Mucocuaneous Lymph Node Syndrome(Kawasaki disease) is a new diseae entity that was first described by Kawasakiin 1967. It occures predominantly in children less than 5yrs old and acute febrile illness, which is mucocutaneousinvolvment associated with swelling of cervical lymph nodes. The coronary artery aneurysms have been revealed 20–30% of patients with Kawsaki disease. The authors report a case of multiple coronary artery aneurysms inKawasaki disease which was diagnosed by a coronary arteriography.
Aneurysm ; Angiography ; Child ; Coronary Vessels ; Humans ; Lymph Nodes ; Mucocutaneous Lymph Node Syndrome

PURPOSE: Longitudinal pancreaticojejunostomy is a treatment option for selected patients with chronic obstructive pancreatitis that is rarely performed laparoscopically. METHODS: A 54-year-old man presented with chronic postprandial abdominal pain. A computed tomography scan revealed multiple calcified stones at the pancreatic head and tail with marked dilation of the pancreatic duct (0.8 cm in diameter). The patient underwent laparoscopic longitudinal pancreticojejunostomy. Impacted stones were removed and Roux-en-Y pancreaticojejunostomy was performed using an intracorporeal suture technique in a longitudinal side-to-side manner. RESULTS: The total operation time and estimated blood loss were 150 min and 50 ml, respectively. The patient tolerated a regular diet without postprandial abdominal pain. Postoperative recovery was uneventful and the patient was discharged on postoperative day 5 in good condition. He returned to work on postoperative day 9. CONCLUSION: Longitudinal pancreaticojejunostomy might be an effective option for relief of chronic pain in treating chronic obstructive pancreatitis.
Abdominal Pain ; Chronic Pain ; Diet ; Head ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pancreatic Ducts ; Pancreaticojejunostomy* ; Pancreatitis* ; Pancreatitis, Chronic ; Suture Techniques ; Tail

Adult ; Hand ; Humans ; Parietal Bone ; Rabeprazole ; Skull ; Sutures ; Tissue Donors ; Transplants

The recent advances in human pluripotent stem cells (hPSCs) enable to precisely edit the desired bases in hPSCs to be used for the establishment of isogenic disease models and autologous ex vivo cell therapy. The knock-in approach based on the homologous directed repair with Cas9 endonuclease, causing DNA double-strand breaks (DSBs), produces not only insertion and deletion (indel) mutations but also deleterious large deletions. On the contrary, due to the lack of Cas9 endonuclease activity, base editors (BEs) such as adenine base editor (ABE) and cytosine base editor (CBE) allow precise base substitution by conjugated deaminase activity, free from DSB formation. Despite the limitation of BEs in transition substitution, precise base editing by BEs with no massive off-targets is suggested to be a prospective alternative in hPSCs for clinical applications. Considering the unique cellular characteristics of hPSCs, a few points should be considered. Herein, we describe an updated and optimized protocol for base editing in hPSCs. We also describe an improved methodology for CBE-based C to T substitutions, which are generally lower than A to G substitutions in hPSCs.

OBJECTIVE: Minimally invasive transforaminal lumbar interbody fusion(mini-TLIF) is an increasingly popular method because of several advantages, including rapid patient recovery, less postoperative pain, and minimized iatrogenic injury of soft tissue and muscle. The purpose of this study is to evaluate the clinical and imaging outcomes after mini-TLIF procedures. Results are compared with open posterior lumbar interbody fusion(oPLIF, Group B) and mini-TLIF(Group A) approach. METHODS: Between March 2007 and May 2008, mini-TLIF and oPLIF were performed in 23 and 36 consecutive patients with single or multilevel lumbar degenerative disease. Clinical outcomes were assessed by postoperative visual analogue scale(VAS) score, operation time, volume of blood loss, number of days to ambulation and duration of hospital stay. To assess fusion rate, all patients underwent postoperative radiography. And postoperative access were compared with an institutional reference series of 36 oPLIF procedures. RESULTS: Fusion success outcomes were obtained in 23(100%) out of 23 patients with mini-TLIF procedure. Mean VAS scores decreased from 8.2 to 1.9 in group A and from 8.1 to 2.4 in group B. The operation time, volume of blood loss, number of days to ambulation and duration of hospital stay were reduced in group A compared with group B. There was no complication associated to mini-TLIF procedure. CONCLUSION: Mini-TLIF yielded good clinical and radiological outcomes with safe and low complication. Further long- term investigating study is required to assess the definitive advantage of mini-TLIF.
Humans ; Imidazoles ; Length of Stay ; Muscles ; Nitro Compounds ; Pain, Postoperative ; Walking

In restorative treatment using fixed dental prostheses, dentists should select appropriate restoration material among various types of dental materials. The strength, marginal fit, esthetics, wear resistance, biocompatibility, and cost are important factors in the choice of restoration materials. The present case showed a surface stain on a monolithic zirconia restoration that was due to wear between the monolithic zirconia restoration and the base metal alloy restoration. This phenomenon was confirmed by surface roughness measurement and electron probe micro-analysis.
Alloys ; Dental Alloys ; Dental Materials ; Dental Prosthesis ; Dentists ; Esthetics ; Humans

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.
Abdomen ; Adolescent ; Angiography ; Chemotherapy, Adjuvant ; Humans ; Liver* ; Magnetic Resonance Imaging ; Male ; Mesenchymoma ; Physical Examination ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma, Embryonal ; Sarcoma* ; Ultrasonography

PURPOSE: To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting. METHODS: We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting. RESULTS: The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups. CONCLUSIONS: The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.
Adult ; Aged ; Aged, 80 and over ; Conjunctiva/*transplantation ; Female ; Fibrin Tissue Adhesive/*pharmacology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Pterygium/*surgery ; Retrospective Studies ; Suture Techniques/*instrumentation ; *Sutures ; Time Factors ; Tissue Adhesives/pharmacology ; Transplantation, Autologous

The vascularized fibula flap, first described in 1975, was originally developed as a vascularized bone flap for extremity reconstruction. In 1989, the first experience with fibula free flap for mandibular reconstruction was published by Hidalgo. Vascularized fibula flaps have many advantages in the restoration of the contour and function of mandible. But a potential disvantages is unreliable skin paddle and the limited volume of fibula. So, we were dissected 63 Korean cadaver limbs. The aim of this study was 1) to define more clearly the anatomy of peroneal artery to fibula and lateral leg skin, specially with regard to the fibular osteocutaneous flap 2) to measure the dimensions of fibula available for dental implant placement. The results were as follows: 1. The peroneal artery arised from the posterior tibial artery in 60 cases(95.2%). But in 3 cases(4.8%), it took place of the posterior tibial artery. The peroneal artery branched off the posterior tibial artery 6.3+/-1.3cm(range 2 - 6.5cm) distal to the fibular head. 2. The musculoperiosteal and septocutaneous branches of the peroneal artery were distributed from 4/10 to 8/10 in most cases. 3. The number of nutrient foramen was one in 60 cases(95.2%). The foramen was positioned on the posterior surface in 50 cases(75.8%) The average foraminal index was 42.4+/-0.8% and its range was 30.2 to 73.3%. 4. The total length of fibula was 35.4+/-1.8 cm (range 31.0 - 39.5cm) in males and 31.3+/-1.5cm(range 28.0 - 35.0cm) in females. 5. The bone height from the base(anatomic posterior surface) to the spot at which was reduced to 6.0mm in midpoint of fibula was 12.3+/-1.8mm in males and 8.8+/-1.9mm in females.
Arteries* ; Cadaver ; Dental Implants ; Extremities ; Female ; Fibula* ; Free Tissue Flaps ; Head ; Humans ; Leg ; Male ; Mandible ; Mandibular Reconstruction ; Skin ; Tibial Arteries

PURPOSE: The primary objective of this study was to examine the changes of basal cortisol and DHEA levels present in saliva and serum with age, and to determine the correlation coefficients of steroid concentrations between saliva and serum. The secondary objective was to obtain a standard diurnal rhythm of salivary cortisol and DHEA in the Korean population. MATERIALS AND METHODS: For the first objective, saliva and blood samples were collected between 10 and 11 AM from 359 volunteers ranging from 21 to 69 years old (167 men and 192 women). For the second objective, four saliva samples (post-awakening, 11AM, 4PM, and bedtime) were collected throughout a day from 78 volunteers (42 women and 36 men) ranging from 20 to 40 years old. Cortisol and DHEA levels were measured using a radioimmunoassay (RIA). RESULTS: The morning cortisol and DHEA levels, and the age-related steroid decline patterns were similar in both genders. Serum cortisol levels significantly decreased around forty years of age (p < 0.001, when compared with people in their 20s), and linear regression analysis with age showed a significant declining pattern (slope= -2.29, t= -4.297, p < 0.001). However, salivary cortisol levels did not change significantly with age, but showed a tendency towards decline (slope= -0.0078, t= -0.389, p=0.697). The relative cortisol ratio of serum to saliva was 3.4 - 4.5% and the ratio increased with age (slope=0.051, t=3.61, p < 0.001). DHEA levels also declined with age in saliva (slope= -0.007, t= -3.76, p < 0.001) and serum (slope= -0.197 t= -4.88, p < 0.001). In particular, DHEA levels in saliva and serum did not start to significantly decrease until ages in the 40s, but then decreased significantly further at ages in the 50s (p < 0.001, when compared with the 40s age group) and 60s (p < 0.001, when compared with the 50 age group). The relative DHEA ratio of serum to saliva was similar throughout the ages examined (slop = 0.0016, t = 0.344, p = 0.73). On the other hand, cortisol and DHEA levels in saliva reflected well those in serum (r = 0.59 and 0.86, respectively, p < 0.001). The highest salivary cortisol levels appeared just after awakening (about two fold higher than the 11 AM level), decreased throughout the day, and reached the lowest levels at bedtime (p < 0.001, when compared with PM cortisol levels). The highest salivary DHEA levels also appeared after awakening (about 1.5 fold higher than the 11 AM level) and decreased by 11AM (p < 0.001). DHEA levels did not decrease further until bedtime (p=0.11, when compared with PM DHEA levels). CONCLUSION: This study showed that cortisol and DHEA levels change with age and that the negative slope of DHEA was steeper than that of cortisol in saliva and serum. As the cortisol and DHEA levels in saliva reflected those in serum, the measurement of steroid levels in saliva provide a useful and practical tool to evaluate adrenal functions, which are essential for clinical diagnosis.
Adult ; Age Factors ; Aged ; Analysis of Variance ; *Circadian Rhythm ; Dehydroepiandrosterone/blood/*metabolism ; Female ; Humans ; Hydrocortisone/blood/*metabolism ; Male ; Middle Aged ; Saliva/*metabolism