The purpose of this study was to evaluate the substantivity of experimentally developed gel type tetracycline HCl and a mixture of tetracycline-citric acid gel, and compare to those of solution type tetracycline HCl. 11 extracted anterior teeth were subjected to this study. After scaling and root planing teeth were randomly divided into 3 treatments groups : group 1; 3 teeth were irrigated with tetracycline HCl(50mg/ml) solution , group 2; tetracycline gel (5%) was inserted in the periodontal pockets of 3 teeth, group 3; a mixture of tetracycline and citric acid gel was inserted in the pockets of 3 teeth. And 2 teeth treated in 0.9 % sterile saline served as controls. After 5-minute exposure, each tooth immediately extracted and incubated at room temperature for 22 days in tris-buffered saline as a desorption media. The total volume of TBS was removed and replaced with fresh TBS, at 24-h intervals. Removed desorption media transferred to a sterile vial and stored at -70 oC. This procedure was repeated every 24 h throughout the 22-day desorption period. Using Porphyromonas gingivalis as an indicator organism, a microtiter assay was used to evaluate antimicrobial activity desorbed from the teeth. 1. 50mg/ml tetracycline HCl solution exhibited the longest antimicrobial activity. Compared to saline treated group, it showed significant difference on the day 1 and day 2 desorption period. 2. The ODs of 5% tetracycline gel and a mixture of tetracycline-citric acid gel were significantly different during the first 24 hour only. 3. There was no statistically significant difference after the day 3 between the groups.(p<0.05). Despite our expectation a mixture of tetracycline-citric acid gel did not show longer antimicrobial activities than those of tetracycline gel, and the solution type exhibited the longest activities. Because the gel type agents may stay in the subgingival environment longer than the solution, if the teeth were not extracted immediately after the delivery of the agent, the result could be different. hus this result suggests the possibilities of practical use of these kind of gel type agents.
Citric Acid ; Periodontal Pocket ; Porphyromonas gingivalis ; Root Planing ; Tetracycline* ; Tooth

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.
Aneurysm ; Aortic Rupture ; Endoleak ; Follow-Up Studies ; Humans ; Mortality ; Thrombosis

BACKGROUND: Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain. METHODS: Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis. RESULTS: One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B (p < 0.05). CONCLUSIONS: The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.
Buttocks ; Diagnosis ; Follow-Up Studies ; Humans ; Nerve Block ; Pain, Referred ; Prospective Studies ; Radiculopathy ; Spinal Diseases ; Spinal Stenosis ; Visual Analog Scale ; Zygapophyseal Joint

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.
Anesthesia ; Catheterization, Swan-Ganz ; Echocardiography, Transesophageal ; Electrocardiography ; Heart ; Humans ; Jugular Veins ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Prolapse ; Situs Inversus ; Thoracic Surgery

No abstract available.
Coronary Artery Bypass* ; Coronary Vessels* ; Transplants*

Myasthenia gravis is a disease characterized by muscle weakness upon exertion of an involved muscle group and partial return of function eithe with rest or the administration of anticholinesterase. It is generally thought that myasthenia gravis is caused by an autoimmune response associated with the thymus gland and thymectomy is considered to be the treatment of choice for countering this autoimmune process. It is a well known fact that perioerative nticholinesterase therapy, muscle relaxant administration during operation and postoperative respiratory management are in dispute. We described a case of a 42 year old male myasthenic patient with mild symptoms who needed 4 days of artificial ventilatory support following thymectomy.
Adult ; Autoimmunity ; Dissent and Disputes ; Humans ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Thymectomy ; Thymus Gland

The resting electrocardiography performed routinely in the clinical field is a useful method for the diagnosis of ischemic heart diasese and for predicting its prognosis. There have been reports about angina patients with symmetric T wave inversion in the precordial leads on the resting electrocardiogram(EGC) who usually showed stenotic lesions of left anterior descending coronary artery and with poor prognosis. However, we have had no studies on this subject in Korea. The authors conducted retrospectively a comparative study on the patients with angina pectoris in the Yonsei University Severance hospital from jan. 1980 to Dec. 1989. We set two groups for comparison; one group consisted of 89 patients who had more than 50% stenosis in luminal diameter of coronary artery on coronary angiogram and persistent symmetric T wave inversion in the precordial leads(T negaive group) ; the other group in cluded 132 patients who had normal ECG but significant stenosis of the coronary arteries(T positive group). We compared these two groups in clinical and coronary angiographic findings and evaluated the changes of T wave after percutaneous transluminal coronary angioplasty (PTCA) and medical treatment in the T negative group. 1) The mean age of the T nagative group was 56.4+/-12.9 years, and the male to female ratio was 2.3 : 1. In the T positive group, the mean age was 54.4+/-8.8 years, and the male to female ratio was 3.1 : 1. There was a relatively high occurrence rate in females in the T negative group, but this was not statistically significant. The duration of angina was 5.7+/-11.2 months in the T negative group, and 9.0+/-13.8 months in the T positive group, and relatively short in the T negative group. There was no difference in the risk factors between these two groups except for a slightly higher level of serum cholesterol in the T positive group than the T negative group(187.4+/-33.5mg/dl v/s/ 199.9+/-49.2mg/dl, p<0.05). 2) The extent of coronary artery disease in the T negative group was 3 cases of left main coronary artery disease(3.3%), 54 cases of one vessel disease(60.7%), 20 cases of two vessel disease(22.5%), 12 cases of three vessel disease(13.5%); in the T positive group, left main coronary artery disease was found in 10 cases(7.5%), on e vessel disease in 71 cases(53.8%), two vessel disease in 29 cases(22.0%), three vessel disease in 22 cases(16.7%). There was no difference in the extent of coronary artery disease between these two groups. 3) The occurrence rate of involvement of left anterior descending artery(LAD) and its branches was 87.9% in the T negative group, and 76.5% in the T positive group, which indicated more frequent involvement of LAD in the T negative group(p<0.05). The mean degree of stenosis of LAD was 79.5+/-17.0% in the T negative group, and 77.0+/-16.2% in the T positive group, but there was no significant difference between the two groups. Those patients with more than 95% stenosis of LAD were 32.9% of the T negative group, 14.3% of the T positve grouup, and the T negative group showed a significantly higher rate than the T positive group(p<0.05). 4) The wall motion abnormalities in the LAD territory were more frequently noted in the T negative group than the T positive group(25.3% v.s. 11.9%, p<0.05). However, upon determining the ejection fraction(68.8+/-12.8% v.s. 71.9+/-11.4%) and left ventricular end diastolic pressure(11.6+/-5.4mmHg v.s. 12.9+/-4.9mmHg), no difference was found. 5) There were no episodes of acute myocardial infarction or hospital death during the admission in either group except for 2 cases of death after coronary artery bypass graft in the T positive group. 6) Although the patients who unerwent PTCA showed more severe stenosis of LAD than those who had medical treatment only in the T negative group(863.8+/-10.9% v.s. 70.8+/-21.4%, p<0.05), there was a higher rate of normalization of T wave inversion in the PTCA group compared with that in the medical treatment gorup(70.8% v.s. 37.0%, p<0.05). The above results suggest that T wave inversion in the precordial leads on the resting ECG in patients with angina pectoris was associated with severe stenosis of LAD and ventricular wall motion abnormalities, and the T wave inversion could be normalized with improvement of myocardial ischemia and the prognosis for such patients was relatively good in appropriate treatments such as PTCA were performed.
Angina Pectoris* ; Angioplasty, Balloon, Coronary ; Cholesterol ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography* ; Female ; Heart ; Humans ; Korea ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Phenobarbital ; Prognosis ; Retrospective Studies ; Risk Factors ; Transplants

Left ventricular rupture is a fatal complication of acute myocardial infarction, however accurate preoperative diagnosis is still difficult. We experienced a postinfarction left ventricular rupture patient whose symptoms and radiologic findings mimicked those of acute intramural hematoma of the aorta. Upon emergency operation, he was proven to have a postinfarction LV rupture and underwent successful surgery. We herein report the case with a brief review of the literature.
Aortic Diseases/*diagnosis ; Case Report ; Diagnostic Errors ; Heart Rupture, Post-Infarction/*diagnosis/surgery ; Hematoma/*diagnosis ; Human ; Male ; Middle Age

The patency of graft vessels and their effects on the native coronary circulation were studied by evaluation of 78 graft sites in 35 patients who underwent selective bypass graft angiography among 152 CABG cases at a mean follow-up 12.6 month. The result were as follows ; 1) The overall graft patency rate was 70.5% : 73.8% for left anterior descending artery, 68.4% for left circumflex arterty, 64.7% for right coronary artery. 2) The patency rate of internal mammary artery was 77.8%. 3) In twenty eight patients who underwent native coronary angiography, twelve pateints showed progression of coronary artery disease in grafted vessel and two patients showed progression of coronary artery disease in non-grafted vessel. 4) The treadmill test was performed before and after coronary artery bypass graft in thirteen patients. Among 13 patients, nine patinets showed improved exercise tolerance. 5) The percutaneous transluminal coronary angioplasty were successfully performed for dilating three cases of stenotic vein graft and two cases of left main lesions after CABG and one case of stenotic left internal mammary artery graft.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Circulation ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Humans ; Mammary Arteries ; Transplants ; Veins

Recent studies in western countries have reported that the mechanism pf pain are concorded with gate control opiage receptor binding sites and the release of intrinsic morphine like substances, sodium glutamate and also with bradykinin, seroconin, histamine and prostaglandin E. Otherwise the mechanism of the stimulstion producing analgesia has been reported to involve a neurophysiologic and neurohumoral inhibitory effect at the level of spinal cord, brain stem, thalamus and cortex. This has been clarified but further study should improve the chance of understanding the mechanism of pain. From the standpoint of pain management, medications used to manage pain have some unfortunate side effects. nerve blocks cause anesthesia toxicity, major neurosurgical procedures have many complications. Subarachnoidal and epidural analgesics have unknown irritation pneumonia and drug toxicity, and plexus or pituitary gland block with phenol or alcohol has uneventful complication. From January 1980 to December 1982, electrical acupuncture stimulation has been used on 210 cases at HANYANG university hospital in the pain clinic. I found it useful in relieving pain which has not responded to various conventional methods which included medications, nerve blocks, neurosurgical intervantion and neuropolytics. The results are as follows: 1) There are two kinds of treated patients: One is consultation case-12 from internal medicine, 16 from orthopedic surgery, 10 from neurosurgical and 2 from psychiatry. Another 170 cases were patients who directly to the clinic. And the age distribution shows the highset number of patients in the 3rd decade(21%) and in the 4th decade(24.8%). 2) The region of pain was 21% lumbar, 13.8% shoulder, 10% lower leg and head or face with 9.5%. 3) The duration of the pain showed 10 days 25.7%, 1~2 month 18.6%, one year 11.4% and the longest up to 20 years. 4) Patients who were able to walk into the clinic were 19.5%, moderate cases who to be accompanied were 58.6% and bedridden cases were 21.9%. 5) Treatment was conducted mainly on low frequency stimulation with various waves that included the general dynamic activity point plus reactive electro permeable point (REPP) 81.9% and REER plus head in situ needle 18.1%. 6) In 16.7% only one treatment was administered, in 46.1% 2~5 treatments were given, in 28.6% 6~10 treatments were given and in 3 cases more than 100 treatments were administered. 7) Of the 210 cases, 43.3% showed marked improvement, 41.4% were improved, 13.8% showed translent improvement and there were 3 cases of no improvement. The total confidence was 84.7%. 8) There are no serious complications except hypertensive shock case, submucosal hemorrhagic petechia 7 cases and generalized fatigue 18 cases. In conclusion, electrical acupuncture stimulation of the peripheral nervous system can be used to relieve pain replacing such conventional means as medications, nerve blocks, major neurosurgical procedures, neuroytics and physiopsychic therapy which are generally less effective.
Acupuncture ; Age Distribution ; Analgesia ; Analgesics ; Anesthesia ; Binding Sites ; Bradykinin ; Brain Stem ; Drug-Related Side Effects and Adverse Reactions ; Electric Stimulation* ; Fatigue ; Head ; Histamine ; Humans ; Internal Medicine ; Leg ; Morphine ; Needles ; Nerve Block ; Neurosurgical Procedures ; Orthopedics ; Pain Clinics ; Pain Management ; Peripheral Nerves* ; Peripheral Nervous System ; Phenol ; Pituitary Gland ; Pneumonia ; Shock ; Shoulder ; Sodium Glutamate ; Spinal Cord ; Thalamus