Assessment of asymmetry in a normal occlusion sample and asymmetric patients with three-dimensional cone beam computed tomography: A study for a transverse reference plane

Objective:To characterize symmetrical features of patients with facial asymmetry and thus to find the most reliable horizontal reference lines easily used in three-dimensional images. The hypothesis was that there is a difference in the location of bilateral landmarks of the upper skull between the normal occlusion sample and skeletal Class III patients with asymmetry.Materials and Methods:Group 1 (normal occlusion sample) was composed of 20 Korean adults with normal occlusion and no noticeable asymmetry. Groups 2 through 4 were selected from patients who were diagnosed as skeletal Class III malocclusion and grouped according to the extent of asymmetry (group 2: symmetric mandible, no maxillary cant; group 3: asymmetric mandible, no maxillary cant; group 4: asymmetric mandible, more than 4 mm maxillary cant measured at maxillary first molars). Three-dimensional cone beam computed tomography images were taken before treatment, and bilateral landmarks of the skull were located and their vertical and horizontal differences compared.Results:No statistically significant difference was noted in the position of bilateral landmarks between groups, except for AG (P < .05). AG showed significant differences in vertical dimension (P < .001) and in horizontal dimension (P < .0001) between groups. The mean of the difference was clearly greatest at FM.Conclusions:The hypothesis is rejected. All groups had a similar pattern of asymmetry in the upper third of the face. Therefore, the transverse reference line of the bilateral Z or orbitale may be used even in patients with severe asymmetry of the maxilla with reference to the clinical photos.     

Prevalence,correlates, and comorbidities of four DSM-IV specific phobia subtypes: Results from the Korean Epidemiological Catchment Area study

Although several studies have detected differences in clinical features among specific phobias, there is a shortage of detailed national data on the on the DSM-IV SP subtypes, particularly in the Asian population. To examine the prevalence, demographic and other correlates, and co-morbidities of DSM-IV SP subtypes in a nationwide sample of Korean adults. We recruited 6510 participants aged 18–64 years for this study. Lay interviewers used the Composite International Diagnostic Interview to assess participants. We analyzed socio-demographics, health-related correlates and frequencies of comorbid mental disorders among participants with SP and each subtypes compared to unaffected adults. The prevalence of lifetime DSM-IV SP was 3.8%, and animal phobias were the most prevalent type of SP. Blood–injection–injury phobia was negatively associated with education, whereas situational phobia was positively associated with education. The strongest mental disorder comorbidity was associated with situational phobia; there is a higher probability of comorbid mood (OR=5.73, 95% CI=2.09–15.73), anxiety (OR=7.54, 95% CI=2.34–24.28), and somatoform disorders (OR=7.61, 95% CI=1.64–35.22) with this subtype. Blood–injection–injury phobia was highly associated with alcohol dependence (OR=9.02, 95% CI=3.54–23.02). Specific phobias are heterogeneous with respect to socio-demographic characteristics and comorbidity pattern. Implications of the usefulness of current subtype categories should continue to be investigated.     

Transventricular endoscopic biopsy of suprasellar tumors: a pediatric case series

Background and purpose

The purpose of this study was to investigate the efficacy and safety of transventricular neuroendoscopic biopsies in pediatric patients with suprasellar tumors.

Methods

Twenty-three pediatric patients (12 males and 11 females) with suprasellar tumors underwent transventricular neuroendoscopic biopsy at our institute by a single surgeon from 2000 to 2011. Neuronavigation has been combined with endoscopic procedures since 2008. Neuroendoscopic biopsies were performed to verify the histopathological diagnosis of neoplasms and to plan appropriate treatment strategies.

Results

Neuroendoscopic biopsy specimens were appropriate for diagnosis in 22 of the 23 patients (95.7 %) and revealed 14 germ cell tumors (12 germinomas, one choriocarcinoma, and one immature teratoma), seven astrocytomas, and one craniopharyngioma. Subsequent treatment modalities including chemotherapy, radiation therapy, or microscopic surgery were determined according to the pathological findings. Seventeen of the 23 patients (73.9 %) showed ventriculomegaly. Among them, ventriculomegaly in 14 patients was resolved after an endoscopic procedure and/or adjuvant chemotherapy, but the remaining three patients (17.6 %) required a ventriculoperitoneal shunt to relieve the ventriculomegaly. The pathologic diagnosis of these three patients was uniformly a large astrocytoma. Navigational tracking was helpful to enter small ventricles and the narrow foramen of Monro in patients without hydrocephalus. No mortalities were related to the procedures, but three transient diabetes insipidus (13.0 %) cases occurred but fully recovered before the patients received adjuvant therapy.

Conclusion

Endoscopic biopsy is feasible and shows acceptable operation-related complications to obtain tissue from suprasellar tumors in pediatric patients. Navigation-assisted neuroendoscopic procedure improves the accuracy of the endoscopic approach. An associated endoscopic procedure can resolve hydrocephalus, but it has limitations with large ventricle-occupying tumors.     

The prevalence of food allergy: a meta-analysis

BACKGROUND: There is uncertainty about the prevalence of food allergy in communities. OBJECTIVE: To assess the prevalence of food allergy by performing a meta-analysis according to the method of assessment used. METHODS: The foods assessed were cow's milk, hen's egg, peanut, fish, shellfish, and an overall estimate of food allergy. We summarized the information in 5 categories: self-reported symptoms, specific IgE positive, specific skin prick test positive, symptoms combined with sensitization, and food challenge studies. We systematically searched MEDLINE and EMBASE for publications since 1990. The meta-analysis included only original studies. They were stratified by age groups: infant/preschool, school children, and adults. RESULTS: A total of 934 articles were identified, but only 51 were considered appropriate for inclusion. The prevalence of self-reported food allergy was very high compared with objective measures. There was marked heterogeneity between studies regardless of type of assessment or food item considered, and in most analyses this persisted after age stratification. Self-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for any food. CONCLUSION: There is a marked heterogeneity in the prevalence of food allergy that could be a result of differences in study design or methodology, or differences between populations. CLINICAL IMPLICATIONS: We recommend that measurements be made by using standardized methods, if possible food challenge. We need to be cautious in estimates of prevalence based only on self-reported food allergy.     

Occult bone marrow involvement in patients with diffuse large B-cell lymphoma: results of a pilot study

AIMS: It is known that advanced stage disease in diffuse large B-cell lymphoma (DLBCL) confers a poor prognosis, and staging investigations are routinely performed at diagnosis, including a bone marrow (BM) biopsy. However, examination of the BM is usually limited to routine light microscopy, with the role of ancillary investigations remaining unestablished. The aim of this pilot study was to estimate the incidence of occult marrow involvement using flow cytometry, immunohistochemistry and immunoglobulin heavy chain (IgH) gene rearrangements, and to determine the impact on survival. METHODS: Clinical and pathological data were obtained on 36 patients diagnosed with DLBCL. Immunohistochemistry using CD3, CD45RO, CD20 and CD79a, and polymerase chain reaction (PCR) to look for IgH gene rearrangements were performed on formalin fixed BM trephines. RESULTS: Nine patients had morphologically apparent BM involvement. Occult marrow involvement was found in seven of 36 (19.4%) patients using the additional diagnostic modalities. When these cases were included with morphologically apparent cases in a proposed new definition of marrow involvement, the median survival of patients with BM involvement was statistically worse (p=0.02) than those without involvement. CONCLUSIONS: The results indicate that use of additional tests on BM at diagnosis can upstage disease for a proportion of patients, which appears to correlate adversely with survival.     

Large liver cell dysplasia in hepatitis B virus x transgenic mouse liver and human chronic hepatitis B virus-infected liver

OBJECTIVES: Large liver cell dysplasia (LCD) is frequently associated with hepatitis B virus (HBV), but it remains uncertain whether it is reactive, senescent or preneoplastic. METHODS: The HBX transgenic mice and normal control mice were sacrificed at 1, 3, 5, 7, 9, 11, 13 and 15 months after birth. Twenty-three cases of human B viral chronic hepatitis/cirrhosis with prominent LCD were selected. The immunohistochemical stain of proliferating cell nuclear antigen (PCNA), transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay and senescence-associated beta-galactosidase (SA-beta-Gal) were evaluated. RESULTS: In HBX transgenic mice, LCD was developed since 3 months and formed small nodules of hepatocellular adenoma, which progressed to hepatocellular carcinoma. The hepatocytes with LCD in HBX transgenic mice showed significantly higher PCNA-labeling index (LI) and lower TUNEL-LI than normal hepatocytes of control mice (p < 0.05). In the majority of human B viral chronic hepatitis/cirrhosis, the hepatocytes with LCD revealed higher PCNA-LI and lower TUNEL-LI than those without, when compared in each case using the same tissue block. SA-beta-Gal staining showed no difference between hepatocytes with and without LCD. CONCLUSION: It is suggested that LCD, related to HBV, might not be just an innocent bystander, but closely related to hepatocarcinogenesis.