Anti-Osteoarthritic Effects of Cartilage-Derived Extracellular Matrix in a Rat Osteoarthritis Model

BACKGROUND@#The extracellular matrix (ECM) has many functions, such as segregating tissues, providing support, and regulating intercellular communication. Cartilage-derived ECM (CECM) can be prepared via consecutive processes of chemical decellularization and enzyme treatment. The purpose of this study was to improve and treat osteoarthritis (OA) using porcine knee articular CECM. @*METHODS@#We assessed the rheological characteristics and pH of CECM solutions. Furthermore, we determined the effects of CECM on cell proliferation and cytotoxicity in the chondrocytes of New Zealand rabbits. The inhibitory effect of CECM on tumor necrosis factor (TNF)-a-induced cellular apoptosis was assessed using New Zealand rabbit chondrocytes and human synoviocytes. Finally, we examined the in vivo effects of CECM on inflammation control and cartilage degradation in an experimental OA-induced rat model. The rat model of OA was established by injecting monosodium iodoacetate into the intra-articular knee joint. The rats were then injected with CECM solution. Inflammation control and cartilage degradation were assessed by measuring the serum levels of proinflammatory cytokines and C-telopeptide of type II collagen and performing a histomorphological analysis. @*RESULTS@#CECM was found to be biocompatible and non-immunogenic, and could improve cell proliferation without inducing a toxic reaction. CECM significantly reduced cellular apoptosis due to TNF-a, significantly improved the survival of cells in inflammatory environments, and exerted anti-inflammatory effects. @*CONCLUSION@#Our findings suggest that CECM is an appropriate injectable material that mediates OA-induced inflammation.

Microbleeds in the Corpus Callosum in Anoxic Brain Injury

Purpose@#This study was performed to evaluate the relationship between callosal microbleeds and anoxic brain injury. @*Materials and Methods@#Twenty-seven patients with anoxic brain injuries were analyzed and retrospectively compared to the control group of patients without a history of anoxic brain injury using Fisher's exact test regarding comorbidities and cerebral microbleeds. The patient group was subdivided according to the presence of callosal microbleeds. Fisher's exact test was used to compare the presence of typical MRI findings of anoxic brain injury, use of cardiopulmonary resuscitation, and prognosis. The Mann-Whitney U test was used to compare the interval between the occurrence of anoxic brain injury to MRI acquisition. @*Results@#The prevalence of cerebral microbleeds in the patient group was 29.6%, which was significantly higher than that in the control group at 3.7% (p = 0.012). All cerebral microbleeds in the patient group were in the corpus callosum. Compared with the callosal microbleed-absent group, the callosal microbleed-present group showed a tendency of good prognosis (6/8 vs. 11/19), fewer typical MRI findings of anoxic brain injury (2/8 vs. 10/19), and more cardiopulmonary resuscitation (6/8 vs. 12/19), although these differences did not reach statistical significance (p = 0.35, p = 0.19, and p = 0.45, respectively). @*Conclusion@#Callosal microbleeds may be an adjunctive MRI marker for anoxic brain injury.

Is It Radiculopathy or Referred Pain? Buttock Pain in Spinal Stenosis Patients

BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.

The Effectiveness of Ultrasound-Guided Selective Nerve Root Block for the Treatment of Radicular Pain in the Lower Cervical Spine: An Assessment of Sustainability and Side Effects / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the sustainability and adverse effects of ultrasound-guided selective nerve root block in patients who complained of radiculopathy due to lower cervical disc herniation. MATERIALS AND METHODS: Between February 2014 and February 2016, 39 out of 60 patients who visited Department of Orthopedic Surgery, Kosin University Gospel Hospital with a chief complaint of radiculopathy due to lower cervical disc herniation were treated with an ultrasound-guided selective nerve root block. To evaluate the efficacy and sustainability of this treatment, the degree of pain relief and functional improvement were evaluated before and 3 months after the procedure. Patients were categorized into two groups: The soft disc group and the hard disc group. The safety of the procedure was evaluated by examining the side effects occurring immediately after the procedure and the following day. RESULTS: Visual analogue scale and Neck Disability Index were improved from 6.00 to 3.02 and from 15.82 to 6.15, respectively (p < 0.05). There were 2 cases of headache and 2 cases of dizziness; however, they were resolved within 1 hour after the procedure. In 32 patients (82.1%), there was improvement in pain, which persisted for more than 3 months in 24 patients. Contrastinly, 7 patients (17.9%) showed no improvement and 6 patients (15.4%) experienced recurrence of pain or symptoms within 1 month after the procedure. In the soft disc group, there was a reduction in pain, from a score of 5.88 before the procedure to 2.64 twelve weeks after the procedure (p < 0.01). In the hard disc group, there was also a reduction in, from a score of 6.09 before the procedure to 3.22 at postoperative 12 weeks (p < 0.01). There was no significant difference between the two groups. CONCLUSION: In patients with cervical disc herniation, an ultrasound-guided selective nerve root block appears to be an effective treatment option for outpatients due to its low risk of serious complications.

Effectiveness of Selective Nerve Root Block for the Treatment of Single-Segment Lumbar Spinal Stenosis and Disc Herniation

STUDY DESIGN: Retrospective clinical study. OBJECTIVES: To determine and compare the therapeutic effectiveness of selective nerve root block performed for single-segment spinal stenosis and disc herniation. SUMMARY OF LITERATURE REVIEW: The usefulness of selective nerve root block has been reported in several previous studies, but those results were aggregated across many diseases, making it difficult to estimate its effectiveness for each disease. MATERIALS AND METHODS: From January 2008 to January 2013, among patients who had undergone selective nerve root block, those who were diagnosed with single-segment spinal stenosis or disc herniation were enrolled in this study. Among a total of 103 patients, 47 spinal stenosis patients were classified as group 1, and 56 disc herniation patients as group 2. Visual analog scale (VAS) scores and Kim's criteria were used to compare the reductions in radiating pain in each group. RESULTS: In group 1, the VAS scores improved from 7.6 before the procedure to 2.6 and 3.3 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.6 before the procedure to 2.9 at the 6-month follow-up. In group 2, the VAS scores improved from 7.8 before the procedure to 2.1 and 2.7 at 1-month and 6-month follow-up visits, respectively. Kim's criteria also improved from a mean of 1.8 before the procedure to 3.2 at the 6-month follow-up. CONCLUSIONS: Radiating pain in the lower limb due to spinal stenosis or disc herniation limited to a single segment was effectively controlled by selective nerve root block.

Clinical Efficacy and Safety of Radiofrequency Ablation Therapy with Cement Augmentation for a Metastatic Spine Tumor

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical efficacy and safety of radiofrequency (RF) ablation therapy followed by a bone cement augmentation procedure in treating and managing pain among metastatic spine tumor patients. SUMMARY OF LITERATURE REVIEW: As a metastatic spine tumor is unresectable, this procedure was performed. Results showed an increase in the necrosis rate, and a decrease in local recurrence and secondary vertebral stability. MATERIALS AND METHODS: From March 2007 to April 2016, 26 patients who were treated with RF ablation with a bone cement augmentation procedure and the same number of patients treated with radiotherapy for metastatic spine lesions were included in this study. Pain relief and functional quality of life were evaluated using a visual analogue scale (VAS) and Roland Morris Questionnaire (RMQ). RESULTS: VAS scores preoperatively and at 1, 4, and 12 weeks follow-up were 7.45, 3.01, 3.78, and 2.97 in the procedure group, and 7.04, 6.65, 5.87, and 3.03 in the radiotherapy group. The procedure group had significantly better average outcomes than the radiotherapy group for pain relief at 4 weeks but showed no difference at 12 weeks. The RMQ score improved from 13.92 to 7.21 in the procedure group, and from 15.33 to 9.75 in the radiotherapy group. Two patients who had a metastatic tumor near the vertebral body posterior cortex showed cement leakage into the disc space, that is, intraforaminal and intracanal space; therefore, operations were performed (7.69% nerve injury). CONCLUSIONS: RF ablation therapy with cement augmentation in treatment of metastatic spine tumor shows effectiveness in early pain relief and brings immediate vertebral stability, helping patients return to normal life. However, it carries a risk of nerve injury due to cement leakage.

Comparison of Ultrasonography and Magnetic Resonance Imaging in Measurement of Lumbar Muscles / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare magnetic resonance imaging (MRI) and ultrasonography measurement of peri-lumbar muscle atrophy which is thought to be a cause of low back pain. MATERIALS AND METHODS: Eighty-two patients (44 males, 38 females) who visited Wonkang University Hospital from March, 2015 to August, 2015 complaining of lumbar back pain and underwent lumbar MRI were enrolled in this study. Cross section area (CSAMRI) and muscle thickness (MTMRI) of psoas major (PS) and lumbar extensor (LM) located on both sides of L4/5 and L3/4 was measured by MRI, and sono measurement of thickness of the same muscle (MTUS) at the same level of that MRI measurement were analyzed. RESULTS: In correlation analysis of PS CSAMRI and PS MTUS is the correlation coefficient of L4/5 was 0.136 (p=0.64), L3/4 right (Rt) was 0.070 (p=0.81), and L3/4 left (Lt) was 0.288 (p=0.32). PS CSAMRI at L4/5 Rt showed that correlation coefficient of PS MTUS showed a positive correlation to 0.559 (p=0.04). In analysis of the PS MTMRI and PS MTUS, the correlation coefficient of L4/5 Rt was measured by a 0.316 (p=0.27), L4/5 Lt was 0.022 (p=0.94), L3/4 Rt was 0.236 (p=0.41), and L3/4 Lt did not show a significant result with 0.287 (p=0.31). In the results of correlation analysis of the LM MTMRI and LM MTUS, the correlation coefficient of L4/5 Rt was 0.207 (p=0.49), L4/5 Lt was 0.051 (p=0.86), and L3/4 was Rt 0.048 (p=0.87), L3/4 Lt did not show a significant value with 0.154 (p=0.61). CONCLUSION: This study proved that muscle volume obtained from ultrasono is effective for evaluation of cross-sectional area of lumbar muscle.

The Usefulness of Selective Spinal Nerve Root Block in Neuropathic Pain Patients with Radiculopathy / 대한정형외과학회잡지

PURPOSE: This study was conducted in order to evaluate effect and efficiency of selective spinal nerve root block for neuropathic pain patients with lower leg radiating pain. MATERIALS AND METHODS: A total of 113 patients were evaluated and follow-up periods were a minimum of 12 months. They were divided into two groups: group A included 41 patients with neuropathic pain and group B included 72 patients with simple lower leg radiating pain. RESULTS: Fourteen (34.1%) patients in group A and 45 (62.5%) patients in group B had favorable results for selective spinal nerve block (p<0.05). Visual analog scale (VAS) was improved from 7.57 to 5.23 at 12 months in group A and from 7.11 to 3.49 at 12 months in group B. CONCLUSION: The initial treatment period for group A was significantly later than in group B. For patients with neuropathic pain and radiculopathy, early assessment was recommended and early selective spinal nerve block could be a good treatment option for neuropathic pain patients.

Effectiveness of Selective Nerve Root Block for the Patient with a Single Level Lumbar Spinal Stenosis who is on the Operation Schedule

STUDY DESIGN: Retrospective study. OBJECTIVES: We reported the therapeutic usefulness of a selective nerve root block (SNRB) for patients with a single level spinal stenosis. SUMMARY OF LITERATURE REVIEW: Selective nerve root block for the radiculopathy due to lumbar disc herniation, spinal stenosis, and spondylolisthesis have been reported frequently. MATERIALS AND METHODS: We retrospectively examined 44 patients with single-level spinal stenosis, for whom surgical treatment was considered due to the failure of other conservative treatments from January 2005 to January 2010. All 44 patients were admitted for surgical decompression. Selective nerve root block was done just before a final decision of surgical procedure; patients with his or her 50% or more pain reduction could avoid surgery. RESULTS: In fourty-four cases, twenty-seven pateints underwent a surgical operation. Seventeen patients avoided surgical procedures by successful SNRB. As a result of a 3 year follow-up, the VAS score was significantly and continuously low on the operation group (p=0.02~0.03). K-ODI and Roland-Morris Disability scores were low in both groups until 1 year after the operation and SNRB procedure (p=0.026~0.042, p=0.03), but there was no statistically significant difference beteween the two groups after 2 years upon follow-up (p=0.072~0.14, p=0.06). Generally, the operation group had good results until 1 year after operation and had better tendency for improvement. The data displayed a high probability of surgical treatment among the patients with foraminal stenosis (p=0.039) highlight - this sentence says there is no difference after 1 year and there is still no difference after 2 years. If this is true, the sentence needs to be rewritten so that it says both times show no difference. If there is a difference between 1 year and 2 year then the sentence needs to be rewritten to make this more clear. The next sentence seems to say they are different. CONCLUSIONS: Selective nerve root block avoided the surgical intervention in 39% of the patients with the spinal stenosis refractory to the conservative treatment. Thus it is one of options for the refractory spinal stenosis.

Evaluation of the Back Muscle Exercise for the Lumbar Discectomy Patients

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify the implementation of self-exercise therapy and analyze the effects of exercise therapy after lumbar discectomy. MATERIALS AND METHODS: Studied 47 patients who underwent partial lumbar discectomy and laminectomy from January, 2009 to December, 2009. They were instructed on 16 kinds of exercise therapy in total from postoperative 1day to postoperative 6weeks. Group A (n=25), whose frequency of outpatient clinic visit is above the average, and Group B (n=22), whose frequency of visit is relatively low;, below 5 times. We tested the visual analog scale (VAS scale) of back, Oswestry disability index and the strength of the two groups before surgery and at postoperative 3, 6, and 12 months. RESULTS: The degree of pain was significantly different (26.6+/-9.4 and 53.5+/-18.6) between group A and group B at postoperative 6 months. Function of daily life and strength test were significantly different (6.6+/-4.8 and 11.3+/-4.0 at group A, 3.6+/-0.9 and 3.0+/-1.1 at group B) between the two groups at postoperative 12 months. The characteristics of low compliance patients are low accessibility to the hospital and lack of knowledge on the importance of exercise according to the degree of pain. CONCLUSION: These results suggested that postoperative exercise program has significant effects on the pain, the function of daily life. It also increases flexibility and strengthens the muscle of patients with high compliance of outpatient clinic visit. The factors influencing the results are the age of patients, the willingness to exercise, and the environment in which each patient lives/resides.

Usefulness of Ultrasound-guided Facet Joint Block in the Out Patient Clinics

STUDY DESIGN: Level III, retrospective studies. OBJECTIVES: This study is conducted to evaluate the effect and usefulness of ultrasound guided facet block for the outpatients who complained of chronic lower back pain. SUMMARY OF THE LITERATURE REVIEW: Facet joint syndrome was introduced in 1976, by Mooney V. It was considered to be one of the major causes of low back pain. MATERIALS AND METHODS: Between October 2009 to March 2011, 98 cases were selected from the outpatients who complained of chronic lower back pain for more than 3 months. The patients had no surgery history and did not complain of neuromuscular symptoms, and they had more than three times outpatient care at least and could be followed up for 1 year. The patients were divided into three groups; first was the ultrasound guided facet block group (27 cases), second was the Fluoroscopy guided facet block group (39cases) and third was the conservative group (32 cases).The clinical results were analyzed using Kim's criteria and the Visual Analog Scale score, ODI score, Physician's global assessment (subjective), Patient's global assessment (Objective). RESULTS: The VAS score was improved from an average of 7.75+/-1.5 to 4.47+/-2.4 in the ultrasound guided facet block group, and from 7.81+/-1.4 to 4.39+/-2.6 in the Fluoroscopy guided facet block group, and from 7.87+/-1.3 to 6.24+/-2.1 in the conservative group. The VAS score, Kim's criteria, ODI score, Physician's global assessment (subjective), and Patient's global assessment (Objective) showed statistically significant improvement in the ultrasound guided facet block group and Fluoroscopy guided facet block group. CONCLUSION: In the outpatient clinics, comparing with the group that underwent conservative treatment with medication, the group treated with ultrasound for block could have better results in clinical improvement.

Prediction of Bone Cement Leakage in Patients Receiving Vertebroplasty by MRI Finding / 대한골다공증학회지

OBJECTIVES: To identify MRI predictors of bone cement leakage, we compared pre operative MRI and postoperative CT. MATERIALS AND METHODS: Between October 2004 to March 2009, percuataneous vertebroplasties were performed in 58 patients from 167 patients of spine compression fracture. Among them, 37 patients took MRI before vertebroplasty and CT after operation to figure bone cement leakage. In 37 patients, 45 vertebras (T9; 1, T10; 3, T11; 5, T12; 8, L1; 11, L2; 9, L3; 4, L4; 3, L5; 1) preoperative MRI was taken to measure the presence of cortical disruption of the vertebral body and vacuum or cystic portion, severity of body compression, bone cement amount and bone cement amount/ severity of body compression ratio. RESULTS: In postoperative CT scan of 42 vertebrae with bone cement, leakage was detected in 17 vertebrae (37.7%). However, no patients displayed any neurological symptoms or required surgery. Endplate cortical disruption was related to an increase risk of intervertebral bone cement leakage (P<0.05). Bone cement leakage tended to occur less frequently when there is a vacuum or fluid collection (P<0.05). No other factors showed significant relation with cement leakage. CONCLUSIONS: Vertebroplasty group in magnetic resonance imaging of cortical damage to the vertebral endplates and fluid collection or vacuum changes when that can be useful to predict the leakage of bone cement after vertebroplasty group findings suggest.

Evaluation of Quality of Website Information about Lumbar Herniated Intervertebral Disc / 대한정형외과학회잡지

PURPOSE: This study evaluated the information quality of websites that provide information about herniated intervertebral discs (HIVD) and examined the correlation between the information quality score (IQS) and the rank of popularity. MATERIALS AND METHODS: From April 1 to May 31, 2005, of 308 homepages that had been searched on three search engines using the key words (vertebra, disc, lumbago, HIVD), 150 homepages with information about HIVD were surveyed. The informational quality score of each homepage was examined according to the existence or nonexistence of 25 criteria and compared the IQS according to the discipline and operating scale. The homepages were rated according to the rank of popularity and the correlations between their point of popularity and informational quality were assessed. RESULTS: The mean IQS of the 150 homepages were 8.5 (+/-6.4) points, IQS of 94 (62.6%) homepages were <10 points. There were no significant differences between the IQS of orthopedic surgery and neurosurgery (p=0.985). However, the IQS of oriental medicine were significantly lower than orthopaedic surgery (p<0.001) and neurosurgery (p<0.001). There was no significant correlation between the popularity and IQS (p=0.256). CONCLUSION: Proper guidelines and certification of the homepage that provide information about HIVD by the medical association are needed.

Conservative Treatment of Spontaneous Spinal Epidural Hematoma: A Case Report / 대한척추외과학회지

A spontaneous spinal epidural hematoma (SSEH) is a rare disease that accompanies severe axial pain in the spine with various levels of paralysis depending on the location of the hematoma. A SSEH is mainly caused by a coagulating disorder or anticoagulants medication, while certain cases relate this disease with spinal inflammatory conditions. The early diagnosis of a SSEH is important for its treatment. Most cases with neurologic symptoms can be treated with a immediate laminectomy and decompression. If the neurologic symptoms improves within 12 hours, a conservative treatment is effective, however few cases have been reported. We encountered a 59 years old male without a prior medical history suffering from severe back pain and paraplegia due to a SSEH at thoracic vertebrae. The patient was successfully treated conservatively. We report this case with a review of the relevant literature.

Gene-expression profiling of titanium-cell interaction / 대한치과보철학회지

STATEMENT OF PROBLEM: In the process of bone formation, titanium (Ti) surface roughness is an important factor modulating osteoblastic function. PURPOSE: This study was carried out to determine the effect of different Ti surface on biologic responses of a human osteoblast-like cell line (MG63). MATERIALS AND METHODS: MG63 cells were cultured on S (smooth), SLA (sandblasted largegrit and acid etching), HA (hydroxyapatite) Ti. The morphology and attachment of the cells were examined by SEM. The cDNAs prepared from total RNAs of MG63 were hybridized to a human cDNA microarray (1,152 elements). RESULTS: The appearances of the surfaces observed with SEM were different in the three types of dental substrates. The surface of SLA and HA were shown to be rougher than S. MG63 cells cultured on SLA and HA were cell-matrix interaction. In the expression of genes involved in osseointegration, upregulated genes were bone morphogenetic protein, Villin, Integrin, Insulin-like growth factors in different surfaces. Downregulated genes were fibroblast growth factor receptor 4, Bcl 2-related protein, collagen, CD4 in different surfaces. CONCLUSION: The attachment and expression of key osteogenic regulatory genes were enhanced by surface roughness of the dental materials.

A tissue response to the titanium alloy (Ti-13Zr-6Nb) in vivo / 대한치과보철학회지

STATEMENT OF PROBLEM: Mechanisms of tissue-implant interaction and the effect of the implant surface on the behavior of cells has not yet been clarified. PURPOSE: This study was performed to investigate the tissue reaction to the titanium alloy submerged into rat peritoneum in vivo. MATERIALS AND METHODS: Titanium alloys (titanium-13Zirconium-6Niobium) were inserted inside the peritoneal cavity of Sprague Dawley rats. After 3 months, the tissue formed around the inserted titanium alloys were examined with a light-microscope. Tissue reaction around the material was analyzed by confocal microscopy to evaluate their biocompatibility in a living body. RESULTS: In in vivo study, foreign body type multinucleated giant cells were found in the fibrous tissue formed as a reaction to the foreign material (4 in 20 cases), but the inflammatory reaction was very weak. After experiment, the contaminants of biomaterials was removed from living tissue. In confocal microscopy, we observed that the staining of vinculin and actin showed mixed appearance. In a few cases, we found that the staining of vinculin and beta-catenin showed the prominent appearance. CONCLUSION: We found that titanium-13Zirconium-6Niobium alloy was an excellent biomaterial.

A Case of Complete Agenesis of Corpus Callosum / 대한산부인과학회잡지

The corpus callosum is the main interhemispheric connection in human brain. Agenesis of corpus callosum may partial or complete, and it may have not functional abnormalities. Its prenatal sonographic diagnosis is difficult because of fetal head position, especially in a cephalic presentation. We experienced a case of complete agenesis of corpus callosum. The prenatal sonographic findings was disproportionate dilatation of lateral ventricle, which were suggestive finding of agenesis of corpus callosum or hydrocephalus. We could confirm the diagnosis of complete agenesis of corpus callosum by postnatal MRI.

The Study on Active and Environmental Tobacco Smoke in Biological Samples among High School Students in Korea / 한국역학회지

PURPOSE: The objective of this study was to determine the active and environmental tobacco smoke (ETS) in biological samples (plasma, saliva and urine) among high school students in Korea. METHODS: Study samples were from 99 nonsmoker or smoking volunteers from high school in Kyungki-do in 2000. ETS was defined as the having smokers of their family members or their friends. Urinary samples were extracted with ethyl ether at pH 10.5, and the extract was injected in GC-NPD. Plasma or saliva was extracted with methylene chloride at pH 10.5 and the quantification was performed with GC-MS (SIM). Peak shapes and quantitation of nicotine and cotinine were excellent, with linear calibration curves over a wide range of 1 to 3000 ng/mL. RESULTS: The results are as followings1. The prevalence of smoking among study subjects were 18.2% among males and 6.1% among females. A 69.7% of total subjects among both males and females were exposed at ETS. 2. The primary metabolite cotinine of nicotine was good indicator of ETS exposure in nonsmokers. Salivary cotinine was found to be highly correlated to the concentration of cotinine in plasma (r=0.9480). 3. Urine cotinine was increased among those with smokers in their family members, while salivary or blood cotinine was increased among with smoking friends. 4. Blood cotinine was highly correlated with salivary cotinine, but it was relatively poorly correlated with urine cotinine. CONCLUSIONS: In conclusion, the results show how the students in high school in Korea suffer from secondhand smoke. It appeared that salivary cotinine was easy to collect and best way to predict the ETS among adolescents

Clinical Usefulness of Electroglottography in the Topographic Diagnosis of Vocal Cord Paralysis Based on Laryngeal Electromyographic Findings / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Some objective and quantitative diagnositc methods are introduced to evaluate vocal cord paralysis, such as electro glottography (EGG) and laryngeal electromyography (LEMG). LEMG is an invasive and highly technical method requiring patient's cooperation. It records action potential generated when intrinsic laryngeal musculature contracts. EGG, on the other hand, records changes of impedence between both vocal cords when theses vibrate and represents many information of vocal cord movements. This method is non-invasive and very simple offering some valuable information about voice function of laryngeal diseases. MATERIALS AND METHODS: From January 1998 through May 2000, we evaluated 15 vocal cord paralysis patients by LEMG and EGG and compared the usefulness of these two methods by determining the lesions of vagal nerve injury. RESULTS: For patients who had severe recurrent laryngeal nerve injuries, EGG and dEGG showed no plateau phase but a loss of two-mass movements. Some showed very irregular saw-tooth shaped wave patterns. Patients with vagal nerve injury, EGG and dEGG showed relatively well maintained plateau phases because they had paralyzed cricothyroid muscles which are counteract to abductor of vocal cord. CONCLUSION: Although EGG did not provide information about such diseases as laryngeal myopathy and arthropathy, it is simple and non-invasive, and may he much valuable as a topodiagnostic method of vocal cord paralysis.

Analysis of Changes in Nasal Formant, Spectra and Resonant Volume in Rhinosinus after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been some reports about acoustic analysis of nasality changes after endoscopic sinus surgery (ESS), but no studies on the relationship between acoustic and volumetric changes of rhinosinus. The aims of this study were to measure and follow the postoperative course of nasal formant and spectral changes of nasal consonants and vowels, to evaluate the relationship between these acoustic and volumetric changes of rhinosinus, and to estimate the effect of rhinosinus as a nasal tract on nasal resonance after operation. MATERIAL AND METHODS: The changes of formants and spectral pattern were evaluated in 30 patients before ESS, and one, three and 12 months after ESS. Axial CT planes of 10 patients taken before and one month after the surgery were used for measuring the resonant volume of rhinosinus. RESULTS: The first formant was decreased when ESS was carried out one month after the surgery. However, it almost recovered to the preoperative level within 3 postoperative months. Twelve months after the surgery, the first formant did not show statistically significant differences compared to those of the preoperative state and the postoperative 1 month. The increment of resonant volume in rhinosinus was not correlated with the degree of decrement of the first formant one month after the surgery. CONCLUSION: Having a proper nasal cavity and the sinuses are important for nasality since hypernasality observed in the postoperative 1 month is thought to be caused by significantly increased resonant volume of the nasal tract. Compensatory control of velopharyngeal port as well as the resonant volume of the nasal tract are important factors to changes in nasality.