Coronary artery bypass grafting (CABG) without extracorporeal circulation (ECC) is now an accepted technique of myocardial revascularization in selective cases of coronary arterial occlusive disease. We experienced a case of CABG without ECC in a 20 year old female patient with complete occlusion of the right coronary artery. Anesthesia was induced and maintained with fentanyl, midazolam and isoflurane. Nitroglycerine and dopamine were given to stabilize the hemodynamics during intra- and post-operative periods. And esmolol was administered with a loading dose of 30 mg over 1 min, followed by a continuous infusion of 50~100 g/kg/min to maintain the heart rate (50~60 beats/min) and systolic blood pressure (60~80 mmHg) during distal anastomosis. The patient was recovered uneventfully and discharged on the 8th postoperative day.
Anesthesia* ; Arterial Occlusive Diseases ; Blood Pressure ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine ; Extracorporeal Circulation ; Female ; Fentanyl ; Heart Rate ; Hemodynamics ; Humans ; Isoflurane ; Midazolam ; Myocardial Revascularization ; Nitroglycerin ; Young Adult

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

Nuedexta (dextromethorphan and quinidine) is an Food and Drug Administration approved medication for pseudobulbar affect. Interestingly, this drug was recently reported to improve speech, swallowing, and the ability to handle oral secretions along with emotional lability in amyotrophic lateral sclerosis (ALS) patients with bulbar symptoms. We report a Korean ALS patient whose bulbar function improved after administering Nuedexta for 6 months, extending therapeutic choice of approach in treating ALS patients.
Amyotrophic Lateral Sclerosis ; Deglutition ; Dextromethorphan ; Humans ; Quinidine ; United States Food and Drug Administration

No abstract available.

PURPOSE: Alarm interventions are effective and safe treatments for nocturnal enuresis when compared with the other treatments. However, the rate of doctors prescribing enuresis alarms is quite low in Korea. This study evaluated the application conditions and treatment results of an enuresis alarm in children with enuresis in Korea. MATERIALS AND METHODS: 147 out of 316 patients who purchased an enuresis alarm through a alarm sales agency in Korea were evaluated retrospectively. The questionnaire had two main categories: items of enuresis(number of episodes during the night, enuresis frequency during a week, etc.) and the items of the enuresis alarm(previous treatment history, a motivation of using enuresis alarm treatment, the period of using the enuresis alarm, initial success, continued success, dropout of using enuresis alarm, nocturia after treatment, etc.). RESULTS: A total 147 children participated in this study. The initial success rate was 30.6% whereas the continued success rate was 34.0%. In addition, the dropout rate was 27.2%. 46.2% of patients purchased the enuresis alarm with a doctor's prescription and 53.8% purchased the alarm without a prescription. Among the factors, the success and dropout rate were affected by only whether the patient visited the hospital. Thirty five patients who took combination therapy with medicine had a significantly lower initial success rate. CONCLUSIONS: In Korea, without a doctor's prescription, 53.7% patients attempt to treat enuresis alarm directly. The initial and continued success rate with the enuresis alarm was approximately 30% and the dropout rate was approximately 30%.
Child ; Commerce ; Enuresis ; Humans ; Korea ; Motivation ; Nocturia ; Nocturnal Enuresis ; Patient Dropouts ; Prescriptions ; Retrospective Studies

This study evaluated the microshear bond strength of composte resin to teeth bleached with commercial whitening strips and compared with those bleached with home bleaching gel. Twelve extracted human central incisors were cut into pieces and central four segments were chosen from each tooth and embedded in acrylic resin. Four blocks with 12 tooth segments embedded in acrylic resin were acquired and numbered from group one to group four. Group 1 was bleached with Crest Whitestrips, group 2 with Claren, group 3 with Opalescence tooth whitening gel (10% carbamide peroxide). Group 4 was used as control. The bleaching procedure was conducted for 14 days according to the manufacturer's instructions; the bleaching strips twice a day for 30 min and the bleaching gel once a day for 2 hr. After bleaching, composite resin (Filtek Supreme) was bonded to the enamel surfaces with a self-etching adhesive (Adper Prompt L-Pop) using Tygon tube. Microshear bond strength was tested with a universal testing machine (EZ-test). The data were statistically analysed by one-way ANOVA. The study resulted in no statistical differences in microshear bond strength between the tooth segments bleached with 2 different whitening strips and bleaching gel. It can be concluded that the effect of bleaching with either commercial whitening strips or bleaching gel on enamel is minimal in bonding with self-etching adhesive to composite resin.
Adhesives ; Bleaching Agents* ; Dental Enamel* ; Humans ; Incisor ; Soil ; Tooth ; Tooth Bleaching ; Urea

Primary aldosteronism is a rare syndrome which may reault from adenoma hyperplasia or carcinoma of the adrenal cortex and may thus be amenable to surgical correction. The findings of hypertension, hypoklemia and metabolic alkalosis suggest the diagnosis. This case report is to present the possibility of cardiac arrest due to hypokalemia during surgery for primary an adrenal tumor that was causing aldosteronism. This 25 year-old male who had a long history of aldosteronism, was admitted for surgery correction. Anesthesia was induced with thiopental sodium and was maintained with nitrous oxide and halothane. While the adrenal gland was being manipulated the patient appeared to have a sudden cardiac arrest with ventricular fibrillation as seen on the monitoring EKG. Cardiopulmonary resuscitation and D.C. shock to reverse the ventricular fibrillation was carried out immediately. The rest of the scheduled operation was continued and finished uneventfully. We concluded that the cause of the cardiac arrest in this case seemed to be a preoperative hypokalemia resulting from aldosteronism which was not corrected. In addition to that, the respiratory alkslosis from hyperventilation during the anesthesia even moreso lowered the preoperative level of hypokalemia.
Adenoma ; Adrenal Cortex ; Adrenal Glands ; Adult ; Alkalosis ; Anesthesia ; Cardiopulmonary Resuscitation ; Death, Sudden, Cardiac ; Diagnosis ; Electrocardiography ; Halothane ; Heart Arrest* ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertension ; Hyperventilation ; Hypokalemia ; Male ; Nitrous Oxide ; Shock ; Thiopental ; Ventricular Fibrillation

Congenital coronary arteriovenous fistula is a rare condition which is an abnormal communication of the coronary artery with the right ventricle, right atrium, left atrium or left ventricle. Coronary artery aneurysm is an uncommon disease which is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. In young ages, symptoms are unusual, but significant symptoms and complications such as congestive heart failure, subacute bacterial endocarditis, coronary steal syndrome, aneurysm formation, rupture, and pulmonary hypertension may appear among the older age group. We report a case of giant aneurysm of a congenital coronary arteriovenous fistula between left co-ronary artery and right ventricular outflow tract with significant left to right shunt confirmed in a 84-year old female with a brief review of literature.
Aged, 80 and over ; Aneurysm* ; Arteries ; Arteriovenous Fistula* ; Coronary Aneurysm ; Coronary Vessels* ; Dilatation ; Endocarditis, Subacute Bacterial ; Female ; Heart Atria ; Heart Failure ; Heart Ventricles ; Humans ; Hypertension, Pulmonary ; Rupture

The aim of this study is to compare the adaptability of thermoplasticized injectable gutta-percha technique to the canal walls in ribbon-shaped canals. Thirty resin models simulated ribbon-shape canals were instrumented to #40 using .06 taper Profile systems. Three groups of each 10 resin models were obturated by the lateral condensation technique(LC) and the two thermoplasticized injectable gutta-percha technique; Ultrafil Endoset+Obtura II(EO) and Ultrafil Firmset(UF), respectively. After resin model were kept at room temperature for 4 days, they were resected horizontally with microtome at 1, 2, 3, 4 and 5mm levels from apex. At each levels, image of resected surface were taken using CCD camera under a stereomicroscope at x40 magnification and stored. Ratio of the area of gutta-percha was obtained by calculating area of gutta-percha cone to the total area of canal using digitized image-analyzing program. The data were collected then analyzed statistically using One-way ANOVA. The results were as follows. 1. At 1mm levels, there was no statistically significant difference in the mean ratio of gutta-percha among the groups. 2. At 2mm level, EO showed the highest mean ratio of gutta-percha (p<0.05) and there was no significant difference between LC and UF. 3. At 3, 4, 5mm levels, EO and UF had significantly greater mean ratio of gutta-percha than LC(p<0.05) and there was no significant difference between EO and UF. In conclusion, the thermoplasticized injectable gutta-percha techniques demonstrated relatively favorable adaptability to canal walls than lateral condensation technique in ribbon-shaped canals except for 1mm level.
Gutta-Percha

Primary osteosarcoma of the breast is very rare. There have been no previously reported cases in Korea. In this paper, a case of primary osteosarcoma of the breast is reported. It should be distinguished from a carcinoma with extensive osseous metaplasia. Immunohistochemical and ultrastructural studies proved that the lesion, in the absence of epithelial differentiation, was a primary osteosarcoma of the breast rather than a carcinoma with extensive osseous metaplasia. Diagnostic aspects and treatment are discussed and a literature review is given.
Breast* ; Korea ; Metaplasia ; Osteosarcoma*