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: 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*

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: 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

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: Rapid and accurate diagnosis is essential for successful management of acute aortic dissection. As transesophageal echocardiography(TEE) provides excellent imaging of thoracic aorta conveniently, TEE is widely indicated as a effective diagnostic method of aortic disease. To evaluate clinical usefulness of TEE in patients with suspected aortic dissection, we assessed diagnostic accuracy and feasibility of TEE. METHODS: Ninety-one consecutive patients with clinically suspected aortic dissection were examined by TEE, computerized tomography(CT), magnetic resonance imagion(MRI) and aortic angiography between August 1991 and September 1994. The diagnosis was confirmend by these techniques and surgery. RESULTS: 1) We diagnosed 27 proximal aortic dissection, 22 distal aortic dissection, 8 aortic intramural hematioma, 12 thoracic aortic aneurysm, 2 penetration ulcer, 1 necrotizing aortitis, 1 traumatioc aortic rupture and 18 normal findings in 91 study patients. 2) The sensitivity and specificity of TEE for aortic dissection were 98% and 97%, respecitively. The sensitivity and specificity of TEE to detect ascending aorta involvement were 94% and 100%. 3) CT was chosen in 62 cases as primary diagnostic method of aortic dissection, whereas TEE was performed in 21 cases. TEE was chosen as confirmative diagnostic method following CT in 45 cases, in one-third of whom TEE played a great role in diagnosis or decision of treatment modality. CONCLUSION: As TEE is and accurate and practical method in diagnosis of aortic dissection, TEE may be suggested as primary diagnostic method in suspected aortic dissection. TEE was also useful as confirmative diagnostic method complemention CT.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortic Rupture ; Aortitis ; Complement System Proteins ; Diagnosis* ; Echocardiography, Transesophageal* ; Humans ; Sensitivity and Specificity ; Ulcer

PURPOSE: Laparoscopic surgery for gastric cancer was introduced in the past decade because it was considered less invasive than open surgery, and this results in less postoperative pain, faster recovery and an improved quality of life. Several studies have demonstrated the safety and feasibility of this procedure. We examined the outcome of performing laparoscopic surgery for gastric cancer over the last two year. MATERIALS AND METHODS: From April 2004 to December 2006, 329 patients with gastric adenocarcinoma underwent a laparoscopy-assisted distal gastrectomy with lymph node dissection. The data was retrospectively reviewed in terms of the clinicopathologic findings, the perioperative outcomes and the complications. RESULTS: The total patient group was comprised 196 men (59.6%) and 133 women (40.4%). The mean BMI was 23.6 and the mean tumor size was 2.7 cm. The mean number of harvested lymph node was 22.7, and this was 18.6 before 30 cases and 23.1 after 30 cases, and the difference was significant (P=0.02). The mean operation time was 180.9 min, and this was than 287.9 min before 30 cases and 170.2 min after 30 cases. After 30 cases, there was a significant improvement of the operation time (P<0.01). The mean incision length after 30 cases was shorter than that before 30 cases (P<0.01). Postoperative complications occurred in 24 (7.3%) of 329 patients and there was no conversion to open surgery. CONCLUSION: Even though the LADG was accompanied by a difficult learning curve, we successfully performed 329 LADG procedures over the past 2 years and we believe that LADG is a safe, feasible operation for treating most early gastric cancers (EGC).
Adenocarcinoma ; Female ; Gastrectomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Lymph Node Excision ; Lymph Nodes ; Male ; Pain, Postoperative ; Postoperative Complications ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: Recently, the use of a transparent cap attached to the tip of the colonoscope has been revealed to be helpful in both detecting colorectal polyps and shortening the intubation time to the cecum. The aim of this study was to examine the usefulness of transparent cap-attached colonoscopy (CAC) as compared with conventional colonoscopy (CC) in terms of the technical ease and efficiency. METHODS: Colonoscopies from a total of 228 patients between May and October 2008 were prospectively collected. All colonoscopies were performed by single colorectal surgeon whose experience exceeded 3,000 colonoscopies. Patients were assigned to the CAC group (n=114) or to the CC group (n=114). The cecal intubation rate and time, the polyp detection rate, the adenoma detection rate, the withdrawal time, and the visual analogue scale (VAS) of the patient's pain were compared. RESULTS: There were no significant differences in the age, sex, body mass index, previous history of abdominal operation, diverticulosis, and the degree of bowel preparation between the two groups. The cecal intubation rate was 100% in both groups. The cecal intubation time was significantly shorter in the CAC group than in the CC group overall (5.3+/-4.0 min vs. 7.6+/-4.3 min, P<0.001), as well as for female (6.1+/-2.8 min vs. 9.1+/-4.7 min, P<0.001) patients. There were no statistically significant differences in the total colonoscopy time (13.1+/-6.3 min vs. 14.5+/-5.2 min, P=0.066), the polyp detection rate (38.6% vs. 33.3%, P=0.408), the adenoma detection rate (28.1% vs. 25.4%, P=0.654), and the VAS scale of pain (2.48 vs. 2.74, P=0.353) between the CAC and the CC groups. CONCLUSION: The transparent cap is effective in shortening the cecal intubation time, especially in female patients.
Adenoma ; Body Mass Index ; Cecum ; Colonoscopes ; Colonoscopy ; Diverticulum ; Female ; Humans ; Intubation ; Polyps ; Prospective Studies

PURPOSE: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performingLATG for the gastric cancer located in the upper or middle portion of the stomach. MATERIALS AND METHODS: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. RESULTS: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago- jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was 212+/-67 minutes. The mean total number of retrieved lymph nodes was 28.9+/-10.54 (range: 12~64) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the BMI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.
Body Mass Index ; Conversion to Open Surgery ; Gastrectomy ; Hand ; Humans ; Jejunostomy ; Korea ; Laparoscopy ; Learning Curve ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Patient Selection ; Prospective Studies ; Stomach Neoplasms