The most common cause of small bowel obstruction is postoperative adhesion, and besides a hernia, metastatic or primary cancer and small bowel tumors are possible causes. Superior mesenteric artery (SMA) syndrome is a rare cause of upper gastrointestinal obstruction and is associated with debilitating conditions with marked weight loss. SMA syndrome results from the compression of the third part of the duodenum due to the narrowing of the aortomesenteric angle. We report a 28-year-old woman with SMA syndrome after acute gastroenteritis. Her stomach was severely dilated due to the duodenal obstruction and computed tomography showed the compression of the third portion of the duodenum by SMA. She was conservatively cared for and thus favorably improved.
Adult ; Duodenal Obstruction ; Duodenum ; Female ; Gastroenteritis ; Hernia ; Humans ; Mesenteric Artery, Superior ; Stomach ; Superior Mesenteric Artery Syndrome ; Weight Loss

Purpose: The purpose of present study was to evaluate the effect of changing structural stability of wax disc on the fit of prosthesis when the milling proceeded in order. Materials and methods: Prepared maxillary left first molar was used to fabricate a Ni-Cr alloy reference model. This was scanned to design crown and then wax pattern was milled, invested and cast to fabricate prosthesis. The wax patterns located in a row centrally within a single wax disc were set into a total of five groups ranging from WM1 group that was first milled to WM5 group that was last milled and the number of each group was set as 10. Silicone replica technique was used to measure the marginal gap, axial internal gap, line angle internal gap, occlusal internal gap. Data was evaluated with one-way ANOVA with significance level set at α = .05 and then Tukey HSD test was conducted for post analysis. Results: Marginal gap measured in each group, it was 40.41 ± 2.15 µm in WM1group, 40.44 ± 2.23 µm in WM2 group, 39.96 ± 2.25 µm in WM3 group, 39.96 ± 2.48 µm in WM4 group, and 40.57 ± 2.53 µm in WM5 group. No significant difference was found between groups. The significant difference between the groups was also not found in the axial internal gap, line angle internal gap, and occlusal internal gap. Conclusion Internal and marginal fit of single crown to the sequential order of milling processing in the single machinable wax disc did not seem to be affected by the sequence.

No abstract available.
Antibodies* ; Kidney Transplantation* ; Kidney*

BACKGROUND: The optimal immunosuppressive strategy for renal transplant recipients at high immunological risk requires clarification. We compared the 3 year outcomes of a sirolimus group (tacrolimus plus sirolimus) to those of a control group (tacrolimus plus mycophenolate mofetil). METHODS: This observational study was an extension of a prospective pilot study. We assessed acute rejection, glomerular filtration rate, adverse events, graft, and patient survival. RESULTS: Overall, 43% of the sirolimus group versus 78% of the control group were still on the initial immunosuppressive regimen at 3 years (P=0.005), and most discontinuations in each group were due to adverse events. No differences were observed between two groups with respect to acute rejection. The mean glomerular filtration rate at 36 months was greater in the sirolimus group than in the control group, but this was not statistically significant (64.0±6.8 mL/min/1.73 m² vs. 61.8±17.1 mL/min/1.73 m², P=0.576). Graft and patient survival were similar in both groups. Importantly, mean tacrolimus through levels were significantly lower in the sirolimus group than in the control group at each time point. No neoplasm was reported in the sirolimus group. In the control group, three cases of neoplasms developed during the study period. CONCLUSIONS: The sirolimus group had a greater number of discontinuations, particularly related to adverse events. Nevertheless, optimal concentration of sirolimus allowed reduced calcineurin inhibitor exposure in high immunologic risk patients, without increasing the risk of acute rejection and graft failure.
Calcineurin ; Glomerular Filtration Rate ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Observational Study ; Pilot Projects ; Prospective Studies ; Sirolimus* ; Tacrolimus* ; Transplant Recipients* ; Transplants

The evaluation of occlusion using digital methods is easier and simpler in terms of recording, comparison, analysis, and objectivity compared to existing methods such as articulating paper and occlusion foil. The purpose of this case report was utilizing the digital method for evaluating occlusion. The occlusion of patient requiring full veneer crown restoration was evaluated using an intraoral scanner (i500, Medit, Seoul, Korea) at every visit. The occlusion was also assessed using conventional articulating paper and a digital occlusal analysis system (Dental prescale II, GC corp., Tokyo, Japan) for comparison. Throughout the treatment process, the intraoral scanner and the conventional articulating paper method showed similar outcomes. The results suggest that the use of digital evaluation system is highly probable in the near future.

The evaluation of occlusion using digital methods is easier and simpler in terms of recording, comparison, analysis, and objectivity compared to existing methods such as articulating paper and occlusion foil. The purpose of this case report was utilizing the digital method for evaluating occlusion. The occlusion of patient requiring full veneer crown restoration was evaluated using an intraoral scanner (i500, Medit, Seoul, Korea) at every visit. The occlusion was also assessed using conventional articulating paper and a digital occlusal analysis system (Dental prescale II, GC corp., Tokyo, Japan) for comparison. Throughout the treatment process, the intraoral scanner and the conventional articulating paper method showed similar outcomes. The results suggest that the use of digital evaluation system is highly probable in the near future.

OBJECTIVE: To determine abnormal MRI findings in adults hospitalized with acute severe axial LBP. METHOD: Sixty patients with back pain were divided into 3 groups consisting of 1) 23 adults with acute axial severe LBP who could not sit up or stand up for several days, but had not experienced previous back-related diseases or trauma (group A), 2) 19 adults who had been involved in a minor traffic accident, and had mild symptoms but not limited mobility (group B), and 3) 18 adults with LBP with radicular pain (group C)., Various MRI findings were assessed among the above 3 groups and compared as follows: disc herniation (protrusion, extrusion), lumbar disc degeneration (LDD), annular tear, high intensity zone (HIZ), and endplate changes. RESULTS: The MRI findings of A group were as follows: disc herniation (87%), LDD (100%), annular tear (100%), HIZ (61%), and end plate changes (4.4%). The findings of disc herniation, annular tear, HIZ, and LDD were more prevalent in A group than in B group (p<0.01). HIZ findings were more prevalent in A group than in group B or group C (p<0.05). CONCLUSION: Patients with acute severe axial LBP were more likely to have disc herniation, LDD, annular tear, HIZ. Among LBP groups, there was a significant association of HIZ on MRI with acute severe axial LBP.
Accidents, Traffic ; Adult ; Back Pain ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets

PURPOSE: Post-transplant diabetes mellitus (PTDM) is believed to cause serious complications. PTDM might be one of the important risk factors of cardiovascular death after renal transplantation. Because the consequence of PTDM is expected to take long time, long-term follow-up is necessary. We performed this study not only to define the prevalence and risk factors of PTDM but also to define the long-term clinical impact of PTDM. METHODS: Among 508 patients who had received renal transplantation at Seoul National University Hospital between July 1969 and December 1995, 431 patients were included. Patients were grouped into PTDM and non-DM groups. The clinical characteristics were compared between two groups. RESULTS: Mean follow-up duration was 121.9 months (2~346 months). PTDM was developed in 68 (15.8%) patients. Recipient age at transplantation (P=0.004), family history of DM (P=0.000) and obesity (P= 0.000) were significant risk factors in multivariate analysis. Complications of PTDM such as cerebrovascular disease (CVD, P=0.040), ischemic heart disease (IHD, P=0.040), and infection (p=0.044) were significantly more frequent in PTDM group. The frequency of chronic allograft nephropathy (CAN) was not different between two groups. Although graft survival rate was not affected by PTDM, patient survival rate was significantly lower in PTDM group (P=0.002). CONCLUSION: PTDM increased complication rates such as CVD, IHD and infection. PTDM seemed not to affect graft survival, but to worsen the patient survival rate.
Allografts ; Cardiovascular Diseases ; Diabetes Mellitus* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Myocardial Ischemia ; Obesity ; Prevalence ; Risk Factors ; Seoul ; Survival Rate ; Transplantation*

Recurrent macrophage activation syndrome (MAS) is very rare. We present the case of an adolescent boy with human leukocyte antigen (HLA) B27-positive ankylosing spondylitis (AS), who experienced episodes of recurrent MAS since he was a toddler. A 16-year-old boy was admitted because of remittent fever with pancytopenia and splenomegaly after surgical intervention for an intractable perianal abscess. He had been diagnosed with hemophagocytic lymphohistiocytosis (HLH) 4 different times, which was well controlled with intravenous immunoglobulin and steroids since the age of 3. We were unable to identify the cause for the HLH. He remained symptom-free until the development of back pain and right ankle joint pain with swelling at 15 years of age. He was diagnosed with HLA B27-positive AS with bilateral active sacroiliitis. He showed symptom aggravation despite taking naproxen and methotrexate, and the symptoms improved with etanercept. On admission, his laboratory data showed leukopenia with high ferritin and triglyceride levels. Bone marrow biopsy examination showed histiocytic hyperplasia with hemophagocytosis. There was no evidence of infection. He received naproxen alone, and his symptoms and laboratory data improved without any other immunomodulatory medications. Genetic study revealed no primary HLH or inflammasome abnormalities. In this case, underlying autoimmune disease should have been considered as the cause of recurrent MAS in the young patient once primary HLH was excluded.
Abscess ; Adolescent* ; Ankle Joint ; Autoimmune Diseases ; Back Pain ; Biopsy ; Bone Marrow ; Etanercept ; Ferritins ; HLA-B27 Antigen ; Humans ; Hyperplasia ; Immunoglobulins ; Inflammasomes ; Leukocytes ; Leukopenia ; Lymphohistiocytosis, Hemophagocytic ; Macrophage Activation Syndrome* ; Macrophage Activation* ; Macrophages* ; Malaria ; Male* ; Methotrexate ; Naproxen ; Pancytopenia ; Sacroiliitis ; Splenomegaly ; Spondylitis, Ankylosing* ; Steroids ; Triglycerides

Most patients experiencing an osteoporotic vertebral compression fracture remain asymptomatic or minimally symptomatic. However, a notable number of these patients do experience significant pain at some time resulting in disability and decreased quality of life. A 77-year-old man was admitted to a hospital with severe thoracolumbar pain and functional disabilities even though, 12 months ago, he had received inpatient treatment for 6 months in another hospital with the diagnosis of T12 vertebral compression fracture. Although initial outside spine MRI revealed a stable T12 com pression fracture with a 27.6% compression rate, delayed subsequent re-fracture of the same vertebrae was found on simple X-ray and thoracolumbar CT scan with an 86.5% compression rate and retropulsion to the central spinal canal. He continued to have severe spinal pain and functional disabilities in spite of undergoing a first anterolateral fusion one year ago and a subsequent posterior fusion. We emphasize a proper clinical and radiologic examination at one-year follow-up after successful conservative treatment of vertebral compression fractures.
Aged ; Follow-Up Studies ; Fractures, Compression ; Humans ; Inpatients ; Quality of Life ; Spinal Canal ; Spine