The fine structure of cells in the trigeminal mesencephalic (Me5) nucleus in the rat was studied by transmission electron microscopy. This nucleus located in the mid-brain and the rostral portion of the pons, most neurons in the caudal part of Me5 nucleus were sufficiently large (40~50micrometer) and appeared as round-shaped unipolar cells. The Me5 neurons had a large, round, centrally located nucleus, and their cytoplasm contained numerous mitochondria, dense granular endoplasmic reticulum, abundant Golgi apparatus, groups of free ribosomes, some heterogeneous particles and neurofilaments. Cell surfaces were studded irregularly with small spinouts processes, and they contained a few fine irregularly arranged neurofilaments and some granular endoplasmic reticulum. Boutons contacting the soma of Me5 neurons were defined as axosomatic synapses and bostons contacting dendrites located between the Me5 neurons were defined as axodendritic synapses. Based on differences in bouton and vesicle morphology, the four synaptic bouton types were identified. 1. Asymmetrical as well as symmetrical synapses with small round vesicles. 2. Asymmetrical synapses with pleomorphic admixture contained predominantlyspherical vesicles. 3. Symmetrical synapses with pleomorphic vesicles of flattened, spherical and dense-core vesicles. 4. Asymmetrical as well as symmetrical synapses with heterogeneous and large dense-core vesicles. Synaptic boutons containing round vesicles and large dense-core vesicles were most frequently observed.
Animals ; Carisoprodol ; Cytoplasm ; Dendrites ; Endoplasmic Reticulum, Rough ; Golgi Apparatus ; Microscopy, Electron, Transmission ; Mitochondria ; Neurons ; Pons ; Presynaptic Terminals ; Rats* ; Ribosomes ; Synapses

BACKGROUND: Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers. METHODS: Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly. RESULTS: The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum. CONCLUSIONS: The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.
Analgesia, Epidural ; Cadaver ; Chronic Pain ; Connective Tissue ; Epidural Space ; Humans ; Incidence ; Ligamentum Flavum* ; Needles ; Spine

STATEMENT OF PROBLEM: When veneering composite resin-metal restoration is prepared, the fact that bond strength between Ti and composite resin is relatively weak should be considered. PURPOSE: The purpose of this study is to evaluate the shear bond strength between the veneering composite resin and commercial pure (CP) Ti / Ti-6Al-4V alloy according to the method of surface treatment. MATERIAL AND METHODS: The disks were cast by two types of metal. Their surfaces were treated by sandblasting, metal conditioner, TiN coating and silicoating respectively. After surface treatment, the disks were veneered by composite resin (Tescera(TM), Bisco, USA) which is 5 mm in diameter and 3 mm in thickness. The specimens were stored in water at 25degrees C for 24 hours, and then evaluated for their shear bond strength by universal testing machine (STM-5(R), United Calibration, USA). These values were statistically analyzed. RESULTS: 1. All methods of surface treatment were used in this study satisfied the requirements of ISO 10477 which is the standard of polymer-based crown and bridge materials. 2. The metal conditioner treated group showed the highest value in shear bond strength of CP Ti, silicoated group, TiN coated group, sandblasted group, in following order. 3. The silicoated group showed the highest value in shear bond strength of Ti-6Al-4V alloy, metal conditioner treated group, sandblasted group, TiN coated group, in following order. CONCLUSION: Within the limitations of this study, all methods of surface treatment used in this study are clinically available.
Alloys ; Calibration ; Collodion ; Crowns ; Tin ; Titanium ; Water

BACKGROUND: Epidural blocks are widely used for the management of acute and chronic pain. The technique of loss of resistance is frequently adopted to determine the epidural space. A discontinuity of the ligamentum flavum may increase the risk of failure to identify the epidural space. The purpose of this study was to investigate the anatomic variations of the cervical and high thoracic ligamentum flavum in embalmed cadavers. METHODS: Vertebral column specimens of 15 human cadavers were obtained. After vertebral arches were detached from pedicles, the dural sac and epidural connective tissue were removed. The ligamentum flavum from C3 to T6 was directly examined anteriorly. RESULTS: The incidence of midline gaps in the ligamentum flavum was 87%-100% between C3 and T2. The incidence decreased below this level and was the lowest at T4-T5 (8%). Among the levels with a gap, the location of a gap in the caudal third of the ligamentum flavum was more frequent than in the middle or cephalic portion of the ligamentum flavum. CONCLUSIONS: The cervical and high thoracic ligamentum flavum frequently has midline intervals with various features, especially in the caudal portion of the intervertebral space. Therefore, the ligamentum flavum is not always reliable as a perceptible barrier to identify the epidural space at these vertebral levels. Additionally, it may be more useful to insert the needle into the cephalic portion of the intervertebral space than in the caudal portion.
Analgesia, Epidural ; Cadaver ; Chronic Pain ; Connective Tissue ; Epidural Space ; Humans ; Incidence ; Ligamentum Flavum ; Needles ; Spine

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes of treatment of non-odontogenic atypical orofacial pain using botulinum toxin-A. METHODS: This study involved seven patients (seven females, mean age 65.1 years) who had non-odontogenic orofacial pain (neuropathic pain and atypical orofacial pain) and visited the Seoul National University Bundang Hospital between 2015 and 2017. All medication therapies were preceded by botulinum toxin-A injections, followed by injections in the insignificant effects of medication therapies. Five of the seven patients received intraoral injections in the gingival vestibule or mucosa, while the remaining two received extraoral injections in the masseter and temporal muscle areas. RESULTS: In five of the seven patients, pain after botulinum toxin-A injection was significantly reduced. Most of the patients who underwent surgery for dental implantation or facial nerve reconstruction recovered after injections. However, the pain did not disappear in two patients who reported experiencing persistent pain without any cause. CONCLUSIONS: The use of botulinum toxin-A for the treatment of non-odontogenic neuropathic orofacial pain is clinically useful. It is more effective to administer botulinum toxin-A in combination with other medications and physical therapy to improve pain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0159-z) contains supplementary material, which is available to authorized users.
Botulinum Toxins ; Dental Implantation ; Dental Implants ; Facial Nerve ; Facial Pain ; Female ; Humans ; Mucous Membrane ; Retrospective Studies ; Seoul ; Temporal Muscle

Abnormalities of body fluid and electrolyte balance, acute renal failure, nephrotic syndrome, interstitial nephritis and papillary necrosis are well known disease of wide spectrum of NSAID induced renal side effect. Many different mechanism such as inhibition of prostaglandin pathway, delayed hypersensitivity reaction and direct toxicity are reported to relate to development of disease. Recently, overuse of NSAID has steadily increased the cases of NSAID induced side effects and in some cases permanent damage to kidney has been reported. Authors experienced a 67-year-old male patient who presented with gross hematuria, edema and azotemia and diagnosed as interstitial nephritis accompanying nephrotic syndrome. Kidney biopsy shows the edema and the diffuse infiltration of lymphocytes in the interstitium. The glomerular changes suggest minimal change lesion or focal segmental glomerular sclerosis in early stage. The patient had continuously consumed piroxicam for 6 months and had improved after discontinuation of this drug as well as treatment with steroid but remained renal damage. This case suggest that piroxicam may be an agent that causes interstitial nephritis and nephrotic syndrome. Therefore clinician should use it with caution especially in patients with high risk factors.
Acute Kidney Injury ; Aged ; Azotemia ; Biopsy ; Body Fluids ; Edema ; Hematuria ; Humans ; Hypersensitivity, Delayed ; Kidney ; Lymphocytes ; Male ; Necrosis ; Nephritis, Interstitial* ; Nephrotic Syndrome* ; Piroxicam* ; Risk Factors ; Sclerosis ; Water-Electrolyte Balance

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

Loss of posterior support may cause extrusion of antagonistic teeth and excessive wear of remaining teeth which often leads to the destruction of the occlusal plane. In such cases, it is critical to verify the need to increase vertical dimension of occlusion (VDO). Should you increase VDO, provisionalization is crucial in evaluating function and esthetics. Double scanning technique is a useful method when fabricating definitive restoration that mimic provisional restoration. In this case, a patient with apparently no loss of VDO and insufficient interocclusal space for dental materials due to loss of posterior support and extrusion of antagonistic teeth was rehabilitated using double scanning technique.
Dental Materials ; Dental Occlusion ; Esthetics ; Humans ; Methods ; Rehabilitation* ; Tooth ; Vertical Dimension

Many kinds of alloplastic implants have been used for surgical reconstruction of orbital wall fractures. Although complication rates caused by them are known to be higher than that by autologous grafts such as calvarian bone graft, there are few reports about collective cases for individual alloplastic implants. A retrospective review was performed on 115 patients who underwent orbital blow-out fractures reconstruction with silicone sheet(Silastic(R)) implants between 1989 and 1998. After the follow-up period from 1 month to 5 years, six patients(4.3%) had to undergo reoperations for implant removal because of complications such as infection, hematoma, displacement and extrusion of implant. Symptoms of Silicone sheet complications were progressive periorbital swelling, tenderness, proptosis, hypesthesia and persistant diplopia. Complications were diagnosed by history of Silicone sheet insertion, physical examination and follow-up facial bone or orbit CT. Mean duration of onset was 23.3 months. In all cases of complication, implants were surgically removed and proper antibiotics were used postoperatively. The symptoms subsided immediately without any other sequelae. The reconstruction of blow-out fractures with silicone rubber implant may cause serious late complications such as infection, displacement, hematoma, migration and extrusion. Therefore, careful follow up is nesessary, and prompt sheet removal should be considered first, if such complications are confirmed.
Anti-Bacterial Agents ; Diplopia ; Exophthalmos ; Facial Bones ; Follow-Up Studies ; Hematoma ; Humans ; Hypesthesia ; Orbit ; Orbital Fractures* ; Physical Examination ; Retrospective Studies ; Silicone Elastomers ; Transplants

STATEMENT OF PROBLEM: It is known that an anodic oxidation technique, one of the methods for the implant surface treatment, remarkably increased surface area, enhanced wettability and accelerated the initial bone healing. Purpose: This study was performed to evaluate the wettability of anodized titanium surface which has a nanotubular structure, to assess osseointegration after the placement of implant with nano-size tubes on tibia of rats and to analyze quantitatively transferable rhBMP-2 on each surface. MATERIAL AND METHOD: Four different kinds of surface-treated titanium discs (polished (machined surface) group, micro (blasting surface) group, nano (anodizedmachined surface) group, and nano-micro (anodized-blasting surface) group) were fabricated (n=10). Three different media were chosen to measure the surface contact angles; distilled water, plasma and rhBMP-2 solution. After a single drop (0.025 ml) of solution, the picture was taken with the image camera, and contact angle was measured by using image analysis system. For the test of osseointegration, 2 kinds of anodized surface (anodized-machined surface, anodized-blasting surface) implants having 2.0 mm in diameter and 5.0 mm in length inserted into the tibia of Wistar rats. After 3 weeks, tibia were harvested and the specimens were stained with hematoxylin and eosin for histological analysis. To test the possibility of drug delivery, after soaking sample groups in the concentration of 250 ng/ml of rhBMP-2 for 48 hours, the excess solution of rhBMP-2 were removed. After that, they were lyophilized for 24 hours, and then the rhBMP-2 on the surface of titanium was resolved for 72 hours in PBS. All the extracted solution was analyzed by ELISA. One-way analysis of variance (ANOVA) was performed on the data. RESULTS: The wettability is improved by anodic oxidation. The best wettability was shown on the nano-micro group, and it was followed by nano group, micro group, and polished group. In the histological findings, all implants showed good healing and the new bone formation were observed along the implant surface. After 3 days, nano-micro group delivered the most amount of rhBMP-2, followed by nano group, micro group, and polished group. CONCLUSION: It indicated that anodic oxidation on blasting surface produce functionally graded nano-micro porous structure and enhance hydrophilicity of the surface and osseointegration. The findings suggest that the nano-micro porous structure could be a useful carrier of osteogenic molecules like rhBMP-2.
Animals ; Durapatite ; Enzyme-Linked Immunosorbent Assay ; Eosine Yellowish-(YS) ; Hematoxylin ; Hydrophobic and Hydrophilic Interactions ; Osseointegration ; Osteogenesis ; Plasma ; Rats ; Rats, Wistar ; Tibia ; Titanium ; Water ; Wettability