The Usefulness of p16INK4a Immunocytochemical Staining in ASC-H Patients

BACKGROUND: The grey zone of cervical cytology, and in particular atypical squamous cells, cannot exclude HSIL (ASC-H) causes diagnostic difficulties and increases medical expenses. We analyzed p16INK4a expression in ASC-H liquid-based cytology specimens (LBCS) to develop more effective methods for the management of ASC-H patients. METHODS: We carried out p16INK4a immunostaining with 57 LBCS of ASC-H diagnostic categories, all of which were histologically cofirmed and 43 cases of which were compared with the results of a human papillomavirus (HPV) chip test. RESULTS: p16INK4a immunostaining with ASC-H LBCS was positive in 20% (3/15) of cervicitis, 25.0% (3/12) of tissue-low-grade squamous intraepithelial lesion, 75.0% (18/24) of tissue-high grade squamous intraepithelial lesion (HSIL), and 100% (6/6) of invasive cancer cases. The positivity of p16INK4a in LBCS was correlated with higher grade of histologic diagnosis (r=0.578, p=0.000). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of p16INK4a immunostaining for the prediction of tissue-HSIL+ were 80.0%, 77.8%, 80.0%, and 77.8%, respectively. The sensitivity, specificity, PPV, and NPV of p16INK4a immunostaining plus HPV chip test for predicting tissue-HSIL+ were 71.2%, 86.4%, 84.2%, and 79.2%. CONCLUSIONS: p16INK4a immunostaining as well as HPV chip testing with remaining LBCS with ASC-H are useful objective markers for the prediction of tissue-HSIL+.

Glutathione S-transferase polymorphism of neonatal hyperbilirubinemia in Korean neonates / 소아과

PURPOSE: Glutathione S-transferase (GST) is a polymorphic supergene family of detoxification enzymes that are involved in the metabolism of numerous diseases. Several allelic variants of GSTs show impaired enzyme activity and are suspected to increase the susceptibility to diseases. Bilirubin is bound efficiently by GST members. The most commonly expressed gene in the liver is GSTM1, and GSTT1 is expressed predominantly in the liver and kidneys. To ascertain the relationship between GST and neonatal hyperbilirubinemia, the distribution of the polymorphisms of GSTT1 and GSTM1 were investigated in this study. METHODS: Genomic DNA was isolated from 88 patients and 186 healthy controls. The genotypes were analyzed by polymerase chain reaction (PCR). RESULTS: The overall frequency of the GSTM1 null was lower in patients compared to controls (P=0.0187, Odds ratio (OR) =0.52, 95% confidence interval (CI), 0.31-0.88). Also, the GSTT1 null was lower in patients compared to controls (P=0.0014, OR=0.41, 95% CI=0.24-0.70). Moreover, the frequency of the null type of both, in the combination of GSTM1 and GSTT1, was significantly reduced in jaundiced patients (P=0.0008, OR=0.31, 95% CI=0.17-0.61). CONCLUSION: We hypothesized that GSTM1 and GSTT1 might be associated with neonatal hyperbilirubinemia. However, the GSTT1 and GSTM1 null type was reduced in patients. Therefore the null GSTT1, null GSTM1, and null type of both in the combination of GSTM1 and GSTT1 may be not a risk factor of neonatal jaundice.

Paraganglioma of the Thyroid: A Case Report

Paragangliomas (PGs) of the thyroid are very rare tumors. Based on the medical literature, thyroid PGs invariably affected women and they were always thought to be benign, and they have always been mistaken for other more common lesions. We report here on the first case of PG of the thyroid in a 45-year-old man in Korea. Ultrasonographically, the tumor showed hypoechoic features. Microscopically, the tumor showed the typical zellballen pattern. The small to medium-sized tumor cells contained moderate amounts of finely granular eosinophilic cytoplasm and round to oval nuclei with fine chromatin. The tumor invaded the thyroid capsule and the extrathyroidal tissue with vascular and perineural invasion. Immunohistochemically, the tumor showed positivity for chromogranin, S-100 protein, CD56a, and synaptophysin and negativity for calcitonin, thyroglobulin, galectin-3, p53, CK19, and EMA. The Ki-67 labeling Index was 10%. We concluded that our case has a high potential of metastasis, and a close follow up would be important.

Perioperative Complications of Lumbar Total Disc Replacement / 대한정형외과학회잡지

PURPOSE: To investigate the perioperative complications and their effect on the clinical outcomes after a lumbar total disc replacement (TDR). MATERIALS AND METHODS: Forty-three patients (18 men and 25 women) who had undergone a lumbar TDR from May 2002 and May 2004 were reviewed. Subgroup analysis was performed to determine if age, gender, previous discectomy, multilevel, learning curve of operator, or the difference between preoperative and postoperative disc height were associated with the development of intraoperative or postoperative complications. The patients rated their low back pain on a visual analogue scale and completed an Oswestry disability index (ODI) at the preoperative and postoperative follow-up. RESULTS: There were 4 cases of intraoperative complications (2 major vein injuries and 2 peritoneal rupture) and 8 cases of postoperative complications (6 radicular pains, 1 subsidence of implant, and 1 dissociation of endplate and polyethylene core). There were no significant differences in the incidence of complications according to age, gender, prior surgery, multilevel, learning curve, or disc height difference (p>0.05). In addition, there were no significant differences in the VAS and ODI between the complication and non-complication groups. CONCLUSION: The authors experienced a relatively high rate of complications (11/43 patients) following TDR and statistical analysis did not reveal any associated risk factors.

Popliteal Artery Entrapment Syndrome: A Case Report / 대한정형외과학회잡지

Popliteal artery entrapment syndrome is a rare but potentially limb threatening anatomical anomaly occurring predominantly in young adults. We experienced a case of a 19 year old man who had suffered from a coldness of his left lower leg, without past history of trauma. Angiogram and MRI were performed and we diagnosed as a popliteal artery entrapment syndrome. The popliteal artery was entrapped in its abnormal course around the medial head of the gastrocnemius muscle, which originated from the femur laterally and the cephalad. Thrombectomy, decompression of the popliteal artery and reposition of the medial head of the gastronemius muscle were successfully done. Blood flow was restored after surgical repair.

Asymmetric Exercise and Scoliosis: A Study of Volleyball Athletes / 대한정형외과학회잡지

PURPOSE: To determine the prevalence of scoliosis in volleyball athletes and compare this with the prevalence in the general population. MATERIALS AND METHODS: One hundred and sixteen volleyball athletes who had been enrolled in the activity for more than one year were examined for prevalence of scoliosis. The Adams forward bending test was performed with a measurement of the truncal asymmetry using a scoliometer (Orthopaedic System, Inc, USA). Those atheletes who showed more than 5degreesof measurement were selected for an X-ray evaluation. Data from a randomized point prevalence survey of Korean Middle school students (46,428) in Seoul City, which had been performed by our department, was adopted for the control group. RESULTS: Among the 116 volleyball players, 60 (51.7%) showed more than a 5degreesof angle of trunk rotation, whereas controls of middle school students showed 2.5%. Cobb's angle more than 10degrees was 6 (5.17%) in athletes and the control group was 465 (1.0%). Despite higher frequency of prevalence, the Cobb' angle was below 15degrees whereas the control group showed a severe scoliosis which of Cobb's angle reaching to 45degrees. CONCLUSION: Volleyball athletes showed a higher incidence of truncal asymmetry and scoliotic spinal columns than the control group. However, we were able to conclude that asymmetrical muscle development can produce a mild scoliosis. However this doesn't have the potential for a severe progression as found in some cases of idiopathic scoliosis.

Idiopathic Scoliosis in Korean Middle School Students: Prevalence study / 대한정형외과학회잡지

PURPOSE: To update and reevaluate the scoliosis prevalence in middle school students in Korea, and correlate those data with past references and other countries general prevalence. MATERIALS AND METHODS: Among the middle schools in Seoul city, forty-five middle schools were randomly selected for screening. Total number of students were 46,428 who were screened for the prevalence of adolescent idiopathic scoliosis. There were 24,892 boys and 21,536 girls. Their age ranged from 12 to 15 years. Adams forward bending test and "Scoliometer" (Orthopaedic Systems, Inc, USA) were used to detect and measure the degree of rotation of trunk. Students more than 5 (ATR were assessed subsequently by standardized clinical and radiological examinations. RESULTS: Using 10 degrees as cut-off points, 465 students were found to have structural idiopathic scoliosis, representing a prevalence of 0.9% overall. CONCLUSION: The prevalence of the scoliosis has not changed from previously estimated rates in Korea, which was about 20 years ago. It nearly approximates with the prevalence of the world wide reported. We also confirmed that it is not necessary to issue a mass screening, considering the cost and effectiveness aspect, due to its low prevalence.

Eccrine Squamous Syringometaplasia

An eccrine squamous syringometaplasia (ESS) is defined as a mature squamous metaplasia of the eccrine ducts. The clinical and pathological features of an ESS are presented. Syringometaplasia is a rare lesion, mostly occuring in the extremities, and as far as we know, no report on the ESS has been published in Korean literature. We experienced a case of an ESS occured in a 15 year-old male, who had a tender erythematous plaque in the right knee. The histologic examination revealed some scattered nests of metaplastic squamous epithelium in the deep dermis, associated with acute nonspecific panniculitis. The importance of the ESS is that it histologically simulates the well differentiated squamous cell carcinoma. The histopathologic findings were discussed and a brief review of the literature was made.

Interfollicular Hodgkin's Lymphoma: A case report

An unusual pattern of focal involvement of lymph nodes by Hodgkin's disease is described using the name Interfollicular Hodgkin's Disease. It is characterized by florid reactive follicular hyperplasia which overshadows involvement of the interfollicular zones by Hodgkin's desease. The importance of interfollicular Hodgkin's disease rests on its misdiagnosis as a benign lesion. We report a case of interfollicular Hodgkin's disease in a 34-year-old female patient in the inguinal area. The lymph nodes showed reactive follicular hyperplasia. The focal interfollicular spaces were invaded by Hodgkin's disease. The Reed-Stemberg cells stained positively with CD15 and CD30 antibody in the immunohistochemical stain. An in situ hybridization study looking for EBV was negative in these R-S cells.

Gastric Duplication

Gatric duplication is a rare congenital anomaly. Thus for about 90 cases of gastric duplication have been recorded in the literature. It is less frequent than small intestinal or eosphageal duplication, and accounts for only 3.8% of all gastrointestinal tract duplication. Most gastric duplications are seen during the first year of life. Palpable abdominal mass and gastric outlet obstruction in infancy are most common presentation. We experienced a case of non-communicating gastric duplication. A 12-year-old girl visited St. Mary's Hospital because of indigestion, intermittent vomiting, and left upper quandrant pain for about 40 days. She have had intemittent abdominal pain with concomitant increased level of amylase since 5 years old. Physical examination showed a hen's egg sized palpable mass on left upper quadrant of the abdomen. Upper GI series and barium enema revealed only indentation of duodenal C-loop, and sonogram and abdominal CT demonstrated isolated cystic mass along the greater curvature of gastric antrum. She had taken an operation under the impression of pancreatic pseudocyst. Operation revealed a cystic mass, located along the greater curvature. There was no pathologic change in the pancreas. Microscopic findings of the cyst wall revealed normal gastric mucosal lining and common muscle layer, shared with gastric antral muscle layer.