Radiologic Findings and Risk Factors of Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion : A Retrospective Matched Cohort Study with 3-Year Follow-Up Using MRI

OBJECTIVE: The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). METHODS: A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. RESULTS: Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. CONCLUSION: The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

Caffeine Consumption and Its Related Symptoms in University Students

BACKGROUND: Although caffeine is commonly consumed substance and not seriously harmful as compared to alcohol and nicotine, Korea is planning to mark on the products which contain caffeine above a definite level with "containing large amounts caffeine". At this point in time, the study concerning caffeine related symptoms is in need. METHODS: After surveying university students by using self-administered questionnaires based on DSM-IV substance related disorder, healthy 810 subjects were assessed for socio-demographic characteristics and features of caffeine intake and its dependence, withdrawal, and intoxication. RESULTS: The mean amount of caffeine consumption in 810 subjects was 120.49 mg (median=93.0) per day. The major features of caffeine dependence were as follows: tolerance (61.1%), withdrawal (46.3%), using more or longer than intended (46.0%), and unsuccessful attempt to cut down or control use (12.6%). The prevalence was increased by daily caffeine consumption. Among 711 subjects who had experienced no caffeine consumption over 24 hours {amount of daily caffeine consumption was 116.0 mg (median=86.5)}, 6.19% showed significant distress in usual activity, and 22.1% used caffeine contents to avoid withdrawal symptoms. The prevalence of caffeine withdrawal based on DSM-IV research criteria was 2.67% and the frequency for symptoms were as follows: fatigue (37.7%), drowsiness (17.6%), headache (14.5%), an anxiety (8.3%). In addition, the prevalence of caffeine intoxication was 2.1% and the frequency for symptoms were as follows: insomnia (41.9%), diuresis (35.8%), tachycardia (26.7%), and gastrointestinal disturbance (23.3%). CONCLUSION: The unwanted symptoms related to caffeine withdrawal or intoxication were common in students using caffeine. Therefore, major features of caffeine-related symptoms should be considered in primary care practice.

The Effects of Depressive Symptoms to Metabolic and Glycemic Control among Type 2 Diabetes Patients

BACKGROUND: Depression is common among type 2 diabetic patients. To determine the relationship between depressive symptoms and metabolic control, we evaluated the risk factors that are related to metabolic control in diabetic patients. METHODS: This study was performed among 356 type 2 diabetic outpatients, who visited the Department of Family Medicine and Endocrinology, Samsung Medical Center, from November 2003 to January 2004. The data were collected through questionnaire about sociodemographic features diabetes-related factors and health behaviors. Beck Depression Inventory (BDI) was administered to measure depressive symptoms. The medical records were reviewed to confirm metabolic controls including HbA1c, lipids, blood pressure, body mass index (BMI), past medical history, and prescriptions. RESULTS: The prevalence of depressive symptoms (BDI> or =11) was 35.4%, including severe symptoms (BDI> or =21) 6.8%. There were significant graded relationships between greater depressive symptoms and higher serum level of HbA1c (P=0.000) and LDL-cholesterol (P=0.046). In binary logistic regression analysis, low level of exercise (OR=1.97; 95% CI=1.18~3.28), lack of exercise (OR= 2.94; 95% CI=1.28~6.77), poor LDL-cholesterol control (OR=1.94; 95% CI=1.19~3.18), and depressed group (OR=2.20; 95% CI=1.35~3.60) were significantly associated with poor glycemic control. CONCLUSION: There is a significant association between depressive symptoms and glycemic control of type 2 diabetes. Therefore, family physicians who provide continuous and comprehensive primary care should be more concerned for depressive symptoms in type 2 diabetes patients.

The Bone Regenerative Effect of Calcium Sulfate- chitosan Complex Powder and Chitosan Microsphere Encapsulating Growth Hormone on Bone Formation in Bone Defect of Rabbits

This study was carried out on 32 New Zealand white rabbits, each weighing 3-3.5kg. Eight rabbits were allocated into each of four groups. The groups were a control group(I), hyaluronic acid group(II), chitosan microsphere encapsulating growth hormone group(III), calcium sulfate-chitosan powder group(IV). After a 1cm sized ostectomy was made on the tibial body with the periosteum preserved, artificial bone substitutes were implanted. Except group I, 1ml of hyaluronic acid were implanted in group II, 1ml of chitosan microsphere encapsulating growth hormone in group III, 1ml of manufactured calcium sulfate-chitosan complex powder in group IV. Results were evaluated using radiographic study every week, bone mineral density test and histologic examination at 2, 4, 6 weeks and three point bending test at 6 weeks after implantation. In the radiographic study, the formation and corticalization of callus were seen similarly in group III, IV and much more and earlier than group I, II. In the bone mineral density test and three point bending test to contralateral normal tibia in 6 weeks, the values in groups III and IV were statistically significantly higher than in group I and II(p<0.05). In histologic examination, group III and IV have more abundant and faster new boner formation than group I and II. In conclusion, calcium sulfate-chitosan complex powder and chitosan microsphere encapsulating growth hormone facilitates the formation of new bone. They will be used effectively as a bone substitute on defected bone in clinical situations.

One case of Kartagener's syndrome with extracemtral microtubule in cilia / 대한내과학회지

Kartagener's syndrome is an autosomal recessively inherited condition characterized by triad of situs inversus, bronchiectasis, and chronic sinusitis. And recently it was classified as a subclass of dyskinetic cilia syndrome, which has a defect in mucociliary transport resulting from immotile or dyskinetic beating of cilia. Electron microscopic examination of the cilia from sperm tails, nasal and bronchial epithelium of patients reveals the partial or the complete absence of dynein arms or radial spoke, or microtubule disposition. This patient had all the triad of Kartagener's syndrome and showed two extracentral microtubules on the electron microscopic examination of the nasal mucosa. Most patients have dynein arms defect, but it is rare to have extracentral microtubules. So we report one case of Kartagener's syndrome with extracentral microtubules confirmed by electron microscopy.

Clinical Significance of Nasal Peak Inspiratory Flow Rate in Patients with Chronic Cough / 결핵

BACKGROUND: The upper respiratory tract is the primary target organ of various airborne pollutants and is easily accessible part of the respiratory tract, and also is the predominant structure where chronic cough originates. The nasal peak inspiratory flow(PIFn), which is the peak inspiratory flow via nose with nasal mask and spirometry, could be a reliable parameter of nasal obstruction. The validity of PIFn has been evaluated in several studies by assessing the correlation between PIFn measurements and other parameters of nasal air flow. This study was designed to show the reproducibility of PIFn, the difference of PIFn between patients with chronic cough and normal subjects, and the usefulness of PIFn in the evaluation of nasal obstruction in patients with chronic cough. METHODS: PIFn was measured by spirometry with nasal mask, twice a day for 3 consecutive days in 7 young normal subjects to evaluate validity of the test. In 32 patients with chronic cough and 25 age-matched normal subjects, PIFn and pulmonary function test(FEV1, FEV1%pred, FVC, and FVC%pred) were measured at first visiting. RESULTS: Values of PIFn, FEV1, and FVC were nearly constant in 7 young normal adults. Patients with chronic cough were 32 (14 males and 18 females) and the mean age was 41.4+/-15.9 years. Normal subjects were 32 (22 males and 10 females) and the mean age was 39.8+/-18.6 years. There was no significant difference of age and pulmonary function test between patients with chronic cough and normal subjects(p<0.05). The PIFn values in patients with chronic cough was significantly lower than those of normal subjects(2.25+/-0.68 L/sec vs. 2.75+/-1.00 L/sec; p=0.02). The postnasal drip syndrome(PNDS) comprised the majority of patients with chronic cough(27). The PIFn in patients with PNDS was significantly lower than that of normal subjects(meanD; 2.18+/-0.66 vs. 2.75+/-1.00 L/sec, p=0.006). CONCLUSION: There was a significant difference of PIFn between patients with chronic cough and normal subjects. Among the patients with chronic cough, patients with PNDS showed the most significant difference with normal subjects in PIFn. The PIFn could be a useful parameter of nasal obstruction in patients with chronic cough, especially in patients with PNDS.