PURPOSE: This study was performed to investigate the effect of desmopressin on nocturia in patients with irritative symptom who do not respond effectively to first line therapy, such as benign prostatic hyperplasia(BPH) medication(alpha-blocker and finasteride), antimuscarinics or calcium antagonist. MATERIALS AND METHODS: Patients had been treated for unresolved severe nocturia(<3 times per night) in spite of first-line therapy for more than 3 months. Additional medication of desmopressin was recommended to the patients with unresolved nocturia in spite of first line therapy. According to clinical diagnosis, the patients were classified into three groups: Group I of male with BPH, Group II of male without BPH and Group III of female. The response to each first-line therapy and desmopressin treatment was estimated by the number of nocturia and quality of life. Additionally, before and after desmopressin treatment, voiding diary and urodynamic study were evaluated, respectively. RESULTS: A total of 79 patients were enrolled in this study. Severe nocturia patients unresolved to 1st line therapy were improved after combination therapy of 1st line therapy with desmopressin. In 66(83.5%) of the total 78 patients, the number of nocturia was significantly reduced to less than 3 after combination therapy. According to groups, the number of nocturia was significantly reduced to less than 3 in 84.8% of Group I(n=46), 71.4% of Group II(n=21), and 100% of Group III(n=12), respectively. CONCLUSIONS: Combination therapy with desmopressin effectively reduced nocturia in patients with unresolved severe nocturia in spite of first line treatment. We recommend combination therapy of desmopressin with first line treatment for unresolved severe nocturia in adults. Long term efficacy and adverse effects should be assessed for the generalized use of desmopressin.
Adult* ; Calcium ; Deamino Arginine Vasopressin* ; Diagnosis ; Female ; Humans ; Male ; Muscarinic Antagonists ; Nocturia* ; Prostatic Hyperplasia ; Quality of Life ; Urination Disorders ; Urodynamics

Polycythemia is a condition in which the red blood cell count is increased due to an inherited or acquired mutation, a physiologic response to hypoxia, autonomous erythropoietin production, or deliberate erythropoietin administration. Higher testosterone levels appear to act as a stimulus for erythropoiesis and testosterone replacement therapies have rarely been reported as causes of polycythemia. We report here a case of a 51-year-old man with polycythemia that was caused by long-acting testosterone undecanoate (Nebido(R)).
Anoxia ; Erythrocyte Count ; Erythropoiesis ; Erythropoietin ; Humans ; Middle Aged ; Polycythemia ; Testosterone

Purpose: Nocturnal enuresis has been regarded as one of the most prevalent problems of childhood. Nocturnal enuresis may lead to a distressing and perplexing problem for children, resulting in social withdrawal, guilty feelings, and a sense of loneliness. In this study, we investigated changes in self-awareness, anxiety, depression, and behavior estimation before and after treatment in children with primary nocturnal enuresis. MATERIALS AND METHODS: Psychologic inventories were evaluated in 48 primary nocturnal enuretic patients who had been successfully treated for their nocturnal enuresis from April 2001 to March 2002. Before and after treatment, self-administered questionnaires, such as Kovac's Children's Depression Inventory, Piers-Harris Children Self-Concept scale, and State-Trait Anxiety Inventory for Children, were evaluated by the enuretics. Their parents were also evaluated by the Child Behavior Check list. RESULTS: In Kovac's Children's Depression Inventory and Piers-Harris Children Self-Concept scale, there were no signs of psychologic abnormality before and after treatment of nocturnal enuresis in terms of self-awareness and depression. Compared with the pre-treatment scores, there was significant improvement in trait anxiety after treatment of nocturnal enuresis (p<0.05). In the Child Behavior Check list, the parents thought that enuresis did not lead to abnormal behavior in their children. CONCLUSIONS: These results suggest no serious psychopathologic abnormalities before and after treatment of primary nocturnal enuresis. The enuretic patients may suffer from trait anxiety. Consequently, the successful treatment of nocturnal enuresis may alleviate a child's anxiety and prevent secondary psychopathologic abnormalities.
Anxiety* ; Child ; Child Behavior ; Depression* ; Enuresis ; Equipment and Supplies ; Humans ; Loneliness ; Nocturnal Enuresis* ; Parents ; Surveys and Questionnaires ; Self Concept ; Weights and Measures*

PURPOSE: To assess the degree and clinical impact of location error of the dens on the X-axis during radiotherapy to brain and head and neck tumors. MATERIALS AND METHODS: Twenty-one patients with brain tumors or head and neck tumors who received three-dimensional conformal radiation therapy or intensity-modulated radiation therapy from January 2009 to June 2010 were included in this study. In comparison two-dimensional verification portal images with initial simulation images, location error of the nasal septum and the dens on the X-axis was measured. The effect of set-up errors of the dens was simulated in the planning system and analyzed with physical dose parameters. RESULTS: A total of 402 portal images were reviewed. The mean location error at the nasal septum was 0.16 mm and at the dens was 0.33 mm (absolute value). Location errors of more than 3 mm were recorded in 43 cases (10.7%) at the nasal septum, compared to 133 cases (33.1%) at the dens. There was no case with a location error more than 5 mm at the nasal septum, compared to 11 cases (2.7%) at the dens. In a dosimetric simulation, a location error more than 5 mm at the dens could induce a reduction in the clinical target volume 1 coverage (V95: 100%-->87.2%) and overdosing to a critical normal organ (Spinal cord V45: <0.1%-->12.6%). CONCLUSION: In both brain and head and neck radiotherapy, a relatively larger set-up error was detected at the dens than the nasal septum when using an electronic portal imaging device. Consideration of the location error of the dens is necessary at the time of the precise radiation beam delivery in two-dimensional verification systems.
Brain ; Brain Neoplasms ; Electronics ; Electrons ; Head ; Humans ; Nasal Septum ; Neck

PURPOSE: The aim of this study was to estimate the effective intervals of the serum prostate specific antigen (PSA) test in men aged over 50 years, with an initial PSA value below 2ng/ml, no palpable nodule at digital rectal examination (DRE) and no abnormal findings on transrectal ultrasonography (TRUS). MATERIALS AND METHODS: 209 men, with initial serum PSA levels below 4ng/ml, who had checked their PSA more than twice, with a minimal interval of 4 months, taking no BPH medication and with no lesion suspicious of malignancy on DRE and TRUS, were enrolled. The factors influencing the changes in the PSA were analyzed, and the rate of conversion of PSA over the cut-off level of 4ng/ml, or age specific reference level of PSA, calculated. Another group of 24 patients, with initial PSA levels below 4ng/ml, but showing no lesion suspicious of malignancy on DRE or TRUS, underwent transrectal biopsies, and their PSA velocities (PSAV) calculated. RESULTS: Of the 209 patients, a PSA conversion, over the age specific reference level of PSA, was not observed over a 4 years period in the group with an initial PSA below 1ng/ml. In the group with initial PSA levels between 1 and 2ng/ml, a PSA conversion of over 4ng/ml was observed in only 3.4% of patients over a 2 year period. Among 24 biopsies, 5 prostate cancers and one high grade PIN were detected, with the calculated PSAV from these patients being 0.75ng/ml/year. When this PSAV was applied as a cut-off value, the sensitivity and specificity were 33.3 and 11.1%, respectively. CONCLUSIONS: The PSAV did not effectively predict the presence of prostate cancer in men with an initial PSA below 4ng/ml. Therefore, in men over 50, and without a lesion suspicious of malignancy on DRE and TRUS, the suggested effective intervals for screening of prostate cancer, for men with an initial PSA below 1ng/ml and between 1 and 2ng/ml, should be 4 and 2 years, respectively.
Biopsy ; Digital Rectal Examination ; Humans ; Male ; Mass Screening* ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: This aim of this study was to evaluate changes in gastric volume and organ position as a result of delayed gastric emptying after a subtotal gastrectomy performed as part of the treatment of stomach cancer. MATERIALS AND METHODS: The medical records of 32 patients who underwent concurrent chemoradiotherapy after a subtotal gastrectomy from March 2005 to December 2008 were reviewed. Of these, 5 patients that had more than 50 cc of residual gastric food detected at computed tomography (CT) simulation, were retrospectively enrolled in this study. Gastric volume and organ location was measured from CT images obtained before radiotherapy, twice weekly. In addition, authors evaluated the change of radiation dose distribution to planning the target volume and normal organ in a constant radiation therapy plan regardless of gastric volume variation. RESULTS: A variation in the gastric volume was observed during the radiotherapy period (64.2~340.8 cc; mean, 188.2 cc). According to the change in gastric volume, the location of the left kidney was shifted up to 0.7 - 2.2 cm (mean, 1.2 cm) in the z-axis. Under-dose to planning target volume (V43, 79.5+/-10.4%) and over-dose to left kidney (V20, 34.1+/-12.1%; Mean dose, 23.5+/-8.3 Gy) was expected, given that gastric volume change due to delayed gastric emptying wasn't taken into account. CONCLUSION: This study has shown that a great change in gastric volume and left kidney location may occur during the radiation therapy period following a subtotal gastrectomy, as a result of delayed gastric emptying. Detection of patients who experienced delayed gastric emptying and the application of gastric volume variation to radiation therapy planning will be very important.
Chemoradiotherapy ; Gastrectomy ; Gastric Emptying ; Humans ; Kidney ; Medical Records ; Retrospective Studies ; Stomach Neoplasms