No abstract available.

Many authors reported the etiology of hypoplasia of the nasomaxillary complex as trauma, infection, underdevelopment. To correct these deformities, Le Fort II Osteotomy and its modification has been popularly applied. This method enabled total advancement of nasomaxillary complexes and acquirememt of midfacial esthetics. But it has some limitations such as various occlusal deviation or lateral shifting of nasomaxillary complex in case of nasomaxillary retrusion. We grouped these patients as follows : 1. Nasomaxillary retrusion without shifting of nasomaxillary complex (1) Anteroposterior deviation of occlusal plane (2) Lateral deviation of occlusal plane(including canting) (3) Supero-inferior deviation of occlusal plane (4) Combined disturbance of occlusal plane without shifting of nasamaxillary complex 2. Lateral shifting of nasomaxillary complex with or without deviation of occlusal plane We performed Le Fort II and I combined osteotomy on eleven cases of midfacial deformity from June 1994 to July 1997 and in most of the cases, followed up maximum 36 months and could acquire positional stability and improvement of facial eathetics.
Congenital Abnormalities* ; Dental Occlusion ; Esthetics ; Humans ; Osteotomy*

This study was performed to analyze the clinical, radiological results of 70 patients with isthmic spondylolisthesis and 30 patients with degenerative spondylolisthesis who were underwent with wide decompression, reduction with transpedicular screw system and posterolateral fusion from Mar. 1990 to Dec. 1995. In this study we excluded posterior lumbar interbody fusion, circumferential fusion or decompression method for sondylolisthesis. The mean follow up duration was 29 months. The most common level was L5-Sl in isthmic group (36 patients, 51%), and L4-5 in degenerative group (23 patients, 77%). The clinical result were analyzed according to Kirkaldy-Willis criteria. The satisfactory result were obtained 90% in each group. Screw failure occured in unstable level with severe slip angle, so anterior column support may be recommended in this group. Pedicle screw fixation and wide decompression augmented with posterolateral bone graft is a satisfactory alternative method for degenerative and isthmic spondylolisthesis.
Decompression ; Follow-Up Studies ; Humans ; Spondylolisthesis* ; Transplants

BACKGROUND: Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE II score. METHODS: 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE II scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. RESULTS: On the day of admission, blood lactate concentrations and APACHE II scores of non-survivors were 48.5 +/- 27.0 mg/dl and 18.5 +/- 5.9, while those of survivors were 23.7 +/- 12.9 mg/dl and 6.7 3.1. On the day of discharge, arterial blood lactate concentrations and APACHE II scores of non-survivors were 143.2 +/- 54.0 mg/dl and 28.2 +/- 6.0, while those of survivors were 14.9 +/- 7.1 mg/dl and 4.7 +/- 2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE II score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. CONCLUSIONS: The result shows that arterial blood lactate concentration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.
Adult ; Anoxia ; APACHE* ; Blood Gas Analysis ; Critical Illness* ; Fatal Outcome ; Hemodynamics ; Hospital Mortality ; Humans ; Lactic Acid* ; Metabolism ; Mortality ; Multiple Organ Failure ; Survivors

BACKGROUND AND OBJECTIVES: Middle ear barotrauma is a damage of the ear resulting from the pressure difference between the middle ear and the atmospheric environment. We investigated the effects of chewing gum and administering the systemic decongestant in hyperbaric oxygen therapy. MATERIALS AND METHOD: We investigated the cases of the middle ear barotrauma which came from hyperbaric oxygen therapy for finger replantation. We studied 81 patients without E-tube dysfunction. They were divided into three groups: the non-treated patients, the patients chewing gums and receiving high-pressure treatment, and the patients receiving the systemic decongestant. We investigated the patients for symptoms, otoscopic findings, tympanometry, and PTA. Otoscopic findings were classified by modified Teed classification. RESULTS: In the first group, 36 of 60 (60%) ears had otologic symptoms, 37 of 60 (62%) ears were above the grade 1, 31 of 60 (52%) ears were B or C type in tympanometry and 20 of 60 (33%) ears were above 20dB in AB gap (air-bone gap). In the second group, 23 of 60 (38%) ears had the otologic symptom, 26 of 60 (43%) ears were above the grade 1, 19 of 60 (32%) ears were the B or C type and 10 of 60 (17%) ears were above 20dB in AB gap. In the third group, 18 of 42 (43%) ears had the otologic symptoms, 19 of 42 (45%) ears were above the grade 1, 15 of 42 (36%) ears were the B or C type and 7 of 42 (17%) ears were above 20dB in the AB gap. CONCLUSION: The second group was better than the first group with regard to otologic symptom, otoscopic findings, tympanometry, PTA, and showed statistical significance. On the other hand, the third group was effective but did not show statistical significance.
Acoustic Impedance Tests ; Barotrauma* ; Chewing Gum ; Classification ; Ear ; Ear, Middle* ; Fingers ; Hand ; Humans ; Hyperbaric Oxygenation* ; Replantation

PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.
Clitoris* ; Collagen ; Estrogen Replacement Therapy ; Estrogens* ; Female ; Humans ; Muscle, Smooth ; Neurons ; Nitric Oxide Synthase ; Ovariectomy ; Rabbits ; Relaxation ; Research Personnel ; Vagina

For the evaluation of exercise induced R wave amplitude changes in lead V5 (big up tri, openR) and multiple leads(summation operatorR), we studied 20 normal subjects and 21 ischemic heart disease patients with positive exercise test. All underwent submaximal, multiple leads multistage treadmill exercise testing. 14 to 20 normal subjects(70%) there were decreased R wave amplitude in multiple leads on treadmill exercise testing. 16 of 21 patients(76%) there were increased R wave amplitude on treadmill exercise testing. In normal group, R wave amplitude between rest and exercise was significantly decreased in lead V5 and multiple leads. In patients grous, R wave amplitude between rest and exercise was significantly increased in lead V5 and multiple leads. It is suggested exercise induced R wave amplitude changes probably enhance the diagnostic reliability by ST segment changes on treadmill exercise testing.
Exercise Test* ; Humans ; Myocardial Ischemia

PURPOSE: To evaluate the tear meniscus in aqueous tear-deficient dry eye patients using Fourier-domain optical coherence tomography (FD-OCT) and to investigate the clinical usefulness of tear meniscus values. METHODS: The present study included 79 aqueous tear-deficient dry eyes and 50 normal eyes. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were imaged using FD-OCT and measured with computer calipers. Schirmer's test, tear break-up time, and corneal fluorescein staining were also performed and the correlations between the tests were analyzed. Additionally, the diagnostic power of tear meniscus values was compared using area under the receiver operating characteristic curve (AUROC). RESULTS: Tear meniscus values were significantly decreased in the aqueous tear-deficient dry eye group (p < 0.05). TMH, TMD, and TMA were positively correlated with Schirmer's test and tear break-up time (p < 0.05), and TMH and TMD were negatively correlated with corneal fluorescein staining in the aqueous tear-deficient dry eye group (p < 0.05). The AUROCs of TMH, TMD, and TMA were 0.978, 0.788, and 0.957, respectively. CONCLUSIONS: Tear meniscus values measured using FD-OCT were significantly lower in aqueous tear-deficient dry eyes and were correlated with Schirmer's test, tear break-up time, and corneal fluorescein staining. Tear meniscus measurements obtained using FD-OCT can be useful clinical parameters for the diagnosis and treatment of aqueous tear-deficient dry eye.
Diagnosis ; Fluorescein ; Humans ; ROC Curve ; Tears* ; Tomography, Optical Coherence*

The dangers of explosion hazards and operation theater contamination by inhalation anesthetics have led to a renewed interest in intravenous anesthesia. without intubation. We have reported clinical studies of Thalamonal-ketamine anesthesia under room air breathing in non-abdominal surgery in a previous paper that discussed advantages, disadvantages and usefulness. Now, we report Thalamonal-N2O-Ketamine anesthesia with a microdrip technique and intubation in 63 patients undergoing various operations. These patients were divided into three groups by operation site: Group 1-upper abdominal, Group 2-lower abdominal and Group 3-non-aMominal surgery. These groups were subdivided, by muscle relaxants used, into pancuronium, d-tubocurarine and no relaxant groups. To minimize potential cardiovascular stimulation and postoperative sequelae, ThalamonaI was used at the beginning of anesthesia. The results were as follows: 1) The average duration of anesthesia was 153.9 minutes. The duration of anesthesia was 217.9 minutes in Group I, 121.9 minutes in Group 2 and 152.1 minutes in Group 3. 2) The average dose of ketamine-during induction was 1mg/kg/19 minutes. The average maintenance dose of ketamine was 1.8mg/kg/hr, 2.3mg/kg/hr in Group 1, 1.6mg/kg/hr in Group 2 and 1.8mg/kg/hr in Group 3. 3) The order of frequency of administration and total dose of pancuronium and d-tubocurarine was Group 1, Group 2 and Group 3. 4) The changes in vital signs after intubation and during anesthesia were insignificant clinically. 5) The average duration required from the end of operation to extubation was 10 minutes. 6) Arterial blood gas study performed preoperatively, during operation and in the recovery room in 11 patients revealed no significant changes. 7) The postanesthetic complications were pleasant dreams 18% (11), unpleasant dreams 6% (4), emergence delirium 3% (2), vomiting 6% (4) and shivering 3% (2).
Anesthesia ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Delirium ; Dreams ; Explosions ; Humans ; Intubation ; Ketamine* ; Pancuronium ; Recovery Room ; Respiration ; Shivering ; Tubocurarine ; Vital Signs ; Vomiting

A 46-year-old man presented with a six-month history of recurrent episodes of abnormal behaviors characterized by agitation, anxiety, aggression, impulsion, and depression. They were not accompanied by obvious convulsions. Brain MRI demonstrated cerebromalacia from previous traumatic brain injury in both frontal and left anterior temporal lobe. Interictal EEG showed a focal seizure disorder arising from both temporal areas. Following antiepileptic medication, the abnormal behaviors disappeared. These results suggest that non-convulsive status epilepticus or a cluster of seizures could account for prolonged behavioral disturbances.
Aggression ; Anxiety ; Brain ; Brain Injuries ; Depression ; Dihydroergotamine ; Electroencephalography ; Encephalomalacia ; Epilepsies, Partial ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Seizures* ; Status Epilepticus ; Temporal Lobe