Characteristics of teeth referred to a dental university hospital for endodontic reason

PURPOSE: The aim of this study is to investigate the characteristics of patients and teeth referred to a university dental hospital for endodontic problem. MATERIALS AND METHODS: From January, 2017 to December, 2018, patients who were referred to a university dental hospital for endodontic problem were collected from clinical records. A total of 1171 patient records were analyzed. The status of the referred teeth was divided into three groups according to whether they were treated endodontically based on radiographs and clinical records at the time of referred visit. RESULTS: 69.9% of the referred teeth were maxillary and mandibular first and second molars. The average time from referral to actual visit is 9.03 days and 65.6% of the case referred with referring letter. The most primary reasons of referral were persistent clinical symptom (pain, swelling, and sinus tract) (37.9%), diagnosis difficulty (16.7%), blockage of canal space (13.8%) and difficult tooth anatomy (11.4%). In the case of referral before endodontic treatment, the most primary reason of referral was failure to make a proper diagnosis. If the teeth were referred in the middle of endodontic treatment, the most primary reason of referral was persistent clinical symptom and blockage of canal space. In the case of referral after root canal filling, the most primary reason of referral was persistent clinical symptom. CONCLUSION: In the case of molars, the rate of persistent clinical symptom and blockage of canal space were the most primary reason of referral, and the rate of apical surgery and management of trauma was high in the case of anterior teeth.

Corrigendum: Corrections to the funding. Quantification of the tug-back by measuring the pulling force and micro computed tomographic evaluation

Corrections to the funding. In this article, the year is missing from the funding information.

Quantification of the tug-back by measuring the pulling force and micro computed tomographic evaluation

OBJECTIVES: The aims of this study were to quantify tug-back by measuring the pulling force and investigate the correlation of clinical tug-back pulling force with in vitro gutta-percha (GP) cone adaptation score using micro-computed tomography (µCT). MATERIALS AND METHODS: Twenty-eight roots from human single-rooted teeth were divided into 2 groups. In the ProTaper Next (PTN) group, root canals were prepared with PTN, and in the ProFile (PF) group, root canals were prepared using PF (n = 14). The degree of tug-back was scored after selecting taper-matched GP cones. A novel method using a spring balance was designed to quantify the tug-back by measuring the pulling force. The correlation between tug-back scores, pulling force, and percentage of the gutta-percha occupied area (pGPOA) within apical 3 mm was investigated using µCT. The data were analyzed using Pearson's correlation analysis, one-way analysis of variance (ANOVA) and Tukey's test. RESULTS: Specimens with a strong tug-back had a mean pulling force of 1.24 N (range, 0.15–1.70 N). This study showed a positive correlation between tug-back score, pulling force, and pGPOA. However, there was no significant difference in these factors between the PTN and PF groups. Regardless of the groups, pGPOA and pulling force were significantly higher in the specimens with a higher tug-back score (p < 0.05). CONCLUSIONS: The degree of subjective tug-back was a definitive determinant for master cone adaptation in the root canal. The use of the tug-back scoring system and pulling force allows the interpretation of subjective tug-back in a more objective and quantitative manner.

Mutations in gyrA and parC Genes and Plasmid-Mediated Quinolone Resistance in Non-typhoid Salmonella Isolated from Pediatric Patients with Diarrhea in Seoul

A total of 91 non-typhoid Salmonella isolated from pediatric patients with diarrhea in Seoul from 2003 to 2009 was tested for antimicrobial susceptibility of nalidixic acid (NA). Forty strains of NA resistance or intermediate susceptible non-typhoid Salmonella were identified and their minimum inhibitory concentrations (MICs) of NA, ciprofloxacin (CIP), and norfloxacin (NOR) were determined. Of the 40 isolates, 26 were resistant to NA (MIC >256 microg/ml). Only one isolate was high-level resistant to CIP (12 microg/ml) and NOR (48 microg/ml). Mutations in gyrA and parC genes were studied by PCR and sequencing. All NA-resistant isolates carried point mutations in the gyrA quinolone resistance determining regions (QRDR) at codon 83 or 87 (MICs of NA, >256 microg/ml; MICs of CIP, 0.047~0.25 microg/ml; MICs of NOR, 0.38~1.5 microg/ml). A double change in GyrA was found in one Salmonella Enteritidis (MIC of CIP, 12 microg/ml; MIC of NOR, 48 microg/ml). In respect of the ParC protein, a single change at Thr57-->Ser was found in 3 isolates (MICs of NA, >256 microg/ml; MICs of CIP, 0.19~0.25 microg/ml; MICs of NOR, 1 microg/ml). At the same time, these strains changed from Ser83 to Tyr in the gyrA. The result of the investigation for the prevalence of plasmid-mediated quinolone resistance (PMQR) genes, 14 isolates harbored qnr gene among 40 isolates. All of 14 isolates showed decreased susceptibility at NA (MICs 4~16 microg/ml) and except one strain, all of qnr genes were identified as qnrB. Mutations in the gyrA gene and production of PMQR determinants were critical for quinolone resistance and decreased susceptibility to fluoroquinolone in these isolates.

Molecular Epidemiology of Legionella pneumophila Isolated from Bath Facilities of Public Establishments in Seoul

The genus Legionella is common in aquatic environments. Some species of Legionella are recognized as potential opportunistic pathogens for human, notably Legionella pneumophila that causes Legionellosis. During the summer season between June and August in 2010, we isolated 61 L. pneumophila from the bath facilities of public establishments of 25 wards in Seoul. The existence of 16S rRNA and mip gene of L. pneumophila was confirmed in the genome of the isolated strains by PCR. Among the 61 strains of L. pneumophila, thirty three isolates belong to serogroup 1 (54.1%), 13 isolates were serogroup 6 (21.3%), 9 isolates were serogroup 5 (14.8%), 3 isolates were serogroup 3 (4.9%), and 3 isolates were identified in serogroup 2 (4.9%). On pulsed-field gel electrophoresis (PFGE) analysis using SfiI, genetic types of L. pneumophila were classified into 8 (A to H) patterns by the band similarity with excess of 65%. Our results suggest the existence of serological and genetic diversity among the L. pneumophila isolates.

Clinical Characteristics of Gastrointestinal Carcinoid Tumors / 대한소화기내시경학회지

BACKGROUND/AIMS: Various factors have been reported that can predict the clinical course and outcome of patients with gastrointestinal (GI) carcinoid tumors. We analyzed the clinical characteristics of GI carcinoid tumors and the factors associated with metastasis. METHODS: We retrospectively analyzed the clinical manifestations, treatment modalities and prognosis of 83 patients with GI carcinoid tumors. RESULTS: The mean age of the patients was 48 years old. The locations of the carcinoid tumors were rectum (n=60), stomach (n=12), duodenum (n=6), appendix (n=4) and colon (n=1). The most common symptom was non-specific (n=65, 79.5%), and the mean tumor size was 11.2 mm. The main treatment modality was endoscopic resection (n=66, 79.5%). Nine patients showed metastasis, and all of their tumors were larger than 2 cm. Univariate analysis revealed that size, ulceration and invasion of the proper muscle layer were significant factors associated with metastasis. Tumor size (p=0.001) was the only independent factor on multivariate analysis. CONCLUSIONS: The diagnosis of small sized, asymptomatic GI carcinoid tumors has increased and endoscopic treatment was a useful modality. Tumor size was a predictive factor for metastasis.

Add on Lamivudine to Adefovir Monotherapy for the Treatment of Lamivudine-resistant Chronic Hepatitis B Patients / 대한소화기학회지

BACKGROUND/AIMS: Add on adefovir (ADV) to ongoing lamivudine (LAM) has been recommended as a standard therapy for the treatment of LAM resistance. In the past, switch to ADV monotherapy was suggested as an option for the treatment of LAM resistance, leading to frequent development of ADV resistance. However, ADV monotherapy has been still used in LAM-resistant patients because of low cost in Korea. The aims of this study were to evaluate the virologic response and virologic breakthrough during adding on LAM in LAM-resistant patients receiving ADV monotherapy. METHODS: The study population comprised 99 patients with LAM-resistance. We divided them into 3 groups (Group 1: switch to ADV monotherapy, N=58, Group 2: add on ADV to ongoing LAM, N=25, Group 3: add on LAM to ADV monotherapy, N=16). HBV DNA levels were assessed at baseline and every 3 months during therapy. Serum HBV DNA levels were measured by bDNA assay or the COBAS TaqMantrade mark HBV test. RESULTS: The median treatment duration for group 1, group 2, and group 3 was 42.0, 20.6, and 31.8 (18.7 mon. of ADV+13.1 mon. of LAM) months, respectively. Cumulative rate of virologic breakthrough in group 1 was 5.2%, 19.0%, and 25.9% at 12, 24, and 36 months of treatment, respectively. Virologic breakthrough was not detected in group 2 and group 3 (p=0.016, group 1 vs. group 2 or 3). In group 3, median serum HBV DNA levels were 4.22 log10 copies/mL prior to LAM administration. Median serum HBV DNA changes from baseline (log10 copies/mL) were -0.91, -1.93, -1.87 and -1.74 at week 12, 24, 36 and 48, respectively. CONCLUSIONS: Later add on LAM to ADV monotherapy prevented the development of ADV resistance in patients with LAM resistance effectively, comparable to ADV add on to continuing LAM therapy.

Rates of Early Surgery and Associated Risk Factors in Crohn's Disease / 대한소화기학회지

BACKGROUND/AIMS: The individual course of Crohn's disease is diverse, and some patients may require bowel resection. The aims of this study were to determine the early surgery rate of Crohn's disease and to identify risk factors associated with early surgery in Korea. METHODS: Ninety six patients with Crohn's disease (68 men; median age at the time of diagnosis: 25 years), who had been followed up more than a year, were retrospectively analyzed. Early surgery was defined as a bowel operation for Crohn's disease or its complications occurring within 3 years from diagnosis. Early surgery rate and risk factors for early surgery were identified. RESULTS: Fifteen patients (15.6%) underwent early surgery. The cumulative surgery rate was 8.6% after 6 months, 11.9% after 12 months, 14.1% after 18 months, and 16.7% after 24 to 36 months. Multivariate analysis revealed penetrating or stricturing behavior to be an independent risk factor for early surgery (p<0.001, Exp (B)=2.97 CI 1.39-6.37). CONCLUSIONS: The cumulative early surgery rate in Korean patients seems to be lower than Western patients. Penetrating or stricturing behavior is significantly associated with early surgery, requiring early aggressive medical treatments.

Clinical efficacy of entecavir therapy and factors associated with treatment response in naive chronic hepatitis B patients / 대한간학회지

BACKGROUND/AIMS: Entecavir is a potent and selective guanosine analogue that has demonstrated a significant antiviral efficacy against hepatitis B virus (HBV). The aim of this study was to characterize the response to entecavir and to examine the factors affecting that response. METHODS: We administered 0.5 mg of entecavir once daily for more than 12 months to 114 naive chronic hepatitis B (CHB) patients. We measured the levels of liver enzymes, serological markers, and serum HBV DNA at 3-month interval. RESULTS: Normalization of serum alanine aminotransferase levels was observed in 68.5% (76/114), 74.6% (85/114), and 81.6% (62/76) of patients after 6, 12, and 24 months of therapy, respectively. HBV DNA levels of <50 copies/mL (as evaluated by polymerase chain reaction) were observed in 43.9% (50/114), 71.1% (81/114), and 85.5% (65/76) of patients after 6, 12, and 24 months, respectively. Viral breakthrough was not observed. The rates of HBeAg loss and seroconversion were 43.5% (27/62) and 14.5% (9/62), respectively, after 12 months of therapy, and 56.4% (22/39) and 15.4% (6/39) after 24 months. The independent factor associated with PCR negativity was early virologic response (EVR; HBV DNA <2,000 copies/mL after 3 months of therapy, P<0.001). The independent factors predicting HBeAg loss were found to be serum albumin levels (P=0.041) and EVR (P=0.005). CONCLUSIONS: Entecavir induced excellent biochemical and virologic responses in naive CHB patients. EVR was an independent factor for predicting HBV PCR negativity and HBeAg loss.

A Case of Tuberculous Myelitis Misdiagnosed as Lupus Myelitis / 대한류마티스학회지

In systemic lupus erythematosus (SLE), besides immunosuppressive therapy, the immunological abnormalities such as impaired phagocytosis and deficiency of cell-mediated immunity contribute to the increased risk of infection. Most of all, the incidence of tuberculous infection is higher and the pattern tends to be more extensive and extrapulmonary than in general population. Therefore the contributory role of tuberculous infection in mortality of SLE should be emphasized, especially in areas endemic for Mycobacterium tuberculosis like Korea. When tuberculous infection involves central nervous system, it can mimic lupus myelitis, showing the clinical manifestations like paraplegia, sensory impairment and bladder dysfunction. Tuberculous myelitis should be differentiated with lupus myelitis as early as possible for proper treatment and better prognosis. We report a 52 year-old woman with SLE presented with paraplegia and urinary incontinence, who were initially suspected as lupus myelitis. But the AFB smear and culture of cerebrospinal fluid were compatible with tuberculosis myelitis.

The effect of propofol for conscious sedation during colonoscopy-A Prospective, Randomized Study / 대한내과학회지

BACKGROUND: The objectives of this study were to assess propofol as sedative agents for colonoscopy in the safety and efficacy, compared with midazolam plus meperidine. METHODS: 120 patients undergoing colonoscopy in a prospective study were randomly assigned to one of three medication regimens. Patients in group A (n=42) received i.v. 25 mg of meperidine and 2.5 mg of midazolam. Patients in group B (n=41) received i.v. a median dose of 96.59 mg of propofol (range 40-180) and patients in group C (n=37) received i.v. 25 mg of meperidine and a median dose of 77.03 mg of propofol (range 40-150), administered by a nurse with endoscopist supervision. Endpoints were patient satisfaction, procedure and recovery times and complications. RESULTS: The mean time to sedation was much faster in 2 groups using propofol (group A: 152+/-105.9 sec, group B: 52.9+/-46.5 sec, group C: 56+/-63.7sec; p<0.001). The mean time to reach the cecum was not different among the 3 groups. There were total 3 episodes of oxygen desaturation to <90%, as one in each group, but the patients were spontaneously recovered with only increasing O2 concentration and arousal. Patients in group C expressed better overall mean satisfaction than patients in group A (p=0.049), but difference was not found between group A and group B. The amnestic effect was better in two groups using propofol than group A (p=0.017) The mean dose of propofol was lower in the patients who received propofol combined with low dose of meperidine than those with propofol only (77.03 mg vs 96.59 mg, p=0.009). CONCLUSION: Nurse-administered propofol sedation with endoscopist supervision is believed to be safe and useful for colonoscopy with careful monitoring.

A Case of Multiple Pedunculated Polypoid Gastric Carcinoids / 대한소화기내시경학회지

Gastric carcinoids usually appear as a single polypoid tumor or yellowish rounded submucosal tumor in the fundus or body of the stomach. Multiple gastric carcinoids are associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia. In Korea, carcinoids usually appear as single round-based submucosal tumor or sessile polyps. Multiple pedunculated polypoid carcinoids were rarely reported. A 27-year old woman was admitted to our hospital due to melena. The endoscopy revealed multiple pedunculated polypoid lesions in the fundus and body, predominantly in Yamada type III and IV. The histopathologic examination revealed the diagnosis of gastric carcinoid tumors. Serum fasting gastrin level was normal. We report a case of multiple pedunculated polypoid gastric carcinoids without atrophic gastritis or hypergastrinemia with a review of relevant literatures.

The Multiple Combined Oral Platelet Aggregation Inhibitors of Aspirin, Ticlopidine and Cilostazol after PCI

BACKGROUND AND OBJECTIVES: Along with intracoronary stenting, medications, such as Ca++ channel blocker, nitric oxide and some platelet aggregation inhibitors, have contributed to the reduction of coronary restenosis. However, restenosis still remains as a challenging dilemma, with a frequency of 20-50%. Aspirin and ticlopidine are known as a standard anti-platelet regimen following PCI, but cilostazol is a comparably effective drug, which has a different mechanism to that of ticlopidine. It is unknown if the triple combination of aspirin, ticlopidine and cilostazol could further reduce adverse events and restenosis. SUBJECTS AND METHODS: The clinical and angiographic data, which had been collected after PCIs at Wallace Memorial Baptist Hospital, between Jan. 2000 and Dec. 2001, were retrospectively analyzed. The patients had taken either aspirin+ ticlopidine or aspirin+ticlopidine+cilostazol, and the clinical observation and follow-up angiography was completed for 6 months. There were 111 (66 males) and 87 (male:57) in the aspirin+ticlopidine and aspirin+ ticlopidine+cilostazol groups, respectively. The rates of major adverse cardiovascular events (MACE) and restenosis were compared during the follow-up period. RESULTS: The frequency of MACE was similar, without a significant increase in the side effects during the follow-up period. The restenosis and target lesion revascularization (TLR) rates were significantly decreased in the triple combination therapy group (37.2% vs. 21.9%, p=0.006, 29.8% vs. 14.1%, p=0.008). CONCLUSION: This study showed that this triple combination of platelet aggregation inhibitors is a good combination therapy for the reduction of restenosis. It is suggested that these effects were probably due to more potent platelet inhibition by the multi-directional mechanism in addition to coronary vasodilation effect.

A Case of Large Hepatic Cyst Infected with Salmonella paratyphi A

Salmonellae cause a number of characteristic clinical infections in humans, including gastroenteritis, enteric fever, bacteremia, focal metastatic infection and an asymptomatic chronic carrier state. We report a case of large hepatic cyst infected with Salmonella paratyphi A. A 47-year-old woman was admitted, because of abdominal complains (fullness and pain) and fever. On physical examination, a mass was palpated on right upper quadrant of the abdomen. The computerized tomography of the abdomen showed a large hepatic cyst, but not cystic infection. Aspiration and percutaneous drainage of the hepatic cyst were perfomed for the therapeutic decompression under fluoroscopic guidance. Cultures of the cyst fluid revealed growth of Salmonella paratyphi A. Radiologic contrast media after draining of the cyst fluid revealed no communication between the cyst and bile ducts. Infected hepatic cyst appeared to result from hematogenic seeding. One month later, the patient improved and was discharged without any complication.

A Case of Large Hepatic Cyst Infected with Salmonella paratyphi A

Salmonellae cause a number of characteristic clinical infections in humans, including gastroenteritis, enteric fever, bacteremia, focal metastatic infection and an asymptomatic chronic carrier state. We report a case of large hepatic cyst infected with Salmonella paratyphi A. A 47-year-old woman was admitted, because of abdominal complains (fullness and pain) and fever. On physical examination, a mass was palpated on right upper quadrant of the abdomen. The computerized tomography of the abdomen showed a large hepatic cyst, but not cystic infection. Aspiration and percutaneous drainage of the hepatic cyst were perfomed for the therapeutic decompression under fluoroscopic guidance. Cultures of the cyst fluid revealed growth of Salmonella paratyphi A. Radiologic contrast media after draining of the cyst fluid revealed no communication between the cyst and bile ducts. Infected hepatic cyst appeared to result from hematogenic seeding. One month later, the patient improved and was discharged without any complication.