OBJECTIVE: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. MATERIALS AND METHODS: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. RESULTS: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL +/- 6.8 before stent insertion, decreased to 4.58 mg/dL +/- 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 +/- 99 days, and the median patient survival was 179 +/- 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). CONCLUSION: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/complications/secondary/*surgery ; Bile Ducts, Extrahepatic/*surgery ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Jaundice, Obstructive/diagnosis/etiology/*surgery ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; *Stents ; Stomach Neoplasms/*complications/secondary/surgery ; Treatment Outcome

Foot ; Growth Plate ; Hand ; Joints ; Mandible ; Metaplasia ; Osteochondroma

Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.
Aged, 80 and over ; Brain/pathology ; Catheterization, Central Venous/*adverse effects ; Echocardiography, Transesophageal ; Embolism, Air/*etiology/ultrasonography ; Embolism, Paradoxical/*etiology/ultrasonography ; Humans ; Intracranial Embolism/*etiology/ultrasonography ; Magnetic Resonance Imaging ; Male ; Tomography, X-Ray Computed

Diabetes Mellitus (DM) is a syndrome accompanied with the abnormal secretion or function of insulin, a hormone that plays a vital role in controlling the blood glucose level (BGL). Type 1and 2 DM are most common form and the prevalence of the latter is recently increasing. The aim of this article was to assess whether Type 2 DM could act as a predisposing risk factor on the pulpo-periapical pathogenesis. Previous literature on the pathologic changes of blood vessels in DM was thoroughly reviewed. Furthermore, a histopathologic analysis of artificially-induced periapical specimens obtained from Type 2 diabetic and DM-resistant rats was compared. Histopathologic results demonstrate that the size of periapical bone destruction was larger and the degree of pulpal inflammation was more severe in diabetic rats, indicating that Type 2 DM itself can be a predisposing risk factor that makes the host more susceptible to pulpal infection. The possible reasons may be that in diabetic state the lumen of pulpal blood vessels are thickened by atheromatous deposits, and microcirculation is hindered. The function of polymorphonuclear leukocyte is also impaired and the migration of immune cells is blocked, leading to increased chance of pulpal infection. Also, lack of collateral circulation of pulpal blood vessels makes the pulp more susceptible to infection. These decrease the regeneration capacity of pulpal cells or tissues, delaying the healing process. Therefore, when restorative treatment is needed in Type 2 DM patients, dentists should minimize irritation to the pulpal tissue un der control of BGL.
Animals ; Blood Glucose ; Blood Vessels ; Collateral Circulation ; Dentists ; Diabetes Mellitus ; Humans ; Inflammation ; Insulin ; Microcirculation ; Neutrophils ; Prevalence ; Rats ; Regeneration ; Risk Factors ; United Nations

BACKGROUND: Few studies have been conducted to evaluate the reliability of the various tools used to assess cognitive and psychomotor recovery after ambulatory anesthesia. Therefore, this study was conducted to compare the sensitivity and reliability of simple, standard tests used to measure postoperative cognitive and psychomotor functions. METHODS: Twenty-seven patients admitted for same day surgery were included in this prospective, randomized study. While in the preanesthetic unit, each patient was asked to perform three different standard psychometric tests, the digit symbol substitution test (DSST), digit span test (DST), and perceptual speed test (PST), to evaluate cognitive and psychomotor functions. The results were then used as baseline values that were subsequently compared to results obtained when patients repeated the tests at 15, 30 and 60 min after extubation. In addition, the observer's assessment of alertness and sedation was evaluated. RESULTS: The DSST scores were significantly lower than the baseline scores at 15 and 30 min after extubation, with a performance ratio of 64.9 and 89.2, respectively (P < 0.05). The DST scores had returned to preanesthetic levels at 30 min post-anesthesia and the PST scores were found to be significantly higher than the baseline scores at 30 and 60 min post-anesthesia. CONCLUSIONS: DSST is a more sensitive indicator of residual drug effect following anesthesia than the other tests evaluated in this study. In addition, a learning effect was obvious when the PST was administered.
Ambulatory Surgical Procedures ; Anesthesia ; Humans ; Learning ; Prospective Studies ; Psychometrics

PURPOSE: The aim of this study was to investigate the effect of tongue cleaner-equipped manual toothbrush on tooth cleanness, tongue cleanness and malodor index. MATERIALS AND METHODS: 504 subjects were included in this study. At 1st visit, basic information such as age, sex, smoking amount and alcohol consumption was recorded. Self assessment by individual subjects was performed regarding satisfaction to old toothbrush and toothbrushing habit. Tooth cleanness, tongue cleanness and malodor index was assessed by professional researcher. Tongue cleaner-equipped manual toothbrush was given to each subject with proper toothbrushing instruction. After 1 month passed, self assessment and researcher assessment regarding the same index were performed and analyzed statistically by chi-square test. RESULTS: At 1st visit subjects seem to ignore tongue cleansing and showed poor tooth cleanness index, tongue cleanness index and malodor index, however the same subjects were motivated to clean their tongue and teeth and presented statistically improved distribution pattern in tooth cleanness index, tongue cleanness index and malodor index after using tongue cleaner-equipped manual toothbrush(p<0.01). Satisfaction to tongue cleaner-equipped manual toothbrush was 98%. CONCLUSION: Tongue cleaner-equipped manual toothbrush would be an effective tool for maintaining good oral hygiene through improving tooth and tongue cleanness and preventing malodor formation.
Alcohol Drinking ; Oral Hygiene ; Self-Assessment ; Smoke ; Smoking ; Tongue ; Tooth ; Toothbrushing

Malignant salivary gland tumor is rare neoplasm. In Korean population, retrospective study of malignant salivary gland tumor has not been performed. We analyzed 67 cases of malignant salivary gland tumors from 2001 to 2005 in Seoul National University Dental Hospital in Seoul, Korea. The mean age is 51.7 and the male to female ratio is 1:1.39. The most affected site is the palate. Histologically, the tumors were classified as adenoid cystic carcinoma(34.4%), mucoepidermoid carcinoma(31.3%), adenocarcinoma, NOS(11.9%), polymorphous low grade adenocarcinoma(3.0%), salivary duct carcionoma(6.0%), carcinoma ex pleomorphic adenoma(4.5%), myoepithelial carcinoma(4.5%), epithelial-myoepithelial carcinoma(1.5%), cyatadenocarcinoma(1.5%) and adenosquamous carcinoma(1.5%).
Adenocarcinoma ; Adenoids ; Female ; Humans ; Korea ; Male ; Palate ; Retrospective Studies ; Salivary Ducts ; Salivary Glands* ; Seoul

OBJECT: Spontaneous pontine hemorrhage can be diagnosed by CT or MRI, but the clinical course is variable according to the location of the hemorrhage. MATERIALS AND METHODS: Author attempted to analyse 39 cases of spontaneous pontine hemorrhage, considering factors to influence their prognosis, admitted in Inje University Busan Paik Hospital from 1998 to 2002. RESULT: Pontine hemorrhage was classified according to the finding of CT scan;4 cases of Type I (hematoma, localized in the tegmentum), 18 cases of Type II (those in the tegmentolaterally), 16 in Type III (those in the basis pontis mainly with tegmentum and midbrain). Male to female ratio was 31:8, mean age was 48.2 years (9-76 years). Initial Glascow Coma scale was 7.6 (3-14), and mean follow-up period was 5.1 months (0.1-52 months). Associated diseases were as follows;hypertension;20, pulmonary tuberculosis;2, hypertension with D.M;1. Treatment modality was consisted of 36 conservative treatment, 1 stereotactic hematoma aspiration, 2 Gamma-Knife radiosurgery for associated cavernous malformations. Prognosis was good at following order of the tegmentotectal, tegmentolateral type. CONCLUSION: The prognosis of tegmentotectal, tegmentolateral type hemorrhage was better than basis pontis. The little volume of the hematoma, the better prognosis.
Busan ; Coma ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Male ; Prognosis ; Radiosurgery

PURPOSE: To describe the US, CT and MR findings in eight patients with bile duct hamartomas. MATERIALS AND METHODS: Bile duct hamartomas were diagnosed in eight patients (5 men and 3 women; age range, 41-69 years; mean age, 56 years) by liver biopsy. The US, CT and MR findings were retrospectively reviewed. RESULTS: Ultrasonographically, the bile duct hamartomas presented diffuse inhomogeneous and coarse echo texture with focal lesions, including bright spotty echoes or small hyperechoic nodules (n=7), hypoechoic nodules (n=7) and comet-tail echo (n=3) in seven patients. 16 of the 39 definable hypoechoic nodules that ranged in size from 5 mm to 16mm showed posterior enhancement. CT revealed innumerable hypodense nodules measuring 2-5 mm (n=3), 2-13 mm (n=1), 2-15 mm (n=2) and 2-18 mm (n=1) in seven patients. They were usually irregular in shape and showed no enhancement, but became more apparent after the administration of intravenous contrast medium. The innumerable hypodense nodules on enhanced CT scans were uniformly (n=5) or nonuniformly (n=2) distributed throughout the liver. In four patients, MR images showed multiple small cyst-like lesions 2-13 mm in diameter. These small cystlike lesions were much more apparent on T2-weighted images or MR cholangiography. The diagnosis was made by either core-needle or wedge biopsy. In one patient, a small single lesion on the liver surface was not visible on the imaging studies. Pathologic examination revealed multiple bile duct hamartomas of varying size or microhamartomas. CONCLUSION: Although the bile duct hamartomas on CT and MR presented as numerous intrahepatic, small cyst-like lesions, they on US showed variable findings consisting of inhomogeneous and coarse echo texture with focal lesions, including bright spotty echoes or small hyperechoic nodules, hypoechoic nodules, and comet-tail echoes.
Bile Ducts* ; Bile* ; Biopsy ; Cholangiography ; Diagnosis ; Female ; Hamartoma* ; Humans ; Liver ; Liver Neoplasms ; Male ; Retrospective Studies ; Tomography, X-Ray Computed

The p16/INK4A is one of the major target genes in carcinogenesis and its inactivation has frequently been reported in other types of tumors. The purpose of this study is to evaluate inactivation patterns of p16/INK4A in oral squamous cell carcinoma. Six different oral cancer cell lines, SCC-4, SCC-9, SCC-15, SCC-25, KB, and SNUDH- 379 were examined for inactivation of p16/INK4A genes. In the analysis of p16/INK4A gene inactivation, PCR amplification, direct sequencing, and methylation-specific PCR methods were adopted for evaluation of homozygous deletion, point mutation, and promoter hypermethylation, respectively. Homozygous deletion was detected in SCC-25 and SCC-9. SCC-15 showed hypermethylated promoter region within p16/INK4A gene. It is suggestive in the present study that inactivation patterns of p16/INK4A were mainly homozygous deletion, promoter methylation rather than point mutation in oral squamous cancer cell lines, so treatment modalities of oral squamous cell carcinoma should be focused on these types of inactivation.
Carcinoma, Squamous Cell/*genetics ; Cell Line, Tumor ; DNA Methylation ; *Gene Silencing ; Homozygote ; Humans ; Mouth Neoplasms/*genetics ; Point Mutation ; Promoter Regions (Genetics)/genetics ; Protein p16/*genetics