• Tuberculosis and Respiratory Diseases
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• v.61 no.5
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• pp.463-472
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• 2006

Background: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. Methods: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. Results: The mean age(${\pm}$standard deviation) of 11 men and 4 women in group A was $58.2{\pm}15.7$ years, and of 9 men and 2 women in group B was $51.6{\pm}9.5$ years. Group B had a significantly shorter hospital stay ($16.6{\pm}7.4$ vs. $33.7{\pm}22.6$ days; p=0.014), shorter chest tube duration ($10.5{\pm}5.7$ vs. $19.5{\pm}14.4$ days; p=0.039), shorter leukocytosis duration ($6.7{\pm}6.5$ vs. $18.8{\pm}13.2$ days; p=0.008), shorter febrile duration ($0.8{\pm}1.8$ vs. $9.4{\pm}9.2$ days; p=0.004), and shorter duration of intravenous antibiotics usage ($14.9{\pm}6.4$ vs. $25.4{\pm}13.9$ days; p=0.018). However, radiological improvements did not show any statistical differences. Conclusion: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

• Tuberculosis and Respiratory Diseases
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• v.61 no.6
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• pp.554-561
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• 2006

Background: In AIDS patients, the respiratory tract is one of the most frequently involved site of by an opportunistic infection, and an even common, casual pulmonary infection manifests in a peculiar ways in AIDS patients. In Korea, because of the low prevalence of AIDS, there is insufficient data compared with other Southeast Asian counties. However, considering the sexual behavior of the younger generation, it is expected that it will not be long before AIDS becomes a major public health issue in Korea. This study examined the clinical manifestation of HIV positive people and AIDS patients. The pulmonary manifestion of HIV-positive was evaluated. This study focused on the differences in the clinical manifestation between AIDS patients with pulmonary disease and simple HIV positive people. The characteristics of common pulmonary infections in AIDS patients were also analyzed. Method: The medical records of 28 HIV positive patients who visited the hospital of ChungAng University Hospital from January, 2001 to February, 2006 were analyzed retrospectively. Result: Twenty-seven patients out of 28 HIV positive patients were male and the average age was 40.6(23-65). Patients in their thirties were most commonly affected. Elven patients had pulmonary diseases. Pulmonary tuberculosis (4 cases) and pneumocystis pneumonia (4 cases) were the most common respiratory infection. One patient showed a peculiar type of systemic cryptococcus. which was accompanied by lung and pleural dissemination. The CD4+lymphocyte count of patients with a pulmonary infection was significantly lower in patients with a pulmonary manifestation than those with only a HIV infection ($79.5/mm^3$ vs $400/mm^3$, respectively)(p<.05). Patients with pulmonary disease were in a more severe immunosuppressive state. There were 4 patients with pulmonary tuberculosis, 4 with pneumocystis pneumonia, 4 with secondary syphilis, 2 with primary syphilis, and 2 with HZV infection. The average CD4 lymphocyte counts was $56/mm^3$ in those with pulmonary tuberculosis, $42/mm^3$ in those with pneumocystis pneumonia, and $455/mm^3$ in those with secondary syphilis. Conclusion: This study examined the clinical manifestation of HIV positive patients, particularly AIDS patients with pulmonary disease, A more severe immunosuppressive status was observed in HIV-related pulmonary compared with those with HIV-related extrapulmonary disease, and the frequency of pulmonary tuberculosis in pulmonary disease was higher than expected. Respiratory infection in AIDS manifest in uncommon ways e.g. disseminated cryptococcosis involving the lung and pleura. Evidently, AIDS patients with a respiratory infection have a more severe form of immunosuppression than those with a simple HIV infection. As expected, patients with a pulmonary infection were in a more severe immunosuppressed state than those with a simple HIV infection. Opportunistic infections can show peculiar clinical presentations in AIDS patients.

• Tuberculosis and Respiratory Diseases
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• v.61 no.1
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• pp.13-19
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• 2006

Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was $69{\pm}11$ years old and the latter was $70{\pm}13$ years old. The mean APCHE II score, ICU days and mortality were not different between the two groups ($16.1{\pm}5.4$ vs. $14.9{\pm}4.8$, P=0.43, $25.1{\pm}13.6$ vs. $39.1{\pm}31.0$, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.555-565
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• 2006

The purpose of the present study is to evaluate the biological stability of the zirconia/alumina composite abutment by histologic and radiographic examination in clinical cases. 17 partially edentulous patients (5 men and 12 women, mean age 47) were treated with 37 implants. The implants were placed following the standard two-stage protocol. After a healing period of 3 to 6 months, zirconia/alumina composite abutments were connected. All radiographs were taken using paralleling technique with individually fabricated impression bite block, following insertion of the prosthesis and at the 3-, 6-, 12 month re-examinations. After processing the obtained images, the osseous level was calculated using the digital image in the mesial and distal aspect in each implant. An ANOVA and t-test were used to test for difference between the baseline and 3-, 6-, 12 months re-examinations, and for difference between maxilla and mandible. Differences at P <0.05 were considered statistically significant. For histologic examination, sample was obtained from the palatal gingiva which implant functioned for 12 months. Sections were examined under a light microscope under various magnifications. Clinically, no abutment fracture or crack as well as periimplantitis was observed during the period of study. The mean bone level reduction(${\pm}standard$ deviation) was 0.34 rom(${\pm}\;0.26$) at 3-months, 0.4 2mm(${\pm}\;0.30$) at 6-months, 0.62 mm(${\pm}\;0.28$) at 12-months respectively. No statistically significant difference was found between baseline and 3-, 6-, 12-months re-examinations (p > 0.05). The mean bone level reduction in maxilla was 0.33(${\pm}0.25$) at 3-months, 0.36(${\pm}0.33$) at 6-months, 0.56(${\pm}0.26$) at 12-months. And the mean bone level reduction in mandible was 0.35(${\pm}0.27$) at 3-months, 0,49(${\pm}0.27$) at 6-months, 0.68(${\pm}0.30$) at 12-months. No statistical difference in bone level reduction between implants placed in the maxilla and mandible. Histologically, the height of the junctional epithelium was about 2.09 mm. And the width was about 0.51 mm. Scattered fibroblasts and inflammatory cells, and dense collagen network with few vascular structures characterized the portion of connective tissue. The inflammatory cell infiltration was observed just beneath the apical end of junctional epithelium and the area of direct in contact with zirconia/alumina abutment. These results suggest the zirconia/alumina composite abutment can be used in variable intraoral condition, in posterior segment as well as anterior segment without adverse effects.

• The Journal of Korean Academy of Prosthodontics
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• v.47 no.2
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• pp.215-221
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• 2009

Statement of problem: Recently the populations of patients receiving implant surgery are greatly increase for maintaining oral health. Purpose: This study was conducted for implanted patients to assess the chewing ability patient satisfaction level and changes in quality of life before and after the implant surgery. Material and methods: The current study subjected 109 adult patients, older than 20 years of age, who received implant surgery from December, 2006 to October, 2007 at the 6 dental clinics located at Daegu and Ulsan metropolitan cities. Twice of surveys were conducted for the patients before and after receiving the dental implant surgery. Results: As the motivation of receiving implant surgery, 45.9% of the patients selected the surgery for the chance o "f chewing function recovery", and " failure of treatment and complications" was found to be the most worrisome at the time of surgery by recording 38.5%.The satisfaction level before the implant surgery scored 30.37, while the score was increased to 45.01 after the surgery by showing a significant difference before and after receiving the surgery(P<.001). Regard on the surgery, 91.8% of the patients responded as "Satisfy", and 89% of the study subjects responded that they have willingness to recommend the surgery to their families and friends. The chewing ability score measured by using the surveys on edible foods, the score before the surgery was 15.24, while the score was increased to 19.11 after the surgery by showing a significant difference before and after receiving the surgery(P<.001). The quality of life score was also found to be increased to 11.17 after the surgery from 9.99 before the surgery by showing a significant difference(P<.001). Conclusion: In a future, the studies on the numbers of implanted loss teeth and the location of tooth loss are necessary, more long-term follow study are needed, and it is thought to be necessary to enlarge the sample size of subjects in conducting the studies.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.587-597
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• 2004

Over the past 20 years, great strides have been made in research regarding the mechanisms involved in the progression of carious lesions, but new equipment and research tools need to be developed to continue these advancements in caries research. Various methods have been applied to reduce the incidence of carious lesions, which have led to a significant decrease in the number of occlusal caries, but a concurrent increase in the proportion of proximal carious lesions. New diagnostic equipment has been developed to detect early stage carious lesions, and these have demonstrated excellent laboratory results and show promise in clinical applications. The research presented here examines the efficacy of the newly developed $DIFOTI^{TM}$ system in detecting proximal carious lesions compared to traditional intraoral exam and bitewing radiography, possible problems or deficiencies of using the system in clinic, possible improvements that can be made to the system, and the efficacy of detecting early, reversible carious lesions that can be remineralized by preventative fluoride applications. The subject pool consisted of 23 grammer school age patients just prior to entering the mixed dentition phase. Each patient was given a thorough oral examination, radiographic examination consisting of bitewing radiographs of the posterior teeth, and $DIFOTI^{TM}$ examination of the anterior and posterior teeth. Each examination was carried out two times by two examiners, and the data were statistically analyzed. The results are as follows: 1. The mean alpha value of reliability test of the visual oral examination was as follows; occlusal surface was 0.8470. mesial surface was 0.6430, distal surface was 0.5727. lingual surface was 0.2807 and distal surface was 0.2339. When the examination was limited to posterior teeth, the mean alpha value was as follows; occlusal surface was 0.8577, distal surface was 0.8211, lingual surface was 0.7728, buccal surface was 0.7152 and mesial surface was 0.6782. 2. The alpha value of reliability test of the radiographic analysis of carious lesions of the occlusal, mesial, and distal surfaces was 0.8500. 3. The alpha value of reliability test of the $DIFOTI^{TM}$ diagnostic analysis of carious lesions of the occlusal, buccal, lingual, mesial, and distal surfaces was determined to be 0.7917. 4. The $DIFOTI^{TM}$ diagnostic system was found to be the most accurate means of detecting occlusal, buccal, and lingual surface carious lesions (p<0.05), while mesial and distal proximal carious lesions were most accurately assessed using bitewing radiography (p<0.05).

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.3
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• pp.416-426
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• 2005

Intravenous sedation have many advantages of rapid onset and recovery, ability of control sedation levels and duration through titration. Midazolam is most commonly used intravenous medication for sedation in pediatrics, endoscopy, oncologic procedures and so on. But in dentistry, midazolam intravenous sedation is usually for adult, and there are few reports for children. Todays, children who need sedation become more and older, intravenous sedation technique is going a matter of concern in pediatric dentistry. The purpose of this paper is to evaluate the efficacy of sedation and clinical success for different initial dosage of midazolam in intravenous sedation for pediatric dental patients. 16 healthy children (male 10, female 6), mean age $54.7{\pm}10.7$ months, who needed at least two separate treatment visits requiring local anesthesia were chosen for this study. Every children were taken 0.3mg/kg, maximum 5mg of midazolam by intramuscular route, and then 30~50% $N_2O-O_2$ for 10 minutes was given. On every visits, one of the following 2 different initial dosage was given by intravenous route : (1) Group I : 0.1mg/kg Midazolam (2) Group II : 0.2mg/kg Midazolam. Additional dosage was half of the first dose. Physiologic parameters (oxygen saturation, heart rate, respiratory rate, end-tidal carbon dioxide pressure) was recorded by ten procedure steps. Behavior was videotaped and rated using Ohio State University Behavioral Rating Scale and Automated Counting System by one investigator, blind to administered dosage. After the treatment, operator evaluated the clinical success. Physiologic parameters were stable and within normal range during treatment in both groups. The analyzed sedative effect, in behavioral evaluation, ratio of favorable Quiet was higher in group II, and clinical success rate of group II was better than group I. Induction time was rapid in group II, and recovery time was rapid in group I. And there was no statistically difference between two groups in every results.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.1
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• pp.91-96
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• 2010

Many studies have shown that there is a strong relationship between the congenitally missing primary teeth and their succedaneous permanent teeth. However, especially in case of lower anterior region, we can observe the existence of permanent teeth even though their precedent primary teeth were missed at times. The purpose of this study was to reveal the relationship between the congenitally missing primary lower anterior teeth and their succedaneous permanent teeth in Korean children. Total of 14,307 children, under 6 years of age, who attended the department of pediatric dentistry, Seoul National University Dental Hospital, Seoul, Korea from January 1st 2005 to September 5th 2008 were radiologically examined using the panoramic x-ray in order to analyze the relationship between the congenitally missing primary lower anterior teeth and their succedaneous permanent teeth. The results were as follows : 1. The prevalence of congenitally missing lower anterior teeth in primary dentition was 0.24%. The odds ratio of both the primary and permanent anterior teeth being present was 7163.5 and only the permanent anterior teeth being present was 0.79. 2. The percentage of all succedaneous permanent teeth being present was 44.12% in cases of missing lower primary anteriors. The odds ratio of at least one succedaneous permanent teeth being present in cases of bilateral primary anterior teeth missing was 1.57 times more common than in cases of unilateral primary teeth missing. 3. The odds ratio of primary missing teeth being unilateral was 2.2 times higher in females. Moreover, the odds ratio of succedaneous permanent teeth being present in cases of primary teeth missing was 2.22 times higher in males.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.1
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• pp.65-72
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• 2010

General anesthesia has been researched and developed in dentistry as on type of management technique to sedate patients who may be uncontrollable or require medical consideration. There has been continuous research into this area, but analysis of large set of patients over a sustained period of time is lacking. Thus, this study analyzes the records of patients who received general anesthesia at the Yonsei University Dental Hospital Department of Pediatric and Clinic for the Disabled. 1. Patient's age ranged from 1 to 66, with under 5 being the largest group with 410 members(38.5%). The study included more men than women, with 695 male members(65.3%). 2. Type of dental procedure performed were as follows(per person) : 5.6 Dental restoration; 2.3 Endodontic treatment of deciduous and primary teeth; 2.5 preformed crowning; and 1.6 extractions. Procedures took an average of 100 minutes. 3. 1022 patients(95.9%) received dental care under general anesthesia once and 43 patients(4.1%) received dental care under general anesthesia two or more times. Dentistry under general anesthesia has the many benefit. However, without appropriate post-treatment care, it is difficult to maintain good oral health. Therefore, it is important to improve the efficiency and safety of general anesthesia through future research.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.4
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• pp.369-381
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• 2019

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.