ABSTRACT
Dental infections and maxillary sinusitis are the main causes of osteomyelitis. Osteomyelitis can occur in all age groups, and is more frequently found in the lower jaw than in the upper jaw. Systemic conditions that can alter the patient's resistance to infection including diabetes mellitus, anemia, and autoimmune disorders are predisposing factors for osteomyelitis. We report a case of uncommon broad maxillary osteonecrosis precipitated by uncontrolled type 2 diabetes mellitus and chronic maxillary sinusitis in a female patient in her seventies with no history of bisphosphonate or radiation treatment.
Subject(s)
Female , Humans , Anemia , Causality , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Jaw , Maxillary Sinus , Maxillary Sinusitis , Osteomyelitis , OsteonecrosisABSTRACT
As popularity of dental implantation is increasing, the number of cases associated with complications also increase. Evaluation on diabetes mellitus is often neglected due to the disease's irrelevance to implantability. However, patients with diabetes mellitus are susceptible to infection due to impaired bactericidal ability of neutrophils, cellular immunity and activity of complements. Due to this established connection between diabetes mellitus and infection, a couple of cases were selected to present patients with diabetes mellitus with glycemic incontrollability, suffering from post-implantation dentigerous inter-fascial space abscess.
Subject(s)
Humans , Abscess , Complement System Proteins , Dental Implantation , Dental Implants , Diabetes Mellitus , Immunity, Cellular , Klebsiella pneumoniae , NeutrophilsABSTRACT
OBJECTIVES: This study was conducted to investigate the relationship between long working hours and suicidal ideation. METHODS: Data based on the fourth Korea National Health and Nutrition Health and Nutrition Examination Survey_(2007~2009) pertaining to a total of 4,539 full-time workers were analyzed. Working hours were divided into four groups (60 hours/week). The relationship between working hours and suicidal ideation was then analyzed after adjusting for general and occupational characteristics using a multivariate logistic regression model. RESULTS: Working 40-51 hours/week showed the lowest suicidal ideation(9.5%), whereas working 52~59 hours/week, over 60 hours/week and less than 40 hours/week showed suicidal ideations of 14.8%, 15.7% and 17.2% respectively. Even after adjusting for general and occupational characteristics, employees working 40~51 hours/week had the lowest suicidal ideation. Working 52~59 hour/week, over 60 hours/week and less than 40 hours/week showed an odds ratios of 1.413(p-value: 0.058), 1.380(p-value: 0.020) and 1.164(p-value: 0.358) respectively. CONCLUSIONS: The results suggest that working long hours, especially over 60 hours per week, is related to suicidal ideation.
Subject(s)
Korea , Logistic Models , Odds Ratio , Suicidal Ideation , SuicideABSTRACT
OBJECTIVE: Fusiform and dissecting aneurysms cannot be treated with conventional clipping or coiling surgery. Various methods are used for treating these aneurysms, including proximal occlusion of the parent artery or trapping the aneurysms with or without cerebral revascularization. We report here on our experience with treating unclippable and uncoilable aneurysms and we present the clinical and angiographic outcomes. METHODS: Nine patients with unclippable and uncoilable aneurysms were managed during a 5 year period at our institution. We retrospectively reviewed all the patients with aneurysms and who underwent multimodal techniques. The mean age of the 9 patients was 56.5 years. The mean clinical follow-up period was 28.1 months. Six patients presented with subarachnoid hemorrhage and 2 had diplopia. Of these patients, 3 had aneurysms arising from the posterior inferior cerebellar artery (PICA), 2 had vertebral artery (VA) aneurysms, 2 had internal carotid artery aneurysms and 2 had middle cerebral artery aneurysms. Eight aneurysms were fusiform and 1 was a giant saccular aneurysm. RESULTS: The treatment included surgical trapping with bypass in 4 patients, endovascular trapping with bypass in 4 patients and vein graft bypass in 1 patient. Among the bypass surgeries, high-flow bypass was performed for a giant internal cerebral artery (ICA) aneurysm. Trapping of the aneurysms with coil and occipital artery (OA)-PICA bypass were performed for 2 VA aneurysms of the PICA origin. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. CONCLUSION: The cerebral bypass technique is a useful, safe for the treatment of dissecting and otherwise unclippable/uncoilable aneurysms.
Subject(s)
Humans , Aneurysm , Aortic Dissection , Arteries , Carotid Artery, Internal , Cerebral Arteries , Cerebral Revascularization , Diplopia , Follow-Up Studies , Hemorrhage , Intracranial Aneurysm , Parents , Pica , Retrospective Studies , Subarachnoid Hemorrhage , Transplants , Veins , Vertebral ArteryABSTRACT
PURPOSE: Yearly many children attend hospital with burns. Most of them are injured to face and neck. In palliative ways, dressing with vaseline gauze, it is thick and tight to absorb the exdute and maintain, but patients are inconvinient in eating and speaking. Especially, in pediatric face and neck burn patients, cooperation is impossible, so there is increased risk of secondary infection by wound exposure and physician should make dressing more frequently. In case of using dressing material, it is not far different in palliative dressing, we should use a tape or elastic bandage to keep wound surface and dressing material in contact. Versiva(R) is combination dressing materials of hydrocolloid, hydrofiber, a polyurethane foam. Authors have used Versiva(R) in a treatment of pediatric face and neck burn, and we experienced that maintenance of dressing is convenient and nutrition supply is easy through oral feeding. METHODS: Between from 2006 January until 2008 December, we performed dressings with Versiva(R) in 20 pediatric second degree face and neck burn patients. Until postburn 2 nd or 3 rd day, we exchanged dressing daily, and after this, exchanged in 2~3 days according to amount of exudate. RESULTS: Versiva(R) had enough absorbing capacity and adhesive strength at the same time. With this slight and thin dressing material, there was considerable decrease in discomfort of patient, frequency of secondary infection and keeping dressing were convenient. Oral feeding was easy due to waterproof surface of the Versiva(R). In comparison with effort and time in palliative dressing, there was a significant reduction of labor force. CONCLUSION: In Treatment of pediatric second degree face and neck burn patient, Versiva(R) dressing was effective method because of decreased hospital day, convinience, labor reduction, decreased patient discomfort, easy to oral feeding.
Subject(s)
Child , Humans , Adhesives , Bandages , Burns , Coinfection , Colloids , Compression Bandages , Eating , Exudates and Transudates , Neck , Petrolatum , PolyurethanesABSTRACT
PURPOSE: Effective management of pediatric hand burn is a considerable challenge for clinicians. Traditional dressings may result in significant pain, wound dryness, weak adhesive strength, and increase necessity for dressing change. Versiva(R)XC is combined dressing materials of hydrocolloid, hydrofiber, a polyurethane foam. Authors have used Versiva(R)XC in treatment of pediatric hand burns, and we experienced that maintenance of dressing is comfortable and decrease patient's discomfort. METHODS: Study enrolled 9 patients of mean age 3.6 years with second degree pediatric hand burn, Versiva(R)XC dressing initially applied after bullae aspiration and saline gauze dressing. After admission, we daily changed the dressing in first two or three days and had an interval of two or three days depending on the degree of exudate from the wound. RESULTS: The mean day of application was 6.3 days. None of patients required surgery and healed with no other complication of scar contracture and hypertrophic scar formation. CONCLUSION: The dressing with Versiva(R)XC was effective method because of decreased pain, easy dressing change, more comfort, and decreased hospital day.
Subject(s)
Humans , Adhesives , Bandages , Blister , Burns , Cicatrix , Cicatrix, Hypertrophic , Colloids , Contracture , Exudates and Transudates , Hand , PolyurethanesABSTRACT
OBJECTIVE: The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. METHODS: From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. RESULTS: All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. CONCLUSION: We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.
Subject(s)
Female , Humans , Male , Anisocoria , Brain Edema , Cerebral Infarction , Consciousness , Decompression, Surgical , Decompressive Craniectomy , Glasgow Coma Scale , Glasgow Outcome Scale , Infarction , Intracranial Pressure , Medical Records , Middle Cerebral Artery , Patient Selection , Reflex , Retrospective Studies , Septum Pellucidum , Tomography, X-Ray ComputedABSTRACT
The azygos anterior cerebral artery, a rare anomaly in the circle of Willis in which only a single vessel supplies the medial aspects of both anterior cerebral hemispheres, is closely associated with saccular aneurysms. We present three cases of azygos anterior cerebral artery aneurysms among the 781 cerebral aneurysms surgically treated at our institution in an 11-year period. These three cases all involved elderly women who presented with subarachnoid hemorrhage. Conventional cerebral angiography and CT angiography revealed small saccular aneurysms at the distal ends of the azygos anterior cerebral arteries. These aneurysms were clipped successfully using a bifrontal interhemispheric approach. Hence, the pathogenesis of these particular aneurysms relating to hemodynamic change, associated anomalies, and surgical pitfalls is discussed with review of literature.
Subject(s)
Aged , Female , Humans , Aneurysm , Angiography , Anterior Cerebral Artery , Cerebral Angiography , Cerebrum , Circle of Willis , Equipment and Supplies , Hemodynamics , Intracranial Aneurysm , Subarachnoid HemorrhageABSTRACT
The four basic mechanisms that cause chronic diarrhea are osmotic, secretory and exudative factors, and abnormal intestinal transit. A gastrointestinal fistula cause chronic diarrhea by abnormal intestinal transit, and it must be included differential diagnosis for unknown cause of chronic diarrhea. Duodenocolic fistula is an uncommon cause of chronic diarrhea. The most common cause of duodenocolic fistula is a colon cancer. Benign duodenocolic fistula is a rare disease, which the most common cause is a duodenal ulcer. Patients usually complain of diarrhea, weight loss. Physical examinations are nonspecific. Barium enema is the most useful diagnostic procedure. Prognosis is good if surgery is undertaken at an early stage. We present a case of a 66-years old man in whom a duodenocolic fistula maybe caused by recurrent microperforation of duodenal ulcer. He complained of chronic diarrhea and weight loss. He had an operation on his fistula, and remained well.
Subject(s)
Aged , Humans , Barium , Colonic Neoplasms , Diagnosis, Differential , Diarrhea , Duodenal Ulcer , Enema , Fistula , Physical Examination , Prognosis , Rare Diseases , Weight LossABSTRACT
Schwannoma of the stomach is a rare controversial neoplasm which requires extensive studies to clarify its nature as a stromal tumor or leiomyoma. We describe the pathologic, immunohistochemical, and ultrastructural characteristics of schwannoma of the stomach in a 33-year-old woman. The tumor was a well-circumscribed submucosal mass located in the posterior wall of the midbody of the stomach. Microscopically, the cells were made up of fasciculating bundles of spindle cells featured with peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse, strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. They also had a focal positive reaction to glial fibrillary acidic protein. Ultrastructurally, many tumor cells showed a number of thin, elongated and interdigitating dendritic-cell-like processes, distinctly uniformed basal laminae, frequent cellular attachments, and microfilaments. These findings support the schwannian nature of the tumor.
Subject(s)
Adult , Female , Humans , Actin Cytoskeleton , Actins , Basement Membrane , Desmin , Glial Fibrillary Acidic Protein , Leiomyoma , Lymphocytes , Muscle, Smooth , Neurilemmoma , S100 Proteins , Stomach , VimentinABSTRACT
To understand the seroepidemiological patterns of haemorrhagic fever with renal syndrome in Korea, a nation-wide survey collaborated with fourteen clinics was carried out from 1994 to 1996. Sera of 4,547 patients with acute febrile episodes were tested by indirect immunofluorescent antibody test and the seroepidemiological analysis including sex, age, seasonal and regional distributions were performed. According to the results obtained in this study, the epidemiological characteristics of haemorrhagic fever with renal syndrome in Korea were summarized as follows: 1. Seropositive rate of hemorrhagic fever with renal syndrome among the patients with acute febrile episodes was 6.4% by the cut-off point of 1:40. 2. Among the seropositives, male outnumbered female and the ratio of males to females was 2.0:1.0. 3. Seventy six % of the seropositive patients were 21-60 years old. 4. The number of seropositive cases increased from October and reached maximum in December and began to decrease gradually from January. 5. The geographical distribution of the seropositives cover most areas including Cheju province in Korea.
Subject(s)
Female , Humans , Male , Fever , Hemorrhagic Fever with Renal Syndrome , Korea , SeasonsABSTRACT
PURPOSE: To evaluate the triple-phase helical CT findings of adenomatous hyperplasia of the liver. MATERIALS AND METHODS: Forty-seven cases of adenomatous hyperplasias (size range: 8 -45 mm, mean: 14mm) in nineteen patients were confirmed by histologic examination following surgery (n=32) or gun biopsy (n=15) and formed the basis of this study. All patients underwent helical CT scanning involving the injection of 100mL nonionic contrast material at a rate of 3mL/sec. Hepatic arterial, portal venous, and equilibrium phase CT images were obtained 30, 60, and 180 seconds, respectively, after the start of contrast injection. The attenuation of each nodule (hyper-, iso-, hypo-, or mixed) was retrospectively determined and the detection rate according to lesion size (> or =14mm or or =14mm) and 76 % (16/21) in the large size group(< 14mm). This rate was thus significantly higher in the large size group than in that in which lesions were small. CONCLUSION: Triple -phase helical CT revealed that in cases of adenomatous hyperplasia, attenuation was variable,with iso-attenuation the most frequent type. Seventy-six percent of nodules larger than 14 mm were detected. Adenomatous hyperplasia may be seen during the hepatic arterial phase as a hyper-attenuated nodule.
Subject(s)
Humans , Biopsy , Hyperplasia , Liver , Retrospective Studies , Tomography, Spiral ComputedABSTRACT
In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining then based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC+ program. The results of this study are summarized as follows; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue(80.6%). 2) Main therapies for the terminal cancer patients were pain control(58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device(11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patents. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.
Subject(s)
Humans , Caregivers , Emergencies , Health Occupations , Home Care Services , Hope , Hospice Care , Internal Medicine , Mass Media , Medical Records , Medical Staff , Nuclear Family , Nurses, Community Health , Nursing Services , Nursing Staff , Nursing , Outpatients , Oxygen , Quality of Life , Surveys and Questionnaires , Seoul , TransportationABSTRACT
Osteogenesis imperfecta is a relatively rare genetic condition of breakable bones with an incidence of 1 per 20,000~60,000. The clinical, genetic, and biochemical heterogeneity in osteogenesis imperfecta allows to least four subtypes to be distinguished. Prenatal diagnosis of osteogenesis imperfecta type II have been reported several times with ultrasonography. We recently experienced a case of osteogenesis imperfecta diagnosed in uterus by ultrasonogram and confirmed after termination and autopsy. We report here with a brief review of the literature.
Subject(s)
Autopsy , Incidence , Osteogenesis Imperfecta , Osteogenesis , Population Characteristics , Prenatal Diagnosis , Ultrasonography , UterusABSTRACT
BACKGROUND: Anesthesiologists should understand the physiology of intraocular pressure and the implications of anesthetic drugs and maneuvers on intraocular pressure(IOP). Although most anesthetics reduce IOP, succinylcholine causes a transient but significant increase in IOP. And thiopental by itself does not prevent to increase blood pressure, IOP. This study was designed to evaluate the preventive effect of propofol on IOP changes during tracheal intubation. METHODS: IOP was measured with a hand-held applanation tonometer in the eye. Baseline(control) IOP was measured before the induction of anesthesia(stage 1) and serial measurements of IOP were made after administration of the induction agent before intubation(stage 2), immediately after intubation(stage 3) and 10 minutes after intubation(stage 4). Heart rate and systolic blood pressure were recorded simultaneously. According to induction agent and neuromuscular blocker, the 60 patients were divided into control group(C; thiopental, succinylcholine), pretreatment group(T) using defasciculation dose of vecuronium bromide, propofol group(P; propofol, succinylcholine) and vecuronium group(V; propofol, vecuronium bromide). RESULTS: Administration of either propofol or thiopenal resulted in a significant reduction in IOP(P<0.01). At stage 2, IOP of gpoup P and V were significantly lower than that of group C(P<0.05). At stage 3, IOP increased significantly compared to the values of stage 1 in all group(P<0.01). At stage 4, IOP decreased significantly compared to the values of stage 1 in all group(P<0.01), but there was no significant difference between groups in IOP at stage 4. CONCLUSIONS: Propofol may be a useful induction agent of general anesthesia for opthalmic surgery, but cannot prevent to increase IOP during endotracheal intubation.