Varicocele has been considered the most common identifiable cause of adult infertility. but little has been known on the significance of histology and volume according to the grade in adults with varicocele. Herein, we have assessed bilateral testicular size before surgical ligation and performed bilateral testicular biopsies at the time of surgical ligation. The volume of each testes in adults with varicocele was smaller than those of normal adults and it was statistically significant. The grades of varicocele did not have a significant effect on differential testicular volumes, although the volume of the left testis in adults with varicocele was always less than that of the right testis. Histologic changes were showed degeneration of germinal epithelium, focal tubular atrophy, and premature sloughing of germinal epithelium into the lumen of the tubules. Tubular thickening was seen in most or the cases. Spermatogenesis was generally reduced in patients with varicocele, but there was no difference between the right and left testis. There was no correlation between the grade of the varicocele and the reduction in spermatogenesis.
Adult* ; Atrophy ; Biopsy ; Epithelium ; Humans ; Infertility ; Ligation ; Spermatogenesis ; Testis ; Varicocele*

BACKGROUND/AIMS: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. METHODS: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. RESULTS: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis.
Bile ; Bile Ducts ; Biliary Tract* ; Catheterization ; Cholangiography ; Choledocholithiasis* ; Cholestasis, Extrahepatic ; Common Bile Duct ; Diagnosis ; Dilatation ; Endosonography* ; Humans ; Pancreas* ; Pancreatitis ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: The authors evaluated the differences between K-wires and Cannulated screw, plate for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. MATERIALS AND METHODS: There were 62 patients (79 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. We divided the patients into 4 groups, Two K-wire fixed group as A, one cannulated screw fixed group as B. Two cannulated screw fixed group as C, Plate fixed group as D, Group A were patients (26 feet) and Group B were patients (9 feet), Group C were patients (31 feet) and Group D were patients (13 feet). Preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patient. ANOVA test and Student t-test were done for statistical analysis. RESULTS: Mean follow up period was 43.8 months (range: 12~82 months). Preoperative mean IMA was 16.4+/-3.5, 17.7+/-11.3, 17.3+/-5.9 and 16.6+/-2.3 degrees in respectively group A, B, C, D. Immediate postoperative mean IMA was 5.6+/-3.4, 7.3+/-4.4, 7.6+/-4.4 and 6.7+/-2.8 degrees in respectively group A, B, C, D. The final mean IMA was 8.9+/-4.5, 15.2+/-7.5, 10.3+/-4.4 and D 7.7+/-3.5 degrees in respectively group A, B, C, D. There were significant statistical increase in final mean IMA of group B and C (p<0.05). CONCLUSION: The IMA was significantly increased in the group which used one or two cannulated screw for fixation on follow up, therefore more caution should be needed when using one or two cannulated screw fixation technique after proximal chevron osteotomy.
Congenital Abnormalities ; Follow-Up Studies ; Hallux ; Hallux Valgus ; Humans ; Metatarsal Bones ; Osteotomy

In 1883 Fournier, a French venereologist, described 5 patients with unexplained fulminating gangrene of the male genitalia. Fournier emphasized 3 characteristics 1) the abrupt onset in a young, healthy male subjects, 2) the rapid progression to gangrene and 3) the absence of a discernible cause. As currently used by many authors, Fournier's gangrene describes a widely destructive, gangrenous process of the genitalia, with little regard for Fournier's original tenets of patient's age or definable etiology. Early identification and prompt initiation of medical and surgical therapy is imperative. We report two cases of Fournier's gangrene with brief review of the literatures.
Fournier Gangrene* ; Gangrene ; Genitalia ; Genitalia, Male ; Humans ; Male

BACKGROUND: We investigated the association between socioeconomic status and adherence to health check-ups in a Korean population aged 40 years or older. METHODS: This cross-sectional study included 12,311 participants who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess each participant's socioeconomic status (household income, occupation, and education) and adherence to health check-ups. RESULTS: Men with a higher income (highest vs. lowest: odds ratio [OR], 1.799; 95% confidence interval [CI], 1.296–2.497) and men with a higher education level (≥12 vs. < 6 years: OR, 1.488; 95% CI, 1.078–2.054) and office workers compared with manual workers (men: OR, 1.431; 95% CI, 1.077–1.902; women: OR, 1.783; 95% CI, 1.256–2.532) appeared to undergo more health check-ups. In particular, men and women with a higher income and education appeared more likely to undergo opportunistic health check-ups (men: highest vs. lowest income: OR, 2.380; 95% CI, 1.218–4.653; ≥12 vs. < 6 years education: OR, 2.121; 95% CI, 1.142–3.936; women: highest vs. lowest income: OR, 4.042; 95% CI, 2.239–7.297; ≥12 vs. < 6 years education: OR, 2.475; 95% CI, 1.283–4.775). CONCLUSION: A higher socioeconomic status was associated with a higher rate of participation in health check-ups. More efforts are needed to identify the factors associated with disparity in adherence to health check-ups.
Adult* ; Cross-Sectional Studies ; Education ; Female ; Health Promotion ; Humans ; Male ; Nutrition Surveys* ; Occupations ; Odds Ratio ; Public Health ; Social Class*

BACKGROUND: Oxidative stress in primary aldosteronism (PA) is thought to worsen aldosterone-induced damage by activating proinflammatory processes. Therefore, we investigated whether inflammatory markers associated with oxidative stress is increased with negative impacts on heart function as evaluated by echocardiography in patients with PA. METHODS: Thirty-two subjects (mean age, 50.3±11.0 years; 14 males, 18 females) whose aldosterone-renin ratio was more than 30 among patients who visited Severance Hospital since 2010 were enrolled. Interleukin-1β (IL-1β), IL-6, IL-8, monocyte chemoattractant protein 1, tumor necrosis factor α (TNF-α), and matrix metalloproteinase 2 (MMP-2), and MMP-9 were measured. All patients underwent adrenal venous sampling with complete access to both adrenal veins. RESULTS: Only MMP-2 level was significantly higher in the aldosterone-producing adenoma (APA) group than in the bilateral adrenal hyperplasia (BAH). Patients with APA had significantly higher left ventricular (LV) mass and A velocity, compared to those with BAH. IL-1β was positively correlated with left atrial volume index. Both TNF-α and MMP-2 also had positive linear correlation with A velocity. Furthermore, MMP-9 showed a positive correlation with LV mass, whereas it was negatively correlated with LV end-systolic diameter. CONCLUSION: These results suggest the possibility that some of inflammatory markers related to oxidative stress may be involved in developing diastolic dysfunction accompanied by LV hypertrophy in PA. Further investigations are needed to clarify the role of oxidative stress in the course of cardiac remodeling.
Adenoma ; Chemokine CCL2 ; Cytokines ; Echocardiography ; Heart ; Heart Diseases ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertrophy ; Interleukin-6 ; Interleukin-8 ; Male ; Matrix Metalloproteinase 2 ; Oxidative Stress ; Tumor Necrosis Factor-alpha ; Veins

BACKGROUND: This study was to determine the impact on the national healthcare expenditure for the treatment of osteoporosis and fractures if the coverage period for osteoporosis medication was extended from maximum a year to continuous period as required. METHODS: Preserving the current reimbursement guidelines, maximum one year's coverage for osteoporosis medication was set as scenario A. Continuous coverage for patients who require medication was set as scenario B. As costs of medical service utilization are paid by the Korean National Health Insurance Program, all items were investigated and analyzed from the payer's perspective. The combined treatment costs for osteoporosis and osteoporotic fractures were assessed for each scenario. RESULTS: Over five years the cost of osteoporosis medication in scenario A will increase from 184.3 billion KRW to 204.6 billion KRW. The cost of osteoporotic fracture treatment will increase from 1,037.3 billion KRW to 1,822.7 billion KRW. In scenario B, the cost of osteoporosis medication will increase from 209.5 billion KRW to 388.1 KRW. The cost of osteoporotic fracture treatment will increase from 600.0 billion KRW to 1,054.3 billion KRW. The result showed savings of 2.50 trillion KRW cumulatively for five years when reimbursement coverage for osteoporosis treatments is extended from one year to as long as it's clinically required. CONCLUSIONS: This study demonstrates that effective osteoporosis management through appropriate insurance coverage for osteoporosis medication should be considered not only for the patient's viewpoint, but in terms of national insurance budget as well.
Budgets ; Delivery of Health Care ; Health Care Costs ; Health Expenditures ; Humans ; Income ; Insurance ; Insurance Coverage ; Korea ; National Health Programs ; Osteoporosis ; Osteoporotic Fractures ; Republic of Korea

No abstract available.
Animals ; Blastocyst* ; Insulin* ; Mice*

BACKGROUND: In management of osteoporosis, several concerns here have been raised. The current issue included the utilization of dual energy X-ray absorptiometry (DXA) and fracture-risk assessment (FRAX), screening of vitamin D deficiency and secondary osteoporosis, and long-term use of bisphosphonate and calcium supplements. There was no study on physicians' attitude on these current issues in Korea. Therefore, we investigated the physicians' attitude on these issues by survey. METHODS: We administered a 30-item questionnaire to all members of Korean Society for Bone and Mineral Research by email survey form. One hundred participants answered the questionnaire. The questionnaire included the questions about the physicians' attitude to current issues and the barriers to osteoporosis treatment in Korea. RESULTS: Most physicians used bone densitometry devices (99%) and, central DXA was the most accessible device (95%). Eighty-eight percent were aware of FRAX(R), but among them, only 19.3% used it. The main reason for not using FRAX(R) was the lack of time in their proactive (76%). Screening for vitamin D status and secondary osteoporosis was performed by 59% and 52% of the respondents, respectively. The lack of awareness among patients and high costs of medication were perceived as the most important barriers to osteoporosis management in Korea. CONCLUSIONS: This study provides physicians' perspective to the current issue for diagnostic and treatment of osteoporosis in Korea. To further improve osteoporosis management, educational programs for patients and doctors, and the improvement of reimbursement system should be considered in Korea.
Absorptiometry, Photon ; Calcium ; Surveys and Questionnaires ; Densitometry ; Electronic Mail ; Humans ; Korea ; Mass Screening ; Osteoporosis* ; Vitamin D ; Vitamin D Deficiency

Leiomyosarcoma is a rare form of soft tissue neoplasm, with only 1% to 5% occurring in the head and neck region. Current recommended treatment suggests surgical excision with a wide lateral margin, but no definite guidelines regarding excisional margin have been established yet. Recently, complete excision with a narrow surgical margin has been recommended, and the authors present a case of cutaneous leiomyosarcoma on the face that was successfully managed by complete removal with a narrow excisional margin. A 74-year-old woman presented with a 3 cm sized, rapidly growing cutaneous mass on her right preauricular area. Preoperative biopsy of the skin lesion suggested a cutaneous leiomyosarcoma. The authors performed complete surgical excision with a 1 cm lateral margin, and the resulting skin defect was repaired with bilateral V-Y advancement local flaps. Histopathology and immunohistochemistry evaluation confirmed a moderately differentiated cutaneous leiomyosarcoma, with negative margin involvement. The patient refused of any additional treatment, but showed no locoregional recurrence during the 1.5 years of postoperative follow-up period. With a regular postoperative follow-up, cutaneous leiomyosarcomas may be successfully treated with a narrow surgical margin.
Aged ; Biopsy ; Female ; Follow-Up Studies ; Head ; Humans ; Immunohistochemistry ; Leiomyosarcoma* ; Neck ; Recurrence ; Skin ; Soft Tissue Neoplasms