Fabrication of computer-aided design/computer-aided manufacturing complete denture and conventional complete denture: case report

Recently computer-aided technology has been widely used in dentistry. DENTCA™ CAD/CAM denture system (DENTCA Inc.), one of CAD/CAM systems for fabricating complete denture, tries to collect and store all of a patient's information at the first visit. This system aims to deliver denture at the second visit through utilizing the CAD/CAM software to access the stored data for designing the 3D denture model. The 3 dimensional (3D) denture will then be fabricated with 3D printer. Many case reports have evaluated clinical application of CAD/CAM system for fabricating complete dentures. This case report is about fabricating of complete dentures using DENTCA system and conventional method in same patient. With two cases, usefulness and limitation of DENTCA system could be evaluated.

Korean Guidelines for Pediatric Procedural Sedation and Analgesia

Procedural sedation and analgesia (below PSA), which is used for induction of appropriate sedation and elimination of pain during many procedures, is particularly essential for children. Many other countries have pediatric PSA guidelines. PSA guidelines are also needed in Korea. We have developed pediatric PSA guidelines for Korea by reference review of pediatric PSA for standard and safe PSA practice in Korea. Pharmacologic and non-pharmacologic methods could be used for performance of ideal pediatric PSA. Pre sedation phase included assessment of patients, with accompanying personnel who have adequate knowledge and experience, and informed consent. For sedation phase, the route of medication should be determined, along with monitoring of patients and evaluation of the depth of sedation. This phase also included writing all of the PSA process, adverse events, and intervention. Considering the pain of the procedures, the time of procedures, necessity for immobilization, and characteristics of PSA medication, we decided on the PSA method. Procedures were categorized into three types according to the level of pain, anxiety, and immobilization. The first type was radiologic imaging, which requires immobilization. The second type of procedure involves a high level of anxiety and a low level of pain, such as simple suturing and lumbar puncture. The third type of procedure involves a high level of anxiety and a high level of pain, such as reduction of fracture and dislocation. After performance of the procedure, patients must be observed and monitored at a location where oxygen and airway management can be applied until they reach full recovery. Discharge information should be provided to competent parents. The main characteristics of Korean guidelines for pediatric PSA were as follows: 1. We emphasized assessment and monitoring of patients during and after PSA. 2. We suggested selection of medication by categorization of procedures according to the level of pain and anxiety. 3. We suggest that PSA be performed by two healthcare personnel; one should have adequate knowledge and experience in performance of PSA. More equipment, locations, and specialized personnel are needed for conduct of safe pediatric PSA practice in Korea.

Time-course analysis of DNA damage response-related genes after in vitro radiation in H460 and H1229 lung cancer cell lines

Radiation is the most useful treatment modality for cancer patients. It initiates a series of signal cascades such as DNA damage response (DDR) signaling for repairing damaged DNA, arresting the cell cycle, and inducing cell death. Until now, few genes have been found to be regulated by radiation, which explains the molecular mechanisms of cellular responses to radiation. Although the transcriptional changes caused by radiation have been widely investigated, little is known about the direct evidence for the transcriptional control of DDR-related genes. Here, we examined the radiosensitivity of two non-small cell lung cancer cell lines (H460 and H1299), which have different p53 status. We monitored the time-dependent changes of 24 DDR-related gene expressions via microarray analysis. Based on the basal expression levels and temporal patterns, we further classified 24 DDR-related genes into four subgroups. Then, we also addressed the protein levels of several DDR-related genes such as TopBP1, Chk1 and Chk2, confirming the results of microarray analysis. Together, these results indicate that the expression patterns of DDR-related genes are associated with radiosensitivity and with the p53 statuses of H460 and H1299, which adds to the understanding of the complex biological responses to radiation.

Epidemiologic Study of Systemic Inflammatory Response Syndrome in Emergency Department

PURPOSE: Epidemiologic data on emergency department (ED) patients with systemic inflammatory response syndrome (SIRS) are limited. We examined the prevalence, risk factors, etiologies and outcomes for the various forms of the SIRS, as well as their relationships with infection in ED. METHODS: The subjects were 16,718 non-trauma adult patients who visited a 900- bed university hospital ED between November 2006 and October 2007. ED records were reviewed, and all patients meeting the criteria for SIRS were enrolled retrospectively. SIRS patients were further subdivided into four groups (non-infectious SIRS, sepsis, severe sepsis, septic shock). Baseline characteristics, ED dispositions, and prognoses of patients in each group were analyzed. RESULTS: Among 16,718 patients, there were 2,790 SIRS patients (16.7%). The SIRS patient group was composed of 1,546 non-infectious SIRS patients (55.4%), 1,078 sepsis patients (38.6%), 119 severe sepsis patients (4.3%), and 47 septic shock patients (1.7%). ED patients with SIRS were older on average than non-SIRS patients (52 versus 48, p<0.001). The most common sources of SIRS was the gastrointestinal system (28.3%), followed by the respiratory system (22.9%) and the genitourinary system (11.8%). Pneumonia (18.9%) was the single most common cause of infectious SIRS. The admission rate was higher for SIRS patients than for non-SIRS patients (44% versus 21%). The 28-day mortality rate for non-infectious SIRS, sepsis, severe sepsis, and septic shock patients were 4.5%, 1.3%, 25.2%, and 63.8%. Sepsis severity was correlated with increased rates of both hospital admission and mortality (p<0.001). CONCLUSION: 55% of SIRS patients who visited the ED had a non-infectious cause. SIRS patients were older than non-SIRS patients, and hospital and ICU admission rates were also higher. Sepsis severity was correlated with older age, increased hospital admission rate, increased ICU admission rate, and increased mortality rate.

Availability of Multimarker IndexTM in Prediction of Ischemic Stroke Severity

PURPOSE: The Multimarker IndexTM (MMX) is derived from 4 biochemical markers (S100 beta, MMP-9, D-dimer, BNP) and is known to be useful in the early detection of stroke. Assessment of severity in the early stages of stroke is as important as early detection of stroke itself, so that early intensive management can be applied. We evaluated wheather MMX is correlated with stroke severity as measured by NIHSS. METHODS: MRI-confirmed stroke patients were prospectively enrolled for analysis of MMX from their serum, and initial NIHSS was recorded. Patients were divided into three convenient groups according to the time from symptom onset. In each group, correlation of MMX and NIHSS was studied. RESULTS: Fifty-one patients were enrolled, and MMX was found to be positively correlated with NIHSS (p<0.01). In subgroup analysis, group A (presented to ED within 6 hours of symptom onset), and group B (presented to ED from 6-12 hours after symptom onset) showed the same positive correlation between MMX and NIHSS (p=0.017, p<0.001), but in group C (presented to ED after more than 12 hours after symptom onset), there was no correlation (p=0.840). CONCLUSION: MMX positively correlated with stroke severity measured by NIHSS for patients presenting to ED within 12 hours of symptom onset.

Early Detection and Prognosis Prediction of Severe sepsis and Septic shock in Emergency Triage Room

PURPOSE: Biochemical markers can help predict neurological outcome in post-resuscitation patients. This prospective study evaluated the prognostic value of serum S100B protein and neuron-specific enolase (NSE) time courses in predicting unfavorable neurological outcomes. METHODS: We serially measured serum S100B protein and NSE levels 12 times during the 96 h after the return of spontaneous circulation (ROSC) in 40 patients. Neurological outcome was assessed at 6 months after cardiac arrest. Patients were divided into good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome groups and assessed for cerebral performance category scores. We compared the two groups at each serum value and calculated cut-off values. RESULTS: Serum S100B protein levels over the study period, except at 4 hours, and NSE levels from 14 hours after ROSC were significantly higher in the poor neurological outcome group (n=32) than the good neurological outcome group (n=8). The most predictive serum S100B protein and NSE times were at 14 hours (cut off value=0.16 microgram/L, sensitivity 81.8%, specificity 100%, AUC=0.938) and 54 hours (cut off value=19.21 microgram/L, sensitivity 86.4%, specificity 100%, AUC=0.932). CONCLUSION: Serum S100B protein and NSE levels are early and useful markers for assessing neurological outcome after successful resuscitation from cardiac arrest.

The Availability of Bedside Ultrasonography in Confirming Endotracheal Tube Placement in the Emergency Department

PURPOSE: The goal of this study was to determine the suitability of ultrasonography for detecting endotracheal tube placement in the emergency department. METHODS: Emergency physicians examined patients immediately following intubation or after intubated patients were transferred. A linear ultrasound transducer was placed transversely on the cricothyroid membrane and suprasternal notch in order to check for the "comet head and tail sign"and "double ring sign", and a sagittal view of the neck was also obtained in order to look for the "bold parallel lines sign". Subsequently, simple thoracic sonography and color doppler sonography were used to check for the "lung sliding sign". The examiner evaluated whether the tube was placed in trachea, the esophagus, or the right main bronchus. The accuracy of ultrasonography was calculated, and the required time for ultrasonography was checked. RESULTS: One hundred ten patients were enrolled in the study. The endotracheal tube was placed in the trachea in 107 patients, in the esophagus in 2 patients, and in the right main bronchus in 1 patient. The sensitivity and specificity of ultrasonography were 100%. The bold parallel lines sign and lung sliding sign proved to be good indicators of endotracheal tube placement. The average required time for ultrasonography was 28.6+/-5.8 seconds. It was difficult to determine tube placement by thoracic ultrasonography in patients with pneumothorax, hemothorax, pleural effusion, or empyema. CONCLUSION: Ultrasonography is well suited for confirming endotracheal tube placement in the emergency department.

Analysis of Predictive Factors for Children with Abdominal Pain in Emergency Departments

PURPOSE: Abdominal pain is one of most common complaints in children who visit emergency department (ED), but sometimes it is very difficult in differential diagnosis between medical and surgical disease. This study was performed to collect and analysis of diagnositic scores of children with abdominal pain who could not definitely diagnosed as medical or surgical disease in ED. METHODS: This study reviewed 201 children who were visited for abdominal pain in ED at a tertiary hospital from January 2005 to June 2005. We reviewed the medical records and analysed clinical characteristics, laboratory findings, and radiologic findings retrospectively. We analyzed the diagnostic scores between medical and surgical disease group. RESULTS: The number of medical disease are 125 patients, and the number of surgical disease are 76 patients. Significant predictable factors for surgical diseases are right quadrant pain, vomiting, tenderness, rebound tenderness, leukocytosis and diagnostic score. The mean diagnostic score of medical diseases is 4.55+/-4.10 (mean+/-SD) and the mean score of surgical diseases is 16.22+/-3.48(mean +/-SD). CONCLUSION: For the diagnosis of children with abdominal pain which is uncertain either medical or surgical disease in ED, the diagnostic scores, careful observation and physical examination repeatedly are helpful for correct diagnosis and prompt treatment.

Increased Intracranial Pressure Detected by Emergency Ultrasonography of the Optic Nerve Sheath Diameter

PURPOSE: A rapid, portable, and noninvasive means of detecting increased intracranial pressure (IICP) is desirable when conventional imaging methods are unavailable. The purpose of this study was to show that ultrasonographic measurement of the optic nerve sheath diameter (ONSD) can accurately predict the presence of IICP. METHODS: We performed a prospective study of emergency department patients suspected of having IICP due to possible focal intracranial pathology. The ONSD was measured 3 mm behind the globe using a linear probe on the closed eyelids of supine patients. For each patient, the mean of the two ONSD measurements was calculated, and the brain computed tomography (CT) was evaluated for signs of IICP. RESULTS: One hundred patients were enrolled; 31 had CT results consistent with IICP, and their mean ONSD was 6.30 mm; the mean ONSD of patients who didn't show signs of IICP on CT was 4.50 mm. The sensitivity and the specificity for the ONSD, when compared with CT results, were 100% and 98.6%, respectively. CONCLUSIONS: The evaluation of the ONSD is a simple noninvasive procedure, and is a potentially useful tool in assessing and monitoring patients suspected of having IICP.

Antiphospholipid Antibody Syndrome: A Case Report

Antiphospholipid antibody (APLA) syndrome, which is presented by seizure, is uncommon. Most seizures in APLA syndrome are associated with systemic lupus erythematosus (SLE) or other autoimmune diseases. Its pathophysiology is not clear; however, many authorities suggest that autoantibodies related to APLA syndrome are related to an ischemic change in the brain. We experienced a man with APLA syndrome, who presented with a seizure, but he had no evidence of an ischemic change in the brain. He underwent conservative management for 2 weeks and was discharged. He was admitted twice due to seizure. One year later, he had a cerebrovascular attack and was hospitalized.

A Case of Penetrating Facial Wound by a Grinder

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.

Changes in VWF-cleaving Metalloprotease (ADAMTS 13) activity in the thrombotic microangiopathy after kidney tranplantation / 대한내과학회지

The thrombotic microangiopathy associated with cyclosporine A after kidney transplantation is a detrimental complication that could lead to the loss of transplanted kidney. Although the pathogenesis is still unclear, the decrease in the activity of von Willebrand Factor (VWF)-cleaving metalloprotease that cleaves unusually large von-Willebrand factor (UL-VWF), such as disintegrin-like metalloprotease with thrombospondin type 1 repeats (ADAMTS) 13, and the inhibitory factors of ADAMTS 13 are reported. Therefore, we measured the activity of ADAMTS 13 and the inhibitory factors in a patient with thrombotic microangiopathy after kidney transplantation. A 28 year-old female patient with hemolytic anemia, thrombocytopenia and impaired renal function after the kidney transplantation was diagnosed as thrombotic microangiopathy after renal biopsy. The activity of ADAMTS 13 during the acute stage of thrombotic microangiopathy was reduced to 12%, but when the renal function returned to normal, ADAMTS 13 level returned to 100%. However, the autoantibody of ADAMTS 13 was not detected. The results from this study suggest that the pathogenesis of thrombotic microangiopathy associated with cyclosporine A after the kidney transplantation could be associated with the decrease in the activity of ADAMTS 13.

Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine / 감염과화학요법

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.

Family Outbreak of Trichinosis After Eating a Raw Meat of Wild Swine / 감염과화학요법

Trichinosis is a worldwide parasitic infection caused by ingesting an uncooked raw meat containing viable larvae of nematode Trichinella. Although most cases have been reported in Western countries, the incidence has decreased due to strict control of meat handlings and improved hygiene in these countries. In Korea, the first case of Trichinella spiralis was reported in a patient who ingested an uncooked badger. We have also experienced four cases of Trichinella spiralis infestation among family members who showed typical clinical manifestations and laboratory findings after ingesting raw wild swine meat, and herein report the finding.

The Usefulness of B-type Natriuretic Peptide test in Critically Ill, Noncardiac Patients / 결핵

BACKGROUND: Previous studies have suggested that a B-type natriuretic peptide(BNP) test can provide important information on diagnosis, as well as predicting the severity and prognosis of heart failure. Myocardial dysfunction is often observed in critically ill noncardiac patients admitted to the Intensive Care Unit, and the prognosis of the myocardial dysfunction needs to be determined. This study evaluated the predictability of BNP on the prognosis of critically ill noncardiac patients. METHODS: 32 ICU patients, who were hospitalized from June to October 2002 and in whom the BNP test was evaluated, were enrolled in this study. The exclusion criteria included the conditions that could increase the BNP levels irrespective of the severity, such as congestive heart failure, atrial fibrillation, ischemic heart disease, and renal insufficiencies. A triage B-Type Natriuretic Peptide test with a RIA-kit was used for the fluorescence immunoassay of BNP test. In addition, the acute physiology and the chronic health evaluation (APACHE)IIscore and mortality were recorded. RESULTS: There were 16 males and 16 females enrolled in this study. The mean age was 59 years old. The mean BNP levels between the ICU patients and control were significantly different (186.7+/-274.1pg/mL vs. 19.9+/-21.3 pg/mL, p=0.033). Among the ICU patients, there were 14(44%) patients with BNPlevels above 100 pg/mL. The APACHEIIscore was 16.5+/-7.6. In addition, there were 11 mortalities reported. The correlation between the BNP and APACHEIIscore, between the BNP and mortality were significant (r=0.443, p=0.011 & r=0.530, p=0.002). The mean BNP levels between the dead and alive groups were significantly different (384.1+/-401.7 pg/mL vs. 83.2+/-55.8 pg/mL p=0.033). However, the PaO2/FiO2 did not significantly correlate with the BNP level. CONCLUSION: This study evaluated the BNP level was elevated in critically ill, noncardiac patients. The BNP level could be a useful, noninvasive tool for predicting the prognosis of the critically ill, noncardiac patients.

The Application of B-Type Natriuretic Peptide Level of the Dyspneic Patients: Differentiation Between Cor Pulmonale and Left Ventricular Dysfunction / 결핵

BACKGROUND: The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. METHOD: 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. RESULTS: The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group (682+/-314 pg/mL vs. 149+/-94 pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. CONCLUSION: Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.

Successful Treatment of Cisplatin Overdose with Plasma Exchange

We report a 48-year-old man with laryngeal cancer who received a massive cisplatin toxic overdose without intravenous prehydration through an error in prescription. He received 400 mg/m2 of cisplatin over a 4-day period. On day 4, he exhibited a broad range of cisplatin toxicities and emergency plasma exchange was started. From day 5 through 19, he underwent 9 cycles of plasma exchange and his plasma cisplatin concentration decreased from 2,470 ng/ml to 216 ng/ml. He completely recovered without any sequelae. No previous reports exist in the English literature of survival without complication after the administration of such a high cisplatin dosage without prehydration.

Prevalence of Obesity and Its Relationship to Diet on Elementary Students / 대한소아소화기영양학회지

PURPOSE: The purpose of our study is to provide useful information for the prevalence of obesity by the standard weight for height and the relationship of the body image to dieting methods for weight control in children. METHODS: The survey was performed by an anthropometry and a special questionnaire on children in grades 5 to 6 at elementary schools from May to June 1997 in Kwangju city. RESULTS: 1) Selected individuals were categorized into obese, normal, thin by the standard weight for height and body image. The prevalence of obesity by the standard weight for height was 19.5%, normal was 70.5%, thin was 10.1% in males and respectively 10.5%, 66.3%, 23.1% in females. The prevalence of obesity in regards to body image was 18.4%, normal was 58.4%, thin was 23.2% in males and respectively 24.5%, 58.6%, 16.9% in females. 2) The obese body image was 6.8% in normal and thin groups in males and 19.4% in females. The body image of obese children who do not perceive themselves as obese was 32.6% in males and 28.7% in females. 3) The standard body image was 88.8% as realized by themselves, 77.9% when they compared themselves to friends, 62.7% as told by parents, 56.8% as told by friends, and 29.9% when they compared themselves to celebrities. 4) The source of information for dieting treatment was 44% from radio and television, 30% from books, newspapers, magazines, 17% from family and 9% from friends and seniors. 5) The prevalence of dieting according to the standard weight for height was 18.0% in thin, 18.7% in normal and 36.7% in obese group in males and respectively 17.8%, 22.4%, 46.3% in females. There was a statistically significant correlation between males and females (p < 0.0005). 6) The prevalence of dieting up to 2 weeks in the thin and normal groups as recognized by weight centile was 17.3% according to body image. The prevalence of dieting up to 2 weeks in the obese groups was 37.2% according to body image (p < 0.001). CONCLUSION: We suggest that many students perceived their body size incorrectly and tried weight control. The incorrect perception of body size seems to cause the problem of failure to thrive, malnutrition etc. It is necessary for further study to find and prevent side effects by unnecessary weight control and to provide proper health education and management about obesity.

A Case of Leukemia Cutis

No abstract available.

A Case of Testicular Tumor Metastasized to The Lung

No abstract available.