Comparative study of the extent of palatal lengthening by different methods

Palatal lengthening is often emphasized in performing palatoplasty. However, definitive data regarding the method of measuring palatal length and the extent of palatal lengthening expressed quantitatively have not been reported. The authors have devised an easy method of measuring palatal length that can be expressed quantitatively, and they examined the characteristics of various methods of palatoplasty that are presently used commonly. A paper ruler was used to measure both a straight-line and a curved distance while the patient was under general anesthesia before and immediately after the palatoplasty. According to this study, the straight-line distance was lengthened to a significantly greater degree than the curved distance was after pushback palatoplasty for incomplete types of cleft palate and two-flap palatoplasty for complete types. Furlow double-opposing Z-palatoplasty and two-flap palatoplasty appeared to allow for greater palatal lengthening than the pushback palatoplasty. Further investigations will be undertaken to determine the correlation between the extent of palatal lengthening and speech development.     

Typical carcinoids and neuroendocrine carcinomas of the stomach: differing clinical courses and prognoses

Background

Gastric endocrine tumors are usually classified as 3 types of well-differentiated endocrine tumors (typical carcinoids or carcinoids) and poorly differentiated carcinomas (neuroendocrine carcinomas [NECs]).

Methods

From 1993 to 2008, 97 patients (73 men and 24 women) were diagnosed with gastric neuroendocrine tumors at the Asan Medical Center.

Results

Of the 45 patients with typical carcinoids, 37 underwent surgery (eg, endoscopic resection). Of the 52 patients with NECs, 43 underwent surgery (eg, radical gastrectomy). One patient died of recurrence of the typical carcinoids, whereas 26 patients with NECs died of related diseases (P < .05). The rates of survival and recurrence did not significantly differ by type of typical carcinoid (P > .05).

Conclusions

Regardless of the type, carcinoids that are not yet advanced can be effectively treated with minimal endoscopic or laparoscopic surgery. However, all NECs and advanced carcinoids should be treated with radical gastrectomy.     

Is endoscopic ultrasonography indispensable in patients with early gastric cancer prior to endoscopic resection?

Background  

Endoscopic resection as curative treatment of early gastric cancer (EGC) requires accurate staging for depth of invasion (T) before therapy. This study aimed to compare T staging of EGC using a miniprobe with that of conventional endoscopy (CE).     

Spontaneous rupture of hepatic artery aneurysm associated with polyarteritis nodosa

Polyarteritis nodosa (PAN) is a vasculitis, which often involves small and medium sized visceral arteries. This condition may result in multifocal aneurismal formation and end-organ damage. Uncommonly, PAN may present with rupture of hepatic artery aneurysms. Here, we report a rare case of a ruptured intrahepatic aneurysm associated with PAN. A 79-year-old woman presenting with abdominal pain had CT scan of the abdomen, which revealed hematoma in the right hepatic lobe. Visceral angiogram confirmed pseudo-aneurysm of a right hepatic arterial branch, and this was managed with endovascular coil embolization. The diagnosis of PAN was made and corticosteroid therapy was initiated. We also performed a literature review to define this condition's demographics, clinical presentations, and appropriate management. The review revealed 17 published cases of ruptured PAN-related intrahepatic aneurysms. We conclude that unexplained findings of visceral arterial aneurysms should prompt investigations for vasculitis as the etiology.     

Surgical Outcomes and Prognostic Factors for T2 Gallbladder Cancer Following Surgical Resection

Background

Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.

Methods

We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.

Results

The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P?<?0.001), extended surgery (P?=?0.028), lymph node dissection (P?=?0.024), non-infiltrative tumors (P?=?0.001), well differentiation (P?=?0.001), absence of lymphatic (P?=?0.025), perineural (P?=?0.001), and vascular (P?=?0.025) invasion, absence of lymph node metastasis (P?=?0.001), negative resection margin (P?=?0.016), and stage (P?=?0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.

Conclusions

For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.     

The relationship between the biogenetic temperament and character and psychopathology in adolescents

BACKGROUND: This study was conducted to investigate the relationship between patterns of temperament and character and self-reported psychopathology in adolescents from the community. SAMPLING AND METHODS: The Junior Temperament and Character Inventory (JTCI) and Youth Self-Report (YSR) instruments were administered to 623 Korean middle school students (boys/girls = 331/292; age = 13.3 +/- 0.9 years old). Multiple linear regression analyses were used to evaluate the relationship between temperament and character based on Cloninger's biogenetic theory of personality and youth psychopathology of internalizing and externalizing problems. RESULTS: Internalizing problems of the YSR (withdrawn, somatic complaint and anxious/depressed scales) were significantly related to high Harm Avoidance and low Reward Dependence (JTCI temperament) and low Self-Directedness and high Self-Transcendence (JTCI character). Externalizing problems of the YSR (delinquency and aggression) were significantly associated with high Novelty Seeking and high Harm Avoidance (JTCI temperament) and low Self-Directedness, low Cooperativeness and high Self-Transcendence (JTCI character). CONCLUSIONS: Findings of the current study suggest that specific patterns of temperament and character potentially influence adolescents' psychopathology in the community.     

Ischemia-related changes of glial-derived neurotrophic factor and phosphatidylinositol 3-kinase in the hippocampus: their possible correlation in astrocytes

In the present study, we observed the changes of endogenous expression of glial-cell-line-derived neurotrophic factor (GDNF) and phosphatidylinositol 3-kinase (PI-3 kinase) in the gerbil hippocampus after transient forebrain ischemia and investigated the correlation between GDNF and PI-3 kinase in the ischemic hippocampus. In the sham-operated group, GDNF and PI-3 kinase immunoreactivity was not found in any cells in the hippocampal CA1 region. GDNF, not PI-3 kinase, immunoreactivity was expressed in non-pyramidal cells in the CA1 region at 6 h after ischemic insult. At 12-24 h after ischemia, GDNF and PI-3 kinase immunoreactivity in the CA1 region was similar to that of the sham-operated group. From 2 days after ischemic insult, GDNF- and PI-3-kinase-immunoreactive astrocytes were detected in the CA1 region, and GDNF and PI-3 kinase immunoreactivity in astrocytes was highest in the CA1 region 4 days after ischemic insult. Moreover, at this time point, GDNF and PI-3 kinase were co-localized in some astrocytes. Western blotting showed that ischemia-related changes of GDNF and PI-3 kinase protein levels were similar to the immunohistochemical changes after ischemia. These results suggest that GDNF and PI-3 kinase may be related to delayed neuronal death and that GDNF and PI-3 kinase may be involved in activation of astrocytes.     

A case of Bickerstaff's brainstem encephalitis; the evidence of cerebellum involvement by SPM analysis using PET

Although the clinical manifestations such as drowsiness, brisk reflexes, extensor plantar responses and hemisensory disturbance usually are considered to suggest Bickerstaff's brainstem encephalitis (BBE) rather than Miller Fisher syndrome (MFS), the nosological relationship between BBE and MFS has yet to be established. Herein, we report upon a 58-year-old man who showed ophthalmoplegia, ataxia and consciousness disturbance. In the absence of any abnormality on brain MRI, electrophysiological studies and SPM analysis using (18)F-FDG PET showed evidence of brainstem and cerebellum involvements.     

Clinical utility of trapezius muscle studies in the evaluation of amyotrophic lateral sclerosis.

Needle electromyography (EMG) and determining the motor evoked potential (MEP) of the genioglossus (tongue) are difficult to perform in evaluation of the craniobulbar region in patients with amyotrophic lateral sclerosis (ALS). Needle EMG and MEP determination in the upper trapezius were carried out in 17 consecutive ALS patients. The needle EMG parameters recorded included abnormal spontaneous activity and motor unit action potential morphology. An upper motor neuron lesion was presumed when either response to cortical stimulation was absent, or the central conduction time was delayed (>mean + 2 SD). Of the 12 patients with limb-onset ALS, using needle EMG, 11 were found to have abnormalities in the upper trapezius, and only five in the tongue. Three of the six patients with isolated limb involvement had abnormal MEP findings. In conclusion, electrophysiological studies of the upper trapezius are useful in ALS patients without bulbar symptoms.