Construction of an obturator for rehabilitation of a patient who underwent a maxillectomy is vital. Routinely a constructed obturator includes denture portion. A patient who may present anatomical limitations due to surgical or radiotherapy complications often challenges the clinician. Purpose: This clinical report describes a patient with severe trismus after surgical resection and radiotherapy treatment of a tumor in the upper left maxilla. Conclusion: This report describes the concepts of using a rotational path insertion for an obturator and a separately constructed maxillary denture. The stability and retention of the obturator were obtained from anatomical features. Where as these were achieved through magnetic attachments and the remaining edentulous ridge to ensure esthetic and function of the prosthesis.
Dentures ; Dietary Sucrose ; Humans ; Magnetics ; Magnets ; Maxilla ; Prostheses and Implants ; Retention (Psychology) ; Trismus

Pregnancy has been shown to be associated with an adverse clinical course and symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Extracorporeal membrane oxygenation (ECMO) is rarely used in pregnant or postpartum women with severe coronavirus disease 2019 (COVID-19). Here, we report the rare case of a pregnant woman diagnosed with SARS-CoV-2 infection placed on ECMO postpartum who subsequently received treatment for active rectal ulcer bleeding. Despite being placed on ECMO for 38 days and receiving a massive transfusion of 95 packs of red blood cells, she recovered and was discharged on hospital day 112. ECMO can be used in most patients with severe COVID-19, including pregnant patients, although potential coagulopathy complications must be considered.

STATEMENT OF PROBLEM: Loss of the marginal bone to the first thread have been accepted but continuous effort have been made to reduce this bone loss by varying implant design and surface texture. PURPOSE: This animal study has examined the histomorphometric variations between implants with micro-thread, micro-grooved and turned surfaced neck designs. MATERIAL AND METHODS: Four mongrel dogs have been used the premolars removed and left to heal for three months. One of each implant systems with turned neck, micro-thread and micro-grooved were placed according to the manufacturers' protocol and left submerged for 8 and 12 weeks. These were then harvested for histological examination. RESULTS: The histologically all samples were successfully ossointegrated and active bone remodelling adjacent to implants. With the micro-grooved implants 0.40 mm and 0.26 mm of the marginal bone level changes were observed at 8 and 12 weeks respectively. The micro-threaded implants had changes of 0.79 mm and 0.56 mm at 8 and 12 weeks respectably. The turned neck designed implants had marginal bone level changes of 1.61 mm and 1.63 mm in 8 and 12 weeks specimens. A complex soft tissue arrangement could be observed against micro-threaded and micro-grooved implant surfaces. CONCLUSION: Within the limitations of this study, it could be concluded that implants with micro-grooved had the least and the turned neck designed implants had the most changes in the marginal bone level. The textured implant surfaces affect soft tissue responses.
Animals ; Bicuspid ; Dogs ; Neck

Intracranial neoplasms usually have definitive symptoms, causing a need for medical intervention, but a few cases result in sudden unexpected death even before diagnosis. In these cases, autopsy or post-mortem imaging may be the only way of identifying the existence of a tumor, so investigators or forensic specialists who participate in the post-mortem inspection should be aware of these possibilities. We report on a case of a 26-year-old woman without any medical history found dead in her home. A 5-cm intraventricular tumor was found during autopsy, which was histologically consistent with anaplastic ganglioglioma a very rare type of neuroglial tumor with the potential for malignant behavior. The tumor showed the characteristic features of anaplastic ganglioglioma, such as increased cellularity, a high Ki-67 proliferative index, and necrosis. There were signs of increased intracranial pressure, including flattened gyri and dilated ventricles, which led to the conclusion that this brain tumor was the cause of death.
Adult ; Autopsy ; Brain Neoplasms ; Cause of Death ; Diagnosis ; Female ; Ganglioglioma* ; Humans ; Intracranial Pressure ; Necrosis ; Neoplasms, Unknown Primary ; Research Personnel ; Specialization

In some cases, it is difficult to determine a single cause of death even after conducting full autopsy and additional tests. A 49-year-old man, reportedly having diabetes mellitus, was found unconscious by his mother and revealed to be dead. He had several contusions all over his body, including the right periocular area, but they did not appear fatal. A focal area of polymicrogyria and cortical dysplasia was found on the right preoccipital notch, accompanied with dystrophic calcification and leptomeningeal angiomatosis. These findings were considered indicative of Sturge-Weber syndrome, a rare neurocutaneous disorder, of atypical type without facial lesions. Blood level of beta-hydroxybutyrate was 859 microg/mL, implying that he also had diabetic ketoacidosis. His ketoacidosis may not have been corrected appropriately because of status epilepticus in association with brain lesion, resulting in his death, but neither direct evidence nor statement was obtained. In cases with several apparent causes of death, the examiner's assumption should be based not on imagination but on evidence, and logic should not be overlooked. It is more helpful for the investigators or the bereaved to obtain more detailed information rather than come to a hasty conclusion.
3-Hydroxybutyric Acid ; Angiomatosis ; Autopsy ; Brain ; Cause of Death ; Contusions ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Humans ; Imagination ; Ketosis ; Logic ; Malformations of Cortical Development ; Middle Aged ; Mothers ; Neurocutaneous Syndromes ; Research Personnel ; Status Epilepticus ; Sturge-Weber Syndrome*

STATEMENT OF PROBLEM: Temporary soft relining materials are used in a diverse clinical situations such as tissue conditioner, relining material, functional impression by varying its viscoelasticity. However, reproduction of consistent viscoelasticity has been not possible. MATERIALS AND METHODS: Considering setting mechanism of this material, this study has measured the effect of varying amount of void in dynamic viscoelasticity of soft relining material, with three different mixing methods. In each methods 10 specimens were made and subjected to dynamic viscoelastic test which were measured at specific times over period of 72 hours. RESULTS: The analysis of the result shown that there was no statistically significant differences between different mixing methods. CONCLUSION: Different mixing methods had no effect over control of viscoelasticity of soft lining material. Further research is recommended for under similar oral environmental condition.
Reproduction

Background: Physicians and caregivers are conflicted over whether to inform patients that their disease is terminal. Studies examining the effect of awareness of prognosis on the survival and quality of life of terminally ill cancer patients report conflicting results. This study aimed to assess the effects of prognosis awareness on the survival time and psychological health of terminally ill cancer patients. Methods: Patients in the hospice wards of two general hospitals were asked to complete a questionnaire. All were mentally alert and could express themselves clearly. Awareness of prognosis was defined as knowing both the diagnosis and exact prognosis. Survival time was defined as the time from hospital admission to death. Multiple psychological examinations were conducted to verify the effect of prognosis awareness on psychological health. Results: Of the 98 subjects who met the inclusion criteria, 65 (66.3%) were aware of their terminal status. The patients’ awareness was significantly related to survival time after adjusting for clinical variables with a hazard ratio of 1.70 (95% confidence interval [CI], 1.01–2.86). Furthermore, the unaware group had a higher risk of cognitive impairment (Mini-Mental State Examination <24; adjusted odds ratio [aOR], 3.65; 95% CI, 1.26–10.59) and a poorer quality of life (physical component summary of the Short Form 36-item Health Survey <20; aOR, 3.61; 95% CI, 1.12– 11.60) than the aware group. Conclusion Knowledge of the exact prognosis might have a positive effect on the survival and quality of life of terminally ill cancer patients.

BACKGROUND: Triple negative breast cancer (TNBC) is defined as a lack of the expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 in breast cancer. Many TNBCs show a profound infiltration of tumor infiltrating lymphocytes (TILs). It is still uncertain whether these TILs are protumoral or antitumoral. Regulatory T cells (Tregs) play a role in inducing immune tolerance to antigens, and they may be selectively recruited by cancer cells. This study was conducted to evaluate the significance of TILs with an emphasis on forkhead box p3 (Foxp3), which is a marker for CD25+CD4+ Treg in TNBC. METHODS: We investigated the Foxp3, CD8 and CD4 expressions in 100 cases of TNBC by immunohistochemistry and using a tissue microarray. The Foxp3 expression was divided as the high and low infiltration groups (cut-off value=20). RESULTS: The high infiltration group was correlated with higher histologic and nuclear grades. However, Foxp3+ Tregs were decreased in the T3 and T4 TNBCs as compared to that of the T1 and T2 TNBCs. No significant differences were found for the nodal status, lymphovascular invasion, stage, recurrence and overall survival. CONCLUSIONS: High Foxp3+ Treg infiltration in TNBC is correlated with the nuclear and histologic grades, but there was no relation to recurrence and overall survival.
Breast ; Breast Neoplasms ; Estrogens ; Forkhead Transcription Factors ; Humans ; Immune Tolerance ; Immunohistochemistry ; Lymphocytes ; Lymphocytes, Tumor-Infiltrating ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Receptors, Progesterone ; Recurrence ; T-Lymphocytes, Regulatory

Vitiligo is a commonly acquired cutaneous depigmentation disorder that affects 0.5~1% of the population worldwide. While phototherapy is the primary treatment for vitiligo, surgical methods can be used for treating patients who are refractory to conventional treatments. Herein, we present the case of a 14-year-old Korean girl who developed vitiligo after hematopoietic stem cell transplantation for the treatment of acute lymphoblastic leukemia. She had multiple depigmented patches on her lower legs that did not respond to narrow-band ultraviolet B phototherapy for 7 months. The depigmented patches were successfully treated by transplantation of non-cultured epidermal cell suspension from the epidermal roof of the suction blister in the right inner thigh. No adverse event, such as secondary infection or scarring in both the donor and recipient sites, was noted. We recommended that non-cultured epidermal cell suspension transplantation using the suction blister method would be a safe and effective option for the treatment of refractory vitiligo.
Adolescent ; Blister* ; Cicatrix ; Coinfection ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Leg ; Methods* ; Phototherapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Suction* ; Thigh ; Tissue Donors ; Vitiligo*

Purpose: To analyze the difference in bony pelvimetry using magnetic resonance imaging (MRI) in women who delivered vaginally and those who underwent cesarean section (CS) due to cephalopelvic disproportion (CPD). Methods: This retrospective case-control study enrolled Korean women who gave birth to their first child between 37 and 42 weeks of pregnancy and underwent pelvic MRI between January 2014 and June 2020. These women were classified into 3 groups: vaginal delivery (VD), CS due to CPD (CPD-CS), and CS due to reasons other than CPD (Other-CS). In MRI images, true conjugate (TC), obstetric conjugate (OC), mid anterior-posterior (AP) distance (MAD), outlet AP distance (OAD), ischial spine distance (ISD), ischial tuberosity distance (ITD), and pubic angle (PA) were measured. Results: In total, 392 women were enrolled. There were no significant differences in maternal height and body mass index at birth among the 3 groups. The ISD was statistically different between the VD group (106.2±6.4 mm) and the Other-CS group (110.4±8.8 mm) (p=0.014). After multiple regression analysis, short ISD (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.87-0.97; p=0.002), short MAD (aOR, 0.95; 95% CI, 0.89-0.99; p=0.047), and short ITD (aOR, 0.95; 95% CI, 0.91-0.99; p=0.019) were significantly associated with CS due to CPD. Conclusion Short ISD, MAD, and ITD, measured using MRI, are important parameters that can predict CS due to CPD. The accumulation of related research could promote the development of an excellent imaging method in terms of cost-effectiveness. Thus, it may be possible to establish a method to reduce obstetric and perinatal complications due to dystonia.