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

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

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

BACKGROUND: Although lung involvement has been reported in 5 to 46% of dermatomyositis/polymyositis (DM/PM) patients, reports of the condition in Korea are rare. This study evaluated the clinical features of lung involvement in DM/PM patients. METHODS: The medical records, laboratory results and radiologic findings of 79 DM/PM patients, who attended the Seoul National University Hospital (SNUH) between 1989 and 1999, were reviewed retrospectively. RESULTS: A total 79 patients of whom 24 patients(33%) showed lung involvement, were enrolled in this study. More patients with lung involvement were female(F:M=11:1), and older compared with those without lung involvement. Patients with lung involvement presented with dyspnea(79%), coughing(67%), an elevated ESR, and CK/LD. Anti-Jo 1 antibody test was positive in 30%, which is significantly higher in patients with lung involvement. A simple chest X-ray of the patients with lung involvement exhibited reticular opacity(50%), reticulonodular opacity(30%), patchy opacity(29%), nodular opacity(13%) and linear opacity(4%). HRCT(n=24) showed ground glass opacity(75%), linear or septal thickening(50%), patchy consolidation(42%), honey-combing(33%) and nodular opacity(17%). The pulmonary function test showed a restrictive ventilatory pattern(77%) and a lower diffusing capacity(62%). The patients were followed up during a mean duration of 30±28 months. They were treated with steroid only(50%) or a combination of steroids and cytotoxic agents(46%). Muscle symptoms were improved in 89% with treatment, but an improvement in the respiratory symptoms or in the pulmonary function test was rare. Patients with lung involvement had a higher mortality rate(21%) than those without lung involvement(10%) during the follow-up periods. CONCLUSION: DM/PM patients with lung involvement were mostly female, older and had a higher positive rate Anti-Jo 1 antibodies, but there was no significant difference in prognosis.
Antibodies ; Dermatomyositis ; Female ; Follow-Up Studies ; Glass ; Humans ; Korea ; Lung Diseases, Interstitial ; Lung* ; Medical Records ; Mortality ; Polymyositis ; Prognosis ; Respiratory Function Tests ; Retrospective Studies ; Seoul ; Steroids ; Thorax

BACKGROUND: Cyclosporin A(CsA) and tacrolimus(FK506) have been widely used as immunosuppressants. The effects of CsA, or FK506, on the IkappaB/NF-kappaB pathway have been shown to vary according to the cell type. However, their effects on the IkappaB/NF-kappaB pathway have not been reported in bronchial epithelial cells. In this study, the effects of CsA and FK506 on the IkappaB/NF-kappaB pathway in bronchial epithelial cells, monocytes, lymphocytes and alveolar macrophages were evaluated. The relationship between their effects on the IkappaB/NF-kappaB pathway and IkappaB kinase(IKK) activity was also investigated. METHODS: BEAS-2B and A549 cells, pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes were used. The cells were pre-treated with CsA, or FK506, for various time periods, followed by stimulation with TNF-alpha, LPS or IL-1beta. The I(kappa)B(alpha) expressions were assayed by Western blot analyses. The IKK activity was evaluated by an in vitro immune complex kinase assay, using GST-I(kappa)B(alpha) as the substrate. RESULTS: Neither CsA nor FK506 affected the level of I(kappa)B(alpha) expression in any of the cell types used in this study. CsA pre-treatment inhibited the TNFalpha-induced I(kappa)B(alpha) degradation in bronchial epithelial cells. In contrast, the TNFalpha-induced I(kappa)B(alpha) degradation was not affected by FK506 pre-treatment. However, FK506 suppressed the cytokine-induced I(kappa)B(alpha) degradation in the pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes. The inhibitory effect of CsA, or FK506, on I(kappa)B(alpha) degradation was not related to IKK. CONCLUSIONS: CsA and FK506 suppressed the I(kappa)B(alpha) degradation in bronchial epithelial cells, mono. cytes, lymphocytes and alveolar macrophages, so this may not be mediated through IKK.
Antigen-Antibody Complex ; Blotting, Western ; Cyclosporine* ; Epithelial Cells* ; Immunosuppressive Agents ; Lymphocytes* ; Macrophages, Alveolar* ; Monocytes* ; NF-kappa B ; Phosphotransferases ; Tacrolimus* ; Tumor Necrosis Factor-alpha

A extrapulmonary small cell carcinoma is a very rare disease, and a primary pleural manifestation is extremely rare. A diagnosis of a small cell carcinoma should be based on the cell morphology, histological pattern, and an immunohistochemical study. We recently experienced a case of small cell carcinoma (SCC) of the pleura in a 59-year-old man who had suffered from right pleuritic chest pain. A histopathological confirmation of SCC was made by a video-associated thoracoscopic lung biopsy. Systemic chemotherapy with etoposide and cisplatin was initiated.
Male ; Humans

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

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