Ji, Moon-Jong;Kang, Shin-Yong;Choe, Byung-Ho;Park, Jin-Young
Advances in pediatric surgery
/
v.11
no.2
/
pp.175-179
/
2005
An 11-year-old girl with a history of two previous attacks of acute pancreatitis was admitted to another hospital. Her epigastrium was tender, and serum amylase was 657 IU/L and lipase 3131 IU/L. Abdominal computed tomography scan suggested necrosis of 30% of the pancreas. Retrograde endoscopic cholangiopancreatography showed a diverticulum covered by normal duodenal mucosa at the second portion of the duodenum, which was separated from the adjacent duodenal lumen by a radiolucent band at UGI series. The apex of the diverticulum was incised endoscopically using a needle knife papillotome. A follow-up endoscopy on the next day noticed bleeding from the incised edge of the diverticulum. Endoscopic hemostasis with hemoclipping and injection of hypertonic saline-epinephrine solution was not successful. The patient was transferred to Kyungpook National University Hospital, and open duodenotomy and excision of the diverticulum were performed. She has recovered well and remains asymptoatic.
Retraction of canines represents a fundamental stage in a considerable number of orthodontic treatment. Correct position of the canine after retraction is most important for function, stability, and esthetics. The purpose of this study was to investigate the stress in the periodontal tissue at the initial phase during canine retraction using various types of sectional retraction springs, by finite element method. Three dimensional model of tooth, periodontal ligament, bone and eight springs were simulated and tested. The following results were obtained. 1. In sectional retraction springs, increasing number of helix and the closed loop in preference to the open loop provided an decrease in horizontal force. Without angulating the arms of spring, the T-loop revealed the highest Moment-to-force ratio. 2. The Moment-to-force ratio raised by angulating mesial and distal arms of spring, but very large horizontal force was applied to canine. 3. When optimal force and optimal moment was applied to canine, the stress induced was homogeneous and the difference of stress value from cervix to the apex was little.
A 19-year-old Korean woman presented with left mandibular dental pain and swelling. Periapical radiolucencies were associated with the mandibular left first molar, second molar and the mandibular right second molar. The mandibular right second molar root developed incompletely and has the open apex. Clinical examination revealed worn accessory occlusal cusps of premolars. A diagnosis of dens evaginatus with associated periapical lesion secondary to pulpal necrosis was made. The root canal of the lower right second premolar was sealed with Calcium hydroxide paste for apexification. About two months later Calcium hydroxide paste was removed and the canal was resealed with new Calcium hydroxide paste. After four months the canal was sealed permanently with guttapercha and zinc oxide-eugenol sealer. The root canals of the lower left premolars were irrigated every week with 3.5% NaOCl solution for and half month. And the canals were sealed with gutta-percha and ZOE sealer. Preventive endodontic treatment for the lower right first premolar was undertaken.
Lee, Kyu Ha;Yoon, Min Jung;Han, Mi Young;Chung, Sa Jun;Kim, Soo Cheol
Clinical and Experimental Pediatrics
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v.50
no.6
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pp.588-591
/
2007
Left ventricular thrombus is mainly caused by anterior myocardial infarction or severe cardiac wall dysfunction of the apex, and is rarely caused by a complication of acute myocarditis. A 12-year-old female who developed symptoms of motor dysphasia and incomplete hemiparesis of the right side was admitted to the hospital. The brain MRI taken on the day of her admission showed acute cerebral infarction in the left basal ganglia and the frontoparietal lobe. The echocardiogram showed a movable thrombus, which was $19{\times}28mm$ sized and located in the apex of the left ventricle. So in order to prevent further thromboembolic event we performed open cardiac surgery via the atrium and removed the thrombus of the left ventricle. After the removal of the thrombus her symptoms improved and she was discharged from the hospital. Thrombus formation in acute viral myocarditis are considered to be related with endocardial injury and blood flow stasis. Treatment with anticoagulants in left ventricular thrombosis may not be effective and may even cause a major thromboembolism. When the thrombus is laminar and fixed, one should consider anticoagulant therapy. But if the thrombus is pedunculated and movable, which means that there are higher possibilities of major embolism or there may be already one, one should consider surgical removal. We report a 12-year-old girl who required surgical removal of a left ventricular thrombus caused by acute viral myocarditis.
Statement of problem: A difficulty in achieving a passive-fitting prosthesis can be overcome by individual crown restoation of multiple implants. But individualized crown has another difficulty in control of contact tightness and stress distribution. Purpose: This in vitro study is to evaluate the stress distribution and the magnitude in the supporting tissues around Endopore implants with different crown lengths, interproximal contact tightness, and the splinting effects. Material & methods: Three Endopore implants($4.1{\times}9mm$) were placed in the mandibular posterior edentulous area distal to the canine and photoelastic model was made with PL-2 resin(Measurements Group, Raleigh, USA). Restorations were fabricated in two crown lengths: 9, 13 mm. For non-splinted restorations, individual crowns were fabricated on three custom-milled titanium abutments. After the units were cemented, 4 levels of interproximal contact tightness were evaluated: open, ideal($8{\mu}m$ shim stock drags without tearing), medium($40{\mu}m$), and heavy($80{\mu}m$). For splinted restorations, 3-unit fixed partial dentures were fabricated. This study was examined under simulated non-loaded and loaded conditions(6.8 kg). Photoelastic stress analysis was carried out to measure the fringe order around the implant supporting structure. Results: 1. When restorations were not splinted, the more interproximal contact tightness was increased among the three implants, the more stress was shown in the cervical region of each implant. When crown length was increased, stresses tended to increase in the apex of implants but there were little differences in stress fringes. 2. When nonsplinted restorations were loaded on the first or third implant, stresses were increased in the apex and cervical region of loaded implant. Regardless of interproximal contact tightness level, stresses were not distributed among the three implants. But with tighter interproximal contact, stresses were increased in the cervical region of loaded first or third implant. 3. When the nonsplinted restorations were not loaded, there were little stresses on the supporting structure of implants, but low level stresses were shown in the splinted restorations even after sectioning and soldering. 4. With splinted restorations, there were little differences in stresses between different crown lengths. When splinted restorations were loaded, stresses were increased slightly on the loaded implant, but relatively even stress distribution occurred among the three implants. Conclusions: Splinting the crowns of adjacent implants is recommended for Endopore implants under the overloading situation.
Journal of Korean Academy of Oral and Maxillofacial Radiology
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v.28
no.2
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pp.435-459
/
1998
In order to achieve a successful endodontic treatment, root canals must be obturated three-dimensionally without causing any damage to apical tissues. Accurate length determination of the root canal is critical in this case. For this reason, I've used the conventional periapical radiography, Digora/sup (R)/(digital imaging system) and Root ZX/sup (R)/(the frequency dependent type apex locator) to measure the length of the canal and compare it with the true length obtained by cutting the tooth in half and measuring the length between the occlusal surface and the apical foramen. From the information obtained by these measurements, I was able to evaluate the accuracy and clinical usefulness of each systems. whether the thickness of files used in endodontic therapy has any effect on the measuring systems was also evaluated in an effort to simplify the treatment planning phase of endodontic treatment. 29 canals of 29 sound premolars were measured with #15, #20, #25 files by 3 different dentists each using the periapical radiography. Digora/sup (R)/ and Root ZX/sup (R)/. The measurements were then compared with the true length. The results were as follows: 1. In comparing mean discrepancies between measurements obtained by using periapical radiography(mean error: -0.449±0.444 mm), Digora/sup (R)/(mean error: -0.417±0.415 mm) and Root ZX/sup (R)/(mean error: 0.123±0.458 mm) with true length. periapical radiography and Digora/sup (R)/ system had statistically significant differences(p<0.05) in most cases while Root ZX/sup (R)/ showed none(p>0.05). 2. By subtracting values obtained by using periapical radiography, Digora/sup (R)/ and Root ZX/sup (R)/ from the true length and making a distribution table of their absolute values. the following analysis was possible. In the case of periapical film. 140 out of 261<53.6%) were clinically acceptable satisfying the margin of error of less than 0.5 mm. 151 out of 261 (53,6%) were acceptable in the Digora/sup (R)/ system while Root ZX/sup (R)/ had 197 out of 261(75.5%) within the limits of 0.5mm margin of error. 3. In determining whether the thickness of files has any effect on measuring methoths, no statistically significant differences were found(p>0.05). 4. In comparing data obtained from these methods in order to evaluate the difference among measuring methods, there was no statistically significant difference between periapical radiography and Digora/sup (R)/ system(p>0.05), but there was statistically significant difference between Root ZX/sup (R)/ and periapical radiography(p<0.05). Also there was statistically significant difference between Root ZX/sup (R)/ and Digora/sup (R)/ system(p<0.05). In conclusion, Root ZX/sup (R)/ was more accurate when compared with the Digora/sup (R)/ system and periapical radiography and seems to be more effective clinically in determining root canal length. But Root ZX/sup (R)/ has its limits in determining root morphology and number of roots and its accuracy becomes questionable when apical foramen is open due to unknown reasons. Therefore the combined use of Root ZX/sup (R)/ and the periapical radiography are mandatory. Digora/sup (R)/ system seems to be more effective when periapical radiographs are needed in a short period of time because of its short processing time and less exposure.
This is one case report of surgically treated partial atrioventricular canal. The 22 year-old male patient had no definitive history of frequent respiratory infection and cyanosis in his early childhood. Since his age of 7 years, dyspnea was manifested on exertion. First appearance of congestive heart failure was at his age of 16 years old. The physical examination revealed that the neck veins were distended and heaving of precordium. A thrill was palpable on the left 3rd-4th intercostal space extending from the sternal border toward the apex and Grade IV/VI systolic ejection murmur was audible on it. Neither cyanosis nor clubbing was noted. Liver was palpable about 5 finger breadths. Chest X-ray revealed increased pulmonary vascularity and severe cardiomegaly (C-T ratio = 74%). EKG revealed LAD, clockwise rotation, LVH and trifascicular block. Echocardiogram showed paradoxical ventricular septal movement, narrowed left ventricular outflow tract and abnormal diastolic movement of the anterior leaflet of mitral valve. Right heart catheterization resulted in large left to right shunt (Qp : Qs = 5.7: 1), ASD and moderate pulfllonary hypertension. Finally, left ventriculogram revealed typical goose neck appearance of left ventrlcalar outflow tract. On Oct. 10, 1980, open heart surgery was performed. Operative findings were: 1. Large primum defect ($6{\times}5$ Cm in diameter) 2. Cleft on the anterior leaflet of mitral valve. 3. The upper portion of ventricular septum was descent but no interventricular communication. 4. Downward attachment of the atrioventricular valves on the ventricular muscular septum. 5. Medium sized secumdum defect ($2{\times}1$ Cm in diameter). The cleft was repaired with 4 interrupted sutures. The primum defect was closed with Teflon patch and the secundum defect was closed with direct suture closure. Postoperatively atrial flutter-fibrillation in EKG and Grade U/VI apical systolic murmur were found. The postoperative course was uneventful and discharged on 29th postoperative day in good general conditions.
We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.
Purpose: Blow-out fractures can be reduced using various methods. The orbital reconstruction technique using a balloon under endoscopic control has advantages over other methods. However, this method has some problems too, such as postoperative follow-up, management of the balloon catheter, and reduction of the posterior orbital floor. Thus, we developed a simple, effective method for orbital floor reduction that involves molding and shaping the antral balloon catheter. Methods: A 0, 30, or $70^{\circ}$, 4-mm endoscope was placed though a two-point, 5-mm maxillary antrostomy. The balloon catheter is placed directly at the orbital apex to reconstruct the anterior shelf (spherical shape), while it is turned in a U-shape towards the anterior maxilla for the posterior shelf (elliptical shape). Orbital floor defects, compound or comminuted fractures are reconstructed with alloplastic materials through an open lid incision under the endoscopic control. Results: This technique was applied to ten patients with orbital floor fractures: five anterior shelf and five posterior shelf fracture, respectively. Four of the patients had zygomatico-orbital fractures, while the rest had isolated orbital floor fractures. Two patients were given porous polyethylene implants Synpor$^{(R)}$) and three underwent reconstruction with a resorbable mesh plate. No complication associated with this technique was identified. Conclusion: The freestyle placement and selection of a urinary balloon catheter under endoscopic control and the preoperative estimation of the volume enhanced the stabilization of the orbital contour. This method improves the adaptation of the orbital floor without the risk of injuring the surrounding orbital contents, dissecting blindly, or using sharp traction. One drawback of this method is the patient's discomfort from the catheter during treatment.
This study was performed to investigate the age distribution with tooth calcification and degree of eruption of permanent teeth. For the study, healthy 184 patients from 5 to 19 years old without any previous serious dental treatment were randomly selected, and intraoral standard films and dental casts were taken for evaluation of stage of calcification and degree of eruption, respectively. Tooth calcification of 13 stages, designed by the author based on the Nolla's classification and eruption level of 4 or 5 degree was used. Data were processed by SAS/Stat program and the obtained results were as follows; 1. The age of root completed with open apex in lower posterior teeth were 13.8 years for first premolar, 14.0 years for second premolar, 10.5 years for first molar, and 14.2 years for second molar. There were no significant difference between right and left side. 2. As for the sequence of eruption, first molar was the first teeth erupted in upper arch, while central incisor was the first teeth in lower arch. In general, eruption of lower teeth were slightly earlier than the corresponding teeth of upper arch. 3. There were no difference of age of the same stage of development between Nolla's and the author's classification. From the results, the author's classification can be used for estimation of age with more finely in age of 8 to 15 years old. 4. Multiple regression equations for age with Nolla's(Ns) and the author's(Ks) classification of tooth calcification, and degree of eruption(DE) were as follow; Age(by #34) = 7.55 + 0.76Ks34 + 0.80DE34 - 0.72Ns34 Age(by #35) = 7.10 + 0.81Ks35 + 0.6IDE35 Age(by #37) = 6.61 + 0.82Ks37 + 0.5IDE37. Age(by #44) = 7.02 + 0.62Ks44 + 0.82DE44 Age(by #45) = 8.04 + 0.93Ks45 + 0.64DE45 - 0.89Ns45 Age(by #47) = 6.40 + 0.86Ks47 + 0.56DE47.
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