The long-term evaluation of the prognosis of implants with acid-etched surfaces sandblasted with alumina: a retrospective clinical study / 대한악안면성형재건외과학회지

Background@#The aim of this study was to evaluate the long-term clinical stability of implants with acid-etched surfaces sandblasted with alumina using retrospective analyses of the survival rate, success rate, primary and secondary stability, complications, and marginal bone loss of the implants. @*Methods@#Patients who had implants placed (TS III SA, SS II SA, SS III SA, and U III SA) with SA surfaces from Osstem (Osstem Implant Co., Busan, Korea) at the Seoul National University Bundang Hospital, from January 2008 to December 2010 were selected for the study. Patients’ medical records and radiographs (panorama, periapical view) were retrospectively analyzed to investigate sex, age, location of implantation, diameter, and length of the implants, initial and secondary stability, presence of bone grafting, types of bone grafting and membranes, early and delayed complications, marginal bone loss, and implant survival rate. @*Results@#Ninety-six implants were placed in 45 patients. Five implants were removed during the follow-up period for a total survival rate of 94.8%. There were 14 cases of complications, including 6 cases of early complications and 8 cases of delayed complications. All five implants that failed to survive were included in the early complications. The survival of implants was significantly associated with the occurrence of complications and the absorption of bone greater than 1mm within 1 year after prosthetic completion. In addition, the absorption of bone greater than 1mm within 1 year after prosthetic completion was significantly associated with the occurrence of complications, primary stability, and implant placement method. Five cases that failed to survive were all included in the early complications criteria such as infection, failure of initial osseointegration, and early exposure of the fixture. @*Conclusions@#Of the 96 cases, 5 implants failed resulting in a 94.8% survival rate. The failed implants were all cases of early complications such as infection, failure of initial osseointegration, and early exposure of the fixtures. Periimplantitis was mostly addressed through conservative and/or surgical treatment and resulted in very low prosthetic complicat

Alopecia Neoplastica due to Gastric Adenocarcinoma Metastasis to the Scalp, Presenting as Alopecia: A Case Report and Literature Review

Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. The scalp is a relatively common site of cutaneous metastasis, usually presenting as a single or multiple firm scalp nodules. Alopecia neoplastica is a well-recognized but rare presentation, and its pathogenesis is incompletely understood. Atrophy of the hair follicles due to tumor invasion of the scalp plays a role in the development of alopecia. Herein, we describe a 33-year-old woman with gastric adenocarcinoma who developed alopecia neoplastica while receiving cancer chemotherapy. Scalp biopsy revealed metastatic adenocarcinoma cells interspersed between collagen bundles and around hair follicles. Immunohistochemical analysis indicated that the tumor cells originated from the primary gastric adenocarcinoma. Therefore, she was diagnosed with alopecia neoplastica due to gastric adenocarcinoma. The findings from this report may be helpful for understanding the mechanism of alopecia neoplastica.

Cicatricial Alopecia Caused by the Epidermal Growth Factor Receptor Inhibitor, Gefitinib / 대한피부과학회지

Epidermal growth factor receptor inhibitors (EGFRIs) are new anticancer agents that act by inhibiting EGFR signaling transduction pathways, thus decreasing tumor growth. They have made anti-cancer treatment more tolerable and have also reduced systemic side effects. However, they have many cutaneous side effects. Alopecia is an uncommon cutaneous side effect of EGFRIs, and cicatricial alopecia has been reported more rarely. A 59-year-old woman presented with itching and hair loss on the scalp, which started 2 months ago. She had been taking gefitinib for 7 months. A physical examination revealed localized erythematous hairless patches with scattered thick crusts on the scalp. Histopathologic examination showed a decreased number of hair follicles with perifollicular lymphocytes infiltration and perifollicular fibrosis, consistent with a scarring alopecia. We report a rare and interesting case of cicatricial alopecia after using the EGFRI, gefitinib.

The Recognition of Skin Health and Diseases in the Geriatric Population / 대한피부과학회지

BACKGROUND: With the development of medical science and technology, the proportion of the aged in the population has significantly increased. For the same reasons, concerns regarding skin aging and skin diseases in the geriatric population has increased. OBJECTIVE: To evaluate the recognition of skin health and disease in the elderly. METHODS: On April 2009, 190 elderly persons were asked to complete a questionnaire in 5 senior welfare centers in the city of in Korea. The questions included: satisfaction with the subject's own skin; treatment-seeking behavior; knowledge and common sense about representative skin problems; efforts taken to achieve healthy skin. RESULTS: Among the elderly, 44.74% were dissatisfied with their own skin. The most complained about skin diseases in the elderly were pruritus and xerosis. Also, interest in esthetic problems such as wrinkles and pigmentation was high. On the question of whether they visit a dermatologic clinic when they develop skin problems, 40.53% of subjects said that they visited the dermatologic clinic. However, this means that 59.47% did not visit a dermatologic clinic. A somewhat unexpected finding was that knowledge of skin diseases and esthetic problems were plentiful in the geriatric population. Among the elderly, 81.05% did something to achieve skin health such as using a moisturizer or sunscreen. CONCLUSION: The present study contributes to our understanding of the recognition of dermatologic problems in the geriatric populations. Dermatologists and society should pay more attention to the provision of correct information and appropriate treatments for skin diseases in the elderly.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2009) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2009. A total of 16 specimens were distributed. Eight specimens were distributed to 339 laboratories with 322 (95.0%) returns in Trial I, and another eight specimens to 337 laboratories with 327 returns (97.0%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in both Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Sterotrophomonas maltophilia, Staphylococcus aureus, Streptococcus agalactiae, Micrococcus luteus, Vibrio parahemolyticus and Candida glabrata (Trial I) were 94.4%, 98.5%, 92.1%, 62.3%, 92.1% and 71.5%, respectively. The acceptable percentages of bacterial identification on Pseudomonas aeruginosa, Enterococcus faecalis, Candida albicans, Staphylococcus epidermidis, Moraxella catarrhalis and Enterobacter cloacae (Trial II) were 98.5%, 94.1%, 89.2%, 86.2%, 79.6% and 98.5%, respectively. The acceptable percentages for antimicrobial susceptibility tests on S. maltophilia and S. aureus (Trial I), and P. aeruginosa and E. faecalis(Trial II) were relatively good compared to data of the last year, except results using disk method for S. maltophilia. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2008) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2008. A total of 16 specimens were distributed. Eight specimens were distributed to 330 laboratories with 319 (96.7%) returns in Trial I, and 8 specimens to 335 laboratories with 319 returns (95.2%) in Trial II. Two slide specimens for mycobacterium stain (AFB) were distributed in Trial I and II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology except for Acinetobacter baumannii. The acceptable percentages of bacterial identification (correct answers to species level) on Klebsiella pneumoniae, Staphylococcus aureus, Neisseria meningitidis, Serratia marcescens, Erysipelothrix rhusiopathiae and Candida albicans (Trial I) were 97.4%, 99.2%, 55.6%, 97.0%, 79.2%, and 92.0%, respectively. The acceptable percentages of bacterial identification on A. baumannii, Enterococcus faecalis, Streptococcus pyogenes, Haemophilus parainfluenzae, Elizabethkingia meningoseptica, and Yersinia pseudotuberculosis (Trial II) were 92.0%, 90.8%, 4.5%, 53.1%, 74.8% and 94.3%, respectively. The acceptable percentages for antimicrobial susceptibility tests on K. pneumoniae and S. aureus (Trial I), and A. baumannii and E. faecalis, (Trial II) were relatively good compared to data of the last year. The acceptable percentages for AFB stain in Trial I and II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good except some cases with poor specimen quality. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2007) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2007. A total of 14 specimens were distributed. Six specimens were distributed to 317 laboratories with 305 (96.2%) returns in Trial I, and 8 specimens to 320 laboratories with 309 returns (96.5%) in Trial II. For the first time, two slide specimens for mycobacterium stain (AFB) were distributed in Trial II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Streptococcus pyogenes, Branhamella catarrhalis, Escherichia coli, Enterococcus faecalis, Aeromonas hydrophilia and Yersinia enterocolitica (Trial I) were 83.5%, 70.8%, 98.1%, 87.0%, 89.2%, and 97.0%, respectively. The acceptable percentages of bacterial identification on Staphylococcus aureus, Pseudomonas aeruginosa, Candida tropicalis, Listeria monocytogenes, Enterococcus casseliflavus and Klebsiella pneumoniae (Trial II) were 98.1%, 97.7%, 71.6%, 77.4%, 72.4% and 96.2%, respectively. The acceptable percentages for antimicrobial susceptibility tests on E. coli and E. faecalis (Trial I), and S. aureus and P. aeruginosa (Trial II) were relatively good compared to data of recent three years. The acceptable percentages for AFB stain in Trial II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2007) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratories were performed in 2007. A total of 14 specimens were distributed. Six specimens were distributed to 317 laboratories with 305 (96.2%) returns in Trial I, and 8 specimens to 320 laboratories with 309 returns (96.5%) in Trial II. For the first time, two slide specimens for mycobacterium stain (AFB) were distributed in Trial II. The acceptable percentages of Gram stain were relatively good for both stainability and morphology. The acceptable percentages of bacterial identification (correct answers to species level) on Streptococcus pyogenes, Branhamella catarrhalis, Escherichia coli, Enterococcus faecalis, Aeromonas hydrophilia and Yersinia enterocolitica (Trial I) were 83.5%, 70.8%, 98.1%, 87.0%, 89.2%, and 97.0%, respectively. The acceptable percentages of bacterial identification on Staphylococcus aureus, Pseudomonas aeruginosa, Candida tropicalis, Listeria monocytogenes, Enterococcus casseliflavus and Klebsiella pneumoniae (Trial II) were 98.1%, 97.7%, 71.6%, 77.4%, 72.4% and 96.2%, respectively. The acceptable percentages for antimicrobial susceptibility tests on E. coli and E. faecalis (Trial I), and S. aureus and P. aeruginosa (Trial II) were relatively good compared to data of recent three years. The acceptable percentages for AFB stain in Trial II were relatively high. In summary, the acceptable percentages of bacterial stain and identification were relatively good. However, it is still necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2005) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratory were performed in 2005. A total of 12 specimens were distributed. Six specimens were distributed to 308 laboratories with 272 (88.3%) returns in Trial I and 276 (89.6%) returns in Trial II. The acceptable percentages of Gram-stain were relatively good. The acceptable percentages of bacterial identification on Acinetobacter baumannii, Staphylococcus aureus, Streptococcus pyogenes, Aeromonas hydrophila, Enterococcus casseliflavus, Brucella species (Trial I) were 80.1%, 98.3%, 87.6%, 81.3%, 55.5%, 38.1%, respectively. The acceptable percentages of bacterial identification on Klebsiella pneumoniae, Enterococcus faecalis, Brahamella catarrhalis, Burkholderia cepacia, Campylobacter fetus, Rhodoccus equi (Trial II) were 97.5%, 85.9%, 71.0%, 85.9%, 8.3%, 51.0%, respectively. The acceptable percentages for antimicrobial susceptibility tests on Acinetobacter baumannii, Staphylococcus aureus and Klebsiella pneumoniae were relatively high, but those on Klebsiella pneumoniae for ESBL and Enterococcus faecalis for vancomycin-resistance were not high. In conclusion, the acceptable percentages of bacterial stain and identification were relatively good except C. fetus. However, it is necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2004) / 임상검사와정도관리

Two trials of external quality assessment for clinical microbiology laboratory were performed in 2004. A total of 12 specimens were distributed. Six specimens were distributed to 293 laboratories with 277 returns in Trial I and six specimens to 293 laboratories with 274 returns in Trial II. The acceptable percentages of Gram-stain on Streptococcus pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis were 96.0%, 98.5%, 97.4% and 98.2%, respectively. The acceptable percentages of bacterial identification on Streptococcus pneumoniae, Escherichia coli, Enterococcus faecalis, Staphylococcus saprophyticus, Shigella flexneri, Gemella spp., Pseudomonas aeruginosa, Enterococcus faecalis (Trial II), Streptococcus agalactiae, Listeria monocytogenes, Erysipelothrix rhusiopathiae, and Eikenella corrodens were 97.5% (including 33.7% of no growth), 99.6%, 93.2%, 82.3%, 95.4%, 50.7%, 98.4%, 92.3%, 87.0%, 78.9%, 92.5% (including 53.4% of no growth), respectively. The acceptable percentages for antimicrobial susceptibility tests on Escherichia coli and Pseudomonas aeruginosa were relatively high, but those on Streptococcus pneumoniae and Enterococcus faecalis were not high. In conclusion, the acceptable percentages of bacterial stain and identification were relatively good. However, it is necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests on Streptococcus pneumoniae and Enterococcus faecalis, and the selection of the most appropriate antimicrobial agents to test should be also considered.

Annual Report on External Quality Assessment in Clinical Microbiology Laboratory in Korea (2002) / 임상검사와정도관리

Three trials of external quality assessment for clinical microbiology laboratory were performed in 2002. A total of 19 specimens were distributed. Five specimens were distributed to 241 laboratories with 222 returns in Trial I, seven specimens to 241 laboratories with 232 returns in Trial II, and seven specimens to 245 laboratories with 220 returns in Trial III. The percentages of fully correct results of Plasmodium falciparum, P. malariae, P. vivax, gram-positive rods, group 5, S. aureus, E. faecium, Leuconostoc spp. Aeromonas hydrophila, Alternaria spp. S. aureus, E. coli, K. pneumoniae, E. faecalis, P. aeruginosa, E. coli, and K. pneumoniae were 38%, 66%, 68%, 85%, 68%, 94%, 76%, 51%, 86%, 76%, 100%, 99%, 93%, 79%, 86%, 95% and 96%, respectively. The acceptable percentages on disk-diffusion antibacterial susceptibility tests against oxacillin and vancomycin of S. aureus (M0206) were 99% and 94%, respectively. Those against vancomycin and teicoplanin of E. faecium (M0208) were 99% and 94%, respectively. Those against vancomycin, oxacillin, penicillin G, clindamycin, erythromycin, ciprofloxacin, gentamicin and teicoplanin of S. aureus (M0213) were 87%, 95%, 93%, 93%, 93%, 82%, 92%, 99%, and 95%, respectively. The acceptable percentages on disk diffusion test against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0214) were 98%, 100%, 98%, 96%, and 87%, respectively. Those against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0215) were 96%, 100%, 98%, 93% and 99%, respectively. Those against vancomycin, ciprofloxacin, ampicillin, penicillin G, erythromycin, and teicoplanin of E. faecalis (M0216) were 91%, 85%, 94%, 87%, 97%, and 100%, respectively. Those against ciprofloxacin, gentamicin, imipenem, ceftazidime, and piperacillin of P. aeruginosa (M0217) were 89%, 99%, 100%, 100%, and 100%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0218) were 98%, 98%, 98%, 100%, 98%, 100% and 90%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0219) were 97%, 97%, 98%, 100%, 99%, 99% and 99%, respectively. Twenty laboratories on Trial III had reported the both results of disk diffusion and MIC methods. The performance on the automated or E-test susceptibility tests was generally good, except in case of teicoplanin, showing the lower MIC in 63% of 51 participants. The susceptibility against teicoplanin should be confirmed by disk diffusion method in case of vancomycin-resistant Enterococcus in the laboratories using automated MIC methods. In conclusion, it is necessary that the quality assurance of the individual laboratories should be improved in the identification of malaria and Enterococcus spp., and in susceptibility tests against vancomycin, erythromycin and ciprofloxacin of S. aureus, and cephalothin of E. coli in case of disk diffusion method, and teicoplanin of Enterococcus in the laboratories using automated MIC methods.

Intussusception in Childhood: The Role of Plain Abdominal Radiographs

PURPOSE: The purposes of this study were to evaluate the plain radiologic findings of the childhood intussusception and to evaluate the role of plain abdominal films in predicting the success of air or barium reduction. SUBJECTS AND METHODS: We retrospectively reviewed 140 cases with the diagnosis of intussusception in children. The radiological signs that included soft tissue mass, dilatation of small bowel suggesting obstruction, crescent sign, and target sign were evaluated in terms of frequency. The relationship between radiological findings and outcome of reduction was analyzed. The site of soft tissue mass or crescent sign seen on plain radiographs was correlated with the position of the apex of the intussusceptum seen at the beginning of barium enema. The degree of dilated small bowel was evaluated by calculating the proportion of air-filled small bowel occupying peritoneal cavity and measuring the maximal diameter of dilated bowel lumen. The radiological finding for small bowel obstruction is determined by observation of the degree of small bowel dilatation and/or air-fulid levels. RESULTS: Ninety-two cases out of 140 showed one or more radiographic signs. Two most common signs were soft tissue mass and small bowel obstruction. The success rate of air or barium reduction was significantly lower in patients with most severe degree of dilatation of small bowel and/or more than 7 air-fulid levels on erect view. The suspected location of intussusception on plain radiographs correlated well with the true location of intussusception seen in the first few seconds of barium reduction. CONCLUSION: Plain abdominal radiography is useful in the diagnosis of intussusception and provides helpful informations for the reduction procedure as well as for the exclusion of the contraindications such as bowel perforation.

Thallium 201 Thyroid Scan: Differential Diagnosis of Benign and Malignant Nodules

PURPOSE: To evaluate useful findings and diagnostic value of TI-201 thyroid scan in differentiating benign from malignant nodules. MATERIAL AND METHOD: We studied 77 cold thyroid nodules proven histologically(27 malignat and 50 benign). Early (5--15rain) and delayed images(3--5hours) were obtained after intravenous injection of thallium 201. In these nodules, we retrospectively analyzed the degree of TI-201 uptake in early and delayed images, histopathologic type, size, and presence or absence of cystic change in the sonograms of 22 malignant nodules. RESULTS: Useful finding for diagnosis of malignant nodules was strong uptake of TI-201 in early and delayed images(specificity:98%, sensitivity:63%, positive predictive value:94.4%). Useful finding for benign nodules was no uptake of TI-201 in delayed image(specificity :88.9%, sensitivity :68%, positive predictive value :91.9%). The accuracy of TI-201 thyroid scan in differentiating benign from malignant nodules was 66.2%. The nodules with strong TI-201 uptake in early image and low TI-201 uptake in delayed image were malignant in 29.4%. Cystic changes were found in 40% of malignant nodules with atypical TI-201 uptake. TI-201 thyroid scan showed high specificity in follicutar neoplasm and adenomatous goiter in which differentiation of benignancy and malignancy is difficult with only cytologic examination. CONCLUSION: We consider that TI-201 thyroid scan is valuable in differentiating benign from malignant nodules and when combined with fine needle aspiration and ultrasound examination, it will enable more accurate differential diagnosis between benign and malignant thyroid nodules.