Background: Hyperglycemia during cardiopulmonary bypass may increase the incidence and severity of neurologic deficits that may result from cerebral ischemia. Moderate hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery despite measures such as eliminating dextrose from the CPB clear pump priming solution and from the intra-operative iv fluids. To ameliorate the hormonal and hemodynamic stress responses during cardiac surgery in neonates, infants and children, high dose fentanyl anesthesia is widely used. The authors wished to determine prospectively whether fentanyl dosage is associated with reduced blood glucose or not in pediatric patients undergoing cardiac surgery. METHODS: Twenty four pediatric patients undergoing cardiac surgery were allocated randomly into 3 groups who received 25 g/kg fentanyl, 50 g/kg fentanyl or 75 g/kg fentanyl before CPB. The changes of plasma glucose and insulin levels were observed after sternotomy, on bypass, 30 min after bypass, off bypass, and the end of the operation. RESULTS: Blood glucose levels were not increased after sternotomy, but significantly increased at bypass to the end of the operation in all fentanyl dosage groups. Plasma insulin level increased, but statistically not significant. Different fentanyl dosage (25~75 g/kg) is not associated with differences in blood glucose level. CONCLUSION: At a dosage of 25~75 g/kg fentanyl anesthesia during pediatric open heart surgery were associated with no differences and below 250 mg/dl of blood glucose level and no significant changes in insulin level.
Anesthesia ; Blood Glucose* ; Brain Ischemia ; Cardiopulmonary Bypass ; Child ; Fentanyl* ; Glucose ; Heart* ; Hemodynamics ; Humans ; Hyperglycemia ; Incidence ; Infant* ; Infant, Newborn* ; Insulin* ; Neurologic Manifestations ; Plasma ; Prospective Studies ; Sternotomy ; Thoracic Surgery*

A 62-year-old woman with hereditary hemorrhagic telangiectasia(HHT) or Osler-Weber-Rendu disease involving the liver is presented. Imaging findings including color Doppler sonograph and CT findings are described.
Female ; Humans ; Liver* ; Middle Aged

An impairment is defined as "a loss, loss of use, or derangement of any body part, organ system or organ function". The impairment evaluation should be performed by physicians. To determine permanent impairment associated with medical condition a standard method should be used. It is a general principle that an evaluation of permanent impairment only be performed when the physician considers the person to have reached a state of maximum medical improvement. Maximum medical improvement is considered when the person's condition has been medically stable and is unlikely to change by more than 3% of whole body impairment within the next 12 months. The physician must use the entire clinical skill and judgment to perform the proper impairment evaluation. A report of the evaluation of permanent impairment should be accurate, comprehensive and fair. The physicians are reminded that they have a duty to act in an ethical, professional and considerate manner when examining the person for the purpose of assessing the permanent impairment.
Clinical Competence ; Humans ; Judgment

PURPOSE: To analyze clinical, radiological and pathological features as well as clinical outcome after surgical treatment of patients with secondary chondrosarcoma arising from osteochondroma(tosis). MATERIALS AND METHODS: We retrospectively reviewed clinical records, radiographs, pathologic slides of 14 patients. Nine patients were male and five were female. The mean age was 34 years. The mean follow-up period was 54 months. RESULTS: All patients had a history of previous mass since childhood or puberty. Preexisted osteochondroma was single in 3 patients and multiple in 10. Remaining 1 patient had multiple osteochondromatosis with enchondromatosis. MRI clearly provided thickness of cartilage cap, which was over 2 cm except in 2 cases. Chondrosarcoma was grade 1 in all except 1 case, which was grade 2. Wide excision was performed in 10 patients, marginal excision in 3 and amputation in 1. Twelve patients were doing very well without evidence of disease. Among 3 patients with marginal excision, 1 patient had local recurrence and 1 patient died of disease. CONCLUSION: Comprehensive understanding of clinical, radiological and pathological features of secondary chondrosarcoma is warranted for accurate diagnosis. The best result can be expected with early recognition of malignant change of osteohcondroma(tosis) and wide excision.
Amputation ; Cartilage ; Chondrosarcoma ; Enchondromatosis ; Female ; Follow-Up Studies ; Humans ; Male ; Osteochondroma ; Osteochondromatosis ; Puberty ; Recurrence ; Retrospective Studies

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.
Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Liposarcoma ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Selection Bias

Fluoride is one of the most potent stimulators of bone formation in vivo. But its direct effects on osteoblast is not yet clear. This study was to investigate the effects of Sodium fluoride on alkaline phosphatase(ALP) activity, cAMP formation responsive to parathormone(PTH) and type I alpha 2 collagen ribonucleic acid (mRNA) level in Murin osteoblast-like (MC3T3-E1) cells. The cells were cultured in alpha -Minimal essential medium ( alpha -MEM) supplement with 10% fetal bovine serum (FBS) and then changed to 0.1% FBS with various concentration of Sodium fluoride. The ALP activity was assayed by the method of Lowry with disodium phenyl phosphated as substrate. cAMP formation was measured by Radioimmuno Assay(RlA). Type I alpha 2 collagen ribonucleic acid(mRNA) expression was studied by Nothern blot analysis. The results were as follows: 1. cAMP level was increased by PTH in MC3T3-E1 cells. 2. Sodium fluoride showed the tendency of inhibitory effects on cAMP responsiveness to PTH in MC3T3-E1 cells. 3. Sodium fluoride increased ALP activity at cocentration of 2micrometer, 4micrometer, and 10micrometer significantly different from control at the 0.001 level. ALP activity revealed maximum value at 10micrometer in this study. 4. Nothern blot analysis of Sodium fluoride treated cells, using Type I alpha 2 collagen prove, revealed significant increase at 10micrometer in MC3T3-E1 cells.
Alkaline Phosphatase ; Collagen* ; Fluorides ; Osteoblasts* ; Osteogenesis ; RNA* ; Sodium Fluoride* ; Sodium*

In proceeding with orthodontic treatment, the prediction for the shape, growth rate and growth direction of mandible plays a major role to set up the treatment plan and determine its period and prognosis. Various approaches being made so far have shown that the linear and angular measurement using lateral cephalograms are relatively accurate to estimate them. This study was purposed to find the shape of mandible more clearly by preventing the overlap of the Condyle head area which appears in lateral cephalogram, and to estimate its growth rate by comparing the growth quantity and ratio via lateral area measurement. This experimental was performed against 40 patients total, of which Class I of 14, Class II of 9 and Class III of 17 consist. Wide open lateral cephalograms of 40 patients were taken over average period of 4 Year 3 Months, then the linear and angular measurements were carried out with 11 itemized lists. Autocad R14 application program was utilized to draw their appearance, measure and compare their lateral area. As a result of study, conclusions were made as follows; 1. Mandibular body length (gonion-menton) tended to increase in order of CIII, CI and CII, and Mandibular body length of CIII group had a tendency to grow twice faster than that of CII group. 2. In lateral items such as Go-Me, A-Cd, B-Cp, E-F and G-H, CIII showed a significant increase on the year-average quantity and rate of the growth, and especially apparent difference was observed in CIII group rather than CII group. 3. For the 4 Year 3 Months period, the year-average growth quantity of lateral area of the mandible was 1.0 cm2 for Class I, 0.8 cm2 for Class II and 1.4 cm2 for Class III, which corresponds to 11.9%, 11.8% and 20.3% of growth ratio respectively. Thus, growth ratio almost 2 times more than other groups was observed in group CIII while growth ratio between group CI and CII has little difference. 4. Considering the results as above, it can be proposed that the difference in size of the mandible between groups is caused by the difference in the growth rate and growth quantity of the mandible, which generated in the middle of growth, rather than the difference in size of congenital Jaw-bone.
Head ; Humans ; Mandible* ; Prognosis

The elastic open activator is one of the modified myodynamic activator. The reduced size of the appliance mass motivates the patients' comfort and longer time of wearing. Its peculiarities in loose fitting and the lack of appliance stabilization in the mouth draws the tongue and the surrounding functional matrices on close interaction with the appliance, consigns the physiologic exertion to target structures, and eventually makes it feasible to the inland of non-extraction treatment. In the context of the sagittal malocclusion, the orthodontic trench is dependent upon the growth of basal structure aimed, therefore, it is contemplated to grabble the effects of Elastic Open Activator upon the class II malocclusion of growing child retrospectively. The cephalometric headfilms and study models of nine class II malocclusion of growing child retrospectively. The cephalometric headfilms and study models of nine class II division 1 and five division 2 patients were evaluated and analyzed, and the following observations were drawn ; 1. The maxilla maintained a normal growth pattern in both groups. 2. The mandible grew anteroinferiorly in both groups. 3. The upper incisors tipped ligually in Class II division 1 and tipped labially in Class II division 2 and anterior vertical alveolar growth was interrupted in both groups. 4. The lower incisors tipped labially. 5.There was an arch expansion in both groups and increase of available space in Class II division 2
Child ; Humans ; Incisor ; Malocclusion* ; Mandible ; Maxilla ; Mouth ; Retrospective Studies ; Tongue

A case is described, where and adolescent boy developed alopecia areata and alopecia totalis during the course of routine orthodontic treatment for the resolution of a dentoalveolar Class II division 1 malocclusion. The orthodontic treatment lasted 22 months, with a successful outcome. However, within eight months of the onset of treatment the patient lost all his hair. Exhaustive medical tests and differential diagnosis determined that the etiolgy of the patient's alopecia was psychological stress evoked by the orthodontic treatment. Numerous reports suggest that psychological stress can cause alopecia by affection the immune system. Therefore, it appears reasonable to assume that in the case of this patient, alopecia had resulted from stress effects on the immune system, leading to autoimmune disease-like conditions in tissues surrounding the scalp hair follicles. The alopecia condition was successfully reversed by daily oral and topical applications of vitamin D. It is concluded that the immune system plays a pivotal role in tissue remodeling around the teeth and elsewhere in the body, and conditions capable of affection this system may cause unfavorable outcomes, such as alopecia.
Adolescent ; Alopecia Areata ; Alopecia* ; Diagnosis, Differential ; Hair ; Hair Follicle ; Humans ; Immune System ; Male ; Malocclusion ; Scalp ; Stress, Psychological ; Tooth ; Vitamin D

It is the aim of this study to determine the impacts of radicular development of lower third molars on its eruption/impaction and to grope the prediction for eruption and/or impaction in advance. Three hundred and thirty cases of orthopantomogram were employed and classified as mesial root-dominant group, distal root-dominant group and identical group according to the radicular development of lower third molars. This presentation has carried out the incipient mesial inclination, radicular development, impaction/eruption rate and changes of mesial inclination of the very teeth. Consequently the following summary and conclusions were drawn; Radicular development dominated mesial root than the distal and dominant mesial root invited higher potentialities for normal eruption. The mesial or horizontal impactions were detected on the distal root-dominant group. This analysis has been suggested the potential eruption/impaction of lower third molars were dependent upon the radicular development and the incipient mesial inclination.
Molar, Third* ; Tooth