Increased interleukin-6 and TP53 levels in rotator cuff tendon repair patients with hypercholesterolemia

Background@#A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. @*Methods@#Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. @*Results@#Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). @*Conclusions@#We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

2014–2017 Nationwide Bariatric and Metabolic Surgery Report in Korea

PURPOSE: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in 2014–2017. MATERIALS AND METHODS: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to 2017. Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. RESULTS: The number of operations has decreased sharply in 2015 comparing to 2014 (913⇒550). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in 2015. The primary surgery number fell from 757 in 2014 to 327 in 2015. In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). CONCLUSION: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased.

Intra-abdominal necrotic lipoma diagnosed by computed tomography as a paraprostatic cyst

A dog with a history of diarrhea and dyschezia exhibited an oval-shaped, soft-tissue opacity mass in the abdomen on radiographs. CT examination revealed a large fluid-filled structure displacing the urinary bladder, prostate, and colon. The mass had continuity with the prostate; therefore, it was tentatively diagnosed as a paraprostatic cyst. Cytologic examination was performed and the mass was considered a non-inflammatory cyst. However, after surgery, histopathologic examination revealed a necrotic, inflamed cystic lipoma. This case shows that unusual intra-abdominal lipomas may have a cystic appearance.

Personal Factors Affecting Therapeutic Responses to BCG Vaccination in Asthmatics

PURPOSE: Bacille Calmette-Guerin (BCG) vaccination has been reported to be an effective treatment for asthma in several animal models. This study investigated whether the response to BCG treatment in asthma depends on subject clinical characteristics. METHODS: Stable asthma patients were vaccinated with BCG. One month later, alterations in pulmonary function after vaccination and their relationships with subject clinical characteristics were determined. RESULTS: Of 149 patients with asthma, 54 (36.2%) showed a good or fair response to BCG. The DeltaFEV1 after vaccination was significantly related to age (r=-0.348, P0.05). A good/fair response was highly prevalent in atopic females compared with atopic males, especially among those aged < or =50 years (90.9% vs. 40.0%, P=0.024). Age (P<0.001, odds ratios (OR)=0.92, confidence interval (CI)=0.88-0.96) and atopy (P<0.01, OR=4.95, CI=1.70-14.44) were significant predictors for a good/fair response in females. However, blood eosinophil counts (P<0.05, OR=1.18, CI=1.01-1.39) and FEV1 % best (P<0.001, OR=0.86, CI=0.79-0.94), but not age or atopy, were significant predictors in males. Approximately three-quarters of the males were smokers. CONCLUSIONS: The therapeutic effect of BCG in asthma may differ according to patient clinical characteristics. The greatest benefit occurred in young atopic females. Asthma activity indices, such as eosinophilia and FEV1 % best, were more predictive of a good/fair response in males; this may have been related to cigarette smoking.

Quality of Life and Anxiety in Patients with Acute and Chronic Pain

OBJECTIVE: To compare the factors such as quality of life (QOL), anxiety and pain intensity in patients with acute and chronic pain. METHOD: Twenty patients with acute (pain duration 3 months) musculoskeletal pain were recruited. Pain intensity was assessed using 3 measures: ratings of average pain on a visual analogue scale (VAS), ratings of average pain on the short form McGill pain questionnaire (SF-MPQ), and ratings of pain on the present pain intensity (PPI) verbal rating scale. Quality of life and anxiety were assessed using 2 measures: the SF-36 (medical outcomes study 36-item short-form health survey) and the STAI (state-trait anxiety inventory). RESULTS: The SF-36 scale was lower and state anxiety scale was higher in chronic pain group. The SF-36 and the state anxiety scale revealed significant difference between the acute and chronic groups (p<0.05), but there was no significant difference between the the groups regarding pain intensity and the trait anxiety scale. CONCLUSION: Patients with chronic pain showed low well-being status and increased anxiety level compared to acute pain patients. According to the above results, proper management of chronic pain might be helpful for enhancing their psychosocial function.

Gender Differences Associated with Pain Patterns and Psychological Variables in Chronic Musculoskeletal Pain Patients

OBJECTIVE: To investigate gender differences in pain patterns and psychological variables among patients with chronic musculoskeletal pain. METHOD: Thirty-five male and thirty-eight female patients who visited our outpatient clinic due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Chronic musculoskeletal pain was defined as pain lasting longer than 6 months. Patients were evaluated with visual analogue scale (VAS), pain site, pain duration and frequency. Beck depression inventory, state-trait anxiety index, somatization scale of symptom checklist-revised, symptom interpretation questionnaire, and pain catastrophizing scale were checked for psychological variables. Correlations among each variable were evaluated statistically. RESULTS: Female patients with chronic musculoskeletal pain recorded higher scores on number of pain site, pain catastrophizing scale, rumination, magnification and catastrophic attribution than male patients (p<0.05). In female patients, VAS was correlated significantly with depression, static anxiety, somatization, catastrophizing thought. rumination, magnification, helpless, and catastrophic attribution. Pain frequency was correlated significantly with somatization, catastrophizing thought, rumination, and helpless. Number of pain site was correlated with somatization, catastrophizing thought, magnification, and helpless. The correlation between pain patterns and psychological variables was also observed in male patients, but statistically less significant than female patients. CONCLUSION: We found gender difference associated with pain patterns and psychological variables in chronic musculoskeletal pain patients. Consideration of psychological factors may be important for management in female patients with chronic musculoskeletal pain.

Are Risk Factors for Failure after Mid-Urethral Sling Operation Different between Patients with Pure Stress and Those with Mixed Urinary Incontinence in the Short-Term Follow-Up?

PURPOSE: Although application of the mid-urethral sling (MUS) operation has expanded to more complicated cases such as patients with mixed urinary incontinence (MUI), the success rates in patients with MUI have been reported to be lower than those in patients with pure stress urinary incontinence (SUI). We evaluated and compared the risk factors for failure after MUS surgery in patients with pure SUI and in those with MUI. MATERIALS AND METHODS: Two hundred twenty-eight women were categorized as having pure SUI (Group A, 163 patients) or MUI (Group B, 65 patients). Preoperative evaluations including a symptom questionnaire, physical examination, and urodynamic study were performed. Patients underwent retropubic (17.5%) or trans-obturator (82.5%) MUS surgery. RESULTS: The demographic characteristics that differed between the 2 groups were body mass index, presence of cystocele, and severity of incontinence. The success rate in Group A (95.7%) was higher than that in Group B (84.6%) (p=0.015, chi-square test). In Group A, VLPP, PdetQmax, and weight of the 1-hour pad test were identified as risk factors for failure of the operation in the univariate analysis, but only weight of the 1-hour pad test was an independent risk factor in the multivariate analysis (adjusted odds ratio [OR]=3.5; 95% confidence interval [CI]=1.204-8.895, p=0.045). In Group B, menopause without hormone replacement, AUA Symptom Index-QoL score, maximal cystometric capacity (MCC), and involuntary detrusor contraction (IDC) were the risk factors in the univariate analysis, but only MCC (adjusted OR=0.9; 95% CI=0.645-0.984, p=0.032) and IDC (adjusted OR=2.3; 95% CI=1.014-3.309, p=0.044) were independent risk factors in the multivariate analysis. CONCLUSIONS: Unlike in pure SUI, weight of the 1-hour pad test was not a significant predictor of failure of surgery in MUI. Meanwhile, MCC and IDC, which indicate the pathophysiologic status of the detrusor muscle itself, were important predictors of failure of surgery in MUI.

Predictive Factors for Female Bladder Outlet Obstruction Defined by Pressure-Flow Study

PURPOSE: We investigated pre-urodynamic study parameters of bladder outlet obstruction (BOO) defined by pressure-flow study (PFS) in female patients without anatomical obstruction. MATERIALS AND METHODS: The cohort of this study consisted of 320 women who did not have anatomical BOO in whom urodynamic study was conducted for lower urinary tract symptoms (LUTS). BOO was defined when the PFS maximal flow rate (Qmax) was or =25 cmH2O. The main outcomes were the incidence of BOO and its predictive factors in our cohort. RESULTS: Of the total patients, 39 (12.2%) were diagnosed with BOO in the PFS. Free Qmax and maximal voided volume (MVV) were significant predictors of BOO (p15 ml/sec or MVV is >350 ml, PFS may be not essential. On the contrary, if free Qmax and MVV are below these levels, PFS may be indicated to evaluate the presence of BOO.

Buttock Pain Secondary to Segmental Neurofibromatosis: A case report

Neurofibromatosis (NF) is a dysplastic disease which consists of multiple cafe-au-lait spots and neurofibromas from neural sheath. The 61-year-old male patient complained of sudden severe pain on the left buttock started one month ago. On physical examination, multiple "lentigines" were seen on his left buttock which spreaded to the thigh and small soft protruding nodules were observed on the right side of the back and left shoulder. Histopathologic finding of a specimen obtained from a nodule was consistent with neurofibroma. Magnetic resonance imaging (MRI) and ultrasonography revealed asymmetrical hypertrophy of neurovascular bundle located in the left greater sciatic foramen. On diagnosing as NF, he was treated with medication, physical modalities and therapeutic intervention (caudal block). Visual analogue scale (VAS) went down to 3/10 with these treatments and he was discharged. We report successful treatment of buttock pain rarely associated with segmental neurofibromatosis.

Single Symptom of 'Pure' Mechano-allodynia Secondary to Acute Herniated Cervical Disc: A case report

Allodynia is pain following a non-noxious stimuli which does not provoke pain normally and develops after incomplete spinal cord injury more commonly in cervical rather than thoracic level, and central cord syndrome. This article presents an unusual patient who presented with the single symptom of an intense allodynia after cervical intervertebral disc herniation. This 36-year-old male patient developed acute lancinating and burning pain aggravated by skimming light touch on both thenar area. Cervical magnetic resonance imaging (MRI) revealed central disc herniation and spinal cord compression. The allodynia secondary to acute herniated cervical disk has been successfully disappeared through pharmacotherapy with pulsed-use of steroid, gabapentin and comprehensive rehabilitation.

A study on the correlations between facial biotype, submentovertex cephalometric measurements and surface EMG activity in patients with facial asymmetry / 대한치과교정학회지

Although the submentovertex radiograph and surface EMG are not often used due to the difficulty of interpretation, they are accepted as useful diagnostic and analytic aids for skeletal asymmetry. There have been reports which state that they were also useful for the evaluation of vertical skeletal relations. The purpose of this study was to evaluate the correlations between EMG data, measurements from submentovertex radiographs, facial types and facial asymmetry following examination of 60 asymmetric patients. The radiographic corpus length were greater in the nonaffected sides (p < 0.001), gonion to interspinosum axis were greater in the affected sides and the mandibular condyle and gonion were located more anteriorly in the non-affected sides than in the affected sides but not significant (p=0.07). The activity of the anterior temporal muscle in rest position was higher in the affected sides than in the non-affected sides (p < 0.01). The activity of the masseter muscle at maximum clenching was found to be nonsignificant but it was higher in the affected sides than in the non-affected sides (p=0.09). There was positive correlation between facial index and the intercondylar axes angle (p < 0.01). There was positive correlation between masseter muscle activity in maximum occlusion and facial index in the affected and non-affected sides (p < 0.05). The results demonstrate that the submentovertex radiograph and EMG can provide useful information for the evaluation of horizontal and vertical skeletal relations.

Intraosseous hemangiolymphangioma of the mandible: a case report

Hemangiolymphangioma is a malformation of both lymphatic and blood vessels. While a hemangiolymphangioma is a benign lesion, its propensity to invade underlying tissues and to recur locally distinguishes it from the simple lymphangioma or hemangioma. Hemangiolymphangiomas are uncommon developmental anomalies and intraosseous hemangiolymphangioma of the mandible is a relatively rare condition: when it occurs, the clinical and radiographic presentation are often nonspecific. The author presents a case of hemangiolymphangioma in mandible.

Bilateral optic neuritis as first manifestation of systemic lupus erythematosus

A 21-year-old woman presented with bilateral optic neuritis, combined with central retinal vein occlusion. General physical examination and neurologic consultation revealed no other findings. Laboratory investigation yielded an elevated erythrocyte sedimentation rate, positive LE preparation, elevated ANA titer, and elevated blood urea nitrogen and creatinine levels. Diagnosis of systemic lupus erythematosus (SLE) was made. Renal failure developed quickly and she was treated with hemodialysis, transfusion and subsequently systemic corticosteroid. Anti-phospholipid antibody was positive to lupus anti-coagulant and the titer was normalized after 2-month steroid therapy at which time the visual outcome differed between the eyes. The right eye showed improvement in visual acuity and visual field, but the left eye was not improved and retained a central scotoma. SLE needs to be considered in young women with optic neuritis when other causes of optic neuritis have been excluded, and serologic tests including anti-phospholipid antibody should be conducted.

A Case of Buried Bumper Syndrome Replaced by Endoscopic Management / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support to the patients who cannot maintain the adequate oral intake. Compared with operative gastrostomy, PEG is a safe, rapid, and less expensive technique. Among several complications, buried bumper syndrome is a late complication in which internal bumper erodes into the gastric wall or migrates into the abdominal wall due to improper compression to the gastric wall. We here report a patient with peritubular leakage, resistance of tube feeding, and abdominal pain which were developed 13 months after percutaneous endoscopic gastrostomy. On endoscopic examination, the gastrostomy lumen could not be found. The gastrostomy tube was replaced successfully to new one with single procedure endoscopic technique. No complication was occurred and the function of tube has been well preserved.

A Case of Rectal Bleeding Treated by Endoscopic Band Ligation / 대한소화기내시경학회지

Endoscopic band ligation has been a standard therapy in esophageal varix bleeding since it was first introduced in 1980s. However, technical problems have interrupted as a therapeutic management of lower gastrointestinal bleeding. We report a case of successful management of rectal bleeding with endoscopic band ligation in patient with chronic renal failure, who had been managed by hemodialysis since eight months before. Successful control of rectal bleeding was achieved by endoscopic band ligation. Three days later, round and shallow ulcer developed at the ligated site, which was improved at follow-up sigmoidoscopy and bleeding was not observed any more. He was discharged without complications. Herein, we report the band ligation as a useful method in treatment of rectal bleeding.

A Case of Idiopathic Colorectal Varices: Case report / 대한소화기내시경학회지

Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.

A Comparison of Frequency Doubling Technology N-30 and Humphrey Field Analyzer Central 30-2

To evaluate the validity of FDT as a field analyzer by comparing to Humphrey perimetry with global indeces.FDT is known as a easy to use and convenient device, and there is restriction in pupil size and refractive error within 7 diopters. Forty-two glaucoma patients[79 eyes]were included in this study. All subjects performed FDT N-30 and HFA C30-2 apart 15 minutes on same day.Mean age of subjects were 48.18 +/-16.46years[from sixteen to seventy four years].Twenty-five men and seventeen women were included in this study. Test duration was 4.92 +/-1.08 minutes with FDT N-30 and 13.79 +/-3.32 minutes with HFA C30-2.In global index mean deviation was 14.63 +/-9.52 decibel with HFA C30-2 and 10.33 +/-6 .8 3 decibel with FDT.There was a significant correlation with coefficient correlation 0.940 between two tests[p<0.01]. Pattern standard deviation was 7.89 +/-3 .8 5 decibel in HFA C30-2 and 7.80 +/-3.13 in FDT.There was a significant correlation with coefficient correlation 0.702 between FDT PSD and HFA C30-2 PSD, and 0.691 between FDT PSD and HFA C30-2 CPSD, too[P<0.01].In diagnosing glaucoma, sensitivity and specificity of FDT was 86% and 70% respectively. FDT is thought to be convenient and effective screening tool in glaucoma patients for with a high correlation with HFA C30-2.

Melnick-Fraser Syndrome in the Same Family / 대한이비인후과학회지

Melnick-Fraser syndrome is a rare congenital anomaly that is characterized by preauricular fistula, branchial fistula, hearing impairment, and is often combined with renal anomaly. Preauricular fistula and branchial fistula can occur in the same individual, but their association with hearing impairment is very rare. The condition is inherited in an autosomal dominant mode. Recently, we experienced a case of Melnick-Fraser syndrome in a 32 years old male patient with familial tendency. We report this case with a review of literature.

Two Cases of Deep Neck Infection with Mediastinal Involvement / 대한이비인후과학회지

Deep neck space infections affect fascial compartments of the head and neck, and their contents. Acute mediastinitis occasionally occurs as a complication of neck infections resulting in neck sepsis, which spreads to the mediastinum via the cervical fascial planes, and this is best referred to as descending necrotizing mediastinitis (DNM). We recently experienced two cases of deep neck infection dissecting along cervical fascial planes into the mediastinum causing a virulent mediastinitis. Aggressive antibiotic treatment of the deep neck infections along with prompt complete mediastinal drainage are recommended for optimal outcome.

Natural History of Small Abdominal Aortic Aneurysms

The operative treatment of abdominal aortic aneurysm (AAA) is generally recommended in ruptured AAA, symptomatic or rapidly expanding AAA, complicated AAA and atypical aneurysms, but there is a controversy in treatment of asymptomatic small-sized AAA. To determine the proper management plan, it is important to know the natural history of AAA, expansion rate and frequency or pattern of complications. There are several reports about the natural history of AAA in western population, but little has been reported in Koreans. Authors performed this study in order to analyze the natural history of small AAA, and to establish a guideline in the proper management of small AAA. PATIENTS & METHODS: Since January 1991, among the patients diagnosed as AAA at Seoul National University Hospital, we followed 15 patients whose aneurysm size was less than 6 cm without operation. In this study, we analysed the natural history of 11 cases with more than 6 months follow up; occurrence of symptoms, physical examinations, and aneurysm size measurement by ultrasound or CT every 6 months. RESULTS: All 11 patients were men, and the mean age was 63.9 years, ranging 54 to 75 years. According to the measurement of largest transverse diameter, mean expansion rate for 6 months was 0.17 0.138 cm. Follow-up period ranged 6~84 months and the median duration was 30 months. Expansion rate according to the initial size was 0, 0.246, 0.178, 0.1 cm/6 months respectively in group A (4.0 cm; 1 case). There was no rupture, aneurysm-related complication, nor death during the follow-up period. We performed elective operations in 2 cases, first case due to aneurysmal expansion over 6 cm, and the other due to severe anxiety of the patient for rupture. CONCLUSIONS: It may be a safe treatment discipline to follow up small AAA patients with sono-guided size measurement and elective operation in selected cases.