Contrast Spread in the Superoposterior Approach of Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy

OBJECTIVE: To observe the contrast spread in superoposterior transforaminal epidural steroid injection (SP TFESI) and investigate the correlation between spread patterns and efficacy. METHODS: Thirty-one patients with lumbosacral radiculopathy underwent single-level TFESI under fluoroscopy. The final needle tip position was targeted toward the SP quadrant of the intervertebral foramen. To observe the spread, 1 mL of contrast material was injected, followed by a steroid injection. The contrast spread was graded anteroposteriorly and vertically in the epidural space. The effect of SP TFESI was evaluated by proportional pain score reduction. RESULTS: Levels injected were L4-5 (n=20) and L5-S1 (n=11). Seventeen cases were lateral, and 14 were central herniated disc (HD). Baseline mean visual analog scale score was 6.23. Contrast dispersed dorsally in all the cases, and 45.2% cases showed a concurrent ventral spread. The proportion of the pain reduction after 2 weeks showed no difference between the two groups. In vertical spreading analysis, mean cephalic/caudal grades were 1.40/1.55 at L4-5 level and 1.73/1.64 at L5-S1 level. The HD location had no effect on contrast dispersion. CONCLUSION: In SP TFESI, ventral contrast spread did not guarantee a better effect; however, the extent of cephalic flow in ventral expansion group correlated with the proportion of pain reduction.

Psychopathology Associated with Participant Role among Bullying Situation / 신경정신의학

OBJECTIVES: In recent years, school violence has been increasing and this situation is complicated by various factors. The objective of this study is to explore the distribution of the participants' roles and to examine the psychopathology associated with these roles among middle school students. METHODS: In a cross-sectional study, 490 middle school students completed the Participant Role Questionnaire (PRQ) for classifying the participants' roles in a bullying situation. The Korean-Youth Self Report (K-YSR), Revised Children's Manifest Anxiety Scale (RCMAS), Rosenberg Self-Esteem Scale (RSE) and Parent Adolescent Communication Inventory (PACI) were also included to evaluate the psychopathology of the students. RESULTS: The distribution rates of the bully, assistant, reinforcer, defender and outsider groups were 4.1%, 3.1%, 5.3%, 53.7%, and 32.0%, respectively. Among the syndrome scales of K-YSR, almost each items' and the total scores (p=0.049), RCMAS (p=0.000), PACI (p=0.000), and RSE (p=0.000) were significantly different among all group. The average scores on the K-YSR and RCMAS were the highest in the assistant and reinforcer groups. CONCLUSION: The assistant and reinforcer groups showed more severe psychopathologies. This means that they suffered from more difficulties than the other groups. Therefore, they need more intensive therapeutic interventions. Except for the defender group, who prevented bullying, the outsider group was the largest group. Therefore, a comprehensive approach that can change outsiders to defenders should be employed for the prevention of bullying in adolescents.

Histomorphometric evaluation of bone healing with natural calcium carbonatederived bone substitutes in rat calvarial defect / 대한치주과학회지

PURPOSE: This study investigated the osteoconductivity of natural calcium carbonate-derived bone substitutes, hen eggshell (ES), and compared with those of commercial bone substitutes. MATERIALS AND METHODS: Osseous defects created in the rat calvaria were filled with particulated ES(ES-1), ES with calcium-deficient hydroxyapatite surface layer (ES-2), Biocoral(Inoteb, France), and Bio-Oss(Geistlich Pharma, Wolhusen, Switzerland). After 4 and 8 weeks of healing, histomorphometic analysis was performed to evaluate the amount of newly formed mineralized bone area (NB%). RESULTS: Histologic and histomorphometric analysis showed new bone formation and direct bony contact with the grafted materials in all groups. At 4 weeks, Biocoral group showed greater NB% compared to Bio-Oss and ES-1 groups (P<0.05). At 8 weeks, Biocoral and ES-2 groups showed significantly greater NB% compared to Bio-Oss group (P<0.05). CONCLUSION: These results indicate that natural calcium carbonate-derived bone substitutes with microporous calciumdeficient hydroxyapatite surface layer may be an effective materials treating osseous defects.

Clinical evaluation of root-resected teeth clinical outcome over 2 years / 대한치주과학회지

Periodontal disease accompany the inflammation around periodontal tissue and generally periodontal destruction is followed. This destruction often makes the molar teeth have furcation defect. And to treat molar furcation involvement, resective surgery such as root resection and ostectomy and regenerative procedure such as guided tissue regeneration were introduced. Also implant can be considered as one of the good treatment methods. Among these treatment alternatives, root resection can be considered as a good procedure in the point of saving one's natural teeth or amount of cost. Therefore the purpose of this article is to evaluate root-resected teeth which were done at least 2 years ago. 70 root-resected teeth in 58 patient who visited Kyungpook National University Hospital were included in this study. They were evaluated by two clinical method. One is subjective evaluation and another is objective evaluation. To evaluate subjective outcome, 58 patients answered to the questionnaire if they experienced tooth extraction, bleeding, swelling, pain, mobility and chewing problem. To evaluate objective outcome, 28 teeth was evaluated according to Langer's criteria. The subjective result showed 82% of success rate and 18% of failure rate. 13 of 70 teeth showed discomfort and were considered as failure, which include chewing problem (39%) and pain (23%). The objective outcome showed that 4 failure (14% failure rate) which were 2 cases of bone loss by periodontal problem, one endodontic problem and one untreatable caries. By these limited results, some of clinical consideration in root resective procedure can be suggested. Periodontal support and less occlusal loading on resected tooth should be evaluated before the procedure, moreover, good oral hygiene is essential. When these factors are considered carefully, the root resection may produce predictive outcomes in the treatment of furcational involvement.

Gastrointestinal Stromal Tumor of Rectum: A Reoport of 7 Cases

PURPOSE: Gastrointestinal stromal tumors (GISTs) are rare. The aim of this study is to investigate and describe the clinicopathologic characteristics of rectal GISTs. METHODS: We retrospectively analyzed the medical records of seven patients who underwent surgery for GIST of the rectum from 1998 to 2003. RESULTS: Male and female patients were two and five respectively. The mean age was 55 years (range, 41~72 years) at the time of diagnosis. The median follow-up period was 23 months (range, 7~75 months). The chief complaints were hematochezia, constipation and anal pain. Curative resections were done in all cases. Abdominoperineal resection was done in five cases and transanal excision was done in one case. In one case, Hartmann's operation with prostatectomy was done. The mean size of tumor was 6.6 cm (1~12 cm). The pathologic feature of all cases were spindle cell type. The mitotic count shown > or =5 in 50 high power field was identified in four cases and that shown < or =5 in 50 high power field in three cases. Adjuvant radiation therapy was done in four cases. Two local recurrences occurred on 54 month and 23 month later after surgery, respectively. CONCLUSION: In cases of GIST of the rectum, the common symptom was same as other rectal tumors. Immuonhistiochemical staning of c-kit is helpful for differential diagnosis. Curative surgical resection should be done for treatment.

Mutation and overexpression of p53 as a prognostic factor in canine mammary tumors

We concentrated ourselves to evaluate the prognostic significance of the p53 gene mutations, its protein expression and MIB-1 index as a proliferative marker in canine mammary tumors. In the present study, a total of 20 cases were examined, among which there were 5 malignant mixed tumors, 4 mammary gland adenocarcinomas, 1 papillary adenocarcinoma, 8 benign mixed tumors and 2 mammary gland adenomas. Positive immunostaining for p53 with PAb240 antibody was found in 2 benign (20%) and 3 malignant (30%) tumors. However, PAb421 antibody did not give positive result at all. In Western blot analysis, the p53 expression in benign and malignant tumors was detected in 4 and 3 cases, respectively. p53 mutations were found in 6 cases out of the cases with detected p53 protein expression. The MIB-1 index in benign and malignant tumors were 17.6+/-20.8% and 29.0+/-27.2%, respectively and there was no significant difference between tumor types. There was a significant correlation between p53 mutations and p53 overexpression (correlation coefficient = 0.5, p < 0.05). In Kaplan-Meier survival analysis, the p53 index was associated with significantly shortened survival time (p < 0.01). In multivariate analysis, p53 overexpression was only an independent factor for indicator of worse prognosis in canine mammary tumors (p = 0.01). These results demonstrated that p53 gene mutations and protein overexpression using the PAb240 anti-p53 antibody were useful predictors of increased malignant potential and poor prognosis in canine mammary tumors.

Mutations of p53 Tumor Suppressor Gene in Spontaneous Canine Mammary Tumors

Mutation of the p53 tumor suppressor gene has been related in the pathogenesis of numerous human and canine cancers, including breast cancers and mammary tumors. We have investigated exons 5-8 of the p53 gene for mutations in 20 spontaneous canine mammary tumors using polymerase chain reaction (PCR) with direct sequence analysis to evaluate the role of this gene in canine mammary tumorigenesis and analyzed to compare with other clinicopathological parameters including age, histology, stage, recurrence and death from tumor. Four missense (one case had two missense mutations) and one nonsense mutations were detected in 10 malignant lesions (40%), and two missense and one silent mutations were found in 10 benign mammary tumors (30%). Five of the missense mutations were located in highly conserved domains II, III, IV and V. After a follow-up period, four dogs showed a progression and three of these patients revealed death from mammary carcinoma with p53 mutation. These results demonstrated that the p53 gene mutations might be involved in the development of canine mammary tumors and contribute to the prognostic status in canine mammary carcinomas.

Hiatal Hernia in Neonate / 대한흉부외과학회지

The incidence of Congenital diaphragmatic hernia is 1 in 2000-5000 live births and hiatal hernia is even rarer especially in neonates. We experienced a case of congenital hiatal hernia (mixed type) in a week old female. Upon confirmation of the diagnosis, the surgery was done. Through the right thoracotomy, Belsey-Mark IV fundoplication was performed after the reduction of herniated viscera. The patient was fed 3 days after operation. there has been no complaint for 6 months after discharge. Therefore, we present this case with overall review of the literature.