Endodontic microsurgery is defined as the treatment performed on the root apices of an infected tooth, which was unresolved with conventional root canal therapy. Recently, the advanced technology in 3-dimensional model reconstruction based on computed tomography such as cone beam computed tomography has opened a new avenue in application of personalized, accurate diagnosis and has been increasingly used in the field of dentistry. Nevertheless, direct intra-oral localization of root apex based on the 3-dimensional information is extremely difficult and significant amount of bone removal is inevitable when freehand surgical procedure was employed. Moreover, gingival flap and alveolar bone fenestration are usually required, which leads to prolonged time of surgery, thereby increasing the chance of trauma as well as the risk of infection. The purpose of this case report is to present endodontic microsurgery using the guide template that can accurately target the position of apex for the treatment of an anterior tooth with calcified canal which was untreatable with conventional root canal therapy and unable to track the position of the apex due to the absence of fistula.
Apicoectomy ; Cone-Beam Computed Tomography ; Dentistry ; Diagnosis ; Fistula ; Humans ; Microsurgery ; Printing, Three-Dimensional ; Root Canal Therapy ; Tooth

We experienced a case of clipping of an intracranial aneurysm of a 63 year old male with a subarachnoid hemorrhage under general anesthesia. Preoperative electrocardiography showed complete Left Bundle Block (LBBB) without subjective symptoms. Among the intraventricular blocks, bundle branch block is the most common type and in particular, complete LBBB may progress to the more serious condition of complete heart block. Consideration of anesthetic management in such patients requires a knowledge of normal cardiac physiology, neurophysiology, the circulatory effects of various anesthetic agents and the pathophysiology of these diseases, to prevent any hypertension in response to intubation and surgery. We report upon the anesthetic management of a patient for clipping of an intracranial aneurysm with complete LBBB, which was performed successfully without complication.
Anesthesia, General ; Anesthetics ; Bundle-Branch Block* ; Electrocardiography ; Heart Block ; Humans ; Hypertension ; Intracranial Aneurysm* ; Intubation ; Male ; Middle Aged ; Neurophysiology ; Physiology ; Subarachnoid Hemorrhage

PURPOSE: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. METHODS: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. RESULTS: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. CONCLUSION: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.
Adult ; Aged ; Aged, 80 and over ; Female ; *Hospital Mortality ; Hospitals ; Humans ; Logistic Models ; Male ; Middle Aged ; Nursing Staff, Hospital/*supply & distribution ; Odds Ratio ; Outcome Assessment (Health Care) ; Pneumonia/etiology/*mortality ; Sepsis/etiology/*mortality ; Severity of Illness Index ; Surgical Procedures, Operative/adverse effects ; Urinary Tract Infections/etiology/*mortality

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins

Intravenous leiomyomatosis (IVL) with intracaval mass, cardiac extension, and pulmonary metastasis is rare and it is characterized by nodular masses of smooth muscle proliferation that may extend to variable distances. We experienced a case of the intravenous leiomyomatosis originating from the uterus and extending to the ovarian veins, the iliac veins, the inferior vena cava, the right atrium and the lung. And it was diagnosed from the various preoperative studies and operated successfully through the single-stage approach. So we report it with a brief review of the literature.
Heart Atria ; Iliac Vein ; Leiomyomatosis* ; Lung ; Muscle, Smooth ; Neoplasm Metastasis* ; Uterus ; Veins ; Vena Cava, Inferior

No abstract available.
Humans ; Pregnancy* ; Prognosis* ; Takayasu Arteritis*

No abstract available.
Brain*

No abstract available.
Brain*

Focal nodular hyperplasia (FNH) is a benig nepithelial tumor of the liver. The etiology of FNH is unknown, but recent evidence suggests that FNH may represent a localized, hyperplastic response to a pre-existing vascular malformat ion. There is a high probability of as sociat edlesions , most commonly hepatic hemangiomas, meningioma, as trocytoma, and arterial dysplasia in various organs . In the present report we describe a FNH with aberrant lymphatics in a 24-year-old woman. In operation field, lymphatics were located on the site of falciform ligament. Histologically, aberrant lymphatics were composed of well vas cularized complex lymphatic channels and the mass were typical FNH. In this case, the role of aberrant lymphatics in the development of FNH was unclear . But as the FNH frequently as sociated with ot her anomalies , we think the aberrant lymphatic as such anomaly that have not been reported.
Carcinoma, Hepatocellular* ; Female ; Focal Nodular Hyperplasia ; Hemangioma ; Humans ; Ligaments ; Liver ; Meningioma ; Young Adult