Denture wearers' recognition for their oral health status, denture cleansing methods, and insurance health system / 대한치과보철학회지

PURPOSE: The aim of the present investigation was to understand the incidence, prevalence of denture stomatitis in denture wearers, who were over 60 years old, and use the results for a fundamental data to promote public awareness about denture stomatitis and its education tools. MATERIALS AND METHODS: From August 21 to September 8 2017, 500 denture wearers, who were more than 60 years old in Seoul and 4 other metropolitan cities (Busan, Daegu, Gwangju, and Daejeon), received questionnaires. The questionnaires included denture wearers' demographic distributions, specific dental treatment experiences, discomforts with current dentures, their oral health conditions, and the method of denture cleansing. RESULTS: Thirty-two percent of 500 denture wearers responded that they have healthy oral conditions. Two hundred and eight respondents (41.6%) were aware of denture stomatitis. Only 131 (26.2%) were informed about the removable denture covered by national health insurance and 327 (65.4%) of denture wearers were using the improper denture cleansing methods. CONCLUSION: A large number of denture wearers still do not recognize the importance of proper treatment for denture stomatitis, insurance covered denture treatments, and adequate denture cleansing methods.

Clinicopathological Analysis of Recurrence in Stage 1 Gastric Cancer

PURPOSE: Recently, diagnosis of stage 1 gastric cancer has increased in number and prognosis is excellent when proper treatment is done. However, some patients have recurrence and their prognosis is poor. Thus, we investigated the risk factors of recurrence in stage 1 gastric cancer patients. METHODS: From January 2004 to December 2008, a total of 1,241 number patients were operated on for stage 1 gastric cancer at the Department of General Surgery, Kosin University Gospel Hospital. We reviewed the characteristics of all patients retrospectively and compared them to recurred group (n=24) and non-recurred group (n=1,114). We analyzed the risk factors associated with recurrence. RESULTS: Twenty-four patients with stage 1 gastric cancer were recurred after radical gastrectomy. Recurrence rate was 2.05%. The most common pattern of recurrence was hematogenous (41.7%), and lymphatic (20.8%), peritoneal seeding (16.7%), combined form (12.5%), and locoregional (8.3%). Five-year survival rate was 50.08% of recurrence group. Of clinicopathological factors, depth of invasion, lymph node metastasis, lymphatic involvement and tumor marker were statistically significant between recurred and other group. CONCLUSION: In this study, tumor marker, tumor depth, node status, lymphatic channel involvement were possible risk factors of recurrence for stage 1 gastric cancer. More intensive follow up and care is needed for those with such risk factors.

A Multicenter Retrospective Study of Outpatient Intravenous Sedation for Dental Treatments

A three-dimensional finite-element analysis of influence of splinting in mandibular posterior implants / 대한치과보철학회지

STATEMENT OF PROBLEM: Over the past two decades, implant supported fixed prosthesis have been widely used. However, there are few studies conducted systematically and intensively on the splinting effect of implant systems in mandible. PURPOSE: The purpose of this study was to investigate the changes in stress distributions in the mandibular implants with splinting or nonsplinting crowns by performing finite element analysis. MATERIALS AND METHODS: Cortical and cancellous bone were modeled as homogeneous, transversely isotropic, linearly elastic. Perfect bonding was assumed at all interfaces. Implant models were classified as follows. Group 1: Branemark length 8.5mm 13mm splinting type Group 2: Branemark length 8.5mm 13mm Nonsplinting type Group 3: ITI length 8.5mm 13mm splinting type Group 4: ITI length 8.5mm 13mm Non-splinting type An load of 100N was applied vertically and horizontally. Stress levels were calculated using von Mises stresses values. RESULTS: 1. The stress distribution and maximum von Mises stress of two-length implants (8.5mm, 13mm) was similar. 2. The stress of vertical load concentrated on mesial side of implant while the stress of horizontal load was distributed on both side of implant. 3. Stress of internal connection type was spreading through abutment screw but the stress of external connection type was concentrated on cortical bone level. 4. Degree of stress reduction was higher in the external connection type than in the internal connection type.

A Case of Malignant Peripheral Nerve Sheath Tumor Arising from Neurofibromatosis during Pregnancy / 대한피부과학회지

Malignant Peripheral Nerve Sheath Tumor is a neoplasm that most often arises in anatomically discernible peripheral nerves or neurofibroma. This rare tumor usually has a strong association with neurofibromatosis type 1. Nearly half of these malignant tumors arise in individuals affected with neurofibromatosis type 1. Neurofibromas often first appear around the time of puberty, increase in size and number during pregnancy, and shrink after giving birth. Because growth hormone (GH) concentration increases during puberty and pregnancy, it is possible that GH influences the growth of these tumors. A 33-year-old pregnant woman presented with a 4-month history of a painful, huge mass growing on the right breast. She suffered from neurofibromatosis type 1, with multiple cafe au lait spots and neurofibromas. The clinical and histopathological findings showed a malignant peripheral nerve sheath tumor. We report a case of malignant peripheral nerve sheath tumor on the right breast in a pregnant woman with neurofibromatosis type 1.

A case of cytomegalovirus colitis in an immunocompetent adult presenting as pancolitis / 대한내과학회지

CMV is common cause of life-threatening opportunistic viral infection in immunocompromised patients, especially in transplant recipients and those who are infected with HIV. Although CMV infection is generally asymptomatic in healthy adults, CMV colitis can occur in immunocompetent adults. While the right colon is the most common site of gastrointestinal CMV infection, it is extremely rare for it to involve the whole colon. We report a rare case of cytomegalovirus (CMV) colitis in an immunocompetent adult presenting as pancolitis. The usual course of gastrointestinal CMV infection is self limited in an immunocompetent adult, but our case revealed that conservative treatment was not enough, and the administration of ganciclovir was essential for the improvement of disease.

Measurement error of spiral CT Volumetry: Influence of Low Dose CT Technique

PURPOSE: To examine the possible measurement errors of lung nodule volumetry at the various scan parameters by using a small nodule phantom. MATERIALS AND METHODS: We obtained images of a nodule phantom using a spiral CT scanner. The nodule phantom was made of paraffin and urethane and its real volume was known. For the CT scanning experiments, we used three different values for both the pitch of the table feed, i.e. 1:1, 1:15 and 1:2, and the tube current, i.e. 40 mA, 80 mA and 120 mA. All of the images acquired through CT scanning were reconstructed three dimensionally and measured with volumetry software. We tested the correlation between the true volume and the measured volume for each set of parameters using linear regression analysis. RESULTS:For the pitches of table feed of 1:1, 1:1.5 and 1:2, the mean relative errors were 23.3%, 22.8% and 22.6%, respectively. There were perfect correlations among the three sets of measurements (Pearson's coefficient = 1.000, p<0.001). For the tube currents of 40 mA, 80 mA and 120 mA, the mean relative errors were 22.6%, 22.6% and 22.9%, respectively. There were perfect correlations among them (Pearson's coefficient = 1.000, p<0.001). CONCLUSION: In the measurement of the volume of the lung nodule using spiral CT, the measurement error was not increased in spite of the tube current being decreased or the pitch of table feed being increased.

The Surgical Therapeutic Options for Polypoid Lesion of Gallbladder / 한국간담췌외과학회지

PURPOSE: Gallbladder polyps have malignant potentials and there are no definitive treatment criteria. Therefore, to establish the appropriate treatment for gallbladder polyps, the gross and microscopic appearance of gallbladder polyps were studied and the clinical findings analyzed. METHODS: Between January 1990 and December 1999, 1108 subjects underwent open and laparoscopic cholecystectomy at our institute. Seventy nine subjects, confirmed to have gallbladder polyps by pathology, were analyzed. To establish the surgical indications of polyps with malignancy potential, gender, age, clinical symptoms, polyp size, numbers, shape, coexistence of stones and the pathological findings were analyzed. RESULTS: The mean age of the subjects with benign and malignant polyps were 44.2 and 55.2 years old, respectively (p=0.034). The mean maximum diameter in benign and malignant polyps were 6.4 and 19.8 mm, respectively (p= 0.029). There were single polyps in 52.6 (30/57) and 86.3% (19/22) of the benign and malignant lesions, respectively (p= 0.046). Comparing the clinical symptoms (abdominal discomfort. etc) between the two groups, benign polyps had 26.3% (15/57), malignant polyps had 86.3% (19/22) (p= 0.0032). Cholesterol polyps were found in 29 (36.7%), inflammatory or hyperplastic polyps in 11 (13.9%) adenomas in 17 (21.5%) and adenocarcinomas in 22 (27.9%) cases. There were no differences in the presence of stones or in the shape of the polyps. CONCLUSION: On the basis of our analysis, when the polyp is of the single type, over 15 mm in diameter and the patient was 50 years old or over, surgical intervention should be considered due to the high risk of malignancy. If surgical intervention is not appropriated, a close follow-up is generally recommended to monitor the changes in the polyp size and shape.

Carcinoembryonic Antigen (CEA) in the Gallbladder Bile (b-CEA) of Gastric Carcinoma Patients with Long-term Follow up

PURPOSE: Despite numorous reports on the relationship between the level of carcinoembryonic antigen (CEA) in gall bladder bile and liver metastasis in colorectal cancer, no similar studies have been carried out for gastric carcinomas. We, therefore, undertook the present study to establish the relationship between the gall bladder bile CEA and liver metastasis as well as the post-operative survival rate in gastric carcinoma patients with curative resections. MATERIALS AND METHODS: In 373 gastric cancer patients (252 males, 121 females, age 21~76 years) operated on at Kosin University Hospital between 1989~1996, the CEA concentration in the gall bladder bile was determined during the operation and the value was related to the rates of post-operative survival and liver metastasis during follow-up period. RESULTS: The overall rate of patient survival decreased gradually with increase in TNM stage. The 13-year post-operative survival rates for stages Ia, Ib, II, IIIa, and IIIb were 95.7%, 92.5%, 79.9%, 50.9%, and 43.3%, respectively, and the 10-year survival rate for stage IV was 22.6%. The patients with a high (> or =10 ng/ml) biliary CEA showed a significantly lower rate of survival than those with a low (0.10), but in those with high TNM stages (III and IV), the survival rate was significantly lower in the high CEA group (25.9%) than in the low CEA group (57.8%) (P<0.05). CONCLUSION: These result suggest that the gall bladder bile CEA level obtained in an advanced-staged gastric cancer operation may be used in predicting the post-operational survival rate and in sorting out patients with a high risk for cancer recurrence, especially in the liver area.

Outbreak of Hepatitis by Orientia tsutsugamushi in the Early Years of the New Millenium / 대한간학회지

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.

A Case of Fulminant Hepatic Failure in Wilson's Disease Combined with Systemic Lupus Erythematosus / 대한간학회지

Patients with systemic lupus erythematosus (SLE) have a chance of developing liver involvement in their lifetime. The main cause of liver involvement in SLE patients is previous treatment with hepatotoxic drugs or hepatotropic viral hepatitis. Wilson's disease is a hereditary disorder and is usually diagnosed in patients presenting either neuropsychiatric disorders or manifestations related to chronic liver disease. Fulminant hepatic failure as the initial manifestation of Wilson's disease is rare. The relationship between systemic lupus erythematosus and Wilson's disease has not been established. We report a case of a 12-year-old girl with SLE who presented fulminant hepatic failure as an initial manifestation of Wilson's disease. The diagnosis was established with decreased serum ceruloplasmin level and the presence of Kayser-Fleischer ring. We treated with repeated plasma exchange. Despite repeated plasma exchange she died of multi-organ failure on the 16th hospital day. Considering this case, Wilson's disease should be considered as a cause of fulminant hepatic failure, especially in juvenile age cases.

A Case of Lymphocytic Hypophysitis in a Postmenopausal Woman / 대한내분비학회지

A 64-year-old Korean woman presented with a 3-week history of severe headache and ocular pain. Her brain MRI showed a cystic pituitary mass compressing the optic chiasm. A hormonal study revealed anterior pituitary insufficiency and a slightly increased prolactin level. We performed a transsphenoidal resection of the pituitary mass. A pathological examination revealed the presence of a heavy inflammatory infiltrate, composed of lymphocytes and plasma cells, and destruction of the adenohypophysial structures. Five months after surgery, her hormonal levels had nearly normalized, without hormone replacement therapy. A follow-up MRI showed no recurrence. We conclude that lymphocytic hypophysitis should be included in the differential diagnosis of pituitary mass at any age. We discuss the features that can help to make a preoperative differential diagnosis, and selection of the appropriate treatment.

A Case of Osteomalacia with Long Term Carbamazepine Therapy / 대한내분비학회지

Anticonvusant therapy with any of several agents, especially phenytoin, phenobarbital, and primidone causes disturbances in bone mineral metabolism. Anticonvulsants stimulate the hepatic microsomal mixed-oxidase enzymes and hence increase the rate of clearance of vitamin D and its metabolism. The severity of clinical manifestations in any given individual appears to be a function of the combined effects of variety of factors including drug type and total drug dose, dietary vitamin D intake, sunlight exposure, and physical activity level. We report a case of osteomalacia associated with long term carbamazepine therapy in a 21-year-old male with less exposure to sunlight.

A Case of Acute Alcoholic Myopathy with Paraparesis and Myoglobinuric Renal Failure

Acute alcoholic myopathy presented with paraparesis, myoglobinuria. And acute renal failure is an uncommon complication of alcoholism. A 34-year-old man had been a heavy alcohol drinker for a year, complained of sudden lower extremity weal; ness and swelling after heavy drinking. On examination, lower extremity was swollen and unable to move. Laboratory data showed markedly elevated GOT, LDH, CK, and myoglobinuria. Initial electrodiagnostic study was indefinite for diagnosis of myopathy and biopsy of the quadriceps muscle showed slight increased eosinophilia of sarcoplasm. But in followup study, myopathic findings and degeneration becarne apparent in electromyography and blopsy.

A Case of Gastric Metastasis of Malignant Melanoma Diagnosed by Gastroscopy / 대한소화기내시경학회지

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.

A Case of Gastric Metastasis of Malignant Melanoma Diagnosed by Gastroscopy / 대한소화기내시경학회지

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.