Long-term Stability after Reduction of Mandible Fracture by Keyhole Plate: Evaluation at the Time of Plate Removal / 대한악안면성형재건외과학회지

Background@#Various types of miniplates have been developed and used for the reduction of facial bone fractures. We introduced Yang’s Keyhole (YK) plate, and reported on its short-term stability. The purpose of this study was to evaluate the long-term stability of the YK plate, as a follow-up study, by examining the patients who had used the YK plate among the patients with the reduction of mandible fractures and who visited for plate removal. @*Methods@#We reviewed the medical records of 16 patients who underwent mandibular fracture fixation using a YK plate (group I) and 17 patients who underwent mandibular fracture fixation using a conventional plate (group II). Assessment was then made on malunion, occlusal stability, discomfort during the application, and clinical symptoms. @*Results@#From January 2015 to December 2017, a total of 36 patients underwent mandibular fracture surgery using a YK plate. A total of 16 patients received plate removal. Among them, 15 were male and 1 female. The average age was 26 years. The applied surgical sites were the 12 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of YK plate was an average of 335 days. During the same period, 45 people underwent surgery on the conventional plate. A total of 17 patients received plate removal. Among them, 15 were male and 2 females. The average age was 36 years. The applied surgical sites were the 8 on mandibular angle, 4 on mandibular symphysis, and 2 on subcondyle. The application period of the conventional plate was an average of 349 days. No malocclusion occurred at the time of removal, and occlusion was stable. No patient complained of joint disease or discomfort. @*Conclusion@#The YK plate system, in which the screw was first inserted and the plate was applied, for clinical convenience did not cause any particular problem and no significant difference from the conventional plate.

Imaging diagnosis of extrahepatic biliary tract obstruction with acquired portosystemic shunt in a cat / 대한수의학회지

A 2-year-old, spayed female, Korean domestic short-hair cat was presented with depression and vomiting. The patient had history of weight loss lasting seven months. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Based on ultrasonography and computed tomography, tentative diagnosis was extrahepatic biliary tract obstruction with acquired portosystemic shunt (PSS). Tumor or inflammation of hepatobiliary system was suspected as the cause of obstruction of the common bile duct. But it could not be determined without biopsy. The severely dilated cystic duct was considered to cause portal hypertension and secondary multiple PSS. The patient expired without histopathologic examination.

Imaging diagnosis of extrahepatic biliary tract obstruction with acquired portosystemic shunt in a cat

A 2-year-old, spayed female, Korean domestic short-hair cat was presented with depression and vomiting. The patient had history of weight loss lasting seven months. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Based on ultrasonography and computed tomography, tentative diagnosis was extrahepatic biliary tract obstruction with acquired portosystemic shunt (PSS). Tumor or inflammation of hepatobiliary system was suspected as the cause of obstruction of the common bile duct. But it could not be determined without biopsy. The severely dilated cystic duct was considered to cause portal hypertension and secondary multiple PSS. The patient expired without histopathologic examination.

The Effect of Autogenous Demineralized Dentin Matrix and Interleukin-6 on bone Regeneration

The aim of this study was to evaluate the role of demineralized and particulate autogenous tooth, and interleukin-6 in bone regeneration. A demineralized and particulate autogenous tooth was prepared and human osteoblast-like cells (MG63) and human osteosarcoma cells were inoculated into the culture. The rate of cell adhesion, proliferation and mineralization were examined, and the appearance of cellular attachment was observed. An 8 mm critical size defect was created in the cranium of rabbits. Nine rabbits were divided into three groups including: An experimental group A (3 rabbits), in which a demineralised and particulate autogenous tooth was grafted; an experimental group B (3 rabbits), in which a demineralized, particulate autogenous tooth was grafted in addition to interleukin-6 (20 ng/mL); and a control group. The rabbits were sacrificed at 1, 2, 4 and 6 weeks for histopathological examination with H-E and Masson's Trichrome, and immunohistochemistry with osteocalcin. The cell-based assay showed a higher rate of cell adhesion, mineralization and cellular attachment in the experimental group A compared with the control group. The animal study revealed an increased number of osteoclasts, newly formed and mature bones in the experimental group A compared with the control group. Eventually, a higher number of osteoclasts were observed in the experimental group B. However, the emergence of newly formed and mature bone was lower than in the experimental group A. The current results suggest that treatment with demineralized and particulate autogenous tooth and interleukin-6 is not effective in stimulating bone regeneration during the bone grafting procedure.

Therapeutic effect of topical application of curcumin during treatment of radiation burns in a mini-pig model

Curcumin protects the skin against radiation-induced epidermal damage and prevents morphological changes induced by irradiation skin, thereby maintaining the epidermal thickness and cell density of basal layers. In this study, the effects of topical curcumin treatment on radiation burns were evaluated in a mini-pig model. Histological and clinical changes were observed five weeks after radiation exposure to the back (⁶⁰Co gamma-radiation, 50 Gy). Curcumin was applied topically to irradiated skin (200 mg/cm²) twice a day for 35 days. Curcumin application decreased the epithelial desquamation after irradiation. Additionally, when compared to the vehicle-treated group, the curcumin-treated group showed reduced expression of cyclooxygenase-2 and nuclear factor-kappaB. Furthermore, irradiation prolonged healing of biopsy wounds in the exposed area, whereas curcumin treatment stimulated wound healing. These results suggest that curcumin can improve epithelial cell survival and recovery in the skin and therefore be used to treat radiation burns.

beta-irradiation (166Ho patch)-induced skin injury in mini-pigs: effects on NF-kappaB and COX-2 expression in the skin

In the present study, the detrimental effect of beta-emission on pig skin was evaluated. Skin injury was modeled in mini-pigs by exposing the animals to 50 and 100 Gy of beta-emission delivered by 166Ho patches. Clinicopathological and immunohistochemical changes in exposed skin were monitored for 18 weeks after beta-irradiation. Radiation induced desquamation at 2~4 weeks and gradual repair of this damage was evident 6 weeks after irradiation. Changes in basal cell density and skin depth corresponded to clinically relevant changes. Skin thickness began to decrease 1 week after irradiation, and the skin was thinnest 4 weeks after irradiation. Skin thickness increased transiently during recovery from irradiation-induced skin injury, which was evident 6~8 weeks after irradiation. Epidermal expression of nuclear factor-kappa B (NF-kappaB) differed significantly between the untreated and irradiated areas. One week after irradiation, cyclooxygenase-2 (COX-2) expression was mostly limited to the basal cell layer and scattered among these cells. High levels of COX-2 expression were detected throughout the full depth of the skin 4 weeks after irradiation. These findings suggest that NF-kappaB and COX-2 play roles in epidermal cell regeneration following beta-irradiation of mini-pig skin.

Radiation-induced eosinophilic, polymorphic, and pruritic eruption in a pig skin model / 한국실험동물학회지

Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) can occur in cancer patients after irradiation. In this study, we characterized the clinical and histopathological features of pig skin that developed widespread polymorphic and pruritic skin lesions following localized 50 Gy gamma-irradiation. The pigs developed pruritus 5-7 weeks after irradiation, and infiltration of the dermis by eosinophils was detected 4-7 weeks after irradiation. The irradiated animals also showed transiently increased numbers of peripheral eosinophils 5-7 weeks after treatment. Irradiation induced desquamation after 2-4 weeks, which and the desquamation gradually resolved after 7 weeks. These pathological changes correspond to those seen in irradiated human skin, indicating that this model could be useful for elucidating the pathogenesis of EPPER and for developing therapeutic and prophylactic methods.

A Case of Pyogenic Liver Abscess Complicating Cardiac Tamponade Caused by Klebsiella pneumoniae / 대한내과학회지

An 83-year-old female patient visited the emergency department for abdominal pain and dyspnea with hemodynamic instability. Abdominal computed tomography showed multiple liver abscesses and a large volume of pericardial effusion. A transthoracic echocardiography revealed features suggestive of cardiac tamponade, including massive pericardial effusion and diastolic collapse of the right atrial wall. Emergency percutaneous pericardial drainage and percutaneous transhepatic drainage were performed. Klebsiella pneumoniae (KP) was isolated from both the pericardial effusion and bile. The first case of cardiac tamponade secondary to a liver abscess in Korea was reported in 1981, and it was caused by amoebal infection via fistula formation between the pericardium and abscess. We recently experienced a case of pyogenic liver abscess caused by KP complicating cardiac tamponade via direct invasion. This is an unusual complication of KP infection because KP is more frequently associated with hematogenous spread.

Severe Hyponatremia Associated with the Use of Angiotensin II Receptor Blocker/thiazide Combinations

There are several widely used combinations of angiotensin II receptor blocker (ARB)/thiazide. The complimentary mechanism of action for such anti-hypertensive therapies is that, while ARB inhibits the vasoconstricting and aldosterone-secreting effects of angiotensin II, hydrochlorothiazide affects the renal tubular mechanisms of electrolyte reabsorption and increases excretion of sodium and chloride in the distal tubule, consequently promoting water excretion. In addition, hypokalemia, which may be triggered by a hydrochlorothiazide-induced increase in urinary potassium loss, is resisted by the use of ARB. Hence, the ARB/thiazide combination is safe in terms of potassium imbalance. For these reasons, fixed-dose ARB/thiazide combination anti-hypertensive drugs have been widely used for the treatment of hypertension. However, there have not been many studies done regarding cases where patients under such regimens showed severe hyponatremia, even when the amount of thiazide included was low. Here we report two cases in which severe hyponatremia occurred following treatment with the ARB/thiazide combinations. Upon discontinuation of the regimen, both patients showed recovery from hyponatremia.

A Case of Overlap Syndrome of Rheumatoid Arthritis and Polymyositis with the Involvement of Upper Pharyngeal Muscles

An overlap syndrome is a combination of major features of more than one connective tissue diseases which is presented in the same patient. An overlap syndrome of rheumatoid arthritis (RA) and polymyositis (PM) which involved the upper pharyngeal muscle has not been reported in Korea. Herein, we report a rare case of a patient with a long-history RA presenting proximal muscle weakness and swallowing difficulty, who was successfully treated with a high-dose of corticosteroid, azathioprine and tacrolimus.

Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

PURPOSE: To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. MATERIALS AND METHODS: We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. RESULTS: A univariate analysis indicted that hypoalbuminemia ( or =1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS > or =1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. CONCLUSIONS: A mid or lower ureteral obstruction, GPS > or =1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Chylous Ascites in a Patient with Liver Cirrhosis after Subtotal Gastrectomy / 대한내과학회지

Chylous ascites is the extravasation of milky chyle into the peritoneal cavity. This condition can occur as a result of the disruption or obstruction of the abdominal lymphatics. Abdominal surgery, malignant neoplasms, and cirrhosis can cause chylous ascites. Here, we report a case of intractable ascites caused by chyle leakage and portal hypertension in a patient with alcoholic liver cirrhosis. The ascites occurred following a subtotal gastrectomy to treat stomach cancer and was not resolved with diuretics. Increasing the diuretic dosage was limited by the aggravation of renal function. The ascites was milky in color and analysis showed transudate caused by portal hypertension. Octreotide and diuretic treatments can resolve mixed ascites. In this article, we present the case and review the literature.

Biphasic Increase of Pro-inflammatory Cytokines in Mice Lung after Irradiation / 결핵및호흡기질환

BACKGROUND: The pathophysiologic mechanisms of radiation-induced lung injury should be elucidated to enhance the therapeutic efficacy of radiotherapy and to manage patients exposed to serious radiation by accident. It has been suggested that pro-inflammatory cytokines play an important role in radiation-induced effect on the lung. This study was aimed to investigate changes in pro-inflammatory cytokines such as TNF-alpha, MIP-2, IL-1beta and HMGB1, a newly recognized inflammatory mediator. METHODS: The chests of BALB/c mice were selectively irradiated with single fraction of 20 Gy and then sacrificed at indicated times. Pathologic changes in the lung were examined after H&E staining. The expression level of pro-inflammatory cytokines was evaluated by ELISA kits in lung homogenate and in serum. RESULTS: Radiation induced inflammatory changes and mild fibrosis in lung. Biphasic increase of TNF-alpha and IL-1beta was found in lung homogenate at 4 hours and at 3 weeks after radiation. The elevation in the second phase tended to be more intense. However, there was no similar change in serum. MIP-2 level was slightly increased in lung homogenate at 4 hours, but not at 3 weeks. HMGB1 was increased at 3 weeks in serum while there was no significant change in lung homogenate. CONCLUSION: Radiation induced a biphasic increase in TNF-alpha and IL-1beta. The effective control of second phase cytokine elevation should contribute to preventing severe lung fibrosis caused by radiation.

Application and Treatment Result of an Enuresis Alarm Based on a Questionnaire in Children with Enuresis? / 대한비뇨기과학회지

PURPOSE: Alarm interventions are effective and safe treatments for nocturnal enuresis when compared with the other treatments. However, the rate of doctors prescribing enuresis alarms is quite low in Korea. This study evaluated the application conditions and treatment results of an enuresis alarm in children with enuresis in Korea. MATERIALS AND METHODS: 147 out of 316 patients who purchased an enuresis alarm through a alarm sales agency in Korea were evaluated retrospectively. The questionnaire had two main categories: items of enuresis(number of episodes during the night, enuresis frequency during a week, etc.) and the items of the enuresis alarm(previous treatment history, a motivation of using enuresis alarm treatment, the period of using the enuresis alarm, initial success, continued success, dropout of using enuresis alarm, nocturia after treatment, etc.). RESULTS: A total 147 children participated in this study. The initial success rate was 30.6% whereas the continued success rate was 34.0%. In addition, the dropout rate was 27.2%. 46.2% of patients purchased the enuresis alarm with a doctor's prescription and 53.8% purchased the alarm without a prescription. Among the factors, the success and dropout rate were affected by only whether the patient visited the hospital. Thirty five patients who took combination therapy with medicine had a significantly lower initial success rate. CONCLUSIONS: In Korea, without a doctor's prescription, 53.7% patients attempt to treat enuresis alarm directly. The initial and continued success rate with the enuresis alarm was approximately 30% and the dropout rate was approximately 30%.

The KIDSCREEN-52 Quality of Life Measure for Children and Adolescents (KIDSCREEN-52-HRQOL): Reliability and Validity of the Korean Version

The KIDSCREEN-52 quality-of-life (KIDSCREEN-52-HRQOL) is a relevant, worldwide tool used for assessing the health-related quality of life in children and adolescents. The purpose of this study was to define measurement properties of the Korean version of the KIDSCREEN-52 HRQOL. The original questionnaire was translated following international translation guidelines. Analysis regarding psychometric properties showed that the Cronbach-alpha ranged from 0.77 to 0.95. The correlation coefficient between the PedQL and KIDSCREEN-52 dimensions were high for the assessments of similar constructs. Therefore, the Korean version of the KIDSCREEN-52 was found to be suitable for use in Korean adolescents.

Prescription Status and Efficacy of OROS-MPH and Parent Perception in Children with Attention Deficit Hyperactivity Disorder : Multi-Center, Observational Study during 4 Weeks / 대한정신약물학회지

OBJECTIVE: This study was performed to evaluate the current prescription status by clinicians, the efficacy of once-daily OROS-methylphenidate (MPH) in the treatment of children with attention deficit hyperactivity disorder (ADHD) and parent anticipation, concern and satisfaction about treatment. METHODS: The subjects with ADHD between 6 and 18 years were prescribed 18, 36, 54 mg OROS-MPH, depending on clinician's judgment. ADHD symptoms and improvement were assessed by clinicians using the Clinical Global Impression-Severity (CGI-S) and the Clinical Global Impression-Improvement (CGI-I). Parents were also measured the Conners Abbreviated Parent Rating Scale (CAPRS) and by the questionnaires inquiring about parental anticipation, concern, satisfaction about treatment at baseline and the 4th week after OROS-MPH trial. RESULTS: A total of 704 subjects were enrolled in the observational study and 645 completed the trial. There was an 18% increase in mean daily dose and 14% increase in mean daily dose per kg during 4 weeks. About 56% of subjects were scored 2 or less by the CGI-I. CAPRS scores were significantly decreased from 14.8 to 8.81. Before treatment, parents anticipated the symptom improvement firstly, followed by education material, parental education and non-pharmacological treatment. Parent concerned about side effect, growth, dependency and abuse. In general, 95% of parent were satisfied with OROS-MPH . CONCLUSION: According to this study, there was an increase in mean daily dose over the study period. OROS-MPH appears to be efficacious for decreasing the symptoms of ADHD and was satisfactory to parents of children with ADHD.

Nested Variant of Transitional Cell Carcinoma with Hydronephrosis / 대한비뇨기과학회지

The nested variant of transitional cell carcinoma(TCC) is rarely found in the bladder. Only about 80 such cases have been reported in the literature. Irregular nests and tubules of TCC infiltrating the lamina propria, with no involvement of the mucosal layer, characterize this disease. These characteristics make it difficult to diagnose the nested variant of transitional cell carcinoma. In this study we reported on a new case and review the relevant literature. This case was accompanied with hydronephrosis. We report on this case with its accompanying hydronephrosis because of its rarity and unusual histology, and also its prognostic significance emphasizes the need to distinguish it from classic TCC.

Biological Variation of Serum Prostate Specific Antigen Levels in Men Aged 50 or Older without Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To evaluated the effect of the intra-individual variation in the serum prostate specific antigen (PSA) level in men without prostate cancer to decide on the requirement of a prostate biopsy. MATERIALS AND METHODS: Patients, aged between 50 and 80 years, were screened for prostate cancer or lower urinary tract symptoms at least 2 times within 3 months using PSA or free PSA measurements. Patients with an initial PSA level between 2.0 and 10.0ng/ml were included. Those with prostate cancer, urinary tract infection or 5-alpha reductase inhibitor medication were excluded. The coefficient of variation (CV) was evaluated in each PSA range. RESULTS: The analysis included 139 patients, with a mean age 62.1 years. The level of free PSA was measured in 56 patients. The mean interval between the two PSA measurements was 36.6 days. The mean CVs for the total PSA and % free PSA were 21.5 and 22.2%, respectively. 20% of patients show a CV of more than 30%, implying a large variation. In our study, the 95% confidence interval of initial PSA levels between 3.0 and 4.9ng/ml included the PSA cut-off point (4.0ng/ml) in the visit results. CONCLUSIONS: The variation the PSA level was relatively small, but some patients showed a CV greater than 30%. Therefore, the intra-individual PSA variation should become part of interpreting the PSA test results, especially for men with a PSA value near the cut-off point.

The Self-Esteem Attributed by Self Perception of Body Image in Community Adolescents / 신경정신의학

OBJECTIVES: Obesity is associated with a range of adverse health impacts on physical and psychosocial aspects. Psychosocial effects may include body image disturbance, negative self-perception and peer problem. We investigated the association between self perception of body image, real body mass index (BMI), and self-esteem in middle school students and explored factors that most attribute to self-esteem. METHODS: We randomly selected 477 middle school students ot 13 to15 years old. Informations on weight, height and BMI were colleted. Subjective perception of body image, wished body image, depression scales and self-esteem scales were checked by the participants. Subjects were divided into three groups according to their BMI values. Underweight, normal-weight and overweight groups were identified and compared with demographic data and several scales. RESULTS: Mean BMI of participants was within the normal range. Male students perceived their body images to be underweight, but female students perceived their body image to be overweight (x2=15.140, p=0.010). Wished body images were in counter directions. Male students wanted to gain weight, but female students wanted to lose weight (x2=39.432, p<0.001). In male students, overweight group had lower scores in total self-esteem, athletic competence and physical appearance than normal weight and underweight groups. In female students, overweight group had lower scores in physical appearance than normal weight and underweight groups. Self perception of body image was the most important factor in their total, athletic competence and physical appearance self-esteem. CONCLUSION: The self-esteem of early adolescents attributed to the self perception of body image and not by BMI or parent's perception of their child's body image.

Comparisons of Temperamental and Sociodemographic Characteristics in Three Groups of Preschool Children with Delayed Language Development / 신경정신의학

OBJECTIVES: Temperamental and sociodemographic characteristics of developmentally delayed preschool children have not been adequately studied. This research compares temperamental and sociodemographic characteristics in 3 groups of preschool children: those with communication disorder (CD), those with mental retardation (MR), and those with pervasive developmental disorder (PDD). METHODS: One hundred ninety eight preschool children (160 males, 38 females, average age 37.8 months) with delayed language development were included in this study. Developmental status of children was assessed by Bayley scales of infant development II, and temperamental characteristics were assessed by PTQ (Parental Temperamental Questionnaire). Sociodemographic characteristics of children were assessed with a questionnaire developed by us. Subjects were divided into three groups according to Bayley scale and Childhood autism rating scale (CARS). RESULTS: CD groups showed higher scores on rhythmicity and persistence than MR and PDD groups. CD group showed lower scores on threshold of reaction than MR group. On intensity of reaction and quality of mood, CD group showed higher scores than the PDD group. Sociodemographic characteristics were not different among the 3 groups. CONCLUSION: There are differences in temperamental characteristics but not in sociodemographic characteristics among CD, MR, and PDD.