The purpose of this study was to identify which combination of zirconia crowns and cements is most similar in color to the maxillary primary incisors by varying the color of zirconia crowns, crown thickness, and shade of cements. Prefabricated zirconia crowns in 3 shades and crowns fabricated using 6 types of zirconia blocks were used in this study. These were filled with A2-shade or translucent-shade resin cement and the L(*), a(*), and b(*) values were calculated using a spectrophotometer. The color differences between the natural teeth and the zirconia crowns were assessed. The shade of the final restoration was more similar to that of the natural teeth using A2-shade than translucent-shade resin cement. Application of A2-shade cement to a 0.5-mm-thick crown fabricated from a smile series 2 zirconia block resulted in the color most similar to that of the natural teeth. A2-shade resin cement is recommended for zirconia crown restoration in anterior primary teeth compared to TR-shade resin cement for more esthetic restoration. Since restorations with Nusmile zirconia crowns were not esthetically favorable in terms of shade, improvement of the shade characteristics of the product or development of a new kind of zirconia crown is required.
Crowns ; Incisor ; Resin Cements ; Tooth ; Tooth, Deciduous

BACKGROUND/AIMS: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstructive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hartmann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed. RESULTS: There were 12 patients with Csendes type I, 6 patients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases. Laparoscopic cholecystectomy was tried in 7 type I cases. 5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were performed. 5 patients with type III were required hepaticojejunostomy. CONCLUSIONS: High index of suspicion is required for diagnosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Retrospective Studies ; Ultrasonography

BACKGROUND/AIMS: Hepatoduodenal ligament lymph node (LN) dissection has been performed as a part of extended LN dissection during the operation for gastric cancer. And additional cholecystectomy has been performed for more radical node dissection and prevention of cholelithiasis in some centers. There are rare studies and reports about the injury of bile duct system with the operation for gastric cancer. The aim of this study is to evaluate the risk of biliary tree injury with LN dissection for gastric cancer. METHODS: 254 patients of gastric cancer were treated with gastrectomy with LN dissection at Kangnam general hospital between January 1996 and December 2001. Among this group, 151 patients of advanced gastric cancer underwent extended LN dissection of D2+alpha or D3 including hepatoduodenal ligament LN and 69 patients of early gastric cancer underwent D2. And we routinely conducted cholecystectomy for advanced and early gastric cancer. Of these patients, 5 cases without remained or recurred tumor of bile leakage after operation were reviewed. And we analyzed the changes of liver function tests (LFT) of 15 patients of early gastric cancer and 21 patients of advanced gastric cancer whose LFT follow-up data were available. RESULTS: The rate of bile leakage was 2.3% (5 patients) after LN dissection of hepatoduodenal ligament for gastric cancer. Among this group, 3 patients underwent reoperation due to unexpected bile leakage and 2 patients underwent T tube choledochostomy due to minor injury to common hepatic duct on operation. One patient died of sepsis with continued bile leakage after T tube removal on the postoperative 41st day. The serum alkaline phosphatase was increased after operation especially in advanced gastric cancer without clinical significance and there was no other significant abnormality in LFT after hepatoduodenal LN dissection and cholecystectomy in non-recurrent cases. CONCLUSION: Extended lymph node dissection including hepatoduodenal ligament LN and cholecystectomy may have the possibility of increasing the risk of bile duct injury. It is important to select the patients who will benefit from hepatoduodenal ligament LN dissection and cholecystectomy. And meticulous surgical technique to operate biliary tract and adequate management of biliary injury are needed.
Alkaline Phosphatase ; Bile Ducts* ; Bile* ; Biliary Tract ; Cholecystectomy ; Choledochostomy ; Cholelithiasis ; Follow-Up Studies ; Gastrectomy ; Hepatic Duct, Common ; Hospitals, General ; Humans ; Ligaments ; Liver Function Tests* ; Liver* ; Lymph Node Excision ; Lymph Nodes ; Reoperation ; Sepsis ; Stomach Neoplasms*