Effect of emergency medical service use on time interval from symptom onset to hospital admission for definitive care among patients with intracerebral hemorrhage: a multicenter observational study

OBJECTIVE: This study evaluated whether emergency medical service (EMS) use was associated with early arrival and admission for definitive care among intracerebral hemorrhage (ICH) patients. METHODS: Patients with ICH were enrolled from 29 hospitals between November 2007 and December 2012, excluding those patients with subarachnoid hemorrhage, traumatic ICH, and missing information. The patients were divided into four groups based on visit type to the definitive hospital emergency department (ED): direct visit by EMS (EMS-direct), direct visit without EMS (non-EMS-direct), transferred from a primary hospital by EMS (EMS-transfer), and transferred from a primary hospital without EMS (non-EMS-transfer). The outcomes were the proportions of participants within early (<1 hr) definitive hospital ED arrival from symptom onset (pS2ED) and those within early (<4 hr) admission from symptom onset (pS2AD). Adjusted odds ratios were calculated to determine the association between EMS use and outcomes with and without inter-hospital transfer. RESULTS: A total of 6,564 patients were enrolled. The adjusted odds ratios (95% confidence intervals) for pS2ED were 22.95 (17.73–29.72), 1.11 (0.67–1.84), and 7.95 (6.04–10.46) and those for pS2AD were 5.56 (4.70–6.56), 0.96 (0.71–1.30), and 2.35 (1.94–2.84) for the EMS-direct, EMS-transfer, and non-EMS-direct groups compared with the non-EMS-transfer group, respectively. Through the interaction model, EMS use was significantly associated with early arrival and admission among direct visiting patients but not with transferred patients. CONCLUSION: EMS use was significantly associated with shorter time intervals from symptom onset to arrival and admission at a definitive care hospital. However, the effect disappeared when patients were transferred from a primary hospital.

Comparative analysis of accuracy of how to use the implant torque controllers / 대한치과보철학회지

PURPOSE: This study was to evaluate the accuracy of how to use the Mechanical Torque-Limiting Devices. MATERIALS AND METHODS: Three different implant manufacturers (Dentium, Osstem, Shinhung) were prepared for each two implant torque controllers. Divided into two groups depending on the method used for removal torque was measured. Repeated measures of ANOVA test (alpha=.05) was used as statistics to evaluate the effect of repeated loading number on the removal torque. Independent t-test was used to evaluate the difference in removal torque of two groups. RESULTS: The removal torque significantly decreased as the number of loading repetition increased (P<.05). There was significant difference between two groups. CONCLUSION: Loosen the handle part of the implant torque controllers spring resilience to recover one group compared to the group that did not, showed a little more closed to the reference value.

Minimally invasive treatment for esthetic enhancement of white spot lesion in adjacent tooth

This article describes the treatment provided to a patient with the maxillary anterior teeth exhibiting severe secondary caries beneath the previous restoration and a white spot lesion on the adjacent incisor. Two implants were placed after extraction of hopeless teeth with the guided bone regeneration technique. A white spot lesion of the adjacent incisor was treated with minimally invasive treatment. This clinical report describes the multidisciplinary treatment for the white spot lesion and esthetic restoration of missing anterior teeth.

Biomechanical considerations for the screw of implant prosthesis: A literature review / 대한치과보철학회지

PURPOSE: This article attempted to determine the factors affecting the preload and screw loosening. METHODS: Available clinical studies from 1981 to 2008 from the PUBMED that presented screw loosening data and review articles regarding screw joint stability were evaluated. Eleven studies dealing the biomechanical principles of the screw mechanics were reviewed. Moreover, the results of our data were included. RESULTS: The frequency of screw loosening was consequently reduced due to the advancement in torque tightening with torque wrench, screw material, coating technique for reducing the frictional force, and thread design, etc. If preload in the screw falls below a critical level, joint stability may be compromised, and the screw joint may fail clinically. The types of fatigue failure of screw were divided to adhesive wear, plastic deformation, and screw fracture. CONCLUSION: An optimum preload is essential to the success of the implant-abutment complex. To maintain optimum preload, using a torque wrench and re-tightening at recall time were needed.

Full mouth fixed implant rehabilitation in a patient with generalized aggressive periodontitis

BACKGROUND: Generalized aggressive periodontitis (GAP) is a destructive periodontal disease that can develop in young age. Only a few cases of full mouth rehabilitation, using dental implants, have been reported in a patient with aggressive periodontitis. CASE DESCRIPTION: This clinical report describes the treatment procedures and results of full mouth rehabilitation in a patient with aggressive periodontitis. After all teeth were extracted, 6 implants were placed in the maxilla and mandible, respectively. Fixed detachable implant prostheses were made. The patient was satisfied with the final results. She was followed for 10 months postloading. CLINICAL IMPLICATION: For a long-term success, continuous maintenance care is critical, as the contributing factors of the disease (such as immune factors or periodontal pathogens) may not be controlled adequately.

Histomorphometry and stability analysis of early loaded implants with two different surface conditions in beagle dogs

STATEMENT OF PROBLEM: Despite an improved bone reactions of Mg-incorporated implants in the animals, little yet has been carried out by the experimental investigations in functional loading conditions. PURPOSE: This study investigated the clinical and histologic parameters of osseointegrated Mg-incorporated implants in early loading conditions. MATERIAL AND METHODS: A total of 36 solid screw implants (diameter 3.75 mm, length 10 mm) were placed in the mandibles of 6 beagle dogs. Test groups included 18 Mg-incorporated implants. Turned titanium implants served as control. Gold crowns were inserted 4 weeks after implant placement and the dogs were immediately put on a food diet. Implants were observed for 10 weeks after loading. Radiographic assessments and stability tests were performed at the time of fixture installation, 2nd stage surgery, 4 weeks after loading, and 10 weeks after loading. Histological observations and morphometrical measurements were also performed. RESULTS: Of 36 implants, 33 displayed no discernible mobility, corresponding to successful clinical function. There was no statistically significant difference between test implants and controls in marginal bone levels (P = .46) and RFA values. The mean BIC% in the Mg-implants was 54.5 +/- 8.4%. The mean BIC% in the turned implant was 45.3 +/- 12.2%. These differences between the Mg-implant and control implant were statistically significant (P = .005). CONCLUSIONS: The anodized, Mg-incorporated implant demonstrated significantly more bone-to-implant contact (BIC) in early loading conditions. CLINICAL IMPLICATIONS: The results of this study in beagle dogs suggest the possibility of achieving predictable stability of early loaded free-standing dental implants with Mg-incorporated surface.

Stability changes of immediately loaded and delayed loaded implants in edentulous mandible / 대한치과보철학회지

STATEMENT OF PROBLEM: It was reported high success rate of implant-supported fixed prostheses using with 5.6 implants on anterior mandible. Recently, immediate loading protocol was focused to overcome disadvantages of classic 2-stage delayed loading protocol. PURPOSE: This clinical study was to evaluate stability changes with time of immediately loaded and delayed loaded implants in edentulous mandible and to compare stability changes with time according to implantation sites. MATERIALS AND METHODS: Five or six implants were placed on anterior mandible depending on the arch shape. The immediately loading group was consisted of 8 patients received their prostheses within 24.48 hours after implantation. The delayed loading group was consisted of 8 patients received their definitive prostheses following classical prosthetic procedures after a healing period of 3 months. All patients were recalled every 6 months for check-up. The evaluations of radiographic examination, ISQ value measurement and recording of complication were done. To evaluate marginal bone level, intraoral periapical radiographs were taken with long cone paralleling technique. At every evaluation recall, all prostheses were removed and ISQ values were measured with Osstell(TM) on individual implants. RESULTS: 1. None of implants was failed. All implants showed stable marginal bone levels and ISQ values. 2. Marginal bone level changes with time showed statistically significant difference between immediately loading group and delayed loading group (P<0.001). 3. ISQ value changes with time did not show statistically significant difference between immediately loading group and delayed loading group (P=0.079). ISQ value decreased with time in both groups, however, all implants showed stable ISQ value at 30 months-recall evaluation. 4. Marginal bone level changes with time did not show statistically significant differences among implantation sites (P=0.604). 5. ISQ value changes with time showed statistically significant differences among implantation sites (P=0.047). ISQ values of most posterior implants decreased with time comparing to other implants. CONCLUSION: Although the marginal bone level of the terminal abutment didn't different with the other implants, ISQ value of the terminal abutment was lower than that of the other implants. Therefore, further clinical evaluation would be needed in this point of view.

Alveolar bone changes around the natural teeth opposing the posterior implants in mandible / 대한치과보철학회지

STATEMENT OF PROBLEM: Alteration of tooth function is assumed to be changed by stress/strain on the adjacent alveolar bone, producing changes in morphology similar to those described for other load-bearing bones. When teeth are removed, opposing teeth will not be functioned. When edentulous area is restored by implant prostheses, opposing teeth will be received physiologic mechanical stimuli. PURPOSE: The aim of this study was to evaluate the bone changes around the teeth opposing implant restoration installed mandibular posterior area. MATERIAL AND METHOD: Eight patients who had mandibular posterior edentulous area were treated with implants. Radiographs of the opposing teeth were taken at implant prostheses delivery(baseline), 3 months, and 6 months later. Customized film holding device was fabricated to standardize the projection geometry for serial radiographs of opposing teeth. Direct digital image was obtained. Gray values of region of interest at each digital image were measured and compared according to time lapse. Repeated measured analysis of variance and post-hoc Scheffe's test were performed at the 95% significance level. RESULTS: Alveolar bone changes around the natural teeth opposing the posterior implant in mandible showed statistically significant difference compared to control group(P0.05). There were no statistically significant differences of alveolar bone changes among mesial-crestal group, mesial-middle group, distal-crestal group, distal-middle group, and control group(P>0.05). CONCLUSION: Alveolar bone around the natural teeth opposing the implant prosthesis showed gradual bony apposition.

Adrenal Myelolipoma Treated with Hand-assisted Transperitoneal Laparoscopic Adrenalectomy / 대한비뇨기과학회지

Adrenal myelolipoma is an uncommon, benign, hormonally non-active lesion that is composed of a mix of hemopoietic elements and mature adipose tissue. Most adrenal myelolipomas are incidentally found by ultrasonogram, computed tomography or magnetic resonance imaging. This tumor is commonly asymptomatic, although patients will occasionally present with nonspecific abdominal pain. We report here on a case of myelolipoma that was treated by Hand-assisted transperitoneal laparoscopic adrenalectomy.

Efficacy of Combination Therapy for Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Study / 대한비뇨기과학회지

PURPOSE: The National Institute of Health (NIH) category III chronic nonbacterial prostatitis/chronic pelvic pain syndromes (CPPS) are commonly seen disorders; however, there has been no consensus on how to manage these patients. The purpose of this trial was to compare the efficacy of antibiotic monotherapy and antibiotic plus alpha-blocker combination therapy for the treatment of CPPS patients. MATERIALS AND METHODS: The study was comprised of 54 patients who were randomly placed into two groups: group I was treated with levofloxacin alone (28 patients), and group II was treated with levofloxacin and alfuzosin (26 patients). The levofloxacin, or the levofloxacin and alfuzosin were given to the respective groups for 8 weeks. The NIH Chronic Prostatitis Symptom Index (NIH-CPSI) was evaluated both before and after the treatment. RESULTS: Before the treatment, the mean CPSI of the group I patients was 23.1+/-8.1, and after the treatment, it was 15.6+/-5.6. For the group II, the mean CPSI before the treatment was 23.9+/-8.3, and after the treatment, it was 11.0+/-4.5. The difference between the pre-and post-treatment CPSI scores of group II was significantly larger than that of group I (p=0.001). The mean differences of the CPSI from the initial scores to the final scores in both groups were followed: 2.2 in group I and 4.3 in group II for the pain domain, 1.5 in group I and 2.8 in group II for the urinary domain, and 3.8 in group I and 5.7 in group II for the quality of life domain. CONCLUSIONS: Combination therapy of levofloxacin with alfuzosin appeared more effective for treating patients with chronic prostatitis/chronic pelvic pain syndrome than just administering antibiotic alone.

Inflammatory Pseudotumor of the Urinary Bladder which Induced Acute Urinary Retention

Inflammatory pseudotumors of the urinary bladder are rare, benign and nonepithelial tumors characterized by proliferative myofibroblast, fibroblast, histiocytes, and occasionally by plasma cell and lymphocytes. Microscopically, inflammatory pseudotumors present as either pedunculated intraluminal tumors that can be seen readily during cystourethroscopy or as submucosal mural lesions that may be easily overlooked. Histological features of this benign lesion mimic those of malignant neoplasm but their clinical course is benign. Although inflammatory poseudotumors can occur anywhere in the body, they are rare in the bladder. We report a case in which induced acute urinary retention and describe the clinical presentation, and radiographic and histologic findings.

Effects of Doxazosin on Sexual Function in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The goal of this study is to estimate the effect of doxazosin GITS on sexual function of patients with benign prostatic hyperplasia using the validated international index of erectile function (IIEF). MATERIALS AND METHODS: We prospectively examined a total of 60 patients with benign prostatic hyperplasia who were treated with doxazosin by using the IIEF questionnaires prior to treatment and after 3 months of medication. The patients whose total IIEF scores were under 21 and treated with finasteride were excluded. RESULTS: The mean total IIEF scores after treatment with doxazosin increased from 41.4+/-10 to 44.2+/-9.3 (p<0.001). The mean scores of IIEF according to the patient's age for the men in their fifties, sixties, and seventies were 48.6+/-8.3, 41.5+/-9.5, and 36.6+/-9.7, respectively, and the mean scores decreased as the patient's age increased. Among the mean scores of each IIEF domain, the erectile function scores increased from 16.4+/-4.8 to 18.2+/-4.2 (p<0.001), the intercourse satisfaction scores increased from 6.9+/-2.3 to 7.3+/-2.2 (p<0.001), the orgasm function scores increased from 6.4+/-1.7 to 6.5+/-1.8 (p=0.038), the sexual desire scores increased from 6.6+/-1.3 to 6.8+/-1.3 (p=0.164), and the overall satisfaction scores increased from 5.4+/-1.9 to 5.8+/-1.7 (p<0.001). CONCLUSIONS: According to the IIEF questionnaire, the generalized sexual function increased after doxazosin treatment in patients with benign prostatic hyperplasia, especially, in the erectile function and intercourse satisfaction domain.

Ductal Adenocarcinoma of Prostate / 대한비뇨기과학회지

A ductal adenocarcinoma of prostate is a rare entity of a prostate carcinoma, originating from the epithelial lining of the primary and secondary ducts of the prostate. Although there have been about 100 reports of a ductal adenocarcinoma of the prostate in the English literature, this is the first case report described in Korea. Ductal adenocarcinomas of the prostate are often clinically underestimated as rectal examinations and the serum prostate specific antigen levels may be normal. We experienced a case of a ductal adenocarcinoma of the prostate in a 78 year-old man.

Relationship between Parameters of Perineal Ultrasonography and Severity of Symptom in Genuine Stress Urinary Incontinence Patients

PURPOSE: The goal of this study is to know the relationship between the parameters of perineal ultrasonography and severity of symptom in stress urinary incontinence patients. MATERIALS AND METHODS: We retrospectively examined total 68 patients with stress urinary incontinence who were diagnosed by physical examination, history, urinalysis and urodynamic study. The patients were divided into three group, 1, 2, 3 by Stamey grade in order of each grade I, II, III. We measured the posterior urethrovesical angle(PUVA) at rest and during strain, descent and funneling of bladder neck using perineal ultrasonography. RESULTS: The mean PUVA at rest was 123.9+/-24.0degrees. In group 1, the angle was 124.6+/-20.6degrees, in group 2, 121.4+/-27.1degrees, in group 3, 138.6+/-4.9degrees(p=0.320). During strain state, the mean PUVA was 139.5+/-24.8degrees. In group 1, the angle was 140.6+/-23.7degrees, in group 2, the angle was 136.9+/-26.5degrees, in group 3, 154.0+/-10.8degrees(p=0.346). The mean descent of bladder neck was 10.8+/-4.4mm. In group 1, the descent was 9.9+/-5.8mm, in group 2, 11.3+/-3.5 mm, in group 3, 11.8+/-0.8 mm(p=0.455). The number of cases presenting funneling of bladder neck was 3, 4, 2 in each group(p=0.150). CONCLUSION: There was no relationship between the parameters of perineal ultrasonography and the severity of symptom in stress urinary incontinence patients.

Effect of Body Mass Index on the Result of the Tension-free Vaginal Tape Procedure in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The aim of the study was to evaluate the clinical outcome, according to the body mass index (BMI), of tension-free vaginal tape (TVT) for the surgical treatment of stress urinary incontinence. MATERIALS AND METHODS: Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30) or obese (BMI>30). The patients characteristics and clinical outcomes of the operation were analyzed according to the BMI. RESULTS: There were no significant differences in the patients characteristics, with the exception of the pre-operative posterior urethrovesical angle (PUVA). The subjective cure rate, satisfaction rate and complications of the normal BMI patients did not significantly differ from the women with the high BMI. CONCLUSIONS: The TVT procedure in stress urinary incontinence patient's results in similar subjective cure rates, satisfaction rates and post-operative complications, irrespective of the BMI, which makes it safe for overweight and obese women, and would appear to be an adequate treatment for future use.

Ganglioneuroma Arising from the Retroperitoneal Sympathetic Chains / 대한비뇨기과학회지

A ganglioneuroma is a rare benign tumor that originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. It is characterized histologically by the composition of mature ganglion cells and nerve fibers. Due to the slow growth of the tumor, it may be incidentally found or detected by the pressure effects on adjacent structures. Herein, a case of a ganglioneuroma arising from the retroperitoneal sympathetic chain is reported in a 45-year-old female patient with a review of the literature.

The Therapeutic Effect of Monotherapy and Combined Therapy for Androgen Blockade in Patients with Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the therapeutic effect of combined androgen blockade (CAB) compared with that of medical, or surgical, castration monotherapy, in the treatment of the metastatic prostate cancer. MATERIALS AND METHODS: Of 53 patients with metastatic prostate cancer, we compared the overall survival between CAB and monotherapy groups, using a Kaplan-Meier survival curve. We also compared the therapeutic effect of flutamide and bicalutamide in the CAB group. RESULTS: There were no differences in known prognostic factors between the CAB and monotherapy groups. The mean survival after treatment were 43 months in the CAB group, and 38 months in monotherapy group, with no significant difference (p=0.470). There were also no differences in the survival rates between the flutamide and bicalutamide groups (p=0.158). CONCLUSIONS: These results implicate that the CAB was no better than medical, or surgical, castration monotherapy in patients with metastatic prostate cancer, and that flutamide or bicalutamide, in CAB, resulted in similar efficacies and tolerabilities.

The Therapeutic Effect of Monotherapy and Combined Therapy for Androgen Blockade in Patients with Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the therapeutic effect of combined androgen blockade (CAB) compared with that of medical, or surgical, castration monotherapy, in the treatment of the metastatic prostate cancer. MATERIALS AND METHODS: Of 53 patients with metastatic prostate cancer, we compared the overall survival between CAB and monotherapy groups, using a Kaplan-Meier survival curve. We also compared the therapeutic effect of flutamide and bicalutamide in the CAB group. RESULTS: There were no differences in known prognostic factors between the CAB and monotherapy groups. The mean survival after treatment were 43 months in the CAB group, and 38 months in monotherapy group, with no significant difference (p=0.470). There were also no differences in the survival rates between the flutamide and bicalutamide groups (p=0.158). CONCLUSIONS: These results implicate that the CAB was no better than medical, or surgical, castration monotherapy in patients with metastatic prostate cancer, and that flutamide or bicalutamide, in CAB, resulted in similar efficacies and tolerabilities.

The Factors Affecting Stone Clearance after Shock Wave Lithotripsy for Lower Calyceal Stones / 대한비뇨기과학회지

PURPOSE: The influence of the stone size and spatial anatomy of the lower pole was evaluated in relation to the stone clearance after shock wave lithotripsy (SWL) for lower calyceal stones. MATERIALS AND METHODS: SWL monotherapy was performed in 44 patients, with lower calyceal stone, using a Dornier Compact-S lithotriptor. The study was comprised of a retrospective analysis of 44 patients. The patients were divided into 2 groups, 33 who were considered to be clear of fragments 3 months after SWL, and 11 who had residual stones. The infundibulopelvic angle, infundibular width and length of lower calyces were determined from intravenous urograms. The stone-free status was assessed 3 months after the last shock wave lithotripsy session. RESULTS: The mean lower calyceal stone size, lower calyceal infundibulopelvic angle and lower calyceal infundibular length and width were 10.2mm, 32.2 degrees, 27.3mm and 5.7mm, respectively. The overall success rate was 75.0%. Success rates for the patients with an infundibulopelvic angle more than 30 degrees and less than 30 degrees were 85.2 and 52.9% respectively. For those with infundibular length more than 30mm and less than 30mm were 78.3 and 71.4%, respectively. For those with an infundibular width more than 5mm and less than 5mm were 76.5 and 74.1%, respectively. CONCLUSIONS: A low calyceal infundibulopelvic angle and the stone size had significant impacts on the stone clearance following shock wave lithotripsy. However, the infundibular length and width were not statistically significant factors associated with the stone clearance. Further examination of the lower pole renal anatomy, with a search for other contributing factors, is still warranted.

Mucinous Adenocarcinoma of Prostate / 대한비뇨기과학회지

It is not atypical for a small amount of mucin to be present in prostate adenocarcinoma. But true mucinous type of adenocarcinoma of prostate occurs rarely, with 88 cases reported in the literature. This has been histopathologically defined as containing lakes of extracellular mucin comprising at least 25% of the primary prostate tumor. The biologic behavior of this malignancy is not well known and the prognosis is considered to be poor compared with typical adenocarcinoma of the prostate. We experienced a case of mucinous adenocarcinoma of prostate that was developed in a 70 year-old man.