Tracheostomy may be used to assure airway protection in various clinical situation. It, as a known operation, has a history spanning 2000 years. The first clear account of a successful tracheostomy was recorded in 1546 by Brasavola. Until 1718 the term "bronchotomy" was used to describe the procedure. Heister then introduce the term "tracheotomy and this was later adopted and popularized by Trousseau about 1830. The term "tracheostomy" appeared in medical literature after 1820 and the two terms "tracheostomy" and "tracheotomy" are used interchangeably today. Indications include relief of upper airway obstruction, facilitation of pulmonary toilet, diminution of dead space and need for prolonged mechanical ventilation. The extent of indication of tracheostomy has a tendency to increase, thus oral and maxillofacial surgeons have some opportunities to face a situation that require tracheostomy. So, we reported retrospective study of 31 cases of tracheostomy patient in oral and maxillofacial surgery with reference review to reveal the significance of surgical skill and management capability of emergercy state maxillofacial surgery patients.
A 56 years old male patient adklitted to our neurology department because of repeated tingling sensation in right 3, 4, 5th. (infers and weakness on grasping, which were progressively developed re ently. At this time, he had also suffered from claudication in both lower extremities. Carotid angiogram showed that right internal carotid artery was obstructed completely, and both common, both external and left internal carotid arteries had significant stenosis, Concommitantly, aortogram suggested complete obstruction just below the renal arteries. We plamled staged operation for two separated arterial lesions. Both carotid endarterectomy was performed. and we used carotid shunt for left side during operation. Abdominal aortic lesion was operated 2 weeks later We obligately clamped aorta just below the celiac artery and infuse4 kidney perservation solution to pertect kidney during ischemia. Reversed Y bypass graft and kidney perservation was successful despite of 40 minute ischemia. Postoperative courts was uneventful and patient was discharged without any specific problem.
Objective : Several clinical studies have explored the feasibility and efficacy of radiosurgical treatment for mesial temporal lobe epilepsy, but the long-term safety of this treatment has not been fully characterized. This study aims to report and describe radiation-induced cavernous malformation as a delayed complication of radiosurgery in epilepsy patients. Methods : The series includes 20 patients with mesial temporal lobe epilepsy who underwent Gamma Knife radiosurgery (GKRS). The majority received a prescribed isodose of 24 Gy as an adjuvant treatment after anterior temporal lobectomy. Results : In this series, we identified radiation-induced cavernous malformation in three patients, resulting in a cumulative incidence of 18.4% (95% confidence interval, 6.3% to 47.0%) at an 8-year follow-up. These late sequelae of vascular malformation occurred between 6.9 and 7.6 years after GKRS, manifesting later than other delayed radiation-induced changes, such as radiation necrosis. Neurological symptoms attributed to intracranial hypertension were present in those three cases involving cavernous malformation. Of these, two cases, which initially exhibited an insufficient response to radiosurgery, ultimately demonstrated seizure remission following the successful microsurgical resection of the cavernous malformation. Conclusion : All things considered, the development of radiation-induced cavernous malformation is not uncommon in this population and should be acknowledged as a potential long-term complication. Microsurgical resection of cavernous malformation can be preferentially considered in cases where the initial seizure outcome after GKRS is unsatisfactory.
Esthetics is important in restoring maxillary anterior area. Alveolar bone resorption and loss of interdental papilla may be minimized by immediate implantation. Previous studies showed successful results with the immediate implantation in healthy extraction socket, while many of these studies objected the immediate implantation into extraction sites with periapical lesions. Recent studies, however, reported successful results of the immediate implantation into extraction sites with periapical lesions with careful debridement of extraction sockets and general medication of antibiotics prior to implantation. A 73-year-old female visited the department of Prosthodontics in ${\bigcirc}{\bigcirc}$ University Dental Hospital with the chief complaint of fallen post-core and crown on left maxillary incisor. Although the incisor was with vertical root fracture and periapical lesion, the immediate implantation following the extraction of tooth was planned. Thorough socket debridement, irrigation with chlorhexidine, and tetracycline soaking were followed by immediate implantation. The general medication of antibiotics (Moxicle Tab.$^{(R)}$, 375 mg) was prescribed before and after the surgery. Immediate provisional restoration was delivered two days after the surgery, and the definitive metal-ceramic restoration was placed about six months later after reproducing the emergence profile from the provisional restoration. This case presents satisfying result esthetically and functionally upto two years after the placement of prosthesis with the harmonious gingival line and no loss of marginal bone.
Objective: When an alveolar cleft is too large to close with adjacent mucobuccal flaps or large secondary fistula following a primary bilateral palatoplasty exists, a one-stage procedure for bone grafting becomes challenging. In such a case, we used the tongue flap to repair the fistula and cleft alveolus in the first stage, and bone grafting to the cleft defect was performed in the second stage several months later. The purpose of this paper is to report our experiences with the use of an anteriorly-based Y-shaped tongue flap to fit the palatal and labial alveolar defects and the ultimate result of the bone graft. Patients: A series of 14 patients underwent surgery of this type from January 1994 to December 1998.The average age of the patients was 15.8 years old (range: 5 to 28 years old). The mean period of follow-up following the 2nd stage bone raft operation was 45.9 months (range: 9 to 68 months). In nine of the 14 cases, the long-fork type of a Yshaped tongue flap was used for extended coverage of the labial side alveolar defects with the palatal fistula in the remaining cases the short-forked design was used. Results: All cases demonstrated a good clinical result after the initial repair of cleft alveolus and palatal fistula. There was no fistula recurrence, although Partial necrosis of distal margin in long-forked tongue flap was occurred in one case. Furthermore, the bone graft, which was performed an average of 8 months after the tongue flap repair, was always successful. Occasionally, the transferred tongue tissue was bulging and interfering with the hygienic care of nearby teeth; however, these problems were able to be solved with proper contour-pasty performed afterwards. No donor site complications such as sensory disturbance, change in taste, limitations in tongue movement, normal speech impairments or tongue disfigurement were encountered. Conclusion: This two-stage reconstruction of a bilateral cleft alveolus using a Y-shaped tongue flap and iliac bone graft was very successful. It may be indicated for a bilateral cleft alveolus patient where the direct closure of the cleft defect with adjacent tissue or the buccal flap is not easy due to scarred fibrotic mucosa and/or accompanied residual palatal fistula.
A derelict bridge called WoljungGyo was restored in Gyeongju, the capital city of ancient Silla. WoljungGyo was originally built in 760AD, and later rebuilt in 1280AD during the Goryeo Kingdom. The bridge lasted in working condition for at least 520 years. The bridge was uncovered to the remains of both abutments and four piers, with only one or two steps remaining. One of the foundation for piers showed evidence of partial settlement. The cause of the partial settlement is important for the successful restoration of the bridge so that an extensive investigation was carried out, which includes layer stratification by boring, 2-D stiffness profiling by surface-wave tests, and large scaled-plate load test for evaluating capacity. In addition to the field studies in the Woljunggyo bridge, 3-D finite element analysis was also conducted. Based on the results of the site investigation and the numerical analysis, it was concluded that the further ground improvement to build the piers was not necessary so that the gravels were placed and leveled underneath the existing pier stones to compensate partial settlement before the restoration.
This study aims to develop materials related to math education for the aged and to identify the effects of application as part of active measures to the aging society with its growing elderly population which is one of the greatest changes in our society. In this purpose, the necessity and objectives for development of materials of 'Silver Math' as education for the aged are explained. Developing and disseminating materials with a role as a program for intelligent needs and physical and spiritual health of the aged presents standards for development of more systemic and meaningful educational materials at this point of time when the importance of education of the aged increases to help the old enjoy qualitatively successful lives in later years in the perspective of lifelong education. Also it aims to present standards of contents and requirements in learning that are adequate and meaningful to old learners at the actual learning sites where education takes place only in terms of making good use of spare time while at the same time suggesting plans of teaching and learning as well as conditions for learning environment. Next, the effectiveness of 'Silver Math' are explored by applying developed materials to the aged. materials of 'Silver Math' for the aged with contents that are appropriate to the definitive and cognitive level of the aged are presented. The developed materials for mathematical activities are divided into 'computation of basic numbers' for those wishing to learn calculation and concepts of numbers, 'active math' that corresponds to definitive factors of old learners, facilitates leisure time through mathematical activities, and Improves communication abilities through cooperative learning among learners, and 'math with thinking power' to solve simple calculation problems by applying to various actual situations.
The prevalence of iron deficiency in later infancy and the toddler years(25% to 40% at 1 year of age) has not decreased remarkably , except in Western countries. The purpose of this study was to 1) determine the relationship between current feeding practices and iron status, and 2) assess compliance to infant feeding instructions. Two groupsof infants were examined. The first group of 302 infants aged 6 to 24months was seen at a well baby clinic while the second group of 135 infants of the same age group was assessed by venipuncture. Cutoff values for laboratory tests were as follows ; hemoglobin<11g/dL, mean corpuscular volume (MCV) <72fl ; red cell distribution width(RDW)>15% ; serum ferritin level<10ng/ml ; and transferrin saturation (serum iron(TIBC)<10%. The diagnosis of iron deficiency anemia (IDA) was made when a low hemoglobin level was associated with either low ferritin orlow transferrin saturation . Of the 302 children brought to the well baby clinic , 12.3%(n=37) were found to have anemia (hemoglobin<11.0/dL). In terms of children grouped according to feeding practices, it was found that children with anemial comprised 32.0% (24/75) of the prolonged breast-fed group (Group A), significantly more than the 4.0%(7/176) of the artificial milk feeding group(Group B). and 3.9%(2/51) of the switched from breast milk to iron -fortified weaning foods group(Group C).Among the 107 children with IDA , iron deficiency in 105 children(98.1%) was suggested by their dietary histories ; exclusive or prolonged breast-feeding for more than 6 months without iron fortification in 98 infants ; cow's milk consumption> 500ml/day without iron fortification during infancy(n=12), or >800ml without iron-fortified foods after infancy(n=15) ; and the use of unfortified forumula or unbalanced diets, mainly limited to rice gruel. Despite the relatively high (79.6%) motivation on the part of the infants mothers and supervison by professional personnel, the poor results in the infants receiving iron fortified foods were due to poor compliance(85.75). Among the mothers of 98 IDA patients who were contacted by telephone , it was revealed that 29% did not give the oral iron preparation for more than 2 months. Furthermore, negligence or disregard by the parents occurred in 14% of the case , discontinuance of the oral iron preparation by the parents due to side effects occurred in 6%, and the children's refusal or poor oral intake and no further trial occurred in 6%. The dietary history of a large group of infants was highly predictive of their risk for anemia . Continued consumption of breast milk until the age of 1 year is not warranted unless iron-fortified foods are given concomitantly. Because there is a problem with compliance, more successful and safe strategies for preventing iron deficiency woold included dual coverage in the from of therapeutic iron supplementation as well use of iron-fortified foods for teddlers who are at risk of iron deficiency.
The use of dental implants has increased tremendously in recent years and is expected to increase even more in the future. The successful outcome of any implant procedure is surely dependent on interrelationship of the various components of an equation that includes biocompatibility of implant material, macroscopic and microscopic nature of the implant surface, the status of implant bed, surgical technique, undisturbed healing phase and subsequent prosthetic design and long-term loading phase. The purpose of this study was to clarify the effects of adrenalectomy on the osseointegration of pure titanium implants. Seventy rats, 11 weeks of age, were divided into two groups : an adrenalectomized group and a control group. Titanium screw implant(diameter, 2.0mm; length, 3.5mm) was placed into left tibia of 70 rats, 35 in control group and 35 in the experimental group. The rats were sacrificed at different time interval (1, 2, 3, 4, 6, 8, and 12 weeks after implantation) for histopathologic observation, histomorphometric analysis and immunohistochemistry with fibronectin and CD44 antibody. The results obtained from this study were as follows: 1. Histopathogically, findings, newly formed bone was seen at 3 weeks control group and became lamellar bone at 12 weeks. At 6 weeks, lipocytes were observed in bone marrow space. Thickness of regenerated trabecular bone increased till 6 weeks after then, that decreased gradually. 2. By histomorphometric analysis, marrow bone density and contact ratio of marrow bone to implant decreased significantly from 8 to 12 weeks in experimental group compared to control group and also total bone to implant contact ratio decreased significantly from 4 to 12 weeks in experimental group compared to control group. 3. Fibronectin immunoreactivity was very strong at 3 and 4 weeks control group. And after that reduced gradually. But it was continuously strong from 1 to 12 weeks experimental group. 4. CD44 immunoreactivity was very strong in the newly formed osteoblasts at 3 and 4 weeks control group. But it reacted minimally later. However, it reacted continuously strong from 3 to 12 weeks experimental group. From these results, bone to implant contact ratio decreased gradually from 4 weeks in adrenalectomized group compared to control group. CD44 and fibronectin immunoreactivities were strong at all times in adrenalectomized rats. Therefore, it could be stated that immature bone remained continuously for a long time and not readily proceeded into mature status.
Kim, Yong-Ik;Kim, Chang-Yup;Shin, Young-Soo;Lee, Kun-Sei
Journal of Preventive Medicine and Public Health
/
v.34
no.4
/
pp.379-388
/
2001
Background : Cervix cancer is the most common form of cancer among Korea women. in spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. Objective : To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). Methods : The survey was conducted from July 21 st to 26th in 1998. Of 3,218 women, 303(12.2%) between 30 and 55 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. Results : The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(altitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. Conclusions : This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.
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