Impact of previous metronidazole exposure on metronidazole-based second-line quadrupletherapy for Helicobacter pylori infection

Background/Aims@#The negative effects on the eradication success of Helicobacter pylori infection after previous exposure to macrolides, including clarithromycin on clarithromycin-based first-line therapy have been demonstrated. However,whether this is true for metronidazole-based second-line quadruple therapy remains unclear. We investigated the relationship between past administration of metronidazole and the failure of metronidazole-based second-line quadruple therapy in patients with H. pylori infection. Methods: Patients over 20 years of age who were diagnosed with H. pylori infection between January 1998 and March 2016 were enrolled in this study. The relationship between the clinical parameters and the results of a C13-urea breath test after metronidazole-based second-line quadruple therapy was analyzed in patients for whom clarithromycin-based triple therapy failed to eradicate H. pylori . @*Results@#The H. pylori eradication failure rate was significantly higher in patients with a history of metronidazole use than in patients without a history of metronidazole use ( p = 0.011). Multivariable analysis showed that the odds ratio of previous metronidazole use for eradication failure was 3.468 (95% confidence interval,1.391 to 8.649; p = 0.008). In the subgroup analysis of patients with a history of metronidazole use, the duration of metronidazole use and interval between its use and eradication therapy did not significantly affect H. pylori eradication failure. @*Conclusions@#Previous exposure to metronidazole was a significant risk factor for treatment failure of metronidazole-based second-line quadruple therapy; therefore, this should be considered when establishing a treatment strategy for patients with H. pylori infection.

Comparison of Effectiveness between Abdominal Vibration Stimulation and Walking Exercise for Bowel Cleansing before Therapeutic Colonoscopy

Background/Aims@#Adequate bowel preparation is important for successful colonoscopy. We aimed to evaluate the clinical feasibility and effectiveness of abdominal vibration stimulation in bowel preparation before therapeutic colonoscopy. @*Methods@#A single center, prospective, randomized, investigator-blinded study was performed between January 2016 and December 2016. Patients for therapeutic colonoscopy were prospectively enrolled and assigned to either the vibrator group or walking group. Patients who refused to participate in this study as part of the experimental group consented to register in the control group instead. During the preparation period, patients assigned to the walking group walked ≥3,000 steps, whereas those assigned to the vibrator group received abdominal vibrator stimulation and restricted walking. All patients received the same colon cleansing regimen: 4-L split-dose polyethylene glycol (PEG) solution. @*Results@#Three hundred patients who received PEG solution for therapeutic colonoscopy were finally enrolled in this study (n=100 per group). Bowel cleansing with abdominal vibration stimulation showed almost similar results to that with walking exercise (Boston Bowel Preparation Scale score for the entire colon: vibrator vs walking vs control, 7.38±1.55 vs 7.39±1.55 vs 6.17±1.15, p<0.001). There were no significant differences between the vibrator group and walking group regarding instances of diarrhea after taking PEG, time to first diarrhea after taking PEG, total procedure time, and patient satisfaction. @*Conclusions@#This study indicates that, compared with conventional walking exercise, abdominal vibration stimulation achieved similar rates of bowel cleansing adequacy and colonoscopy success without compromising safety or patient satisfaction.

Effect of PTEN Polymorphism on the Development of Hepatitis B Virus-associated Hepatocellular Carcinoma

BACKGROUND/AIMS: Phosphatase and tensin homolog (PTEN) is a known tumor suppressor gene that is downregulated in hepatocellular carcinoma (HCC). Here, we investigated the association between single nucleotide polymorphisms (SNPs) of PTEN and HCC development in patients with hepatitis B virus (HBV) infection. METHODS: Six SNPs of PTEN at positions rs1234221, rs1903860, rs1234220, rs1903858, rs2299941, and rs17431184 were analyzed in a development population (417 chronic HBV carriers without HCC and 281 chronic HBV carriers with HCC). PTEN rs1903858, rs1903860, and rs2299941 SNPs were further assessed for the development of HCC in a validation population of 200 patients with HBV-related liver cirrhosis. RESULTS: In the development population, PTEN rs1903860 C allele, rs1903858 G allele, and rs2299941 G allele were associated with a low risk of HCC. The haplotype A-T-A-A-A was associated with an increased risk of HCC (recessive model; odds ratio=2.277, 95% confidence interval [CI] =1.144-4.532, P=0.019). In the validation population, PTEN rs2299941 G allele was the only significant protective genetic polymorphism related to HCC development after adjustment for age and sex (hazard ratio=0.582, 95% CI =0.353–0.962, P=0.035). CONCLUSIONS: These findings suggest that genetic polymorphisms in PTEN may affect HCC development in patients with chronic HBV infection.

Renal Artery Embolization in Patients with Polycystic Kidney Disease / 대한내과학회지

Polycystic kidney disease (PCKD) is the most common life-threatening genetic disease that causes kidney failure worldwide. Patients with autosomal dominant PCKD notice an increase in abdominal size as the kidney cysts grow and present with gastrointestinal and pulmonary symptoms. Surgical therapy, percutaneous drainage, sclerotherapy, cyst decompression, and laparoscopic fenestration have been used to treat the symptoms, but the results are often unsatisfactory. We recruited five patients with PCKD. Each patient complained of severe abdominal discomfort, and had a poor quality of life. In these patients, we performed renal artery embolization. After the procedure, all of the patients were discharged without severe complications. Follow-up abdominal computed tomography was performed 3-6 months after the procedure, and we were able to confirm a reduction in the size of both kidneys. In addition, the clinical symptoms improved in all five patients.

Rupture of a Superior Mesenteric Artery Pseudoaneurysm Presenting with Asymptomatic Anemia / 대한내과학회지

Anemia is a common cause of referrals to gastroenterologists. Only a small number of anemia cases result from vascular abnormalities. Visceral artery aneurysms and pseudoaneurysms are rare forms of vascular disease that have significant potential for rupture, resulting in potentially life-threatening hemorrhaging. We present the case of a 70-year-old female patient with a pseudoaneurysm of the superior mesenteric artery complicated with rupture, who had no abdominal pain and only anemia.

An Unusual Presentation of Diabetic Ketoacidosis in Familial Hajdu-Cheney Syndrome: A Case Report

A 21-year-old man with diabetic ketoacidosis (DKA) displayed short and clubbed fingers and marked eyebrow, which are typical of Hajdu-Cheney Syndrome (HCS). Laboratory findings confirmed type 1 diabetes mellitus (DM). After conservative care with hydration and insulin supply, metabolic impairment was improved. Examinations of bone and metabolism revealed osteoporosis and craniofacial abnormalities. The mutation (c.6443T>G) of the NOTCH2 gene was found. The patient was diagnosed with HCS and DM. There may be a relationship between HCS and DM, with development of pancreatic symptoms related to the NOTCH2 gene mutation.

Prader-Willi Syndrome with Hypogonadism / 대한남성과학회지

Prader-Willi syndrome (PWS) is a rare genetic disease caused by a deletion or disruption of genes in chromosome 15. Commonly associated characteristics of this disorder include obesity, mental retardation, short stature, and hypogonadotropic hypogonadism. A 3-year-old-boy who initially presented hypoplastic scotum, small penis and bilateral cryptorchism was confirmed the diagnosis of PWS using of with genetic tests. Finally, he was taken bilateral orchiopexy.

Uroplakin mRNA Expression in the Micro-dissected Mouse Prostate / 대한남성과학회지

PURPOSE: Prostatitis is a common condition with a significant effect on quality of life. Even though the etiology of chronic prostatitis remains unclear, certain bacterial infections may play a major role. In recent studies, E. coli, one important etiology of urinary tract infection, was found to mediate invasion into the bladder epithelium after binding uroplakin Ia in the apical membrane of the urinary bladder. Because E. coli is also an important pathogen for bacterial prostatitis, we investigated the uroplakin mRNA expression in micro-dissected mouse prostates. MATERIALS AND METHODS: We harvested the urinary bladder, ventral prostate, dorso-lateral prostate, and coagulating gland from 3 male imprinting control region (ICR) mice. The total RNA was extracted, cDNA was prepared, and finally the five target genes--uroplakin Ia, Ib, II, III, and beta-actin were amplified. We also examined the expressed sequence tags (EST) about above four uroplakin genes from mouse EST data. RESULTS: Uroplakin Ia, Ib, II, and III were expressed in the urinary bladder. However, only uroplakin Ia was definitively expressed in the ventral prostate. Uroplakin Ib and II were weakly expressed in the ventral, dorso-lateral, and coagulating prostate. Uroplakin III was not expressed in the prostate tissue. The mouse RNA transcripts in the EST data also showed similar results to uroplakin expression in the prostate. CONCLUSIONS: These results suggest that the mouse ventral prostate may be an adequate locus for acute or chronic bacterial prostatitis study. Further in-vitro bacteriologic studies of the ventral prostate will help reveal the mechanisms of chronic bacterial prostatitis.

Cystic Embryonal Sarcoma of the Kidney: Report of a Case with US and CT Findings

Here we report a case in a 41-year-old woman histologically proven cystic embryonal sarcoma of the kidney, with emphasis on the imaging findings and pathological features. A large lobulated solid mass in the cystically dilated pelvocalyceal region was accompanied with hydroureter as depicted on both ultrasound and contrast-enhanced CT images.

The Effect of Dutasteride on Serum Prostate-specific Antigen (PSA) in Patients with Benign Prostate Hypertrophy

PURPOSE: 5alpha reductase, dutasteride, has widely used to treat enlarged prostate (BPH). By suppressing the conversion of testosterone to dihydrotestosterone it decreases serum prostate-specific antigen (PSA) which is very important screening marker for prostate cancer. We evaluate the early serum PSA changes after dutasteride treatment to Korean BPH patients. MATERIALS AND METHODS: A total 159 men with a clinical diagnosis of BPH and no evidence of prostate cancer were enrolled. They were treated with dutasteride 0.5mg daily for 12 months. Serum PSA was evaluated at 2, 6, and 12 months after the medication. RESULT: Dutasteride statistically significantly reduced serum PSA to 0.70+/-0.52, 0.64+/-0.35, and 0.59+/-0.49 from baseline level at 2, 6, and 12 months after the medication, respectively. However, there was no statistical significance among the three groups in serum PSA changes after dutasteride. There were statistically significant correlations between a high pre-treatment serum PSA level and a large reduction of follow-up PSA levels at 2, 6, and 12 months after dutasteride treatment. CONCLUSIONS: The reduction of serum PSA is variable in patients to patients at 2, 6, and 12 months after dutasteride treatment. The patient with high initial serum PSA revealed a large reduction of serum PSA level after treatment. The traditional concept that follow-up serum PSA level should be doubled for prostate cancer screening may overestimate real serum PSA level within 12 months in Korean men receiving 5alpha reductase inhibitors.

Use of Consensus Primer Set, GP5+ and GP6+, to Detect Human Papillomavirus within Genital Lesions / 대한비뇨기과학회지

PURPOSE: The human papillomavirus (HPV) group comprises over 90 different genotypes, of which more than 30 are mucosotropic. HPV types 16 and 18 are considered the major cause of invasive carcinomas and their related precursors. However, other types are also responsible for the development of carcinomas, condylomas acuminatas and genital warts. The prevalence of the different HPV genotypes in the general population shows heterogeneity and geographical variations. Therefore, a consensus primer set was evaluated to detect HPV in patients with genital lesions. MATERIALS AND METHODS: Genomic DNA was extracted from 2 penile squamous cell carcinomas, 2 verrucous carcinomas, 11 condyloma acuminatas and 2 suspicious lesions. A general primer GP5+ /GP6+ mediated PCR was performed. RESULTS: All the condyloma acuminata, carcinoma and suspicious lesions showed a 150 bp PCR products with the consensus primer GP5+ /GP6+ . CONCLUSIONS: The PCR method, with a general primer set, GP5+ /GP6+ , can detect mucosotropic HPV from various genital lesions. It may be a broad spectrum PCR method, but it can also detect small amounts HPV from suspicious lesions.

The Changes of Seminal Quality after Varicocelectomy in Adolescence / 대한비뇨기과학회지

The varicocele, a correctable cause of male infertility, affects both testes in histologically and physiologically, and the testicular damage is related to the duration of the varicocele. But the correction of an adolescent with a varicocele is controversial. To evaluate the efficacy of early surgical correction of the varicocele, seminal analysis was compared preoperatively and postoperatively for 6 months in 52 adolescents. In all the patients, improvement of postoperative men quality was observed with statistical significance, but morphology was not changed. operative abnormal semen quality was noted in 12 patients and was improved in 5 patients postoperatively. According to this results, early diagnosis and early surgical correction in adolescent with varicocele maybe prevent further testicular damage and increase fertility ultimately.

Sexuality in the Later Years

No abstract available.

Intralesional Injection of Triamcinolone for Urethral Stricture after Visual Urethrotomy / 대한비뇨기과학회지

Contraction and epithelization are two phenomena of wound healing which are retarded by steroid. Triamcinolone activates collagenase which enhanced the degradation of scar tissues. All 7 cases were treated with visual urethrotomy and injected triamcinolone into the lesion. The results were excellent :all 7 patients were asymptomatic without need of further management and their peak flow rates were within normal range. No adverse effect of intralesional injection of triamcinolone was seen.

Clinical Experience for Radiolucent Stones; A Report of 27 Cases / 대한비뇨기과학회지

The cause of radiolucent filling defects in the upper urinary tract are malignant tumor, radiolucent stones, blood clots, air bubbles, congenital deformities of renal parenchyme, and various specific and non-specific infection and their sequence. So the differential diagnosis between malignancy and radiolucent stones is very important, and the exact and fast diagnosis of radiolucent stones is useful in excluding the possibility of malignancy. 27 cases with radiolucent stones were evaluated retrospectively for exact diagnosis and appropriate treatment method. Intravenous urography was done in all cases, and retrograde pyelography, ultrasonography, computed tomography and/or ureterorenoscopy were performed for diagnosis, if needed. Size of stones were measured below 10mm by transverse length in 19 cases (70.4%) with a range of 3 to30mm. The locations of stones were pelvocalyceal system in 8 cases (29.6%) and ureter in 19 cases (70.4%). Among the diagnostic methods, computed tomography was used most frequently. ESWL with retrograde pyelography was most frequent used method of treatment, also simple hydration to small stone was effective.

Evaluation of the Painless Scrotal Masses / 대한비뇨기과학회지

Painless scrotal masses are clinical syndromes composed of variable causes such as benign disease and testicular cancer. So, the methods of treatment are differ from each causes and in the case of testicular cancer, as its painless nature, the delayed treatment can be alter the methods of treatment and the prognosis. During 21 months, between June 1994 and March 1996, we evaluated the confirmed diagnosis, the method of treatment, the diagnostic method and the distribution of age from the 125 cases of 109 patients who are admitted to the hospital from the painless scrotal mass and underwent surgical treatment and pathologic typing, retrospectively. Of the 125 cases, 57 cases (46%) were below 20 years old and communicating hydrocele was most common case (51case) and 66 cases were age of over 20 years old. In 66 cases, 17 cases (25%) were chronic epididymitis, 15 cases (22.1%) were noncommunicating hydrocele and 9 cases (13.2%) were varicocele, respectively. Malignant neoplasm was distributed to the 1 case of pediatric group and 3 cases (4.4%) of adult group. Transillumination test, generally, revealed negative or equivocal finding except to hydrocele. On the ultrasonographic test (35 cases). most cases were identical or correspond to the postoperative diagnosis and 1 case was misdiagnosed (accuracy rate, 97.1%) but in the case of inflammatory disease, it was difficult to differentiate between specific and non-specific infection. We conclude that the work up for the painless scrotal mass should begin with careful physical examination, and when the physical examination, scrotal transillumination and scrotal ultrasonography show the equivocal finding, surgical exploration with inguinal incision will be necesssary to prevent sequelae or complication of malignant disease.

Treatment of Ureteral Stone using Modulith SL-20 : Analysis of the Factors influencing on Stone Fragmentation / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy (ESWL) is a golden standard to treatment of symptomatic urinary calculi. Many experiences treated with ESWL has been reported in worldwide literatures. But there are a little reports which analyze factors influencing on successful stone fragmentation with ESWL. We reviewed 136 patients with primary ureteral calculi treated with the third generation lithotripter, Modulith SL-20, to analyze the factors influencing on stone fragmentation and to determine the limit of repeated ESWL. The results were as follows: 1.The cumulative successful rates of the first, second, third, 4th and 8th session were 72%, 90%, 96%, 98% and 98%, respectively. Any successful stone fragmentation is not seen after the 5th session. 2.The more the size of calculi increase, the more the numbers of repeated ESWL are increased (p=0.001). 3.The number of repeated ESWL for successful fragmentation increase in radio-opaque calculi than slightly opaque calculi (p=0.001). 4.The location of calculi is not correlated to the numbers of repeated ESWL for successful fragmentation (p=0.09). 5.The degree of ureteral obstruction is not correlated to the numbers of repeated lithotripsies for successful fragmentation (p=0.28). It could be concluded that the size and radio-opacity of calculi are well correlated to the numbers of repeated lithotripsies for successful fragmentation, whereas the location and the degree of ureteral obstruction are not.

A Semi-Nested Polymerase Chain Reaction for Amplification of Chlamydia trachomatis Omp1 Gene / 대한비뇨기과학회지

PURPOSE: Chlamydia trachomatis(CT) infection is the most common bacterial sexually transmitted disease. Because of vague symptoms and delayed diagnosis, untreated infection can be transmitted to sexual partners and progress to infertility, pelvic inflammatory disease and ectopic pregnancy. Genotyping and serotyping for CT are very important to establish contact networks and for epidemiological and evolutionary studies. Cryptic plasmid and omp1 genes are targets for the detection of CT. Although the plasmid is a good target for amplification, it is very difficult to analyze sequences from the plasmid amplicons. The omp1 gene is an ideal target for sequence analysis because of large and publicized data deposits on the internet. However, very few studies have been published using a polymerase chain reaction(PCR) for the detection of the chlamydial omp1 gene in Korea. The purpose of this study was to detect CT infection with semi-nested amplification of the chlamydial omp1 gene. MATERIALS AND METHODS: Genomic DNA was extracted from the urethral swabs of 20 patients with urethritis or idiopathic chronic prostatitis, and from the vaginal swabs of 80 patients attending the gynecology clinic due to various vaginal symptoms. The primers were designed on omp1 genes from 12 CT and 2 sequences of lymphogranuloma venereum. The estimated products from the first and second rounds of PCR were 656 and 100 bp, respectively. RESULTS: With the 1st PCR bands there were confusing and non-specific bands, but all the specific PCR products from the 1st and 2nd amplifications with new primer sets were identified. CT was identified in 2 of 20 male patients (10%) and 4 of 80 female patients (5%). CONCLUSIONS: CT infections were detected from patients with semi-nested amplifications of the chlamydial omp1 gene. The semi-nested PCR method may be a more sensitive and specific test than first round PCR.

A clinical analysis of rhabdomyosarcoma in the genitourinary tract / 대한비뇨기과학회지

The purpose of this study was to assess the effectiveness of chemotherapy in addition to radiation therapy and surgical managements for Rhabdomyosarcoma in genitourinary fields. We have studied 11 cases of rhabdomyosarcoma who admitted to the Department of Urology. Korea University Medical Center, Anam and Kuro Hospital from March 1983 to March 1992 and concluded as follows: 1. 5 patients had prostatic Rhabdomyosarcoma, 4 patients in paratesticular Rhabdomyosarcoma, 1 patient in pelvic cavity and 1 patient in kidney. 2. Various radiologic imaging examinations were done: a. tumor sizes measured by CT scans ranged from 4 x 4 x 3 cm to 13 x 15 x 15 cm. b. paraaortic lymph node enlargement was found only in one patient. 3. According to IRS clinical grouping system, 4 patients belong to the group I ,one in group II. 5 in group m and one in group IV. 4. Grossly complete mass excision was done in 6 patients but it was impossible in another 5 patients due to bulky tumor mass. 5. The histologic classifications were embryonal( 7 patients), alveolar(2 patients) and pleomorphic type (2 patients). 6. 7 of 11 patients did not have adequate treatment: all 7 patients died of disease. The rest 4 patients were adequately treated with our protocol: 3 patients has responsed to prolocol and one patient had failed. 7. 6 of 11 patients treated with various modes of surgery initially such as complete excision of mass(3 patients), nephroureterectomy (one patient), urinary diversion (one patient), radical cystoprostatectomy (one patient)and 5 patients achieved complete remission with surgery for 40, 6. 14, 63 and 32 months, respectively. However 3 of these 5 patients had a local recurrence during the period of follow up: all 3 patients were died of Rhabdomyosarcoma and only 2 of5 patients were still alive without Rhabdomyosarcoma during follow up. 4 of 11 patients initially received pulse VAC chemotherapy, only one patient was achieved a complete remission for 72 months and he is still alive without Rhabdomyosarcoma. 3 patients achieved a partial response for 3, 8, 8 months but all patients died of disease.

Prokaryotic 16S rDNAs from Various Prokaryotes That Are Suggested as Etiologies of Idiopathic Chronic Prostatitis / 대한비뇨기과학회지

PURPOSE: Specific microorganisms, such as C trachomatis, Mycoplasma and T vaginalis, are rarely detected in idiopathic chronic prostatitis. However, fastidious and nonculturable microorganisms may be important in the etiology of idiopathic chronic prostatitis. The object of this study was to test a new PCR primer set to detect 16S rDNA from various prokaryotes suggestive of the etiologies of idiopathic chronic prostatitis. MATERIALS AND METHODS: A new 16S rDNA primer set was designed from common prokaryotic genetic sequences using bioinformatic tools. The genomic DNAs from E-coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Actinobacter baumanmii, coagulase negative Staphylococcus, Corynebacterium, Serratia marcescens, Proteus mirabilis and Staphylococcus aureus were extracted by boiling colonies from their plated cultures. The template DNAs from the above microorganisms were amplified using this new 16S rDNA primer set. RESULTS: The correct PCR product, 470 bp, was obtained from E-coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Actinobactrer baumanmii, Corynebacterium spp, Serratia marcescens and Proteus mirabilis. However, a constant result from gram positive bacteria, such as Stapylococci, could not be obtained. CONCLUSIONS: A new PCR primer set, which can detect various prokaryotes suggestive of the etiologies of idiopathic chronic prostatitis, was obtained.