Recent development of maxillofacial surgery has taken an interest in the regeneration of facial bone defects. For the reconstruction of facial bone defects, autogenous bone grafts have been widely used. However, there are some clinical problems : the morbidity of donor sites, resorption of autogenous bone graft and, the availability of the proper form and size. The purpose of this study is to find the effective solutions to above problems. The present study was designed to evaluate the roles and regenerating capacity of fibrin sealant. Fibrin sealant is a newly developed substance for hemostasis, tissue sealing and wound healing. I made the experimental study on the effects and roles of bibrin sealant in sutogenous bone graft procedure to minimize the above complications and problems. Twenty-five adult white rabbits were used as the experimental material. Three trephine defects were made by drilling on the parietal bone of each rabbit. Defect size was 8x8mm. First group consisted of the rabbits which had the artificial defect on the parietal bone as control. The defect in second group was sealed up with autogenous boon chip only. Last group comprised the rabbits autografted by mixing the bone chip with the fibrin sealant. The results were carefully examined grossly and microscopically from the 3rd day to the 28th day postoperatively. The following results were obtained ; 1. The mixture of fibrin sealant and bone chip was useful for regenerating the bone defects. Most of the defects were substituted by new bone. 2. In the case of the graft with bone chip only, most defects were also filled with new bone, but less than fibrin group. 3. In the control group, new bone was formed around the peripheral area only. A mixture of fibrin sealant and autogenous bone chip plays an effective role in forming new bone. find judging from the results of this experiment, it may be expected the much use of the fibrin sealant in maxillofacial orthopedic surgery.
Adult ; Autografts ; Bone Regeneration* ; Facial Bones ; Fibrin Tissue Adhesive* ; Fibrin* ; Hemostasis ; Humans ; Orthopedics ; Parietal Bone ; Rabbits ; Regeneration ; Surgery, Oral ; Tissue Donors ; Transplants ; Wound Healing

OBJECTIVE: In a rabbit model using hysteroscopy-guided inoculation of E.coli with antibiotic administration, we determine the effects of persistent intrauterine infection on perinatal outcome including fetal death, congenital sepsis, and abnormal fetal-placental growth and amniotic fluid volume in live fetuses. METHODS: Rabbits with timed pregnancies underwent hysteroscopy at 20 to 21 days of gestation(70%). Animals were inoculated with E. coli (0.2 ml containing 10 cfu/ml) and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) every 8 hours beginning 30 minutes after microbial inoculation until they were killed 5 days after hysteroscopy. In the first study, the following outcome parameters were evaluated between fetuses with and without pe#rsistent intrauterine infection: fetal survival, congenital sepsis, maternal morbidity, and placental pathology. In second study was performed in 16 rabbits having only both live fetuses with and without persistent intrauterine infection in a rabbit simultaneously. We evaluate the effects of persistent intrauterine infection on fetal-placental weight and amniotic fluid volume in live fetuses. RESULTS: 1) Fetuses with persistent intrauterine infection had significantly fewer live fetuses, more positive cord blood cultures than those without (live fetuses: 44% vs 82%, p<0.000001; positive cord blood cultures: 44% vs 3%, p<0.000001, respectively; Fishers exact test). However the rates of maternal morbidity and placental inflammatory lesions were similar between the two groups. 2) The placental weight and amniotic fluid volume were significantly less in live fetuses with than in those without persistent intrauterine infection. Moreover the fetal weight was decreased in live fetuses with persistent intrauterine infection, but it was not statistically significant(placental weight: p<0.05; amniotic fluid volume: p<0.05; fetal weight: p 0.051, respectively; Wilcoxon matched-pairs signed ranks test). CONCLUSION: Fetal complications including fetal death, congenital sepsis, and decreased fetal-placental weight and amniotic fluid volume wae produced in utero when pasistent intrauterine infection was present with antibiotics administration after inoculstion of E. coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitar the presence of persistent intrauterine infection, and if it is peristent, delivery may be considered for the improvement of pregnancy outcome.
Amniotic Fluid ; Animals ; Anti-Bacterial Agents ; Female ; Fetal Blood ; Fetal Death ; Fetal Weight ; Fetus ; Hysteroscopy ; Obstetric Labor, Premature ; Pathology ; Pregnancy ; Pregnancy Outcome ; Rabbits ; Sepsis

BACKGROUND: Malpositioning of the endotracheal tube within airway after intubation may results in serious complications, such as accidental extubation and inadvertent endobronchial intubation. Therefore, early detection of malposioning of the endotracheal tube is very impotant for deciding patient's prognosis. METHODS: We assessed the distance from the tip of the endotracheal tube to the carina according to the patient's age, sex, and the time, the location, and the route of intubation. The chest x-ray was taken for 333 patients (men, 226: women, 107) who were admitted to the intensive care unit of Wonju Christian Hospital from march 1, 1995 to February 28, 1996. Chest x-ray was obtained after intubation to verify endotracheal tube position. Appropriate endotracheal tube position on chest x-ray was defined as between 2 and 6 cm above the carina. RESULTS: Of the 333 intubations, 106 (31.8%) endotracheal tubes were inappropriately placed according to the chest x-ray. The percentage of malpositioned endotracheal tubes (<2 cm) was higher in women than in men (11.2% vs. 5.3%, p<0.05), with higher in night (7 PM to 7 AM) than in day (7 AM to 7 PM) (42% vs. 24%, p<0.05). Distance from the carina to the tip of endotracheal tube is 4.34 +/- 1.77cm in women and 5.23 +/- 1.64cm in men. Thus, position of the endotracheal tube in women is deeper than men (p<0.001). CONCLUSIONS: We conclude that the chest x-ray for confirmation of endotracheal tube position after endotracheal intubation may remain the standard of practice. And endotracheal tube position should be carefully assessed immediately after tracheal intubation, particularly in women and at night.
Female ; Gangwon-do ; Humans ; Incidence* ; Intensive Care Units ; Intubation ; Intubation, Intratracheal* ; Male ; Prognosis ; Thorax*

PURPOSE: More effective diagnosis and treatment through a survey on clinical aspect for the last 5 years and interrelation between cold agglutinin titer and mycoplasma antibody titer of Mycoplasma pneumoniae pneumonia. METHODS: 369 patients hospitalized in the department of pediatrics of Chung Goo Sung Shim Hospital for the 5 years from January 1990 to December 1994 have been surveyed, which diagnosed to be Mycoplasma pneumoniae pneumoniaby physical findings or chest x-ray findings with the titer of 1:64 in cold agglutinin test or the titer of 1:80 in Mycoplasma antibody test or forefold increase of any one or both of 2 titers in follow-up tes RESULTS: 1) More cases were found in 1990(76 cases, 20.6%) and 1994(181 cases, 49%) and the monthly distribution showed irregular fluctuations. Male to female ratio was 1:1.2 and high incidence was in the age of 3 to 5 years(27.9%), but 46 cases(12.5%) affected the infants below 1 year old. 2) Cough, fever, sputum were the most chief complaints. More moist rales, pharyngial injection, wheezing were found in physical examination. 86.7% of pneumonic infiltration were found in x-ray findings, 35.8% of which were both lung infiltration. The most common affected site was Rt. lower lobe and then Lt lower lobe and then followed by Rt. upper lobe. 71.8% of the whole cases were hospitalized for 5-8 days. 3) EM administration started 10-12 days after the onset in 29.3%. Mean duration of hospitalization of the cases administrated within 6 days from onset was 7.5+/-2 days, which was shorter than 8.4+/-3.5-that of the cases administrated after 6days from onset. The observation on those duration meant little atatistically(p>0.1) 4) The measure of Mycoplasma antibody titer in 142 cases among 245 positive cold agglutinin test case showed 61.3% of positive ratio. Positive ratio of cold agglutinin test peaked from 13th to 15th day after onset(89%) and went down(33%) after 19th day. Positive ratio of Mycoplasma antibody titer was at its summit(91%) from 7th to 9th day and went down(63%) after 16th day. decreased to 63% after 16 days. 264 cases tested simultaneously for cold agglutinin titer and Mycoplasma antibody titer. Titers of each simultaneous test for cold agglutinin and Mycoplasma antibody were in proportion each other(p<0.005, N=264, r=0.51). CONCLUSIONS: Mycoplasma pneumoniae pneumonia prevailed every 4 years(1990, 1994) and monthly distribution had been irregular. The most cases were found at age of 4 and 5. Mycoplasma antibody titer seems more effective for early diagnosis for Mycoplasma antibody titer showed high positive rate earlier and the rate went down earlier than cold agglutinin titer. The earlier diagnosis and treatment are required because of tendency of later erythromycin administration.
Child* ; Cough ; Diagnosis ; Early Diagnosis ; Erythromycin ; Female ; Fever ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Infant ; Lung ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pediatrics ; Physical Examination ; Pneumonia* ; Pneumonia, Mycoplasma* ; Respiratory Sounds ; Sputum ; Thorax

Biliary atresia is a surgical disease of infancy with a very poor prognosis usually attributed to the rarity of surgically correctable case. This paper presents a case of incorrectable type of biliary atresia 50 days old Direan female infant who were subjected to the Modified Kasai Operation She had shown good bile excretion after surgery but developed recurrent fever, severe hypocalcemia and roentgenographically prover rickets during the follow up periods. She died 7 months after the operation.
Bile ; Biliary Atresia* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hypocalcemia ; Infant ; Prognosis ; Rickets

Over the physiologic range of heart rate, the duration of electrical systole(QT) is shorter than that of electromechanical systole(QS2), which reflects direct physiologic link between electrical repolarization and mechanical events of the cardiac cycle. The present study designed to test usefulness of systolic time intervals and QT-QS2(QT minus QS2) value as complication predictors, which may predict prognostic status of myocardial infarction. The studied subjects were consisted of 33 healthy adults as control(22 men, 11 women) and 35 patients with myocardial infarction. And studied patients were divided into 3 groups; group I of 14 patients with or without complication in acute stage, group II of 11 uncomplicated patients under recovery of chronic status, group III of 10 complicated patients under recovery or chronic status. The observation periods were 3 to 13 days in group I, 5 to 96 weeks in group II and III after their onset. The results were follows; 1) The normal ranges were defined as mean+/-2 standard deviations of the measured values of control, that of QTc were shorter than 431ms of man and 458ms of woman, that of QS2 I were longer than 503ms of man and 514ms of woman, that of PEP/LVET ratio was less than 0.40, that of QT-QS2 value was less than 0 ms respectively. 2) QTc of all patient groups were significantly prolonged compared with that of control, and that of group III was significantly longer than that of group II(481+/-25 vs 432+/-32, p<0.005). 3) The changes of QS2 I were not significant in all patient groups compared with QS2 I of control. 4) QT-QS2 value showed QT>QS2 in group I and III. and QTQS2 had positive predictive value of 82% for predicting probability of previous complicated status. We concluded that QT-QS2 value, including PEP/LVET ratio and QTc, could be used as complication predictors. But it is necessary to examine these indicators prospectively to confirm its clinical applicability.
Adult ; Female ; Heart Rate ; Humans ; Male ; Myocardial Infarction* ; Reference Values ; Sensitivity and Specificity ; Systole*

PURPOSE: We report two cases of mucocele formation after medial orbital wall fracture repair with an alloplastic implant. CASE SUMMARY: A 61-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant five years earlier presented with a several-month history of left proptosis without diplopia, pain, or lid edema. A 55-year-old man with a history of a medial orbital wall fracture repaired with an alloplastic implant seven years prior, presented with a five.year history of left proptosis with diplopia. Computed tomography (CT) scans revealed a large cyst on the orbital medial wall, which surrounded the alloplastic implant and had no definite enhancement. The patients underwent orbital surgery to remove both the cyst and implant. Histologic examination of the cyst revealed a capsule lined with ciliated pseudostratified columnar epithelium. Both patients had an uncomplicated postoperative course with resolution of the proptosis. CONCLUSIONS: For cases that present with late proptosis after orbital fracture repair, mucocele formation should be included in the differential diagnosis.
Diagnosis, Differential ; Diplopia ; Edema ; Epithelium ; Exophthalmos ; Humans ; Middle Aged ; Mucocele ; Orbit ; Orbital Fractures

Complications related to a broken stylet during endotracheal intubation have been infrequently reported. In most cases, broken stylets have been recognized by chest radiography. We report a case of unrecognized iatrogenic aspiration of a broken stylet. A 37-year-old man, who underwent explo-laparotomy two days previously, was reintubated with an uncoated stylet in the intensive care unit because of dyspnea and pulmonary congestion. He was on artificial ventilation for one day and was extubated one week later. We could not find the broken stylet on serial chest x-ray films until a metallic substance was expectorated while the patient was coughing 28 days after extubation. During the intervening period the patient did not complain of any chest discomfort and we did not realize that the broken stylet remained. The use of a plastic coated stylet and its careful observation after intubation are recommended to avoid this complication.
Adult ; Cough* ; Dyspnea ; Estrogens, Conjugated (USP) ; Humans ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Plastics ; Radiography ; Thorax ; Ventilation ; X-Ray Film

PURPOSE: In this study we compared the intraocular pressures (IOPs) measured using dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) and investigated the correlation between central corneal thickness (CCT) and IOP. METHODS: In a prospective study, 178 eyes of 91 subjects with glaucoma and glaucoma suspect were enrolled. IOP was measured using DCT and GAT and CCT was measured using ultrasound pachymetry. Each eye was classified into 1 of 3 groups according to their CCT: low CCT (Group A; CCT < 525 microm), normal CCT (Group B; 525 < or = CCT < 561 microm), and high CCT (Group C; CCT > or = 561 microm). In each group, we investigated the correlation between CCT and IOP measurement using GAT and DCT. RESULTS: A significant correlation was found between CCT and IOP measured using GAT (p < 0.001), but not between CCT and IOP measured using DCT (p = 0.108) in all patients. Subgroup analysis showed that CCT affected IOP measured with GAT only in Group A (p = 0.027) and IOP measured with DCT was not affected by CCT in all 3 groups. CONCLUSIONS: IOP measured using GAT and DCT were significantly affected by CCT, especially when the CCT was low. CCT may have no effect on DCT thus, IOP measured using DCT is more reliable than GAT in patients with thin corneas.
Cornea ; Glaucoma ; Humans ; Intraocular Pressure ; Manometry* ; Prospective Studies ; Ultrasonography

Primary aldosteronism is typically characterized by hypertension, hypokalemia, elevated plasma aldosterone concentration, and suppressed plasma renin activity. Surgieal excision of the tumor mostly cures hypertension as well as electrolyte and hormonal abnormalities in patient with aldosterone-producing adenoma. We have experienced the anesthetic management of unilateral adrenalectomy in a 32 years old male, who was diagnosed as aldosterone-producing adenoma, under the general anesthesia with careful monitoring. Postoperative recovery was uncomplicated.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Anesthesia, General ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Male ; Plasma ; Renin