• Journal of Chest Surgery
• /
• v.37 no.2
• /
• pp.160-165
• /
• 2004

Successful treatment of multi-loculated pleural effusion or thoracic empyema requires effective drainage and definitive diagnosis of causative organism. The purpose of this study was to assess the efficacy of the video-assisted thoracoscopic surgery in the management of thoracic empyema or multi-loculated pleural effusion after chest tube drainage treatment had failed. Material and Method: Between April 2000 and July 2002, 20 patients with thoracic empyema or multi-loculated pleural effusion that failed to chest tube drainage or other procedures who underwent an operation. All patients were assessed by chest-computed tomogram and underwent video assisted thoracoscopic drainage, debridement, biopsy and irrigation of pleural cavity. Result: In 18 cases (90%), underwent successful video-assisted thoracoscopic surgery. In 2 cases, decortications by mini-thoracotomy were necessary. The ratio of sex was 4 : 1 (16 male: 4 female), mean age was 48.9 years old (range, 17∼72 years), mean duration of postoperative chest tube placement was 8.2 days (range, 4∼22 days), mean postoperative hospital stay was 15.2 days (range, 7∼33 days). Causative disease was tuberculosis, pneumonia, trauma and metastatic breast cancer, There were no major postoperative complications. Symptoms improved in all patients and were discharged with OPD follow up. Conclusion: In an early organizing phase of empyema or multi loculated pleural effusion, video-assisted thoracoscopic drainage and debridement are safe and suitable treatment.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.5
• /
• pp.396-399
• /
• 2008

Factitious hemoptysis is the bleeding type of Munchausen's syndrome, and this describes a group of patients who intentionally produce symptoms. Because factitious hemoptysis is a very rare manifestation of hemoptysis, it generally passes unnoticed. We report here on a case of factitious hemoptysis in a 15-year-old boy who presented with hemoptysis. During his three hospitalizations, we conducted many diagnostic procedures, including chest CT, laryngoscopy, bronchoscopy and bronchial arteriography, yet we failed to find the definitive cause of the patient's hemoptysis. He kept on complaining of repetitive hemoptysis and seizure-like activity. His father discovered that he had collected his blood into the specimen cup via an intravenous line. After we removed the intravenous line, he did not show blood to us again. We suggest that factitious hemoptysis should be considered in the differential diagnosis of hemoptysis of an unclear bleeding focus, and especially when the patient has a bizarre hospital course or unusual behavior. We also include a review of the relevant literature.

• The Journal of Korean Academy of Prosthodontics
• /
• v.54 no.2
• /
• pp.140-145
• /
• 2016

Excessive occlusal wear causes loss of tooth structure, occlusal plane disharmony, impaired function and esthetic problems. Although the decrease of occlusal vertical dimension may be compensated by the growth of alveolar bone and tooth eruption, minimal increase of occlusal vertical dimension may be required for esthetics and retention of prosthesis. In this case, a 44-year-old male patient visited Seoul National University Dental Hospital with chief complaint of severe tooth wear and shade disharmony. Based on assessment of diagnostic wax-up, 3 mm increase of occlusal vertical dimension was determined. Removable occlusal splint and interim prosthesis was used to ascertain patient's comfort and adaptation. After the adaptation period, definitive prosthesis fabricated with full-contour monolithic zirconia were delivered and the patient was recommended to wear a nightguard device for prosthesis protection. This report presents a case of full mouth rehabilitation with the elevation of patient's occlusal vertical height, resulting in satisfactory esthetics and functions.

• The Journal of Korean Academy of Prosthodontics
• /
• v.51 no.1
• /
• pp.39-46
• /
• 2013

The loss of posterior support may cause attrition of anterior teeth, and loss of occlusal vertical dimension (OVD). The collapse of the posterior support will eventually cause the pathologic change of the TMJ and masticatory muscles, unesthetic facial appearance and decreased masticatory function. Patients with destroyed dentition need extensive prosthetic treatments. Proper diagnosis and treatment planning are necessary for the stability of the neuromuscular system and the TMJ, and esthetic and functional definitive restorations. In this case, 63 year-old male presented with decreased masticatory force and esthetic problems due to pathologic destruction of teeth structure on entire dentition. Based on assessment of OVD including intraoral findings, radiographic examination and diagnostic cast, full-mouth rehabilitation with increase of OVD was planned using fixed partial denture and removable partial denture. Diagnostic wax-up was done after 4 mm increase of OVD determined by assessment of OVD. The OVD was maintained with the overlay type removable interim prostheses for 12 weeks to ascertain his comfort and adaptation to the new OVD. After the adaptation period, second interim prostheses with tooth preparation maintaining the established OVD was delivered. After 4 weeks, final prostheses were fabricated and delivered. After 7 month follow-up period, occlusal stability is maintained. Through this procedure, satisfactory outcomes were achieved both in functional and esthetic aspects.

• The Journal of Korean Academy of Prosthodontics
• /
• v.56 no.3
• /
• pp.243-249
• /
• 2018

Excessive tooth wear results in unacceptable damage to the occlusal surface and can cause pulpitis, occlusal disharmony, dysfunction, and unesthetic result. Patients with severe attrition have to be classified as several types relative to the vertical dimension of occlusion (VDO) and the interocclusal distance for the prosthetic space. The patient in this case was a 80 - year - old woman who lost support of posterior occlusion and collapsed of the occlusal plane due to confrontation of the opposing teeth, accompanied by an increase in the number of remaining bristles, resulting in a loss of intermaxillary space for prosthesis. In this case, treatment with increased vertical dimension may have stability if the increase in vertical occlusal height is minimized within the required range, and a stable occlusal contact is provided after an increased vertical occlusal height stabilization period. After the new VDO had been confirmed under interim fixed restorations, definitive fixed restorations were produced. Through these treatment processes, we obtain satisfactory results that are functional and aesthetically pleasing.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.29 no.4
• /
• pp.555-560
• /
• 2002

Replantation may be a treatment choice for a completely avulsed tooth caused by a traumatic injury. The outcome of replantation depends on the following factors ; minimal damage to pulp and periodontal membrane, the length of time the avulsed tooth was out of the mouth, how the tooth was stored, the level of root formation, etc. The time from the act of avulsion of the tooth to the actual replantation is especially important. Generally, when replanted within 30 minutes, more than 90% of the cases succeed, but when the time is between 30 to 90minutes, 43%, and greater than 90 minutes, 7%. This is a case of a replanted tooth with relatively good prognosis by ankylosis though there was a great time lapse since the tooth was avulsed. Though such treatment lead to loss of the tooth, in cases of children or adolescents, this treatment is meaningful, because it may earn time until any definitive therapy, functionally stimulate the alveolar bone to retain its height for a better prognosis for future treatment, and act as space maintainer.

• Journal of Yeungnam Medical Science
• /
• v.8 no.2
• /
• pp.76-83
• /
• 1991

A total of 53 gastric adenomas from endoscopically biopsied gastric mucosa were examined histopathologically. The average age at the time of endoscopic biopsy was 59 years, and gastric adenomas were found to be more frequent in the aged, particularly above the age of 50. The majority of adenomas occurred at the antrum. Concerning the shape of the adenomas, Yamada type II was more frequent(55%). All adenomas were accompanied by varying degree of intestinal metaplasia, and this findings suggest that gastric adenoma develops from intestinal metaplasia. In adenomas with severe atypia(grade III), endocrine cells(argyrophil and argentaffin cells)were markedly decreased or absent. Gastric adenocarcinomas coexistent with adenoma were seen in 5(9.4%) out of 53 cases, and were more frequent in male than female patients(sex ratio, 4 : 1) and the average age was 61.4 years. It is suggested that there is a necessity of thorough follow-up study for definitive correlation between gastric adenoma and adenocarcinoma.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.13
• /
• pp.5487-5492
• /
• 2014

Ultrasonography is non-invasive and can give useful clues in the diagnosis of cervical lymphadenopathy, However, differential diagnosis is difficult in some situations even combined with color Doppler imaging. The present study was conducted to evaluate the clinical value of real time elastography in patients with unexplained cervical lymphadenopathy using a quantitative method. From May 2011 to February 2012, 39 enlarged lymph nodes from 39 patients with unexplained cervical lymphadenopathy were assessed. All the patients were examined by both B-mode ultrasound, color Doppler flow imaging and elastography. The method of analyzing elasto-graphic data was the calculation of the 10 parametres ("mean", "sd", "area%", "com", "kur", "ske", "con", "ent", "idm", "asm") offered by the software integrated into the Hitachi system. The findings were then correlated with the definitive tissue diagnosis obtained by lymph node dissection or biopsy. Final histology revealed 10 cases of metastatic lymph nodes, 11 cases of lymphoma, 12 cases of tuberculosis and 6 cases of nonspecific lymphadenitis. The significant distinguishing features for conventional ultrasound were the maximum short diameter (p=0.007) and absent of echogenic hilum (p=0.0293). The diagnostic accuracy was 43.6% (17/39 cases) and there were 17 patients with equivocal diagnosis. For elastography, "mean" (p=0.003), "area%" (p=0.009), "kurt" (p=0.0291), "skew" (p=0.014) and "cont" (p=0.012) demonstrated significant differences between groups. With 9 of the 17 patients with previous equivocal diagnoses (52.9%) definite and correct diagnoses could be obtained. The diagnostic accuracy for conventional ultrasound combined elastography was 69.2% (27/39 cases). There were differences in the diagnostic sensitivity of the two methods (p=0.0224). Ultrasound combined with elastography demonstrated higher rates of conclusive and accurate diagnoses in patients with unexplained cervical lymphadenopathy than conventional ultrasound. The quantitative program showed good correlation with the pathology of different lymph node diseases.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.10
• /
• pp.5989-5993
• /
• 2013

Background: Radiation therapy is the mainstay of treatment for nasopharyngeal carcinoma. Importance of tumor coverage and challenges posed by its unique and critical location are well evident. Therefore we aimed to evaluate our radiation treatment plan through dose volume histograms (DVHs) to find planning target volume (PTV) dose coverage and factors affecting it. Materials and Methods: This retrospective study covered 45 histologically proven nasopharyngeal cancer patients who were treated with definitive 3D-CRT and chemotherapy between Feb 2006 to March 2013 at the Department of Oncology, Section Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan. DVH was evaluated to find numbers of shrinking field (phases), PTV volume in different phases and its coverage by the 95% isodose lines, along with influencing factors. Results: There were 36 males (80%) and 9 females (20%) in the age range of 12-84 years. Stage IVA (46.7%) was the most common stage followed by stage III (31.1). Eighty six point six-percent received induction, 95.5% received concurrent and 22.2% received adjuvant chemotherapy. The prescribed median radiation dose was 70Gy to primary, 60Gy to clinically positive neck nodes and 50Gy to clinically negative neck regions. Mean dose to spinal cord was 44.2Gy and to optic chiasma was 52Gy. Thirty seven point eight-percent patients completed their treatment in three phases while 62.2% required four to five phases. Mean volume for PTV3 was $247.8cm^3$ (50-644.3), PTV4 $173.8cm^3$ (26.5-345.1) and PTV5 $119.6cm^3$ (18.9-246.1) and PTV volume coverage by 95% isodose lines were 74.4%, 85.7% and 100% respectively. Advanced T stage, intracranial extension and tumor volume > $200cm^3$ were found to be important factors associated with decreased PTV coverage by 95% isodose line. Conclusions: 3D CRT results in adequate PTV dose coverage by 95% isodose line. However advanced T stage, intracranial extension and large target volume require more advanced techniques like IMRT for appropriate PTV coverage.

• Journal of the Korean School Mathematics Society
• /
• v.17 no.4
• /
• pp.717-746
• /
• 2014

The study aimed to explore how to improve mathematical thinking through metacognitive learning by stressing metacognitive abilities as a core strategy to increase mathematical creativity and problem-solving abilities. Theoretical exploration was followed by an analysis of correlations between metacognitive abilities and various ways of mathematical thinking. Various metacognitive teaching and learning methods used by many teachers at school were integrated for sharing. Also, the methods of learning application and assessment of metacognitive thinking were explored. The results are as follows: First, metacognitive abilities were positively related to 'reasoning, communication, creative problem solving and commitment' with direct and indirect effects on mathematical thinking. Second, various megacognitive ability-applied teaching and learning methods had positive impacts on definitive areas such as 'anxiety over Mathematics, self-efficacy, learning habit, interest, confidence and trust' as well as cognitive areas such as 'learning performance, reasoning, problem solving, metacognitive ability, communication and expression', which is a result applicable to top, middle and low-performance students at primary and secondary education facilities. Third, 'metacognitive activities, metaproblem-solving process, personal strength and weakness management project, metacognitive notes, observation tables and metacognitive checklists' for metacognitive learning were suggested as alternatives to performance assessment covering problem-solving and thinking processes. Various metacognitive learning methods helped to improve creative and systemic problem solving and increase mathematical thinking. They did not only imitate uniform problem-solving methods suggested by a teacher but also induced direct experiences of mathematical thinking as well as adjustment and control of the thinking process. The study will help teachers recognize the importance of metacognition, devise and apply teaching or learning models for their teaching environments, improving students' metacognitive ability as well as mathematical and creative thinking.