Monoclonal Gammopathy-Associated Scleredema Adultorum of Buschke in a Patient with Diabetes Mellitus Successfully Treated with Intravenous Immunoglobulin and Narrow-Band Ultraviolet B Phototherapy: A Case Report

no abstract available.

Onion peel extract and its constituent, quercetin inhibits human Slo3 in a pH and calcium dependent manner

Sperm function and male fertility are closely related to pH dependent K⁺ current (KSper) in human sperm, which is most likely composed of Slo3 and its auxiliary subunit leucine-rich repeat-containing protein 52 (LRRC52). Onion peel extract (OPE) and its major active ingredient quercetin are widely used as fertility enhancers; however, the effect of OPE and quercetin on Slo3 has not been elucidated. The purpose of this study is to investigate the effect of quercetin on human Slo3 channels. Human Slo3 and LRRC52 were co-transfected into HEK293 cells and pharmacological properties were studied with the whole cell patch clamp technique. We successfully expressed and measured pH sensitive and calcium insensitive Slo3 currents in HEK293 cells. We found that OPE and its key ingredient quercetin inhibit Slo3 currents. Inhibition by quercetin is dose dependent and this degree of inhibition decreases with elevating internal alkalization and internal free calcium concentrations. Functional moieties in the quercetin polyphenolic ring govern the degree of inhibition of Slo3 by quercetin, and the composition of such functional moieties are sensitive to the pH of the medium. These results suggest that quercetin inhibits Slo3 in a pH and calcium dependent manner. Therefore, we surmise that quercetin induced depolarization in spermatozoa may enhance the voltage gated proton channel (Hv1), and activate non-selective cation channels of sperm (CatSper) dependent calcium influx to trigger sperm capacitation and acrosome reaction.

Wouldn't Human Understanding be Necessary to Treat Patients with Pancreaticobiliary Disease More Effectively? / 대한췌담도학회지

Human understanding is one of the three virtues that are expected of physicians in Harrison's principles of internal medicine, and it was emphasized that a Shakespearean breadth is needed to be the true physician. Recently, there has been an increase in the need for human understanding, such as a continuous increase in GB stones, an association between the patient's life events and pancreaticobiliary diseases, an increase in autoimmune disease, and a high recurrence rate after treatment. Therefore, we attempted a holistic and fundamental approach for figuring out the pathogenesis of pancreaticobiliary diseases including human habit loop and adaptive response and suggests the model for the development of pancreaticobiliary disease considering human understanding.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PURPOSE: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age > or =50 years, International Prostatic Symptom Score (IPSS) > or =13, maximum flow rate (Qmax) or =40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. CONCLUSIONS: PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

The Effect of Transurethral Resection of the Prostate in Detrusor Underactivity / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of transurethral resection of the prostate (TUR-P) in men with detrusor underactivity (DUA) who do not respond to conservative medical treatment. MATERIALS AND METHODS: Of the patients who underwent TUR-P for LUTS at our institution, we reviewed the records of 71 patients who had undergone preoperative urodynamic study. According to the bladder outlet obstruction index and the bladder contractility index, the patients were divided into two groups: group A (25 patients) with unobstructed and underactive detrusor function, and group B (46 patients) with obstructed and/or normal detrusor contractility. We evaluated the difference of International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), post void residual (PVR) volume and the subjective satisfaction after TUR-P. RESULTS: There were no significant differences preoperatively between the groups for age, Qmax and PVR. The total IPSS/QoL score was higher and the prostatic size was smaller in group A. After TUR-P in group A, the IPSS/QoL score and PVR were significantly improved; the Qmax was also improved, but this was not significant. There were significant improvements in all parameters in group B. Patients in group B showed the more significant improvement rate of the IPSS score and they were more satisfied after TUR-P than those in group A. CONCLUSIONS: Patients with DUA had less improvement in their symptom score and operative satisfaction than those with obstructed and/or normal detrusor contractility after TUR-P. However, there was significant improvement in IPSS/QoL and PVR after TUR-P in former group and 64% of these patients were satisfied. Therefore, TUR-P is thought to be an optional surgical procedure for treating the men with DUA who do not respond to conservative medical treatment.

Evaluation of Complementary and Alternative Medicine for Treating Patients with Erectile Dysfunction / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate complementary and alternative medicines (CAM) employed for treating patients with erectile dysfunction. Materials and Methods: A total of 204 patients with erectile dysfunction who completed a questionnaire between January and June 2005 were evaluated. The questionnaire was composed of 13 questions. This survey employed a broad definition for CAM, including acupuncture, biofeedback, folk remedies, chiropractic, homeopathy, hypnosis, massage, psychotherapy, relaxation, energy healing, imagery, special diet, spiritual healing and herbal medicine. The CAMs used by the patients with erectile dysfunction were divided into processed health foods, natural health foods and other therapies, and these were all analyzed. Results: The mean age was 57.9+/-10.1 years. 78 of the total patients with erectile dysfunction had employed at least one CAM. CAM users were more likely to be high school educated, nonsmokers and exercisers. The CAMs used were processed health foods 62% (48/78), natural health foods 15% (12/78), and other therapies 66% (52/78). The processed health foods were soy 25%, ginseng 23% and mushroom 19%. Of the natural health foods, tomato was 42%, soy was 25% and ginseng was 17%. Of the other therapies, herbal medicine was 45%, acupuncture was 25%, moxibustion and cupping a boil were 17%. 35% (27/78) of the patients with erectile dysfunction had employed more than one of the processed health foods, natural health foods and other therapies. Conclusions: Patients with erectile dysfunction had mainly employed processed health foods more than the natural health foods, herbal medicine and acupuncture. We think that more research is required about the effects and benefits of CAM in association with ED.

Physiological Roles and Properties of Ion Channels in Corporal Smooth Muscle / 대한남성과학회지

Decreased penile vascular resistance induced by corporal smooth muscle relaxation is the most important step in penile erection. The heightened tone of the corporal smooth muscles is considered a major cause in impotence. Modulation of corporal smooth muscle tone is a complex process requiring the integration of a host of intracellular events and extracellular signals. In intracellular events of corporal smooth muscle cell, the potassium channels and calcium channels play a major role. Functionally, potassium channels are important regulators of smooth muscle membrane potential in response to depolarizing stimuli and they counteract calcium channels. Potassium channels have been shown to play a fundamental role in both the physiologic and pathophysiologic regulation of smooth muscle tone in diverse tissues. Among the several subtypes of potassium channels, the calcium-sensitive potassium channel subtypes (KCa channel) and ATP-dependent potassium channel subtypes (KATP channel) are thought to be the most physiologically relevant in human corporal smooth muscle. With respect to intercellular communication, gap junction channels (connexin 43) are important in corporal smooth muscle cells. Thanks to gap junction channels, the signal of one cell can be spread to adjacent cells and coordination of corporal tissue response is possible. This report reviews the known details concerning junctional and nonjunctional ion channels in corporal smooth muscle and suggest the possibility of gene therapy targeting ion channels for erectile dysfunction

Physiologic Role of K+ Channels in Relaxation of Rabbit Corpus Cavernosal Tissue / 대한남성과학회지

PURPOSE: Ion channels play key roles in determining smooth muscle tone by setting the membrane potential and allowing Ca2+ influx. Potassium channels may be important in modulating corporal smooth muscle tone. In this study, we investigated the effects of potassium channels in the rabbit corpus cavernosal smooth muscle by blocking them with various agents. MATERIALS AND METHODS: Strips of rabbit corpus cavernosum were prepared for mounting and isometric tension measurement in an organ bath. On cavernosal strips contracted with phenylephrine (PHE), sodium nitroprusside (SNP) was applied in increasing concentrations from 10(-7)M to 10(-4)M, causing dose-dependent relaxation. The effects of various potassium channel blockers on SNP-induced relaxation were then evaluated by measuring the tension of the cavernosal strips. The potassium channel blockers used were tetraethyl ammonium (TEA), charybdotoxin, gliben clamide, and apamin. RESULTS: The relaxation responses to SNP of the corporal preparations contracted in response to PHE were significantly attenuated by TEA (10(-2)M) and charybdotoxin (10(-7)M), with no significant difference observed between the two drugs. The SNP-induced relaxation responses were not significantly attenuated by glibenclamide (10(-5)M) or apamin (10(-5)M). CONCLUSIONS: These results suggest that maxi-K+ channels play an important role in corpus cavernosal relaxation. The KATP channel and small-conductance KCa channel are thought to be unrelated to corpus cavernosal smooth muscle relaxation.

Control of Postpartum Bleeding by Rectal Misoprostols: A Report of 2 Cases / 대한산부인과학회잡지

Obstetrical hemorrhage is one of the deadly triad, along with hypertensive disorder in pregnancy and infection. Postpartum hemorrhage is the major cause of obstetrical hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, and resulted from poor uterine contraction after delivery of the fetus and placenta. Initial management to control postpartum uterine atonic bleeding is based on the use of uterotonics such as well known oxytocin and ergot preparations together with uterine massage. Prostaglandin E2 analogue, sulprostone can be used next when these agents are failed to produce uterine contraction. The woman unresponsive to non-surgical managements requires surgical interventions including emergency hysterectomy. Recently prostaglandin E1 analogue, misoprostol, has been known to elicit potent uterine contraction and cervical ripening after oral, vaginal or rectal administration. We have experienced two cases of postpartum uterine atonic bleedings which were unresponsive to oxytocin, ergot, or prostaglandin E2, but were successfully controlled by rectal administration of misoprostols.

The Effects of beta-adrenocreptor Stimulation on the Maxi-K+ Channels in Human Corporal Smooth Muscle Cells / 대한비뇨기과학회지

PURPOSE: beta-adrenoceptors have been demonstrated in human corporal smooth muscles by the receptor binding assays, and have been known to elicit relaxation of the precontracted corporal tissues. Despite these findings, it is not clear whether the beta-adrenoceptors have any role in the control of penile erection. Potassium channels play an important role in the physiology of the corporal smooth muscle. The maxi-K+ channel subtypes are thought to be the most physiologically relevant K+ channels expressed in this tissue. The goal of this study was to clarify the contribution of the beta-adrenoceptors to the modulation of the corporal smooth muscle tone. MATERIALS AND METHODS: Patch-clamp technique was applied to the cultured human corporal smooth muscle cells. RESULTS: Maxi-K+ channel was activated by the application of the beta-adrenoceptor stimulator, isoproterenol (ISO). ISO increased the open probability (nP0) by 512+/-53% and the mean open time by 214+/-12% in the cell-attached patch recording. The whole cell patch recording indicated that the application of ISO in the bath solution increased the peak amplitude of the whole cell outward K+-current during the step depolarization (from -70 to + 130 mV). The presence of a specific protein kinase A inhibitor (PKI) in the pipette tip suppressed the ISO-induced increase of the whole cell outward K+-current. CONCLUSIONS: These studies showed that the beta-adrenoceptor activation contributed to the modulation of the corporal smooth muscle tone by activating the potassium channels, and moreover, that the activation of the potassium channels by the beta-adrenoceptors was related to the protein kinase A pathway.

The effects of androgen milieu change on erection and central dopaminergic receptor in apomorphine-induced penile erection of the rat model / 대한비뇨기과학회지

The systemic administration of low doses of dopamine(DA) agonist, such as apomorphine, LY 171555 and n-propyl norapomorphine induces penile erection and yawning in rats. Such a response is apparently mediated by the stimulation of central DA receptors of the D2 type and studies have suggested a localization of this action to the paraventricular nucleus(PVN) of the hypothalamus. We have investigated the effect of serum testosterone level on the apomorphine induced penile erection and yawning and the effect of serum testosterone level on the in vitro binding of [3H]N -n -propyl norapomorphine ( [3H]NPA) in cryostat from the paraventricular nucleus (PVN) of the hypothalamus in rats. All rats of control group demonstrated an erectile response and yawning behavior. Castrated rats did not have erections and had diminished yawning but responded normally after testosterone administration. In autoradiography, castration elicited significant reduction in the specific binding of 0.25 nM [ 3H] NPA to D2 receptor sites in paraventricular nucleus, but after testosterone replacement the specific binding increased above control level. Testosterone was necessary to the maintenance of a specific dopaminergic centrally mediated erection and it's blood level affects the binding properties of tritium NPA from paraventricular nucleus of hypothalamus. In these study we could suggest one aspect of androgen action on penile erection and the rationale of androgen replacement therapy.

No incision percutaneous seminal vesiculography / 대한비뇨기과학회지

Seminal vesiculography is an excellent method of evaluating the male genital tract not only for obstruction but also for other structural lesions that may cause infertility. To date it has been usually performed under general or spinal anesthesia as a preliminary to an operative procedure or durirre the epididymovasastomy. We report on no incision percutaneous seminal vesiculography under local anesthesia prior to the surgical correction of infertility. It was developed by applying the percutaneous vas puncture technique to seminal vesiculography and needed neither incision nor dissection. Thirty azoospermic patients were evaluated by this method for patency and image of the vas, seminal vesicles and ejaculatory ducts before corrective surgery. Not more than three punctures were made on one vas. To clarify the possibility that it may be complicated by the stenosis of the vas at the puncture site, fifteen patients were evaluated by intraoperative seminal vesiculography two months later and among them three patients were additionally evaluated pathologically. In cases whose vases were punctured more than twice at the same site of the vas, there were partial or severe obstruction but there was no obstruction when multiple punctures were done on the different sites of one vas. Although this procedure requires a fair skill. it is simple to an expert. We could suggest that no incision percutaneous seminal vesiculography is plausible, safe and valuable in saving unnecessary scrotal exploration and shortening the surgical time. The future roles of this imaging technique are discussed.

The infraspinal neural pathway of apomorphine-induced erection : an experimental study by the comparison with electrostimulation-induced erection on the rat model / 대한비뇨기과학회지

The erectile response is peripherally mediated by cavernous nerve that contains thoracolubar sympathetic nerve and sacral parasympathetic nerve. It is known that thoracolubar sympathetic nerve involves in detumescence and sacral parasympathetic nerve in tumescence, however there are some opinions that rhoracolubar sympathetic nerve participates in psychogenic erectile mechanism. We previously reported that by the comparison with electrostimulation-induced erection, apomor- phine-induced erection was a vascular event. The aim of our study was to determine the infraspinal neural pathway of APO-induced erection. The sham operated rats remained normal in all measured respects. All rats having undergone neurotomy ot the hypogastric nerves showed APO-induced erection except one. The only 5 rats having undergone neurotomy of the pelvic nerves showed APO-induced erection. Erections could be elicited upon cavernous or pelvic nerves stimulation in all rats having undergone neurolomy of the hypogastric nerves. Among 17 rats having undergone neurotomy of the pelvic nerve erection could be elicited upon cavernous nerves slimulation in 14 rats, however. the intracavernous pressure (47.9+/-16.5 mmHg) was lower than that found in sham-operated rats. Erectile response in these 14 rats appeared to result from stimulation of penile neurons coming from the major pelvic ganglion. In contrast to no response in sham-operated rats, stimulation of the hypogastric nerves also resulted in erections in 7 out of 17 rats. In conclusion, this present study suggests that APO-induced ereclion is primarily mediated via the sacral parasympathetic nerve system and may be mediated by the thoracolumbar sympathetic pathway following injury to the parasympathetic nerve system. Furthermore we can guess the possibility that the neural pathway of psychogenic erection is same that of AP0- induced erection.