Regeneration of emergence profile with soft tissue graft and wide computer aided design/computer aided mamufacturing abutments: a clinical report

Fixed restoration using implants for patients with posterior partial edentulism is generalized technique. As patient demands increase, the functional and esthetic implant restoration to achieve similar results to lost natural teeth is becoming an important issue. It is inevitable to use customized CAD/CAM abutments rather than ready-made abutments for the creation of implant prosthesis which closely resembles natural teeth. Using CAD/CAM abutment made it possible to obtain natural emergency profiles for posterior implant prostheses, ensuring more comfortable, efficient management of oral hygiene. However, keratinized gingiva with sufficient width and height for a natural emergence profile is required to use a large diameter CAD/CAM abutment which ensures stability and esthetics of hard/soft tissue around the implants. In this case, for esthetical and functional implant zirconia prosthesis, soft tissue graft was performed and customized CAD/CAM abutments were used following ridge augmentation, sinus graft and implantation. Satisfactory results were obtained functionally and esthetically through periodic clinical evaluation, and I hereby report this case.

Evaluation of shear-bond strength between different self-adhesive resin cements with phosphate monomer and zirconia ceramic before and after thermocycling / 대한치과보철학회지

PURPOSE: This study compared shear bond strengths of five self-adhesive cements with phosphate monomer to zirconium oxide ceramic with and without airborn particle abrasion. MATERIALS AND METHODS: One hundred zirconia samples were air-abraded (50 microm Al2O3). One hundred composite resin cylinders were fabricated. Composite cylinders were bonded to the zirconia samples with either Permacem 2.0 (P), Clearfil(TM) SA Luting (C), Multilink(R) Speed (M), RelyX(TM) U200 Automix (R), G-Cem LinkAce(TM) (G). All bonded specimens were stored in distilled water (37degrees C) for 24 h and half of them were additionally aged by thermocycling (5degrees C, 55degrees C, 5,000 times). The bonded specimens were loaded in shear force until fracture (1 mm/min) by using Universal Testing Machine (Model 4201, Instron Co, Canton, MA, USA). The failure sites were inspected under field-emission scanning electron microscopy. The data was analyzed with ANOVA, Tukey HSD post-hoc test and paired samples t-test (alpha=.05). RESULTS: Before and after thermocycling, Multilink(R) Speed (M) revealed higher shear-bond strength than the other cements. G-Cem LinkAce(TM) (G) showed significantly lower bond strengths after thermocycling than before treatment (P.05). CONCLUSION: Most self-adhesive cements with phosphate monomer showed high shear bond strength with zirconia ceramic and weren't influenced by thermocycling, so they seem to valuable to zirconia ceramic bonding.

Risk Factors and Biomarkers of Ischemic Stroke in Cancer Patients / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. METHODS: A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for stroke and stroke subtypes in cancer patients were compared with age- and sex-matched noncancer patients with ischemic stroke who were admitted to the same hospital during the same period. RESULTS: One hundred fifty-six cancer patients with ischemic stroke were identified. Cancer patients with ischemic stroke were found to have a significantly lower proportion of hypertension, atrial fibrillation, hyperlipidemia, and ischemic heart disease than noncancer patients with ischemic stroke. However, stroke biomarkers, such as erythrocyte sedimentation rate and high-sensitivity C-reactive protein, fibrinogen, pro-brain natriuretic peptide, and D-dimer levels, were significantly increased in cancer patients with ischemic stroke than in noncancer patients. Large-artery atherosclerosis and stroke of undetermined cause were more common in cancer patients with ischemic stroke than in noncancer patients with ischemic stroke. CONCLUSIONS: Cancer patients with ischemic stroke showed different risk factors, stroke biomarkers, and stroke etiology compared with noncancer patients with ischemic stroke.

Effect of erbium-doped: yttrium, aluminium and garnet laser irradiation on the surface microstructure and roughness of sand-blasted, large grit, acid-etched implants

PURPOSE: The present study was performed to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on sand-blasted, large grit, acid-etched (SLA) implant surface microstructure according to varying energy levels and application times of the laser. METHODS: The implant surface was irradiated by the Er:YAG laser under combined conditions of 100, 140, or 180 mJ/pulse and an application time of 1 minute, 1.5 minutes, or 2 minutes. Scanning electron microscopy (SEM) was used to examine the surface roughness of the specimens. RESULTS: All experimental conditions of Er:YAG laser irradiation, except the power setting of 100 mJ/pulse for 1 minute and 1.5 minutes, led to an alteration in the implant surface. SEM evaluation showed a decrease in the surface roughness of the implants. However, the difference was not statistically significant. Alterations of implant surfaces included meltdown and flattening. More extensive alterations were present with increasing laser energy and application time. CONCLUSIONS: To ensure no damage to their surfaces, it is recommended that SLA implants be irradiated with an Er:YAG laser below 100 mJ/pulse and 1.5 minutes for detoxifying the implant surfaces.

Cauda Equina Syndrome due to Epidural Hematoma After Lumbar Epidural Block : A Case Report / 대한척추외과학회지

Cauda equina syndrome after epidural block is a rare complication, but it requires emergency surgery when it is diagnosed. A 65-year-old man who underwent epidural block at a local clinic was admitted with right lower leg weakness and decreased leg sensation, severe lower radiating pain, dysuria and decreasing sensation in the perianal region. Magnetic resonance image showed protruded disc material between L4-L5 and a hematoma that occupied most of the spinal canal and this was compressing the spinal cord. These findings were diagnostic for cauda equina syndrome after epidural block and so laminectomy, excision of the herniated disc and removal of the hematoma were done. At 6 months follow-up, the neurologic symptoms were resolved except for the dorsiflextion of the ankle and the big toe. We report here on a case of cauda equina syndrome as a rare complication after epidural anesthesia.

Retroauricular Dermoid Cyst

Dermoid cyst is a teratoma that contains developmentally mature skin, with hair follicles, sweat glands and so on. Dermoid cyst is painless oval or round shaped cystic mass that can make the bony depression after complete excision. Dermoid cyst is commonly found on lateral brow, nasofrontal area, subglottic area. But, we report two cases of dermoid cyst on retroauricular area. A 27 year-old male patient wanted to excise the retroauricular mass. Computed tomography showed that the mass looked like a dermoid cyst without connection to cranial cavity. So, we could completely excise the mass. The other 29 year-old male patient show the infected cystic mass on retroauricular area. We could completely excised the mass. After the excision of the mass, pathologist reported these are dermoid cysts. Retroauricular dermoid cysts have been rarely reported. But, we can suspect the retroauricular dermoid cyst originated in squamomastoid suture through the patient's history, physical and radiologic examination.

A Case of Basal Cell Carcinoma Arising in Nevus Sebaceous on Scalp

PURPOSE: Nevus sebaceous is a distinctive growth commonly found on the scalp, forehead and retroauricular region. Nevus sebaceous has age-related changes in morphologic and histologic appearance. Secondary neoplasm including basal cell carcinoma is found in 20% of the nevus sebaceous which were not treated properly. So, we report a case of basal cell carcinoma that is arising in nevus sebaceous but has no malignant appearance. METHODS: A 38 year-old female patient wanted to excise the lesion on scalp. It looked like typical nevus sebaceous because we didn't find any malignant appearances. We excised the lesion including minimal normal tissue. RESULTS: After the excision of the lesion, pathologist reported the nevus sebaceous with multifocal basal cell carcinoma. CONCLUSION: Many patients want to excise the nevus sebaceous that stands out to other people. But they don't know the potency of malignant changes. So, plastic surgeons have to notify the potency and make plan for proper treatment.

The Therapeutic Effect of Inhibitory Repetitive Transcranial Magnetic Stimulation on Right Inferior Frontal Gyrus in Subcortical Aphasia

OBJECTIVE: To investigate whether suppression of right inferior frontal gyrus (Broca's homologue) by 1 Hz repetitive transcranial magnetic stimulation (rTMS) can improve speech recovery. METHOD: We applied low frequency rTMS on right Broca's homologue twice a week for 6 weeks in eight subcortical aphasia patients who were 3 months to 3 years poststroke onset. They were tested with Korean Version-Western Aphasia Battery before and after procedure. Also, they were tested with Parallel Short Forms for the Korean-BostonNaming Test and Animal Naming Test serially for outcome measure. rTMS was performed with intensity of 80% of motor threshold for 10 min (600 pulses) at 1 Hz frequency. RESULTS: Significant improvement was observed in picture naming at post-rTMS only in nonfluent aphasia patients but not in fluent aphasia patients. CONCLUSION: rTMS may provide a novel treatment for aphasia by possibly modulating the distributed, bi-hemispheric language network.

A case of multicystic dysplastic kidney and cystic adenomatoid malformation of the lung identified as incidental findings / 소아과

Multicystic dysplastic kidney and congenital cystic adenomatoid malformation of the lung are independent disorders, but both result from abnormal morphogenesis during embryogenesis. Congenital cystic adenomatoid malformation of the lung is associated with renal anomalies as well as other extrapulmonary anomalies and almost all cases with these anomalies are stillborn. We report a case of a 21-month-old male who was admitted with the impression of acute infectious gastroenteritis; multicystic dysplastic kidney with congenital cystic adenomatoid malformation of the lung was detected incidentally during evaluation.

Terson's Syndrome : A case report

Terson's syndrome is one of the cerebro-ocular syndrome which entails the findings due to intraocular hemorrhage in association with increased intracranial pressure following subarachnoid hemorrhage. We reported a patient suffering from total blindness after basal ganglia hemorrhage, who was diagnosed as Terson's syndrome and vitrectomy was done. Our patient recovered normal visual acuity after vitrectomy, which fascilitated rehabilitative process. We also performed diffusion tensor tractography to investigate abnormalities of brain related to the visual dysfunction, which revealed decreased orientation and integrity of the right optic radiation. It is important to diagnose Terson's syndrome early because it is one of the cerebro-ocular syndrome which needs early intervention with consideration of the integrity of optic pathway.

A Case of Syndrome of Inappropriate Antidiuretic Hormone Secretion and Pneumomediastinum Complicated by Bougienation in Malignant Esophageal Stricture / 대한소화기내시경학회지

Bougienation is generally an effective method providing temporary relief of obstruction to facilitate stent insertion in patients with malignant esophageal stricture. The complicated by after bougienation such as esophageal perforation, mediastinitis, bronchoesophageal fistula, pneumomediastinum, pneumothorax were reported. However, syndrome of inappropriate antidiuretic hormone secretion (SIADH) complicated by bougienation has rarely been reported. Thus, we report a case of SIADH and pneumomediastinum complicated by bougienation in a patient with malignant esophageal stricture.

A Case of Epoxy Resin Induced Thermal Injury in Upper Gastrointestinal Tract / 대한소화기내시경학회지

Epoxy resins has been used as a adhesive material in industry. Toxic effects for epoxy resin are known as respiratory, dermatologic, ophthalmologic and allergic symptoms. Ingestion of epoxy resin has been known to induce moderate toxic effect, but reports are very rare. Toxic injury due to ingestion in gastrointestinal tract is usually caused by suicidal attempt or incidental ingestion in young ages and alcoholics. Herein, we report a case of diffuse mucosal injury in upper gastrointestinal tract caused by thermal injury from epoxy resin with a review of relevant literatures.

Endoscopic Treatment of Esophageal Foreign Bodies in Adult: Management of 257 Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: The majority of foreign body ingestions occur in pediatric population. We assessed the characteristics and endoscopic treatment outcome of esophageal foreign bodies in adults. METHODS: Medical records of consecutive 257 patients who received trial of endoscopic treatment for esophageal foreign bodies, from January 1998 through November 2003 in Gyeongsang National University Hospital, were analyzed retrospectively. RESULT: Among 257 cases, 132 were male. The incidence was highest in 5th decade, and mean age was 54.6 years. Most common location was upper esophagus (84.6%). Accidental ingestion accounted for 92.2%. Twenty cases (7.8%) of voluntary ingestion were all prisoners or in psychiatric problems. Fish bone was the most common type. Endoscopic treatment was successful in 253 cases (98.4%) and 4 were managed with rigid esophagoscopy. Four cases who complicated by acute mediastinitis or pneumomediastinum at presentation had sharp-pointed or long objects lodged in upper esophagus, and almost presented at 48 hours after the ingestion. Full esophagogastroduodenoscopy could find 37 organic lesions in 35 cases. CONCLUSIONS: Majority of esophageal foreign bodies in adults developed accidentally during meals. Voluntary ingestion of foreign bodies was not related to meals, and developed by prisoners or psychiatric patients. The sharp-pointed or long objects lodged in upper esophagus with delayed presentation may cause complication. Endoscopic treatment is safe and beneficial, and a full endoscopic evaluation should be recommended for the evaluation of a synchronous organic disease.

The Clinical Study on Spontaneously Ruptured Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.

A Case of Solitary Gastric Neurofibroma Presenting as Hematemesis and Melena / 대한소화기내시경학회지

Gastric neurofibroma is rare and its exact incidence is unknown. We experienced a case of solitary gastric neurofibroma. A 49-year-old woman was admitted because of hematemesis and melena. Neither cafe-au-lait spots in skin nor superficial tumor were found. Gastrofibroscopic examination and UGI series showed a 3 * 4 cm sized luminal protruding mass with adjacent bridging mucosal fold and cental ulceration on the anterior wall of lower body. Mass excision was performed. Grossly, the mass was 4.5 * 3.0 * 2.0 cm sized, well circumscribed submucosal tumor with homogenous cut surface, Microscopically, each of the tumor cells had oval shaped nucleus and spindle shaped cytoplasm. Nuclear atypism and frequent mitosis were not observed. We report a rare case of solitary gastric neurofibroma with review of the literatures.