Targeted presurgical decompensation in patients with yaw-dependent facial asymmetry / 대한치과교정학회지

Facial asymmetry can be classified into the rolling-dominant type (R-type), translation-dominant type (T-type), yawing-dominant type (Y-type), and atypical type (A-type) based on the distorted skeletal components that cause canting, translation, and yawing of the maxilla and/or mandible. Each facial asymmetry type represents dentoalveolar compensations in three dimensions that correspond to the main skeletal discrepancies. To obtain sufficient surgical correction, it is necessary to analyze the main skeletal discrepancies contributing to the facial asymmetry and then the skeletal-dental relationships in the maxilla and mandible separately. Particularly in cases of facial asymmetry accompanied by mandibular yawing, it is not simple to establish pre-surgical goals of tooth movement since chin deviation and posterior gonial prominence can be either aggravated or compromised according to the direction of mandibular yawing. Thus, strategic dentoalveolar decompensations targeting the real basal skeletal discrepancies should be performed during presurgical orthodontic treatment to allow for sufficient skeletal correction with stability. In this report, we document targeted decompensation of two asymmetry patients focusing on more complicated yaw-dependent types than others: Y-type and A-type. This may suggest a clinical guideline on the targeted decompensation in patient with different types of facial asymmetries.

Amyotrophic lateral sclerosis diagnosed after lumbar epidural block for treating low back pain: Two cases report

Lumbar epidural block is one of effective methods for treating low back pain with or without radiculopathy. However, neurologic complications can occur after epidural block due to several causes such as direct nerve injury or epidural hematoma. It is important to determine whether the neurologic complication is related to the procedure or is due to the underlying neurologic disease. We report two cases of patients who complained of weakness in their lower extremities after receiving a lumbar epidural block; they were ultimately diagnosed with amyotrophic lateral sclerosis.

Paraplegia Following Intercostal Nerve Neurolysis with Alcohol and Thoracic Epidural Injection in Lung Cancer Patient

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and 11th intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

Subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and pneumoperitoneum secondary to colonic perforation during colonoscopy / 대한마취과학회지

No abstract available.

Subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and pneumoperitoneum secondary to colonic perforation during colonoscopy / 대한마취과학회지

No abstract available.

Preliminary three-dimensional analysis of tooth movement and arch dimension change of the maxillary dentition in Class II division 1 malocclusion treated with first premolar extraction: conventional anchorage vs. mini-implant anchorage / 대한치과교정학회지

OBJECTIVE: This study aimed to compare the effects of conventional and orthodontic mini-implant (OMI) anchorage on tooth movement and arch-dimension changes in the maxillary dentition in Class II division 1 (CII div.1) patients. METHODS: CII div.1 patients treated with extraction of the maxillary first and mandibular second premolars and sliding mechanics were allotted to conventional anchorage group (CA, n = 12) or OMI anchorage group (OA, n = 12). Pre- and post-treatment three-dimensional virtual maxillary models were superimposed using the best-fit method. Linear, angular, and arch-dimension variables were measured with software program. Mann-Whitney U-test and Wilcoxon signed-rank test were performed for statistical analysis. RESULTS: Compared to the CA group, the OMI group showed more backward movement of the maxillary central and lateral incisors and canine (MXCI, MXLI, MXC, respectively; 1.6 mm, p < 0.001; 0.9 mm, p < 0.05; 1.2 mm, p < 0.001); more intrusion of the MXCI and MXC (1.3 mm, 0.5 mm, all p < 0.01); less forward movement of the maxillary second premolar, first, and second molars (MXP2, MXM1, MXM2, respectively; all 1.0 mm, all p < 0.05); less contraction of the MXP2 and MXM1 (0.7 mm, p < 0.05; 0.9 mm, p < 0.001); less mesial-in rotation of the MXM1 and MXM2 (2.6degrees, 2.5degrees, all p < 0.05); and less decrease of the inter-MXP2, MXM1, and MXM2 widths (1.8 mm, 1.5 mm, 2.0 mm, all p < 0.05). CONCLUSIONS: In treatment of CII div.1 malocclusion, OA provided better anchorage and less arch-dimension change in the maxillary posterior teeth than CA during en-masse retraction of the maxillary anterior teeth.

Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy: A case report / 대한마취과학회지

We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period.

Aloe-induced Toxic Hepatitis

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.

A case of congenital adrenal hyperplasia presenting as adrenal incidentaloma / 대한내과학회지

Congenital adrenal hyperplasia, an autosomal recessive disorder resulting from an enzymatic defect during cortisol biosynthesis (i.e., 21-hydroxylase deficiency), is characterized by impaired production of cortisol with or without impaired production of aldosterone, chronic stimulation of the adrenal cortex by corticotropin, and overproduction of cortisol precursors and androgens. The severity of the hormonal abnormalities and clinical symptoms depend on the degree of enzymatic activity. Phenotypes are classified into the following types: the severe salt-wasting type, the simple virilizing type, and the non-classic type. Despite adequate treatment, patients may be at risk for salt-wasting adrenal crisis, precocious puberty, short stature, infertility, psychosocial problems, and tumor formation, including adrenal incidentaloma. Here we present a case of adrenal incidentaloma in a 14-year-old boy who was eventually diagnosed with congenital adrenal hyperplasia due to a 21-hydroxylase deficiency. The patient had a history of salt-wasting adrenal crisis, but survived without continuous glucocorticoid and mineralocorticoid treatment. Note also that both plasma aldosterone and plasma renin activity were elevated in this case.

Catastrophic antiphospholipid syndrome presenting with disseminated intravascular coagulation, cerebral infarction, and acute respiratory distress syndrome / 대한내과학회지

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial or venous thrombosis and recurrent fetal loss accompanied by elevated titers of antiphospholipid antibodies. Catastrophic APS is a small subset of APS, characterized by widespread systemic thrombotic disease with multiorgan failure. The diagnosis of catastrophic APS may be difficult, predominantly due to its frequently atypical presentation. In the present work, we describe a case of a 68-year-old male who presented with cerebral infarction, disseminated intravascular coagulation (DIC), and acute respiratory distress syndrome. The patient was successfully treated with anticoagulants, antibiotics, and steroid therapy. Physicians should be aware of the possibility of this syndrome as a cause of DIC with thrombotic disease because prompt recognition is essential for effective treatment.

Catastrophic antiphospholipid syndrome presenting with disseminated intravascular coagulation, cerebral infarction, and acute respiratory distress syndrome / 대한내과학회지

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by a combination of arterial or venous thrombosis and recurrent fetal loss accompanied by elevated titers of antiphospholipid antibodies. Catastrophic APS is a small subset of APS, characterized by widespread systemic thrombotic disease with multiorgan failure. The diagnosis of catastrophic APS may be difficult, predominantly due to its frequently atypical presentation. In the present work, we describe a case of a 68-year-old male who presented with cerebral infarction, disseminated intravascular coagulation (DIC), and acute respiratory distress syndrome. The patient was successfully treated with anticoagulants, antibiotics, and steroid therapy. Physicians should be aware of the possibility of this syndrome as a cause of DIC with thrombotic disease because prompt recognition is essential for effective treatment.

A case of fulminant hepatic failure due to cyproterone acetate in a patient with cryptogenic liver cirrhosis / 대한내과학회지

Cyproterone acetate is an antiandrogenic drug that has been used in prostatic cancer. The drug is thought to be well-tolerated but has hepatotoxic effects. An 89 year-old man treated with cyproterone acetate 300 mg/d for prostatic cancer presented with a hepatotoxic reaction. Toxic hepatitis was diagnosed and cyproterone acetate was stopped immediately. The patient was treated with supportive management and a corticosteroid, but he died 28 days after administration due to liver failure. A liver biopsy performed after his death revealed the presence of acute hepatitis with cirrhosis. Underlying cirrhosis was not suspected before his death. Ultimately, the case was diagnosed as fulminant hepatic failure due to cyproterone acetate with underlying cryptogenic liver cirrhosis. This case and current literature highlight the hepatotoxic potential of cyproterone acetate and illustrate the importance of clinical surveillance, especially in patients with unrecognized liver disease.

A Case of Granulomatous Liver Disease Combined with Crohn's Disease / 대한소화기내시경학회지

Crohn's disease is a chronic intestinal inflammation and its etiology and pathogenesis have not been defined. Clinical manifestations of Crohn's disease involve abdominal pain, diarrhea, weight loss, intestinal stenosis, presence of fistulas and gastrointestinal hemorrhage. Crohn's disease is also associated with a variety of extraintestinal manifestations such as ankylosing spondylitis, uveitis and primary sclerosing cholangitis. We report a case of Crohn's disease associated with noncaseating granulomatous liver disease that is rare in Korea.

A Case of Gastric Schwannoma in a Male Patient / 대한소화기내시경학회지

Gastric schwannoma that originates from nerve sheath comprises about 0.2% of all gastric tumors and 4% of all benign gastric tumors. It is difficult to precisely diagnose gastric schwannoma via endoscopic biopsy or imaging studies. A 57-year-old male was referred to our hospital from a private clinic for further evaluation of a gastric tumor-mass that was diagnosed by gastroscopy. Gastroscopy and endoscopic ultrasonography showed a submucosal mass larger than 3 cm in size at the low body of the stomach. That the mass had malignant potential could not be excluded because of its size and shape. The patient underwent subtotal gastrectomy. The tumor cells showed immunoreactivity to S-100 protein. This submucosal tumor was diagnosed as a gastric schwannoma on the basis of these findings. Gastric schwannoma is known to occur more frequently in females than males. This is the first reported case of gastric schwannoma that's occurred in a Korean male patient.

A Case of Multiple Cystic Brunner's Gland Hyperplasia / 대한소화기내시경학회지

Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics.

Three Cases of Santorinicele without Pancreas Divisum / 대한소화기내시경학회지

Santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla. It is unclear whether a santorinicele is congenital or an acquired lesion secondary to relative obstruction and a weakness of the distal dorsal duct wall. Because almost all santorinicele reported to date have been associated with pancreas divisum, it has been assumed that santorinicele is related to the obstruction of pancreatic outflow and resultant pancreatitis that occurs in the pancreas divisum. We describe three cases of santorinicele without pancreatic divisum which were identified incidentally.

A Case of Mantle Cell Lymphoma with Feature of Colitis Involving Duodenum and Colon / 대한소화기내시경학회지

Mantle cell lymphoma (MCL) of the gastrointestinal tract is a rare form of primary gastrointestinal lymphoma. MCL of the gastrointestinal tract can involve the stomach, small intestine or colon. The major subtype of MCL is characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. So multiple lymphomatous polyposis (MLP) has been considered as a variant form of MCL. The diagnosis of high-grade variants of MCL is a particular challenge, as these tumors exhibit a broad spectrum of morphologic findings that can be misinterpreted as other type of NHL. The development of immunohistochemical and molecular assays for MCL has allowed more accurate diagnosis of cases. We report a case of MCL with feature of colits involving duodenum, colon and rectum observed in a 60-year-old man who complained of low abdominal discomfort.

A Case of Ischemic Colitis with Deep Vein Thrombosis and Patent Foramen Ovale / 대한소화기내시경학회지

Colonic ischemia is the most prevalent form of gastrointestinal ischemia and causes 3~9% of all acute lower intestinal bleeding. Most common cause is known to be cardiac embolus. A 67-year-old female patient presented with rectal bleeding. The patient had cerebral infarction 15 days ago. A colonoscopy showed a large ulcer with hemorrhage in the rectum. Computed tomography showed deep vein thrombosis from the left popliteal vein to infrarenal inferior vena cava. Transthoracic echocardiography was carried out, but no abnormal feature was found. Then, transesophageal echocardiography, with agitated saline contrast to find out a right to left shunt, was performed, patent foramen ovale was found. This patient was treated with anticoagulation and inferior vena cava filtering. We suggest this ischemic colitis may be due to arterial embolization from deep vein thrombosis through PFO.

Idiopathic Necrotizing Fasciitis in the Chest Wall: A case report / 대한흉부외과학회지

Necrotizing fasciitis, an uncommon, often fulminant bacterial infection, rarely originates in the chest wall. Although it can occur in any region of the body, the abdominal wall, perineum, and extremities are the most common sites of infection. It is characterized by wide spread fascial necrosis with relative sparing of skin and underlying muscle. Diagnosis is often extremely difficult and relies on a high index of suspicion. Prompt surgical intervention is essential. We experienced a patient with idiopathic necrotizing fasciitis in the chest wall and reported with brief review of literature.

Regional load deflection rate of multiloop edgewise archwire / 대한치과교정학회지

This study was conducted in order to analyze the mechanical characteristics of multiloop edgewise archwire(MEAW). The purposes were 1) to compare load deflection rate(LDR) of MEAW with that of various other archwires in the individual interbracket span, 2)to compare the wire stiffness in the interbracket span with that in the multi-L-loop region (the span from distal border of the bracket of the lateral incisor to the mesial border of the buccal tube of second molar), and 3) to verify the experimental results with theoretically derived formula. The single L-loops five different horizontal lengths and multi-L-loops for the upper and lower arches were made out of .016 X .022 permachrome stainless steel wire. Straight segment of plain stainless steel, TMA and NiTi wire of the same dimension were prepared. The LDR was measured using Instron model 4466 with the load cell of 50N capacity at cross head speed of 1.0mm/min, and maximum deflection of 1.0mm. Five specimens were tested under each experimental condition. The wire stiffness number for each interbracket region and multi-L-loop region was calculated from the LDR and the interbracket spans. By dividing the theoretical model of multi-L-loop into 35 linear segments, the energy stored in each segment was obtained. Then the LDR and wire stiffness of single L-loop and multi-L-loop were calculated and compared. The findings were as follows : 1) The average LDR of MEAW in the individual interbracket region was 1/1.53 of that of the NiTi, 1/247 of TMA and 1/5.16 of the plain stainless steel wire. 2) The wire stiffness of MEAW in the multi-L-loop region was 1.53 times larger than that in the interbracket region, and the LDR was almost twice as large as that of NiTi in that region. 3) According to the theoretically derived equation, the wire stiffness of the single L-loop was lower than that of multi-L-loop. The results of this study suggest that MEAW has the unique mechanical property which could allow individual tooth movement and transmit elastic force effectively through the entire arch wire.