Some of cerebral palsy patients are accompanied by mental retardation, convulsion, scoliosis and thoracic deformity. We experienced general anesthesia of a 22-year-old male with cerebral palsy accompanied by high degree mental retardation and scoliosis for dental caries therapy. We performed anesthetic management of this patient without any occurrence of anesthesia-related complications, though we had some difficulties in anesthetic induction and postural maintenance during the process. We recognized that considerable attention is needed for the patients with cerebral palsy to avoid undesirable anesthetic complications, especially ventilatory failure and neurologic sequelae.
Anesthesia, Dental ; Anesthesia, General ; Cerebral Palsy* ; Congenital Abnormalities ; Dental Caries ; Humans ; Intellectual Disability ; Male ; Scoliosis ; Seizures ; Young Adult

Congenital lipoid adrenal hyperplasia is the most severe form of CAH, leading to impaired production of all steroid hormones including glucocorticoids, mineralocorticoid, and sex steroids. The affected individuals are all phenotypically female with a severe salt-losing syndrome that is fatal if steroid replacement is not begun immediately after birth. The lesion of this disorder has been suggested to be in the first step of steroidogenesis of conversion of cholesterol to pregnenolone by P450scc. Recently, molecular defect of this disease has been located in the transport of cholesterol into mitochondria due to defective regulatory protein called 'steroidogenic acute regulatory protein' while the enzyme P450scc itself is normal, differing from other types of congenital adrenal hyperplasia. We experienced 2 1/2 month old phenotypical girl who was admitted due to lethargic state and persistent vomiting with severe hyperkemia and hyponatremia. Blood levels of cortisol, aldosteron, and 17-OH progesteron were low and levels of ACTH, angiotensin, and plasma renin activity were high, urinary levels of 17-KS and 17-OHCH were low. The patient was found to have karyotype of 46, XY and has been being treated with predinisolone, fluorocortisol and sodium supplement in diet and doing well. The molecular study for P450scc gene and StAR gene of patient and family is in progress.
Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Angiotensins ; Cholesterol ; Diet ; Female ; Glucocorticoids ; Humans ; Hydrocortisone ; Hyperplasia* ; Hyponatremia ; Karyotype ; Mitochondria ; Parturition ; Plasma ; Pregnenolone ; Renin ; Sodium ; Steroids ; Vomiting

Bilateral chylothorax as a complication of modified radical neck dissection is extremely rare, but it is potentially serious and sometimes fatal. Early diagnosis and proper management is very important. We report here on a case of bilateral chylothorax following left modified radical neck dissection that was successfully treated with conservative management.
Chylothorax* ; Early Diagnosis ; Lymph Node Excision* ; Lymph Nodes* ; Neck Dissection ; Neck* ; Thyroid Neoplasms

PURPOSE: Although the diagnostic accuracy of thyroid cancer by fine needle aspiration cytology (FNAC) is increasing, there are some nodules for which ultrasonography and FNAC show indeterminant. The purpose of this study was to determine the usefulness of thyroid ultrasonography by the surgeon prior to operation METHODS: Forty-nine patients who underwent thyroid operations between June 2006 and January 2007 were selected for this study. Thyroid ultrasonography was performed on each patient.And we recorded and analyzed the shape and the margin of the nodule, internal echogeneiety, heterogeneiety, the presence of microcalcification, height versus width, and the presence of level VI lymph node larger than 3 mm, assigning each a score of 1, 2 or 3. RESULTS: The average score was 17.1. Assuming an average score over 14 is considered to be malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.6%, 88.9%, 91.7%, 94.1% respectively. Statistically significant characteristics of malignancy were the shape and the margin of the nodule, internal echogeneiety, microcalcification, taller than wide shape and the presence of enlarged VI lymph nodes. The heterogeneiety had no significant P value. CONCLUSION: When malignancy cannot be confirmed even after repeated FNAC, preoperative ultrasonograpy performed by surgeons can be a reliable test and helpful for operations.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes ; Sensitivity and Specificity ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography*

The purpose of this study was to evaluate the effect of dual bonding technique by comparing microshear bond strength between two different luting methods of resin cement to tooth dentin. Three dentin bonding systems(All-Bond 2, One-Step, Clearfil SE Bond), two temporary cements (Propac, Freegenol) were used in this study. In groups used conventional luting procedure, dentin surfaces were left untreated. In groups used dual bonding technique, three dentin bonding systems were applied to each dentin surface. All specimens were covered with each temporary cement. The temporary cements were removed and each group was treated using one of three different dentin bonding system. A resin cement was applied to the glass cylinder surface and the cylinder was bonded to the dentin surface. Then, micro-shear bond strength test was performed. For the evaluation of the morphology at the resin/dentin interface, SEM examination was also performed. 1. Conventional luting procedure showed higher micro-shear bond strengths than dual boning technique. However, there were no significant differences. 2. Freegenol showed higher micro-shear bond strengths than Propac, but there were no significant differences. 3. In groups used dual bonding technique, SE Bond showed significantly higher micro-shear bond strengths in One-Step and All-Bond 2 (p < 0.05), but there was no significant difference between One-Step and All-Bond 2. 4. In SEM observation, with the use of All-Bond 2 and One-Step, very long and numerous resin tags were observed. This study suggests that there were no findings that the dual bonding technique would be better than the conventional luting procedure.
Dentin* ; Glass ; Prospective Payment Assessment Commission ; Resin Cements* ; Tooth

A neonate born at 38 gestational weeks was admitted due to generalized tonic-clonic seizure and cyanosis. The neonate was born six days previously at home through normal delivery and the umbilical cord was cut using scissors sterilized in boiling water. The neonate weighed 3,180 g at admission. Physical examination revealed cyanosis, opisthotonus, trismus and reactive muscle spasms. Laboratory exam, brain sonogram and EEG showed no significant abnormal findings. Based on her history and physical examination, the neonate was diagnosed with tetanus and put in an incubator isolated in a quiet, dark room. Treatment with tetanus human immunoglobulin along with antibiotics (penicillin G) were started immediately, and mechanical ventilation, administration of neuromuscular blocking agent and muscle relaxant were also started off. The frequency of seizure episode decreased gradually, and on the 32nd hospital day, mechanical ventilatory support was stopped along with extubation two days later. Thereafter, the neonate was in continuous generalized hypertonic state and showed feeding difficulty, but there was gradual improvement. She was dismissed on the 49th hospital day and is currently under OPD follow-up, doing well with no special problems. Respiratory management is critical to neonatal tetanus. We report here a case of tetanus treated with inhibition of self-respiration, neuromuscular blocker and application of ventilator, and present this method as a useful direction for future treatment of neonatal tetanus.
Anti-Bacterial Agents ; Brain ; Cyanosis ; Electroencephalography ; Follow-Up Studies ; Humans ; Immunoglobulins ; Incubators ; Infant, Newborn ; Neuromuscular Blockade* ; Physical Examination ; Respiration, Artificial ; Seizures ; Spasm ; Tetanus* ; Trismus ; Umbilical Cord ; Ventilators, Mechanical ; Water

PURPOSE: HuR, human family embryonic-lethal abnormal vision-like protein, can bind to mRNA and stabilizes the nucleic acid in the cytoplasm, resulting in more efficient translation. HuR is predominantly present in the nucleus and shuttles between the nucleus and cytoplasm. HuR stabilizes cyclooxygenase-2 (Cox-2) mRNA in several cancers, including breast, stomach, lung and brain cancer. MATERIALS AND METHODS: We investigated the expression and cellular location of HuR, as well as evaluated Cox-2 expression in 79 colorectal cancer patients with the use of immunohistochemical methods. The biological implications of HuR localization and Cox-2 expression in colorectal carcinoma were evaluated. RESULTS: Nuclear HuR expression was observed in 59 (74.7%) tumors and cytoplasmic HuR expression was seen in 25 (31.6%) tumors. Cox-2 immunoreactivity was noted in 42 (53%) tumors. The expression of cytoplasmic HuR was significantly associated with Cox-2 expression (p=0.004). Cytoplasmic expression of HuR showed a correlation with lymphatic invasion (p=0.025) and the presence of a lymph node metastasis (p=0.027). The presence of nuclear HuR showed no correlation with Cox-2 expression or any other of the clinicopathological parameters that were examined. CONCLUSION: These results suggest that cytoplasmic translocation of HuR is associated with Cox-2 expression for some colorectal carcinomas.
Brain Neoplasms ; Breast ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Cyclooxygenase 2 ; Cytoplasm ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; RNA, Messenger ; Stomach

Occupational hazards of firefighting and rescue works include frequent exposure to emergencies and life-threatening situations. These stressful work conditions of being constantly under pressure and exposed to potentially traumatic events put them at higher risk of developing posttraumatic stress disorder (PTSD), compared to the general population. PTSD is a potentially debilitating mental disorder, due to persistent intrusive thoughts, negative alterations of mood and cognition, hypervigilance, avoidance of similar situations and reminders, and re-experiences of the traumatic event. Previous studies have shown a relatively high prevalence of PTSD among firefighters, indicating the need for a systematic approach of early detection and prevention. Therefore, a critical review of the current literature on PTSD in firefighters would provide valuable insights into developing effective prevention and intervention programs. Literature indicated that there are risk factors of PTSD in firefighters, such as pre-existing depression, anxiety, sleep disorders, occupational stress, physical symptoms, and binge drinking, whereas social support and adequate rewards are protective factors. Although there are differences in the prevalence of PTSD across studies, partly due to various assessment tools utilized, different sample sizes, and sample characteristics, over one tenth of the firefighters were estimated to have PTSD. The current review warrants further investigations to precisely assess PTSD and co-morbid mental disorders, functional outcomes, and associated factors, and to develop evidence-based preventive and interventional programs to help firefighters with PTSD.
Anxiety ; Binge Drinking ; Cognition ; Depression ; Emergencies ; Firefighters* ; Humans ; Mental Disorders ; Prevalence ; Protective Factors ; Rescue Work ; Reward ; Risk Factors ; Sample Size ; Sleep Wake Disorders ; Stress Disorders, Post-Traumatic*

BACKGROUND: The cause of autoimmune thyroid diseases (AITD), including Graves disease and Hashimotos thyroiditis, is largely unknown. To identify the genes responsible, most attention has been focussed on the HLA regions in the early studies. However, these studies have repeatedly shown a weak association between AITD and the HLA-DR3 in Caucasians. To understand and find out the mechanisms underlying the development of AITD, a search for non-HLA linked susceptibility genes is important. A recent study from American population have indicated an association between a polymorphism of CILA-4 gene and Graves disease. To clarify the relationship of the CTLA-4 polymorphism and AITD, the allele frequency of CTLA-4 gene from the patients with Graves disease and with Hashimotos thyroiditis in Korean papulation were analysed. METHODS: The CTLA-4 exon 1 polymorphism (49, A/G) was analysed by PCR-based, RFLP (Restriction Fragment Length Polymorphism) from 92 women and 37 men with Graves disease and 50 women and 9 men with Hashimotos thyroiditis diagnosed. Also, 287 healthy controls including 155 women and 132 men with no clinical evidence or family history of thyroid disease were enrolled. RESULTS: 1) In the group of Graves disease, there was significantly more patients with alanine homozygote (GG) than in control group (P<0.0005, RR=1.40). However, there was not significant with threonine homozygote (AA) between two groups (P=0.052). In the group of Hashimotos thyroiditis, no significant differences were found between all homozygotes and heterozygote. 2) In the group of Graves disease, there were significantly more patients with alanine homozygote (GG) (P<0.0001, RR=1.85) and significantly fewer patients with threonine homozygote (AA) than in the group of Hashimoto's thyroiditis (P<0.005, RR 0.25). CONCLUSION: Regardless of sex difference, alanine homozygote (GG) at exon 1 (codon 17) of CTLA-4 is associated with Graves disease in Korean population, which suggests genetic susceptibility is some role in the pathogenesis of Graves disease.
Alanine ; Exons ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Graves Disease ; Heterozygote ; HLA-DR3 Antigen ; Homozygote ; Humans ; Lymphocytes* ; Male ; Polymorphism, Restriction Fragment Length ; Sex Characteristics ; Threonine ; Thyroid Diseases* ; Thyroid Gland* ; Thyroiditis

PURPOSE : The purpose of this study was to develop the radiographic technique for detecting the demineralization which is known as indication of dental caries MATERIALS AND METHODS : This technique was based on the comparing of multiple radiographs which was irradiated by multiple X-ray spectra. For the meaningful comparing, the multiple radiographs were reconstructed to the dosimetrically consistent images using a standard material. The difference of resulting images of same target with multiple spectra represents the difference of response of material as regards the spectra. RESULTS : We have found about 10% of demineralization of dental hard tissues particularly in the proximal region through the analyzing of differences. CONCLUSION : Most intriguing thing in this investigation was that the method to analyze difference shows us to an anatomic structure of dental hard tissues even if absolute values of optical density were excluded during the procedures.
Dental Caries