The purpose of this in vitro study was to compare the effects of root canal debridement following rotary Ni-Ti instruments with positive versus negative rake angle. Seventy sound, extracted human anterior teeth & premolars were randomly divided into four groups. The used rotary instruments were Ni-Ti HERO 642(Micro-Mega in France, 20 specimen), Ni-Ti ProFile(Maillefer, Ballaigues, Switzerland, 20 specimen), stainless steel engine reamer(Mani, Matsutani Seisakusho Co.,Japan, 20 specimen) and negative control group(10 specimen) was only extirpated with barbed broach(Mani, Matsutani Seisakusho Co.,Japan) Group 1 & 2 teeth were prepared to a #40 at the apex followed by 1 mm using crown-down technique. Group 3 teeth were instrumented from a #15 to a #40 in sequential order. After preparation and final irrigation, the roots split longitudinally into a bucco-lingual direction. Root halves were cross-sectioned in apical third portion again. all root specimens were prepared for SEM investigation & photographed. Separate evaluations were undertaken for smear layer on prepared walls with a five score-index for each using reference photograph in root halves. the penetration depth of smear layer into dentinal tubules was also estimated in the other halves. the following results were obtained : 1. Smear layer was observed on all the prepared walls with three experimental groups except negative control group 2. Smear layer characteristics 1) HERO 642 groups showed snowy & dusty appearance & were observed only few some dentinal tubuli open on the prepared walls, and the penetration depth of it into dentinal tubules may be 1-2 microm thick. 2) ProFile groups showed shiny & burnished appearance & complete root canal wall covered by a homogenous smear layer with no open dentinal tubuli and penetration depth of it into dentinal tubules may be 1-2 microm thick. 3) Engine reamer groups showed obviously file's passed tracks on the prepared walls & were observed complete root canal wall covered by a homogenous smear layer with no open dentinal tubuli. The results revealed that a completely clean root canal could not be achieved regardless of positive & negative rake angle, which is in accordance with the majority of studies on root canal cleanliness. In conclusion, throughout irrigation with antibacterial solutions or chelating agents is recommended to remove the smear layer on prepared canal walls.
Bicuspid ; Chelating Agents ; Debridement ; Dental Pulp Cavity ; Dentin ; Electrons ; France ; Humans ; Nickel ; Smear Layer ; Stainless Steel ; Switzerland ; Titanium ; Tooth ; Track and Field

Sudden cardiac arrest during epidural anesthesia is a rare but catastrophic complication. It was recently reported that occurs in one per 10,000 epidural anesthesia cases. We report one case of cardiac arrest in a healthy 45-year-old male patient undergoing relatively minor surgery. His preoperative blood pressure was 110-130/70-80 mmHg, heart rate 75-80 beats per minute, and oxygen saturation 98%. Immediately after tourniquet release, cardiac arrest was developed without warning signs. The patient was resuscitated by prompt precordial thump pacing, a fluid bolus, intravenous injection of atropine and ephedrine, and ventilated with oxygen. The procedure was completed and the patient recovered uneventfully.
Anesthesia, Epidural* ; Atropine ; Blood Pressure ; Death, Sudden, Cardiac* ; Ephedrine ; Heart Arrest ; Heart Rate ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Oxygen ; Surgical Procedures, Minor ; Tourniquets*

Transient global amnesia is characterized by a sudden inability to form new memories (anterograde amnesia) that usually last for minutes to several hours but never longer than 24 hours. and there are no other focal neurologic signs or symptoms. Retrograde amnesia from a few hours to many years may also be associated with this condition. We report a case of a 56-year-old female patient who experienced transient global amnesia in the recovery room after general anesthesia. She repeated the same queries several times to persons nearby and appeared perplexed. A detailed neurologic examination was otherwise entirely normal. Her symptoms resolved completely the next day.
Amnesia, Retrograde ; Amnesia, Transient Global* ; Anesthesia, General* ; Female ; Humans ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations ; Recovery Room*

BACKGROUND: Calcium plays a key role in vascular contraction and regulates receptor sensitivity to certain neurotransmitters. Calcium channel blockers are useful in the treatment of both clinical and experimental hypertension. The present study was designed to examine whether there is an alteration of the activity of calcium channels in association with the development of hypertension. METHODS: Deoxycorticosterone acetate(DOCA)-salt hypertension was made by subcutaneous implantation of DOCA(200mg/kg)strip plus saline drinking(1%) and 2-kidney, 1 clip(2KIC)hypertension by clipping the left renal artery with a silver clip(internal gap of 0.2mm). They were used 4 weeks later. Age-matched normal rats served as a control. Mean arterial pressure(MAP) and heart rate(HR) were continuously recorded from the right femoral artery. The drugs were administered intravenously. RESULTS: Vehicle alone was without effect on MAP or HR. In normotensive rats, nifedipine infusion(5 and 10ug/kg/min)caused a dose-dependent decrease in MAP without significant changes in HR, while Bay k 8644(Bay K, 5 and 10 ug/kg/min) increased MAP transiently. Both the depressor response to nifedipine and the pressor response to Bay k were more marked in DOCA-salt hypetensive rats than in normotensive rats. The maximal changes in MAP indced by nifedipine(5 and 50 ug/kg) or Bay K(5 and 50 ug/kg) were also enhanced in 2KIC hypertensive rats as compared with control rats. CONCLUSION: These results indicate that calcium channel inhibitors and activators can affect on the regulation of blood pressure in an opposite fashion. It is also suggested that the activity of calcium channels might be altered in the developement of experimental hypertension.
3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester* ; Animals ; Bays* ; Blood Pressure ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Desoxycorticosterone ; Femoral Artery ; Heart ; Hypertension ; Neurotransmitter Agents ; Nifedipine* ; Rats* ; Renal Artery ; Silver

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.
Adult ; Amputation ; Extremities ; Humans ; Infusions, Intravenous* ; Ketamine* ; Leg ; Phantom Limb* ; Prevalence ; Sensation

BACKGROUND: Induction with propofol has a high incidence of pain, as well as postoperative nausea and vomiting (PONV). The aim of this study was to assess the effect of a course of dexamethasone on the pain, postoperative nausea and vomiting associated with a Propofol injection, in patients undergoing otolaryngology-head and neck surgery. METHODS: One hundred twenty adults, 20-60 years of age, ASA physical status I or II, were allocated to one of two groups. Either dexamethasone 5 ml (8 mg) or saline 5 ml was administered intravenously to each group. After 60 seconds, propofol was injected into the patients' hand veins over a 30 second period and the patient was asked questions regarding the injection pain after 10 seconds. Postoperative nausea, vomiting and post-tonsilectomy pain were recorded in the recovery room (1 h after surgery) and in the hospitalization area (6 h after surgery). RESULTS: The severity and incidence of pain at the time of the propofol injection, PONV, and the level of post-tonsillectomy pain were significantly lower in the dexamethasone group than in the control group. CONCLUSIONS: The prophylactic intravenous administration of 8 mg dexamethasone is effective in reducing the severity of pain after a propofol injection and after the tonsillectomy, and decreased the incidence of PONV.
Administration, Intravenous ; Adult ; Dexamethasone* ; Hand ; Hospitalization ; Humans ; Incidence ; Nausea* ; Neck* ; Pain, Postoperative* ; Postoperative Nausea and Vomiting ; Propofol ; Recovery Room ; Tonsillectomy ; Veins ; Vomiting*

Primary cardiac tumor has very low incidence, especially in cases of malignancy. A 29 year old male patient visited our cardiologic clinic for recent aggrevation of dyspnea on exertion and palpitation. Echocardiography showed a large tumor in the left atrium, which suggested the left atrial myxoma. Urgent open heart surgery was taken. The operative finding was fossa ovalis based a large tumor (35 x 90 x 50 mm) that invaded the posterior wall of LA and right superior pulmonary vein directly. The tumor was excised well by simple dissection, and the final pathologic report was malignant myxofibrosarcoma. His postoperative course was smooth and he was discharged in good health. Postoperative radiation and chemotherapy had taken with satisfactory clinical outcome.
Adult ; Drug Therapy ; Dyspnea ; Echocardiography ; Heart Atria ; Heart Neoplasms ; Humans ; Incidence ; Male ; Myxoma ; Pulmonary Veins ; Thoracic Surgery

We experienced a malignant hyperthermia in 24-year-old male with sevoflurane during the mandibular prognathism surgery. The malignant hyperthermia emerged 150 minutes after induction of general anesthesia using propofol, rocuronium, sevoflurane, N2O and O2. Sevoflurane has been reported that it can induce delayed onset of malignant hyperthermia under absence of succinylcholine. The prognosis of malignant hyperthermia is determined by early recognition, vigorous treatment and the time of dantrolene injection. In our case, when we suspected episode, all anesthetics were stopped and dantrolene injection was immediately given intravenously. The patient recovered normal temperature and consciousness without any complication.
Anesthesia, General* ; Anesthetics ; Consciousness ; Dantrolene ; Humans ; Male ; Malignant Hyperthermia* ; Prognathism ; Prognosis ; Propofol ; Succinylcholine ; Young Adult

BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.
Acute Disease ; Adult ; Antiviral Agents/therapeutic use ; BK Virus/*physiology ; Creatinine/blood ; Female ; *Graft Rejection/diagnosis/virology ; Humans ; Immunosuppressive Agents/administration & dosage ; Kidney/*virology ; Kidney Diseases/pathology/surgery/*virology ; *Kidney Transplantation ; Male ; Middle Aged ; Polyomavirus Infections/drug therapy/*etiology/pathology ; Retrospective Studies ; Tacrolimus/administration & dosage ; Time Factors ; Transplantation, Homologous/adverse effects ; Tumor Virus Infections/drug therapy/*etiology/pathology

Charcot-Marie-Tooth disease, which is also known as hereditary motor and sensory neuropathy, is a heterogenous group of inherited diseases of the peripheral nerve. The spectrum of severity varies from asymptomatic individuals to those with severe limb abnormalities requiring corrective surgery. We report two brothers who had previously been diagnosed with Charcot-Marie- Tooth disease 3 years earlier and were scheduled to undergo a correction osteotomy of both feet under general anesthesia. General anesthesia was induced with propofol 2 mg/kg, rocuronium 0.8 mg/kg and was maintained with O2-N2O-Sevoflurane. The younger brother showed no delay in recovery of the neuromuscular blockade but the elder brother showed a delay.
Anesthesia, General ; Charcot-Marie-Tooth Disease* ; Extremities ; Foot ; Hereditary Sensory and Motor Neuropathy ; Humans ; Neuromuscular Blockade* ; Osteotomy ; Peripheral Nerves ; Propofol ; Siblings ; Tooth Diseases