Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

PURPOSE: Status epilepticus (SE) is one of the most common neurologic emergencies in children requiring immediate aggressive intervention. Despite advances in treatment of this condition, SE is still associated with a significant morbidity and mortality. To evaluate etiology and neurologic outcome of SE is very important for improving the methods of evaluation and management of SE as well as decreasing morbidity and mortality. METHODS: We retrospectively reviewed the records of 98 children aged 1 month to 15 years who were admitted to our department of pediatrics from January, 1992 to December, 1998. We analyzed age distribution, etiology, seizure type, abnormalities of EEG and brain MRI, and neurologic outcome. We try to find any coherence between neurologic sequelae and clinical factors. RESULTS: The incidence was high in toddler age, especially younger than 3 years old (67.4%). Generalized convulsive SE was the most common type (67.3%), and 54.1% of children with SE which was the first seizure episode. Major etiology of SE in young children younger than 3 years old were febrile convulsion (54.5%) and acute symptomatic causes (22.7%). Neurologic sequelae were left in 21.4% and the mortality rate was 7.1%. The neurologic complications were highly associated with the underlying causes and the seizure durations, especially over 2 hour seizures left in 75% complications. The mortality and neurologic sequelae were higher in acute symptomatic SE than other causes. Febrile SE had usually benign course, but in four in our cases showed neurologic sequale it shows 4 neurologic sequelae cases. CONCLUSION: SE is a life-threatening neurologic condition and especially occurs in young children. The early detection of seizure etiology and aggressive management are the essential factors to decrease the mortality and morbidity rates.
Age Distribution ; Brain ; Child* ; Child, Preschool ; Electroencephalography ; Emergencies ; Humans ; Incidence ; Magnetic Resonance Imaging ; Mortality ; Pediatrics ; Retrospective Studies ; Seizures ; Seizures, Febrile ; Status Epilepticus*

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Depression* ; Electrocardiography ; Exercise Test ; Heart Rate* ; Heart* ; Humans ; Myocardial Ischemia* ; Sensitivity and Specificity

Among the various types of congenital meniscal anomalies, the double-layered lateral meniscus is extremely rare. The double-layered meniscus consists of both the upper additional and the lower normal meniscus. As the upper additional meniscus is mobile, it can be easily displaced, while the lower lateral meniscus is usually normal in shape and volume. A 42-year-old woman suffering from pain and locking of her left knee underwent Magnetic resonance imaging (MRI) examination and an arthroscopic surgery. A rare meniscal abnormality was seen in her left knee, which presented as a double-layered lateral meniscus with displacement. It was remarkable that the upper additional meniscus was displaced over the intercondylar eminence of the tibia and it mimicked a bucket-handle tear. Even though it is rare, it is necessary to consider the possibility of displaced double-layered meniscus in the differential diagnosis of a bucket-handle tear. Here, we report the MRI and arthroscopic findings of a displaced double-layered lateral meniscus, which was similar to the bucket-handle tear.
Adult ; Arthroscopy ; Diagnosis, Differential ; Female ; Humans ; Knee ; Magnetic Resonance Imaging ; Menisci, Tibial* ; Tears* ; Tibia

No abstract available.
Antigens, Surface* ; Hepatitis B* ; Hepatitis*

Endotracheal intubation has been a routine practice in general anesthesia and is accepted by anesthetiste and surgeons as an integral part of airway management during anesthesia and operation. Paradoxically however, there have been several cases of obstruction of the airway which occurred due to endotracheal intubation. The authors experienced two cases of airway obstruction due tendotracheal and endobronchial techniques, using tubes with malfunctioning cuffs. The lumen of an endotracheal tube was collapsed by intracuff pressure, shortly after inflation of the cuff and resulted in extremely high airway resistance. In the other case, gradual leakage of air from the distal cuff of a Carlens tube led to collapse of the distal cuff. This promoted the movement of blood, secretions, and pus from the diseased right lung to the normal healthy left lung in association with the left lateral recumbent position, which in turn resulted in total airway obstruction.
Airway Management ; Airway Obstruction ; Airway Resistance ; Anesthesia ; Anesthesia, General ; Inflation, Economic ; Intubation, Intratracheal* ; Lung ; Suppuration ; Surgeons

PURPOSE: The purpose of this study is to present our clinical results after surgical treatment in tarsal tunnel syndrome due to space occupying lesions. MATERIAL AND METHODS: We performed surgical decompression for tarsal tunnel syndrome in 20 patients from July 2004 to February 2007. Out of them, thirteen cases were due to space occupying lesions around the tarsal tunnel. The average age at operation was 51.3 years old and the duration from symptom onset to surgery was 16.5 months. The operation included removal of space occupying lesions and tarsal tunnel decompression. The clinical parameters were pain visual analogue scale (VAS), AOFAS scale, and subjective satisfaction. RESULTS: The ganglion cysts were the most frequent causes (ten cases) and synovial chondromatosis in 1 case, neurofibroma in 1 case, talocalcaneal coalition in 1 case. The average follow-up duration was 14.5 months. The AOFAS scale showed significant improvement from 77.8 to 92.7. The average VAS decreased from 6.4 to 2.2. Seven out of thirteen patients were satisfied with the results. The excellent results were shown in six patients, the good results in one patient, the fair result in three patients and the unsatisfactory results in three patients. CONCLUSION: Favorable results could be obtained in patients with known etiology. But not all cases with surgical decompression of space occupying lesions showed satisfactory results. We assume that the clinical results were related to the multiple factors, not only well performed surgery but also age, size lesions and duration of symptoms, ect.
Chondromatosis, Synovial ; Decompression* ; Decompression, Surgical ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Neurofibroma ; Tarsal Tunnel Syndrome

Background: The use of topical antibiotics (TA) for prophylactic purposes after clean dermatologic procedures (CDP) is generally not recommended, and the prescription of TA needs to be individualized in consideration of each patient’s situation and underlying disease. The aim of this study was to determine the proportion of patients who underwent CDP in outpatient settings and were prescribed TA inappropriately, as well as the factors that may affect the prescription of TA. Methods: Outpatient visits coded for CDP were selected using claims data from the Health Insurance Review and Assessment Service in 2018. Of these, patients receiving TA prescriptions were classified as having inappropriate TA use, and the proportion was estimated through technical analysis. A logistic regression analysis was used to identify factors influencing inappropriate prescriptions. Results: Data were analyzed using 423,651 visits, and TA was prescribed for approximately 1.9% of the visits. TA usage was higher among women (2.0%), 0–19 years of age (2.2%), medical aid (2.2%), clinic settings (2.4%), and metropolitan areas (2.0%). TA was prescribed more frequently in urology (8.6%), pediatrics (5.0%), and dermatology (4.2%) than in other specialties. Conclusion The prescription rate of TA after CDP was 1.9% using the 1.4 million patient sample from the national health insurance claims data in Korea, which is equally weighted to represent 50 million people. Although the proportion of inappropriate TA prescriptions in Korea is lower than that in other nations, it cannot be overlooked because of the large number of cases. Efforts to improve quality are required to reduce the number of inappropriate prescriptions.

PURPOSE: The aim of this study was to evaluate the effects of relining materials on the flexural strength of relined thermoplastic denture base resins (TDBRs). MATERIALS AND METHODS: For shear bond strength testing, 120 specimens were fabricated using four TDBRs (EstheShot-Bright, Acrytone, Valplast, Weldenz) that were bonded with three autopolymerizing denture relining resins (ADRRs: Vertex Self-Curing, Tokuyama Rebase, Ufi Gel Hard) with a bond area of 6.0 mm in diameter and were assigned to each group (n=10). For flexural strength testing, 120 specimens measuring 64.0×10.0×3.3 mm (ISO-1567:1999) were fabricated using four TDBRs and three ADRRs and were assigned to each group (n=10). The thickness of the specimens measured 2.0 mm of TDBR and 1.3 mm of ADRR. Forty specimens using four TDBRs and 30 specimens using ADRRs served as the control. All specimens were tested on a universal testing machine. For statistical analysis, Analysis of variance (ANOVA) with Tukey's test as post hoc and Spearman's correlation coefficient analysis (P=.05) were performed. RESULTS: Acry-Tone showed the highest shear bond strength, while Weldenz demonstrated the lowest bond strength between TDBR and ADRRs compared to other groups. EstheShot-Bright exhibited the highest flexural strength, while Weldenz showed the lowest flexural strength. Relined EstheShot-Bright demonstrated the highest flexural strength and relined Weldenz exhibited the lowest flexural strength (P < .05). Flexural strength of TDBRs (P=.001) and shear bond strength (P=.013) exhibited a positive correlation with the flexural strength of relined TDBRs. CONCLUSION: The flexural strength of relined TDBRs was affected by the flexural strength of the original denture base resins and bond strength between denture base resins and relining materials.
Denture Bases ; Denture Liners ; Denture Rebasing ; Dentures

INTRODUCTION: Mandibular third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. Although the overall complication rate is low with most complications being minor, mandibular third molar removal is so common that the population morbidity of complications might be significant. Therefore, efforts to limit intraoperative or postoperative complications might have a significant impact in terms of enhancing the patient outcome. The aims of this study were to identify the position and angulation associated complications after mandibular third molar extractions. MATERIALS AND METHODS: This study surveyed 568 patients who had a mandibular third molar extracted, showed clinical complications and underwent a radiographic measurement of the available space, depth and spatial relationship. RESULTS: The results obtained were as follows: 1. The complications were a dry socket, nerve injury, root rest, infection, bleeding, hamatoma, and adjacent teeth injury. 2. There were no significant differences between the complication and ramus relationship (available space) of the mandibular third molar. 3. There were no significant differences between the complications and depth of the mandibular third molar. 4. There were no significant differences between the complications and spatial relationship of the mandibular third molar. CONCLUSION: There were no significant differences in the complication rate, ramus relationship, depth and spatial relationship of the mandibular third molar. This suggests that the position and angulation of the mandibular third molar may not have an impact on the complications. The relationship between the position and angulation of the mandibular third molar, and complications deserves a further study using longitudinal data.
Dry Socket ; Hemorrhage ; Humans ; Molar, Third ; Postoperative Complications ; Surgery, Oral ; Tooth