OBJECTIVES: Long standing ulcerative colitis (UC) has been known to be one of the precancerous diseases of colorectal cancer. Although the frequent loss of p53 allele (LOH) and aneuploidy were reported as the molecular events in carcinoma and dysplasia known as the precursor of UC, p53 genetic alteration was not reported in indefinite dysplasia and UC involved mucosa in long standing UC. Therefore, we investigated the mutational inactivation of the p53 gene in UC patients who showed dysplastic mucosa, as well as non-dysplastic mucosa on H & E stain and, secondly, if there is p53 mutation, we examined the relationship between p53 alteration and clinical data. METHOD: Sixteen patients with UC who had different duration of colitis were studied by endoscopic examination with rectal mucosal biopsies, p53 gene alterations were detected by PCR-SSCP for exon 4-8 and immunohistochemical staining with p53 monoclonal antibody. RESULTS: Among 16 patients, 2 patients (12%) showed dysplasia on H-E stain. The p53 point mutations were detected in 4 (two dysplasia and 2 normal looking mucosa) on PCR-SSCP. 4 patients who had p53 gene mutation were positive in immunohistochemical staining. With regard to clinical characteristics, these patients with p53 point mutation showed poor response to medical treatment. CONCLUSION: These results suggest that the p53 mutation may be an early molecular event of cancerous change in UC.
Adolescence ; Adult ; Base Sequence ; Biopsy, Needle ; Child ; Child, Preschool ; Colitis, Ulcerative/pathology ; Colitis, Ulcerative/genetics* ; Colonic Neoplasms/genetics* ; Colonoscopy ; Female ; Human ; Infant ; Intestinal Mucosa/pathology ; Male ; Molecular Sequence Data ; Mutation* ; Polymerase Chain Reaction ; Precancerous Conditions/genetics* ; Protein p53/genetics* ; Rectum/pathology* ; Substances: Protein p53

PURPOSE: We investigated the efficacy and safety of oral sildenafil, and the selection rate of sildenafil, for the continuous treatment of erectile dysfunction (ED) in patients who received intracavernous injection (ICI) therapy. MATERIALS AND METHODS: A total of 69 ED patients (55.1+/-12.3 years) who received ICI therapy, with trimix (papaverine 18.75mg+phentolamine 0.625mg+PGE1 6.25microgram/ ml) for more than 6 months, were recruited for this study. All patients received a starting dose of 50mg sildenafil. The dose was adjusted to 100mg or 25mg based on its efficacy and tolerability. The erection quality, side effects, and selection rates of sildenafil for the continuous treatment, with reasons for its selection, were compared with those of ICI. RESULTS: Good erectile responses, to both trimix and sildenafil, were noted in 52 (75.4%) patients. There were no differences in the age, frequency of associated diseases, dose of trimix, duration of the injection therapy, and IIEF Q3 or Q4 on the ICI between sildenafil-responders and -nonresponders. The dose of sildenafil in the responders was 100mg, 50mg and 25mg in 37, 14 and 1, respectively. Of the 52 sildenafil-responders, the erectile quality with ICI was better than with the sildenafil in 46 (88.5%), whereas only 2 showed a better quality, and 4 showed similar responses. Among the 52 responders, 18 (34.6%) preferred to continue the oral drug, 18 (34.6%) used both treatment alternatively, and 16 (30.8%) returned to the ICI. The main reason for selecting sildenafil was its easier administration (88.9%), whereas that for the ICI was its better erection quality (74.3%). The most common adverse reactions to the sildenafil included, hot flushes (17.4%) and headaches (13%). CONCLUSIONS: Patients with ED on the ICI therapy are likely to have similar erectile responses and adverse reactions to those on sildenafil from their comparison with other clinical trials on sildenafil. However, the selection rate of ICI for the continuous treatment in sildenafil-responders was high due to its better erection quality.
Erectile Dysfunction ; Headache ; Humans ; Male ; Sildenafil Citrate

PURPOSE: Intracavernous injection (ICI) was once the cornerstone of treatment for erectile dysfunction (ED). This study was designed to investigate how the treatment of ED has changed since introduction of oral sildenafil. MATERIALS AND METHODS: In a total of 574 new ED (mean duration 2.9 years) patients with a mean age of 52.6 11.8 years, associated diseases, the cause and duration of ED, and the treatment used initially and after 6 months were investigated. RESULTS: The ED was psychogenic in 40.7% of the men. The most common cause of organic ED was vascular (18.1%) followed by diabetes (15.9%). The associated diseases were hypertension (19.9%), diabetes mellitus (16.5%), trauma and surgery (5.5%), endocrinologic (4.7%), coronary artery (1.6%), and hypercholesterolemia (1.1%). The initial treatment modality was an oral sildenafil in 68.7%, ICI in 11.3%, testosterone replacement in 2.7%, implantation of penile prostheses in 0.8%, and wait and see in 16.5%. Six months later, excluding the patients lost to follow-up, 73.4% of the patients were using oral sildenafil and 20.5% were using ICI. CONCLUSIONS: Oral sildenafil has largely replaced intracavernous injection for the initial treatment of erectile dysfunction.
Coronary Vessels ; Diabetes Mellitus ; Erectile Dysfunction* ; Humans ; Hypercholesterolemia ; Hypertension ; Lost to Follow-Up ; Male ; Penile Prosthesis ; Testosterone ; Sildenafil Citrate

BACKGROUND: Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. METHODS: Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. RESULTS: The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. CONCLUSIONS: A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.
Adult ; Aged ; Arthroscopy/*adverse effects/*methods ; Carboxymethylcellulose Sodium ; Drug Carriers ; Female ; Humans ; Hyaluronic Acid/adverse effects/*therapeutic use ; Male ; Middle Aged ; Pain ; Prospective Studies ; Range of Motion, Articular ; Recovery of Function ; Rotator Cuff/injuries/*surgery ; Shoulder Joint/physiology ; Tissue Adhesions/*prevention & control ; Treatment Outcome ; Viscosupplements/adverse effects/*therapeutic use

The objective of this study was to compare dentin shear bond strength (DSBS) of dentin bonding agents (DBAs) cured with a plasma arc (PAC) light curing unit (LCU) and those cured with a light emitting diode (LED) LCU. Optical properties were also analyzed for Elipar freelight 2 (3M ESPE); LED LCU, Apollo 95E (DMT Systems); PAC LCU and VIP Junior (Bisco); Halogen LCU. The DBAs used for DSBS test were Scotchbond Multipurpose (3M ESPE), Singlebond 2 (3M ESPE) and Clearfil SE Bond (Kuraray). After DSBS testing, fractured specimens were analyzed for failure modes with SEM. The total irradiance and irradiance between 450 nm and 490 nm of the LCUs were different. LED LCU showed narrow spectral distribution around its peak at 462 nm whereas PAC and Halogen LCU showed a broad spectrum. There were no significant differences in mean shear bond strength among different LCUs (P > 0.05) but were significant differences among different DBAs (P < 0.001).
Dentin ; Dentin-Bonding Agents ; Enzyme Multiplied Immunoassay Technique ; Light ; Plasma ; Resin Cements

BACKGROUND/AIMS: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. METHODS: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. RESULTS: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. CONCLUSIONS: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.
Bilirubin ; Coinfection ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A virus ; Hepatitis E ; Humans ; Immunoglobulin M ; Korea ; Length of Stay ; Liver Failure, Acute ; Liver Function Tests ; Retrospective Studies ; RNA

BACKGROUND/AIMS: Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. METHODS: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. RESULTS: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). CONCLUSIONS: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy.
Cecum ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Constriction, Pathologic ; Diverticulum ; Gastroscopes ; Humans ; Intubation

BACKGROUND: Use of corticosteroid appears to increase the risk of upper gastrosintestinal side effects associated with NSAIDs. But, there is no study for the effects of these drugs to NSAID induced small intestinal damage. Therefore, we examed the effects of corticosteroid to NSAID induced enteropathy and bacterial translocation. METHODS: Rat received no drug, NSAID alone (diclofenac 80 mg/kg per os), corticosteroid alone (dexamethasone 5 mg/kg intraperitoneal, 2 times) or NSAID with corticosteroid. Amounts of food intakes, body weight, intestinal permeability, enteric aerobic bacterial counts in small and large intestine, serum biochemical profiles, and pathologic findings of ileum were measured. Cultures of the mesenteric lymph nodes, as well as liver, spleen and systemic blood were taken. RESULTS: Diclofenac or dexamethasone alone administration caused gut barrier damage, enteric bacterial overgrowth and increased bacterial translocation. The supplements with dexamethasone increased NSAID induced gut barrier damage, villous atrophy, enteric bacterial overgrowth and bacterial translocation to mesenteric lymph nodes, liver, spleen and systemic blood. Also, these increased diclofenac induced body weight loss, but not hypoproteinemia. CONCLUSION: Corticosteroid increase NSAID induced body weight loss, gut barrier dysfunction, villous atrophy, enteric bacterial overgrowth and bacterial translocation in experimental animals.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Atrophy ; Bacterial Load ; Bacterial Translocation* ; Body Weight ; Dexamethasone ; Diclofenac ; Hypoproteinemia ; Ileum ; Intestine, Large ; Intestine, Small ; Liver ; Lymph Nodes ; Permeability ; Rats* ; Spleen

Dermatomyositis is an idiopathic inflammatory myopathy with typical cutaneous manifestations. It has been proposed that dermatomyositis may be caused by autoimmune responses to viral infections. Previous studies have shown an association between dermatomyositis and malignant tumors such as ovarian cancer, lung cancer, and colorectal cancer. However, a chronic hepatitis B virus (HBV) infection associated with dermatomyositis and hepatocellular carcinoma (HCC) has been very rarely reported. Here, we report a rare case of dermatomyositis coinciding with HBV-associated HCC. A 55-year-old male was confirmed to have HCC and dermatomyositis based on proximal muscle weakness, typical skin manifestations, elevated muscle enzyme levels, and muscle biopsy findings. This case suggests that HCC and/or a chronic HBV infection may be factors in the pathogenesis of dermatomyositis through a paraneoplastic mechanism.
Antiviral Agents/therapeutic use ; Biopsy ; Carcinoma, Hepatocellular/diagnosis/*virology ; Dermatomyositis/diagnosis/drug therapy/*virology ; Disease Progression ; Fatal Outcome ; Glucocorticoids/therapeutic use ; Hepatitis B, Chronic/*complications/diagnosis/drug therapy ; Humans ; Liver Neoplasms/diagnosis/*virology ; Male ; Middle Aged ; Paraneoplastic Syndromes/diagnosis/drug therapy/*virology ; Risk Factors ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: To evaluate the efficacy and safety of nitofurazone-coated urinary catheter in inhibitory activity of catheter associated urinary tract infection (CAUTI). METHODS: From March to September 2001, 177 patients in five university hospitals who were expected to use urinary catheters and be satisfied with the inclusion, exclusion criteria were analyzed. Through urine culture, we compared the incidence rate and onset of CAUTI after catheterization of standard silicone urinary catheters (control group) and nitofurazone-coated catheters (experimental group). CAUTI was defined as over 103 CFU/mL of bacteria in urine culture. The catheter surface was examined by scanning electron microscopy (SEM) to analyze the bacteial biofilms. RESULTS: The incidence rate of CAUTI was lower in experimental group than in control group but there was no statistical significancy. However, in the patients who had indwelling urinary catheters for 5~7 days, the incidence rate of CAUTI was significantly low in experimental group. Depending on catheter insertion period, the incidence onset of CAUTI was analyzed. It was found that the longer the insertion period was, the lower the incidence rate of CAUTI in experimental group was than in control group, but there was no statistical significancy. In the patients who had indwelling urinary catheters for 5~7 days, the incidence rate of CAUTI was significantly low in experimental group. According to the result of this study, patient who was older and had longer insertion- period, had higher incidence rate of CAUTI. SEM showed the formation of bacterial biofilm in silicone catheters throughout the 5~7 days, but deterioration of the bacterial biofilm was visible on the surface of nitofurazone-coated catheters. There was no side-effect in any groups. CONCLUSION: This study suggests that nitofurazone-coated catheters can be useful for inhibition of urinary tract infection, with systemic and local safety, in patients who have indwelling urinary catheter more than 5 days and old-age paitents.
Bacteria ; Biofilms ; Catheterization ; Catheters* ; Hospitals, University ; Humans ; Incidence* ; Microscopy, Electron, Scanning ; Nitrofurazone ; Silicones* ; Urinary Catheters* ; Urinary Tract Infections* ; Urinary Tract*