To assess the correlation between the remaining serum testosterone and bone mineral density(BMD), and to determine the effect of exogenous testosterone on BMD in subjects with male hypogonadism, we evaluated the serum testosterone levels and BMDs of the femur neck, Ward's triangle and the spine(L1-4) in 20 subjects with Klinefelter's syndrome and 7 with hypogonadotropic hypogonadism before and after testosterone replacement. BMDs of the femur neck, Ward's triangle and the spine were below the age-matched normal mean at 77.8%(21/20), 74.1%(20/27) and 88.9%(24/27), respectively. There were significant differences in serum testosterone levels and the spinal BMD between the two groups and the BMD of the spine closely correlated with the serum testosterone level (R = 0.63, p < 0.001). Following a mean 11.8 +/- 4.9 months of testosterone replacement, the BMD at all sites increased significantly and the pretreatment difference in spinal BMD between the two groups disappeared. We conclude that, although testosterone may increases the bone density, it has a site-specific effect of maintaining and increasing the bone mass especially at the spine in male hypogonadism.
Adult ; Bone Density/*drug effects/physiology ; Human ; Hypogonadism/blood/*metabolism ; Klinefelter Syndrome/blood/drug therapy/*metabolism ; Male ; Middle Age ; Testosterone/blood/metabolism/*pharmacology

This study attempted to assess the risk factors for mortality of very-low-birth-weight (VLBW) infants in the neonatal intensive care unit (NICU, n=2,386). Using data from the Korean Neonatal Network, we investigated infants with birth weights <1,500 g and gestational ages (GAs) of 22-31 weeks born between January 2013 and June 2014. Cases were defined as death at NICU discharge. Controls were randomly selected from live VLBW infants and frequency matched to case subjects by GA. Relevant variables were compared between the cases (n=236) and controls (n=236) by Cox proportional hazards regression to determine their associations with cause-specific mortality (cardiorespiratory, neurologic, infection, gastrointestinal, and others). In a Cox regression analysis, cardiorespiratory death were associated with a foreign mother (hazard ratio, HR, 4.33; 95% confidence interval, CI, 2.08-9.02), multiple gestation (HR, 1.65; 95% CI, 1.07-2.54), small for gestational age (HR, 2.06; 95% CI, 1.25-3.41), male gender (HR, 1.69; 95% CI, 1.10-2.60), Apgar score < or =3 at 5 min (HR, 1.97; 95% CI, 1.18-3.31), and delivery room resuscitation (HR, 2.60; 95% CI, 1.53-4.40). An Apgar score < or =3 at 5 min was also associated with neurological death (HR, 2.95; 95% CI, 1.29-6.73). Death due to neonatal infection was associated with outborn delivery (HR, 5.09; 95% CI, 1.46-17.74). Antenatal steroid and preterm premature rupture of membranes reduced risk of cardiorespiratory death (HR, 0.43; 95% CI, 0.27-0.67) and gastrointestinal death (HR, 0.30; 95% CI, 0.13-0.70), respectively. In conclusion, foreign mother, multiple gestation, small gestation age, male gender, Apgar score < or =3 at 5 min, and resuscitation in the delivery room are associated with cardiorespiratory mortality of VLBW infants in NICU. An Apgar score < or =3 at 5 min and outborn status are associated with neurological and infection mortality, respectively.
Apgar Score ; Cohort Studies ; Databases, Factual ; Female ; Gestational Age ; Humans ; Infant ; *Infant Death ; *Infant Mortality/trends ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Kaplan-Meier Estimate ; Male ; Pregnancy ; Pregnancy, Multiple ; Proportional Hazards Models ; Republic of Korea ; Resuscitation ; Risk Factors ; Sex Factors

PURPOSE: To evaluate the application of MRI to the ILAE classification of epilepsies and epileptic syndromes in the setting of epilepsy clinic. METHODS: We reviewed epilepsy registry forms, EEG, and MRI of 300 patients who were consecutively registered to the Yonsei Epilepsy Clinic. The algorhithm of syndromic classification consisted of 3 steps ; 1) clinical diagnosis based on the clinical informations described in the registry form, 2) clinical-EEG correlations, and 3) clinical-EEG-MRI correlations. The interictal epileptiform discharges (IEDs) in EEG were divided into focal, multilobar/multifocal, and generalized. MRI-lesions were divided into focal and non-focal (multilobar/multifocal, and diffuse) lesions. The clinical-EEG, EEG-MRI, and MRI-clinical correlations were categorized as concordant, not discordant, and discordant. RESULTS: Among 300 patients evaluated, 249 patients were found to have epilepsies and both EEG and MRI. By clinical analysis, 190 of 249 patients were diagnosed as localization-related epilepsies (LRE), 24 patients were generalized epilepsies (GE), 34 patients were undetermined epilepsies (UDE), and one patient had alcohol related epilepsy. EEG revealed IEDs in 124 patients and altered the clinical diagnosis in 79 patients. MRI lesions were found in 106 patients with focal lesions in 65 patients and non-focal lesions in 41 patients. MRI lesions were found in 47 of 125 patients with negative EEG. Concordance rates of clinical-EEG, EEG-MRI, and MRI-clinical correlations in 54 patients with lobar epilepsies, who had positive EEG and MRI, were 39%, 54%, and 52%, respectively, and discordant rates were 17%, 11% and 7%, respectively. The complete concordance of all 3 correlations was found in only 33% of them. In 20 patients diagnosed as GE by clinical-EEG correlations, MRI lesions were found in only 3 patients and none of them changed the diagnostic categories due to MRI lesions. CONCLUSION: In lobar epilepsies, the sensitivity of MRI was quite comparable with EEG and the clinical-MRI correlation was superior to the clinical-EEG correlations. MRI provided additional and complimentary informations and should be incorporated to the ILAE-classification system as the category of 'lesional epilepsy'.
Classification ; Diagnosis* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Generalized ; Humans ; Magnetic Resonance Imaging*

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis ; Hematuria ; Multivariate Analysis ; Prospective Studies ; Sensitivity and Specificity ; Urinalysis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: We prospectively evaluated the diagnostic efficacy of the BTA TRAK assay according to the stage, grade and hematuria in detecting primary and recurrent bladder cancer, and compared results with voided urine cytology. MATERIALS AND MTHODS: Urinalysis, cytology and BTA TRAK assay were performed simultaneously with the single voided fresh urine samples from 130 subjects. The sensitivity and specificity of the BTA TRAK assay were compared to those of urine cytology and analyzed according to the stage or grade. The subjects were also divided into 4 groups according to the degree of hematuria and the influence of hematuria on the result of the BTA TRAK assay was evaluated. RESULTS: The overall sensitivity and specificity of the BTA TRAK assay for detecting bladder cancer were 82.8% and 65.3%, respectively and those of urine cytology were 44.8% and 100%. The sensitivity of the BTA TRAK assay was significantly higher than that of urine cytology in bladder cancer with lower stage and grade. On univariate and multivariate analysis, gross hematuria and the presence of bladder cancer affected the results of the BTA TRAK assay significantly. In cases following after transurethral resection of bladder tumor (TURB), the sensitivity and specificity of the BTA TRAK assay for detecting recurrent bladder cancer were 100% and 79.5%, respectively. CONCLUSIONS: The BTA TRAK assay was more sensitive but less specific than voided urine cytology. Because gross hematuria affected the result of the BTA TRAK assay independently, it appears reasonable to delay the BTA TRAK assay until gross hematuria subsides in cases with gross hematuria. In cases following after TURB, the BTA TRAK assay appears to be useful for detecting recurrent bladder cancer.
Diagnosis ; Hematuria ; Multivariate Analysis ; Prospective Studies ; Sensitivity and Specificity ; Urinalysis ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Diffuse axonal injury(AI) s a severe form of traumatic brain injury and it is associated with immediate coma lasting from six hours to prolonged coma. Object of this study was to review various clinical parameters which might have been related to outcome of patients with DAI and, thus, to provide some valuable guidelines in management. A series of 41 patients of DAI treated in our institution between October 1992 to September 1997 are included in this study. Clinical factors such as age, sex, Glasgow Coma Scale(CS), duration of coma, presence of hypotension at admission, hypoxemia, signs of hypothalamic injury, abnormal eyeball movement, abnormal light reflex, abnormal electrocardiography, cerebral infarct, and seizure are reviewed and analyzed in conjunction with outcome. Among all clinical factors evaluated for the statistical significances only initial GCS, hypoxemia, abnormal light reflex, signs of hypothalamic injury, abnormal motor response(decortication or decerebration) at admission revealed to have significant correlation with outcome. Factors such as age, hypotension, abnormal ECG, cerebral infarct, seizure were not statistically significant in our study. Other findings, such as causes of deaths(old age associated with either expanding hemorrhage or hemorrhage in posterior fossa) in 2 of 9 patientswith initial GCS greater than 13 and highest mortality rate for patients with combined hypoxemia and hypotension, should also be stressed. These findings suggest that when such clinical settings are evident physicians should be borne in mind that these will play unfavorable role to patients in terms of outcome and prognosis. Thus, careful and prompt attention should be given to these patients, especially treating elderly patients, even though they may have good initial GCSs.
Aged ; Anoxia ; Axons ; Brain Injuries ; Coma ; Craniocerebral Trauma ; Diffuse Axonal Injury* ; Dyskinesias ; Electrocardiography ; Hemorrhage ; Humans ; Hypotension ; Mortality ; Prognosis ; Reflex ; Reflex, Abnormal ; Seizures

Radiation therapy is one of the most important treatment modalities following surgery of the primary malignant or metastatic brain tumors. But radiation can be harmful to normal healthy brain tissues around the tumor. There have been numerous reports of radiation induced damage such as delayed necrosis to human brain after therapeutic exposure. Apoptosis is a form of cell death with morphological and biochemical features that differ from those of necrosis. The aim of this study is to evaluate the apoptosis in normal rat brain after irradiation. Twenty one Sprague-Dawley rats were given a single dose of 10 Gy using high dose rate Ir-192 over 5 minutes at the right frontal region. Apoptosis was evaluated by the TUNEL method(In-situ end labelling technique) and mutant p53 protein, bc1-2 and bax genes were evaluated by immunohistochemical stain. Apoptosis was assessed at 1 week(group A, n=5), 2 week(group B, n=), 4 week(group C, n=), 6 week(group D, n=), 8 week(group E, n=) after irradiation. Apoptosis was noted with 20% of cases(1/5) in group A, 40% of cases(2/5) in group B, 60% of cases(3/5) in group C, 67% of cases(2/3) in group D and 100% of cases(3/3) in group E. Overall apoptosis positive rate was 52.4%(11/21). Apoptosis was most prominently found in external granular and external pyramidal layer(82%, 9/11) and found one case in internal pyramidal layer and the other one case in corticowhite matter junction. There were no positive stainning for mutant p53 protein, bc1-2 and bax gene in all cases pertaining to the phenomenon of apoptosis. In conclusion, apoptosis was evident in the rat brain after irradiation and the incidence of apoptosis was increased with time after irradiation. But the genes related to apoptosis after irradiation were not apparent in this study. Further evaluation including biochemical and clonogenic study needs to clarify the mechanism of apoptosis in normal brain after irradiation.
Animals ; Apoptosis* ; Brain Neoplasms ; Brain* ; Cell Death ; Humans ; In Situ Nick-End Labeling ; Incidence ; Necrosis ; Rats* ; Rats, Sprague-Dawley

Pyogenic granulomas (PGs) are rare benign lobular capillary hemangiomas that occur on the skin or mucosa. The most common sites of PG occurrence are the skin, lip, face and finger. This entity is extremely rare in the alimentary tract, with the exception of the oral cavity. We describe here a 72-year-old man who presented with dysphagia due to the presence of a pyogenic granuloma. The tumor was located in the mid-esophagus and it was treated with endoscopic submucosal dissection. PG is considered a lesion of reactive origin that may develop in response to trauma, infection, pregnancy, angiogenic factors or hormones. Gastrointestinal PG need to be treated because it is a rare cause of gastrointestinal hemorrhage, and it is hard to differentiate from tumorous conditions such as Kaposi's sarcoma.
Aged ; Angiogenesis Inducing Agents ; Deglutition Disorders ; Fingers ; Gastrointestinal Hemorrhage ; Granuloma ; Granuloma, Pyogenic ; Hemangioma ; Humans ; Lip ; Mouth ; Mucous Membrane ; Pregnancy ; Skin

Unmethylated CpG oligodeoxynucleotides (CpG ODNs) activate immune cells to produce immune mediators. This study demonstrates that in murine macrophage RAW 264.7 cells, CpG ODN-mediated matrix metalloproteinase-9 (MMP-9) expression is regulated at transcriptional level and requires de novo protein synthesis. Inhibition of ERK and p38 MAPK, but not JNK, results in significant decrease of CpG ODN-induced MMP-9 expression. We found that endosomal maturation inhibitors, chloroquine and bafilomycin A, block CpG ODN-induced ERK and p38 MAPK activation and the subsequent MMP-9 expression. We also observed that CpG ODN induces NF-kappa B activation and NF-kappa B is a downstream target of p38 MAPK. Taken together, our data demonstrate that CpG ODN triggers MMP-9 expression via TLR-9 dependent ERK and p38 MAPK activation followed by NF-kappa B activation.
Animals ; Cell Line ; Enzyme Activation/drug effects ; Enzyme Induction/drug effects ; Matrix Metalloproteinase 9/*biosynthesis ; Mice ; Mitogen-Activated Protein Kinase 1/antagonists & inhibitors/metabolism ; Mitogen-Activated Protein Kinase 3/antagonists & inhibitors/metabolism ; Mitogen-Activated Protein Kinases/*metabolism ; NF-kappa B/*metabolism ; Oligodeoxyribonucleotides/*pharmacology ; Signal Transduction/drug effects ; Toll-Like Receptor 9/antagonists & inhibitors/*metabolism ; p38 Mitogen-Activated Protein Kinases/antagonists & inhibitors/metabolism

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.
Bone Density/drug effects ; Diaphyses/drug effects/injuries ; Diphosphonates/*adverse effects ; Female ; Femoral Fractures/*chemically induced/diagnosis/surgery ; Fracture Fixation, Internal ; Fracture Healing/drug effects ; Fractures, Spontaneous/*chemically induced/diagnosis/surgery ; Fractures, Stress/*chemically induced/diagnosis/surgery ; Humans ; Middle Aged ; Osteoporosis/*drug therapy ; Radiopharmaceuticals/diagnostic use ; Technetium Tc 99m Medronate/analogs & derivatives/diagnostic use ; Treatment Outcome ; Whole Body Imaging