Most complications of carotid endarterectomy originate from either thrombotic or embolic ischemia. Although the incidence of hemorrhagic hyperperfusion syndrome after carotid endarterectomy is extremely rare, it can cause significant morbidity and mortality. Several mechanisms are involved in the pathophysiology of cerebral hyperperfusion syndrome including impaired cerebral autoregulation and normal pressure breakthrough. Presently, a different mechanism is suggested. Unfortunately, suggestions for prevention are limited to strict perioperative control of hypertension in patients with critical stenosis and chronic cerebral hypoperfusion. We report hypertensive-like ipsilateral basal ganglia hemorrhage after carotid endarterectomy.
Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Constriction, Pathologic ; Endarterectomy, Carotid ; Homeostasis ; Humans ; Hypertension ; Incidence ; Ischemia

PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.
Angiography ; Budd-Chiari Syndrome ; Carcinoma, Hepatocellular ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Mass Screening ; Neoplasm Metastasis ; Portal Vein ; Portography* ; Splenic Vein ; Splenorenal Shunt, Surgical ; Stomach Neoplasms ; Ultrasonography ; Umbilical Veins ; Varicose Veins ; Vena Cava, Inferior ; Venous Thrombosis

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

Prurigo nodularis (PN) is a disease characterized by chronic itch and presence of firm nodules or papules on the skin. The underlying pathophysiology of PN is still under debate, but it has been reported to be due to synergistic neural- and immune-mediated mechanisms. In this review, the authors summarize the etiology, epidemiology, clinical characteristics, and diagnosis of PN and suggest management protocols for patients with PN despite the absence of local guidelines for PN in Korea. The prevalence of PN in Korea was reported as 0.036%, similar to that in other countries. The various etiologies of PN are known to be associated with neural sensitization and inflammation, and the related treatment targets being studied for PN include interleukin-4, 13, 31, and transient receptor potential vanilloid 1 (TRPV1). Understanding of predisposing factors or concomitant diseases is beneficial towards targeted management of patients with PN. In addition, it has been reported that PN is more frequently accompanied by metabolic diseases, or renal disorders compared to other inflammatory skin diseases characterized by itchiness such as atopic dermatitis or psoriasis. The clinical diagnosis of PN is generally based on three core symptoms; chronic pruritus over six weeks, firm lesions, and repeated scratching. To evaluate the severity of PN, the following objective and subjective assessments can be used: Investigator’s Global Assessment for PN or Peak Pruritus Numerical Rating Scale. We propose a localized work-up algorithm for PN. It is expected that the increased awareness of PN can facilitate its diagnosis, thereby reducing the disease burden of patients with PN.

The uterus with rudimentary horn occurs as a result of a lack of development during fetal life of the middle and lower part of one of the M llerian ducts, in which there is a failure of fusion of the two ducts. Pregnancy in the rudimentary uterine horn is very rare, its incidence is reported nearly as 1 case per 100,000 normal pregnancy. We experience a case of ruptured rudimentary uterine horn twin pregnancy at 29-gestational week and report the case with brief review of literatures.
Animals ; Horns* ; Humans ; Incidence ; Pregnancy ; Pregnancy, Twin* ; Twins* ; Uterus

BACKGROUND: Total knee arthroplasty (TKA) is associated with severe pain postoperatively. Femoral nerve block is commonly used for pain control after TKA. This study investigated whether continuous femoral nerve block (CFNB) can improve postoperative analgesia and functional outcome as compared to intravenous patient controlled analgesia (PCA) in patients with TKA. METHODS: We reviewed the electronic medical records of patients who underwent TKA with spinal anesthesia between March 2014 and February 2015. In Group IV, postoperative pain was managed by IV-PCA. Group CFNB received CFNB-PCA via a device. Thirty patients were enrolled per group. Patient outcomes were assessed by analgesia, functional outcomes, and health-related quality of life factors. RESULTS: Additional analgesics and additional nerve block for adequate pain control were significantly more frequent in the IV than CFNB group (P = 0.015 and P = 0.012, respectively). Range of motion up to 105 degrees was prolonged in the IV group than CFNB group (P = 0.013). EuroQol five dimensions score was improved in the CFNB group than IV group postoperative 3 weeks (P = 0.003). The incidence of transfusion due to postoperative bleeding was significantly frequent in the IV group than CFNB group (P = 0.042). CONCLUSIONS: Postoperative low concentration continuous femoral nerve block for analgesia after TKA improves analgesia, functional outcomes, and incidence of transfusion without falling risk.
Accidental Falls ; Analgesia* ; Analgesia, Patient-Controlled ; Analgesics ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Knee* ; Blood Transfusion ; Electronic Health Records ; Femoral Nerve* ; Hemorrhage ; Humans ; Incidence ; Nerve Block ; Pain, Postoperative ; Patient Outcome Assessment ; Quality of Life ; Range of Motion, Articular

PURPOSE: The cardiopulmonary exercise test (CPET) is an important clinical tool for evaluating exercise capacity and is frequently used to evaluate chronic conditions including congenital heart disease. However, data on the normal CPET values for Korean children and adolescents are lacking. The aim of this study was to provide reference data for CPET variables in children and adolescents. METHODS: From August 2006 to April 2009, 76 healthy children and adolescents underwent the CPET performed using the modified Bruce protocol. Here, we performed a medical record review to obtain data regarding patient' demographics, medical history, and clinical status. RESULTS: The peak oxygen uptake (VO2Peak) and metabolic equivalent (METMax) were higher in boys than girls. The respiratory minute volume (VE)/CO2 production (VCO2) slope did not significantly differ between boys and girls. The cardiopulmonary exercise test data did not significantly differ between the boys and girls in younger age group (age, 10 to 14 years). However, in older age group (age, 15 to 19 years), the boys had higher VO2Peak and METMax values and lower VE/VCO2 values than the girls. CONCLUSION: This study provides reference data for CPET variables in case of children and adolescents and will make it easier to use the CPET for clinical decision-making.
Adolescent ; Bacterial Toxins ; Child ; Demography ; Exercise Test ; Heart Diseases ; Humans ; Medical Records ; Metabolic Equivalent ; Oxygen

No abstract available.
Reflex Sympathetic Dystrophy* ; Reflex*

BACKGROUND: Upper airway obstruction is caused by an intrinsic or extrinsic neck mass and vocal cord paralysis. A recognized hazard of prolonged endotracheal intubation is progressive airway occlusion resulting from deposition of secretions. If the obstruction persists, it may be life threatening condition. However, early diagnosis of partial airway obstruction is very difficult because patients are asymptomatic and do not have lesions with abnormal radiological characteristics. METHODS: In the test lung model, lung compliances were set to normal (25 ml/cmH2O; [control, C25 group]) and to levels seen in chronic obstructive pulmonary disease (40 ml/cmH2O; [C40 group]), and acute respiratory distress syndrome (20 ml/cmH2O; [C20 group] and 15 ml/cmH2O; [C15 group]). A ventilator (Drager Fabius GS, Germany) was attached to a test lung, and a series of endotracheal tubes (ETTs) ranging in size from 7.5 to 2.5 mm in inner diameter (ID) of the connector were used to simulate progressive occlusion. During the lung compliance and the connector size were changed, we measured some respiratory mechanics. RESULTS: Progressive ETT occlusion induced an increase in the peak inspiratory pressure. In the C40 group, the inspiratory pause pressure spontaneously increased on repeated ventilation. Auto- positive end-expiratory pressure (Auto-PEEP) was observed under the condition of high compliance and occlusion. Dynamic compliance decreased at an ID of 5.5 mm in all groups. Respiratory resistance was inversely proportional to the ID of the connector. CONCLUSIONS: The dynamic compliance and resistance were significantly changed. However the change of static compliance had little effect on respiratory mechanics.
Airway Obstruction ; Airway Resistance ; Compliance ; Early Diagnosis ; Humans ; Intubation, Intratracheal ; Lung ; Lung Compliance ; Neck ; Positive-Pressure Respiration ; Positive-Pressure Respiration, Intrinsic ; Pulmonary Disease, Chronic Obstructive ; Respiratory Distress Syndrome, Adult ; Respiratory Mechanics ; Ventilation ; Ventilators, Mechanical ; Vocal Cord Paralysis

Complications increases when crown height space is excessive and one should be careful of choosing type of fixed prosthesis in case crown height space is over 12 mm. In this condition, tooth seems to be longer, therefore, it is needed to use gingival shade in aesthetically important area for fixed prosthesis. In this case, fixed prosthesis which has inappropriate maintenance and hygiene could hold food, plaque, calculus, thus increase incidence of inflammation and infection. Moreover, it could lead to chronic inflammation and infection and in that case surgical improvement could be necessary. In present case report, gingival inflammation and swelling developed around prosthesis after having made it considering articulation and aesthetic view in patient who had excessive crown height space. Finding out that design of prosthesis is a factor to make it hard to maintain oral hygiene, a temporary prosthesis which has enough interproximal space and proper emergence profile was fabricated. After two months of observation, significant abnormal symptoms are not found and oral reconstruction is performed using fixed prosthesis with zircornia infrastructure and porcelain build-up based on convenient self hygiene design. Through serial treatment, inappropriate soft tissue response is not observed and satisfactory result in functional aspect comes out.
Calculi ; Crowns ; Dental Porcelain ; Humans ; Hygiene ; Incidence ; Inflammation ; Oral Hygiene ; Prostheses and Implants ; Tooth