Clinical evaluation and imaging studies such as magnetic resonance imaging, computed tomography, and/or myelography can localize the pathologic process in most patients with lumbar radiculopathy. However, these studies occasionally fail to demonstrate exactly the cause and site for ongoing radicular symptom. So we evaluated 54 patients for the efficacy of selective nerve root blocks to identify a symptomatic nerve. The lumbar nerve root injections were performed at L3 root in 1 patients, at L4 root in 4 patients, at L5 root in 46 patients, and at S1 root in 3 patients. Among them, forty two patients were done before operation(HNP 32, stenosis 5, spondylolisthesis 5), 9 patients were done after operation due to poor results (root injury 2, infection 2, adhesion 1, incorrect diagnosis 4), and 3 patients had improved radiculopathies following nerve root injection(HNP 2, stenosis 1). The results of the nerve root injections and of the operations were not affected by age and sex. There was a good correlation between the response of the nerve root injection and the result of the operation(p<0.05). The concentration of bupivacaine 0.5% has no additional effect comparing to 0.25%(70%/73.5%) solution in spite of its adverse effect causing transient motor weakness. Additional use of depomedrol(50mg) proved to be no more beneficial. Three patients had Improved symptoms for a long period after nerve root injection which consequently made operation unnecessary. Five patients with previous history of operations had moderate pain relief. In summary, lumbar nerve root injection can be used as a functional diagnostic tool to predict operative result and as a treatment modality following failure of a previous surgery.
Bupivacaine ; Constriction, Pathologic ; Diagnosis* ; Humans ; Magnetic Resonance Imaging ; Myelography ; Radiculopathy ; Sciatica* ; Spondylolisthesis

PURPOSE: The aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone. METHODS: Forty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view. RESULTS: In the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was 11.19 +/- 3.59. The mean PES was 5.17 +/- 2.29 and mean WES was 6.02 +/- 1.96. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant. CONCLUSIONS: The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.
Adult ; Bicuspid ; Crowns ; Dental Implants, Single-Tooth ; Esthetics ; Esthetics, Dental ; Humans ; Patient Satisfaction ; Students, Dental ; Tooth ; Treatment Outcome

PURPOSE: To review reversible posterior leukoencephalopathy syndrome. MATERIALS AND METHODS: We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. RESULTS: Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement; in one, enhancement was mild, and in two, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions; in two, small infarctions remained but the extent of the lesions had decreased. CONCLUSION: Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immonosuppresive therapy. The characteristic MR finding is edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the need for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.
Basal Ganglia ; Brain ; Cerebellum ; Cyclosporine ; Eclampsia ; Edema ; Female ; Follow-Up Studies ; Frontal Lobe ; Gadolinium DTPA ; Headache ; Hematoma ; Humans ; Hypertension ; Infarction ; Magnetic Resonance Imaging ; Migraine with Aura ; Neurologic Manifestations ; Occipital Lobe ; Pons ; Posterior Leukoencephalopathy Syndrome* ; Pre-Eclampsia ; Pregnancy ; Prognosis ; Rabeprazole ; Renal Insufficiency ; Seizures ; Temporal Lobe ; Thalamus

Eosinophilic cystitis is an uncommon disease which is characterized by eosinophilic infiltration into all layers of bladder. It was first described in 1959 by Brown and 50 cases have been reported in the literature. The presenting symptoms are frequency, urgency, dysuria and hematuria. It is chronic disease with remission and exacerbation and mimics other forms of chronic cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasm. Diagnosis is made by biopsy. Treatment consists of removal of inciting allergens, corticosteroids, antihistamines, and antibiotics for secondary bacterial infection. Most women and children with eosinophilic cystitis had the history of allergic disease or asthma and most male patients had bladder or prostatic disorders, such as benign prostatic hypertrophy, bladder carcinoma, and congenital anomalies. But eosinophilic cystitis has not been found in diabetic patients yet. We report a case of eosinophilic cystitis in a 59- year-old diabetic patient with brief review of the literature.
Adrenal Cortex Hormones ; Allergens ; Anti-Bacterial Agents ; Asthma ; Bacterial Infections ; Biopsy ; Child ; Chronic Disease ; Cystitis* ; Cystitis, Interstitial ; Diabetes Mellitus* ; Diagnosis ; Dysuria ; Eosinophils* ; Female ; Hematuria ; Histamine Antagonists ; Humans ; Male ; Prostatic Hyperplasia ; Tuberculosis ; Urinary Bladder ; Urinary Bladder Neoplasms

Purpose: This study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines. Methods: From June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines. Results: Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%). Conclusion The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.

Active surveillance (AS) has been widely adopted as an alternative to immediate surgery owing to the indolent nature and favorable outcomes of papillary thyroid microcarcinoma (PTMC). AS is generally recommended for tumors measuring ≤1 cm without aggressive cytological subtypes, risk of gross extrathyroidal extension (ETE), lymph node metastasis (LNM), or distant metastasis. AS requires careful patient selection based on various patient and tumor characteristics, and ultrasound (US) findings. Moreover, during AS, regular US is performed to monitor any signs of tumor progression, including tumor growth, new US features of potential gross ETE, and LNM. Therefore, appropriate imaging-based assessment plays a crucial role in determining whether AS or surgery should be pursued. However, detailed recommendations concerning US evaluation are currently insufficient, necessitating the formulation of this guideline. The Korean Society of Thyroid Radiology has developed a consensus statement for low-risk PTMC, covering US assessment methods when considering AS as a management option and conducting follow-up imaging tests during AS. This guideline aims to provide optimal scientific evidence and expert opinion consensus regarding a standardized US-based assessment protocol for low-risk PTMC.