Distraction osteogenesis has become an alternative technique to treat craniomaxillofacial anomalies. It was initially used to treat mandibular dysplasia and now it is applied to other regions of the craniofacial skeleton. We now present our clinical experience of midface distraction with the use of rigid external distraction for the treatment of an 8-years-old girl with midface hypoplasia in Crouzon's disease, who had undergone fronto-orbital advancement at the age of 6. We performed midface advancement by Le Fort III osteotomy with rigid external distraction system(RED II, KLS Martin, Jacksonville, FL). The active distraction was initiated on the 3rd postoperative day and was continued until the 20th postoperative day for 18 days. The rate of distraction can be adjusted during this time according to clinical judgment and cephalometric assessment. On completion of distraction, the RED II was left in place without activation for 25 days for rigid retention. The RED II was then removed and an orthodontic facemask was applied with elastic traction for 6wks. The total amount of distraction was 18.5mm, 28.5mm, 10.5mm, 14.5mm at right inferior orbital rim, left inferior orbital rim, right intraoral, left intraoral area respectively. The photography, cephalometry, and 3D CT(3 dimensional computed tomography) show that facial convexity was improved. We could correct midface deficiency successfully by LeFort III osteotomy and rigid external distraction.
Cephalometry ; Craniofacial Dysostosis* ; Female ; Humans ; Judgment ; Orbit ; Osteogenesis, Distraction ; Osteotomy ; Photography ; Skeleton ; Traction

Purpose: The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). Materials and Methods: From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). Results: cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. Conclusion The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Purpose: The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). Materials and Methods: From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). Results: cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. Conclusion The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Renal thromboembolism almost always occurs in the setting of cardiac disease. Acute renal infarction may occur rarely in middle-aged patients without apparent risk factors for cardiac thromboembolism. We report a 40-year-old man who developed bilateral renal infarction and had no cardiovascular risk factors, except smoking. In middle-aged healthy patients with renal colic without lithiasis, the diagnosis of idiopathic renal infarction should be considered, especially if lactate dehydrogenase is elevated.
Adult ; Heart Diseases ; Humans ; Infarction ; Kidney ; L-Lactate Dehydrogenase ; Lithiasis ; Renal Colic ; Risk Factors ; Smoke ; Smoking ; Thromboembolism

The proliferation of high-technology infusion devices has greatly influenced the practice of anesthesia by allowing precise delivery intraoperatively and postoperatively of intravenous anesthetics, analgesics, and vasopressors. During continuous drug administration to pediatric patients, unfavorable pharmacologic effects have occured. These effects were attributed to variations in flow from infusion devices. The intent of this investigation was to evaluate the influence of infusion devices on the accuracy and continuity effused fluid. Hartmann's solution was run through eight infusion pump at 5, 10, 15, 20, 25, 30, 40, 60, 80 and 100ml/hr. The volume of the fluid was measured for one hour at each flow rate using a infusion device analyzer(IDA-2) in vitro. Flow accuracy(ml/hr) was calculated by dividing the effused volume by the effusion time ; this value was subsequently expressed as a percentage of the desired flow rate. Flow continuity was expressed by the coefficient of variance(CV); analysis of variance with SAS was used for comparisons. Results were as follows ; 1) The flow accuracy values ranged from 98.8% to 114.2% of the desired rate. 2) Seven infusion pumps had flow rates within 5% of the desired rates at each flow rate but one pump had more than 10% of desired rate. 3) Each of the respective infusion pumps produced various levels of flow continuity and ranged from 0.7% to 2.5%(CV value). Conclusion , further evaluations are needed to differentiate continuity from other infusion devices(e.g., syringe infusion pump) in vitro and evaluations are needed to define the clinical significance in vivo. Future use of flow-rate data will likely be of significant value in establishing policies and procedures for the utilization of infusion devices and guidelines for product selection.
Analgesics ; Anesthesia ; Anesthetics, Intravenous ; Humans ; Infusion Pumps ; Syringes

OBJECTIVE: This study was performed to evaluate the influence of maternal age on embryo quality and the frequency of multiple pregnancy in IVF-ET program. METHOD: 86 conventional IVF-ET cycles were divided into three groups according to the age by 5 year (group A: 26-30, group B: 3135, group C: 36-40 yrs). The in vitro fertilization and development outcome (fertilization, cleavage and high quality embryo rate) and the pregnancy outcome (pregnancy, implantation, G-sac/high quality embryo and multiple pregnancy rate) were examined. And then, these results were compared among the groups. RESULTS: The rates of fertilization (62.7, 68.5 and 65.4%, respectively) and cleavage (95.6, 97.6 and 98.0%, respectively) were not different among the groups. And the high quality embryo (HQE) rate also was not different among the groups (61.8, 62.9 and 62.8%, respectively). The pregnancy rate of group C (23.3%) was significantly lower than that of group A (41.2%) and B (48.7%). And the implantation rate was significantly decreased to group B (32.2%) and C (14.3%) when compared to group A (71.4%) and B (36.8%). CONCLUSION: The pregnancy rate was significantly decreased over 35 years. The G-sac/HQE and multiple pregnancy rate were significantly high below 31 years. Thus, these results suggest that the number of high quality embryo transferred should be limited by the age and another criteria for embryo quality evaluation were required for single embryo transfer.
Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro ; Maternal Age* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Pregnancy, Multiple* ; Single Embryo Transfer

Neurostenalgia is a neuropathic pain that results from continuing irritation of an anatomically intact nerve by a noxious agent. The pain resolves promptly after surgical release of the nerve. The authors report a case of neurostenalgia of the radial nerve in which the posterior interosseous branch was compressed at the arcade of Frohse, presenting with severe arm and elbow pain. The pain was immediately relieved after surgical release of the nerve.
Arm ; Elbow ; Neuralgia ; Radial Nerve*

Several studies have shown that curcumin, which is derived from the rhizomes of turmeric, possesses antimicrobial, antioxidant and anti-inflammatory properties. The antitumor properties of curcumin have also now been demonstrated more recently in different cancers. This study was undertaken to investigate the modulation of cell cycle-related proteins and the mechanisms underlying apoptosis induction by curcumin in the SCC25 human tongue squamous cell carcinoma cell line. Curcumin treatment of the SCC25 cells resulted in a time- and dose-dependent reduction in cell viability and cell growth, and onset of apoptotic cell death. The curcumin-treated SCC25 cells showed several types of apoptotic manifestations, such as nuclear condensation, DNA fragmentation, reduced MMP and proteasome activity, and a decreased DNA content. In addition, the treated SCC25 cells showed a release of cytochrome c into the cytosol, translocation of AIF and DFF40/CAD into the nuclei, a significant shift in the Bax/Bcl-2 ratio, and the activation of caspase-9, caspase-7, caspase-6, caspase-3, PARP, lamin A/C, and DFF45/ICAD. Furthermore, curcumin exposure resulted in a downregulation of G1 cell cycle-related proteins and upregulation of p27KIP1. Taken together, our findings demonstrate that curcumin strongly inhibits cell proliferation by modulating the expression of G1 cell cycle-related proteins and inducing apoptosis via proteasomal, mitochondrial, and caspase cascades in SCC25 cells.
Apoptosis* ; Carcinoma, Squamous Cell* ; Caspase 3 ; Caspase 6 ; Caspase 7 ; Caspase 9 ; Cell Cycle Checkpoints* ; Cell Death ; Cell Line* ; Cell Proliferation ; Cell Survival ; Curcuma ; Curcumin ; Cytochromes c ; Cytosol ; DNA ; DNA Fragmentation ; Down-Regulation ; Humans ; Proteasome Endopeptidase Complex ; Rhizome ; Tongue* ; Up-Regulation

Bilateral mandibular hypoplasia is found in Treacher Collins syndrome, Pierre Robin sequence, and bilateral craniofacial microsomia. It causes many aesthetic and functional problems such as facial deformities with malocclusion and airway problems. We have corrected bilateral hypoplastic mandible with distraction osteogenesis, which is a highlighted method in mandibular lengthening. For last 3 years 8 months, We applied this method to four bilateral cases, where were Treacher Collins syndrome patients and bilateral craniofacial microsomia patient in rapid multidirectional fashion. A complete ostectomy was made at angle of the mandible and the mandible was fixed 5 days after lengthening was started serially 1mm every 12 hours. After consolidation period for one to three month, the device was removed. We have distracted the mandibles in vertical plane, left.18.8mm, right. 13.4mm, in horizontal plane, left 13.9mm, right 13.7mm on the average. We could achieve good aesthetic results, and their airway problems were improved without any complications.
Congenital Abnormalities ; Goldenhar Syndrome ; Humans ; Malocclusion ; Mandible* ; Mandibulofacial Dysostosis ; Osteogenesis, Distraction ; Pierre Robin Syndrome

Venous aneurysm of the superior vena cava(SVC) is a rare congenital lesion and can be classified morphologically as either fusiform or saccular. Although there is a controversy with regard to the need for either conservative or surgical treatment, surgery is recommended for the saccular type as major complications of the aneurysm may occur. We report a case of saccular aneurysm of the SVC, treated by means of an endoluminal stent-graft.
Aneurysm* ; Vena Cava, Superior*