Multiple intracerebral space-occupying lesions (SOL) demonstrated by computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide brain scanning or cerebral arteriography often present a diagnostic enigma. The differential diagnosis between brain abscess and brain tumor is occasionally difficult to determine on the basis of imaging studies and clinical judgement, especially in the case of brain SOL with mainly cystic or necrotic component. Elderly patients with a history suggestive of hidden malignancy and the above radiological features are usually presumptively diagnosed as having multiple cerebral metastases. We experienced a case of multiple brain abscess which was confirmed by diagnostic surgery, in a 67- year old male who showed clinical and radiological findings of mimicking cystic brain metastases with undetermined primary focus. Even with long-term therapy with antibiotics and supportive care, the patient suffered from massive ventriculitis and subsequently died.
Aged ; Angiography ; Anti-Bacterial Agents ; Brain Abscess* ; Brain Neoplasms ; Brain* ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Metastasis*

Orthognathic surgery is the primary treatment option for severe skeletal discrepancy. However, orthodontic camouflage should be considered as an alternative treatment option, considering the risks of surgery. A 19.5-yearold man presented with a severe prognathic mandible with a Class III molar relationship and an anterior crossbite. Orthognathic surgery could be considered because of his severe skeletal discrepancy and mandibular prognathism. However, the anesthetist for orthognathic surgery did not recommend surgery under general anesthesia because of risk factors associated with the patient’s aplastic anemia, including bleeding and infections. Thus, a camouflage treatment to promote backward rotation of the mandible via orthodontic extrusion of the posterior teeth was planned. An anterior bite plate, intermaxillary elastics, and fixed orthodontic appliances were used to extrude the posterior teeth and to align the dentition. After 17 months of nonsurgical orthodontic treatment, normal occlusion was achieved, and the facial profile was dramatically improved. This case report describes the dentoskeletal and soft-tissue effects of mandibular rotation and its long-term stability.

INTRODUCTION: Identifying menton (Me) on posteroanterior cephalograms and three-dimensional (3D) cone-beam computed tomography (CBCT) images is difficult, because the midpoint of the symphyseal area is not identifiable after the mandibular symphysis fuses at an early age. The aim of this study was to evaluate the reliability of the identification of the genial tubercle (GT) in patients with mandibular asymmetry and to compare it with that of the traditional landmark, Me. METHODS: The samples comprised 20 CBCT images of adults with mandibular asymmetry. Two examiners performed the identifications and measurements. Me and GT were marked, and the anteroposterior, vertical, and transverse distances to the three reference planes were measured on 3D-reconstructed CBCT images. The intra- and inter-examiner reliability of landmark identification of Me and GT were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: The Me and GT landmarks showed excellent reliability (ICC ≥ 0.993) three-dimensionally. In the transverse evaluation, the ICC values of the GT (range, 0.997–0.999) tended to be slightly higher than those of Me (range, 0.993–0.996). In the Bland-Altman plots for the two separate assessments, Me showed a maximum error of 1.76 mm in the transverse direction, whereas the GT showed a maximum error of 0.96 mm in the 95% limit. CONCLUSIONS: Our results suggest that both Me and GT are clinically reliable and equally useful landmarks for the evaluation of mandibular asymmetry on CBCT images.
Adult ; Cone-Beam Computed Tomography ; Diagnosis* ; Humans ; Prospective Studies*

Cysts of the adrenal glands are uncommon and present difficult problems in differential diagnosis. In autopsy studies, the incidence of adrenal cysts is ranges from 0.064% to 0.18%. Recently, we have experienced a 22-year-old female patient with spontaneous hemorrhagic pseudocyst of adrenal gland without known cause, presenting symptoms of nausea, epigastric discomfort and intermittent pain of right upper abdomen. In clinical presentation, abdominal ultrasonogram and computerized tomogram suggest cystic degeneration of malignant pheochromocytoma, but screening hormonal evaluation was normal. Selective adrenal venous sampling, adrenal scintigram and pathologic examination were not compatible with the functioning adrenal cortical or medullary adenoma/carcinoma, the mass results in spantaneous hemorrhagic necrosis and cystic degeneratio#n of adrenal gland. The authors reported a case of spontaneous hemorrhagic pseudocyst of adrenal gland, which was successfully resected by laparoscopic excision with reviews of the literatures.
Abdomen ; Adrenal Glands* ; Autopsy ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Mass Screening ; Nausea ; Necrosis ; Pheochromocytoma* ; Ultrasonography ; Young Adult

PURPOSE: This retrospective study was performed to investigate the prevalence of the idiopathic osteosclerosis (IO) in Korean malocclusion patients according to age, sex, and the Angle's classification of malocclusion. MATERIALS AND METHODS: This study consisted of 2,001 randomly selected patients from the Department of Orthodontics at the Gangneung-Wonju National University Dental Hospital, Korea. The prevalence of IO in Korean malocclusion patients was recorded using their panoramic radiographs, and the following parameters were surveyed; age, sex, and the Angle's classification of malocclusion. The chi-square test was analyzed to determine the statistical significance of differences in the prevalence of IO between age, sex, and the Angle's classification of malocclusion. RESULTS: The prevalence of IO in the jaws was 6.7% in a total of 2,001 examined orthodontic patients. The majority of IO was found in the mandible (96.58%). The 30-39 age group showed the highest prevalence of IO (9.60%). There was a higher prevalence in females (6.89%) than in males (6.45%). The prevalence of IO in Angle Class I group (7.07%) was the most frequent, followed by Angle Class II group (6.72%), and Angle Class III group (6.40%). However, there was no statistical significance in sex and Angle's classification of malocclusion. CONCLUSION: The prevalence of IO in malocclusion patients showed the differences between various age groups and most of them were found in the mandibular posterior area. However, sex and the type of malocclusion are not to be considered as a contributing factor of IO.
Female ; Humans ; Jaw ; Korea ; Male ; Malocclusion ; Malocclusion, Angle Class I ; Malocclusion, Angle Class II ; Malocclusion, Angle Class III ; Mandible ; Orthodontics ; Osteosclerosis ; Prevalence ; Radiography, Panoramic ; Retrospective Studies

PURPOSE: This study investigated the results of cementless total hip arthroplasty using a circumferentially porous coated tapered femoral stem and a porous coated acetabular cup after a follow-up of more than 2 years. MATERIALS AND METHODS: 70 hips in 65 patients were followed up for more than 2 years after surgery who underwent total hip arthroplasty with a Versys Fiber Metal Taper femoral stem (Zimmer, Warsaw, IN) and Trilogy acetabular cup (Zimmer, Warsaw, IN). RESULTS: The mean Harris hip score increased to 96.2 points. There was no osteolysis in the acetabulum. There was no distal osteolysis in the femur but there was osteolysis observed in Gruen zone I in 1 hip (1.4%). Endosteal bone formation was observed in 67 hips (95.7%) mostly in Gruen zones II and VI. There was no subsidence of the stem. The survival with an acetabular and femoral revision for aseptic loosening was 100% respectively. CONCLUSION: Cementless total hip arthroplasty using a circumferentially porous coated tapered femoral stem and a porous coated acetabular cup showed excellent results after a follow-up of more than 2 years, inducing good bone ingrowth, as well as no migration of the cup and no osteolysis around the distal femur and acetabulum. However, a long term follow up is necessary.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Femur ; Follow-Up Studies ; Hip ; Humans ; Osteogenesis ; Osteolysis

The maxillary protraction headgear has been widely used in the treatment of skeletal Class III children with maxillary deficiency. A variety of treatment objectives which allow dentoalveolar movements may be established, but when only maxillary protraction without dentoalveolar movement is needed, one of the limitations in maxillary protraction with conventional tooth-borne anchorage is the loss of dental anchorage. This is because a bone remodeling occurs not only at circummaxillary sutures but also within the periodontal tissues. During protraction treatment in the mixed dentition phase, in older children or for the patient with multiple congenitally missing teeth, it is not uncommon to observe undesirable mesial movement of maxillary teeth. Such a side effect can be eliminated or minimized using absolute anchorage such as skeletal anchorage. The purpose of this case report is to introduce a new technique of the maxillary protraction headgear treatment using surgical miniplates.
Bone Remodeling ; Child* ; Dentition, Mixed ; Humans ; Sutures ; Tooth

Although the submentovertex radiograph and surface EMG are not often used due to the difficulty of interpretation, they are accepted as useful diagnostic and analytic aids for skeletal asymmetry. There have been reports which state that they were also useful for the evaluation of vertical skeletal relations. The purpose of this study was to evaluate the correlations between EMG data, measurements from submentovertex radiographs, facial types and facial asymmetry following examination of 60 asymmetric patients. The radiographic corpus length were greater in the nonaffected sides (p < 0.001), gonion to interspinosum axis were greater in the affected sides and the mandibular condyle and gonion were located more anteriorly in the non-affected sides than in the affected sides but not significant (p=0.07). The activity of the anterior temporal muscle in rest position was higher in the affected sides than in the non-affected sides (p < 0.01). The activity of the masseter muscle at maximum clenching was found to be nonsignificant but it was higher in the affected sides than in the non-affected sides (p=0.09). There was positive correlation between facial index and the intercondylar axes angle (p < 0.01). There was positive correlation between masseter muscle activity in maximum occlusion and facial index in the affected and non-affected sides (p < 0.05). The results demonstrate that the submentovertex radiograph and EMG can provide useful information for the evaluation of horizontal and vertical skeletal relations.
Axis, Cervical Vertebra ; Facial Asymmetry* ; Humans ; Mandibular Condyle ; Masseter Muscle ; Temporal Muscle

OBJECTIVE: The purpose of this study was to evaluate the stress distribution in bone and displacement distribution of the miniscrew according to the length and number of the miniscrews used for the fixation of miniplate, and the direction of orthodontic force. METHODS: Four types of finite element models were designed to show various lengths (6 mm, 4 mm) and number (3, 2) of 2 mm diameter miniscrew used for the fixation of six holes for a curvilinear miniplate. A traction force of 4 N was applied at 0degrees, 30degrees, 60degrees and 90degrees to an imaginary axis connecting the two most distal unfixed holes of the miniplate. RESULTS: The smaller the number of the miniscrew and the shorter the length of the miniscrew, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. Most von Mises stress in the bone was absorbed in the cortical portion rather than in the cancellous portion. The more the angle of the applied force to the imaginary axis increased, the more the maximum von Mises stress in the bone and maximum displacement of the miniscrew increased. The maximum von Mises stress in the bone and maximum displacement of the miniscrew were measured around the most distal screw-fixed area. CONCLUSIONS: The results suggest that the miniplate system should be positioned in the rigid cortical bone with 3 miniscrews of 2 mm diameter and 6 mm length, and its imaginary axis placed as parallel as possible to the direction of orthodontic force to obtain good primary stability.
Axis, Cervical Vertebra ; Displacement (Psychology) ; Finite Element Analysis ; Traction

Congenital Abnormalities ; Facial Asymmetry ; Humans ; Imaging, Three-Dimensional ; Lip ; Mouth ; Orthognathic Surgery ; Osteotomy