Removal of a suture needle: a case report / 대한악안면성형재건외과학회지

Background@#Foreign bodies may be embedded or left behind in the oral cavity during oral surgical procedure. The loss of instruments such as impression material, surgical gauze, and broken injection needles are commonly reported in the dental field. These complications are generally symptomatic and show signs of inflammation, pain, and purulent discharge. Accidental breakage of suture needles is a rare but potentially dangerous event.Case presentation: In this report, we present one case of lost suture needle during the procedure of flap operation at local dental clinic and its successful removal under local/general anesthesia administration via CBCT with a help of two reference needles to localize the 6-0 nylon needle and consulting with the clinician. @*Conclusion@#CT scanning taken while mouth-closing may not be accurate with regard to real location measurement performed while mouth-opening. If so, other up-to-date radiographic devices and methods to retrieve a needle are recommended.

Social Stigmata of Electroconvulsive Therapy and Their Reduction Strategies

Modified electroconvulsive therapy (ECT) which started in 1950s is a safe and efficacious treatment for several mental disorders including mood disorders and psychotic disorders. However, its usage in present days is still limited by misconceptions and stigmata of ECT. This paper overviews the background from which the stigmata of ECT stemmed and the current status of stigmata surrounding ECT among the public and medical professionals. In addition, a few potential strategies for reducing stigmata of ECT are provided in this review.

Social Stigmata of Electroconvulsive Therapy and Their Reduction Strategies

Modified electroconvulsive therapy (ECT) which started in 1950s is a safe and efficacious treatment for several mental disorders including mood disorders and psychotic disorders. However, its usage in present days is still limited by misconceptions and stigmata of ECT. This paper overviews the background from which the stigmata of ECT stemmed and the current status of stigmata surrounding ECT among the public and medical professionals. In addition, a few potential strategies for reducing stigmata of ECT are provided in this review.

Investigation and Development of Competency-based Training Program for Pharmacists in a Hospital

OBJECTIVE: This study was to investigate and develop a training program that integrated and strengthened clinical competence and capacity of hospital pharmacists which would be implemented at the pharmacy department of Ewha Womans University Mokdong Hospital. METHODS: We assessed the training programs of hospital pharmacists in the United Kingdom, the United States and Japan and compared those of major hospitals in Seoul and Gyeonggi provinces in Korea. The survey assessed the satisfaction on the current educational programs for pharmacists at Ewha Womans University Mokdong Hospital and a newly designed education program was suggested. RESULTS: The major differences of the programs among the Korean hospitals and Mokdong Hospital were the training period and contents of the entry-level pharmacist education program. The overall satisfaction of the training program was >3 points on 5-Likert scale in the survey. There was no significant difference of the satisfaction level based on the employment period of pharmacists. The pharmacists were in more than 7 training programs of clinical support work. We proposed the clinical support training for the new pharmacists to be separated from orientation and concentrated on actual work duty. In order to improve the competency, it was encouraged to participate the in-house seminar or certify the related fields provided by Korean Society of Health-system Pharmacists. CONCLUSION: The education program was assessed among different countries and hospitals of Korea. We suggested to update education program in the hospital to enhance pharmacists' competency.

Hepatogastric fistula as a rare complication of pyogenic liver abscess

Hepatogastric fistula following a pyogenic liver abscess is extremely rare, and only a handful of cases have been reported. An 88-year-old female presented with generalized weakness, fever and chills. An abdominal computed tomography scan revealed a 5cm-sized hypodense lesion with internal septa in the left lateral section of the liver. Due to initial suspicion of early liver abscess, she was treated with empirical intravenous antibiotics. Initially, aspiration or drainage of the liver abscess was not performed due to immature lesion characteristics. An ultrasonography-guided percutaneous drainage of the liver abscess was performed 17 days after hospitalization due to a more mature lesion appearance on follow-up imaging. On tubography, contrast media leakage through the fistulous tract was visualized. Surgical management was performed, and she was discharged 2 weeks after surgery.

Coexistence of an EGFR Mutation and an ALK Rearrangement in a Patient with Lung Adenocarcinoma: a Case Report / 대한내과학회지

A 58 year-old woman was diagnosed with lung adenocarcinoma (cT3N1M0). We detected a point mutation in epidermal growth factor receptor (EGFR) exon 21 (L858R) and an echinoderm microtubule-associated protein-like 4- anaplastic lymphoma kinase (ALK) rearrangement. The patient was treated with preoperative neoadjuvant chemotherapy and underwent a left lower lobectomy with mediastinal lymph node dissection. However, we could not detect any mutation in EGFR or the ALK rearrangement from the tumor tissue removed. Then, 70 days after completion of adjuvant chemotherapy, she visited our outpatient clinic with diminished visual accuracy and tinnitus. A single brain metastatic lesion was seen on brain magnetic resonance imaging. She underwent surgical removal of the brain mass, which showed a mutation of EGFR, exon 21, but no ALK rearrangement. We report this unusual case of lung adenocarcinoma with a coexisting EGFR mutation and ALK rearrangement, and identify gene alterations before chemotherapy, after chemotherapy, and at recurrence.

Factors Associated With Upper Extremity Motor Recovery After Repetitive Transcranial Magnetic Stimulation in Stroke Patients

OBJECTIVE: To determine factors associated with motor recovery of the upper extremity after repetitive transcranial magnetic stimulation (rTMS) treatment in stroke patients. METHODS: Twenty-nine patients with subacute stroke participated in this study. rTMS was applied to the hand motor cortex for 10 minutes at a 110% resting motor threshold and 10 Hz frequency for two weeks. We evaluated the biographical, neurological, clinical, and functional variables, in addition to the motor-evoked potential (MEP) response. The Manual Function Test (MFT) was performed before, immediately after, and two weeks after, the treatment. Patients were divided into a responder and non-responder group according to their respective improvements on the MFT. Data were compared between the two groups. RESULTS: Patients with exclusively subcortical stroke, absence of aphasia, the presence of a MEP response, high scores on the Mini-Mental Status Examination, Motricity Index arm score, Functional Independence Measure, and Functional Ambulatory Classification; and a shorter period from stroke onset to rTMS were found to be significantly associated with a response to rTMS. CONCLUSION: The results of this study suggest that rTMS may have a greater effect on upper extremity motor recovery in stroke patients who have a MEP response, suffer an exclusively subcortical stroke, mild paresis, and have good functional status. Applying rTMS early would have additional positive effects in the patients with the identified characteristics.

Functional Outcomes of Patients with Severe MCA Infarction after Decompressive Craniectomy

OBJECTIVE: To compare the functional outcomes between surgical treatment and conservative medical treatment for severe middle cerebral artery (MCA) infarction. METHOD: This is comparative analysis of prospectively documented data with 25 patients have malignant MCA infarction. Ten patients in Group A (male 7, female 3) received surgical treatment such as decompressive craniectomy, and fifteen patients in Group B (male 10, female 5) received conservative medical treatment. We defined MCA infarction as "severe" when it concerned both the deep and superficial areas of the MCA or when the Functional Independence Measure (FIM) was lower to 75 on admission to our department. Functional status was measured using modified Rankin Scale (mRS), FIM, Motricity Index (MI) and Trunk Control Test (TCT). All evaluations were measured at baseline and 90 days after stroke. RESULTS: Mean age were 55.0 +/- 8.6 and 58.7 +/- 12.3 in Group A and B. Rt. MCA infarction were 4 in Group A and 5 in Group B. Lt. MCA infarction were 5 in Group A and 10 in Group B. Baseline functional status between two groups was not significantly different. Each group showed functional improvement according to the time. When compared changes between two groups, arm Motricity Index, K-MMSE, mRS and FIM were no significant difference between two groups. Leg segments of MI and TCT was significantly improved in Group A more than B at 90 days after baseline evaluation (p<0.05). CONCLUSION: Decompressive craniectomy improved motor function of affected leg and trunk in patients with severe MCA infarction more than conservative medical treatment alone.

Three-dimensional evaluation of the relationship between nasopharyngeal airway shape and adenoid size in children / 대한치과교정학회지

OBJECTIVE: To evaluate the shapes and sizes of nasopharyngeal airways by using cone-beam computed tomography and to assess the relationship between nasopharyngeal airway shape and adenoid hypertrophy in children. METHODS: Linear and cross-sectional measurements on frontal and sagittal cross-sections containing the most enlarged adenoids and nasopharyngeal airway volumes were obtained from cone-beam computed tomography scans of 64 healthy children (11.0 +/- 1.8 years), and the interrelationships of these measurements were evaluated. RESULTS: On the basis of frontal section images, the subjects' nasopharyngeal airways were divided into the following 2 types: the broad and long type and the narrow and flat type. The nasopharyngeal airway sizes and volumes were smaller in subjects with narrow and flat airways than in those with broad and long airways (p < 0.01). Children who showed high adenoid-nasopharyngeal ratios on sagittal imaging, indicating moderate to severe adenoid hypertrophy, had the narrow and flat type nasopharyngeal airway (p < 0.01). CONCLUSIONS: Cone-beam computed tomography is a clinically simple, reliable, and noninvasive tool that can simultaneously visualize the entire structure and a cross section of the nasopharyngeal airway and help in measurement of adenoid size as well as airway volume in children with adenoid hypertrophy.

Association between Mismatch Negativity and Functional Status in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: It has been constantly reported that mismatch negativity (MMN) is impaired in patients with schizophrenia. However, the mechanism which relates impaired MMN and schizophrenia is not clear yet. The aim of this study is to investigate the association between MMN and clinical variables including functional status in patients with schizophrenia. METHODS: The present study assessed MMN using passive auditory oddball task in 26 patients with schizophrenia and 48 healthy controls. Repeated measures Analysis of Variance with age as a covariate was carried out for comparing peak amplitude and latency of MMN at 8 central line electrodes (FPz, Fz, FCz, Cz, CPz, Pz, POz, Oz) across groups. Pearson's correlation was performed to reveal the relationship between MMN and clinical variables including neurocognitive test results and the Global Assessment of Functioning score. RESULTS: MMN amplitude was significantly reduced in patients with schizophrenia compared with healthy controls. Pearson's correlation showed that subsets of short form of Korean Wechsler Adult Intelligence Scale scores and GAF scores were associated with MMN amplitude in patients with schizophrenia. CONCLUSION: These findings suggest that MMN amplitude is associated with current functional status including cognitive function in patients with schizophrenia.

Childhood Cancer Survivor's Services Needs for the Better Quality of Life

PURPOSE: The study aimed to identity specific needs for services and programs to help childhood cancer survivors adjust and adapt to life after treatment. METHODS: In-depth interviews were conducted with 31 childhood cancer survivors, diagnosed with cancer before the age of 18 and currently between 15 and 39 years of age. Each survivor had completed his/her cancer treatment. RESULTS: The participating cancer survivors reported needs for services related to psychological counseling, schooling and learning, social skills, mentorship, integrated health management, self support activities, families of survivors, and public recognition and awareness. CONCLUSION: The results of the study indicate a need to better understand childhood cancer survivors, provides a basis for developing various services and programs to improve the quality of life among childhood cancer patients, survivors, and their families, and supports the importance of psychosocial adjustment.

The Effect of Hyaluronidase in Interlaminar Lumbar Epidural Injection for Failed Back Surgery Syndrome

OBJECTIVE: To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI). METHOD: Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI. RESULTS: After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI. CONCLUSION: ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.

The Additional Effect of Hyaluronidase in Lumbar Interlaminar Epidural Injection

OBJECTIVE: To evaluate the effect of hyaluronidase in lumbar interlaminar epidural injection (LIEI) for low back pain and sciatica. METHOD: Sixty-one patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T (n=18, mean duration of illness: 2.12+/-1.16 months) received lumbar interlaminar epidural injection (LIEI) with 2 ml triamcinolone (40 mg/ml) and 5 ml bupivacaine (0.25%). Group H (n=16, mean duration of illness: 2.05+/-1.12 months) received LIEI with 1,500 IU hyaluronidase and 5 ml bupivacaine (0.25%). Group TH (n=27, mean duration of illness: 2.16+/-1.65 months) received LIEI with 1,500 IU hyaluronidase, 2 ml triamcinolone (40 mg/ml), and 5 ml bupivacaine (0.25%). The effects were evaluated using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at preinjection and 2 weeks, 4 weeks, and 8 weeks after LIEI. RESULTS: Pain improved in all groups after 2 weeks (p<0.05). After 8 weeks, there was no significant difference in VAS improvement among the 3 groups. However, pain improved in 70.4% of Group TH compared with preinjection, in contrast to 44.4% of Group T and 31.3% of Group H. The ODI improved significantly only in Group TH after 8 weeks (p<0.05). CONCLUSION: LIEI with triamcinolone and hyaluronidase is more effective for reducing pain after 8 weeks than injection with triamcinolone or hyaluronidase alone.

Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

OBJECTIVE: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). METHOD: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). RESULTS: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8+/-1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6+/-3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. CONCLUSION: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.

Clinical Validity of Gugging Swallowing Screen for Acute Stroke Patients

OBJECTIVE: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. METHOD: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). RESULTS: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p<0.001). By physician B, GUSS (p<0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p<0.05). The kappa-value was 0.916 between physician A and B (p<0.05). CONCLUSION: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.

The Comparison of Clinical and Electrophysiological Characteristics of Epilepsy with Typical Rolandic Spikes and Concomitantly Additional Frontal or Occipital Spikes with Rolandic Spikes / 대한간질학회지

PURPOSE: Recently have there been a few reports that raised the question that Benign Rolandic Epilepsy (BRE) could be a spectrum. This study was conducted to identify whether or not the clinical and electrophysiological characteristics of typical Rolandic Spikes (RS) are different from those of concomitantly additional frontal or occipital spikes with RS. METHODS: The consecutive 39 patients who showed centro-temporal spikes were divided into typical RS and RS+ groups. We defined RS+ groups as having concomitantly additional frontal or occipital spikes with RS. The independent variables included clinical data 0(age of onset, a significant antecedent event as part of their etiology of epilepsy, nocturnal seizure, abnormal development, abnormal neurologic examination, pattern of seizure, response to medication for at least 1 year and epilepsy syndrome) and electrophysiological data (dipoles, spikes accentuated during sleep). RESULTS: Eighty two percents (32/39) of patients were RS, whereas 18% (7/39) were RS+. The median age of onset was 7 years old and only 10% showed significant antecedent events. Eighty six percents (34/39) of patients had BRE as epilepsy syndrome. Neither clinical factors nor electrophysiological characteristics were different between both groups. CONCLUSION: Although RS+ showed additional spikes more than centro-temporal area, the clinical and electrophysiological characteristics of RS+ were not different from those of RS. Centro-temporal with or without additional spikes could be a homogeneous condition rather than a spectrum.

A Case of Neurosyphilis Radiologically Mimicking Herpes Simplex Encephalitis

The neuroradiologic findings of neurosyphilis are variable. A 36-year-old man was admitted due to gradually progressing abnormal behavior and personality change. The brain MRI revealed bilateral mesiotemporal hyperintensity on FLAIR and T2 weighted MR images. Analysis of serum and CSF demonstrated the presence of antibodies to Treponema pallidum. The patient was treated with penicillin, and he had clinical improvements. Neurosyphilis can manifest with MR imaging abnormalities similar to those of herpes encephalitis.

The Relationship between Interleukin-1beta Gene Polymorphism and Partial Epilepsy

BACKGROUND: Neuronal cell death, reactive gliosis, enhanced neurogenesis, and axonal sprouting are well-known pathogenetic mechanisms of epileptogenesis. Pro-inflammatory cytokines are known to modulate the process of epileptogenesis. Interleukin (IL)-1beta-511*2 allele (T at position -511) is associated with increased production of ILs. Symptomatic partial epilepsy (SPE) has not been traditionally regarded as having a major genetic contribution, but recent studies suggest the possibility of genetic predisposition to SPE. In humans, the relationship between SPE and genetic predisposition is not well known. We hypothesized that the IL-1beta gene promoter polymorphism may be a genetic predisposition to SPE in humans. METHODS: Genomic DNA was extracted from peripheral blood leukocyte of consecutive 164 epilepsy patients and 230 normal controls. A single base pair polymorphism at position -511 in the promoter region of the IL-1beta gene was analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Ninety-four patients had partial epilepsy and were divided into SPE and cryptogenic partial epilepsy (CPE). RESULTS: Forty patients had SPE and 63% of SPE showed structural lesions on MRI. The frequency of homozygote for IL-1beta -511*2 allele was significantly higher in SPE than in controls and CPE [45% (18/40) in SPE vs. 23% (54/230) in controls, p=0.01, and 45% in SPE vs. 28% (15/54) in CPE, p=0.02]. CONCLUSIONS: The IL-1beta -511 polymorphism may be related to the genetic predisposition of SPE.

The Relationship between Interleukin-1beta Gene Polymorphism and Partial Epilepsy

BACKGROUND: Neuronal cell death, reactive gliosis, enhanced neurogenesis, and axonal sprouting are well-known pathogenetic mechanisms of epileptogenesis. Pro-inflammatory cytokines are known to modulate the process of epileptogenesis. Interleukin (IL)-1beta-511*2 allele (T at position -511) is associated with increased production of ILs. Symptomatic partial epilepsy (SPE) has not been traditionally regarded as having a major genetic contribution, but recent studies suggest the possibility of genetic predisposition to SPE. In humans, the relationship between SPE and genetic predisposition is not well known. We hypothesized that the IL-1beta gene promoter polymorphism may be a genetic predisposition to SPE in humans. METHODS: Genomic DNA was extracted from peripheral blood leukocyte of consecutive 164 epilepsy patients and 230 normal controls. A single base pair polymorphism at position -511 in the promoter region of the IL-1beta gene was analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Ninety-four patients had partial epilepsy and were divided into SPE and cryptogenic partial epilepsy (CPE). RESULTS: Forty patients had SPE and 63% of SPE showed structural lesions on MRI. The frequency of homozygote for IL-1beta -511*2 allele was significantly higher in SPE than in controls and CPE [45% (18/40) in SPE vs. 23% (54/230) in controls, p=0.01, and 45% in SPE vs. 28% (15/54) in CPE, p=0.02]. CONCLUSIONS: The IL-1beta -511 polymorphism may be related to the genetic predisposition of SPE.