Purpose: We assessed the effects of medication with dutasteride on serum prostate-specific antigen (PSA), PSA density (PSAD) and prostate volume to avoid unnecessary biopsies. Materials and Methods: Between 2005 and 2007 patients with serum PSA level of 4~10 ng/ml were recruited in this prospective study. Patients were treated with 0.5 mg of dutasteride once daily for 3 months. PSA, PSAD and prostate volume were measured at baseline and at the end of treatment. The patients with a high PSA level (> or =4 ng/ml) after medication with dutasteride had a prostate biopsy. The patients were divided as group I (prostate cancer; n=29) and group II (benign disease; n=55). We compared the changes of serum PSA, PSAD, and prostate volume change between two groups. Results: In group I, PSA, PSAD and prostate volume decreased from baseline means of 8.16 ng/ml, 0.23 ng/ml/cm3 and 46.81 cc to 5.69 ng/ml, 0.18 ng/ml/cm3 and 40.41 cc. The difference in PSA, PSAD and prostate volume was -0.2%, -2.1% and -3.6% for group I. On the contrary, in group II, PSA, PSAD and prostate volume decreased from baseline means of 7.65 ng/ml, 0.16 ng/ml/cm3 and 56.48 cc to 4.48 ng/ml, 0.11 ng/ml/cm3 and 51.35 cc. The difference in PSA, PSAD and prostate volume was -41.4%, -33.3% and -9.1% for group II. When 4.83 ng/ml and 0.15 ng/ml/cm3 were chosen as the PSA and PSAD cutoff levels after treatment with dutasteride, unnecessary biopsies could be avoided effectively. Conclusions: These data suggest that the magnitude of changes in serum PSA and PSAD after 3 months of dutasteride challenge could be useful to avoid unnecessary prostate biopsies in patients with elevated PSA level.
Azasteroids ; Biopsy ; Humans ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Dutasteride

PURPOSE: Patients with diabetic cystopathy ultimately undergo morphometric and functional changes in their bladder. Therefore, various voiding symptoms such as frequency, nocturia, urgency, hesitancy, retention and weak stream were evaluated. Irritative symptoms usually develop in cases where the prevalence period of diabetes mellitus (DM) is short, and the obstructive symptoms develop in the opposite case. Improving the voiding symptoms might differ according to prevalence period. Therefore, the therapeutic efficacy of the treatment was compared. MATERIALS AND METHODS: One hundred ten patients were divided into three groups according to how long they had suffered from DM, and were treated with medical therapy over a 4 week period: group A (<5yrs), group B (5-10yrs), group C (>10yrs). The patients were asked to write their subjective symptoms in a voiding diary and a urodynamic study was undertaken. RESULTS: After medical therapy, the frequency, nocturia and urgency in group A had improved to 72%, 77% and 88% respectively (p<0.05). The frequency, nocturia, urgency, hesitancy, retention and weak stream in group B had improved to 51%, 57%, 66%, 59%, 69% and 61% respectively (p<0.05), and in group C these symptoms had improved to 15%, 12%, 10%, 17%, 12% and 8% respectively (p>0.05). In a urodynamic study of group B, the maximum detrusor pressure had increased from 20.3+/-6.7cmH2O to 53.5+/-8.1cmH2O and the post void residuals decreased from 62.3+/-36.4ml to 21.2+/-17.1ml (p<0.05). In addition, there were little improvements in the maximum bladder capacity, the first sensation and compliance (p>0.05). In group C, there was little improvement in the urodynamic study (p>0.05). CONCLUSIONS: The medical therapeutic efficacy for these patients reduces as the DM revalence period is longer.
Compliance ; Diabetes Mellitus* ; Humans ; Nocturia ; Prevalence* ; Rivers ; Sensation ; Urinary Bladder ; Urodynamics

PURPOSE: We investigate the age-related changes in the production of nitiric oxide (NO) in the articular cartilage and its effects on cell proliferation. MATERIALS AND METHODS: Forty New Zealand white rabbits of four different age groups were used. There were 10 rabbits in each group and the age groups were 1 month, 6 months, 1 year and 3 years of age. We measured the basal and induced production of NO in cultured articular chondrocytes that were obtained from distal femur by using a nitrite assay. We observed the changes in the proliferative activity of the chondrocytes after exogenous NO administration using a nonradioisotopic proliferation assay. In addition, we also detected endothelial nitric oxide synthase (eNOS) in articular cartilage using immunohistochemical staining. RESULTS: The basal and induced levels of NO were lower in the cultured chondrocytes from older rabbits. Exogenous NO administration suppressed the proliferative activity of chondrocytes to a greater degree in the younger rabbits than in the older ones. Immunohistochemistry showed a predominance of eNOS positive chondrocytes in the superficial layer. The number of eNOS positive chondrocytes decreased in older rabbits. CONCLUSION: The production of NO decreased with aging in normal articular cartilage. The suppression of proliferative activity in chondrocytes by exogenous NO declined with aging.
Aging* ; Cartilage, Articular* ; Cell Proliferation ; Chondrocytes ; Femur ; Humans ; Immunohistochemistry ; Nitric Oxide Synthase Type III ; Nitric Oxide* ; Rabbits

A series of clinical studies on the psychiatric aspects of hemodialysis and kidney transplantation were done with Korean patients, kidney donors, their families and unit nurses. All subjects were interviewed and evaluated for their psychiatric reactions and symptoms and for the underlying causes. Depression was the most common reaction, although the clinical features were somewhat different between groups studied. In addition, a unique and episodic psychotic syndrome was found in four patients. Depression and psychotic episodes seemed to reflect the psychodynamic components such as instinctual frustration, physical, familial and financial loss, dependency on a machine, sensory deprivation and the so-called fear of death and fear of life. These seemed to follow the unique features of hemodialysis and transplantation. The main defense mechanism seemed to be denial. The possible role of psychiatrists was discussed for evaluation, treatment, and prevention of these reactions and for the support of the family and the treatment team.
dult ; Aged ; Female ; Human ; Kidney Transplantation* ; Korea ; Male ; Middle Age ; Renal Dialysis/psychology* ; Transplantation, Homologous/psychology*

No abstract available.
R Factors* ; Shigella*

Adenomatoid tumors are rare benign neoplasms thought to be of mesothelial origin. Although most reported cases developed from the epididymis, rare cases have been reported in the testicular tunica, spermatic cord and ejaculatory ducts. Because of the benign nature of this tumor, the treatment of choice is local excision. We report a rare case of adenomatoid tumor of the spermatic cord treated by local excision.
Adenomatoid Tumor ; Ejaculatory Ducts ; Epididymis ; Male ; Spermatic Cord

BACKGROUND AND OBJECTIVES: Neuropathology around the cochlea could create variation from site to site in physiological thresholds of cochlear implant users. This variability would be detrimental to speech recognition with a cochlear implant for a variety of reasons, including distortion of the place code and variation in the number of neurons. The purpose of this study is to examine the relationship between thresholds of electrically evoked compound action potential (ECAP) and speech perception in children implanted with the Nucleus Freedom devices. SUBJECTS AND METHOD: Fifty-seven children implanted with the Nucleus Freedom device participated in this study. ECAP thresholds were recorded using the automated neural response telemetry test protocol. We then calculated mean threshold and three metrics to assess across-site variation within subjects: 1) the variance of T levels for all tested sites, 2) the range of T levels (highest minus lowest) across all tested sites and 3) site-to-site variation. For each subject, these measures were compared with performance on tests of word recognition. RESULTS: There was considerable across-site (within-subject) and across-subject variability in thresholds. However, we found no significant correlation between speech recognition and across-site variation of thresholds as well as mean threshold levels. CONCLUSION: These data suggest that the ECAP measures of thresholds may not be an accurate predictor of speech perception ability.
Action Potentials ; Child ; Cochlea ; Cochlear Implants ; Freedom ; Humans ; Hypogonadism ; Mitochondrial Diseases ; Neurons ; Ophthalmoplegia ; Speech Perception ; Telemetry

The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.

OBJECTIVE: Aneurysms arising from the trunk of the supraclinoid internal carotid artery(ICA) unrelated to the branching are rare and treatment of these aneurysm is well known as difficult due to intraoperative premature rupture and postoperative bleeding. The authors report an analysis of 12 cases of ICA trunk aneurysms treated with transcranial or endovascular methods. METHODS: Between Mar. 1999 and Apr., 2001, 12 patients were treate for the ICA trunk aneurysms. The medical records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: These 11(92%) presented with symptoms related to intracranial hemorrhage. All aneurysms were small in size. Eleven patients(92%) were in good neurological status(Hunt Hess grade 0-III), one (8%) in poor grade(H-H grade IV). Eight patients were treated with transcranial surgery, operated on by the ipsilateral pterional approach and 4 patients were treated with endovascular surgery. Intraoperative premature rupture of the aneurysm occured in 6 cases(75%) with transcranial surgery and these were managed with ICA trapping in 4 cases, wrapping using temporalis fascia and clip in 1 and clipping with Sundt-Kee encircling clip in 1. The management outcome of the transcranial surgery was: 3(38%) Glasgow outcome scale(GOS) I, 1(12.5%) GOS II, 2(25%) GOS IV, and 2(25%) GOS V(death). The major causes of morbidity and mortality related to transcranial surgery were cerebral infarction and brain swelling due to intraoperative rupture and vasospasm. Four cases underwent endovascular surgery using Guglielmi detachable coils. The management outcome of the endovascular surgery was: 3(75%) GOS I and one GOS V 1(25%). The cause of mortality related to endosaccular coiling was brain swelling due to vasospasm. CONCLUSION: Treatment of the ICA trunk aneurysm, especially with blister-like nature, has high risk of the intraoperative rupture. Prevention and successful management of the intraoperative bleeding can be made by careful preoperative diagnosis of the aneurysm and preparation for the intraoperative rupture.
Aneurysm* ; Brain Edema ; Carotid Artery, Internal* ; Cerebral Infarction ; Diagnosis ; Fascia ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Medical Records ; Mortality ; Neuroimaging ; Retrospective Studies ; Rupture

A thymic cyst in the middle mediastinum adjacent to the right pericardium is extremely rare. We report a case of a large thymic cyst in the right cardiophrenic angle, compressing the right atrium, which was presented as a cardiomegaly on the chest radiograph and a pericardial cyst on the echocardiography. The definitive diagnosis was confirmed using surgical resection and biopsy.
Biopsy ; Cardiomegaly ; Diagnosis ; Echocardiography ; Heart Atria ; Magnetic Resonance Imaging ; Mediastinal Cyst* ; Mediastinum* ; Pericardium ; Radiography, Thoracic