Acute tubular necrosis has been rarely reported as a complication of typhoid fever in the literature. We experienced four cases of acute tubular necrosis associated with typhoid fever in children. Patients showed significant titer of widal reaction associated with acute renal failure and one of them rised in 2 months after onset of clinical symptoms. Renal biopsy findings were compatible with acute tubular necrosis and immune complexes were not deposited in the glomeruli. Clinical and urinary findings were normalized by hemodialysis and antibiotic therapies. In conclusion, close longterm follow up of widal titer is mandatory in acute tubular necrosis, especially when associated with high fever.
Acute Kidney Injury ; Antigen-Antibody Complex ; Biopsy ; Child ; Fever ; Follow-Up Studies ; Humans ; Necrosis* ; Renal Dialysis ; Typhoid Fever*

PURPOSE: Current trend in implant dentistry is changing from external connection to internal connection. To evaluate the splinting of external and internal connection implant on screw loosening, 2-units prosthesis was fabricated with BioPlant System(R) of external connection type and Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. MATERIAL AND METHOD: Experimental group is classified into three groups. 1) G1-EE: 2-units prosthesis was fabricated with two BioPlant System. of external connection type. 2) G1-EI: 2-units prosthesis was fabricated with one BioPlant System(R) of external connection type and one Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. 3) G1-II: 2-units prosthesis was fabricated with two Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. In fabricating 2-units prosthesis, two hexed abutments are recommended when two implants are installed parallel, otherwise one hexed abutment is used on major occlusal force area and one nonhexed abutment is used on the other area. Since it is rare to find two implants being parallel, it is hard to fabricate prosthesis with passive adaptation using two hexed abutments. It is much more difficult to acquire passive adaptation when using hex abutment compared to nonhex abutment. To evaluate the influence of hexed and nonhexed abutment on screw loosening, 2-units prosthesis was fabricated with hexed and nonhexed abutment. Experimental group is classified into three groups. 1) G2-HH: 2-units prosthesis was fabricated with two hexed abutments. 2) G2-HN: 2-units prosthesis was fabricated with one hexed abutment and one nonhexed abutment. 3) G2-NN: 2-units prosthesis was fabricated with two nonhexed abutments. RESULT: The results of comparing the detorque value after loading on a each prosthesis periodically are as follows. 1. In splinting group of external and internal connection implant, G1-II group demonstrated the biggest detorque value, followed by G1-EI group and G1-EE group. 2. There is no notable significance between external connection implant of G1-EI group and G1-EE group and also no significance between internal connection implant of G1-EI group and G1-II group. 3. G2-HH group showed higher detorque value than G2-HN and G2-NN group. From the results, we can concluded that using both external connection and internal connection implant together is clinically acceptable and in order to acquire a good passive adaptation in fabricating 2-units implant prosthesis we can use two nonhexed abutments.
Bite Force ; Dentistry ; Prostheses and Implants ; Splints

OBJECTIVE: To determine the usefulness of neonatal nucleated red blood cell counts (nRBC) as an independent predictor of fetal hypoxia and perinatal outcome in severe preeclampsia. METHODS: One hundred thirty eight patients with severe preeclampsia were studied. Umbilical artery Dopppler velocimetry was performed in all patients, and were divided into two groups, the control group with present umbilical artery end diastolic velocity, and the case group with absent or reversed velocity. The patients were also separately grouped as another control (n=58), acute (n=19), and chronic hypoxia (n=55) according to abnormal Doppler findings, presence of oligohydramnios, intrauterine growth restriction (IUGR), and pattern of fetal heart rate tracings during labor. At delivery, the umbilical cord blood was collected and the levels of nRBC per 100 WBC were measured from the samples along with blood gas analysis. The results were compared between the control and acute groups, and chronic hypoxic fetus. Correlation with perinatal outcomes was also evaluated. Student's t-test, ANOVA, and regression analysis were performed for statistical analysis. RESULTS: Those with absent or reversed end diastolic velocity did not have significantly greater nRBC counts, but had lower platelet counts (p=0.02), lower pO2 (p=0.005), and higher pCO2 saturation levels (p=0.01). There were no significant differences with regard to nRBC counts among the control, acute, and chronic hypoxia groups. Elevated nRBC counts were significantly associated with neonatal intensive care unit stay of more than 28 days (p=0.013), respiratory distress syndrome (p=0.003), disseminated intravascular coagulopathy, or sepsis (p=0.041). CONCLUSION: nRBC counts did not show significant difference according to umbilical artery Doppler velocity. Also we could not find any difference between the control, acute, and chronic hypoxic group, suggesting that nRBC counts does not correlate with both hypoxic status, or duration of hypoxia. Correlation with elevated nRBC counts and neonatal intensive care unit stay of more than 28 days, respiratory distress syndrome, disseminated intravascular coagulopathy, and sepsis was observed. However, the overlapping results and the wide range of nRBC counts according to the complications limits its role as a predictor of poor perinatal outcome.
Anoxia ; Blood Gas Analysis ; Erythrocyte Count ; Female ; Fetal Blood ; Fetal Hypoxia* ; Fetus ; Heart Rate, Fetal ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Oligohydramnios ; Platelet Count ; Pre-Eclampsia* ; Pregnancy ; Rheology ; Sepsis ; Umbilical Arteries

No abstract available.
Amebiasis* ; Diabetes Mellitus* ; Humans ; Kidney* ; Liver*

Primary leptomeningeal melanomas(PLMs) are rare aggressive central nervous system(CNS) tumors without systemic foci. It can be very difficult, however, to clearly distinguish PLMs from those that have metastasized. We report a case of malignant leptomenigeal melanoma occurring in the right temporal convexity of a 77-yearold woman. Almost all malignant CNS melanomas in the old are secondary to the cutaneous melanoma and can cause diverse neurological manifestations; certain clinical findings of the presented case-namely, the patient's age, vague neurologic findings and absence of cutaneous lesions -are therefore interesting. Thorough clinical checkups, including whole-body bone scan, whole spine MRI, abdominal ultrasound, and tumor marker studies to find extracranial lesions revealed no abnormalities. Based on these clinical findings, we suppose-though are not certain-that the tumor of the presented case is a PLM.
Female ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Neurologic Manifestations ; Spine ; Ultrasonography

Hemoptysis leading to airway obstruction by blood clot is a serious and potentially lethal condition in pediatric patients because of the unpredictable course and technical difficulty of managing small airways. An 11-month-old male patient with a contact burn on his left foot was intubated uneventfully during induction for general anesthesia. After 15 minutes, we noted blood in his endotracheal tube along with high airway pressure and desaturation. Immediate suction was performed, and the oxygen saturation recovered, but the airway pressure and small exhaled tidal volume were unchanged. We had difficulty differentiating endotracheal tube obstruction from bronchial spasm at that time. We successfully managed the endotracheal obstruction by extubation with removal of the blood clot and reintubation after the diagnosis was made using fiberoptic bronchoscopy. We review the etiology and management of airway obstruction and hemoptysis in the operating room.
Airway Obstruction ; Anesthesia, General ; Bronchial Spasm ; Bronchoscopy ; Burns ; Foot ; Hemoptysis ; Humans ; Infant ; Intubation ; Male ; Operating Rooms ; Oxygen ; Suction ; Tidal Volume

No abstract available.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular*

OBJECTIVES: The composition of gallstones is very variable depending on many factors such as diet, sex, race, genetic background, and so on. The compositional changes of gallstones have been reported in Korean people. Author studied the compositional characteristics of gallstones in Pusan area to see geographical difference. MATERIAL AND METHODS: Gas chromatography and Mass spectrophotometry was performed on the gallstones obtained from the 34 patients who had been taken cholecystectomy because of acute or chronic cholecystitis. Cholesterol gallstone was defined as the composition of the cholesterol is more than 50%. RESULTS: The cholesterol gallstone was 67.6% (23/34) in the 34 patients. There was sexual difference in the cholesterol gallstone group, which the ratio of male and female was 1:2.3(7/16), while there was no difference in the non-cholesterol stone(5:6). The cholesterol stone consisted with cholesterol, bilirubin, bile acid, and palmitic acid and the propotion of them was 75.6%, 4.6%, 15.0%, and 1.8% respectively. While the proportion of non-cholesterol stone was 30.2%, 26.8%, 37.5%, and 5.5% respectively. CONCLUSIONS: The cholesterol stone was major fraction of gallstone of the patients in Pusan area. There was no difference on the compostion of gallstones between those of patients in Pusan area and in the other area of Korea.
Bile ; Bilirubin ; Busan* ; Cholecystectomy ; Cholecystitis ; Cholesterol ; Chromatography, Gas ; Chromatography, High Pressure Liquid ; Continental Population Groups ; Diet ; Female ; Gallstones* ; Gyeongsangnam-do* ; Humans ; Korea ; Male ; Palmitic Acid ; Soil ; Spectrophotometry

OBJECTIVES: The purpose of this study was to investigate the stress coping strategies and psychological characteristics, such as combined psychopathology and tendency of symptom interpretation, in patients with somatization disorder. METHODS: Thirty patients meeting the criteria of DSM-IV somatization disorder were compared with thirty controls. We evaluated the subjects using Symptom Checklist-90-Revised (SCL-90-R), Somato-Sensory Amplification Scale (SSAS), Symptom Interpretation Questionnaire (SIQ), and The Ways of Stress Coping Questionnaire (SCQ). Independent t-test and Pearson correlation analysis were used. RESULTS: From the results of SCL-90-R subscales, the scores of somatization, obsession-compulsion, depression, anxiety, and psychoticism were significantly higher in patients with somatization disorder than normal controls. Somatization disorder patients had greater amplification of physical sensation in SSAS and significantly higher score in physical interpretation of SIQ compared with psychological or environmental interpretation. In the SCQ of somatization disorder patients, we observed generally lower levels of total coping scores than the control group and significant positive correlation between passive coping style of SCQ and psychological interpretation of SIQ. CONCLUSION: These results show that patients with somatization disorder have various psychopathology, greater amplification of physical sensation, physical interpretation tendency of symptoms, and insufficient copying strategy.
Anxiety ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychopathology ; Surveys and Questionnaires ; Sensation ; Somatoform Disorders*

Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
Bile Ducts, Extrahepatic ; Biliary Tract Diseases/complications/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Duodenal Diseases/*diagnosis/etiology/therapy ; Female ; Gallbladder Neoplasms/diagnosis ; Humans ; Intestinal Perforation/*diagnosis/etiology/therapy ; Middle Aged ; Plastics ; Stents/*adverse effects ; Tomography, X-Ray Computed