Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review

The primary aim of this systematic review was to assess the evidence on periodontal disease progression after treatment in patients receiving supportive periodontal therapy (SPT) and to identify predictors of clinical attachment level (CAL) loss. A protocol was developed to answer the following focused question: In adult patients treated for periodontitis, what is the disease progression in terms of CAL loss after surgical or non-surgical treatment? Randomized controlled clinical trials, prospective cohort studies, and longitudinal observational human studies with a minimum of 5 years of follow-up after surgical or non-surgical treatment that reported CAL and probing depth changes were selected. Seventeen publications reporting data from 14 investigations were included. Data from 964 patients with a follow-up range of 5–15 years was evaluated. When the CAL at the latest follow-up was compared to the CAL after active periodontal therapy, 10 of the included studies reported an overall mean CAL loss of ≤0.5 mm, 3 studies reported a mean CAL loss of 0.5–1 mm, and 4 studies reported a mean CAL loss of >1 mm. Based on 7 publications, the percentage of sites showing a CAL loss of ≥2 mm varied from 3% to 20%, and a high percentage of sites with CAL loss was associated with poor oral hygiene, smoking, and poor compliance with SPT. The outcomes after periodontal therapy remained stable over time. Disease progression occurred in a reduced number of sites and patients, mostly associated with poor oral hygiene, poor compliance with SPT, and smoking.

A comparison of the accuracy of ulnar versus median nerve stimulation for neuromuscular monitoring / 대한마취과학회지

BACKGROUND: Inexperienced anesthesiologists are frequently unclear as to whether to stimulate the ulnar or median nerve to monitor the adductor pollicis. The primary purpose of this study was to determine whether monitoring the adductor pollicis by positioning the stimulating electrodes over the median nerve is an acceptable alternative to applying electrodes over the ulnar nerve. METHODS: In 20 patients anesthetized with propofol and remifentanil, one pair of stimulating electrodes was positioned over the ulnar nerve. A second pair was placed over the median nerve on the other hand. The acceleromyographic response was monitored on both hands. Rocuronium 0.6 mg/kg was administered. Single twitch (ST) and train-of-four (TOF) stimulations were applied alternatively to both sites. RESULTS: None of the patients showed a twitch response at either site after injection of rocuronium. There were no differences in the mean supramaximal threshold, mean initial TOF ratio, or mean initial ST ratio between the two sites. Bland-Altman analysis revealed a bias (limit of agreement) in the TOF and ST ratios over the median nerve of 7% (+/- 31%) and 26% (+/- 73%), respectively, as compared with the ulnar nerve. The median nerve TOF ratio was overestimated by 16.2%, as compared with that of the ulnar nerve value, and the median nerve ST ratio was overestimated by 72.9%, as compared to that of the ulnar nerve. CONCLUSIONS: The ulnar and median nerves cannot be used interchangeably for accurate neuromuscular monitoring.

Rocuronium-induced neuromuscular block after long pretreatment of clonidine in rabbits / 대한마취과학회지

BACKGROUND: Clonidine, an alpha-2 adrenergic agonist, is used in the perioperative period and in intensive care for the management of hypertension. The in vivo and in vitro effects of clonidine on the actions of nondepolarizing neuromuscular blocking drugs are conflicting. We evaluated the potency and time course of rocuronium-induced neuromuscular block after prolonged pretreatment with clonidine in rabbits. METHODS: Sixty rabbits were randomly assigned to three groups; control (C) group: normal saline 0.1 ml/kg daily subcutaneous for 6 weeks; S3 group: clonidine 4 microgram/kg daily subcutaneous for 3 weeks; S6 group: clonidine 4 microgram/kg daily subcutaneous for 6 weeks. The dose-response relations of rocuronium were tested in 30 rabbits (10 from each of the three groups) during ketamine-thiopental anesthesia, while the time course of rocuronium 0.6 mg/kg was examined in 10 rabbits each from the three groups. RESULTS: There was no difference in mean arterial pressure and pulse rate among the experimental groups. The calculated ED(50) for rocuronium decreased significantly from 64.1 microgram/kg (C group) to 50.3 microgram/kg (S3 group) and 47.8microgram/kg (S6 group) (P < 0.001). There was no difference in the onset and the recovery times after rocuronium. CONCLUSIONS: Rocuronium after pretreatment with clonidine for three or six weeks may have an increased effect, but no difference in the duration of action compared with control group.

A Case of Keratoconjunctivitis Induced by Dieffenbachia Plant Sap

PURPOSE: To report a case of keratoconjunctivitis induced by Dieffenbachia plant sap. CASE SUMMARY: A 44-year-old woman presented with severe ocular pain and decreased visual acuity which developed after she accidentally got Dieffenbachia plant sap in her left eye. During her initial evaluation, visual acuity was 0.4 in her left eye. On slit lamp examination, we found that she had moderate injection of the conjunctiva, an epithelial defect, and fine needle-like blue crystals in the stromal layer of the cornea. The patient was treated with topical steroids and antibiotics. We checked the treatment response using a regular slit lamp examination. Six days after the injury, all of the findings which were observed on the first day had resolved except the needle-like blue crystals in the stromal layer of the cornea. These gradually disappeared from the cornea 11 days after the accident. After six weeks, the crystals in the stromal layer had completely resolved. She maintained good visual acuity during this time. There was no opacity noted in her cornea. CONCLUSIONS: We experienced a case of keratoconjunctivitis induced by Dieffenbachia plant sap. This sap caused severe ocular pain and a reversible decrease in visual acuity when in contact with the eye.

A Correlation between Neurocognitive Function and Serum Lipid Levels among the Korean Elderly / 신경정신의학

OBJECTIVES: In this study, we evaluated the correlation between neurocognitive function and serum lipids levels among Koreans over 60 years old. Also, we investigated the sociodemographic risk factors and vascular risk factors in Alzheimer's disease. METHODS: Six hundred fifty elderly persons participated in this study. We screened for cognitive impairment via the Mini-Mental Status Examination-Korean version (MMSE-KC) and evaluated 181 participants using the Consortium to Establish a Registry for Alzheimer's disease, Korean version (CERAD-K). For further classification, we employed the Clinical Dementia Rating Scale (CDRS) and DSM-IV diagnostic criteria. Participants having a CDRS score of 1 or more were diagnosed as having Alzheimer's disease. RESULTS: We diagnosed 38 participants as having Alzheimer's disease, 67 participants as having mild cognitive impairment, and 76 participants as having no cognitive impairment. There were significant differences among the groups with regard to age, education, history of diabetes mellitus medication, history of head trauma, history of CVA, and Hachinski ischemic score (p<0.05). The mild cognitive impairment group showed inverse correlations between triglyceride serum level and both total MMSE-KC score and Orientation in MMSE-KC (rs=-0.267, p=0.029 ; rs=-0.324, p=0.007). This group also showed inverse correlations between total cholesterol serum level and both total MMSE-KC score and Orientation in MMSE-KC (rs=-0.259, p=0.034 ; rs=-0.417, p=0.000) and an inverse correlation between low density lipoprotein serum level and Orientation in MMSE-KC (rs=-0.320, p=0.008). CONCLUSION: There were inverse correlations between some lipids' serum levels and cognitive functions in the mild cognitive impairment group.

Effects of Medpor(R) Sheet as Substitute for Tarsus in Eyelid Reconstruction

PURPOSE: To report a simple surgical technique for rebuilding the palpebral tarsal plate using a Medpor(R) sheet. The formation of a palpebral tarsal plate is very important in the reconstruction of the eyelid. Transplantation of cartilaginous tissue is often necessary to create the palpebral tarsal plate. However obtaining enough cartilaginous tissue is difficult. CASE SUMMARY: Eyelid reconstruction and surgical resection of each lesion was attempted on two patients clinically diagnosed with basal cell carcinoma and sebaceous gland carcinoma between August, 2006 and November, 2007. Reconstruction was performed using a modified Cutler-Beard method or the sebaceous gland carcinoma that occurred in the upper eyelid, and a modified Tenzel semicircular rotational flap procedure was used or the basal cell carcinoma that occurred in the lower eyelid. For the reconstruction of tarsus, 0.45 mm Medpor(R) sheet was used. Complications, such as shortage of eyelid movement, dragging of eyelid or unstable eyelid margin, did not occur after the operations in either subject. In the case of the upper eyelid reconstruction, the eyelid became stiff at the early stage, but the condition improved after 6 months. CONCLUSIONS: The reconstruction of the palpebral tarsal plate using a Medpor(R) sheet is considered an effective and safe technique for the reconstruction of an eyelid.

Sarcomatoid Urothelial Carcinoma of the Renal Pelvis with Extremely Aggressive Clinical Behavior

Sarcomatoid urothelial carcinoma is a rare malignancy with a poor prognosis. We experienced a case of sarcomatoid urothelial carcinoma of the renal pelvis with extremely aggressive clinical behavior. An 81-year-old woman underwent a laparoscopic radical nephroureterectomy to remove a 4.5x3.1 cm sized localized left renal pelvis mass. The mass was pathologically confirmed as a sarcomatoid urothelial carcinoma. Although the operation was successful, the patient died 2 months postoperatively with widely metastatic disease.

Large Prostatic Calculi Causing Urethral Obstruction

Although prostatic calculi are common, complications are fortunately rare. Here, we report a case of prostatic calculi causing urethral obstruction. A 66-year-old man presented with severe voiding difficulty and urge incontinence. He was found to have multiple large prostatic calculi obstructing the prostatic urethra as well as several bladder calculi. Attempts at endoscopic removal were unsuccessful, which resulted in an iatrogenic urethral diverticulum due to fragmented calculi. The residual calculi and diverticulum were removed successfully by open surgery.

Decreased Serum Brain-Derived Neurotrophic Factor Levels in Elderly Korean with Dementia

OBJECTIVE: The primary purpose of this study was to investigate the differences in the serum brain-derived neurotrophic factor (BDNF) level between elderly Korean people over 65 years with and without dementia. METHODS: 171 individuals over 65 years were enrolled in this study. Screening for cognitive impairments was carried out using the Mini-Mental Status Examination-Korean version (MMSE-KC). One hundred thirty-two subjects scored below 1.5 standard deviations (SD) of the mean MMSE-KC score, and these were evaluated using the Consortium to Establish a Registry for Alzheimer's Disease, Korean version (CERAD-K) and the Geriatric Depression Scale (GDS). The Clinical Dementia Rating Scale (CDRS) and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnostic criteria were used for further evaluation. Subjects with a CDRS score of 1 or higher were classified as having Alzheimer's disease (AD), and subjects with a CDRS score of 0.5 were classified as having a mild cognitive impairment (MCI). Subjects with a CDRS score of 0 were classified as having aging-associated cognitive decline (AACD). Serum BDNF levels were analyzed using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The serum BDNF levels were significantly lower in the subjects with MCI and AD compared with the healthy controls (p<0.01). A significant correlation was found between the total MMSE-KC score and serum BDNF level (r=0.295; p<0.01). However, no significant correlation was observed between the severity of MMSE-KC and the total GDS score. A significant difference was found in the total score of GDS between the AACD group and subjects with AD (p<0.05). CONCLUSION: This study suggested that BDNF might be involved in the pathophysiology of cognitive decline in elderly people.

Decreased Serum Brain-Derived Neurotrophic Factor Levels in Elderly Korean with Dementia

OBJECTIVE: The primary purpose of this study was to investigate the differences in the serum brain-derived neurotrophic factor (BDNF) level between elderly Korean people over 65 years with and without dementia. METHODS: 171 individuals over 65 years were enrolled in this study. Screening for cognitive impairments was carried out using the Mini-Mental Status Examination-Korean version (MMSE-KC). One hundred thirty-two subjects scored below 1.5 standard deviations (SD) of the mean MMSE-KC score, and these were evaluated using the Consortium to Establish a Registry for Alzheimer's Disease, Korean version (CERAD-K) and the Geriatric Depression Scale (GDS). The Clinical Dementia Rating Scale (CDRS) and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnostic criteria were used for further evaluation. Subjects with a CDRS score of 1 or higher were classified as having Alzheimer's disease (AD), and subjects with a CDRS score of 0.5 were classified as having a mild cognitive impairment (MCI). Subjects with a CDRS score of 0 were classified as having aging-associated cognitive decline (AACD). Serum BDNF levels were analyzed using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The serum BDNF levels were significantly lower in the subjects with MCI and AD compared with the healthy controls (p<0.01). A significant correlation was found between the total MMSE-KC score and serum BDNF level (r=0.295; p<0.01). However, no significant correlation was observed between the severity of MMSE-KC and the total GDS score. A significant difference was found in the total score of GDS between the AACD group and subjects with AD (p<0.05). CONCLUSION: This study suggested that BDNF might be involved in the pathophysiology of cognitive decline in elderly people.

A Correlation between Neurocognitive Impairments and Serum Lipid Levels among the Korean Elderly / 신경정신의학

OBJECTIVES: In this study, the authors evaluated the correlation between neurocognitive impairments and serum lipids levels among Korean elderly over the age of 65. METHODS: A total of 609 elderly individuals participated in this study. Screening for cognitive impairments were carried out using the Mini-Mental Status Examination-Korean version (MMSE-KC). There were 197 subjects above 1.5SD of MMSEKC and they were evaluated using the Korean versions of the Consortium to Establish a Registry for Alzheimer's Disease (AD)(CERAD-KC) and Geriatric Depression Scale (GDS-K). RESULTS: There was a correlation between old age/low levels of education and AD (p<0.05, p<0.01). There was an inverse correlation between the serum level of total cholesterol and the word list recognition test scores. The serum levels of LDL cholesterol were inversely correlated with the scores on the constructional praxis test, word list recall test and word list recognition test. Inverse correlations between the serum level of triglyceride and scores on the word list recall test and word list recognition test were also observed. CONCLUSION: There were inverse correlations between the serum levels of lipids and language/memory function in subjects with AD.

Prevalence of Alzheimer's Dementia and Its Risk Factors in Community-Dwelling Elderly Koreans

OBJECTIVE: We estimated the prevalence of Alzheimer's dementia (AD) and mild cognitive impairment (MCI) and their risk factors in an urban community setting, focusing especially on metabolic syndrome. METHODS: A two-phase investigation based on a door-to-door survey was performed. In Phase I, we administered the Korean version of the Mini-Mental State Examination (MMSE-KC) of the Consortium to Establish a Registry for Alzheimer's disease (CERAD-K). Assessment Packet and the Korean version of the Geriatric Depression Scales (GDS-K) to all 706 participants aged 65 years or older. In Phase II of the study, 175 persons underwent physical and neurological examinations according to the protocol of the CERAD-K clinical assessment battery [CERAD-K (C)] and the neuropsychological assessment battery [CERAD-K (N)]. We also examined the association between cognitive decline and metabolic syndrome. AD and MCI were defined using the DSM-IV-TR criteria and the Clinical Dementia Rating (CDR) scales. RESULTS: The mean age (+/-SD) of the subjects was 74.3+/-16.7 years and the ratio of males to females was 53.2 to 46.8. The prevalence of Alzheimer's dementia was 9.0%, while that of MCI was 32.9%. Old age and lower educational level had significant associations with cognitive decline in the elderly, but gender, years of alcohol intake or smoking, and metabolic syndrome were not associated with AD or MCI. CONCLUSION: In this study, metabolic syndrome was not associated with Alzheimer's AD or MCI. Information regarding an association between Alzheimer's dementia and metabolic syndrome in this study will be helpful in formulating future public health policy and prevention strategies in Korea.

Electroejaculation in the Male Rat / 대한비뇨기과학회지

PURPOSE: We examined the possibility of electroejaculation for the evaluation of fertility in the male rat. MATERIALS AND METHODS: Ten 8-week-old Sprague-Dawley male rats that underwent seminal vesiculectomy were used for semen collection by electroejaculation. With a transrectal probe(60Hz, 3V, 0.5A), sign wave electric stimulation was applied to an anesthetized rat. Ejaculated semen was collected by a pipette and the volume and sperm density of the ejaculate were analyzed. Two weeks later, a second electroejaculation was performed under the same conditions with the same rats. RESULTS: At the first attempt, all 10 rats ejaculated following electric stimulation. The mean semen volume was 8.9 microliter (range, 3.0-28.5 microliter) and the mean sperm density was 6,428/ml(range, 320-20,997/ml). At the second attempt, only 7 of 10 rats(70%) ejaculated. The mean semen volume was 5.6 microliter(range, 3.3-8.6 microliter) and the mean sperm density was 2,801/ml (range, 227-12,555/ml). CONCLUSIONS: These results indicated that electroejaculation has the possibility of being a useful method for evaluation of fertility in the male rat.

Clinical Results of Endoscopic Dacryocystorhinostomy using a Microdebrider

PURPOSE: The success rate of endoscopic dacryocystorhinostomy has been increasing with the development of better instruments and techniques. We conducted this study to evaluate the clinical results of endoscopic dacryocystorhinostomy using a Microdebrider, which has also been used for functional endoscopic sinus surgery. METHODS: We selected 76 patients (with a total of 84 affected eyes) who had been diagnosed with a nasolacrimal duct obstruction. These patients underwent an endoscopic dacryocystorhinostomy using a Microdebrider, which removed both nasal mucosa and lacrimal sac mucosa and also trimmed the margins of the ostotomy site. We assessed patients' outcomes on an anatomical basis using a dye test and endoscopy, which were used to define the anatomical success. We also arbitrarily defined functional success as whether the subjective epiphora was absent. At a four to 18 month follow-up, we monitored the clinical course to examine any recurrent episodes. RESULTS: The symptoms were alleviated in 72 eyes, with a primary success rate of 85.7%. On nasal endoscopy, a functional failure was seen in four eyes. In these four eyes, the orifice was narrowed by the presence of either granulation tissue or conjunctivochalasis. By contrast, surgical outcomes were the anatomical failure in eight eyes. In these eight eyes, the orifice was obstructed by the presence of granulation tissue as well as the adhesion of nasal mucosa. CONCLUSIONS: Endoscopic dacryocystorhinostomy using a Microdebrider enabled us to make the large fistula while minimizing the damage of adjacent tissue. It might be the recommended surgery that reduces the complications and enhances the success rate.

The Usefulness of Non-contact Erection Observation for Evaluation Sexual Function in Male Rat / 대한비뇨기과학회지

PURPOSE: Evaluation of sexual function is an important step for animal studies about sexual function. Male rats could display penile erection in the presence of an inaccessible estrous female. We examined the usefulness of observing non-contact erection (NCE) for the evaluation of sexual function in male rats. MATERIALS AND METHODS: Forty five Long-Evans male rats (8 weeks old) were used in this study. Tests for NCE were conducted in a glass chamber divided in half by 2 wire-mesh screens that prevented direct contact, but the rats freely passed other forms of stimulation. If at least 1 NCE could be observed during 45 minutes, we considered this as a positive response. In case of two or three positive responses in three NCE tests, that was considered as NCE (+). After NCE, copulation observations were noted to evaluate sexual function. If at least two ejaculations could be observed during 45 minutes, we considered that a positive response. In case of two or three positive responses in three copulation observations, that was considered as normal sexual function. RESULTS: Twenty one of 45 male rats (47%) were NCE (+) and 34 of 45 male rats (76%) had normal sexual function. In 21 NCE (+) rats, 20 rats had normal sexual function: only one was impotent. The positive predictive value of the NCE observation for the evaluation of sexual function was 95%. In 11 impotent rats, 10 rats were NCE (-). The specificity of the NCE observation was 91%. CONCLUSIONS: These results indicated that NCE observation could be a useful method for evaluating the sexual function of male rat.

Bladder Xanthoma / 대한비뇨기과학회지

A xanthoma is an abnormal localized collection of histiocytic tissue containing lipid. It is not a true tumor, but is a reactive histiocytic proliferation often secondary to alternations in serum lipids. Xanthoma lesions are seen in the skin and tendons, and may occur at other sites, such as the stomach and arytenoepiglottic fold. However, a xanthoma is rare in the bladder, with only 9 reported cases. Here, a case of a xanthoma of the bladder detected incidentally during cystoscopic examination for a gross hematuria is reported.

A Adult Primary Prostatic Wilms' Tumor with Liver Metastasis / 대한비뇨기과학회지

A case of extrarenal Wilms' tumor, arising in the prostate, with liver metastasis in a 44-year-old male is reported. A literature review indicated that the incidences of Wilms' tumors arising in the extrarenal region are extremely rare, with only one reported case in the literature. The clinical features, and a review of the disease, are briefly discussed.

Change of PSA Density after Finasteride Therapy in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The prostate-specific antigen (PSA) density has been proposed to distinguish between benign prostatic hyperplasia (BPH) and prostate cancer. It is of importance that patients who take finasteride for their BPH should be taken deep interest in the potential for malignancy. The PSA density after finasteride therapy for 12 months in patients with BPH was investigated. MATERIALS AND METHODS: Sixty-two patients (mean age 64 years) with BPH were enrolled in this study. The PSA densities were calculated before and after 12 months of finasteride therapy. The prostate volumes were measured by transrectal ultrasonography and the PSA was measured by an enzyme immunoassay. RESULTS: After 12 months of the finasteride therapy, the PSA decreased by 45.5%, the prostate volumes by 15.4% and the PSA densities by 30.5% (p >0.01). The PSA density after the finasteride therapy ranged from 0.01 to 0.14 ng/ml/cm3. In 62 patients, the cumulative percent of the PSA densities was 96.8% at 0.11 ng/ml/cm3 or less. In 31 patients over the PSA of 4.0 ng/ml, the cumulative percent of PSA densities also showed the same result. CONCLUSIONS: In most BPH patients treated with finasteride for 12 months, the PSA densities ranged 0.11 ng/ml/cm3 or less.

Analysis of stress by korean social rcadjustment rating scale in peptic ulcer patients

No abstract available.

Detection of proteinase resistant protein from scrapie-affected mice and hamsters

No abstract available.