Implant overdentures are widely used as a treatment method to restore oral function in completely edentulous or partially edentulous patients with severe bone resorption. Using a milled bar, it is mechanically advantageous as the implant fixtures are splinted. Applying additional attachments to the bar has the advantage of dispersing the stress applied to the implant. In this case, a patient who used implant overdentures using 4 implants wanted to fabricate a new prosthesis due to repeated fractures of the denture and weakened retention. Milled bar with ADDTOC attachment and zirconia prosthesis were fabricated by CAD-CAM method and mechanically and aesthetically satisfactory results were obtained.

Infantile digital fibromatosis is a rare benign tumor on the fingers and toes of infants and childhood which is characterized by fibroblastic proliferation. Usually the lesions occur singly or severally on the dorsal or lateral aspects of the distal phalanges of the toes and fingers. The thumb and great toe are usually spared. These asymptomatic, firm, red, smooth nodules, some lcm diameter, occur during the first year of life. Forty-seven percent occur in the first month of life. This disease can occur after trauma. The lesions do not metastasize. Occasionally, spontaneous regression has been reported. After excision, recurrence can be possible. A 2 years old female infant had three large bean sized erythematous masses on the left 2,3,4th fingers. The erythematous aacule was developed at 6 months old and grew slowly. We could find inclusion body stained bright red with Massons trichrome and purple with PTAH in cytoplasm of fibroblast. The patient was treated with a simple excision followed by a skin graft. During 5 rnonths after operation, recurrence was not occurred.
Child, Preschool ; Cytoplasm ; Female ; Fibroblasts ; Fibroma* ; Fingers ; Humans ; Inclusion Bodies ; Infant ; Recurrence ; Skin* ; Thumb ; Toes ; Transplants*

We present a case of a colonic involvement associated with necrotizing pancreatitis, with a review of the literature. A 10 year old boy had an appendectomy at the local clinic ten days ago. On admission, he complained nausea, vomiting and severe constipation. His abdomen was distended and he had tenderness on the left abdomen. Laboratory and radiologic studies revealed findings consistent with acute pancreatitis with colonic complication. He was treated conservatively for 30 days but did not improve. On hospital 30th day, abdominal pain developed and his vital sign changed. Abdominal CT suggested ischemic change of the transverse colon. At laparotomy, the left colon showed stenosis. The greatly distended transverse colon was resected and a transverse end colostomy was done. He was discharged at postoperative 45th day with improvement and colostomy closure was performed 8 months later.
Abdomen ; Abdominal Pain ; Appendectomy ; Child ; Colon* ; Colon, Transverse ; Colostomy ; Constipation ; Constriction, Pathologic ; Humans ; Laparotomy ; Male ; Nausea ; Pancreatitis ; Pancreatitis, Acute Necrotizing* ; Tomography, X-Ray Computed ; Vital Signs ; Vomiting

Many different myelographic contrast media have been employed for the radiographic visualization of the spinal cord. Unfortunately, none has fulfilled all the requirements of an ideal contrast medium-no toxicity, complete and rapid absorption, good radiographic contrast, and miscibility with the cerebrospinal fluid. Toxic reactions have been reported from the water soluble contrast media, which require the administration of a spinal anesthesia and have thus been employed clinically only in examination of the lumbosacral area. Some authors have advocated the use of new contrast media, Conray(Meglumine iothalamate), Dimer-X, for the lumbar myelography without a spinal anesthesia and obtained good results. The present work is an attempt to provoke and emphasize the toxicologic response and the pathologic changes by variation in amount of Conray and rate of injection. Each dog was prepared with a catheter in lumbar subarachnoid space under the light anest hesia. After recovery from the anesthesia, myelography was performed by lumbar subarachnoid injection of Conray by variations in amount of Conray and rate of injection under the control of a fluoroscope. The experimental conditions were varied as follows. 1. Conray was injected in variable amounts from the lumbosacral subarachnoid space to the high cervical and intracranial subarachnoid space. 2. Conray was injected in variable rate of injection. 3. Decadron was added to Conray in another group. 4. The brain and the spinal cord including the dura and the nerve roots were taken for the pathologic study in variable durations after myelography. The results were summarized as follows. 1. A large amount of Conray injection to the high cervical and intracranial subarachnoid space produced wevere toxic reactions followed by death. 2. Rapid injection of Conray was considered to elicit more toxic reactions. 3. The toxic reactions included changes in behavior and respiration, neck muscle spasms, paresis of forelegs and hindlegs, urination, defecation and epileptiform convulsions. 4. There was no difference in toxic reactions in adding Decardon. 5. Radiographic contrast densities were somewhat less than that of Pantopaque. Conray was freely miscible with the cerebrospinal fluid, thus providing total myeloraphy. 6. No recognizable reaction was noted in gross and histopathological examination.
Absorption ; Anesthesia ; Anesthesia, Spinal ; Animals ; Brain ; Catheters ; Cerebrospinal Fluid ; Contrast Media ; Defecation ; Dogs ; Iophendylate ; Myelography* ; Neck Muscles ; Paresis ; Respiration ; Seizures ; Spasm ; Spinal Cord ; Subarachnoid Space ; Urination

BACKGROUND: The purpose of this study is to investigate the incidence and associated factors of postoperative delirium in elderly patients with hip fracture. METHODS: We interviewed 90 patients with hip fracture with the aim of identifying underlying diseases and laboratory data. Cognitive function was measured with Mini Mental Status Exam-K (MMSE-K) before surgery. RESULTS: Delirium developed in 20 patients (22.2%). History of dementia (p=0.041) and mean score of MMSE-K (p<0.001) were significantly related to the incidence of delirium. An MMSE-K score less than 20 was an independent risk factor for postoperative delirium in patients with hip fracture. CONCLUSION: Cognitive impairment was a risk factor of postoperative delirium. MMSE-K is expected to be a simple indicator for predicting postoperative delirium in older patients with hip fracture.
Aged ; Delirium ; Dementia ; Hip ; Humans ; Incidence ; Risk Factors

After acute interruption of cerebral blood flow, various hemodynamic, morphologic and metabolic changes ensue in the occluded area. Such changes and subsequent brain damage are of great concern in the course of temporary arterial occlusion during aneurysmal surgery. Many experimental studies investigating the processes of cerebral infarction have been done through selective occlusion of intracranial vessels, and it has been known that 4 to 8 minutes interruption of cerebral blood flow results in irreversible brain damage. Cerebral resistance following vascular occlusion may be influenced by collateral circulation, hypothermia and hyperventilation. Recently we experienced two patients with right middle cerebral artery aneurysms, who were operated upon under normothermia, slight hypotension, and hyperventilation using microsurgical technique. The technique of temporary occlusion of middle cerebral artery was applied as an adjunctive method.
Aneurysm ; Brain ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Humans ; Hyperventilation ; Hypotension ; Hypothermia ; Intracranial Aneurysm* ; Middle Cerebral Artery*

STUDY DESIGN: A retrospective study. OBJECTIVES: To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit. SUMMARY OF LITERATURE REVIEW: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit. MATERIALS AND METHODS: 40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification. A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion. RESULTS: The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05). CONCLUSION: We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement.
Classification ; Decompression* ; Follow-Up Studies ; Humans ; Laminectomy ; Neurologic Manifestations* ; Retrospective Studies ; Spinal Canal

Intrasellar or pituitary abscess was first reported about a century ago, after then once relatively common but now is rare. Since 1925, about 50 cases have been reported in the literatures, of which characters were variable, but clinical very similar to one of pituitary tumor. So they were often diagnosed preoperatively as pituitary tumor. Several pathogenic factors were postulated in relation to clinical aspects. We had recently experienced a case of pituitary abscess combined with chromophobe adenoma. A 28 years old clerkman was admitted to our hospital with complaints of impared ejaculation and visual disturbance. Clinical aspects and diagnostic studies gave us a strong impression of pituitary tumor. Upon surgery we found a cystic mass in pituitary region, of which aspiration showed whitish-gray, tenacious and liquid material. Many polymorphous leukocytes were noted by direct smear, but no microorganisms were detected in culture. He had postoperatively suffered from transient polyuria and polydipsia, which soon disappeared under the medication of Esidrex. He was discharged from this hospital with recommendation of radiation therapy. Clinical features and treatment were also discussed with review of ever reported cases.
Abscess* ; Adenoma, Chromophobe ; Adult ; Ejaculation ; Humans ; Hydrochlorothiazide ; Leukocytes ; Male ; Pituitary Neoplasms ; Polydipsia ; Polyuria

A number of authors have called attention to the difficulty encountered in diagnosing tumors near the foramen magnum and have formulated symptom complexes in an effort to facilitate early recognition of these lesions. Emphasis has been placed on their bizarre symptoms and on their resemblance to the clinical picture associated with some degenerative diseases of the central nervous system, ruptured cervical disc and cervical spondylosis. Fortunately, it has been known that most of tumors around the foramen magnum are benign, extramedullary and amenable to cure by surgical excision and with minimal morbidity and mortality, provided they are diagnosed early. Recently we experienced a rare case of glioblastoma multiforme at the cervico-medullary junction. A 28-year-old Korean man was admitted to the Dept. of Neurosurgery on May 27, 1974, with 5 months history of cervical and suboccipital pain, and progressive visual disturbance. He had sustained hyperextension injury to his neck 8 months ago, and subsequently developed mild suboccipital and cervical pain which subsided easily with some analgesice. Three months later, he noticed paresthesia and tingling sensation in his upper limbs and anterior chest, especially when he turned his neck to either side. He also had pain in suboccipital region radiating to his both shoulders. Seven months later, he developed sudden paraperesis, poor vision and incoordination with severe suboccipital headache and vomiting. On admission, neurological examination disclosed clear consciousness, bilateral papilledema and abducens nerve palsy and markedly decreased vision. There were clumsiness of movement of both legs, hypesthesia in the face, decreased perception of vibration and position sense below the neck and increased deep tendon reflexes. Fine coordination movements in the upper limbs were disturbed and horizontal hystagmus was also present. Simple skull films showed destruction of the dorsum sellae and the posterior clinoid process, suggesting increased intracranial pressure. Cervical spine films were interpreted as normal. Right carotid angiograms demonstrated marked hydrocephalic patterns, and right vertebral angiograms demonstrated posterior displacement of the tip of the basilar artery and of the choroidal point. Conray ventriculogram showed a sharp filling defect at the level of lateral recess of the fourth ventricle. Suboccipital craniectomy and bilateral laminectomy of the first two cervical vertebrae were performed, disclosing a nodular, meaty, firm mass with some necrosis. The tumor was located posterolateral to the medulla and the spinal cord from the obex to the C2, compressing them and displacing the right cerebellar tonsil upward and laterally. The tumor was removed partially and Torkildsen's shunt was performed. Post-operatively he died suddenly at the end of the second week without any remarkable improvement in symptoms and signs. Pathological report was a glioblastoma multiforme. At autopsy, the tumor was originated from the cervicomedullary junction, extending posteriorly from the obex to the C2 and anteriorly along the brain stem up to the perichiasmatic region.
Abducens Nerve Diseases ; Adult ; Ataxia ; Autopsy ; Basilar Artery ; Brain Stem* ; Brain* ; Central Nervous System ; Cervical Vertebrae ; Choroid ; Consciousness ; Female ; Foramen Magnum ; Fourth Ventricle ; Glioblastoma* ; Headache ; Humans ; Hypesthesia ; Intracranial Pressure ; Laminectomy ; Leg ; Mortality ; Neck ; Neck Pain ; Necrosis ; Neurologic Examination ; Neurosurgery ; Palatine Tonsil ; Papilledema ; Paresthesia ; Proprioception ; Reflex, Stretch ; Sensation ; Shoulder ; Skull ; Spinal Cord ; Spine ; Spondylosis ; Thorax ; Upper Extremity ; Vibration ; Vomiting

Fluorescein retinal angography has been used in order to make differential diagnosis between true papilledema and pseudopapilledema, and to make early confirmation of the incipient papilledema. After injection of 5 cc of 10% fluorescein sodium into antecubital vein, the fluorescein retinal angiographic findings of 6 normal adults and 17 papilledematous patients of the brain tumor were obtained by Zeiss fundus camera(exciter filter:Kodak Wratten 47 A, barrier filter:Schott GG 14). 1. The characteristic findings of papilledema in the disc are: a. Leakage of fluorescein from capillaries and persistence of the fluorescence till late stage. b. Capillary dilatation. c. Microaneurysm. 2. The massive leakage of the fluorescen is seen in the patients of the 3 rd ventricular or posterior fossa tumors. 3. The decreased visual acuity is prominent in the patients showing marked capillary dilatation and microaneurysm.
Adult ; Brain Neoplasms* ; Brain* ; Capillaries ; Diagnosis, Differential ; Dilatation ; Fluorescein* ; Fluorescence ; Humans ; Infratentorial Neoplasms ; Papilledema* ; Retinaldehyde ; Veins ; Visual Acuity