Intrahepatic stones are found predominantly in southeast Asia and causes serious problems including obstructive jaundice, cholangitis, and liver abscesses. The operative principles for resolving these problems are complete removal of the stones within intrahepatic and extrahepatic ducts and establishment of adequate drainage. The clinical features and follow-up results of 90 patients with intrahepatic stones who were treated surgically at the Department of Surgery of St. Benedict Hospital during the period of 10 years from January 1987 to December 1996 are presented. This study includes all the gallstones located in the intrahepatic ducts above the confluence of the main hepatic ducts. Biliary bypass operations were performed in 30 cases (33%) with 29 biliojejunostomies and one choledochoduodenostomy. Five of the 29 hepaticojejunostomies had subcutaneous jejunal limb. Partial hepatectomies were performed in 20 cases (22%) with 16 left lateral segmentectomy and 4 of left hepatic lobectomies. The overall postoperative complication rate was 40%: 70% in the hepatic resection group and 31% in the non-hepatic resection group. The relative incidence of good results was higher in the hepatic resection group (68%) than in the non-hepatic resection group (41%) and in the biliary bypass operation group (54%) than in the non-biliary bypass operation group (41%). In conclusion, an aggressive hepatic resection with biliary bypass operation should be performed, if permitted, in patients with intrahepatic stones.
Asia, Southeastern ; Cholangitis ; Choledochostomy ; Drainage ; Extremities ; Follow-Up Studies ; Gallstones ; Hepatectomy ; Hepatic Duct, Common ; Humans ; Incidence ; Jaundice, Obstructive ; Liver Abscess ; Mastectomy, Segmental ; Postoperative Complications

No abstract available.
Cervix Uteri* ; Female ; Pregnancy*

PURPOSE: The mechanical insights of death of cancer cells by ionizing radiation are not yet clearly defined. Recent evidences have demonstrated that radiation therapy may induce cell death via activation of signaling pathway for apoptosis in target cells. This study was designed whether ionizing radiation may activate the signaling cascades of apoptosis including caspase family cystein proteases, mitogen-activated protein (MAP) kinases, and transcriptional activation factors in target cells eventually leading to death. MATERIALS AND METHODS: HL-60 cell line in the log phase was used in this study and the culture media was RPMI 1640. The irradiation was done using the linear accelarator and the radiation does was 10 Gy, 20 Gy, and 30 Gy, respectively. The cell viability was tested by MTT assay and apoptosis was identified by the DNA fragmentation assay. JNK1 (cJun N-terminal kinase) and ERK (extracellular-signal regulated protein kinase) activity was analyzed by the in vitro Ig complex kinase assay. NF- kB (Nuclear Factor- kB) and AP-1 (activator protein-1) activity was assayed by the electrophoretic mobility sbift assay. RESULTS: Ionizing radiation decreased the viability of HL-60 cells in a time and dose dependent manner. Ionizing radiation-induced cell death of HL-60 cells may be an apo- ptotic death which was evidenced as apoptotic characteristic ladder pattern fragmentation of DNA over 20 Gy at 4 hours. Ionizing radiation specifically induced the activation of CPP32-like cystein protease rather than ICE-like protease of HL-60 cells in a time and dose dependent manner. The activation of CPP32-like cystein protease was also evidenced by the digestion of poly (ADP-ribose) polymerase with 30 Gy ionizing irradiation at 2 hours. The activity of JNK1 was transiently increased up to 3.6 fold by 30 Gy ionizing radiation at 2 hours. Ionizing radiation also rapidly activated the transcriptional activation factors including AP-1 and NF- kB at 10 or 30 min. CONCLUSION: These data suggested that ionizing radiation-induced apoptosis was mediated by the activation of CPP32-like cystein protease, JNK1, and transcriptional activation factors
Apoptosis ; Cell Death ; Cell Survival ; Culture Media ; Digestion ; DNA ; DNA Fragmentation ; HL-60 Cells ; Humans ; Peptide Hydrolases ; Phosphotransferases ; Radiation, Ionizing ; Transcription Factor AP-1 ; Transcriptional Activation

STATEMENT OF PROBLEM: Implant inclination and cantilever loading increse loads distributed to implants, potentially causing biomechanical complications. Controversy exists regarding the effect of the intentionally distal-inclined implant for the reduction of the cantilever length. PURPOSE: This study investigated the stress distribution at the bone/implant interface and prostheses with 3D finite element stress analysis by using four different cantilever lengths and implant inclinations in a mandibular implant-supported bar overdenture. MATERIAL AND METHODS: Four 3-D finite element models were created in which 4 implants were placed in the interforaminal area and had four different cantilver lengths(10, 6.9, 4 and 1.5mm) and distal implant inclinations(0degrees, 15degrees, 30degrees and 45degrees) respectively. Vertical forces of 120N and oblique forces of 45N were applied to the molar area. Stress distribution in the bone around the implant was analysed under different distal implant inclinations. RESULTS: Analysis of the von Mises stresses for the bone/implant interfaces and prostheses revealed that the maximum stresses occurred at the most distal bone/implant interface and the joint of bar and abutment, located on the loaded side and significantiy incresed with the implant inclinations, especially over 45degrees. CONCLUSION: Within the limitations of this study, it was suggested that too much distal inclination over 45 degrees can put the implant at risk of overload and within the dimension of the constant sum of a anterior-posterior spread and cantilever length, a distal implant inclination compared to cantilever length had the much larger effect on the stress distribution at the bone/implant interface.
Denture, Overlay* ; Finite Element Analysis* ; Intention ; Joints ; Molar ; Prostheses and Implants

PURPOSE: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years. METHODS: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately. RESULTS: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%). CONCLUSIONS: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.
Classification ; Congenital Abnormalities ; Fistula ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Surgical Procedures, Operative ; Urinary Retention

No abstract available.
Lung Transplantation* ; Lung*

STATEMENT OF PROBLEM: There are many articles that showed that the magnetism affected the bone formation around titanium implant. It means that a proper magnetism made the osseointegration improved around the implant. So after additional research on the other effect of magnetism on bone formation in implant therapy, we can conclude its possibility of clinical application on implant treatment. PURPOSE: The purposes of this study were to find out the intensity of magnetic field where magnetism in the titanium implant specimen inserted into the bone could affect the bone formation, and to discover the possibility of clinical application in the areas of dental implants and bone grafts. MATERIAL AND METHOD: Ten adult male rabbits(mean BW 2Kg) were used in this study. Titanium implant specimens were surgically implanted on the mesial side of the tibia of rabbits. Neodymium magnets(Magnedisc 500, Aichi Steel Corp. Japan) were placed into the implants of experimental group except control group, just after placement of the titanium implants. At 2, 4 and 8 weeks after the surgery, the animals were sacrificed, specimens were obtained and stained with Hematoxylin-Eosin for light microscopic evaluation and histomorphometric analysis. CONCLUSION: The results were as follows: 1. In radiographic findings, increased radiopacity downward from crestal bone was observed along the titanium implant specimen at experimental period passed by 2,4, and 8 weeks in both control and experimental group. 2. In histoiogic findings, increased new bone formation was shown in both control and experimental group through the experiment performed for 2,4, and 8 weeks. More new bone formation and bone remodeling were shown in experimental group. 3. In histomorphometric analysis, the bone contact ratios were 11.9% for control group and 38.5% for experimental group(p<0.05).
Adult ; Animals ; Bone Remodeling ; Dental Implants ; Electromagnetic Fields ; Humans ; Magnetic Fields ; Male ; Neodymium ; Osseointegration ; Osteogenesis* ; Rabbits ; Steel ; Tibia* ; Titanium* ; Transplants

STATEMENT OF PROBLEM: The use of mouthguard is important as the leisure life is popular today. PURPOSE: The purpose of this study is to investigate the effect of a mouthguard on stress distribution in teeth, maxilla and mandible for maxilla impact. MATERIAL AND METHODS: The 3-dimensional finite element model was based on a CT scan film of an average korean adult when the subject is using a customized mouthguard which was made with the Signature Mouthguard system of Dreve. The load was applied to the upper central incisor cervical area parellel impact force for 0.1sec(L1), The Von-mises stress analysis with a mouthguard and without a mouthguard was compared. RESULTS: The results of this study were as follows: 1. Without the mouthguard, stress was concentrated on teeth and alveolar bone in all load conditions. 2. With the mouthguard, maximum stress value was decreased and stress was dispersed in all load conditions. 3. Stress extinction with the mouthguard was faster than without the mouthguard in all load conditions. CONCLUSION: We acknowledged that the mouthguard has a stress buffer effect as the maximum stress value was decreased and stress was dispersed when impact force was applied.
Adult ; Finite Element Analysis* ; Humans ; Incisor ; Leisure Activities ; Mandible* ; Maxilla* ; Tomography, X-Ray Computed ; Tooth*

PURPOSE: Studies on the incidence and mortality of refractures after primary osteoporotic fracture are limited by the relatively rare incidence of such refractures and small sample sizes. The objectives of this research were: 1) to determine the incidence of osteoporotic refractures and fracture locations and 2) to assess mortality rates associated with osteoporotic refracture over a median follow up of 3 years using nationwide claim database. MATERIALS AND METHODS: Patients over 50 years of age who had an osteoporotic fracture that was confirmed operationally were enrolled. Refracture was defined as that after 6 months of an untreated period. Mortality rate was calculated using the Charlson comorbidity index and was analyzed using Cox proportional hazards regression analysis. RESULTS: A total of 18956 first-time instances of osteoporotic fracture were reported between 2007 and 2012 after a median follow up of 3.1 years (range, 1 to 7 years). Among 18956 patients, 2941 (15.50%) experienced refracture. After follow up for 1 year, cumulative mortality rates for re-fracture and non-refracture groups were 9.1% and 7.2%, respectively. After adjusting for covriates, mortality rate was 1.2 times greater in patients with re-fracture than in patients without re-fracture over a median follow up of 3 years (hazard ratio: 1.20, 95% confidence interval: 1.08–1.34, p<0.001). CONCLUSION: The incidence of osteoporotic re-fracture in this nationwide study was 15.5%, and the mortality rate of re-fracture patients was 1.2 times higher than that of non-refracture patients over a median follow up of 3 years.
Comorbidity ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mortality ; Osteoporotic Fractures ; Sample Size

Pulmonary embolism is a rare complication after percutaneous vertebroplasty for compression fracture. Embolization is related to cement leakage outside the treated vertebral body into the adjacent venous system. We report on a case of pulmonary embolism with bone cement in the right pulmonary artery in a 75-year-old female who had undergone percutaneous vertebroplasty 2 months before. Her simple X-ray of the spine captured polymethyl metacrylate leakage from the vertebral body, which indicated the pathophysiology of this event.
Aged ; Asymptomatic Diseases ; Bone Cements ; Female ; Fractures, Compression ; Humans ; Pulmonary Artery ; Pulmonary Embolism* ; Spine ; Vertebroplasty*