PURPOSE: Recent studies suggest that the symptomatic improvement in benign prostatic hyperplasia significantly related with transition zone volume (TZV). The purpose of this study was to determine the clinical significance of TZV and transition zone index (TZI) in changes of prostate volume (PV) and clinical parameters following finasteride therapy. MATERIALS AND METHODS: 140 patients over 50 years of age with symptomatic benign prostatic hyperplasia were treated with finasteride (5mg/d) for 12 months and underwent transrectal ultrasound evaluation of PV and TZV prior to initiating therapy and after 12 months. Patients were grouped according to the results of PV (> OR =40ml or <40ml), TZI (> OR =0.45 or <0.45) and PSA level (> OR =2.5 or <2.5). The responders was determined as improvement in peak flow rate more than 3mL/sec. RESULTS: PV decreased by 14.11% in patients with TZI less than 0.45, while the decrease was 19.25% for men with TZI greater than 0.45 (p<0.01). In addition, PV was significantly decreased by 16.72% in patients with PV less than 40cc and TZI greater than 0.45 (p<0.01). PV decreased by 17.37% in patients with PSA less than 2.5, while the decrease was 18.92% in men with PSA greater than 2.5. In responders, only TZI was significantly different among PSA, PV and TZI (p<0.05). CONCLUSIONS: Treatment effect of finasteride on symptomatic benign prostatic hyperplasia patients was increased in proportion to enlarged PV, increased TZI, increased PSA. TZI was a useful proxy for predicting clinical outcomes in initiating finasteride therapy on benign prostatic hyperplasia.
Finasteride* ; Humans ; Male ; Prostate ; Prostatic Hyperplasia* ; Proxy ; Ultrasonography

PURPOSE: This analysis was conducted to evaluate the cost-effectiveness of gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patients in an outpatient setting compared with the traditional inpatient setting. METHODS: A cost-effective analysis was conducted from a societal perspective. The effects of treatment, which was measured as an adverse event rate, were abstracted from a published literature search and empirical data from one university hospital. The costs included both direct and indirect costs. Direct costs included hospitalizations, outpatient visits, and lab tests. Pharmaceutical costs were excluded in analysis because they were same for both options. Indirect costs included productivity loss of patients as well as care-givers. In order to determine the robustness of the results, sensitivity analysis on treatment protocol was conducted. RESULTS: Literature search showed no difference in adverse effect rates between inpatient treatment protocol and outpatient treatment protocol. Therefore, this analysis is a cost-minimization analysis. Cost-savings in the outpatient setting was 555,936 won for one treatment cycle. Our sensitivity analysis indicated that the outpatient chemotherapy still showed cost-savings, regardless of changes in treatment protocol. CONCLUSION: The outpatient gemcitabine-cisplatin chemotherapy for non small-cell lung cancer resulted in cost savings compared to inpatient chemotherapy. More importantly, outpatient chemotherapy could improve the utilization of health service resources in terms of available beds.
Antineoplastic Combined Chemotherapy Protocols/*economics/therapeutic use ; Carcinoma, Non-Small-Cell Lung/*drug therapy/*economics ; Cisplatin/*economics/therapeutic use ; Cost Allocation ; Cost-Benefit Analysis ; Deoxycytidine/*analogs & derivatives/economics/therapeutic use ; Humans ; Lung Neoplasms/*drug therapy/*economics ; Outpatients

PURPOSE: This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities. METHODS: The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit. RESULTS: Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38. CONCLUSION: The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.
Administrative Personnel ; Aged ; Community Health Nursing ; Cost-Benefit Analysis ; Delivery of Health Care ; Diabetes Mellitus ; Health Expenditures ; Hospital Charges ; Humans ; Hypertension ; Nursing Care ; Outpatients ; Pharmacy ; Transportation

OBJECTIVES: Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence. METHODS: Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (> or =80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level. RESULTS: The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill. CONCLUSION: A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes.
Acer ; Amlodipine ; Cardiovascular Diseases ; Cholesterol, LDL ; Compliance ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Korea* ; Lipoproteins* ; Medication Adherence ; Atorvastatin Calcium

Sjogren's syndrome is a chronic,slowly progressive,autoimmune disease in which the exocrine glands are damaged by lymphocytic infiltration,resulting in xerostomia and xerophthalmia.Fever in patients with Sjogren's syndrome is rarely manifested with the exception of cases with complicated illness such as lymphoma.We experienced a 70-year-old male patient with Sjogren's syndrome who was presented with fever of unknown origin.Despite of thorough investigation,other diseases to cause fever could not be found.Fever and other clinical features were improved with empirical steroid therapy.
Aged ; Exocrine Glands ; Fever of Unknown Origin* ; Fever* ; Humans ; Male ; Sjogren's Syndrome ; Xerostomia

BACKGROUND/AIMS: This meta-analysis compared the effects of amlodipine besylate, a charged dihydropyridine-type calcium channel blocker (CCB), with other non-CCB antihypertensive therapies regarding the cardiovascular outcome. METHODS: Data from seven long-term outcome trials comparing the cardiovascular outcomes of an amlodipine-based regimen with other active regimens were pooled and analyzed. RESULTS: The risk of myocardial infarction was significantly decreased with an amlodipine-based regimen compared with a non-CCB-based regimen (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84 to 0.99; p = 0.03). The risk of stroke was also significantly decreased (OR, 0.84; 95% CI, 0.79 to 0.90; p < 0.00001). The risk of heart failure increased slightly with marginal significance for an amlodipine-based regimen compared with a non-CCB-based regimen (OR, 1.14; 95% CI, 0.98 to 1.31; p = 0.08). However, when compared overall with beta-blockers and diuretics, amlodipine showed a comparable risk. Amlodipine-based regimens demonstrated a 10% risk reduction in overall cardiovascular events (OR, 0.90; 95% CI, 0.82 to 0.99; p = 0.02) and total mortality (OR, 0.95; 95% CI, 0.91 to 0.99; p = 0.01). CONCLUSIONS: Amlodipine reduced the risk of total cardiovascular events as well as all-cause mortality compared with non-CCB-based regimens, indicating its benefit for high-risk cardiac patients.
Amlodipine/*therapeutic use ; Antihypertensive Agents/*therapeutic use ; Blood Pressure/*drug effects ; Calcium Channel Blockers/*therapeutic use ; Chi-Square Distribution ; Clinical Trials as Topic ; Heart Failure/etiology/mortality/*prevention & control ; Humans ; Hypertension/complications/diagnosis/*drug therapy/mortality/physiopathology ; Myocardial Infarction/etiology/mortality/*prevention & control ; Odds Ratio ; Risk Factors ; Stroke/etiology/mortality/*prevention & control ; Treatment Outcome

BACKGROUND: Aprotinin, a serine protease inhibitor, has an anti-inflammatory and hemostatic effect and has been used to reduce perioperative blood loss and lung injury after cardiopulmonary bypass in cardiac surgery. Acute respiratory distress syndrome (ARDS), which results in clinical manifestations due to non-cardiogenic permeability edema is a fatal condition associated with a mortality rate of 50 to 80%. The purpose of this study was to evaluate the effects of aprotinin on acute lung injury induced by bacterial endotoxin in rabbits. METHODS: Nineteen rabbits were anesthetized with intravenous xylazine, Ketamine and vecuronium and ventilated with a Harvard apparatus maintaining normocapnea. In 7 rabbits, 2 mg/Kg of lipopolysaccharide from E. coli was infused intravenously for 30 min (Toxin group) and in another 7 rabbits aprotonin loading with 200,000 KIU/Kg followed by a continuous infusion of 50,000 KIU/Kg/hr was performed 30 min before the endotoxin infusion throughout the experiment (Aprotinin group). At 1, 2, 3, and 4 hours after endotoxin infusion, arterial blood gas, blood cell count, prothrombin time, activated partial thromboplastin time, fibrinogen, and hemodynamic profiles were checKed. At four hours, the animals were dissected at which time the lungs were divided into three regions for wet/dry weight ratio (WW/DW), myeloperoxidase activity and microscopic examination. RESULTS: In the Aprotinin group, pulmonary vascular resistance, arterial oxygen partial pressure and coagulation function were well preserved compared with the Toxin group. Furthermore, lung WW/DW, myeloperoxidase activity, and inflammatory responses also increased less in the Aprotinin group. CONCLUSIONS: The results of the current data showed that aprotinin has prophylactic effects against acute lung injury and coagulation impairment induced by bacterial endotoxin in rabbits.
Acute Lung Injury* ; Animals ; Aprotinin* ; Blood Cell Count ; Cardiopulmonary Bypass ; Edema ; Fibrinogen ; Hemodynamics ; Ketamine ; Lung ; Lung Injury ; Mortality ; Oxygen ; Partial Pressure ; Partial Thromboplastin Time ; Permeability ; Peroxidase ; Prothrombin Time ; Rabbits* ; Respiratory Distress Syndrome, Adult ; Serine Proteases ; Thoracic Surgery ; Vascular Resistance ; Vecuronium Bromide ; Xylazine

Primary vesical actinomycosis is an extremely rare disease. In most cases it is misdiagnosed as vesical or urachal tumor and usually diagnosed through post-operative pathologic confirmation. Here we report a case of primary vesical actinomycosis confirmed by preoperative repeated multiple transabdominal biopsies. The patient was a 49-yr-old woman who presented with frequency, dysuria, and intermittent gross hematuria for 2 months. Computed tomography and cystoscopic examination showed broad-based, edematous, and protruding mass at the dome and anterior portion of the bladder. The clinical and imaging findings of the patient initially suggested vesical malignancy. Transurethral resection and multiple biopsies of the mass were performed. Pathologic examination demonstrated fibrosis with chronic inflammation. We performed repeated transabdominal multiple needle biopsies for further pathologic confirmation. Histopathologic examination demonstrated typical sulfur granules, which were consistent with actinomycosis.
Abdomen ; Actinomycosis/drug therapy/*pathology/surgery/ultrasonography ; Biopsy, Needle/methods ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Penicillins/therapeutic use ; Treatment Outcome ; Urinary Bladder/*pathology/surgery/ultrasonography ; Urinary Bladder Diseases/drug therapy/*pathology/surgery/ultrasonography

BACKGROUND: Primary ovarian failure is reportedly increasing in recent years. Environmental factors have been frequently implicated as responsible for this increase, However, only a few of the environmental factors have been proven to cause the ovarian failure in human. METHODS: In June 1995, 24 female laborers, who worked in a factory which used Solvent #5200 (with a main chemical component being 2-bromopropane), developed symptoms of amenorrhea or irregular menstruation. All subjects underwent laboratory tests including measurement of serum LH, FSH, and estradioL Magnetic resonance imaging and ultrasonography of the pelvis were performed in all subjects. Laparoscopic examination was performed in 6 out of 24 patients after obtaining informed consent and 4 of 6 underwent ovarian biopsy. RESULTS: One subject was excluded because she had undergone hysterectomy previously. Among the remaining 23 subjects, 14 and 9 complained of amenorrhea and irregular menstrual periods, respectively. When we defined primary ovarian failure as FSH>30mIU/mL, all of those 14 patients with amenorrhea could be classified as primary ovarian failure. On the other hand, those 9 patients with irregular menstruations had normal FSH levels. Pathologic examination of ovaries showed interstitial fibrosis, loss of primordial follicles, and development arrest of follicles in the group with amenorrhea, similar to what is found in those who received chemotherapy or were exposed to radiation. CONCLUSION: The female laborers who were exposed to the solvent with 2-bromopropane developed primary ovarian failure. This failure was associated with longer duration of exposure. To our knowledge, this is the first report in the world indicating 2-bromopropane as a possible agent for ovarian failure.
Amenorrhea ; Biopsy ; Drug Therapy ; Estradiol ; Female ; Fibrosis ; Hand ; Humans ; Hysterectomy ; Informed Consent ; Magnetic Resonance Imaging ; Menstruation ; Ovary ; Pelvis ; Ultrasonography

OBJECTIVES: The present study assessed the effect of trazodone on the cerebral hemodynamics of male Sprague-Dawley rats. METHOD: The changes of regional cerebral blood flow(rCBF) and pill arterial diameter were measured by laser-Doppler flowmetry and by a videomicroscopy, respectively. The changes in vascular tone and intracellular free Ca2+ concentration ([Ca2+]i) of isolated basilar artery were simultaneously measured using a small vessel myograph and a cation measurement system, respectively. RESULT: Both the rCBF and the pill arterial diameter were dose-dependently decreased by systemic administration of trazodone(0.3-10 mg/kg, i.v.), but not by topical application of trazodone(10-300 micrometer). Pretreatment with 5-HT(2A/2C) receptor antagonist(ketanserin or ritanserin, 1 mg/kg, i.v., respectively) significantly blocked the changes in rCBF induced by trazodone. m-Chlorophenylpiperazine(mCPP ; 0.1-3 mg/kg, i.v. or 5-500 micrometer topical), a major active metabolite of trazodone, also dose-dependently decreased the rCBF as well as the pial arterial diameter. The mCPP-induced decreases in rCBF were significantly blocked by ketanserin. Pretreatment with itraconazole(1 mg/kg, p.o.), a selective inhibitor of CYP3A4, a subfamily of cytochrome P450, markedly attenuated the trazodone-induced changes in rCBF. In an isolated rat basilar arterial strip loaded with fura-2/AM, mCPP(5-500 micrometer caused a vasoconstriction in association with increases in [Ca2+]i, in a concentration-dependent manner. Pretreatment with 1 micrometerketanserin strongly blocked the effects of mCPP on the vascular tone as well as on the [Ca2+]i, of rat basilar artery. CONCLUSION: These results suggest that trazodone decreases rCBF through stimulation of 5-HT(2A/2C) receptors by its active metabolite, mCPP.
Animals ; Basilar Artery ; Cytochrome P-450 Enzyme System ; Hemodynamics* ; Humans ; Ketanserin ; Laser-Doppler Flowmetry ; Male ; Microscopy, Video ; Rats* ; Rats, Sprague-Dawley ; Ritanserin ; Trazodone* ; Vasoconstriction