) with BPH and OAB showed improvement after the addition of tolterodine. CONCLUSIONS: The combination therapy was more effective than alpha blockers alone in the treatment of patients with coexisting BPH and OAB. We recommend identifying these patients with an initial urodynamic study, which allows for the appropriate management and identification of those patients that may benefit from a more invasive treatment.
Creatinine ; Humans ; Incidence* ; Prostate ; Prostatic Hyperplasia* ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urodynamics ; Tolterodine Tartrate