Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

OBJECTIVES: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. MATERIALS AND METHODS: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. CONCLUSION: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.

Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

OBJECTIVES: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. MATERIALS AND METHODS: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. CONCLUSION: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.

Incidence and Risk Factors for Deep Vein Thrombosis after Abdominal Surgery / 대한혈관외과학회지

PURPOSE: The incidence of deep vein thrombosis (DVT) after abdominal surgery has been thought to be lower in Asian populations than in Western populations, but there is little information on the incidence and risk factors in Korea. This study aimed to investigate the incidence of postoperative DVT and to analyze the risk factors for DVT in patients who were not administered perioperative prophylactic anticoagulation. METHODS: On a prospective basis, we evaluated the incidence of DVT and analyzed the risk factors associated with the development of DVT in 152 patients who were scheduled to undergo abdominal surgery for gastrointestinal, hepatobiliary, or pancreatic disease. All patients were examined by duplex scanning on both of their lower extremities during hospitalization. RESULTS: The mean patient age was 56.8+/-11.8 years, and the male to female ratio was 1:0.7. DVT occurred at a rate of 7.2% (11 patients). All the cases of DVT were asymptomatic and located in the calf veins. There was no statistically significant difference between the DVT and non-DVT groups for risk factors. CONCLUSION: The prevalence of DVT after abdominal surgery at a single institute was lower than levels currently suggested in Western countries. A larger, randomized, multi-center study is needed to establish the guidelines towards the prevention of DVT occurrence after abdominal surgery in Korea.

Comparison of Cardiovascular Risk Factors between Normotension and Prehypertension / 대한진단검사의학회지

BACKGROUND: The individuals with prehypertension are known to progress to hypertension, one of the risk factors of cardiovascular disease, more readily than the group of normal blood pressure. This study was performed to investigate the differences in the risk factors of cardiovascular disease between normotensive and prehypertensive groups, and to identify the determinants of prehypertension. METHODS: Normotensive (N=3,732) and prehypertensive individuals (N=676) were selected from the people who underwent routine medical checkups at the Health Promotion Center (Seoul, Korea). The age, body mass index (BMI), fasting blood glucose, total cholesterol, triglyceride, LDL-cholesterol (C), HDL-C, high sensitivity C-reactive protein (hsCRP), lipoprotein(a) [Lp(a)], and the number of white blood cell were compared between the normotensive and prehypertensive groups. RESULTS: The age, BMI, fasting blood glucose, triglyceride, and total cholesterol were higher in the males and females in the prehypertensive group than in the normotensive group. LDL-C, however, was higher and HDL-C was lower in the females in the prehypertensive group than in the normotensive group. The determinants of prehypertension were found to be age, BMI, and triglyceride. CONCLUSIONS: There were differences in the risk factors of cardiovascular disease between the prehypertensive and normotensive groups.

Prevalence and Related Parameters of Daytime Sleepiness in Patients with Habitual Snoring

BACKGROUND: Excessive daytime sleepiness (EDS) is a common symptom in patients with habitual snoring, including obstructive sleep apnea (OSA). However, there had been no studies for the prevalence and related factors of EDS in patients with habitual snoring in Korea. So we studied the prevalence and related factors of EDS in patients with habitual snoring. METHODS: Sixty two patients with habitual snoring were selected from our sleep center from February 2004 to January 2007. All patients were given an overnight polysomnography and then took the multiple sleep latency tests the following day. They were classified into two groups: EDS (mean sleep latency, MSL or =10 minutes). We studied the prevalence of EDS in patients with habitual snoring and compared two groups about the demographic data and polysomnographic characteristics. RESULTS: Most (72.6%) patients with habitual snoring demonstrated EDS. There were significant different parameters between the EDS group and the no EDS group, such as total sleep time, percent of slow wave sleep, snoring index, arousal index, and number of desaturation. Among these, the logistic regression analysis identified total sleep time as a significant predictive factor for daytime sleepiness. MSL correlated significantly with the percent of slow wave sleep and number of desaturation. CONCLUSIONS: Our results showed the high prevalence of EDS in patients with habitual snoring in Korea. Long total sleep time in polysomnography seems to predict EDS.

Clinicopathological Correlation of hMLH1 and hMSH2 Protein Expressions in Stage III Colon Cancer

PURPOSE: Functional loss of mismatch repair has been reported to be the reason for resistance to several chemotherapeutic drugs. The expressions of hMLH1 and hMSH2 were examined to assess whether they correlated with the biological behavior and the chemotherapeutic responsiveness in paflents with sporadic colon cancers. METHODS: Ninety-one patients with stage III primary colon cancer were included from the tumor registry of the Asan Medical Center, Seoul, Korea. All patients underwent a curative operation and postoperative chemotherapy with 5- fluorouracil and leucovorin for 6 cycles between 1993 and 1997. Immunohistochemical staining for hMLH1 and hMSH2 was performed using archival paraffin blocks. A positive expression was determined when unequivocal nuclear staining was identified in more than 10% of the cancer cells. The survival and the clinicopathologic variables regarding hMLH1 and hMSH2 expressions were assessed using the log-rank test and the Cox proportional regression method. RESULTS: Either hMLH1 or hMSH2 expression was lost in nine cases (9.9%). hMLH1 and hMSH2 expressions were significantly correlated with tumor invasion (P=0.012) and tumor differentiation (P=0.017). The disease-free survival did not differ with respect to hMLH1 and hMSH2 expressions. The number of metastatic lymph nodes and the preoperative serum CEA level were independent predictors of disease-free survival on a multivariate analysis. CONCLUSIONS: The loss of hMLH1 or hMSH2 expresscon appears to be involved in the differentiation of and the invasion by colon cancer. However, nether hMLH1 nor hMSH2 expression was correlated withthe 5-fluorouracil responsiveness.

A Case of Amyloidosis Presenting with Massive Small Bowel Bleeding / 대한소화기내시경학회지

The gastrointestinal (GI) tract is one of the commonly affected organs in amyloidosis. However, it is difficult to make a correct diagnosis of GI amyloidosis because of its varied clinical manifestation and nonspecific endoscopic findings. Moreover, GI bleeding as a presenting symptom is rare, but can be serious in some cases. Therefore, missed diagnosis and delayed management in GI amyloidosis may potentially lead to a critical outcome. We report a 51-year-old man with multiple myeloma whose major symptom was massive hematochezia due to GI amyloidosis. In our case, amyloid deposits could be distinctly visualized endoscopically in the stomach and the colon. They were manifested as submucosal hematomas in the small bowel resulting in massive bleeding that was successfully controlled with the aid of intraoperative endoscopy.

The Significance of Perioperative Serum Carcinoembryonic Antigen Measurement in Patients with Curative Colorectal Cancer

PURPOSE: Regular monitoring of serum carcinoembryonic antigen (CEA) has been used as a tool to detect recurrence of colorectal cancer postoperatively. This study aimed to evaluate the significance of perioperative serum CEA level in patients with curative colorectal cancer. METHODS: We analyzed the data obtained from the 420 patients with colorectal cancer who underwent curative resection. Preoperative serum CEA level (ng/ml) was divided into 3 groups, i.e. groups I: or=20. Each group of preoperative serum CEA level was analyzed in accordance with location, histologic differentiation, stage of tumor, recurrence and survival. Postoperative serum CEA level was analyzed in accordance with preoperative serum CEA level and recurrence. RESULTS: Preoperative serum CEA level correlated with tumor stage (P=0.009). Ninety six patients among 420 patients showed recurred and recurrences were more common in patients with high preoperative serum CEA level (P =0.002). Systemic recurrences were more common in patients with high preoperative serum CEA levels than normal levels (P=0.029). In recurrence cases, 75 patients (78.1%) had elevated serum CEA levels and 55 patients had high preoperative serum CEA levels (P=0.008). The disease free 5-year survival rate in preoperative serum CEA group I, II, and III were 91.4%, 70.5%, and 58.3% respectively (P= 0.000) CONCLUSION: Preoperative serum CEA levels seemed to be closely correlated with distant metastasis and survival. Meticulous follow-up evaluation and generous use of adjuvant therapy are recommanded in patients with high preoperative CEA level.

Manometric Assessment after Ileal Pouch- Anal Anastomosis

PURPOSE:Functional derangement in bowel movement after ileal pouch-anal anastomosis (IPAA) is not infrequent. It results from several mechanisms mainly decreased rectal reservoir capacity and rectal sensation. Anal sphincter or pelvic nerve damage during surgery contributes physiological changes, also. This study was performed to evaluate manometric changes after IPAA and compare them with functional outcomes regarding anastomotic technique. METHODS:Forty seven (M:F=23:24) patients who underwent IPAA and manometric assessment were enrolled. Pathological diagnoses of them were 32 ulcerative colitis, 12 familial adenomatous polyposis, and 3 hereditary non-polyposis colorectal cancer. Every pouch was constructed in J shape, 15cm length. Pouch-anal anastomosis was performed by 27 hand-sewn and 20 double stapling technique. Diverting ileostomy was performed in 30 cases (64%) and closed 2-3 months after IPAA. Manometry was performed preoperatively and 3 to 6 months interval, postoperatively. Twenty two patients underwent full manometic assessment pre- and post-operatively. The others did it either pre or postsoperatively. Functional outcome was investigated at the median follow-up period 25 (2-54) months. Statistical analysis was performed by using Chi- square and Fisher's exact test. Significance was assigned to a P value of 0.05). Postoperative stool frequency and incontinence rate were not different between two groups. Thirty one percent of patients revealed night time seepage. MRP of this seepage group was significantly lower than the other group (67.9 vs. 48.4 mmHg; P=0.038). CONCLUSIONS:Characteristic changes of manometric findings after IPAA were summarized as decrease of MRP and disappearance of RAIR. Rectal compliance was significantly improved since 6 months after IPAA or ileostomy closure. Decrease of MRP was more remarkable in hand-sewn group. However, we could not find any difference in functional outcomes between two anastomotic techniques. MRP was a crutial factor for postoperative seepage.

Simultaneous bilateral tubal pregnancies following in - vitro fertilization and embryo transfer / 대한산부인과학회잡지

Over the last 20 years, the frequency of multiple pregnancy has increased mainly because of the introduction of exogenous pituitary gonadotropins in the treatment of infertility. Since the advent of assisted reproductive technology, the concern about ectopic implantation of embryos has increased dramatically and it continues to be a major complication of in vitro fertilization and embryo transfer (IVF-ET). Bilateral tubal pregnancy is the least common type of ectopic implantation of two embryos. Of all extrauterine pregnancies, 1:725~1:1580 are bilateral1,2. Simultaneous tubal pregnancies have been reported in natural cycles, recently, after ovulation induction, in-vitro fertilization2,3. The high incidence of ectopic pregnancy associated with IVF-ET continues to be a problem and frequencies of between 2.4 and 12.4% have been only a few reports of simultaneous bilateral tubal pregnancies following IVF-ET4. This paper describes a case of a simultaneous bilateral tubal pregnancy after IVF-ET in a 33 year old patient. The diagnosis was confirmed by diagnostic laparoscopy performed 25 days after embryo transfer(sixth week of gestation), which revealed bilateral tubal pregnancy. Bilateral salpingectomy was performed. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.

A Clinical Study on the Incompetent Internal Os of Cervix / 대한주산의학회잡지

No abstract available.

Three cases of successful pregnancy outcome after intensive care in the patients with complete uterine septum, cervical duplication and longitudinal vaginal septum / 대한산부인과학회잡지

Three cases of successful pregnancy outcome after intensive care in the patients with rare mullerian anomaly of complete uterine septum, hypoplastic cervical duplication and longitudinal vaginal septum in infertility clinic are reported. These presented three cases are the reports of supporting the embryologic hypothesis of bidirectional mullerian development which fusion and resorption begins at the isthmus and proceeds simultaneously in both the cranial and caudal directions rather than the classical views of unidirectional(caudal to cranial) mullerian development. Thus, we present here three cases of rare mullerian anomaly and their pregnancy outcomes in an attempt to alert gynecologist to the possible occurrence of such a malformation. In 2 cases, successful pregnancy outcomes were achieved after abdominal or hysteroscopic uterine septotomy before pregnancy and in the last case, successful pregnancy outcome intensive obstetric care was achieved even under uncorrected uterine anomaly and complete removal of uterine septum resulted in uneventful postoperative courses at the same time of cesarean section.

Clinical Analysis for Lymph Node Metastasis as a Guide to Modified Surgery for Early Gastric Cancer

The authors have analyzed the clinicopathologic data of 855 patients with early gastric cancer (EGC) who underwent D2 lymph node dissection during the 7-year period between January 1990 and December 1996 in order to evaluate the factors influencing lymph node metastasis and to establish the clinical indications and guidelines for modified surgery in EGC patients. The overall rate of lymph node metastasis was 13.5% (115/855). There was a significant statistical difference for lymph node metastasis between men (67/575, 11.7%) and women (48/280, 17.1%)(p<0.05). In mucosal cancer, the rate of lymph node metastasis was 4.7% (20/427), and in submucosal cancer, it was 22.2% (95/428), which is a significant difference between the two groups. There was also a significant difference for lymph node metastasis between the elevated types (EGC type I and IIa) and the depressed types (type IIb, IIc, and III), 8.4% (13/154) and 14.6% (102/701), respectively (p=0.05). There were only one lymph node positive case (1/82, 1.2%) among the elevated mucosal cancers. Smaller tumors((10 mm) showed a significantly lower incidence of lymph node metastasis than larger tumors (11 mm)(p<0.01); 4 cases invoving tumors of less than 11 mm had lymph node metastasis(2 mucosal and 2 submucosal lesions). Differentiated mucosal carcinomas showed a significantly lower incidence of lymph node metastasis than undifferentiated carcinomas (0.9% vs 8.5%, p<0.001), whereas there was no significant difference between differentiated and undifferentiated submucosal cancers. There were 14 cases of EGC with metastasis in the secondary lymph node group (N2) consisting of 5 men and 9 women, with a mean age of 53 years. Among them, the 7 cases under the age of 50 were all female patients. For thses 14 case, the average tumor size was 34 mm (15~90 mm), and the majority of were depressed types (11 cases) and undifferentiated type (12 cases). These results suggest that modified surgery is indicated as an optimal treatment option for mucosal cancer with elevated and/or differentiated type tumors, on the basis of not only radicality but also postoperative quality of life.

Primary Signet Ring Cell Carcinoma of the Colon and Rectum / 대한암학회지

PURPOSE: Signet ring cell carcinoma is a rare type of adenocarcinoma in the colon and rectum. We evaluated the differences of clinical features between colorectal signet ring cell carcinoma and ordinary adenocarcinoma. MATERIALS AND METHODS: The clincopathologic data of 13 cases with primary colorectal signet ring cell carcinoma were reviewed. The primary colorectal signet ring cell carcinoma was diagnosed when following criteria were met: 1) the tumor was primary; 2) histologic material was adequate; 3) signet ring cells represented more than 50% of the cancer. RESULTS: Patients ranged in age from 20 to 68 (median, 45) years; 7 were male, and 6 were female. Three tumors were located in the proximal colon, 3 in the distal colon, and 7 in the rectum. There was no case that had family history. Most cases (77%) were stage III, one was stage II, and two were stage IV with peritoneal seeding. There were 9 cases that showed local recurrence or distant metastases during follow-up periods 6 cases with peritoneal seeding, 3 with bone metastases, 2 with brain metastases and 1 with pelvic recurrence (two cases had either bone and brain metastasis, and one case had bone and peritoneal seeding). Prognosis was extremely poor, and overall two years survival rate was 25%. CONCLUSION: Early onset, mode of metastasis and poor prognosis may imply the different biologic behavior of signet ring cell carcinoma, compared with ordinary adenocarcinoma. To improve outcome, early diagnosis and radical operation should be stressed.

Multiple Primary Malignant Neoplasm with Colorectal Cancer / 대한암학회지

PURPOSE: The incidence of multiple primary malignant neoplasm has increased in recent decades. The etiologies and epidemiologies of multiple primary malignant neoplasm are still remained to be verified. A group of patients with multiple primary malignant neoplasms accompanied by colorectal cancer was analyzed to determine the relationship between certain cancers and colorectal cancer. MATERIALS AND METHODS: From Jan. 1989 to Jun 1997, there were 56 patients with colorectal cancers accompanied by cancers of another organs. The retrospective analysis was done on the basis of cancer origin and intervals between the cancers. RESULTS: The male-to-female ratio was 25 to 31. The characteristics of colorectal cancers in multiple primary malignant neoplasm were similar to the colorectal cancers without other cancers. Among 56 patients, 50 patients had the double primaries and 6 had the triple primaries. In the patients with double primaries, extracolonic cancers were found in the stomach(16), hepatobiliary system(12), urologic system(6), gynecologic organ(6) and others. In the patients with triple primaries, extracolic cancers were found in the stomach(5), uterus(2), lung(2) and others. The patients with family history of malignancy were 10 cases and the rate in the triple primaries seemed to be higher than double primaries. CONCLUSION: It could be desirable to follow-up and work-up the patients with colorectal cancer keeping in mind that the malignancy in other organs especially stomach might be present.

Nonoperative Management of Extraperitoneal Bladder Rupture / 대한비뇨기과학회지

During last two year and seven month, We have seen 38 patients bladder rupture due to 34 blunt trauma, 2 penetrating injuries and 2 iatrogenic causes. There were 13(34.2%) intraperitoneal and 25(65.8%) extraperitoneal injuries. Nonoperative( catheter ) management was used in 21 patients with extraperitoneal rupture of the bladder with extravasation of dye found by retrograde cystogram and successfully treated by urethral catheter drainage only. We excluded 4 patients coexisting urethral rupture and significant intraabdominal injury. Complication occurred in 8 of the 2l patients but all were treated spontaneously during catheter drainage. It seemed obvious that nonoperative management will give a satisfactory result and would not be necessarily benefit from an operation to closing the bladder.

A Case of Retroperitoneal Castleman's Disease / 대한비뇨기과학회지

Castleman's disease (angiofollicular lymph node hyperplasia) is a large benign tumor. Most of the lesion are located in mediastinum, but some presents as an isolated retroperitoneal mass radiographically indistinguishable from retroperitoneal malignancy. We report a case of the hyaline-vascular variant of Castleman's disease presenting as a palpable abdominal mass.

A Case of Successful Normal Delivery after Renal Transplantation / 대한비뇨기과학회지

We report a case of successful normal vaginal delivery in a 28 years old female patient who received living related renal transplantation three years ago due to chronic renal failure resulted from eclampsia and polyhydroammnios.

Gastric remnant cancer after gastric operation for benign disease / 대한암학회지

No abstract available.

Three Cases of Stargadt's Disease

Stargardt's disease, first described in detail by Stargardt in 1909, is a recessively inherited macular dystrophy which evidences itself by reduced visual acuity, bilaterality, slowly progressive lesion, occurring familially, starting in youth (8 to 15 years). We have recently seen macular dystrophies occurring in siblings, three out of six. All developed this disease between 9 to 15 years and vision deteriorate progressively to the adult hood. Ophthalmoscopic examination revealed slight pale dise, narrowing of retinal vessels, definite alterations in the macular region associated with the development of red-yellow flecks in the center surrounded by yellow-white flecks in the paracentral region. Angiogram showed the evidence of marked alteration in the retinal pigment epithelium on the macula bilaterally. All cases were noted by ring shaped area of mottled hyperfluorescene but central flecks were nonfluorescent. Field examination showed the central scotoma to a small targets and ERG the subnormal in photopic and scotopic responces. The Ishihara test disclosed a mild to moderate red-green dyschromatopsia.