The osteoplasties of maxilla and mandible as the craniomaxillofacial surgery is popular and markedly developed in technically. In traditional osteoplasty, we have been use the mechanical saw, burr, cutting bar which is big sized instrument to transmit the energies to the saw or burr tips. So it is technically difficult to use such big instrument in narrow operative field Recently, the development of laser technology makes wider influence in the medical field. So, the laser is applying to high energy-using osteotomy in addition to hemangioma, tatoo, laserbrasion, hypertrophic scar and endoscopic surgery. The objective of the present study is to evaluate the extent of damage of bone and subsequent healing between the conventional mechnical saw osteotomies and the ND-YAG laser used osteotomies on the rabbit mandible angles by the histologic examination. Fifteen New Zealand white rabbits were used for the study. After exposure of rabbit's mandibular angle, one side of mandible angles were osteomized used by Nd-YAG laser and the other by the saw randomly. We compared the extent of damage and healing of laser and saw osteotomies at immediate, 2 week, 4 week, 3 months, 6 months postoperatively. The result revealed that, in two weeks after operation, the one of damaged bone was looks wider in laser osteotomies sites than by conventional mechanical saw osteotomies sites, but there is not remarkable differences between the laser and saw used group after 4 weeks, and we believe that it is possibility to use alser in craniomaxillofacial field saftly in near future.
Cicatrix, Hypertrophic ; Hemangioma ; Lasers, Solid-State* ; Mandible ; Maxilla ; Osteotomy ; Rabbits

We experience coronary artery aneurysm and coronary artery stenosis in an adult as complications of Kawasaki disease. The patient suffered from ischemic heart disease due to coronary artery aneurysm and stenosis, We carried out PTCA and stenting at stenotic coronary artery successfully. A brief review of related literature was made.
Adult* ; Aneurysm ; Angioplasty, Balloon, Coronary* ; Constriction, Pathologic ; Coronary Aneurysm* ; Coronary Stenosis* ; Coronary Vessels* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Ischemia ; Stents

BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity

We performed radionuclide ventriculography before and within 1 week after percutaneous mirtal valvuloplasty(PMV) to evaluate left ventricular(LV) function in 20 patients(3 males and 17 females, mean age of 38±10 years) who were pure mitral stenosis before PMV and less than grade 1 mitral regurgitation developed after PMV. 9 out of 20 patients had atrial fibrillation and 3 patients developed a small left-to-right shunt(Qp/Qs<1.5)after PMV using double-balloon technique resulted in a increase in mitral valve area(0.9±0.3 to 2.1±0.8mm
Atrial Fibrillation ; Cardiac Output ; Female ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Radionuclide Ventriculography ; Stroke Volume

BACKGROUND: Myocardial contrast two-dimensional echocardiography(MC-2DE) has been known to have the real time capabilities for repeat in vivo assessment of ischemic risk areas and for evaluation of the myocardial perfusion. The aims of this investigation are (1) to evaluate the feasibility of MC-2DE for the delineation and quantitation of the area at risk. (2) to determine the relationship between the extent of the echocontrast defect area(EDA) during reperfusion and the size of myocardial infarction as determined by post-mortem tissue examination, and (3) to observe serial changes in the time echo-intensity characteristics of MC-2DE during coronary occlusion and reperfusion. METHODS: Myocardial contrast echocardiographic images were made by injecting bolus 5mL of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix(R)) and normal saline(2 : 3 by volume) into the aortic root before and during coronary occlusion of the left anterior descending coronary artery, distal to the first diagonal branch and during reperfusion on eight open-chest dogs. Two-dimensional echocardiographic short axis views were obtained at four anatomic levels : the apex, the low papillary muscle, the high papillary muscle and the mitral valve. The changes in EDA and echo-intensity with its wash-out half time(WHT) at the high papillary muscle level during coronary occlusion and reperfusion were measured every 15 minutes. The total EDA was measured by planimetry at 3 minutes after coronary occlusion and at 60 minutes after reperfusion. Evans blue or methylene blue were used for the measurement of the anatomic area at risk and triphenyl-tetrazolium chloride(TTC) for the measurement of the infarct area. RESULTS: The EDA measured 30 minutes after coronary occlusion(19.6%) was smaller than that at 3 minutes after coronary occlusion(24.0%, p<0.01). Then EDA at 3 minutes occlusion was strongly predictive of the anatomic extent of area at risk(EDA=0.48 Area at risk+16.95, r=0.84, p<0.05). The EDA at 60 minutes after reperfusion, which showed an irregular margin and was located within the subendocardium of the area at risk, also correlated well with the infarct area(IA)(EDA=0.78 IA+3.32, r=0.82, p=0.09). The peak echo-intensity in the ischemic area during coronary occlusion was significantly low(14.2+/-6.5 vs 73.8+/-31.7 in the non-ischemic area, p<0.01) and the WHT was delayed more in the ischemic area than in the non-ischemic area(23.2+/-2.8 sec vs 8.1+/-3.3sec, p<0.01). During the period of reperfusion, WHT in the previously ischemic area was markedly delayed compared to that in the non-ischemic area (p<0.01), although the peak echo-intensity in the ischemic area at 3 minutes after reperfusion increased modestly compared to that in the non-ischemic area(80.9+/-22.8 vs 72.7+/-8.4), suggesting the impairment in the transit of microbubbles is probably due to microvascular damage after reperfusion. There were no adverse hemodynamic or electrocardiographic effects after injection of the contrast agent. CONCLUSIONS: These findings suggest that myocardial contrast echocardiography was useful as a non-invasive technique, first, to delineate the area at risk in vivo during coronary occlusion and, after reperfusion, the infarct area, and secondly, to evaluate indirectly the state of myocardial perfusion during coronary occlusion and reperfusion.
Animals ; Axis, Cervical Vertebra ; Coronary Occlusion* ; Coronary Vessels ; Dogs ; Echocardiography* ; Electrocardiography ; Evans Blue ; Hemodynamics ; Meglumine ; Methylene Blue ; Microbubbles ; Mitral Valve ; Myocardial Infarction ; Papillary Muscles ; Perfusion* ; Reperfusion* ; Sodium

PURPOSE: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. METHODS: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. RESULTS: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. CONCLUSION: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.
Diagnosis ; Enterocolitis, Necrotizing ; Gastrectomy ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Intestinal Perforation ; Intestinal Pseudo-Obstruction ; Laparotomy ; Medical Records ; Mortality ; Pneumoperitoneum ; Reproductive History ; Retrospective Studies ; Stomach Rupture ; Survival Rate ; Vomiting

BACKGROUND: Dobutamine echocardiography is a useful method to detect myocardial viability in ischemic heart disease. Recently myocardial contrast echocardiography(MCE) is reported to be a new method to evaluate myocardial viability by assessing microvascular integrity of dysfunctional myocardium. We hypothesized if the microvascular integrity is maintained, the dysfunctional myocardium would improve its function by dobutamine infusion. METHOD: 10 myocardial infarction patients (acute : old=8 : 2, M : F=7 : 3, mean age=61+/-11yr) were included in the study. 2 dimensional echocardiography was performed before and during dobutamine infusion and after contrast injection to right and left coronary arteries in the catheterization laboratory. Echocardiographic analysis was done in parasternal short, apical 4 and 2 chamber views. Left ventricule was devided by 20 segments from 3 views. In each segment, will motion score(graded 1, normal, to 5, dyskinesia) before and after dobutamine infusion and opacification grade(0, 0.5, 1 denoting no, intermediate and normal opacification respectively) was compared. RESULTS: The number of segments with abnormal wall motion at baseline were 57 segments. 5 segments was exciuded due to poor image quality. Among 52 segments, 25 segments improved it's function during dobutamine infusion. Improvement of regional function was more frequent in hypokinetic segments than akinetic or dyskinetic segments (69% vs 15%). The improvement of dysfunctional regional wall motion by dobutamine infusion was observed in 80%(19/24), 67%(6/9) and 5%(1/19) of normally, intermediately and none opacified segment respectively. The correlation between wall motion score with opacification grade was 0.598 at baseline and increased to 0.766 after dobutamine infusion. CONCLUSION: In patients with myocardial infarction the dysfunctional segments but intact microvasculature assessed myocardial contrast echocardiography improves function by dobutamine infusion. These findings myocardial contrast echocardiography would be a useful method to detect myocardial viability.
Catheterization ; Catheters ; Coronary Vessels ; Dobutamine* ; Echocardiography* ; Humans ; Microvessels ; Myocardial Infarction* ; Myocardial Ischemia ; Myocardium

BACKGROUND: QT dispersion(QTD=QTmax-QTmin) on the 12 lead ECG has been known to reflect regional variation of ventricular repolarization, and thus a marker of an increased risk of arrhythmia events. Late potential(LP) on signal averagina ECG(SAECG) is independent risk factor of ventricular arrhythmia following acute myocardial infaction(AMI). However, the relation between LP and QTD as indicator of electrophysiologic instability in AMI remains to be determined. METHOD: To determine whether there is a difference in QTD between in parients with AMI during acute phase and in normal control and whether thrombolytic therapy is assiciated with a reduction in QTD, and to determine the relationship between change of QTD and late potential on SAECG, we studied 71 patient with AMI(male 54, female 14, mean age 57yrs) and 23 controls(malw 17, female 6, mean age 58yrs). QT interval was measured on a standard 12 lead ECG in patients with AMI on admission, 2 hours after urokinase IV and 10-14 days post-AMI, and QT dispersion was calculated by difference of maximal and minimal corrected QT interval(QTmax-QTmin). A signal averaged ECG was recorded in 36 patients before discharge and coronary angiogeaphy(CAG) was performed in all patients 10-14 days post-AMI. RESULT: QTD is significantly increased in AMI compared to control(78.7+/-39.5ms vs. 24.6+/-22.3ms, P < 0.01). In patients who received thrombolytic therapy with urokinase, QTD is decreased from 75.0+/-34.4ms to 53.9+/-36.0ms(P < 0.01), whereas there is no significant change in patients who did not received thrombolytic therapy(84.8+/-47.6ms vs. 78.9+/-36.2ms, NS). There in no difference in QTD between patients with positive LP(68.4+/-23.6ms) and those with negative LP(77.8+/-32.1ms) on admission, those with positive LP(66.6+/-27.6ms) and those with negative LP(56.0+/-26.4ms) after 10-14days post-AMI. But magnitude of change of 10-14 days post-AMI QTD in patients with negative LP is larger than those with positive LP(-21.7+/-33.4ms vs. -1.8+/-15.2ms, P=0.06). CONCLUSION: QTD in acute phase of AMI is significantly reduced by the thrombolytic therapy. Patients with negative late potential tent to have greater QTD reduction within 14 days after AMI. These finding suggest that QT dispersion in patients with AMI can be reduced by early recanalization and its reduction is associated with the presence of late potential.
Arrhythmias, Cardiac ; Electrocardiography ; Female ; Humans ; Myocardial Infarction* ; Risk Factors ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator

BACKGROUND: Following several decades of decline, the incidence of tuberculosis has recently begun to increase in many countries and the control of this disease has been impeded by the emergence of multi-drug resistant tuberculosis (MDR-TB). The development of rapid diagnostic methods and effective new drugs are needed to control MDR-TB. One of the new drugs for MDR-TB is rifabutin (RBU) which has been known to be effective in some patients with MDR-TB. A few reports showed that some types of mutaitions of the rpoB gene, which were known to be present in 96-98% of rifampicin-resistant M. tuberculosis, were associated with the rifampicin-resistant but RBU-susceptible phenotype. This study was performed to investigate the correlation between RBU susceptibility and the patterns of rpoB gene mutations in Korean MDR-TB. METHODS: Sixty-five clinical isolates of multi-drug resistant Mycobacterium tuberculosis, gathered from patients two visited the Asan Medical Center from July 1997 to June 1999, were investigated. Clinical responses to rifabutin-containing regimen were evaluated. An RBU susceptibility test and sequencing analysis of rpoB gene were performed, and the result were analyzed to confirm which mutations correlated with RBU-susceptible MDR-TB. RESULTS: Fifty-three of 56 (95%) clinical isolates of MDR-TB had 60 mutations of the rpoB gene. The most frequent mutations were found at codon 531 (43%), and two mutations were combined in seven clinical isolates. Five of 53 (10%) clinical isolates showed the RBU-susceptible phenotype, and in them the characteristic patterns of point mutations were found at codon 509, 516, and 526. CONCLUSION: The frequency and pattern of mutations of the rpoB gene of Korean MDR-Tb isolates were similar to those in western countries, where the prevalence of tuberculosis is low, but some show RBU-susceptible phenotypes. RBU-susceptible MDR-TB isolates showed the characteristic pattern of mutations of the rpoB gene which could be used to rapidly diagnose RBU susceptibility.
Chungcheongnam-do ; Codon ; Humans ; Incidence ; Mycobacterium tuberculosis* ; Mycobacterium* ; Phenotype ; Point Mutation ; Prevalence ; Rifabutin* ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

BACKGROUND: The stability of A-V junctional rhythm is the most important clinical interest in the patients with the complete heart block with narrow QRS complex. The QRS morphology, the basal heart rate & the reponse of subsidiary pacemaker to drugs may be helpful to assess the stability. But it can not be assessed exactly. The recording of the His-bundle was thought to be a means of predicting the clinical course of the patients and the necessity of the artificial pacemaker insertion;also it can assess the A-V block site. But it is invasive study cannot assessed exactly the stability of subsidiary pacemaker. To investigate the characteristics of subsidiary pacemaker, we studied the responses of the artificial pacemaker to ventricular overdrive suppression and the drugs by used the artificial pacemaker in the patient with the complete heart block with the narrow QRS complex, which can be accepted as "stabli" in general. METHOD: There was total of 11 patients diagnosed with the complete AV block with the narrow QRS complex(the escape junctional rhythm was less than 0.10sec) at the Yeungnam University Hospital from May 1988 to June 1989. To investigate the ventricular overdrive suppression of subsidiary pacemaker, the response of the subsidiary pacemaker after IV administatin of drugs (atropine, isoproterenol, lidocaine) and the junctional recovery time were measured. RESULTS: Thtee patterns were obtained in the overdrive suppression test (fig.1). The recovery time of the subsidiary pacemaker was 364.5+/-212.15% of the basal R-R interval. Among seven of the eight patients who showed syncoped, the JRTmax were 3 times higher than the basal R-R interval. In one of eight, CJRT which represent the absolute time, was prolonged to 560 msec. In one case, we examined overdrive suppression test serially was which shows gradual decrement of junctional recovery time, and normal sinus rhythm was recovered at the 14th after the development of complete heart block. After VOS, the junctional recovery time of the subsidiary pacemaker was 364.5+/-212.1% of basal R-R interval in complete heart block group. After injection of atropine, the decrement of R-R interval was 5.51+/-3.88% of basal R-R interval. After injection of isoproterenol, the decrement of R-R interval was 32.76+/-8.09% of basal R-R interval. Marked increase of the basal heart rate was observed. After injection of lidocaine, the increment of R-R interval was 1.72+/-1.82% of basal R-R inteval. CONCLUSION: The results suggest that measurement of the junctional recovery time following overdrive suppression is useful for evaluation of stability of subsidiary pacemaker. And also the subsidiary pacemaker shows the better response to sympathomimetic agent than to parasympathetic blocker.
Atrioventricular Block ; Atropine ; Heart Block ; Heart Rate ; Humans ; Isoproterenol ; Lidocaine ; Pacemaker, Artificial ; United Nations