Structural Analysis of Proximal Humerus in Korean / 대한정형외과학회잡지

PURPOSE: Third generation shoulder arthroplasty is widely performed nowadays; however, few studies on the anatomy of the proximal humerus in the Korean population have been reported. The authors have attempted to review the anatomy of the proximal humerus. MATERIALS AND METHODS: The study sample consisted of 100 humeri of patients with a mean age of 48 years (range of 17 to 83 years) who underwent computed tomography imaging between January 2009 and October 2011 at Myongji Hospital. Diameter of the articular surface, head thickness, radius of curvature, head inclination, head to tuberosity height, bicipital groove-shaft angle, lateral angle, medial offset and posterior offset were analyzed. Results were compared depending on age and gender. RESULTS: Mean values of diameter of the articular surface was 42.70+/-3.57 mm, head thickness was 14.3+/-2.0 mm, and radius of curvature was 22.50+/-1.97 mm; these three variables showed significant sex differences. Head inclination was measured as 130.00+/-4.28 degrees, head to tuberosity height was 7.50+/-0.99 mm, bicipital groove-shaft angle was 6.60+/-0.92 degrees, and lateral angle was 163.40+/-4.05 degrees. Mean medial and posterior offset were 5.2+/-2.1 mm and 3.1+/-1.8 mm, respectively. CONCLUSION: Based on the results of this study, the measurement values of Korean humeri can be used in design of the arthroplasty prosthesis, and this will lead to more accurate anatomical reconstruction of the shoulder joint.

Diagnostic Role of Prostate Resection in the Elderly Patients Who Experience Significant Co-Morbidity with a High Clinical Suspicion of Prostate Cancer

The necessity of routine prostate biopsy prior to transurethral resection of the prostate (TURP) in elderly comorbid patients with a high prostate specific antigen (PSA) level remains controversial. We assessed the role of TURP in prostate cancer diagnosis in these individuals. A total of 197 patients underwent TURP in conjunction with prostatic needle biopsy. Pathologic reviews of specimens of TUR chips and biopsy cores were analyzed. Overall, prostate cancer (CaP) was detected in 114 patients (57.6%). Ninety-eight cancers (86%) were detected with TURP and biopsy, and seven cancers (6.1%) with only TURP. The Gleason score of a TUR-specimen was identical to that of the biopsy-core in 43.9% of cases. Variables associated with diagnostic accuracy in the TUR-specimens included the prebiopsy PSA level, prostate specific antigen density (PSAD), and the Gleason score in biopsy cores. In patients with a PSA level and a PSAD that was greater than 15.4 ng/mL and 0.69 ng/mL/g, respectively, 100% of the cancers were detected in the TUR-specimens. Our results suggest that a prostatic biopsy might be omitted prior to TURP in elderly patients with significant co-morbidity and levels for PSA of >15.4 ng/mL.

Outcome of Prostate Biopsy in Men Younger than 40 Years of Age with High Prostate-Specific Antigen (PSA) Levels

PURPOSE: Prostate cancer is rarely diagnosed in men younger than 40 years of age. At present, the available data show a low rate of cancer detection from prostate-specific antigen (PSA) screening of this group of young men. We analyzed the outcome of prostate biopsy results in patients of this age group with a high PSA. MATERIALS AND METHODS: Between October 1997 and August 2008, a total of 81 men less than 40 years of age were referred from the Health Care Promotion Center as the result of elevated PSA levels. Six men with prostatitis were excluded. The remaining 75 men were asymptomatic and had normal findings on the digital rectal examination (DRE) and were selected to have a transrectal ultrasound-guided prostate biopsy for suspected prostate cancer. The patients with sustained high PSA levels underwent repeat biopsies. RESULTS: The median age of the 75 men was 33 years (range, 26-40 years) and the mean PSA level was 6.57 ng/ml (range, 4.32-13.45 ng/ml). The results of the primary biopsy was 1 (1.3%) case of prostate cancer, 70 cases (93%) with benign tissue, 2 cases (2.6%) with inflammation, and 1 case each (1.3%) with high grade intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP). Of the 10 men who underwent a second biopsy, all had benign findings. Three of the men who underwent a third biopsy all had benign tissue findings. CONCLUSIONS: The prostate cancer detection rate in young men less than 40 years of age with high PSA levels and normal DREs was very low. Repeat biopsy for sustained high PSA levels in young men less than 40 years of age may not be indicated.

Structural Analysis of the Coracoclavicular Ligaments in Koreans: A Cadaveric Study / 대한정형외과학회잡지

PURPOSE: Recently, the methods for reconstructing the acromion joint focused on an anatomical reconstruction. However, the reports of the anatomical method of the coraco-clavicle ligament have given different descriptions. This paper reports an anatomical study of the coraco-clavicle ligament in Koreans. MATERIALS AND METHODS: One hundred and two coraco-clavicle ligaments distracted from 6 fresh cadavers and 96 drug-administered cadavers were analyzed and calibrated. A quantitative analysis of the shape and location of the attachment site of the coracoid process and clavicle was performed, and the clinical and radiological applications were examined considering the calibrating variables. RESULTS: The conoid and trapezoid ligaments were thick and wide when measured in the middle part, and the average length up to the attachment site of the coracoid process was 11.3+/-3.6mm in men and 9.5+/-2.2mm in women. The average length of the clavicle was 158.5+/-55.7mm in men and 146.6+/-50.9mm in women. The length between the middle of the trapezoid tubercle or conoid tubercle and the lateral edge of the clavicle was 21.7+/-3.2mm and 42.8+/-3.4mm respectfully in men and 20.9+/-1.8mm and 39.9+/-3.3 respectfully in women, respectively. The angles of the conoid ligament and trapezoid ligament from the anteroposterior and lateral aspects were measured to be 25+/-8degrees and 19+/-3degrees respectfully in men and 28+/-5degrees and 17+/-3degrees degree respectfully in women. CONCLUSION: A more delicate reconstruction of the coraco-clavicle ligament is believed to be possible with regard to the mean distance from the clavicle to the conoid and trapezoid ligaments and the anticipation of a relationship between these ligaments.

Efficacy and Safety of Artificial Urinary Sphincter for Stress Urinary Incontinence after Prostate Surgery

PURPOSE: To evaluate the efficacy and safety of artificial urinary sphincter (AUS) for the treatment of stress urinary incontinence (UI) after prostate surgery. MATERIALS AND METHODS: We performed a retrospective chart review of 19 patients who underwent AUS implantation from July 2003 to November 2008. Efficacy was evaluated in terms of the postoperative changes in daily pad use, incontinence visual analogue scale (I-VAS), International Continence Society male-Short Form questionnaire (ICS-male SF), Incontinence Quality of Life questionnaire (I-QoL), and patients' satisfaction postoperatively. No pad use was defined as cure, and use of 1 pad or fewer per day as improvement. Cure and improvement were regarded as success. Complications and durability of the AUS were evaluated. RESULTS: The median age of the patients was 70.0 years (range, 47-76 years). With a median follow-up period of 11.8 months (range, 6.2-48.1 months), the success rate was 68.4% (13/19; cure in 12 and improvement in 1). I-VAS, subscale scores of ICS-male SF (incontinence and QoL), and total and subscale scores of I-QoL (psychosocial impact, social embarrassment, avoidance, and limiting behaviors) were significantly improved. Fifteen (78.9%) patients reported being satisfied. Six (31.5%) patients required revision: volume adjustment for 2, second cuff implantation for 2, pump reposition for 1, and pump reposition, volume adjustment, and second cuff implantation for 1. One of the patients who had a second cuff implantation had the sphincter explanted for infection. CONCLUSIONS: Despite the high rate of revision, the satisfaction rate was high and the quality of life was significantly improved after AUS implantation for urinary incontinence after prostate surgery.

Finite Element Analysis of Stress Distribution on Telescopic System for Mandibular Implant Supported Overdenture / 대한치과보철학회지

PURPOSE: The purpose of this study was to investigate the stress distribution in mandibular implant overdentures with telescopic crowns compared to bar attachment. MATERIAL AND METHODS: Three-dimensional finite element models consisting of the mandibular bone, 4 implants, and primary bar-splinted superstructure or secondary splinted superstructure with telescopic crowns were created. Vertical and oblique loads were directed onto the occlusal areas of the superstructures to simulate the maximal intercuspal contacts and working contacts such as group function occlusion. Maximum stress and stress distribution were analysed in mandibular bone, implant abutments, and superstructures. RESULTS: 1. In comparison of von Mises stress on mandibular bone, telescopic overdenture had a little lower stress values in vertical load and working side load except oblique load. In the mandible, the telescopic overdenture distributed more uniform stress than the bar overdenture. 2. In comparison of von Mises stress on implant abutments, telescopic overdenture had much lower stress values in all load conditions. In implant abutments, the telescopic overdenture distributed stress similar to the bar overdenture. Stress was concentrated on the distal surfaces of the posterior implant abutments in both mandibular overdentures. 3. In comparison of von Mises stress on superstructures, the telescopic overdenture had much more stress values in all load conditions. However, the telescopic overdenture distributed more uniform stress on superstructure than the bar overdenture. In the bar overdenture, stress was concentrated on each cental area of bar structures and connected area between implant abutments and bar structures. CONCLUSION: In the results of this study, the telescopic overdenture had lower stress values than the bar overdenture in mandibular bone and implant abutments, but more stress values in superstructures. However, if optimal material was selected in making superstructures, the telescopic overdenture was compared to the bar overdenture in stress distribution.

A study of sagittal condylar inclination and occlusal plane inclination of two semiadjustablearticulators with different reference plane / 대한치과보철학회지

STATEMENT OF PROBLEM & PURPOSE: Articulators are very important for education and overall clinical situation in the field of prosthodontics, however preexisting articulators are designed and built based on maxillofacial structures and mean values of mandibular movement of Western people. Purpose of this research is to find out a adequate basis for applicating these articulators, presently used for clinical education, for Korean. MATERIAL AND METHODS: 59 Korean adults (41 males, 18 females), aged between 24 to 41, where selected for this study. Two pairs of both maxillary and mandibular models were made for each examinee. These models where attached to both KaVo PROTARevo 7 and Hanau Modular semiadjustable articulators by using facebow transfer, than sagittal condylar inclination, occlusal plane inclination and position of mandibular on the articulator where measured. RESULT AND CONCLUSION: 1. Mean sagittal condylar inclination for KaVo PROTAR semiadjustable articulator was 33.75degree (standard deviation 12.46degree) meanwhile Hanau Modular semiadjustable articulator showed 40.72degree (standard deviation 12.09degree) for mean sagittal condylar inclination. 2. Mean occlusal plane inclination for KaVo PROTAR semiadjustable articulator was -2.76degree (standard deviation 3.63degree) meanwhile Hanau Modular semiadjustable articulator showed 11.87degree (standard deviation 3.63degree) for mean occlusal plane inclination. 3. On the average center of the mandibular dentition were in the range of 5 to 7 mm of the central position of the articulator. Both anterior and posterior dentition were positioned at the center of the articulator vernacularly for KaVo PROTAR semiadjustable articulators, meantime for Hanau Modular semiadjustable articulator, anterior dentition was positioned 5 mm downwards and 3mm upwards for posterior dentition from vertically central position of the articulator.

The survey on oral health and maxillofacial trauma incidence of the sports players in Korea / 대한치과보철학회지

STATEMENT OF PROBLEM: In spite of increasing sports injury, there was no collected data on the rate and type of dental injuries for athletes in Korea. PURPOSE: The purpose of this study was to investigate the occurrence of maxillofacial injuries and attitude of college sports player in Korea towards mouthguard. MATERIAL AND METHODS: Total 617 athletes answered a series of questionnaire concerning their sports injury and using mouthguard. RESULTS: 1. 81%(502) of athletes had, playing or training a sports, suffered an injury. Female athletes suffered an injury more than male athletes(p<0.05). Contact sports athletes were injured more than non contact sports athletes(p<0.05). 2. 335 athletes(54.8%) had suffered maxillofacial injuries while playing or training. 81.8% of athletes suffered an maxillofacial injury in contact sports(p<0.05). 3. Laceration of oral area, wrick in neck, fracture or avulsion on upper incisors, concussion, TMJ injury, fracture or avulsion on lower incisors, fracture or avulsion on lower molars were frequently injured area. 4. 67.2% of athletes answered that mouthguard could prevent sports injury especially high in contact sports(p<0.05). But only 39.1% of athletes required mouthguard while playing. 44.6% of athletes showed their intention of using mouthguard. CONCLUSION: This study shows that the incidence of maxillofacial injuries is very high while the actual use of mouthguard is very low. To prevent sports injury, a dentist must inform sports players and coaches of accurate information about mouthguard so that they can use it well. A dentist also has to provide them with better mouthguard on the basis of user's complaint.

3D finite element analysis of overdenture stability and stress distribution on mandibular implant-retained overdenture / 대한치과보철학회지

STATEMENT OF PROBLEM: Recently there are on an increasing trend of using implants -especially in edentulous mandible of severly alveolar bone recessed. PURPOSE: The aim of this study was to analyze the displacement and stress distribution of various mandibular implant-retained overdenture models supported by two implants in interforaminal region under the occlusion scheme load. MATERIAL AND METHOD: FEA models were made by the 3D scanning of the edentulous mandibular dentiform. The three models were named as Model M1, M2, and M3 according to the position of implants: M1, Lt. incisor area, M2, Canine area, and M3, 1st Premolar area. Inter-implant angulation model was named as M4. Conventional complete denture was named M5 and used as a control group. Ball implant and Gold matrice were used as a retentive anchors. The occlusion type loads were applied horizontally over each tooth. RESULTS: 1. In mandibular implant retained overdenture Canine Protected Occlusion type load resulted in higher levels of stress to the implants and female matrices than other types of loads. 2. The overdenture model, M1, with implants in lateral incisor areas resulted in lower stress concentration to the implants and female matrices than other models. 3. In mandibular implant retained overdenture the stresses of the implant and female matrice were lower in mesially inclined implant than these of parallel installed implant. CONCLUSION: Lateral incisor areas could be the best site for the implants in mandibular implant-retained overdenture. The mandibular implant retained overdenture models mentioned above showed to the lowest stress to the implants and female matrices.

A study on the difference of the sagittal condylar guidance by semi-adjustable articulator and axiograph / 대한치과보철학회지

STATEMENT OF PROBLEM: In the Protar articulator, the models are almost parallel with the Camper's plane. The ultrasonic-based ARCUSdigma system is basis for the determination of dynamic function parameters with so-called "articulator related registration". PURPOSE: The purpose of this study was to compare the sagittal condylar guidance angles found by use of the wax protrusive records in a semi-adjustable articulator(KaVo Protar 7) with those found by use of the Axiograph(ARCUSdigma). 83 volunteers with intact dentition participated in this study after obtainment of informed consent. MATERIAL AND METHOD: The sagittal condylar guidance angles were measured and estimated statistically by semi-articulator and Axiograph. All the readings were in degrees. No control was used in this project. To test whether there was a significant difference between the 2 independent samples, paired t-test and Kruskal-Wallis test were carried out(p=.05). RESULTS: 1. The mean results for the wax protrusive records were as follow: right side (32.65 degrees, SD 16.48); left side (33.27 degrees, SD 17.49). 2. The mean results for the Axiograph were as follow: right side (32.26 degrees, SD 7.00); left side (33.07 degrees, SD 7.58). 3. There was no statistical difference on the wax protrusive records and Axiograph(p>0.05). CONCLUSION: Both methods of wax protrusive records and Axiograph are clinically acceptable for measuring the sagittal condylar guidance angles in semi-adjustable articulators.