Effects of Repetitive Transcranial Magnetic Stimulation to Temporoparietal Cortex in Patients with Chronic Schizophrenia with Treatment-Resistant Auditory Hallucinations / 신경정신의학

OBJECTIVES: It has been reported that repetitive transcranial magnetic stimulation (rTMS), which stimulate the focal region of brain may relieve auditory hallucination in patient with schizophrenia. This study was aimed to evaluate the effect of rTMS on left and right temporoparietal cortex in schizophrenic patients with treatment-resistant auditory hallucination. METHODS: Twenty-six patients with chronic schizophrenia with treatment -resistant auditory hallucination were randomly allocated to rTMS group on left and right temporoparietal head regions. The rTMS was applied to TP3/4 region by EEG 10-20 international system at 1 Hz for 20 minutes per day for 10 treatment days. A Figure of eight TMS coil with a solid core was used for rTMS at 100% of individual motor threshold. Efficacy was evaluated with Auditory Hallucination Rating Scale (HRS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) Scale on 5 and 10 days of treatment. RESULTS: Ten days administration of 1-Hz rTMS to temporoparietal cortex significant improved frequency (p<0.001) and attentional salience (p=0.038) of auditory hallucination, positive (p<0.001) and negative symptom (p=0.02), and CGI-improvement (p<0.001). There were no significant differences between right and left side stimulations. CONCLUSION: These results suggest that the low frequency rTMS on temporoparietal cortex may be useful in treating schizophrenic patients with treatment-resistant auditory hallucination and it could be a useful novel treatment option.

Effects of Repetitive Transcranial Magnetic Stimulation to Temporoparietal Cortex in Patients with Chronic Schizophrenia with Treatment-Resistant Auditory Hallucinations / 신경정신의학

OBJECTIVES: It has been reported that repetitive transcranial magnetic stimulation (rTMS), which stimulate the focal region of brain may relieve auditory hallucination in patient with schizophrenia. This study was aimed to evaluate the effect of rTMS on left and right temporoparietal cortex in schizophrenic patients with treatment-resistant auditory hallucination. METHODS: Twenty-six patients with chronic schizophrenia with treatment -resistant auditory hallucination were randomly allocated to rTMS group on left and right temporoparietal head regions. The rTMS was applied to TP3/4 region by EEG 10-20 international system at 1 Hz for 20 minutes per day for 10 treatment days. A Figure of eight TMS coil with a solid core was used for rTMS at 100% of individual motor threshold. Efficacy was evaluated with Auditory Hallucination Rating Scale (HRS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) Scale on 5 and 10 days of treatment. RESULTS: Ten days administration of 1-Hz rTMS to temporoparietal cortex significant improved frequency (p<0.001) and attentional salience (p=0.038) of auditory hallucination, positive (p<0.001) and negative symptom (p=0.02), and CGI-improvement (p<0.001). There were no significant differences between right and left side stimulations. CONCLUSION: These results suggest that the low frequency rTMS on temporoparietal cortex may be useful in treating schizophrenic patients with treatment-resistant auditory hallucination and it could be a useful novel treatment option.

Effects of Brief Symptom Management Module on Inpatients with Chronic Schizophrenia: A Preliminary Study / 신경정신의학

OBJECTIVES: The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpatients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. METHODS: The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). RESULTS: Overall, patients showed improvement over the treatment period on psychopathology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9+/-4.0 before training to 12.9+/-4.2 after training(p<0.01) and scores of CGI were improved from 3.7+/-0.9 to 2.8+/-0.8 (p<0.01). However age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with un-awareness of psychosis. CONCLUSION: These results suggest that SMM-B could be a reliable method to improve self-awareness of psychosis in patients with chronic schizophrenia and one of important elements in rehabilitation.

Distribution of Beta-Catenin Expression in Adenoid Cystic Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: beta-catenin has functions in cell-cell adhesion with a complex of proteins that link cadherin to the cortical actin cytoskeleton and signal transduction through wnt developmental pathway. In this study, we investigated the distribution of beta-catenin in adenoid cystic carcinoma according to the histologic subtypes, perineural invasion, T classification, nodal status and stage. MATERIALS AND METHODS: Each formalin-fixed paraffin-embedded surgical specimens were obtained from seventeen patients with adenoid cystic carcinoma. We performed immunohistochemical staining with beta-catenin monoclonal antibodies and compared its staining patterns with patients' clinical characteristics. RESULTS: In tubular subtype, there were intense membranous staining pattern than other subtypes (p0.05). CONCLUSIONS: It is suggest that there are mixed functional roles of beta-catenin in adenoid cystic carcinoma in tumor aggressiveness.

Bronchogenic Cyst Presenting as an Anterior Neck Mass / 대한이비인후과학회지

A bronchogenic cyst is an abnormality of pulmonary differentiation, usually detected in pediatric patients. The location of bronchogenic cysts in the midline of anterior neck has been described, but it is known to be quite rare. A case of a 6-year-old male with a palpable mass in the anterior neck is presented. The patient was admitted with a complaint of a 2 X 2 cm sized, soft, non-tender mass in the anterior neck. The clinical impression was that of a thyroglossal duct cyst ; however, the histopathologic diagnosis of a bronchogenic cyst was made on the surgical specimen, Following surgical treatments, the recovery was uneventful. Since masses of the head and neck may encompass a variety of histopathologic diagnoses, it is important to include bronchogenic cysts in differential diagnoses for infants and children.

Effect of Endogenous Nitric Oxide on Neurogenic Plasma Extravasation in Nasal Mucosa of Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide is a labile neurotransmitter causing vasodilation by relaxing vascular smooth muscle. Endogenous nitric oxide is an important modulator of airway function, but its role in the regulation of airway microvascular leak remains unclear. The purpose of this study was to investigate modulatory action of nitric oxide on capsaicin-induced neurogenic plasma extravasation. MATERIALS AND METHODS: Neurogenic inflammation in rat nasal mucosa was induced by intranasal application of the capsaicin, 50 mM, 50 microliter. Rats were administered i.v. Nw-nitro-L-arginine (L-NNA, 1 to 10 mg/kg), as well as concurrent pretreatment with L-arginine (50 mg/kg). The amount of plasma extravasation was measured by measuring amount of extravasated Evans blue using spectrophotometer and by counting percent area density of Monastral blue-labeled blood vessels. RESULTS: In L-NNA(50 mg/kg) pretreated group, the amount of extravasated Evans blue and percent area density of Monastral blue-labeled blood vessels decreased in a dose-dependent manner (p < 0.01). This inhibition was reversed significantly by adding L-arginine. CONCLUSION: It is suggested that endogenous nitric oxide may have as modulatory role in neurogenic plasma extravasation.

Epithelial-myoepithelial Carcinoma Arising in the Nasal Cavity-Immunohistochemical and Electron Microscopic Study / 대한이비인후과학회지

Epithelial-myoepithelial carcinoma is a very rare malignant tumor accounting for less than one percent of sa1ivary gland neoplasms. Histologically, the tumor consists of a mixture of trabecular structure with double-layered arrangement of inner ductal cells and outer myoepithelial cells. Immunohistochemistry and electron microscopy confirm dual differentiation toward myoepithelial and ductal cells. We report a 22-year-old man with epithelial-myoepithelial carcinoma arising from nasal cavity, one of the most unusual locations.

p27(Kip1) and Ki-67 Expression in Mucoepidermoid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: p27(Kip1), novel cyclin-dependent kinase inhibitor plays an important role in the inhibition of cell cycle progression by binding to the cyclin E/cyclin-dependent kinase (CDK) 2 complex. And a nuclear antigen Ki-67, expressed in all phases of cell cycle except G0, is a reliable cellular proliferative index. The present study investigated p27(Kip1) and Ki-67 expressions in mucoepidermoid carcinoma for their usefulness of indicator in tumor progression, aggressiveness and prognosis. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded surgical specimens were obtained from patients with mucoepidermoid carcinoma. We performed immunohistochemical staining with p27(Kip1) and Ki-67 monoclonal antibodies and compared its labeling index with patients' clinicopathologic characteristics and survival rates. RESULTS: There was significant correlation between low p27(Kip1), high Ki-67 expression and high grade, large tumor size, positive nodal status and high stages. Also, Ki-67 expression showed significant inverse correlation with p27(Kip1) expression and there were high survival rates in high p27(Kip1) and low Ki-67 patients. CONCLUSIONS: Therefore, p27(Kip1) and Ki-67 are good and reliable predictive markers of tumor progression, aggressiveness and prognosis in mucoepidermoid carcinomas.

Expression of MMP-9 and TIMP-1 in the Nasal Mucosa of Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Allergic rhinitis is characterized by airway structural changes, including inflammation and basement thickening. An imbalance between matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) is thought to play a critical role in the synthesis or degradation of the extracellular matrix of the airway architecture. To elucidate the mechanism of remodeling in allergic rhinitis, we investigated the expressions of MMP-9 and TIMP-1 in the nasal mucosa of allergic rhinitis patients and the control subjects. We also compared the number of infiltrating inflammatory cells (eosinophils) and the immunostained areas of MMP-9 and TIMP-1. MATERIALS AND METHODS: Nasal biopsy specimens were obtained from 20 subjects with allergic rhinitis and 20 healthy control subjects, and the extent of staining by MMP-9 and TIMP-1 was estimated by using immunohistochemicd staining. Using a computer assisted image analysis system, we quantified the expressions of MMP-9 and TIMP-1, and the number of inflammatory cells was also determined. RESULTS: Expressions of MMP-9 and TIMP-1 were observed in the nasal mucosa of epithelial cells and infiltrating inflammatory cells. The extent of immunostained areas of MMP-9 was signi6cantly greater than that of TIMP-1 in the allergic rhinitis patients. A significant correlation was found between the number of eosinophils and the extent of MMP-9 immunostained area. CONCLUSION: The increased expression of MMP-9 in the allergic nasal mucosa suggests that MMP-9 secreted from the infiltrating inflammatory cells and the nasal epithelium causes tissue remodeling in the allergic nasal mucosa.

Immunohistochemical Classification and Clinical Evaluation of Nasal Malignant Lymphoma

BACKGROUND AND OBJECTIVES: Polymorphic reticulosis (PMR), a type of lethal midline granuloma, has characteristics of necrosis, angiocentricity, and angiogenesis, which is also known as nasal T-cell lymphoma. In this study, we classified PMR and nasal lymphoma using immunohistochemical staining and investigated the clinical characteristics of nasal malignant lymphoma including survival rates with treatment modalities. MATERIALS AND METHODS: Twenty-six patients previously diagnosed with PMR or nasal lymphoma from May 1992 to April 1997 were included in this study. We performed immunohistochemical staining with CD3, CD56 and CD79a for classification and reviewed the patients' clinical characteristics and survival rates, retrospectively. RESULTS: Of twenty-six patients, twenty-five patients were classified as having angiocentric lymphoma and only one patient with B-cell lymphoma. Higher mortality rates were observed in patients receiving chemotherapy alone than in those receiving chemotherapy and radiation therapy and in advanced stage. CONCLUSIONS: Early detection and combined treatment could improve the survival rate of patients with nasal malignant lymphomas.

Reconstruction of Septal Perforation with Alloderm / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The closure of nasal septal perforation is a significant surgical challenge with high failure rates. Acellular human dermal graft (Alloderm) placed between mucoperichondrial advancement flaps may be an alternative. The purpose of this study was to investigate the usefulness of Alloderm for the repair of nasal septal perforation. MATERIALS AND METHODS: Seven consecutive patients with septal perforation who received the septal perforation repair with Alloderm were included in this study. The causes of septal perforations were previous nasal surgeries, trauma, chemical irritation, inflammation, or unknown. Follow-up periods ranged from 7 to 36 months. RESULTS: Six of seven patients had successful outcomes with complete closure of their perforations. The remaining one patient had an incomplete closure, but the size of the performation was reduced with no further symptoms. CONCLUSION: AIloderm can be used as a connective tissue and interpositional grafts in the repair of septal perforations with high success rates. Therefore, Alloderm is the viable alternative for the closure of nasal septal perforations.

Expression of HSP72 in Nasal Mucosa of Patients with Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Heat shock protein (HSP) is to be involved in inflammation. HSP may be expressed in allergic rhinitis which is an inflammation disease. The purpose of this study was to investigate whether overexpression of HSP72 is specific for allergic rhinitis and is correlated with clinical severity of disease. MATERIALS AND METHODS: We studied expression of HSP72 by immunohistochemistry using ABC technique on nasal mucosa from 20 patients with allergic rhinitis, 10 patients with chronic hypertrophic rhinitis and 10 patients with normal turbinates. RESULTS: In biopsies from patients with allergic rhinitis, immunopositive cells were observed on epithelium, basement membrane, submucous gland cells, and inflammatory cells. Expression of HSP72 in patients with allergic rhinitis was significantly increased in nasal mucosa (p<0.01) and was significantly correlated with clinical severity of the disease (p<0.01) and eosinophil count (p<0.01). CONCLUSION: Inflammation of nasal mucosa in patients with allergic rhinitis may be linked to production of HSP72.

Heat Shock Protein 72 Expression Following Odor Exposure in Olfactory System of Rat

BACKGROUND AND OBJECTIVES: Heat shock proteins (HSPs) are group of evolutionary conserved proteins whose synthesis are greatly enhanced in cells following exposure to various stressors and play an important role in cellular protection and survival. The purpose of this study was to determine whether olfactory stimulation induces the synthesis of HSP72 in olfactory system of the rat. MATERIALS AND METHODS: Animals were exposed to odorant stimuli using 2% propionic acid odorant stimuli and expression pattern of HSP72 in the olfactory system were detected by immunohistochemistry using anti-HSP72 antibody according to time course and by Western blotting. RESULTS: HSP72 immunopositive cells were expressed in the olfactory epithelium and in the olfactory bulb neurons and a 72 kD band was detected by Western blotting. CONCLUSION: These results suggest that expression of HSP72 in olfactory system of the rat following exposure to odor may serve as a marker for cellular stress and potential damage and may be involved in cellular protection against injuries.

Histochemical Localization of NADPH-diaphorase in Olfactory System of Rat / 대한이비인후과학회지

Nitric oxide(NO) has recently been identified as a short-lived intracellular messenger in the central and peripheral nervous systems. Nitric oxide synthase(NOS) is a key enzyme for NO biosynthesis by formation of citrulline from L-arginine. This enzyme reaction requires reduced nicotine adenine dinucleotide phosphate(NADPH) as a co-factor and the electron transferring c-terminal sequence of NOS give rise to its NADPH-diaphorase activity. However, it has yet to prove that NO is a sensory neurotransmitter in olfactory nervous system. The purpose of this study was to localize histochemically the distribution of NADPH-diaphorase in the olfactory system of rats. In the olfactory mucosa, NADPH-diaphorase positive cells were demonstrated in the ciliary layers, Bowmann's glands and olfactory nerve bundles. In main olfactory bulb, a large number of NADPH-diaphorase positive cells were also demonstrated in nerve fibers of olfactory nerve layer, periglomerular cell, superficial short axon cells of external plexiform layer and deep short axon cells between granular and subependymal layers. Furthermore there were NADPH-diaphorase positive cells of plexiform and granular cell layers of the accessory olfactory bulb. Therefore, it is suggested that the presence of NADPH-diaphorase acitivity in nerve fibers of olfactory system may be involved in odor processing.

Surgical Treatment of the Trochanteric Fracture of the Femur / 대한정형외과학회잡지

The authors have treated 30 cases of trochanteric fracture of the femur from June 1987, to July 1988 at Dong Suwon General Hospital. The 30 cases included, 8 Condylocephalic Kuentscher nailing, 9 Ender nailing, 7 Multiple pinning, 5 Antegrade Kuentscher nailing and 1 Row plating. 1. The shape of condylocephalic Kuentscher nail should be designed differently, contoured circular arc in anteroposterior and angled in lateral plane. In the anteroposterior plane : The length of the radius of the arc is measured by following way. 1) Design the shape of the nail on the X-ray film of the normal femur which was taken in full internal rotation of the leg. 2) Make three points in the femoral film. One is A, midcentral point of the femoral canal of the isthmus. Point B is center of upper lateral quadrant of the femoral head. Point C is apart from medial cortex 5-7mm at the level of entry portal of the nail. 3) Make point D: Draw the perpendicular lines from the right middle of the AB and AC. These lines meet at the point D. AD is radius of the arc of nail. Draw an arc measuring by the length of AD and mold the nail following the arc. In the lsteral plane ; The nail is bent into three or four segments and the length of the longest segment should not be exceeded the permissible length of straight nail, the latter is distance from entry portal of the nail to anterior cortex of the femur where the tip of the inserted nail is impinged, about 15cm. 2. Two different types of the Ender nailings are used depend on the type of the fracture. In intertrochanteric fracture, the trochanter is remained in the distal fragment and acts as the crane post to fix the proximal fragment(interfragmental compression screw fixation) by horizontal screw inserted through the lateral cortex of the distal fragment into medial cortex of the proximal fragment and fixed with another screw inserted into the distal fragment by tension band wiring. In transtrochanteric frscture, the proximal fragment is fixed by two different kinds of the nails, prior to the nailing medial displacement of the distal fragment is not reduced. The first nail is driven along the medial wall of the medullary canal of the distal fragment, the tip of the nail comes out of the fracture site and impinges to the inferomedeial aspect of the head along the out side of the neck. The nail is inserted into the head after correction of nail direction. The second and third nails are inserted through the medullary canal of the fragments. The proximal fragment is fixed between two nail groups. 3. Antegrade Kuentscher nailing is used for undisplaced trochanteric fracture with segmental fracture or comminuted, segmental subtrochanteric fracture. The open reduction and fixation is preferable in comminuted segmental subtrochanteric fracture for its accurate reduction. The authors msde additional several holes, transverse, sagittal (at the dorsum of the nail) oblique holes around the nail, so the interlocking screw can be easily inserted to the nail when the insertion of the screw through the transverse holes are difficult. 4. It's extremely important to study the fracture carefully when the surgeon plans to use the multiple pinning for trochanteric fracture. The fracture configuration has to be determined in regard to expect stability after local pinning especially in lateral plane. The fracture is fixed by horizontal pin, low angle pin, curved buttress pin(or screw) solidly, not parallel as in neck fracture. The curved buttress rush pin should be inserted as acting as the anteromedial or posteromedial buttress.

Giant Cell Tumor of Thumb: A case report / 대한정형외과학회잡지

Following is a case report of giant cell tumor of the metacarpal bone of rlght thumb treated with surgical method. The metacarpal bone except both articular surfaces was excised and replaced with an autogenous iliac bone graft. The graft bone was fixed with 3 Kirschner's wires and the thumb was immobilized with plaster cast. There has been no evidence fo recurrence during the 6 years following and function of the hand is normal.

A Clinical Study on Ligamentous Injuries of the Knee / 대한정형외과학회잡지

It has been well known that the knee joint is burdened on motion and weight bearing and structurally, it is more frequently injuried than other joints. Injuries to the ligaments of the knee joint are of frequent occurrence because of the increasing traffics and popularity of sports. It seems to be impotant to study on the mechanism of Injury, method of physical examination and treatment of the Iigamentous injuries of the knee. The purpose of this paper is to get accurate diagnosis and proper treatment. 68 cases of ligamentous injuries in 65 patients who were admitted and treated at the Department of Orthopaedic Surgery of Hanyang University Hospital from May, 1975 to April, 1979 have been reviewed. The results of this study were as follows: 1. The ligamentous injuries of the knee were more prevalent in male 4.9 times than female; and frequently occured in 20 to 30 decades (60%). 2. Traffic accident was the most common cause, and the most frequent injury associated with the ligament injuries of the knee was fracture. 3. Medial collateral ligament was ruptured most frequently and its tibial attachement was the most common site of the rupture. 4. Frequently, lateral collateral ligament was detached from the fibular attachment, anterior and posterior cruciate ligaments were ruptured through their substances. 5. There were 3 cases of isolated cruciated ligament injury, one was anterior and others were posterior. 6. Excellent or good result was obtained in 77.3% by operative treatment and in 93.3% by nonoperative treatment. 7. Early repair (under two weeks) gave much better results than late repair.