OBJECTIVE: The objective of this study was to evaluate the displacement pattern and the stress distribution of the finite element model 3-D visualization during symphyseal widening according to the osteotomy position, osteotomy type, and distraction device. METHODS: The kinds of distraction devices used were tooth-borne type, hybrid type, bone-borne type and tooth-borne type 30degrees angulated, and the kinds of osteotomy design were vertical osteotomy line between the central incisors and step osteotomy line through the symphysis. RESULTS: All reference points of the mandible including the condyles were displaced laterally irrespective of the osteotomy position, osteotomy method and distraction device. The anteroposterior or vertical displacements showed small differences between the groups. The widening pattern of the osteotomy line in the tooth-borne type of device was v shaped, and that of bone-borne type was a reverse v shape. However, the pattern in the hybrid type was parallel. The lateral displacement of the mandibular angle by the bone-borne device was more remarkable than the other types of devices. The displacement by the 30degrees angulated tooth-borne type was different between the left and right sides in both the transverse and anteroposterior aspects. CONCLUSION: The design of the distraction devices and osteotomy line can influence the displacement pattern and the stress distribution during mandibular symphyseal distraction osteogenesis procedures.
Chimera ; Displacement (Psychology) ; Finite Element Analysis ; Incisor ; Mandible ; Osteogenesis, Distraction ; Osteotomy

Objective: : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods: : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results: : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0–2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, nonrecanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/ D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.

PURPOSE: To compare surgically induced astigmatism (SIA) and some corneal higher order aberrations in patients who underwent microcoaxial cataract surgery (MCCS) or conventional cataract surgery. METHODS: A prospective randomized study included 60 eyes of 55 patients. Thirty eyes received MCCS using a 2.2mm clear corneal incision (group 1), and 30 eyes received conventional cataract surgery using a 2.8 mm clear corneal incision (group 2). SIA and corneal higher order aberrations were measured with a Keratometer (Humphrey, Zeiss) and i-Trace (Tracey Technologies) preoperatively, and at 1 and 3 months after cataract surgery. SIA was analyzed vectorially using the Alpins method. RESULTS: There was no significant difference in preoperative UCVA or BCVA between the two groups. At 1 month and 3 months after surgery, SIA in group 1 was less than that in group 2, but this difference was not significant. There was no statistically significant difference in postoperative change of corneal higher order aberrations in each group at 1 month or 3 months after surgery, and there was no statistically significant difference in corneal higher order aberrations between the two groups preoperatively, at 1 month, or 3 months after surgery. CONCLUSIONS: There was no significant difference in SIA and corneal higher order aberrations between the two groups.
Astigmatism ; Cataract ; Eye ; Humans ; Prospective Studies

Objective: Serious bacterial infection (SBI) is a common disease among infants, and it is associated with high morbidity and mortality. Making the diagnosis of SBI is challenging and measurement of various biomarkers is useful. This study examined the utility of lactate at an emergency department for diagnosing SBI patients. Methods: This was a retrospective, observational study of febrile infants less than 90 days old presenting to the emergency department of a tertiary hospital between September 2014 and August 2017. The demographic and laboratory data was collected through a chart review. Results: Laboratory tests such as the white blood cell count, C-reactive protein (CRP), procalcitonin, and lactate showed significant differences on the Student-T test and the Mann Whitney-U test. Multivariabe logistic regression test was done using the variables with significant differences. CRP (P=0.037; odds ratio, 1.01), procalcitonin (P=0.011; odds ratio, 1.02) and lactate (P=0.001; odds ratio, 2.38) shows significant correlation. Conclusion For febrile infants at the emergency department, the measurement of lactate is expected to be a useful tool to diagnose serious bacterial infection.

Objective: Tsutsugamushi disease is a febrile illness caused by tick bites. Delay in making the diagnosis and treatment cause an increase of the frequency of complications and mortality. The aim of this study was to determine quick sequential organ failure assessment (qSOFA) to predict the clinical outcome of scrub typhus patients in emergency departments. Methods: This was a retrospective, observational study of patients with tsutsugamushi disease and who presented to the emergency department of an urban hospital and a rural tertiary hospital between January 2013 and December 2018. The demographic and laboratory data was collected through a chart review. Statistical analysis was performed by dividing the patients into the general ward admission group (general ward) and the intensive care unit admission group (ICU). Results: Age, Acute Physiology and Chronic Health Evaluation II (APACHE) II score and laboratory tests such as pH, leukocyte count, C-reactive protein, and procalcitonin also showed significant differences between the general ward and ICU groups on the univariable logistic regression analysis, but only the qSOFA score among the variables showed a significant difference on the multivariate logistic regression analysis (P=0.014). Conclusion The qSOFA score will be a prompt and useful tool for predicting the prognosis of patients with tsutsugamushi disease in the emergency department.

PURPOSE: We evaluated the technical aspect and efficacy of transcatheter arterial embolization (TAE) in cases of intractable postpartum bleeding by comparing the angiographic findings women patients according to their delivery pattern. MATERIALS AND METHODS: Between July of 2003 and March of 2008, 55 female patients were enrolled in this study. Of the 55 patients, 36 underwent a vaginal delivery (group 1), whereas 19 underwent a cesarean section delivery (group 2). We retrospectively evaluated the angiographic findings and the embolization technique between groups, using a Pearson Chi-Square test. Medical records and telephone interview findings were also reviewed to evaluate the efficacy of TAE and the outcome of fertility. RESULTS: Significantly greater positive angiographic findings were found in group 2 (63.2%) relative to group 1 (30.6%). For positive angiographic findings, except for AVM, the embolization was performed using coil or glue with gelfoam. For the negative angiographic findings or AVM, the gelfoam was the only embolic agent used. In all patients except for one, bleeding stopped after embolization. Major complications occurred in 2 patients only, and included uterine synechia and perforation. All patients except for one recovered after menstruation. In total, four patients became pregnant and one patient delivered a healthy infant. CONCLUSION: Positive angiographic findings requiring embolization with coil or glue, as well as gelfoam, were more commonly encountered in group 2 than in group 1. Based on the outcome of the study group, TAE is a safe and effective treatment for intractable postpartum bleeding and is also useful for preserving fertility.
Adhesives ; Angiography ; Cesarean Section ; Embolization, Therapeutic ; Female ; Fertility ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Infant ; Interviews as Topic ; Medical Records ; Menstruation ; Obstetric Labor Complications ; Postpartum Hemorrhage ; Postpartum Period ; Pregnancy ; Retrospective Studies ; Uterus

Female ; Gonadotropins ; Ovary* ; Ultrasonography*

OBJECTIVE: The aim of this study was to describe a single center's experience in the management of craniopharyngiomas in children over a 15-year period. METHODS: The clinical records of pediatric patients treated for craniopharyngiomas between December 1995 and February 2011 were reviewed. Thirty-five pediatric patients diagnosed with craniopharyngioma were treated, and their medical records and imaging data were analyzed retrospectively. RESULTS: The mean follow-up duration was 76 months (range, 10-195). Overall survival and local control rates at 10 years were 94.7+/-5.1% and 37.1+/-11.9%, respectively. The female-to-male ratio was 16 : 19, and the mean age was 8.6 years (range, 1-17). Initially, gross total resection (GTR) was performed in 30 patients; subtotal resection (STR) followed by radiotherapy was performed in 5 patients. Of the 14 cases that showed recurrence after GTR, 5 patients were treated with GTR, 1 with radiation therapy (RT), 4 with gamma knife radiosurgery (GKRS), and 4 with subtotal resection followed by RT. No patients who underwent RT or GKRS had recurrences. Two cases with recurrence after STR followed by RT were treated with GTR. One patient died of hormonal insufficiency 64 months after the first surgery. The overall median time progression was 51.2 months (range, 3-182) : 49.7 months in the patients who underwent GTR and 60.2 months in the patients who underwent STR followed by RT. CONCLUSION: If safe resection is possible, GTR at the initial treatment should be attempted to reduce the tumor recurrence. However, if the tumor recurs after the first surgery, RT or GKRS with/without reoperation may be an effective salvage treatment for recurrent craniopharyngioma.
Child ; Craniopharyngioma ; Follow-Up Studies ; Humans ; Medical Records ; Microsurgery ; Radiosurgery ; Recurrence ; Reoperation ; Retrospective Studies

Primary tumors of the heart are rare and the most are benign. Malignant tumors constitute less than 25% of primary cardiac tumors and angiosarcomas are the most commonly reported histologic type. At least 160 cases have been reported in the world, but no previous report in Korea. We reported a case of primary cardiac angiosarcoma located in right atrium.
Heart ; Heart Atria ; Heart Neoplasms ; Hemangiosarcoma* ; Korea

It is difficult to estimate PMI of whom died long times ago, because corpse goes by many decomposition stages. So it makes investigation more difficult. Nowadays many studies about PMI estimation have been performed. In other countries, forensic entomology studies which is possible to estimate not characteristic of death site but also exact death time are actively advanced. So forensic entomology has been more important related not PMI estimation but also many lawsuits in other countries. In Korea, the necessity of Forensic entomology has increased after occuring of the case 'Gaeguri Sonyeon(missing boys who went to catch a flog)'. In this case, regional characteristic is known by insects found on the corpse or clothes. We suggest possibility of applying forensic entomology, consideration, some limitations and the direction of the future study through the analysis, comparison with true facts, and PMI estimation using collected fly larvae in "Hwaseong Case".
Cadaver ; Diptera ; Entomology* ; Female ; Humans ; Insects ; Korea ; Larva