Complete denture fabricated by Jiro Abe's method for edentulous patient with severe alveolar ridge resorption: a case report / 대한치과보철학회지

Fabrication of complete denture by Jiro Abe's method was introduced that enhance the retention and stability of denture by sealing around the denture border with mucous membrane to make negative pressure at the inner surface of denture base when swallowing or occlusion. In this case, taking impression and fabricating complete denture by the Jiro Abe's method for an edentulous patient with severe mandibular alveolar bone resorption allowed us to obtain clinically enhance stability of denture and improve satisfaction of patient.

Full mouth implant rehabilitation with double scanning of provisional restoration / 대한치과보철학회지

It is important to produce a provisional restoration reflecting the patient's jaw relation, occlusal plane, lip support, shape of teeth, and occlusion type for fully edentulous patients before making a definite prosthesis. The patient introduced in this study showed bad prognosis of remained tooth after severe periodontal diseases. Therefore, remaining teeth were extracted and replaced with dental implants. Provisional restorations were fabricated and the the patient's vertical and horizontal jaw relationship, occlusal plane, amount of overjet and overbite, size of teeth, and length of anterior tooth were recorded. Provisional restorations were scanned and CAD/CAM techniques were used to fabricate a monolithic zirconia bridge, which contour is identical with the provisional restorations. The patient was satisfied with the treatment results on functional, esthetic aspects and the prosthesis retained stable during the four-month clinical observation period.

Position of maxillary central incisor and intercanine width in Korean adults / 대한치과보철학회지

PURPOSE: The aim of this study was to propose the position of maxillary anterior teeth and intercanine width measurements based on the incisive papilla in accordance with the cephalic type and gender of dentate Korean adult with normal teeth alignment. MATERIALS AND METHODS: 42 students with Class I normal occlusion, without crowding or spacing, were selected from the Chonnam National University School of Dentistry. The lateral skull radiographs of the subjects were taken and were classified as different cephalic types, based on their PFH / AFH ratios. 42 casts of their maxilla were prepared and both the distance between the upper central incisors and the middle of the incisor papilla was measured with a vernier caliper (A) and the distance between the maxillary canine cusp tips (B) were measured. Statistical analysis was performed using SPSS version 15 and their significance was investigated. RESULTS: For dolichocephalic group, the mean values for A and B were 8.43 (SD: 0.61) and 36.73 (SD: 2.17), respectively. The mean value for A was 8.51 (SD: 1.27) for the mesocephalic group and 8.76 (SD 1.03) for the brachycephalic group. The mean value for B was 35.91 (SD: 1.86) for the mesocephalic group and 37.34 (SD: 2.23) for the brachycephalic group. For the male group, the mean A value was 8.86 (SD: 1.04) and the mean B value was 37.60 (SD: 0.24). For the female group, the mean A value was 8.41 (SD: 0.93) and the mean B value was 36.18 (SD: 2.01). The difference between male and female group in A values were not statistically significant (P>.05). The B values of the male subjects were greater than those of the female subjects and was statistically significant (P<.05). CONCLUSION: 42 students with normal dentition and occlusion in korea, the distance from the incisive papilla and the incisal edge of maxillary central incisors had no difference in cephalic type or gender. However, the distance between the cusp tip of both canines had significant difference in gender where the male showed higher values than the female, while having no difference in cephalic types.

Changes in Heart Rate during and after Exercise Treadmill Test as Prognostic Factor in Cardiovascular Disease

BACKGROUND AND OBJECTIVES: Many studies have established risk factors for cardiovascular diseases. The Duke treadmill score has gained widespread acceptance for prognosis and diagnosis in cardiac diseases. Recently, changes in heart rate during and after exercise have also been studied to predict the prognosis of cardiac diseases. We examined the relationship between the incidence of cardiovascular events and exercise capacity, achievement of 85% maximal predicted heart rate (MPHR) or heart rate recovery (HRR) after a routine exercise treadmill test. SUBJECTS AND METHODS: We studied 88 patients with chest pain who were over the age of 30. They were referred for exercise treadmill test for assessment of chest pain and underwent symptom-limited, exercise test with a cool down period of 30 seconds. HRR was defined as the difference in heart rate between peak exercise and 1 minute after exercise. Delta heart rate (DHR) was defined as the difference in heart rate between resting and peak exercise. Other parameters in the exercise test were also measured. RESULTS: Cardiovascular events were found in 13 of the 88 patients. In the events group, age, peak heart rate in exercise, ST depression, maximal exercise capacity, HRR, DHR and achievement of 85% MPHR were all significant variables. There was a favorable prognosis in the patients with a value of HRR >22 beats/minute and a value of DHR >83 beats/minute. Even after adjusting for age, sex, ST depression and left ventricular hypertrophy, the parameters of maximal exercise capacity, HRR, DHR, and achievement of 85% MPHR remained predictive prognostic factors in cardiovascular events. CONCLUSION: Parameters in exercise treadmill test, such as maximal exercise capacity, HRR, DHR and achievement of 85% MPHR, appear to provide additional information and are important variables associated with the prediction of risk in cardiac events.

Clinical and Echocardiographic Findings in Patients who Underwent Mitral Valve repair Surgery

No abstract available.

Risk Assessment with Duke Treadmill Score in Patients with Coronary Artery Disease: Comparison with Scintigraphic and Angiographic Findings

BACKGROUND AND OBJECTIVES: The Duke treadmill exercise score (DTS) has been used to stratify patients with coronary artery disease into low-, moderate-, and high-risk groups. To determine the coronary angiographic and myocardial scintigraphic correlates of these scores, we have compared the degree of risk assessed by the DTS and with those obtained by angiography and SPECT. SUBJECTS AND METHODS: The subjects were classified into low risk (DTS >or= 5), moderate risk ( 4 > DTS >or= -11) and high risk (DTS 10 abnormal segments, group 3 (n=41) had one vessel disease and less than 5 abnormal segments, and group 2 (n=41) included the remaining subjects. Based on the DTS, 37 (36%) were in the low-risk, 44 (43%) in the moderate risk, and 21 (21%) in the high risk groups. In the low-risk DTS patients, 32.4% were in group 1, 35.2% in group 2 and 32.4% in group 3. In relation to the subjects with moderate risk DTS, there were 9, 16 and 55% in groups 1, 2 and 3, respectively. Whereas, there were 19, 24 and 57% in groups 1, 2 and 3 with high risk DTS subjects, respectively. CONCLUSION: Although considerable overlap exists, the degree of risk assessed from the angiography and SPECT findings were different from those by DTS. We suggest that patients classified into the low-risk DTS group may have extensive coronary artery disease, or myocardial perfusion SPECT abnormalities, whereas patients in the high-risk DTS group may be normal, or have mild coronary artery disease or mild SPECT abnormalities.

A Case of Acute Myocardial Infarction Associated with Spontaneous Coronary Artery Dissection

A spontaneous coronary artery dissection is a rare cause of acute myocardial ischemia. However, its precise etiology, pathogenesis, prevalence and treatment is unclear. The clinical presentation of a spontaneous coronary artery dissection can be sudden death or an acute coronary syndrome and sometimes no symptoms are present. We report a case of a 39-year-old man with a spontaneous coronary artery dissection in the right coronary artery. He presented with a history of chest pain persisting for 4 hours. The initial electrocardiogram showed a ST segment elevation in lead II III and aVF. He received intravenous urokinase, but no improvement in his symptoms was observed and the electrocardiographic changes did not resolve. A rescue coronary angiogram was performed, which demonstrated an area of dissection in the distal right coronary artery with resultant TIMI II flow. A 3.5x36 mm MAC stent was deployed across the lesion. After implanting the stent, the remainder of his stay was uncomplicated and he has remained asymptomatic at the time of this review.

Echocardiographic Findings and Clinical Manifestations of Hypertrophic Cardiomyopathy: Including 3 Cases of Anomalous Insertion of Papillary Muscle

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) has been of great interest to clinicians because of its diverse clinical, morphologic, pathophysiologic and molecular genetic manifestations. We investigated the frequencies and clinical manifestations according to the types in Maron's classification of HCM. METHODS: Patients with HCM who were seen at our institution from June 1999 to July 2001 were retrospectively reviewed. Echocardiographic patterns were classified by Maron's classification. RESULTS: Of 62 patients (M/F=39/23, 56+/-14.8 years), 6 patients (9.7%) were type I (relatively mild left ventricular hypertrophy confined to the anterior portion of ventricular septum), 10 patients (16.1%) were type II (hypertrophy of the anterior and posterior septum in the absence of free-wall thickening), 25 patients (40.3%) were type III (diffuse hypertrophy of substantial portion of both the ventricular septum and anterolateral free wall), 1 patients (1.6%) were type IV (hypertrophy in the posterior septum or anterolateral free wall) and 20 patients (32.3%) were type V (apical hypertrophy). Compared with western countries in which the type III was most common, type III was also most common in Korea, but type V was more common in Korea. Systolic anterior motion of mitral leaflet (SAM) were noted in 12 patients in which 10 patients had type III. 43 of 62 patients (69.4%) had chest pain (33.9%), dyspnea on exertion (30.6%), palpitation (1.6%) and syncope (3.2%). 19 of 62 patients (30.6%) had no subjective symptoms, and there was no significant statistical difference between types. Three of 62 patients had anomalous insertion of papillary muscle at mitral valve. SUMMARY: The most common type was type III, and SAM was found mostly in type III. Anomalous insertion of papillary muscle was noted in 3 out of 62 cases. There was no differences in subjective symptom between the types.

Partial Anormalous Pulmonary Venous Return with Scimitar Sign / 대한흉부외과학회지

We experienced a case of partial anomalous pulmonary venous return from righ lung to inferior vena cava, which combined with Scimitar sign in 18 years old female patient. Diagnostic procedures were simple chest x-ray chest CT, and cardiac catheterization. We redirected the anomalous venous flow from inferior vena cava to left atrium through the intracardiac tunnel which was made with autologous pericardium. Postoperative course was not eventful.

Successful Treatment of Huge Hepatic Cyst by One-Shot Instillation of Minocycline Chloride / 대한간학회지

Despite the high prevalence of benign hepatic cysts, they rarely exhibit symptoms. Radiologic studies such as ultrasonography or computed tomography disclose these cysts incidentally. Occasionally, large cysts may compress organs next to them, resulting in accompanying symptoms in patients. Recently, some reports have shown that treatment with minocycline chloride instillation into the cyst, after aspiration of cystic fluid, produces good results. First, we instilled doxycycline into the cyst after aspiration of the cyst with a resultant decrease in size. We aspirated 25% of the cyst followed by instillation of minocycline chloride (200 mg in 10 ml of 2% lidocaine) into the recurrent cyst which became larger 45 days later. In the other case we succeeded in making the cyst decrease in 4 months with no recurrence by an instillation of minocycline chloride (500 mg in 10 ml of 2% lidocaine) following aspiration of 25% of the cyst. We report, with references, both cases in which we have succeeded.

Value of Tissue Harmonic Imaging for the Left Ventricular Wall Imaging

BACKGROUND: Assessment of segmental wall motion is one of the most challenging tasks in echocardiography. The diagnosis of ischemic heart disease by echocardiography depends on the accurate detection of segmental wall motion abnormalities. However, echocardiographic regional wall motion analysis is impaired by incomplete endocardial definition due to obesity, chronic obstructive lung disease, etc. The purpose of this study was to examine the value of tissue harmonic imaging for endocardial border definition. METHODS: We recorded echocardiograms in 30 consecutive patients, in which more than one segment of left ventricule were poorly visualized, by ATL HDI 3000 and analyzed left ventricular segmental wall motion and then recorded echocardiograms again by tissue harmonic imaging (THI) technique. Endocardial border definition for each segment was graded from grade A to C (grade A in which endocardium is clearly visualized, grade B in which endocardium is poorly visualized and grade C in which endocardium is not seen). Densitometric analysis was perfromed in 10 randomly selected patients. Mean density and dynamic range in histogram were obtained at septum, posterior wall and left ventricle cavity on parasternal long axis view with both techniques. RESULTS: Among total 480 segments, 237 segments (49.4%) were categorized as grade A, 152 segments (31.7%) were categorized as grade B and 91 segments (18.9%) were categorized as grade C in fundamental modes. However, 380 segments (79.2%) were categorized as grade A, 75 segments (15.6%) were categorized as grade B and 25 segments (5.2%) were categorized as grade C in tissue harmonic modes. Visualization of 37.7% (181 segments/480 segments) of all segments was improved in tissue harmonic imaging, with 5.2% (25 segments/480 segments) improved from "not seen" to "clearly visualized". Of these improved 181 segments in THI, 105 segments (58%) were the lateral and anterior walls on apical views. In densitometric analysis of septum, wall density and delta density (wall densityLV cavity density) were significantly higher in THI than fundamental modes (p<0.05). But, W/C ratio (wall density/LV cavity density) was not different between two imaging modalities. In densitometric analysis of posterior wall, all parameters were not significantly different between two imaging modalities. Also, W/C ratio of dynamic range (posterior wall dynamic range/LV cavity dynamic range) was not significantly different between two imaging modalities. CONCLUSION: Tissue harmonic imaging has significant value in endocardial border definition in the patients with poor echocardiographic windows and appears promising with the added advantage of no requirement for intravenous access.

Effect of a Meal on Cardiac Performance in Patients with Coronary Artcry Disease

BACKGROUND: It has been well recognized that exercise tolerance and angina threshold in patients with coronary artery disease (CAD) are reduced after a meal. But precise mechanism leading to the postprandial worsening of angina has yet to be adequately defined. This study was undertaken to determine the effect of a mixed meal on cardiac performance and heart rate variability (HRV) in patients with CAD. METHODS: 24 patients with angina or myocardial infarction were studied. Echocardiographic examination and heart rate variability test were performed in the fasting state and the other 40-60 minutes after a 600-800 kcal mixed meal. RESULTS: In the postprandial state, resting heart rate was significantly increased by 5.2% from 64.8+/-10.69 beats/min to 68.2+/-10.2 beats/min (p<0.01), stroke volume by 8.1% from 59.6+/-17.3 ml to 64.4+/-18.1 ml (p<0.01), cardiac output by 14.2% from 3.8+/-1.06 to 4.3+/-1.21 (p<0.01). E wave and A wave of mitral filling flow and E/A ratio were not significantly different in the fasting and postprandial tests. But DT and IVRT were significantly increased in the postprandial state (p<0.05, p<0.01 respectively). HRV was not different in the fasting and postprandial state. CONCLUSIONS: In patients with CAD, a 600-800 kcal mixed meal significantly increased resting heart rate, stroke volume, cardiac output, DT and IVRT.

Short-term prognostic value of CRP in the patients with acute coronary syndrome

BACKGROUND AND OBJECTIVES: Acute coronary syndrome occurs most commonly in the setting of atherosclerotic coronary artery disease, but there is little information concerning the mechanism responsible for the transition from stable to unstable coronary atherosclerotic plaque. Hypothetically, several microorganism(Chlamydia pneumonia, Cytomegalovirus and Helicobacter pylori) and their inflammatory reaction have been suggested as a causative motive in progression of acute coronary syndrome. Although it is unclear whether the serum level of CRP as a inflammatory parameter is concerned with previous inflammatory change or myocardial necrosis, CRP apper to be predictive of higher risk for cardiac event in the patients with acute coronary syndrome. Our objective was to evaluate whether the inflammatory parameters(CRP, ESR and WBC count) is useful in predicting the short-term cardiac risk within 30 days. MATERIALS AND METHOD: One hundred and ten patients with acute coronary syndrome were enrolled from April 1998 through August 1998. Blood samples were collected at 1st hour, 24th hour, 48th hour and 7th day and tested for CRP, ESR, WBC count and CK-MB level. Values of 323 normal were used as control. All patients were followed up for 30 days and assessed for the presence of cardiac complications. RESULTS: Peak CRP value of the patients with acute myocardial infarction(3.4+/-3.85 mg/dL, n=2) was higher than that of the patients with unstable angina(0.7+/-0.93 mg/dL, n=8, p2 mg/dL, n=0), the cardiac complication rate was higher than the low-CRP group(< or =2 mg/dL, n=0) (43.3% vs 2.5%, p<0.05). Peak CRP value was correlated with age(r=.191, p=.045), pulse rate(r=.186, p=.008), left ventricular ejection fraction(r=0.384, p<0.001), peak ESR(r=.383, p<0.001) and peak WBC count(r=.307, p=.001), but not with peak CK-MB level. CONCLUSION: Elevated CRP level in patients with acute coronary syndrome seems to be a valuable prognostic factor for the development of cardiac complications within 1 month after admission.

Metastatic Thy roid Carcinoma of Jugular Foramen Simulating Glomus Jugulare Tumor: A Case Report

We report a case of hyper vascular metastatic thyroid carcinoma of the jugular fora-men simulating a glomus jugulare tumor. Computed tomography(CT) revealed areas of irregular lytic bony destruction of the left jugular foramen, as well as characteristic in vasion routes of a glomus jugulare tumor. Magnetic resonance(MR) imaging and angiography demonstrated a hypervascular mass similar to a glomus tumor.