The surgical reconstruction of complex facial injuries have focused on the following; early one-stage repair, exposure of all fracture fragments, precise anatomic rigid fixation, immediate bone grafting, and definite soft tissue management were the main surgical procedures, as in other facial bone injuries. Complex facial bone fractures involving dentition should be managed by the same principles. However, conventional methods can not achieve accurate preinjury occlusion when there are unstable fracture segments, edentulous state, or complex palatal/maxillary and mandibular fractures. Seventeen patients were surgically reconstructed in conjunction with dental impression, model surgery, and fabrication of dental splints to establish better occlusion. Among the facial fractures that had the occlusal problem, maxillary/palatal fractures and complex mandibular fractures, were the major indications for fabrication of acrylic splints. During operation, fracture segments were reduced and repositioned according to dental wear facets of the prefabricated occlusal splint and then temporary intermaxillary fixations were performed. This allowed us to accomplish precise anatomical reduction and rigid intrenal fixations. The postoperative occlusions were acceptible and no complication occurred as direct effects of dental splint. We suggest that fabrication of an acrylic occlusal splint is necessary for the management of complex facial injuries involving dentition.
Bone Transplantation ; Dentition ; Facial Bones ; Facial Injuries* ; Humans ; Mandibular Fractures ; Occlusal Splints ; Splints* ; Tooth Wear

An incidentally detected transposition of the inferior vena cava in patient with gall bladder carcinoma isreported with discussion of findings of CT scan and review of anomalies of the inferior vena cava. Since anomalousvena cava may simulate any other abnormality such as metastatic disease, it is very important to know anomaly ofthe vena vaca with understanding of its embryological back ground.
Humans ; Tomography, X-Ray Computed ; Urinary Bladder ; Vena Cava, Inferior

The treatment of facial bone fractures aims at restoring normal anatomical feature and obtaining the physiologic function by accurate fracture reduction and adequate stability. Among various facial bone fractures, displaced mandibular angle and subcondylar fractures are common injuries. Their structural problems such as increased risk of oromasticatory dysfunction and aesthetic drawbacks can be corrected by surgical treatment. In case of displaced comminuted fracture of zygoma, the zygomatic arch should be reduced and rigidly fixed, because it can be used as a key landmark for reconstruction. In case of these fractures, we performed external incision and conventional bicoronal incision to repair mandibular fractures and expose zygomatic arch. However, there are some disadvantages associated with these extensive incisions: a possible facial nerve injury, prolonged massive swelling, noticeable external scarring and increased risk of blood loss. On the other hand, the intraoral incision approach for mandibular angle, subcondyle and zygomatic arch makes possible the anatomic reduction and rigid internal fixation by using a trocar method concomitantly, which requires only an additional small skin incision over the perpendicular point of the fracture site. Additionally, this approach has several advantages, including decreased possibility of facial nerve injury, decreased blood loss, early subsidence of postoperative swelling and minimal external scarring. From March 1997 to November 1999, we used the trocar method for the treatment of various facial bone fractures of 15 males and 3 female patients (age ranged from 17 to 60 years). In this approach, operative endoscope or C-arm was used concomitantly in order to improve the limited operative visual field and to allow surgical access. The use of trocar method through the intraoral and tiny skin incisions provides the accurate reduction and rigid internal fixation. It is considered a good method to minimize the disadvantages of external approaches for the treatment of various facial bone fractures.
Cicatrix ; Endoscopes ; Facial Bones* ; Facial Nerve Injuries ; Female ; Fractures, Comminuted ; Hand ; Humans ; Male ; Mandibular Fractures ; Skin ; Surgical Instruments* ; Visual Fields ; Zygoma

PURPOSE: Multiple rib fracture (MRF) and a hemopneumothorax accompany with most blunt chest traumas. We aimed to analyze the factors increasing the probability of a hemopneumothorax. In addition, other injuries accompanying MRF were analyzed. METHODS: We retrospectively reviewed the medical records of 154 mutiple rib fracture patients who visited our hospital between January 2005 and December 2007. The medical records were reviewed for sex, age, mechanism of injury, location, number of fractures, distance of dislocated rib fragments, and presence of complications. We measured the distance of bony dislocations by using the PACS (Picture Archiving and Communication System). RESULTS: The average number of rib fractures was 3.7+/-2.1, and the number of rib fractures significantly influenced the incidence of a hemothorax (p<0.001). The risk of a phemothorax was increased in a bilateral MRF compared to a unilateral MRF (p=0.027). The distance of dislocated rib fragments influenced the probability of a hemothorax significantly (p=0.018), and subcutaneous emphysema and lung contusion were significantly associated with a pneumothorax (p=0.021, p=0.036). CONCLUSION: The number of MRFs did not influence the risk for a pneumothorax, but did influence the risk for a hemothorax. The laterality, distance of dislocation, also had an influence on the risk for a hemothorax. Also, subcutaneous emphysema and lung contusion were increased in cases with a pneumothorax. We must consider the possibility of a hemothorax even when the initial chest X-ray shows no evidence of a hemothorax. If a lung contusion is present, then an occult pneumothorax must be considered.
Contusions ; Dislocations ; Hemopneumothorax ; Hemothorax ; Humans ; Incidence ; Lung ; Medical Records ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Ribs ; Subcutaneous Emphysema ; Thorax

OBJECTIVE: To evaluate the neuroprotective effect of growth hormone (GH) following lateral fluid percussion brain injury. METHOD: Sprague-Dawley rats weighing 200~250 g were subjected to moderate lateral fluid percussion brain injury and evaluated at 1, 7, 14 and 28 days post-injury. Rats were divided into control and GH pretreatment groups. GH (10 microgram/10microliter) or normal saline (10microgram/10microliter) was administered by intracerebro-ventricular injection 30 min before brain injury. We measured histopathological changes with TUNEL and toluidine blue Nissl stain and conducted motor function tests and an 8-arm radial maze test to identify neurobehavioral deficits and cognitive deficits, respectively, at one day to 4 weeks post-injury. RESULTS: In the pretreated GH group, a significant reduction in TUNEL-positive cells was found compared with the control group at 1 day and 1 week post-injury (p<0.05). The pretreated GH group showed significantly greater improvement than controls motor function tests at 1 day post-injury (p<0.05) and in an 8-arm radial maze test at 2 and 4 weeks post-injury (p<0.05). CONCLUSION: These findings suggested that GH had a neuroprotective effect in neuronal cell death, motor function and cognitive deficits following experimental brain injury.
Animals ; Brain Injuries ; Brain* ; Cell Death ; Growth Hormone* ; In Situ Nick-End Labeling ; Neurons ; Neuroprotective Agents* ; Percussion ; Rats ; Rats, Sprague-Dawley ; Tolonium Chloride

BACKGROUND: Although the polyproteins of hepatitis C virus(HCV) are processed and formed in nearly equimolar amounts, individual functional proteins have a discrepancy in their time of appearance following HCV infection and eliciting immune response. This study was conducted to compare the reactivity toward regional specific HCV protein in relation to virological characteristics, including HCV genotype and HCV replication. METHODS: Sera from forty-five patients with chronic HCV infection were analyzed through the experiments of the recombinant immunoblot assay(RIBA-2), HCV genotyping and HCV RNA quantitation. RESULTS: The frequencies of seropositivity to C22-3, C33C, C100-3 and 5-1-1 proteins were 91.1+ACU-, 91.1+ACU-, 64.4+ACU- and 53.3+ACU-, respectively, of all the patients, and thus the antibodies to C22-3 and C33C proteins were found more frequently (p +ADw- 0.05). The antibody responses between core or NS3 proteins and NS4 proteins showed more discrepancy in the HCC group than that in the CH group, implying a possibility of oncogenic potential of core or NS3 gene in hepatocarcinogenesis. The detection rate of antibodies to C22-3 and C33C, in accordance with serum HCV RNA levels, was significantly higher in highly viremic patients than that in low viremic patients (p +ADw- 0.05). Antibodies to C22-3, C33C, C100-3 and 5-1-1 were also found more frequently in patients with HCV genotype 1b, compared to those with HCV genotype 2a (p +ADw- 0.05). CONCLUSION: These results suggest that antibody detection of HCV may depend on the virological characteristics of HCV, the levels of HCV replication and HCV genotype and, therefore, HCV RNA detection using RT-PCR technique is essential for confirmatory diagnosis for HCV infection. Furthermore, the HCV core or NS3 Protein may play important role in hepatocarcinogenesis.
Adult ; Aged ; Female ; Genotype ; Hepatitis C Antibodies/blood+ACo- ; Hepatitis C, Chronic/virology ; Hepatitis C, Chronic/immunology+ACo- ; Hepatitis C-Like Viruses/physiology ; Hepatitis C-Like Viruses/genetics ; Human ; Male ; Middle Age ; RNA, Viral/blood ; Viral Core Proteins/immunology+ACo- ; Viral Nonstructural Proteins/immunology+ACo- ; Virus Replication

BACKGROUND: Immunosuppressive agents with higher potencies, such as tacrolimus and mycophenolate mofetil (MMF), have been introduced and widely accepted in clinical practice. This study evaluated the impact of these newer immunosuppressive drugs on the pattern and timing of post-kidney transplantation infections. METHODS: Data of kidney transplant recipients at the Seoul National University Hospital between January 1990 and November 2005 were analyzed. Recipients were divided into double immunosuppression (double group, n=198), triple immunosuppression including MMF (MMF group, n=253), and azathioprine (AZA, n=184) groups. RESULTS: The MMF group demonstrated higher graft survival and reduced rates of acute rejection within the fifth post-transplant year than both the AZA (P<0.001) and the double (P<0.001) groups. The overall incidence of infection in the first month was significantly higher in the MMF group (2.17/1,000 transplant-days) than in the AZA (0.73/1,000 transplant-days) and double (0.84/1,000 transplant-days) groups (P=0.01, ANOVA), and this was caused by viral infections that were significantly higher in the MMF (1.57/1,000 transplant-days) group than in the AZA (0.54/1,000 transplant-days) and double (0.67/1,000 transplant-days) groups. MMF was identified as a significant risk factor for viral infection (P=0.013; OR, 2.04; 95% CI, 1.16-3.60) in a multivariate logistic regression analysis. CONCLUSIONS: The results suggest that viral infection rates were higher in the MMF group and should be considered the primary source of perioperative infectious complications in MMF-receiving recipients.
Azathioprine ; Graft Rejection ; Graft Survival ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Logistic Models ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Tacrolimus ; Transplants ; Viruses

PURPOSE: This study was undertaken to evaluate the prognostic factors for patients suffering with alcoholic ketoacidosis. METHODS: We retrospectively evaluated and categorized 55 alcoholic ketoacidosis patients into two groups: the survivors (group 1) and non-survivors (group 2). We compared the general characteristics and the laboratory results, including the arterial blood gas analysis (ABGA) and the complications of the two groups, and we assessed the severity of the between the two groups by using the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Simplified Acute Physiology Score (SAPS). RESULTS: There were 50 male patients (90%) and 5 female patients (10%). On laboratory testing, the levels of arterial HCO3-, total protein, albumin and serum glucose were significantly lower in group 2 than that in group 1. The levels of total bilirubin and BUN (blood urea nitrogen), the PT (prothrombin time) and the aPTT (activated partial thromboplastin time) were significantly higher in group 2 than that in group 1. Serial ABGA follow-up showed that unimproved ABGA results meant a poor prognosis. The SAPS was significantly higher for group 2 than that for group 1 (p<0.001) but the APACHE II was not significantly different. The incidence of hepatic encephalopathy, hepatic failure and acute respiratory distress syndrome (ARDS) were higher in group 2 than that in group 1. The total bilirubin, arterial HCO3- and albumin were found to be significant prognostic factors by logistic regression analysis. CONCLUSION: The poor prognostic factors for alcoholic ketoacidosis were low levels of arterial HCO3-, impaired hepatic function, the incidence of ARDS and unimproved ABGA results.
Alcoholics ; Alcoholism ; APACHE ; Bilirubin ; Blood Gas Analysis ; Female ; Follow-Up Studies ; Glucose ; Hepatic Encephalopathy ; Humans ; Incidence ; Ketosis ; Liver Failure ; Logistic Models ; Male ; Prognosis ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Stress, Psychological ; Survivors ; Thromboplastin ; Urea

No abstract available.
Lung Neoplasms* ; Lung* ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 1*

PURPOSE: Venomous snakebite is an important medical emergency in Korea, but the factors affecting outcomes are unclear. METHODS: We conducted an 8-year retrospective study of 169 snake bite patients who visited the emergency departments of Keimyung University at Dongsan Medical Center between January, 2000, and December, 2007. Patients were divided by systemic symptoms and complications (group 1) or local symptoms only (group 2). We compared the general characteristics and clinical and laboratory findings of the two groups. RESULTS: The male to female ratio was 1.19. The most common systemic symptom was dizziness (7.6%), and the most common complication was rhabdomyolysis (23.6%). Distal bite sites (finger, toe) in group 1 occurred in 20 (35.7%) cases, and proximal (hand, foot, ankle, arm, calf, perianal area) in 36 (64.3%) cases (p<0.05). The median interval from envenomation to hospital visit was 6.0 (0.3-96.0) h in group 1, which was longer than group 2 (p<0.05). Among 33 (19.5%) patients with local effect scores of 9~16, 25 (75.8%) patients had systemic symptoms and complications. The local effect scores and the interval from bite to antivenin treatment in the hospital were significant risk factors for systemic symptoms and complications in logistic regression analysis. CONCLUSION: Snakebite poisoning is an emergency and we must evaluate risk factors to prevent the development of serious complications.
Animals ; Ankle ; Arm ; Bites and Stings ; Dizziness ; Emergencies ; Female ; Foot ; Humans ; Korea ; Logistic Models ; Male ; Retrospective Studies ; Rhabdomyolysis ; Risk Factors ; Snake Bites ; Snakes ; Venoms