Eating Habits and Food Preferences of Elementary School Students in Urban and Suburban Areas of Daejeon

This study investigated the dietary habits and food preferences of elementary school students. The survey was conducted by means of a questionnaire distributed to 4th and 5th grade elementary school students (400 boys and 400 girls) in urban and suburban areas of Daejeon. The results of this study were as follows: male students in urban areas ate breakfast, unbalanced diets, and dairy products more frequently than male students in suburban areas (p < 0.05). Female students in urban areas ate dairy products (p < 0.01) and fruits (p < 0.001) more frequently than female students in suburban areas. Students had the high preferences for boiled rice and noodles with black bean sauce, beef rib soup, steamed beef rib, steamed egg, beef boiled in soy sauce, egg roll, bulgogi, pork cutlet, deep-fried pork covered with sweet and sour starchy sauce, and honeyed juice mixed with fruit as a punch. All students preferred kimchi, although students in the suburban areas preferred kimchi-fried rice (p < 0.05), and those in the urban areas preferred bean-paste soup (p < 0.01). Students in suburban areas showed a greater preference for seasoned bean sprouts and Altari kimchi. All of the students preferred fruits, rice cake made with glutinous rice, and pizza among other foods. Overall, there were distinct differences in the eating habits and food preferences of elementary school students according to the place of residence.

Measurement of Hyaluronic Acid Amounts Using ELISA from Cultured Human Skin Fibroblasts / 대한피부과학회지

BACKGROUND: Assay of glycosaminoglycans or proteoglycans from skin is complicated due to individual methods where the measurements are highly specialized. The results from these different methods are not able to be compared and there is a large variance. OBJECTIVE: It seems reasonable that a major glycosaminoglycan in the skin, hyaluronic acid, might be ideal as a representative instead of the whole components of glycosaminoglycan. To develop a simple and reliable assay method, the in vitro cell culture system was selected to reduce time and variety of data. The usefulness of the ELISA method, using hyaluronic acid binding protein (HA-ELISA), was evaluated. METHODS: The amount of hyaluronic acid synthesis was measured under a standardized protocol for cultured human skin fibroblasts from the elderly and neonates, as well as the NIH 3T3 mouse fibroblast cell line. To see whether this screening method (HA-ELISA) could be time-saving and reliable under in vitro conditions, some well-known stimulants for glycosaminoglycan synthesis such as retinol, retinyl palmitate, polyethoxyretinide retinamide and hydroxyproline were treated. RESULTS: The production of hyaluronic acid was influenced by both culture condition and source of fibroblasts. The level of quantity showed different patterns due to factors such as culture period, serum in the medium and cell proliferation rate. We found that stable levels of hyaluronic acid assay from culture supernatant were obtained by delaying the sampling time after 24 hours of treatment with stimulants. CONCLUSION: For a reliable quantitative assay, either NIH 3T3 mouse fibroblasts or neonate fibroblasts were suitable. The culture condition and time of harvest should be determined first to estimate the stable kinetics of hyaluronic acid synthesis. This in vitro test protocol can be used as an additional evaluation system towards a potential agent for dermal connective tissue, while further efforts are still mandatory to correlate the confounding factors of in vitro and in vivo.

Clincal Features and Surgical Treatment of Solid Pseudopapillary Tumor of Pancreas

PURPOSE: A solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm, with low malignant potential, which tends to occur predominantly in younger females. Most patients are diagnosed due to the abdominal pain or the large palpable abdominal mass. The treatment is surgical resection, using either enucleation or more radical procedures. Only a few cases of SPT have been reported; therefore, the purpose of this study was to evaluate the clinicopathological characteristics and prognosis after surgical resection of this rare type of tumor. METHODS: In this paper, twelve cases of SPT, treated at the Department of Surgery, Chonnam National University Hospital, between 1994 and 2003, are presented. RESULTS: 10 females, with a mean age of 32.2 years, ranging from 14 to 48, and 2 males, aged 15 and 32, were diagnosed. The tumors were large, with a mean resected diameter of 7 cm, had cystic degene rations between the solid areas, and were distributed in the head (7 cases) and the body-tail (5 cases) of the pancreas. Immunohistochemical studies were performed in 7 patients, which revealed the majority of the cases to be a-1 antitrypsin and neuron specific enolase (NSE) positive. The surgical managements of the tumors included enucleation (6 cases) or more radical procedures, such as a distal pancreatectomy (5 cases) and pancreaticoduodenectomy (1 case). There was no recurrence after the complete surgical resection. CONCLUSION: The mainstay of treatment in patient with a SPT is surgical resection, after which the prognosis was favorable.

Ultrasound-guided Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

OBJECTIVE: Ultrasound can be used in the treatment of large intracerebral hematoma. The authors present our experiences with Ultrasound-guided catheter placement for lysis and drainage of ganglionic hematoma, with emphasis on technical aspects. METHODS: The authors applied real-time ultrasonography for the aspiration of intracerebral hematoma in 6cases. Ultrasound-guided aspiration via a burrhole was performed under local anesthesia. We selected a temporal entry point instead of the frequently used precoronal approach in ganglionic hematoma. A burrhole was made 4 to 6cm posterior from posterior border of frontal process of the zygomatic bone at the level of 4 to 5cm above the external auditory meatus. RESULTS: In all patients, the catheter was placed accurately into the hematoma target. All patients were irrigated with urokinase once to three times a day. The catheter could be removed within two or three days. The mean hematoma volume was reduced from initially 32mL to 5mL in an average of two days. There were no intraoperative complications related to the use of real-time ultrasonography and no postoperative infections were noted. CONCLUSION: Ultrasound allows an easy and precise localization of the hematoma and the distance from the surface to the target can be calculated. Ultrasound-guided catheter placement for fibrinolysis and hematoma drainage is a simple and safe procedure.

Concurrent Intracranial and Extracranial Arterial Aneurysms: Report of Three Cases

Systemic multiple aneurysms are rare, and an association between intracranial and visceral arterial or abdominal aortic aneurysm in the same patient is a very rare occurrence. We report herein three such cases. In one case, aneurysms of the right internal carotid artery(ICA) and the right middle cerevral arterial bifurcation(MCAB) coexisted with the inferior pancreaticoduodenal arterial pseudoaneurysm and two ileal arterial aneurysms. In another case, the patient had the A-com arterial aneurysm and the right renal arterial aneurysm. And in the other patient, he had the right vertebral artery dissecting aneurysm with the abdominal aortic aneurym. Initially, all patients were referred to our hospital with subarachnoid hemorrhage(SAH), and thereafter first two patients developed visceral arterial aneurysm rupture in the course of hospital stay and in the last patient, the abdominal aortic aneurysm was detected incidentally during carotid angiogram for Guglielmi detachable coil(GDC) embolization of vertebral dissecting aneurym. After thorough review of our cases together with pertinent literatures, we emphasize the possibility of underlying extracranial aneurysms in ruptured intracranial arterial aneurysm patient and it's uncommon but fatal complication.

The Possible Roles of Matrix Metalloproteinases -1, 2, 3 in Lumbar Disc Herniation

OBJECTIVE: Surgically removed herniated lumbar disc specimen are immunostained to evaluate the production of MMPs(Matrix metalloproteinases) -1, 2, 3 for the investigation of the possible correlation of MMPs in lumbar disc herniation depending on the types of disc herniation. METHODS: The study population consists of 30 patients with lumbar disc herniation. There were 18 men and 12 women with patient age averaging 43.4 years(19-68years). The types of disc herniation identified at the time of surgery were classified as follow ; protruded type(Group 1, 10cases), extruded type(Group 2, 10cases), sequestrated type(Group 3, 10cases). Immunohistochemical study for the MMPs of the herniated disc tissue was performed and results of staining were graded to examine differences in histology among three types of disc herniation . RESULTS: The MMPs immunopositive cells were increased in old patients but statistically it was not significant(p=0.074). A significantly increased incidence of positive cells for MMP-1, 2 was found in the herniated lumbar disc tissue than the control group(p=0.02) but there were no significant differences among the three types of disc herniation. The MMP-3 positive cells were predominantly detected in the sequestrated disc tissue group(p=0.037) more than other groups. CONCLUSION: These results suggest that the MMP-1, 2, 3 may play important roles in the process of degeneration, herniation, and resorption of the lumbar intervertebral discs and that the MMP-3 may express the severity of lumbar disc herniation and play a role in resorption of the sequestrated disc tissue.

Clip Reinforcement Technique by Circumferential Wrapping with Silastic Sheet for Treatment of Cerebral Aneurysms and Its Follow-Up Outcome / 대한뇌혈관외과학회지

OBJECTIVE: To describe the clip reinforcement technique by circumferential wrapping with silastic sheet for the treatment of unclippable cerebral aneurysms and evaluate its long term follow-up results. METHODS: The nature of 26 unclippable aneurysms were as follow:12 blister-like superior wall aneurysm of internal carotid artery (ICA), 6 microaneurysms (<2 mm), 4 fusiform aneurysms, 4 broad-based aneurysms. After aneurysm and the parent artery are circumferentially wrapped by silastic sheet, aneurysm clips are positioned on the sheet with parallel to the parent artery. The mean follow-up period was 37 months (range, 3-140 months). RESULTS: 25 of 26 patients had a favorable outcome and one patient had a severe disabled due to severe vasospasm at 3 months after operation. Of the 21 patients who underwent immediate angiographic examination, stenosis of parent artery was detected in 6 patients and remnant of aneurysm in 4 patients. Asymptomatic occlusion of parent artery was observed in one patient on follow-up angiographic examination. 22 of 24 patients followed-up for a long time had a favorable outcome and 2 patients had a severe disabled (one patient was due to previous severe disabled and the other was due to thalamic intracerebral hematoma developed during the follow-up period). CONCLUSION: In our study, there was no clip reinforcement technique-related clinical complications such as rebleeding of aneurysm or ischemic event during follow-up period. Clip reinforcement technique by circumferential wrapping with silastic sheet is simple and useful method for the unclippable cerebral aneurysm.

Outcome of Endoscopic Third Ventriculostomy

OBJECTIVE: The authors review 17 cases of obstructive hydrocephalus treated with endoscopic third ventriculostomy to elucidate the adequate age, indication, surgical technique and radiologic criteria. METHODS: From March 1998 to August 2002, 17 endoscopic third ventriculostomies were performed(11 male and 6 female patients). The operation records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: The age of the patients ranged from 2 months to 70 years(mean age 21 years). Hydrocephalus was caused by aqueductal stenosis in 8 patients, tumor in 8(pineal mass: 5, cystic mass in third ventricle: 2 cerebellar mass: 1), cavernous angioma in 1. The overall success rate was 64.7%(11/17). In the present study, the preoperative increased intracranial pressure symptom was a reliable indicator of surgical outcome. The lateral ventricular size and the III ventricle width reduction, the presence of a signal void on the third ventricle floor appeared to correlate with clinical success. But the cystic mass in the third ventricle was less likely to benefit. Complications were bleeding in 3, infections in 2 and transient III and VI nerve palsy in one case, but there was no permanent morbidity or mortality. CONCLUSION: Endoscopic third ventriculostomy is a safe, simple, effective alternative treatment option of obstructive hydrocephalus in appropriate patient selection.

Endoscope-assisted Microsurgery to Internal Carotid Artery Aneurysms

OBJECTIVE: Complete obliteration of aneurysm while preserving the parent artery, its branches, and perforators is sometimes difficult in case of internal carotid artery(ICA) aneurysm because of its anatomic feature. To solve this problem, we report an experience of neuroendoscope in the surgery of the ICA aneurysm. METHODS: Between September 2002 and May 2003, eighteen patients with 19 ICA aneurysms underwent microsurgical clipping with the help of the neuroendoscope. A rigid rod lens neuroendoscope (Karl Storz, Tuttllingen, Germany) with the diameter of 4.0mm and angles of 0 or 30 degrees was used for all patients. RESULTS: The clips were repositioned or changed in 6 patients with detection of remnant aneurysm in neuroendoscope. Occlusion of the branch of anterior choroidal artery by clip in 2 patients was observed along the aneurysmal neck in neuroendoscope. There were no neuroendoscope-related complications. CONCLUSION: Neuroendoscope is a safe and useful instrument to confirm the optimal position of the clip in the microsurgery of patients with ICA aneurysm.

Intracranial Hemorrhage from Pilocytic Astrocytoma in Pons

We report a case of brain-stem glioma with hemorrhage. A 24-year-old female presented with a 2-month history of headache, vomiting, right hemiparesis. Magnetic resonance image showed a 4X2.5cm sized mass with subacute stage hemorrhage in the left cerebellopontine angle. The mass and hemorrhage was surgically removed and pathological findings were consistent with pilocytic astrocytoma with recent hemorrhage. The patient discharged with mild neurological deficit.

Prognostic Factors in Patients with Brain Metastases

OBJECTIVE: Prognostic factors in 92 patients with brain metastases, treated in our hospital, are identified in order to determine subgroups of patients suitable for selection in future trials. METHODS: From January 1985 through March 1998, 117 patients with computed tomography(CT) or magnetic resonance(MR) image diagnosed brain metastases were referred to our department. The follow-up data of 92 cases were available in this study. One half of the patients were treated with conservative treatment(53.2%), the remainder were treated with surgery alone or surgery with radiation therapy. Information on potential prognostic factors was collected, and then univariate analysis was performed to determine significant prognostic factors. RESULTS: Overall median survival was 7.6 months, with 1-month, 1-year, and 2-year survival rates of 92.4%, 32.9% and 17.9% respectively. Age, performamce status and primary tumor treatment were significant prognostic factors on survival. Number and treatment modality of brain metastases were also identified as prognostic factors. Median survival in patients conservatively treated with steroid alone or with radiotherapy was significantly different from that in patients treated with surgery(p=0031). CONCLUSION: Age(80), number of brain metastases(single), treatmet modalities of primary tumor and brain metastases(surgical treatment) appeared to be statistically significant prognostic factors. These prognostic factors could be helpful to determine subgroups of patients suitable for selection in future trials.

Early Closed Reduction in Patients with Cervical Fracture-Dislocation Injury without Prior Magnetic Resonance Imaging

OBJECTIVE: We report an evaluation of incidence of the traumatic disc herniation and an effect of early closed reduction without prior magnetic resonance(MR) imaging in cervical spine fracture-dislocation injury. METHODS: The medical records and radiologic images of twenty consecutive traumatic cervical spine injury from the C2-3 to C7-T1 were reviewed. The disc injury on MR images was divided into two category: a herniation defined as deforming the thecal sac or nerve root and a disruption defined as a disc with high T2-weighted signal characteristics. Closed reduction was attempted in all patients and neurologic status was measured on admission and following reduction. MR image was obtainted within three days after early closed reduction. RESULTS: Early closed reduction by Gardner-Wells skeletal traction and serial plain radiography was achieved in 90% of patients and there was no associated neurological deterioration after reduction. The incidence of disc injury at the level of the fracture subluxation on the postreduction MR images was 60%(herniation-30%, disruption-30%), but the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association(ASIA) motor score and the Frankel scale following early closed reduction. The average ASIA motor score prior reduction was 48.4 compared with 62.5 following reduction. CONCLUSION: Although disc herniation and disruption can occur following traumatic cervical fracture-dislocation, the actual incidence of neurological deterioration following early closed reduction is rare. Therefore, immediate closed reduction using traction in patients with any neurological deficit can be safe and effective before MR imaging.

Uniportal Endoscopic Thoracic Sympathicotomy for Primary Hyperhidrosis

OBJECTIVE: Endoscopic thoracic sympathectomy is an effective procedure for primary hyperhidrosis. The author present a retrospective analysis of uniportal endoscopic thoracic sympathicotomy for primary hyperhidrosis. METHODS:P Twenty patients underwent bilateral uniportal endoscopic sympathicotomy since August 1999. After collapsing the lung, a 6mm skin incision was made at the third intercostal space in anterior axillary line or just behind the posterior border of the pectoralis major and perforated with operating sheath. The endoscopy was 6.5mm in diameter and has one working channel(Karl Storz). An insulated 2mm coagulating forceps was introduced and T1-2 sympathicotomy with(13 patients) or without T2-3 sympathicotomy(7 patients) was performed. After the lung was fully inflated, the scope and the operating sheath were removed without chest tube, followed by single stitch. RESULTS: Both sides were usually done within twenty minutes in a single stage. There was no postoperative complication except one case of pneumothorax and nineteen patients discharged at the following morning. Nineteen patients were satisfied with immediate and permanent relief of palmar perspiration. Recurrence of palmar hyperhidrosis has been noticed in one patient who underwent T1-2 sympathicotomy only, but the symptom was not so severe. There was no surgical mortality. CONCLUSION: The results of endoscopic sympathicotomy in patients suffering from severe palmar and axillary hyperhidrosis are favorable. Single-port technique is enough for the successful sympathicotomy with less postoperative discomfort and scars.

Simultaneous Occurrence of Subarachnoid Hemorrhage due to Ruptured Aneurysm and Remote Hypertensive Intracerebral Hemorrhage: Case Report

Simultaneous occurrence of aneurysmal subarachnoid hemorrhage (SAH) and hypertensive intracerebral hemorrhage (ICH) is very rare and only two cases have been previously reported in the literatures. We present a case of 68-yr-old man with a history of untreated hypertension, who suffered from sudden onset of headache followed by right hemiparesis. Computed tomographic (CT) scan revealed SAH in the basal cistern and remote ICH at the left putamen. Cerebral angiography showed a saccular aneurysm at the anterior communicating artery. No other vascular anomaly could be found at left putaminal area. Nine days after the ictal attack of SAH, the neck of aneurysm was clipped via the left frontotemporal craniotomy. Because of the ICH at the left frontal lobe and intraventricular hematoma on postoperative CT, we performed hematoma removal and external ventricular drainage 3 hours after the first operation. Postoperative neurological status had been improved to be drowsy and he was discharged in a severely disabled state 4 weeks after surgery. We suggest that the rupture of aneurysm possibly caused a rapid increase in blood pressure and subsequently resulted in hypertensive ICH.

Clinical Analysis of Decompressive Craniectomy for Acute Massive Cerebral Infarction

OBJECTIVES: Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. METHOD: We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). RESULTS: All 15 patients(five men, ten women; mean age, 52.3 years; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale: GOS I, II), unfavorable in 6 cases(Glasgow outcome scale:GOS III, IV) and dead in 4 cases. CONCLUSION: Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

Skull or Brain Metastasis from Thyroid Carcinoma: Analysis of 7 Cases

Skull or brain metastasis from thyroid carcinoma is rare. Between Jan. 1993. and Jan. 2000. the authors experienced 7 cases of skull(4 cases) or brain(3 cases) metastasis from thyroid carcinoma. Clinical characteristics, radiologic findings and pathologic features were analyzed retrospectively. Among 4 cases of skull metastasis, 3 cases were follicular carcinoma and one was papillary carcinoma with follicular variant. All cases of brain metastasis were papillary carcinoma. We treated the patients by combination with surgical resection, radioactive iodine therapy and radiation therapy. Characteristics of skull or brain metastasis from thyroid carcinoma is reviewed with a pertinent literature.

Results of Microvascular Decompression in Hemifacial Spasm

OBJECTIVES: Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement on one side of face. It is known that hemifacial spasm is mainly due to pulsatile compression by vessels at the root exit zone(REZ) of the facial nerve. Microvascular decompression at REZ of the facial nerve has become the standard treatment modality for hemifacial spasm. The authors have analized patients with hemifacial spasm treated with microvascular decompression to evaluate operation result and clinical course after operation. PATIENTS AND METHODS:From 1992 to 1999, 41 patients with hemifacial spasm underwent this operation. Retrospective analysis of operation results and clinical recovery patterns was done. The length of observation had been more than 6 months in all cases. RESULTS: The ratio of male to female was 1: 1.4, and age at operation ranged from 24 to 66 years. Their mean age was 47.6 years and the mean preoperative duration of symptoms was 7.2 years. Most common offending vessels were AICA in 18 cases(48%) and second most common were PICA in 13 cases(31.7%). The rest of them were 3 case in vertebral artery, and 7 cases(13%) in multiple offending vessels. Patterns of improvement after surgery could be divided into 4 clinical types. There was complete recovery in 3 days after operation in 24 cases(58.6%, Immediate complete recovery). There was complete recovery in 3 days after operation, and symptom was recurred partially, which was gradually subsided in 2 weeks after operation in 4 cases(9.8%, Delayed complete recovery type I). There was partial recovery after operation and symptom was compretely disappeared gradually in 6 months after operation in 7 cases(17.1%, Delayed complete recovery type II). Finally, there was partial recovery after operation, and symptom was somewhat remained after 6 months later(14.5%, Delayed partial recovery). CONCLUSION: In conclusion, microvascular decompression for hemifacial spasm is a safe and reliable treatment modality with good results of improvement and there are 4 recovery patterns in clinical course after operation in our series. Therefore, follow-up observation after microvascular decompression is necessary to evaluate the operative results and complication, especially in the delayed resolved cases.

Early Recurrence of a Lateral Ventricle Meningioma with Malignant Transformation

Although malignant transformation of meningiomas has been reported, it is extremely rare in meningiomas of ventricular system. Less than 2% of all meningiomas show malignant transformation from benign meningioma. We report a case of meningioma with early recurrence and malignant transformation and investigated possible underlying factors using immunohistochemistry for PCNA and p53 protein expression.

Secondary Amenorrhea Caused by Hydrocephalus Due to Aqueductal Stenosis : Report of Two Cases

Amenorrhea is rarely presented as a manifestation of endocrinological disturbances in patients of chronic hydrocephalus. We describe two cases of secondary amenorrhea caused by hydrocephalus due to aqueductal stenosis. Two female patients of age 30 and 20 yr presented with amenorrhea and increasing headache. Magnetic resonance images revealed marked, noncommunicating hydrocephalus without any tumorous lesion. In one patient, emergent extraventricular drainage was necessary because of progressive neurological deterioration. Each patient underwent surgical intervention for the hydrocephalus-ventriculoperitoneal shunt and endoscopic third ventriculostomy. Both resumed normal menstruation continuing so far with further normal menstrual bleeding. These two cases and others reported in the literature indicated that the surgical intervention for hydrocephalus resolves amenorrhea in all the cases of amenorrhea due to hydrocephalus. The suspected role of the surgery is the correction of increased intracranial pressure, which is an important pathogenetic factor in the development of amenorrhea.

Multiple Supra- and Infratentorial Hemangioblastomas : Case Report and Review of the Literature

A rare case of multiple supratentorial and infratentorial hemangioblastomas in a 50-year old man is presented. There were neither manifestations of visceral tumors nor familial history. The two tumors were totally removed in two sessions and the diagnosis in both tumors were hemangioblastomas.