Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries

Background@#Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. @*Methods@#We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. @*Results@#Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists’ responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen’s kappa coefficient κ ≥ 0.6). @*Conclusions@#A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a “yes” response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.

Adenoma miss rate of polypectomy-referring hospitals is high in Korea

Background/Aims@#We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. @*Methods@#We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. @*Results@#A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). @*Conclusions@#Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

Change of the upper airway after mandibular setback surgery in patients with mandibular prognathism and anterior open bite / 대한악안면성형재건외과학회지

PURPOSE@#It has been reported before that the amount of pharyngeal airway space (PAS) significantly decreases following mandibular setback (MS) surgery in patients with mandibular prognathism (MP). Further, MP patients with an anterior open-bite (AOB) presentation may show a larger decrease in PAS compared with those without AOB. However, studies on postoperative PAS changes in MP patients with AOB remain rare. This study sought to evaluate changes in PAS and hyoid bone positioning following MS surgery in MP patients with and without AOB.@*PATIENTS AND METHODS@#Twenty patients who underwent two jaw surgery involving MS movement were included. Patients were divided into a non-AOB group (n = 10; overbite > 2 mm) and an AOB group (n = 10; overbite <− 4 mm). Three-dimensional changes in PAS and hyoid bone positioning were compared and statistically evaluated pre- and postoperatively using computed tomography (CT).@*RESULTS@#The mean magnitude of MS was 6.0 ± 2.8 mm and 5.6 ± 3.2 mm in the non-AOB group and AOB group, respectively. The oropharyngeal volume and upper hypopharyngeal volume were significantly reduced after surgery in both the groups (p = 0.006 and p = 0.003), while the retroglossal cross-sectional area was significantly reduced only in the AOB group (p = 0.028). Although the AOB group showed a larger decrease in PAS, the difference was not statistically significant between the groups. The position of the hyoid bone showed significant posterior and inferior displacement only in the AOB group, while the vertical displacement of the hyoid bone showed a statistically significant difference between the two groups.@*CONCLUSION@#PAS was significantly decreased after MS in both the groups, while only the AOB group presented a statistically significant reduction in the retroglossal cross-sectional area. Vertical displacement of the hyoid bone showed a statistically significant difference between the groups, while the PAS change was not. Surgeons should be aware of potential postoperative airway problems that may arise when performing MS surgeries.

Distribution of medical status and medications in elderly patients treated with dental implant surgery covered by national healthcare insurance in Korea

BACKGROUND: The purpose of this study was to investigate the distribution of systemic diseases and medications in patients older than 65 years of age who visited the hospital for implant treatment, as well as to investigate basic information about surgical complications that may occur after insured implant treatment. METHODS: A total of 126 patients over 65 years of age were treated for implant surgery from October 1, 2013 to October 30, 2016. Electronic chart review was conducted to obtain medical records, which included sex, age, systemic diseases, medication(s) being taken, and control of the medications. Five patients were excluded due to lack of medical records giving information about systemic disease. RESULTS: Of the 126 patients, 112 (88.9%) were taking medication due to systemic disease and 9 patients (7.1%) were not. The sex distribution was 71 women and 55 men and the highest proportion of patients were between 65 and 69 years old. The most common diseases were, from most to least frequent, hypertension, cardiovascular disease, diabetes, and osteoporosis. The drug groups that can cause major complications after dental treatment were classified as hemorrhagic, osteoporotic, and immunosuppressive agents, and were taken by 45 (35.7%), 22 (17.5%) and 4 (3.2%) patients, respectively. CONCLUSION: Given that 88.9% of the elderly patients who were eligible for insurance implant treatment had systemic disease, it is necessary to carefully evaluate patients' medical histories and their general conditions in order to prevent emergencies during implant surgery.

Reconstruction of hand

The characteristics of hand trauma are changing due to automation of industrial facilities, improved access to health care, and the aging population. Since the inception of hand surgery as a subspecialty, hand defects have been reconstructed with the restoration of the original functionality as the primary goal. With advancement and maturation of surgical techniques, however, restoration of aesthetics also began to take hold as an important aspect of hand surgery practice. After the first successful replantation of an amputated digit, the rapid development of microsurgical techniques had a significant impact on the field of reconstructive hand surgery. In the first two decades, the success of replantation was evaluated by the survival rate for a single operator or a specialized institution. These days, however, microsurgical techniques have been widely adopted, with digital replantation possible even for infants. In addition to various local flaps, the evolution of free flaps has vastly expanded the repertoire of reconstructive options for hand surgeons. With the wide variety of free flaps available, it is possible for a severely injured hand to be salvaged and restored to its original functional and aesthetic status. In South Korea, hand surgery is becoming an established profession with a separate subspecialty certification. Hand surgery has a bright outlook, with future research directed at new biocompatible materials and novel reconstructive methods.

Temporomandibular joint chondrosarcoma: a case report and literature review

Chondrosarcoma is a malignant tumor that originates from cartilaginous cells and is characterized by cartilage formation. Only 5% to 10% of chondrosarcoma occurs in the head and neck area, and it is uncommon in the temporomandibular joint area. This report describes an unusual case with a rare, large chondrosarcoma in a 47-year-old woman who presented with painless swelling and trismus. Computed tomography showed a large mass approximately 8.5×6.0 cm in size arising adjacent to the lateral pterygoid plate and condyle. There were features suggestive of bone resorption. The tumor was resected in a single block with perilesional tissues, and a great auricular nerve graft was performed because of facial nerve sacrifice. Microscopic examination of sections stained with H&E revealed chondrocytes with irregular nuclei and heterogeneous hyper chromatic tumor cells embedded in the chondrocyte lacuna. The diagnosis was a grade I chondrosarcoma. There was no evidence of recurrence at the 8-month follow-up, and a reconstruction surgery with fibular osteocutaneous free flap was performed. We report this unusual entity and a review of the literature.

Immediate implant placement for schizophrenic patient with outpatient general anesthesia

The difficult oral healthcare in intellectually disabled patients with poor behavioral control has led to debate over the cost-effectiveness and validity of implant treatment in these patients. The patient in the present report had schizophrenia that had led to poor oral care and severe dental caries in the full mouth. Tooth extraction and a removable prosthesis were planned, but the guardian wanted an implant procedure. Since the guardian showed strong will and cooperation with regard to the patient's oral healthcare, extraction followed by immediate implant placement was performed across two rounds of general anesthesia. Since the outcome appears successful, we present this case report. Immediate implant placement after tooth extraction requires fewer surgeries and rounds of general anesthesia, reduces horizontal bone resorption, and can achieve better esthetic results. Therefore, as long as a certain degree of oral care is possible, this can be a positive option for restoration of a partially edentulous mouth, even in intellectually disabled patients.

Immediate implant placement for schizophrenic patient with outpatient general anesthesia

The difficult oral healthcare in intellectually disabled patients with poor behavioral control has led to debate over the cost-effectiveness and validity of implant treatment in these patients. The patient in the present report had schizophrenia that had led to poor oral care and severe dental caries in the full mouth. Tooth extraction and a removable prosthesis were planned, but the guardian wanted an implant procedure. Since the guardian showed strong will and cooperation with regard to the patient's oral healthcare, extraction followed by immediate implant placement was performed across two rounds of general anesthesia. Since the outcome appears successful, we present this case report. Immediate implant placement after tooth extraction requires fewer surgeries and rounds of general anesthesia, reduces horizontal bone resorption, and can achieve better esthetic results. Therefore, as long as a certain degree of oral care is possible, this can be a positive option for restoration of a partially edentulous mouth, even in intellectually disabled patients.

Therapeutic effects of traditional herbal medicine on cerebral ischemia: a perspective of vascular protection / 中国结合医学杂志

Although many agents for acute ischemic stroke treatment have been developed from extensive preclinical studies, most have failed in clinical trials. As a result, researchers are seeking other methods or agents based on previous studies. Among the various prospective approaches, vascular protection might be the key for development of therapeutic agents for stroke and for improvements in the efficacy and safety of conventional therapies. Traditional medicines in Asian countries are based on clinical experiences and literature accumulated over thousands of years. To date, many studies have used traditional herbal medicines to prove or develop new agents based on stroke treatments mentioned in traditional medicinal theory or other clinical data. In the current review, we describe the vascular factors related to ischemic brain damage and the herbal medicines that impact these factors, including Salviae Miltiorrhizae Radix, Notoginseng Radix, and Curcumae Rhizoma, based on scientific reports and traditional medical theory. Further, we point out the problems associated with herbal medicines in stroke research and propose better methodologies to address these problems.

The Factors Related to Health-related Quality of Life(HRQOL), and Correlation between Occupational Stress and HRQOL among Municipal Fire Officers in Incheon / 대한산업의학회지

OBJECTIVES: This study was performed to investigate the factors related to HRQOL, and a correlation between occupational stress and HRQOL among municipal fire officers. METHODS: In November 2005, 341 male municipal fire officers submitted to the following tests: A general questionnaire, a medical questionnaire, the Korean Occupational Stress Scale Short Form(KOSSSF), and the SmithKline Beecham quality of life scale (SBQOL). RESULTS: Back pain (OR=3.54, 95% C.I.=1.81-6.93) and occupational stress (OR=6.33, 95% C.I.=3.12-12.83) were significantly related to poor HRQOL scores among municipal fire officers, and there is negative relationship between KOSS-SF score and SBQOL score. Logistic regression analysis indicated that the medium occupational stress group (OR=2.21, 95% C.I.=1.04-4.71) and the high occupational stress group (OR=6.33, 95% C.I.=3.12-12.83) were more significantly associated with poor HRQOL than low occupational stress group. CONCLUSIONS: Among municipal fire officers, back pain and occupational stress were found to be related to their HRQOL. Based on this study, we suggest that the management of back pain and occupational stress are instrumental to improving the HRQOL among municipal fire officers.