The Effect of Daily Low Dose Tadalafil on Cerebral Perfusion and Cognition in Patients with Erectile Dysfunction and Mild Cognitive Impairment

OBJECTIVE: The aims of this study were to investigate the effects of daily low-dose tadalafil on cognitive function and to examine whether there was a change in cerebral blood flow (CBF) in patients with erectile dysfunction (ED) and mild cognitive impairment. METHODS: Male patients aged 50 to 75 years with at least three months of ED (International Index of Erectile Function [IIEF]-5 score ≤ 21) and mild cognitive impairment (Montreal Cognitive Assessment [MoCA] score ≤ 22) were included in the study. The subjects were prescribed a low-dose PDE5 inhibitor (tadalafil 5 mg) to be taken once daily for eight weeks. Changes in MoCA score and single-photon emission computed tomography (SPECT) study between the two time-points were assessed by paired t tests. RESULTS: Overall, 30 male patients were assigned to the treatment group in this study and 25 patients completed the eight-week treatment course. Five patients were withdrawn due to adverse events such as myalgia and dizziness. Mean baseline IIEF and MoCA scores were 7.52 ± 4.84 and 18.92 ± 1.78. After the eight-week treatment, mean IIEF and MoCA scores were increased to 12.92 ± 7.27 (p < 0.05) and 21.8 ± 1.71 (p < 0.05), respectively. Patients showed increased relative regional CBF in the postcentral gyrus, precuneus, and brainstem after tadalafil administration versus at baseline (p < 0.001). CONCLUSION: The results of this prospective clinical study suggest that daily use of tadalafil 5 mg increases some regional CBF and improves cognitive function in patients with ED and mild cognitive impairment.

The Cyclosporine-A Treatment does not have Harmful Effect on the Linear Growth of Pediatric Patients with Steroid-dependent and Steroid-resistant Nephrotic Syndrome

PURPOSE: This study was performed to evaluate the effects of cyclosporine-A (CsA) on linear growth in pediatric patients with steroid-dependent (SDNS) or resistant nephrotic syndrome (SRNS). METHODS: Thirty-five pediatric patients with SDNS or SRNS undergoing glucocorticoid (GC) and/or CsA treatment were retrospectively reviewed. Seventeen patients were treated with GC alone and 18 were treated with GC and CsA. The cumulative doses of GC and CsA were quantified (mg/kg/day). Linear growth during the follow-up period was defined as the difference in Z-score between the initial and final height according to the follow-up period (Δ height Z score/year). The associations between linear growth and clinical parameters were analyzed. RESULTS: The linear growth of patients in the two groups was not significantly different (P=0.262). The Δ height Z score/year did not show a significant correlation with the cumulative doses of CsA, but was negatively correlated with the cumulative dose of GC and positively correlated with the Z score for height at the time of diagnosis. CONCLUSION: In children with SDNS or SRNS undergoing GC therapy, added CsA treatment may not have harmful effects on linear growth.

Pancreatic mucinous cystadenoma of borderline malignancy associated with Clonorchis sinensis

No abstract available.

Fanconi's Syndrome Associated with Prolonged Adefovir Dipivoxil Therapy in a Hepatitis B Virus Patient

Adefovir dipivoxil (ADV) is commonly used as an antiviral agent in the treatment of chronic hepatitis B or human immunodeficiency virus infection. Nephrotoxicity has been shown to occur at daily dosages of 60-120 mg. Fanconi's syndrome is a generalized dysfunction of the renal proximal tubular cells, which is usually accompanied by complications. Here we report a case of Fanconi's syndrome in a chronic hepatitis B patient who had been treated with a prolonged regimen of ADV at 10 mg/day. A 47-year-old man complained of severe back and chest-wall pain. He had chronic hepatitis B and had been treated with ADV at a daily dose of 10 mg for 38 months. He was hospitalized because of severe bone pain, and laboratory and radiologic findings suggested a diagnosis of Fanconi's syndrome with osteomalacia. After discontinuation of the ADV, he recovered and was discharged from hospital. His laboratory findings had normalized within 2 weeks. This case indicates that Fanconi's syndrome can be acquired by a chronic hepatitis B patient taking ADV at a conventional dosage of 10 mg/day. Therefore, patients treated with long-term ADV should be checked regularly for the occurrence of ADV-induced Fanconi's syndrome.

A case of metastatic hepatocellular carcinoma of the rib, treated by transcatheter arterial chemoembolization / 대한간학회지

Bone is a common site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of rib metastasis from HCC treated by transcatheter arterial chemoembolization (TACE). A 55-year-old man with liver cirrhosis presented with right lower chest pain. The diagnosis was an HCC with a bone metastasis in the right eighth rib. Intra-arterial injections of doxorubicin mixed with Lipiodol and Gelfoam particles were instituted through the right eighth intercostal artery. Computed tomography and a Tc99-labeled scan performed 2 months after the third TACE revealed no viable HCC in the right eighth rib.

A Case of Liver Abscess with Subcapsular Hematoma Mimicking Ruptured Hepatic Cholangiocarcinoma / 대한소화기학회지

Subcapsular hematoma is a very rare complication of liver abscess. We report a case of liver abscess with subcapsular hematoma mimicking ruptured hepatic cholangiocarcinoma. A 59-year old man presented with right upper quadrant pain and febrile sense. Computed tomography showed a low attenuated mass with extensive subcapsular hematoma on the right hepatic lobe. The initial impression was a hematoma caused by the rupture of cholangiocarcinoma. Hepatic arteriography was performed, but no active bleeding focus was found. After drainage of the subcapsular hematoma, a hematoma wall biopsy through the drainage catheter and a liver biopsy of the low attenuated mass were performed. The biopsies showed many neutrophils, macrophages, and granulation tissues consistent with an abscess, but no malignant cells were detected. After antibiotics therapy for 6 weeks, computed tomography was performed 4 months later, and revealed complete resolution of the hematoma and the low attenuated hepatic lesion.

Determination of Appropriate Sampling Frequency and Time of Multiple Blood Sampling Dual Exponential Method with 99mTc-DTPA for Calculating GFR / 핵의학분자영상

PURPOSE: To determine appropriate sampling frequency and time of multiple blood sampling dual exponential method with 99mTc-DTPA for calculating glomerular filtration rate (GFR). MATERIALS AND METHODS: Thirty four patients were included in this study. Three mCi of 99mTc-DTPA was intravenously injected and blood sampling at 9 different times, 5ml each, were done. Using the radioactivity of serum, measured by gamma counter, the GFR was calculated using dual exponential method and corrected with the body surface area. Using spontaneously chosen 2 data points of serum radioactivity, 15 collections of 2-sample GFR were calculated. And 10 collections of 3-sample GFR and 12 collections of 4-sample GFR were also calculated. Using the 9-sample GFR as a reference value, degree of agreement was analyzed with Kendall's tau correlation coefficients, mean difference and standard deviation. RESULTS: Although some of the 2-sample GFR showed high correlation coefficient, over or underestimation had evolved as the renal function change. The 10-120-240 min 3-sample GFR showed a high correlation coefficient (tau=0.93), minimal difference (Mean+/-SD=-1.784+/-3.972), and no over or underestimation as the renal function changed. The 4-sample GFR showed no better accuracy than the 3-sample GFR. CONCLUSIONS: In the wide spectrum of renal function, the 10-120-240 min 3-sample GFR could be the best choice for estimating the patients' renal function.

Spontaneous Resolution of Vanishing Bile Duct Syndrome in Hodgkin's Lymphoma / 대한간학회지

Cholestasis in a patient with Hodgkin's disease is uncommon, and the causes of cholestasis are mainly direct tumor involvement of the liver, hepatotoxic effects of drugs, viral hepatitis, sepsis and opportunistic infections. Vanishing bile duct syndrome (VBDS) represents a very rare cause for cholestasis in this disease. We report here on a case of a 45-year-old man who developed VBDS during the complete remission stage of Hodgkin's lymphoma. There was no history of hepatitis or intravenous drug abuse, and the patient had negative results for hepatitis A virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and human immunodeficiency virus. The serological studies for antinuclear antibodies, anti-mitochondrial antibodies and anti-smooth muscle antibodies were also negative. Liver biopsy disclosed the absence of interlobular bile ducts in 9 of 10 portal tracts without any active lymphocyte infiltration and there were no Reed-Sternberg cell in the liver. The patient's cholestasis was in remission and the serum bililrubin level was normalized after two months without treatment, but tumor recurrence was noted at multiple sites of the abdominal lymph nodes on follow-up abdomino-pelvic computed tomogram.

Usefulness of 18F-FDG PET/CT in the Diagnosis of Cervical Lymph Node Metastases of Head and Neck Cancer / 대한핵의학회잡지

PURPOSE: This study evaluated the diagnostic value of 18F-FDG PET/CT in detecting cervical lymph node metastases in head and neck cancer patients. MATERIALS AND METHODS: The patients were divided into two groups, 46 patients underwent PET/CT scan for initial staging before surgery, and 20 patients for restaging of recurrence after primary treatment. Increased FDG uptakes in cervical lymph nodes were evaluated retrospectively and correlated with the histopathologic results. RESULTS: In the initial staging group, 21 lymph nodes were detected by PET/CT in 15 patients. 20 lymph nodes were confirmed as metastases with a mean peak SUV of 5.84, and the remaining one lymph node was an inflammatory lesion, with a peak SUV of 2.75. Seven metastatic lymph nodes were reported only by histopathology. The sensitivity, specificity, positive predictive value and negative predictive value were 74.0%, 99.6%, 95.2% and 97.3%, respectively. In the recurrence group, 11 lymph nodes were detected in 9 patients, and 8 nodes were true positive, with a mean peak SUV of 5.65. The other three were inflammatous lymph nodes, and the peak SUVs were 2.16, 2.94 and 3.53. One false negative lymph node was reported. The sensitivity, specificity, positive predictive value and negative predictive value were 88.8%, 97.7%, 72.7% and 92.9%, respectively. CONCLUSIONS: FDG-PET/CT shows higher positive predictive value in the initial staging group, and better sensitivity in the recurrence group. Therefore PET/CT could be useful for both initial staging and restaging of recurrent cervical lymph node metastases.

A Case of Primary Pulmonary Plasmacytoma Presenting as Endobronchial Mass / 결핵

Extramedullary plasmacytoma(EMP) comprises 5% of all plasma cell neoplasms and commonly occurs in the upper airway or digestive tract. However, it rarely develops in the lungs. We present a case of primary pulmonary plasmacyotma in a 45 year old man, who presented as an endobronchial mass with a pleural effusion, but without evidence of multiple myeloma. The treatment options for EMP include surgery, surgery and radiotherapy, surgery and chemotherapy or chemotherapy alone. Surgery and radiation therapy appeared to be equally effective forms of treatment. The local recurrence rate was reported to be 30%, with 48% progressing to multiple myeloma, and median survival was reported to be 63-101 months. Our patient was initially treated with melphalan and prednisolone. However the disease progressed, and radiotherapy was combined with chemotherapy. In addition, the chemotherapy regimen was also changed to thalidomide and dexamethasone. The patient did not respond to this treatment regimen and finally died.

GFRs Measured by Gates' Method According to 5 Background Sites: Comparison with GFR Measured by I-125-Iothalamate Method / 대한핵의학회잡지

PURPOSE: The aim was to assess how the background site affects the Gates' glomerular filtration rate (GFR) measurement using Tc-99m-DTPA in correlation with GFR by I-125-iothalamate method. MATERIAL AND METHODS: The study populations were 63 adults with 39 men and 24 women aged from 20 to 59 yrs (mean = 37.9 yrs). The following five background regions of interest were used in measurement of GFR using Gates' method: 1) lower side of each kidney (subrenal), 2) around each kidney (circumferential), 3) upper side of each kidney (suprarenal), 4) lateral side of each kidney (lateral), 5) between the two kidneys (inter-renal). We also measured GFR using I-125-iothalamate in each subject. The two studies were separated by 1 to 3 weeks. The subjects were divided into two groups by renal depth. Group 1 with renal depth> or=7cm and group 2 with renal depth or=7cm. CONCLUSION: GFRs measured with Gates' method showed higher correlation with the GFR measured by I-125-iothalamate when the regions of interest were placed over the suprarenal and inter-renal backgrounds. And GFRs measured with Gates method showed statistically significant correlation with the GFR measured by I-125-iothalamate in the group with renal depth < 7cm.

A case of native valve infective endocarditis caused by Microbacterium species / 대한내과학회지

Microbacterium species is part of the normal flora of the skin and pharynx. Native valve infective endocarditis caused by Microbacterium speciesis is rare case. We describe a 37-year-old man with native valve endocarditis caused by Microbacterium species. He presented with high fever, myalgia, weight loss. Microbacterium species was isolated from blood culture. Successful treatment was achieved with intravenous ceftriaxone and oral amoxicillin.

A Case of Systemic Vasculitis Presented as Fever of Unknown Origin

Fever of unknown origin (FUO) means fever that does not resolve spontaneously in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. We experienced a case of FUO associated with systemic vasculitis, which was diagnosed with clinical manifestation, radiographic findings, the presence of anti-neutrophil cytoplasmic antibody (ANCA), and renal biopsy. A 54-year-old female was admitted to our hospital with remittent fever of 3 months. A paranasal sinus (PNS) view revealed maxillary and ethmoidal sinusitis, and urine analysis showed microscopic hematuria. We performed a renal biopsy on the basis of positive ANCA and microscopic hematuria. The renal biopsy showed pauci-immune crescentic glomerulonephritis without granuloma, interstitial inflammation, and small vessel vasculitis. Under the diagnosis of ANCA-associated systemic vasculitis, she was treated with steroid and cyclophosphamide. She showed marked clinical improvement.

A Case of Systemic Vasculitis Presented as Fever of Unknown Origin

Fever of unknown origin (FUO) means fever that does not resolve spontaneously in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. We experienced a case of FUO associated with systemic vasculitis, which was diagnosed with clinical manifestation, radiographic findings, the presence of anti-neutrophil cytoplasmic antibody (ANCA), and renal biopsy. A 54-year-old female was admitted to our hospital with remittent fever of 3 months. A paranasal sinus (PNS) view revealed maxillary and ethmoidal sinusitis, and urine analysis showed microscopic hematuria. We performed a renal biopsy on the basis of positive ANCA and microscopic hematuria. The renal biopsy showed pauci-immune crescentic glomerulonephritis without granuloma, interstitial inflammation, and small vessel vasculitis. Under the diagnosis of ANCA-associated systemic vasculitis, she was treated with steroid and cyclophosphamide. She showed marked clinical improvement.

A Case of Pulmonary Artery Aneurysm by Pulmonary Actinomycosis / 결핵

Pulmonary aneurysm is a rare vascular anomaly.Infection is one of major causes of pulmonary aneurysms. Pulmonary aneurysm by pulmonary actinomycosis is a rare case. Our case is maybe the first case in Korea,so far similar case has not been reported Worldwide written in English. We describe a 73-year-old man with aneurysm of pulmonary artery caused by actinomycosis infection on lung. We detected aneurysm by angiography of pulmonary artery, and actinomycosis infection was revealed by confirm sulfur granules on specimens taken by percutaneous needle aspiration(PCNA). Antibiotic therapy was applied to this patient and aneurym was embolized with coils.With this therapy,the patient was successfully managed and improved.

Surgical Results of Functional Hemispherectomy and Peri-insular Hemispherotomy

No abstract available.

An I/D Polymorphism in Angiotensin-Converting Enzyme Gene in Myocardial Infarction

BACKGROUND: The angiotensin-converting enzyme(ACE) plays an important role in cardiovascular disease by production of angiotensin and degradation of bradykinin. Cloning of ACE gene revealed an insertion/deletion(I/D) polymorphism according to the presence/absence of a 287 base pair fragment in the 16th intron of ACE gene, and the ACE polymophism was associated with ACE activity. The genotype DD was identified as a risk factor for myocardial infarction in several studies. We analyzed the ACE I/D polymorphism in 62 patients with myocardial infarction and 67 normal subjects. METHODS: Genomic DNA from peripheral blood was amplified by polymerase chain reaction and characterized by three ACE genotypes; two insertion alleles(genotype II), two deletion alleles(genotype DD) and heterogenous alleles(genotype ID). ACE activity was determined by spectrophotometric method utilizing the synthetic substrate. RESULTS: There was no significant difference in ACE polymorphism between patients and normal subjects. But, the frequency of genotype DD was significantly increased in the low-risk group of patients compared with the high-risk group. The multi-vessel disease was more strongly associated with genotype DD, but there was no statistical significance. The ACE activity was strongly associated with ACE polymorphism with the activity being highest in genotype DD. There was no significant difference between patients and control subjects of the same genotype. CONCLUSION: There was no significant difference in ACE polymorphism between patients and normal subjects. The frequencies for genotype II, ID, DD were 0.328, 0.537, 0.134, respectively in normal subjects. There was high frequency of genotype II compared with Caucasians. A deletion polymorphism(genotype DD) may increase the risk for myocardial infarction in lowrisk group, and the serum ACE activity was correlated with three genotypes.

A case of nephrotic syndrome associated with protein S deficiency and cerebral thrombosis

Protein S is found in two forms in plasma; as free and functionally active protein S, and complexed to C4b-binding protein. Patients with nephrotic syndrome are at risk for arterial and venous thrombosis at various localizations, and acquired protein S deficiency due to the selective urinary loss of the free form may be a risk factor for the development of thromboembolic complications. We report a case of cerebral arterial thrombosis associated with decreased level of free protein S antigen (44%) in a 39-year-old female patient with nephrotic syndrome.