OBJECTIVES: Sleep problems has been consistently reported as a suicidal risk factor in adults and, recently, also in adolescents. In this study, dividing study subjects by the previous suicidal behaviors (suicidal vs non-suicidal), we compared the group differences of suicidal risk factors, and examined the possibility of sleep as a suicidal risk factor. METHODS: Study subjects were 561 (271 boys and 290 girls) from a community sample of high school students. Suicidal Risk Behavior Checklist, Center for Epidemiological Study-Depression (CES-D), Symptom Checklist-90-Revision (SCL-90-R) Anxiety and Aggression subscale, Pittsburg Sleep Quality Index (PSQI) were done. RESULTS: Forty six students (8.1%) reported previous actual self-harm behavior as a suicidal attempt, 181 students (32.4%) reported having suicidal thought only. Three hundred thirty four students (59.5%) reported no previous suicidal behavior (thought and attempt, both). Suicidal behavior group showed higher score on risk behaviors such as school violence, substance use and internet addiction. CES-D, SCL-90-R, PSQI showed significant group difference. Logistic regression analysis showed suicidal risk were significantly associated with depression, stress in suicidal risk factors and sleep latency, daytime dysfunction in PSQI. Analysis of variance (ANOVA) shows the most prolonged sleep latency and increased index of all PSQI components except sleep efficiency in suicidal attempt group. CONCLUSIONS: Sleep Problems had a strong association with the suicidal risk behavior in adolescents. Sleep problems, especially, prolonged sleep latency, daytime dysfunction might be important markers for suicidal behavior. Screening for sleep problems in adolescents are encouraged for the parents, school teachers, and related medical physicians.
Adolescent ; Adult ; Aggression ; Anxiety ; Checklist ; Depression ; Humans ; Internet ; Logistic Models ; Mass Screening ; Parents ; Risk Factors ; Risk-Taking ; Suicide ; Violence

BACKGROUND: Retrograde interlaminar ventral epidural injection (RIVEI) may hypothetically be more effective if the catheter is placed at the ventrocaudal aspect of the exiting nerve. We tested that hypothesis by measuring ventral and dorsal epidural contrast flow during RIVEI. METHODS: To perform RIVEI, a 17 G Tuohy needle was inserted to access the epidural space. A 19 G epidural catheter was inserted and advanced through the needle, passing in a caudal direction to the lower aspect of the contralateral pedicle. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Based on the images of contrast dispersal, the extent of contrast spreading was assessed in 82 patients. RESULTS: All 82 patients (100%) injected with 3.0 ml contrast medium demonstrated ventral epidural spreading. Mean spreading level from the catheter tip was 2.21 +/- 0.93 with 3.0 ml of contrast. Spreading to the superior aspect of the supra-adjacent intervertebral disc was observed in 67/82 (81.7%) of RIVEIs with 3.0 ml of contrast injected into the ventral epidural space. We found that 3.0 ml of contrast reached the inferior aspect of the infra-adjacent intervertebral disc in 95.1% (78/82) of RIVEIs performed. CONCLUSIONS: Our findings imply that a one-level RIVEI may be sufficient in situations where a two-level injection would currently be used.
Catheters ; Contrast Media ; Epidural Space ; Humans ; Injections, Epidural* ; Intervertebral Disc ; Needles ; Organic Chemicals ; Quaternary Ammonium Compounds

BACKGROUND: Although numerous previous studies on the subject have been performed, the correlations between various pathologic findings on magnetic resonance imaging and pain reproduction by provoked discography have not been fully explained. A higher sensitivity and positive predictive value (PPV) of the high intensity zone (HIZ) for predicting concordant pain was reported. Moreover, although the apparent validity of this sign has been corroborated by some investigators, it has been questioned by others. The validity of this sign awaits confirmation. The various pathologic parameters seen on magnetic resonance imaging (MRI) in patients with discogenic lumbar pain was assessed and correlated with observations on discography. METHODS: There were 18 patients enrolled, ranging in age from 28 to 64 years with an average age of 48.8 +/- 10.2 (mean +/- SD) years. Five men (28%) and thirteen women (72%) participated in the study. All patients underwent provocation discography by a standard technique, as mentioned previously. The lumbar discs examined were L3-L4;(2), L4-L5;(14) and L5-S1;(10). The relationship between discogenic lumbar pain and disc morphology was investigated by using MRI and provocation discography. RESULTS: Of the 26 discs being studied, 16 proved to be concordantly painful at discography relative to clinical back, buttock, hip, groin, and proximal leg pain complaints. Fourteen of the 16 painful and concordant pain discs exhibit grade 2, 3 with annular tears, and four with free leakage of contrast into the epidural space. Using chi-square analysis, we observed a significant correlation (P < 0.05) between the annular disruption grade and the provoked pain response. We were not able to demonstrate that the HIZ was associated with any particular grade of disc disruption. Similarly, there was no significant correlation (P > 0.05) between a concordant pain response and the presence of an HIZ regardless of the level and grade of disc disruption. CONCLUSIONS: The presence or lack of the HIZ does not exclude the disc as a source of pain and should not replace provocation discography as a means of evaluating low back pain with or without sciatica.
Buttocks ; Epidural Space ; Female ; Groin ; Hip ; Humans ; Leg ; Low Back Pain ; Magnetic Resonance Imaging* ; Male ; Reproduction ; Research Personnel ; Sciatica

The retraction of anterior teeth could be performed more easier by inducing of skeletal anchorage system rather than by conventional method on orthodontic treatment. But, we wonder how effective the system draws well without anchorage loss and draws anterior teeth aside posteriorly, and if the system can reduce the time, in comparison with the anchorage of posterior teeth. For that reason we have studied on the subject of patients, who were required the maximum anchorage on orthodontic treatment and the cases without crowding. The subjects of the experimental group are 35 areas of 20 people who were inserted miniscrews after Mx or Mn 1st premolar extracted. Also, the subjects of the control group are 81 areas of 45 people who were not inserted miniscrews. Compared the anchorage loss of experimental group with control one, we could get the result that the anchorage loss of experimental group is 1.034+/-0.891mm and control group is 2.790+/-1.882mm(P<0.01). Compared the space closing time of experimental group with control one, we could get the result that the space closing time of experimental group is 369.40+/-110.81days and control group is 406.56+/-231.63days. But the result of comparing space closing time has no significance in statistics. We recognized that the experimental group is more faster than the control group in the canine retraction velocity from the result ; the speed of a experimental group has as much as 0.60+/-0.23mm/30days while the speed of a control group has 0.44+/-0.35mm/30days(P<0.05). So, we could convince that orthodontic miniscrew is used effectively in the cases required the maximum anchorage.
Bicuspid ; Crowding ; Humans ; Tooth*

Metaplastic breast carcinoma is very rare, and metaplastic carcinoma with chondroid differentiation is even rarer. Here, we report a case of metaplastic carcinoma with extensive chondroid differentiation mimicking chondrosarcoma that was challenging to diagnose. The tumor was characterized by an abundant chondromyxoid matrix. The definitive area of classic invasive ductal carcinoma was minimal. The peripheral portion of the tumor showed increased cellularity with pleomorphism and definitive invasive growth. Tumor cells in the chondrosarcomatous areas were diffusely immunoreactive for S-100 protein, patchy positive for cytokeratin, but negative for epithelial membrane antigen (EMA). Tumor cells in carcinomatous areas were diffusely positive for cytokeratin, S-100 protein, and patchy positive for EMA. In both areas, tumor cells were negative for smooth muscle actin (SMA) and CD34, while oncoprotein p53 was overexpressed. When pathologists encounter breast tumors with chondroid differentiation, careful sampling and immunohistochemistry for cytokeratin and SMA are most helpful to differentiate metaplastic carcinoma from malignant phyllodes tumor and malignant adenomyoepithelioma.
S100 Proteins/chemistry ; Neoplasm Metastasis ; Muscle, Smooth/pathology ; Middle Aged ; Metaplasia ; Keratins/metabolism ; Immunohistochemistry ; Humans ; Female ; Cell Differentiation ; Carcinoma/*complications/metabolism/pathology ; CA-15-3 Antigen/metabolism ; Breast Neoplasms/complications/metabolism/*pathology ; Antigens, CD34/biosynthesis ; Actins/metabolism

No abstract available.
Pyelonephritis, Xanthogranulomatous* ; Wilms Tumor*

PURPOSE: We evaluates if the administration of tamsulosin increases the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the patients with upper ureteral stones and if this decreased the use of analgesic drugs after the procedure. MATERIALS AND METHODS: A total of 45 patients with stones 6-12mm in size that were located in the upper ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=23) received 3 times a day oral treatment of 20mg caroverine (a spasmolytic drug). Group 2 (n=22) received one time a day oral therapy of 0.2mg tamsulosin. All the patients received oral treatment for 14 days. Both groups of patients were allowed to use 30mg ketorolac trimethamine intramuscular injections on demand. The endpoint of the study was the stone expulsion rate, the use of analgesics and the drug adverse effects during treatment. RESULTS: The average stone size was 7.9+/-2.79mm for group 1 and 8.2+/-3.14mm for group 2. No statistical difference between the two groups was found for the stone size, age and gender distribution. The expulsion rate was significantly higher in group 2 (90.9%) compared with group 1 (65.2%) (p=0.038). The average number of pain control injections was 0.78 for group 1 and 0.23 for group 2, and there was a statistically significant difference between the two groups (p=0.042). CONCLUSIONS: The use of tamsulosin proved to be effective and safe, as demonstrated by the increased stone expulsion rate and the lesser need for pain control than that when using just a spasmolytic drug for ESWL of upper ureter stones.
Analgesics ; Humans ; Injections, Intramuscular ; Ketorolac ; Lithotripsy* ; Shock* ; Ureter* ; Urinary Calculi

Introduction: Last Decades, Date by date medical developments providing friendly, high-efficiency treatment equipment and services in developed countries are working toward an advanced, as our country medical services are trying to that country’s technology has been introduced. In our country every day there is only surgical care necessary to endocrine gland disorders, including most common thyroid surgery. It is open and robotic assistant endoscopic surgery in the world. But robotic assistant endoscopic surgery is too expensive and impossible in our country. Thus we chose Thunderbeat for open thyroid surgery in especially huge enlarged goiter and vascularized goiter to try prevent bleeding, recurrent laryngeal nerve palsy and post operation hematoma and other complications Thunderbeat is new generation instrument combines an advanced bipolar clamp to the existing ultrasonic cutter. Materials and Methods: M 51-years-oldwoman was admitted to Mongol Hyundae hospital because of front of neck pain, multi nodular goiter, tachycardia, sweaty and not controlling emotion. Anamnesis: She diagnosed to Thyrotoxicosis in 2005 and she took medicine last ten years but not controlling that poisoning. Status locals: Huge enlarged goiter in front of her neck Treatment plan: 1. Preoperative Preparation 2. Operation: Open total thyroidectomy 3. Medicine 4. Wound dressing 5. Observation We did operation after day of admission day, Patient is placed in a Semi erect position with a folded sheet underneath the shoulders so that the head is sharply angulated backward on the multifunctional surgical table under general anesthesia. We used thunderbeat from muscular to all procedures, dissection both thyroid gland and isthmus after Kocher skin incision and sub skin tissue dissected. There is no complication while procedure and post operation days Result: Nodular hyperplasia of thyroid gland with focci of micro adenomatous change Conclusion: Thunderbeat in use open thyroid surgery first outcomes blood loss than 30ml, no injury of recurrent laryngeal nerve and no penetration ligament of Berry while procedure, second outcomes no hematoma, painless, wound healing process faster and short time hospitalization.

Carotid body tumor is a manifestation of paraganglioma, a systemic disease, in the head and neck region. Bilateral presentation is rare, and it may or may not be functional. In symptomatic cases, it is important to evaluate the patient thoroughly through the whole body for the causative lesion. We experienced an unusual patient who had a history of resection for a carotid body tumor presenting with fluctuating hypertension. Work up revealed contralateral carotid body tumor and increased levels of catecholamine. He underwent resection of the contralateral carotid body tumor, but his symptoms persisted. Further studies led to detection of extraadrenal retroperitoneal paraganglioma with liver infiltration, for which he had an operation. His hypertension and catecholamine levels returned to normal.
Carotid Body Tumor* ; Carotid Body* ; Head ; Humans ; Hypertension ; Liver ; Neck ; Paraganglioma*

BACKGROUND: The aim of the study is to evaluate the relevant spreading for contrasts in the ventral and dorsal epidural space during retrograde interlaminar ventral epidural injections (RIVEIs) with the catheter tip placed ventral or dorsal to the spinal nerve. METHODS: For RIVEIs, a 17G Tuohy needle was inserted in retrograde fashion. Catheter containing a removable stylet was inserted and advanced via the needle and passed to the lower aspect of contralateral pedicles in 75 patients. Fluoroscopic images were recorded at 1.5 ml increments of contrast. Using the fluoroscopy, the contrast spreading pattern and whether the contrast spread to the specific anatomic landmarks (superior aspect of the supra-adjacent intervertebral disc [SIVD] and inferior aspect of the infra-adjacent intervertebral disc [IIVD]) were evaluated. Whether the catheter was placed ventral or dorsal to the spinal nerve was assessed with the computed tomography axial and sagittal views. RESULTS: There were no significant differences in the mean levels of epidural contrast spreading extents between ventral and dorsal catheter placements. Ventral or dorsal catheter tip placements demonstrated ventral concurrent flows over to the SIVD and IIVD over 80% of subjects with 3.0 ml of contrast. CONCLUSIONS: During RIVEIs, the catheter tip placed ventral to the spinal nerve did not show superiority with regards to epidural spreading extent as compared with dorsal catheter placement. One-level instead of a two-level injection may be considered for the two-level central pathology.
Anatomic Landmarks ; Catheters ; Contrast Media ; Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Intervertebral Disc ; Needles ; Spinal Nerves