A Case of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Mycosis Fungoides with Large Cell Transformation Involving Cutaneous Lesions, and Metastasis to Lymph Node and Viscera

Large cell transformation (LCT) of mycosis fungoides (MF) is a histopathological transformation of neoplastic small lymphocytes with a clonally identical large cell phenotype, which is found in 20%–50% of cases of advanced MF. Some few cases and studies have been reported about the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG PET/CT) in diagnosing MF-LCT. This is a case of a 55-year-old man who had a left neck mass for 4–5 months. He underwent excisional biopsies on the skin and soft tissue. The histopathologic report showed MF-LCT. The 18F-FDG PET/CT findings revealed hypermetabolic lesions in the skin, cervical lymph node, and visceral organ. We introduce a rare case of MF-LCT involving both cutaneous and extracutaneous lesions.

Korean Medication Algorithm for Schizophrenia 2019, Second Revision: Treatment of Psychotic Symptoms

Objective@#In 2001, the Korean College of Neuropsychopharmacology and the Korean Society for Schizophrenia Research developed the Korean Medication Algorithm Project for Schizophrenia (KMAP-SPR 2001, revised 2006) through a consensus of expert opinion. The present study was carried out to support the second revision of the KMAP-SPR. @*Methods@#Based on clinical guidelines and studies on the treatment of psychotic symptoms in schizophrenia, the Executive committee completed a draft of KMAP-SPR 2019. To obtain an expert consensus, a Review committee of 100 Korean psychiatrists was formed and 69 responded to a 30-item questionnaire. Based on their responses, the KMAP-SPR 2019 was finalized. @*Results@#The revised schizophrenia algorithm now consists of 5 stages. At Stage 1, monotherapy with atypical antipsychotics was recommended by expert reviewers as the first-line strategy. At Stage 2, most reviewers recommended the use of typical or atypical antipsychotic drugs not used at Stage 1. At Stage 3, many reviewers agreed with the administration of clozapine. At Stage 4, a combination of clozapine and other agents such as antipsychotics, mood stabilizers, antidepressants, or electroconvulsive therapy was recommended. At Stage 5, most reviewers recommended combined treatment with an antipsychotic other than clozapine; and a mood stabilizer, antidepressant, or electroconvulsive therapy. At any stage, prescribing long-acting injectable antipsychotics at the discretion of the clinician was recommended. @*Conclusion@#Compared with previous versions, the KMAP-SPR 2019 now recommends using clozapine earlier in treatment-refractory schizophrenia. In addition, the use of long-acting injectable antipsychotics is now considered to be available at any stage.

Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience / 신경중재치료의학

Purpose@#We present ultrasound-guided percutaneous low-dose thrombin (200–250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups. @*Materials and Methods@#From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a “whirlpool” hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test. @*Results@#Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups. @*Conclusion@#Ultrasound-guided percutaneous low-dose thrombin injection (200–250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.

Efficiency of Air Bubble Removal in Preparation of Low-Profile Angioplasty Balloon Catheter: Bench-Top Comparison of Six Methods / 신경중재치료의학

PURPOSE: Complete removal of air bubbles from balloons for neurovascular angioplasty is cumbersome. We compared the preparation difficulty, air removal efficiency, and air collection pattern of six different balloon catheter preparation methods to propose a better preparation method for both initial and second balloon uses, especially for small-profile angioplasty balloon catheters. MATERIALS AND METHODS: A total of 18 neurovascular angioplasty balloon catheters with nominal diameters of 2 mm were prepared to test six different preparation methods: the instruction for use method (method A), simplified method using a syringe (method B) and four newly devised preparation methods using inflating devices (methods C–F). Serial radiographs were obtained while the balloons were gradually inflated. We measured the time for each preparation and the bubble number, analyzed their distribution in the balloon, and calculated the contrast filling ratio (contrast filling area/total balloon area) for initial and second ballooning. The whole process was repeated three times. RESULTS: The preparation time varied widely (11.5 seconds [method D] to 73.3 seconds [method A]). On initial inflation, the contrast filling ratio at 8 atm was the highest (100%) with methods A and F. On second inflation, the ratio was again highest with method A (99.5%), followed by method F (99.2%). Initial ballooning tended to show a uniform pattern of single bubble in the distal segment of the balloon; in contrast, second ballooning showed varying patterns in which the bubbles were multiple and randomly distributed. CONCLUSION: None of the six methods were able to completely exclude air bubbles from the balloon catheters including the second ballooning; however, the method of repeating aspiration with high-volume inflating device (method F) could be a practical option considering the simplicity and efficiency of preparation.

The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung / 대한핵의학회잡지

PURPOSE@#We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC).@*METHODS@#Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ≥1.0 cm vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient.@*RESULTS@#Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis.@*CONCLUSIONS@#Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.

The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung / 대한핵의학회잡지

PURPOSE: We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC).METHODS: Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ≥1.0 cm vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient.RESULTS: Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis.CONCLUSIONS: Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.

The Incidence and Characteristics of Patients with Small Ruptured Aneurysms (<5 mm) in Subarachnoid Hemorrhage

OBJECTIVE: Small unruptured aneurysms (<5 mm) are known for their very low risk of rupture, and are recommended to be treated conservatively. However, we encounter many patients with small ruptured aneurysms in the clinical practice. We aimed to investigate the incidence and characteristics of patients with small ruptured aneurysms. METHODS: We reviewed all patients admitted to our hospital with subarachnoid hemorrhage from January 2005 to December 2015. The patients were divided into two groups: those with aneurysms <5 mm (group S) and those with aneurysms ≥5 mm (group L). The patient’s age and sex, size and location of aneurysms, and risk factors such as hypertension, diabetes, alcohol use, and smoking were compared between the two groups. RESULTS: Eight-hundred eleven patients were diagnosed with ruptured aneurysms, and 337 (41.6%) were included in group S. The mean size of all aneurysms was 6.10±2.99 mm (range, 0.7–37.7); aneurysms with a diameter of 4–5 mm accounted for the largest subgroup of all aneurysms. Female sex was significantly associated with the incidence of small ruptured aneurysms (odds ratio [OR] 1.50, 95% confidence intervals [CI] 1.02–2.19, p=0.037). Despite female predominance in the incidence of small ruptured aneurysms, the proportion of small ruptured aneurysms in young (<50 years) men was high. In men, there were no significant differences regarding the location of the aneurysms between group S and group L (p=0.267), with the most frequent location being the anterior communicating artery (ACoA) in both group S (50.9%) and group L (51.4%). However, in women, there were significant differences regarding the location of the aneurysms between group S and group L (p=0.023), with the most frequent locations being the ACoA (33.0%) in group S, and the posterior communicating artery (30.6%) in group L. In women, two locations were significantly associated with small (<5 mm) ruptured aneurysms: the ACoA (OR 2.14, 95% CI 1.01–4.54, p=0.047) and anterior cerebral artery (OR 3.54, 95% CI 1.19–10.54, p=0.023). Multiplicity and smoking were significantly associated with large (≥5 mm) ruptured aneurysms in women. The use of alcohol was related to small ruptured aneurysms in men over 50 years of age (OR 2.23, 95% CI 1.03–4.84, p=0.042). CONCLUSION: In this study, small (<5 mm) ruptured aneurysms exhibited different incidences by age, sex, location, and risk factors such as multiplicity, smoking, and alcohol use.

Optimal Guiding Catheter Length for Endovascular Coiling of Intracranial Aneurysms in Anterior Circulation in Era of Flourishing Distal Access System / 신경중재치료의학

PURPOSE: To determine the minimum required guiding catheter length for embolization of various intracranial aneurysms in anterior circulation and to analyze the effect of various patient factors on the required catheter length and potential interaction with its stability. MATERIALS AND METHODS: From December 2016 to March 2017, 90 patients with 93 anterior circulation aneurysms were enrolled. Three types of guiding catheters (Envoy, Envoy DA, and Envoy DA XB; Codman Neurovascular, Raynham, MA, USA) were used. We measured the in-the-body length of the catheter and checked the catheter tip location in the carotid artery. We analyzed factors affecting the in-the-body length and stability of the guiding catheter system. RESULTS: The average (±standard deviation) in-the-body length of the catheter was 84.2±5.9 cm. The length was significantly longer in men (89.1±5.6 vs. 82.1±4.6 cm, P<0.001), patients older than 65 years (87.7±7.8 vs. 82.7±4.2 cm, P<0.001), patients with a more tortuous arch (arch type 2 and 3) (87.5±7.4 vs. 82.7±4.4 cm, P<0.001), and patients with a distal aneurysm location (distal group) (86.2±5.0 vs. 82.7±6.1 cm, P=0.004). A shift in the tip location was noted in 19 patients (20.4%); there was no significant different among the 3 catheters (P=0.942). CONCLUSION: The minimum required length of a guiding catheter was 84 cm on average for elective anterior-circulation aneurysm embolization. The length increased in men older than 65 years with a more tortuous arch. We could reach a higher position with distal access catheters with little difference in the stability once we reached the target location.

The Association of the 2nd to 4th Digit Ratio with the Age of Onset and Metabolic Factors in Korean Patients with Schizophrenia

OBJECTIVES: The ratio of second to fourth digit length (2D : 4D) could be a potential epigenetic marker of sexual dimorphism reflecting prenatal testosterone exposure. Testosterone is known to affect the development of the brain through an epigenetic mechanism. The purpose of this study was to investigate the effects of exposure to fetal testosterone on the metabolic syndrome based on 2D : 4D of schizophrenia patients and the relationship with the age of onset of schizophrenia. METHODS: A total of 214 schizophrenia patients participated in this study. The participant's physical and blood tests were performed according to the American National Cholesterol Education Program's Third Amendment of the Metabolic Syndrome Diagnostic Criteria, and the 2D : 4D was measured by the method designed by McFadden. Data were statistically analyzed by t-test, Pearson's correlation analysis and multiple regression model analysis. RESULTS: 2D : 4D was significantly higher in female than male in both hands, and there was a statistically significant negative correlation between 2D : 4D and the age of onset of schizophrenia in male. However, 2D : 4D did not show statistically significant correlation with metabolic factors. CONCLUSIONS: Fetal testosterone suggests the possibility of affecting the age of onset of schizophrenia through the epigenetic mechanism, but there is no clear relationship with metabolic factors.

Emergent Double-barrel Bypass Shortly after Intravenous Administration of Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke

Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA. A 66-year-old man with no previous medical history developed left hemiparesis. A computed tomography scan revealed no acute lesion and he received IV rt-PA within 1.5 hours after symptom onset. Emergent magnetic resonance imaging showed significant diffusion-perfusion mismatch. He received IAT 2 hours after IV rt-PA administration, but IAT failed because of total occlusion of the cervical internal carotid artery. We initially planned to perform STA-MCA bypass the next morning because he had received IV rt-PA, but, 8 hours after IV rt-PA administration, his hemiparesis worsened from motor grade 3/4 to motor grade 1/2. Because of the large perfusion defect in both MCA divisions, double-barrel STA-MCA bypass was performed 10 hours after IV rt-PA administration. His symptoms rapidly improved after surgery and his modified Rankin Scale score 3 months later was grade 0. We suggest that emergent double-barrel bypass can be a viable option in patients who have perfusion defects of both MCA divisions in acute ischemic stroke after IV rt-PA administration.

Clinical evaluation of ridge augmentation using autogenous tooth bone graft material: case series study

OBJECTIVES: Interest in bone graft material has increased with regard to restoration in cases of bone defect around the implant. Autogenous tooth bone graft material was developed and commercialized in 2008. In this study, we evaluated the results of vertical and horizontal ridge augmentation with autogenous tooth bone graft material. MATERIALS AND METHODS: This study targeted patients who had vertical or horizontal ridge augmentation using AutoBT from March 2009 to April 2010. We evaluated the age and gender of the subject patients, implant stability, adjunctive surgery, additional bone graft material and barrier membrane, post-operative complication, implant survival rate, and crestal bone loss. RESULTS: We performed vertical and horizontal ridge augmentation using powder- or block-type autogenous tooth bone graft material, and implant placement was performed on nine patients (male: 7, female: 2). The average age of patients was 49.88+/-12.98 years, and the post-operative follow-up period was 35+/-5.31 months. Post-operative complications included wound dehiscence (one case), hematoma (one case), and implant osseointegration failure (one case; survival rate: 96%); however, there were no complications related to bone graft material, such as infection. Average marginal bone loss after one-year loading was 0.12+/-0.19 mm. Therefore, excellent clinical results can be said to have been obtained. CONCLUSION: Excellent clinical results can be said to have been obtained with vertical and horizontal ridge augmentation using autogenous tooth bone graft material.

Effects of onion peel water extracts on swimming endurance in rat / 동물의과학연구지

Onion (Allium cepa L.) contains high levels of dietary fibers and antioxidants, including vitamin C, D, and folates. Onion is also known as a quercetin-rich vegetable with high flavonoid content. Onion peel contains over 20 times more quercetin than onion flesh. The aim of this study was to examine the question of whether onion peel extract supplementation has an effect on maximal exercise performance in rat. Onion peel extracts were extracted with hot water. Thirty male Sprague Dawley rats were maintained on a pellet diet for one week, and then randomly divided into five groups: Normal control, Positive control (quercetin 20 mg/kg), Onion peel 4 mg/kg, Onion peel 20 mg/kg, and Onion peel 100 mg/kg. Oral administration was performed daily. The experimental period was four weeks. Thereafter, animals were then forced to swim in water and the maximal exercise performance period from the swimming start time to the exhausted time, in which they failed to rise to the surface of the water to breathe within a 7 second period, was measured. After necropsy, weights of gastrocnemius muscles were measured. Lactate dehydrogenase concentration in serum was measured using an enzymatic method, using a commercial kit. The maximal exercise performance period was significantly longer in the onion peel extracts fed groups, compared with the control group. The lactate dehydrogenase concentration of the onion peel extracts fed groups was significantly lower, compared with the control group. Based on these results, we suggest that onion peel water extract supplementation can enhance exercise capacity caused by the mechanism of decreasing lactate dehydrogenase concentration.

Added Value of Magnetic Resonance Imaging in Staging of Malignant Pleural Mesothelioma

PURPOSE: We investigated the possible added value of magnetic resonance imaging (MR) in staging of malignant pleural mesothelioma (MPM) compared to computed tomography (CT). MATERIALS AND METHODS: We retrospectively enrolled 20 patients (M;F = 14:6; mean age, 53.5 yrs) who diagnosed as MPM by histology and underwent CT and MR at initial evaluation from Jan 1997 to Dec 2012. Two radiologists performed clinical staging by using CT alone or MR alone in consensus. In patients underwent surgery (n = 13), we evaluated the diagnostic accuracy of CT and MR in terms of staging compared to surgical staging. In all patients, we compared clinical staging of CT only and CT with MR. RESULTS: The diagnostic accuracy for T staging of CT only was 23.1% (3/13) and that of combined CT and MR was 38.5% (5/13), respectively. Among 13 patients underwent surgery, surgical stage was higher than combined CT and MR stage in 5 patients, but lower in 3 patients. CT only and combined CT and MR agreed in 85.0% (17/20). In cases of disagree (15.0%, 3/20), combined CT and MR showed higher stage than CT only. CONCLUSION: Combined CT and MR increases the diagnostic accuracy in staging of MPM compared to CT only and is important in determining the appropriate treatment in patients being considered for surgery.

Mental Health of Medical School Students and the Effects of Their Strategy for Enhancing Self-Esteem / 한국의학교육

PURPOSE: This study investigated the mental health status, self-esteem, social comparison, and narcissism among medical school students. In addition, the mediational effect of social comparison between self-esteem and narcissism was also tested with regard to whether the students compared themselves with others to enhance their own self-esteem. METHODS: Data were collected from 427 medical school students at a medical school in Seoul. The questionnaire included the Minnesota Multiphasic Personality Inventory (MMPI) 383 scale, the self-esteem scale, the Iowa-Netherlands Comparison Orientation Measure, and the narcissism scale. Using the MMPI findings, a clinical psychologist screened for possible clinical cases. Then, the frequencies of those with distress were compared between three groups, based on affiliation; premedical, medical, and graduate medical students. Also, the level of self-esteem, social comparison, and narcissism was tested by analysis of (ANCOVA), and the mediational role of social comparison was explored. RESULTS: Irrespective of affiliation, almost 10% of medical school students showed mental illness or distress. Of the clinical scales on the MMPI, the T scores of the Pa (Paranoia), Sc (Schizophrenia), and Ma (Hypomania) scales were higher in premedical and medical school students than in graduate medical school students. In addition, the mediational role of social comparison was confirmed only in medical school students. CONCLUSION: We demonstrated that subjective distress in certain medical school students needs to be addressed. Also, self-esteem was an important factor that correlated with mental health and distress indices. However, comparing oneself with others to enhance self-esteem by derogating or focusing could result in increased narcissism.

The peroxisome proliferator-activated receptor-gamma agonist, Rosiglitazone, improves aortic wall stiffness in type 2 diabetic patients / 대한내과학회지

BACKGROUND: Diabetes is a major risk factor for the development of coronary artery disease. Atherosclerosis is thought to arise as a result of a chronic inflammatory process within the arterial wall. Insulin resistance is central to the pathogenesis of type 2 diabetes and may contribute to atherosclerosis, either directly or through associated risk factors. Rosiglitazone, a peroxisome proliferator-activated receptor gamma agonist, is used in the treatment of type 2 diabetes mellitus, and previous findings suggest that it may have anti-inflammatory effects on atherosclerosis. This study was performed to evaluate whether rosiglitazone can improve arterial stiffness in type 2 diabetic patients. METHODS: This study consisted of 40 patients with type 2 diabetes. These subjects were classified into two groups either medicated with glimepiride (GLIME group, 61.5+/-8.2 years, M:F = 9:11) or with glimepiride and rosiglitazone (ROSI group, 65.6+/-9.5 years, M:F = 4:16). For each group, plasma a hsCRP, lipid profile, HOMAIR and HbA1c were measured before and after 12 months of medical treatment. At the same time, pulse wave velocity (PWV) using an automatic device (PP 1000, Hanbyul, Jeonju, Korea) was measured. RESULTS: The plasma hsCRP level was significantly decreased in the ROSI group as compared with the GLIME group (4.22+/-4.65 vs. 1.07+/-0.80 mg/L, p=0.025). The carotid-femoral PWV of the ROSI group improved significantly as compared with the GLIME group (8.29+/-1.25 vs. 7.26+/-1.49 m/sec, p=0.024). The changes of PWV were correlated with the changes of hsCRP (r=0.412, p=0.033). CONCLUSIONS: These findings suggest that rosiglitazone can improve the arterial stiffness in type 2 diabetic patients.

Clinical Observation on Fifty-eight Cases of Chronic Prostatitis / 대한비뇨기과학회지

Fifty-eight cases of chronic prostatitis were studied endoscopically and prostatic fluid culture was performed of sixteen cases. Needle biopsy of prostate was also done on twenty-five cases concomitantly and the following results were obtained: 1) Endoscopic appearance of the bladder neck was as follows, 1. Normal bladder neck, 13 cases (22. 4 per cent) 2. Elevated posterior urethra, 6 cases (10. 3 per cent) 3. Contracture of the neck, 8 cases (13. 8 per cent) 4. Diffuse, irregular swelling and narrowing of the neck, 11 cases (18, 9 per cent) 5. Reversed V-neck, 20 cases (34.4 per cent) The bladder neck was abnormal in 77.6 per cent of the cases 2) In 15 cases in which prostatic fluid culture was done, microorganisms were cultured in 13 cases. Staphylococcus epidermis was isolated in 6 cases and was most frequent etiologic organism of chronic prostatitis. 3) Result of biopsied tissue in 25 cases was as follows, no pathologic finding was present in 7 cases (28 per cent) and corpora amylacea in 6 cases (24 per cent) and inflammatory cells in 8 cases (32 per cent) and corpora amylacea with inflammatory cells in 4 cases (16 per cent). 4) Endoscopic examination, prostatic fluid culture and needle biopsy of prostate on chronic prostatitis, which was resistant to conventional therapy, are worthwhile and important procedures in establishing therapeutic criteria.

Clinical Observation on lntrascrotally Impalpable Testis / 대한비뇨기과학회지

A clinical observation was made on 177 cases of intrascrotally impalpable testis seen in the Department of Urology, Seoul National University Hospital during the period from January. 1979. The following results were obtained: 1. Only 53 cases (29.9%) visited hospital in the preschool age and 165 cases(93.2%) before the age of 25. 2. ll4 cases (64.4%) had unilateral involvement and right site was more frequently affected. Bilaterality was noted in 63 cases (35.6%). 3. 237 testes were surgically explored and hernial sac was found in l91 explorations (80.6%). 4. Among 237 explorations, 4 cases were confirmed as monorchism and inguinal canal was the most frequent site of testicular retention (78.5%). 5. Chromosome study was done on 7 cases and all cases yielded 46 XY, cytogenetically normal male. 6. Semen analysis was performed on 20 postpuberal cases and all 13 cases of bilateral intrascrotally impalpable testis revealed azoospermia. In 7 cases of unilateral intrascrotally impalpable testis 3 cases were within normal limits and 4 cases showed oligospermia. 7. Surgical specimens were obtained from 29 cases and l case turned out to be seminoma. Pathologic findings of 28 cases excluding seminoma were evaluated on the basis of basement membrane thickening, peritubular fibrosis, Leydig cell hyperplasia and spermatogenic activity. 8. Treatment consisted of pre-or post-operative HCG injection in the dosage of 2,500 to l0,000 IU on 57 prepubeta1 or puberal cases and 217 orchiectomies (5.8%) and 2l7 orchiopexies (90.4%).

Two Cases of Xanthogranulomatous Pyelonephritis / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis, characterized by yellow masses macroscopically and foamy, lipid-laden macrophages microscopically. It may involve the kidney diffusely, or may be more focal as in the tumefactive form, which presents as a renal mass lesion and is virtually always unilateral. We have recently experienced two cases of xanthogranulomatous pyelonephritis in 28 and 34 year old Korean females.

A Case of Valproate-Induced Hyperammonemic Encephalopathy / 신경정신의학

The authors report a case of a 45-year-old man who developed stupor and hyperammonemia during pharmacological therapy with valproate for bipolar affective disorder. He was found to have a significantly elevated ammonia level (>400 microgram/dl) without any signs of hepatic insufficiency such as hepatic failure. The patient showed severely increased serum ammonia level, but the serum valproate level was within the therapeutic range. And he didn't use any other mood stabilizer and have any risk factors for hyperammonemia such as hepatic dysfunction and metabolic abnormality. The authors conclude that the mental change and hyperammonemia in this case are attributable to valproate medication. The authors also reviewed current literatures on hyperammonemia caused by valproate therapy and treatment with carnitine. Clinicians should be cautious about the potential risk for hyperammonemic encephalopathy caused by valproate medication, and patients who are treated with valproate need to be monitored for blood level of ammonia, especially in the case which shows characteristic mental and/or behavioral change.

Preliminary Results of Microsurgical Vasovasostomy / 대한비뇨기과학회지

No abstract available.