Background: This study compared and analyzed the surface properties, including gloss, Vickers hardness, surface roughness,surface morphology, and color stability, of various aesthetic restorative materials subjected to in-office tooth bleaching treatments. Methods: The experimental groups consisted of various commercially available aesthetic restorative materials, includinglight-cured composite resin (CR), light-cured bulk-fill resin (BF), compomer (CP), resin-modified glass ionomer cement (RMGI), and glass ionomer cement (GI). Before and after the bleaching treatment using 30% hydrogen peroxide, the gloss was measured with a gloss meter, the Vickers hardness values were assessed with a Vickers hardness tester, and the surface roughness was analyzed using a surface profilometer. Surface morphology was observed using scanning electron microscopy.After the bleaching treatment, color stability was evaluated by immersing the specimens in coffee, Pepsi Cola, black tea, and distilled water solutions. The color changes (ΔE*) were analyzed at 1, 3, and 7 days. Results: Compared with the pre-treatment values, gloss significantly decreased in the BF and RMGI groups (p＜0.05), Vickers hardness significantly decreased in the RMGI and GI groups (p＜0.05), and surface roughness significantly increased in the CR and RMGI groups (p＜0.05). The surface morphological changes were minimal in all the experimental groups, except for RMGI and GI. In terms of color stability, the CP group exhibited the highest color stability in distilled water, while the GI group showed the lowest (p＜0.05). The BF group demonstrated the highest color stability in the coffee, Pepsi-Cola, and black tea solutions, whereas the RMGI group showed the lowest color stability (p＜0.05). Conclusion The findings of this study will provide foundational data for selecting aesthetic restorative materials that have minimalimpact on surface properties, while offering optimal aesthetic outcomes and patient satisfaction tailored to the specific oral conditions of the patient.

Background: This study compared and analyzed the surface properties, including gloss, Vickers hardness, surface roughness,surface morphology, and color stability, of various aesthetic restorative materials subjected to in-office tooth bleaching treatments. Methods: The experimental groups consisted of various commercially available aesthetic restorative materials, includinglight-cured composite resin (CR), light-cured bulk-fill resin (BF), compomer (CP), resin-modified glass ionomer cement (RMGI), and glass ionomer cement (GI). Before and after the bleaching treatment using 30% hydrogen peroxide, the gloss was measured with a gloss meter, the Vickers hardness values were assessed with a Vickers hardness tester, and the surface roughness was analyzed using a surface profilometer. Surface morphology was observed using scanning electron microscopy.After the bleaching treatment, color stability was evaluated by immersing the specimens in coffee, Pepsi Cola, black tea, and distilled water solutions. The color changes (ΔE*) were analyzed at 1, 3, and 7 days. Results: Compared with the pre-treatment values, gloss significantly decreased in the BF and RMGI groups (p＜0.05), Vickers hardness significantly decreased in the RMGI and GI groups (p＜0.05), and surface roughness significantly increased in the CR and RMGI groups (p＜0.05). The surface morphological changes were minimal in all the experimental groups, except for RMGI and GI. In terms of color stability, the CP group exhibited the highest color stability in distilled water, while the GI group showed the lowest (p＜0.05). The BF group demonstrated the highest color stability in the coffee, Pepsi-Cola, and black tea solutions, whereas the RMGI group showed the lowest color stability (p＜0.05). Conclusion The findings of this study will provide foundational data for selecting aesthetic restorative materials that have minimalimpact on surface properties, while offering optimal aesthetic outcomes and patient satisfaction tailored to the specific oral conditions of the patient.

Background: This study compared and analyzed the surface properties, including gloss, Vickers hardness, surface roughness,surface morphology, and color stability, of various aesthetic restorative materials subjected to in-office tooth bleaching treatments. Methods: The experimental groups consisted of various commercially available aesthetic restorative materials, includinglight-cured composite resin (CR), light-cured bulk-fill resin (BF), compomer (CP), resin-modified glass ionomer cement (RMGI), and glass ionomer cement (GI). Before and after the bleaching treatment using 30% hydrogen peroxide, the gloss was measured with a gloss meter, the Vickers hardness values were assessed with a Vickers hardness tester, and the surface roughness was analyzed using a surface profilometer. Surface morphology was observed using scanning electron microscopy.After the bleaching treatment, color stability was evaluated by immersing the specimens in coffee, Pepsi Cola, black tea, and distilled water solutions. The color changes (ΔE*) were analyzed at 1, 3, and 7 days. Results: Compared with the pre-treatment values, gloss significantly decreased in the BF and RMGI groups (p＜0.05), Vickers hardness significantly decreased in the RMGI and GI groups (p＜0.05), and surface roughness significantly increased in the CR and RMGI groups (p＜0.05). The surface morphological changes were minimal in all the experimental groups, except for RMGI and GI. In terms of color stability, the CP group exhibited the highest color stability in distilled water, while the GI group showed the lowest (p＜0.05). The BF group demonstrated the highest color stability in the coffee, Pepsi-Cola, and black tea solutions, whereas the RMGI group showed the lowest color stability (p＜0.05). Conclusion The findings of this study will provide foundational data for selecting aesthetic restorative materials that have minimalimpact on surface properties, while offering optimal aesthetic outcomes and patient satisfaction tailored to the specific oral conditions of the patient.

Background: Sympathetic blocks (SBs) have been used widely to relieve the symptoms of sympathetically maintained pain (SMP). The thoracic sympathetic ganglion is not separated from somatic nerves by muscles and connective tissue. The upper thoracic ganglion runs along the posterior surface of the vertebral column in close proximity to the adjacent epidural region. This anatomical difference leads to frequent epidural and intercostal spread in cases of thoracic SBs. The purpose of this study was to investigate the incidence of inadvertent intercostal and epidural injections during thoracic SBs. Methods: Twenty-two patients who were suffering from complex regional pain syndrome or lymphedema after breast cancer surgery were managed with two or three times of thoracic SBs. Therefore, injections of 63 thoracic SBs from 22 patients were enrolled in this study. An investigator who did not attend the procedure evaluated the occurrence of intercostal or epidural spread using anteroposterior fluoroscopic images. Results: The overall incidence of inadvertent intercostal or epidural spread of contrast was 47.5%. Among the inadvertent injections, intercostal spread (34.9%) was more frequent than epidural spread (12.6%). Only 52.5% of the thoracic SBs demonstrated successful contrast spread without any inadvertent spread. The mean difference in skin temperature between the blocked and unblocked sides was 2.5 ± 1.8ºC. Fifty-nine (93.6%) injections demonstrated more than 1.5ºC difference. Conclusions Thoracic SBs showed a high incidence (47.5%) of inadvertent epidural or intercostal injection. Thus, special attention is required for the diagnosis of SMP or the injection of any neurolytic agent around sympathetic ganglion.

Objectives: . The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size. Methods: . Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted. Results: . Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis. Conclusion . gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.

Objectives: . The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size. Methods: . Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted. Results: . Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis. Conclusion . gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.

Objectives: . The presence of extrathyroidal extension (ETE) in patients with differentiated thyroid cancer (DTC) serves as a significant prognostic indicator. Consequently, the staging of DTC is categorized into extensive ETE and gross ETE that solely impacts the strap muscles (gross strap muscle invasion [gSMI]). However, there is a lack of sufficient evidence concerning the relationship between gSMI and prognosis, particularly in terms of tumor size. Methods: . Relevant literature was searched in Medline, Embase, Cochrane Library, and KoreaMed. All procedures were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and carried out by two independent reviewers. The meta-analysis utilized a random-effects model to account for the diversity of the studies. Risk of Bias for Nonrandomized Studies (RoBANS) version 2.0, an evaluation tool for non-randomized studies, was employed to assess the quality of the selected research. Clinical data from observational studies that examined the relationship between the degree of ETE and prognosis were gathered, and a meta-analysis was conducted. Results: . Eighteen observational studies were included in this analysis. Subgroup analyses were conducted for each outcome. The findings revealed that the recurrence rate (odds ratio [OR], 2.498), disease-specific mortality (risk ratio [RR], 2.984), overall mortality (RR, 1.361), and lymph node (LN) metastasis (OR, 5.355) were significantly higher in patients with gSMI than in those without ETE. However, when the analysis was restricted to tumors measuring 4 cm or smaller, no significant differences in prognostic outcomes were observed, with the exception of LN metastasis. Conclusion . gSMI negatively impacts prognosis; however, this correlation diminishes with smaller tumor sizes. Thus, a more cautious approach is warranted during the treatment process.

Intubation of an double-lumen endotracheal tube (DLT) in either a normal or a difficult airway may be more difficult than the intubation of a single-lumen endotracheal tube (ETT). A 72-year-old man undergoing right upper lobectomy could not be intubated with either a 37 Fr or a 35 Fr DLT after induction of anesthesia due to an inability to visualize the glottis. Difficult intubation had not been foreseen, but inspection through the laryngoscope revealed a Cormack grade III condition. Following two attempts to place the DLT, fibroptic bronchoscopy also proved unsuccessful. We intubated a 8.0 mm ETT with OELM (optimal external laryngeal manipulation) and followed this by inserting an infusion set catheter into the ETT as a guiding stylet. The ETT was then withdrawn with the catheter in situ in the trachea, and a 35 Fr DLT successfully introduced. After removing the catheter, the position of the DLT was corrected by fibroptic bronchoscopy. No further complication occurred and surgery was finished satisfactory. We achieved successful DLT intubation using the modified Seldinger technique with an infusion set catheter through an intubated ETT in a patient with an unanticipated difficult airway.
Aged ; Anesthesia ; Bronchoscopy ; Catheters ; Glottis ; Humans ; Intubation* ; Laryngoscopes ; Trachea

PURPOSE: This study was undertaken to investigate the clinical features and outcomes of meconium intestinal obstruction (MIO) in preterm infants. METHODS: A retrospective analysis of medical records and radiologic images was conducted in a neonatal intensive care unit over a 3-year period (2009-2011). In addition, birth year- and gestational age-matched babies were selected by random sampling with twice the number as the control group. RESULTS: There were 43 infants with MIO who were appropriate as subjects. In perinatal factors, a maternal history of hypertension and the use of magnesium sulfate were more frequent in patients with MIO, but not significant. Feeding intolerance was more common in the MIO group than the control (86% vs. 24.4%; P<0.001). The frequency of gastrografin enema was once in all but one of the patients, and the microcolon was detected in 7 cases (16.3%. Radiographic change after enema was seen earlier than clinical improvement (P<0.05).The patients with MIO took longer to achieve full enteral feeding, and had a more prolonged hospital stay (P<0.001). CONCLUSION: Feeding intolerance in preterm infants may be an early clinical finding of MIO. Meconium obstruction causes a delay of full enteral feeding and extension of hospital stay.
Colon ; Diatrizoate Meglumine ; Enema ; Enteral Nutrition ; Humans ; Hypertension ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Intestinal Obstruction ; Length of Stay ; Magnesium Sulfate ; Meconium ; Medical Records ; Parturition ; Retrospective Studies

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Aged ; Critical Care ; Fever ; Hematoma ; Hemorrhage ; Humans ; Immunoglobulins ; Leukocyte Count ; Leukocytosis ; Multiple Myeloma ; Respiration ; Respiratory Insufficiency ; Thorax