BACKGROUND: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. METHODS: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. RESULTS: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 +/- 0.6 to 3.5 +/- 1.3 after the procedure. CONCLUSIONS: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Humans ; Low Back Pain/etiology/*therapy ; Lumbar Vertebrae/anatomy & histology/*ultrasonography ; Male ; Middle Aged ; Nerve Block/*methods ; Sciatica/etiology/*therapy ; Spinal Stenosis/complications/*diagnosis ; Zygapophyseal Joint/anatomy & histology/ultrasonography

Objectives: The purpose of this study was to explore the effectiveness of the STEAM (Science, Technology, Engineering, Arts, and Mathematics) education program on the use of specific food groups in improving nutrition-related knowledge and attitude, dietary behavior, creative problem solving, and STEAM attitude. Methods: We selected two classes at a kindergarten in Jeollabuk-do, South Korea. A total of 44 kindergarteners from the two classrooms participated in this study. The experimental group and the control group were formed with 22 students each. The experimental group attended 11 STEAM classes on the use of the grain, fruit, and milk food groups. First, we performed the paired t-test to examine changes from pre-to-post classes for both groups.Then, we used ANCOVA to compare post-test scores between the experimental and control groups with the adjustment of pre-test scores. Results: The results demonstrate that the STEAM education program on the use of the food groups significantly improved (1) nutrition-related knowledge and attitude, and dietary behavior (P < 0.001), (2) creative problem solving (P < 0.001), and (3) STEAM attitude (P < 0.001) in the intervention group when compared with the control group. Conclusions The STEAM education program on the use of food groups is effective in enhancing nutrition knowledge and attitude, dietary behavior, creative problem solving, and STEAM attitudes among kindergarten students.

Purpose: This paper reports the surgical treatment results of open calcaneal fractures performed at the author’s clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes. Materials and Methods: This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted. Results: In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032). Conclusion In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.

Purpose: This paper reports the surgical treatment results of open calcaneal fractures performed at the author’s clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes. Materials and Methods: This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted. Results: In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032). Conclusion In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.

The conventional approach to treatment of patients with ankylosing spondylitis (AS) have been rather limited in the last decades. Evidence is accumulating that tumor necrosis factor (TNF) blocker is highly effective in AS. This article reviews the most recent and the most pertinent advances in the treatment in AS. TNF blocker have been evaluated in a number of randomized controlled trials in AS and have been demonstrated to be effective in disease activity, function, and quality of life in these patients. TNF blocker is emerging as the best therapeutic option available for patients with AS.
Humans ; Quality of Life ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha

High-output cardiac failure is a rare complication of hereditary hemorrhagic telangiectasia (HHT) usually caused by shunting of blood through atriovenous malformations (AVMs) in the liver. We describe two cases of high output heart failure due to large hepatic AVMs. Clinical suspicion of HHT based on detailed history taking and physical examination is essential for early detection and proper management of heart failure associated with HHT.
Heart ; Heart Failure ; Liver ; Physical Examination ; Telangiectasia, Hereditary Hemorrhagic

Primary malignant lymphoma of the urinary bladder is a rare disease, and it accounts for only 0.2% of all the cases of extranodal lymphoma. The prognosis of primary bladder lymphoma has been favorable, with many patients being alive and well several years after treatment. We report here on a case of primary diffuse large B cell lymphoma of the urinary bladder in a 75-year-old man patient who presented with a one-month history of persistent dysuria. The abdominal CT revealed a mass at the posterior wall of the urinary bladder. The tissue obtained by transurethral cystoscopy showed an atypical lymphoid proliferation, which was consistent with diffuse large B cell lymphoma. The patient received systemic chemotherapy of rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) and he achieved a significant partial remission.
Aged ; Antibodies, Monoclonal, Murine-Derived ; Cystoscopy ; Doxorubicin ; Dysuria ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Prognosis ; Rare Diseases ; Urinary Bladder ; Vincristine ; Rituximab

BACKGROUND AND OBJECTIVES: In this study, we evaluated differences in the prevalence of allergic rhinitis, asthma, atopic dermatitis and specific immunoglobuline E (IgE) value for some respiratory antigens in Korean adults. SUBJECTS AND METHOD: The study was conducted using data from the 5th National Health and Nutrition Survey (2010-2012). All subjects who were aged 19 years or older completed questionnaires on asthma, atopic dermatitis and allergic rhinitis. The subjects were first divided into male and female, and then into age groups of 19-29, 30-39, 40-49, 50-59, 60-69, ≥70 each. The lifetime and current prevalence rates for allergic rhinitis, asthma, and atopic dermatitis were calculated for each age group. The total and specific IgE level for Dermatophagoides farinae (DF), cockroach, and dog dander were also calculated. RESULTS: Final participants of 17542 were analyzed for the prevalence rate among the total of 25534 participants. The mean IgE level was calculated from 2028 subjects from the final participants. In asthma, the lifetime prevalence and current prevalence increased with age, but decreased with atopic dermatitis and allergic rhinitis. Total IgE level increased with age, but IgE level of DF reached its peak at 20-29 years, and then decreased rapidly thereafter. There was no clear trend for cockroach and dog dander. CONCLUSION: The prevalence of allergic diseases in adults varies widely by age group. Asthma has a low prevalence after age 20 and gradually increases after age 50. Atopic dermatitis and allergic rhinitis are the most prevalent in their 20s and gradually decrease thereafter.
Adult* ; Animals ; Asthma ; Cockroaches ; Dander ; Dermatitis, Atopic ; Dermatophagoides farinae ; Dogs ; Female ; Humans ; Immunoglobulin E ; Immunoglobulins ; Korea* ; Male ; Methods ; Nutrition Surveys* ; Prevalence* ; Rhinitis, Allergic

BACKGROUND AND OBJECTIVES: The purpose of this study was 1) to assess differences in categories of olfactory dysfunction according to the pathological classification of chronic rhinosinusitis with nasal polyp (CRSwNP) patients; 2) to identify the degree of olfaction recovery after endoscopic sinus surgery (ESS); and 3) to identify the factors that predict the changes in olfactory status. SUBJECTS AND METHOD: The sample of the study consisted of patients with CRSwNP who underwent ESS with biopsy from January 2012 to September 2014. Seventy five patients were classified into eosinophilic CRS (ECRS) and non-ECRS groups. During an approximately five-month follow-up, the Korean Version of Sniffin' Sticks test II (KVSS II) was conducted on each patient to examine the difference between the preoperative and postoperative states of olfactory function. RESULTS: The ECRS group showed a statistical significant increase in the postoperative KVSS II scores when compared to the preoperative scores, while the non-ECRS group did not show any statistically significant change. For the anosmia category by KVSS II, the ECRS group showed significantly improved olfactory function test scores for the threshold, discrimination, and identification tests. CONCLUSION: ECRS and preoperative olfactory function status (anosmia) could be predictable factors of postoperative olfactory function.
Biopsy ; Classification ; Discrimination (Psychology) ; Eosinophils* ; Follow-Up Studies ; Humans ; Methods ; Nasal Polyps ; Olfaction Disorders ; Polyps* ; Smell