This study was carried out to research the adaptation patterns of head posture after activator therapy in functional class ill malocclusion patients. For this purpose, 29 functional class III malocclusion patients, from the ages of 8 to 13 years old, were used. 1. Increase in capacity of oral cavity capacity were found in all the samples, but craniocervical angulation were varied into increased group and decreased group after activator therapy. 2. Head posture exhibited the compensatory adaptation in the relative growth increments of the vertical dimension, ALFH and PLFH. 1) A group with more PLFH and less sagittal angle showed relatively small growth increment in PLFH during the treatment period, thus craniocervical angulation was increased. 2) A group with less PLFH and more sagittal angle showed relatively great growth incrmenet in PLFH during the treatment period, thus craniocervical angulation was decreased.
Adolescent ; Head* ; Humans ; Malocclusion* ; Mouth ; Posture* ; Vertical Dimension

Congenital lipoid adrenal hyperplasia is the most severe form of CAH, leading to impaired production of all steroid hormones including glucocorticoids, mineralocorticoid, and sex steroids. The affected individuals are all phenotypically female with a severe salt-losing syndrome that is fatal if steroid replacement is not begun immediately after birth. The lesion of this disorder has been suggested to be in the first step of steroidogenesis of conversion of cholesterol to pregnenolone by P450scc. Recently, molecular defect of this disease has been located in the transport of cholesterol into mitochondria due to defective regulatory protein called 'steroidogenic acute regulatory protein' while the enzyme P450scc itself is normal, differing from other types of congenital adrenal hyperplasia. We experienced 2 1/2 month old phenotypical girl who was admitted due to lethargic state and persistent vomiting with severe hyperkemia and hyponatremia. Blood levels of cortisol, aldosteron, and 17-OH progesteron were low and levels of ACTH, angiotensin, and plasma renin activity were high, urinary levels of 17-KS and 17-OHCH were low. The patient was found to have karyotype of 46, XY and has been being treated with predinisolone, fluorocortisol and sodium supplement in diet and doing well. The molecular study for P450scc gene and StAR gene of patient and family is in progress.
Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Angiotensins ; Cholesterol ; Diet ; Female ; Glucocorticoids ; Humans ; Hydrocortisone ; Hyperplasia* ; Hyponatremia ; Karyotype ; Mitochondria ; Parturition ; Plasma ; Pregnenolone ; Renin ; Sodium ; Steroids ; Vomiting

OBJECTIVE: To compare current perception threshold with nerve conduction study, we measured current perception threshold (CPT) in healthy control and patients with carpal tunnel syndrome (CTS). METHOD: Twenty control subjects and twenty patients with CTS were included. Latency and amplitude of median and ulnar motor and sensory nerves were measured. The sensory current perception threshold was measured at the distal interphalangeal joint of third and fifth fingers and the palm with electrical current of 5 Hz, 250 Hz, and 2,000 Hz in frequency. We compared the results of the nerve conduction study with the data of the CPT. RESULTS: We found that measuring of the sensory threshold might detect carpal tunnel syndrome, especially with 2,000 Hz and 250 Hz stimulation and that CPT data correlated to sensory latency and amplitude of the median nerve. CONCLUSION: The sensory threshold test might be useful for diagnosis and follow up test in carpal tunnel syndrome.
Carpal Tunnel Syndrome* ; Diagnosis ; Fingers ; Humans ; Joints ; Median Nerve ; Neural Conduction ; Sensory Thresholds

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

OBJECTIVES: In this study, we evaluated early surgical results including 30 days early stroke and death rate and complications in 168 cases carotid endarterectomy (CEA). METHODS: A retrospective review of patients who underwent CEA at our institute between September 1999 and August 2010 was done. Preoperative symptoms were stroke in 72 cases, transient ischemic stroke or reversible ischemic neurologic deficit in 56 cases and asymptomatic in 40 cases. Most of the patients had conventional cerebral angiography or neck computed tomography angiography (CTA) for preoperative evaluation. Immediate radiological follow up was performed by neck CTA 1 week postoperatively. RESULTS: The overall postoperative stroke rate including transient ischemic attack within 30 days of the treatment was 1.7%. Major stroke rate with morbidity and death rate within 30 days was 0.6% (1 : major stroke, 1 : death). The cause of death was airway occlusion due to wound hematoma. Cranial nerve palsy developed in two patients (1.1%) and neck hematoma in six patients (3.5%). Neck CTA revealed total occlusion of internal carotid artery in one patient with acute cerebral infarction and then recovered fully. Intracranial hemorrhage relating to the hyperperfusion syndrome developed in one patient. Radiological patency rate was 98.7%. The comparison of 30 days morbidity and mortality rate between CEA and carotid angioplasty and stenting were each 0.6% and 1.5%, but there was no statistical significance. CONCLUSIONS: Carotid endarterectomy provides considerable future risk prevention against stroke in patients with symptomatic and asymptomatic carotid stenosis.
Angiography ; Angioplasty ; Carotid Artery, Internal ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Cerebral Infarction ; Cranial Nerve Diseases ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hemorrhages ; Ischemic Attack, Transient ; Neck ; Neurologic Manifestations ; Retrospective Studies ; Stents ; Stroke

This study was done to investigate the effect volume overloading of right ventricle(RV) on the left ventricular(LV) volume and function in patients with isolated secundum type atrial septal defect(ASD) and to determine the hemodynamic indices affecting the postoperative reduction of RV size. Pre and postoperative echocardiogram and equilibrium radionuclide cardiac angiogram were analyzed in 39 patients of isolated secundum type ASD, who had their diagnosis confirmed by right heart catheterization and were operated at Seoul National University Hospital from January 1982 to July 1984. The ratio fo RV end-diastolic dimension to LV end-diastolic dimension(RVED/LVED), ratio of LV pre-ejection period and LV ejection time(PEP/LVET), ejection fraction(E.F.), fractional shortening(F.S.) mean velocity of circumferential fiber shortening(mVcf), peak ejection rate(PER) and peak filling rate(PFR) were measured in 24 normal control subjects and 39 patients with ASD before and after operation. The results obtained were as follows : 1) The postop. reduction of RV size could be correlated with age at operation, but showed no correlation with the degree of QP/Qs, main pulmonary arterial systolic, diastolic, mean pressure, RVEDP and previous RV size. 2) The ratio of postop. RVED/LVED(0.58+/-0.15) was significantly decreased, compared with the ratio of preop(0.96+/-0.28)(P<0.005)(Mean+/-1 S.D.). In preop and postop. status of ASD, the ratio of RVED/LVED was significantly larger than that of normal control subject(0.30+/-0.09)(P<0.005). 3) The ratio of preop PEP/LVET(0.33+/-0.02) was significantly decreased, compared with ratio of preop PEP/LVET(0.39+/-0.04)(P<0.005). There was significant difference between the ratio of preop. PEP/LVET and ratio of normal control subjects(0.33+/-0.05)(P<0.005), but no significant difference between the ratio of postop. PEP/LVET and ratio of normal control subjects(P>0.1). 4) There was no significant difference in LV systolic contractile functional indices between ASD group and normal control subjects and between pre and postop. status of ASD patients : LVEF was 63.5+/-6.1(%) in preop., 63.0+/-5.7(%) in postop and 62.4+/-6.6(%) in normal control subjects. F.S. was 27.3+/-5.7(%) in preop., 28.2+/-3.1(%) in postop. and 28.7+/-4.5(%) in normal control subjects. mVcf was 0.81+/-0.11(Cire/sec) in preop., 0.80+/-0.10(Circ/sec) in postop. and 0.82+/-0.14(Circ/sec) in normal control subjects. PER was 2.82+/-0.61(EDV/sec) in preop., 2.84+/-0.56(EDV/sec) in postop. and 2.84+/-0.45(EDV/sec) in normal control subjects. 5) The postop. PFR 3.34+/-0.46(EDV/sec) was significantly increased, compared with preop. PFR 2.51+/-0.46(EDV/sec)(P<0.005). There was significant difference between preop. PFR and normal control PFR 3.29+/-0.66(EDV/sec)(P<0.005), but no significant difference between postop. PFR and normal control PFR(P>0.1). 6) The postop. RVEF(51.4+/-6.3%) was significantly decreased, compared with preop. RVEF(54.5+/-9.9%)(P<0.005). Pre and postop. RVEF of ASD patient were significantly lower than RVEF of normal control group(60.3+/-3.1%)(P<0.01, P<0.005). The results indicate that postop. reduction of RV size could be correlated with age at operation. The effect of RV volume overloading on LV could not change systolic contractile functional indices, but diastolic filling index. There is many evidences suggesting that RV filling influences LV diastolic function which are occured by means of left ward shift of the interventricular septum and indirectly by linkage of filling of the two ventricules by common enclosure in the pericardium(underfilled LV volume and decreased LV compliance). Mildly diminished overall LV performance as shown by systolic time intervals appears to be related to the volume overload of the RV and to the concomitantly diminished volume of LV rather than to any myocardial contractility. LV systolic time inverval was non-invasive and sensitive index in assessing overall LV performance independent to LV geometric configuration and abnormal motion of regional ventricular wall.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Heart Septal Defects, Atrial* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Seoul ; Systole ; Ventricular Function, Left*

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
Enema* ; Fiducial Markers ; Humans ; Prostate* ; Prostatic Neoplasms ; Radiotherapy* ; Retrospective Studies

OBJECTIVE: Despite several limitations, the Trauma Injury Severity Score (TRISS) is normally used to evaluate trauma systems. The aim of this study was to evaluate the preventable trauma death rate using the TRISS method in severe trauma patients with traumatic brain injury using our emergency department data. METHODS: The use of the TRISS formula has been suggested to consider definitively preventable death (DP); the deaths occurred with a probability of survival (Ps) higher than 0.50 and possible preventable death (PP); the deaths occurred with a Ps between 0.50 and 0.25. Deaths in patients with a calculated Ps of less than 0.25 is considered as no-preventable death (NP). A retrospective case review of deaths attributed to mechanical trauma occurring between January 1, 2011 and December 31, 2011 was conducted. RESULTS: A total of 565 consecutive severe trauma patients with ISS>15 or Revised Trauma Score<7 were admitted in our institute. We excluded a total of 24 patients from our analysis : 22 patients younger than 15 years, and 2 patients with burned injury. Of these, 221 patients with head injury were analyzed in the final study. One hundred eighty-two patients were in DP, 13 in PP and 24 in NP. The calculated predicted mortality rates were 11.13%, 59.04%, and 90.09%. The actual mortality rates were 12.64%, 61.547%, and 91.67%, respectively. CONCLUSION: Although it needs to make some improvements, the present study showed that TRISS performed well in predicting survival of traumatic brain injured patients. Also, TRISS is relatively exact and acceptable compared with actual data, as a simple and time-saving method.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Emergencies ; Humans ; Injury Severity Score ; Retrospective Studies

No abstract available.
Appendicitis* ; Child* ; Humans

PURPOSE: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. MATERIALS AND METHODS: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. RESULTS: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). CONCLUSION: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.
Humans ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon*