Improving Accuracy and Reliability of Hearing Tests: An Exploration of International Standards

This study explores the internal standards for hearing tests and benefits of implementing international standard protocols, including the International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC), and discusses how ISO and IEC standards provide a framework for designing, calibrating, assessing hearing test instruments and methods, and exchanging and comparing data globally. ISO and IEC standards for hearing tests improve accuracy, reliability, and consistency of test results by applying standardized methods and environments. Moreover, they promote international harmonization and data interoperability, enabling information exchange and research collaboration. Those standards for hearing tests are beneficial but have challenges and limitations, such as variation in equipment and calibration, lag in updating standards, variation in implementation and compliance, and lack of coverage of clinical aspects, cultural diversity, and linguistic diversity. These affect the quality and interpretation of test results. Adapting ISO or IEC standards locally would improve their applicability and acceptability, while balancing customization and compatibility with global standards.

Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis

Purpose@#We investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients. @*Methods@#Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed. @*Results@#Among 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up. @*Conclusion@#DKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.

Long-term outcomes of Graves’ disease in children and adolescents receiving antithyroid drugs

Purpose@#Antithyroid drugs (ATDs) are primarily used as an initial treatment in pediatric patients with Graves’ disease (GD). We aimed to investigate the long-term outcomes in pediatric GD patients receiving ATDs. @*Methods@#Retrospective data from a single center were collected from April 2003 to July 2020. A total of 98 children and adolescents aged 2–16 years diagnosed with GD and receiving ATDs was enrolled. We investigated the factors correlated with remission by comparing children who achieved remission after 5 years and those with persistent disease. @*Results@#The study included 76 girls (77.6%) and 22 boys (22.4%). During the 5-year follow-up period, 18 children (18.3%) maintained remission, ATDs could not be discontinued in 74 patients (75.5%), and relapse occurred in 6 patients (6.2%). The remission group had significantly lower thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) level at diagnosis (P=0.002) and 3 months (P=0.002), 1 year (P=0.002), 2 years (P≤0.001), 3 years (P≤0.001), 4 years (P≤0.001), and 5 years (P≤0.001) after ATD treatment than did the nonremission group. The remission group also had a shorter time for TBII normalization after ATD treatment (P≤0.001). Multiple logistic regression analysis showed that the time to TBII normalization (cutoff time=2.35 years) was related to GD remission (odds ratio, 0.596; 95% confidence interval, 0.374–0.951). @*Conclusion@#TBII level and time to TBII normalization after ATD treatment can be used to predict remission in pediatric GD patients.

Therapeutic Efficacy of Bone Marrow Derived Mesenchymal Stem Cells in Ototoxic Sensorineural Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Ototoxic sensorineural hearing loss causes permanent hearing loss in most cases. Recently there have been many reports describing cell base therapy with stem cells that has some effect on hearing recovery. We evaluated the efficacy of clinical grade, pre-made, human bone marrow derived mesenchymal stem cells (BM-MSCs) in ototoxic deaf animal model.Materials and Method BM-MSCs were cultured in a clinical grade laboratory. The animals were divided into 2 groups as follows: a saline injected control group and a stem cell injected group (MSC-group). Cultured MSCs were transplanted into the brachial vein of the deaf mice model. We recorded auditory brainstem response (ABR) and conducted immunohistochemistry at 1, 3, and 5 weeks. @*Results@#After the transplantation of MSC, a significant improvement in the hearing threshold of ABR was observed in the MSC transplanted group. Five weeks after transplantation of MSCs, hair cell regeneration was confirmed from the basal to the apex of the cochlea in fluorescent dyed image under the microscope compared to the control group. @*Conclusion@#BM-MSCs were effective in an acute ototoxic deaf animal model. These results show that stem cell transplantation mediate inner ear regeneration.

Topical Tacrolimus for the Treatment of Atopic Dermatitis with Truncal Lesion

BACKGROUND: Topical tacrolimus is an effective anti-inflammatory therapy for acute and chronic states of atopic dermatitis (AD) in both adults and children. Topical tacrolimus has particular use at sensitive areas such as the face, anogenitals, and skin folds of neck and extremities. However, many AD patients also experience aggravated symptoms on trunk. OBJECTIVE: The aim of this study was to investigate the efficacy and safety of topical tacrolimus for AD patients with truncal lesions. METHODS: AD patients with truncal lesions who were aged ≥2 years were recruited from 20 centres in Korea. They received treatment with topical tacrolimus ointment twice daily during 4 weeks. The primary end point was change of the local eczema area and severity index (EASI) of the trunk from baseline to day 28. The secondary end points were changes in the patient global assessment (PGA) score and itch visual analogue scale (VAS) score of the trunk between baseline and day 28. RESULTS: Two hundred and ninety-one patients were recruited, and 176 patients completed the full 4-week treatment course. By the end of the treatment, the mean local EASI of the trunk (2.2±4.71) was significantly decreased from that at baseline (4.71±4.03, p < 0.001). PGA (1.71±1.15) and itch VAS score of the trunk (2.61±2.19) on day 28 were also profoundly decreased compared with the baseline (2.96±1.07 and 5.15±2.47, respectively). No serious adverse events were observed during the study period. CONCLUSION: Topical tacrolimus is an effective and safe therapy for truncal lesions in AD patients.

Awareness of Atopic Dermatitis and Attitudes toward Different Types of Medical Institutions for Its Treatment among Adult Patients and the Parents of Pediatric Patients: A Survey of 500 Participants

BACKGROUND: Physicians can play a crucial role in the knowledge that patients have about a disease and its prognosis. Recently, patients with atopic dermatitis (AD) are increasingly turning from western medicine to oriental herbal medicine. However, their awareness of AD and attitude toward Western medicine and oriental herbal medicine clinics are scarcely reported. OBJECTIVE: The aim of this study was to determine the understanding of AD among patients and their parents and to identify their awareness of and attitude toward Western medicine and oriental herbal medicine as treatments for AD. METHODS: An online questionnaire was administered to 500 consenting respondents with AD (age, 16~49 years) and parents of children with AD (age, 0~15 years). RESULTS: The mean percentage of correct answers to questions about AD was 52.54%. A parental history of AD was independently associated with higher respondent’s knowledge about the disease and its treatment. The satisfaction with treatment outcomes was highest among patients treated at private clinic of dermatology specialists (49.4%), while lowest among those treated at oriental herbal medicine clinics (38.4%). Many participants were aware that oriental herbal medicine requires a longer treatment period for a cure and does not burden the skin, while steroid phobia was seen in most of participants. CONCLUSION: Physicians need to educate AD patients and their parents about the disease and its treatment. Misconceptions for Western medicine and oriental herbal medicine among AD patients and parents should be corrected to improve their prognosis.

The Performance Evaluation of Public Municipal Hospitals: Data Envelopment Analysis and Panel Analysis / 보건행정학회지

This study aims to examine the performance of public municipal hospitals through the analysis of data envelopment analysis, efficiency, profitability, and publicness by using panel data during period from 2006 to 2010. The main findings of the study are as follows. First, as a result of efficiency analysis during the period from 2006 to 2010, it was revealed that the number of staff by each job category, labor cost ratio, the number of operating beds need to be decreased. Second, the performance data represented by the indicators of efficiency, profitability and publicness were complementary and showed a tendency of being increased or decreased in same direction. Third, from the result of panel analysis, the efficiency was mainly influenced by the structural factors, while the profitability was influenced by managerial factors, and the publicness by medical environment. In conclusion, in order to enhance the performance of public municipal hospitals in Korea, it is important to harmonize the effort for efficiency, financial and policy support by central and local government, and the continuous participation of community residents.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. OBJECTIVE: We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. METHODS: We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. RESULTS: Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. CONCLUSION: This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part II): Systemic Treatment

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.

Consensus Guidelines for the Treatment of Atopic Dermatitis in Korea (Part I): General Management and Topical Treatment

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were released by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been several advances in AD management. OBJECTIVE: We aimed to establish updated evidence- and experience-based treatment guidelines for Korean AD. METHODS: We collected a database of references from relevant systematic AD reviews and guidelines regarding general AD management such as bathing and skin care, avoidance of exacerbating factors, education and psychosocial support, and the use of moisturizers and topical anti-inflammatory and antipruritic drugs. Evidence for each statement was graded and the strength of the recommendation for each statement classified. Thirty-nine KADA council members participated in three rounds of voting to establish an expert consensus of recommendations. RESULTS: Basic AD treatment includes proper bathing and skin care, avoidance of exacerbating factors, proper education and psychosocial support, and use of moisturizers. The regular use of moisturizer has a steroid-sparing effect and reduces relapse episodes. The short- and long-term use of topical corticosteroids and calcineurin inhibitors improves AD symptoms and should be encouraged to use in an active and proactive treatment. Wet-wrap therapy can be used for rapid recovery of acute exacerbation. Topical antipruritic drugs cannot be recommended for the treatment of AD. CONCLUSION: This report provides up-to-date evidence- and experience-based treatment guidelines for AD regarding general management and topical treatment. In addition, the average agreement scores obtained by a panel of experts based on the Korean healthcare system and patient adherence are presented.

Extraneural Metastasis of Glioblastoma Multiforme Presenting as an Unusual Neck Mass

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and it commonly spreads by direct extension and infiltration into the adjacent brain tissue and along the white matter tract. The metastatic spread of GBM outside of the central nervous system (CNS) is rare. The possible mechanisms of extraneural metastasis of the GBM have been suggested. They include the lymphatic spread, the venous invasion and the direct invasion through dura and bone. We experienced a 46-year-old man who had extraneural metastasis of the GBM on his left neck. The patient was treated with surgery for 5 times, radiotherapy and chemotherapy. He had survived 6 years since first diagnosed. Although the exact mechanism of the extraneural metastasis is not well understood, this present case shows the possibility of extraneural metastasis of the GBM, especially in patients with long survival.

Computer-Assisted Modified Mid-Sacrectomy for En Bloc Resection of Chordoma and Preservation of Bladder Function

A 67-year-old woman presented for evaluation of severe coccygeal pain. The computed tomography scans and magnetic resonance imaging showed an asymmetric midline sacral tumor invading the right lower portion of S2. To preserve both S2 nerve roots and to obtain negative surgical margins, a modified mid-sacrectomy with an aid of a computed navigation system was performed. The sacral tumor was excised en bloc with negative tumor margins. Both S2 nerve roots were preserved and additional reconstruction was not necessary because of minimal resection of the sacroiliac joint. We report a case of a sacral chordoma which was excised en bloc with adequate surgical margins by a computer-assisted modified mid-sacrectomy. The computed navigation system may be a useful tool for tumor targeting and safe osteotomies in sacral tumor surgery via the posterior only approach.

Contrast Medium-Induced Transient Neurologic Deteriorations Following Cerebral angiography and Coil Embolization for Unruptured Aneurysm: Report of Two Cases / 대한뇌혈관외과학회지

Cerebral angiography with contrast medium (CM) is a key method for diagnosis and interventional treatment of intracranial cerebral vascular lesions. Cerebral angiography causes few neurologic complications. There have been rare reports of complications related to disruption of the blood-brain barrier due to the administration of nonionic CM. We observed two patients with transient neurologic complications following cerebral angiography and coil embolization for unruptured aneurysm.

Comparison of Three Different Techniques in Cervical Transpedicular Screw Insertion

OBJECTIVE: This is a cadaver study to assess the accuracy of three cervical screw insertion techniques: the blind technique (Group I), the laminotomy technique (Group II), and the funnel technique (Group III). METHODS: Ten human cadavers embalmed with formaldehyde were prepared. After exposing the spinous processes, the laminas and the lateral masses, titanium alloy transpedicular screws were inserted from C3 to C7. A total of 100 pedicles were ramdomly assigned to one of three techniques (the blind technique: 31 screws, the laminotomy technique: 51 screws, the funnel technique: 18 screws). Axial computed tomography with 1-mm slices, and sagittal and coronal reformation were performed to identify the accuracy of the screw insertion and the anatomic relationships. RESULTS: In Group I, 9 screws (29%) were either contained within or penetrated less than 1mm, which were rated as successful. In Group II, 24 screws (47%) were successful. In Group III, 16 screws (89%) were successful. In the multiple comparison, there was a statistically significant difference between Groups I and III and between Groups II and III (chi-square test and Bonfenoni test). CONCLUSION: The funnel technique can help a surgeon's understanding about the cervical pedicle more precisely than the other two techniques. The funnel technique is less dependent on lateral soft tissue retraction state.

Role of gamma-aminobutyric acid B (GABA B) receptors in the regulation of kainic acid-induced cell death in mouse hippocampus

Kainic acid (KA) is well-known as an excitatory, neurotoxic substance. In mice, KA administered intracerebroventricularly (i.c.v.) lead to morphological damage of hippocampus expecially concentrated on the CA3 pyramidal neurons. In the present study, the possible role of gamma-aminobutyric acid B (GABA B) receptors in hippocampal cell death induced by KA (0.1 microgram) administered i.c.v. was examined. 5-Aminovaleric acid (5-AV; GABA B receptors antagonist, 20 microgram) reduced KA-induced CA3 pyramidal cell death. KA increased the phosphorylated extracellular signal-regulated kinase (p-ERK) and Ca2+ /calmodulin-dependent protein kinase II (p-CaMK II) immunoreactivities (IRs) 30 min after KA treatment, and c-Fos, c-Jun IR 2 h, and glial fibrillary acidic protein (GFAP), complement receptor type 3 (OX-42) IR 1 day in hippocampal area in KA-injected mice. 5-AV attenuated KA-induced p-CaMK II, GFAP and OX-42 IR in the hippocampal CA3 region. These results suggest that p-CaMK II may play as an important regulator on hippocampal cell death induced by KA administered i.c.v. in mice. Activated astrocytes, which was presented by GFAP IR, and activated microglia, which was presented by the OX-42 IR, may be a good indicator for measuring the cell death in hippocampal regions by KA excitotoxicity. Furthermore, it showed that GABA B receptors appear to be involved in hippocampal CA3 pyramidal cell death induced by KA administered i.c.v. in mice.

The study of efficiency of corticotomy in treatment of bimaxillary protrusion

The Usefulness of Pressure-Flow Study as Preoperative Evaluation in Benign Prostatic Hyperplasia Patients / 대한비뇨기과학회지

PURPOSE: To evaluated the usefulness of pressure-flow study (PFS) as a preoperative technique, and to compare its sensitivity and specificity, with uroflow, post void residual urine and prostate volume, in benign prostatic hyperplasia patients. MATERIALS AND METHODS: The records of 109 men, with lower urinary tract symptoms that underwent a transurethral resection of prostate (TURP), between May 1995 and June 2002, were retrospectively analyzed. Fifty one patients underwent preoperative PFS and 58 did not. The PFSs were performed with an 8Fr suprapubic catheter. The results of the PFS were divided into two groups: obstructed and unobstructed, using an ICS nomogram, pQ slope or the minimal urethral opening pressure. The outcomes of the operations were estimated with IPSS and the maximal flow rate 3 month after the operations. RESULTS: With the PFS operations, 47 cases (81.0%) were obstructed and 11 (19.0%) unobstructed. The success rates of the TURP for the obstructed, unobstructed and non-invasive study groups were 87.2, 63.6 and 88.2%, respectively. The sensitivity and specificity of the PFS were 84.5 and 40.4%, respectively. The sensitivity of the maximal flow rate (or=30gm) was 50.0%. CONCLUSIONS: PFS is not a mandatory preoperative technique for men, with lower urinary tract symptoms, who undergo a TURP. However, it can decrease the TURP failure rate. Other noninvasive parameters can be preoperatively useful for men who undergo TURP, as long as they are applied compositely carefully.

Outcome of Tubularized Incised Plate (TIP) Urethroplasty according to the Type of Middle Hypospadias / 대한비뇨기과학회지

PURPOSE: The outcomes of a tubularized incised plate (TIP) urethroplasty were evaluated according to the type of middle hypospadias repair. MATERIALS AND METHODS: A total of 36 TIP urethroplasties were performed for middle hypospadias. The medical records of all patients; the level of meatus, age at surgery, outcome, complications, method of second operation and their outcomes etc, were retrospectively reviewed. The mean age of the patients at the time of the operation and the follow up period were 5 years 6 months (12 months to 43 years) and 8.8 months (3 months to 2 years), respectively. The initial types of hypospadias were distal penile in 14 patients, mid-shaft in 11 and proximal penile type in 11, repectively. RESULTS: The success rates of first operation, according to the type of middle hypospadias, were 12/14 (85.7%) in the distal penile, 8/11 (72.7%) in the mid-shaft and 9/11 (81.8%) in the proximal penile types (overall success rate: 80.6%). The complication rates with the distal penile, mid-shaft and proximal penile types were 14.3, 27.3 and 18.2%, respectively (overall complication rate: 19.4%). Urethrocutaneous fistula and retrusive meatus occurred in 4 and 3 patients, respectively. All of the urethrocutaneous fistulas were successfully covered with 3 fistulectomies and 1 TIP urethroplasty. All the retrusive meatus were repaired with a TIP urethroplasty, but only 1 case was successful. Meatal stenosis did not occur in any of the cases. Overall success rate of the second operation was 34/36 patients (94.4%). CONCLUSIONS: This preliminary experience indicated that there was no significant difference in the outcomes of a TIP urethroplasty according to the type of middle hypospadias.

Combination Therapy of Imipramine and Desmopressin in Children with Monosymptomatic Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: We prospectively studied to evaluate the therapeutic effect of combination therapy of imipramine and desmopressin on the monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: From April 1997 to July 2000, all of 129 monosymptomatic enuretic patients were randomized to three groups: combination therapy group of imipramine and desmopressin (I+D, 46 cases), imipramine group (I, 43 cases) and desmopressin group (D, 40 cases). We performed motivational counselling, reduction of fluid intake prior to bed time and voiding diary in addition to drug thrapy. Therapeutic response was classified as excellent (0-1 wet night/week), good (over 50% reduction of night) and poor responder (less than 50% reduction of night). RESULTS: Therapeutic response in group I+D, I and D were excellent in 84.8%, 81.4% and 60.0%, good in 10.9%, 11.6% and 35.0% and poor in 4.3%, 7.0% and 5.0%, respectively. As compared with group I and D, average response duration in group I+D was significantly shorter (p<0.05). There was no significant difference of relapse rate at 3 months after cessation of medication in excellent responders among each groups. There were no significant side effects in all of three groups. CONCLUSIONS: These data suggest that combination therapy of imipramine and desmopressin has no better therapeutic effect than impramine or demopressin monotherapy on the monosymptomatic nocturnal enuresis, except shorter average response duration.