Anti-inflammatory effects of Salvia plebeia R. Br extract in vitro and in ovalbumin-induced mouse model

BACKGROUND: Asthma is an increasing global health problem, and novel strategies to prevent or ameliorate the condition are needed. Here, the effects of 80 % ethanol extracts of Salvia plebeia R. Br. (SE) on an induced inflammatory response were investigated RESULTS: Salvia plebeia R. Br. inhibited production of pro-inflammatory cytokines, such as TNF-α and IL-6, as well as nitric oxide (NO) in LPS-stimulated RAW 264.7 cells. NO and pro-inflammatory cytokine production was suppressed more effectively by SE of the aerial parts (SE-A) than of the roots (SE-R) of S. plebeia. In BEAS-2B cells, both SE-A and SE-R inhibited the increase in production of the inflammatory cytokines IL-6 and IL-8. We also investigated the antiasthmatic effects of SE in an ovalbumin (OVA)-induced BALB/c mouse model. SE-A treatment significantly reduced the number of airway eosinophils, IL-4 and IL-13 levels, mucus production, and inflammatory infiltration, as compared with the corresponding levels in the untreated, OVA-induced mice, and had similar effects to dexamethasone CONCLUSIONS: Salvia plebeia ethanol extract ameliorated the induced inflammatory response in RAW 264.7 and BEAS-2B cells, with more effective inhibition noted for SE-A than for SE-R. SE-A treatment was effective in improving the histopathological changes in the lungs of asthma model mice via modulation of eosinophils and Th2 cytokines. These results suggest that SE-A can be considered as a therapeutic agent that can potentially relieve asthma

Does Diabetes Mellitus Influence Standardized Uptake Values of Fluorodeoxyglucose Positron Emission Tomography in Colorectal Cancer?

BACKGROUND/AIMS: Hyperglycemia is associated with decreased 2-18[F]fluoro-2-deoxy-D-glucose (FDG) uptake by tumors assessed by positron emission tomography (PET). In this retrospective study we investigated a comparison of standardized uptake values (SUVs) in patients with primary colorectal cancers who either had diabetes mellitus (DM) or were otherwise healthy. METHODS: The medical records of 397 patients who were diagnosed with colorectal cancer and underwent PET-CT between January 2006 and December 2012 were analyzed. Eighty patients with DM and 317 patients without DM were included. Clinical characteristics were reviewed and maximal standardized uptake values (SUVmax) were calculated in the primary colorectal lesions. RESULTS: There was no significant difference between tumor SUVmax in DM patients (10.60+/-5.78) and those without DM (10.92+/-5.44). In addition, no significant difference was detected between tumor SUVmax in DM patients with glycated hemoglobin (HbA1c) levels or =8% (10.61+/-7.27). The maximum size of the primary colorectal tumor was associated with SUVmax in a linear regression analysis. CONCLUSION: The results of this study showed that DM did not influence FDG uptake values in colorectal cancer patients regardless of glucose levels.

Preoperative Factors Affecting Postoperative Early Quality of Life During the Learning Curve of Holmium Laser Enucleation of the Prostate / 대한배뇨장애요실금학회지

PURPOSE: The aim of this study was to investigate the preoperative factors related to early quality of life (QoL) in patients with benign prostatic hyperplasia after holmium laser enucleation of the prostate (HoLEP) during the surgeon's learning curve. METHODS: The medical records of 82 patients with a follow-up period of at least 3 months who were treated with HoLEP during the time of a surgeon's learning curve were analyzed retrospectively. We divided the patients into two groups on the basis of the QoL component of the International Prostate Symptom Score (IPSS) 3 months after HoLEP: the high QoL group (IPSS/QoL or =4). Preoperative factors in each group were compared, including prostate volume, prostate-specific antigen, history of acute urinary retention (AUR), urgency incontinence, IPSS, and urodynamic parameters. Detrusor underactivity was defined as a bladder contractility index less than 100 on urodynamic study. RESULTS: A total of 61 patients (74.3%) had a high QoL, whereas 21 (25.7%) had a low QoL. A history of AUR, detrusor pressure on maximal flow (PdetQmax), bladder outlet obstruction grade, bladder contractility index, and detrusor underactivity were associated with postoperative QoL in the univariate analysis. In the multivariate analysis, a history of AUR and PdetQmax were independent factors affecting postoperative QoL. CONCLUSIONS: A history of AUR and bladder contractility affect early QoL, and preoperative urodynamic study plays an important role in the proper selection of patients during the HoLEP learning curve.

Clinicopathologic Feature of Esophageal Submucosal Tumors Treated by Surgical Approach / 대한소화기학회지

BACKGROUND/AIMS: Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. METHODS: We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. RESULTS: The mean age was 48.9 years old and male to female ratio was 2.6:1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). CONCLUSIONS: Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.

Single Oral Dose Toxicity Study of Prebrewed Armeniacae Semen in Rats

Armeniacae semen (AS) has been considered a toxic herb in the Korean medicine as it contains hydrogen cyanide and amygdalin, especially in its endocarp. Therefore, prebrewed AS that is devoid of endocarp has been traditionally used. In the present study, amygdalin content of the prebrewed AS was significantly lower (2.73 +/- 0.32 microg/ml; p < 0.01) than the content in the extract that contained the endocarps (28.50 +/- 6.71 microg/ml); amygdalin content corresponded to 10% of the extract in the present study. Because of single oral dose toxicity of prebrewed AS according to the recommendation of Korea Food and Drug Administration Guidelines (2009-116, 2009), which was based on single oral dose toxicity study of prebrewed AS, mortality due to toxic principles was significantly reduced. In this study, 2,000 mg/kg of prebrewed AS led to death of 1 female rat and 1 male rat at the end of 2 hr of administration. Based on these results, the 50% lethal dose in both male and female rats was determined to be 9279.5 mg/kg. Seizure, loss of locomotion, and increases in respiration and heart rate were observed as prebrewed AS treatment-related toxicological signs; these signs were restrictedly manifested in the prebrewed AS (2,000 mg/kg)-treated rats. In addition, no changes were observed in body weight, organ weight, gross features, and histopathological parameters with 2,000 mg/kg of AS in both male and female rats. These findings serve as direct evidence that amygdalin in AS is the toxic principle, which can be reduced by the traditional prebrewing method involving the exclusion of endocarp.

A Case of Cholangiocarcinoma with Brain and Leptomeningeal Carcinomatosis / 대한내과학회지

Cholangiocarcinoma is a malignant disease originating from the epithelium of the biliary tract, and its prognosis is dismal due to distant metastasis in its early stages. The most common metastatic sites are the intra-abdominal organs, lymph nodes, and lungs. A patient was diagnosed with intrahepatic cholangiocarcinoma and underwent surgical resection. During the follow-up period, metastases were detected at the remnant liver and both lung fields. Eleven months after resection, the patient complained of severe headache. An approximately 5-cm cystic mass was found at the left occipital lobe of the cerebrum, and metastatic malignant cells were present on cerebrospinal fluid cytology. The patient underwent whole-brain radiotherapy. We herein report a rare case of cholangiocarcinoma with cystic brain metastasis together with a review of the relevant literature.

Analysis of the Treatment of Two Types of Acute Urinary Retention

PURPOSE: This study analyzed the type of acute urinary retention (AUR) and evaluated the treatments used, including trial without catheter (TWOC). MATERIALS AND METHODS: This study was based on 299 patients who were treated for AUR from January 2007 to August 2009. The patients were classified into the spontaneous AUR group (group S) and the precipitated AUR group (group P), in which AUR was consecutive to triggering events. The treatment modalities including TWOC, the success rate of TWOC, age, prostate-specific antigen (PSA) levels, the volume of the prostate, and the drained volume at catheterization were analyzed in each group. RESULTS: Of 299 men with AUR, 160 (54%) had spontaneous AUR and 139 (46%) had precipitated AUR. Compared with group P, patients in group S were more likely to be treated by surgery, either immediately (16.9% vs. 3.6%, p or =70 years) and in those with enlarged prostates (> or =50 ml), higher PSA levels (> or =3 ng/ml), and a large drained volume at catheterization (> or =1,000 ml). CONCLUSIONS: In this group of AUR patients, there were slightly more patients with spontaneous AUR (54%) than with precipitated AUR (46%). The success rate of TWOC was more than 70% regardless of the type of AUR. Although TWOC is recommended primarily in the treatment of AUR, early surgical intervention should be considered if the patient has an enlarged prostate (> or =50 ml) or a large drained volume at catheterization (> or =1,000 ml).

Depression, Anxiety, Stress Perception, and Coping Strategies in Korean Military Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

PURPOSE: The objective of this study was to examine the psychological features and coping strategies of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: The participants consisted of 55 military personnel suffering from CP/CPPS and 58 military personnel without CP/CPPS symptoms working at the Military Capital Hospital. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to assess CP/CPPS symptoms. The Responses to Hospital Anxiety and Depression (HAD) scale, Social Readjustment Rating Scale, and Global Assessment of Recent Stress (GARS) scale were compared between the two groups. The Weisman Coping Strategy Scale was used to assess coping ability with CP/CPPS. RESULTS: The NIH-CPSI score of the CP/CPPS group was significantly higher than that of the control group for all domains including pain, urinary symptoms, quality of life, and summed score. The Anxiety and Depression domain of the HAD showed significant differences between the two groups. There were no significant differences in the Social Readjustment Rating Scale between the two groups, but the sum of the GARS score was higher in the CP/CPPS group than in the control group. These were correlated with the pain, quality of life, and sum domains of the NIH-CPSI. The Weisman Coping Strategy Scale showed that intellectualization, redefinition, and flexibility were higher in frequency in descending order, and that fatalism, externalization, and self-pity were lower in frequency. CONCLUSIONS: The CP/CPPS patients had depression, anxiety, and higher perception of stress. In particular, these were closely related to the pain and quality of life of the patients.

Primary cutaneous B-cell lymphoblastic lymphoma in an elderly man / 대한혈액학회지

Precursor B-cell lymphoblastic lymphoma (B-LBL) is an uncommon high-grade neoplasm of immature B cells. It occurs predominantly in childhood with extranodal involvement such as skin and bone. Therefore, primary cutaneous involvement in elderly adults is a very rare manifestation of B-LBL. Here, we report a 78-year-old man with B-LBL presenting as a single cutaneous lesion which was immunohistochemically positive for leukocyte common antigen (LCA), CD79a, paired box 5 (PAX5), B cell lymphoma-2 (bcl-2), and terminal deoxynucleotidyl transferase (TdT) staining, but was without systemic involvement. The patient was treated using cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP), and achieved complete response (CR) at the first response assessment conducted after 3 CHOP cycles. After an additional cycle of CHOP treatment, radiotherapy was administered at a total dose of 3,600 cGy over 4 weeks. At the 21-month follow-up, he had maintained CR.

A Case of Cimetidine-induced Immune Hemolytic Anemia / 대한수혈학회지

There have been 5 case reports about immune hemolytic anemia related with cimetidine, but there has been no such report in Korea. A sixty-four-year-old woman was admitted to the emergency department in a coma. She was diagnosed with diffuse large B-cell lymphoma 5 years ago and she achieved a complete remission after treatment. She was in a state of shock, and her blood pressure was 70/40 mmHg. The laboratory test results were consistent with hemolytic anemia (HA) as follows: hemoglobin: 1.9 g/dL, corrected reticulocyte count: 2%, total/conjugated bilirubin: 6.4/2.1 mg/dL, lactate dehydrogenase: 1,083 U/L and haptoglobin <10 mg/dL. She had a history of taking the drugs including cimetidine, acetaminophen and etizolam for two days. She urgently received transfusion of 3 units of packed red blood cells and then she regained consciousness. To investigate the relation between cimetidine and HA, we subsequently performed a drug-induced immune complex test and an antibody test by using cimetidine, AB serum and phosphate-buffered saline. The results proved that cimetidine was the cause of the HA. Patient was treated with steroid, and the following laboratory tests showed rapid improvement. This is the first case report from Korea that shows the causal relationship between cimetidine and immune HA.

Clinical Manifestation of Emphysematous Pyelonephritis and Risk Factors for Mortality

BACKGROUND: Emphysematous pyelonephritis (EPN) is an acute gas forming necrotizing infection of the renal parenchyma with high mortality. Although its incidence is relatively low, it mostly occurs in patients wiith diabetes mellitus. The aim of the study is to identify the risk factors related to mortality and assess the outcome of managements according to the radiologic classification. MATERIALS AND METHODS: The clinical records of 23 patients diagnosed with EPN were reviewed retrospectively. The cases were grouped into two types on the basis of computed tomography scan. Type 1 EPN was defined as renal necrosis and gas formation with total absence of fluid content. Type 2 EPN was defined as the presence of renal or perirenal fluid in association with bubbly or loculated gas pattern. The patients' symptoms, performed investigations, and treatments were analyzed. RESULTS: All patients had diabetes mellitus. Escherichia coli (78.6%) was the most common pathogen in urine and blood cultures. The factors showing statistically significant differences between survivors and non-survivors were age (P=0.013), the presence of obstructive uropathy (P= 0.008), and type 1 group (P=0.030). Multivariate logistic regression showed that factor significantly related to death was age (odds ratio=1.20, 95% confidence interval 1.01-1.38, P=0.037). Conservative treatment including antibiotics and percutaneous drainage was successful in type 2 group. Overall mortality was 26.1%; all expired patients were from type 1 group. The mortality of conservative treatment and nephrectomy in type 1 group was 83.3% and 20.0%, respectively. CONCLUSION: These results suggest that old age is a significant risk factor for mortality in patients with EPN. Nephrectomy should be considered as the main treatment option in patients with type 1 EPN.

Clinical Characteristics and Treatment Results of Acute Bacterial Prostatitis

BACKGROUND: Acute bacterial prostatitis is an uncommon male urinary tract infection that is the result of severe prostatic infection mainly by gram-negative bacteria. We conducted a retrospective study to report clinical outcomes of patients with acute bacterial prostatitis. MATERIALS AND METHODS: The clinical records of 49 patients diagnosed with acute bacterial prostatitis were reviewed retrospectively and patients' symptoms, investigations, and treatments were analyzed. RESULTS: All patients presented with fever and voiding symptoms. Some patients (22.4%) had a history of prior manipulation of the lower urinary tract including transrectal prostate biopsy. Urine cultures were positive for 51% of the patients. The most common pathogen was Escherichia coli (60%), followed by Pseudomonas aeruginosa (20%) and Staphylococcus aureus (12%). The ciprofloxacin susceptibility against E. coli was 80%. All patients were treated with parenteral antibiotics in the hospital followed by oral antibiotics for average of three weeks. The major drugs used for empirical treatment were cephalosporins, aminoglycosides, and fluoroquinolones. Prostatic abscess was found in two (4.1%) patients and chronic pelvic pain syndrome developed in six (12.2%) patients during follow-up. CONCLUSION: The currently used empirical antibiotics were mostly effective in the treatment of acute bacterial prostatitis. Continuous monitoring on antimicrobial susceptibility of acute bacterial prostatitis was necessary for providing proper treatment guideline.

Clinical Manifestation of Emphysematous Pyelonephritis and Risk Factors for Mortality

BACKGROUND: Emphysematous pyelonephritis (EPN) is an acute gas forming necrotizing infection of the renal parenchyma with high mortality. Although its incidence is relatively low, it mostly occurs in patients wiith diabetes mellitus. The aim of the study is to identify the risk factors related to mortality and assess the outcome of managements according to the radiologic classification. MATERIALS AND METHODS: The clinical records of 23 patients diagnosed with EPN were reviewed retrospectively. The cases were grouped into two types on the basis of computed tomography scan. Type 1 EPN was defined as renal necrosis and gas formation with total absence of fluid content. Type 2 EPN was defined as the presence of renal or perirenal fluid in association with bubbly or loculated gas pattern. The patients' symptoms, performed investigations, and treatments were analyzed. RESULTS: All patients had diabetes mellitus. Escherichia coli (78.6%) was the most common pathogen in urine and blood cultures. The factors showing statistically significant differences between survivors and non-survivors were age (P=0.013), the presence of obstructive uropathy (P= 0.008), and type 1 group (P=0.030). Multivariate logistic regression showed that factor significantly related to death was age (odds ratio=1.20, 95% confidence interval 1.01-1.38, P=0.037). Conservative treatment including antibiotics and percutaneous drainage was successful in type 2 group. Overall mortality was 26.1%; all expired patients were from type 1 group. The mortality of conservative treatment and nephrectomy in type 1 group was 83.3% and 20.0%, respectively. CONCLUSION: These results suggest that old age is a significant risk factor for mortality in patients with EPN. Nephrectomy should be considered as the main treatment option in patients with type 1 EPN.

Clinical Characteristics and Treatment Results of Acute Bacterial Prostatitis

BACKGROUND: Acute bacterial prostatitis is an uncommon male urinary tract infection that is the result of severe prostatic infection mainly by gram-negative bacteria. We conducted a retrospective study to report clinical outcomes of patients with acute bacterial prostatitis. MATERIALS AND METHODS: The clinical records of 49 patients diagnosed with acute bacterial prostatitis were reviewed retrospectively and patients' symptoms, investigations, and treatments were analyzed. RESULTS: All patients presented with fever and voiding symptoms. Some patients (22.4%) had a history of prior manipulation of the lower urinary tract including transrectal prostate biopsy. Urine cultures were positive for 51% of the patients. The most common pathogen was Escherichia coli (60%), followed by Pseudomonas aeruginosa (20%) and Staphylococcus aureus (12%). The ciprofloxacin susceptibility against E. coli was 80%. All patients were treated with parenteral antibiotics in the hospital followed by oral antibiotics for average of three weeks. The major drugs used for empirical treatment were cephalosporins, aminoglycosides, and fluoroquinolones. Prostatic abscess was found in two (4.1%) patients and chronic pelvic pain syndrome developed in six (12.2%) patients during follow-up. CONCLUSION: The currently used empirical antibiotics were mostly effective in the treatment of acute bacterial prostatitis. Continuous monitoring on antimicrobial susceptibility of acute bacterial prostatitis was necessary for providing proper treatment guideline.

Effects of Subclinical Prostatitis on Benign Prostatic Hyperplasia

PURPOSE: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate surgery specimens. We evaluated the correlation between the symptoms of benign prostatic hyperplasia (BPH) and the grades of inflammation in surgical specimens of patients who had undergone operation for BPH without any evidence of clinical prostatitis. MATERIALS AND METHODS: Seventy five patients with BPH, who had gone through transurethral resection of the prostate (TURP) at our department from March 2004 to May 2007, were retrospectively studied. Of the 75 patients, 57 patients were pathologically diagnosed as having a BPH with prostatitis and 18 patients had the only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered inflammatory cell infiltrate within the stroma without lymphoid nodules), II (group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory areas with confluence of infiltrate). The serum prostate-specific antigen (PSA) level, PSA density (PSAD), International Prostate Symptom Score (IPSS) and maximum urinary flow rate were compared among the grades of inflammation. RESULTS: In the patients had undergone TURP, prostatic inflammation was found in 76% (57/75). The storage symptoms of IPSS and PSAD were significantly correlated to the extent of inflammation in each groups (p<0.05). No significant correlations were observed between PSA, size of prostate, voiding symptoms, quality of life (QoL) of IPSS, and maximum urinary flow rate. CONCLUSIONS: The extent of chronic inflammation had considerably more relationship with storage symptoms than voiding symptoms and with the increased PSAD. These findings suggest that the subclinical prostatitis may be one of the factors of storage symptoms of BPH patients and postoperative maintained lower urinary tract symptoms.

Tuberculous Prostatic Abscess Following Intravesical Bacillus Calmette-Guerin Instillation

Tuberculous granulomatous infection of the urinary tract is a rare complication of intravesical Bacille Calmette-Guerin (BCG) immunotherapy, which is commonly used for superficial urothelial cell carcinoma of the bladder. We present a case of tuberculous prostatic abscess in a patient who had undergone intravesical BCG immunotherapy for bladder carcinoma in situ.

Relations between Prostatic Calculi and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

PURPOSE: Recently as ultrasonography is increasingly used to evaluate lower urinary tract symptoms (LUTS) in the elderly patients, prostatic calculi are more often revealed; however, the mechanism of formation of prostatic calculi is not clearly known, and their impacts on LUTS are controversial. We investigated whether the type and location of prostatic calculi might influence LUTS in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS: From July 2003 to January 2008, 1,437 consecutive patients underwent transrectal ultrasonography. Of these patients 383 with clinical BPH were retrospectively studied. According to the type (type A: a discrete small reflection; type B: a large mass of multireflection; type M: mixed) and location (periurethral vs. non-periurethral) of prostatic calculi, the serum prostate-specific antigen (PSA) levels, volume of prostate, maximum urinary flow rate and residual urine volume, and International Prostate Symptom Score (IPSS) were compared. RESULTS: Prostatic calcification was found in 70% (268/383), and type A in 38%, type B in 46% and type M in 16%. There was no significant difference according to the presence or types of prostatic calcification, comparing serum PSA levels, volume of prostate, maximum urinary flow rate and residual urine volume. And there was no significant correlation between the types of prostatic calcificaton and each item of IPSS. Periurethral and non-periurethral prostatic calcification failed to show the significant difference in each items of IPSS. CONCLUSIONS: There is no significant difference in LUTS according to presence, types, or locations of prostatic calculi in clinical BPH patients.

The Factors Affecting the Compliance of Additional Anticholinergic Medication in the Patients with Benign Prostatic Hyperplasia

PURPOSE: Anticholinergic agents are effective in relieving overactive bladder symptoms and historically has been contraindicated in benign prostatic hyperplaisa (BPH) patients because of concerns for developing acute urinary retention. Recently, however, treatment for men with predominant storage symptoms is combined with an antichoilnergic agents. We evaluated the efficacy, discontinuation rate, adverse events and clinical parameters of alpha-blockers and/or 5alpha-reductase inhibitors treatment combined with anticholinergic agents in patients with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: 137 patients with BPH, who had treated with alpha-blockers and/or 5alpha-reductase inhibitors combined with anticholinergic agents at our department from January 2003 to November 2008, were retrospectively studied. In 92 patients, anticholinergic agents continued to be administered (group I) and in 45 patients, ceased to be given (group II). The efficacy and adverse events of anticholinergics treatment were estimated. The International Prostate Symptom Score (IPSS), serum prostate specific antigen (PSA) level, prostate volume, maximum urinary flow rate and residual urine volume before administration of anticholinergics were evaluated. The change in maximum urinary flow rate and residual urine volume and the presence of acute urinary retention after giving anticholinergics were compared. RESULTS: There was no significant difference comparing age, IPSS, serum PSA levels, prostate volum, maximum urinary flow rate and residual urine volume except IPSS storage subscore between the two groups. In group I, there was no significant change in maximum urinary flow rate and residual urine volume after administering anticholinergics. IPSS storage subscore were more significant in group I (9.0+/-3.4 vs 7.4+/-3.4, p<0.05). The duration of anticholinergics administration was longer in group I than II (325.0+/-316.7 vs 95.5+/-96.1). The discontinuation rate was 32.8%. Nocturia (n=48), frequency (n=28) and urgency (n=16) were significantly improved in group I after additional anticholinergic medication. Adverse events causing discontinuation in group II were the increase of residual sensation (n=13), difficult voiding (n=12), dry mouth (n=6), hesitancy (n=6) and constipation (n=2). Acute urinary retention was not reported in both groups. CONCLUSIONS: In men with LUTS suggestive of BPH, anticholinergic treatment appears to be safe and when the storage symptoms were severer, the better compliance was. The overall discontinuation rate was 32.8%, and acute urinary retention was not reported.

Bladder Outlet Obstruction in the Female Overactive Bladder: Correct Diagnostic Criteria for Bladder Outlet Obstruction?

PUROPOSE: We analyzed retrospectively the result of urodynamic studies of the female patients with overactive bladder to reveal the incidence of accompanying bladder outlet obstruction and compared the urodynamic charateristics according to the diagnostic criteria for bladder outlet obstruction to help make the appropriate diagnosis. MATERIAL AND METHODS: A total of 230 women who underwent urodynamic studies for evaluation of overactive bladder were retrospectively reviewed. The patients were classified as having obstruction based on two criteria, including one pressure flow cutoff point criteria (free Qmax or = 20cmH2O) (group I) and moderate or severe obstruction by the Blaivas- Groutz nomogram (group II). Urodynamic characteristics of the patients in Group 1 and 2 were compared with those of 42 patients having only overactive bladder without any voiding symptom (OAB group). RESULTS: Of the patients 31 (13.5%) were in group I, 42 (18.3%) in group II. Qmax of group I was the lowest among 3 groups. Detrusor pressure at maximum measurable flow and maximum detrusor pressure during voiding in group 1 and II were significantly higher than in OAB group. Detrusor overactivity was more observed in group I and II, and there was no signigicant difference in the presence of voiding symptoms between group I and II. Only 9 patients (4%) had obstruction by both of criteria. CONCLUSIONS: Considering the high incidence of bladder outlet obstruction in the patients of overactive bladder and non-specificity of the symptoms by bladder outlet obstruction, thorough urodynamic study may be helpful in detection and treatment of bladder outlet obstruction of the overactive bladder patients. The further study for the criteria of female bladder outlet obstruction should be necessary to make its accurate diagnosis.

The Changes of the Erectile Function and Histology of the Corpus Cavernosum in a Rat Model of Metabolic Syndrome / 대한남성과학회지

PURPOSE: We evaluated the changes of the erectile function and histology of the corpus cavernosum in a rat model of metabolic syndrome. MATERIALS AND METHODS: We used male spontaneous hypertensive rats (SHRs) as an experimental group (n=6) and Wistar-Kyoto rats as a control group (n=6). The SHRs were fed with a high fat diet, but the Wistar-Kyoto rats were fed with a normal fat diet for 12 weeks. All the groups were then checked for body weight and various biochemiclal parameters. To investigate penile erection, the intracavernosal pressure (ICP), mean arterial pressure (MAP) and cGMP level of the corpus cavernosum were recorded for all the groups. Serial sections of the penis were used to perform Masson's trichrome staining and immunohistochemistry for determining the TGF-beta 1 expression. RESULTS: We confirmed that metabolic syndrome was induced in the experimental group by the significant difference of the various biochemical parameters. (ED note: For the results of erectile function? This wasn't clear.)As a result of erectile function, the ICP/MAP ratios were checked as 51.0+/-7.5% and 31.0+/-5.5%, respectively, for the control and experimental groups. So the ICP/MAP ratio of the latter was markedly decreased compared with the former and the cGMP level of the corpus cavernosum was the same for both groups. On Masson's trichrome staining, the number of smooth muscle cell was decreased and the collagen fibers with an irregular, distorted arrangement were increased in the experimental group. The immunoreactivity for TGF-beta 1 tended to increase in the experimental group. These histological findings revealed that fibrosis of the corpus cavernosum occurred in the experimental group. CONCLUSIONS: Our results demonstrate that metabolic syndrome is harmful to erectile function and it leads to histological changes of the corpus cavernosum according to a rat model of metabolic syndrome.