Trichoblastic fibroma is a benign trichogenic tumor that has both epithelial and mesenchymal components and exhibits partial follicular induction. We studied 4 cases of trichoblastic fibroma and reviewed their clinical and histologic features. Two tumors were present in the face. The remaining two were in the vulva and perianal area, respectively. The age of the patients ranged from 53 to 68 years, with an average age of 62. All were female. Histologically, the lesions showed a well circumscribed mass, located at dermo-subcutaneous junction in three patients and subcutaneous in one. They demonstrated mesenchymal induction evidenced by hair germ-like structure and perifollicular sheath. There was no connection between the tumor and epidermis. Differentiation toward hair structure led to the formation of the infundibulum through inner root sheath. Trichoblastic fibroma may be confused clinically and/or histologically with basal cell carcinoma. Identification of the mixed epithelial and mesenchymal components, and the absence of epidermal connection and cleft within the stroma are important in differentiating this benign neoplasm from basal cell carcinoma.
Carcinoma, Basal Cell ; Epidermis ; Female ; Fibroma* ; Hair ; Humans ; Vulva

BACKGROUND: One of the main disadvantages of caudal block is the long latent period before a satisfactory blockade is obtained. Many investigators have used various preparations of local anesthetic solutions to improve the speed of onset. This study was performed to evaluate the effectiveness of prewarming of lidocaine HCl for caudal block. METHODS: Fifty healthy young patients (ASA I) were allocated into two groups, A and B. In group A, the local anesthetic solution were injected at room temperature (25 degrees C), while in group B, they were injected at 37oC. All the caudal block were performed using 2% lidocaine HCl 20 ml with fentanyl 100ug and epinephrine 1:200,000. The onset time was defined as the period from completion of injection until the patient first noticed loss of sensation to pin-prick on perianal region. Assessment of sensory loss was made at 15 seconds interval. We have compared the onset of sensory blockade between groups. The duration of analgesia and any significant side effects were also recorded. RESULTS: The onset of sensory blockade was significantly faster in group B (3.5 +/- 0.5 minutes) than group A (6.2 +/- 0.9 minutes). The duration of analgesia were not significantly changed between groups. Side effects of urinary retention, pruritus and nausea were noted between both groups but the difference was not significant. CONCLUSIONS: We have found that the onset time was 44% faster with warm lidocaine-fentanyl mixture (37 degrees C) than with the room temperature (25 degrees C). The improved clinical usefulness was achieved with no increase in side effects. The technique is a safe and effective method to reduce the latency of onset.
Analgesia ; Epinephrine ; Fentanyl ; Humans ; Lidocaine ; Nausea ; Pruritus ; Research Personnel ; Sensation ; Urinary Retention

An ABO discrepancy was encountered in a 29-year-old woman with a pregnancy of 36 weeks. The patient's red cell was typed as group O and her serum had only anti-A antibody. Absence of B antigen on patient's RBC was confirmed by adsorption-elution test, B substance was not demonstrated in the saliva and serum. B-transferase activity was not detected in the serum. Patient's serum Ig level was within normal range. The patient's father and son had normal O phenotype and no additional abnormalities were detected among the family members studied.
Adult ; Fathers ; Female ; Humans ; Phenotype ; Pregnancy ; Reference Values ; Saliva

PURPOSE: Dysregulation of gastric epithelial cell proliferation and apoptosis are important in development of ulcer, atrophy and neoplasia in Helicobacter pylori (H. pylori) infection. The aim of this study was to investigate the effect of infection of H. pylori on gastric epithelial cell proliferation and apoptosis in children. METHODS: Histological grading by updated Sydney system, PCNA immunostaining and TUNEL method were performed in H. pylori positive (N=58) and negative (N=40) gastric biopsy specimens. RESULTS: In H. pylori positive children, there were significantly higher grade of polymorphonuclear neutrophil activity (P=0.000), chronic inflammation (P=0.000), epithelial damage (P=0.000) and lymphoid follicles (P=0.000) than in H. pylori negative children. Intestinal metaplasia was not seen in H. pylori positive children. PCNA index was significantly different between H. pylori positive children (67.8+/-18.13) and H. pylori negative children (54.8+/-14.46, P=0.000). There was positive correlation between PCNA index and H. pylori density (r=0.277, P=0.007), polymorphonuclear neutrophil activity (r=0.280, P=0.007) and chronic inflammation (r=0.284, P=0.006). Apoptosis index of H. pylori positive children (0.44+/-0.447) was significantly higher than of H. pylori negative children (0.14+/-0.196, P=0.000). There was positive correlation between apoptosis index and H. pylori density (r=0.472, P=0.000), polymorphonuclear neutrophil activity (r=0.370, P=0.001) and chronic inflammation (r=0.483, P=0.000). There was positive correlation between PCNA index and apoptosis index (r=0.353, P=0.003). CONCLUSION: The PCNA and apoptosis index in H. pylori positive children were significantly higher than in H. pylori negative children. This study suggested that gastric epithelial cell proliferation and apoptosis are important to pathogenesis of H. pylori infection in children.
Apoptosis* ; Atrophy ; Biopsy ; Child* ; Epithelial Cells* ; Helicobacter pylori* ; Helicobacter* ; Humans ; In Situ Nick-End Labeling ; Inflammation ; Metaplasia ; Neutrophils ; Proliferating Cell Nuclear Antigen ; Ulcer

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododendron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.
Atropine ; Bradycardia ; Diplopia ; Dizziness ; Flowers ; Honey ; Humans ; Hypertension ; Hypotension ; Nausea ; Plant Nectar ; Pollen ; Resuscitation ; Rhododendron ; Thorax ; Vomiting

OBJECTIVE: The purpose of this study was to compare the skeletal, dental, and soft-tissue treatment effects of nonextraction therapy using the modified C-palatal plate (MCPP) to those of premolar extraction (PE) treatment in adult patients with Class II malocclusion. METHODS: Pretreatment and posttreatment lateral cephalographs of 40 adult patients with Class II malocclusion were retrospectively analyzed. The MCPP group comprised 20 patients treated with total arch distalization of the maxillary arch while the PE group comprised 20 patients treated with four PE. Fifty-eight linear and angular measurements were analyzed to assess the changes before and after treatment. Descriptive statistics, paired t-test, and multivariate analysis of variance were performed to evaluate the treatment effects within and between the two groups. RESULTS: The MCPP group presented 3.4 mm of retraction, 1.0 mm of extrusion, and 7.3° lingual inclination of the maxillary central incisor. In comparison, the PE group displayed greater amount of maxillary central incisor retraction and retroclination, mandibular incisor retraction, and upper lip retraction (5.3 mm, 14.8°, 5.1 mm, and 2.0 mm, respectively; p < 0.001 for all). In addition, the MCPP group showed 4.0 mm of distalization and 1.3 mm of intrusion with 2.9° distal tipping of the maxillary first molars. CONCLUSIONS: These findings suggest the MCPP is an effective distalization appliance in the maxillary arch. The amount of incisor retraction, however, was significantly higher in the PE group. Therefore, four PE may be recommended when greater improvement of incisor position and soft-tissue profile is required.
Adult ; Bicuspid* ; Humans ; Incisor ; Lip ; Malocclusion ; Molar ; Multivariate Analysis ; Retrospective Studies

OBJECTIVE: The purpose of this study was to analyze initial displacement and stress distribution of the maxillofacial complex during dentoskeletal maxillary protraction with various appliance designs placed on the palatal region by using three-dimensional finite element analysis. METHODS: Six models of maxillary protraction were developed: conventional facemask (Type A), facemask with dentoskeletal hybrid anchorage (Type B), facemask with a palatal plate (Type C), intraoral traction using a Class III palatal plate (Type D), facemask with a palatal plate combined with rapid maxillary expansion (RME; Type E), and Class III palatal plate intraoral traction with RME (Type F). In Types A, B, C, and D, maxillary protraction alone was performed, whereas in Types E and F, transverse expansion was performed simultaneously with maxillary protraction. RESULTS: Type C displayed the greatest amount of anterior dentoskeletal displacement in the sagittal plane. Types A and B resulted in similar amounts of anterior displacement of all the maxillofacial landmarks. Type D showed little movement, but Type E with expansion and the palatal plate displayed a larger range of movement of the maxillofacial landmarks in all directions. CONCLUSIONS: The palatal plate served as an effective skeletal anchor for use with the facemask in maxillary protraction. In contrast, the intraoral use of Class III palatal plates showed minimal skeletal and dental effects in maxillary protraction. In addition, palatal expansion with the protraction force showed minimal effect on the forward movement of the maxillary complex.
Finite Element Analysis* ; Palatal Expansion Technique ; Traction

Background: s/Aims: Despite advances in antiviral therapy for hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC) still develops even after sustained viral response (SVR) in patients with advanced liver fibrosis or cirrhosis. This meta-analysis investigated the predictive performance of vibration-controlled transient elastography (VCTE) and fibrosis 4-index (FIB-4) for the development of HCC after SVR. Methods: We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for studies examining the predictive performance of these tests in adult patients with HCV. Two authors independently screened the studies’ methodological quality and extracted data. Pooled estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for HCC development using random-effects bivariate logit normal and linear-mixed effect models. Results: We included 27 studies (169,911 patients). Meta-analysis of HCC after SVR was possible in nine VCTE and 15 FIB-4 studies. Regarding the prediction of HCC development after SVR, the pooled AUCs of pre-treatment VCTE >9.2–13 kPa and FIB-4 >3.25 were 0.79 and 0.73, respectively. VCTE >8.4–11 kPa and FIB-4 >3.25 measured after SVR maintained good predictive performance, albeit slightly reduced (pooled AUCs: 0.77 and 0.70, respectively). The identified optimal cut-off value for HCC development after SVR was 12.6 kPa for pre-treatment VCTE. That of VCTE measured after the SVR was 11.2 kPa. Conclusions VCTE and FIB-4 showed acceptable predictive performance for HCC development in patients with HCV who achieved SVR, underscoring their utility in clinical practice for guiding surveillance strategies. Future studies are needed to validate these findings prospectively and validate their clinical impact.

Indobufen (Ibustrin®), a reversible inhibitor of platelet aggregation, exists in two enantiomeric forms in 1:1 ratio. Here, we characterized the anti-platelet effect of S- and R-indobufen using response surface modeling using NONMEM® and predicted the therapeutic doses exerting the maximal efficacy of each enantioselective S- and R-indobufen formulation. S- and R-indobufen were added individually or together to 24 plasma samples from drug-naïve healthy subjects, generating 892 samples containing randomly selected concentrations of the drugs of 0–128 mg/L. Collagen-induced platelet aggregation in platelet-rich plasma was determined using a Chrono-log Lumi-Aggregometer. Inhibitory sigmoid I(max) model adequately described the anti-platelet effect. The S-form was more potent, whereas the R-form showed less inter-individual variation. No significant interaction was observed between the two enantiomers. The anti-platelet effect of multiple treatments with 200 mg indobufen twice daily doses was predicted in the simulation study, and the effect of S- or R-indobufen alone at various doses was predicted to define optimal dosing regimen for each enantiomer. Simulation study predicted that 200 mg twice daily administration of S-indobufen alone will produce more treatment effect than S-and R-mixture formulation. S-indobufen produced treatment effect at lower concentration than R-indobufen. However, inter-individual variation of the pharmacodynamic response was smaller in R-indobufen. The present study suggests the optimal doses of R-and S-enantioselective indobufen formulations in terms of treatment efficacy for patients with thromboembolic problems. The proposed methodology in this study can be applied to the develop novel enantio-selective drugs more efficiently.
Blood Platelets ; Colon, Sigmoid ; Healthy Volunteers ; Humans ; In Vitro Techniques ; Plasma ; Platelet Aggregation ; Platelet-Rich Plasma ; Treatment Outcome

Selective termination can be used to preserve normal fetus from the other fetus with chromosomal, structural abnormality in multifetal pregnancy. This case is about twin pregnant patient who had undergone in vitro fertilization and embryo transfer. In 18 weeks of gestation, we found that one of the fetus had cranical encephalocele and was in concern for the termination by using ultrasound guided intrcardiac injection of 2.5 ml of potassium chloride solution. After performing this procedure the other healthy female newborn was naturally delivered at 38 weeks gestation with weight of 2.8 kg.
Embryo Transfer* ; Embryonic Structures* ; Encephalocele* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Infant, Newborn ; Potassium Chloride ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnancy, Twin ; Twins, Dizygotic* ; Ultrasonography