We describe a case of traumatic aortic dissection associated with cardiac compression in a patient with anaphylactic cardiac arrest who underwent cardiopulmonary resuscitation (CPR). A 54-year-old man who was scheduled to undergo surgery for gastric cancer went into cardiac arrest caused by an anaphylactic reaction to prophylactic antibiotics in the operating room. Veno-arterial extracorporeal membrane oxygenation (ECMO) was performed. CPR, including chest compressions, was performed for 35 minutes, and the patient was transferred to the intensive care unit (ICU) after spontaneous circulation returned. The patient received ECMO for 9 hours until confirmation of normal cardiac function on transthoracic echocardiography. Twenty days after cardiac arrest, an aortic dissection and fractures in the left fourth and fifth ribs due to chest compression were detected by abdominal computed tomography. The DeBakey type III aortic dissection extended from the distal arch of the thoracic aorta to the proximal level of the renal artery, involving the celiac trunk. It was considered an uncomplicated type B aortic dissection with no sign of malperfusion of the major vessels. This case demonstrates the potential traumatic injuries that can occur after CPR and encourages proper management of mechanical complications in cardiac arrest survivors.
Anaphylaxis ; Anti-Bacterial Agents ; Aorta, Thoracic ; Cardiopulmonary Resuscitation* ; Echocardiography ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Intensive Care Units ; Middle Aged ; Operating Rooms ; Renal Artery ; Ribs ; Stomach Neoplasms ; Survivors* ; Thorax ; Tomography, Spiral Computed

Patient with Kawasaki disease who presented with acute myocardial infarction in young age Although the clinical course of Kawasaki disease is self limiting, coronary aneurysm or myocardial disorders develop in about 20% of the patients. In recent years there have been reports of ischemic heart disease as sequelae of Kawasaki disease in adults, especially young adults. In Korea, there was only one case report in 1995. We report a young woman who presented as acute myocardial infarction with coronary artery aneurysms which highly suggest the underlying Kawasaki disease. The acute myocardial infarction in this patient seems to be the late cardiologic sequelae of Kawasaki disease, which has been silent clinically until the presentation as an acute myocardial infarction. New noninvasive diagnostic tests are being tried to improve the detection of coronary artery complication. However, coronary angiography is still widely used to determine the presence of coronary artery lesions and access the feasibility of coronary intervention. Another advantage of coronary angiography is that, it is possible to analyze the shape and the size of aneurysm and predict the prognosis. In this case we performed the percutaneous transluminal coronary angioplasty(PTCA) instead of surgery. Further study comparing surgery with percutaneous coronary angioplasty is needed.
Adult ; Aneurysm ; Angioplasty ; Coronary Aneurysm ; Coronary Angiography ; Coronary Vessels ; Diagnostic Tests, Routine ; Female ; Humans ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction* ; Myocardial Ischemia ; Prognosis ; Young Adult

Ganglia in soft tissue are common and usually occur in close relations with joints, tendon sheaths, or tendons. However, intra-osseous ganglia are very rare. We report a case of intra-osseous ganglion arising from the right sided proximal humerus in a 33 year-old woman. It was multiple cysts surrounded by thin rims of sclerotic bone in the subchondral epiphysis without other features of degenerative joint disease or destruction of adjacent soft tissue.
Female ; Humans ; Cysts

Most instances of choriocarcinoma of the ovary are gestational in origin. In contrast, nongestational choriocarcinoma of the ovary is an exceedingly rare primary germ cell neoplasm that has worse prognosis than gestational neoplasm. We report a case of pure nongestational choriocarcinoma of the ovary in view of the rarity of its kind. The patient was a 35-year-old Korean unmarried woman who had suffered from vaginal bleeding and feeling of abdominal inflation for two months. The X-ray studies and CT scanning revealed a child head sized cystic mass on the right pelvic cavity and multiple nodular densities in both lung fields and the liver. The mass in pelvic cavity was excised and histologically confirmed to be a nongestational pure choriocarcinoma, arising from the right side ovary.
Child ; Male ; Female ; Humans

No effective therapy has yet developed for liver fibrosis/cirrhosis by directly inhibiting the accumulation of extracellular matrix. This study was undertaken to determine the effect of tetrandrine in rat model of liver fibrosis induced by carborn tetrachloride (CCl4) administration intraorally. Tetrandrine, a calcium channel blocker, is anti-inflammatory constituent of the families Menispermaceae and Ranunculaceae, which have been used as folk remedies in China. Repeated administration of CCl4 for 14 weeks to rats induced liver fibrosis with steatosis. Rats were killed after 4, 8 or 14 weeks of treatment with CCl4, CCl4 tetrandrine (30 mg/kg) or CCl4 tetrandrine (50 mg/kg). The histopathological findings of liver were observed semi-quantitatively by light microscopy and volume percentage of the collagen deposition was determined by image analyzer. Tetrandrine inhibited collagen deposition induced by CCl4 administration, as shown by less severe steatosis and fibrosis and significantly decreased volume percentage of collagen fibers in CCl4 tetrandrine treated animals compared with CCl4 only group. Thus, the administration of tetrandrine holds great promise for treating subjects with liver fibrosis/cirrhosis as a result of chronic hepatic injury.
Animals ; Calcium Channels ; Carbon Tetrachloride ; China ; Collagen ; Extracellular Matrix* ; Fibrosis* ; Humans ; Liver ; Liver Cirrhosis ; Medicine, Traditional ; Menispermaceae ; Microscopy ; Models, Animal ; Ranunculaceae ; Rats*

The ideal restorative material should mimic the properties of the tissues it replaces. Dental composite resins have been used widely as restorative materials due to its advantages such as excellent esthetics and ease of manipulation. But inadequate wear resistance has been a major factor limiting the use of composite restorative materials. Improved manufacturing techniques have allowed the development of hybrid composites, with a greater percentage volume filler loading, which have improved physical an mechanical properties. However they are lacking the study wear resistance. The purpose of this study was to evaluate the wear of human enamel against ceromer by the use of a pin-on-disk type wear testers. Discs of ceromer(Targis : Ivoclar, Vivadent, Amherst. NY) and discs of type III gold alloy as a control were used for test specimens. Intact cusp of premolar and molar were used for enamel specimens. The wear of enamel was determined by weighing the cusp before and after each test, and the weight converted to volumes by average density of enamel. Surface profilometer was used to quantify wear of the ceromer and gold specimens. Vicker's hardness tester was used to evaluate the surface hardness of test specimens. The SEM was used to evaluate the wear surfaces. The results were as follows; 1. Ceromer produced less enamel wear than gold(p<0.05). 2. The wear volume of ceromer was greater than that of gold(p<0.01). 3. The hardess of ceromer was lower than that of gold, but there was no correlation between the hardness and wear of the ceromer and gold. 4. SEM analysis revealed that there were many voids and microcracks in the wear tract of ceromer. in gold group, many minute V-shaped grooves were examined.
Alloys ; Bicuspid ; Composite Resins ; Dental Enamel* ; Esthetics ; Hardness ; Hardness Tests ; Humans* ; Molar

There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Child ; Dentition ; Diagnosis ; Facial Bones* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible ; Nasal Bone ; Orbital Fractures ; Physical Examination ; Postoperative Care ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography ; Zygoma

Nasal chondromesenchymal hamartoma is a distinctive mixed mesenchymal lesion of sinonasal region with a complex histologic appearance and benign clinical course and clinicopathologically similar to those of the mesenchymal hamartoma of the chest wall of infancy. We report a case of nasal chondromesenchymal hamartoma occurred in the right nasal cavity in a 3-month-old female. She was admitted with a history of profuse nasal bleeding and obstruction. CT revealed complex solid and cystic mass, measuring 3.5x2.5x2.5 cm in dimensions which filled the right nasal cavity and extended into ethmoid sinus and cribriform plate. The received piecemeal fragments of tissue were brown tan-colored firm semitranslucent tissue with a cartilaginous appearance. Microscopically, the basic morphologic elements were irregular islands of hyaline cartilage and myxoid to spindle cell stroma with various cellularity.
Epistaxis ; Ethmoid Bone ; Ethmoid Sinus ; Female ; Hamartoma* ; Humans ; Hyaline Cartilage ; Infant ; Islands ; Nasal Cavity ; Thoracic Wall

No abstract available.
Attention Deficit Disorder with Hyperactivity

Background: As prevention of coronavirus disease 2019 (COVID-19) transmission in healthcare settings has become a critical component in its effective management, COVID-19 specific infection prevention and control (IPC) guidelines were developed and implemented by numerous countries. Although largely based on the current evidence-base, guidelines show much heterogeneity, as they are influenced by respective health system capacities, epidemiological risk, and socioeconomic status. This study aims to analyze the variations and concurrences of these guidelines to draw policy implications for COVID-19 response and future guidelines development. Methods: The contents of the COVID-19 IPC guidelines were analyzed using the categories and codes developed based on “World Health Organization guidelines on core components.” Data analysis involved reviewing, appraising and synthesizing data from guidelines, which were then arranged into categories and codes. Selection of countries was based on the country income level, availability of COVID-19 specific IPC guideline developed at a national or district level. Results: The guidelines particularly agreed on IPC measures regarding application of standard precautions and providing information to patients and visitors, monitoring and audit of IPC activities and staff illnesses, and management of built environment/equipments.The guidelines showed considerable differences in certain components, such as workplace safety measures and criteria for discontinuation of precautions. Several guidelines also contained unique features which enabled a more systematic response to COVID-19. Conclusion The guidelines generally complied with the current evidence-based COVID-19 management but also revealed variances stemming from differences in local health system capacity. Several unique features should be considered for benchmark in future guidelines development.