Changes in maximum lip-closing force after extraction and nonextraction orthodontic treatments / 대한치과교정학회지

OBJECTIVE@#The aims of the present study were to evaluate the changes in the maximum lip-closing force (MLF) after orthodontic treatment with or without premolar extractions and verify the correlation of these changes with dentoskeletal changes.@*METHODS@#In total, 17 women who underwent nonextraction orthodontic treatment and 15 women who underwent orthodontic treatment with extraction of all four first premolars were included in this retrospective study. For all patients, lateral cephalograms and dental models were measured before (T0) and after (T1) treatment. In addition, MLF was measured at both time points using the Lip De Cum LDC-110R® device. Statistical analyses were performed to evaluate changes in clinical variables and MLF and their correlations.@*RESULTS@#Both groups showed similar skeletal patterns, although the extraction group showed greater proclination of the maxillary and mandibular incisors and lip protrusion compared to the nonextraction group at T0. MLF at T0 was comparable between the two groups. The reduction in the arch width and depth and incisor retroclination from T0 to T1 were more pronounced in the extraction group than in the nonextraction group. MLF in the extraction group significantly increased during the treatment period, and this increase was significantly greater than that in the nonextraction group. The increase in MLF was found to be correlated with the increase in the interincisal angle and decrease in the intermolar width, arch depth, and incisor–mandibular plane angle.@*CONCLUSIONS@#This study suggests that MLF increases to a greater extent during extraction orthodontic treatment than during nonextraction orthodontic treatment.

Malignant Adenomyoepithelioma of the Breast and Responsiveness to Eribulin / 한국유방암학회지

Adenomyoepithelioma (AME) of the breast is an uncommon tumor characterized by its dual differentiation into luminal cells and myoepithelial cells. In most cases these tumors have a benign clinical course, but distant metastases have been reported. We present the case of a 51-year-old woman diagnosed with malignant AME. The patient underwent a right modified radical mastectomy, and pathological examination confirmed the diagnosis of malignant AME. Ten months after the operation, multiple hepatic, pleural, and abdominal wall metastases were detected. A number of palliative chemotherapeutic agents were tried, including anthracycline and taxanes. However, the disease continued to progress, and superior vena cava syndrome developed as a result of direct tumor invasion. The patient received salvage eribulin monotherapy. After two cycles of this treatment, her clinical symptoms were ameliorated, and a computed tomography scan showed a partial response. Eribulin chemotherapy was thus effective in treating malignant AME in this case.

Clinical Course of Intestinal Behcet's Disease according to the Characteristics of Ulcer in Colonoscopy

BACKGROUND/AIMS: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet's disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. METHODS: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. RESULTS: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. CONCLUSIONS: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively.

Clinical Course of Intestinal Behcet's Disease according to the Characteristics of Ulcer in Colonoscopy

BACKGROUND/AIMS: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet's disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. METHODS: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. RESULTS: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. CONCLUSIONS: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively.

Effect of Extremely Low Frequency Electromagnetic Fields (EMF) on Phospholipase Activity in the Cultured Cells

This study was conducted to investigate the effects of extremely low frequency electromagnetic fields (EMF) on signal pathway in plasma membrane of cultured cells (RAW 264.7 cells and RBL 2H3 cells), by measuring the activity of phospholipase A2 (PLA2), phospholipase C (PLC) and phospholipase D (PLD). The cells were exposed to the EMF (60 Hz, 0.1 or 1 mT) for 4 or 16 h. The basal and 0.5 microM melittin-induced arachidonic acid release was not affected by EMF in both cells. In cell-free PLA2 assay, we failed to observe the change of cPLA2 and sPLA2 activity. Also both PLC and PLD activities did not show any change in the two cell lines exposed to EMF. This study suggests that the exposure condition of EMF (60 Hz, 0.1 or 1 mT) which is 2.4 fold higher than the limit of occupational exposure does not induce phospholipases-associated signal pathway in RAW 264.7 cells and RBL 2H3 cells.

Degenerative Osteoarthritis of the Hip Misconceived as a Failed Back Surgery Syndrome: A case report / 대한마취과학회지

We report the treatment experience of a patient who developed pain in the right anterior thigh and buttock 3 months later after lumbar disc surgery. He was treated as failed back surgery syndrome and had no symptom improvement. On physical examination, groin pain was elicited by Patrick's test and internal rotation of the hip. Plain radiographs of the pelvis showed calcification or osteophytes near the superior lip of the acetabulum. On magnetic resonance imaging, the lesion was identified as osteophytes and joint effusion was also noted. Under C-arm guidance, we injected corticosteroids and local anesthetics, and the patient obtained dramatic pain relief and no recurrence of symptoms.

Analysis of Satisfaction with Removal Dental Prosthesis among Hansen`s Patients / 나학회지

The purposes of this study were to investigate the satisfaction of use of removable denture elated to general, functional and esthetic factors among dental patients in national sorokdo hospital, and to establish the structure relationships of dental treatment satisfaction. Two hundred fifty hansen`s patients who consented with this survey were selected and examined their oral status. Satisfaction degree was estimated by means of self-developed questionarires, filled out by face-to-face interview. Collected data were analyzed by t-tast The obtained results were as follow : 1. The satisfaction degree of four subscales was highest in esthetic actor (3.17+/-0.36), denture retention factor(3.10+/-0.60), general treatment satisfaction factor(2.94+/-0.56), and masticatory function factor (2.90+/-0.68) in descending order. It was appeared that patients was generally satisfied with all four factor. 2. On the comparison between proportion of denture satisfaction and satisfactio 02n of subscales, as the satisfaction of general treatment, masticatory function and denture retention were increased, the proportion of denture satisfaction of esthetic function and proportion of denture satisfaction. 3. The masticatiory function factor, denture retention factor and genernal satisfaction of treatment factor were directly affected on the denture satisfaction, but esthetic factor was affected indirectly on the denture satisfaction as a result of path analysis

The Degrees of Hepatocyte Cytoplasmic Expression of Hepatitis B Core Antigen correlate with Histologic Activity of Liver Disease in the Young Patients with Chronic Hepatitis B Infection

Subcellular localizaton of HBcAg have been found to be related to the activity of liver disease and HBV replication. The aim of this study was to determine whether the degree of expression of HBcAg in the hepatocyte nucleus and cytoplasm reflects the level of viral replication and histological activity in chronic HBV infection. A total of 102 patients with biopsy proven chronic hepatitis B were included. There was a highly significant correlation between the levels of HBV DNA in serum and the degree of expression of HBcAg in the nucleus for HBeAg-positive(p=0.000) and negative patients(p=0.04). There was a highly significant, correlation between the degrees of expression of HBcAg in hepatocyte cytoplasm and histologic activities (p<0.01) for HBeAg-positive patients. The degrees of expression of HBcAg in the hepatocyte cytoplasm correlated positively with the lobular activities (p<0.01), but not correlated with the portal activity and fibrosis for HBeAg-negative patients. In conclusion, in the young patients with chronic B viral hepatitis, the degree of expression of HBcAg in the hepatocyte nucleus may affect viral load, and the degree of expression of HBcAg in the hepatocyte cytoplasm may affect histologic activities of liver disease.

Preprocedural hs-CRP Level Serves as a Marker for Procedure-Related Myocardial Injury During Coronary Stenting

BACKGROUND AND OBJECTIVES: Elevated hs-CRP (high sensitivity C-reactive protein) is well known as a biomarker reflecting the inflammatory process that might evoke the potential for microembolization of an atheromatous plaque, and imparts a poor prognosis in patients with coronary artery disease. We designed this study to evaluate whether the preprocedural hs-CRP level was associated with procedure-related myocardial injury following coronary stenting. SUBJECTS AND METHODS: We obtained the plasma hs-CRP level from angina patient, who underwent coronary stenting, within 24 hours prior to the procedure, and divided the patients into either the normal CRP (hs-CRP or =3 mg/L). We defined the reduction of TMP (TIMI myocardial perfusion) grade as at least one decrease in the TMP grade following coronary stenting compared with the pre-procedural TMP. We also evaluate the procedure-related myocardial damage by measuring CK-MB leakage after stenting. RESULTS: We enrolled 279 lesions in 226 patients, who were divided into two groups: the normal CRP group (n=137, 1.28+/-0.71 mg/L) and the elevated CRP group (n=89, 6.89+/-4.23 mg/L). A reduction in the TMP grade was significantly more prevalent in the elevated CRP (20 lesions, 17.4%) compared to the normal CRP group (6 lesions, 3.7%, p=0.001). An elevated CRP level was related to an increased CK-MB leakage following stenting (elevated CRP group; 23 patients, 25.8%, normal CRP group; 21 patients, 15.3%, p=0.041). In a multivariable analysis, the only significant predictor of a reduction in the TMP grade following stenting was an elevated CRP level. CONCLUSION: Systemically detectable inflammatory activity, served by the plasma hs-CRP level, is associated with procedure-related microvascular injury, as assessed by a reduction in the TMP grade and CK-MB elevation following coronary stenting.

Clinical aspects of gastrointestinal stromal tumors / 대한내과학회지

BACKGROUND: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The GISTs are immunohistochemically defined as KIT (CD117) positive tumors. To evaluate the prognostic factors for GISTs, we investigated the clinicopathological factors and the patient's survival rate. METHODS: Between 1996 and 2002, 37 patients were diagnosed with GIST at Dong-A University Medical Center, and 34 of these patients with localized GIST underwent surgical resection. For the immunohistochemical staining, we used KIT, CD34, s100 and SMA. RESULTS: The primary tumor site was the stomach (60%), and this was followed by small intestine (40%). The most common tumor morphology was spindle cell (83%) followed by epithelial cell (17%). An immunohistochemical analysis revealed that KIT was expressed 100% and CD34 was expressed in 29 cases (78.4%), SMA in 13 patients (35%), and s100 in 7 patients (18.9%). According to the tumor size and mitotic count, 4 patients were classified as very low, 8 were low, 14 were intermediate and 8 patients were high risk. Nine patients (24.3%) underwent adjuvant chemotherapy. The median follow up duration was 29 months. The 5-year disease free survivalrate was 55.1%, and 5-year overall survival rate was 72.8%. The 5-year disease free survival rates for patients with very low and low risk classifications were 100%, and the intermediate risk and high risk were 76.4% and 38.9%, respectively (p=0.1489). The five year overall survival rates for patients with very low and low risk classification were 100%, and intermediate risk and high risk were 90.0% and 0%, respectively (p=0.0179). However, age, pathologic subtype, adjuvant chemotherapy, and immunohistochemical stain results were not significant prognostic factors. CONCLUSION: These results suggest that risk stratification was the most important prognostic factor in GISTs.

A case of angioedema associated with losartan / 천식및알레르기

Angioedema is a non-pitting edema that occurs in the skin and mucus membranes. It is known that major etiologies include hereditary deficiency of C1 esterase inhibitor, temperature extreme, trauma, food sensitivity, and medications such as penicillin, aspirin, NSAIDS and ACE inhibitors. ACE inhibitors are blocking the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, and increasing local levels of bradykinin, a potent vasodilator. This increased bradykinin has been theorized to cause angioedema and cough in patients on ACE inhibitors. However, there has been very few causes of angioedema induced by angiotensin II receptor blocker. This is the first report of a patient presenting angioedema induced by losartan -angiotensin II receptor blocker- in this century.

A case of wheat-induced anaphylaxis in an adult / 천식및알레르기

Wheat is known as a causative agent of bakers' asthma, wheat-dependent exercise induced anaphylaxis and food allergies in infants and young children. However, there has been few cases of wheat-induced anaphylaxis in adult age. We report a case of wheat-induced anaphylaxis patient presented in an adult and two IgE-binding components(43 kDa and 48 kDa) were identified.

Psoas abscess: Analysis of 24 cases / 대한내과학회지

BACKGROUND: Psoas abscess is a rare condition with vague clinical presentations, therefore misdiagnosis or delayed diagnosis is often made. We have reviewed the characteristics of the clinical presentation, microbiology, and treatment of 24 patients with psoas abscess. METHODS: The records of all patients treated with psoas abscess at Ajou University Hospital between March, 1996 and May, 2001 were retrospectively reviewed. RESULTS: A total of 24 cases of psoas abscess were reviewed: among these 17 cases were due to secondary cases and seven cases were diagnosed as primary psoas abscess. The right side was affected in 11 cases, the left side in nine, and both sides in four. Methicillin-susceptible Staphylococcus aureus was the most frequent (7/24 cases) pathogen, which were detected in cultures from five of seven patients with primary abscesses, whereas Mycobacterium tuberculosis (6/17 cases) and mixed enteric flora were detected in secondary abscesses. Three of the patients with primary psoas abscess expired from septic shock. The mortality rate was 12.5%. CONCLUSION: A psoas abscess should be considered when any patient presents with nonspecific abdominal pain, back pain and fever. This condition may be diagnosed promptly with computed tomography. Treatment involves use of appropriate antibiotics, as well as drainage of the abscess. Antibiotic coverage must include S. aureus and enteric bacteria. However, in endemic areas (such as Korea), tuberculous infection should be also considered.

Clinical Impacts of Tumor Cell Contamination of Hematopoietic Stem Cell Products in Metastatic Breast Cancer Patients undergoing Autologous Peripheral Blood Stem Cell Transplantation: Multicenter Trial

To determine whether the tumor cell contamination of peripheral blood stem cells influences clinical impacts on high-dose chemotherapy in patients with metastatic breast cancer, we analyzed carcinoembryonic antigen (CEA) mRNA in the apheresis products by nested RT-PCR (reverse transcriptase-polymerase chain reaction). A total of 38 metastatic breast cancer patients and ten normal healthy subjects as a negative control were included. Twenty out of 38 (51.3%) apheresis products from patients with metastatic breast cancer were positive for CEA mRNA. CEA mRNA was noted in 54.8% (17/31) of patients mobilized with chemotherapy plus G-CSF and 42.8% (3/7) of patients with G-CSF alone. There was no significant difference in age, estrogen receptor, menopausal status, mobilization method, disease free interval, or number of metastasis sites (1 vs >/=2) between positive and negative groups. The presence of CEA mRNA in apheresis products did not influence the time to progression and overall survival in both groups. However, both the univariate and the multivariate analysis disclosed that the number of metastasis was associated with survival significantly. We suggest that the tumor cell contamination does not predict poor treatment outcome in patients with metastatic breast cancer.

Hemodynamic Effects on Atherosclerosis-Prone Coronary Artery: Wall Shear Stress / Rate Distribution and Impedance Phase Angle in Coronary and Aortic Circulation

The objective of the present study was to evaluate the hemodynamic characteristics of an atherosclerosis-prone coronary artery compared to the aorta. We describe three- dimensional spatial patterns of wall shear stress (WSS) according to the impedance phase angle in pulsatile coronary and aorta models using in vivo hemodynamic parameters and computed numerical simulations both qualitatively and quantitatively. Angiography of coronary arteries and aortas were done to obtain a standard model of vascular geometry. Simultaneously to the physiologic studies, flow-velocity and pressure profiles from in vivo data of the intravascular Doppler and pressure wire studies allowed us to include in vitro numerical simulations. Hemodynamic variables, such as flow-velocity, pressure and WSS in the coronary and aorta models were calculated taking into account the effects of vessel compliance and phase angle between pressure and flow waveforms. We found that there were spatial fluctuations of WSS and in the recirculation areas at the curved outer wall surface of the coronary artery. The mean WSS of the calculated negative phase angle increased in the coronary artery model over that in the aorta model and the phase angle effect was most prominent on the calculated amplitude of WSS of the coronary artery. This study suggests that the rheologic property of coronary circulation, such as the fluctuation of WSS/WSR induces several hemodynamic characteristics. A separation of flow-velocity, a difference in phase between pressure conductance and blood flow and prominent temporal and/or spatial oscillatory fluctuations of the shear forces as a function of pulsatile flow might be important factors in atherogenesis and progression of atherosclerosis.

The Clinical Characteristics of Hyperthyroidism Combined with Ocular Myasthenia Gravis: Report of Six cases / 대한내분비학회지

Myasthenia gravis is an autoimmune disease characterized by impaired neuromuscular transmission due to circulating antiacetylcholine receptor autoantibodies. The relation between myasthenia gravis and thyroid disease remains unclarified. The association is thought to be uncommon and approximately 0.2% of myasthenia gravis has been reported in patients with autoimmune thyroid disease. Clinical expression of myasthenia gravis varies, ranging from a mild localized disease such as ocular myasthenia gravis (OMG) to a severe generalized disease. A higher frequency of thyroid antibodies has been observed in OMG compared to generalized myasthenia gravis, but the exact mechanisms of this increased association between OMG and thyroid autoimmunity has not been confirmed. The "see-saw" relationship between hyperthyroidism and myasthenia gravis is presented by some authors, while others reported that the optimal maintenance of euthyroid status was essential in treatment. Today many authors agree to the latter and we think that the adequate control of hyperthyroidism is more important. We have experienced six cases of hyperthyroidism combined with OMG and it was somewhat difficult to diagnose myasthenia gravis when the patient have Graves' ophthalmopathy.

A Case Report of Polyarteritis Nodosa in Small Bowel

Polyatreritis nodosa is a rare autoimmune disease (the immune system attacking its own body) characterized by spontaneous inflammation of the arteries (arteritis) of the body. Because arteries are involved, the disease can affect any organ of the body. The most common areas of involvement include the muscles, joints, intestines (bowels), nerves, kidneys, and skin. Gastrointestinal involvement is reported in about 50% of the cases, but bleeding complications are rare and result in a poor prognosis. Polyarteritis nodosa is most common in middle-age persons. Recently, we experienced polyarteritis nodosa which presented as small bowel bleeding and which was diagnosed by angiography, a small-bowel series, and patholgic examination of the surgically removed ileum specimen. We report this case with a brief review of the literature.

Gianturco Metallic Biliary Stent in Malignant Biliary Obstruction: Results of Follow-up in Dead Patients

PURPOSE: In order to study the patency, restenosis, efficacy, and complications of the metallic stent in the course of treatment of malignant biliary obstruction,the results of follow up of the dead patients after stent insertion were reviewed. MATERIALS AND METHODS: Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients :10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. RESULTS: The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1.14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. CONCLUSION: On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected.

A Case of Dilated Cardiomyopathy Associated with Pheochromocytoma

The diagnosis of dilated cardiomyopathy associated with pheochromocytoma was made in a 24 year old male on the basis of symptoms and signs, measurements of metabolites of catecholamine,echocardiography and radionuclide ventriculography were preformed and demonstrated. The presence of a tumor on both adrenal glands without definite distant metastasis was demonstrated by abdominal ultrasonography, CT scanning and 131I-MIBC scintigraphy. Surgical removal was performed after proper preoperative preparation with a-adrenergic blocker. During the surgery, neither significant arrhythmia nor severe change of blood pressure was observed. After surgery, cardiac function of the patient improved slowly and progressively.

Paget's Disease of the Male Breast

Paget's disease of the breast occurs almost exclusively in women, and is characterized by a unilateral, sharply defined eczematous skin lesion caused by epidermal metastases from underlying ductal adenocarcinoma of the breast. Paget's disease of the male breast is extremely rare. A 61-year-old patient had a skin lesion on the right nipple for 1 year. The lesion was a well defined, brownish, crusted, and keratotic papule, and was associated with an underlying walnut sized, fixed, hard mass and a palpable ipsilateral axillary lymph node. Histologic findings were consistent with Paget's disease. Results of immunoperoxidase staining technigues for S-100 protein and carcinoembryonic antigen were negative. After a modified radical mastectomy and chemotherapy, the patient has been in remission for 12 months.