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1.  Traumatic Penile Injury: From Circumcision Injury to Penile Amputation 
BioMed Research International  2014;2014:375285.
The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.
PMCID: PMC4164514  PMID: 25250318
2.  Primary testicular carcinoid tumour with mature teratoma in undescended testis metastatic to lymph nodes 
We report a case of primary testicular carcinoid tumour with mature teratoma metastatic to the para-aortic lymph node and the lymph node around the left gonadal vein, which was treated with radical orchiectomy, bleomycin, etoposide, and cisplatin chemotherapy, and modified retroperitoneal lymph node dissection. Three days after modified retroperitoneal lymph node dissection, bleomycin induced pneumonitis occurred, which was resolved with steroid administration. The patient is alive without recurrence 31 months after radical orchiectomy.
PMCID: PMC4001652  PMID: 24839491
3.  A completely isolated intestinal duplication cyst mimicking ovarian cyst torsion in an adult 
Intestinal duplications are rare congenital anomalies that can occur anywhere in the gastrointestinal tract. They are most commonly located in the ileum and are usually detected in infancy or early childhood. Duplicated segments are usually firmly attached to and sometimes communicate with the normal gastrointestinal tract. Rarely, intestinal duplications are completely isolated, thus not associated at all with any part of the gastrointestinal tract. Such duplications do not share a common blood supply with the adjacent normal intestinal segment, unlike the usual form of duplication, but rather have a separate vascular pedicle. Reports of completely isolated duplication cysts in adults are extremely rare; we found only five such reports in the English-language medical literature. Here, we report a case of a completely isolated duplication cyst 12 cm long in an adult female. The cyst had no connection to any part of the intestinal tract and had a dedicated vascular pedicle.
PMCID: PMC3923038  PMID: 24574732
Congenital abnormalities; Digestive system; Duplication; Cysts; Adult
4.  Are Hypoechoic Lesions on Transrectal Ultrasonography a Marker for Clinically Significant Prostate Cancer? 
Korean Journal of Urology  2013;54(10):666-670.
To investigate the relationship of transrectal ultrasound (TRUS) findings with the pathological characteristics of prostate cancer (PCa).
Materials and Methods
The study was conducted retrospectively by analyzing the data for 970 patients who underwent prostate biopsies. Gleason scores and other clinical variables were compared between PCa patients with and without hypoechoic lesions on TRUS.
Of the 970 patients, PCa was diagnosed in 291 (30%). Of these, high-grade PCa (Gleason score of 7 or more) was diagnosed in 190 (65%). The cancer detection rate was higher in patients with hypoechoic lesions (43.9%) than in those without hypoechoic lesions (21.4%, p<0.001). High-grade PCa was detected more often in patients with hypoechoic lesions than in those without hypoechoic lesions (p<0.001). Independent predictors for high-grade PCa by logistic regression analysis included hypoechoic lesions on TRUS and abnormal digital rectal examination findings.
Patients with PCa who had hypoechoic lesions on TRUS had more aggressive pathological disease than did those without lesions. Therefore, hypoechoic lesions on TRUS could be a marker for clinically significant PCa.
PMCID: PMC3806989  PMID: 24175039
Clinical marker; Prostate neoplasms; Ultrasonography
5.  Concurrent Bladder Lymphoma and Bladder Cancer Presenting as Metastatic Bladder Cancer 
The World Journal of Men's Health  2012;30(2):141-145.
Malignant lymphoma of the bladder is a rare lesion, representing approximately 0.2% of the primary lesions and approximately 1.8% of the secondary lesions. A disseminated lymphoma presenting as a bladder mass is an infrequent phenomenon. The authors report the case of a 71-year-old patient with concurrent bladder lymphoma and bladder cancer presenting as metastatic bladder cancer. To the best of our knowledge, this is the first report of concurrent bladder lymphoma and bladder cancer.
PMCID: PMC3623523  PMID: 23596602
Urinary bladder neoplasms; Carcinoma, transitional cell; Lymphoma, non-Hodgkin
6.  Gamma knife radiosurgery for elderly patients with brain metastases: evaluation of scoring systems that predict survival 
BMC Cancer  2015;15:54.
Gamma knife radiosurgery (GKRS) has been increasingly employed for the treatment of elderly patients with brain metastases, mainly due to its demonstrated effectiveness and low complication rate. However, only a few studies have investigated the prognostic factors that influence the survival of elderly patients after GKRS. The purpose of this study was to identify a scoring system that is able to predict the survival of elderly patients undergoing GKRS using data obtained at the time of diagnosis for brain metastases.
Between 2004 and 2011, death was confirmed in 147 patients aged 70 years and older who had been treated with GKRS for brain metastases. Median age at the time of GKRS was 75.7 years (range, 70–86 years). The median tumor volume was 5.1 cm3 (range, 0.05–59.9 cm3). The median marginal prescription dose was 21.4 Gy (range, 14–25 Gy).
The median survival was 167 days. Overall survival rates at 6 months and 1 year were 60.4% and 29.4%, respectively. Among the patient characteristics pertaining to systemic cancer and brain metastasis for which data were obtained preoperatively, a multivariate analysis showed that low Karnofsky performance status (KPS ≤ 80, P = 0.047) and the presence of extracranial metastases (P = 0.014) detected at the time of brain metastasis diagnosis were independent prognostic factors for short survival. A high score index for radiosurgery (SIR score ≥ 4, P = 0.024) and a high graded prognostic assessment (GPA score ≥ 2, P = 0.004) were associated with longer survival. A multivariate analysis of the important characteristics of systemic cancer, and the scoring system evaluating survival duration showed that a low GPA score was the most powerful independent factor for predicting short survival (hazard ratio 1.756, 95% confidence interval 1.252–2.456, P = 0.001).
GKRS is a safe approach to treat brain metastases in patients age 70 years and older. In this group, our study identified GPA score at the time of GKRS as a powerful prognostic factor for survival.
PMCID: PMC4333254
Brain metastasis; Elderly; Gamma knife radiosurgery; Prognosis; Survival
7.  Initial Biopsy Outcome Prediction in Korean Patients-Comparison of a Noble Web-based Korean Prostate Cancer Risk Calculator versus Prostate-specific Antigen Testing 
We developed and validated a novel Korean prostate cancer risk calculator (KPCRC) for predicting the probability of a positive initial prostate biopsy in a Korean population. Data were collected from 602 Koreans who underwent initial prostate biopsies due to an increased level of prostate-specific antigen (PSA), a palpable nodule upon digital rectal examination (DRE), or a hypoechoic lesion upon transrectal ultrasound (TRUS). The clinical and laboratory variables were analyzed by simple and multiple logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was computed to compare its performance to PSA testing alone. Prostate cancer was detected in 172 (28.6%) men. Independent predictors included age, DRE findings, PSA level, and prostate transitional zone volume. We developed the KPCRC using these variables. The AUC for the selected model was 0.91, and that of PSA testing alone was 0.83 (P < 0.001). The AUC for the selected model with an additional dataset was 0.79, and that of PSA testing alone was 0.73 (P = 0.004). The calculator is available on the website: The KPCRC improved the performance of PSA testing alone in predicting the risk of prostate cancer in a Korean population. This calculator would be a practical tool for physicians and patients.
PMCID: PMC3012855  PMID: 21218035
Prostate Neoplasms; Biopsy; Forecasting; Asian Continental Ancestry Group
8.  The Effect of the Partial Obstruction Site of the Renal Vein on Testis and Kidney in Rats: Is the Traditional Animal Model Suitable for Varicocele Research? 
Korean Journal of Urology  2010;51(8):565-571.
We investigated the influence of the location of the partial renal vein obstruction on the left kidney, the bilateral testes, and cauda epididymal sperm quality and determined whether this animal model is suitable for varicocele study.
Materials and Methods
A total of 25 adult male Sprague-Dawley rats were assigned to three groups: group 1 (experimental varicocele by partial ligation medial to the internal spermatic vein for 8 weeks, n=8), group 2 (partial ligation lateral to the internal spermatic vein for 8 weeks, n=10), and group 3 (sham operation for 8 weeks, n=7). Rats in groups 1, 2, and 3 underwent a left nephrectomy and bilateral orchiectomy at 8 weeks after the operation. Histological changes and Johnsen score in both testes were analyzed. Fibrotic changes in the left kidney were assessed by quantitative image analysis. Numbers of sperm and proportions of motile sperm in the cauda epididymides were determined.
Significant histological abnormalities and Johnsen score changes were observed in the testes in group 1. Renal fibrosis did not differ significantly among the groups. The proportions of motile sperm were significantly lower bilaterally in group 1 than in groups 2 and 3. However, the mean bilateral epididymal sperm count in group 1 was not significantly lower than in groups 2 and 3.
Our results showed that experimental varicocele in the rat, induced by partial ligation medial to the internal spermatic vein, influences epididymal sperm quality without harmful effects on the left kidney. The present study certifies that this traditional animal model is suitable for varicocele research.
PMCID: PMC2924562  PMID: 20733964
Animal models; Physiopathology; Rats; Varicocele
9.  Pulmonary Hodgkin Lymphoma in a Patient with Crohn’s Disease 
Korean Journal of Pathology  2014;48(5):387-389.
PMCID: PMC4215967  PMID: 25366077
10.  Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils 
Korean Journal of Radiology  2014;15(5):613-621.
The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR).
Materials and Methods
A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed.
Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed.
Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.
PMCID: PMC4170162  PMID: 25246822
Detachable interlock microcoil; Endovascular aneurysm repair; Internal iliac artery embolization
11.  Primary Renal Hydatid Cyst: Mis-Interpretation as a Renal Malignancy 
Primary renal echinococcosis, a rare disease involving the kidney, accounts for 2-3% of human echinococcosis. A 64-year-old female patient from Uzbekistan presented with complaints of left flank pain. A CT scan revealed a cystic mass in the upper to midpole of the left kidney. We regarded this lesion as a renal malignancy and hand-assisted laparoscopic radical nephrectomy was performed to remove the renal mass. The mass consisted of a large unilocular cyst and multiple smaller cysts without any grossly visible renal tissue. The final pathologic diagnosis was a renal hydatid cyst. For patients from endemic areas, hydatid cyst should be included in the differential diagnosis. Here, we present a case of renal hydatid cyst in a female patient who relocated from Uzbekistan to Korea.
PMCID: PMC4096642  PMID: 25031471
Echinococcosis; kidney; nephrectomy
12.  Relining technique for continuous sac enlargement and modular disconnection secondary to endotension after endovascular aortic aneurysm repair 
Endotension is an unpredictable late complication of endovascular aortic aneurysm repair (EVAR). This case report will discuss the successful treatment of enlarged aneurysmal sac due to endotension using the relining technique. An 81-year-old male complained of nondecreasing huge aneurysm sac. He had undergone EVAR for infrarenal abdominal aortic aneurysm 7 years prior and no endoleak was found through follow-up. Initially computed tomography-guided sac aspiration was tried, but in vain, Relining using the double barrel technique and tubular endograft for modular diconnection, which was unexpectedly found in the original endograft, were performed sucessfully. During follow-up after the relining procedure, the size of aneurysm sac continued to decrease in size. The relining technique is effective mothod for treating endotension.
PMCID: PMC3994625  PMID: 24761425
Aortic aneurysm; Endovascular procedures; Endoleak; Complication
13.  Development of a Screening Algorithm for Alzheimer's Disease Using Categorical Verbal Fluency 
PLoS ONE  2014;9(1):e84111.
We developed a weighted composite score of the categorical verbal fluency test (CVFT) that can more easily and widely screen Alzheimer's disease (AD) than the mini-mental status examination (MMSE). We administered the CVFT using animal category and MMSE to 423 community-dwelling mild probable AD patients and their age- and gender-matched cognitively normal controls. To enhance the diagnostic accuracy for AD of the CVFT, we obtained a weighted composite score from subindex scores of the CVFT using a logistic regression model: logit (case)  = 1.160+0.474× gender +0.003× age +0.226× education level – 0.089× first-half score – 0.516× switching score -0.303× clustering score +0.534× perseveration score. The area under the receiver operating curve (AUC) for AD of this composite score AD was 0.903 (95% CI = 0.883 – 0.923), and was larger than that of the age-, gender- and education-adjusted total score of the CVFT (p<0.001). In 100 bootstrapped re-samples, the composite score consistently showed better diagnostic accuracy, sensitivity and specificity for AD than the total score. Although AUC for AD of the CVFT composite score was slightly smaller than that of the MMSE (0.930, p = 0.006), the CVFT composite score may be a good alternative to the MMSE for screening AD since it is much briefer, cheaper, and more easily applicable over phone or internet than the MMSE.
PMCID: PMC3879263  PMID: 24392109
14.  Comparison of outpatient versus inpatient transurethral prostate resection for benign prostatic hyperplasia: Comparative, prospective bi-centre study 
We compare the symptomatic relief with urodynamic parameter change and operative safety of the outpatient transurethral resection in saline (TURIS-V) technique with inpatient transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH).
This prospective cohort comparison study enrolled patients who needed BPH surgery. Between January 2010 and June 2011, outpatient TURIS-V was performed at 1 centre and the results of the treatment were compared with inpatient TURP performed at a separate hospital. Preoperative characteristics, including prostate volume, were similar in both groups. Perioperative data and any treatment complications were recorded. The analysis compared postoperative outcomes, including a 6-month postoperative International Prostate Symptom Score (IPSS), a quality of life (QoL) evaluation and a record of any changes in uroflowmetry findings, between the 2 groups.
In the TURIS-V patient group, 75 patients agreed to be in the study. Of these, 69 ultimately complete the study. In the TURP group, 76 patients agreed and 71 of these completed the study. Both study groups were well-matched for age, IPSS, QoL and uroflowmetry findings. The TURIS-V group experienced both shorter operation times (54.6 vs. 74.8 minutes) and shorter catheterization times (2.2 vs. 4.2 days) when compared to the TURP group. There were comparable improvements in the 6-month postoperative IPSS, QoL, and uroflowmetry findings between the 2 groups. There were also equally low incidence rates of procedural complications.
Both TURIS-V and TURP relieve lower urinary tract symptoms in a similar way, with great efficacy and safety. Overall, TURIS-V had shorter operative and catheterization times compared to TURP. Notwithstanding the paper’s limitations (non- randomized cohort comparison with possible selection or surgeon bias and small heterogeneous sample size), TURIS-V can be performed safely even in an outpatient setting.
PMCID: PMC3896556  PMID: 24454598
15.  Effect of Treadmill Exercise on Interleukin-15 Expression and Glucose Tolerance in Zucker Diabetic Fatty Rats 
Diabetes & Metabolism Journal  2013;37(5):358-364.
Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models.
Male Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles.
After 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04).
The present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.
PMCID: PMC3816137  PMID: 24199165
Exercise; Glucose intolerance; Interleukin-15; Rats, Zucker; Treadmill
16.  A Prospective Randomized Controlled Trial of the Efficacy of Tamsulosin After Extracorporeal Shock Wave Lithotripsy for a Single Proximal Ureteral Stone 
Korean Journal of Urology  2013;54(8):527-530.
The objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone.
Materials and Methods
This prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications.
A stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously.
The results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.
PMCID: PMC3742905  PMID: 23956828
Lithotripsy; Tamsulosin; Urolithiasis
17.  Free Prostate-Specific Antigen Provides More Precise Data on Benign Prostate Volume Than Total Prostate-Specific Antigen in Korean Population 
To investigate the efficacy of total prostate-specific antigen (tPSA) and free prostate-specific antigen (fPSA) for the estimation of prostate volume (PV) in pathologically-proven benign prostatic hyperplasia (BPH) patients.
From January 2010 to March 2013, 165 Korean men with a PSA less than 10 ng/mL who were diagnosed without prostate cancer by prostate biopsy were enrolled. Patients were classified into three age groups: ≤60, 61-70, and >70 years old. The results were organized to estimate and compare the ability of serum tPSA and fPSA to assess the PV.
Enrolled patients had a median age of 63.5 years (44 to 80), a median tPSA of 5.72 ng/mL, a median fPSA of 0.98 ng/mL and a median PV of 53.68 mL, respectively. Among the associations between tPSA, fPSA, age, and PV, the highest correlation was verified between fPSA and PV (r=0.377, P<0.0001); the correlation coefficient between tPSA and PV was much lower (r=0.262, P<0.001). All stratified age cohorts showed the same findings. The ROC curves (for PV greater than 30, 40, and 50 mL) showed that fPSA (area under the curve [AUC]=0.781, 0.718, and 0.700) outperformed tPSA (AUC=0.657, 0.583, and 0.67) in its ability to predict clinically significant PV enlargement.
Both tPSA and fPSA significantly correlated with PV in Korean men, while the correlation efficiency between fPSA and PV was more powerful. fPSA may be a useful tool in making therapeutic decisions and follow-up management in BPH patients.
PMCID: PMC3713245  PMID: 23869271
Prostate-specific antigen; Prostatic hyperplasia; Organ volume
18.  Rapid resolution of acute subdural hematoma in child with severe head injury: a case report 
Rapid spontaneous resolution of traumatic acute subdural hematoma is an infrequent phenomenon and mainly develops in a case of simple acute subdural hematoma without parenchymal contusion. However, it has been rarely reported in a pediatric case with severe initial head injury.
Case presentation
A 7-year-old Asian girl with traumatic acute subdural hematoma was transferred to our hospital for an emergency operation based on the results of an initial computed tomography scan and neurological examination. However, a repeat computed tomography scan two hours after trauma disclosed considerable reduction of the hematoma and midline shift with neurological improvements. Serial follow-up imaging studies demonstrated apparent redistribution of the hematoma over the cerebellar tentorium, posterior interhemispheric fissure and subarachnoid space. The patient was discharged with mild confusion 40 days after the admission.
A follow-up computed tomography scan is strongly recommended before surgery when a child with a severe head injury presents with any sign of neurological improvement, especially with a mixed density hematoma on the initial computed tomography scan.
PMCID: PMC3607936  PMID: 23497374
Acute subdural hematoma; Pediatric head injury; Rapid resolution; Spontaneous resolution
19.  Effective application duration of sodium ascorbate antioxidant in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth 
The aim of this study was to determine an appropriate application duration of sodium ascorbate (SA) antioxidant gel in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth.
Materials and Methods
Eighty endodontically-treated human incisors were randomly divided into eight groups: control, no bleaching; IB and DB, immediate and delayed bonding after bleaching, respectively; S10m, S60m, S24h, S3d and S7d, bleaching + SA gel for 10 min, 60 min, 24 hr, 3 day and 7 day, respectively. For bleaching, a mixture of 30% hydrogen peroxide and sodium perborate was applied for 7 day. All access cavities were restored using One-Step adhesive (Bisco Inc.) and then Aelite LS Packable composite (Bisco Inc.). The bonded specimens were subjected to 500 thermal cycles, immersed in 1% methylene blue for 8 hr, and longitudinally sectioned. Microleakage was assessed with a 0 - 4 scoring system and analyzed using nonparametric statistical methods (α = 0.05).
Group IB showed a significantly higher microleakge than the control group (p = 0.006) and group DB a statistically similar score to the control group (p > 0.999). Although groups S10m, S60m, and S24h exhibited significantly higher scores than group DB (p < 0.05), the microleakage in groups S3d and S7d was statistically similar to that in group DB (p = 0.771, p > 0.999).
Application of SA gel for 3 day after nonvital bleaching was effective in reducing microleakage of composite restoration in intracoronally-bleached teeth.
PMCID: PMC3591585  PMID: 23493742
Application duration; Composite restoration; Intracoronal bleaching; Microleakage; Sodium ascorbate
20.  Clinical Features of Mumps Orchitis in Vaccinated Postpubertal Males: A Single-Center Series of 62 Patients 
Korean Journal of Urology  2012;53(12):865-869.
Although the measles-mumps-rubella vaccination covers most children against mumps in Korea, the development of mumps has been reported. However, the clinical manifestations of mumps orchitis in postpubertal vaccinated patients have never been investigated. Herein we report the clinical features of mumps orchitis in postpubertal vaccinated patients.
Materials and Methods
This study included a total of 62 postpubertal males who developed acute mumps orchitis from 2005 to 2010. The clinical manifestations such as the incubation period, febrile duration, and the mean duration of orchitis were retrospectively investigated. The laboratory and sonographic findings were also reviewed and compared with the features of previously reported cases of unvaccinated postpubertal mumps orchitis.
The mean age of the 62 patients was 17.56 years (range, 15 to 29 years). All patients were serologically confirmed with acute mumps infection (positive immunoglobulin [Ig] M and negative or positive IgG). The mean incubation period was 5.39 days (range, 0 to 23 days), with a febrile duration of 1.8 days (range, 0.5 to 3 days), and a mean duration of orchitis of 4.96 days (range, 0 to 17 days). Sonography revealed unilateral orchitis in 58 patients (93.6%) and bilateral orchitis in only 6 (6.4%).
In our study, mumps orchitis in postpubertal vaccinated patients showed a relatively shorter febrile duration. In addition, less scrotal swelling and a lower incidence of bilaterality were found upon physical examination and ultrasonography. In the future, additional long-term follow-up is needed to determine the features of mumps orchitis in postpubertal vaccinated males, and an additional booster vaccination should be considered.
PMCID: PMC3531641  PMID: 23301132
Mumps; Orchitis; Vaccination; Young adult
21.  Metastatic Squamous Cell Carcinoma of the Kidney from Cholangiocarcinoma 
The World Journal of Men's Health  2012;30(3):198-201.
We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy.
PMCID: PMC3623539  PMID: 23596614
Neoplasm metastasis; Carcinoma, squamous cell; Nephrectomy
22.  Stent fractures after superficial femoral artery stenting 
Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site.
PMCID: PMC3433557  PMID: 22977767
Stents; Vascular patency; Femoral artery; Early intervention
23.  Association between Serum Cholesterol Level and Bone Mineral Density at Lumbar Spine and Femur Neck in Postmenopausal Korean Women 
Korean Journal of Family Medicine  2012;33(3):166-173.
Blood lipid profiles have been suggested to be a risk factor for osteoporosis. However, the association between lipid profiles and bone mineral density (BMD) is still unclear. This study aimed to evaluate an association between blood lipid profiles and BMD through both a cross-sectional and a longitudinal study.
Study subjects were 958 postmenopausal Korean women who have repeatedly undertaken laboratory tests and BMD measurements at lumbar spine and femur neck with an interval of 7.1 years. The associations between lipid profiles and BMD were examined using Spearman correlation analysis with an adjustment for age, smoking, alcohol drinking, physical activity, body mass index, and follow-up duration.
Lumbar spine BMD was not associated with total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HLD-C) regardless of when the measurement was performed. In an analysis using data measured at the beginning of the study, femur neck BMD was not associated with TC and LDL-C. However, femur neck BMD showed weak but significantly positive correlation with HDL-C (correlation coefficient, 0.077; 95% confidence interval, 0.005 to 0.149). When the analysis was repeated with data measured at the end of the follow-up, there was no significant correlation between femur neck BMD and any lipid profile. In addition, change in femur neck BMD during follow-up was not associated with the change in lipid profiles.
Although further study with a consideration of calcium intake and osteoporosis medication seems necessary, this study found no association between serum lipid profiles and BMD in postmenopausal Korean women.
PMCID: PMC3391642  PMID: 22787539
Bone Density; Cholesterol, LDL; Cholesterol, HDL; Osteoporosis
24.  Anterior vaulting of single piece in-the-bag intraocular lens after blunt trauma 
Journal of Optometry  2012;5(1):6-8.
A 64-year-old man complained of difficulty with far vision in the right eye after blunt trauma by his hand during sleep. He had undergone uneventful phacoemulsification and intraocular lens (IOL) implantation of both eyes one week before the event. On slit lamp examination, the anterior chamber was shallow compared to postoperative one day or the left eye. After mydriasis, IOL position was perfect, within the capsulorrhexis margin, and no haptics were protruded. SE of his right eye was −4.00 diopter after trauma, although spherical equivalent (SE) of both eyes was near emmetropia one day after cataract surgery. We decided on IOL reposition or exchange. Intraoperatively, we pushed the IOL posteriorly; the IOL was vaulted posteriorly, as expected. After surgery, his SE was +0.25 with the same diopter IOL. We report the case on the possibility of 4-point haptic IOL vaulting anteriorly by blunt trauma within the capsular bag.
PMCID: PMC3861315
Blunt trauma; Intraocular lens (IOL); Traumatismo contuso; Lentes intraoculares (IOL)
25.  Macintosh laryngoscope vs. Pentax-AWS video laryngoscope: comparison of efficacy and cardiovascular responses to tracheal intubation in major burn patients 
Korean Journal of Anesthesiology  2012;62(2):119-124.
Patients with major burns accompanied with airway edema need more attention for airway management. Although the Pentax-AWS has an advantage in managing endotracheal intubation more easily, its usefulness cannot be assured if it does not maintain hemodynamic stability in burn patients. The aim of this study was to compare cardiovascular responses and general efficacy of the Pentax-AWS and Macintosh laryngoscopes in burn patients.
American Society of Anesthesiologists physical status 2 or 3 adult patients with major burn injury were randomly assigned to group P (AWS, n = 50) or group M (Macintosh, n = 50). Fifty-nine patients assigned to the Macintosh group and no patient to AWS group were excluded because of failure to first intubation. Hemodynamic data at baseline, just before and after intubation as well as 3, 5 and 10 minutes after intubation and grade of sore throat were recorded in two groups. Intubation time, success rate of intubation, number of intubation attempts and the percentage of glottic opening (POGO) scores were also observed and analyzed in all patients.
A statistically significant increase in heart rate just after laryngoscopy was seen in group M. The success rate of the first attempt in group P (100%) was greater than with the group M (46%). POGO scores were higher in group P (97 ± 4%) than in group M (48 ± 29%)
The use of Pentax-AWS offers a reduced degree of heart rate elevation compared with the Macintosh laryngoscope and better intubation environments in major burn patients.
PMCID: PMC3284732  PMID: 22379565
Burns; Hemodynamics; Intratracheal; Intubation; Laryngoscopes

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