PURPOSE: Authors attempted to evaluate the effect on explanation of pathogenesis and stress management as the initial care of temporomandibular disorders. MATERIALS AND METHODS: The materials were 634 patients with temporomandibular disorder, who had been referred to our Department of Dentistry, Wonju Christian Hospital during recent 5 years. We examined about clinical aspects of temporomandibular disorders, such as, major signs of temporomandibular joint disor-der, life environment and habits, radiological findings of temporomandibular joint and electromyography of masseter muscle. The patients were treated by explanation of TMJ pathogenesis and stress management. After that, the patient were evaluated about the effect in third week. RESULTS: The result was more favorable (96.5% success rate) without intolerable signs of temporomandibular joint disorder. CONCLUSIONS: The explanation of TMJ pathogenesis and stress management were thought as the very effective care in management of patients with temporomandibular disorder.
Dentistry ; Electromyography ; Gangwon-do ; Humans ; Masseter Muscle ; Primary Health Care* ; Temporomandibular Joint Disorders* ; Temporomandibular Joint*

Chemical burns onto oral mucosa which are infrequent, may result from contact with a wide variety of chemical agents. The degree of injury depends on the chemical, its concentration, duration of contact, and the natural penetrability and resistance of the tissues involved. Chemicals do not usually "burn" in that they do not cause destruction by hyperthermic activity. Rather, they damage tissue by causing coagulation of protein by one of several processes, reduction, oxidation, desiccation, corrosion, or vesication. Paraquat(Gramoxon) is the most frequently agricultural chemicals that induce the severe toxic reactions onto the organs of human body in Korea. The toxic reaction are composed of pulmonary edema and fibrosis, formation of hyaline membrane, inflammatory reaction and bleeding tendency, owing to the cell damage by the production of superoxide radicals. The contents of essential treatment in paraquat intoxication are commonly airway and breathing maintenance, gastric lavage, much hydration and diuresis, hemoperfusion and medications for the removal of the chemicals and the prevention of various complications. The sedative oral dressings, such as, orabase ointment application, warm saline gargling, lidocaine viscous gargling and oral gargling by the mixed solutions(tetracycline, prednisolone and 10% dextrose water) are important for the improvement of chemical oral mucositis and the comfortable feeding of diet. The authors managed properly two cases of oral chemical mucositis that were occurred by the incorrect use of agricultural chemicals(paraquat) and report the cases with the review of literatures about care of the chemical intoxication and oral mucositis.
Agrochemicals ; Bandages ; Blister ; Burns, Chemical* ; Corrosion ; Desiccation ; Diet ; Diuresis ; Fibrosis ; Gastric Lavage ; Glucose ; Hemoperfusion ; Hemorrhage ; Human Body ; Hyalin ; Korea ; Lidocaine ; Membranes ; Mouth Mucosa ; Mucositis ; Paraquat ; Prednisolone ; Pulmonary Edema ; Respiration ; Stomatitis* ; Superoxides

PURPOSE: The surgical morbidity and mortality after a pancreaticoduodenectomy has been decreasing but still remains high. The most serious complications are pancreatic leakage, gastrointestinal or intra-abdominal hemorrhage, and an intraabdominal abscess. The less serious complications are delayed gastric emptying and wound problems. The aim of this study was to evaluate the risk factors for morbidity and mortality after a pancreaticoduodenectomy. METHODS: Among 90 patients who underwent pancreaticoduodenectomy from Feb. 1992 to Dec, 2000. 68 patients whose hospital records could be reviewed thoroughly were enrolled in this study. The postoperative morbidity and mortality after a pancreaticoduodenal resection were evaluated in terms of the patient's age, combined disease, laboratory values, biliary drainage, transfusion, types of pancreaticojejunostomy, pancreatic duct size, consistency, and the administration of octreotide. Univariate and multivariate analysis were performed with a chi-square test and multiple logistic regression test. RESULTS: Postoperative complications were observed in 43 cases (63.2%). Wound complications were noted in 13 cases (19.1%), gastric emptying disturbance in 10 cases (14.7%), bleeding in 9 cases (13.2%), an abscess in 4 cases (5.9%), and leakage in 22 cases (32.4%). Nine cases (13.2%) had died. The causes of death were sepsis due to leakage in 3 cases, bleeding in 3 cases, and others causes in 3 cases. Univariate analysis showed that diabetes mellitus was significantly (P<0.05) related to delayed gastric emptying. In multivariate analysis, transfusion was significantly (P<0.05) related to wound infections and mortality. Old age ( 65 years) was significantly related to leakage and delayed gastric emptying. CONCLUSION: Pancreaticoduodenectomy is still associated with a high mortality and morbidity rate even though there has been significant progress in the field of pancreatic surgery and postoperative follow-up. Old age and transfusions appeared to be the main risk factors for morbidity and mortality after a pancreaticoduodenectomy in this study. In addition to these factors, better anticipation and management of the postoperative complications is essential for improving the surgical outcome.
Abscess ; Cause of Death ; Diabetes Mellitus ; Drainage ; Follow-Up Studies ; Gastric Emptying ; Hemorrhage ; Hospital Records ; Humans ; Logistic Models ; Mortality* ; Multivariate Analysis ; Octreotide ; Pancreatic Ducts ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Postoperative Complications ; Risk Factors ; Sepsis ; Wound Infection ; Wounds and Injuries

OBJECTIVE: Infliximab, a monoclonal antibody to tumor necrosis factor-alpha, is effective in patients with ankylosing spondylitis (AS), who have not responded to conventional therapy. There were no data on the efficacy and side effect of infliximab in patients with AS in Korea. The objective of this study is to observe the efficacy and adverse effect of infliximab retrospectively in Korean patients with AS. METHODS: We reviewed the medical records of thirty-three AS patients. The patients were enrolled to fulfill the modified New York criteria of AS and be in active disease state and resist to conventional therapy. Patients were given 3~5 mg/kg of infliximab infusions at weeks 0, 2, 8 and 16. Information on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) test was collected at each infusion. The paired t-test was used for comparison between the visits. RESULTS: There were 29 male and 4 female patients. The mean age at first infliximab treatment was 34.6+/-9.8 years. All patients were HLA-B27 positive. ESR and CRP decreased significantly from baseline to 16 weeks after treatment (p<0.001, respectively). The mean ESR was 76.1+/-36.5 mm/h at baseline and 21.3+/-31.6 mm/h at 16 weeks. The mean CRP was 6.4+/-4.8 mg/dL at baseline and 1.3+/-2.1 mg/dL at 16 weeks. Only 1 out of 33 patients got worse. All patients were tested negative for ANA at baseline. After 16 weeks of therapy, the induction of ANA was observed in 8 patients, but no patients have lupus-like symptoms. CONCLUSION: Infliximab is an effective therapy with non-specific adverse effect in AS non-responsive to conventional therapy in Korea.
Antibodies, Antinuclear ; Blood Sedimentation ; C-Reactive Protein ; Female ; HLA-B27 Antigen ; Humans ; Infliximab ; Korea ; Male ; Medical Records ; Retrospective Studies ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.
Adult ; Angiography ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic* ; Cystotomy* ; Gelatin ; Humans ; Inflammation ; Leg ; Male ; Phenobarbital ; Popliteal Artery ; Smoke ; Smoking ; Thrombosis ; Ultrasonography ; Vascular Diseases

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.
Adult ; Angiography ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic* ; Cystotomy* ; Gelatin ; Humans ; Inflammation ; Leg ; Male ; Phenobarbital ; Popliteal Artery ; Smoke ; Smoking ; Thrombosis ; Ultrasonography ; Vascular Diseases

Nocardiosis is usually a subacute infection, which can occur as an opportunistic infections in patients with systemic lupus erythematosus. There are rare cases of nocardiosis concurrent with Mycobacterium tuberculosis. We report a case of intramuscular nocardial abscess concurrent with pulmonary tuberculosis in a patient with lupus nephritis. She has received cyclophosphamide pulse therapies and is receiving oral steroid therapy 3 months ago. After Nocardia farcinica and Mycobacterium tuberculosis were confirmed by PCR and PCR-RFLP, we initiated trimethoprim/ sulfamethoxazole and antituberculous agents. After then, patient was improved and discharged, maintaining the medications.
Abscess* ; Cyclophosphamide ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Mycobacterium tuberculosis ; Nocardia Infections ; Nocardia* ; Opportunistic Infections ; Polymerase Chain Reaction ; Sulfamethoxazole ; Tuberculosis, Pulmonary*

BACKGROUND: Though leptin, the adipocytes-derived hormone, plays an important role in obesity, it can act as a growth factor for several cancers including gastrointestinal malignancies. Based on this background, we investigated whether leptin expression correlated with the clinicopathological characteristics or disease outcome in patients with colon cancer. We immunohistochemically analyzed the expression of leptin in a "colon adenoma-carcinoma sequence" in the normal colon mucosa, an adenomatous polyp and adenocarcinoma tissue, from a surgical resection for each patient. METHODS: We collected samples from 24 patients with a colorectal adenocarcinoma that was removed in either a total colectomy or hemicolectomy, and who presented with an adenomoatous polyp and an adenocarcinoma in the same surgical specimen. Leptin expression was assessed using immunohistochemical methods and was evaluated by grading the staining intensity as 0, +1, +2, +3. RESULTS: Whereas leptin expression was observed in 4.2% (1/24) of the normal colon mucosa, adenomatous polyps and adenocarcinomas showed 33.3% (8/24) and 50.0% (12/24) expression of leptin, respectively (p<0.05), suggesting that leptin expression in the adenomatous polyps and adenocarcinomas was higher than in the normal colon mucosa (p<0.05). There was no significant difference in leptin expression between the adenomatous polyps and adenocarcinomas, statistically. There was no relationship between leptin expression and patients age, sex, BMI (body mass index), cancer stage, and lymph node metastasis. However, the tumor size in the positive leptin expression group was larger than in the negative leptin expression group (5.6+/-2.2 cm vs 3.9+/-1.4 cm; p<0.05) CONCLUSIONS: Since leptin expression in adenomatous polyps and adenocarcinomas was higher than in the normal colon mucosa and leptin expression significantly correlated with the tumor size, leptin might play a role in the development of an adenomatous polyp and an adenocarcinoma in the colon. However, leptin does not contribute to the progression of colon adenoma, and further evaluation studies will be required.
Adenocarcinoma* ; Adenoma ; Adenomatous Polyps* ; Colectomy ; Colon* ; Colonic Neoplasms* ; Humans ; Leptin* ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Obesity ; Polyps