The effect of autogenous tooth bone graft material without organic matter and type I collagen treatment on bone regeneration / 대한악안면성형재건외과학회지

Objectives@#The aim of this study is to examine the effect of particulate autogenous tooth graft removed with organic matter and type I collagen addition on bone regeneration and to validate the possibility of useful allograft material for jaw defects.Material and methods: Autogenous tooth bone maker (Korean Dental Solution® KOREA) made particulate autogenous tooth not including organic matter. We used to the developed tooth grafts for experiment. Cell adhesion test with hemacytometer and energy dispersive X-ray spectroscopy (Supra40 VP®, Carl Zeiss, Germany) analysis about the particulate autogenous tooth and type I collagen were performed. Rabbits were divided into three groups: bone graft with organic matter (OM) removing particulate autogenous tooth group, bone graft with OM removing particulate autogenous tooth and type I collagen group, and a control group. Bone grafting was performed in rabbit’s calvaria. The rabbits were sacrificed at different interval at 1, 2, 4, and 6 weeks after bone grafting for the histopathologic observation and observed the effect of bone regeneration by SEM, H-E & Masson stains, osteocalcin IHC staining.Result: In vitro cytopathological study showed affinity for cells, cell attachment pattern, and cell proliferation in the order of control group, OM-removed and collagen-treated group, OM-removed particulate autogenous tooth group. The results of the degree of mineralization were opposite to those of the previous cell experimental results, and the OM-removed group, OM-removed group and collagen-treated group were relatively higher than the control group. Histopathologic analysis showed that vascularization and neonatal bone formation were higher in particulate autogenous tooth group with removing OM and with addition of collagen than control group and group of OM removed only. Immunohistochemical analysis showed that osteocalcin (OSC) expression was not observed in the control group, but at 4 weeks groups, OSC expression was observed the OM removed and OMremoved-collagen-treated particulate autogenous tooth, and the degree of expression was somewhat stronger in group of the OM removed and collagen additionally treated particulate autogenous tooth. @*Conclusion@#Particles that do not contain organic matter, the saint tooth, was responsible for sufficient bone graft material through the role of space maintenance and bone conduction, and further improved bone formation ability through additional collagen treatment. Therefore, research on various extracellular substrates and autologous bone grafting materials is necessary, and through this, it is possible to lay the foundation for a new type of autologous bone grafting material with excellent academic and technical utility.

Takotsubo cardiomyopathy in a patient with oral cancer

A patient with squamous cell carcinoma on the left mandible presented with symptoms similar to acute coronary syndrome just after surgery. The exact etiology was unclear, but following transthoracic echocardiogram, takotsubo cardiomyopathy was diagnosed. This is a rare, acute, and reversible form of heart failure, and the patient recovered completely within weeks. Related risk factors are believed to include extended surgery times and extended time under general anesthesia. Early recognition, followed by postoperative control of pain and anxiety are crucial to patient recovery.

Takotsubo cardiomyopathy in a patient with oral cancer

A patient with squamous cell carcinoma on the left mandible presented with symptoms similar to acute coronary syndrome just after surgery. The exact etiology was unclear, but following transthoracic echocardiogram, takotsubo cardiomyopathy was diagnosed. This is a rare, acute, and reversible form of heart failure, and the patient recovered completely within weeks. Related risk factors are believed to include extended surgery times and extended time under general anesthesia. Early recognition, followed by postoperative control of pain and anxiety are crucial to patient recovery.

First Report of Stemonitis splendens Rostaf Causing Bark Decay of Oak Logs Used for Shiitake Cultivation in Korea

Severe bark decay disease was observed on oak logs at a shiitake cultivation farm in Geochang-gun, Gyeongnam province. The symptoms observed were fruiting bodies that had developed on the top and side surface of oak logs. As a result, the bark came off easily exposing the sapwood. Slime mold specimens collected from oak logs showed developing fruiting bodies comprising of stalks, hypothallus, capillitium, and columella, and the causal agent of bark decay disease was identified as Stemonitis splendens on the basis of morphological characteristics. To our knowledge, this is the first report of Stemonitis splendens causing bark decay of oak logs used for shiitake mushroom cultivation in Korea.

First Report of Black Spot Disease Caused by Alternaria alternata on Sweet Persimmon Fruits

Black spot of sweet persimmon, caused by Alternaria alternata, occurred in an orchard in Gyeongnam province, Korea in 2012. The symptom was appearance of 0.5 to 4 cm black spots on the surface of fruit. The pathogen was isolated from flesh of disease lesions. The causal agent was identified as A. alternata by morphological characteristics and sequencers of the internal transcribed spacer (ITS) 1 and ITS4 regions of rRNA. Artificial inoculation of the pathogen resulted in development of disease symptoms and the re-isolated pathogen showed characteristics of A. alternata.

Bilateral Insufficiency Fracture of Medial Subtrochanteric Area of the Femur: A Case Report / 대한고관절학회지

A non-traumatic, incomplete insufficiency fracture commonly involves the lateral side of the femoral cortex; whereas a non-traumatic, incomplete stress fracture commonly involves the medial side of the femoral cortex. Here, we describe a case of a 66-year-old woman with a two-month history of bilateral thigh pain without trauma or medication usage who was diagnosed with bilateral subtrochanteric insufficiency fractures involving the medial side of the femoral cortex.

The impact factors on 5-year survival rate in patients operated with oral cancer

OBJECTIVES: The purpose of this study is to analyze clinical impact factors on the survival rate, and to acquire basic clinical data for the diagnosis of oral cancer, for a determination of the treatment plan with long-term survival in oral cancer patients. MATERIALS AND METHODS: Through a retrospective review of the medical records, the factors for long-term survival rate were analyzed. Thirty-seven patients, among patient database with oral cancer treated in the Department of Oral and Maxillofacial Surgery at Pusan National University Hospital within a period from March 1998 to March 2008, were selected within the study criteria and were followed-up for more than 5 years. The analyzed factors were gender, age, drinking, smoking, primary tumor site, type of cancer, TNM stage, recurrence of affected region, and metastasis of cervical lymph node. The 5-year survival rate on the impact factors was calculated statistically using the Kaplan-Meier method. RESULTS: By classification of clinical TNM at the 1st visit, there were 11 (29.7%) cases for stage I, 11 (29.7%) cases for stage II, 3 (8.1%) cases for stage III, and 12 (32.5%) cases for stage IV. The 5-year survival rate of total oral cancer patients after the operation were 75.7%, pathological TNM stage related 5-year survival rate were as follows: stage I 90.0%, stage II 81.8%, stage III 100% and stage IV 45.5%; in which the survival rate difference by each stage was significantly observed. The recurrence of cervical lymph node was the significant impact factor for the survival rate, because only 30.0% the survival rate in recurrent cases existed. During the follow-up, there were 15 (40.5%) patients with confirmed recurrence, and the 5-year survival rate of these patients was decreased as 46.7%. CONCLUSION: The classification of clinical and pathological TNM stage, local recurrence after surgery, and metastasis of cervical lymph node after surgery were analyzed as the 3 most significant factors.

Differentiation of human labia minora dermis-derived fibroblasts into insulin-producing cells

Recent evidence has suggested that human skin fibroblasts may represent a novel source of therapeutic stem cells. In this study, we report a 3-stage method to induce the differentiation of skin fibroblasts into insulin-producing cells (IPCs). In stage 1, we establish the isolation, expansion and characterization of mesenchymal stem cells from human labia minora dermis-derived fibroblasts (hLMDFs) (stage 1: MSC expansion). hLMDFs express the typical mesenchymal stem cell marker proteins and can differentiate into adipocytes, osteoblasts, chondrocytes or muscle cells. In stage 2, DMEM/F12 serum-free medium with ITS mix (insulin, transferrin, and selenite) is used to induce differentiation of hLMDFs into endoderm-like cells, as determined by the expression of the endoderm markers Sox17, Foxa2, and PDX1 (stage 2: mesenchymal-endoderm transition). In stage 3, cells in the mesenchymal-endoderm transition stage are treated with nicotinamide in order to further differentiate into self-assembled, 3-dimensional islet cell-like clusters that express multiple genes related to pancreatic beta-cell development and function (stage 3: IPC). We also found that the transplantation of IPCs can normalize blood glucose levels and rescue glucose homeostasis in streptozotocin-induced diabetic mice. These results indicate that hLMDFs have the capacity to differentiate into functionally competent IPCs and represent a potential cell-based treatment for diabetes mellitus.

Skeletal Stability after Orthognathic Surgery in Severe Skeletal Class III Malocclusion Patients according to Changes in Anteroposterior Discrepancy and Occlusal Planes

Interaction between odontoblast and bio-calcium phosphate cement reinforced with chitosan

PURPOSE: Calcium phosphate cement (CPC) is one of many useful materials for restoring tooth defects, periodontium and maxillofacial area. Chitosan is a biodegradable material that has been shown to promote the growth and differentiation of osteoblasts in culture. This study examined the interaction between odontoblasts and bio-calcium phosphate cement reinforced with chitosan. MATERIALS AND METHODS: 5x10(3) odontoblastic cells were seeded into each well. Various concentrations of bio-calcium phosphate cement reinforced with chitosan (10, 20, 50, 100, 200, 500 microg/ml, 1, 2, 4 mg/ml) were diluted and added to the wells. The well was incubated for 24 h, 48 h and 72 h. After incubation, the number of cells was assessed to determine the cell viability. A cytokinesis-block micronucleus assay and chromosomal aberration test were carried out to estimate the extent of chromosomal abnormalities. Microscopic photographs and RT-PCR were performed to examine the adhesion potential of bio-calcium phosphate cement reinforced with chitosan. RESULTS: Bio-CPC-reinforced chitosan did not show significant cytotoxicity. The number of damaged chromosomes in the cells treated with Bio-CPC-reinforced chitosan was similar to that in the control cells. There was no significant increase in the number of chromosomal aberrations in the Bio-CPC reinforced chitosan exposed cells. Microscopic photographs and RT-PCR confirmed the adhesive potential of bio-CPC reinforced chitosan to odontoblasts. CONCLUSION: Bio-CPC-reinforced chitosan did not affect the odontoblastic cell viability, and had no significant cytotoxic effect. Bio-CPC-reinforced chitosan showed adhesive potential to odontoblasts. These results are expected form the basis of future studies on the effectiveness of dental restorative materials in Bio-CPC reinforced with chitosan.

Small bowel hernia through 5 mm trocar site with drainage tube in situ and its reduction by laparoscopy: A case report / 대한산부인과학회지

The incisional hernia through trocar site is an uncommon complication of gynecologic laparoscopy. Its incidence is less than 1% and most of them are occurring through 10 mm trocar site. Small bowel herniation through 5 mm trocar site is very rare. Furthermore, 5 mm trocar site bowel herniation with drain tube in situ has not yet been reported. We present a case of small bowel herniation through 5 mm trocar site with drain tube in situ and its reduction by laparoscopy with a brief review of literature.

Factors Affecting Patients' Graft Choice in Anterior Cruciate Ligament Reconstruction

BACKGROUND: Multiple studies have reported that allografts are acceptable alternatives to autografts for anterior cruciate ligament (ACL) reconstructions. Our clinical practice allows patient involvement in graft decision-making. This study examined the patients' preference for graft selection and the factors affecting their decision. METHODS: Patients scheduled to undergo an ACL reconstruction surgery (n = 129) at a university medical center in Korea were enrolled in this study. Information leaflets with graft descriptions were provided prior to hospital admission, and the patients were allowed to choose one of two surgical graft types. The patients were asked to complete a questionnaire that reflected their decision-making processes, and the patients' trends and factors affecting their choice of graft were analyzed based on their responses. RESULTS: Most patients (54.3%) selected autografts for the ACL reconstruction. The surgeon's explanation was the most important factor affecting the final patient decision followed by the information derived from Internet searches. Patients who derived the majority of their understanding of the graft types from the Internet chose allografts at significantly higher rates. CONCLUSIONS: Patient graft selection is a reasonable way of designating the type of surgical procedure. Most patients selected autografts for their ACL reconstruction. However, patients who performed significant Internet-based research tended to prefer allografts.

Study for the clinical efficacy of laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.

STAT3 is involved in phosphatidic acid-induced Bcl-2 expression in HeLa cells

Phosphatidic acid (PA), the product of a PLD-mediated reaction, is a lipid second messenger that participates in various intracellular signaling events and is known to regulate a growing list of signaling proteins. We found that Bcl-2 was upregulated by PA treatment in HeLa cells. However, how PA upregulates Bcl-2 expression has not yet been studied. In this study, we tried to discover the mechanisms of Bcl-2 up-regulation by PA treatment in HeLa cells. Treatment with PA resulted in significantly increased expression of Bcl-2 in HeLa cells. Moreover, PA-induced Bcl-2 expression was blocked by mepacrine, an inhibitor of PLA2, but not by propranolol, an inhibitor of PA phospholyhydrolase (PAP). Treatment of 1,2-dipalmitoryl-sn-glycero-3-phosphate (DPPA) also increased Bcl-2 expression. These results indicate that Bcl-2 expression is mediated by lysophosphatidic acid (LPA), not by arachidonic acid (AA). Thereafter, we used MEK1/2 inhibitor, PD98059 to investigate the relationship between ERK1/2 MAPK and PA-induced Bcl-2 expression. PA-induced Bcl-2 expression was decreased when ERK1/2 was inhibited by PD98059. The transcription factor such as STAT3 which is controlled by ERK1/2 MAPK was increased along with Bcl-2 expression when the cells were treated with PA. Furthermore, STAT3 siRNA treatments inhibited PA-induced Bcl-2 expression, suggesting that STAT3 (Ser727) is involved in PA-induced Bcl-2 expression. Taken together, these findings indicate that PA acts as an important mediator for increasing Bcl-2 expression through STAT3 (Ser727) activation via the ERK1/2 MAPK pathway.

Identification of Diachea leucopodia on Strawberry from Greenhouse in Korea

We have detected the slime mold, Diachea leucopodia (GNU06-10) in a strawberry greenhouse located in Sancheong-gun, Gyeongnam. Typical fruiting bodies had developed gregariously on the strawberry leaves, petioles, and plant debris on ground soil habitat, and also surprisingly on plastic pipes and a vinyl covering. Field samples were examined via stereomicroscopy, light microscopy, and SEM for the determination of morphological characteristics. Dark-brown to black spores formed gregariously within the stipitate cylindrical sporangium, and were covered by an iridescent peridium, which may be intact at maturity, or may have disintegrated. The upper portion of the peridium generally breaks up to expose the spores, whereas the lower portion was usually persistent. The results of energy dispersive X-ray spectrometer (EDS) analysis showed that lime was present in the stalk and columella but absent from the spores, capillitium, and peridium. The above characteristics confirm its taxonomic position in the genus Diachea. However, this genus is intermediate in character between the Physarales and Stemonitales of the Myxogastromycetidae. Hence, this genus had been classified as a member of the Stemonitales until the mid-1970's, on the basis of its iridescent peridium and noncalcareous capillitial system, similar to Comatricha of the Stemonitaceae. By way of contrast, emphasis on morphological characteristics, most notably the calcareous stalk and typical columella, places Diachea within the order Physarales. The presence of a phaneroplasmodium during the trophic stage and lime deposition in its sporophores, as was confirmed in this work, supported the inclusion of Diachea in the Physarales, and the noncalcareous capillitial system verified its identification as a member of the Didymiaceae. Further characteristics of the species D. leucopodia include the following: phaneroplasmodium, spore globose 7.5 microm in diameter, very minutely roughened; sporangia 500 microm x 1mm, more or less cylindrical, gregarious, stalked 1.2mm; stalk and columella white.

A case of extratubal secondary trophoblastic implants after laparoscopic treatment of ectopic pregnancy / 대한산부인과학회지

Persistent ectopic pregnancy (PEP) is defined as persisting pregnancy after conservative surgical treatment of ectopic pregnancy. PEP usually occurs in the original implantation site after incomplete removal of the trophoblast, but rarely may occur in other sites within the abdominal cavity, i.e., extratubal secondary trophoblastic implantation (ESTI). A 35-year old patient visited our clinic 40 days after laparoscopic surgery for ectopic pregnancy. She was diagnosed with hemoperitoneum and had then undergone a laparotomy procedure. Her operative findings revealed secondary implantation of the trophoblast in her greater omentum, which presented acute bleeding from the ruptured implanted trophoblast. In order to prevent the occurrence of ESTI, management must include minimizing any possible remnant trophoblast during the operative procedure, close and regular follow up of postoperative hCG, and consideration of postoperative prophylactic methotrexate. The patient must be well informed about all possible complications after treatment of ectopic pregnancy.

Vesicovaginal fistula repaired by laparoscopic surgery: A case report / 대한산부인과학회지

Vesicovaginal fistula may be a complication of gynecologic and obstetric procedures, of which abdominal hysterectomy remains as the most common cause. Although there are a number of transvaginal or transabdominal surgical techniques for the correction of this condition, we performed a laparoscopic repair to reduce the morbidity of the transabdominal approach. A 44-year-old woman presented with urinary incontinence after undergoing Cesarean hysterectomy for uterine atony eight years ago. After confirming her vesicovaginal fistula, laparoscopic repair was performed. The bladder and vaginal walls were mobilized by meticulous dissection and repaired by intracorporeal stitches in 2 layers followed by omental interposition. Total operative time was 3 and half hours and estimated blood loss was about 400 ml. Foley catheter was removed at 23rd day after operation. Patient was discharged at 26th day after confirming the complete correction of the fistula by cystogram. Laparoscopic repair of a vesicovaginal fistula appears to be a safe and effective procedure. We report this case with a brief review of literature.

Clinical efficacy on the use of colpotomy in laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: Recently, laparoscopic operations are widely used for the resection of uterine myomas and the method for extraction of resected tissue leiomyoma is chiefly used with the morcellator or minilaparotomy. We investigated the feasiblity of colpotomy for the extraction of myoma tissue in the laparoscopic myomectomy. METHODS: A retrospective study was performed from May 2004 to July 2007 after a review of the medical records of 75 patients who have undergone myomectomy utilizing colpotomy. The patients profiles characteristics included myoma size, operation time, amount of blood loss, and complications in the Hanyang University Guri Hospital. RESULTS: Seventy-five patients were involved. The mean age of the patients was 40.5 (27-53) years, multiparity was found in 55 (73%) patients, the mean weight of the myomas was 204.3 (30-890) gm, the mean operation time was 2.47 (1.1-5.8) hours, the mean decrement of hemoglobin was 2.98 (0.2-5.9) gm/dL, the number of patients that needed transfusion was 8 (10.6%) and the number of the cases experiencing complications was one (0.01%). CONCLUSIONS: We concluded that colpotomy for the extraction of myoma tissue in laparoscopic myomectomy is a safe procedure in aspects of risk and cosmetic outcome and on an individual basis, can be used as an alternative to the usage of morcellator or minilaparotomy.

Preoperative Diagnosis and Medical Treatment of Pelvic Actinomycosis

The diagnosis of the pelvic actinomycosis is seldom made preoperatively because of no reliable or specific clinical manifestation which has tendency to mimic advanced gynecological malignancy and the relative infrequency of the disease. To explore the method for improvement of preoperative diagnosis and possibility of avoiding the surgical management of pelvic actinomycosis, we collected and summarized the data of age, parity, state of menopause, history of intrauterine device (IUD) use, symptoms, laboratory findings, radiologic findings, provisional diagnosis and treatment from 14 cases diagnosed pathologically and treated in Hanyang University Hospital from 2000 to 2007. Eleven (78.6%) of 14 cases were IUD users. Most common complaints were lower abdominal pain (71.4%) and vaginal discharge (57.1%) which were followed by fever (28.6%) and back pain (28.6%). Four cases (28.6%) were identified as pelvic actinomycosis before operation and in 3 cases (21.4%) malignancy was provisional preoperative diagnosis. Pelvic actinomycosis was suspected via abdominal computed tomography (CT) or cervicovaginal cytology and confirmed via endometrial biopsy or fine needle aspiration biopsy. Two cases that were diagnosed before operation and received only antibiotics therapy had no recurrence. It was suggested that pelvic actinomycosis could be suspected via abdominal CT and cervicovaginal cytology in IUD users, and endometrial biopsy and fine needle aspiration biopsy may help establish the diagnosis before the operation. Adequate preoperative antibiotics therapy could make extensive exploratory surgery avoided or conservative surgery feasible.

A case of ectopic pregnancy in the previous Cesarean section scar treated by laparoscopic surgery / 대한산부인과학회지

Pregnancy in the previous Cesarean section scar is a very rare form of ectopic pregnancy. This ectopic pregnancy may cause grave complications such as severe vaginal bleeding or spontaneous uterine rupture. Suction curettage, exploratory laparotomy, or systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treat a case of this patient by laparoscopic surgery. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.