PURPOSE: To compare and analyze the therapeutic effects and changes in the prostate-specific antigen (PSA) level with treatment with finasteride or dutasteride for benign prostatic hyperplasia (BPH) for 1 year. MATERIALS AND METHODS: We retrospectively investigated patients who suffered from BPH for 1 year between January 2005 and December 2008. For treatment groups, we divided the patients into two groups: one was treated with alfuzosin and finasteride and the other was treated with alfuzosin and dutasteride. At the beginning of treatment, the patients underwent transrectal ultrasonography and measurement of urine flow rate, residual urine volume, PSA, and International Prostate Symptom Score (IPSS). Patients with diseases affecting urinary function were excluded. We not only analyzed the data at the time of initial treatment, but also after 1 year of treatment. A total of 219 patients were able to be evaluated for 1 year. RESULTS: Both finasteride and dutasteride reduced PSA and prostate volume significantly. The comparison between groups showed a more significant reduction of PSA (p=0.020) and prostate volume (p=0.052) in the dutasteride group. Other parameters did not differ significantly between the groups. CONCLUSIONS: 5-alpha Reductase inhibitors for BPH treatment reduced PSA and prostate volume significantly when the patients were treated for 1 year. Administration of dutasteride is considered to be more effective in reducing PSA and prostate volume. Therefore, dutasteride should not be considered equivalent to finasteride in the reduction rate of PSA. The intensity of dutasteride must be reevaluated in comparison with finasteride.
5-alpha Reductase Inhibitors ; Azasteroids ; Finasteride ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Quinazolines ; Retrospective Studies ; Dutasteride

PURPOSE: We aimed to reduce unnecessary prostatic biopsy in patients with high prostate-specific antigen (PSA) by consideration of prostatic inflammation. MATERIALS AND METHODS: The investigation was conducted prospectively in 413 patients with a PSA level of 4 to 10 ng/ml from January 2004 to December 2009. All patients underwent the expressed prostatic secretion (EPS) or voided bladder urine 3 (VB3) test to be classified into two groups: positive group and negative group. Patients with a positive result on the EPS or VB3 test were treated with antibiotics for 2 months, and in cases in which the PSA level remained high, we performed prostate biopsy. In patients with a negative result on the VB3 test, we performed prostate biopsy directly. RESULTS: Of the 413 study patients, 215 (52%) patients had positive findings on the EPS or VB3 test. After 8 weeks of antibiotics therapy, 53 of the 215 men avoided prostate biopsy because their PSA level was normalized. The other patients (162 of 215) still had elevated PSA levels of more than 4 ng/ml, including 7 patients in whom the biopsy revealed cancer. Patients with negative findings (198 of 413) underwent prostate biopsy. Of the 198 patients, 41 were diagnosed with prostate cancer. The total prostate cancer detection rate was 11.6% in our subjects, where as it was 20.7% in the patients with negative findings on the EPS or VB3 and 3.3% in the patients with positive findings, respectively. CONCLUSIONS: In cases in which the PSA level is increasing, if we first exclude prostatitis and carry out a serial diagnostic procedure, it may help to reduce unnecessary prostatic biopsy.
Anti-Bacterial Agents ; Biopsy ; Humans ; Inflammation ; Male ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Prostatitis ; Urinary Bladder

Cryptococcus neoformans, an encapsulated fungus, is an important opportunistic pathogen that can cause meningitis in immunocompromised patients. Since patients with cryptococcemia have high mortality, it is essential to make an early diagnosis and promptly initiate antifungal therapy. However, it is often very difficult to differentiate between cryptococcal meningitis and hepatic encephalopathy in patients with liver cirrhosis, and there is delay in making the diagnosis. Therefore, these patients have a particularly grave prognosis and consequently many patients die before culture results become available. In one study, starting antifungal therapy within 48 hours of the blood culture was associated with improved survival, but patients with liver cirrhosis were significantly less likely to receive antifungal therapy within 48 hours compared to those without liver cirrhosis. Recently, the authors experience a case of a 68-year-old woman with liver cirrhosis who presented with fever and a drowsy mental status. She had a previous history of having been admitted for infection-associated hepatic encephlopathy. Cryptococcal meningitis and cryptococcemia were diagnosed by spinal puncture and culture of cerebrospinal fluid. In spite of adequate treatment, the patient developed multi-system organ failure and eventually expired. Herein, we report a case of cryptococcal meningitis mimicking hepatic encephalopathy in a patient with liver cirrhosis.
Aged, 80 and over ; Brain/radiography ; Cryptococcus/isolation & purification ; Female ; Hepatic Encephalopathy/complications/*diagnosis ; Hepatitis C, Chronic/complications/pathology ; Humans ; Liver Cirrhosis/etiology/pathology ; Meningitis, Cryptococcal/complications/*diagnosis/microbiology ; Tomography, X-Ray Computed

Malignant melanoma of the lacrimal sac is very rare and primary malignant melanoma is extremely rare. It is usually diagnosed at an advanced stage after excision or biopsy of a tumor. We treated a patient with tearing and bloody discharge from the left eye. We performed a dacryocystectomy with the suspicion of a chronic dacryocystitis. However, the pathological findings and the immunohistochemical studies showed a malignant melanoma of the lacrimal sac. The patient underwent postoperative irradiation therapy. Follow up two months after surgery revealed no evidence of recurrence. Early diagnosis is very important for prognosis in patients with malignant melanoma of the lacrimal sac. Because this tumor often presents with symptoms similar to dacryocystitis and may masquerade as a chronic dacryocystitis, it can be difficult to make an early diagnosis.
Tomography, X-Ray Computed ; Ophthalmologic Surgical Procedures/methods ; Middle Aged ; Melanoma/*diagnosis/surgery ; *Lacrimal Apparatus ; Humans ; Follow-Up Studies ; Female ; Eye Neoplasms/*diagnosis/surgery ; Diagnosis, Differential ; Biopsy

PURPOSE: Peritoneal dialysis related peritonitis remains one of the most common causes of hospitalization and discontinuation of peritoneal dialysis. Patient education and the individual environment play a significant role in improving the clinical outcomes. Therefore, this study focused on the preventive effects of practical training on the spot for peritoneal dialysis related peritonitis in continous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Fifty-eight patients who were started on CAPD were as the primary intended treatment modality. The patients were given to a questionnaire regarding their gender, age, place of residence, level of education, economic status, sterile technique, knowledge of personal hygiene, placing a correct region for exchanging a fluid bag, and their duration of CAPD. During a home visit, the patients were instructed in how to sterilize the region of dialysis and maintain sterility in dialysis. RESULTS: Seventy four cases of peritonitis from 35 patients were identified over the 2 year's period. In the rural residences where there is a lower socio-economic status, the rates of peritonitis decreased in those patients who had received training on the spot within 6 months from the start of peritoneal dialysis compared with the patients after the 6 month period. Lower rates of peritonitis were noted in the patients who received training earlier (r=0.19, p=0.03). CONCLUSION: Ongoing and repetitive individualized education is needed to prevent peritoneal dialysis related peritonitis. The incidence of peritoneal dialysis related peritonitis can be reduced by educating these patients individually.
Dialysis ; Education ; Hospitalization ; House Calls ; Humans ; Hygiene ; Incidence ; Infertility ; Patient Education as Topic ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Surveys and Questionnaires