No abstract available.
Cholecystectomy

The purpose of this study was to compare en masse retraction of six anterior teeth with separate canine retraction in the amount of the anchorage loss and the retraction of the anterior teeth. The subjects consisted of 30 adult female patients with Angle Class I malocclusions who were treated by .022" straight wire appliance with 4 first premolar extraction. They were composed of two groups. Group 1 consisted of 15 subjects, whose six anterior teeth were retracted by en masse retraction. Group 2 consisted of 15 subjects, whose canines were retracted separately. Pre-treatment and post-treatment lateral cephalometric radiographs were analyzed. All data were processed statistically with independent samples t-test, and the conclusions were as follows. 1. There was no significant difference in the amount of the anchorage loss between two groups(p>0.05). 2. There was no significant difference in the amount of the retraction of the anterior teeth between two groups(p>0.05). 3. There was a significant difference in the amount of the inclinational change of the upper incisors between two groups. It was greater in Group 2. 4. There was a significant difference in the vertical positional change of the upper incisal edges between two groups. The upper incisal edges in Group 2 were more extruded than Group 1 by about 1 mm. 5. There was no significant difference in the vertical positional change of the root apex of the upper incisors between two groups(p>0.05). And there was no significant difference in the vertical positional change of the upper molar(p>0.05).
Adult ; Bicuspid ; Female ; Humans ; Incisor ; Malocclusion ; Malocclusion, Angle Class I ; Tooth*

Photodynamic therapy (PDT) can be used as palliative therapy to reduce obstructive symptoms in patients with advanced lung cancer. Herein, we report on the case of a patient with fatal broncho-mediastinal fistula after PDT. A 57-year-old woman was diagnosed as non-small cell lung cancer (squamous cell carcinoma, cT4N3). She received PDT on the endobronchial mass obstructing her right main bronchus twice in 48 hours interval. Two weeks later, concurrent chemoradiation therapy (CCRT) with weekly Paclitaxel/Carboplatin was started. During maintenance chemotherapy, a new nodule in her scalp developed and turned out to be a metastatic nodule. A broncho-mediastinal fistula was suspicious on follow-up chest computed tomography and a broncoscopy revealed an extensively damaged medial right main bronchial wall. On the day following bronchoscopy, the patient died of sudden massive hemoptysis.
Bronchi ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung ; Female ; Fistula ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung Neoplasms ; Maintenance Chemotherapy ; Middle Aged ; Palliative Care ; Photochemotherapy ; Scalp ; Thorax ; Triazenes

Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related morbidity and mortality. However, it is frequently not diagnosed and under-reported, which could result in inappropriate treatment. Diagnostic definition for TRALI consists of hypoxia and bilateral pulmonary edema occurring during or within 6 hours of a transfusion in the absence of cardiac failure or intravascular volume overload. Here, we report a fatal case, which resulted from under-recognition and misdiagnosis of TRALI occurring during transfusion with packed red blood cells during a bilateral total knee replacement.
Acute Lung Injury ; Anoxia ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Diagnostic Errors ; Erythrocytes ; Heart Failure ; Knee ; Pulmonary Edema

No abstract available.
Carcinoma, Squamous Cell* ; Cisplatin* ; Drug Therapy* ; Head* ; Neck*

PURPOSE: This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS: We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS: The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION: Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
Ampulla of Vater ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Common Bile Duct ; Cystic Duct ; Gastric Emptying ; Humans ; Medical Records ; Neoplasms, Second Primary ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pathology ; Reoperation ; Retrospective Studies ; Survival Rate

We report a case of subcutaneous panniculitic T-cell lymphoma (SPTCL) which occurred in a 10-year-old Korean girl. Her disease presented as multiple erythematous subcutaneous nodules on the right cheek, left chest, abdomen, left flank, both calves, and left shin with systemic symptoms. She had a protracted course of multiple erythematous subcutaneous nodules for 2 months often with spiking fever. Histopathologic findings for the subcutaneous nodules revealed lobular panniculitis-like findings composed of atypical small, bland lymphocytes and histiocytes. Characteristically, atypical lymphocytes rimmed individual fat cells in a lace-like pattern and some histiocytes occasionally phagocytosed WBCs. Bone marrow findings revealed increased phagocytic histiocytes with engulfed hematopoietic cell. The immunophenotypic studies showed CD45RO (UCHLl)+, CD20-, CD4-, CD8+ and CD56+ (focal), lysozyme+, CD45 (LCA)+ and EBV-. She received three cycles of high-dose cyclophosphamide, adriamycin, vincristine, prednisolone (CHOP) and methotrexate, intrathecal methotrexate and one cycle of fludarabine, mitoxantrone and dexamethasone (FND) chemotherapy. She died of acute renal failure during multiple chemotherapy.
Abdomen ; Acute Kidney Injury ; Adipocytes ; Bone Marrow ; Cheek ; Child* ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Glycogen Storage Disease Type VI ; Histiocytes ; Humans ; Lymphocytes ; Lymphoma, T-Cell* ; Lymphoma, T-Cell, Cutaneous ; Methotrexate ; Mitoxantrone ; Prednisolone ; T-Lymphocytes* ; Thorax ; Vincristine

PURPOSE: Precocious puberty refers to the development of secondary sex characteristics before ages 8 and 9 years in girls and boys, respectively. Central precocious puberty (CPP) is caused by premature activation of the hypothalamus-pituitary-gonadal (HPG) axis and causes thelarche in girls before the age of 8. A gonadotropin-releasing hormone (GnRH) stimulation test is the standard diagnostic modality for diagnosing CPP. However, the test cannot always be used for screening because it is expensive and time-consuming. This study aimed to find alternative reliable screening parameters to identify HPG axis activation in girls <8 years old (CPP) and for girls 8–9 years old (early puberty, EP). METHODS: From January 2013 to June 2015, medical records from 196 girls younger than 9 years old with onset of breast development were reviewed, including 126 girls who had a bone age (BA) 1 year above their chronological age. All patients underwent a GnRH stimulation test, and 117 underwent pelvic sonography. The girls were divided into 4 groups based on age and whether the GnRH stimulation test showed evidence of central puberty. Subanalyses were also conducted within each group based on peak luteinizing hormone (LH) level quartiles. RESULTS: Basal serum LH level was the most sensitive marker for screening CPP and EP. The cutoff values were 0.245 IU/L for CPP under 8 years old (P=0.049, area under the curve [AUC]=0.764, 88% sensitivity, 48% specificity) and 0.275 IU/L for EP between 8–9 years old (P=0.005, AUC=0.813, 79% sensitivity, 77% specificity). Peak LH level decreased as BMI z-score among subgroups increased when there was no difference in BA; however, higher BA eliminated this effect. CONCLUSION: Basal serum LH level is a useful screening parameter for diagnosing CPP and EP in girls. Peak LH levels were lower with increasing BMI z-score, although older BA eliminated this effect.
Adolescent ; Breast ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Lutein ; Luteinizing Hormone ; Mass Screening ; Medical Records ; Puberty ; Puberty, Precocious ; Sex Characteristics

Bone defect of the long bone continues to challenge orthopedic surgeons. It is usually very difficult to obtain union. Ilizarov ext. fixation has recently gained popularity as a multifactorial approach to the management of tibial bone defect because nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. From February 1992 to May 1993 at the department of orthopedic surgery, Inje University Pusan Paik Hospital, 9 patients aged from 8 to 37 years were treated for tibial bone defect. The causes were open comminuted fractures with initial bone loss and bone defect after removal of infected necrotic bone. Bony defect size was ranged from 2cm to 14cm, averaging 7.2cm. Bony defects were gradually closed by the Ilizarov's internal bone transport technique, and final equalization of leg length discrepancy was achieved by means of external lengthening technique. Soft tissue defects were treated with secondary closure, split thickness skin graft, and muscle flap. The average healing index was 42.8 days/cm. According to Paley's classification the complications were developed as follows; The problem included pin tract infection(9), knee flexion contracture(4), and intractable pain(1), the obstacles included delayed union(3) and premature consolidation(1), the complication included nonunion(9) and equinus ankle(1). At an average 1 years follow up, according to Paley and Catagnl's classification, body and functional results were either excellent or good in 7 cases. So, we recommend that Ilizarov technique is very useful treatment for open fracture with bone loss, bone defect after removal of infected necrotic bone and limb shortening.
Busan ; Classification ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Fractures, Comminuted ; Fractures, Open ; Humans ; Ilizarov Technique ; Knee ; Leg ; Orthopedics ; Skin ; Surgeons ; Tibia ; Transplants