A study on the processing of dental ceramic composites by using laser / 대한치과보철학회지

PURPOSE: The laser processability of dental prosthesis is investigated using two ceramic composites, including 3M, Lava Ultimate and Ivoclar vivadent, IPS e.max. MATERIALS AND METHODS: The CO₂ laser, picosecond laser and femtosecond laser are used to assess the processing power of dental prosthetic materials Lava Ultimate and IPS e.max and the line processing shape was measured using a confocal microscope. RESULTS: The brittleness, carbonization and micro crack of the ceramic composite were influenced by heat accumulation of the material and could be controlled by the laser power and pulse time. CONCLUSION: In the case of CO₂ lasers, micro crack and carbonation occurred immediately, and in the picosecond laser processing, the micro cracks are partially improved, but the carbonization occurs continuously. Finally, we confirmed the high efficiency of laser processing with femtosecond laser. In particular, Lava Ultimate, a ceramic resin composite material, showed the best processability when processed using a femtosecond laser.

Subcutaneous tissue calcification in a patient with rheumatoid arthritis / 영남의대학술지

Subcutaneous tissue calcification in rheumatic diseases usually occurs in connective tissue diseases, such as systemic lupus erythematosus, scleroderma, and dermatomyositis. Domestic cases of calcification in rheumatoid arthritis have not been reported. The mechanism of subcutaneous tissue calcification may differ depending on the cause and it can develop on all parts of the body. Calcification occurring in rheumatic diseases is a major mechanism of tissue damage caused by chronic inflammation. No standard therapy for calcification has been established; however, many studies have reported on medical and surgical treatment. We report on subcutaneous tissue calcification in a rheumatoid arthritis patient tissue calcification on both sides of the buttocks, the upper limbs, and the lower limbs.

Snakebite in Korea: A Guideline to Primary Surgical Management

PURPOSE: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validity and safety of snakebite protocol for surgery when treating snakebite patients. MATERIALS AND METHODS: Retrospective research was performed on patients who were admitted after being treated at the emergency center from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and general symptoms, time to receive antivenin, and complications. RESULTS: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resulting in a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. CONCLUSION: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this research was safely and properly followed during surgical treatment.

Rupture of Finger Flexor Tendon Due to Needle Tip Injury During Steroid Injection Therapy: A Case Report / 대한정형외과연구학회지

While injuries of finger flexor tendons are relatively commonly encountered trauma in orthopedic clinics, a closed rupture of these tendons is known to be rare due to their large flexibility and tension. Closed rupture of the finger flexion tendons can occur due to repeated movements following the fracture or malunion of the fingers or distal radius, and it also occurs nonspecifically among patients with autoimmune diseases. We report a case of spontaneous rupture of flexor digitorum tendons in a 49-year-old male who was diagnosed with carpal tunnel syndrome after received several sessions of steroid injection at the wrist joint; he was monitored for two-months and recovered well following operation.

Rupture of Finger Flexor Tendon Due to Needle Tip Injury During Steroid Injection Therapy: A Case Report / 대한정형외과연구학회지

While injuries of finger flexor tendons are relatively commonly encountered trauma in orthopedic clinics, a closed rupture of these tendons is known to be rare due to their large flexibility and tension. Closed rupture of the finger flexion tendons can occur due to repeated movements following the fracture or malunion of the fingers or distal radius, and it also occurs nonspecifically among patients with autoimmune diseases. We report a case of spontaneous rupture of flexor digitorum tendons in a 49-year-old male who was diagnosed with carpal tunnel syndrome after received several sessions of steroid injection at the wrist joint; he was monitored for two-months and recovered well following operation.

The Efficacy of Ultrasound-Guided Brachial Plexus Block in Trauma Patients

PURPOSE: We evaluated the efficacy of brachial plexus block under the guide of ultrasonography for immediate management of open wound in patients with multiple trauma. METHODS: From July 2012 to April 2013, 34 patients with multiple trauma had brachial plexus block for immediate management of open wound in the upper extremity. We evaluated the patient satisfaction of the anesthesia and any complications related to the block. RESULTS: During the brachial plexus block, intravascular injection of lidocaine occurred in one patient. Except this, all patients who received brachial plexus replied they would choose brachial plexus block if they had to undergo the same surgery. CONCLUSION: Brachial plexus block is an effective anesthesia technique in the immediate management of open wound in upper extremities.

Surgical Management of Pisiform Bone Deformity Associated with Tendonitis of Flexor Carpi Ulnaris

PURPOSE: This study was performed to investigate the degree of symptom improvement after removal of bone fragment in patients with deformed pisiform bone associated with tendonitis of flexor carpi ulnaris. METHODS: Pisiform bone fragment removal was performed in 12 patients who had failed conservative treatment from January 2008 to December 2011. They were followed up at 2 weeks, 1 month, 2 months, 6 months, and 12 months after surgery. Their symptoms were assessed with Green score. RESULTS: Eleven of 12 patients who underwent bone fragment removal showed symptom improvement. Symptoms worsened in 1 patient due to pain and restricted range of motion caused by postoperative scar. CONCLUSION: The results of this study suggest that removal of bone fragment may be an effective treatment in patients with tendonitis of flexor carpi ulnaris accompanied by pisiform bone deformity whose pain does not improve with conservative management.

Non-traumatic Atlanto-axial Rotatory Subluxation: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of diagnostic, clinical and radiologic follow-up of a non-traumatic atlanto-axial rotatory subluxation. SUMMARY OF LITERATURE REVIEW: Atlanto-axial rotatory subluxation, caused by a non-traumatic inflammation or infectious diseases, has been branded as "Grisel's syndrome". However, the pathophysiology of the syndrome has not been clearly understood, and its diagnostic criteria and appropriate treatment plans are not established. MATERIALS AND METHODS: The patient suffering from antlanto-axial subluxation without any neurological symptoms was treated with halter traction and Miami J brace. RESULTS: The patient maintained a normal reduction state, and a normal cervical movement was observed after undergoing 4 weeks of non-surgical treatment. CONCLUSION: Early detection and treatment are essential and critical in avoiding catastrophic outcomes. It requires a combination of clinical assessment and appropriate radiographic imaging.

Efficiency of Implant Removal for Treatment of the Thoraco-lumbar Unstable Fractures: Multi Segments Fixation, Single Segment Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the safety and usefulness of implant removal based on fusion by radiological change analyses and non-fused segment motion angle after open reduction, multi-segment fixation, and single segment fusion. SUMMARY OF LITERATURE REVIEW: There have been reports that discuss possible fracture of fixator, loss of reduction, or failure of fixation in certain cases of single segment fixation consistent with thoracolumbar fracture. MATERIALS AND METHODS: We analyzed 83 patients who had undergone treatment by fixation of the top 2 segments and the bottom segment. The posterolateral fusions were performed for the top segment for thoracolumbar fractures. The mean follow-up was 21.3 months. Wedge and local kyphotic angles, anterior, and posterior heights of the vertebral body were measured on plain radiograph. The range of motion of each segment was recorded by flexion-extension lateral radiographs at 6 month after the removal of implants. RESULTS: Radiologic assessments performed on 83 patients demonstrated preoperative mean wedge angle, kyphotic angle, mean anterior body height of 20.1degrees, 18.5degrees and 62.0%, respectively, and, postoperatively, these were corrected by 9.0degrees, 9.3degrees and 24.6%, respectively. In the 44 cases that had the implants removed, the correction losses were 0.4degrees(P=0.258) and 3.7degrees(P=0.000), 0.5%(P=0.756), and at the last follow-up, compared to measurements prior to the removal. There was no statistical significance in wedge angle or anterior body height. The range of motion measured on the non-fused segment was 3.9degrees on average at 6-months after the hardware removal. CONCLUSIONS: The multi-segments fixation and single-segment fusion for the thoracolumbar fracture can preserve correction and the motion of non-fusion segment. Although the implant removal after union can sustain motion, further studies regarding degenerative change of the non-fused segment are necessary.

Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group

PURPOSE: Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade. MATERIALS AND METHODS: We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05. RESULTS: Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR. CONCLUSION: It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.

The Spectrum of Lesions and Clinical Results of Arthroscopic Stabilization of Acute Anterior Shoulder Instability

PURPOSE: The purpose of this study is to investigate and analyze accom-panying lesions including injury types of anteroinferior labrum lesion in young and active patients who suffered traumatic anterior shoulder dislocation for the first time. Meterials and Methods: The study used magnetic resonance angiography (MRA) to 40 patients with acute anterior shoulder dislocation from April 2004 to April 2008, and of those, 36 with abnormal MRA finding were treated with arthroscopy. RESULTS: There was a total of 25 cases of anteroinferior glenoid labrum lesions. A superior labrum anterior-posterior lesion (SLAP) lesion was observed in 8 cases. For bony lesions, 22 cases of Hill-sachs lesions, 4 cases of lesions in greater tuberosity fracture of humerus, and 4 cases of loose body were found. For lesions involving rotator cuff, partial articular side rupture was found in 2 cases and 2 cases were found to have a complete rupture. CONCLUSION: Under MRA and arthroscopy performed on patients with acute anterior shoulder dislocation, it was observed to have varying types of anteroinferior labrum lesions such as Perthes, Bankart, ALPSA, and bony Bankart lesion. that MRA is a remar-kably useful tool to classify various lesions in acute anterior dislocation of the shoulder and to make a diagnosis, making it a useful tool to decide a treatment method while consulting patients and their families.

Reconstruction of the Extensor Pollicis Longus Tendon by Tendon Graft or Tendon Transfer

PURPOSE: To compare the clinical results of spontaneous rupture of extensor pollicis longus tendon treated by palmaris longus tendon graft (group I) versus extensor indicis proprius tendon transfer (group II). MATERIALS AND METHODS: Out of twenty-five patients who suffer from spontaneous extensor pollicis longus tendon rupture, twelve patients were treated by palmaris longus tendon graft and thirteen patients were treated by extensor indicis proprius tendon transfer. Postoperatively thumbs were immobilized with thumb spica splint for three weeks. Active and passive movement was allowed subsequently for six weeks. The functions of the thumbs were assessed by the Geldmacher criteria and statistically compared. RESULTS: The overall outcome was excellent in 5(20%) of patients and good in 17(68%) of patients and satisfactory in 3(12%) of patients. The mean scores using the Geldmacher criteria were 18.50 for palmaris longus tendon graft and 19.69 for extensor indicis proprius tendon transfer. No significant difference was noted between two groups. CONCLUSION: Both methods establish equally good clinical results in patient with chronic extensor pollicis longus tendon rupture. Extensor indicis proprius tendon transfer seems more available methods.

A Clinical Trial of Topiramate for Weight Loss in Schizophrenia with Overweight or Obesity / 대한정신약물학회지

OBJECTIVE: Antipsychotic-induced weight gain is associated with treatment noncompliance and is also known to be associated with several medical conditions in schizophrenia. Topiramate, a relatively new antiepileptic drug, is currently used for mood and eating disorders, and also offers the advantage of weight loss. This study explored the efficacy and tolerability of topiramate as an adjuvant treatment of schizophrenia with overweight or obesity. METHODS: In this 8-week, prospective open trial, 30 hospitalized, schizophrenic patients took topiramate at a mean maintenance dosage of 159.37+/-61.15 mg/day. The primary measures were weight, body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio. The safety measures included adverse events, physical examination, clinical laboratory data, and vital signs. The Clinical Global Impression Severity (CGI-S) Scale was used to quantify changes in schizophrenic symptoms and signs. RESULTS: Body weight, BMI, waist circumference, and hip circumference decreased significantly after treatment but the waist-to-hip ratio did not. The changes of body weight and BMI during 8 weeks treatment with topiramate were significantly correlated with the maintenance dose of topiramate. The high dose group (>100 mg/d) was significantly more changed in body weight and BMI between baseline and 8 weeks than the low dose group (< or =100 mg/d). The scores on the CGI-S scale decreased significantly over the 8 weeks of treatment. CONCLUSION: The results suggest that topiramate is both efficacious and tolerable for the short-term adjuvant treatment of schizophrenia with overweight or obesity. Further placebo controlled studies included larger samples would be needed to confirm these results. And much more clinical researches should be required to establish guideline for the optimal dose and duration of treatment using topiramate as an antiobesity agent in schizophrenia.