PURPOSE: Obesity is related to many diseases, including urological conditions. We investigated the prevalence, risk factors, and treatment of male obesity. MATERIALS AND METHODS: This study included 17,485 men older than 20 years of age who participated in the fourth, fifth, and sixth administrations of the Korean National Health and Nutrition Examination Survey. Two main cutoff points for obesity were defined: a body mass index (BMI) ≥25 kg/m2 and a BMI≥30 kg/m2. Additionally, we defined obesity requiring pharmacotherapy as the presence of a BMI≥30 kg/m2 or a BMI≥27 kg/m2 co-occurring with at least one associated comorbid medical condition, such as hypertension, dyslipidemia, or diabetes. RESULTS: The prevalence rates of a BMI≥25 kg/m2, a BMI≥30 kg/m2, and obesity requiring pharmacotherapy were 35.7%, 3.4%, and 10.5%, respectively. The prevalence of obesity increased over time for all definitions of obesity. The prevalence of obesity requiring pharmacotherapy was highest in Jeju (12.5%) and lowest in Gangwon-do (7.7%). Having a higher income, being a non-manual worker, and having completed a high level of education were significantly related to obesity requiring pharmacotherapy. More than 70% of patients with obesity requiring pharmacotherapy reported taking diet pills, eating functional foods, or consuming a one-food diet for weight reduction, but only 13.9% reported exercising for this purpose. CONCLUSIONS: Male obesity is a common condition, the prevalence of which is expected to continue to increase over time. A better strategy is required to manage male obesity in Korea.
Body Mass Index ; Diet ; Drug Therapy ; Dyslipidemias ; Eating ; Education ; Functional Food ; Gangwon-do ; Humans ; Hypertension ; Korea ; Male ; Nutrition Surveys ; Obesity* ; Prevalence ; Risk Factors ; Weight Loss

Hepatic steatosis is common in obese individuals with hyperinsulinemia and is an important hepatic manifestation of metabolic syndrome. Sterol regulatory binding protein-1c (SREBP-1c) is a master regulator of lipogenic gene expression in the liver. Hyperinsulinemia induces transcription of SREBP-1c via activation of liver X receptor (LXR) and specificity protein 1 (Sp1). Cilostazol is an antiplatelet agent that prevents atherosclerosis and decreases serum triglyceride levels. However, little is known about the effects of cilostazol on hepatic lipogenesis. Here, we examined the role of cilostazol in the regulation of SREBP-1c transcription in the liver. The effects of cilostazol on the expression of SREBP-1c and its target genes in response to insulin or an LXR agonist (T0901317) were examined using real-time RT-PCR and western blot analysis on cultured hepatocytes. To investigate the effect of cilostazol on SREBP-1c at the transcriptional level, transient transfection reporter assays and electrophoretic mobility shift assays (EMSAs) were performed. Cilostazol inhibited insulin-induced and LXR-agonist-induced expression of SREBP-1c and its downstream targets, acetyl-CoA carboxylase and fatty acid synthase, in cultured hepatocytes. Cilostazol also inhibited activation of the SREBP-1c promoter by insulin, T0901317 and Sp1 in a luciferase reporter assay. EMSA analysis showed that cilostazol inhibits SREBP-1c expression by repressing the binding of LXR and Sp1 to the promoter region. These results indicate that cilostazol inhibits insulin-induced hepatic SREBP-1c expression via the inhibition of LXR and Sp1 activity and that cilostazol is a negative regulator of hepatic lipogenesis.
Animals ; Cells, Cultured ; Hep G2 Cells ; Hepatocytes/drug effects/*metabolism ; Humans ; Hydrocarbons, Fluorinated/pharmacology ; Insulin/pharmacology ; Lipogenesis ; Mice ; Mice, Inbred C57BL ; Orphan Nuclear Receptors/agonists/*metabolism ; Promoter Regions, Genetic ; Protein Binding ; Rats ; Sp1 Transcription Factor/*metabolism ; Sterol Regulatory Element Binding Protein 1/genetics/*metabolism ; Sulfonamides/pharmacology ; Tetrazoles/*pharmacology

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.
Analgesics ; Anemia ; Anesthesia, General ; Blood Transfusion ; Bronchopulmonary Dysplasia ; Child* ; Cryptorchidism ; Diagnosis ; Electronic Mail ; Groin ; Hernia ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea* ; Laparoscopes ; Male ; Pediatrics ; Surveys and Questionnaires

BACKGROUND/AIMS: Treatment of pancreatic duct stones by extracorporeal shockwave lithotripsy (ESWL) serves as a nonsurgical treatment modality in patients with stones that are located in upstream of the strictures or in patients with impacted stones. We present the results of ESWL in endoscopically unretrievable pancreatic duct stones in the past 2 years. METHODS: Between January 2002 and December 2003, 58 patients with chronic pancreatitis were treated by ESWL for pancreatic duct stones. ESWL was performed with an electrohydraulic lithotripter ultrasound focusing system. RESULTS: The mean number of shockwave treatments was 2.5, and the patients received 4,578 (1,527-10,155) shockwave discharges with a mean energy of 15.8 kV. Fragmentations of the stones were achieved in 54 patients (93.2%), and complete clearance of the stones were noticed in 27 patients (46.6%). Fragmentation of stones equal or less than 3 mm in diameter was associated with successful removal of stones (p<0.05). Complete relief of pain occurred in 32 patients (55.2%). The procedures were well tolerated and no patient had significant complications such as acute pancreatitis. CONCLUSIONS: ESWL is an effective and a safe procedure for endoscopically unretrievable main pancreatic duct stones. ESWL combined with endoscopic therapy can increase the success rate of nonsurgical removal of pancreatic duct stones in patients with chronic pancreatitis.
Adolescent ; Adult ; Aged ; Calculi/*therapy ; English Abstract ; Female ; Humans ; *Lithotripsy ; Male ; Middle Aged ; Pancreatic Diseases/*therapy ; *Pancreatic Ducts ; Pancreatitis, Chronic/complications

A re-pull-through operation for Hirschsprung's disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung's disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were 11months (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung's disease was Duhamel's procedure in 17, Swenson's in 6 and Soave's 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n=1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply). Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave's in 12, Duhamel's in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson's in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung's disease was effective and safe for the patients complicated to the initial pull-through operation.
Adhesives ; Constriction, Pathologic ; Fistula ; Follow-Up Studies ; Hirschsprung Disease* ; Humans ; Ileostomy ; Ileus ; Interviews as Topic ; Postoperative Complications ; Pulmonary Embolism ; Reoperation ; Retrospective Studies ; Seoul ; Soil ; Wound Infection

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a spectrum of conditions ranging from benign to malignant. It is known that the biologic behavior of IPMT is slower and less aggressive than that of pancreatic ductal carcinoma. We report a case of IPMT of pancreas resected 5 years after diagnosis. The carcinoma remained localized without evident stromal invasion or lymph node metastasis with the background of adenoma, suggesting a adenomacarcinoma sequence. This is a case report that may be helpful to study the natural history of IPMT, particularly slow progression of IPMT.
Adenoma ; Carcinoma, Pancreatic Ductal ; Diagnosis* ; Lymph Nodes ; Mucins* ; Natural History ; Neoplasm Metastasis ; Pancreas*

The mucin-hypersecreting bile duct tumor is rare and its clinical, radiologic, and pathologic features are not well known. We report the case of mucin-hypersecreting biliary papillomatosis with malignant transformation including review of 11 korean literatures. A 65-year-old female was admitted to our hospital with fever, chills, and right upper quadrant pain. A CT scan showed marked dilatation of left intrahepatic duct with intraductal filling defects. During endoscopic retrograde cholangiograpy, mucin from the ampulla was observed and dilated common bile duct with multiple amorphous filling defects was noted. Cholangioscopy revealed muliple coral-like mucosal papillary projections with large amount of mucin in the left intrahepatic ducts. The patient underwent left lobectomy, and the biopsy revealed intraductal papillary adenocarcinoma in the background of papillary adenoma.
Adenocarcinoma ; Adenocarcinoma, Papillary ; Adenoma ; Aged ; Bile Ducts ; Biopsy ; Chills ; Common Bile Duct ; Dilatation ; Female ; Fever ; Humans ; Mucins ; Papilloma* ; Tomography, X-Ray Computed

Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Gallstone ileus is frequently proceeded by an episode of acute cholecystitis. The resulting inflammation and adhesions facilitate the erosion of the offending gallstone through the gallbladder wall forming a cholecystoenteric fistula and allowing the passage of the gallstone. Fifty five-year-old, 71-year-old, and 74-year-old female patients were admitted to the Asan Medical Center for nausea, vomiting, and nonspecific abdominal pain. Erect abdominal plain film revealed several moderately dilated loops of small bowel with air fluid levels. Computed tomography showed the classic triad of findings of gallstone ileus. Dilated loops of small bowel, air in the biliary tree and an ectopic stone in the ileum were demonstrated. These impacted stones were removed by surgical intervention.
Abdominal Pain ; Aged ; Biliary Tract ; Cholecystitis, Acute ; Chungcheongnam-do ; Female ; Fistula ; Gallbladder ; Gallstones* ; Gastrointestinal Tract ; Humans ; Ileum ; Ileus* ; Inflammation ; Nausea ; Vomiting

PURPOSE: deVries and Pena in 1982, reported posterior sagittal anorectoplasty (PSARP) as an operative procedure for a high or intermediate imperforate anus (IA). PSARP has gained overall acceptance as a standard operative method for the repair of high and intermediate anorectal malformations. However, reports concerning the long-term outcomes of patients who have undergone a PSARP are still quite few. METHOD: To evaluate the quality of life for IA patients after a PSARP, 26 out of 43 patients who had undergone a PSARP were evaluated by using a questionnaire more than 10 years after closure of colos tomy. The questionnaire was composed of 5 categories; defecation patterns, defecation aids, social life, satisfaction, and problems after the PSARP. RESULTS: There were 23 males and 3 females. Ages were 13-26 years old. There were 17 rectourethral fistulae, 3 rectovesical fistulae, one rectal atresia, one rectovestibular fistula, and 2 rectovaginal fistulae. Follow-up periods were 12-16 years. For defecation patterns, normal defecation was observed in 62% of the patients, accidental soiling in 23%, and continuous soiling in 15%. For defecation aids, 54% of the patients used no defecation aids, 38% used enemas, and 8% used laxatives. In social life, 69% of the patients had no problems, 23% missed school, and 8% missed camp or a trip. As to the patients' own satisfaction, 81% wanted no reoperation and 19% wanted a reoperation. Problems after PSARP were reoperations for an anal transposition in 4 patients and a urethral stricture in one. CONCLUSION: PSARP resulted in good bowel control and satisfaction in the majority of IA patients, but some patients needed supportive measures and wanted a reoperation, if possible.
Anus, Imperforate* ; Defecation ; Enema ; Female ; Fistula ; Follow-Up Studies ; Humans ; Laxatives ; Male ; Quality of Life ; Surveys and Questionnaires ; Rectovaginal Fistula ; Reoperation ; Soil ; Surgical Procedures, Operative ; Urethral Stricture

BACKGROUND: Kasai portoenterostomy has been the standard operative procedure in cases of biliary atresia (BA) since Kasai reported the first successful operative case in 1959. However, BA is still one of the pediatric surgical lesions that does not always show satisfactory operative results. METHODS: To evaluate the long-term results and the prognostic factors influencing the survival with the Kasai portoenterostomy for BA, we reviewed 80 BA patients treated at Department of Pediatric Surgery, Seoul National University Hospital from 1980 to 1990. Kaplan-Meier method and Log-rank test were used for statistical analysis. RESULTS: Overall 5-year and 10-year survival rates were 42% and 37%, respectively. Thirty-one patients underwent surgery at ages under 60 days, 31 at ages between 60 and 90 days, 11 at ages between 90 and 120 days and 7 at ages beyond 120 days. There were no statistically significant differences in survival rates among the age groups. In the liver biopsy, minimal hepatic fibrosis was noted in 2 patients, moderate fibrosis in 13, severe fibrosis in 25 and cirrhosis in 5. There were no statistically significant differences in the survival rates according to the degree of hepatic fibrosis but there was a statistically significant difference between patients with cirrhosis and without cirrhosis (p= .03). The size of the bile ductules at the porta hepatis was less than 50 micrometers in 18 patients, between 50 and 100 micrometers in 19 patients, between 100 and 200 micrometers in 4 patients and greater than 200 micrometers in 3 patients. There were no statistically significant differences in the survival rates according to the size of the bile ductules at the porta hepatis. Out of the 12 long-term survivors, survival of more than 10 years, 5 patients had abnormal liver function and 7 patients showed clinical manifestations of portal hypertension. CONCLUSIONS: Kasai portoenterostomy offers reasonable long-term survival and should be the initial procedure for biliary atresia, but a significant portion of the long-term survivors has abnormal liver functionand portal hypertension. Continuous and careful follow-up is needed not to miss the proper time for liver transplantation. Liver cirrhosis at the time of the operation was the only statistically significant prognostic factor influencing the survival.
Bile ; Biliary Atresia* ; Biopsy ; Fibrosis ; Follow-Up Studies ; Humans ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Seoul ; Surgical Procedures, Operative ; Survival Rate ; Survivors