A patient (Hellman dental age IIIA) who had anterior cross bite due to functional factor was treated with activator. Following results were obtained: 1) Anterior cross bite was crorrected 3 months after the initial application of the appliance. 2) Comparing pretreatment records with posttreatment, the main effects were labioversion of upper incisors, increase of upper arch length and downward-backward rotation of the mandible. 3) There was no damage on teeth and periodontal tissues and the patient had normal occlusion 1 year after the treatment.
Humans ; Incisor ; Malocclusion ; Mandible ; Prognathism* ; Tooth

BACKGROUND: Tricuspid valve replacement is very rarely performed procedure and its long- term result is not yet satisfactory. Moreover, it is not well known whether bioprosthesis or mechanical prosthesis is the best selection for artificial valve. We reviewed 72 cases of tricuspid valve replacements in 71 patients between January 1989 and December 1998, trying to analyze the overall results and risk factors for mortality and morbidity. MATERIAL AND METHOD: Average age of the patients at the time of operation was 42+/-13 years(range 16 to 65 years) and the sex ratio of male versus female was 32/39. Primary diagnosis consisted of 50 cases of aquired valvular heart disease and 18 cases of congenital heart disease, such as Ebstein's anomaly. 4 cases had isolated tricuspid valve regurgitation. Implanted valves were 69 mechanical prosthesis and 3 bioprosthesis. Concomitant mitral or aortic valve replacements were performed in 50 cases. One patient received concomittant pulmonary valve replacement. RESULT: There were 7(9.72%) operative deaths and 7(13.0%) late deaths. Actuarial survival at 10 years was 59.2+/-7.2%. Prosthetic tricuspid valve thrombosis occurred 11 times in 5 patients. Reoperation for prosthetic tricuspid valve failure was performed in 1 patient. In this case, examination of the explanted prostheses showed that the tricuspid stenosis was the result of valve thrombosis. Among the 47 survivors, 46 patients(98%) were in functional class I or II. CONCLUSION: In our ten-year experience of tricuspid valve replacement, mortality and morbidity were satisfactory. Mechanical prosthesis in tricuspid position showed comparable clinical results as bioprosthesis.
Aortic Valve ; Bioprosthesis ; Constriction, Pathologic ; Diagnosis ; Ebstein Anomaly ; Female ; Heart Defects, Congenital ; Heart Valve Diseases ; Humans ; Male ; Mortality ; Prostheses and Implants ; Pulmonary Valve ; Reoperation ; Risk Factors ; Sex Ratio ; Survivors ; Thrombosis ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

BACKGROUND: Valvular heart disease is still the most common health problem i n Korea.By the end of the year 1999,there has been 94,586 cases of open heart surgery since the first case in 1958.Among them,36,247 cases were acquired heart diseases and 20,704 of those had valvular heart disease.But there was no database system and every surgeon and physician had great difficulties in analysing and utilizing those tremendous medical resources. Therefore,we developed a valve registry database program and utilize it for risk factor analysis and so on. MATERIAL AND METHOD: Personal computer-based multiuser database program was created using Microsoft AccessTM.That consisted of relational database structure with fine-tuned compact field variables and server-client architecture.Simple graphic user interface showed easy-to-use accessability and comprehensibility.User-oriented modular structure enabled easier modification through native AccessTM functions.Infinite application of query function aided users to extract, summarize,analyse and report the study result promptly. RESULT: About three-thousand cases of valve replacement procedure were performed in our hospital from 1968 to 1999.Total number of prosthesis replaced was 3,700.The numbers of cases for mitral,aortic and tricuspid valve replacement were 1600,584,76, respectively. Among them,700 patients received prosthesis in more than two positions. Bioprosthesis or mechanical prosthesis were used in 1,280 and 1,500 patients respectively. Redo valve replacements were performed in 460 patients totally and 40 patients annually. CONCLUSION: Database program for registry of valvular heart disease was successfully developed and used in personal computer-based multiuser environment.This revealed promising results and perspectives in database management and utilization system.
Bioprosthesis ; Heart ; Heart Diseases ; Heart Valve Diseases ; Humans ; Prostheses and Implants ; Risk Factors* ; Thoracic Surgery ; Tricuspid Valve

No abstract available.
Carotid Arteries*

OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.
Contrast Media/diagnostic use ; *Coronary Artery Bypass ; Coronary Disease/*surgery ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pericardium/surgery ; Retrospective Studies ; Statistics, Nonparametric ; Ventricular Septum/*physiopathology

BACKGROUND: Glutaraldehyde (GA) is a widely used cross-linking agent for improving mechanical properties and resistance to enzymatic degradation of collagenous tissue, but it has several drawbacks such as calcification and cytotoxicity. The aim of this study was to find the alternative effective cross-linking methods to GA. MATERIALS AND METHODS: Bovine pericardium was processed with GA with ethanol+octanol and glycine detoxification, and polyethylene glycol (PG) space filler, dimethyl 3,3'-dithiobispropionimidate (DTBP), 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) treatment, and the physical fixation of ultraviolet irradiation were done. The biologic material properties of variously treated pericardial tissues were assessed by biochemical, mechanical and histological tests. Treated pericardial tissues were also implanted subcutaneously or intramuscularly into the rabbit for 10 weeks to assess the xenoreactive antibody response of immunoglobulin G and M, their anti-calcification effect. RESULTS: The biochemical and mechanical properties of EDC fixed pericardial tissues were comparable to the GA fixed tissue. The cytotoxicity was lowest in space filler treated GA fixed group. In rabbit subcutaneous or intramuscular implantation models, decellularization, space filler, EDC treatment group showed significantly lower calcium content than GA only and DTBP treatment group (p<0.05, analysis of variance). The titer of anti Galalpha1-3Galbeta1-4GlcNAc-R antibodies did not change in the postimplantation serial enzyme-linked immunosorbent assay. Hematoxylin and eosin and von Kossa staining showed that decellularization, space filler, EDC, and ultraviolet treatment had less inflammatory cell infiltration and calcium deposits. CONCLUSION: The decellularization process, PG filler, and EDC treatments are good alternative cross-linking methods compared to GA only fixation and primary amine of DTBP treatment for cardiovascular xenograft preservation in terms of the collagen cross-linking stability and in vivo anti-calcification effects.
Antibodies ; Antibody Formation ; Bioprosthesis ; Calcium ; Collagen ; Cyclohexanes ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Glutaral ; Glycine ; Hematoxylin ; Imidoesters ; Immunoglobulin G ; Pericardium ; Polyethylene Glycols ; Transplantation, Heterologous ; Trisaccharides

BACKGROUND: Intravenous injection of rocuronium is associated with withdrawal responses which are attributable to the pain from the injection of rocuronium. Several methods have been proposed to abolish and attenuate rocuronium-induced pain. We hypothesized priming dose of rocuronium could reduce withdrawal responses associated with administering a second large dose of rocuronium for tracheal intubation. We compared the efficacy of the priming dose technique of rocuronium with intravenous lidocaine as a pre-treatment for the prevention of withdrawal responses associated with rocuronium injection. METHODS: We recruited 150 patients aged between 18 and 60 years, ASA physical status 1 or 2, who were going to undergo elective surgery requiring general anesthesia. Patients were allocated into three groups. Group C received normal saline, Group L received lidocaine 1 mg/kg, and Group P received rocuronium 0.06 mg/kg 2 minutes before administering a second large dose of rocuronium for tracheal intubation. After the loss of consciousness, rocuronium 0.6 mg/kg was administered intravenously over 10 seconds for tracheal intubation. The withdrawal responses to the injection of rocuronium were evaluated. RESULTS: The incidence of withdrawal responses associated with rocuronium injection for tracheal intubation was 56, 50, 24% in group C, group L, and group P, respectively. The incidence of withdrawal responses was lower in group P than group C and group L, but there was no difference between group L and group C. CONCLUSIONS: Priming dose technique is a useful clinical method to alleviate withdrawal responses associated with rocuronium injection.
Administration, Intravenous ; Aged ; Androstanols ; Anesthesia, General ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Lidocaine ; Unconsciousness

A 57-year-old woman developed an inflammatory carcinoma in her left breast next to the spot of a silicone injection that had been used for augmentation some 20 years previously. She underwent a modified radical mastectomy with an axillary lymph node dissection. There have been relatively few cases reported in the literature that have noted breast cancer associated with silicone injections. During physical examinations, such breasts are frequently firm, tender, painful, and inflamed. Far more important, in silicone-injected breasts, carcinomas become more difficult to detect by physical examination, mam mography, and other known methods. Although no causal relationship between silicone and breast carci nomas is implied, a heightened awareness of the possible coexistence of silicone mastopathy and a breast carcinoma is necessary.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Node Excision ; Mastectomy, Modified Radical ; Middle Aged ; Noma ; Physical Examination ; Silicones*

A 57-year-old woman developed an inflammatory carcinoma in her left breast next to the spot of a silicone injection that had been used for augmentation some 20 years previously. She underwent a modified radical mastectomy with an axillary lymph node dissection. There have been relatively few cases reported in the literature that have noted breast cancer associated with silicone injections. During physical examinations, such breasts are frequently firm, tender, painful, and inflamed. Far more important, in silicone-injected breasts, carcinomas become more difficult to detect by physical examination, mam mography, and other known methods. Although no causal relationship between silicone and breast carci nomas is implied, a heightened awareness of the possible coexistence of silicone mastopathy and a breast carcinoma is necessary.
Breast Neoplasms* ; Breast* ; Female ; Humans ; Lymph Node Excision ; Mastectomy, Modified Radical ; Middle Aged ; Noma ; Physical Examination ; Silicones*

BACKGROUND: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. METHODS: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25microgram/kg/min (Group 0.25), or remifentanil 0.5microgram/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. RESULT: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56+/-0.2 mg/kg, 1.07+/-0.2 mg/kg and 0.9+/-0.1 mg/kg, respectively. CONCLUSIONS: A combined injection of 0.5microgram/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness.
Anesthesia ; Arterial Pressure ; Cardiovascular System ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Unconsciousness