코골이 및 폐쇄성 수면 무호흡증의 두부 규격 방사선 계측학적 기여 인자

Purpose: This study was intended to perform a cephalometric comparison between the patients with and without obstructive sleep apnea (OSA). The factors influencing the OSA in the lateral cephalogram were also investigated. Methods: Fifty patients who had visited the Sleep Disorder Clinic at the Ajou University Hospital and evaluated with the polysomnograph (PSG) and cephalogram, were included in the study. The patients had the apnea-hypopnea episode over 5 times per hour (apnea-hypopnea index [AHI]≥5) were diagnosed as OSA after the overnight PSG. To evaluate the hard and soft tissue profiles, the cephalometric radiograms were taken at the maximal intercuspation. The correlation between the patient’s age, height, weight, body mass index (BMI) and AHI was inspected in the OSA and control group. The difference between the OSA and control group was evaluated (Mann-Whitney U Test). The cephalometric influencing factors to OSA were analyzed (Pearson’s correlation coefficient) statistically using SPSS statistics. Results: The OSA Group had a significantly higher BMI than the control group. The mean lower facial height (ANS-Me) was longer in the OSA group; however, statistically significant difference was not detected in the anteroposterior craniofacial measurements. The distance between mandibular plane and hyoid bone of the OSA group was significantly longer than that of the control group. The hyoid position (MP-Hyoid) had a positive correlation between AHI (P＜0.001). However, the measurements of oropharyngeal airway were not different between the two groups. The hypothesis, that the antero-posteriorly narrow oropharyngeal airway may aggravate the airway resistance and give rise to a higher AHI, was rejected in the study. Conclusion: We suggest that the lateral cephalogram may be utilized as a useful method to evaluate OSA. The patients with a lower hyoid position can be expected to have higher risks of OSA. However, a comprehensive intraoral inspection, including the soft palate and tonsilar hypertrophy, is emphasized, as the lateral cepahlogram cannot visualize the oropharyngeal status completely

◇ 新刊紹介 ◆ 『朱宰佑の知略の計 ： 朝米関係、その宿命の歴史』

articl

국내산 새우 중하(Metapenaeus joyneri)에 대한 특이 IgE 항체 측정 및 알레르겐 규명

Background: Shrimp is one of the major causative crustacean food allergen. An investigation has been reported that tropomyosin belonged to muscle protein is a major allergen within shrimp. But there have been a few investigations on shrimp allergen in Korea. The aim of this study is to evaluate skin reactivity and specific IgE sensitization to Metapenaeus joyneri which is one of the major shrimp in this country, and to identitify IgE binding components and evaluate allergenic relationship with other species. Methods: We performed skin prick test with M. joyneri extract in 1,738 patients. ELISA was performed for detection of serum specific IgE antibody. To evaluate the cross allergenecity between M. joyneri and other crustaceans (crab, lobster, crayfish), Dermatophagoides pteronyssinus (Dpt), triton shell, abalone and buckwheat. ELISA inhibition tests were performed with each four patient's sera showing high specific IgE antibody. To identify IgE binding components, SDS-PAGE followed by IgE-Immunoblot were applied. Results: 211 patients (12.2%) showed positive responses (A/H ≥2+) on skin prick test. Serum specific IgE antibodies were detected in 61 patients (37.2%) of 164 sensitzed patients. ELISA inhibition test using four patient's sera showed significant inhibitions by M. joyneri. and other crustaceans including lobster, crab and crayfish, partial inhibitions were noted by Dpt, triton shell, buckwheat and abalone. SDS-PAGE and IgE-imunoblot with patients' individual sera sensitized to M. joyneri showed 12 IgE binding components (31, 32, 38-44, 57, 70, 81 kDa) and two (31, 32 kDa) were bound to IgE in more than 50% of sera tested. Five (43, 44, 57, 70 and 81 kDa) were bound to IgE in more than 25% of sera tested. Conclusion: Specific IgE was detected in 37.2% of allergy patients sensitized to M. joyneri. Twelve IgE binding components and two (31, 32 kDa) major allergens were indentified. Cross allergenecity was noted with other crustaceans

방사성 요오드 저항성 갑상선암에서 수술적 치료의 역할

Most patients with thyroid cancer (of follicular cell origin) are successfully managed with a combination of surgery, radioactive iodine (131I-RAI), and suppression of thyroid-stimulating hormone with thyroid hormone replacement, obtaining survival rates approaching 90% at 20 years. Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is favorable, recurrence occurs in up to 30% patients. In addition, many patients with recurrent or metastatic disease, as well as those with less differentiated tumors, will have a much poorer prognosis and lose their ability to concentrate functional iodine and are therefore not targeted by 131I-RAI therapy. There are many treatment options but no definitive treatment for radioiodine refractory thyroid cancer. This paper will discuss the roles of surgical treatment for patients with radioiodine refractory thyroid cancer

Outfracture Osteotomy Sinus Graft에 대한 임상적 연구

Purpose: The purpose of this study was to evaluate the feasibility of the outfracture osteotomy sinus graft technique with the evaluation of 8.5 year survival rate of the implants placed in the atrophic edentulous posterior maxillary area. Methods: One hundred and seventy-six cases of 145 patients who visited our center from August 2004 to February 2013 and were diagnosed as atrophic edentulous maxillary alveolar ridge, were selected and underwent sinus graft with outfracture osteotomy sinus graft technique. Feasibility of the outfracture osteotomy sinus graft technique was investigated with clinical and radiographic evaluation to assess the survival rate of the total dental implants in augmentation sinus surgery. Total fixture number available in follow-up period was 320, in which the lost 15 patients were excluded out of 160 patients. Results: Eight point five year cumulative survival rate was 95.6% with 14 failures of total 320 fixtures. The average follow-up period was 28 months 16 days with the minimum and maximum follow-up periods of 4 months 5 days and 94 months 10 days, respectively. Conclusion: Traditional infracture technique is a popular method for an augmentation sinus surgery. The authors modified this classical method by outfracturing and readapting the bony window after sinus graft, with excellent treatment results evidenced by high survival rate, which proves the feasibility of the newly-designed outfracture osteotomy sinus graft technique

Osteopathia Striata with Cranial Sclerosis: 2예 증례 보고

Osteopathia striata with cranial sclerosis is a very rare sclerosing bone dysplasia that is characterized by the radiological appearance of longitudinal striations at the metaphysis of the long bones associated with cranial sclerosis. Here, we report a 10-month-old female infant and a 31-year-old male, who were diagnosed incidentally by showing longitudinal sclerotic lines symmetrically in the long bone ends and basal sclerosis of the cranium. The diagnostic linear striation was found not only in the long bones but also in the ribs and phalanges, which are very rare sites for striation. We discuss the radiology findings of osteopathia striata with the possible complication of cranial sclerosis

사지 운동성 행위상실증을 주소로 내원한 전두측두엽 치매 환자 1예

A 59-yr-old, right-handed woman developed bilateral clumsiness of the hands and dysarthria 6 months prior to admission. A detailed neurologic evaluation showed limb-kinetic apraxia with frontal lobe dysfunction. Brain MRI showed significant anterior temporal lobar atrophy. Brain PET revealed bilateral decreases in glucose metabolism around the motor cortices and temporal lobes, predominantly on the right side. This case suggests that limb-kinetic apraxia is a presenting symptom of frontotemporal dementia

결장 전절제술 및 회장 직장 문합술 후 합병증, 사망률 및 배변 기능변화

Purpose: This study reviews the feasibility of a total colectomy with ileo-rectal anastomosis (TCIRA) and the functional outcome following the operation. Methods: The cases of a total of 50 patients (31 men and 19 women) with a median age of 61 who underwent a TCIRA were reviewed retrospectively. The median follow-up time was 28 months (4∼72). The clinical records were reviewed to analyze the postoperative complications and bowel function. The clinical outcomes were examined directly from patients’ scoring. Results: The indications of TCIRA were metachronous or synchronous colorectal cancer (34 percent), multiple polypoid lesions (22 percent), malignant colon obstruction (24 percent), ischemic colitis (2 percent), Crohn’s disease (6 percent), and tuberculosis colitis (2 percent). The overall mortality and morbidity rates were 0 and 31 percent, respectively. The morbidity included postoperative bleeding, obstruction, intra-abdominal abscess formation, pneumonia, and wound complications. We used the CCIS index to evaluate postoperative functional bowel habit change. The CCIS index evaluation revealed perfect continence in 57 percent of the patients with short-term follow up (＜6 months) and in 83 percent of the patients who had undergone a TCIRA more than 2 years ago. Conclusions: Most patients were satisfied with their bowel function on long-term follow up, and we think the TCIRA is a safe operation, and the clinical outcomes are relatively satisfactory

국소진행성 직장암에서 Irinotecan을 이용한 술전보강화학방사선치료 시 UGT1A1 유전자 다형태의 유용성

Purpose: Irinotecan (CPT-11) is hydrolyzed to an active SN-38, which is further detoxicated to SN-38G through conjugation by uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) enzymes. There are many reports that UGT1A1 polymorphisms are associated with irinotecan related dose-limiting toxicity. The aim of the present study is to determine whether UGT1A1 polymorphisms affect individual variations of the toxicity due to and the tumor response to irinotecan via the alteration of bioavailability of SN-38 in Korean patients with locally advanced rectal cancer. Methods: Twenty patients with locally advanced rectal cancer, who had received surgery after irinotecan- containing chemoradiation from 2003 to 2006, were enrolled. We analyzed the association of UGT1A1 genotypes with toxicity and tumor response to chemoradiation therapy. A tumor response was assumed when a tumor regression grade I or II was obtained. Toxicity was graded in accordance with the NCI common toxicity criteria. Results: The frequence of -53(TA)6＞7 (UGT1A1*28), 211G＞A (UGT1A1*6), 686C＞A (UGT1A1*27), -3279T＞G (UGT1A1*60), and -3156G＞A were 25% (5/20), 25% (5/20), 0% (0/20), 55% (11/20), and 20% (4/20), respectively. There were five grade III neutropenia and one severe diarrhea. Patients with UGT1A1*28 and -3156G＞A showed higher complete tumor response rates (40% vs. 6.7%, P=0.07; 50% vs. 6.3%, P=0.08), but there was no differences in toxicity and tumor response between responders and non-responders. Patients with -3279T＞G (UGT1A1*60) showed a tendency for lower tumor response in tumor responders, but there was no statistically significant difference (P=0.07). Conclusions: This study suggested that -3279T＞G (UGT1A1*60) may be useful in predicting tumor response of irinotecan. In the future, further study is warranted using large numbers of cases to reach statistical significance

비스포스포네이트 관련 악골괴사(BRONJ)의 병기 2기에서의 외과적, 보존적 치료에 대한 비교 연구

Purpose: This study evaluated the prognosis of conservative and surgical treatment according to the staging of bi-sphosphonate-related osteonecrosis of jaw (BRONJ) by American Association of Oral and Maxillofacial Surgeons and American Society for Bone and Mineral Research. Methods: We evaluated 53 patients of BRONJ who visited Department of Dentistry, Ajou University School of Medicine from May 2007 to February 2013. Twenty eight patients in stage 2, were divided into surgical and conservative groups with cessation of bisphosphonate therapy. Fifteen patients belonged to the conservative treatment group, in which mouth rinsing and antibiotics medication were done. Thirteen patients were treated with debridement or sequestrectomy, in the surgical treatment group. Each study list was analyzed by SPSS ver. 14.0 (SPSS Inc., USA) software and the favorable rate was verified by the Fisher exact test. P-values less than 0.05% were deemed significant. Results: Clinical outcome was evaluated on the basis of both clinical and radiographic findings. Of all the 28 patients of stage 2, 15 patients underwent conservative treatment and 13 patients received surgical treatment. In the surgical group, 9 of 13 (69.2%) showed good prognosis, 4 of 13 (30.7%) showed recurrence. In the conservative group, 13 of 15 (86.6%) showed no change duting the follow-up period. Two of 15 patients even showed a bad prognosis, such as pain and pus discharge, which are criteria for stage 3. P-value was 0.067 (＞0.05). Conclusion: The results of the present study suggests that surgical intervention is good choice against the conservative treatment, after proper drug holidays period, while further investigation is needed for a definite solution to BRONJ