Korea Academy of Prosthodontics criteria for longevity studies of dental prostheses / 대한치과보철학회지

PURPOSE: The most important factor in longevity studies of dental prostheses is objective and consistent evaluation of the prosthesis. The Korean Academy of Prosthodontics suggested developing a standardized method for longevity studies of dental prostheses. The purpose of this study is to evaluate previously-used criteria and to develop new criteria, in the form of a procedure flowchart and an evaluation sheet. These new criteria may be able to provide a unified standard for future longevity studies of dental prostheses. MATERIALS AND METHODS: A literature review was performed about the evaluation of dental prostheses. Taking into account the strengths and weaknesses of previously used criteria, a novel, intuitive and objective method was developed for assessment of dental prostheses. Then, a pilot survey was performed with the newly developed flowchart and evaluation sheet to determine problems and implement possible improvements. RESULTS: Thirty cases of fixed dental prosthesis (FDP), 25 cases of removable dental prosthesis (RDP), and 13 cases of implant supported prosthesis (ISP) were evaluated. The average life expectancy estimate was 12.82 years for FDP, 5.96 years for RDP, and 4.82 years for ISP with Kaplan-Meier survival analysis. Additionally, possible improvements discovered by the pilot survey were reflected in the flowchart and evaluation sheet. CONCLUSION: The newly developed KAP criteria, flowchart and evaluation sheet enabled objective and consistent results in trial longevity studies of dental prostheses. It is expected that future studies will not only use the KAP criteria but also further improvement will be made on them.

Change in Serum Concentration of Magnesium and Calcium Ions Following Moderate Diffuse Axonal Injury in Rats: Preliminary Study

OBJECTIVE: Traumatic brain injury has been shown to result in a decrease of the brain-free magnesium concentration that is associated with the development of neurologic deficits. However, changes in free magnesium homeostasis have not been characterized in other fluid compartments. We examine the ionized serum magnesium(Mg2+) and ionized serum calcium(Ca2+) in the moderate diffuse axonal injury of rat model. METHODS: We designed a study to determine whether ionized serum magnesium(Mg2+) and / or ionized serum calcium(Ca2+) levels correlate with moderate diffuse axonal injury(mDAI). A new ion-selective electrode was used to determine Mg2+ and Ca2+ level in the serum, prior to and following weight-drop induced mDAI. RESULTS: Serum Mg2+ remained significantly depressed to about 76% of preinjury values for 3 hours (0.73+/-0.01 mg/dL, 0.79+/-0.03 mg/dL, 0.84+/-0.03 mg/dL at 1, 2, 3 hours after trauma, respectively) compared to control group (1.07+/-0.03 mg/dL, p<0.05), but not in total serum magnesium(tMg). Mg2+/ tMg was shown a significant decrease for first 3 hours (49%, 53.4%, 56.4% at 1, 2, 3 hours after trauma respectively) compared to control group (70.9%, p<0.05). Head trauma resulted in small decrease of Ca2+, but there was a significant increase in the amount of Ca2+/ Mg2+(mean value in control group: in injured group for 3 hours after trauma = 4.65+/-0.012: 5.71+/-0.015, p<0.05). Apoptotic change was shown at 3 hours after mDAI and apoptotic index(AI) was significantly increased at 12 and 24 hours after trauma (54.8+/-1.7, 51.5+/-3.2 at 12, 24 hours, p<0.05). CONCLUSION: These findings suggest that the early decline in serum Mg2+ and increase in the amount of Ca2+/ Mg2+ following brain trauma may be a critical factor in the development of irreVersible tissue injury and early treatment with magnesium salt may be effective in histological changes following experimental traumatic brain injury in the rat.

Role of Acetazolamide Brain SPECT in the Evaluation of Delayed Ischemic Neurological Deficits Following Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: The purpose of this study is to evaluate the role of acetazolamide brain SPECT in the assessment of delayed ischemic neurological deficits(DINDs) following aneurysmal subarachnoid hemorrhage. METHODS: Prospective analysis of consecutive patients with aneurysmal subarachnoid hemorrhage was made from July 1999 to December 2000. Regular neurological examination and Transcranial Doppler(TCD) monitoring were done for monitoring development of DINDs. Postoperative cerebral angiography and acetazolamide brain SPECT were performed according to our spasm-monitoring algorithm. Correlation of three diagnostic tools with development of DINDs was evaluated and concordance rates between each diagnostic tool were investigated. RESULTS: A total of 65 patients were included. DINDs were developed in 44.6% of patients. Spasm evidences on TCD monitoring, cerebral angiography and acetazolamide brain SPECT were observed in 38.5%, 40.0%, 41.5% of patients. Although there is no statistical significance, acetazolamide brain SPECT was more correlated with DINDs development than other two tools. Spasm evidence on TCD were not proceeded the development of DINDs in 58.6% of patients with DINDs. Concordance rate between acetazolamide brain SPECT and cerebral angiography was highest. However, there are significant numbers of discordance between two tools. CONCLUSION: Three diagnostic tools are complementary to each other in the assessment of DINDs. However, considering that DINDs is basically attributable to cerebral hemodynamic alteration rather than arterial morphologic change, acetazolamide brain SPECT seems to be the most useful tool in the evaluation of DINDs.

The Effect of MK-801 and Naloxone in a Sympathetically Independent Neuropathic Pain Rat Model

OBJECTIVE: The authors evaluate the effects of each spinally administered MK-801, naloxone and coadministerd both drugs on the neuropathic pain states in the sympathetically independent pain(SIP) model induced by unilateral sural and tibial nerve transection of the sciatic nerve branches in the rat. METHODS: Pain sensitivity was measured with a von Frey filament for mechanical allodynia and acetone applied to the sensitive area for cold hyperalgesia. We evaluated the ability of the spinally applied MK-801 to spinal cord after laminectomy on T12, T13 and L1 to alleviate neuropathic pain either by itself of when spinally or intravenously administerd together with naloxone and coincidentally measured the behavioral test. RESULTS: Twenty out of 25 rats in which the tibial and sural nerves were injured showed well-developed neuropathic pain behaviors. The response rates of the rat models to the von Frey filament and acetone spray in hindlimbs by MK-801 were significantly reduced but, by naloxone were not changed. The pharmacological inhibition to mechanical allodynia and cold hyperalgesia for MK-801 when co-adminstered naloxone was reversed. CONCLUSION: MK-801 has been shown to alleviate neuropathic pain in SIP but, co-administered naloxone reversed the N-methyl-D-aspartate blocking effects of MK-801. These findings suggest that naloxone, which does not specifically relieve neuropathic pain, can reverse the neuropathic pain-relieving action of MK-801.

EFFECT OF TIME AND TEMPERATURE ON THE MARGINAL FIT OF PROVISIONAL RESIN CROWN DURING POLYMERIZATION / 대한치과보철학회지

The purpose of this study was to compare the marginal fit of provisional restorations by differentiating the removal time and setting temperature during resin polymerization. After mixing autopolymerizing methyl metharcrylate resin, the material was placed in a preformed resin shell crown. The crown was seated on a die with 1mm shoulder margin. Crowns were removed after 3,4,5,6 minutes and polymerization was continued under the following conditions : 25degrees C air,30degrees C, 40degrees C, 50degrees C,60degrees C,70degrees C water. After polymerization, the crown was sectioned. The marginal & occlusal discrepancies were measured. The mean marginal discrelpancies at 3 minutes, 4 minutes, 5 minutes and 6 minutes of removing time were 96.6micrometer,84.6micrometer, 86.7micrometer and 105.6micrometer.The mean occlusal discrepancies at 3 minutes, 4 minutes, 5 minutes and 6 minutes of removing time were 106.7micrometer, 89.3micrometer, 98.6micrometer and 127.7micrometer.There was significant difference between 4 minutes group and 6 minutes group in occlusal discrepancies. The mean marginal & occlusal discrepancies for crowns polymerized in 25degrees C air were 98.2micrometer and 124.1micrometer. The crowns polymerized in 50degrees C water demonstrated the smallest marginal & occlusal discrepancies. The mean value of marginal & occlusal discrepancies in 50degrees C water were 73.1micrometer and 77.5micrometer. These values were smaller than that of 25degrees C air.There were significant differences in the occlusal discrepancies between 25degrees C air and water conditions of 50degrees C water (alpha=0.05) but, no significant differences in marginal discrepancies. There was no significant difference in the interaction between time and temperature. 4 minutes waiting time & 50degrees C water polymerizing condition produces the best fit at the margin of the provisional crown.

A study of microorganisms in oral & maxillofacial infected patients

Relationship between Cerebral Arteriovenous Oxygen Difference and Development of Delayed Cerebral Infarction in Patients with Severe Head Injury

No abstract available.

The Selective T3 Sympathicotomy in Patients with Essential Palmar Hyperhidrosis

No abstract available.

The Analysis of Surgical Results to the Lumbar Spinal Disorders of Aged Persons

No abstract available.

The Factors Affecting the Fovorable Outcomes in the Treatment of the Failed Back Surgery Syndrome

No abstract available.

A Surgical Treatment of Low-Grade Spondylolisthesis: A Comparative Study of in Situ Fusion and Fusion after Reduction

OBJECTIVE: This study retrospectively analysed the influence of reduction to postoperative symptoms in 57 patients with low-grade degenerative or ishmic spondylolisthesis managed with posterolateral fusion delete. PATIENTS AND METHODS: The clinical and radiological severity were assessed with Prolo's grade(economic and functional) and static and dynamic lateral radiographs(displacement and angulation). The postoperative questionnaire and the change of translation and angulation of static and dynamic lateral radiographs were used to judge the clinical and radiological success. All patients were treated with decompression and stabilization with instrumentation and autologous bone fusion, with or without reduction. The patients were followed clinically for a mean of 693.11 days (range, 6 to 18 months). RESULTS: There were 32 cases of spondylolytic spondylolisthesis, and the remaining 25 cases were degenerative spondylolisthesis. The average Prolo's economic grade delete of 20 patients delete managed without reduction was not statistically different from that delete of 37 patients managed with reduction(4.20 vs. 4.24, p>0.01). Also, the average Prolo's functional grade delete of 20 patients managed without reduction was not statistically different from delete of 37 patients managed with reduction(4.05 vs. 3.97, p>0.01). CONCLUSIONS: The authors conclude that in situ stabilization using autologous posterolateral arthrodesis combined with pedicular screw fixation resulted a good outcome. The additional procedure of reduction, performed with decompression and instrumented posterolateral fusion, for the treatment of the patients with low-grade degenerative and isthmic spondylolisthesis does not appear to provide additional benefits on functional outcome.

Para-condylar Foraminal Approach in Microvascular Decompression for Hemifacial Spasm

The ideal approach in microvascular decompression(MVD) for hemifacial spasm(HFS) should provide the shortest and perpendicular route to the facial nerve root exit zone(FNREZ) with minimal cerebellar retraction and early cerebrospinal fluid drainage to avoid surgical morbidity. Small basal craniectomy anterior, posterior and superior to the condylar foramen would be the ideal approach for HFS, because it is maximal basal route to FNREZ. We performed this approach in 15 patients with HFS. Slightly curved skin incision 5cm in length was placed from inferior nuchal line 2cm posterior to the mastoid notch toward the angle of the mandible and the neck muscles were splitted. Posterior condylar emissary vein was elevated from condylar fossa. Small basal craniectomy extending from the inferior nuchal line to the condylar foramen was made. Jugular process was drilled out along the superior margin of the occipital condyle to expose distal sigmoid sinus and the junction of sigmoid sinus and jugular bulb. Lateral margin of foramen magnum posteroinferior to the condylar foramen was removed for early drainage of CSF from lateral medullary cistern. Dura was opened in T-shaped manner. With minimal elevation of cerebellum, arachnoid around lower cranial nerves can be dissected and FNREZ can be identified easily and safely. In conclusion, para-condylar foraminal approach can be considered to be minimally invasive and maximally safe in MVD for HFS.

Surgical Application of Magnetic Resonance Imaging Anatomy for Temporal Lobe Epilepsy Surgery

Anterior temporal lobectomy is the most popular surgical method for mesiobasal temporal lobe epilepsy. The key point in anterior temporal lobectomy is to resect lateral neocortex as little as possible, and mesiobasal structures as much as possible without surgical complication. We analyzed surgical anatomy on MRI scans of 20 persons to evaluate the relationships of anatomical structures related with surgical steps in anterior temporal lobectomy. On the oblique axial scan, the distance from temporal pole to anterior margin of hippocampus was 29.8+/-1.5mm. The length of hippocampus to the level of posterior margin of cerebral peduncle was 25.6+/-2.4mm. On the oblique coronal image through hippocampal head, the distance between the surface of superior temporal sulcus and lateral margin of temporal horn roof was 32.5+/-2.2mm. The angle between middle fossa base line and the line connecting superior temporal sulcus and lateral margin of temporal horn roof was 33.6+/-5.2 degree. The distance between lateral temporal surface and brain stem, and that between lateral temporal surface and collateral sulcus was 49.9+/-1.9mm and 40.6+/-3.3mm, respectively. The distance between collateral sulcus and lateral margin of temporal horn roof was 14.2+/-1.8mm, and the angle between middle fossa base line and the line connecting lateral margin of temporal horn roof and collateral sulcus was 60.4+/-7.4 degree. On the sagittal image, the angle between superior temporal sulcus and hippocampal axis was 18.8+/-1.1 degree. In conclusion, surgical complication of anterior temporal lobectomy can be reduced by careful consideration of anatomical relationships between anatomical structures encountered in each surgical steps in anterior temporal lobectomy.

Concurrence of Traumatic Spinal Epidural and Subdural Hematoma without Spine Injury at Occipitocervical Junction: A Cases Report

Spinal epidural and subdural hematomas are uncommonly recognized conditions. These conditions can result in severe irreversible neurologic deficits, if left untreated. Like intracranial lesions, these hematomas can expand rapidly and cause sudden spinal cord and/or cauda equina compression. This case is very rare in which is a concurrence of cervical spinal epidural and subdural hematoma after motor vehicle accident without spine fracture. The pathophysiology of these entities are discussed and the radiologic diagnosis focused on MR findings are reviewed. The importance of prompt surgical treatment is emphasized to facilitate good postoperative outcome.

Dysphagia due to Cervical Osteophytes: Case Report

Forestier's disease, also known as diffuse idiopathic skeletal hyperostosis(DISH), is a rare condition. It frequently occurs in elderly men, and is mostly asymptomatic. Patients with severe involvement of the cervical spine may, however, develop dysphagia, dysphonia, dyspnea, and foreign body sensation. We decribe that one case of Forestier's disease with dysphagia, successfully treated by surgery, and also present a review the literature.

Comparative Efficacy Study between Monocortical and Bicortical Screws in Anterior Cervical Fusion

The purpose of the study was to assess the role of two types screws(bicortical screws with 3.5mm diameter and monocortical screws with 4.5mm diameter) in anterior cervical spinal fusion. Seventy patients surgically treated on the same surgeon was retrospectively reviewed. All patients were managed as the same technique(modified Smith-Robinson technique) and the same non-locking plate system(Top plate system), but the bicortical screws were used in 40 patients(Group 1) and the monocorical screws in 30 patients(Group 2). The overall fusion rate during the 3 months follow up at least was to be satisfied on the both groups. The complication from the Group 2 was never seen but Group 1 was observed in 5 patients; one as slip of grafted bone, 2 as screw loosening, 1 as psychologic intolerance and 1 as CSF leakage. The monocortical screw was considered to be superior than bicortical screw and was related to the screw diameter.

The Effect of Caudal Block with Morphine Sulfate on Postoperative Pain Levels in Lumbar Spinal Surgery

In 38 of 70 patients who underwent lumbar spinal surgery, we performed a randomized, prospective double-blind study of the effect of caudal block with morphine sulfate on postoperative pain levels. Age, sex, clinical features, postoperative analgesic consumption, pain score, adverse effects and patient satisfaction on discharge were recorded. The consumption of parenteral analgesics on the 1st, 2nd and 3rd days was significantly lower in the morphine sulfate group(p<0.05), than in the control group. Caudal block with morphine sulfate also led to marked reductions in pain levels and thus increases patients satisfaction during the postoperative period(p<0.05). Transient respiratory depression occurred in three of 38 patients(7.9%), but further treatment was not needed. Seventeen patients(44.7%) developed urinary retention, but this recovered spontaneously. The present study demonstrates that caudal block with morphine sulfate leads to a highly significant reduction in pain during postoperative periods and a corresponding reduction in the need for additional postoperative analgesics, in addition, patients are more satisfied.

Postural Reduction in Compression Fracture of Spines

121 patients with cervical(45 patients), thoracolumbar(76 patients) compression or mild burst fractures from January 1984 to December 1994 were studied:98 patients were treated postural reduction with hyperextension posture and 23 patients were with postural reduction and surgical methods. We compared the initial and post-reduction compression height ratio, wedge angle and kyphosis angle of compression fractures. The results were not only expansion of a compressed vertebral body but also successful fusion. The neurological recovery status according to Frankel classification was also improved after postural reduction. Most of the compression fractures or stable burst fractures of the cervical, thoracolumbar spines can be restored by the postural reduction.

Granulocytic Sarcoma in the Cerebellum

Granulocytic sarcoma, a rare extramedullary solid tumor arising from early myeloid precursors, is capable of invading the meninges or the rain parenchyma. The tumor may occur during or after the onset of systemic myelogenous leukemia. On rare occasions, the tumor may evolve before the onset of systemic myelogenous leukemia. Children are affected more often than adults, but sex is not related. Although no definite target area of the brain can be demonstrated, there may be some predilection of the tumor for the posterior fossa. The authors report a case of 4-year-old-boy with granulocytic sarcoma occurring in the posterior fossa presenting with gait disturbance and torticollis. The patient was treated by surgical removal of the tumor, there by avoiding the potentially lethal complication of a posterior fassa mass. This rare case is reported together a review of the literature.

Incidentally Revealed Cerebrovascular Diseases Following Craniocerebral Trauma

Five separate incidences of patients with cerebrovascular disease(CVD) were revealed among 555 craniocerebral traumatic victims between 1991 and 192. The 5 cases of with cerebrovascular disease revealed included 3 aneurysm. 1 arteriovenous malformation and 1 spontaneous intracerebral hematoma caused by angiographic study. The frequent use of computerized tomographic scans in the evaluation of head-injured victims can well demonstrate an intracerebral hemorrhage, but may not ge able to detect the associated cerebrovascular disease;whereas the efficacy of angiogrphy, on the contrary, has been losing its popularity as diagnostic armamentarium. The importance of angiographic study should be considered, if clinical signs and/or brain CT ideate the possibility of cerebrovascular disease even during the course of head injury management.