The purpose of present study was to observe the radiographic finding and histologic response by Confocal Laser Scanning Microscopy(CLSM) on interface of the bone and titanium implant coated by chitosan. The tissue of rabbit tibiae to the surgical placement titanium implant coated by chitosan was examined at 3, 9 and 24 days postoperatively. The radiographic finding showed that surrounding bone density of implants was not significantly different compare with the bone on 3 and 9 days group. A large amount new bone was formed on 24 days group, the reason was osteconduction activity by chitosan. The CLSM analysis show that the surface coating by chitosan filled the gap between bone and implant on 3 days group and filled by mew born on 9 days group. On 24 days group, the bone and titanium surface was filled by lamella bone. This results indicated that this enhanced the initial stability of implant significantly and chitosan induced osseointegration around implant. CLSM allows the non-destrutive histo-tomography of bone biopsy as well as clinical practice. We conclude that CLSM allowed a good comprehension of the nature of bone-implant contact, avoiding artifacts due to the thickness of the specimen.
Artifacts ; Biopsy ; Bone Density ; Chitosan* ; Comprehension ; Microscopy, Confocal* ; Osseointegration ; Tibia ; Titanium*

In this study, we designed the expert system for the diagnosis of stroke. The causes of stroke in central nervous systems are very diverse, so a doctor who treats the patients with stroke must have the expert knowledge for the quick and correct diagnosis and for the adequate medical management. But the primary physician who engaged in the primary care of the patient with stroke does not have the expert knowledge for the stroke. So, we need to develop the expert system for assisting the diagnosis of stroke. Also the diagnosis system can be used as simulator for the medical students who study the neurology. In this study, we developed the diagnosis expert system that offer a pathological name provided by artificial neural networks. And we designed the inference engine and GUIs(graphical user interfaces). The artificial neural network is a system that provide a possible diagnosis of stroke. We implemented the system using Visual Basic 6.0 of Microsoft Co.
Central Nervous System ; Diagnosis* ; Expert Systems* ; Humans ; Neurology ; Primary Health Care ; Stroke* ; Students, Medical

BACKGROUND: An aggressive skin cancer on the nose, tends to have poorly defined clinical margins, and has a higher recurrence rate. A small tumor on the nose is usually easily treated by any of the standard methods. However, removal and reconstruction with preserved cosmesis is more laborous in a basal cell carcinoma larger than 10 mm in diameter. This is because the nose has complex contoures, unique skin color and texture, and the limited availability of mobile adjacent skin. When available Mohs micrographic surgery is the preferred treatment for these large tumors. OBJECTIVE: Our purpose was to investigate the preferred reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the nose after Mohs micrographic surgery. METHODS: From March 1991 to February 1997, twenty-one patients were diagnosed with basal cell carcinoma on the nose at our department. All the tumors were removed with Mohs micrographic surgery, and then the defects were reconstructed with a primary closure, skin graft, and local flap.
Carcinoma, Basal Cell* ; Humans ; Mohs Surgery* ; Nose* ; Recurrence ; Skin ; Skin Neoplasms ; Transplants

BACKGROUND: The rate of rise of left ventricular(LV) systolic pressure, dp/kt, and the peak ejection rate(PER) of LV may be more accurate indices for assessing LV systolic function than ejection fraction(EF). Both can be easily obtained by noninvasive methods, M-mode echo/phonocardiography and automated border detection(ABD) echocardiography, respectively. Mean dp/dt by M-mode echo/phonocardiography and PER by ABD echocardiography were compared with mean dp/dt by Doppler echocardiography. METHODS: Twenty-one adult patients who had normal sinus rhythm, mitral regurgitant signals by continuous wave Doppler echocardiography and an apical 4 chamber view of LV in which at least 75% of the endocardium was clearly visualized were selected for our study. The off-line estimation of LV end-diastolic volume (1) were performed by the method of disc, after manually tracing the endocardial border on the apical 4 chamber view and EF was calculated. M-mode echocardiography of the aortive valve and phonocardiography were simultaneously recorded on the strip chart to measure the isovolumic contraction time(dtM). A blood pressure (2) and LV end-diasolic pressure(LVEDP) was assigned 20mmHg in patients with Q wave myocardial infarction or EF< or =40% and 10mmHg in others. The mean dp/dtM during isovolumic contraction time was calculated as (aortic diastolic pressure-LVEDP)/dtM and was compared with the Doppler-derived mean rate of LV pressure rise(dp/dtDoppler) over the time period between velocities of 1 and 3m/sec on the ascending slope of the Doppler velocity spectrum. ABD system was used to measure the changes in LV volume and PER on the apical four chamber view. PER was compared with mean dp/dtDoppler. RESULTS: Mean dp/dtM positively correlated with mean dp/dtDoppler(r=0.73, p<0.001), but the limits of agreement between two methods were somewhat wide(-659-937mmHg/sec). PER also positively correlated with dp/dtDoppler and EF(r=0.73, p<0.001 ; r=0.80, p<0.001). CONCLUSIONS: Mean dp/dtM by M-mode echo/phomocardiography and PER by ABD echocardiography may be useful indices for assessing LV systolic function.
Adult ; Blood Pressure ; Echocardiography* ; Echocardiography, Doppler ; Endocardium ; Humans ; Myocardial Infarction ; Phonocardiography

An avulsion fracture of the second metacarpal base by the extensor carpi radialis longus is rare. There have been only 7 reports (in 10 patients) of this injury in the literature. We report upon a case of avulsion fracture of the second metacarpal base, which was treated successfully by open reduction and internal fixation.

BACKGROUND: The PUVA therapy of psoriasis is a very effective therapeutic modality that combines the action of light and drugs. Generally the conventional PUVA therapy based on patient's skin type is used in Korea. But there are many reported that conventional PUVA therapy is not suitable in several instances including the determination of oral 8-methoxypsoralen(8-MOP) dose, initial and incremental UVA dose and so on. OBJECTIVE: The purpose of this study is to establish a new protocol of PUVA therapy that is photomedically acceptable. METHOD: From 1997 to 2001, twenty psoriasis patients of moderate to severe grade who visited our clinic, were treated with PUVA therapy. Initial UVA dose was the same as MPD of each patient and proportion of weekly incremental UVA dose was 20% added to previous dose. All patients received PUVA therapy twice a week. The 8-MOP dose was determined by body surface area. RESULT: Total of 8 patients were skin type III, and 12 patients were skin type IV. The average of initial MPD in skin type III was 1.75J/cm2(0.5~2.5J/cm2) and skin type IV was 3.25J/cm2(2.5~4.5J/cm2). The average number of treatments to the end of therapy were 13.63(10~16) in skin type III, and 12.5(8~18) in skin type IV. The total cumulative UVA dose was 44.73J/cm2(30~68.2J/cm2) in skin type III, and 67.98J/cm2(31.6~109J/cm2) in skin type IV. CONCLUSION: The excellent effectiveness and safety of our new PUVA protocol have been demonstrated. We conclude that this PUVA protocol is a very effective, safe, and efficient method for the treatment of psoriatic patients.
Body Surface Area ; Humans ; Korea ; Methoxsalen ; Psoriasis* ; PUVA Therapy* ; Skin

BACKGROUND: Up to eighty percent of all basal cell carcinomas occur in the head and neck region. Mohs micrographic surgery(MMS) was known as an ideal treatment for primary or secondary basal cell carcinoma. The surgical defects after the removal of malignant skin lesions are usually reconstructed with secondary intention, primary closure, skin graft, and local flap. When we reconstruct the surgical defect, we must consider the reconstruction method, defect site or size, recurrence, patient age, general health state, and functional and cosmetic aspects. OBJECTIVE: The purpose of this study was to evaluate the cure rate and the reconstruction method(especially, local flap reconstruction) by the cosmetic unit of the face after MMS. METHODS: From March 1991 to February 1998, fifty-seven patients were diagnosed histologically with basal cell carcinoma on the face at the department of dermatology of our unit. All the tumors were removed with MMS. According to the facial cosmetic unit, we divided the face into nose, cheek, eyelid, forehead, and temple. We reviewed the local flaps after Mohs micrographic surgery of basal cell carcinoma. RESULTS: 1. 50 of the 57 patients(86%) who had been diagnosed as basal cell carcinoma visited our hospital after their tumors increased over 10mm. Only one case among the fifty seven cases having MMS showed recurrence which means cure rate is ninty eight percent. 2. The forty two patients(74%) who had basal cell carcinoma on the head and neck were treated with local flap, ten patients(17%) were treated with primary closure, and five patients(9%) were treated with skin graft to reconstruct skin defect after MMS. 3. Reconstruction of the nose after MMS of basal cell carcinoma : Of the twenty nine patients that had basal cell carcinoma on the nose twenty four were local flap. The large defects were repaired by glabella and nasolabial flap, while small defects were Banner flap, and Limberg flap. 4. Reconstruction of the the cheek after MMS of basal cell carcinoma : Of the twelve patients that had basal cell carcinoma on the cheek ten were local flap. We preferred to reconstruct the cheek with cheek rotation flap. 5. Reconstruction of the eyelid after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the eyelid five were local flap. The depth of invasion was limited to the anterior lamella. We reconstructed the eyelid with variable local flap like unipedicle flap, bipedicle Tripier flap, cheek advancement flap, and glabella flap. 6. Reconstruction of the forehead, temple, scalp, and auricle after MMS of basal cell carcinoma : Of the eight patients that had basal cell carcinoma on the temple, scalp, and auricle three were local flap. We reconstructed the defects with scalp rotation flap, glabella rotation flap, and Banner flap. CONCLUSION: MMS is an ideal method for the treatment of basal cell carcinomas in that it provides 98% cure rates and maximum preservation of normal tissue by complete surgical margin control. Because of high cure rates(98%) after MMS, we can reconstruct the head and neck, especially face with the local flap which obtained the desired result functionally and aesthetically compared with other reconstruction methods like skin graft and secondary intention.
Carcinoma, Basal Cell* ; Cheek ; Dermatology ; Eyelids ; Forehead ; Head ; Humans ; Intention ; Mohs Surgery* ; Neck ; Nose ; Recurrence ; Scalp ; Skin ; Transplants

Background: and Purpose To determine the imaging characteristics and cutoff value of18F-florapronol (FC119S) quantitative analysis for detecting β-amyloid positivity and Al- zheimer’s disease (AD), we compared the findings of FC119S and 18F-florbetaben (FBB) positron-emission tomography (PET) in patients with cognitive impairment. Methods: We prospectively enrolled 35 patients with cognitive impairment who underwent FBB-PET, FC119S-PET, and brain magnetic resonance imaging. We measured global and vertex-wise standardized uptake value ratios (SUVRs) using a surface-based method with the cerebellar gray matter as reference. Optimal global FC119S SUVR cutoffs were determined using receiver operating characteristic curves for β-amyloid positivity based on the global FBB SUVR of 1.478 and presence of AD, respectively. We evaluated the global and vertex-wise SUVR correlations between the two tracers. In addition, we performed correlation analysis for global or vertex-wise SUVR of each tracer with the vertex-wise cortical thicknesses. Results: The optimal global FC119S SUVR cutoff value was 1.385 both for detecting β-amyloid positivity and for detecting AD. Based on the global SUVR cutoff value of each tracer, 32 (91.4%) patients had concordant β-amyloid positivity. The SUVRs of FC119S and FBB had strong global (r=0.72) and vertex-wise (r>0.7) correlations in the overall cortices, except for the parietal and temporal cortices (0.4Conclusions Quantitative FC119S-PET analysis provided reliable information for detecting β-amyloid deposition and the presence of AD.

BACKGROUND: Intracranial complications of paranasal sinus infection are rare and may be misdiagnosed during an initial evaluation because they often show subtle symptoms, which include elusive physical and neurological findings and imaging. The late recognition of these conditions and the delayed treatment can increase morbidity and mortality rates. We aimed to characterize the typical clinical features of intracranial complications associated with sinusitis. METHODS: Twelve patients who visited the Eulji Medical Center from 1994 to 2000, with sinogenic suppurative intracranial lesions were reviewed. Medical records and radiological studies were reviewed retrospectively. RESULTS: There were 12 cases with 15 sinogenic intracranial complications. The ratio of males to female was 2 : 1. The ages of patients ranged from 16 to 81 (average: 46.7). Four cases had meningitis, four had focal cerebritis, three had cavernous sinus throm-bophlebitis, two had subdural empyema, and two had epidural abscess or empyema. The primary lesions of paranasal sinusitis were located at the sphenoid in three, ethmoid sinus in two, frontal sinus in one and the multiple sinus in six. The outcome revealed complete recovery in six cases, mild neurologic sequelae in three cases, death in two cases and recurrence in one case. CONCLUSIONS: The type of intracranial complication and origin of paranasal sinusitis may be changing. Cases in which such complications are suspected, in order for an early diagnosis, a MRI should be considered. The successful management of intracranial complications consists of timely antibiotics therapy combined with surgical drainage of the loculated infection. (J Korean Neurol Assoc 19(5):457~463, 2001)
Anti-Bacterial Agents ; Cavernous Sinus ; Drainage ; Early Diagnosis ; Empyema ; Empyema, Subdural ; Epidural Abscess ; Ethmoid Sinus ; Female ; Frontal Sinus ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Meningitis ; Mortality ; Recurrence ; Retrospective Studies ; Sinusitis

Uterine carcinosarcomas are rare and highly aggressive tumors with a poor prognosis. Due to early metastasis and disease progression, it is known to be far more aggressive than matched grade 3 endometroid endometrial carcinomas. Five-year survival for stage IV is reported to be 10% and overall survival for stage IVB is expected to be very poor. The authors report one case after experiencing long-term survival (over 5 years) for stage IVB carcinosarcoma of uterus. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed to 56 year old patient for uterine myoma. On pathology report, uterine carcinosarcoma was diagnosed and image studies were performed. With the impression of stage IVB uterine carcinosarcoma, 6 cycles of chemotherapy (ifosfamide and cisplatin) was conducted as adjuvant. Up to recently (over 5 years), she maintains good performance scale without evidence of tumor recurrence or disease progression.
Carcinosarcoma ; Disease Progression ; Endometrial Neoplasms ; Female ; Humans ; Hysterectomy ; Myoma ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Uterus