PURPOSE: This study addressed the feasibility and effect of surgical treatment of metachronous periampullary carcinoma after resection of the primary extrahepatic bile duct cancer. The performance of this secondary curative surgery is not well-documented. METHODS: We reviewed, retrospectively, the medical records of 10 patients who underwent pancreaticoduodenectomy (PD) for secondary periampullary cancer following extrahepatic bileduct cancer resection from 1995 to 2011. RESULTS: The mean age of the 10 patients at the second operation was 61 years (range, 45-70 years). The primary cancers were 7 hilar cholangiocarcinomas, 2 middle common bile duct cancers, and one cystic duct cancer. The secondary cancers were 8 distal common bile duct cancers and 2 carcinomas of the ampulla of Vater. The second operations were 6 Whipple procedures and 4 pylorus-preserving pancreaticoduodenectomies. The mean interval between primary treatment and metachronous periampullary cancer was 20.6 months (range, 3.4-36.6 months). The distal resection margin after primary resection was positive for high grade dysplasia in one patient. Metachronous tumor was confirmed by periampullary pathology in all cases. Four of the 10 patients had delayed gastric emptying (n = 2) or pancreatic fistula (n = 2) after reoperation. There were no perioperative deaths. Median survival after PD was 44.6 months (range, 8.5-120.5 months). CONCLUSION: Based on the postoperative survival rate, PD may provide an acceptable protocol for resection in patients with metachronous periampullary cancer after resection of the extrahepatic bile duct cancer.
Ampulla of Vater ; Bile Ducts, Extrahepatic* ; Cholangiocarcinoma ; Common Bile Duct ; Cystic Duct ; Gastric Emptying ; Humans ; Medical Records ; Neoplasms, Second Primary ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Pathology ; Reoperation ; Retrospective Studies ; Survival Rate

OBJECTIVES: The purpose of this study was to compare psychological test profiles of psychiatric outpatients with high and low depression/suicide ideation and to identify predictor variables for depression/suicide ideation. METHODS: Component scores of the Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were compared using t-tests. Discriminant analysis was conducted for predictor variables of depression/suicide ideation. RESULTS: Regarding PAI profiles, somatic complaints (SOM), anxiety (ANX), anxiety-related disorder (ARD), depression (DEP), paranoia (PAR), borderline features (BOR), antisocial features (ANT), mania (MAN) drug problems (DRG) scores were significantly elevated in high depression and high suicide ideation groups. Concerning MMPI-2 profiles, the scores of hypochondriasis (Hs), depression (D), hysteria (Hy), psychopathic deviate (Pd), paranoia (Pa), psychasthenia (Pt), schizophrenia (Sc), social introversion (Si) were significantly elevated in these same groups. The PAI and MMPI-2 profile shapes were remarkably similar between high depression and high suicide ideation groups. Therefore, in terms of psychological profile, depression and suicidal ideation seemed to reflect the same construct. However, in discriminant analysis, significant predictors for depression were found to be Pt and D Sc from MMPI-2, while those for suicide ideation were found to be Pa and Sc, suggest subtle differences. CONCLUSION: The superficial characteristics of depression and suicide ideation groups reflected by the psychological test profiles seemed similar, but the determining factors may differ. Thus, the psychological interventions for these two groups may have to follow different routes considering these subtle differences.
Anxiety ; Bipolar Disorder ; Depression ; Discriminant Analysis ; Humans ; Hypochondriasis ; Hysteria ; Introversion (Psychology) ; Minnesota ; Outpatients ; Paranoid Disorders ; Personality Assessment ; Psychological Tests ; Schizophrenia ; Suicidal Ideation ; Suicide

Rotatory fixation of the atlantoaxial joint is relatively rare in adults but somewhat more common in children. Most of them are reduced spontaneously or after traction. However, combined rotatory injury of atlantoaxial joint and unilateral occipitoatlantal subluxation is a rare disease, and it is often difficult to diagnose accurately. Because the craniovertebral junction is complex and patients with combined atlantoaxial rotatory fixation (AARF) and occipitoatlantal subluxation has a less rotated head than patients with pure AARF. And injury of the occipitoatlantal and atlantoaxial joint can often result upper cervical instability, so early diagnosis is very important. We present a case of the combined AARF and unilateral counter occipitoatlantal subluxation after minor trauma.
Adult ; Arthrodesis ; Atlanto-Axial Joint ; Child ; Early Diagnosis ; Head ; Humans ; Organothiophosphorus Compounds ; Rare Diseases ; Traction

BACKGROUND: Recently, the trend pursuing slimness is significantly increasing in adolescents. Because of distorted body image, excessive body weight control can cause problems of health. The goal of this study is to investigate the factors of distorted body image and its problems. METHODS: The survey was performed in a high school of Jindo island on May, 2000. All of 258 students in 1st and 2nd grade participated in this study by questionnaires. Thirteen truthless questionnaires were excluded in this study. Therefore 245 student were selected. RESULTS: Only 20% of 245 repliers were satisfied with their body figure. In male, 24.1% wanted weight loss, and 39.8% wanted weight gain. In female, 73% wanted weight loss. In a populations(BMI<20), 70 males wanted weight loss, whereas 35(52.2%) among 67 females want weight loss. According to these result, female stuedents wanted strongly weight loss than male. The factors which most influenced body figure were sports star in males(36.1%), and movie stars in female.(43.8%) A group of 58.4% of repliers has experienced body weight control. A group of 37% in male and 39.6% in female suffered from side effects. 77% of total hoped to be educated about adequate body weight control method. CONCLUSION: Almost of adolescents dissatisfied with their body figure, Many adolescent who is not obese attempt weight loss, and are sufferd from side effects. Therefore, it is required for effective education about body weight control and social attitude permitting adequate body image.
Adolescent ; Body Image* ; Body Mass Index ; Body Weight ; Education ; Female ; Hope ; Humans ; Male ; Sports ; Weight Gain ; Weight Loss ; Surveys and Questionnaires

Recently, soluble TNF receptor homolog osteoprotegerin (OPG) and its membrane-bound ligand osteoclast differentiation factor (ODF) were found to regulate osteoclast formation and function, and bone metabolism. It is now well established that ODF acts via RANK expressed on hematopoietic osteoclast precursor cells to facilitate their differentiation to osteoclasts, and OPG prevents the formation of osteoclasts by interfering the binding of ODF and RANK. Expression of OPG and ODF was believed to be closely related to the pathogenesis of bone resorption and destruction from osteoporosis, periodontal diseases, malignant bone tumor, and arthritis. The periodontal ligament fibroblasts (PDLF), located between the tooth and tooth socket, has been thought to play an important role in maintaining bone homeostasis of periodontal tissues. However, the exact mechanism by which bone formation and resorption are regulated by PDLF is not well understood. In this study we have prepared primary cultures of human PDLF from periodontium of malaligned tooth extracted due to orthodontic reason, and determined steady state or inflammatory signal-induced OPG and ODF expression using RT-PCR and western blot analysis. OPG and ODF mRNA and protein were expressed constitutively in the PDLF and these expression were slightly increased by osteotropic cytokine IL-1beta. Lipopolysaccharide-treated PDLF showed decrease in OPG mRNA and protein expression, and increase in ODF mRNA and protein expression. These results indicated that PDLF influence the osteoclastogenesis by OPG and ODF expression in the inflammatory situation as well as physiological condition, and thereby pathogenesis of periodontal alveolar bone destruction.
Arthritis ; Blotting, Western ; Bone Resorption ; Fibroblasts* ; Homeostasis ; Humans* ; Metabolism ; Osteoclasts* ; Osteogenesis ; Osteoporosis ; Osteoprotegerin* ; Periodontal Diseases ; Periodontal Ligament* ; Periodontium ; RANK Ligand* ; Receptors, Tumor Necrosis Factor ; RNA, Messenger ; Tooth ; Tooth Socket

Dislodgement of a crown or extension bridge and the loosening of a retainer of a bridge is a serious clinical problem in fixed restoration. Generally these problems are considered to be associated with deformation of the restoration. During biting, the restoration is subjected to complex forces and deforms considerably within the limit of its elasticity. Deformation of the restoration under the occlusal force induces excessive stress in the cement film, which then leads to the cement fracture. Such a fracture may eventually cause loss of the restoration. Because most of the past retention tests for full veneer crown were done without fatigue loading, they were not exactly simulating intraoral environment. And the purpose of this study was to evaluate the effect of cyclic cantilever loading on the retentive strength of full veneer crowns depending on different type of cements and taper of prepared abutment. Steel dies with 8degrees or 16degrees convergence angle were fabricated through milling and crowns with the same method. These dies and crowns were divided into 8 groups. Group 1: 16degrees taper die, cementation with zinc phosphate cement, without loading Group 2: 16'taper die, cementation with zinc phosphate cement, with loading Group 3: 8degrees taper die, cementation with zinc phosphate cement, without loading Group 4: 8degrees taper die, cementation with zinc phosphate cement, with loading Group 5: 16degrees taper die, cementation with Panavia 21, without loading Group 6: 16degrees taper die, cementation with Panavia 21, with loading Group 7: 8degrees taper die, cementation with Panavia 21, without loading Group 8: 8degrees taper die, cementation with Panavia 21, with loading After checking the fit of die and crown, the luting surface of dies and inner surface of crowns were air-abraded for 10 seconds. The crowns were cemented to the dies, with cements mixed ac cording to the manufacturer' s recommendations. A static load of 5 kg was then applied for 10 min utes with static loading device. Twenty-four hours later, group 1,3,5,7 were only thermocycled, group 2,4,6,8 were subjected to cyclic loading after thermocycling. Retentive tests were performed on the Instron machine. From, the finding of this study, the following conclusions were obtained. 1. Panavia 21 showed significantly higher retentive strength than zinc phosphate cement for all groups(p<0.05). 2. There was a significant difference in the retentive strength between 8degrees and 16degrees taper for zinc phosphate cement(p<0.05), but no significant difference for Panavia 21(p>0.05). 3. Cyclic loading significantly decreased the retentive strength for all groups (p<0.05) . 4. For zinc phosphate cement, there was 35% reduction of the retentive strength after loading in the 16degrees taper die, 25% in the 8degrees taper die, and for Panavia 21, 21% in the 16degrees taper die, 18% in the 8degrees taper die.
Bite Force ; Cementation ; Crowns* ; Elasticity ; Fatigue ; Steel ; Zinc ; Zinc Phosphate Cement

Head ; Humans ; Orthognathic Surgery ; Traction

A 5-year-old intact female Persian cat was referred with anorexia and vomiting. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Ultrasonography revealed several findings including uniformly hyperechoic hepatic parenchyma compared to adjacent falciform fat, increased attenuation of the ultrasound beam, and poor visualization of intrahepatic vessel borders. Computed tomography revealed hypoattenuation of the hepatic parenchyma with a radiodensity value of
Animals ; Anorexia ; Cats ; Child, Preschool ; Diagnosis ; Fatty Liver ; Female ; Humans ; Jaundice ; Lipidoses ; Mouth Mucosa ; Physical Examination ; Sclera ; Ultrasonography ; Vomiting

A 5-year-old intact female Persian cat was referred with anorexia and vomiting. Physical examination revealed icterus in the pinna, oral mucosa, and sclera. Ultrasonography revealed several findings including uniformly hyperechoic hepatic parenchyma compared to adjacent falciform fat, increased attenuation of the ultrasound beam, and poor visualization of intrahepatic vessel borders. Computed tomography revealed hypoattenuation of the hepatic parenchyma with a radiodensity value of -60 Hounsfield units. The adjacent intrahepatic vessels appeared hyperattenuated relative to the hepatic parenchyma as if the vessels were contrast-enhanced. Based on ultrasonography and computed tomography results, the cat was tentatively diagnosed as feline hepatic lipidosis.

PURPOSE: Hypothermia has been demonstrated to protect the brain from reperfusion injury in patients suffering from cardiac arrest. We hypothesized that infusion of normal saline at 4 degrees C into the carotid artery (hypothermic carotid arterial flush, HCAF) during cardiac arrest would achieve selective cerebral hypothermia during cardiac arrest and cardiopulmonary resuscitation (CPR), without a detrimental effect on the rate of return of spontaneous circulation (ROSC) or significant impairment of cardiopulmonary function after ROSC. METHODS: Ventricular fibrillation was induced in 18 dogs weighing 12~18 kg, and circulatory arrest was maintained for 9 minutes. The subjects were then resuscitated using open cardiac massage. Group I (n=6) received no normal saline, while the dogs of group II (n=6) and group III (n=6) received infusions of 15 ml/kg and 30 ml/kg of normal saline solution, respectively, at 4 degrees C into both carotid arteries (cephalad) via 18 gauge catheters. RESULTS: Tympanic temperature decreased from 37.7 (37.5~37.7) degrees C to 34 degrees C within 1.2 (1~2) min and 1.0 (1~2) min from the start of HCAF in groups II and III, respectively. Thereafter, tympanic temperatures were maintained below 34 degrees C to 7.7 (1.5~14.5) min and 21.2 (12~37) min, respectively, from the start of HCAF in groups II and III. There were no significant differences in CPR-related variables or post-ROSC hemodynamic and laboratory variables between the two groups. CONCLUSION: HCAF rapidly induces selective cerebral hypothermia without detrimental effects on the rate of ROSC or significant impairment of cardiopulmonary function after ROSC.
Animals ; Brain ; Cardiopulmonary Resuscitation ; Carotid Arteries ; Catheters ; Dogs ; Heart Arrest* ; Heart Massage ; Hemodynamics ; Humans ; Hypothermia* ; Reperfusion Injury ; Sodium Chloride ; Ventricular Fibrillation