The segmented TMA T-loop spring, used for reciprocal space closure and described by Burstone, was used to achievebodily movement of canine. Photoelastic analysis is a technique for the transformation of internal stress into visible light patterns. The two-dimensional photoelastic stress analysis was performed, and stress distribution was recorded by photography. The purpose of this study was to visualize photoelastically the distribution of forces transmitted to the alveolus and surrounding structures using new segmented TMA T-loop spring for canine retraction. The results were as follows: 1. Decreased activation produced decreased stress of upper 1st. premolar extraction site and increased intrusive stress of upper 1st. molar, regardless of T-loop position. 2. At 5mm activation, More posterior positioning of T-loop produced an increased stress in upper 1st. premolar extraction site. 3. At 3mm activation, More posterior positioning of T-loop produced an increased stress in upper 1st. premolar extraction site and mesial lower half of upper 1st. molar mesio-buccal root. 4. At 1mm activation, More anterior positioning of T-loop produced an increased stress in upper mesial and blew apex area of upper canine root. 5. 0.25 B/L ratio and 3mm activation produced bodily movement of canine. To summarize, desired tooth movement and anchorage requirement is possible by altering the activation and mesio-distal position of the T-loop spring.
Bicuspid ; Light ; Molar ; Photography ; Tooth Movement

OBJECTIVE: Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. METHODS: Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and > or =70 years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and > or =70 years of age). RESULTS: Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (> or =70 years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. CONCLUSION: In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.
Aged ; Aneurysm ; Aneurysm, Ruptured ; Dependency (Psychology) ; Drainage ; Humans ; Hydrocephalus ; Incidence ; Subarachnoid Hemorrhage

OBJECTIVE: It has been suggested that elevated cardiac troponin T (cTnT) level is a marker of increased risk of mortality in acute ischemic stroke and subarachnoid hemorrhage (SAH). However, the association of serum cTnT level and prognosis of intracerebral hemorrhage (ICH) has been sparsely investigated. The aim of this study was to identify the relationship between cTnT level and the outcome in patients with spontaneous ICH. METHODS: We retrospectively investigated 253 patients identified by a database search from records of patients admitted in our department for ICH between January 1, 2003 and December 31, 2007. The patients were divided into 2 groups; the patients in group 1 (n=225) with serum cTnT values of 0.01 ng/mL or less, and those in group 2 (n=28) with serum cTnT values greater than 0.01 ng/mL. RESULTS: The serum cTnT level was elevated in 28 patients. There were significant differences in sex, hypertension, creatine kinase-myocardial band, midline shift, side of hematoma, and presence of intraventricular hemorrhage between the 2 groups. Logistic regression analysis identified the level of consciousness on admission, cTnT and midline shift as independent predictors of hospital mortality. CONCLUSION: Theses results suggest that increased serum cTnT level at admission is associated with in-hospital mortality and the addition of a serum cTnT assay to routine admission testing should be considered in patients with ICH.
Cerebral Hemorrhage ; Consciousness ; Creatine ; Diagnostic Tests, Routine ; Hematoma ; Hemorrhage ; Hospital Mortality ; Humans ; Hypertension ; Logistic Models ; Prognosis ; Retrospective Studies ; Stroke ; Subarachnoid Hemorrhage ; Troponin ; Troponin T

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.
Body Weight ; Creatine ; Diagnosis ; Doxylamine* ; Eating ; Humans ; Incidence* ; Myoglobin ; Rhabdomyolysis* ; Sensitivity and Specificity ; Vomiting

PURPOSE: To evaluate accuracy of magnetic resonance(MR) imaging for staging of lung cancer and to compare the accuracies of CT and MRI. MATERIALS AND METHODS: We retrospectively analyzed 25 cases of lung cancer, which were confirmed surgically and pathologically. Five experienced radiologists participated in the receiver operating characteristic (ROC) analysis to evaluate and compare accuracies of the CT and MR imaging in preoperative staging of non small cell lung cancer by assessing tumor invasion of bronchus, mediastinum, chest wall, and hilar or mediastinal lymph node metastasis. Imaging results were evaluated against "truth" data based on both surgery and pathologic examination. RESULTS: Sensitivity of CT in distinguishing T3-T4 tumors was 60% ;specificity was 76%. These values for MR imaging were not significantly different(53% and 72%). With ROC analysis, no difference existed between accuracies of CT and MR imaging in diagnosis of bronchial involvement, but MR imaging was significantly more accurate than CT(p<0.05) in diagnosis of mediastinal invasion. There was no significant difference between accuracies of CT and MR imaging in detecting mediastinal node metastasis(N2 or N3); sensitivities were 64% and 78%, respectively, and specificities were 64% and 66%. CONCLUSION: There was no significant difference in accuracies of CT and MR imaging in preoperative tumor classification and assessment of mediastinal node metastasis, but MR imaging was more accurate than CT in assessment of mediastinal invasion.
Bronchi ; Carcinoma, Bronchogenic* ; Classification ; Diagnosis ; Lung Neoplasms ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mediastinum ; Neoplasm Metastasis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thoracic Wall

PURPOSE: To evaluate accuracy of magnetic resonance(MR) imaging for staging of lung cancer and to compare the accuracies of CT and MRI. MATERIALS AND METHODS: We retrospectively analyzed 25 cases of lung cancer, which were confirmed surgically and pathologically. Five experienced radiologists participated in the receiver operating characteristic (ROC) analysis to evaluate and compare accuracies of the CT and MR imaging in preoperative staging of non small cell lung cancer by assessing tumor invasion of bronchus, mediastinum, chest wall, and hilar or mediastinal lymph node metastasis. Imaging results were evaluated against "truth" data based on both surgery and pathologic examination. RESULTS: Sensitivity of CT in distinguishing T3-T4 tumors was 60% ;specificity was 76%. These values for MR imaging were not significantly different(53% and 72%). With ROC analysis, no difference existed between accuracies of CT and MR imaging in diagnosis of bronchial involvement, but MR imaging was significantly more accurate than CT(p<0.05) in diagnosis of mediastinal invasion. There was no significant difference between accuracies of CT and MR imaging in detecting mediastinal node metastasis(N2 or N3); sensitivities were 64% and 78%, respectively, and specificities were 64% and 66%. CONCLUSION: There was no significant difference in accuracies of CT and MR imaging in preoperative tumor classification and assessment of mediastinal node metastasis, but MR imaging was more accurate than CT in assessment of mediastinal invasion.
Bronchi ; Carcinoma, Bronchogenic* ; Classification ; Diagnosis ; Lung Neoplasms ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mediastinum ; Neoplasm Metastasis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; Thoracic Wall

A 17-year-old girl was admitted to our hospital due to mild generalized edema. Laboratory tests revealed a serum creatinine was 0.7mg/dL, protein/albumin 6.7/3.5g/dL, cholesterol 190mg/dL, hemoglobin 10.0g/dL, and 24 hour urinary protein 4,40mg/day. Chest X-ray and renal ultrasound were normal. There were no clinical or serologic evidences of paraproteinemia, cryoglobulinemia, light chain disease or systemic lupus erythematosus. Renal biopsy showed membranoproliferative glomerulonephritis-like pattern with lobular accentuation, hypercellularity and diffuse GBM thickening by light microscope. Congo red staining was negative. Granular IgG and C3 deposits were found along the glomerular capillary wall and mesangium by immunofluorescence microscope. Ultrastructurally, abundant subendothelial and mesangial fibrillary deposits were found associated with thickening and wrinkling of GBM. These fibrils, measured about 20-30nm in diameter, were nonbranching and randomly arranged without either periodicity or an organized structure. These findings were compatible with those of fibrillary glomerulonephritis. Thus we report a case of idiopathic fibrillary glomerulonephritis, which is a rare cause of nephrotic syndrome.
Adolescent ; Biopsy ; Capillaries ; Cholesterol ; Congo Red ; Creatinine ; Cryoglobulinemia ; Edema ; Female ; Fluorescent Antibody Technique ; Glomerulonephritis* ; Humans ; Immunoglobulin G ; Lupus Erythematosus, Systemic ; Nephrotic Syndrome ; Paraproteinemias ; Periodicity ; Thorax ; Ultrasonography

Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.
Abdominal Pain ; Cardiomyopathies ; Catecholamines ; Female ; Hemodynamics ; Hemoptysis ; Hemorrhage ; Humans ; Hypertension ; Pheochromocytoma ; Pneumonia ; Pulmonary Edema

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation, which can occur in approximately 10% to 15% of renal transplant patients and usually affects males with relatively good renal function. It is also associated with an increased incidence of thromboembolic events. Clinical manifestations of PTE include malaise, headache, plethora, lethargy, and dizziness. It is correlated with use of cyclosporin, gender, posttransplant renal function, and type of antihypertensive medication. The angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor is preferred as an initial treatment for PTE because these agents are effective and reasonably safe in the majority of patients with PTE, and can also provide a necessary antihypertensive effect for kidney transplant patients. We report here on a 35-year-old male who had erythrocytosis after renal transplantation. After renal transplantation, his level of hemoglobin was 21 g/dL. We treated this patient with ARB and his symptoms and signs have been completely relieved.
Adult ; Angiotensin Receptor Antagonists ; Angiotensins ; Cyclosporine ; Dizziness ; Headache ; Humans ; Incidence ; Kidney Transplantation ; Kidney* ; Lethargy ; Male ; Polycythemia

Esophagogastroduodenoscopy (EGD) is considered a relatively safe procedure. However, the procedure and the materials used in EGD with conscious sedation can cause stress to the patient. Adverse events during EGD have been reported, represented by cardiopulmonary complications. To date, five cases have reported worldwide to be associated with gastrointestinal endoscopy. Stress cardiomyopathy (SCMP) is a reversible cardiomyopathy that typically occurs in postmenopausal women due to stress and may resolve within a few weeks. SCMP resembles acute myocardial infarction but differs in terms of treatment and prognosis. Here, we describe two cases of SCMP with shock during EGD with conscious sedation.
Cardiomyopathies ; Conscious Sedation ; Endoscopy, Digestive System* ; Endoscopy, Gastrointestinal ; Female ; Humans ; Myocardial Infarction ; Prognosis ; Shock ; Takotsubo Cardiomyopathy*