Peripheral cementifying fibroma is histomorphologically similar to the central cementifying fibroma, but this lesion is unique to the gingival mucosa and is only rarely seen in edentulous area. In most instances, it arise from interdental papilla, with 80% occurring anterior to molar region. This lesion appears to involve the maxilla and mandible equally, demonstrates the highest occurrence rate during the second decade of life, and affects female more frequently than male, with 4.3:1 to 3:2. Peripheral cementifying fibroma presents as firm, pedunculated or sessile mass with an intact or ulcerated surface depending on the presence of trauma. Microscopically, it reveals a highly cellular mass of connective tissue containing numerous plump, proliferating fibrolasts and several forms of calcification. Effective treatment requires deep excision, which includes the ligament and periosteum, followed by a thorough root scaling of the adjacent teeth. A reveiw of the literature and a report of a case of peripheral cementifying fibroma are presented.
Connective Tissue ; Dental Scaling ; Female ; Fibroma* ; Gingiva ; Humans ; Ligaments ; Male ; Mandible ; Maxilla ; Molar ; Mucous Membrane ; Periodontal Ligament* ; Periosteum ; Tooth* ; Ulcer

PURPOSE: The clinical benefits of intravesical electrical stimulation (IVES), in patients with increased residual urine or reduced bladder capacity, have been reported. However, studies on the underlying mechanism of IVES have been limited to the Adelta afferent in healthy rats. This study investigated the changes in the calcitonin gene- related peptide (CGRP) and substance P (SP) expressions, in the lumbosacral dorsal root ganglia (DRG) and the bladder of spinalized rats, to determine the effect of IVES on the C fiber afferent nerve. MATERIALS AND METHODS: Forty Sprague-Dawley rats were divided into normal controls (n=10); IVES treated normal rats (n=10); spinalized rats (n=10) and IVES treated spinalized rats (n=10). The IVES was performed for 2 weeks (5 days a week), 3 weeks after the spinalization in the spinalized animals. All animals had their DRG removed at the lumbosacral (L5-S1) level. Changes in the CGRP and SP, at the DRG and bladder, were measured by western-blot analysis. RESULTS: The relative density of the CGRP and SP following spinalization was significantly higher than those in the controls in both the DRG and the bladder. However, IVES in the spinalized rat significantly decreased the relative density of the SP, in both the DRG and the bladder, compared to the rats with spinalization alone. IVES in the spinalized rats significantly decreased the relative density of the CGRP, in the DRG only, compared to the rats with spinalization. CONCLUSIONS: IVES significantly reduced the CGRP and SP levels in the DRG of spinalized rats, but only the SP levels in the bladder. CGRP and SP are the main factors contributing to the hyper-excitability of the micturition reflex following spinal cord injury. These results suggest that the bladder C fiber afferents are also involved in modulating the micturition reflex with IVES.
Animals ; Calcitonin ; Diagnosis-Related Groups ; Electric Stimulation* ; Ganglia, Spinal ; Humans ; Nerve Fibers, Unmyelinated ; Neuropeptides* ; Rats* ; Rats, Sprague-Dawley ; Reflex ; Specific Gravity ; Spinal Cord Injuries ; Substance P ; Urinary Bladder* ; Urination ; Visceral Afferents

PURPOSE: Bladder tissue fibrosis is characterized by the abnormal deposition of connective tissue within different layers of the bladder wall, resulting in "non-compliance". The different etiologies of bladder fibrosis are either neurogenic, which encompasses myelodysplasia and spinal cord injury, or nonneurogenic, due to a bladder outlet obstruction. In this study, bladder fibrosis was examined to see if it was due to the effect of an abnormal innervation or to abnormal bladder dynamics. MATERIALS AND METHODS: Thirty-five male Sprague-Dawley rats (250-300g) were divided into four groups; the normal (n=5), bilateral pelvic nerve transection; denervation (n=10), vesicostomy (n=10) and vesicostomy after denervation (n=10) groups. After 4 weeks, the bladders of the animals in each group were obtained. In the histological study, the collagen to muscle ratio from Masson's trichrome staining, and the elastin density (%) from Van Gieson staining, were determined using a Metamorph ver 4.6r5 image analyzer. The TGF-beta1 and collagen III protein expressions were detected by Western blotting. RESULTS: The collagen to muscle ratios of the normal, vesicostomy, denervation and vesicostomy after denervation groups were; 0.67+/-0.04*, 0.67+/-0.04*, 1.25+/-0.03* and 0.96+/-0.02 (*p<0.001) and the elastin densities were 14.73+/-1.09**, 16.38+/-2.27, 23.6+/-1.93** and 18.35+/-1.27, respectively (**p<0.01). From the Western blotting, the denervation group showed significantly increased TGF-beta1 and collagen III protein expressions compared with the normal and vesicostomy groups. CONCLUSIONS: The orders of the collagen to muscle ratio and the deposition of elastin were; denervation>vesicostomy after denervation>vesicostomy>normal from the histological study. The levels of TGF-beta1 and of collagen III in the denervation group were higher than those in the vesicostomy after denervation group. The above findings show that pressure and nerve innervation in the bladder both have significant effects on the process of bladder fibrosis. Meanwhile, a vesicostomy could reduce the fibrotic effect caused by denervation, although this is not complete.
Animals ; Blotting, Western ; Collagen ; Connective Tissue ; Cystostomy ; Denervation ; Elastin ; Fibrosis* ; Humans ; Male ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; Transforming Growth Factor beta1 ; Urinary Bladder Neck Obstruction ; Urinary Bladder*

Unlike class I patients, skeletal class II patients have unstable occlusion thus leading to instability of mandibular complete denture. Therefore, mandibular implant overdenture has been the standard of care due to its advantages in stability and retention. The types of attachments can be divided into two categories: solitary and bar type. The indications vary between two categories. In this clinical report, digital technology was utilized from the implant planning to the choice of appropriate attachment. Implants were placed at the desired location as previously planned in terms of angle and depth. Maxillary removable partial denture and mandibular implant overdenture are expected to have fair prognosis.
Denture, Complete ; Denture, Overlay ; Denture, Partial, Removable ; Humans ; Prognosis ; Spatial Analysis ; Standard of Care

OBJECTIVE: To determine the effects of concentric isokinetic knee strength training on gait, balance and health related quality of life in chronic stroke patients. METHOD: Fifteen patients with chronic stroke participated in this study. All subjects were community ambulators and trained using Biodex System 3 isokinetic dynamometer three times a week for 6 weeks. The training program consisted of concentric isokinetic strengthening of both knee extensors and flexors. Peak torque of knee extensors and flexors, walking performance (temporospatial parameter of gait and stair climbing time), balance (overall balance index, anterior/ posterior index and medial/lateral index) and health-related quality of life measure (36-item short form health survey, SF-36) were evaluated before and after training period. RESULTS: Muscle strength improved significantly after training. Walking speed, stride length and stair climbing time improved significantly after training. Balance indices and SF-36 score also improved significantly after training. CONCLUSION: Gain in muscle strength appeared to be transferred to functional improvement. Therefore, isokinetic resistance training program would be one of the effective rehabilitation programs for chronic stroke survivors. Further investigations are required for long-term effect and development of strength-specific resistance training program.
Education ; Gait* ; Health Surveys ; Humans ; Knee* ; Muscle Strength ; Quality of Life* ; Rehabilitation ; Resistance Training* ; Stroke* ; Survivors ; Torque ; Walking

OBJECTIVE: Although guideline recommends beta blockers (BBs) as first line antianginal agent and calcium channel blockers (CCBs) as alternatives after percutaneous coronary intervention (PCI), the prescription patterns in real practice are not in accordance with the guideline. We aimed to investigate the prescribing patterns of primary antianginal drug and relating factors in patients who underwent PCI. METHODS: Patients who have undergone PCI without myocardial infarction (MI) from November 2012 to June 2014 and followed up at least one year in a tertiary teaching hospital were included. Prescribing patterns of primary antianginal drug before, at the time of, and one year after PCI were described. Factors affecting drug selection, and their relationship with incidence of clinical outcomes defined as MI and repeated PCI, unscheduled admission or visit related with heart problem were analyzed with multivariate logistic regression. RESULTS: A total of 506 patients were included and as primary antianginal drugs, BB, CCB, and both were prescribed in 32.2%, 24.5%, and 17.8% of patients, respectively. Also, neither BB nor CCB was prescribed at the time of PCI in 25.5% of patients. Compared with BB, CCBs were more likely prescribed in patients who had hypertension (Odds Ratio, OR 2.18, 95% confidence interval, CI 1.16-4.07), use of same class before PCI (OR 7.18, 3.37-15.2) and concomitant angiotensin receptor blocker (ARB) use (OR, 1.92, 95% CI 1.10-3.33). Incidence of clinical outcomes were not significantly greater in patients who prescribed CCB compared with BB at the time of PCI (aOR 1.32, CI 0.65-2.68). CONCLUSION: This study demonstrated that half of the patients who underwent PCI were prescribed BB. CCB were favored in patients with hypertension, use of same class before PCI, and concomitant ARB use. Significant difference in clinical outcome was not observed between BB and CCB selection as primary antianginal drug.
Angiotensins ; Calcium Channel Blockers* ; Calcium Channels* ; Calcium* ; Heart ; Hospitals, Teaching ; Humans ; Hypertension ; Incidence ; Logistic Models ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prescriptions*

BACKGROUND AND OBJECTIVES: The relative proportion of infective endocarditis (IE) with congenital heart disease (CHD) has increased because of improved survival with CHD. This may affect the current profile of IE with CHD. The aim of this study is to assess the changing profiles of IE with CHD. SUBJECTS AND METHODS: All cases diagnosed from January 1985 to May 2006 were retrospectively reviewed and were analyzed according to the diagnosed period (period I-prior to 1995, period II-after 1996). Duke criteria were used for the definition of diagnosis. RESULTS: As a whole, 121 episodes occurred (63 episodes in period I and 58 episodes in period II). Although the mean age was similar for patients diagnosed in the two periods, the proportion of younger age patients was larger during period II. During period II, the number of non-surgical ventricular septal defect (VSD) cases decreased and the number of Rastelli procedure cases increased. Negative blood cultures were similar in patients for both periods. S. viridans was the most common causative organism in patients during both periods. Post-surgical cases and IE after a dental procedure increased during period II. The in-hospital mortality rate, total complication rate, and proportion of IE requiring early surgery were not different for patients in either period. However, the interval to early surgery was shorter for patients during period II (period I 35+/-21.1 days, period II 22+/-16.5 days, p=0.041). CONCLUSION: Our study indicates that IE in CHD is still a major problem with similar clinical features exhibited during the two different periods. The presence of non-surgical VSD as a major underlying defect indicates that one needs to pay more attention to the education of the population at risk.
Diagnosis ; Education ; Endocarditis* ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Population Characteristics ; Retrospective Studies*

Purpose: No ideal method for subdividing and assessing changes in neurons of the spinal cord during specific conditions has been established. We attempted to develop a method for subdividing spinal neurons using immunohistochemical and fluorescent staining, which is an important key towards understanding the mechanism of reflex voiding. Materials and Methods: Thirty Sprague-Dawley rats, weighting 200-300g, were divided into five groups. A cystometrogram was performed during saline or acetic acid instillation. We identified the neuronal pathway associated with the detrusor by injecting a pseudorabies virus (PRV) into the detrusor muscle and inspecting the changes in relation to different time sequences. An immunohistochemical staining method was used to stain the fos-protein encoded by the c-fos gene. Immunofluorescent staining was performed to evaluate changes in the neurons in relation to the voiding reflex, and the neurons then subdivided. Results: We confirmed pseudorabies virus (PRV) infection of the cells in the sacral parasympathetic nucleus through immunohistochemical staining two days after injection. On detection of an increase in c-fos positive cells after dividing the c-fos positive area of the L6 and S1 spinal cord into 4 sections, significant increases were observed in the sacral parasympathetic nucleus (SPN) and dorsal commissure (DCM). Double staining was performed to detect the neurons associated with the voiding reflex in the SPN and DCM areas showing overexpression of c-fos. Conclusions: The establishment of a method for detecting morphological changes, and subdividing neurons by immunohistochemical and fluorescent staining, may provide an important key towards understanding the mechanism of various neuromodulations of clinically applied treatments. (Korean J Urol 2005;46:487-494)
Acetic Acid ; Genes, fos ; Herpesvirus 1, Suid ; Neurons* ; Proto-Oncogene Proteins c-fos ; Rats, Sprague-Dawley ; Reflex ; Spinal Cord

The clinical benefits of intravesical electrical stimulation (IVES) in patients with increased residual urine or reduced bladder capacity have been reported. However, studies on the underlying mechanism of IVES has been limited to the A delta afferent and parasympathetic neurons. This study investigated the changes in the calcitonin gene-related peptide (CGRP), substance P (SP), and nitric oxide synthase (NOS) expression in the thoracolumbar and lumbosacral dorsal root ganglia (DRG) of spinalized rats to determine the effect of IVES on the C fiber afferent nerve. Forty Sprague-Dawley rats were divided into normal controls (n=10); IVES treated normal rats (n=10), spinalized rats (n=10), and IVES treated spinalized rats (n=10). IVES was performed for 2 weeks (5 days a week). IVES was started 3 weeks after spinalization in the spinalized animals. All animals had the DRG removed at the thoracolumbar (T13-L2) and lumbosacral (L5-S1) level. Changes in the CGRP, SP and n-NOS levels at the DRG were measured by western-blot analysis. The relative density of the CGRP and SP following spinalization was significantly higher compared to the controls in both the T13-L2 and L5-S1 DRG. However, IVES in the spinalized rat significantly decreased the relative density of the CGRP and SP compared to the rats with spinalization alone. A significant increase in the relative density of n-NOS was detected in the L5-S1 DRG following spinalization. However, the density of n-NOS was significantly lower after IVES in both the T13-L2 and L5-S1 DRGs. In conclusion, IVES significantly reduced the CGRP, SP and n-NOS levels in the DRG of spinalized rats. CGRP, SP and n-NOS are the main factors that contribute to the hyperexcitability of the micturition reflex after spinal cord injury. These results suggest that the bladder C fiber afferent is also involved in modulating the micturition reflex by IVES.
Animal ; Calcitonin Gene-Related Peptide/analysis ; Electric Stimulation ; Ganglia, Spinal/*physiology ; Neurons, Afferent/*physiology ; Nitric-Oxide Synthase/analysis ; Rats ; Rats, Sprague-Dawley ; Reflex ; Spinal Cord Injuries/*physiopathology ; Substance P/analysis ; Urination/physiology

A duodenal diverticulum is common in the second portion of the duodenum and can occur at any age. An obstruction, bleeding, perforation, diverticulitis are not an uncommon complicationa of duodenal diverticulum. As a rare complication, bleeding in the duodenal diverticulum may be massive, and duodenal diverticulum is resected primarily as a result of the difficulty in determining the site of bleeding. However, there has been a recent increase in endoscopic diagnosis and the treatment of diverticular bleeding. Band ligation increases the risk of duodenal diverticular perforation because of the thin diverticular wall. An endoscopic hemoclip is a preferable method for endoscopic sclerotherapy. We report a 48- year-old man with a giant duodenal diverticulum that was treated with a hemoclip. The duodenal diverticular perforation was treated effectively with supportive care.
Diagnosis ; Diverticulitis ; Diverticulum* ; Duodenum* ; Hemorrhage ; Ligation ; Sclerotherapy