Two Cases of Post Traumatic Cerebral Infarction in Head Injury

We present cases of post traumatic infarction after head injury. Two patients were admitted to our emergency room after traffic accidents. They developed neurological deficiency after a few hours to days after the accidents. In both cases, an initial computed tomography scan of the head was normal. A follow-up computed tomography obtained later revealed a hypodense lesion at cerebral hemisphere and a diffusion-weighted magnetic resonance imaging disclosed an area of infarction. The patients were conservatively medicated. One patient died due to a medical complication and the other patient fully recovered in several weeks. Hospital admission, careful observation and early diffusion-weighted magnetic resonance examination should be considered for patients with persistent neurological deficits.

A Study on the Effect of the Depressive Disorder in Suicidal Attempt Aspect

PURPOSE: The number of suicide attempts has increased in Korea. Depressive disorders are a major cause. This study investigated the clinical characteristics and outcomes of attempted suicide victims who had been admitted to the emergency department based on a psychiatric disorder. METHODS: We performed a retrospective analysis of 168 suicide attempters who visited the Chosun University hospital emergency medical center between June 1st, 2007 and May 31st, 2008. From chart reviews, we divided the victims into three groups by psychiatric histories, especially depressive disorder. We analyzed the effect of various factors including age, sex, previous suicide attempts outcome of suicide attempts. We used Pearson's chi-square test to chart the statistical data. RESULTS: Depressive patients had significantly more suicide attempts than other psychiatric patients and more than those who had no psychiatric history. Repeated attempts were also more frequent in depressive patients (64%). Sixty percent of depressive patients were admitted into our hospital or local clinic and eight percent of depressive suicide attempters died. Compared to other national statistics, there were fewer persons who consulted with a psychiatrist, but depressive patients had more interviews with psychiatrists (62.9%) than did the other groups. CONCLUSION: Even if the depressive disorder patient group shows a high recurrence rate, it also shows a high psychiatric interview acceptance rate and a relatively low rank on physical and psychiatric severity. Therefore, it is possible to prevent the recurrence of suicide attempts for the depressive group and to reduce the fatality rate. This can be done through on-going educational opportunities and psychiatric interviews. The rate of psychiatric consultations in Korea are significantly lower than in other countries. This situation requires more active psychiatric consultations and interviews later on.

A Study on Organophosphate Poisoning Patients: Comparison of the Survivor Group and Dead Group

PURPOSE: Organophosphate insecticide poisoning is common in Korea, but there is no definitive guideline for determining the severity of the poisoning and the predictive factors. Therefore, we evaluated the organophosphate poisoned patients and we divided them into two groups, the survivors and the dead, and the results might be useful for treating organophosphate poisoning patients. METHODS: We performed a retrospective analysis of 68 organophosphate poisoned patients who visited the Chosun University Hospital Emergency Medical Center during a 24-month period from January, 2007 to December, 2008. We made a work sheet of the patients' characteristics and the collected data was analyzed and we compared this data between the survivor group and the dead patient group. RESULTS: There were significant differences between the survivor group and the dead patient group for the mean age, the alcohol intake state and the typically expressed signs. The dead patients had lower blood pressure, tachycardia and a lower Glasgo Coma Score (GCS) score than the survivor group. On the arterial blood gas analysis, the dead patients had more severe acidemia and they had lower saturations. Increased serum amylase levels were found in the dead patients. The survivors' initial and follow up serum pseudocholinesterase activity (after 6~8 days) was significantly higher than that of the dead group. The total amount of atropine injected to patient was less in the survivors than that in the dead patients. CONCLUSION: Old age and expressing the typical intoxication signs, a lower GCS score and blood pressure, showing acidosis on the gas analysis and low serum cholinesterase activity may be useful as poor prognostic indicators for patients with organophosphate poisoning. We suggest that physicians must pay careful attention to the signs and prognostic factors of organophosphate insecticide poisoned patients.

The anxiety in patients undergoing third molar extraction

The purpose of this study is to understand anxiety in patients undergoing third molar extraction and care patients of third molar extraction. The subjects in the study were Sixty-three patients who visited the department of dentistry at Pusan Paik Hospital from May 2006 to September 2006 and who underwent third molar extraction. Patients' anxiety(state anxiety and trait anxiety) to use Spielberger's state-trait anxiety inventory(STAI) were measured. They were asked to fill out STAI question paper immediately before third molar extraction(pre-extraction) and on the day after the extraction(post-extraction). And visual analog scale(VAS) to measure patient's postoperative pain on the day after extraction(postextraction day) was used. Then Differences in anxiety before and after extraction, between men and women, between the first and second extraction, with impacted versus nonimpacted third molar extraction, between extraction time and anxiety, and between postoperative pain and anxiety were evaluated. The anxiety status of patients undergoing third molar extraction could be quantitatively evaluated using the STAI-KYZ. There were significant difference before and after third molar extraction. Especially women and patients of more severe postoperative pain was more anxious. We need to alleviate patient's anxiety(especially women) and to control postoperative pain throughout the tooth removal process.

Availability of autologous transfusion in bilateral sagittal split ramus osteotomy for mandibular prognathism

OBJECTIVE: Autologous transfusion is frequently used with orthognathic surgery. The necessity of autologous transfusion has begun to question alone in bilateral sagittal split ramus osteotomy. The aim of this study was to evaluate the availability of autologous transfusion. METHODS: The chart reviews of sixty patients who had undergone bilateral sagittal ramus osteotomy were done. The subjects were divided into two groups : In experimental group, 30 patients who autodonated 320ml in the preoperative 3 weeks actually received a transfusion in the postoperative 6 hours were included. In control group, 30 patients who underwent the same operation without preoperative donation and any other transfusion were included. Hemoglobin, hematocrit, and changes of these values in both groups were evaluated. RESULTS: 1. From postoperative 3 hours to postoperative 1 day, the increases of hemoglobin(0.8g/dL in experimental group, 0.2g/dL in control group) and hematocrit(0.3% in experimental group, 0.6% in control group) were not statistically significant between both groups. 2. From postoperative 1 day to postoperative 1 week, the increase of hemoglobin(0.6g/dL in experimental group, 0.3g/dL in control group) was not statistically significant between both groups. But the increase of hematocrit(2.5% in experimental group, 1.0% in control group) was statistically significant between both groups over the same period(hematocrit p=0.043). 3. On postoperative 1 week, the values of hemoglobin(12.3% in both groups) and hematocrit(35.6% in experimental group, 36.8% in control group) were not statistically significant between both groups. CONCLUSION : The autologous transfusion in surgery of just a little blood loss was not effective. The most results show that there is little availability of autologous transfusion according to changes of hemoglobin and hematocrit in bilateral sagittal split ramus osteotomy.

Osteoradionecrosis on mandible: A case report and literature review

The osteoradionecrosis of the mandible can be a serious complication of radiotherapy for malignancies of the head and neck. The cause and pathogenesis of osteoradionecrosis are unclear and anecdotal. There are various treatment-, patient- and tumor-related risk factors on development of osteoradionecrosis. The treatment of osteoradionecrosis relies on conservative measures (antibiotics, debridement, irrigation and HBO) and surgical measures (sequestrectomy, marginal resection and segmental resection with or without reconstruction). But the indications are not defined. We present the two cases of patients who were not controlled by conservative treatment but good-resulted by surgical treatment.

Expression of cytokeratin subtypes and vimentin in ameloblastoma

Ameloblastoma is the most common odontogenic tumor of the jawbones, but the origin of this tumor has been remained to be unproven. Cytokeratins (CKs) are specific intermediate filament of epithelial cells, and vimentin is expressed in mesenchymal cells. The immunohistochemical detection of different CKs and vimentin has made it easier to know the origin of tumor. Paraffin-embedded tissue sections from 15 ameloblastomas and 1 ameloblastic carcinoma were used for immunohistochemical evaluation of CK 7, 8, 13, 14, 19 and vimentin. Their expression is evaluated in different tumor cells, which are observed in different type of tumors. In the follicular and reticular subtype, central stellate cells of tumor nests expressed CK 8, 14, 19 and peripheral columnar cells expressed CK 14. CK 7, and 13 were not expressed. Vimentin was detected in fibrous stroma around tumor nest, not in tumor cells. The tumor cells of ameloblastic carcinoma expressed CK 7, 14 and 19, but CK 8 was more weakly stained than that in ameloblastoma. Central stellate cells and peripheral columnar cells of acanthomatous subtype showed same expression pattern with others. Meta plastic squamous cells expressed CK 8, 14, 19 and keratinizing squamous cells expressed CK 13, 19. CK 7 and vimentin were not detected in tumor cells and vimentin was expressed in fibrous stroma. Most of the tumor cells of ameloblastoma showed CK 14 and CK 19 and did not express CK 7 and vimentin. These findings were similar to the immunophenotype of dental lamina. And these results will be beneficial to differential diagnosis of odontogenic tumors and other kind of tumors arising at the oral cavity.

Intrusion Of The Severe Extruded Maxillary Post.Teeth Using Post.Segmental Osteotomy And Orthodontic Treatment With Skeletal Anchorage System: Cases Report