Intra-sinus rigid fixation of a resorbable barrier membrane to repair a large perforation of the sinus membrane: a technical note

A resorbable barrier membrane is commonly used for the repair of perforated sinus membranes during sinus lifting surgeries. However, repairing largescale perforations poses challenges for clinicians as the protection and isolation of graft material remain uncertain. With this technique, we aimed to prevent graft material loss and subsequent sinus-related complications using intra-sinus rigid fixation of the resorbable barrier membrane in cases with a large perforation of the sinus membrane.

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

Assessment of dentists' subjective satisfaction with a newly developed device for maxillary sinus membrane elevation by the crestal approach

PURPOSE: The purposes of this study were to assess the dentists' subjective satisfaction with the crestal approach sinus (CAS) kit, a device for maxillary sinus membrane elevation by the crestal approach using a special drilling system and hydraulic pressure, and to summarize the subjective satisfaction of dental implants placed after a sinus lift procedure with the CAS kit. METHODS: Thirty dental clinicians who had experience with dental implant placement after a sinus lift procedure with the CAS kit from June 2010 to May 2012 were included in this study. The questionnaire for the evaluation of the dentists' subjective satisfaction with the CAS kit was sent to the respondents and returned. The questionnaire was composed of two main parts. The first part was related to the sinus membrane perforation rate. The second part was related to the dentists' subjective satisfaction with the CAS kit. RESULTS: A total of 28 dentists answered the questionnaire. Among 924 implant cases, sinus membrane perforation occurred in 38 cases (4.1%). Among the 28 dentists, 26 dentists (92.9%) were satisfied or very satisfied with the CAS kit. In particular, 24 dentists (85.7%) reported that safety, cutting performance, and user-friendliness of the CAS drill were advantages of the CAS kit. However, 7 dentists (25%) did not routinely use the hydraulic lifter for sinus membrane elevation. CONCLUSIONS: From the survey, it was shown that the respondents were generally satisfied with the CAS kit and that the cutting performance and safety of the drill component were considered strengths of the CAS kit.

Evaluation of the feasibility of bony window repositioning without using a barrier membrane in sinus lateral approach

INTRODUCTION: In the lateral window approach for a maxillary sinus bone graft, there has been considerable controversy regarding the placement of a barrier membrane over the osteotomy site. In particular, when there is no damage to the Schneiderian membrane, clinicians should decide whether to use a barrier membrane or not, considering the benefits and costs. This study presents the clinical cases to demonstrate that only repositioning the detached window can lead to satisfactory bony healing of the grafted material without using a barrier membrane in the lateral approach for a maxillary sinus bone graft. MATERIALS AND METHODS: Five consecutive patients were treated with the same surgical procedures. After performing the antrostomy on the lateral maxillary wall using a round carbide bur and diamond bur, the bony window was detached by a gentle levering action. After confirming no perforation of the Schneiderian membrane, the grafting procedure was carried out the detached window of the lateral maxillary wall was repositioned over the grafted material without using a barrier membrane. A gross examination was carried out at the postoperative 6 month re-entry, and the the preoperative and postoperative dental computed tomography (CT) at re-entry were compared. RESULTS: All the procedures in the 5 patients went on to uneventful healing with no complications associated with the bone graft. Satisfactory bone regeneration without the interference of fibrous tissue on the gap between the repositioned window and lateral wall of the maxillary sinus was observed in the postoperative 6 month re-entry. The CT findings at re-entry revealed the, reconstruction of the external cortical plate including repositioned bony window. In addition, the loss of the discontinuity of the lateral maxillary wall was confirmed. CONCLUSION: This preliminary report showed that the detached window, which was just repositioned on the grafted material, could function as a barrier membrane in the lateral approach for a maxillary sinus bone graft. Therefore additional morphometric and histologic studies will be needed.

Experimental study about the bony healing of hydroxyapatite coating implants

INTRODUCTION: Hydroxyapatite(HA) coating implant can accelerate osseointegration, however, there are many controversies. MATERIALS AND METHODS: This study examined the early osseointegration of two types of hydroxyapatite coated implants. Twelve adult male miniature pigs (Medi Kinetics Micropigs, Medi Kinetics Co., Ltd., Busan, Korea) were used in this study. In the implants placed in the mandible, a histomorphometric evaluation was performed to evaluate the bone-implant contact (BIC) ratio. RESULTS: The BIC ratio increased with time. TS III HA and Zimmer HA were not significantly different (P>0.05). At 8 weeks, the BIC of Zimmer HA was higher than TS III HA, but there was no significant difference (P>0.05). CONCLUSION: HA coated implants will accelerate early osseointegration.

Multicentric retrospective clinical study on the clinical application of mini implant system

INTRODUCTION: Mini-implant system is applicable to areas of narrow space and area requiring temporary loading support. The purpose of this study was to evaluate the clinical outcome of a mini-implant system as well as the application of mini-implant system in the dental clinical field. MATERIALS AND METHODS: The patients who had been operated from Jan 2007 to Dec 2007 in the four dental facility including Seoul National University Bundang Hospital were enrolled. To evaluate the factors associated with the clinical outcome, the patients were classified according to gender, age, area of surgery, type of implant, diameter and length of the implant, and the purpose of the mini-implant system application. RESULTS: From 147 implants, only three implants failed, one of them was for temporary loading. There were no serious surgical or prosthetic complications in this study. CONCLUSION: An analysis of the preliminary data revealed a satisfactory clinical outcome. However, more long-term evaluation of narrow ridge type as well as the patient's satisfaction on the use of a provisional type mini-implant system is needed.

The Value of Brachial-Ankle Pulse Wave Velocity as a Predictor of Coronary Artery Disease in High-Risk Patients

BACKGROUND AND OBJECTIVES: Arterial stiffness has been known as an independent contributory factor for coronary artery disease (CAD). Brachial-ankle pulse wave velocity (baPWV) is widely used as a simple noninvasive measure of arterial stiffness. The aim of our study was to test whether baPWV had predictive value for CAD in the subset of patients with high pretest probability. SUBJECTS AND METHODS: We enrolled 174 consecutive patients who were referred for evaluation of suspected CAD, and who underwent both baPWV measurement and computed tomography (CT) for coronary artery calcium scoring (CACS) as part of a diagnostic work-up. Subsequently, 160 of those patients underwent invasive coronary angiography. The CAD indices consisted of 1) CACS, 2) modified Gensini scoring system, and 3) presence of obstructive CAD and 4) multi-vessel obstructive CAD. RESULTS: baPWV correlated with CACS (r=0.25, p=0.001), but not with modified Gensini scoring (r=0.10, p=0.19). However, after adjustment for factors influencing PWV, baPWV no longer correlated with CACS (r=0.14, p=0.14). By receiver operating characteristic (ROC) curve analysis, baPWV was neither a sensitive nor specific index for predicting the presence of obstructive CAD or multi-vessel obstructive CAD (sensitivity: 53% and 59%; specificity: 50% and 55%, respectively). CONCLUSION: Our findings demonstrated that baPWV is associated with CACS, however, this may be primarily attributed to common risk factors, such as age. Furthermore, baPWV may be of limited value in identifying patients at risk for CAD.

Long-Term Exercise Training Attenuates Age-Related Diastolic Dysfunction: Association of Myocardial Collagen Cross-Linking

The incidence of diastolic heart failure increases dramatically with age. We investigated the impact of long-term exercise training on age-related diastolic dysfunction. Old (25-month-old) male Fischer 344 rats were studied after 12 weeks of treadmill exercise training or sedentary cage life (N=7, in each group). We determined cardiac performance using a pressure-volume conductance catheter and magnetic resonance imaging. Collagen volume fraction (CVF) and myocardial collagen solubility by pepsin as an index of advanced glycation end products (AGEs) crosslinked collagen were measured. The maximal slope of systolic pressure increment (+dP/dt) and the slope of end-systolic pressure-volume relation were higher, and end diastolic volume (EDV), delta EDV (the percentage of the EDV increment-to-baseline EDV) and the slope of end-diastolic pressure-volume relation were lower in training group. The maximal slope of diastolic pressure decrement (-dP/dt) and time constant of LV pressure decay (tau) had no difference. AGEs cross-linked collagen, not CVF was reduced by exercise training. Long-term exercise training appears to attenuate age-related deterioration in cardiac systolic function and myocardial stiffness and could be reduce in pathologic AGEs cross-linked collagen in myocardium.

Multicenter retrospective study of immediate two different RBM surfaced implant systems after extraction

A retrospective multicenter clinical study of installed US II / SS II implants after maxillary sinus floor elevation

PURPOSE: The purpose of this study was to evaluate the Osstem(R) implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the Osstem(R) implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. MATERIALS AND METHODS: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. RESULTS : 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. CONCLUSION : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

Portopulmonary hypertension in pregnancy: Treatment with sildenafil / 대한내과학회지

The mortality of pulmonary hypertension that complicates pregnancy is very high. The increased pulmonary vascular resistance combined with the normal physiological changes of pregnancy and delivery is difficult to manage. We describe here the case of a pregnant woman who presented with severe portopulmonary hypertension. A 30-yr-old woman presented with dyspnea at 8 weeks of pregnancy. The mean pulmonary artery pressures (PAP), as measured from a pulmonary artery catheter at 20 weeks gestation, were 71 mmHg. Sildenafil was used to reduce the PAP for 4 months. She responded to sildenafil therapy and successfully completed her pregnancy.

Significance of Bioelectrical Impedance during Ischemia-Reperfusion Injury in the Rabbit's Liver

PURPOSE: During liver resection and transplantation, liver is damaged by ischemia-reperfusion injury. Until now, there is no approved method to measure or predict the extent of liver injury during the operation. This is the preliminary study to make the real time monitoring system by quantification of bioelectrical impedance and ischemia-reperfusion injury in liver. METHODS: Male Newzealand white rabbits(body weight 3.5-4.0 kg) were used. We observed changes of bioelectrical impedance during ischemia and reperfusion injury according to frequency(120 Hz-100 KHz). Bioelectrical impedance of liver tissue were measured every 5 minutes interval with two mono-polar needle coated with platinum using LCR meter (GS-4311B, ANDO, Japan). Cell viability was assessed by metabolic capacity of fatty acid (palmitic acid metabolic rate) and histologic examination (H&E stain) at every 30 minutes interval during 120 minutes ischemia. RESULTS: Liver bioelectrical impedance was changed significantly(p<0.05) during ischemia in lower frequency compared to those of higher frequency. Bioelectrical impedance(120 Hz) increased during ischemia and returned to base line level after reperfusion. The level of bioelectrical impedance(120 Hz) increased gradually after ischemia for 1 hour. After 1 hour, the level of bioelectrical impedance had tendency to maintain plateau. Palmitic acid oxidation rate were not changed significantly during 120 minutes ischemia and there were no significant difference in histologic examination. CONCLUSION: We found the possible role of bioelectrical impedance to measure and predict the extent of ischemia-reperfusion injury.

Left Ventricular Pressure-Volume Relationship and Effect of Long-term Exercise in A Rat Model of Advanced Aging

BACKGROUND: Heart failure due to diastolic dysfunction rises dramatically with age. Normal aging process is also known to depress left ventricular diastolic performance. It was reported that exercise training prevented diastolic dysfunction in old men and old rats. We investigated the diastolic function after long-term exercise training in old rats using the Millar Pressure-Volume conductance catheter system. MATERIALS AND METHODS: Young and old male Fischer 344 rats were assigned to sedentary controls groups(young control group: YC, old control group: OC), and an exercise training group (old trained group: OT). After 12-week treadmill exercise training (6 mo of age and 25 mo of age, respectively), the cardiac performance at different preloads was assessed using the Millar Pressure-Volume conductance catheter system. RESULTS: Heart rate (HR), mean arterial pressure, LV systolic pressure, maximal slope of the systolic pressure increment (+dP/dt), and maximal slope of the diastolic pressure decrement (-dP/dt) were decreased in OC compared with YC (all p<0.05). However, LV end diastolic pressure, end diastolic volume (EDV), end systolic volume, time constant of LV pressure decay (tau), and the slope of the end-diastolic pressure-volume relation (EDPVR slope) significantly increased in OC compared with YC (all p<0.05). After 12-week exercise training, HR, +dP/dt (p<0.05), and -dP/dt (p=0.07) were increased, but EDV, EDPVR slope (p<0.05), and tau (p=0.1) decreased in OT compared with OC. CONCLUSION: Longterm exercise training in old rats attenuated age-related deterioration in diastolic function. Our findings indicates that in rats, some age-associated changes in diastolic function are reversible and thus may not be intrinsic to aging.

Arterial Stiffness are Related to the Severity of Isolated Diastolic Dysfunction in Elderly Hypertensive Patients

Background: Reduced arterial compliance has recently been reported in patients with diastolic dysfunction and correlated with the severity of diastolic dysfunction. We tried to investigate the relation of arterial compliance to diastolic dysfunction in elderly hypertensive patients. Subjects and Methods: 250 medically treated elderly hypertensive patients without clinical atherosclerotic cardiovascular disease (131 men, 71.5+/-5.1 years) and 15 normotensive controls were enrolled. Using an automated wave form analyzer, the pulse wave velocity(PWV) and augmentation index (AI) were simultaneously measured as indices of arterial compliance. Diastolic function was determined based on Doppler echocardiography. Results: According to conventional Doppler echocardiography of transmitral and pulmonary venous flow, diastolic function was classified as relaxation abnormality in 220 patients and pseudonormal in 30 patients. hfPWV and baPWV were lowest in controls (842.0+/-251.9, 1,463.3+/-265.9 m/sec) and became progressively higher in patients with hypertension and relaxation abnormality (1,171.5 +/-234.5, 1,824.2+/-389.9 m/sec), and pseudonormalization (1,433.3+/-344.4, 2,009.3+/-579.4 m/sec; p<0.001 in both). In patients with diastolic dysfunction, hfPWV and baPWV were related to age (p<0.001), blood pressure (p<0.001), and E/Ea (p< 0.01). hfPWV was directly deceleration time (p=0.01) and Aa (r=0.13, p=0.03). After adjustment for age, sex, blood pressure, parameters of arterial compliance worked as independent predictors of diastolic dysfunction. Conclusions: In elderly hypertensive patients, diastolic function is inversely related with arterial compliance. Arterial compliance is an independent predictor of diastolic dysfunction in elderly patients with hypertension and should be considered a potential target to optimize ventriculo-arterial coupling and cardiac performance in diastolic HF.

A Case of Congenital Left Atrial Appendage Aneurysm

Atrial aneurysms involving the free wall or atrial appendage are very rare intracardiac anomalies, less than 100 case reported worldwide. It is usually detected by chance and also could be associated with atrial arrhythmias or systemic embolism. Transthoracic echocardiography and cardiac MRI is the standard diagnostic modality. Aneurysmectomy is usually recommended especially in symptomatic cases. We review the literature and report a case of atrial appendiceal aneurysm, a 23 year-old young man whose diagnosis was established with transthoracic echocardiography and cardiac CT angiography.

A Case of Gallstone Ileus Following Endoscopic Sphincterotomy / 대한소화기내시경학회지

Gallstone ileus is caused by mechanical obstruction of the gastrointestinal tract by the gallstone and accounts for 1~3% of all intestinal obstructions. Endoscopic sphincterotomy (EST) is the accepted treatment of choice for choledocholithiasis. Recognized complications of EST include bleeding, acute pancreatitis, retroperitoneal perforation. However, gallstone ileus is a rare complication of EST. A 70-year-old woman was admitted to our hospital with right upper quadrant pain. Abdominal ultrasound revealed single common bile duct (CBD) stone. ERCP was performed to remove the large CBD stone without mechanical lithotripsy. Nausea, vomiting and abdominal pain were developed after stone removal. Plain abdomen X-ray and computerized tomography represented marked dilatation of small bowel loops without definite obstructive lesion. Because the mechanical obstruction was sustained, explorolaparotomy was performed. On the operation, single stone was impacted at the distal ileum, narrowed by previous radiotheraphy. We reported a case of gallstone ileus after the removal of CBD stone following EST without lithotripsy.

A Study On Differential Diagnosis And Approaches Of Lateral Neck Mass

A study on the bone mineral density of iliac and tibial bone using dual energy x-ray absorptiometry

A Case of Primary Systemic Amyloidosis Presenting Submucosal Hematoma and Bleeding in the Lower Gastrointestinal Tract / 대한소화기내시경학회지

A case of systemic amyloidosis involving the upper and lower gastrointestinal tract is presented. The initial manifestation of this case was bloody diarrhea. On colonoscopy, multiple submucosal hematomas and irregular ulcerations of the sigmoid and descending colon were found. The pathologic diagnosis was confirmed by an endoscopic mucosal biopsy of the gastrointestinal tract and the specimen revealed massive amyloid deposits in the wall of the upper and lower intestinal tract. With intensive medical treatment, the submucosal hematoma disappeared and the ulcerations decreased in size. However, on the 29th day, the patient was expired due to unexpected sepsis.

SURGICAL REPAIR OF COMPLETE 80NY BILATERAL CHOANAL ATRESIA VIA TRANSPALATAL APPROACH