Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.
Biomarkers* ; Diving ; Epidemiologic Studies* ; Epidemiology ; Hyperlipidemias ; Osteonecrosis* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Protein S ; Risk Factors ; Thrombophilia

PURPOSE: The purpose of this study is to evaluate the CT and MR findings of brain absecss with emphasis on the thickeness and signal intensity of abscess wall. MATERIALS AND METHODS: Twenty CT scans and seven MR studies of 23 patients with brain abscess (27 abscesses) were retrospectively reviewed with respect to thickeness and signal intensity of abscess wall, shape and size of abscess, etc. Thickness of abscess wall was measured in the greatest abscess diameter on the CT scans and MR images obtaihed after intravenous administration of contrast material. RESULTS: Enhancing abscess wall was 2mm--6mm (average 3mm) thick. The abscess wall was uniform in thickness in 14 cases (52%), thinner in the roedial wall than lateral wall in 8 cases (30%), and thicker in the medial wall than lateral wall in 5 cases (18%). Signal intensity of abscess wall was isointense relative to gray matter on Tl-weighted MR images and hypointense on both proton- and T2-weighted MR images in 7 out of 8 lesione (88%). The inner margin of the abscess wall was smooth in 14 (52%) and irregular in 13 lesions (48%). The outer margin was smooth in 15 (55%) and irregular in 12 lesions (45%). The size of the abscesses was variable, ranging from lcm to 6cm in diameter. They were round (16 cases), elliptical (6 cases), or multilobulated (5 cases) in shape. Satellite or daughter abscesses were found in 5 patients. CONCLUSION: Abscess wall showed variable thickness in the medial and lateral walls with no specific findings. Other CT and MR findings were also nonspecific, although hypointensity of abscess wall on T2-weighted MR images may be helpful in diagnosis of brain abscess.
Abscess* ; Administration, Intravenous ; Brain Abscess* ; Brain* ; Diagnosis ; Humans ; Nuclear Family ; Retrospective Studies ; Tomography, X-Ray Computed

The authors developed a biodegradable polymer that releases an antibiotic (nalidixic acid) slowly and continuously, for prevention of catheter-induced infection during drainage of cerebrospinal fluid. We investigated the in vitro antibiotic releasing characteristics and bacterial killing effects of the new polymer against E. coli. The novel fluoroquinolone polymer was prepared using diisopropylcarbodiimide, poly (e-capro-lactone) diol, and nalidixic acid. FT-IR, mass spectrometry, and elemental analysis proved that the novel antibacterial polymer was prepared successfully without any side products. Negative MS showed that the released drug has a similar molecular weight (M.W.=232, 350) to pure drug (M.W.=232). In high pressure liquid chromatography, the released drug and drug-oligomer showed similar retention times (about 4.5-5 min) in comparison to pure drug (4.5 min). The released nalidixic acid and nalidixic acid derivatives have antibacterial characteristics against E. Coli, Staphylococcus aureus, and Salmonella typhi, of more than 3 months duration. This study suggests the possibility of applying this new polymer to manufacture drainage catheters that resist catheter-induced infection, by delivering antibiotics for a longer period of more than 1 month.
Anti-Bacterial Agents/*administration & dosage ; Biodegradation ; Biofilms ; Catheterization/*adverse effects ; Cerebrospinal Fluid/*physiology ; Chromatography, High Pressure Liquid ; Drainage/*adverse effects ; *Drug Delivery Systems ; Humans ; Nalidixic Acid/*administration & dosage ; Polymers/administration & dosage ; Research Support, Non-U.S. Gov't ; Spectrum Analysis, Mass

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis. OVERVIEW OF LITERATURE: Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated. METHODS: A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually. RESULTS: Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions. CONCLUSIONS: The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.
Aged ; Constriction, Pathologic ; Humans ; Incidence ; Magnetic Resonance Imaging ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine

PURPOSE: We studied the usefullness of intravenous administration of contrast material to facilitate in situ shock wave lithotripsy(SWL) of ureteral stones in cases that stone localization was difficult as radioluscent, less radiodense, small stone, and interference with visualization by bone or intestinal gas. MATERIALS AND METHODS: From March 1992 to June 1997 we treated 831 patients with ureteral stone by in-situ SWL using EDAP-LT02 piezoelectric lithotriptor which utilizes ultrasono and fluroscopy for stone localization. Among 831 patients, intravenous contrast material were used in 53 cases to facilitate stone localization during SWL treatments. To evaluate the effectiveness of stone localization by the assistance of intravenous contrast media we compared success rate, storages, treatment sessions, durations, and side effects of two groups with or without intravenous contrast material, based on the location and the size of stones. RESULTS: Among 53 patients, stone was localized without ureteral catheterization in 5.7%(25/437) of upper ureteral stone, 18.2%(18/99) of mid-ureteral stone, and 3.4%(10/295) of lower ureteral stone after administration of intravenous contrast material. There were no significant differences in success rate, storages, treatment sessions, and durations(p>0.05). There were no significant complications except dye hypersensitivity in two patients, who were managed conservatively. CONCLUSIONS: The administration of intravenous contrast material during SWL allows effective localization of ureteral stones that otherwise could not be imaged adequately without ureteral catheterization. We believe that the use of intravenous contrast material for localization of ureteral stone in SWL have the benefits of inexpensiveness, noninvasiveness, and painlessness.
Administration, Intravenous ; Contrast Media ; Humans ; Hypersensitivity ; Shock ; Ureter* ; Urinary Catheterization ; Urinary Catheters

Dentin hypersensitivity must be one of the most frequent postoperative complaints in periodontal patients. Obliterating the open dentinal tubules or decreasing the diameter of their orifices would, therefore, be an objective of treatment for hypersensitive teeth. The purpose of this study was to evaluate the effect of a pulsed Nd:YAG laser irradiation on obliteration of dentinal tubules and to determine any difference according to irradiation methods. The 45 posterior teeth that had been extracted due to periodontal disease were initially treated with tetracycline HCl(100 mg/ml, 4 min.) to remove the smear layer after root planing. The root surfaces were then irradiated by a pulsed Nd:YAG laser(EL.EN.EN060, Italy) by different laser beam spot size and different exposure condition; group 1: irradiated group by small spot(beam diameter=1mm, 1W, 2 sec) group 2: irradiated group by large spot(beam diameter=10mm, 1W, 200 sec) group 3: irradiated group by gradual increase of watt(from 0.3W to 1.0W), beam diameter=4mm group 4: irradiated group by fixed watt(1.0 W), beam diameter= 4mm control group: no irradiation but root planing and tetracycline HCl conditioning only. Additionally, the specimens were retreated with tetracycline HCl(100mg/ml, 4min.) to evaluate the stability of obliteration effect by Nd:YAG laser. Specimens were examined under the scanning electron microscope(JEOL, JSM-840A, Japan). Photomicrographs were taken at x4,000 magnification and were analyzed statistically. The results were as follows; 1. Scanning electron micrographs of root surface treated by tetracycline HCl alone(control group) showed widened, funnel-shaped dentinal tubules, while those of the root surface irradiated by various methods showed partially or completely obliterated dentinal tubules and various surface alterations, eg, flat, multiple pitted, melted and resolidified surface at the same energy density. 2. There was no significant difference in the obliteration effect of dentinal tubules between group 1 and group 2, and between group 3 and group 4(p>0.05). 3. The obliteration effect of dentinal tubules by a Nd:YAG laser irradiation was relatively stable to tetracycline HCl. The results demonstrate that a pulsed Nd:YAG laser irradiation within 1.0W, regardless of irradiation methods, can obliterate dentinal tubules effectively.
Dentin Sensitivity ; Dentin* ; Humans ; Periodontal Diseases ; Root Planing ; Smear Layer ; Tetracycline ; Tooth

The purpose of this study was to evaluate the abrasion-resistance of root surface after NaF iontophoresis, Nd:YAG laser irradiation and combined treatment 50 anterior teeth with flat interproximal root surface that had been extracted due to periodontal destruction were selected. All teeth were treated by the same procedure as conventional periodontal root treatment, such as scaling and root planing, root conditioning with tetracycline HCl(100mg/ml, 5min). The pre-treatment weight of each tooth was measured by a dial scale(SHIMADEU Co., LIBROR EB-220HU, capacity 220.000 g, Japan). All teeth were divided into 5 groups as follows; Nd:YAG laser irradiation(group 1, 1 W, 100 mJ, 10Hz, fiberoptic-root surface distance=5mm, 10 sec.x6times, EL.EN.EN060, Italy); NaF iontophoresis(group 2, 150micronA, 4 min.); Nd:YAG laser irradiation following NaF iontophoresis(group 3); NaF iontophoresis following Nd:YAG laser irradiation(group 4); No treatment(control group). Electric toothbrushing (Oral-B, Brown Co., Germany) was conducted during 1 hour(10 min.x6 times). Subsequently post-treatment weight was remeasured by the same method as pre-treatment weight measurement. The difference of abrasion rate among all groups was statistically analyzed by ANOVA(SAS program). Following results were obtained; 1. The abrasion rate was significantly lower in Nd:YAG laser irradiation group than NaF iontophoresis group(p < 0.001). 2. The abrasion rate was significantly lower in combined groups of Nd:YAG laser irradiation and NaF iontophoresis than either Nd:YAG laser irradiation group or NaF iontophoresis group(p < 0.001). 3. There was no significant difference in abrasion rate according to application order in the combined groups(p > 0.05). 4. The abrasion rate was significantly lower in all experimental groups than control group(p < 0.001). The results suggest that combined treatment of Nd:YAG laser irradiation and NaF iontophoresis on exposed root surface after periodontal therapy can enhance the abrasion-resistance of root surface and may inhibit the root caries development.
Iontophoresis* ; Root Caries ; Root Planing ; Tetracycline ; Tooth ; Toothbrushing

PURPOSE: It is very important to evaluate and fix coronoid process fractures because they are a critical element for a stable, effective elbow function. The lateral view of the elbow joint is used for a radiographic evaluation of the coronoid but an understanding of the fracture pattern is often difficult because of overlap of the radial head and obliquity of the fracture line. We developed the coronoid view, which is a new radiograph for an evaluation of the coronoid process fracture, and discuss its advantages for a postoperative follow-up. MATERIALS AND METHODS: The coronoid view was designed for an evaluation of the anteromedial fragment of the coronoid process. After the patient sat on his side, the shoulder was abducted 45degrees and the elbow was flexed 90degrees The X-ray beam was shot perpendicular to the table. Since shoulder was abducted 45degrees the fracture line of the coronoid process can be parallel to the X-ray beam, and the radial head can be cleared. CONCLUSION: The coronoid view can be a good alternative radiograph for an evaluation of a coronoid process fracture because the beam is parallel to the fracture line. The coronoid view can be particularly useful in postoperative patient follow-up where computed tomography is impractical due to metal implants and cost.
Elbow ; Elbow Joint ; Follow-Up Studies ; Head ; Humans ; Shoulder

Periodontal disease and/or loss of teeth brings pathologic tooth migration that can result in esthetic and occlusal problems. Diastema and general spacing of the teeth, particularly in the anterior segments of the dentition are frequently developed in individuals with advanced periodontal disease. Thus, the overall treatment plan for a patient with advanced periodontal disease often involves periodontal orthodontic combined therapy. Orthodontic treatment in adults with periodontal disease is restricted to tooth alignment with special caution. Indirect bonding can achieve accurate bracket placement. A 38 year old woman with adult periodontitis was treated by periodontal therapy. Subsequently, her diastema was orthodontically corrected by indirect bonding technique. It must be an appropriate case report of periodontal-orthodontic combined therapy.
Adult ; Chronic Periodontitis ; Dentition ; Diastema ; Female ; Humans ; Periodontal Diseases ; Periodontitis* ; Tooth ; Tooth Migration

Embryonal cell carcinoma of the testes in infants are rare tumors of germ cell origin consisting of undifferentiated multipotent cells. We experienced two cases of embryonal cell carcinoma of the testes in 2 year-old boys, who were carried out immediate orchiectomy. Postoperative follow up results were good.
Child, Preschool ; Follow-Up Studies ; Germ Cells ; Humans ; Infant* ; Orchiectomy ; Testis*