As an alternative to the conventional fixed appliance that uses orthodontic brackets, a simple round tube without a bonding base can be bonded to the tooth surface by covering the tube with flowable resin. In this technique, bent wires cannot be inserted into the simple tubes; therefore, repositioning of the simple tubes is often required for adjustments. To reduce repositioning of simple tubes, a dome-shaped resin covering of the simple tube can be designed with a customized in-and-out compensation, using three-dimensional computer-aided design software based on digital simulation of orthodontic tooth movement. In the present case, the use of simple tubes bonded with customized resin coverings in a Class I nonextraction case is described in a 17-year-old male, in whom moderate crowding of the anterior teeth was treated over an 8-month period. This case shows that simple tubes can be used as an alternative to brackets in some Class I nonextraction cases, with the potential benefit of reducing decalcification.

Malignant hyperthemia is an autosomal-dominant inherited disorder of the skeletal muscle cell charac terized by a hypermetabolic response to all commonly used inhalational anesthetics and depolarizing muscle relaxants. The clinical syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria as result of increased carbon dioxide production, oxygen consumption and muscle membrane breakdown. Early recognition and vigorous treatment are very important factors to determine patient's prognosis in malignant hyperthermia. However, it is very difficult to diagnose malignant hyperthermia during anesthesia because malignant hyperthermia presents with multiple nonspecific signs and laboratory findings of variable intensity and time course during and after exposure to anesthetic agents. We report a case of malignant hyperthermia which was diagnosed early using capnography before the appearance of hyperthermia and successfully treated. The malignant hyperthermia episode developed 20 minutes after induction of anesthesia with thiopental sodium, pancuronium, isoflurane, N2O and O2. When we suspected episode, we could not observe any classical signs of malignant hyperthermia except unexplained tachycardia and elevated end-tidal CO2. We discuss here the usefulness of capnography in early recognition of malignant hyperthermia and the importance of early recognition in prognosis.
Anesthesia ; Anesthetics ; Capnography* ; Carbon Dioxide ; Fever ; Hypercapnia ; Isoflurane ; Malignant Hyperthermia* ; Membranes ; Muscle Rigidity ; Muscle, Skeletal ; Myoglobinuria ; Neuromuscular Depolarizing Agents ; Oxygen Consumption ; Pancuronium ; Prognosis ; Tachycardia ; Thiopental

Low-grade fibromyxoid sarcoma (LGFS) is a soft tissue tumor that rarely occurs in the head and neck region. It occurs mainly in the proximal extremities and the trunk and is prevalent in the young and middle-aged adults. In the present case, LGFS was present at an atypical location and at an unusual age. The treatment of choice for LGFS is radical wide surgical excision with a clear margin. Long-term follow-up is essential for all patients with LGFS, as it has the potential for late recurrence or metastasis.

Background and Objectives: Nasal surgery is known to improve the quality of life in patients with obstructive sleep apnea; however, its effect on the airway structure is little known. This study attempted to identify the impact of nasal surgery on the pharyngeal airway structure.Subjects and Method We enrolled in the study patients who underwent nasal surgery from July 2015 to March 2018 due to nasal obstruction with severe snoring or sleep apnea. Patients with palate surgery or previous history of airway surgery were excluded. Demographic factors, symptoms regarding nasal obstruction, sleep study, preoperative cephalometry, and postoperative 3-month cephalometry were taken into account and analyzed. We also performed a subgroup analysis according to the severity of sleep apnea. Results: Sixty-three patients were enrolled in this study. Soft palate thickness showed no significant change. Pre and postoperative soft palate thickness were 10.82±3.00 and 11.11±3.35 (p=0.261), respectively. However, the pharyngeal airway space was enlarged via nasal surgery from 12.05±3.35 to 13.04±3.35 (p=0.006), respectively. The subgroup analysis showed that the pharyngeal airway was mainly enlarged in the patients with lower Apnea-Hypopnea Index (AHI). Conclusion Although nasal surgery does not reduce soft palate thickness, it can enlarge the pharyngeal airway space. The effect of surgery would be more prominent in patients with AHI of lower than 15 event/hour (p=0.005) as nasal surgery alone does not affect the pharyngeal airway of patients with AHI greater than 15.

The purpose of this study was to evaluate clinical characteristics and treatment outcome of patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP), treated according to the method of our hospital. Six patients with histopathologically and radiologically confirmed HNSCCUP January 2010-December 2016 were enrolled in this study. All patients underwent radical neck dissection involving level I-V, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative radiotherapy (RT), with or without concurrent chemotherapy. There were no major complications resulting from surgical intervention. Duration of follow-up was 56.3±20.2 months (range, 28-82 months). There was no recurrence or late detection of primary site of HNSCCUP. All patients with HNSCCUP except one were alive, at the time of the last follow-up. The other patient had no recurrence of HNSCCUP, but died of colon cancer at 58 months postoperatively. We have successfully treated patients with HNSCCUP by performing radical neck dissection, bilateral tonsillectomy, and diagnostic esophagoscopy and postoperative RT with concurrent chemotherapy, and recommend using this method as the main treatment method.

Squamous cell carcinoma antigen (SCC-Ag) is a well-established tumor marker for monitoring recurrence of squamous cell carcinoma of the cervix. However, serum levels of SCC-Ag could be elevated by some benign conditions not to speak of squamous cell malignancies other than cervical carcinoma. Sinonasal inverted papilloma is one of benign tumor which may elevate serum SCC-Ag level. We experienced a case of cervical carcinoma patient whose serum level of SCC-Ag was not normalized in spite of combination chemotherapy until surgical removal of maxillary inverted papilloma detected by PET/CT.
Carcinoma, Squamous Cell ; Cervix Uteri ; Drug Therapy, Combination ; Female ; Follow-Up Studies* ; Humans ; Papilloma, Inverted* ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Recurrence

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.
Adolescent ; Baths ; Defecation ; Epidemiology ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Obstetrics ; Physical Examination ; Rape ; Retrospective Studies ; Seasons ; Seoul* ; Therapeutic Irrigation ; Tooth ; Urination

OBJECTIVE: To analyse sexual assault cases epidemiologically. METHODS: We evaluated 129 female patients who visited the female sexual assault center in northeast area of Seoul with a complaint of sexual assault. After patient's consent was obtained, history taking and physical examination was performed. Photographic record was obtained on appropriate sites. We reviewed their medical and standardized rape records and photographs retrospectively. Descriptive statistics was performed with medico-legal parameters. RESULTS: Of 129 sexual assault victims, 44.2% were under 19 years of age. Spring was relatively vulnerable season for sexual assaults, vulnerable time was between 12 to 18 o'clock for victims younger than 14 years and between 0 to 6 o'clock for victims older than 13 years. Most frequent place was hotel for adolescent victims and was victim's house for other age groups. Sixty seven percent of assailants were strangers to the victims. Genital trauma was more frequent in victims younger than 20 years and alcohol use was more prevalent among adolescent victims. 82.2% of victims visited hospital within 24 hours and 91.4% of victims has destroyed potential physical evidences by bathing, douching, tooth brushing, changing clothes, defecation or urination. Follow up rates are low: 28.7% in obstetrics and gynecology clinic, 5.4% in psychiatric clinic. CONCLUSION: This study provide more accurate information about epidemiology of sexual assaults.
Adolescent ; Baths ; Defecation ; Epidemiology ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Obstetrics ; Physical Examination ; Rape ; Retrospective Studies ; Seasons ; Seoul* ; Therapeutic Irrigation ; Tooth ; Urination

Tumor necrosis factor alpha (TNFalpha) is a multifunctional cytokine that is elevated in inflammatory diseases such as atherosclerosis, diabetes and rheumatoid arthritis. Recent evidence has suggested that beta2 adrenergic receptor (beta2AR) activation in osteoblasts suppresses osteogenic activity. In the present study, we explored whether TNFalpha modulates betaAR expression in osteoblastic cells and whether this regulation is associated with the inhibition of osteoblast differentiation by TNFalpha. In the experiments, we used C2C12 cells, MC3T3-E1 cells and primary cultured mouse bone marrow stromal cells. Among the three subtypes of betaAR, beta2 and beta3AR were found in our analysis to be upregulated by TNFalpha. Moreover, isoproterenol-induced cAMP production was observed to be significantly enhanced in TNFalpha-primed C2C12 cells, indicating that TNFalpha enhances beta2AR signaling in osteoblasts. TNFalpha was further found in C2C12 cells to suppress bone morphogenetic protein 2-induced alkaline phosphatase (ALP) activity and the expression of osteogenic marker genes including Runx2, ALP and osteocalcin. Propranolol, a beta2AR antagonist, attenuated this TNFalpha suppression of osteogenic differentiation. TNFalpha increased the expression of receptor activator of NF-kappaB ligand (RANKL), an essential osteoclastogenic factor, in C2C12 cells which was again blocked by propranolol. In summary, our data show that TNFalpha increases beta2AR expression in osteoblasts and that a blockade of beta2AR attenuates the suppression of osteogenic differentiation and stimulation of RANKL expression by TNFalpha. These findings imply that a crosstalk between TNFalpha and beta2AR signaling pathways might occur in osteoblasts to modulate their function.
Alkaline Phosphatase ; Animals ; Arthritis, Rheumatoid ; Atherosclerosis ; Bone Morphogenetic Proteins ; Durapatite ; Mesenchymal Stromal Cells ; Mice ; Osteoblasts ; Osteocalcin ; Propranolol ; Receptor Activator of Nuclear Factor-kappa B ; Receptors, Adrenergic ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: This study compared two types of skin graft reconstruction for the defect of the radial forearm free flap. SUBJECTS AND METHOD: Ten cases of split-thickness skin graft (STSG) harvested from the thigh were analyzed. Also, ten cases of full-thickness skin graft (FTSG) harvest from the inguinal area applied with vacuum-assisted closure (VAC) system were analyzed. RESULTS: The defect size of the radial forearm was increased more in the STSG group than in the FTSG group (p<0.05). Skin grafts were recovered completely sooner in the FTSG group than in the STSG group although it was not statistically significant (p=0.082). Five complications (pruritus, hypertrophic scar) were found in the donor site in the STSG group (p<0.05). FTSG gave better scores according to the Vancouver Scar Scale in terms of pigmentation, pliability, and height (p<0.05). CONCLUSION FTSG harvested from the inguinal area with the application of VAC system has many advantages for the defect of the radial forearm free flap although it is usually used for smaller size defects than for STSGs.