The Ultrasonographic Findings of Trigger Points of Myofascial Pain Syndrome in a Rabbit Model

PURPOSE: Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain. Myofascial trigger points (MTrPs) have been repeatedly described by numerous authors. However, there have been few studies in which their existence and behavior was supported and their location confirmed. The purpose of this study was to determine whether diagnostic ultrasonography is an objective diagnostic tool which is able to significantly identify or detect the soft tissue changes in the region of clinically identified active MTrPs by using a rabbit experimental model. MATERIALS AND METHODS: Ten MPS model rabbits were used in this study. We made an MPS animal model by causing the rabbits to overuse one leg for 3 weeks by cutting the contralateral L4 spinal nerve root. We compared the ultrasonographic findings of the taut band at pre-OP with those at post-OP during the consecutive three week period. To find the taut bands of the muscle, after skin exposure, the muscles were gently rubbed or pinched with the thumb and index finger on the two opposing surfaces of the muscle across the direction of the fibers. Then, the muscle was held in the same way, but with a 5-8 MHz stick probe being used in place of the thumb. After the palpation of various muscles, we selected the hardest and largest myofascial trigger nodule, in order to observe the ultrasonographic and power Doppler findings of the MPS. The size, shape, echogenecity and vascularity of the MTrPs were observed. RESULTS: The analysis of the results of the ultrasonography revealed that all MTrPs have a hyperechoic area. The mean thickness of the hyperechoic lesion in the biceps was 0.96+/-0.14 cm in the MPS site (at pre-OP?), and 0.49+/-0.12 cm at post-OP 3weeks (p < 0.01). The hyperechoic lesions in all of the studied biceps femoris of the rabbits were observed by high resolution ultrasonography. No definitively decreased vascularity was observed within the hyperechoic area by power Doppler imaging. CONCLUSION: Until now, there has been no objective method for the diagnosis of MPS. However, this study suggests the possibility of using diagnostic ultrasonography as an objective diagnostic tool, by identifying the tissue changes in the region of clinically indicated active MTrPs.

The Efficacy of 38 mg Low Dose Capsule-Based 13C-urea Breath Test for the Diagnosis of Helicobacter pylori Infection / 대한소화기내시경학회지

BACKGROUND/AIMS: Urea breath test (UBT), the noninvasive test for diagnosing Helicobacter pylori infection, was developed in 1987 and had advanced in accuracy and convenience by improvement of analytic device, 13C or 14C urea regimen, expiration sampling protocol and test meal. However, conventional UBT using 75 mg or 100 mg of 13C-urea is expensive and time consuming. The objective of this study was to evaluate the diagnostic performance of UBT using capsulated 38 mg low dose 13C-urea (HeliFinder(R)) developed by Medichems Co., Ltd. METHODS: A total of one hundred forty seven volunteers were enrolled and examined at Catholic University, Korea University, and Soon Chun Hyang University hospital. UBT was performed using 38 mg 13C urea capsule and compared with the gold standard methods (rapid urease test and histology). Baseline and 20 min breath samples were collected. We used delta13C 2.0permile as the cut-off value suggested by the manufacturer. RESULTS: Of the 147 subjects, 142 cases were available for analysis. The sensitivity and specificity of UBT using the 38 mg 13C urea capsule at 20 min were 98.7% and 100% respectively. CONCLUSIONS: A 20 min, 38 mg capsule based 13C urea breath test protocol is more efficient, cost effective, and convenient than conventional protocol.

Hyperacute Radiation Effect on Cerebral Cortex after Local Gamma-irradiation in the Rat Brain

OBJECTIVE: We investigated the morphologic changes within 24 hours after a single gamma-irradiation in the rat brain. METHODS: Forty Sprague-Dawley rats were used. After a burr hole trephination on right parietal area, cerebral hemisphere was irradiated with 2Gy and 5Gy using iridium-192(192Ir), respectively. The effect was assessed at 4, 8, 12 and 24 hours after irradiation. The histological changes were scored following the detection of edema or disarray severity. TUNEL-positive cells exhibiting apoptotic morphology were counted in irradiated region. RESULTS: Cortical edema and disarray were initially showed at 4 or 8hour and almost all defined at 24hour after irradiation. And the injury was wedge shape. TUNEL-positive cells were minimal at 8hour after irradiation as the number of positive cells were 2.6+/-5.27(n=5) after 2Gy, and 0.8+/-0.84(n=5) after 5Gy. But, the number of apoptotic cells were increased markedly to 60+/-6.24 at 12hour after 2Gy and to 104+/-19.7 at 24hour after 5Gy. CONCLUSION: There were prominent morphologic changes immediately after gamma-irradiation. And, apoptosis was increased according to the time period. These findings implicate that brain irradiation induces rapid apoptotic change, which may play an important role in the pathogenesis of radiation-induced pathologic conditions.

Ultrasound and Pathologic Findings of Nodules in the Medial Hamstring Muscle of the Rabbit: Experimental Study for Myofascial Pain Syndrome

OBJECTIVE: To establish the objective method of diagnosing the myofascial pain syndrome through diagnostic ultrasound and pathology. METHOD: Hamstring muscles of 7 female house rabbits, weighing 2.5~3.0 Kg, were studied. The existence of nodule was confirmed by palpation and through diagnostic ultrasound. A horizontal length, vertical length, thickness, and an area of hyperechoic region were measured. Hyperechoic regions were biopsied and stained with hematoxylin-eosin. RESULTS: All examined rabbits had muscular nodules in the medial hamstring. Characteristic increase of echogenecity was observed in the medial hamstring muscles. Some uneven hyperechoic areas were seen in the lateral hamstring muscles. Fatty degeneration and giant round cells were observed in the medial hamstring where the echogenecity was increased. The giant round cells were observed only in the lateral hamstring. CONCLUSION: Increased echogenecity of the medial hamstring muscle is probably contributed by muscles cells with fatty degeneration and giant round cells, and some portions of hyperechogenecity of lateral hamstring requires further study.

Solitary Juvenile Polyp Manifesting as Spontaneous Resection with Rectal Bleeding in a Child

Juvenile polyp of the large intestine is the most common polyp among children and has no malignant potential. We experienced a case of 3-year old male who presented with rectal bleeding and polyp. The polyp was spontaneously resected and the size was 35 50 10 mm. Pathologically, the polyp was consistent with juvenile polyp of the rectum.

Mucinous and Nonmucinous Type of Bronchioloal veolar Carcinoma: Difference in CT Findings

PURPOSE: To search for CT findings which helpfully differentiate mucinous from nonmucinousbronchi-oloalveolar carcinoma and to assess the difference in stages between the two types of tumors. Twenty-two patients with pathologically proven bronchioloalveolar carcinoma (BAC) were included inthis study. On the basis of CT findings, tumors were classified as either solitary or multiple and as eithermass/nodule, consolidation, or mixed type. CT stages of the tumors were determined by two radiologists andconclusions were reached by consensus. RESULTS: Twelve patients had nonmucinous BACs and ten had mucinous BACs.Among the ten cases of mucinous BAC, six were solitary and four were multiple. These were mass/nodule (n=3),consolidation (n=5), and mixed pattern (n=2). In contrast, among the twelve cases of nonmucinous BAC, six weresolitary and six were multiple. All were mass/nodule, except for one mixed type. Among the mucinous BACs, threewere operable and seven (above stage IIIa) were inoperable. Among the nonmucinous BACs, four were operable andeight were inoperable. CONCLUSION: Consolidation was more common in mucinous BAC and mass/nodule was more commonin non-mucinous BAC (p0.05).

An Experimental Study of Exo genous Lipoid Pneumonia: Sequential Changes in High-Resolution CT and MR Findings

PURPOSE: To evaluate sequential changes in high-resolution CT(HRCT) and MR findings of exogenous lipoidpneumonia in rabbits and to compare the radiologic and histopathologic findings. MATERIALS AND METHODS: A singleendobronchial administration of shark liver oil(0.5 or 1 ml/kg of body weight) was given to 25 rabbits. HRCT scanswere obtained immediately(n=17), at 1 day(n=14), 3 days(n=10), 1 week(n=15), 2 weeks(n=10), 4 weeks(n=9), 6weeks(n=5), 8 weeks(n=6), 10 weeks(n=4), 12 weeks(n=2), 14 weeks(n=3), and 16 weeks(n=2) after administration.Changes in distribution, extent, and attenuation were assessed on HRCT scans. MR scans were obtainedimmediately(n=12), at 1 day(n=9), 3 days(n=9), 1 week(n=15), 2 weeks(n=9), 4 weeks(n=11), 6 weeks(n=5), 8weeks(n=7), 10 weeks(n=3), 14 weeks(n=3), and at 16 weeks(n=2) after administration. Changes in distribution,extent, and signal intensity were assessed on MR scans. In 16 rabbits, CT and MR findings were compared withhistopatholo-gic findings obtained in the same plane. RESULTS: HRCT findings included consolidation withair-bronchogram, ground-glass attenuation and fat attenuation within the lesion at earlier stages(immediate-2weeks). The extent of lesions was greatest at 1 week, and was then seen to gradually decrease on follow-up CTscans. T1-weighted MR images(T1WI) showed high or intermediate signal intensity(SI) at earlier stages andintermediate SI at later stages, while T2-weighted MR images(T2WI) showed high SI at both earlier and laterstages. Histopathologic correlation showed that ground-glass attenuation and consolidation on HRCT reflectedintraalveolar lipid-laden macrophages, cuboidal metaplasia of alveolar epithelial cells, and alveolar septalwidening with inflammatory cell infiltration. Maximal infiltration of oil in the lung correlated closely with thepeak low-attenuation seen on CT scans and the high signal intensity seen on T1WI. CONCLUSION: Shark liveroil-induced exogenous lipoid pneumonia in rabbits is reliably diagnosed by HRCT and MR during earlier stages(1-2weeks). The absence of fat at later stages cannot exclude for certain a diagnosis of exogenous lipoid pneumonia.

Lymphoepithelioma-like Carcinomas of the Stomach Report of 4 cases associated with Epstein-Barr virus

Lymphoepithelioma-like carcinoma (LELC) that histologically resembles nasopharyngeal lymphoepithelioma has been reported in various sites including the stomach, salivary gland, lung, skin, thymus, tonsil and uterine cervix. LELC of the stomach was rarely reported after the first report by Burke et al. in 1990. More than 60% of them were associated with Epstein-Barr virus (EBV). Most commonly affecting elderly Asians with slight male predominance (M/F ; 1.2/1), it usually is located in the proximal portion of the stomach and distinguished from lymphoid-rich adenocarcinoma by the absence of definitive glandular differentiation in the LELC. We recently experienced 4 cases of LELC of the stomach associated with EBV. Patients consisted of two Korean females and two Korean males with one in 3rd decade, one in 5th decade and two in 6th decade. The tumors of all cases were located in the proximal portion of the stomach. Gross types were 1 Borrman type I, 2 Borrman type II and 1 early gastric carcinoma type IIc. The size of the tumors varied from 0.8 cm to 7 cm. Microscopic findings were similar in all 4 tumors.; The tumors were composed of syncytial nests of undifferentiated cells having vesicular nuclei with prominent nucleoli, admixed with abundant lymphoplasma cell infiltration in the stroma. Immunohistochemical staining revealed that the tumor cells were reactive for cytokeratin and the stromal lymphocytes were mostly T cells. There were dark hybridization signals in the nuclei of most of the tumor cells but no signals in the stromal lymphocytes in three cases on in situ PCR hybridization and on all cases PCR amplification for EBNA-1. It is concluded that LELCs of the stomach have distinctive histologic characteristics and the usual association with EBV. Further accumulation of these cases will define the prognosis.

AN EXPERIMENTAL STUDY OF PLATELET-DERIVED GROWTH FACTOR ABOUT BONE FORMATION IN DENTAL IMPLANT / 대한치과보철학회지

Bony fixation of implants during the early phase of healing is important in order to get secondary stability of the implant assuring the success of the treatment. Because the successful placement of the implant is limited by the quality and quantity of bone, other agents which stimulate bone formation in the peri-implant spaces has been illustrated. Platelet-derived growth factor (PDGF) has been shown to regulate DNA and protein synthesis in bone cells in vitro and to interact synergistically to enhance soft tissue wound healing in vivo. The purpose of this study was to evaluate bone promotion around implants which were augmented with sagittal split osteotomy or autogenous veneer bone graft using the platelet derived growth factor(PDGF). After placement of newly designed twenty four screw-type implants, which were 12mm in length and 4mm in diameter in 6 dogs. 4microgram of PDGF B/B was applied with surgicel carriers. The dogs were sacrificed at 3 days, 1, 2, 3, 6, and 12 weeks after implantation. Specimens were examined clinically, radiographically, histologically, and histomorphometrically. The results were as follows: 1. Clinically and radiologically, there was no significant difference in bone formation and healing pattern between experimental and control group. 2. In autogenous veneer bone graft group, bone formation was observed at 1st week in the experimental groups but 2nd week in the control groups. At 3rd week, the expeimental groups showed more bone formation comparing to the control groups. 3. In sagittal split osteotomy group, bone formation was observed at 1st week in both groups. But the experimental groups showed more bone formation comparing to the control groups after 2nd week. 4. The bone growth rate of experimental group was more rapid than that of control group. These results indicated that PDGF did not affect the initiation of new bone formation, but it accelerated the bone formation at the early period.

A Comparative Study of PCNA(Proliferating Cell Nuclear Antigen) and AgNORs(Argyrophilic Nucleolar Organizer Regions) in Malignancy of Brain Tumors

The authors studied the expression of proliferating cell nuclear antigen (PCNA) and the number of argyrophilic nucleolar organizer regions (AgNORs) in 94 cases of various brain tumors and in 5 cases of normal brains. PCN was recognized immunohistochemically in paraffin sections by the monoclonal antibody PC-10. AgNORs could be demonstrated using the silver impregnation method. The PCNA index was not significantly different from the histological grading of glioma(glioblastoma multiforme: 41.40+/-29.14%, anaplastic astrocytoma: 35.00+/-41.02%, and low grade astrocytoma: 22.37+/-30.85%) and there was a wide range of staining even in the same tissue section. However, the AgNORs count per cell correlated well with the pathologic grading of glioma (glioblastoma multiforme : 3.19+/-0.71, anaplastic astrocytoma : 2.06+/-0.16, and low grade astrocytoma : 1.27+/-0.29) with statistical significance. In meningiomas, AgNORs were useful to differentiate benign meningiomas(1.25+/-0.19) and malignant meningiomas(1.78+/-0.35) The authors suggest that the AgNORs count is a faster, less expensive, and a more predictive method in the malignancy of brain tumors than the PCNA immunochemistry expression.

Results of Experimental Canine Gastric Wall Ligation using 0-shaped Rubber Band / 대한소화기내시경학회지

Objectives: Endoscopic variceal ligation is well established metbod of treatment for esophageal varices whereas for gastric varices there has not been any systematic report of its use as a method of treatment. To evaluated its possible clinical application, the band ligation(banding) and the method of band ligation in conjuction with submucosal ethanolamine injection(banding with sclero) were tested on canine stomach, and results were assessed.

The prognostic significance of expression of proliferating cell nuclear antigen(PCNA) in prostatic adenocarcinoma / 대한암학회지

No abstract available.

A case of tuberculosis of the penis / 대한비뇨기과학회지

Tuberculosis of the penis is an extremely rare disease. In 1878 Fournier reported the first case and up to 1971 only 139 cases had been reported. In Korea there were some cases but no report was made in the era of antituberculous drugs. We report a case of tuberculosis of the penis and review the literature briefly.

A Case of Renal Oncocytoma Associated with Angio-invasion / 대한비뇨기과학회지

Renal oncocytoma is an epithelial tumor of the kidney with a particularly good prognosis and is composed entirely of uniform packets of eosinophilic granular cells so-called 'Oncocytic cells' The cytoplasm of the oncocytoma cells is packed with mitochondria and contains few other organelles. At present time 4 cases have been reported in Korean literature without any identifiable angioinvasive lesions. We report a case of renal oncocytoma associated with angioinvasion that was suspected preoperatively and confirmed by pathologic examination including electron microscopy postoperatively. The pathology, diagnosis and treatment of this uncomrnon entity is discussed.