Medical Travel among Non-Seoul Residents to Seek Prostate Cancer Treatment in Medical Facilities of Seoul / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study aims to investigate the trend in medical travel by non-Seoul residents to Seoul for treatment of prostate cancer and also to investigate the possible factors affecting the trend. MATERIALS AND METHODS: This study represents a retrospective cohort study using data from theKoreanNationalHealth Insurance System from 2002 to 2015. Annual trends were produced for proportions of patients who traveled according to the age group, economic status and types of treatment. Multiple logistic analysiswas used to determine factors affecting surgeries at medical facilities in Seoul among the non-Seoul residents. RESULTS: A total of 68,543 patients were defined as newly diagnosed prostate cancer cohorts from 2005 to 2014. The proportion of patients who traveled to Seoul for treatment, estimated from cases with prostate cancer-related claims, decreased slightly over 9 years (28.0 at 2005 and 27.0 at 2014, p=0.02). The average proportion of medical travelers seeking radical prostatectomy increased slightly but the increase was not statistically significant (43.1 at 2005 and 45.4 at 2014, p=0.26). Income level and performance ofrobot-assisted radical prostatectomy were significant positive factors for medical travel to medical facilities in Seoul. Combined comorbidity diseases and year undergoing surgery were significant negative factors for medical travel to medical facilities in Seoul. CONCLUSION: The general trend of patients travelling from outside Seoul for prostate cancer treatment decreased from 2005 to 2014. However, a large proportion of traveling remained irrespective of direct distance from Seoul.

The Treatments for Low-Risk Prostate Cancer

Recently, the prevalence of prostate cancer has been increased with the screening of prostate-specific antigen and the increase in the elderly population. In particular, the diagnosis of the low-risk prostate cancer has increased greatly, and social interest for overtreatment has been heightened in Korea. Therefore, this review aimed to provide evidence-based treatment guidelines in low-risk prostate cancer based on Korean population. The literature provides evidence on treatment options, such as watchful waiting, active surveillance, radical prostatectomy, and radiation therapy according to the life expectancy of patients with low-risk prostate cancer. Furthermore, this review provides information on the efficacy of pelvic lymph node dissection and adjuvant radiation therapy during/after radical prostatectomy in low-risk prostate cancer.

Analysis of Trends of 3 Major Benign Prostatic Hyperplasia Surgery in the Last 5 Years

PURPOSE@#The goal of this study is to analyze the trends in surgical management of Benign prostatic hyperplasia (BPH) in Korea during the last 5 years from 2014 to 2018.@*MATERIALS AND METHODS@#We retrieved the medical statistics associated with the Healthcare Big Data Opening System available online. We analyzed the number of cases after 2014 for transurethral resection of prostate (TURP), photoselective vaporization of the prostate (PVP), and holmium laser enucleation of the prostate (HoLEP), respectively. We then analyzed and charted the cases according to the number of patients hospitalized or treated as outpatients, depending on age group, type of medical institutions, and the location of medical institutions.@*RESULTS@#The number of patients with BPH has increased steadily. The number of TURP and HoLEP procedures steadily increased, while the number of PVP interventions decreased dramatically. The number of HoLEP cases increased by 22% from 2014 to 2018, which is the fastest rate among the three surgeries. In addition, the number of patients aged 75 years or older as well as the proportion of inpatient surgeries compared with outpatient treatments has increased. The number of cases undergoing TURP increased rapidly in general hospital and those treated with HoLEP increased in the general and tertiary referral hospitals.@*CONCLUSIONS@#Interventions using TURP and HoLEP has increased, and the age of patients undergoing surgery has increased gradually. Cases treated with TURP and HoLEP in general and tertiary referral hospitals showed an increasing trend from the metropolitan area to the province.

Relationship of Prostate-Specific Antigen Level With Obesity Indices in Korean Middle-Aged Population

PURPOSE: We evaluated the relationship of prostate-specific antigen (PSA) and obesity indices (weight, body mass index [BMI] and waist circumference [WC]) in Korean middle-aged men. MATERIALS AND METHODS: From February to September 2013, 1,900 police men under 60 years old who participated in a prostate health screening program were included this cross-sectional study. All subjects underwent clinical examinations including weight, height, BMI, WC, fasting blood sugar, lipid profiles, estimated glomerular filtration rate (GFR), and PSA. Total prostate volume (TPV) was assessed clinically. Spearman correlation and multiple linear regression tests were performed to evaluate the obesity indices and PSA relationships. RESULTS: The mean age was 52.0±4.7 years, and the mean PSA was 0.97±0.99 ng/mL. The PSA showed a significant positive correlation with the age (r=0.108, p < 0.01), TPV (r=0.349, p < 0.01), height (r=−0.052, p < 0.05), weight (r=0.186, p < 0.05), low-density lipoprotein cholesterol (r=0.056, p < 0.05), and GFR (r=−0.096, p < 0.01). All obesity indices including weight, BMI, and WC showed negative correlations with PSA (beta=−0.013, p < 0.001; beta=−0.039, p < 0.001; and beta=−0.010, p=0.005; respectively) in age and TPV-adjusted model. CONCLUSIONS: Common obesity indices (weight, BMI, and WC) were associated with lower PSA in Korean middle-aged population. Thus, an individual's degree of obesity should be considered when PSA is checked in the first prostate cancer screening of life.

Idiopathic Calcinosis Cutis of the Scrotum: A Case Report

Calcinosis cutis-calcification in soft tissue-is a rare benign disease that is separated into the following subtypes: dystrophic, iatrogenic, metastatic, calciphylaxis, and idiopathic. One of common site of calcinosis cutis is the scrotum. The nodules slowly grow for years or decades. The characteristic of calcinosis cutis of the scrotum is generally asymptomatic, yellowish marble-like, hard, polypoidal, solitary, or multiple. However, the pathogenesis of this nodule remains ambiguous and controversial. Thus, we reviewed possible causes and therapeutic consideration of calcinosis cutis of the scrotum.

Semen parameters from 2002 to 2013 in Korea young population: A preliminary report

PURPOSE: To analyze the differences of semen parameters in Korean young population for three periods from 2002 to 2013. MATERIALS AND METHODS: A total of 516 semen samples were collected from Korean men presenting for infertility, varicoceles or other infectious problems for three periods from 2002 to 2012: January 2002-December 2003, January 2007-December 2008, and January 2012-December 2013. A standard World Health Organization procedure for semen analysis was performed for assessment of semen concentration, volume, motility, morphology, and pH. RESULTS: A total of 160, 162, 194 men constituted the study populations in 2002 to 2003, in 2007 to 2008, and in 2012 to 2013, respectively. The overall sperm parameter results suggested a statistically significant difference between 2002 to 2003 and 2012 to 2013 except pH. However, considering the data from 2007 to 2008, there were no trends in changes in overall semen parameters. Negative correlations were observed in all semen parameters with increasing age in all patients, except for pH. In addition, semen volume, motility, and morphology had higher negative correlation coefficients with age, from 2002 to 2013, serially. CONCLUSIONS: There were no significant changes in the semen parameters of Korean men from 2002 to 2013. In addition, semen volume, motility, and morphology showed higher negative correlation coefficients with age from 2002 to 2013, serially.

Body mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health

PURPOSE: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. MATERIALS AND METHODS: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. RESULTS: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. CONCLUSIONS: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.

Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis

PURPOSE: To determine effectiveness of Valsalva maneuver and standing position on scrotal color Doppler ultrasound (CDU) for the varicocele diagnosis. MATERIALS AND METHODS: We reviewed the physical examination and CDU finding in 87 patients who visited National Police Hospital from January 2011 to April 2014. Diameters of pampiniform plexus were measured bilaterally during resting and Valsalva maneuver in the supine position and standing position. We calculated the ratio of mean of maximal vein diameter (mMVD) during resting and Valsalva maneuver (resting-Valsalva ratio) and compared in the both position. RESULTS: In the resting and supine position, mMVD of varicocele testis units were 1.8 mm, 2.1 mm, 2.6 mm (grades I, II, III, respectively), and that of normal testis units (NTU) 1.2 mm. During Valsalva maneuver in the supine position, mMVD were 3.0 mm, 3.4 mm, 4.2 mm (grades I, II, III) vs 1.8 mm (NTU) (p=0.007, p<0.001, p<0.001, respectively). Average of resting-Valsalva ratio in the supine position were 0.69, 0.74, 0.74 (grades I, II, III) and 0.67 (NTU). Whereas in the resting and standing position, mMVD were 2.8 mm, 3.3 mm, 3.8 mm (grades I, II, III) and 1.8 mm (NTU) (p=0.002, p<0.001, p<0.001). During Valsalva maneuver in the standing position, mMVD were 5.0 mm, 5.8 mm, 6.6 mm (grades I, II, III) and 2.5 mm (NTU) (p=0.002, p<0.001, p<0.001). And average resting-Valsalva ratio were 0.76, 0.90, 0.71 (grades I, II, III) and 0.26 (NTU), which showed significant differences from all grades (p<0.001, p<0.001, p<0.001). CONCLUSIONS: It is suggested that the standing position and Valsalva maneuver during CDU could improve diagnostic ability for varicocele. Resting-Valsalva ratio in the standing position could be a new diagnostic index for varicocele diagnosis using CDU.

Comprehensive Review of Asian Cosmetic Upper Eyelid Oculoplastic Surgery: Asian Blepharoplasty and the Like

BACKGROUND: Asian Aesthetic Oculoplastic Surgery is a fast-growing field, both within the United States and abroad. With growing interest, there have also been multiple terminologies used for the same concepts. This has created redundant and confusing language - prone to errors in patient-physician communication. In addition, there has been an upsurge of various techniques or variations to existing techniques that has created unnecessary confusion among plastic surgeons. The objective of this article is to provide organization and simplification to the terminology and to the techniques used in what some broadly refer to as "Asian Blepharoplasty" or perhaps more correctly termed Asian Aesthetic Oculoplastic Surgery. METHODS: Unified terminology, aesthetic goal and detailed operative technique of commonly conducted Asian blepharoplasty were suggested by experienced oculoplastic surgeons. RESULTS: The main procedures of Asian Aesthetic Oculoplastic Surgery including supratarsal crease surgery and medial epicanthoplasty were presented with figure and video in this paper. We also have provided author's preferred selection of the major techniques with evaluation of its advantages and disadvantages. CONCLUSIONS: The most important element in patient satisfaction is clear communication of surgical expectations. Then, proper selection of the most suitable pre-operative design, type of surgery performed, and specific crease configuration based on the individual's anatomic and physiological characteristics can be achieved.

Prostate Volume Measurement by Transrectal Ultrasonography: Comparison of Height Obtained by Use of Transaxial and Midsagittal Scanning

PURPOSE: The purpose of this study was to compare prostate volume measured by transrectal ultrasonography (TRUS) between transaxial scanning and midsagittal scanning. We tried to determine which method is superior. MATERIALS AND METHODS: A total of 968 patients who underwent TRUS for diagnosis of any diseases related to the prostate were included in this study. When measuring prostate volume by TRUS, we conducted the measurements two ways at the same time in all patients: by use of height obtained by transaxial scanning and by use of height obtained by midsagittal scanning. Prostate volume was calculated by using the ellipsoid formula ([heightxlengthxwidth]xpi/6). RESULTS: For prostate volume measured by TRUS, a paired t-test revealed a significant difference between using height obtained by transaxial scanning and that obtained by midsagittal scanning in all patients (28.5+/-10.1 g vs. 28.7+/-9.9 g, respectively, p=0.004). However, there were no significant differences in the prevalence of prostate volume more than 20 g (known benign prostatic enlargement [BPE]) between the two methods by chi-square test (90.5% [n=876], 90.8% [n=879], respectively; p=0.876). When analyzed in the same way, there were no significant differences in the prevalence of prostate volume more than 30 g (generally, high-risk BPE) between the two methods (34.5% [n=334], 36.3% [n=351], respectively; p=0.447). CONCLUSIONS: Although prostate volume by TRUS differed according to the method used to measure height, that is, transaxial or midsagittal scanning, we conclude that there are no problems in diagnosing BPE clinically by use of either of the two methods.

Prevalence and Associated Factors for Four Sexually Transmissible Microorganisms in Middle-Aged Men Receiving General Prostate Health Checkups: A Polymerase Chain Reaction-Based Study in Korea

PURPOSE: To investigate the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Ureaplasma urealyticum (UU) in first-voided urine samples and to determine the factors associated with positivity for sexually transmissible microorganisms in healthy, middle-aged Korean men. MATERIALS AND METHODS: Five hundred fifty-one men who came to the hospital for a general prostate health checkup were tested between August 2011 and December 2011. PCR assays for CT, NG, MG, and UU were done with first-voided urine samples and the prevalence of microorganism positivity and association with several clinical parameters were evaluated. RESULTS: The mean age of the men studied was 50.8+/-4.7 years. Among the 551 men, 72 (13.1%) had a positive result for at least one microorganism; one (0.2%) had two different species. The overall prevalence of asymptomatic sexually transmitted infections was 11.1% (61/551). The prevalence rates of CT, NG, MG, and UU infection in the general population were 0.4% (2/551), 0.0% (0/551), 1.0% (6/551), and 11.8% (65/551), respectively. CT-positive patients had a lower mean age than did CT-negative patients. There were no significant differences in symptoms by positivity of each microorganism. CONCLUSIONS: We checked the prevalence rates of four microorganisms, the proportion of symptomatic people, and the association of microbes, age, and symptoms, as the baseline data for Korean middle-aged men. In this population, CT, NG, MG, and UU infections do not seem to be symptomatic. However, the potential role of CT in young men and of UU in middle-aged men with a high rate of detection should be studied continuously as a source of opportunistic infection.

Current Status of Targeted Therapy for Advanced Renal Cell Carcinoma

The treatment of metastatic renal cell carcinoma (mRCC) has recently evolved from being predominantly cytokine-based treatment to the use of targeted agents, which include sorafenib, sunitinib, bevacizumab (plus interferon alpha [IFN-alpha]), temsirolimus, everolimus, pazopanib, and most recently, axitinib. Improved understanding of the molecular pathways implicated in the pathogenesis of RCC has led to the development of specific targeted therapies for treating the disease. In Korea, it has been 5 years since targeted therapy became available for mRCC. Thus, we now have broader and better therapeutic options at hand, leading to a significantly improved prognosis for patients with mRCC. However, the treatment of mRCC remains a challenge and a major health problem. Many questions remain on the efficacy of combination treatments and on the best methods for achieving complete remission. Additional studies are needed to optimize the use of these agents by identifying those patients who would most benefit and by elucidating the best means of delivering these agents, either in combination or as sequential single agents. Furthermore, numerous ongoing research activities aim at improving the benefits of the new compounds in the metastatic situation or their application in the early phase of the disease. This review introduces what is currently known regarding the fundamental biology that underlies clear cell RCC, summarizes the clinical evidence supporting the benefits of targeted agents in mRCC treatment, discusses survival endpoints used in pivotal clinical trials, and outlines future research directions.

Role of Pelvic Lymph Node Dissection in Prostate Cancer Treatment

Pelvic lymph node dissection (PLND) is the most accurate and reliable staging procedure for detecting lymph node invasion (LNI) in prostate cancer. Recently, [11C]-choline positron emission tomography imaging and magnetic resonance imaging with lymphotropic superpara-magnetic nanoparticles have shown potential for detecting LNI but are still under investigation. The risk of LNI in low-risk groups could be underestimated by use of the current nomograms, which rely on data collected from patients who underwent only limited PLND. Extended PLND (ePLND) shows higher lymph node yield, which leads to the removal of more positive nodes and fewer missed positive nodes. It may be possible to refrain from performing PLND on low-risk patients with a prostate-specific antigen value <10 ng/ml and a biopsy Gleason score < or =6, but the risk of biopsy-related understaging should be kept in mind. Theoretically, meticulous ePLND may also impact prostate cancer survival by clearing low-volume diseases and occult micrometastasis even in pN0. The therapeutic role of PLND in prostate cancer patients is still an open question, especially in individuals with low-risk disease. Patients with intermediate- to high-risk disease are more likely to benefit from ePLND.

Prostate Volume has Prognostic Value Only in Pathologic T2 Radical Prostatectomy Specimens

The objective of this study was to evaluate the prognostic roles of the prostate volume, tumor volume, and tumor percentage as a function of the pathologic T stage in radical prostatectomy specimens. This study included 259 patients who underwent radical prostatectomy between 2005 and 2010. The mean follow-up period was 41.2 months. In all of the specimens, prostate volume (P = 0.021), the Gleason score (P = 0.035), and seminal vesicle invasion (P = 0.012) were independent predictors of biochemical recurrence (BCR). In the T2 group, multivariate analysis showed that the BCR was significantly associated with prostate specific antigen (PSA) (P = 0.028), a lower prostate volume (P = 0.004), and the Gleason score (P = 0.040). The Kaplan-Meier survival curve showed that a smaller prostate volume was significantly associated with a greater risk of BCR ( or = 30 mL; P = 0.010). In the T3 group, patients with seminal vesicle invasion had a significantly shorter mean BCR-free survival (P = 0.030). In this study, tumor volume and tumor percentage did not predict BCR. Notably, a lower prostate volume is an independent predictor for BCR only in the organ-confined radical prostatectomy specimens. But, prostate volume could not predict BCR in most locally advanced tumors.

Bcl-2 as a Predictive Factor for Biochemical Recurrence after Radical Prostatectomy: An Interim Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The objective of this study was to determine Bcl-2 expression in localized prostate cancer and its potential role as a predictive factor for biochemical recurrence (BCR). MATERIALS AND METHODS: This study included 171 Korean patients with newly diagnosed adenocarcinoma of the prostate who underwent radical prostatectomy (RP) without neoadjuvant therapy at a single center between February 2005 and May 2009. RP specimens obtained from these patients were analyzed for the expression of Bcl-2 using tissue microarray. The values of Bcl-2 and other clinicopathologic factors were evaluated. Statistical analysis was performed with contingency table analysis, chi-square tests, and a Cox proportional hazard model. RESULTS: Bcl-2 expression was immunohistologically-confirmed in 42 patients (24.6%). Bcl-2 expression was not associated with conventional clinicopathologic factors. Bcl-2 negative patients had a significantly longer mean BCR-free survival than Bcl-2-positive patients (p=0.036). Among several variables, a high Gleason score in the RP specimen (> or =8), extraprostatic extension, seminal vesicle invasion (SVI), lymphovascular invasion (LVI), and Bcl-2 expression were significant predictors of BCR based on univariate analysis. Multivariate Cox proportional hazards analysis revealed that BCR was significantly associated with a high prostate specific antigen level (p=0.047), SVI (p<0.001), a positive surgical margin (p=0.004) and Bcl-2 expression (p=0.012). CONCLUSION: Bcl-2 expression in RP specimens is associated with a significantly worse outcome, suggesting a potential clinical role for Bcl-2. Post-operative Bcl-2 could be a significant predictor of outcome after RP.

Lower Blepharoplasty in Aged Persons

With increase in average life expectancy, more patients of an older demographics are undergoing periocular facial rejuvenation procedures. One of the most common procedures performed for periocular rejuvenation is the lower blepharoplasty. One of the most common and challenging postoperative complication after this procedure is lower lid retraction. The degree of lower lid retraction can be presented in a varying range from lateral canthal rounding and scleral show to cicatrical ectropion. Causes of lower eyelid retraction seem to be multifactorial and there are a variety of surgical approaches for correction of lower eyelid retraction. According to the cause and degree of lower lid retraction, the author must incorporate a customized approach for each deformity. Techniques used to correct lower lid retraction include midface lift, lateral canthopexy or canthoplasty, oculi muscle suspension, and a spacer graft. To effectively correct the retraction, the surgeon must have a sound understanding of the anatomy of lower eyelid. Technically, key essential fundamentals to correct lower lid retraction include: knowledge of elevating the mid face, anchoring the lateral canthal tendon securely, and proper insertion of the spacer graft. The author presents multiple techniques to correct significant postsurgical lower lid malposition without the use of skin grafts.

Prostate Specific Membrane Antigen mRNA in Blood as a Potential Predictor of Biochemical Recurrence after Radical Prostatectomy

We investigated whether the detection of prostate specific membrane antigen (PSMA) in blood preoperatively has predictive value for biochemical recurrence (BCR) after radical prostatectomy in patients with prostate cancer. All 134 patients scheduled to receive radical prostatectomy for prostate cancer were prospectively enrolled. The authors used nested reverse transcriptase-polymerase chain reaction (RT-PCR) assay to detect PSMA mRNA-bearing cells in peripheral blood, and analyzed the ability of PSMA mRNA positivity to predict BCR after surgery. PSMA-mRNA was detected in 24 (17.9%) patients by RT-PCR. Over a median follow-up of 20 months (range, 3 to 46 months), BCR developed in 15 patients (11.2%) and median time to BCR was 7 months (range, 3 to 25 months). Kaplan-Meier analysis revealed a significant difference between those positive or negative for PSMA in terms of recurrence-free actuarial probability (log rank P=0.0039). Multivariate analysis showed that positivity for PSMA mRNA (HR: 3.697, 95% CI 1.285-10.634, P=0.015) and a biopsy Gleason score of > or =7 (HR: 4.500, 95% CI 1.419-14.274, P=0.011) were independent preoperative predictors of BCR. The presence of PSMA mRNA in peripheral blood can be used to predict BCR after radical prostatectomy.

Effects of Metabolic Syndrome on Chronic Kidney Disease

PURPOSE: Metabolic syndrome (MS) has been identified as a causal risk factor for cardiovascular disease, stroke, and cardiovascular mortality. Recent studies have suggested a possible relation between MS and renal function. The aim of this study was to evaluate the influence of MS on renal function. MATERIALS AND METHODS: We analyzed 12,348 healthy Koreans who underwent a general health checkup. MS was defined as 3 or more of the criteria according to the National Cholesterol Education Program Adult Treatment Panel guidelines III (NCEP ATP III). The glomerular filtration rate (GFR) was estimated by the redefined Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was categorized into 3 categories according to the Kidney Disease: Improving Global Outcomes guidelines; I: GFR> or =90 ml/min, II: 60-89 ml/min, III: 30-59 ml/min. RESULTS: The overall proportion with MS was 19.3%. Compared with populations without MS, those with MS showed a significantly decreased GFR. The prevalence of CKD increased with the number of MS components, and it was prominent in the group of males over 40 years of age. In multivariate analyses using age, sex, and individual MS components, age (odds ratio [OR]=20.40; 95% CI: 10.81-38.49), sex (OR=1.98; 95% CI: 1.51-2.60), and obesity (OR=1.48; 95% CI: 1.13-1.93) were strongly associated with CKD. CONCLUSIONS: This study showed that MS is a significant determinant of CKD. Handling of correctable factors such as obesity may be considered one of the preventive modalities against the development of CKD.

Treatment of Lower Eyelid Retraction

With the average life expectancy increasing and a larger percent of the population aging, more patients of an older demographics are undergoing periocular facial rejuvenation procedures. One of the most common procedures performed for periocular rejuvenation is the lower lid blepharoplasty. As interest in this type of surgery increases however, we are seeing more complications associated with this procedure. One of the most common and challenging postoperative complication after this procedure is lower lid retraction. The degree of lower lid retraction can present in a varying range from lateral canthal rounding and scleral show to cicatricial ectropion. Causes of lower eyelid retraction seem to be multifactorial and there are a variety of surgical approaches for correction of lower eyelid retraction. According to the cause and degree of lower lid retraction, the author must incorporate a customized approach for each deformity. In this study, 33 patients had corrective surgery to treat lower eyelid retraction between July 2004 and June 2006. Of these, only one patient presented for primary correction all others were secondary cases. Techniques used to correct lower lid retraction included a midface lift, a lateral canthopexy or canthoplasty, an oculi muscle suspension, or a spacer graft. There was noted improvement in all cases performed, however a mild degree of recurrence was noted in 6 cases. To effectively correct lower lid retraction, the surgeon must have a sound understanding of the anatomy of the lower eyelid. Technically, key essential fundamentals to correcting lower lid retraction include: knowledge of elevating the mid face, anchoring the lateral canthal tendon securely, and proper insertion of the spacer graft. This article presents multiple techniques to correct significant postsurgical lower lid malposition without the use of skin grafts.

Metabolic Abnormalities and the Risk for Recurrence in Obese Patients with Urolithiasis / 대한비뇨기과학회지

PURPOSE: Recent studies have suggested an increased prevalence of urolithiasis with obesity. This study aimed to assess the influence of obesity on urinary metabolic abnormalities and the recurrence of stone. MATERIALS AND METHODS: We analyzed 802 consecutive stone formers(SF: first-time SF=501, recurrent SF=291) who underwent a comprehensive metabolic evaluation that included blood chemistry tests and a 24-hour urinary examination, as well as determining the body mass index(BMI). The BMI was categorized into the non-obese(BMIor=25kg/m2) according to the re-defined Western Pacific Region WHO criteria on obesity(WPRO). All possible risk factors such as age, gender, BMI, the clinical characteristics and the metabolic parameters were compared between both groups. Among them, 184(22.9%) patients had been followed up for more than 24 months or they recurred during the follow up(mean: 56.0, median: 58.5, range: 7.0-140.0) and they were examined for the risk of stone recurrence by performing multivariate Cox regression analysis. RESULTS: Obesity was significantly associated with the increased urinary excretion of sodium, calcium and oxalate(p<0.05, respectively). The urinary pH value showed inverse correlation with obesity(p=0.012). Urinary metabolic abnormalities were more common in the obese SF patients than the non-obese SF patients(p=0.003). Obesity was significantly associated with the stone recurrence rate(p=0.009). Cox regression analysis revealed that obesity was a strong predictor for recurrent stone formation(adjusted HR=2.384 95% CI: 1.372-4.143, p=0.002). CONCLUSIONS: Our results reveal that obesity is highly associated with metabolic alterations and urinary stone recurrence. Therefore, weight control might be considered as one of the preventive measures against recurrent stone formation.