The author treated 3 class I malocclusion patients with the lingual appliance followed by the extraction of the 4 bicuspids. One of them was finished with the labial appliance at the final stage. The treatment results were acceptable and the patients had good tolerance to the lingual appliance without complaints in these cases. There were some problems in treatment on the lingual side both the patient and the practioner, but I think we can overcome them with the development of the orthodontic materials, the treatment technics & the increased clinical experience. Of course, we cannot treat all the patients with the lingual braces, but patients are carefully selected, lingual braces will be a valuable orthodontic appliance. In conclusion, the lingual braces have very good esthetic advantages, so the patients, especially in adults, who hesitate or refuse the orthodontic treatment due to the esthetic problem of the labial braces will get the motivation & the chance for the orthodontic treatment.
Adult ; Bicuspid ; Braces ; Humans ; Malocclusion* ; Motivation ; Orthodontic Appliances

Cortical blindness means visual loss caused by bilateral destruction of visual cortex. Cortical blindness can develop after cerebral angiography due to hypertonic contrast medium which open the blood-brain barrier and then alternate the function of visual cortex transiently. About 30 minutes after injection of contrast medium (Ultravist 370(R)) during cerebral angiography, the patient complained of decrease of visual acuity. And 3 hours later, evaluation revealed that she could not see even the light. But her vision began to improve after 19 hours and recovered completely after 7 days. MRI taken at 12 hours after cerebral angiography showed high signal intensities in the both occipital lobes. But in repeated MRI study, which was taken after 3 days, previously noted high densities were completely disappeared. So we diagnosed this case as cortical blindness caused by hypertonic contrast medium.
Blindness, Cortical* ; Blood-Brain Barrier ; Cerebral Angiography* ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Visual Acuity ; Visual Cortex

Cortical blindness means visual loss caused by bilateral destruction of visual cortex. Cortical blindness can develop after cerebral angiography due to hypertonic contrast medium which open the blood-brain barrier and then alternate the function of visual cortex transiently. About 30 minutes after injection of contrast medium (Ultravist 370(R)) during cerebral angiography, the patient complained of decrease of visual acuity. And 3 hours later, evaluation revealed that she could not see even the light. But her vision began to improve after 19 hours and recovered completely after 7 days. MRI taken at 12 hours after cerebral angiography showed high signal intensities in the both occipital lobes. But in repeated MRI study, which was taken after 3 days, previously noted high densities were completely disappeared. So we diagnosed this case as cortical blindness caused by hypertonic contrast medium.
Blindness, Cortical* ; Blood-Brain Barrier ; Cerebral Angiography* ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Visual Acuity ; Visual Cortex

Around the time of recovery from general anesthesia we usually use atropine and neostigmine to counteract the effect of muscle relaxant that is remaining in the body. We used various kinds of combinations of atropine and neostigmine to see the effect of them on heart rate. The combinations were as follows: I) atropine 0.02mg/kg+neostigmine 0. 02mg/kg. 2) atropine 0. 2mg /kg+neostigmine 0.03mg/kg. 3) atropine 0. 02mg/kg+neostigmine 0.04mg/kg. 4) atropine 0.02mg/kg+neostigmine 0.05mg/kg. 5) atropine 0.02mg/kg+neostigmine 0.06mg/kg. 6) atropine 0.02mg/kg+neostigmine 0.07mg/kg. Ten subjects(ps.I.ASA) were taken for each combination. Thus total sample size of the six combinations were sixty, Each study has been performed in the state of ASA P.S.1, and anesthetized for b but two hours. N2O-O2-Halothane technique was used for anesthesia. The dosage of pancuronium was 0. 08mg/kg. The age distribution of the sample was 2 to 60, and male to female ratio was 4 to 6. We came to the following conclusions from this study. 1) Types of dosage combinations those caused little change in heart rate were; atrop!ne 0.02mg/kg+neostigmine 0.02mg/kg, and atropine 0.02mg/kg+ neostigmine 0.03mg/kg. 2) Just after the simultaneous injection of the drugs, there appeared mild tachycardia, but fifteen minutes after the administration severe bradycardia came on and, after that the heart rate returned to normal. 3) The combinations which included neostigmine, more than 0. 04mg/kg, caused severe braycardia, and the most severe bradycardia was seen with a combination of atropine 0.02mg/kg and neostigmine 0.06mg/kg.
Age Distribution ; Anesthesia ; Anesthesia, General ; Atropine* ; Bradycardia ; Female ; Heart Rate* ; Heart* ; Humans ; Male ; Neostigmine* ; Neuromuscular Blockade* ; Pancuronium ; Sample Size ; Tachycardia

Changes of body temperature were observed in the esophagus and rectum by telethermometer during extracorporeal circulation in 40 cases of open heart for detection of significant differences in survivals and non-survivals. The following results were obtained; 1) Esophageal and rectal temperature(just prior to extracorporeal circulation) were 36.4+/-0.69 degrees C, 36.8+/-0.8 degrees C respectively in non-survivals and 36.0+/-0.73 degrees C, 36.4+/-0.8 degrees C in survivals after open heart surgery 2) Normal differences between rectal and esophageal temperature came to disappear after 30 minutes of extracorporeal circulation in two groups. 3) Esophageal temperatures were higher than rectal temperatures after extracorporeal circulation for open heart surgery in both groups. 4) Changes of temperature differences between rectum and esophagus have no correlation with mortality because of the variation in two areas in both groups.
Body Temperature* ; Clinical Study* ; Esophagus ; Extracorporeal Circulation* ; Heart* ; Mortality ; Rectum ; Thoracic Surgery*

The management of patient undergoing thoracic aortic surgical procedures represents a major challenge for the anesthesiologists. Aortic cross-clamping and unclamping are particularly hszardous during the- course of the thoracic aortic operation. Proximal hypertension, myocardial ischemia and arrhythmia have been reported to occur after application of the aortic cross-clampmg. Removal of the cross-clamp often results in severe hypotension with subsequent myocardial, cerebral and renal ischemia. In this case, the patient was managed successfully using Regitine drip during the cross-clamp and slow release of clamp during unclamp, combined with slight overhydration just before unclamp.
Aortic Aneurysm, Thoracic* ; Arrhythmias, Cardiac ; Humans ; Hypertension ; Hypotension ; Ischemia ; Myocardial Ischemia ; Phentolamine

A central vacuum scavenger modified by the authors, was used to control the atmospheric contamination of the operating room by anesthetic gases and vapours. Air pollution was monitored by measuring the concentrations of halothane vapour in the air of the operating room with the gas chromatograph. Under endotrachal intubation, the semi-colsed circle absorber system was used for anesthetic administration and maintained with 0.8~1.2% Halothane. Total gas flow rates were 4 liter/min with 50% oxygen in nitrous oxide for daily work. Air sampling was taken early in the morning at 10cm high from the floor before anesthesia. After daily work, they were also done at 10cm, 120cm, and 140cm high from the floor and at the corridor of the operating room. We investigated the differences of halothane concentration according to each sits by the changing central vacuum pressure. Results are followings: The atmospheric halothane concentration of the operating room before anesthesia were 0.27+/-0.12, 0.22+/-0.11 and 0.15+/-0.06 ppm.The atmospheric halothane concentration of the operating room after daily work were 7.94 +/- 1.30 ppm without the active central vacuum pressure.The atmospheric halothane concentration of the operating room after daily work were 1.41 +/-0.48ppm of 20mmHg of central vacuum pressure.The tmospheric halothane concentration of the operating room after daily work were 0.49+/-0.18ppm of 40mmHg of central vacuum pressure. The atmospheric halothane concentrations at the corridor of the operating room after daily work were 1.09+/-0.19, 0.77+/-0.11n and 0.36+/-0.17ppm when each vacuum pressure was 0mmHg, 20mmHg and 40mmHg. A significant reduction (p<0.01) in atmospheric halothane concentration of the operation room was obtained by the use of the central vacuum pressure with the scavenger. The higher the vacuum pressure, the greater reduction of the operating room air pollution was observed.
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Air Pollution* ; Anesthesia ; Anesthetics, Inhalation ; Halothane* ; Intubation ; Nitrous Oxide ; Operating Rooms* ; Oxygen ; Vacuum*

BACKGROUND: An important metabolic feature of acromegaly is a reduced action of insulin on hepatic gluconeogenesis and peripheral glucose disposal which mediated by growth hormone hypersecretion. Octreotide, a synthetic octapeptide somatostatin analogue exerts complex effects on hormonal and metabolic regulations affecting glucose homeostasis. This study was designed to ascertain the shorterm effect of octreotide on glucose tolerance in acromegaly. METHODS: 10 patients (five men and five women, age 47.9+/-11.8) were injected subcutaneously with octreotide, 100 micrograms for 24 hours. Patients were assessed with respect to growth hormone, glucose, and insulin response to a standard 100 g oral glucose tolerance test (OGTT) before and during the last 2 hour of octreotide infusion. RESULTS: During the therapy, there was significant decrease in mean blood glucose response to OGTT (678.4+/-51.9 vs 581.9+/-47.3 mg/dL/2hr: mean areas under the glucose curve, p=0.01) and mean serum insulin response to oral glucose load was significantly reduced in all patients (339.2+/-106.2 vs 256.7+/-111.3 U/mL/2hr: mean areas under the insulin curve, p=0.01). Using glucose tolerance test criteria three patients of 10 had normal glucose tolerance, four and three had impaired glucose tolerance and diabetes, respectively, at base line. While on octreotide these composition was changed to six patients of NGT, three of IGT and one diabetes. CONCLUSION: We conclude that insulin resistance mediated by GH hypersecretion was improved by shorterm octreotide treatment.
Acromegaly* ; Blood Glucose ; Female ; Gluconeogenesis ; Glucose Tolerance Test ; Glucose* ; Growth Hormone ; Homeostasis ; Humans ; Infusions, Subcutaneous* ; Insulin ; Insulin Resistance ; Male ; Octreotide* ; Social Control, Formal ; Somatostatin

Purpose: The introduction of immune checkpoint inhibitors represents a major advance in the treatment of lung cancer, allowing sustained recovery in a significant proportion of patients. Nivolumab is a monoclonal anti–programmed death cell protein 1 antibody licensed for the treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) after prior chemotherapy. In this study, we describe the demographic and clinical outcomes of patients with advanced NSCLC treated with nivolumab in the Korean expanded access program. Materials and Methods: Previously treated patients with advanced non-squamous and squamous NSCLC patients received nivolumab at 3 mg/kg every 2 weeks up to 36 months. Efficacy data including investigator-assessed tumor response, progression data, survival, and safety data were collected. Results: Two hundred ninety-nine patients were treated across 36 Korean centers. The objective response rate and disease control rate were 18% and 49%, respectively; the median progression-free survival was 2.1 months (95% confidence interval [CI], 1.87 to 3.45), and the overall survival (OS) was 13.2 months (95% CI, 10.6 to 18.9). Patients with smoking history and patients who experienced immune-related adverse events showed a prolonged OS. Cox regression analysis identified smoking history, presence of immune-related adverse events as positive factors associated with OS, while liver metastasis was a negative factor associated with OS. The safety profile was generally comparable to previously reported data. Conclusion This real-world analysis supports the use of nivolumab for pretreated NSCLC patients, including those with an older age.