In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice it is still subject to certain drowba-cks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketarnine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30 % of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratery depression, and there no postoperative neurologic sequelae. The present results indicated the need for farther studios to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of posto- peratiue pain.
Analgesics, Opioid ; Depression ; Epidural Space ; Ketamine* ; Pain, Postoperative* ; Respiratory Insufficiency

The MERA-F breathing circuit is a light in weight, disposable, multi-purpose breathing system corsisting of double coaxial tubes ; inner tube for inspiration and outer corrugate tube for expiration. This circuit is especially effective on head and neck operations that may lead to :Iccidental disconnection or extubation. And the circuit provides effective carbon dioxide elimination with only conventional total fresh gas flow(70 ml/kg/minute) and appropriate maintenance of heat and humidity of the airway mucosa.
Carbon Dioxide ; Head ; Hot Temperature ; Humidity ; Mucous Membrane ; Neck ; Respiration*

Dental plaque, a biofilm consisting of more than 500 different bacterial species, is an etiological agent of human periodontal disease. It is therefore important to characterize interactions among periodontopathic microorganisms in order to understand the microbial pathogenesis of periodontal disease. Previous data have suggested a synergistic effect of tow major periodontal pathogens Porphyromonas gingivalis and Tannerella forsythia in the periodontal lesion. In the present study, to better understand interaction between P. gingivalis and T. forsythia, the coaggregation activity between these bacteria was characterized. The coaggregation activity was observed by a direct visual assay by mixing equal amount (1 x 10(9)) of T. forsythia and P. gingivalis cells. It was found that the first aggregates began to appear after 5-10 min, and that the large aggregates completely settled within 1 h. Electron and epifluorescence microscopic studies confirmed cell-cell contact between two bacteria. The heat treatment of P. gingivalis completely blocked the activity, suggesting an involvement of a heat-labile component of P. gingivalis in the interaction. On the other hand, heat treatment of T. forsythia significantly increased the coaggregation activity; the aggregates began to appear immediately. The coaggregation activity was inhibited by addition of protease, however carbohydrates did not inhibit the activity, suggesting that coaggregation is a protein-protein interaction. The results of this study suggest that coaggregation between P. gingivalis and T. forsythia is a result of cell-cell physical contact, and that coaggregation is mediated by a heat-labile component of P. gingivalis and T. forsythia component that can be activated on heat treatment.
Bacteria ; Biofilms ; Carbohydrates ; Dental Plaque ; Forsythia* ; Hand ; Hot Temperature ; Humans ; Periodontal Diseases ; Porphyromonas gingivalis* ; Porphyromonas*

Background: Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods: Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results: PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion: PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe.
Ambulatory Surgical Procedures* ; Humans ; Korea ; Length of Stay ; Patient Discharge* ; Postoperative Complications ; Recovery Room

Maxillary palatal mucosa is the most frequently used donor site of the soft tissue for periodontal plastic surgery. In our study, thickness of the palatal mucosa between the mesial side of the maxillary first premolars and the distal side of the maxillary first molars was measured with a periodontal probe and an ultrasonic device in 30 young Korean adults. Using the data, the possibility of the clinical application of ultrasonic devices was evaluated. The results of this study were as follow; 1. The thickness of the palatal mucosa of the maxillary premolars is the thickest and that of the mid-palatal portion of the maxillary first molar is the thinnest. 2. The thickness of the palatal mucosal tissue increases from the gingival margin to the mid-palatal suture. 3. The measurements of the periodontal probe and the ultrasonic device revealed the strong positive correlations.
Adult ; Bicuspid ; Humans ; Molar ; Mucous Membrane* ; Surgery, Plastic ; Sutures ; Tissue Donors ; Ultrasonics

The primary cause of tooth loss after 30 years of age is periodontal disease. Destruction of alveolar bone by periodontal disease is done by bone resorbing activity of osteoclasts. Understanding differentiation and activation mechanism of osteoclasts is essential for controling periodontal disease. The purpose of this study is to identify the possible effects of Vitamin D and cytokines affecting osteoclasts and its precursor cells. Four to six week-old mice were killed and humerus, radius, tibia and femur were removed aseptically and washed two times with Hank's solution containing penicillin-streptomycin and then soft tissue were removed. Bone marrow cells were collected by 22 gauge needle. Cells were cultured in Hank's solution containing 1 mg/ml type II collagenase, 0.05% trypsin, 4mM EDTA. Supernatant solution was removed 5 times after 15 minutes of digestion with above mentioned enzyme solution, and remained bone particles were maintained in alpha-MEM for 15 minutes and 4degrees C temperature. Bone particles were agitated for 1 minute and supernatant solution containing osteoclast precursor cells were filtrated with cell stainer. These separated osteoclast precursor cells were dispensed with 100-mm culture dish by 1x10(7) cells unit and cultured in alpha-MEM containing 20 ng/ml recombinant human M-CSF, 30 ng/ml recombinant human soluble osteoclast differentiation factor and 10% fetal calf serum for 2 and 7 days. Total RNA of osteoclast precursor cells were extracted using RNeasy kit. One microgram of total RNA was reverse transcribed in 42degrees C for 30 minutes using SuperScriptII reverse transcriptase. Expression of transcribed receptors of each hormone and cytokine were traced with 1 microliter of cDNA solution by PCR amplification. Vitamin D receptor was found in cells cultured for 7 days. TNF-alphareceptor was found in cells cultured for 2 days and amount of receptors were increased by 7 days. IL-1 type I receptor was not found in cells cultured 2 and 7 days. But, IL-1 receptor type II was found in cells cultured for 2 days. TGF-alpha,betatype I receptor was found in cells cultured 2 and 7 days, and amount of receptors were increased by 7 days of culture. These results implies Vitamin D and cytokines can affect osteoclasts directly, and affecting period in differentiation cycle of osteoclasts is different by Vitamin D and cytokines.
Animals ; Bone Marrow Cells ; Collagenases ; Cytokines* ; Digestion ; Dihydroergotamine ; DNA, Complementary ; Edetic Acid ; Femur ; Humans ; Humerus ; Interleukin-1 ; Macrophage Colony-Stimulating Factor* ; Mice ; Needles ; Osteoclasts* ; Periodontal Diseases ; Polymerase Chain Reaction ; Radius ; RANK Ligand ; Receptors, Calcitriol ; RNA ; RNA-Directed DNA Polymerase ; Tibia ; Tooth Loss ; Trypsin ; Vitamin D* ; Vitamins*

BACKGROUND: Incomplete flap coverage or early exposure over implants and/or barrier membranes have a negative effect on bone regeneration. In cases of using regenerative techniques, complete soft tissue coverage of the implant area is necessary to promote adequate conditions for guided bone regeneration. Primary socket closure may be difficult, when periosteal releasing incision is only used, due to the opening left by extracted tooth. Therefore, Soft tissue grafting techniques are used to achieve primary soft tissue closure. MATERIALS AND METHODS: Soft tissue grafting techniques, with or without barrier membranes, were performed for primary closure in four cases of immediate placements. Three different methods were used (CTG, VIP-CT, Palatal advanced flap). Clinical results of the grafting were evaluated. RESULT: One case showed early exposure of cover-screw and, no other complications were noted. In the others, Primary closure was achieved by soft tissue grafting techniques. One of the cases, Graft showed partial necrosis, but there were no exposure over implants and/or barrier membranes. CONCLUSION: The use of grafting techniques, in immediate implant placement, can predictably obtain primary closure of extraction sockets, thereby providing predictable bone formation and improved implant results.
Bone Regeneration ; Membranes ; Necrosis ; Osteogenesis ; Tissue Transplantation ; Tooth ; Transplants

PURPOSE: The purpose of this study was to assess the long term survival rates of the most posterior single tooth implant and to evaluate the influence of implant characteristics on implant survival. MATERIAL AND METHODS: This retrospective report presents findings on 37 patients with 43 implants replacing single molars. The inclusion criteria were having implants replacing a molar of the most posterior region and follow-up data over at least 6 months. Data were recorded regarding the incidence of complications and survival rates of these implants. RESULTS: The range of follow-up was from 9 to 66 months(mean: 40.2 months). The cumulative survival rate of total implants was 93.0% which reflects the loss of three implants: one had broken neck, one implant failed because of infection, one implant showed failed osseointegration. Abutment- screws loosening occurred in five implants(11.6%). CONCLUSION: Within the limits of this study, a single tooth-implant can serve as a good long-term and predictable treatment modality to replace the most posterior teeth with low complication and failure rates.
Follow-Up Studies ; Humans ; Incidence ; Molar ; Neck ; Osseointegration ; Retrospective Studies ; Survival Rate ; Tooth

This article reports the case of a woman who developed a pure motor paraplegia following epidural analgesia. 80mg of Depomedrol and 2ml of 1% lidocaine were injected epidurally for relief of back pain. Within one day the patient complained of severe pain in both lower extremities and the left lower extremity rapidly became paraplegic. Myelography showed no obstruction and compression. The paraplegia was permanent in the left lower extermity. We note a number of potential etiologies and analyze their possible mechanism of action.
Analgesia, Epidural* ; Back Pain ; Female ; Humans ; Lidocaine ; Lower Extremity ; Myelography ; Paraplegia*

Spinal fluid(CSF) was analyzed in ten pregnant women at term undergoing C-section with spinal anesthesia and in ten non-pregnant women undergoing gynecological operation with spinal anesthesia. The acid-base status, protein and sugar levels in the CSF of the CSF are summarized in Table-2 and Table-3. The pH was slightly higher in the pregnant group compared to that of the non-pregnant controls. The bicarbonate level and the total CO2 content were significantly lower in the pregnant group compared to non-pregnant controls. The protein and sugar level were lower in the pregnant group compared to non-pregnant controls. Acid base changes can markedly affect dissociation of the local anesthetics. More free base will be available for transfer across lipid barriers in a relatively more alkalotic medium which was found in spinal fluid of pregnant women. In addition, lower bicarbonate levels may also affect dissociation of local anesthetic and activity by changing the buffering capacity. In conclusion, our results show that pregnancy induces significant changes in the acid base balance of the spinal fluid. These changes may contribute to the facilitated spread of local anesthetics in both the epidural and subarachnoid spaces.
Acid-Base Equilibrium ; Anesthesia, Spinal ; Anesthetics, Local* ; Female ; Humans ; Hydrogen-Ion Concentration ; Pregnancy ; Pregnant Women* ; Subarachnoid Space