Vertical positioning of dental implants relative to the cementoenamel junction (CEJ) of the adjacent teeth is essential for maintaining peri-implant bone stability and long-term success. This retrospective study evaluated how the vertical distance from the CEJ affects peri-implant bone loss in patients who had implants positioned at various distances from the CEJ. Bone loss was evaluated using panoramic radiographs over a 2-year follow-up period, with additional consideration of factors such as smoking and diabetes. Implants positioned >4 mm away from the CEJ exhibited a higher mean bone loss; however, this difference was not significant. Smoking significantly influenced bone loss, whereas diabetes and jaw location had no significant effect. These results highlight the potential influence of vertical implant positioning on peri-implant bone health and highlight the importance of appropriate maintenance care to reduce bone loss and ensure long-term implant survival.

A 7-year-old, 4.6 kg spayed female Korean short hair cat presented for health screening with occasional vomiting but had no significant medical history or remarkable clinical symptoms. Radiographic examination revealed bifurcation of the proximal part of the right 9th rib, extending into the caudo-ventral direction of the thoracic cavity without abnormalities in the vertebrae or other organs. This report highlights the importance of understanding radiographic findings and discusses the clinical significance of bifid ribs in veterinary medicine, especially during surgical procedures and trauma management. Advanced diagnostic imaging, including computed tomography, could provide potential valuable insights for detecting such rib anomalies and evaluating their significance. It is crucial that these types of rib anomalies are properly diagnosed in practice to ensure effective treatment and management. Further research into the genetic or developmental factors associated with rib anomalies in veterinary patients is recommended.

Infective endocarditis (IE) is not a common cause of stroke. Considering the high mortality rates, however, IE should always be considered as a possible cause of stroke even when the chances are low. Atrioesophageal fistula is a life-threatening condition that can cause IE and subsequent stroke, but the diagnosis is often delayed due to its rarity. We report a case of multiple embolic infarcts caused by infective endocarditis associated with atrioesophageal fistula after radiofrequency catheter ablation for atrial fibrillation.
Atrial Fibrillation ; Catheter Ablation ; Diagnosis ; Endocarditis ; Esophageal Fistula ; Fistula ; Mortality ; Stroke

No abstract available.
Hypogonadism* ; Lutein* ; Luteinizing Hormone*

PURPOSE: There is a paucity of evidence about prognosis after a first febrile seizure in older children. We investigated the prognosis and potential risk factors associated with subsequent unprovoked seizures in children who had experienced a first febrile seizure over 6 years of age, which we termed as late-onset febrile seizure. METHODS: We included all patients six years or older who presented to the emergency department with a febrile seizure between 2009 and 2015. Clinical data was collected by chart review and parents were contacted for information on seizure progress. We used the Cox proportional-hazards model and Kaplan-Meier analysis for evaluating the risk factors for subsequent unprovoked seizures. RESULTS: Of 247 patients, we excluded 168 children who had a history of epilepsy, unprovoked, or febrile seizure and who were followed-up for period less than six months. Overall, 79 patients were classified as having had a first late-onset febrile seizure. During follow-up of 34.9±25.7(mean±SD) months, unprovoked seizure recurred in 7 of 79 patients (9%). The cumulative probability of seizure recurrence was 4% at 6 months, 6% at 1 year and 9% at 2 years. Clinical variables predictive of subsequent unprovoked seizures were not proved. CONCLUSION: This is the first multicenter study focusing on prognosis after a late-onset febrile seizure in children six years or older. The percentage of subsequent unprovoked seizure in patients with late-onset febrile seizure was 9% at 2 years of follow-up. Prospective follow-up study with longer duration is warranted.
Child ; Emergency Service, Hospital ; Epilepsy ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Parents ; Prognosis* ; Prospective Studies ; Recurrence ; Risk Factors ; Seizures ; Seizures, Febrile*

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a disease that is characterized by acute psychiatric symptoms, seizures, and central hypoventilation. Patients with anti-NMDAR encephalitis exhibit speech alterations, insomnia, seizures, and movement disorders. We describe a previously healthy 6-year-old girl who presented with seizures, disorientation, and fever. Over the five weeks of treatment, the patient exhibited progressive neurologic symptoms, including a change in mental status. Her serum and cerebrospinal fluid contained high titers of antibodies against the NMDAR, and she was diagnosed with anti-NMDAR encephalitis. She was treated with plasmapheresis, steroid pulse therapy, intravenous immunoglobulins, and repeated doses of rituximab. After the patient was diagnosed with a concomitant ovarian teratoma, a unilateral salpingo-oophorectomy was performed. A histopathologic examination revealed that neuronal elements accounted for 60% of the resected ovarian teratoma. The patient's clinical symptoms and antibody titers improved after the surgical treatment and rituximab therapy. These observations suggested that patients with high titers of anti-NMDAR antibodies should be examined for the presence and quantity of neuronal components in concurrent ovarian teratomas.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Antibodies ; Cerebrospinal Fluid ; Child ; Encephalitis* ; Epilepsy ; Female ; Fever ; Humans ; Hypoventilation ; Immunoglobulins, Intravenous ; Movement Disorders ; Neurologic Manifestations ; Neurons* ; Plasmapheresis ; Rituximab ; Seizures ; Sleep Initiation and Maintenance Disorders ; Teratoma*

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a disease that is characterized by acute psychiatric symptoms, seizures, and central hypoventilation. Patients with anti-NMDAR encephalitis exhibit speech alterations, insomnia, seizures, and movement disorders. We describe a previously healthy 6-year-old girl who presented with seizures, disorientation, and fever. Over the five weeks of treatment, the patient exhibited progressive neurologic symptoms, including a change in mental status. Her serum and cerebrospinal fluid contained high titers of antibodies against the NMDAR, and she was diagnosed with anti-NMDAR encephalitis. She was treated with plasmapheresis, steroid pulse therapy, intravenous immunoglobulins, and repeated doses of rituximab. After the patient was diagnosed with a concomitant ovarian teratoma, a unilateral salpingo-oophorectomy was performed. A histopathologic examination revealed that neuronal elements accounted for 60% of the resected ovarian teratoma. The patient's clinical symptoms and antibody titers improved after the surgical treatment and rituximab therapy. These observations suggested that patients with high titers of anti-NMDAR antibodies should be examined for the presence and quantity of neuronal components in concurrent ovarian teratomas.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Antibodies ; Cerebrospinal Fluid ; Child ; Encephalitis* ; Epilepsy ; Female ; Fever ; Humans ; Hypoventilation ; Immunoglobulins, Intravenous ; Movement Disorders ; Neurologic Manifestations ; Neurons* ; Plasmapheresis ; Rituximab ; Seizures ; Sleep Initiation and Maintenance Disorders ; Teratoma*

PURPOSE: The purpose of this study was to investigate the effect of common sources of infection on outcome in patients with severe sepsis and septic shock in the emergency department (ED). METHODS: We conducted a retrospective observational study involving adult patients who were diagnosed with severe sepsis or septic shock in the ED of a tertiary care hospital during the period between August 2008 and March 2012. We categorized patients according to four groups based on source of infection (respiratory infection, intra-abdominal infection [IAI], urinary tract infection [UTI], and other sources [OS] group). The primary outcome was inhospital mortality. Multivariable logistic regression analysis was performed for adjustment of potential confounders, including age, gender, serum lactate concentrations, the Sequential Organ Failure Assessment score, timely antibiotic use, and achievements of early resuscitation targets. RESULTS: A total of 758 patients were included and overall in-hospital mortality was 16.6%. Significant differences in mortality were observed between four groups (27.5% for respiratory infection, 12.1% for IAI, 2.6% for UTI, and 20.0% for other sources, p<0.01). In patients with IAI, adjusted odds ratios (ORs) for mortality were 0.49 (95% confidence interval [CI], 0.27-0.92) compared with the OS group and 0.57 (95% CI, 0.35-0.93) compared with non-IAI. For UTI, adjusted ORs were 0.08 (95% CI, 0.02-0.32) compared with the OS group and 0.09 (95% CI, 0.03-0.35) compared with non-UTI. For respiratory infection, adjusted ORs were 1.33 (95% CI, 0.74-2.39) compared with the OS group and 2.56 (95% CI, 1.60-4.10) compared with non-respiratory infection. CONCLUSION: Results of our study showed that source of infection was independently associated with in-hospital mortality in patients with severe sepsis and septic shock in the ED. In particular, UTI and IAI showed significant association with in-hospital survival. Patients with respiratory infection showed significantly higher mortality, compared with non-respiratory infection patients.
Adult ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Intraabdominal Infections ; Lactic Acid ; Logistic Models ; Mortality ; Observational Study ; Odds Ratio ; Resuscitation ; Retrospective Studies ; Sepsis* ; Shock, Septic* ; Tertiary Healthcare ; Urinary Tract Infections

BACKGROUND: The incidence of acute heart failure (AHF) increases in cold weather. Whether or not AHF has seasonal variation in Korea is unclear, and the influence of humidity on AHF incidence is also unclear. The aim of this study was to examine the correlation between the number of daily emergency department (ED) visits for AHF and the temperature and humidity in Korea. METHODS: On a retrospective basis, we investigated the medical records of patients who visited the ED with dyspnea from Jan. 1, 2008 to Dec. 31, 2010. Inclusion criteria comprised both evidence of clinical symptoms and the presence of signs of pulmonary congestion on chest X-rays. Exclusion criteria included a medical history showing end-stage renal disease with dialysis or showing an acute ST elevation myocardial infarction. The number of daily ED visits for AHF was compared with meteorological data after stratifying temperature or humidity into 3 parts. RESULTS: After stratification by humidity, the results revealed that the number of daily ED visits was significantly associated with minimum temperatures occurring one to 2 days prior to ED admission, although only in the lowest tertile of humidity (p = 0.012, p = 0.021, respectively). The relationship between humidity and daily ED visits for AHF was the same as that mentioned above (p = 0.016, p = 0.039, respectively). CONCLUSIONS: The number of patients with AHF in Korea increases in cold weather, as is the case in other countries. Specifically, AHF incidence was related to temperature minimums occurring one to 2 days prior to ED admission, as well as with humidity.
Climate ; Cold Temperature ; Dialysis ; Dyspnea ; Emergencies ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Humidity ; Incidence ; Kidney Failure, Chronic ; Korea ; Medical Records ; Myocardial Infarction ; Retrospective Studies ; Seasons ; Thorax ; Weather

BACKGROUND: To analyze hemodynamic changes during single catheter technique of hepatic venous isolation and extracorporeal charcoal hemoperfusion for malignant liver tumor. METHODS: Drugs for chemotherapy were infused to the liver through hepatic artery. With 4-lumen- 2-balloon (4L-2B) catheter, hepatic venous blood was circulated to the extracorporeal charcoal system. During extracorporeal charcoal system circulation, drugs were eliminated and the blood was reinfused to supra-hepatic vein-IVC. At the same time, IVC was clamped. Systemic vascular resistance index (SVRI), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), heart rate (HR) and arterial blood gas were measured after 4L-2B catheter insertion (T1), during test circulation (T2), after 20min chemotherapy (T3) and after 10min reperfusion (T4). RESULTS: MAP was decreased at T3 compared to T1 and increased at T4 compared to T3. CI was decreased at T3 and increased at T4 compared to T1. SVRI was decreased at T4 compared to T1. HR was increased at T2 and T3 compared to T1. SVI was decreased at T2 and T3 compared to T1. CONCLUSIONS: During clamping of IVC, MAP is decreased by decreased SVI in spite of increased HR. After IVC is released and the stagnated blood of lower extremity is recirculated, the MAP is returned to the value of after catheter insertion by increased SVI in spite of decreased SVRI.
Arterial Pressure ; Blood Pressure ; Carcinoma, Hepatocellular* ; Catheters ; Charcoal ; Constriction ; Drug Therapy ; Heart Rate ; Hemodynamics* ; Hemoperfusion* ; Hepatic Artery ; Liver* ; Lower Extremity ; Reperfusion ; Stroke Volume ; Vascular Resistance