Iron Therapy in Chronic Kidney Disease: Days of Future Past.

Anemia affects millions of patients with chronic kidney disease (CKD) and prompt iron supplementation can lead to reductions in the required dose of erythropoiesis-stimulating agents, thereby reducing medical costs. Oral and intravenous (IV) traditional iron preparations are considered far from ideal, primarily due to gastrointestinal intolerability and the potential risk of infusion reactions, respectively. Fortunately, the emergence of novel iron replacement therapies has engendered a paradigm shift in the treatment of iron deficiency anemia in patients with CKD. For example, oral ferric citrate is an efficacious and safe phosphate binder that increases iron stores to maintain hemoglobin levels. Additional benefits include reductions in fibroblast growth factor 23 levels and the activation of 1,25 dihydroxyvitamin D. The new-generation IV iron preparations ferumoxytol, iron isomaltoside 1000, and ferric carboxymaltose are characterized by a reduced risk of infusion reactions and are clinically well tolerated as a rapid high-dose infusion. In patients undergoing hemodialysis (HD), ferric pyrophosphate citrate (FPC) administered through dialysate enables the replacement of ongoing uremic and HD-related iron loss. FPC transports iron directly to transferrin, bypassing the reticuloendothelial system and avoiding iron sequestration. Moreover, this paper summarizes recent advancements of hypoxia-inducible factor prolyl hydroxylase inhibitors and future perspectives in renal anemia management.

Dry sauna therapy is beneficial for patients with low back pain

BACKGROUND: Dry sauna has been very popular as an alternative therapy for promoting health among people who want to improve their health condition without relying on pharmaceuticals. The aim of this study was to investigate whether dry sauna therapy improved quality of life and reduced pain in participants with low back pain.METHODS: Study participants comprised a total of 37 consecutive patients who were over 20 years of age with low back pain. Dry sauna therapy was performed twice per day for 5 consecutive days over the course of 1 week, thus comprising a total of 10 sessions each of 15 min of exposure to a 90℃ dry sauna.RESULTS: The verbal numerical rating scale (VNRS) and Oswestry disability index (ODI) scores were significantly reduced after dry sauna therapy (P < 0.001 for both). VNRS pain scores had a median (range) of 5 (2–8) before dry sauna therapy and 3 (0–8) after dry sauna therapy. ODI scores had a median (range) of 12 (2–24) before dry sauna therapy and 8 (1–17) after dry sauna therapy. The proportion of participants who reported successful treatment (excellent + good) was 70%. No adverse effects were observed related to dry sauna therapy.CONCLUSIONS: Our results suggest that dry sauna therapy may be useful to improve quality of life and reduce pain in patients with low back pain. Therefore, pain physicians can recommend dry sauna therapy as an alternative and complimentary therapy for patients with low back pain.

Change of Extracellular Glutamate Level in Striatum during Deep Brain Stimulation of the Entopeduncular Nucleus in Rats

OBJECTIVE: Globus pallidus interna (GPi) is acknowledged as an essential treatment for advanced Parkinson’s disease (PD). Nonetheless, the neurotransmitter study about its results is undiscovered. The goal of this research was to examine influences of entopeduncular nucleus (EPN) stimulation, identical to human GPi, in no-lesioned (NL) rat and 6-hydroxydopamine (6-HD)-lesioned rat on glutamate change in the striatum. METHODS: Extracellular glutamate level changes in striatum of NL category, NL with deep brain stimulation (DBS) category, 6-HD category, and 6-HD with DBS category were examined using microdialysis and high-pressure liquid chromatography. Tyrosine hydroxylase (TH) immunoreactivities in substantia nigra and striatum of the four categories were also analyzed. RESULTS: Extracellular glutamate levels in the striatum of NL with DBS category and 6-HD with DBS category were significantly increased by EPN stimulation compared to those in the NL category and 6-HD category. EPN stimulation had no significant effect on the expression of TH in NL or 6-HD category. CONCLUSION: Clinical results of GPi DBS are not only limited to direct inhibitory outflow to thalamus. They also include extensive alteration within basal ganglia.

Change of Extracellular Glutamate Level in Striatum during Deep Brain Stimulation of the Entopeduncular Nucleus in Rats

OBJECTIVE: Globus pallidus interna (GPi) is acknowledged as an essential treatment for advanced Parkinson’s disease (PD). Nonetheless, the neurotransmitter study about its results is undiscovered. The goal of this research was to examine influences of entopeduncular nucleus (EPN) stimulation, identical to human GPi, in no-lesioned (NL) rat and 6-hydroxydopamine (6-HD)-lesioned rat on glutamate change in the striatum.METHODS: Extracellular glutamate level changes in striatum of NL category, NL with deep brain stimulation (DBS) category, 6-HD category, and 6-HD with DBS category were examined using microdialysis and high-pressure liquid chromatography. Tyrosine hydroxylase (TH) immunoreactivities in substantia nigra and striatum of the four categories were also analyzed.RESULTS: Extracellular glutamate levels in the striatum of NL with DBS category and 6-HD with DBS category were significantly increased by EPN stimulation compared to those in the NL category and 6-HD category. EPN stimulation had no significant effect on the expression of TH in NL or 6-HD category.CONCLUSION: Clinical results of GPi DBS are not only limited to direct inhibitory outflow to thalamus. They also include extensive alteration within basal ganglia.

Stabilization of serum alkaline phosphatase in hemodialysis patients by implementation of local chronic kidney disease-mineral bone disorder management strategy: A quality improvement study

BACKGROUND: The aim of this study is to narrow the gap between global guidelines and local practices, we recently established domestic recommendations by adapting the international guidelines for management of chronic kidney disease-mineral bone disorder (CKD-MBD) in patients on maintenance hemodialysis (MHD). This study was undertaken to determine whether application of this guideline adaptation was associated with improved serum mineral profiles in patients with CKD-MBD. METHODS: A total of 355 patients on MHD were enrolled from seven dialysis units. After adhering to our strategy for one year, serum phosphorus, calcium, intact parathyroid hormone (iPTH), and alkaline phosphatase (AP) levels were compared with the baseline. The endpoint was improvement in the proportion of patients with serum mineral levels at target recommendations. RESULTS: The median serum phosphorus level and proportion of patients with serum phosphorus within the target range were not changed. Although the median serum calcium level was significantly increased, the proportion of patients with serum calcium within the target range was not significantly affected. The proportion of patients with serum iPTH at the target level was not altered, although the median serum iPTH was significantly decreased. However, both median serum AP and the proportion of patients with serum AP at the target level (70.4% vs. 89.6%, P < 0.001) were improved. CONCLUSION: In our patients with MHD, serum mineral profiles were altered and the serum AP level stabilized after implementing our recommendations. Long-term follow-up evaluations are necessary to determine whether uremic bone disease and cardiovascular calcifications are affected by these recommendations.

Vitamin D and Hypertension

Vitamin D has the pleiotropic effects in multiple organ systems, and vitamin D deficiency was suggested to be associated with high blood pressure according to previous reports. Several interventional studies have examined the effect of vitamin D supplementation on high blood pressure patients, but the results have been inconsistent. In this article, we examined the literature that have proposed a mechanism involving vitamin D in the regulation of blood pressure and review previous observational and interventional studies that have shown the relationship between vitamin D and hypertension among various populations.

Comparison of CVF (Cyclophosphamide+Vinorelbine+5-Fluorouracil) and CMF (Cyclophosphamide+Methotrexate+5-Fluorouracil) Adjuvant Chemotherapy in Early Breast Cancer / 한국유방암학회지

PURPOSE: Our study aimed to evaluate the feasibility of adjuvant cyclophosphamide/vinorelbine/5-fluorourail (CVF) chemotherapy as an alternative to cyclophosphamide/methotrexate/5-fluorouracil (CMF) chemotherapy for treating early breast cancer. METHODS: One hundred and forty-nine patients were randomly assigned to CMF or CVF adjuvant chemotherapy for treating their early stage breast cancer between September 2000 and December 2007. The disease-free survival (DFS), the overall survival (OS), and the toxicity profiles of both groups were compared. RESULTS: Sixty-seven patients underwent CMF chemotherapy whereas 82 patients underwent CVF chemotherapy. The DFS and OS were 88 months (95% confidence interval [CI], 76-101 months) and 94 months (95% CI, 83-104 months), respectively for the CMF group, and 97 months (95% CI, 93-101 months), and 101 months (95% CI, 98-104 months), respectively for the CVF group. However, those survival gains of the CVF group were not statistically significant (p-value=0.069 for the DFS and 0.99 for the OS). The CVF group showed a favorable toxicity profile in terms of the grade 3/4 hematologic toxicities as compared to that of the CMF group. CONCLUSION: Clinical outcome of CVF chemotherapy was comparable to CMF with a favorable toxicity profiles. However, it is difficult to conclude the feasibility of CVF regimen because of small number of studied patients.

Effects of Atorvastatin on the Induction of Experimental Cerebral Aneurysm in a High Lipid Diet Rat Model / 대한뇌혈관외과학회지

OBJECTIVE: Previously, we reported that a high lipid diet significantly increases the induction rate of cerebral aneurysm (CA) formation in an experimentally induced CA rat model, suggesting that hypercholesterolemia with chronic inflammation leads to aneurysm formation. To elucidate the role of hypercholesterolemia in CA formation, experimentally induced CA was evaluated in rats fed a high lipid diet and treated with low and high doses of atorvastatin. METHODS: Thirty-seven, 7-week-old male Sprague-Dawley rats underwent a CA induction procedure. The control animals (n = 11) were fed a normal diet, and the experimental animals (n = 26) were fed a diet containing high lipid content for 3 months. The experimental group comprised a high-dose atorvastatin group (20 mg/kg/day, n = 15) and low-dose atorvastatin group (1 mg/kg/day, n = 11). Three months after the operation, induction of CA formation in the three groups was analyzed. RESULTS: Induced CA formation was 67%, 63%, and 36% in the control, high lipid/high atovastatin, and high lipid/low atovastatin group, respectively. The differences resulting from high-dose and low-dose atorvastatin were significant (Pearson k2, P = 0.028 and 0.029, respectively). CONCLUSIONS: A high lipid diet can significantly increase induction of CA formation. However, the lack of decreased induction in atorvastatin-treated animals suggests that high and low doses of atorvastatin do not inhibit the potential effects of hypercholesterolemia on CA formation. Further studies, such as those utilizing apolipoprotein E knockout mice, are necessary to elucidate the exact role of hypercholesterolemia in the pathophysiology of CA.

The effect of low temperature aging on the mechanical property & phase stability of Y-TZP ceramics

STATEMENT OF PROBLEM: Recently Yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) has been introduced due to superior flexural strength and fracture toughness compared to other dental ceramic systems. Although zirconia has outstanding mechanical properties, the phenomenon of decrease in the life-time of zirconia resulted from degradation in flexural strength after low temperature aging has been reported. PURPOSE: The objective of this study was to investigate degradation of flexural strength of Y-TZP ceramics after various low temperature aging treatments and to evaluate the phase stability and micro-structural change after aging by using X-ray diffraction analysis and a scanning electron microscope (SEM). MATERIAL AND METHODS: Y-TZP blocks of Vita In-Ceram YZ (Vita Zahnfabrik, Bad Sackingen, Germany) were prepared in 40 mm (length) x 4 mm (width) x 3 mm (height) samples. Specimens were artificially aged in distilled water by heat-treatment at a temperature of 75, 100, 125, 150, 175, 200, and 225degrees C for 10 hours, in order to induce the phase transformation at the surface. To measure the mechanical property, the specimens were subjected to a four-point bending test using a universal testing machine (Instron model 3365; Instron, Canton, Mass, USA). In addition, X-ray diffraction analysis (DMAX 2500; Rigaku, Tokyo, Japan) and SEM (Hitachi s4700; Jeol Ltd, Tokyo, Japan) were performed to estimate the phase transformation. The statistical analysis was done using SAS 9.1.3 (SAS institute, USA). The flexural strength data of the experimental groups were analyzed by one-way analysis of variance and to detect statistically significant differences (alpha= .05). RESULTS: The mean flexural strength of sintered Vita In-Ceram YZ without autoclaving was 798 MPa. When applied aging temperature at below 125degrees C for 10 hours, the flexural strength of Vita In-Ceram YZ increased up to 1,161 MPa. However, at above 150degrees C, the flexural strength started to decrease. Although low temperature aging caused the tetragonal-to-monoclinic phase transformation related to temperature, the minimum flexural strength was above 700 MPa. CONCLUSION: The monoclinic phase started to appear after aging treatment above 100degrees C. With the higher aging temperature, the fraction of monoclinic phase increased. The ratio of monoclinic/tetragonal + monoclinic phase reached a plateau value, circa 75% above 175degrees C. The point of monoclinic concentration at which the flexural strength begins to decrease was between 12% and 54%.

Effects of PCB Congeners in Rodent Neuronal Cells in Culture

We attempted to analyze the mechanism of polychlorinated biphenyl (PCB) -induced neurotoxicity and identify the target molecules in the neuronal cells for PCBs. Since the developing neuron is particularly sensitive to PCB-induced neurotoxicity, we isolated cerebellar granule cells derived from 7-day old Sprague Dawley (SD) rats and grew cells in culture for additional 7 days to mimic PND-14 conditions. Only non-coplanar PCBs at a high dose showed a significant increase of total protein kinase C (PKC) activity at phobol 12, 13-dibutyrate ([3H]PDBu) binding assay, indicating that non-coplanar PCBs are more neuroactive than coplanar PCBs in neuronal cells. PKC isozymes were immunoblotted with the selected monoclonal antibodies. PKC-alpha, delta, and epsilon were activated with non-coplanar PCB exposure. Receptor for activated C kinase-1 (RACK-1), anchoring protein for activated PKC, was more induced with exposure to coplanar PCBs than non-coplanar PCBs. Reverse transcription PCR (RT-PCR) analysis showed induction of neurogranin (RC-3) and growth associated protein-43 (GAP-43) mRNA with non-coplanar PCBs. The results indicate that these factors may be useful biomarkers for differentiating non-coplanar PCBs from coplanar PCBs. The present study demonstrated that non-coplanar PCBs are more neuroactive congeners than coplanar PCBs.

Effect of Visible Light Therapy in Stroke Patients

OBJECTIVE: The aims of this study was to evaluate the effects of visible light therapy for the stroke patients. METHOD: Thirty stroke patients were enrolled and classified into two groups, experimental (n=19) and control group (n=11). Control group received conventional rehabilitation therapy. Experimental group received additional light therapy with red light (intensity 962 lux, wave length 620 nm) on wrist, elbow, and shoulder joint area (diameter 10 cm) at the same time, 3 times per day, 20 minutes per session, 5 days per week, for 2 weeks. All patients were assessed their paralytic upper extremity functions using manual muscle testing, two point discremination test (2-PD), Semmes-Weinstein monofilament test, and modified Ash-worth scale. To evaluate neurophysiological effects of light therapy, sympathetic skin response, thermography, and doppler ultrasound on radial artery were performed. RESULTS: Compared to the control group, the experimental group significantly improved in the 2-PD test, Semmes-Weistein monofilament test, and the hand grip power. Neurophysiologic parameters showed no significant difference between experimental and control groups. CONCLUSION: Visible light therapy maybe used as an effective therapeutic modality for improving hand function of stroke patients. Further studies are required to define the mechanism of effects on paralytic extremity of visible light.

Effect of Visible Light Therapy in Patients with Somatic Pain

OBJECTIVE: The purpose of this study is to evaluate the effect of visible light therapy for the management of somatic pain. METHOD: Subjects consisted of 42 patients with pain and were divided into two groups; control (n=22) and experimental (n=20) groups. Control group received conventional physical therapy only, while experimental group received additional light therapy with blue light (light intensity 4080 lux, wave length 581 nm, distance from lamp 5 cm). Intensity of pain was assessed by visual analogue scale (VAS) and McGill pain questionnaire. Sympathetic skin response was measured to assess the status of autonomic nervous system. VAS and McGill pain questionnaire were administered before treatment and at 1 day, 2 days, 3 days, 1 week, and 2 weeks after treatment. Sympathetic skin response were performed before and 2 weeks aftertreatment. RESULTS: 1) In both experimental and control groups, VAS became significantly lower at two weeks after treatment compared to pretreatment scale (p<0.05). 2) McGill pain questionnaire showed significantly lower scores two weeks after treatment compared to pretreatment score, only in experimental group (p<0.05). 3) Experimental group showed significantly lower McGill pain questionnaire score than control group at two weeks after treatment (p<0.05). 4) Latency and amplitude of sympathetic skin response showed no significant difference between experimental and control groups. CONCLUSION: Visible light therapy can be used as an effective therapeutic modality for the management of symptomatic pain in combination with conventional physical therapy.

FRACTURE STRENGTH AND MARGINAL FIT OF IN-CERAM, COPY-MILLED IN-CERAM, AND IPS EMPRESS 2 ALL-CERAMIC BRIDGES / 대한치과보철학회지

All-ceramic restorations have become an attractive alternative to porcelain-fused-to-metal crowns. In-Ceram, and more recently IPS Empress 2 were introduced as a new all-ceramic system for single crowns and 3-unit fixed partial dentures. But their strength and marginal fit are still an important issue. This study evaluated the fracture resistance and marginal fit of three systems of 3 unit all-ceramic bridge fabricated on prepared maxillary anterior resin teeth in vitro. The 3 all-ceramic bridge systems were: (1) a glass-infiltrated, sintered alumina system (In-Ceram) fabricated conventionally, (2) the same system with copy-milled alumina cores (copy-milled In-Ceram), (3) a heat pressed, lithium disilicate reinforced glass-ceramic system (IPS Empress 2). Ten bridges of each system with standardized design of framework were fabricated. All specimens of each system were compressed at 55degree at the palatal surface of pontic until catastrophic fracture occurred. Another seven bridges of each system were fabricated with standard method. All of the bridge-die complexes were embedded in epoxy resin and sectioned buccolingually and mesiodistally. The absolute marginal discrepancy was measured with stereomicroscope at x50 power. The following results were obtained: 1. There was no significant difference in the fracture strength among the 3 systems studied. 2. The Weibull modulus of copy-milled In-Ceram was higher than that of In-Ceram and IPS Empress 2 bridges. 3. Copy-milled In-Ceram (112micrometer) exhibited significantly greater marginal discrepancy than In-Ceram (97micrometer), and IPS Empress 2 (94micrometer at P=0.05. 4. The lingual surfaces of the ceramic crowns showed smaller marginal discrepancies than mesial and distal points. There was no significant difference between teeth (incisor, canine) at P=0.05. 5. All-ceramic bridges of three systems appeared to exhibit sufficient initial strength and acceptable marginal fit values to allow clinical application.

A study of HLA-DR polymorphism in four physical constitution groups classified by Korean traditional medicine / 대한내과학회지

BACKGROUND: In Korean traditional medicine, human beings are classified into 4 groups accordance with the characteristics of physical constitution, named; Taeum, Taeyang, Soum, and Soyang. Most of Korean traditional doctors believe that the back ground of pathophysiology is differ among each group in many diseases. HLA is the most polymorphic gene and related with human immune response. It has been used for determination of individual identification, genetic diversity and a study of disease association in different ethnic group. It has well known that the most human inflammatory disease which thought to have some autoimmune basis are in some way promoted by genes of the HLA region. The purpose of this study is to observe the distribution of HLA-DR genotypes in 4 types of physical constitution in Korean traditional medicine. METHODS: Three hundred and ten Korean subjects(Soyang : 58cases, Soum :142cases, Taeum : 92cases, Taeyang : 18cases) were enrolled for this study. Genomic DNAs extracted by phenol/chroloform were amplified with allele specific primers and determined by 2% agarose gel electrophoresis with ethidium bromide staining for analysis of HLA-DR polymorphism. RESULTS: The genotype frequency of HLA-DR in a total or 310 Koreans was DR1 ; 7.2%, DR 2; 10.5%, DR 3;1.7%, DR 4; 19.9%, DR 5; 11.9%, DR 6;19.9%, DR 7; 7.0%, DR 8; 10.6%, DR 9; 8.7%, DR10;1.9%. There was no significant diffrence of HLA-DR genotype distribution among four physical constitution groups classified by Korean traditional medicine. CONCLUSION: Our results suggest that the classification of physical constitution in Korean traditional medicine is not related to HLA-DR genotypes.

A Case of Chinese Herbs Nephropathy / 대한신장학회잡지

No abstract available.

THE INFLUENCE OF SURFACE TREATMENTS ON THE SHEAR BOND STRENGTH OF RESIN CEMENTS TO IN-CERAM CORE / 대한치과보철학회지

An increasing demand for esthetic restorations has led to the development of new ceramic systems. In-Ceram, a glass-infiltrated alumina ceramic has three to four times greater flexural strength than other ceramic glass material. Because of its high strength, In-Ceram has been suggested as inlay, crown, laminate veneer and core material for resin bonded fixed partial dentures. This clinical application requires a stable resin bond to In-Ceram core. The purpose of this study was to evaluate the shear bond strength between In-Ceram core and resin cements according to various surface treatments and storage conditions. The surface of each In-Ceram core sample was subjected to one of the following treatments and then bonded to Panavia 21 or Variolink II resin cement. ; (1) sandblasting with 110 micrometer aluminum oxide powder, (2) sandblasting and silanization, (3) sandblasting and Siloc treatment, (4) sandblasting and Targis link application. Each of eight bonding groups was tested in shear bond strengths after the following storage times and thermocycling. ; A) 24 hours storage in distilled water at 371C, B) 5 weeks storage in dis tilled water at 37 C, C) 5 weeks storage in distilled water at 371C and thermocycled 2,000 ther mocycling for every 10 days(totally 10,000 thermocycling) in 51C - 551C bath. The bond failure modes were observed with scanning electron microscope (SEM). The results were as follows : 1. The shear bond strengths of sandblasting group were significantly lesser than the other groups after 24 hours water storage. 2. No significant difference of bonding strengths was found between storage time conditions (24 hours and 5 weeks). The shear bond strengths showed a tendency to decrease in Variolink II bonding groups and to increase in Panavia 21 bonding groups. 3. After thermocycling, the shear bond strengths of all groups were significantly decreased (p<0.01) and Targis link group exhibited significantly greater strengths than the other groups(p<0.05). 4. Panavia 21 bonding groups exhibited significantly greater bonding strengths in sandblasting group(p<0.01) and silane group(p<0.05) than Variolink II bonding groups. 5. In observation of bond failure modes, Targis link group showed cohesive failure in resin part and silane group and Siloc group showed complex failure and sandblasting group showed adhesive failure between In-Ceram and resin.

Influence of Total Ginseng Saponin on Contractile Responses of Vasoconstrictors in the Isolated Rat Aorta

BACKGROUND: It has been known that Ginseng extract causes the hypotensive action while it rather produces the hypertensive action. Some studies have suggested that Ginseng extract causes a biphasic response on blood pressure, namely, transient fall followed by prolonged elevation. It has been also shown that administration of Korean Red Ginseng powder has no effect on blood pressure in normotensive and hypertensive rats. The present study was designed to examine the effect of total Ginseng saponin on contractile responses of vasoconstrictors in the rat aorta and to establish the mechanism of its action. METHODS: The ring segment of aorta was mounted in a muscle bath filled with oxygenated Krebs solution for the measurement of isometric tension. After the equilibration period, under the presence of total Ginseng saponin, isometric tension induced by some vasoconstrictors were observed and compared to the control responses. The data were expressed as % of the control tension. RESULTS: Phenylephrine (an adrenergic alpha1-receptor agonist) and high potassium (a membrane depolarizing agent) caused greatly contractile responses in the rat aorta, respectively. However, in the presence of total ginseng saponin (600 g/ml), the contractile responses of phenylephrine (10(-6) and 10(-5) M) and high potassium (3.5 x 10(-2) and 5.6 x 10(-2) M) were markedly potentiated whereas prostglandin F2alpha(5 x 10(-6) M)-induced contractile responses was not affected. The contractile responses induced by phenylephrine (10(-5) M) and high potassium (3.5 x 10(-2) M) even under the presence of total ginseng saponin (600 g/ml) were greatly inhibited by the pretreatment of nicardipine (10(-6) M), a calcium channel blocker. CONCLUSION: Taken together, these experimental results suggest that total ginseng saponin can enhance the contractile responses evoked by stimulation of adrenergic alpha1-receptor and the membrane depolarization in the isolated rat aortic strips, which seems to be associated to calcium influx.

Transsternal Approach for BPF closure: A Case Report / 대한흉부외과학회지

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.

A STUDY ON FRACTURE STRENGTH OF CONVENTIONAL AND COPY-MILLED IN-CERAM CROWNS / 대한치과보철학회지

The purpose of this study was to compare the fracture resistance of copy-milled and conventional In-Ceram crown. Four groups of ten uniform sized all-ceramic crowns were fabricated. In-Ceram Spinell and In-Ceram Alumina crowns were fabricated as control group, Celay In-Ceram Spinell and Celay In-Ceram Alumina crowns were fabricated as test group. All specimen were cemented on stainless steel master die with resin cement, and stored in 37degrees C water for 1 day prior to loading in Instron testing machine. Using a steel ball at a crosshead speed of 0.5mm/min, the crowns were loaded at 30degree angle until catastrophic failure occurred. The results obtained were as follows : 1. With the value of 984.8N+/-103.67N, the strength of Celay In-Ceram Alumina crowns had a significantly higher fracture strength than conventional In-Ceram Alumina crowns(876.2N+/-92.20N) (P0.05). 3. The In-Ceram Alumina crowns had a significantly higher fracture strength than In-Ceram Spinell crowns in both methods(P<0.05). 4. Ther order of fracture strength was as followed : Celay In-Ceram Alumina, In-Ceram Alumina, Celay In-Ceram Spinell and In-Ceram Spinell crowns

Responders Versus Non-responders to Transurethral Microwave Thermotherapy in BPH: A Retrospective Analysis of Patient Profile / 대한비뇨기과학회지

277 patients were investigated retrospectively to identify patient related parameters which could possibly correlate with a successful treatment outcome or to identify best responders to transurethral microwave thermotherapy(TUMT) with a minimum follow up of 6 months. Responders(R) were defined as having (1) symptom score(SS) decrease > 50% and maximal flow rate(MFR) increase > 50 % (> 15 ml/sec) or (2) symptom score decrease > 50% and residual urine volume(RU) decrease >50% (150ml). Each group was composed of 57, 71 and 108 patients respectively. Before TUMT, significant differences(p<0,05) were found in prostate volume(R:29.7 vs. PR:34. 2 vs. NR:38.0ml), prostatic urethral length(38.9 vs. 41.5 vs. 44.8mm) and history of acute retention(3/57 vs. 13/71 vs. 20/108) between R and NR group only. However, no significant differences were found in age(65.8 vs. 65.1 vs. 66.2), PSA(4.8 vs. 4.4 vs. 4.0ng/ml), Boyarsky symptom score(13.6 vs. 14.8 vs. 14.6), MFR(9.7 vs. 8.3 vs. 9.7ml/sec) and RU(86.4 vs. 78.6 vs. 67.8ml) between three groups. Conclusively, prostate volume(<30ml) and possibly prostatic urethral length(<38mm) in the absence of acute retention history seem to be correlated with relatively good clinical outcome and may be taken into consideration in our clinical setting.