Aneurysmal Neck Clipping as the Primary Treatment Option for Both Ruptured and Unruptured Middle Cerebral Artery Aneurysms

OBJECTIVE: Although middle cerebral artery (MCA) aneurysms are less amenable to coil embolization, an increasing number of studies support favorable endovascular treatment for them. The purpose of this study is to compare the outcomes of two different treatments (surgery versus coiling) and evaluate the benefits of surgical clipping for MCA aneurysms. METHODS: Here we retrospectively analyzed the outcomes of 178 ruptured and unruptured MCA aneurysms treated in patients between September 2008 and April 2012. Parameters assessing treatment outcomes include degree of aneurysm occlusion, presence of regrowth, clinical status, and complications. RESULTS: Among 178 MCA aneurysms, 153 were treated surgically. After a mean follow-up of 12 months, the surgery group showed a clinically significant complete occlusion rate (98%) compared with the coiling group (56%) (p<0.001). Follow-up radiologic evaluation showed a higher regrowth rate (four of 16 cases) in the coiling group than in the surgery group (one of 49 cases) (p=0.003). There was no statistically significant difference in favorable clinical outcome rate between the two groups. The procedure-related permanent morbidity and mortality rates were 2% (three of 153 cases) in the surgery group and 0% (0 of 25 cases) in the coiling group. CONCLUSION: Compared to endovascular treatment, surgical neck clipping for both ruptured and unruptured MCA aneurysms results in a significantly higher complete obliteration rate and less regrowth. Therefore, even in this endovascular era, we still recommend surgical clipping as the primary treatment option for MCA aneurysms rather than coil embolization.

The seven-year cumulative survival rate of Osstem implants

OBJECTIVES: This study was performed to analyze the cumulative survival rate of Osstem implants (Osstem Implant Co., Ltd.) over a seven-year period. MATERIALS AND METHODS: A total of 105 patients who had 467 Osstem implants that were placed at the Section of Dentistry, Seoul National University Bundang Hospital (Seongnam, Korea) from June 2003 through December 2005 were analyzed. The life table method and a cross-tubulation analysis, log rank test were used to evaluate the survival curve and the influence that the prognostic factors. The prognostic factors, i.e., age and gender of patients, diameter and length, type of implants, bone graft history and loading time were determined with a Cox proportional hazard model based on logistic regression analysis. RESULTS: The seven-year cumulative survival rate of Osstem implants was 95.37%. The Cox proportional hazard model revealed that the following factors had a significant influence on survival rate; increased diameter, reduced prosthetic loading period and performance of bone grafting. CONCLUSION: The osstem implants showed satisfactory results over the seven-year study period.

Resorption of bone graft after maxillary sinus grafting and simultaneous implant placement

OBJECTIVES: The purpose of this study was to evaluate the sinus bone graft resorption over 3 years after two-stage implant placement. MATERIALS AND METHODS: The subjects for this study included 30 patients whose maxillary posterior ridges were too atrophic for implants. Bone-added osteotome sinus floor elevation was used in 15 maxillary sinuses, while the bone graft by lateral approach technique was used in 25 maxillary sinuses. The height from the top of the fixture to the sinus floor was estimated immediately after implant placement and the follow-up period was over 3 years. The surgery was classified with two groups: sinus bone grafting with and without autogenous bone. All implants were placed simultaneously. RESULTS: The mean vertical bone loss was 3.15+/-2.95 mm. The survival rate of implants was 94.7%. CONCLUSION: The amount of bone resorption was not significantly associated with the surgical methods, the type of bone graft materials used, or sinus perforation during surgery.

Corrigendum: The seven-year cumulative survival rate of Osstem implants

This correction is being published to correct the errors of sentences and spelling in abstract.

An Analysis of the Surface Anatomical Location of the Posterior-inferior Margin of the Sacroiliac Joint

BACKGROUND: The blind sacroiliac joint (SIJ) block cannot always be performed accurately; it is commonly performed in the office based setting because intraarticular and periarticular injections are effective for SIJ pain. However, knowledge on the surface anatomy of the SIJ is lacking. The purpose of this study was to analyze the surface anatomical location of the posterior-inferior margin of the SIJ. METHODS: After informed consent was obtained, fifty patients undergoing SIJ block in the prone position were examined. The oblique angles where the anterior-inferior margin and the posterior-inferior margin of the SIJ overlap on X-ray were evaluated. In addition, the surface anatomical relationships between the posterior-inferior margin of the SIJ on X-ray and the posterior superior iliac spine (PSIS) and sacral hiatus by palpation were assessed. RESULTS: The oblique angle was 5.4 +/- 2.9degrees. The vertical and transverse distance between the posterior-inferior margin of the SIJ and PSIS were 3.8 +/- 0.8 cm and 0.9 +/- 0.6 cm, respectively. The vertical and transverse distance between the posterior-inferior margin of the SIJ and the midpoint of the sacral hiatus were 3.4 +/- 0.7 cm and 3.9 +/- 0.6 cm, respectively. Only the vertical distance between the posterior-inferior margin of the SIJ and PSIS showed significant difference between the male and the female groups (P = 0.0016). CONCLUSIONS: The measurements in this study can be used as a reference standards for the blind SIJ block.

Effect of prophylactic continuous infusion of isosorbide dinitrate on myocardial protection and hemodynamics in patients undergoing off-pump coronary bypass surgery

BACKGROUND: Multi-vessel off-pump coronary bypass surgery (OPCAB) imposes cumulative myocardial ischemia/reperfusion injury, which may be attenuated by continuous infusion of nitrate. However, nitrate infusion and consequent decrease in preload may be hazardous during heart displacement which causes restrictive filling of the ventricles. Therefore, we evaluated the effect of nitrate infusion on myocardial protection and hemodynamics in patients undergoing OPCAB, in a prospective, randomized and controlled trial. METHODS: Fifty patients with stable angina and left ventricular ejection fraction >40% undergoing elective, isolated, multivessel OPCAB were enrolled. Patients were randomized equally to either continuous infusion of isosorbide dinitrate 0.5microg/kg/min or same amount of normal saline during the surgery. Operative data including hemodynamic variables, intraoperative ST segment changes and postoperative cardiac enzyme release (creatine kinase-MB, troponin T) were compared. RESULTS: Patients characteristic and operative data including ST segment changes and use of vasopressors were similar between the groups except the total amount of infused crystalloid during the surgery which was significantly higher in the nitrate group. Postoperative variables including cardiac enzyme release were also similar between the groups. CONCLUSIONS: Prophylactic continuous infusion of nitrate during OPCAB exerted no additional benefit in terms of myocardial protection. It also, was not associated with accentuated decrease in cardiac output during heart displacement, and the decrease in preload seems to have been nullified by modest increase in fluid therapy.

Cardiovascular effects of oral tri-iodothyronine in patients undergoing valvular cardiac surgery / 대한마취과학회지

BACKGROUND: Cardiopulmonary bypass produces a state of functional hypothyroidism characterized by low levels of circulating tri-iodothyronine (T3). Theoretically, supplementing T3 should result in improved hemodynamics as well as patients' outcome. The aim of the present study was to determine whether pretreatment with single oral T3 could prevent serum T3 reduction, and improve hemodynamics and clinical outcome. METHODS: Forty-seven patients undergoing valvular heart surgery were included in the study. Patients were randomly assigned into two groups (T = T group; C = control group) the day before surgery and received single oral T3 40 microg or placebo before operation. Blood samples were collected for determination of serum levels of total T3, T4 and TSH before administration of oral T3 or placebo (baseline), 1, 6 and 18 hour after weaning of cardiopulmonary bypass. Hemodynamic parameters and medication were recorded during the intraoperative period and throughout the first 24 h after arrival at the intensive care unit. RESULTS: T3 levels were significantly higher in the T group 1 hr after weaning of cardiopulmonary bypass. T3 levels in the T group were all maintained within the normal range throughout the study period, whereas it was decreased to below normal level in the C group at 18 hr after weaning of cardiopulmonary bypass. In the T group, vasoactive agent requirements were reduced during and after cardiopulmonary bypass. CONCLUSIONS: Pretreatment with single oral T3 prevented the reduction in T3 level after valvular heart surgery, with subsequent reduction in vasoactive agent requirement.

The association of KLOTHO gene polymorphism with coronary artery disease in Korean subjects / 대한내과학회지

BACKGROUND: Klotho knock-out mouse is being thought as a good animal model for human aging and these mice show typically severe atherosclerosis of large arteries. Recent studies report on the association of KLOTHO gene mutation with cardiovascular diseases in humans. We observed the frequencies of G395A in promoter and C1818T in exon 4 of KLOTHO gene and investigated their relationships with the presence of coronary artery disease (CAD) in those patients underwent coronary angiograms METHODS: Total 168 subjects (mean age 58 years, 26-87 years) who underwent coronary angiograms due to chest pain were enrolled and blood pressure, body mass index, fasting blood glucose and lipid profiles were measured in all subjects. Genotypings were performed with real-time polymerase chain reaction from sampled blood. RESULTS: The allele frequencies of G395A were 0.872 for G allele and 0.128 for A allele and those of C1818T were 0.830 for C allele and 0.170 for T allele. Both were in compliance with Hardy-Weinberg equilibrium (p=0.99, p=0.82). When the subjects were classified into four groups according to the number of stenotic vessels, there were no differences among the mean values of the cardiovascular risk factors, except high-density lipoprotein cholesterol, that showed a significant difference between that of normal and the diseased vessel groups. There were no differences in the prevalence of CAD according to the genotypes of G395A polymorphism, but for C1818T polymorphism, subjects with T allele showed lower prevalence of CAD than those with CC genotype. When the subjects were divided into two groups according to age, in the group under 60 years of age, T allele carriers of C1818T polymorphism showed lower prevalence of CAD than non-carriers. In the group older than 60 years, A allele carriers of G395A polymorphism showed lower prevalence of CAD than non-carriers. CONCLUSIONS: The frequencies of KLOTHO G395A and C1818T polymorphisms in Koreans were observed similarly to those reported in other Asian races and the phenotypic expression on CAD was different according to age groups. These results infer the possibility of KLOTHO gene as the candidate gene of atherosclerosis in humans, which needs further research.

Association between two SNPs (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases / 대한내과학회지

BACKGROUND: Adiponectin, an adipocyte-secreted protein, is known to have anti-atherogenic, anti-inflammatory and anti-diabetic properties. Adiponectin levels are decreased in obesity, type 2 diabetes, and coronary artery disease. Several studies have been performed aiming to investigate the association of genetic variations in the adiponectin with obesity, insulin resistance, and type 2 diabetes but few studies were performed in association with coronary artery disease. Therefore we examined the association between two single nucleotide polymorphisms (SNPs) (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases (CAD). METHODS: One hundred fifty six subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (97 males, 59 females, mean age 57.40+/-11.15 yrs). Body mass index, fasting blood glucose, lipid profiles were measured in every subject. Single nucleotide polymorphisms (SNPs) in the adiponectin gene were determined by Taqman polymerase chain reaction (PCR) method. The presence of CAD was defined as a >50% reduction of coronary artery diameter. RESULTS: Among 156 subjects, the allele frequencies were 0.683 for G allele and 0.317 for T allele in SNP +276G>T and 0.705 for T allele and 0.295 for G allele in SNP +45T>G. Both genotypes were in compliance with Hardy-Weinberg equlibrium. Mean serum fasting glucose level was significantly higher and mean high-density lipoprotein cholesterol (HDL-C) level was lower in CAD groups (p=0.015, p=0.004). No association with the presence of CAD was observed for adiponectin gene SNP276 and SNP45 (p=0.954, p=0.843). Also, no significant association was observed between the severity of CAD and either SNPs (p=0.571, p=0.955). CONCLUSIONS: Our study showed that SNP +276G>T and +45T>G in adiponectin gene were not associated with the presence of CAD. Further studies will be necessary to confirm the role of SNP 276G>T and 45T>G in the development of CAD.

Association between serum osteoprotegerin levels and disease severity and cardiovascular risk factors in patients with coronary artery diseases / 대한내과학회지

BACKGROUND: Osteoprotegerin (OPG) is a glycoprotein that acts as a decoy receptor to receptor-activated RANKL (receptor-activated NF-kappa B ligand) and inhibits the differentiation of osteoclasts. OPG knock-out mice showed severe osteoporosis and aortic calcification and high serum OPG levels have been shown to predict future cardiovascular mortality in old Caucasian females. We measured serum OPG levels in coronary artery disease patients, compared serum OPG levels among different groups according to the number of stenotic vessels and observed the correlation with aortic calcification and cardiovascular risk factors. METHODS: One hundred subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (59 males, 41 females, mean age 56.9 +/- 11.9 yrs). Blood pressure, body mass index, fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were measured in every subject. Cardiac echocardiograms were checked in 82 subjects and left ventricular mass indices (LV mass index) were calculated. Serum OPG levels were measured with enzyme-linked immunosorbent assay (ELISA) method. The presence of calcifications in aortic knob was checked in simple chest X-ray. RESULTS: Subjects were divided in 4 groups according to the number of stenotic vessels (significant stenosis>or=50%); 45 subjects in normal group, 30 in 1-vessel disease group, 15 in 2-vessel disease group and 10 in 3-vessel disease group. Mean value for age was significantly different among groups (p<0.01). Mean serum HDL-cholesterol level of normal group was higher than that of 1-vessel disease or 2-vessel disease group (p<0.05). Serum OPG levels increased significantly as the number of stenotic vessels increased and in post-hoc analysis, mean serum OPG levels were higher in 3-vessel disease group than normal or 1-vessel disease groups (p<0.05). Age, LV mass index and number of stenotic vessels showed significantly positive correlation with serum OPG levels, although only number of stenotic vessels showed persistently significant correlation after adjustment for age. There were no differences of serum OPG levels according to the presence of fasting hyperglycemia or aortic calcifications. CONCLUSION: Serum OPG levels increased as the number of stenotic coronary arteries increased and showed positive relationships with age, LV mass index. OPG seems to be elevated as a compensatory mechanism to the progression of atherosclerosis in humans.

Comparison of Periodontology Terminology between South and North Korea / 대한치주과학회지

Background: Terminology is a good index of reflections in conceptional imaginations, trends and technological advances in the field of their own. The purpose of this study is to compare the similarity and difference of terms in periodontology to evaluate the communicability between South and North Korea. These result may be particularly helpful for making glossary, academic communication and social unity at the time of reunion. Methods: This study was carried out by searching northern periodontology terminologies used in literatures published in North Korea and comparing those terms with the southern terms. The standard northen terms were not able to be distinguished, so the terms used frequently were chosen as the standard northern terms. Results: The South and North both use terms that stem from Chinese characters, but this tendency is stronger in the South. The main differences between the South and North are due to the North Korea's effort in converting terms into the native languages. There are also some differences in inscription of foreign language, spelling and spacing, and so on. Conclusion: The terminology using in South and North Korea in the field of periodontology is somewhat different but both side can be capable of communication. Now the basic efforts in both parts must be taken, such as establishing new terms, in order to relieve these differences.

A Case of Twin Pregnancy with Fetus Papyraceus Prenatally Diagnosed / 대한주산의학회잡지

No abstract available.

A Case of Rudimentary Uterine Horn associated with Agenesis of right Kidney and Pelvic Endometriosis / 대한산부인과학회잡지

Congenital M llerian anomalies of uterus are so infrequently encountered and endometriosis, primary infertility, hematometra, and urinary tract anomalies are claimed to be common complaints in women with unicornuate uterus. We report one case of rudimentary horn associated with agenesis of right kidney and pelvic endometriosis which is presented with brief review of literature about anomaly of the female genital tract.

Home-made Rapid Urease Test for Detection of Helicobacter pylori Infection / 대한임상미생물학회지

BACKGROUND: The rapid urease test has been widely used for detection of Helicobacter pylori infection because it is easy, simple and rapid result. The CLO test and PyloriTek test observe color changes after the gastric biopsy specimens are inerted into the test kits. Because H. pylori is not evenly distributed in the gastric mucosa, grinding or mincing of gastric specimens prior to culture enhances isolation rate of H. pylori. Therefore, we evaluated the effects of rubbing the gastric biopsy specimens onto the urea soaked filter paper in this home-made rapid urease test. METHODS: Forty-three patients referred for upper gastrointestinal tract endoscopy were evaluated for H. pylori infection. The home-made rapid urease test was prepared by soaking a piece of Whatman No. 2 filter paper in 2% urea agar. We compared the results of the home -made rapid urease test with histologic examination, gram stain, CLO test and culture. RESULTS: Of forty-three patients, 28 were found to be H. pylori-positive either by gram stain or by culture. The sensitivity and specificity of CLO test, based on the results of gram stain and culture were 85.7% and 92.9%. The sensitivity and specificity of home -made rapid urease test, based on the results of gram stain and culture were 92.9% and 92.9%. CONCLUSIONS: The home-made rapid urease test is faster and shows a high sensitivity and specificity.

MR Imaging of Gestational Trophoblastic Tumor: Role of Gadolinium Enhancement

PURPOSE: To investigate the role of gadolinium enhanced MR imaging in the evaluation of gestational trophoblastic tumors (invasive mole and choriocarcinoma). MATERIALS AND METHODS: Pre-enhanced T1-and T2-weighted images and gadolinium enhanced T1-weighted images of 34 gestational trophoblastic tumors (15 choriocarcinomas, 19 invasive moles) were evaluated retrospectively. Enhanced patterns of gestational trophoblastic tumors were analyzed. Morphologic differences and structural characterstics were analyzed by the evaluation of tumor margin, patterns of hemorrhagic necroses, development of intratumoral vascularity, and molar villi. Graded scores of MR findings between pre- and gadolinium enhanced images were given in the following criteria ; 1) visualization of tumor margin 2) distinction between tumor necrosis and zone of trophoblastic proliferation, and 3) molar villi. Statistical differences between graded scores of pre-and post-enhanced images were analyzed. RESULTS: Choriocarcinoma was a well-defined mass with peripheral rim enhancement and central hemorrhagic necrosis. Invasive mole was a ill-defined mass with partial necrosis, tiny cystic areas and increased intratumoral vascularity with dense reticular enhancement. Interface between tumor necrosis and zone of trophoblastic proliferation was better visualized on the gadolinium enhanced images than on the pre-enhanced images. Tumor margin and intratumoral molar villi were clearly discrimated on the gadolinium enhanced images only in invasive mole. There was no statistical difference in the visualization of tumor margin of choriocarcinoma between the pre-and post-enhanced images. CONCLUSION: Gadolinium enhanced MR image was helpful in the visualization of tumor characterstics in gestational trophoblastic tumors, and in the differential diagnosis between invasive mole and choriocarcinoma.