Radiolucent Pure Matrix Stones on Computed Tomography Scan, Arising in Patient with Type I Diabetes and Chronic Kidney Disease: A Case Report / 가정의학회지

Kidney matrix stones are a rare form of calculi, which are challenging to diagnose. Matrix stones consist of a proteinaceous material which has a radiolucent appearance that might be overlooked on imaging. Recently, endourological intervention has been the standard treatment method for matrix stones. We report a case of urinary matrix stones in a patient with type 1 diabetes mellitus and chronic kidney disease, in whom the stones formed into a pure matrix and were not visualized in the computed tomography scan. The stones were found after additional work-up, and they were managed using a transureteral stone basket, not through endourological intervention.

3D Histology Using the Synchrotron Radiation Propagation Phase Contrast Cryo-microCT / 체질인류학회지

3D histology is a imaging system for the 3D structural information of cells or tissues. The synchrotron radiation propagation phase contrast micro-CT has been used in 3D imaging methods. However, the simple phase contrast micro-CT did not give sufficient micro-structural information when the specimen contains soft elements, as is the case with many biomedical tissue samples. The purpose of this study is to develop a new technique to enhance the phase contrast effect for soft tissue imaging. Experiments were performed at the imaging beam lines of Pohang Accelerator Laboratory (PAL). The biomedical tissue samples under frozen state was mounted on a computer-controlled precision stage and rotated in 0.18° increments through 180°. An X-ray shadow of a specimen was converted into a visual image on the surface of a CdWO4 scintillator that was magnified using a microscopic objective lens (X5 or X20) before being captured with a digital CCD camera. 3-dimensional volume images of the specimen were obtained by applying a filtered back-projection algorithm to the projection images using a software package OCTOPUS. Surface reconstruction and volume segmentation and rendering were performed were performed using Amira software. In this study, We found that synchrotron phase contrast imaging of frozen tissue samples has higher contrast power for soft tissue than that of non-frozen samples. In conclusion, synchrotron radiation propagation phase contrast cryo-microCT imaging offers a promising tool for non-destructive high resolution 3D histology.

Dynamic Contrast-Enhanced CT Findings of a Extrapleural Solitary Fibrous Tumor in the Spleen: A Case Report and Literature Review

Extrapleural solitary fibrous tumor, formerly referred to as “hemangiopericytoma” is a rare soft tissue vascular tumor which has elevated malignancy potential arising from the capillary pericytes. Extrapleural solitary fibrous tumors, originating from the spleen, are extremely rare. We report on a rare case of a patient presenting with splenic extrapleural solitary fibrous tumors with intratumoral irregular calcification detected by dynamic contrast-enhanced computed tomography.

Misinterpreting Odds Ratio in the Articles Published in Korean Journal of Family Medicine / 가정의학회지

BACKGROUND: In reporting results of case-control studies, odds ratios are useful methods of reporting findings. However, odds ratios are often misinterpreted in the literature and by general readers. METHODS: We searched all original articles which were published in the Korean Journal of Family Medicine from 1980 to May 2011 and identified those that report "odds ratios." Misinterpretation of odds ratios as relative risks has been identified. Estimated risk ratios were calculated when possible and compared with odds ratios. RESULTS: One hundred and twenty-eight articles using odds ratios were identified. Among those, 122 articles were analyzed for the frequency of misinterpretation of odds ratios as relative risks. Twenty-two reports out of these 122 articles misinterpreted odds ratios as relative risks. The percentage of misinterpreting reports decreased over years. Seventy-seven reports were analyzed to compare the estimated risk ratios with odds ratios. In most of these articles, odds ratios were greater than estimated risk ratios, 60% of which had larger than 20% standardized differences. CONCLUSION: In reports published in the Korean Journal of Family Medicine, odds ratios are frequently used. They were misinterpreted in part of the reports, although decreasing trends over years were observed.

A Comparison of Efficacy and Safety of Non-steroidal Anti-inflammatory Drugs versus Acetaminophen in the Treatment of Episodic Tension-type Headache: A Meta-analysis of Randomized Placebo-controlled Trial Studies / 가정의학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies. METHODS: We searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics. RESULTS: We identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I2 = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I2 = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I2 = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I2 = 0%). CONCLUSION: In this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.

Effects of Having Usual Source of Care on Preventive Services and Chronic Disease Control: A Systematic Review / 가정의학회지

BACKGROUND: Having usual source of care has been associated with improved receipt of preventive services and control of chronic diseases (such as hypertension, diabetes, and hypercholesterolemia). The objective of this study was to examine whether having usual source of care is associated with improved receipt of preventive services and control of chronic diseases. METHODS: We searched MEDLINE, EMBASE, Cochrane, CINAHL, KMbase, KoreaMed, RiSS4U, National Assembly Library, and KISS for studies released through May 31st 2011. Two authors independently extracted the data. We manually searched the references and twenty recent related articles on PubMed. To assess the risk of bias RoBANS tool was used. RESULTS: We identified 10 studies. Most having usual source of care were associated with improved receipt of preventive services (cervical cancer screening, clinical breast exam, mammogram, prostate cancer screening, and flu shot) compared with no usual source of care. However, gastric cancer and colon cancer screening were difficult to conclude and blood pressure checkup showed mixed results. Overall there was no association between having usual source of care and smoking behaviors and the effect on chronic disease control was difficult to conclude. CONCLUSION: Having usual source of care was associated with improved receipt of preventive services and overall the results were consistent. So, the results suggested that having usual source of care may help to receive preventive services. Hereafter, cohort studies are needed to evaluate casual relationships and more studies are needed in various countries and systems.

The Effects of Bleomycin on Growth and Apoptosis of Keloid Fibroblast

Bleomycin, the generic name for a group of sulfur- containing polypeptide antibiotics derived from Streptomyces verticillus, has been used as a single agent and in combination for treatment of various neoplasms and viral diseases. Recently, intradermal bleomycin injections have been shown to bring about significant improvements in keloid and hypertrophic scar. However, the mechanism by which this drug acts on keloid is not entirely clear. In this study, the effects of bleomycin on growth rate, apoptosis, production of transforming growth factor(TGF-beta) and expression of its receptor, secretion of fibronectin were evaluated in keloid and normal human dermal fibroblasts. Human keloid and normal fibroblasts were primarily cultured from earlobe keloids of three female patients and treated with various concentration of bleomycin. Cell toxicity was assessed by MTT assay, growth rate and apoptosis was assessed by FACS, production of fibronectin by immunoprecipitation and western blot, TGF-beta secretion by ELISA, and expression of TGF-beta receptor by western blot, respectively. The obtained results are follows : Bleomycin induced cell toxicity dose-dependently in keloid fibroblasts in the range of 0.0012-0.075mg/ml, and the MTT90 and MTT50 values of bleomycin were 0.0081mg/ml and 0.0352mg/ml, respectively. Even in lower concentration (MTT90) of bleomycin, the cell growth was significantly suppressed in both normal and keloid fibroblasts, with the latter more suppressed than the former. Keloid fibroblasts secreted more TGF-beta than normal fibroblasts, but there was no significant difference of TGF-beta secretion between the group with bleomycin treatment and the untreated control group. There was no significant effect of bleomycin on the suppression of the expression of TGF-beta receptor and the production of fibronection in fibroblast. Keloid fibroblasts responded to bleomycin more sensitively than normal fibroblasts, and the percentage of apoptosis was higher in keloid fibroblasts than in normal fibroblast at the MTT50 concentration of bleomycin. Bleomycin had growth-inhibitory effect with inducing the apoptosis directly in lower concentration(MTT90). Therefore, clinical application with lower concentration than 1.0 mg/ml is adviced. Further studies, including clinical demonstration, will be required to better elucidate the anti-keloid effect of bleomycin depending on the dosage and the additive effect of different anti-keloid action by other agents. In summary, bleomycin may be a drug of promise in the treatment of keloid and hypertrophic scar.

Septoplasty Through Dorsal Approach

Septal deviations interfere with the nasal airflow and contribute to the deformities in the external appearance of the nose. An aesthetically and functionally satisfactory correction of severe septal deformities often requires temporary intraoperative removal of the septal cartilage for appropriate remodeling. This article describes septoplasty through dorsal approach for the correction of septal deviation. From March 2001 to April 2004, the author performed septoplasty through dorsal approach for the correction of septal deviations on 45 patients, of whom 22 of whom had nasal obstruction. Open rhinoplasty was used for dorsal approach in all patients and operation was performed under the general anesthesia or local anesthesia. The follow-up period of the patients ranged from 3 to 15 months with a mean of 10 months, and postoperative results were quite satisfactory. There was neither incidences of patients' complaints, nor any complications such as hematoma, septal perforation, supratip deformity, or recurrence. And there was some improvement of nasal obstruction in 15 patients. In conclusion, Septoplasty through dorsal approach is an effective method for the correction of septal deviation and improvement of the nasal airway obstruction.

The Efficiency of Fibrin Glue at Bicoronary Approach in Facial Surgery

Fibrin glue has been widely used as an adhesive in plastic and reconstructive surgery. It is effective in hemostasis, sealing anastomosis sites, promoting wound healing and tissue adhesion. The aim of this study is to establish that fibrin glue is effective at bicoronary approach in facial surgery in direction of hemostasis and wound healing. We reviewed the data from 40 consecutive patients with medial orbital wall fracture who were operated by bicoronary approach in Dong-A University Hospital from May 2001 to August 2002. We used Fibrin glue(Tisseel(R)) in 20 patients and the others were control. We analized the data from the view point of operation time, amount of Hemo-vac(R) count duration until removal of Hemo-vac(R), facial edema status, duration of admission. Statistical analysis was done with student's t-test(p <0.05). The results were as follow; Operation time was reduced by average 15 minutes in group using fibrin glue. Amount of Hemo-vac(R) at postoperative 1st day was reduced by average 31cc in group using fibrin glue significantly. Duration until removal of Hemo-vac(R) was reduced by average 2.7 day in group using fibrin glue significantly. Facial edema status from the viewpoint of patient & third party was recovered by average 1.7 day earlier in group using fibrin glue. Duration of admission was reduced by average 4 day in group using fibrin glue significantly. In conclusion, our clinical experience demonstrates several advantages of fibrin glue; Hemostasis, early adherence and wound healing are improved. The comfort of the patients is remarkably increased over the healing period. The comparatively small additional costs incurred seem very much worthwhile for these operation, because the duration of admission was reduced.

Urinary Cytologic Findings of Small Cell Neuroendocrine Carcinoma: A Case Report / 대한세포병리학회지

We report the cytologic features of a case of primary small cell carcinoma of the urinary bladder with high grade transitional cell and signet ring cell carcinomatous components. A 64-year-old male presented with gross hematuria for one week. Computed tomography revealed an ill-defined mass in the left lateral wall of the urinary bladder. Urinary cytology showed hypercellularity with predominantly isolated single cells and clustered cells. They have scanty cytoplasm and naked hyperchromatic nuclei with finely granular nuclear chromatin and rare nucleoli. The tumor cells occurred predominantly singe cells, but a few in clusters. Nuclear molding was prominent. No glandular formation or nesting was noted. The second tumor cells had high nuclear/cytoplasmic ratio, irregular nuclear membrane, and coarse granular chromatin. The background was inflamed and necrotic. The histologic findings of transurethral resection were mainly composed of small cell carcinoma, and partly transitional cell and signet ring cell carcinomatous components. Small cell neuroendocrine carcinoma have distinctive cytologic features to make a proper diagnosis.

Reconstructive Treatment of Subungal Malignant Melanoma Through the Early in Situ Level Diagnosis

Subungal malignant melanoma is a relatively rare disease with reported incidence between 1% to 3% of all melanoma cases in the USA, 10% to 31% in Japan. It is a serious disease with a survival period of 5 years. This poor prognosis is the result of late diagnosis in many of the cases, usually the patient not presenting himself early enough in the course of the disease. However, far more important is the frequent failure of the physician or surgeon to recognize the clinical signs and to perform a biopsy from the correct site, which leads to an accurate diagnosis. Therefore we focused the nail color change of the subungal malignant melanoma to diagnose the disease at the early stage. Five patients who visited our hospital with nail color change into black took the biopsy. This should be done on nail bed and matrix lesions which shows color change into black. A wedge form is taken from the area with maximal clinical concern, including normal tissue at the edge of the lesion. In cases of melanoma in situ (4 cases) diagnosed during the previous biopsy, surgical treatment was done as soon as possible. The melanoma was excised by Mohs technique and the margins were checked by frozen section. If the margins and base of tumor did not have micrometastasis, immediate reconstruction using various flaps was done. In case that micrometastasis was suspicious however, special staining using HMB45 immunostaining was done for confirmation. After a few days for special staining, delayed reconstruction was done. By means of the early diagnosis and Mohs micrographic operation technique, we could excise the tumor completely and preserve the tendon, bone, joint and length of digits.

PCB Instrumentation with Lubboc Bone in Anterior Cervical Interbody Fusion

OBJECTIVE: PCB cervical instrument is a newly introduced fusion device which comprises cervical plate, cage (spacer) and screw system. It is developed to enhance fusion rate and stability, as well as to reduce complications related to hardware failure. We investigated the efficacy of clinical and radiological results of PCB instrument and Lubboc bone. METHODS: From August, 1998 to October, 1999, authors performed 54 cases of anterior cervical interbody fusion with PCB instrument and Lubboc bone. Retrospective analysis was undertaken based on clinical and radiological findings. Clinical improvement was evaluated according to Odom's criteria. Cervical plain films and tomography were taken every 2 months to evaluate the degree of interbody fusion and disc height changes. RESULTS: Bone fusion was observed in 36 cases(90%) over 6 months after operation, and during which time there was no significant interval change. There were 3 cases of hardware dislodgement. Disc height was increased significantly and preserved in all cases. Clinical outcome over good degree was seen more than 94% of patients. CONCLUSION: Longer follow-up period and comparative studies to similar instrument appear to be necessary, but this instrumentation system has shown high fusion rate and fewer adverse effects in our series. We believe this system might be indicated for the treatment of cervical trauma and degenerative disease in selective cases.

Speech Assessment in Bilateral Complete Palatoplasty

The purpose of palatoplasty in cleft palate patient is to form normal speech and normal growth of maxilla. Still now, varient trial and evaluation to palatoplasty have been introduced and investigated for long time, but evaluation of long term result in platoplasty has been neglected. So, authors tried to analyze long term result in bilateral complete palatoplasty by speech analysis. The speech outcome was studied retrospectively in 27 bilateral complete cleft patients who underwent push-back palatoplasty from October 1990 to November 1997. The patient was underwent palatoplasty in 9-10 month old. The patients were divided to 4 group as 3-4, 5-6, 7-8, 9-10 year old and compared with 20 normal children (control groups were divided to 4 groups). Nasal emission test and hypernasality test and articulation test were done by speech evaluation table which was consisted of 39 different words. For nasal emission test, we test the numbers of nasal emission word. For hypernasality test and articulation test, each word has score such as normal; 3 points, fair; 2 points, poor 1 point and thus total score was 87points. The score of nasal emission was that the number of nasal emission word, and the number was reduced by aging. And the score of hypernasality test and articulation test was improved by aging. The score of patients who have been taken speech therapy was high in their age group. In comparison with normal control group, the score of patients was slightly lower than control group. And about 74.1% of the patients obtained normal speech after bilateral complete palatoplasty. So we think speech test after palatoplasty is necessary for assessment and treatment of the patients.

Occult Intrasacral Meningocele Associated with Arachnoid Cyst

case of occult intrasacral meningocele associated with arachnoid cyst in a 35-year-male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and urinary incontinence for several months. Myelography revealed delayed filling of a meningocele. Computed tomographic(CT) myelography and magnetic resonance(MR) imaging showed huge intrasacral mass without neural elements. A favorable outcome was achieved by decompression of the cyst, obliteration of the conduit to subarachnoid space, and fenestration of arachnoid cyst into subarachnoid space.

MR Imaging of Proximal Femur: Age-related Changes

PURPOSE: The purpose of this study is to illustrate MR patterns of signal intensity of proximal femur in normal subjects according to the age distribution. METHOD AND MATERIAL: Tl-weighted MR images of the proximal femur in 125 subjects, aged 13 days to 25 years, were retrospectively analyzed. Age distribution was classified to 4 groups;below 4 months, 5 months to 4 years, 5 years to 14 years, and 15 years to 25 years. RESULTS: By the age of 4 months, the non-ossified femoral epiphysis was seen as intermediate-signal-intensity cartilage. At 5 months-4 years, the ossified fernoral capital epiphysis was seen within intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow surrounded by a rim of low-signal-intensity cortical bone. At 5-14 years, the ossified femoral capital and greater trochanteric epiphysis were seen within the intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow. At 15-25 years, the proximal metaphyseal marrow showed increased signal intensity. Four patterns of the metaphyseal marrow were recognized by Ricci et al. The frequency of pattern la progressively decreased with age. Pattern 2 and 3 were visible in the 15-25 years age group. CONCLUSION: An understanding of the spectrum of normal age-related change of the proximal femoral cartilage and marrow patterns serves as the foundation for interpretation of proximal femur pathologies.

Transfusional Hemosiderosis; Correlation of MR Findings with Clinical Findings

PURPOSE: Parenchymal iron deposition occurs in hemochromatosis, while iron is deposited in reticuloendothelial cells after blood transfusions(Hemosiderosis). We stuided correlation between MR finding and clinical findings(serum ferritin, TSI, LFT, disease duration) of hemosiderosis. MATERIALS AND METHODS: 12 patients with chronic renal failure and one patient with aplastic anemia, who have received multiple transfusion, were performed MRI with a 2.0 Tesla unit. RESULTS: In All of 13 patients(17 cases), the liver revealed low signal intensity equal to background noise. In 4 of 17 cases whose serum ferritin level was below 1000 ng/ml, pancreas, gastric wall, adrenal gland were involved in 1 case. In 4 cases with serum ferritin level between 1000 and 1500, pancreas was involved in 2 cases, and other organ was involved in 1 case. In 9 cases with serum ferritin level above 1500ng/ml, pancreas involved in 9 cases, and other organ in 4 cases. CONCLUSIONS: The MR findings are well correlated with serum ferritin level whereas the TSI, LFT, disease duration are not correlated with involved organ on MR.