Kawasaki disease (KD) is an acute, systemic vasculitis of childhood. The early mortality of KD results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction, and the subacute phase of KD has the highest risk of mortality. Although there have been reports of ischemic heart disease as late cardiologic sequelae of KD in young adults, acute myocardial infarction caused by coronary complications in the subacute phase of KD is rare. We experienced one pediatric patient who developed coronary artery aneurysm and acute myocardiac infarction (AMI) during the subacute phase of incomplete and intravenous immunoglobulin (IVIG)-nonresponsive KD. The patient was given a good prognosis due to close monitoring and early recognition of AMI. Physicians should carefully monitor KD patients who do not respond to initial IVIG therapy and who show progressive coronary artery dilatation. If such a patient complaints of chest pain and the ECG shows hyperacute T waves, the physician should suspect development of AMI.
Aneurysm ; Chest Pain ; Coronary Vessels ; Dilatation ; Electrocardiography ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Infarction ; Male* ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction* ; Myocardial Ischemia ; Prognosis ; Systemic Vasculitis ; Thrombosis ; Young Adult

Spontaneous spinal epidural hematoma is a rare entity. Various definitions for spontaneous epidural hematoma have been reported in the literature. The expression of nontraumatic spinal epidural hematoma seems to be less ambiguous and includes idiopathic hematomas and hematomas secondary to coagulopathy, vascular malformations, and tumors. We report three cases of nontraumatic spinal epidural hematomas observed from 1991 to 2000. The causes of the spinal epidural hematomas were not clear in two cases among them, but in the another one case, the cause was determined to be an acquired coagulopathy. We reviewed 24 cases reported in the Korean Journal of Neurosurgery and our three cases with particular emphasis on the various causes such as coagulopathy, vascular malformations and tumors. Among the 27 cases, numerous causes were detected such as three cases of vascular malformation, one case of anticoagulant treatment, five cases of combined lumbar disc herniation, two cases associated with pregnancy and postpartum, one case associated with hypertension, and one case associated with ossification of ligamentum flavum. No causes were detected in the ten cases. The authors reviewed the literature.
Hematoma ; Hematoma, Epidural, Spinal* ; Hypertension ; Ligamentum Flavum ; Neurosurgery ; Postpartum Period ; Pregnancy ; Vascular Malformations

Persistent truncus arteriosus categories associated with different natural histories and various surgical approaches were reported. Although pulmonary overflow and severe heart failure are common, some patients who have hypoplastic pulmonary artery systems may show lesser symptoms of heart failure and remain in relatively stable condition. We experienced a 33-year-old woman with uncorrected type II persistent truncus arteriosus who presented with cyanosis rather than congestive heart failure, and are presenting her images.
Adult* ; Aorta ; Cyanosis ; Female ; Heart Failure ; Humans ; Pulmonary Artery ; Truncus Arteriosus ; Truncus Arteriosus, Persistent*

Root surfaces affected by periodontal disease undergo various forms of changes. Cementum exposure from gingival recession may result in absorption of calcium, phosphorus, and fluoride and subsequent hypermineralization and increased radiodensity. Although some reports have suggested that inorganic content with root cementum might show various changes depending upon age or extent of periodontal disease, but no consensus can be reached regarding the the distribution of various elements. The present study examines the difference in mineral content between healthy and periodontal diseased roots by analyzing three areas per tooth along the root surface in cervico-apical direction using electron probe and scanning electron microscope. Healthy tooth that was extracted for orthodontic purpose was used as control. Experimental teeth include those with periodontal pocket depth exceeding 6mm and those with gingival recession and periodontal pocket depth of 2-4mm. Levels of Ca, P, Mg and Na were measured using wavelength dispersive x-ray spectrometer at three areas per tooth. The examined areas were located apical to cemento-enamel junction in control and periodontal ligament-depleted areas in experimental teeth. The corresponding areas were also examined with scanning electron microscope(x70) The results are as follows. 1. Minerals were detected in order of Ca, P, Mg and Na. In all root surfaces, levels of Ca and P were higher in dentin than in cementum. 2. Level of Mg was twice as high in dentin than in cementum. There was no significant difference in the level of Mg and Na between normal and periodontal diseased roots or between the various locations in the same root. 3. Level of Ca and P in the surface cementum showed no difference between normal and periodontal diseased root, although the areas in dentin with high level of either ion also showed high level of corresponding ion incementum. 4. Difference in the Ca and P content between various locations within the same root was noted, although no coherent pattern existed. These results suggest that although the mineral content of the root cementum in periodontitis-affected tooth is affected by exogenous ions from saliva and food, but there was no difference in the mineral contents between normal and periodontally diseased root.
Absorption ; Calcium ; Consensus ; Dental Cementum ; Dentin ; Electron Probe Microanalysis* ; Fluorides ; Gingival Recession ; Ions ; Minerals ; Periodontal Diseases ; Periodontal Pocket ; Phosphorus ; Saliva ; Tooth

One of the fundamental causes of periodontal disease is accumulation of bacterial plaque and calculus and most effective method of removing these plaque and calculus are scaling and root planning using hand curet and ultrasonic scaler. Many studies concerning residual degenerated mineral content after periodontal therapies have been carried out, but some problems about these studies were also known. This research studies mineral concents and distribution of residual root surfaces after perfoming hand curet and ultrasonic scaler on root surfaces of single rooted teeth which were extracted for periodontal reasons. EPMA were used to avoid errors from chemical quantative analysis and in addition SEM observation was also performed. The results were as follows. 1. No differences were found between curet group andultrasonic scaler group in Ca, P, Mg and Na level. 2. Concentration level was decreased in the sequence of Ca, P, Mg and Na. 3. Ca and P level were decreased as going to apical portion at curet group and ultrasonic scaler group. 4. More cementum was removed at cervical portion compared to other portion at curet group and ultrasonic scaler group. 5. Ca, P, Mg level was higher in dentin compared to cememtum. There was no difference in mineral level for Ca, P, Mg and Na between root surfaces treated with hand curet and ultrasonic scaler.
Calculi ; Dental Cementum ; Dentin ; Hand ; Periodontal Diseases ; Tooth ; Ultrasonics*

The extracellular PH has been known to be lowered under the condition of chronic inflammation, and the tetrodotoxin-resistant sodium currents(TTX-r INa ) is thought to responsible for the inflammatory pain. We investigated the effects of PH and lidocaine on the TTX-r INa in sensory neurons derived from abolt rat trigeminal root ganglion(TRG) using whole-cell patch clamp technique to evaluate the underlying mechanisms of the poor analgesia following the administration of local anesthetic solutions into or around the area of the of inflammation. The results are as follows: 1. Two types of INa showing different sensitivity to TTX, TTX-sensitive and TTX-resistant INa , were expressed in the rat TRG neurons. 2. The amplitude and the current-voltage(I-V) relationship of TTX-r INa were significantly affected by the changes of extracellular pH. The acidification of external pH reduced the current amplitude and shifted the I-V relation to the depolarizing directions. 3. The change of extracellular PH also affected the voltage-dependence of activation and steady-state inactivation of TTX-r sodium channels. The voltage-dependence of the channel shifted to a depolarizing direction by the elevated concentration of external hydrogen ion. 4. Lidocaine suppressed TTX-r INa in a dose-dependent manner, and inhibitory effect of lidocaine decresed as the external PH lowered. 5. Lidocaine significantly shifted the activation and steady-state inactivation curves of TTX-r sodium channel to a hyperpolarizing direction by about -20 mV. 6. The effects of lidiocaine on TTX-r sodium channel producing an increase in the probability of channel inactivation greatiy decreased when the external pH was changed to 6.3 or 8.3 7. The 0.1mM lidocaine applied at PH 8.3 shifted the steady-state curve to a hyperpolazizing direction by -20mV compared to that obtained at lidocaine-free pH 7.3 condition. In contrast, the steady-state inactivation curve obtained in the presence of 0.1 mM lidocaine at pH 6.3 614 not showed any significant difference to that obtained at lldocaine-free pH 7.3 condition. These results suggest that the inhibitory action of lidocaine on the TTX-r sodium channel may be derived from the modificition of channel gating as well as blockade of channel pore. The reduced extracellular PH may reduce the TTX-rINa and increase the threshold for activation of TTX-r sodium channels. which may be responsible for the decresed neuronal excitability in the acidified environment. In the presence of lidocaine, however, the sensory neuron is thought to be more excitable in the acidic condition than in physiological PH, which may be due to the decreased lidocaine-induced inactivation of TTX-r sodoum channel as well as reduced amount of hydrophobic neutral from of lidocaine in acidosis.
Acidosis ; Analgesia ; Animals ; Ganglion Cysts* ; Hydrogen-Ion Concentration* ; Inflammation ; Lidocaine* ; Neurons* ; Protons ; Rats* ; Sensory Receptor Cells ; Sodium Channels ; Sodium*

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.

The present study evaluated the effects of guided tissue regeneration using biodegradable membrane, with and without calcium-phosphate thin film coated deproteinated bone powder in beagle dogs. Contralateral fenestration defects(6 x 4 mm) were created 4 mm apical to the buccal alveolar crest on maxillary canine teeth in 5 beagle dogs. Ca-P thin film coated deproteinated bone powder was implanted into one randomly selected fenestration defect(experimental group). Biodegradable membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four- & eight-week healing interval and prepared for histologic analysis. The results of this study were as follows. 1. The regeneration of new bone, new periodontal ligament, and new cementum was occurred in experimental group more than control group. 2. The collapse of biodegradable membranes into defects were showed in control group and the space for regeneration was diminished. In experimental group, the space was maintained without collapse by graft materials. 3. In experimental group, the graft materials were resorbed at 4 weeks after surgery and regeneration of bone surrounding graft materials was occurred at 8 weeks after surgery. 4. Biodegradable membranes were not resorbed at 4 weeks and partial resorption was occurred at 8 weeks but the framework and the shape of membranes were maintained. No inflammation was showed at resorption. In conclusion, the results of the present study suggest that Ca-P thin film coated deproteinated bone powder has adjunctive effect to GTR in periodontal fenestration defects. Because it has osteoconductive property and prohibit collapse of membrane into defect, can promote regeneration of much new attachment apparatus.
Animals ; Cuspid ; Dental Cementum ; Dogs* ; Guided Tissue Regeneration* ; Inflammation ; Membranes* ; Periodontal Ligament ; Regeneration ; Transplants

The influence of calcium phosphate (Ca-P) coating on the bone response of titanium implants was investigated two types of titanium implants, i.e. as -machined ,as -machined with Ca-P coating, were prepared. The Ca-P coating produced by OCT Inc technique. These implants were inserted into the left and right femur of beagle dog. After implantation periods of 3 days, 1weeks, weeks, 4weeks, 8weeks, 12weeks, 24weeks, the bone-implant interface was evaluated histologically, histomorphometrically, and removal torque. Histological evaluation revealed no new bone formation around different implant materials after 2weeks of implantation. After 4 weeks, Ca-P coated implants showed a higher amount of bone contact than either of the non coated implants. After 12weeks, bone healing was almost completed. And implant were removed by reverse torque rotation with torque-measuring device. Mean torque values for 4weeks control were 2.375Kgf.cm and experimental were 2.725Kgf.cm. And mean torque values for 8weeks control were 1.25Kgf.cm and experimental were 1.0Kgf.cm On the basis of these findings, we concluded that deposition of a Ca-P coating on an implant has a beneficial effect on the bone response to this implant during the healing phase. Besides implant surface conditions the bone response is also determined by local implant site condition.
Animals ; Calcium* ; Dogs* ; Femur ; Osseointegration* ; Osteogenesis ; Titanium ; Torque

We present two rare cases of anomalous vertebral artery (VA) with retroesophageal right subclavian artery. One patient had a right VA arising from the right common carotid artery (CCA), and a left VA originating from the third branch off the aorta. Both VAs ascended anteriorly to the transverse foramen of C5 to C6 vertebra and entered the transverse foramen of C4. The other patient had a right VA arising from the right CCA and entering the transverse foramen of C5. The presence of anomalous variations of the origin and course of vertebral artery might have serious implications in angiographic and surgical procedures, and it is of great importance to be aware of such a possibility.
Aorta ; Carotid Artery, Common ; Humans ; Spine ; Subclavian Artery ; Vertebral Artery