The lower 2(nd) molar eruption is beginning to mesiolingually, then rotate to distobuccally so it has a tendency to be tilted and impacted mesially. Signs and symptoms of impacted 2(nd) molar are similar to impacted 3(rd) molar's. However, treatment plan for impacted 2nd molar is different from that of impacted 3(rd)'s. The former is the preservation and uprighting of 2(nd) molar so that it could act to recovery of mastication, symmetrical facial growth, maintaining the symmetry of dental arch, stable occlusion, while the latter is the extraction of tooth. If the uprighting treatment is planned, most proper protocol of treatment and the additional treatment opition should be applied with consideration for it's crown exposure, present of 3(rd) molar which interrupt the uprighting process, extrusion of opposite tooth. Although it could not improve the esthetic result, it could prevent many dental problems. Therefore, uprighting for impacted lower 2(nd) molar is meaningful treatment.
Crowns ; Dental Arch ; Mastication ; Molar* ; Tooth ; Tooth Movement

BACKGROUND: Direct laryngoscopy and tracheal intubation frequently induce transient hypertension, tachycardia and arrhythmia. This study was to evaluate the effect of nicardipine on the changes of the blood pressure and heart rate induced by direct laryngoscopy and tracheal intubation. METHODS: Sixty patients were randomly divided into three groups: Group 1 (nicardipine 0.02 mg/kg, n=20), Group 2 (diltiazem 0.2 mg/kg, n=20), Group 3 (normal saline 3 cc, n=20). Two minutes after intravenous injection of 2 mcg/kg of fentanyl, thiopental 5 mg/kg and nicardipine or diltiazem or normal slaine was administered intravenously. Then succinylcholine 1.5 mg/kg was administered. One minute after succinylcholine injection, direct laryngoscopy and tracheal intubation was done and vecuronium 0.1 mg/kg was injected. Anesthesia was maintained with 50% nitrous oxide in oxygen and 2 vol % of enflurane. Blood pressure and heart rate were measured at the period of preintubation, immediately after intubation, 1, 3 and 5 minutes following intubation by noninvasive method. RESULTS: After tracheal intubation, the increase of systolic blood pressure was supressed significantly in nicardipine and diltiazem group compared with control group (nicardipine group 11%, diltiazem group 13%, control group 24%). The increase of heart rate was greatest in nicardipine group (nicardipine group 38% diltiazem group 29%, control group 20%). CONCLUSIONS: Nicardipine was effective in attenuating pressor responses to laryngoscopy and intubation, but in nicardipine group, increase of heart rate was greater than control group.
Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Diltiazem ; Enflurane ; Fentanyl ; Heart Rate ; Humans ; Hypertension ; Injections, Intravenous ; Intubation* ; Laryngoscopy ; Nicardipine* ; Nitrous Oxide ; Oxygen ; Succinylcholine ; Tachycardia ; Thiopental ; Vecuronium Bromide

BACKGROUND: Tracheal intubation by direct laryngoscopy induces frequently transient hypertension, tachycardia and arrhythmia. The purpose of this study was to examine the effect of esmolol and clonidine in attenuating the changes of blood pressure and heart rate by tracheal intubation. METHODS: Eighty patients were randomly divided into four groups: Group 1 (control , n=20), Group 2 (esmolol 0.5 mg/kg IV, n=20), Group 3 (clonidine 4 mcg/kg PO, n=20) and Group 4 (clonidine 4 mcg/kg PO and esmolol 0.5 mg/kg IV, n=20). The clonidine premedication were given orally with a sip of water 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental 5 mg/kg, vecuronium 0.1 mg/kg, 50% nitrous oxide in oxygen and 2 vol % enflurane. After 5 minutes, tracheal intubation was performed. Patients in the group 2 and group 4 were given esmolol 0.5 mg/kg 90 seconds prior to tracheal intubation. Blood pressure and heart rate were measured at ward, preinduction, preintubation, immediately after intubation, 1, 3 and 5 minutes after intubation. RESULTS: After tracheal intubation, the increase in systolic blood pressure was supressed significantly in the clonidine-treated patients (Group 3, Group 4) compared with control group (p<0.05). The attenuating effect on increase of mean arterial pressure(MAP) was sustained longer in group 4 than group 3. Heart rate increased after tracheal intubation in all groups, but were markedly increased in the control group (p<0.05). The differences of MAP which measured at preinduction and immediately postintubation were smaller in group 4 than control group (p<0.05). The differences of heart rate which measured at preinduction and immediately postintubation were smaller in group 4 than group 1 or group 3 (p<0.05). CONCLUSIONS: Esmolol 0.5 mg/kg given as bolus, is effective for controlling the increase of heart rate but not in attenuating increase of blood pressure. Oral clonidine is effective for controlling the increase of blood pressure but not in attenuating increase of heart rate. Therefore esmolol combined with oral clonidine results in effective control of both heart rate and blood pressure.
Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Clonidine* ; Enflurane ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Laryngoscopy ; Nitrous Oxide ; Oxygen ; Premedication* ; Tachycardia ; Thiopental ; Vecuronium Bromide ; Water

The differential diagnosis of benign tumors from other intra-ureteric lesions was difficult. But. recently. it is easy due to developed diagnostic procedures. such as ureteroscopy. We herein report a case of fibroepithelial polyp of the left ureteropelvic junction which was diagnosed with ureteroscopic finding and biopsy with brief review or literatures.
Biopsy* ; Diagnosis, Differential ; Polyps* ; Ureter* ; Ureteroscopy

BACKGROUND: The diagnosis of malaria has been usually made using microscopic examination of Wright stained thin blood films in Korean army. This method is labor-intensive, time consuming and requires the microscopic expertise. Therefore, the alternative techniques, rapid diagnostic test, have been sought for use in Korean army. We performed a comparison of the OptiMAL test with GENEDIA Malaria (P. vivax) Ab Rapid I, II to assess its sensitivity and specificity of Plasmodium vivax malaria. METHODS: Blood specimen were collected from 51 patients who were presented and initially diagnosed for P. vivax by the microscopy of blood smears and from 30 control patients without malaria infection at the Capital Armed Forces General Hospital (CAFGH) between October 2000 and February 2001. Among the 51 patients, we also collected 24 samples from 24 patients at 2 or 3 days after therapy. The OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid I, II were performed according to the manufacturer's instructions on all samples respectively. RESULTS: Compared with the blood film, sensitivities and specificities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II were 94.1~100% (29/29), 80.4~83.3%, 96.1~96.7% respectively. One case was interpreted as 'undetermined' by OptiMAL test. In 24 patients during therapy, the sensitivities of the OptiMAL test, GENEDIA Malaria (P. vivax) Ab Rapid I and GENEDIA Malaria (P. vivax) Ab Rapid II on 8 specimens with mean 120/microliter parasitemia and 16 specimens with negative parasitemia were 75~43.8%, 87.5~81.3%, 100~100% respectively. CONCLUSION: Our data demonstrated that the sensitivity and specificity of the GENEDIA Malaria (P. vivax) Ab Rapid I were not satisfactory, but the sensitivity and specificity of the OptiMAL test and GENEDIA Malaria (P. vivax) Ab Rapid II were relatively high and useful diagnostic tests for diagnosis of P. vivax in areas like the militaries where laboratory facilities are poor or non-existent.
Arm ; Diagnosis* ; Diagnostic Tests, Routine ; Hospitals, General ; Humans ; Malaria* ; Malaria, Vivax ; Microscopy ; Military Personnel* ; Parasitemia ; Plasmodium vivax* ; Plasmodium* ; Sensitivity and Specificity

A clinical investigation was undertaken on 30 patients who underwent epididymectomy during the period from April 1986 to November 1991. In this study. clinical reasons of epididymectomy were as follows: First, for confirming of tuberculous epididymitis( 19 cases). Second. for treatment of chronic epididymitis(8 cases). Third, for treatment of acute epididymitis(2 cases). Pathohistologic findings were tuberculous epididymitis( 15 cases), chronic epididymitis(9 cases), sperm granuloma(3 cases). cystadenoma(2 cases). spermatocele(1 case). The highest occurrence was observed in the age groups of 20 to 39(60%) in tuberculous epididymitis. 30 to 49(66.6%) in chronic epididymitis. Tuberculous epididymitis was presented clinically non-tenderful epididymal nodule 66%, tenderful epididymal nodule 33%, scrotal fistula 20%. Chronic epididymitis was tenderful epididymal nodule 80%. scrotal swelling 26.6%. In urine examination, tuberculous epididymitis was observed on pyuria 40%, hematuria I3%. and tubercle bacilli 1 case. Chronic epididymitis was pyuria 37.5%, urine culture(E. coli 10(5)/ml) 25%. Tuberculous epididymitis corresponds b 268 of total male patients with genitourinary tuberculosis. The lateralization showed 46% in the left 33% in both side, 20% in the right. The most common affected region of epididymis was diffuse(40%). followed by tail 33%, head 26%. Associated tuberculous lesions. lung 25%, kidney 13%. vas 33.3%, testis 20%.
Epididymis ; Epididymitis* ; Fistula ; Head ; Hematuria ; Humans ; Kidney ; Lung ; Male ; Pyuria ; Spermatozoa ; Testis ; Tuberculosis

BACKGROUND: There were no reports of any other species of Plasmodium except for P. vivax in Korea and the diagnosis of malaria has been made using microscopic examination of Giemsa-stained thick and thin blood films. This method is labor-intensive, time consuming and requires microscopic expertise. Therefore, the alternative techniques, rapid immunocapture assays, have been sought for use in the Korean Military. We performed an evaluation of the OptiMAL test to assess its sensitivity and treatment monitoring of Plasmodium vivax malaria. METHODS: We collected 77 whole blood in EDTA from 55 patients who were presented and diagnosed for P. vivax by microscopy of blood smears (thick and thin) at the Capital Armed Forces General Hospital (CAFGH) between May and October 2000. The OptiMAL test was performed according to the manufacturer's instructions on all samples. RESULTS: Compared with the blood film, the OptiMAL test identified 51 cases (83.6%) among 61 microscopy positive cases. Six cases were misinterpreted as Plasmodium falciparum. The diagnostic sensitivity of the OptiMAL test was 93.4% on 61 samples and 96.7% on 30 samples at a parasitemia level of more than 2,000/L parasites regardless of Plasmodium species. The discrepancy rate between the microscopy and the OptiMAL test is 38.1% in the samples from 21 patients at 2 or 3 days after treatment. CONCLUSIONS: Our data demonstrated that the OptiMAL test has limits and is not yet satisfactory to replace the conventional microscopy. However, regardless of the Plasmodium species the sensitivity of the OptiMAL test is relatively high and is comparable to that of microscopy in detecting malaria at the parasitemia level of more than 2,000/L parasites. It is an easy, rapid and useful tool in a field like the military.
Arm ; Diagnosis* ; Edetic Acid ; Hospitals, General ; Humans ; Korea ; Malaria ; Malaria, Vivax* ; Microscopy ; Military Personnel ; Parasitemia ; Parasites ; Plasmodium falciparum ; Plasmodium vivax* ; Plasmodium*

Purpose: Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods: In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results: There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion: Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.
Adult ; Birth Weight ; Critical Illness ; Disseminated Intravascular Coagulation ; Gestational Age ; Glucose ; Humans ; Hyperglycemia ; Infant Equipment ; Infant, Newborn ; Infant, Premature ; Insulin ; Logistic Models ; Prognosis ; Sepsis

Idiopathic pulmonary hemosiderosis (IPH), a rare disease of unknown etiology, is characterized by iron deficiency anemia and chronic recurrent pulmonary symptoms such as cough, hemoptysis, and dyspnea. Recurrent intra-alveolar hemorrhage resulting in hemosiderin accumulation and progressive fibrosis often leads to death. We experienced a case of IPH in a two-year-old male who was presented with cough, dyspnea, hemoptysis and anemia. The diagnosis was confirmed by hemosiderin-laden macrophages in a gastric aspirate. He was initially treated with oral iron and prednisolone for one year. But pulmonary symptoms such as cough and hemoptysis recurred five times while he was on oral prednisolone and the side effects of moon face and truncal obesity developed. So inhaled steroid (budesonide) was administered for 18 months, with improvement of pulmonary symptoms. This suggests that early treatment with inhaled steroids may work in IPH without the serious side effects of systemic steroid. The effect of inhaled steroid should be evaluated as the initial treatment of IPH.
Anemia ; Anemia, Iron-Deficiency ; Child ; Cough ; Diagnosis ; Dyspnea ; Fibrosis ; Hemoptysis ; Hemorrhage ; Hemosiderin ; Hemosiderosis* ; Humans ; Inhalation* ; Iron ; Macrophages ; Male ; Obesity ; Prednisolone ; Rare Diseases ; Steroids

Idiopathic pulmonary hemosiderosis (IPH), a rare disease of unknown etiology, is characterized by iron deficiency anemia and chronic recurrent pulmonary symptoms such as cough, hemoptysis, and dyspnea. Recurrent intra-alveolar hemorrhage resulting in hemosiderin accumulation and progressive fibrosis often leads to death. We experienced a case of IPH in a two-year-old male who was presented with cough, dyspnea, hemoptysis and anemia. The diagnosis was confirmed by hemosiderin-laden macrophages in a gastric aspirate. He was initially treated with oral iron and prednisolone for one year. But pulmonary symptoms such as cough and hemoptysis recurred five times while he was on oral prednisolone and the side effects of moon face and truncal obesity developed. So inhaled steroid (budesonide) was administered for 18 months, with improvement of pulmonary symptoms. This suggests that early treatment with inhaled steroids may work in IPH without the serious side effects of systemic steroid. The effect of inhaled steroid should be evaluated as the initial treatment of IPH.
Anemia ; Anemia, Iron-Deficiency ; Child ; Cough ; Diagnosis ; Dyspnea ; Fibrosis ; Hemoptysis ; Hemorrhage ; Hemosiderin ; Hemosiderosis* ; Humans ; Inhalation* ; Iron ; Macrophages ; Male ; Obesity ; Prednisolone ; Rare Diseases ; Steroids