Prevalence of internet addiction and psychological factors in adolescents during the covid-19 pandemic / Prevalência de dependência da internet e fatores psicológicos em adolescentes durante a pandemia de covid-19 / Prevalencia de la adicción a internet y factores psicológicos en adolescentes durante la pandemia de la covid-19

Addictive behaviors related to Internet are becoming more common and this tool has been essential once it enables home office, entertainment, homeschooling, and easy access to information. Despite the easiness brought by technology, the exaggerated use has affected users in different ways, including in the development of psychiatric disorders. This study aimed to assess internet addiction, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), attention, impulsivity, and stress in 48 adolescents (26 young women and 22 young men), aged from 15 to 18 years, with a mean age of 16.74 (0.61), mostly students of public schools, during COVID-19, to investigate correlations between these variables according to sex and sociodemographic aspects. To assess the factors, the Internet Addiction Test (IAT); the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) Questionnaire ; the Depression, Anxiety, and Stress scale for brazilian adolescents (EDAE-A); the Barratt Impulsiveness Scale (BIS-11); and a sociodemographic questionnaire were applied. The data collection was performed in schools located in southern Brazil. The results indicated that 12 out of 48 adolescents were considered addicted to the Internet. Moreover, Internet addiction was a predictor of depression in regression analysis (p<0.001). In addition, participants classified as more addicted to the Internet scored lower averages in general attention (p<0.035) and higher averages in behavioral symptoms of inattention and ADHD (p<0.050), stress (p<0.003), anxiety (p<0.016), and depression (p<0.015), with effect sizes ranging from moderate to high. Therefore, the intense internet use by adolescents might cause psychological consequences such as depression in adolescents. Family support and professional intervention might help in the reduction of symptoms and consequences of internet addiction as well as in its prevention.(AU)

A dependência de internet é cada vez mais comum, pois essa ferramenta tem se tornado imprescindível, uma vez que possibilita home office, entretenimento, educação domiciliar e fácil acesso às informações. No entanto, o uso exagerado da tecnologia afeta os usuários de diversas formas, inclusive no desenvolvimento de transtornos psiquiátricos. Este estudo visou avaliar a dependência de internet, depressão, ansiedade, hiperatividade, atenção, impulsividade e estresse em 48 adolescentes (26 meninas e 22 meninos) de 15 a 18 anos, com idade média de 16,74 (0,61), estudantes de escolas públicas do Sul do Brasil durante a covid-19, para investigar correlações entre as variáveis anteriores de acordo com gênero e aspectos sociodemográficos. Para avaliar, aplicou-se o Internet Addiction Test (IAT), um teste de atenção, escala SNAP IV, escala de depressão, ansiedade e estresse para adolescentes (EDAE-A), escala de impulsividade de Barratt e um questionário sociodemográfico. Os resultados indicaram que 12 adolescentes foram considerados viciados em internet, e que a dependência desta foi preditora da depressão na análise de regressão (p < 0,001). Ainda, os participantes classificados como adictos tiveram médias mais baixas em atenção geral (p < 0,035) e mais altas em sintomas comportamentais de desatenção e hiperatividade (p < 0,050), estresse (p < 0,003), ansiedade (p < 0,016) e depressão (p < 0,015), com efeitos que variaram de moderado a alto. Portanto, o uso intenso da internet por adolescentes pode ter consequências psicológicas, como a depressão. Bom apoio familiar e intervenção profissional podem ajudar na redução dos sintomas e consequências, bem como na prevenção da dependência.(AU)

La adicción a Internet es cada vez más habitual, puesto que esta herramienta es esencial para el trabajo remoto, el entretenimiento, la educación domiciliar y el fácil acceso a la información. Sin embargo, su uso exagerado afecta a la vida de las personas de diferentes maneras, incluso en el desarrollo de trastornos psiquiátricos. El objetivo de este estudio fue evaluar la adicción a Internet, depresión, ansiedad, hiperactividad, atención, impulsividad y estrés en 48 adolescentes (26 muchachas y 22 muchachos), de entre 15 y 18 años, con una edad promedio de 16,74 (0,61), en su mayoría estudiantes de escuelas públicas del Sur de Brasil, durante la pandemia de la COVID-19, para investigar las correlaciones entre las variables mencionadas según género y aspectos sociodemográficos. Para evaluar los factores, se aplicaron el Test de Adicción a Internet (TAI), un test de atención, la escala SNAP IV, la Escala de Depresión, Ansiedad y Estrés para adolescentes (EDAE-A), la escala de impulsividad de Barratt y un cuestionario sociodemográfico. Los resultados indicaron que 12 adolescentes fueron considerados adictos a Internet, además, la adicción a Internet fue un predictor de la depresión en el análisis de regresión (p<0,001). Igualmente, los participantes clasificados como más adictos a Internet tuvieron promedios más bajos en atención general (p<0,035), y más altos en síntomas conductuales de falta de atención e hiperactividad (p<0,050), estrés (p<0,003), ansiedad (p<0,016) y depresión (p<0,015), con efectos que varían de moderado a alto. Por lo tanto, el uso intenso podría producir consecuencias psicológicas como la depresión en los adolescentes. Tener un buen apoyo familiar e intervención profesional puede ayudar a reducir los síntomas y las consecuencias de la adicción a Internet, así como prevenirla.(AU)

Estilo de vida y estrés postraumático en mujeres desplazadas víctimas de abuso sexual en Santa Marta, Colombia / Lifestyle and post-traumatic stress disorder in displaced women victims of sexual abuse in Santa Marta, Colombia

RESUMEN Introducción: El fenómeno del desplazamiento forzoso en Colombia es una consecuencia de la violencia ejercida por diversos actores armados ilegales que afectan la estabilidad de un determinado sector de la población y del país. Objetivo: Identificar la relación entre estilo de vida y estrés postraumático en un grupo de mujeres desplazadas víctimas de abuso sexual. Métodos: Investigación descriptiva correlacional, con diseño transversal y muestreo intencional. Población constituida por 100 mujeres desplazadas víctimas de abuso sexual, de la que se tomó muestra intencional de 20 mujeres, de entre 20 y 55 años de edad, que aceptaron participar y otras 20 mujeres desplazadas. Se aplicó el Cuestionario fantástico de estilo de vida y la Escala de gravedad de síntomas del trastorno de estrés postraumático. Para el análisis estadístico se hicieron análisis descriptivos, se aplicó la prueba T de student para diferencia de medias y Rho de Spearman para determinar la intensidad de la correlación entre las dos variables estudiadas. Resultados: Luego de un tiempo de reexperimentación de 1 a 5 años, el 80 % de las mujeres desplazadas víctimas de abuso sexual se encontraban en nivel crónico grave de estrés postraumático, a diferencia del 35 % de mujeres desplazadas no víctimas. El 40 % de las mujeres desplazadas víctimas de abuso sexual presentaron un estilo de vida inadecuado, a diferencia del 15 % de las mujeres desplazadas no víctimas. Conclusiones: El impacto negativo del trastorno de estrés postraumático perdura más en las mujeres que han sufrido una doble victimización que aquellas que solo sufrieron desplazamiento forzoso. Esta difícil situación afecta indudablemente la salud y el estilo de vida de esta población, aunque en el presente estudio no se comprobó correlación entre estilo de vida y estrés postraumático.

ABSTRACT Introduction: The phenomenon of forced displacement in Colombia is a consequence of the violence perpetrated by various illegal armed actors affecting the stability of a particular sector of the population and the country. Objective: To identify the relationship between lifestyle and post-traumatic stress disorder in a group of displaced women who were victims of sexual abuse. Methods: Descriptive correlational research with cross-sectional design and intentional sampling. Population constituted by 100 displaced women victims of sexual abuse, in which it was taken an intentional sample of 20 women, between 20 and 55 years old who accepted to participate, and other 20 displaced women. It was applied the Fantastic questionnaire of lifestyle and the Post-traumatic stress disorder´s symptoms severity scale. For the statistical analysis, descriptive analyzes were made, it was applied the student's T test for difference of means, and Spearman's Rho to determine the intensity of the correlation between the two variables studied. Results: After a 1 to 5 years´ time of re-experiencing, 80% of displaced women victims of sexual abuse were in severe chronic level of post-traumatic stress disorder, unlike the 35 % of non-victim displaced women. The 40 % of the displaced women victims of sexual abuse presented an inadequate lifestyle, unlike the 15 % of the non-victims displaced women. Conclusions: The negative impact of post-traumatic stress disorder lasts more in women who have suffered a double victimization than in those who only suffered forced displacement. This difficult situation undoubtedly affects the health and lifestyle of this population, although in the present study there was no evidence of correlation between lifestyle and post-traumatic stress disorder.

Influencia de la estructura de las redes personales sobre el desarrollo de procesos comunitarios en población desplazada / Influence of personal networks structure on the development of community processes in displaced population

El desplazamiento forzado afecta a más de 5 millones de personas en Colombia. El proceso de movilidad que experimentan los desplazados implica el debilitamiento de los vínculos con su entorno relacional y supone la privación del derecho de incidir a nivel sociopolítico. El sentido de comunidad, la participación y el empoderamiento sirven para comprender tanto el proceso de adaptación en la comunidad de destino, como el incremento de la participación comunitaria. Desde un enfoque estructural, el Análisis de Redes Sociales hace posible evaluar las redes de apoyo social de la población desplazada. Los objetivos de la investigación son (a) evaluar los tres procesos mencionados, (b) analizar las redes personales de los participantes y (c) examinar los posibles efectos que la estructura de las redes personales pueda ejercer sobre el desarrollo de los procesos comunitarios analizados. Los resultados indican que las propiedades estructurales de las redes inciden en el nivel de participación en actividades de desarrollo comunitario. Sin embargo, no se han detectado relaciones significativas entre los indicadores estructurales y los otros dos procesos comunitarios evaluados. Existen evidencias que indican que la densidad contribuye positivamente sobre la participación mientras que los parámetros de centralización afectan de forma negativa. Concluimos discutiendo el alcance de nuestros resultados para diseñar estrategias de intervención que promuevan la integración plena de los desplazados en la comunidad receptora.

Forced displacement affects over 5 million people in Colombia. The process of mobility experienced by displaced implies the weakening of the linkages with their relational environment and may involve the deprivation of the right to decide at socio-political level. The sense of community, the community engagement and the psychological empowerment display a strong potential to understand both the adaptation process in destination community, and the increase in community involvement. From a structural viewpoint, Social Network Analysis allows to evaluate the social support networks of the displaced population. The aims of this study are: (a) assess the three community processes; (b) analyze the personal networks structure of the displaced population; and (c) identify the potential effects that personal networks may exert on the development of community processes. Results suggest that structural properties of networks impact on the level of participation in community development activities. However, no significant relationships were identified between the structural measures and the other two community processes evaluated. Density contributes positively on community participation while centralization parameters affect in a negative way. We conclude discussing the applications of our results to design effective intervention strategies to promote the full integration of displaced population in the host community.

trazos para una metodología que permita comprender las razones de éxito y fracaso regional del control territorial de las farc-ep / features for a methodology which allows the understanding of the reasons of the regional success and failure behind the territorial control of farc-ep: the perspective of the qualitative comparative analysis (csqca)

El siguiente artículo recoge la propuesta metodológica de una investigación que se formuló con el propósito de dar cuenta de las razones que explican la diferente presencia que, a nivel territorial, expresan las Farc al término del periodo 1998-2010, tiempo en que la estrategia contrainsurgente del estado colombiano si bien logró desplazar a esta guerrilla de algunas regiones del país, en otras no lo consiguió. La perspectiva metodológica aquí planteada propone una estrategia analítica para identificar, definir y comprender las causas de la diversidad regional de la geografía de la guerra en Colombia. Tal estrategia se enfocó desde una óptica comparada a partir de un modelo desarrollado por la ciencia política denominado Conjunto de Variables para el Análisis Comparativo Cualitativo (csQCA en sus siglas en inglés, crips set of Qualitative Comprative Analysis).

The following article contains the methodological proposal of a piece of research that was carried out in order to give an account of the reasons which explain the different presence that, at the territorial level, the FARC express, at the end of the 1998 – 2010 period. That was a time in which the counterinsurgency strategy of the Colombian State even though it managed to move the guerrillas in some regions of the country, in others did not. The methodological perspective, which is posed here, proposes an analytical strategy to identify, to define, and to understand the causes of the regional diversity of the geography of the war in Colombia. Such a strategy has shifted from a comparative perspective based on a model developed by the political science called Set of Variables for Qualitative Comparative Analysis (csQCA in its acronym in English, crips set of Qualitative Comparative Analysis).

A Case of Dental Implant Complication Coexisting with an Inverted Papilloma in the Nasal Cavity / 대한이비인후과학회지

Unexpected displacement of a dental implant into the maxillary sinus is an unusual but potential complication in dental procedure. A dental implant that migrates into the maxillary sinus often develops paranasal sinusitis and cause diverse peri-implant soft tissue complications. A 59-year-old man complaining of nasal obstruction for several months presented with a huge polypoid mass in the nasal cavity. He had undergone a dental implant procedure in the maxilla at a dental clinic seven years ago. The implant fixture was found displaced to the maxillary sinus. The migrated fixture and nasal mass were removed by endonasal endoscopic surgery and mini Caldwell-Luc operation. The pathology was diagnosed as an inverted papilloma. To our knowledge, this is the first case reported in the literature regarding a dental implant complication that developed independently of sinonasal inverted papilloma.

Restoration of Facial Deformity Caused by a Radicular Cyst after Marsupialization / 대한이비인후과학회지

Radicular cyst is the most common type of odontogenic cyst. The cyst originates from the maxilla occasionally, causes facial deformation and displacement of adjacent structures. An 11-year-old girl visited the outpatient clinic with the left cheek swelling and facial asymmetry. The cheek lesion was hard, accompanied by tenderness. The computed tomography (CT) scans revealed a large unilocular radicular cyst, which involved the floor of the left maxillary sinus, the palatine and alveolar process of the left maxilla. It was treated by transnasal marsupialization under endoscopic guidance. At the one postoperative year follow-up, facial asymmetry was restored and the marsupialization site was closed. The follow-up CT scan showed that the site of a radicular cyst was restored by bone formation. Therefore, we report a case of radicular cyst accompanied with facial asymmetry, which was restored after marsupialization. We also discuss the mechanism about the restoration of facial asymmetry.

Pelvic Bone Fracture with Bladder Rupture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the injury mechanism of pelvic bone fracture and injury type and treatment of bladder rupture associated with pelvic bone fracture. MATERIALS AND METHODS: From September 2002 to February 2011, we treated pelvic bone fracture with bladder rupture in 56 cases with minimal follow up of one year. Each of the 56 cases was classified into groups depending on the mechanism of pelvic fracture (Young classification) and the aspect of bladder rupture (intraperitoneal rupture, extraperitoneal rupture, combined rupture) after which the relationship between the two aspects was analyzed retrospectively. RESULTS: There were a total of 56 cases where bladder ruptures occurred in association with pelvic bone fractures; 34 patients were men and 22 patients were women. The average age was 58.2 years (range: 19-84). Traffic accidents were the main cause of pelvic bone fractures with bladder ruptures in 41 cases. The main injury mechanism was lateral compression, and pubic ramus fractures occurred in 38 cases (67.9%). Regarding the classifications of bladder ruptures, there were 17 cases of intraperitoneal rupture, 37 cases of extraperitoneal rupture, and two cases of combined rupture. Operations were performed on all cases of intraperitoneal and combined rupture and on six cases of extraperitoneal rupture. CONCLUSION: Lateral compression was the most common injury of bladder rupture in pelvic bone fracture. Bladder ruptures occurred even in cases where the displacement of pelvic bones was not severe and also in cases of low energy injury.

Comparison of Minimally Invasive Total Hip Arthroplasty versus Conventional Hemiarthroplasty for Displaced Femoral Neck Fractures in Active Elderly Patients / 전남의대학술지

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.

Psychosocial impact of malocclusion in Spanish adolescents / 대한치과교정학회지

OBJECTIVE: To evaluate the psychosocial impact of malocclusion, determine its relationship with the severity of malocclusion, and assess the influence of gender and social class on this relationship in adolescents. METHODS: A random sample of 627 Spanish adolescents aged 12 - 15 years underwent intraoral examinations by 3 calibrated examiners (intraexaminer and interexaminer kappa > 0.85) at their schools. Psychosocial impact was measured through a self-rated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). The severity of malocclusion was measured by the Index of Orthodontic Treatment Need (IOTN). Gender and social class were also recorded. RESULTS: The total PIDAQ score and those of its 4 subscales, social impact, psychological impact, aesthetic concern, and dental self-confidence, presented significant differences (p < or = 0.05 by analysis of variance) and linear relationships with the IOTN grades (p < or = 0.05 by linear regression). Stepwise linear regression models showed that the IOTN dental health component was a predictive variable of the total and subscale PIDAQ scores. Neither gender nor social class was an independent predictive variable of this relationship, except the linear model for psychological impact, where gender was a predictive variable. The occlusal conditions responsible for higher PIDAQ scores were increased overjet, impeded eruption, tooth displacement, and increased overbite. CONCLUSIONS: Malocclusion has a psychological impact in adolescents and this impact increases with the severity of malocclusion. Social class may not influence this association, but the psychological impact seems to be greater among girls.

Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

OBJECTIVES: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. MATERIALS AND METHODS: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. CONCLUSION: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.

Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction

OBJECTIVES: This study sought to evaluate the effect of simultaneous application of arthrocentesis and occlusal splint. MATERIALS AND METHODS: A retrospective study of 43 patients (3 males, 40 females) whose symptoms had improved was conducted at the Department of Oral and Maxillofacial Surgery, Dong-A University Hospital between 2008 and 2010. Subjects were divided into three groups: Group A (17 patients with arthrocentesis and occlusal splints simultaneously applied), Group B (13 patients whose symptoms did not improve with occlusal splints, undergoing arthrocentesis after occlusal splint use for 8 weeks), and Group C (13 patients that only used occlusal splints). We compared these groups in maximum comfortable opening (MCO) and the visual analogue scale of pain and noise. Follow-up was performed at 1 week, 1 month, 3 months, and 6 months. RESULTS: The improvement of symptoms was noted in all three groups, but Group A had a quicker improvement than the other groups, in terms of pain reduction and MCO increases. CONCLUSION: The simultaneous application of arthrocentesis and occlusal splints can reduce patient discomfort more quickly.

Clinical Results of Various Surgical Techniques for Isolated Fracture of Greater Tuberosity of Humerus

PURPOSE: To compare the clinical and radiologic outcomes of various surgical techniques for an isolated fracture of greater tuberosity of the humerus. MATERIALS AND METHODS: From February 2001 to December 2008, 31 patients, who underwent an operation for isolated greater tuberosity fracture and were followed up for more than 1 year, were enrolled in this study. The mean age at the time of operation was 49.3 years (range, 23-73 years). The operation methods included in this study were as follows: a transosseous suture using nonabsorbable suture material (16 cases), a fixation by cannulated screws (10 cases), tension band wiring (2 cases), bony fragment excision with rotator cuff repair (2 cases), and percutaneous pinning (1 case). RESULTS: At the last follow-up, the average Constant score was 79.4 and Korean Shoulder Score (KSS) was 81.2. Among the various operation methods used in this study, the transosseous suture had the highest scores with 82.5 in Constant score and 89.3 in KSS. Bone union was achieved at average 10.3 weeks (range, 7-15 weeks), and there were 2 cases in which the reoperation was required due to internal fixation failure. Postoperative shoulder stiffness occurred in 3 cases, and all the cases were done with the deltopectoral approach. CONCLUSION: Clinically and radiologically satisfactory results were obtained using various operation techniques for an isolated greater tuberosity fracture of the humerus. The transosseous suture showed relatively better results than the other methods used in this study. To achieve favorable clinical and radiologic results, it is important to select an appropriate surgical approach and fixation method according to the fracture site, degree of displacement, and size of fragment.

Torque control during lingual anterior retraction without posterior appliances / 대한치과교정학회지

OBJECTIVE: To evaluate the factors that affect torque control during anterior retraction when utilizing the C-retractor with a palatal miniplate as an exclusive source of anchorage without posterior appliances. METHODS: The C-retractor was modeled using a 3-dimensional beam element (0.9-mm-diameter stainless-steel wire) attached to mesh bonding pads. Various vertical heights and 2 attachment positions for the lingual anterior retraction hooks (LARHs) were evaluated. A force of 200 g was applied from each side hook of the miniplate to the splinted segment of 6 or 8 anterior teeth. RESULTS: During anterior retraction, an increase in the LARH vertical height increased the amount of lingual root torque and intrusion of the incisors. In particular, with increasing vertical height, the tooth displacement pattern changed from controlled tipping to bodily displacement and then to lingual root displacement. The effects were enhanced when the LARH was located between the central and lateral incisors, as compared to when the LARH was located between the lateral incisors and canines. CONCLUSIONS: Three-dimensional lingual anterior retraction of the 6 or 8 anterior teeth can be accomplished using the palatal miniplate as the only anchorage source. Using LARHs at different heights or positions affects the quality of torque and intrusion.

Comparison of Minimally Invasive Total Hip Arthroplasty versus Conventional Hemiarthroplasty for Displaced Femoral Neck Fractures in Active Elderly Patients / 전남의대학술지

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.

Transarticular Fixation of Akin Osteotomy on Patients with Hallux Valgus after Resection of Medial Protrusion of Base of Proximal Phalanx / 대한족부족관절학회지

PURPOSE: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. MATERIALS AND METHODS: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. RESULTS: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. CONCLUSION: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.

Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy / 대한마취과학회지

BACKGROUND: Increased intra-abdominal pressure during laparoscopic surgery causes cephalad displacement of the diaphragm, resulting in the formation of atelectasis, which can be overcome by positive end-expiratory pressure (PEEP). The aim of this prospective study was to investigate the level of optimal PEEP to maintain adequate arterial oxygenation and hemodynamics during robot-assisted laparoscopic radical prostatectomy (RLRP). METHODS: One hundred patients undergoing RLRP were randomly allocated to one of five groups (n = 20) (0, 3, 5, 7 and 10 cmH2O of PEEP). Hemodynamic variables and respiratory parameters were measured at baseline with the patient in the supine position; at 30 min, 1, 2, 3 and 4 h during CO2 insufflation with the patient in the post-Trendelenburg position; and after deflation in the supine position with increasing PEEP. RESULTS: The PaO2 levels and alveolar-arterial difference in oxygen tension (AaDO2) were improved in patients with PEEPs compared with patients in whom PEEP was not used. The application of PEEP (10 cmH2O) resulted in higher PaO2 levels compared to those with lower PEEP levels, but excessive peak airway pressure (PAP) was sometimes observed. The application of a PEEP of 7 cmH2O resulted in similar PaO2 levels without causing excessive PAP. There was a significant difference in central venous pressure between the groups, but there were no significant differences in heart rate, mean arterial pressure or minute ventilation between the groups. CONCLUSIONS: A PEEP of 7 cmH2O is associated with the greater improvement of PaO2 and AaDO2 without causing excessive PAP during RLRP.

Treatment of the Distal Radius Fractures in the Elderly Patients

Distal radius fractures are one of the most common types of fractures in the elderly. It is well documented that increased risk of a distal radius fracture in older patients is associated with decreased bone mineral density. Also, low bone mineral density increased severity of fracture and instability of fracture after reduction. Fracture displacement in the elderly does not necessarily result in functional impairment. Therefore, conservative treatment has been a mainstay treatment even in unstable fracture in the elderly. However, there is an increasing trend toward operative treatment recently, because functional demand increased in the elderly due to active life style and volar locking plate fixation enables the elderly early return to daily activity even in osteoporotic distal radius fracture.

Radiographic Characteristics and the Clinical Results of the Operative Treatment of Muller-Weiss Disease / 대한족부족관절학회지

PURPOSE: To present radiographic characteristics and report the clinical results of the operative treatment of Muller-Weiss disease. MATERIALS AND METHODS: This is a retrospective study including 13 patients, 14 feet who had been operated for Muller-Weiss disease between April 2006 and December 2011. Osteoarthritis of the peri-navicular joints were radiographically evaluated. Various range of peri-navicular fusion and joint-preserving surgeries according to patients' symptoms and radiographic findings were done. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). RESULTS: On radiographs, osteoarthritic changes were presented at talonavicular joint in 11 cases, calcaneocuboid joint in 7 cases, subtalar joint in 6 cases, naviculo-cuneiform joint in 1 case. The mean anteroposterior talocalcaneal angle was 16.6 degrees. On hindfoot alignment view, 6 cases were varus, 5 cases were neutral and 3 cases were valgus alignment. Fusion comprised 6 cases in triple fusion, 1 case in talonavicular-cuneiform fusion, 2 cases in talonavicualr fusion and 1 case in talonavicular & calcaneocuboid fusion. Joint-preserving surgeries were bony fragment excision of the lateral part of navicular & medial displacement calcaneal osteotomy in 1 case, bony spur excision of talonavicular joint in 1 case and medial displacement calcaneal osteotomy in 2 cases. The postoperative AOFAS and VAS score were improved significantly (p=0.000, p=0.000). CONCLUSION: In cases of Muller-Weiss disease without osteoarthritic changes at peri-navicular joints, fragment excision of navicular, bony spur excision with or without medial displacement calcaneal osteotomy were effective operative treatments.

Clinical Outcomes of Anterior Open Reduction and Posterior Percutaneous Screw Fixation for Displaced Talar neck Fractures / 대한족부족관절학회지

PURPOSE: Posteroanterior screw fixation is biomechanically stronger than anteroposterior screw fixation. However, there are few literature about the correlation between clinical results and more strength by posteroanterior fixation. This study was performed to evaluate the clinical outcomes of the accelerated rehabilitation following anterior open reduction and posterior percutaneous screw fixation for displaced talar neck fractures. MATERIALS AND METHODS: Eighteen cases were followed up for more than 1 year after posteroanterior fixation using headless compression screw for talar neck fractures. The clinical evaluation was performed according to American Orthopaedic Foot and Ankle Society (AOFAS) score and Hawkins criteria. As radiographic evaluation, the degree of fracture displacement, period to union, and occurrence rate of complications such as avascular necrosis through MRI were measured. RESULTS: The AOFAS score was average 90.4 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the Hawkins criteria. Therefore, 16 cases(88.8%) achieved satisfactory results. The degree of fracture displacement had improved significantly from preoperative average 5.6 mm to 1.2 mm immediate postoperatively, and maintained to 1.1mm at the last follow-up. All cases achieved bone union, and the period to union was average 12.4 weeks. There were 3 cases of avascular necrosis of talar body and 2 cases of post-traumatic arthritis. CONCLUSION: Anterior open reduction and posterior percutaneous headless screw fixation seems to be an effective surgical method for displaced talar neck fractures, because of the possibility of accurate restoration of articular surface, fixation strength enough to early rehabilitation, and needlessness of hardware removal.

Acute Schmorl Node in Dorsal Spine: An Unusual Cause of a Sudden Onset of Severe Back Pain in a Young Female

Schmorl nodes represent displacement of intervertebral disc tissue into the vertebral body and have been considered as an asymptomatic incidental radiological finding on plain radiographs, computed tomography and magnetic resonance imaging (MRI). Although uncommon, acute symptomatic Schmorl nodes causing severe back pain do occur. We report here an unusual case of acute painful Schmorl node in a young healthy woman, with no previous trauma, presenting with a sudden significant localized back pain within hours accompanied by characteristic findings on a MRI scan. We reviewed all reports of symptomatic Schmorl nodes known in the literature, focusing mainly on MRI findings, and recent treatment options.