Meta-analysis of the efficacy of invisible orthodontic appliances for maxillary molar distalization in adult patients / 口腔疾病防治

Objective@#To evaluate the clinical efficacy of invisible orthodontic appliances without brackets for the distal movement of maxillary molars to improve the ability of orthodontists to predict treatment outcomes.@*Methods@#Web of Science, Cochrane Library, Embase, PubMed, Wanfang Database, CNKI Database, and VIP Database were searched for studies investigating the efficacy of invisible orthodontic appliances for distal movement of maxillary molars in adult patients and published from database inception to August 1, 2023. A total of three researchers screened the studies and evaluated their quality and conducted a meta-analysis of those that met quality standards.@*Results@#This study included 13 pre- and postcontrol trials with a total sample size of 281 patients. The meta-analysis revealed no significant differences in the sagittal or vertical parameters of the jawbone after treatment when compared with those before treatment (P>0.05). The displacement of the first molar was MD=-2.34, 95% CI (-2.83, -1.85); the displacement was MD=-0.95, 95% CI (-1.34, -0.56); and the inclination was MD=-2.51, 95% CI (-3.56, -1.46). There was a statistically significant difference in the change in sagittal, vertical, and axial tilt of the first molar before and after treatment. After treatment, the average adduction distance of the incisors was MD=-0.82, 95% CI (-1.54, -0.09), and the decrease in lip inclination was MD=-1.61, 95% CI (-2.86, -0.36); these values were significantly different from those before treatment (P<0.05).@*Conclusion@#Invisible orthodontic appliances can effectively move the upper molars in a distal direction and control the vertical position of the molars. When the molars move further away, there is some degree of compression and distal tilt movement, which is beneficial for patients with high angles. The sagittal movement of incisors is beneficial for improving the patient's profile.

Post-COVID multisystem inflammatory syndrome in adults: a study from a tertiary care hospital in south India

Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e. 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids.

Bowel angina: Henoch-Schonleinpurpura in adult patient based on clinical approach: a case report

The GI involvement of Henoch-Schonlein purpura (HSP) has often been described as self-limiting, with no long term morbidity.GI manifestation is higher in adult patient. HSP is an autoimmune disorder characterized by the deposition of IgA immune complexes in the wall of small to medium size arteries. We present a 41-year-old patient with GI involvement (Bowel angina) in HSP case admitted at Wangaya Regional Hospital Denpasar. The case are treated by steroid and symptomatictreatment. Diagnosis is established through a clinical approach with EULAR criteria. The patient recovered with supportive treatment and had a favourableclinical outcome.

De onde me vem Isso? / Where does This come from? / ¿De dónde me viene Eso? / D'où me vient Ça?

A autora aborda a experiência inquietante de sermos possuídos por afetos e comportamentos que não reconhecemos como "meus", e que nos impõem a pergunta: "de onde me vem Isso?" Em resposta a esta questão, Freud precisou criar o conceito de inconsciente. Um inconsciente vivo, constituído pelas marcas deixadas pela história emocional vivida na relação com o objeto, mas não suficientemente integrada. Por meio de dois casos clínicos, a autora ilustra o retorno do recalcado e do clivado, enfatizando a dimensão intersubjetiva daquilo que foi recalcado e clivado.

The author addresses the unsettling experience of being possessed by affections and behaviors that we do not recognize as "mine", and that impose the question "Where does This come from?" In response to this question, Freud had to create the concept of unconscious. A living unconscious, constituted by the marks left by the emotional history experienced with the object, but not sufficiently integrated. Through two clinical cases, she illustrates the return of repressed and of the splitted, emphasizing the intersubjective dimension of what has been repressed and splitted.

La autora aborda la experiencia inquietante de ser poseídos por afectos y comportamientos que no reconocemos como "míos", y que nos impone la pregunta: ¿de dónde me viene Eso? En respuesta a esta cuestión, Freud necesitó crear el concepto de inconsciente. Un inconsciente vivo, constituido por las marcas dejadas por la historia emocional vivida con el objeto, pero no suficientemente integrada. A través de dos casos clínicos, ilustra el retorno del reprimido y del clivado, enfatizando la dimensión intersubjetiva de lo que fue reprimido y clivado.

L'auteur aborde l'expérience troublante d'être possédé par des affections et des comportements que nous ne reconnaissons pas comme "miens" et qui imposent la question "d'où me vient Ça?" En réponse à cette question, Freud a dû créer le concept de inconscient. Un inconscient vivant, constitué des marques laissées par l'histoire émotionnelle vécue mais insuffisamment intégrée. A travers deux cas cliniques, il illustre le retour de refoulés et de clivés, en soulignant la dimension intersubjective de ce qui a été refoulé et clivé.

Tuberculose pulmonar deflagrando insuficiência cardíaca no adulto com anomalia de Ebstein: relato de caso / Pulmonary tuberculosis triggering heart failure in adult with Ebstein's anomaly: case report / Tuberculosis pulmonar desencadenando insuficiencia cardíaca en un adulto con anomalía de Ebstein: relato de un caso

A anomalia de Ebstein caracteriza-se pela implantação anômala do folheto septal e frequentemente do folheto posterior no interior do ventrículo direito. A síndrome de disfunção ventricular direita é uma forma incomum de apresentação dessa cardiopatia na idade adulta. Relata-se caso de paciente masculino, 41 anos, com admissão por insuficiência cardíaca descompensada após um ano de investigação sem diagnóstico. Discutem-se os aspectos fisiopatológicos e a evolução dos pacientes com anomalia de Ebstein, com ênfase na variabilidade de apresentações clínicas.

Ebstein's anomaly is characterized by the abnormal implantation of the septal leaflet and often the posterior leaflet into the right ventricle. The syndrome of right ventricular dysfunction is an unusual presentation of this disease in adulthood. We report the case of a male patient, 41 years old, admitted with decompensated heart failure after a year of research undiagnosed. We discuss the pathophysiology and outcome of patients with Ebstein's anomaly, with emphasis on the variability of clinical presentations.

La anomalía de Ebstein se caracteriza por la implantación anormal de la valva septal de la válvula tricúspide y con frecuencia de la valva posterior en el interior del ventrículo derecho. El síndrome de disfunción del ventrículo derecho es una inusual presentación de esta enfermedad en la edad adulta. Presentamos el caso de un paciente de sexo masculino de 41 años que ingresó al hospital por insuficiencia cardíaca descompensada después de un año de investigación sin diagnosticar. Se discute la fisiopatología y la evolución de los pacientes con anomalía de Ebstein, con énfasis en la variabilidad de la presentación clínica.

Defeito osteoporótico focal do adulto: conceito, diagnóstico e os implantes osseointegráveis / Focal osteoporotic bone marrow defect: concept, diagnosis and osseointegrated implants

O Defeito Osteoporótico Focal do Adulto deve constar na lista de diagnósticos diferenciais de lesões radiolúcidas uni e multiloculares, especialmente as mandibulares, pequenas e médias. O diagnóstico clínico e imaginológico pode ser seguro, mas, se houver uma dúvida mínima, deve-se providenciar biópsia e o laudo revelará um tecido medular hematopoieticamente ativo. O Defeito Osteoporótico Focal do Adulto não inviabiliza os implantes osseointegráveis na região, pois biologicamente não impede o reparo ósseo, e até pode favorecê-lo, pela medula óssea ter numerosas células-tronco e ser rica em células osteoprogenitoras. O diagnóstico deve ser seguro para diferenciá-lo de outras lesões semelhantes na mandíbula, mas agressivas. As principais características do Defeito Osteoporótico Focal do Adulto são ressaltadas neste trabalho, considerando-o uma variável do trabeculado ósseo e medular em um contexto de normalidade

Focal osteoporotic defects in adult patients must be on the list of differential diagnosis of small and medium uni and multiocular radiolucent lesions, especially in the mandible. Clinical and imaginologic diagnoses are safe, however, a biopsy must be performed in case of doubt, in which case the report will include hematopoietically active medullary tissue. Focal osteoporotic defects in adult patients does not hinder osseointegrated implant placement because, biologically speaking, it does not hamper bone repair. In fact, it may even favor it as a result of the large number of stem and osteoprogenitor cells comprising the bone marrow. Safe diagnosis is essential to differentiate focal osteoporotic defects from more severe lesions also found in the mandible. Focal osteoporotic defects in adult patients is considered a variation of normal bone and medullary trabecula, and its main characteristics are highlight herein

Observations on the Activation of Chronic Compensated Hydrocephalus in Adult Patients / 대한신경손상학회지

OBJECTIVE: There is a broad spectrum of compensated hydrocephalus. Various terms such as long-standing overt ventriculomegaly in adult (LOVA) has been coined, however, even such terms leave diverse aspect of this condition out of account. We have experienced compensated hydrocephalus cases which were considered to be activated after a long time period of quiescent state, and tried to compare their clinical characteristics with the relatively well described entity of LOVA. METHODS: We conducted a retrospective review of 206 patients who underwent ventriculoperitoneal shunt (VPS) between February 2001 and May 2012. Of these, 6 patients had chronic compensated hydrocephalus. The clinical and radiological characteristics are evaluated. RESULTS: Definite triventriculomegaly was observed in two patients. Macrocephaly was observed in two cases, one with aqueductal stenosis (AS), the other with unknown status of aqueduct. All of the cases with triventriculomegaly were normocephalic. Spinal causes were thought as aggravating factor in two. Two endoscopic third ventriculostomy and eight VPS were performed in five patients. Four patients responded well but one took a very complicated course. CONCLUSION: The relationships between macrocephaly, triventriculomegaly, and AS suggested in other studies were inconsistent. Blockage or narrowing of cerebrospinal fluid pathways were observed at various sites. Disturbances of spinal arachnoid pathways were related to the activation in some cases. Treatment is to be tailored individually considering various reigniting event. It is suggested that this entity is to be evaluated for better nomenclature reflecting diverse aspects of this condition. Further study is needed to elucidate underlying pathophysiology and effective management.

Three Cases of Primary Hypothyroidism with Down Syndrome in Adult / 대한내분비학회지

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.

Gluteal Fibrosis in Adult / 대한정형외과학회잡지

Gluteal fibrosis is rare in Kores. We thought the probable primary etiology of gluteal fibrosis might be repeated intramuscular injection into the buttock, Inability to adduct the legs in the sitting position and flex the hips in neutral position had been observed. Four cases(3 persons) of gluteal fibrosis in adult from October 1986 to February 1987 are presented with much improvement of squatting and flexion of hip in neutral position after operation.

Clinical Study on Avascular Necrosis of Femoral Head in Adult / 대한정형외과학회잡지

One hundred twenty-one patients with avascular necrosis of the femoral head in adults, who were admitted in Department of Orthopadic Surgery, Kyungpook National University Hospital between January of 1972 and June of 1986 are investigated in terms of the history, clinical data, radiographic findings and laboratory examinations. And, the following results were obtained. 1. The highest incidence was in the 5th decade and the sex ratio between male and female was 5: l. 2. 62 cases(51.2%) had the bilateral hip involvement, and higher incidence of bilateral hip involvement in steroid or alcohol induced cases. 3. Etiological factors were unknown(38 cases, 31.4%), steroid (31 cases, 25.6%), alcohol (22 cases, 18.2%), femur neck fracture (15 cases, 12.4%), trauma (13 cases, 10.7%) and caissons disease (2 cases). 4. Underlying diseases in steroid-induced avascular necrosis of the femoral head were dermopathy (8 cases), pain over other joints (7 cases), head trauma (5 cases), nephropathy (4 cases), etc. 5. The time intervals between etiological events and appearance of clinical symptoms were 1 year and 7 months in steroid-induced cases, 1 year and 9 months in femur neck fracture cases, 1 year and 1 month in trauma-induced cases, 1 year and 5 months in caissons disease. 6. The duration of morbidity was 21 months on average. 7. At first hospital visit, the Ficat stage of femoral head avascular necrosis were stage II in 12 cases (10%), transition stage in 17 cases (14%), stage III in 34 cases (29%) and stage IV in 56 cases (47%). 8. Bone scanning was performed in 59 hips of 42 cases. Cold spot was observed in 17 hips and hot spot in 36 hips. There were false negative findings in 4 hips in spite of ischemic findings of femoral head on simple x-ray. 9. Bone marrow pressure was higher than 30mmHg and was increased 10mmHg more than initial pressure by stress test. 10. On intramedullary venography, diaphyseal reflux of contrast medium and diaphyseal stasis more than 15 minutes in 7 of 9 cases over stage II.

Clinical Study of Discitis in Adult / 대한정형외과학회잡지

A primary infection of the intervertebral disc in adult is an uncommon entity. Usually these patients are not actually ill and their symptoms have been present for some months. Pyogenic infection of the intervertebral disc in children was well documented by a number of authors,but this condition was less well recognized in the adult. We analysed 12 cases of discitis in adults which were treated at the Department of Orthopedic Surgery of Severance Hospital for 10 years from January 1975 to March 1984 by curettage and autogenous iliac bone graft through anterior approach. The results obtained from this study were as follows: 1. The average duration of symptoms before diagnosis was 9.6 months. 2. The lumbar spine was involved in 83% and next in thoracic spine. 3. The most prominent symptoms and signs are backache and local tenderness at the site of the lesion. 4. Ten patients had the preceding disease or definile past history of previous back surgery, myelogram, abscess, urinary tract infection, heavy lifting and back trauma. 5. The white cell count was of little value in the initial investigation, but the E.S.R. was raised in 67%. 6. Positive cultures from the intervertebral disc were obtained in 8 cases(67%). The causative organisms were 5 Staphylococcus, 2 E-coli, and 1 Pseudomonas aeruginosa. 7. The most common radiological finding on admission was narrowing of the intervertebral disc space, and the tomogram showed the most reliable finding for the preoperative diagnosis. 8. In the treatment, focal curettage or diskectomy and anterior fusion with autogenous iliac bone graft was done in all cases. Antibiotics were administrated for 4 to 10 weeks (average 5.5 weeks) after operation and the cast or brace was applied for immobilization. 9. Over-all clinical result were as follows; eight patients (67%) excellent, 3 patients good, 1 patient fair, and no recurrence.