• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.4
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• pp.766-770
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• 2008

Gingival fibromatosis is a rare condition characterized by varying degrees of gingival hyperplasia. Gingival fibromatosis usually occurs as an isolated disorder or can be associated with a variety of other syndromes. It usually appears at the time of eruption of permanent dentition but, can develop at the time of eruption of the primary dentition and rarely at birth. It may deform palatal contour and subsequently restrict the tongue movement, resulting in interference during speech and mastication. In addition, it incapacitates maintenance of normal lip closure. A 14-month-old girl visited the department of pediatric dentistry, Yonsei University Dental Hospital, for the congenital gingival overgrowth. There was no one in the family, who showed similar pattern of gingival growth. The intraoral clinical examination revealed generalized severe gingival enlargement throughout the maxillary and the mandibular arches. Enlarged gingival tissue was pink and had firm consistency. She was referred for chromosomal analysis, which confirmed absence of any known syndrome. Under local anesthesia, "Punch-biopsy" was performed on the labial area, and the specimen was histologically diagnosed as gingival fibromatosis. For she did not have any medical problem nor familiar history, she was diagnosed as having idiopathic gingival fibromatosis. Regarding her age and behavior, close follow-up was decided.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.18 no.4
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• pp.652-672
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• 1996

Dysfunction of the inferior alveolar nerve may result from trauma, diseases or iatrogenic injury. The development and refinement of an objective method to evaluate this clinical problem is highly desirable and needed, especially concerning for an increasing medico-legal issue. Evoked potential techniques have attracted considerable attention as a means of assessing the function and integrity of nerve pathways. The purpose of this study was to characterize the Sensory Evoked Potentials(SEPs) and Somatosensory Evoked Potentials(SSEPs) elicited by electrical stimulation of mental nerve. SEPs and SSEPs were measured and analyzed statistically before and after needle injury on the inferior alveolar nerve of Sprague-Dawalye rats. Measuring SEPs was more sensitive in evaluation of the recovery of sensory function from inferior alveolar nerve injury then measuring SSEPs but we measured SSEPs in the hope of providing a safe, simple and objective test to check oral and facial sensibility, which is acceptable to the patient. We stimulated mental nerve after needle injury on the inferior alveolar nerve and SEPS on the level of mandibular foramen and SSEPs on the level of cerebral cortex were recorded. Threshold, amplitude, and latency of both of SEPs and SSEPs were analyzed. The results were as follows ; 1. Threshold of SEPs and SSEPs were $184{\pm}14{\mu}A$ and $164{\pm}14{\mu}A$ respectively. 2 SEPs were composed of 2 waves, i.e., N1 N2 in which N1 was conducted by II fibers and N2 was conducted by III fibers. 3. SSEPS were composed of 5 waves, of which N1 and N2 shower statistically significant changes(p<0.01, unpaired t-test). 4. SEPs and SSEPs were observed to be abolished immediately after local anesthesia and recovered 30 minutes later. 5. SEPs were abolished immediately after injury. N1 of SSEPs was abolished immediately and amplitued of N2 was decreased($20.7{\pm}12.2%$) immediately after 23G needle injury, but N3, N4 and N5 did not change significantly. Recovery of waveform delayed 30 minutes in SEPs and 45 minutes in SSEPs. 6. The degree of decrease in amplitude of SEPs and SSEPs, after 30G needle injury was smaller than those with 23G. SEPs recorded on the level of mandibular foramen were though to be reliable and useful in the assessment of the function of the inferior alveolar nerve after injury. Amplitude of SSEPs reflected the function and integrity of nerve and measuring them provided a safe, simple and abjective test to check oral and facial sensibility. These results suggest that measuring SEPs and SSEPs are meaningful methods for objective assessment in the diagnosis of nerve injury. N1 and N2 of SSEPs can be useful parameters for the evaluation of the nerve function following a needle injury.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.3
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• pp.481-488
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• 2009

Buckley's formocresol was first introduced as a pulp medicament in 1904, and since 1930, it has been the treatment of choice for primary molar pulpotomies. Formocresol has fixation effect of pulp tissue and high clinical success rate. But side effect such as displacement and loss of permanent successor, amelogenesis imperfecta, cyst formation, mutation by general absorption, possibility of cancer induction have been reported. Of those, dentigerous cyst can form in the periradicular region after formocresol pulpotomy caused by an alteration of the reduced enamel epithelium, which result in fluid accumulation between the epithelium and the tooth crown. The present case describes a 6-year-old girl who had accidentally discovered in the panoramic radiograph a single, well-defined, radioluscent area enclosing the second unerupted mandibular premolar. The second left primary molar had been pulpotomizied 3 year before. Surgical treatment was carried out, the primary molar was extracted and cystectomy was performed under local anesthesia. In the extracted second primary molar, formocresol cotton pellet was left in the pulp chamber. Histologic study confirmed the suspected diagnosis of dentigerous cyst. This report present a case of dentigerous cyst associated with inadequate formocresol pulpotomized deciduous molar.

• Tuberculosis and Respiratory Diseases
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• v.38 no.3
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• pp.236-244
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• 1991

The prevalence rate of pulmonary tuberculosis is 1.8% in 1990, and endobronchial tuberculosis may exist in 10 to 40% of active disease. Endobronchial tuberculosis usually leaves bronchial stenosis as the complication despite of modern chemotherapy, and it is often misdiagnosed as bronchial asthma. When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical intervention and/or laser therapy, but the therapeutic result is often disappointing. To exploit a new treatment modality for bronchial stenosis, balloon dilatation was carried out in 12 patients with endobronchial tuberculosis. Under local anesthesia, 4F-Fogarty balloon was inserted via bronchofiberscope in ten cases and 10F-Gruentzig balloon was introduced under fluoroscopic guide in two others. Endobronchial tuberculoses were subdivided into two(16.7%) with actively caseating type, seven (58.3%) with fibrostenotic type, and three (25.0%) with stenotic type without fibrosis, according to the bronchoscopic findings. In 7 healed cases which were all stenotic with fibrosis, three (42.9%) took favorable turn in clinical status but four (57.1%) were not improved with balloon dilatation. In 5 active cases, all (two with actively-caseating type and three with stenotic type without fibrosis) were improved with this method. $FEV_{1.0}$ or FVC increased 10% or more after procedure in seven (70.0%) of ten and bronchial lumen remained enlarged in eight (66.7%) of twelve, in whom follow-up examination was done after the procedure. Balloon dilatation of bronchial stenosis is more effective, when endobronchial tuberculosis is in active stage than in healed fibrotic stage. It is suggested that bronchial stenosis can be minimized by early diagnosis and early application of balloon dilatation in the course of disease.

• Radiation Oncology Journal
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• v.32 no.4
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• pp.256-261
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• 2014

Purpose: We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. Materials and Methods: Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. Results: As the animals were anesthetized, the baseline temperature at the start of each session decreased by $1.3^{\circ}C$ to $2.8^{\circ}C$ (median, $2.1^{\circ}C$). The mean increases in temperature measured by the intrahepatic sensors were $2.42^{\circ}C$ (95% confidence interval [CI], 1.70-3.13) and $2.67^{\circ}C$ (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were $2.10^{\circ}C$ (95% CI, 0.71-3.49) and $2.87^{\circ}C$ (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. Conclusion: We observed mean $2.67^{\circ}C$ and $2.87^{\circ}C$ increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.5
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• pp.355-364
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• 2011

Introduction: This study evaluated nerve recovery through retrospective study of patients with lingual nerve damage. Patients and Methods: The patients who visited Seoul National University Dental Hospital for an injury to the lingual nerve from April 1988 to August 2009 were enrolled in this study (n=41). The relevance of various factors including the causes of damage, age, etc. was analyzed by the subjective improvement based upon questionnaires and the clinical records. The evaluation variants were a subjective assessment and neurosensory examination composed of the direction, contact threshold, two-point discrimination, pin prick, thermal discrimination and current perception threshold. Results: The causes of lingual nerve damage were an extraction of the lower third molar (75.6%), local anesthesia (9.7%), incision and drainage (4.88%), trauma (2.44%). The evaluation of subjective prognosis exhibited no difference in sensory improvement depending on the cause, age and gender. Based upon the subjective evaluation, 44.7% of patients showed sensory improvement. The first hospital visit from injury was shorter in the group showing subjective improvement (3.41 months) than those showing no improvement (5.24 months) (P=0.301). Thirty six out of 41 patients were treated with only conservative therapy and 5 patients were treated by surgical intervention. Neurosensory examinations revealed improvement, although not statistically significant, and the degree was higher in the subjectively improved group. The contact threshold discrimination showed the highest correlation with subjective improvement (P=0.069). Most of the sensory recovery was gained within 12 months and the degree of improvement at the tip of the tongue was higher than that of the dorsum (P<0.001). Conclusion: The damaged lingual nerve improved at a rate of 44.7% and mostly within 12 months after the incident. There was no difference between the subjective prognosis and neurosensory examination depending on the cause of damage, age and gender, whereas the contact threshold discrimination was the best variant that reflected the subjective prognosis statistically.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.187-191
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• 2006

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.437-444
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• 2009

Purpose: Transgender is a disorder of gender identity, who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. There is a persistence discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. Transgender is a psychiatric problem, but surgical method provides more satisfactory adjustment for patients. In gender reassignment surgery for female to male transgender, mastectomy, nipple reduction, hysterectomy, oophorectomy and phalloplasty are included. And as the final operation, recommended for scrotoplasty and artificial testes insertion. So we investigated the necessity and method of scrotoplasty in the final operation of female to male transgender. Method: The authors have long term follow-up of 75 cases female to male transgender during January, 1991 to February, 2008. Among them, 13 cases were evaluated in this study. During phalloplasty, the labium major skin preserved. And this labium majoral skin flap was made for the neoscrotum. At least six months later, artificial testes were inserted in neoscrotum with local anesthesia. Middle sized (3 cm diameter) artificial testes(silicon gel or carving soft silicone implant) were used because of the limitation of the neoscrotum. We evaluated the questionnaire and interview about the postoperative satisfaction in configuration of reconstructed scrotum, and the necessity of operation, the postoperative psychosocioeconomic improvement and limitation of body exposure activities such as swimming, public bathing. Results: Based on this study, satisfaction of reconstructed scrotum after scrotoplasty was improved(92%). The necessity of scrotoplasty was in 92.3% and the postoperative psychosocioeconomic well - being improvement was 77% in answers. Less limitation of activities requiring body exposure was 54% in answers. Most of the patients were satisfied with the results of surgical operation inspite of the operative procedure had some postoperative complications. Conclusion: This study was reported that the scrotoplasty in female to male transgender is not only a conversion of external genitalia but also an improvement of psychosocial state. Most patients sincerely hope to this operation, so we improve our surgical method for more good results.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.36-42
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• 1999

Background: The current maximal recommended doses of lidocaine are 7 mg/kg with $5\;{\mu}g/ml$ of epinephrine. But in clinical practice, sometimes more doses of lidocaine are required to produce adequate regional anesthesia. Method: Twenty-two healthy women patients were divided into two groups and pretreated with valium 5 mg p.o., morphine 5 mg i.m., and midazolam 2 mg i.v. before operation. Of these, 7 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine were given to 11 patients epidurally. Initial 3 ml of epinephrine mixed lidocaine was given as a test dose and remaining doses were given 5 ml/30 sec with 3 min intervals. Radial arterial blood were drawn at 5, 10, 15, 20, 30, 45, 60, 90, 120 min to measure plasma lidocaine concentrations. After confirming all of the peak plasma concentrations of 7 mg/kg lidocaine were absolutely under $5\;{\mu}g/ml$, the other 11 patients were given 10 mg/kg of 2% lidocaine with $5\;{\mu}g/ml$ of epinephrine epidurally and blood samplings were taken according to the same method of 7 mg/kg group. The peak plasma concentration ($C_{max}$), time to reach to $C_{max}$ ($T_{max}$), time to reach to $T_4$, maximal sensory block level, systemic toxicity, and vital sign changes were investigated. Result: $C_{max}$ was significantly higher in 10 mg/kg group ($5.1{\pm}1.3\;{\mu}g/ml$) than 7 mg/kg group($3.3{\pm}0.5\;{\mu}g/ml$), but $T_{max}$ ($10.5{\pm}2.7$ min vs $10.9{\pm}3.1$ min) was not different. Time to reach $T_4$ was significantly shorter in 10 mg/kg group ($9.5{\pm}2.7$ min) than 7 mg/kg group ($12.7{\pm}3.2$ min) but maximal sensory block level ($T_{3.7{\pm}0.7}$ vs $T_{2.7{\pm}1.0}$) was not different. In four patients of 10 mg/kg group, peak plasma concentrations exceeded $5\;{\mu}g/ml$, but no systemic toxicities appeared. No significant vital sign changes were observed. Conclusion: The current maximal recommended doses of lidocaine, merely based on body weight are not always appropriate. Further studies are needed to determine more precise guideline of maximal doses that include various pharmacokinetic components.

• Restorative Dentistry and Endodontics
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• v.30 no.3
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• pp.149-157
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• 2005

Mechanical removals in decayed teeth have been performed using drill and sharp hand instruments. These methods have some disadvantages such as pain, local anesthesia and overextended cavities Therefore chemo-mechanical excavation of dentin carious lesions has been introduced. The purpose of this study was to evaluate the efficacy of traditional mechanical methods using burs and chemo-mechanical methods (Carisolv) of caries dentin. Mechanical caries removal was carried with low speed round bur Chemo-mechanical caries excavation was performed with Carisolv (Medi-team), using the Carisolv hand instruments. The mean time to remove caries with two different methods was evaluated and the data analyzed with SPSS software (ver 11.5) by t-test (p < 0.05). For histomorphometry of caries removal were also carried with mechanical or chemo-mechanical (Carisolv) methods from 20 extracted caries permanent molars. Complete caries removal was verified with a $\#$23 sharp explorers, Caries Detector (Kuraray Co. Japan), and standard apical radiography. 1. Chemo-mechanical method was taken more times than mechanical method (1.5 fold) (p < 0.05) 2. Excavation for caries took more time for molar lesion than premolar lesion, and the least time was taken to remove the caries in incisor lesion (p < 0.05). 3. There were no significant differences to remove the caries between the maxilla and mandible (p > 0.05). 4. The remaining carious dentin was detected after the ckemo-mechanical removal of the carious dentin, and no smear layer were seen after the mechanical and chemo-mechanical removal of the carious dentin.