Long-term Follow-up Results of Femoral Revision Hip Arthroplasty Using Impaction Bone Grafting and Standard Cemented Polished Stem

Background@#To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency. @*Methods@#We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39–75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts. @*Results@#The modified HHS improved from an average of 55.04 (range, 25–79.5) preoperatively to 90.1 (range, 81–93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9–17.8 years). The radiographic analysis revealed stable stems.Femoral stems showed an average subsidence of 3.2 mm (range, 2–8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting. @*Conclusions@#Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.

Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes / 대한이비인후과학회지

Background and Objectives@#Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed. @*Results@#IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group. @*Conclusion@#IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.

Two Cases of Cerebral Infarction after Endoscopic Sinus Surgery / 대한이비인후과학회지

Perioperative stroke is one of the most fatal complications for patients as well as for doctors. It is defined as a brain infarction or hemorrhage, occurring during or within 30 days after a surgical procedure. Most of the perioperative strokes have ischemic etiology while only 1% has hemorrhagic etiology, according to one study. The incidence of perioperative stroke is influenced by the complexity and type of the surgery. Generally, its incidence is very low, being about to 0.1-1.9%, with majority of the cases pertaining to cardiac, vascular, neurological surgeries. Based on our research, most cases are perioperative strokes that occur after cardiac and vascular surgeries. Here we report two cases of cerebral infarction after endoscopic sinus surgery, which are very rare.

Comparison of the Results between the First Steroid Treatment Group and the Retreatment Group with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Sudden sensoryneural hearing loss (SSNHL) is an otological emergency disease of a non-specific cause. If there is no improvement or if the degree of hearing loss is severe, patients are often referred to other medical institution. Many papers have reported regarding the treatment results of SSNHL, however, most of them failed to mention the fact that patients were referred from other clinics after steroid treatment. This paper would like to compare the treatment results between patient groups who had been referred following steroid treatment and those who received steroid treatment for the first time.SUBJECTS AND METHOD: We retrospectively analyzed 127 patients from January 2015 to August 2017. Patients who received steroid treatment for the first time were classified as group 1; those who had received steroid treatment at another hospital and those who were re-treated were classified as group 2. The treatment results of each group were evaluated.@*RESULTS@#According to the results of this study, the recovery rates for group 1 and 2 were 66.7% and 31.4%, respectively.@*CONCLUSION@#Most of the previous studies on the treatment results of sudden hearing loss were performed in tertiary medical institutions. It is likely that the treatment results of patients who recovered after treatment in the primary and secondary medical institutions were missed, which means that the results of steroid therapy may be better than those reported previously.

The effect of implant system with reverse beveled platform design on marginal bone stress distribution / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate the effects of the surface morphology of the implant neck on marginal bone stress measured by using finite element analysis in six implant models. MATERIALS AND METHODS: The submerged type rescue implant system (Dentis co., Daegu, Korea) was selected as an experimental model. The implants were divided into six groups whose implant necks were differently designed in terms of height (h, 0.4 and 1.0 mm) and width (platform width, w = 3.34 + 2b [b, 0.2, 0.3 and 0.4 mm]). Finite element models of implant/bone complex were created using an axisymmetric scheme. A load of 100 N was applied to the central node on the top of crown in parallel with the implant axis. The maximum compression stress was calculated and compared. RESULTS: Stress concentration commonly observed around dental implants did not occur in the marginal bone around all six test implant models. Marginal bone stress varied according to the implant neck bevel which had different width and height. The stress was affected more markedly by the difference in height than in width. CONCLUSION: This result indicates that the implant neck bevel may play an important role in improving stress distribution in the marginal bone area.

A comparison of the fidelity of various zirconia-based all-ceramic crowns fabricated with CAD/CAM systems / 대한치과보철학회지

STATEMENT OF PROBLEM: The interest in all-ceramic restorations has increased as more techniques have become available. With the introduction of machinable dental ceramics and CAD/CAM systems there is a need to evaluate the quality levels of these new fabrication techniques. PURPOSE: This study is to evaluate the crown fidelity (absolute marginal discrepancy and internal gap) of various zirconia-based all-ceramic crowns fabricated with different CAD/CAM (computer-assisted design/computer-assisted manufacturing) systems and conventional cast metal-ceramic crowns. MATERIAL AND METHODS: A resin tooth of lower right second premolar was prepared. After an impression was taken, one metal master die was made. Then 40 impressions of metal master dies were taken for working dies. 10 crowns per each system were fabricated using 40 working dies. Metal-ceramic crowns were cast by using the conventional method, and Procera, Lava, and Cerec inLab crowns were fabricated with their own CAD/CAM manufactruing procedures. The vertical marginal discrepancies and internal gaps of each crown groups were measured on a metal master die without a luting agent. The results were statistically analyzed using the one-way ANOVA and Tukey's HSD test. RESULTS: 1. Vertical marginal discrepancies were 50.6 +/- 13.9 micrometer for metal-ceramic crowns, 62.3 +/- 15.7 micrometer for Procera crowns, 45.3 +/- 7.9 micrometer for Lava crowns, and 71.2 +/- 2.0 micrometer for Cerec inLab crowns. 2. The Internal gaps were 52.6 +/- 10.1 micrometer for metal-ceramic crowns, 161.7 +/- 18.5 micrometer for Procera crowns, 63.0 +/- 10.2 micrometer for Lava crowns, and 73.7 +/- 10.7 micrometer for Cerec inLab crowns. CONCLUSION: 1. The vertical marginal discrepancies of, 4 crown groups were all within the clinically acceptable range (120 micrometer). 2. The internal gaps of LAVA, Cerec inlab, and metal-ceramic crowns were within clinically acceptable range except Procera crown (140 micrometer).

An evaluation of angles between the alveolar crest bone and the implant effect on the implant crestal area induced stresses using a finite element method / 대한치과보철학회지

STATEMENT OF PROBLEM: Main consideration was given to the stresses at the site of implant entry into the cortical bone at the alveolar crest. As a suspectible factor affecting the occurrence of stress concentrations, the contact angle between the implant and the alveolar crest bone was addressed. PURPOSE: The purpose of this study is to evaluate angles between the alveolar crest bone and the implant effect on the implant crestal area induced stresses using a finite element method. MATERIAL AND METHODS: Cylindrically shaped, standard size ITI implants entering into alveolar crest with four different contact angles of 0, 15, 30, and 45 deg. with the long axis of the implant were axisymmetrically modelled. Alterations of stresses around the implants were computed and compared at the cervical cortical bone. RESULTS AND CONCLUSION: The results demonstrated that regardless of the difference of the implant/alveolar crest bone contact angles, stress concentration occurred at the cervical bone and the angle differences led to insignificant variations in stress level.

The Use of Extension Tube in Sono-guide FNAC / 대한내분비외과학회지

PURPOSE: Sono-guided FNAC (fine needle aspiration cytology) is a safe and accurate diagnostic procedure for thyroid nodules. We examined the use of an extension tube in FNAC as useful. METHODS: We reviewed 175 cases of patients with thyroid nodules where an extension tube was used in sono-guide FNAC and 153 cases where a syringe holder was used in Jeonju Jesus hospital, from July 2005 to September 2006. RESULTS: For cases with an extension tube, tumor size was smaller than 1 cm (38%), from 1 cm to 2 cm (27%), or larger than 2 cm (35%), with cytology results of benign (73%), intermediate (8%), malignant (7%), or nondiagnostic (12%). In cases with a syringe holder, tumor size was smaller than 1 cm (40%), from 1 cm to 2 cm (40%), or larger than 2 cm (20%), with cytology results of benign (51%), intermediate (4%), malignant (3%), or nondiagnostic (42%). The nondiagnostic percentage in cases where an extension tube was used was lower than in cases using a syringe holder. However, the number of tumors larger than 2 cm was significantly larger in the syringe group than the extension tube group. CONCLUSION: The use of an extension tube or a syringe holder in FNAC produce similar results.

Finite element approach to investigate the influence of the design configuration of the ITI solid implant on the bone stresses during the osseointegration process / 대한치과보철학회지

STATEMENT OF PROBLEM: Standard type of ITI solid implant model in the 6.2mm thick jaw bone was axisymmetrically modelled for finite element stress analyses. PURPOSE: Primary objective was to investigate the influences of the characteristic design configuration of the ITI solid implant model on the bone stress with the course of osseointegration process at the bone/implant interfaces. To simulate the characteristics of the osseointegration process, five different stages of the bone/implant interface model were implemented. As load conditions, vertical load of 50N was taken into consideration. Bone at the cervical region of implant was the areas of concern where the higher level of stress were likely to take place. RESULTS: The results indicated that rather slightly different stress level could be obtained as a function of the osseointegration conditions. CONCLUSION: Under vertical load, the lower level of stress was observed at the cervical cortical bone in the initial and final stages of osseointegration. Relatively higher stress level, however, was observed during the transitional stages where the osseointegration at the cancellous bone interface were yet to fully develop.

Metanephric Adenoma Treated with Laparoscopic Radical Nephrectomy / 대한비뇨기과학회지

Metanephric adenoma is rare renal adenoma. In some cases, it is difficult to distinguish from other renal neoplasms such as Wilms' tumor or renal cell carcinoma on the basis of clinical and histologic findings. A unique case of metanephric adenoma of left kidney is reported in 35-year-old foreign woman presenting with intermittent left flank pain for 3 months. Computed tomography revealed a heterogeneous enhanced mass, 7.5x 6.8cm in diameter, at the lower pole of the left kidney. Laparoscopic radical nephrectomy was performed under the clinical impression of hypovascular renal cell carcinoma or oncocytoma. The resected mass, measuring 8x7cm, was well circumscribed and its cut surface was tan-pink. Microscopically, the tumor cells had small scant cytoplasms, containing round and uniform nuclei. There was no mitosis or cellular atypia indicating a malignant transformation. The histological diagnosis was metanephric adenoma. The patient was healthy without recurrence or metastasis 6 months after surgery.

A Gynecologic Aspects of Child Sexual Abuse / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate victims of child sexual abuse and assess the similarities and differences between them. METHODS: The authors studied retrospectively 55 patients among 230 sexual abuse victims between the ages 2 and 13 who visited and were treated at the Department of Obstetrics and Gynecology, National Police Hospital between the dates Oct, 13, 2001 and Mar, 25, 2003 were followed and observed. RESULTS: Female infants and children composed 94.5% instances of sexual abuse were most common between 4 and 7 o'clock in the afternoon. Unlike adult cases, assailants were in most cases acquaintances (55.5%), and the crimes were committed most often at the homes of either victim or assailant (50.9%). 38.2% of victims had been directed to the National Police Hospital from police stations, 21.8% from other hospitals. Diagnosis resulted in 5.5% of cases with no observable symptoms, 18.2% with lacerations, among these cases 1 instance (1.8%) requiring surgical repair. 1 case each of Gonorrhea and genital herpes were found, with no instances of pregnancy. CONCLUSION: Child sexual abuse results in life-long bodily and psychological stress for both the victim and his/her family. Witnesses are in some cases unable to testify in legal proceedings, and the gathering of evidence is more difficult than in adult cases. This could lead to frequent social and legal negligence. Cooperation among such numerous and various professional institutions as hospitals, child guidance clinics, child psychiatrists, police, prosecutory offices and the courts is requisite to the settlement of these cases. Since the gynecologist plays the leading role in the identification and treatment of child and infant sexual abuse victims, and is often the first to come in contact with these cases, careful attention is required in the processes of inspection, inquiry, evidence collection, treatment and diagnosis.

Stress analysis with nonlinear modelling of the load transfer characteristics across the osseointegrated interfaces of dental implant / 대한치과보철학회지

A modelling scheme for the stress analysis taking into account load transfer characteristics of the osseointegrated interfaces between dental implant and surrounding alveolar bone was investigated. Main aim was to develop a more realistic simulation methodology for the load transfer at the interfaces than the prefect bonding assumption at the interfaces which might end up the reduced level in the stress result. In the present study, characteristics of osseointegrated bone/implant interfaces was modelled with material nonlinearity assumption. Bones at the interface were given different stiffness properties as functions of stresses. Six different models, i.e. tens0, tens20, tens40, tens60, tens80, and tens100 of which the tensile moduli of the bones forming the bone/implant interfaces were specified from 0, 20, 40, 60, 80, and 100 percents, respectively, of the compressive modulus were analysed. Comparisons between each model were made to study the effect of the tensile load carrying abilities, i.e. the effectivity of load transfer, of interfacial bones on the stress distribution. Results of the present study showed significant differences in the bone stresses across the interfaces. The peak stresses, however, were virtually the same regardless of the difference in the effectivity of load transfer, indicating the conventional linear modelling scheme which assumes perfect bonding at the bone/implant interface can be used without causing significant errors in the stress levels.

A Case of Pelvic Actinomycosis / 대한산부인과학회잡지

Actinomycosis is a chronic, progressive, suppurative disease which present some difficulty in establishing a correct preoperative diagnosis. Because pelvic actinomycosis has variable nonspecific clinical manifestations. Actinomyces species are gram-positive, non-acid fast, anaerobic bacteria that exhibit branching filamentous growth. After trauma, surgery, or other infection that alter the host's mucosal barriers, these organism advance to invade surrounding tissues and organs. Recent reports have demonstrated an increased incidence in women using Intrauterine device (IUD). It is accounted that IUD cause chronic intrauterine infection, tissue injury, and act as nucleus for parasitic infestation. We have experienced a cause of pelvic actinomycosis in a 37-year-old woman using IUD and report it with brief review of literature.

Clinical study of Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Ectopic pregnancy can still cause maternal death, though we have undergone it frequently. So, we survey 80 cases ectopic pregnancies treated our hospital for early detection and proper management. METHODS: In this study, the authors studied retrospectively 80 cases which had been admitted and treated at the department of Obstetrics and Gynecology, National Police Hospital from Jan. 1, 1991 to Dec. 31, 2000. RESULTS: Incidence of ectopic pregnancy was one in 68 normal deliveries for 10 years, 63.7% of cases occurred in 25~34 years-old age group, and 52.6% of patients had previous abdominal surgery including cesarean section. Average interval of tubal ligation was 6.5 years between the onset of ectopic pregnancy and tubal ligation. Lower abdominal pain was the most common clinical symptom developed in 91.3% of the patients. Average interval between the onset of symptom and LMP was 7.6 weeks. Most ectopic pregnancies were tubal pregnancies and salpingectomy was done in 56.3% of the patients. CONCLUSION: According to our study, ectopic pregnancy occurred most frequently in women in their reproductive age and one of most important prognostic factors is time between onset of symptom and arrival of patient at hospital. We must make our efforts to preserve utero-ovarian function in treatment of patients with ectopic pregnancy.

A Feasibility Study On The Application Of The Knitted Glass Fabric Composites To Fixed Prosthodontic Restoration In Dentistry / 대한치과보철학회지

Current dental restorations present a relatively weak resistance to fracture. Owing to their unique mechanical properties, fibre-reinforced polymers are now being considered. Unidirectional or woven continuous fibres, made of glass, polyethylene, carbon or Kevlar, have been evaluated. This study focused on the use of glass fibre knitted fabrics to reinforce acrylate resins, in order to investigate the possibility to construct single crowns as well as three unit bridges. Some points affecting the final composite system were tested: 1) static strength, with focus on the stress transfer under a occlusal contact point; 2) modelling of a three unit bridge; 3) fatigue strength as a posterior three unit bridge material. The study demonstrated that knitted fabric reinforcements are showing an interesting compromise between stiffness, static strength for single crown. For three unit bridge applications in the posterior arch, however, knitted glass fabric reinforcements were not strong enough in fatigue. An additional reinforcement in the posterior arch fixed partial denture design was recommended.

Two Cases of Scar endometriosis / 대한부인종양콜포스코피학회잡지

Endometriosis is defined as the presence of endometrial tissue(gland and stroma) outside the uterus. The incidence of scar endometriosis is quite rare, and must differentiate with cellulitis and abscess. We have experienced one case of perineal endometriosis and one case of abdominal wall endometriosis at the site of postoperative wound scar. The possible pathogenesis of endometriosis and treatment were discussed.

A Case Report of Complete Testicular Feminization Syndrome with Rudimentary Salpinx / 대한산부인과학회잡지

The Complete testicular feminization syndrome is a hereditary syndrome characterized clinically by female phenotype with 46, XY karyotype and bilateral testes. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Therefore, androgen induction of Wolffian duct development does not occur. However, anti-mullerian hormone activity is present and the individual does not have mullerian development. Principle of treatment is reinforced to live normal female life. This is a case report of testicular feminization syndrome with rudimentary salpinx with the brief review of literatures.

SHEAR BOND STRENGTH OF PRETREATED DENTIN SURFACE WITH RESIN-REINFORCED GLASS IONOMER CEMENT / 대한치과보철학회지

The purpose of this study was to evaluate the effect of dentin pretreatment with Dentin Conditioner,Ultra-Etch,conditioner of Fuji Plus cement on the shear bond strength of resin-reinforced glass ionomer cements to dentin and analyze the fractured surfaces. To evaluate the bond strengh, the extracted human teeth which had uniform area of exposed dentin were cemented with conventional glass ionomer cement. 3M RelyX TM Luting (Vitremer luting cement). Fuji Plus cement after dentin pretreatment. The shear bond strengh was measured using the Universal testing machine(Instron Co., USA) with a crosshead speed of 1mm/m. The effect of dentin pretreatment was evaluated by observing pretreated dentin surfaces under the scanning electron microscope,measuring the shear bond strength and observing the fractured surfaces under the scanning electron microscope. The results were as follows: On the SEM observation of surface morphology, the specimens treated with Dentin Conditioner, Ultra-Etch and conditioner of Fuji Plus cement were removed the smear layer and funneled dentinal tubules in dentin surfaces. In RelyX TM Luting cement group, shear bond strengh of pretreated group was significantly higher than control group. In Fuji Plus cement group and Fuji I group, regardless of the type of pretreatment agents, there was tendency of increase in the shear bond strength. On the SEM observation of fractured surfaces, as the shear bond strength increase, it were shown thicker cement layers and were not shown dentinal tubules. According to these results, it were shown that dentin pretreatment have much effect on bonding states.

A Comparison of Intravaginal Misoprostol and Dinoprostone for Cervical Ripening of the Unfavorable Cervix and Labor Induction at Term Pregnancy / 대한주산의학회잡지

No abstract available.

Two Cases of Squamous Cell Carcinoma of the Ovary Arising in Mature Cystic Teratoma / 대한산부인과학회잡지

Between 1 and 2% of benign cystic teratomas undergo malignant transformation. This occurs most frequently in postmenopausal women, who account for only 10% of benign cystic teratoma. A wide variety of neoplasms arise in the mature tissues of otherwise benign teratomas. Of the malignancies arising in teratomas, squamous carcinoma is the most common (83%) with sarcomas accounting for 7%, adenocarcinoma and carcinoid tumors make up most of the others. The presentation in Stage I disease does not differ from that of benign cystic teratoma, except that ascites is occasionally present. In the more advanced neoplasms, the symptoms are those of epithelial ovarian cancer of the same stage. Differential diagnosis between squamous cell carcinoma and benign mature teratoma is difficult but seems to be related to age, size, serum tumor marker (SCC, CA125, CEA). Prognosis of squamous cell carcinoma in mature cystic teratoma was reported much poorer than other epithelial ovarian cancers In the early stages, treatment is possible through surgical intervention alone, but when advanced, 5 year survival rate shows less than 15 percent. We experienced two cases of squamous cell carcinoma of ovary arising in mature teratoma and present with a brief review of literature.