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*

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

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

This study aimed at investigating the skeletal, dentoalveolar, and soft tissue changes of Class III malocclusion cases treated by second molar extraction. The lateral cephalograms of 15 subjects with moderate Class III malocclusion by average ANB -1.4degrees and IMPA 85degrees were traced and the computerized superimposition of average craniofacial change was made. The data was gathered and statistically analyzed. The results were as follows: 1. Lower anterior facial height/anterior facial height increased by 0.6%(P<0.01), mandibular plane increased by 1.5degrees (P<0.05). 2. There was a slightly downward & backward rotation of the mandible. 3. Lower first molar tipped distally by 4.06mm(P<0.001), lower anterior teeth lingually tipped by 3.2degrees (P<0.05). 4. Retracted lower lip improved facial profile. This study may suggest that second molar extraction could be effective for a moderate Class III malocclusion to make distalization of the lower first molar easier and avoid severe lingual tipping of the lower incisor, if the lower third molar has a normal shape, good direction of eruption and adequate time for lower second molar extraction.
Incisor ; Lip ; Malocclusion ; Mandible ; Molar* ; Molar, Third ; Tooth

The purpose of this study was to compare four groups of Oriental young adults (169 males and 174 females) with normal occlusion and well balanced faced. Lsteral cephalograms of 100 Koreans, 100 Chinese, 73 Vitnamese and 71 Japanese were digitized and six profile measures were computed. Analyses of variance showed that total facial profile(GI'-Pr'-Pg') of Chinese was significantly less convex than the profile of Koreans or Vietnamese. Facial profile(GI'-Pr'-Pg') of Chinese was also significantly less convex than that of Vietnamese. Holdaway's soft tissue angle(Pg'-LS:N-B) was significantly greater in Vietnamese than Chinese and Koreans, who were in turn greater than Janpanese. The upper of Vietnamese is significantly closer to Ricketts' esthetic plane, than Chinese; Koreans and Japanese are significantly further behind the plane than Chinese. The lower lip of Koreans and Janpanese was close to the esthetic lpane, while Chinese and Vietnamese were approximately wmm ahead. The nasolabial angle was significantly smaller for Chinese and Japanese than Koreans and Vietnamese. Sex differences were primarily dependent on the nose; total facial convexity and the nasolabial angle wee significantly larger in females than males. The results of this study demonatrate that a single standard of facial profile id not sufficient or appropriate for Oriental patients.
Adult* ; Asian Continental Ancestry Group ; Female ; Humans ; Lip ; Male ; Nose ; Sex Characteristics ; Young Adult

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

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*

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