OBJECTIVE: The primary aim of this study was to further characterize the acute effects of amitriptyline (AMI) and escitalopram (ESC) on serum levels of ghrelin, leptin, cortisol and prolactin in healthy humans. METHODS: Eleven healthy male participants received a single dose of AMI 75 mg, ESC 10 mg, or placebo (PLA) at 9:00 PM in a double blind, randomized, controlled, repeated measures study separated by one week. Fasting morning serum levels (7:00 AM) of ghrelin, leptin, cortisol and prolactin were assessed. RESULTS: A repeated measures multivariate analysis of variance revealed a significant main effect for the factor condition (AMI, ESC, PLA). Subsequent univariate analyses demonstrated significant condition effects for ghrelin and cortisol. Post-hoc analyses demonstrated a significant reduction of ghrelin levels after AMI in comparison to PLA, and a significant reduction of cortisol levels after AMI in comparison to both ESC and PLA. Other contrasts did not reach statistical significance. CONCLUSION: Administration of a single dose of AMI, but not of ESC, leads to a significant reduction in morning serum ghrelin and cortisol levels. No effects on leptin and prolactin levels were observed. The differential impact of AMI and ESC on hormones might contribute to different adverse effect profiles of both substances.
Amitriptyline* ; Citalopram* ; Fasting ; Ghrelin ; Healthy Volunteers* ; Humans ; Hydrocortisone ; Leptin ; Male ; Multivariate Analysis ; Prolactin ; Weight Gain

OBJECTIVE: The objective of this study was to describe and characterize the clinical course of treatment for invasive prolactinoma patients using bromocriptine. METHODS: The study group included 23 patients who were treated with bromocriptine for their invasive prolactinomas. Clinical histories, serum prolactin level and pituitary hormone assessments, tumor diameter and signal intensity on sella magnetic resonance imaging (MRI), visual field exams and the dosage of medications were reviewed for each patient. RESULTS: During 30 months (median, range 6-99) of follow-up period, 19 patients treated with bromocriptine alone achieved biochemical remission. Four patients changed the medication to cabergoline due to the adverse effects or observed resistance of bromocriptine treatment. All of five patients who had visual symptoms improved after the course of medication. Four surgically treated patients were not able to discontinue medication because they could not maintain biochemical remission state without medication. Multivariate analysis showed that decreased enhancement on the initial followed MRI after medication and longer follow-up periods were associated with higher radiologic response. CONCLUSION: We reassure that the dopamine agonist is safe and effective for the treatment of invasive pituitary adenomas. Meanwhile, surgery has a limited role on biochemical remission. Decreased enhancement on the initial follow-up MRI after medication may reflect the treatment response. Further study is required to validate the role of MRI or other factors on the actual prognosis.
Bromocriptine* ; Dopamine Agonists ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Pituitary Neoplasms ; Prognosis ; Prolactin ; Prolactinoma* ; Visual Field Tests

PURPOSE: To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. METHODS AND MATERIALS: The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. RESULTS: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy, the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P > 0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achived normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. CONCLUSION: The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes.
Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; Pituitary Neoplasms* ; Prolactin ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Visual Fields

The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microgram/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist- controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.
Adult ; Anesthetics, Intravenous ; *Anxiety ; *Conscious Sedation ; Female ; *Fertilization in Vitro ; Human ; Hydrocortisone/blood ; Korea ; *Ovum ; Preoperative Care ; Prolactin/blood ; *Propofol ; Regression Analysis ; Statistics ; *Tissue Harvesting

BACKGROUND: Recent discoveries on the physiology of an erection have demonstrated that the organic causes of impotence are more common, and psychogenic impotence is correspondingly less common than was formally believed. The incidence of sexual dysfunctions in chronic obstructive pulmonary disease (COPD) patients is largely unknown or may be perfunctorily attributed to the associated illness or to aging. This study investigated whether or not the impotence was related to the COPD itself as well as whether or not it may stem from organic causes in a notable proportion of such patients. METHODS: The sexual function was evaluated in 10 COPD patients and 10 normal control subjects. A nocturnal Rigi Scan was performed to evaluate the erectile function of each group. The level of hormones such as the free testosterone, prolactin and thyroid stimulating hormone (TSH) was measured, and a pulmonary function test and arterial blood gas analysis was performed. RESULTS: The time duration and frequency of a penile erection were significantly lower in COPD patients than the controls (p<0.05). In addition, the PaO2 levels correlated with the time duration of the penile erection. CONCLUSION: These results suggest that COPD is one of the causes of organic erectile dysfunction.
Aging ; Blood Gas Analysis ; Erectile Dysfunction* ; Humans ; Incidence ; Male ; Penile Erection ; Physiology ; Prolactin ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Function Tests ; Testosterone ; Thyrotropin

Since the introduction in 1996 of the novel antipsychotic risperidone in Korea, clinical experiences with this agent for the treatment of schizophrenia have been accumulated. This article attempts to review the published literature on clinical effects of risperidone in Korean patients with schizophrenic disorder. All available clinical articles by Korean authors or involving Korean patients were searched through electronic databases (KISEP and KMBASE) or manually. Retrieved articles were primarily written in Korean and were of several types (original article, case report, review and tutorial), and addressed various issues:efficacy, safety and tolerance, quality of life and subjective well-being, pharmacoeconomics, optimal dose and titration rate, etc. The main results are as follows. Many clinical trials to date have shown that risperidone is an effective antipsychotic agent in the treatment of positive and negative symptoms, with a milder side effect profile, in particular much less EPS than haloperidol. The effects were favorable even in chronic or treatment-resistent patients. It appears to have additional effects on quality of life and subjective well-being. Preliminary evidence suggested that risperidone may improve some types of cognitive function. Weight gain was a major problem although the weight increase was less severe than that seen with clozapine and olanzapine. Some experimental studies demonstrated prolactin elevation in patients treated with risperidone;however, clinical significance of hyperprolactinemia was unclear. Various specific cases of adverse events were reported during risperidone therapy, including new onset of manic symptoms, neuroleptic malignant syndrome, stuttering, premature ventricular contraction and hepatotoxicity;however, the numbers of cases were very few, the causal relationship was not clear in some cases, and there were no fatalities or life threatening events. At present the medication costs for risperidone are much greater than those for conventional drugs. However, risperidone therapy may be associated with substantial cost benefits, when total health service costs and quality of life were taken together into account. The target dose found to be effective was lower than the originally proposed target dose of 6 mg/day. A slower titration was also found to be preferable. Taken together, in spite of lacking in randomized controlled clinical trials and long term studies, Korean literature on risperidone use for schizophrenia provides valuable information to clinicans regarding the effective use of risperidone. Risperidone should be a first line drug for the treatment of Korean patients with schizophrenic disorder.
Clozapine ; Cost-Benefit Analysis ; Economics, Pharmaceutical ; Haloperidol ; Health Services ; Humans ; Hyperprolactinemia ; Korea ; Neuroleptic Malignant Syndrome ; Prolactin ; Quality of Life ; Risperidone* ; Schizophrenia* ; Stuttering ; Ventricular Premature Complexes ; Weight Gain

It has long been known that smoking can have a deleterious effect on sexual potency and fertility capacity of males but the subject of the possible adverse effects of cigarette smoking on steroidogenesis and spermatogenesis is controversial. The comparative study presented here was conducted on 30 cigarette-smokers and 30 non-cigarette-smokers of men. They were divided into 3 different groups such as control group (composed of 10 smokers and 10 non-smokers), impotence group (10 smokers and 10 non-smokers) and infertility group (10 smokers and 10 non-smokers). They were subjected to the investigation of medical history, body weight, height, testicular size, coital frequency per week, nocturnal penile tumescence frequency per week, routine laboratory works, plasma FSH, LH, testosterone and prolactin by radioimmunossay and semen analyses. The smokers were found to have a slightly smmaller frequency of coitus per week and also that of nocturnal penile tumescence per week than non-smokers but the differences were not significant. Plasma FSH, LH, testosterone and prolactin levels were also hot significantly different between smokers and non-smokers of each group. The levels of LH and testosterone of control group were greater than thoses of impotence and infertility groups. Semen samples from control and impotence groups showed no significant differences on volume, count, motility and morphology between smokers and non-smokers. Only in the infertility group, sperm motility was significantly greater in non-smokers than smokers and also morphology was slightly greater in non-smokers than smokers but the difference was not significant. The results of this study identify that the postulated deteriolated effect of cigarette smoking on steroidogenesis and spermatogenesis would have most significantly impinged. However, its clarification will require more careful and extensive investigations with large groups of subjects.
Body Weight ; Coitus ; Erectile Dysfunction ; Fertility ; Humans ; Infertility ; Male ; Penile Erection ; Plasma ; Prolactin ; Semen ; Semen Analysis ; Smoke* ; Smoking* ; Sperm Motility ; Spermatogenesis* ; Testosterone

OBJECTIVETo observe the therapeutic efficacy of Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique under laparoscope for treating clomiphene-resistant polycystic ovary syndrome (PCOS).

METHODSForty infertility patients with clomiphene-resistant PCOS were assigned to two groups using stratified random sampling method according to age, infertility time, and body mass index, 20 in each group. Patients in Group A were treated with Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation, while those in Group B were treated with Chinese medical syndrome typing and treatment combined unipolar electrocoagulation drilling technique. After operation Chinese herbal treatment was administered to all patients according to syndrome typing. The serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), androgen (T), estradiol (E2), and prolactin (PRL) were determined before and after operation. The ovulation was monitored. The pregnancy rate and the pregnancy outcomes were recorded after operation.

RESULTSThere was no statistical difference in the 3-month spontaneous ovulation rate or the 1-year pregnancy rate (P > 0.05). The levels of LH, T, and PRL were significantly lower after operation than before operation in the two groups (P < 0.05). The menstruation and ovulation were obviously improved after operation. The total ovulation rate was 95% (19/20) in Group A. Successful pregnancy occurred in 15 cases of Group A. Ovarian hyperstimulation syndrome (OHSS) occurred in 1 case of Group A. The total ovulation rate was 90% (18/20) in Group B. Successful pregnancy occurred in 13 cases of Group B. Hypovaria occurred in 1 case of Group B. Luteinized unruptured follicle (LUFS) occurred in 2 cases of Group A and 1 case of Group B.

CONCLUSIONSChinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique could effectively promote the ovulation. The two methods showed similar therapeutic effects.

Adult ; Clomiphene ; pharmacology ; Drug Resistance ; Electrocoagulation ; Female ; Follicle Stimulating Hormone ; analysis ; Humans ; Integrative Medicine ; Laparoscopy ; Luteinizing Hormone ; analysis ; Medicine, Chinese Traditional ; methods ; Polycystic Ovary Syndrome ; therapy ; Pregnancy ; Prolactin ; analysis

Integrins are heterodimeric glycoproteins that have been found to undergo dynamic temporal and spatial changes in the endometrium during the menstrual cycle and in early pregnancy. Specificity of integrins is known to be different in human endometrial stromal cells and decidual cells. These shifts of integrins suggested to play an important role in embryo implantation and can be modulated by progesterone, cAMP derivatives, and cytokines. The mechanisms of decidualization and its precise physiological role are still not clearly understood and in vitro systems could provide an alternative that overcomes limitations of studying such complex biological phenomena in vivo at the time of implantation. This study was undertaken to establish an in vitro model system for human decidualization using 8-bromo-cAMP and to investigate the characteristics of stromal integrin expression in vitro by 8-Br-cAMP. Endometrial stromal cells were isolated and cultured, and then were induced to decidualize by 0.5 mM 8-Br-cAMP for 15 days. Immunofluorescence staining and flow cytometric analyses of the integrin subunits (alpha1, alpha4, alpha5, alpha6, beta1 and alpha v beta3) were performed at day 9. In the presence of 8-Br-cAMP, the staining intensity of alpha v beta3 was significantly higher than control and measurements for alpha1, alpha4, alpha5, alpha6, and beta1 were similar. Immunofluorescent localization of the integrins reflected the differences obtained from the flow cytometric analyses described above. In summary, the expression of alpha;avbeta;b3 integrin increased in stromal cells in vitro decidualized by 8-Br-cAMP and this up-regulation of alpha v beta3 integrin expression during decidualization might influence on human implantation.
8-Bromo Cyclic Adenosine Monophosphate/*pharmacology ; Cell Size ; Cells, Cultured ; Decidua/*cytology/drug effects/metabolism ; Female ; Flow Cytometry ; Human ; Integrins/*analysis/metabolism ; Prolactin/analysis ; Stromal Cells/cytology/*drug effects/*metabolism

A 30-year-old man with male phenotype visited our Infertility Clinic because of infertile marital life for 5 years. On physical examination, height was 162cm and body weight 52kg. Size of testis was 5 ml and that of penis, 6cm in length and 6cm in circumference. Distribution of pubic hair was sporadic and inverted triangle shape. No gynecomastia was obsessed. urogenital sinus or Mullerian duct system was not found in retrograde cystourethrography. Hormonal assay revealed that plasma FSH (46.6 IU/L) and LH (48.4 IU/L) were found to be elevated but testosterone (5.35 ng/ml) was within normal range. Prolactin level (21.1 ng/ml) was also normal. Repeated semen analyses showed that no sperm in 1.5-2.0 ml of ejaculates. Histology of testis revealed that hyalinization of seminiferous tubules and Leydig cell hyperplasia. Chromosomal analysis with peripheral blood revealed that 46XX by repeated analyses. This is first case report of XX male syndrome or sex reversal syndrome from Korea.
46, XX Testicular Disorders of Sex Development* ; Adult ; Body Weight ; Gynecomastia ; Hair ; Humans ; Hyalin ; Hyperplasia ; Infertility ; Korea ; Male ; Penis ; Phenotype ; Physical Examination ; Plasma ; Prolactin ; Reference Values ; Semen Analysis ; Seminiferous Tubules ; Spermatozoa ; Testis ; Testosterone