The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

Background@#In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients. @*Methods@#We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints. @*Results@#There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group. @*Conclusions@#Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.

Staged reconstruction of a chronically infected large skull defect using free tissue transfer and a patient-specific polyetheretherketone implant

Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

Sex-related and racial variations in orbital floor anatomy

Background@#Repair of the orbital floor following trauma or tumor removal remains a challenge because of its complex three-dimensional shape. The purpose of the present study is to understand normal orbital floor anatomy by investigating its differences across four groups (Caucasian American and East Asian, males and females) via facial bone computed tomography (CT). @*Methods@#A total of 48 orbits in 24 patients between 20 and 60 years of age were evaluated. Although most patients underwent CT scanning following trauma, the orbital walls were intact in all patients. Linear and angular measurements of the orbital floor were obtained from CT images. @*Results@#Orbital floor width, length, angle between the orbital floor and medial wall, and distance from the inferior orbital rim to the lowest point of the orbital floor did not show a statistically significant difference between groups. Angles made by the infraorbital rim, the lowest point of the floor, and the anterior border of the infraorbital fissure were statistically significantly wider in East Asian females than in male groups. The floor depth in East Asian females was significantly smaller compared to all the other groups. @*Conclusion@#East Asian female population had smaller curvature and depth of an orbital floor than the other groups, which means racial and sex-related differences should be considered in the orbital floor reconstruction.

Epithelial-mesenchymal transition in keloid tissue

No abstract available.

Axial wall thickness of zirconia abutment in anterior region / 대한치과보철학회지

PURPOSE: The purpose of this study was to evaluate the proper axial thickness of zirconia abutment applied to implant in the anterior region. MATERIALS AND METHODS: Zirconia abutments were prepared at different axial wall thickness by processing pre-sintered zirconia blocks via CAD/CAM to obtain equal specimens. The abutments were each produced with a thickness of 0.5 mm (Group 1), 0.8 mm (Group 2), 1.2 mm (Group 3), or 1.5 mm (Group 4). The implant used in this study was a external connection type one (US, Osstem, Pussan, Korea) product and the zirconia abutment was prepared via replication of a cemented abutment. The crowns were prepared via CAM/CAM with a thickness of 1.5 mm and were cemented to the abutments using RelyX(TM) UniCem cement. A universal testing machine was used to apply load at 30 degrees and measure fracture strength of the zirconia abutment. RESULTS: Fracture strength of the abutments for Group 1, Group 2, Group 3, and Group 4 were 236.00 +/- 67.55 N, 599.00 +/- 15.80 N, 588.20 +/- 33.18 N, and 97.83 +/- 98.13 N, respectively. Group 1 showed a significantly lower value, as compared to the other groups (independent Mann-Whitney U-test. P.05). CONCLUSION: Zirconia abutment requires optimal thickness for fracture resistance. Within the limitation of this study, > 0.8 mm thickness is recommended for zirconia abutment in anterior implants.

Resorption of labial bone in maxillary anterior implant

PURPOSE: The purpose of this study was to evaluate the amount of resorption and thickness of labial bone in anterior maxillary implant using cone beam computed tomography with Hitachi CB Mercuray (Hitachi, Medico, Tokyo, Japan). MATERIALS AND METHODS: Twenty-one patients with 26 implants were followed-up and checked with CBCT. 21 OSSEOTITE NT(R) (3i/implant Innovations, Florida, USA) and 5 OSSEOTITE(R) implants (3i/implant Innovations, Florida, USA) were placed at anterior region and they were positioned vertically at the same level of bony scallop of adjacent teeth. Whenever there was no lesion or labial bone was intact, immediate placement was tried as possible as it could be. Generated bone regeneration was done in the patients with the deficiency of hard tissue using Bio-Oss(R) (Geistlich, Wolhusen, Switzerland) and Bio-Gide(R) (Geistlich, Wolhusen, Switzerland). Second surgery was done in 6 months after implant placement and provisionalization was done for 3 months. Definite abutment was made of titanium abutment with porcelain, gold and zirconia, and was attached after provisionalization. Two-dimensional slices were created to produce sagittal, coronal, axial and 3D by using OnDemand3D (Cybermed, Seoul, Korea). RESULTS: The mean value of bone resorption (distance from top of implant to labial bone) was 1.32 +/- 0.86 mm and the mean thickness of labial bone was 1.91 +/- 0.45 mm. CONCLUSION: It is suggested that the thickness more than 1.91 mm could reduce the amount and incidence of resorption of labial bone in maxillary anterior implant.

The Influence of an Overactive Bladder on Falling: A Study of Females Aged 40 and Older in the Community / 대한배뇨장애요실금학회지

PURPOSE: An overactive bladder (OAB) affects a person's quality of life. Patients who suffer from OAB run to the toilet frequently to prevent incontinence, and this behavior increases their risk of falling and fear of falling. This study evaluated the influence of OAB on falls and concern about falling in females aged 40 and over living in urban and rural communities. METHODS: We conducted a population-based cohort study using King's Health Questionnaire (KHQ), the Korean version of Falls Efficacy Scale-International (KFES-I) and a questionnaire regarding falls, in females aged 40 and over in Guri city and Yangpyeong county. The data from 514 responders were analyzed. The definition of OAB was 'moderately' or 'a lot' of urgency, or urge incontinence in KHQ. Falls was defined as experience of falls in the last year. High fear of falling was defined as a score of 24 or over in KFES-I. The factors were analyzed by the exact chi-square test and Student's t-test. The multivariate logistic regression model was adopted in order to examine the effects of OAB on falls and concern about falling. RESULTS: Of the 514 responders, 98 fitted the criterion of OAB. Eighty-nine (17.3%) of the responders had experienced falls in the last year: twenty-seven (27.5%) in the group with OAB and 62 (14.9%) in the group without OAB. There was a significant association between falls and OAB (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.00 to 3.08; P=0.0485), and between high fear of falling and OAB (OR, 2.72; 95% CI, 1.42 to 5.20; P=0.0024). CONCLUSIONS: Urgency and symptoms of urge incontinence increase the risk of falls in women aged 40 or older in the community. Early diagnosis and proper treatment may prevent falls and improve quality of life in OAB patients.

Bladder Reconstruction Using Bovine Pericardium in a Case of Enterovesical Fistula

The use of graft materials in bladder mucosa has been examined in animal models, but debate exists over which materials are effective. Intestine has been used as a substitute in augmentation cystoplasty for patients with neuropathic bladder, but serious adverse effects of the operation have occurred in some instances. We report a case of a successful repair of an enterovesical fistula by use of bovine pericardium. The patient has remained well for 2.5 years. We suggest that bovine pericardium may be a suitable option as a bladder substitute.

Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy

PURPOSE: The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy. MATERIALS AND METHODS: We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage. RESULTS: Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS. CONCLUSIONS: If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.

Unusual Foreign Bodies in the Urinary Bladder and Urethra Due to Autoerotism / 대한배뇨장애요실금학회지

Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Herein we present 2 cases of self-inserted lower genitourinary foreign bodies with a brief review of the literature.

Urachal Actinomycosis Mimicking a Urachal Tumor

A 26-year-old man presented with lower abdominal discomfort and a palpable mass in the right lower quadrant. An abdominal computed tomography (CT) scan revealed an abdominal wall mass that extended from the dome of the bladder. Fluorine-18 fluorodeoxyglucose (FDG) positron-emission tomography/CT (PET/CT) showed hypermetabolic wall thickening around the bladder dome area that extended to the abdominal wall and hypermetabolic mesenteric infiltration. Differential diagnosis included a urachal tumor with invasion into adjacent organs and chronic inflammatory disease. Partial cystectomy with abdominal wall mass excision was performed, and the final pathologic report was consistent with urachal actinomycosis.

Sinking and fit of abutment of locking taper implant system

STATEMENT OF PROBLEM: Unlike screw-retention type, fixture-abutment retention in Locking taper connection depends on frictional force so it has possibility of abutment to sink. PURPOSE: In this study, Bicon(R) Implant System, one of the conical internal connection implant system, was used with applying loading force to the abutments connected to the fixture. Then the amount of sinking was measured. MATERIAL AND METHODS: 10 Bicon(R) implant fixtures were used. First, the abutment was connected to the fixture with finger force. Then it was tapped with a mallet for 3 times and loads of 20 kg corresponding to masticatory force using loading application instrument were applied successively. The abutment state, slightly connected to the fixture without pressure was considered as a reference length, and every new abutment length was measured after each load's step was added. The amount of abutment sinking (mm) was gained by subtracting the length of abutment-fixture under each loading condition from reference length. RESULTS: It was evident, that the amount of abutment sinking in Bicon(R) Implant System increased as loads were added. When loads of 20 kg were applied more than 5 - 7 times, sinking stopped at 0.45 +/- 0.09 mm. CONCLUSION: Even though locking taper connection type implant shows good adaption to occlusal force, it has potential for abutment sinking as loads are given. When locking taper connection type implant is used, satisfactory loads are recommended for precise abutment location.

Short-term Results of Two-stage Reimplantation Using Antibiotic-loaded Articulating Cement Spacer in Infected Total Knee Arthroplasty

PURPOSE: We reviewed the short-term clinical results of two-stage reimplantation using antibiotic-loaded articulating cement spacer in infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Nineteen consecutive patients (20 knees) with chronic indolent infection after TKA from July, 2004 were treated by two-stage reimplantation using articulating antibiotic spacer and were followed them with a minimum of 18 months. We assessed infecting organism, response of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level following insertion of antibiotic spacer, elapsed time to reimplantation, and duration of parenteral antibiotics therapy. And we also evaluated clinical results using Hospital for Special Surgery (HSS) score, range of motion (ROM) and reinfection rate. RESULTS: The most common was methicillin-resistant staphylococcus epidermidis (8 patients, 53.3%) among the infecting organisms identified in 15 patients. Average ESR and CRP level were 28.9 mm/hr and 3.0 mg/L, each before reimplantation. The elapsed time to reimplantation was 9.7 weeks and the mean duration of parenteral antibiotics was 5.4 weeks. The ROM before spacer insertion was 72.5degrees, increasing to 103.3degrees and HSS score also improved from 47.8 preoperatively to 88.8 without evidence of reinfection at latest follow-up. CONCLUSION: Two-stage reimplantation using articulating antibiotic spacer in infected TKA is thought to be veryeffective surgical option to achieve excellent clinical results through controlling infection and permitting active joint motion.

Radiological Assessment of Component Position and Limb Alignment in Coronal Plane after Total Knee Replacement with Image-free Navigation System

PURPOSE: We compared radiological measurements of component position and limb alignment in the total knee replacement(TKR) using image-free navigation system with those of conventional jig-based TKR. MATERIALS AND METHODS: TKR was performed in 52 knees(Group A) using image-free navigation system(Version 3.0, Stryker orthopedics, Kalamazoo, Michigan) and we compared them with same number of conventional jig-based TKR(Group B) in 43 patients from Mar. 2005 to Feb. 2006 in regard to coronal alignment of femoral(alpha) and tibial(beta) component, and mechanical femorotibial angle(mFTA;omega) on postoperative radiolographs. The differences in measure- ments of each group based on optimum angle and acceptable range(optimum angle+/-2 degrees) were used independent T-test and Pearson chi-square test respectively. The level of significance is less than 0.05 point. RESULTS: Postoperative radiographs for component position revealed the mean alpha angle was 90.0+/-1.3 degrees in group A and 88.7+/-2.2 degrees in group B, mean beta angle was 90.3+/-1.5 degrees in group A and 89.3+/-2.2 degrees in group B. Group A also showed significant difference in coronal alignment(alpha and beta) of components(p=0.001 and p=0.02) based on acceptable range. Long-leg standing view for limb alignment revealed mean mFTA was 1.4+/-1.3 degrees in the group A and 2.9+/-2.0 degrees in the group B(p=0.00). CONCLUSION: Total knee replacement using image-free navigation system revealed better results in coronal alignment of components as well as restoration of limb alignment based on optimum angle and acceptable range.

Results of Arthrodesis in Ankle Arthritis with Deformity / 대한족부족관절학회지

PURPOSE: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. MATERIALS AND METHODS: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. RESULTS: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within 5 degrees valgus in frontal plane and 13 cases within neutral to 5 degrees dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over 5 degrees. Degenerative changes of adjacent joints was seen in 2 patients. CONCLUSION: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.

Results of Arthrodesis in Ankle Arthritis with Deformity / 대한족부족관절학회지

PURPOSE: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. MATERIALS AND METHODS: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. RESULTS: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within 5 degrees valgus in frontal plane and 13 cases within neutral to 5 degrees dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over 5 degrees. Degenerative changes of adjacent joints was seen in 2 patients. CONCLUSION: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.

Results of Surgical Treatment in Schatzker Type VI Tibial Plateau Fracture

PURPOSE: The purpose of this study was to evaluate the factors influencing the results for the treatment of the Schatzker type VI tibial plateau fractures. MATERIALS AND METHODS: Twenty-two cases of the 21 patients in Schatzker type VI tibial plateau fractures were analyzed. Treatment results were analyzed according to the type of fracture (open vs closed), method of operative treatment, angulation more than 5 degree and status of infection. The functional results was evaluated by Hohl's functional criteria. Student t-test was used for the statistical analysis. RESULTS: Functional outcome demonstrated 5 excellent, 8 good, 6 fair and 3 poor results. There was no significant difference in the treatment results between type of fracture, method of operative treatment and status of infection. Among 9 cases with angular deformity of more than 5 degree, 2 showed excellent or good result and 7 showed fair or poor result (p<0.05). There was no significant difference between rate of postoperative infection and the mean period of the clinical bone union (p=0.66). CONCLUSION: Accurate anatomical reduction and rigid fixation is essential for the treatment of Schatzker type VI tibial plateau fractures for the prevention of the angular deformity. And early weight bearing exercise should be controlled for the prevention of loss of reduction and loss of alignment leading to angular deformity.