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Objective@#This outcome analysis study evaluated the actual positions of the orthodontic miniplate and miniplate anchoring screws (MPASs) and the risk factors affecting adjacent anatomic structures after miniplate placement in the mandibular incisal area. @*Methods@#Cone-beam computed tomographic images of 97 orthodontic miniplates and their 194 MPASs (diameter, 1.5 mm; length, 4 mm) in patients whose miniplates provided sufficient clinical stability for orthodontic treatment were retrospectively reviewed. For evaluating the actual positions of the miniplates and analyzing the risk factors, including the effects on adjacent roots, MPAS placement height (PH), placement depth (PD), plate angle (PA), mental fossa angle (MA), and root proximity were assessed using the paired t-test, analysis of variance, and generalized linear model and regression analyses. @*Results@#The mean PDs of MPASs at positions 1 (P1) and 2 (P2) were 2.01 mm and 2.23 mm, respectively. PA was significantly higher in the Class III malocclusion group than in the other groups. PH was positively correlated with MA and PD at P1. Of the 97 MPASs at P1, 49 were in the no-root area and 48 in the dentulous area; moreover, 19 showed a degree of root contact (19.6%) without root perforation. All MPASs at P2 were in the no-root area. @*Conclusions@#Positioning the miniplate head approximately 1 mm lower than the mucogingival junction is highly likely to provide sufficient PH for the P1-MPASs to be placed in the no-root area.
ABSTRACT
Objective@#This outcome analysis study evaluated the actual positions of the orthodontic miniplate and miniplate anchoring screws (MPASs) and the risk factors affecting adjacent anatomic structures after miniplate placement in the mandibular incisal area. @*Methods@#Cone-beam computed tomographic images of 97 orthodontic miniplates and their 194 MPASs (diameter, 1.5 mm; length, 4 mm) in patients whose miniplates provided sufficient clinical stability for orthodontic treatment were retrospectively reviewed. For evaluating the actual positions of the miniplates and analyzing the risk factors, including the effects on adjacent roots, MPAS placement height (PH), placement depth (PD), plate angle (PA), mental fossa angle (MA), and root proximity were assessed using the paired t-test, analysis of variance, and generalized linear model and regression analyses. @*Results@#The mean PDs of MPASs at positions 1 (P1) and 2 (P2) were 2.01 mm and 2.23 mm, respectively. PA was significantly higher in the Class III malocclusion group than in the other groups. PH was positively correlated with MA and PD at P1. Of the 97 MPASs at P1, 49 were in the no-root area and 48 in the dentulous area; moreover, 19 showed a degree of root contact (19.6%) without root perforation. All MPASs at P2 were in the no-root area. @*Conclusions@#Positioning the miniplate head approximately 1 mm lower than the mucogingival junction is highly likely to provide sufficient PH for the P1-MPASs to be placed in the no-root area.
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Purpose@#The vascular clipping system (VCS) is beneficial as it is simple and easy to apply for microvascular suturing. Arteriovenous fistula (AVF) creation is a very basic standard technique of microvascular surgery. In this study the VCS and the conventional suture methods were compared in a rabbit model using the carotid artery and vein to create an AVF. @*Methods@#There were 28 rabbits assigned equally into 2 groups using the AVF creation method (conventional suturing or the VCS procedure). Histopathology was performed on fixed samples. The procedure time of the 2 methods and changes in histopathology of tissue samples after surgery were compared. @*Results@#The VCS procedure showed a lower degree of fibrosis and hyperplasia histologically compared with the conventional suture method. The VCS was quicker to perform and no significant anastomosis stricture was observed. @*Conclusion@#In a rabbit model of AVF, the VCS has benefits over the conventional suture method. The VCS provides comparable patency rates, produces fewer side effects such as fibrosis and hyperplasia, and takes less operation time than suturing. The VCS is expected to be useful for cases where renal patients need periodic hemodialysis and thus repetitive access to a vessel.
ABSTRACT
Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.
ABSTRACT
Purpose@#The vascular clipping system (VCS) is beneficial as it is simple and easy to apply for microvascular suturing. Arteriovenous fistula (AVF) creation is a very basic standard technique of microvascular surgery. In this study the VCS and the conventional suture methods were compared in a rabbit model using the carotid artery and vein to create an AVF. @*Methods@#There were 28 rabbits assigned equally into 2 groups using the AVF creation method (conventional suturing or the VCS procedure). Histopathology was performed on fixed samples. The procedure time of the 2 methods and changes in histopathology of tissue samples after surgery were compared. @*Results@#The VCS procedure showed a lower degree of fibrosis and hyperplasia histologically compared with the conventional suture method. The VCS was quicker to perform and no significant anastomosis stricture was observed. @*Conclusion@#In a rabbit model of AVF, the VCS has benefits over the conventional suture method. The VCS provides comparable patency rates, produces fewer side effects such as fibrosis and hyperplasia, and takes less operation time than suturing. The VCS is expected to be useful for cases where renal patients need periodic hemodialysis and thus repetitive access to a vessel.
ABSTRACT
Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.
ABSTRACT
Traumatic intrapulmonary glass foreign bodies that are missed on an initial examination can migrate and lead to severe complications. Here, we present a rare case of a traumatic intrapulmonary glass foreign body surgically removed by a direct pulmonary incision, which preserved the pulmonary parenchyma and avoided severe complications caused by migration.
ABSTRACT
Acute appendicitis is the most common indication for emergency abdominal surgery worldwide. The risks and benefits of incidental appendectomy during other operations have been debated for over a century. There is no right answer to the question of whether or not to perform incidental appendectomy. Although there are only a few indications where it is explicitly recommended such as in gynecological surgery, malrotation, and Ladd's procedure, incidental appendectomy is cost-effective in selected patient groups, especially in the young, without an increase in morbidity and mortality. In this review, the literature on incidental appendectomy was assessed from several perspectives.
Subject(s)
Adolescent , Female , Humans , Appendectomy , Appendicitis , Costs and Cost Analysis , Emergencies , Gynecologic Surgical Procedures , Mortality , Risk AssessmentABSTRACT
PURPOSE: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. METHODS: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients' demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. RESULTS: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. CONCLUSION: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers.
Subject(s)
Humans , Cause of Death , Classification , Demography , Emergencies , Emergency Service, Hospital , Hand , Information Systems , Korea , Mortality , Neck Injuries , Neck , Sex Ratio , Trauma Centers , Wounds and InjuriesABSTRACT
BACKGROUND: The decision to administer oral anticoagulation therapy depends on accurate assessment of stroke risk in patients with atrial fibrillation (AF). Various stroke risk stratification schemes have been developed to help inform clinical decision making. The CHADS2 and CHA2DS2-VASc scores have been used in estimating the risk of stroke in patients with AF. Recently R2CHA2DS2-VASc score was developed. The objective of the current study is to validate the usefulness of the R2CHA2DS2-VASc score and to compare the accuracy of the CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores in predicting a patient's risk of stroke. METHODS: Based on medical records, we conducted a retrospective study of patients hospitalized with AF from March 2011 to July 2013. A total of 448 AF patients were included in this study. The receiver operating characteristic (ROC) curve analysis in MedCalc was used for comparison with respective diagnostic values. RESULTS: The patient characteristics showed male predominance (60.9%). Among the 448 AF patients, 131 (29.2%) patients had strokes during the study. A R2CHA2DS2-VASc score of more than 5 is the optimal cut-off value for prediction of stroke. A risk score of three, the area under the ROC curve (AUC) of R2CHA2DS2-VASc score (AUC 0.631; 95% confidence interval, 0.585-0.679) was the highest. A significant difference was observed between AUC for R2CHA2DS2-VASc, CHADS2, and CHA2DS2-VASc scores, but no meaningful difference between CHADS2 and CHA2DS2-VASc scores. CONCLUSION: We determined the usefulness of the R2CHA2DS2-VASc score, which showed better association with stroke than the CHADS2 and CHA2DS2-VASc scores.
Subject(s)
Humans , Male , Area Under Curve , Atrial Fibrillation , Clinical Decision-Making , Medical Records , Retrospective Studies , ROC Curve , StrokeABSTRACT
This study assessed the dynamics of morphological and immunophenotypic properties of activated microglia in a 6-hydroxydopamine (6-OHDA) induced Parkinsonian animal model. Neurodegeneration in the substantia nigra pars compacta (SNc) was induced by unilateral injection of 6-OHDA into the medial forebrain bundle. Parkinsonian animal model were sacrificed at 1, 2, 4 and 8 weeks after 6-OHDA injection. Changes in the functional activity of activated microglia were identified using different monoclonal antibodies: OX6 for major histocompatibility complex (MHC) class II, ED1 for phagocytic activity. Phagocytic microglia, characterized by ED1- or OX6-immunoreactivity, appeared in the SNc at 1 week after 6-OHDA injection, activated microglia selectively adhered to degenerating axons, dendrites and dopaminergic neuron somas in the SNc. This was followed by significant loss of these fibers and nigral dopaminergic neurons. Activation of microglia into phagocytic stage was most pronounced at 2 week after 6-OHDA injection and gradually subsided, but phagocytic microglia persisted until 8 weeks after 6-OHDA injection. Taken together, our results indicate that activated microglia is lead to persistently neuron cell death and promotes loss of dopaminergic neuron by degeneration of the dopaminergic neurons.
Subject(s)
Animals , Axons , Carisoprodol , Cell Death , Dendrites , Dopaminergic Neurons , Major Histocompatibility Complex , Medial Forebrain Bundle , Microglia , Models, Animal , Neurons , Oxidopamine , Substantia NigraABSTRACT
We observed and measured the structures showing the golden ratio in human body. Southeast Asian tribes, Aka and Lahu who live in Thailand, Miyanmar and China mountain areas and Koreans were examined by means of facial photography. The pictures of lateral facial view were taken by the fixed method. Then the length and width of auricles were measured by Phi-matrix software (version 1.1) on the scanned images. Helix ratio were also obtained by the same method. As a results, the ratio of the ear of Southeast Asian tribes showed the golden ratio and the racial and the individual differences were noticed a little.
Subject(s)
Humans , Asian People , Beauty , China , Ear , Human Body , Individuality , Photography , Population Groups , ThailandABSTRACT
Gout occurs as a response to monosodium urate crystal, that is present in joints, bones and soft tissue. The classic symptoms of gouty arthritis are recurrent attacks of acute, markedly painful monoarticular or oligoarticular inflammation; but polyarthritis and chronic arthritis can also occur. Differential diagnosis from infectious arthritis is important. A definitive diagnosis requires the direct identification of urate crystals in the joint, and the exclusion of infection. We report the case of systemic inflammatory response syndrome (SIRS), developed from acute polyarticular gout. SIRS is characterized by loss of local control of inflammation, or an overly activated response resulting in an exaggerated systemic response. The SIRS was presumably due to systemic effects of a localized inflammatory response to urate crystals.
Subject(s)
Arthritis , Arthritis, Gouty , Arthritis, Infectious , Diagnosis, Differential , Gout , Inflammation , Joints , Sepsis , Systemic Inflammatory Response Syndrome , Uric AcidABSTRACT
Tali are one of the essential components for weight bearing and play an important role in the foot action. The three calcaneal articular facets of the talus are believed to have diverse morphological variations. However, so far, analysis of the articular facets has not been performed in Korean. In the present study, we classified calcaneal articular facets of the talus and measured several parameters of this bone in Korean adults. Seventy six dry tali (male, 47; female, 29; right, 38; left 38) obtained from forty six (male, 28; female, 18) Korean adult cadavers were used for the investigation. The average age of the cadavers was 64-year-old. Types of calcaneal articular facets of the talus were classified as follows: Type A, a type with three separated facets; Type B, types in which anterior and middle facets are connected, but distinguished by a ridge. Type B was subdivided into B1 (having a notch that separates the two facets partially) and B2 (without a definite notch, thus the two facets appear to be continuous smoothly); Type C, a type with combined anterior and middle facets. Type B was found to be the most common type (60.5%), and the incidence of its subtype B1 (28.9%) and B2 (31.6%) was similar to each other. Type C was noted in 30.3% of the cases, and type A was ranked the lowest (9.3%). Compared to the opposite gender, type C occurred more frequently in males, while type B1 was more prevalent in females. The length of the talus was somewhat longer in males (55.9 mm) than in females (52.8 mm). However, there was no difference between the two sexes in the width of the talus. We could confirm that morphology of calcaneal articular facets of the talus is different between males and females. Also, our results indicate that characteristics of the facets of Korean differ from those of other races. The characteristics of calcaneal articular facets of the talus disclosed by the present study may provide valuable information for the understanding of motor mechanics of the foot in Korean.
Subject(s)
Adult , Female , Humans , Male , Cadaver , Racial Groups , Foot , Incidence , Mechanics , Subtalar Joint , Talus , Weight-BearingABSTRACT
No abstract available.
ABSTRACT
Gastric marginal zone B cell lymphoma of the MALT type (MALT lymphoma) is usually accompanied by a Helicobacter pylori (H. pylori) infection. Most gastric MALT lymphomas regress after the eradication of H. pylori. Therefore, H. pylori eradication therapy is an effective first-line treatment for gastric MALT lymphoma. A second-line treatment for patients who fail to respond to eradication therapy, including radiotherapy and chemotherapy, produces a good response and survival rate. We encountered 2 cases of H. pylori eradication-resistant gastric MALT lymphoma, which were treated with cyclophosphamide monotherapy. A complete response was obtained in both cases after a treatment duration of 3 months and remission continued for 15 and 18 months, respectively. Treatment-related toxicity was mild. Oral monochemotherapy might be an alternative, effective and safe treatment modality for patients with gastric MALT lymphoma who are resistant to H. pylori eradication therapy.
Subject(s)
Humans , Cyclophosphamide , Helicobacter pylori , Lymphoma, B-Cell, Marginal Zone , Stomach , Survival RateABSTRACT
The main transmitter substance mediating erection is the nitric oxide released from the vascular endothelial cells of corpus cavernosum and from the nonadrenergic, noncholinergic nerve endings. In addition, some neurotransmitters, such as acetylcholine or vasoactive intestinal polypeptide (VIP), have been reported to play an important role in mediating the erection. Thus, autonomic neuropathy may cause erectile dysfunction, and in reality, it occurs frequently in individuals with diabetes mellitus (DM), in which polyneuropathy, including both peripheral somatic sensorimotor neuropathy and autonomic neuropathy, develops usually. Thiazolidinedione (TZD) is an insulin-sensitizing agent used for the treatment of type 2 DM with insulin resistance, and has been reported to ameliorate nephropathy, decrease plasma glucose level and reduce blood pressure. However, the effect of this drug on the neuropathy related to erectile dysfunction has never been proved. In the present study, to evaluate the effect of TZDs on the neuropathy concerned with erectile dysfunction, we examined neurochemical changes of major pelvic ganglion (MPG) neurons in Otsuka Long Evans Tokushima Fatty (OLETF) rats, genetic models with non-insulin-dependent DM, after TZDs (pioglitazone and rosiglitazone) treatment. Age-matched nondiabetic Long Evans Tokushima Otsuka (LETO) rats were used as controls. Nitric oxide synthase (NOS), tyrosine hydroxylase (TH), VIP, and neuropeptide Y (NPY) contents were measured in MPG neurons of LETO, OLETF and pioglitazone- or rosiglitazone-treated OLETF rats by morphometry. Compared to the corresponding LETO group, number of TH-, NOS- and VIP-immunoreactive (ir) neurons decreased, while that of NPY-ir neurons, which modulate noradrenergic vasoconstriction of penile arteries, increased in the MPG of the OLETF group. After administration of pioglitazone- or rosiglitazone to OLETF rats for 23 weeks, these neurochemical changes were recovered to the control levels of the LETO group, although some variations were accompanied. These results suggest that TZDs treatment may be helpful for the treatment of autonomic neuropathy concerned with erectile dysfunction.
Subject(s)
Animals , Male , Rats , Acetylcholine , Arteries , Blood Pressure , Diabetes Mellitus , Endothelial Cells , Erectile Dysfunction , Ganglion Cysts , Glucose , Insulin Resistance , Models, Genetic , Negotiating , Nerve Endings , Neurons , Neuropeptide Y , Neurotransmitter Agents , Nitric Oxide , Nitric Oxide Synthase , Plasma , Polyneuropathies , Rats, Inbred OLETF , Thiazolidinediones , Tyrosine 3-Monooxygenase , Vasoactive Intestinal Peptide , VasoconstrictionABSTRACT
PURPOSE: Among the surgeries that can be performed for patients with acute peptic ulcer perforation, the frequency of performing laparoscopic surgeries is gradually increasing and it is being reported that laparoscopic surgeries have many advantages over laparotomies. So we will examined if laparoscopic surgery has advantages as compared to open surgery for appropriately selected patients. METHODS: The subjects were 15 patients who were diagnosed with peptic ulcer perforation and they were operated on by a single surgeon between September 2007 and January 2009 at the National Medical Center. The subjects were divided into an LG and an OG. Statistical analyses were performed using two-tailed students T-tests. RESULTS: There were 6 patients in the LG and 9 patients in the OG. All the patients in the two groups were male. The time until fist flatulence was 1.6 days in the LG and 2.6 days in the OG. The time until the first oral intake was 3 days in the LG and 3.4 days in the OG. The time during which pain control was necessary was 2.6 (range: 2~4) days in the LG and 3.3 (range: 2~4) days in the OG. The number of days of the hospital stay after surgery was 5.6 days (range: 4~7) in the LG and 10 days (range: 6~26) in the OG. There were 2 cases of complications in the OG only, and all of them were wound infections. CONCLUSION: It is thought that laparoscopic surgeries can be performed relatively easily and safely for patients with peptic ulcer perforation by selecting appropriate patients.
Subject(s)
Humans , Male , Flatulence , Laparoscopy , Laparotomy , Length of Stay , Peptic Ulcer , Peptic Ulcer PerforationABSTRACT
In the traditional cadaver dissection course, it is hard to demonstrate dissection skills to all the medical students because of limitations such as the high ratio of students to instructors and the lack of facilities. To overcome these limitations, we developed a digital anatomy dissection course. Through this system, it was possible to perform effective instruction of anatomic dissection. This method could provide the appropriate teaching in a short period of time. Furthermore, students can review the dissection course on digital files saved on a CD-ROM. Clinical cadaveric workshops can be provided by this method not only for students but also for continuing medical education for clinicians.
Subject(s)
Humans , Cadaver , CD-ROM , Education, Medical, Continuing , Students, MedicalABSTRACT
The hypothesis that adverse experience alters the balance of neurotransmitters in the amygdala rendering it hyperresponsive to stress was examined in the present study. Since astrocytes regulate the brain's neurochemical milieu by uptaking neurotransmitters, we have examined these cells in the amygdala of prenatally stressed rats, a model of pathological anxiety. Here we examined morphometric changes on the cell bodies of astrocytes in the amygdala induced by prenatal stress and restraint stress. For this purpose, rats were classified into 4 groups; control group (CON), only restraint stressed (starting on P90 for 3 days) group (CONR), prenatally stressed group (PNS), and prenatally and restraint (on P90 for 3 days) stressed group (PNSR). Astrocytes stained with GFAP immunohistochemistry were counter stained with methylene blue/azure II and were examined using the Neurolucida. The present study showed that prenatal and restraint stress caused the significant increase in the total number and length of the amygdaloid astrocytic processes. In conclusion, astrocytes show structural indices of activation with stress.