1. MOBILE- VS. FIXED-BEARING TOTAL KNEE ARTHROPLASTY
Tuvshinjargal B ; Dashtsogt S ; Choidog O ; Enkhtaivan N ; Temuulen M ; Otgonbayar M
Journal of Surgery 2016;20(2):78-82
Introduction: The theory that usingmobile bearing (MB) design for total kneereplacementsurgeries can reduce the riskof tibial component loosening compared tofixed-bearing (FB) designs is still unclear.Arthroplastic surgeries developed rapidlywithin recent 10 years, but there is no similarstudy performed yet. This randomized studyinvestigated the impact of prosthesis design toloosening of components at 2 years for totalknee replacement surgeries.Materials and Methods: 479 patientswho underwent total knee arthroplastyin FirstCentral Hospital of Mongolia were allocated toeither FB or MB tibialarticulation.We comparedour results to similar studies which performedabroad due to there is no such a studyperformed before in Mongolia.Results: There is no significant differenceby age, sex, weight, height, body mass index,operation side (right or left) in both groups.Pre- and postoperative range of motionwasalmostsame for MB and FB groups.Butloosening complication was higher for the FBgroup (1.16%) than MB group (0%).Conclusion: Using MB design for total kneearthroplasty has less loosening complicationthan using FB design in Mongolians. Bonemineral density (dual energy absorptiometry)and radiostereometric analysis are necessaryfor widening studies in field of total kneereplacement surgeries in the future.
2. ANTICOAGULANT TREATMENT OUTCOMES FOLLOWING ARTIFICIAL JOINT REPLACEMENT SURGERY
Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М
Journal of Surgery 2016;19(1):41-43
Introduction: Orthopedic surgery is a highrisk of surgical formation of thromboemboliccomplications.Many researchers are exploringprevent surgical complications.Anticoagulanttreatment is the first choice to preventthromboembolic complications.Artificial jointreplacement surgery has been made in 2008,in National First Central Hospitals (NFCH).Wehave not guideline of anticoagulant treatmentafter surgery and have not principle of choisefollow-drug treatment and unclear testingschedule to monitor anticoagulant treatment,that has become the basis for this study. Westudied by comparing a comparative benefitfor anticoagulant treatment of unfractionatedand low molecular weight heparin results.And studied thromboembolic complications,monitoring test of anticoagulant treatment,fatal bleeding, changes hemostasis ofanticoagulant therapy in both groups. Thesurvey results in practice is doing researchaims to introduce and review the results of thelong-term results.Materials and Methods: Included in thesurvey about 1,400 patients, who had kneeand hip replacement surgery in 2008-2016, inJoint Center of NFCH. All patients are dividedin three group. The first group is control group,do not use anticoagulation treatment, in thesecond group used unfractionated heparin andin the third group used low-molecular-weightheparin.Each group studied comparativewhether thromboembolic complications anddeath caused by thromboembolic, fatalbleeding.Between surgical complication andanticoagulant therapy relationship to investigatethe relationship the correlation is likely trueof 95%. Caused by other thromboemboliccomplications detected cases were removedfrom the study.Results: Control groups has not hospitalmortality, but has 3 cases of sudden death ina after discharge.Hemostasis is longer (INR1,3-1,5) in the second group. There hospitalmortality occurred in 1 (cardiac infarction),and thromboembolic complications 1 (arterialthrombosis in the jugular) in the third group.Low molecular weight heparin are no changeshemostasis, it is strongly dependent (r=0,8).Also in this group there is no fatal bleeding.Conclusions: Orthopedic surgery isnecessary for prevention of thromboemboliccomplications are showing from in controlgroup has sudden death.2 groups have not fatalbleeding when used heparin in normal doses.Other countries researchers conclude lowmolecular-weight-heparin is more effectivethan unfractionated heparin, our study is notvisible correlation reliability.When used lowmolecularweight heparin, hemostasis is notchanged is showing a strong dependence.
3. FEMORAL NECK FRACTURE SURGERY TREATMENT OPTIONS
Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М
Journal of Surgery 2016;19(1):49-52
Introduction: We performed more than1200 arthroplasty surgeries at National FirstCentral Hospitalfrom 2008, so we haveour surgical technique and experiences.Thepurpose of this study is to assess our surgicalresults and complications after surgery forfemoral neck fracture made in Joint Center,National First Central Hospital, and tocomparingsimilar studies in other countries,and to develop the best optionsurgicaltherapy.Materials and Methods: Between 2008-2015, hip replacement surgery accountedatotal of 168 cases, that was 13.9% allof replacement surgery. A retrospectiveanalysis of patient database based onhospital discharge data and medical recordswas performed. The medical records ofthese patients were reviewed to confirmthe presence of a surgical site infection asdescribed by the Centers for Disease Control(CDC)/NNIS guidelines.Results: Between 2008-2015, in theJoint Center,National First Central Hospital,are seeing increasing number of patientswith hip replacement surgery each year.The cause for hip replacement surgery isaseptic necrosis (42%), at second is femoralneck fractures (22%). Joint Center,NationalFirst Central Hospital currently not providedemergency trauma care center. Therefore,younger patient with femoral neck fracturewas not to happen duringresearch. Olderthan 60 year patients with osteoporosis and,in some cases with nonunion, was doneforhip replacement surgery. The averageage of 75.7 (61-87).Bipolar hip arthroplastywas 14 cases all of 36 patients with femoralneck fracture.9 (5,31%), complications ariseall of hip replacement surgery (168 cases).Including: Infection - 1 (0.59%), sliding - 1(0.59%), dislocation - 2 (1.78%), fracture- 2 (1,18%), nerve injury - 2 (1,18%) andpostoperative mortality - 1 (0.59%).Conclusion: Internal Fixation- for patientage under 60 andgood bone quality. Thatoperation complication is femoral headnecrosis, not healing /nonunion/ delivery ofa lot of research that shows focus. Further,most surgery for femoral neck fracture is hipreplacement that is expected to be widelyavailable.
4. STUDY OF POSTOPERATIVE INFECTIOUS COMPLICATION IN JOINT CENTER OF NATIONAL FIRST CENTRAL HOSPITAL
Dasgtsogt S ; Temuulen М ; Tuvshinjargal B ; Choidog О ; Zolboo E ; Enkhtaivan M ; Otgonbayar М
Journal of Surgery 2016;19(1):53-56
Introduction: Artificial joint replacementsurgery started in 2008, in Joint centerof National First Central Hospital. Hasexperienced a variety of post-surgicalcomplications.Postoperative infectiouscomplications, prevent and investigate thecauses of the research is carried out todetermine whether the opportunity.Materials and Methods: Facilitiesrandomly selected cases difficult patientswith postoperative septic, and analyzedby descriptive method. In all cases,Bacteriological analysis of the clinicallaboratory department of joint fluidsamples received. We determined artificialjoints causes of postoperative infectiouscomplications and artificial joints determinethe factors of postoperative infectiouscomplications. Calculate the treatment ofinfectious complications.Results: Since 2008, done a total1200 with an artificial joint replacementsurgery. Each year, a surgical number isincreasing. 82% of all cases were kneeartificial joint replacement surgery and18% were hip artificial joint replacementsurgery. There are 20 cases of postoperativeinfectious complications.Most suppurativecomplications (14 cases, 70%) are earlycomplications, that directly related to thesurgery and hospital infections are likelyto be. Pathogenic bacterial samples weredetected 10 cases. An assay blanks dependon laboratory capacity and the number ofsamples. Open surgery is 83,3% effective,when early infectious period. No mortalitydue to infectious complications in our center.Conclusion: The main reason of thepostoperative infectious complications ofartificial joint surgery is S. Aureus (99%).14 cases (70%) of all postoperativecomplications are early complications, thatdirectly related to the surgery and hospitalinfections are likely to be. The main factorsaffecting disinfection of the surgical roomand trauma.
5. AUTO BONE GRAFT FOR BONE DEFECTS OF THE MEDIAL TIBIA DURING PRIMARY TOTAL KNEE ARTHROPLASTY
Choidog O ; Dashtsogt S ; Temuulen M ; Tuvshinjargal B ; Enhtaivan N ; Zolboo M ; Otgonbayar M
Journal of Surgery 2016;20(2):83-86
joints with severe defects of the medialtibia usually progress as varus or valgusdeformities, with daily functional handicapssuch as, limping, aches and instability. Duringthe last seven years, in total 1200 knees ofpatients were treated by both bilateral andunilateral total knee arthroplasty in the Jointcenter of National First Central Hospital. Thisresearch shed a light on patients that weretreated by unilateral total knee arthroplastyto correct large defects of tibia.Materials and Methods: The objectiveof this paper is to compare patients whowere treated with auto bone graft withpatients who were treated without auto bonegraft, in order to assess the effectiveness ofthe auto bone graft technique through theretrospective method.Results: The unilateral total kneearthroplasty was operated on 553 patients,30 (5,42%) of whom were treated withautobone graft and 523(94,58%) of whomwere treated without the auto bone graft.Postoperative complication was observed in3 cases (9,9%) among the first group ofpatients, and in 25 cases (4,5%) amongthe second group of patients. As patients,diagnosed with osteoarthrotic knees withsevere tibial bone defects, were treatedthrough the auto bone graft, it could beconcluded that more complications wereobserved on patients with large tibialbone losses. However, no complicationwas observed in other 27 cases that weretreated with the bone graft during the postoperativefollow-up period ranged fromtwelve to eighty four months.Conclusion: In conclusion, total kneearthroplasty using auto bone graft forpatients with severe tibial bone defects iseconomically as well as clinically effectivetechnique for our country.
6.The detection of trichomonas vaginalis by cytological stained tests
Bayarmaa E ; Bayarhishig CH ; Enkhzul B ; Giimaa N ; Temuulen D ; Kyung Il Im
Mongolian Medical Sciences 2012;161(3):8-10
Background: One of the confronted problems of doctors and medical personnels is sexually transmitted disease has not been decreased in our country up to now. By last 5 years propagation of trichomoniasis was 16.7-9.5% per 10000 population and infected T.vaginalis. In the practice of parasitology of our country metilen is revealed by gram method hasn’t been introduced which is used in up to date histological analyse. This became the background of our research work. Aim of our research is to diagnose trichomoniasis which infects sexually by cytological analyse and to define its specific and sensibility.Materials and Methods: A total 99 smears of 33 females aged 19-39, used cross sectional descriptive method. Finding T.vaginalis on specimens (1) Vaginal wet mount, (2) Gram staining and (3) Pap stain. Result: In our research T.vaginalis leaked out in wet mount smear was 33%, in Gram stain was (21.2%). The sensibility quality of T.vaginalis on Gram stain is 63%, specific quality is 90%, value of kappa coefficient (К=0.58 Р<0.002). In Pap stain T.vaginalis diagnosed 27,2% and sensibility quality of T.vaginalis is 81%, specific quality is 100%, value of kappa coefficient (К=0.87 Р<0.005). In the case when 3 analysis were positive case was 5 or 15.2%, in the case where 2 analysis were positive case was 6 or 18.2%. Conclusions: The Pap stain sensibility quality of T.vaginalis is 81%, specific quality is 100%, value of kappa coefficient (К=0.87 Р<0.005), that shows should be to give effect on diagnosing of sexually transmitted infectious disease.
7.ЭХЭМҮТ-Н ХЗП-Н СОНСГОЛ ЗАСЛЫН КАБИНЕТААР ҮЙЛЧЛҮҮЛСЭН ГАДНА ЧИХНИЙ ГАЖ ХӨГЖИЛТЭЙ ХҮҮХДҮҮДИЙН ХЯНАЛТЫН СУДАЛГААНЫ ЗАРИМ ҮР ДҮН
Ariuntuya D ; Zolzaya Ts ; Enkhtunsag B ; Temuulen B
Innovation 2018;12(3):18-21
BACKGROUND: Microtia is often associated with hearing loss and patients typically
require treatment for hearing impairment and surgical ear reconstruction. The
occurrence of microtia is of public health importance in part due to the psychosocial
sequelae, including the stigma associated with malformations of the ear and the burden
of undergoing multiple surgeries
In addition, greater than 90% of individuals with microtia experience conductive hearing
loss on the affected side. Although children with microtia-anotia are at a greater risk of
delayed language development and attention deficit disorders.
METHODS: Our study has a 173 childrens from the UB city and countryside. 23 children
has a bilateral microtia and anotia. 6 patient wearing BAHA soft band from 6 months
age. 150 patients have an unilateral microtia. Microtia was found more commonly in
males, unilateral and right sided. Even children with bilateral microtia may have wearing
BAHA soft band before 6 months age.
RESULTS: External ear malformations are more commonly found in males. Sex ratio 2:1.
From other studies right ear malformations are more common in male children. In our
study children who have bilateral ear abnormalities wearing BAHA softband and
language therapy from 6 months age to able to have normal language development.
Children who had surgical treatment and using hearing aid can have normal social life
and increased quality of life.
CONCLUSION: Early screening in children who have external ear malformation,
monitoring language development, wearing BAHA softband from 2 months age who
have bilateral ear malformation and one ear affected other one is normal children
wear BAHA softband increases children speech and language development.
8.ADULT ORTHODONTICS WITH DAHL TECHNIQUE FOR BETTERFUNCTION AND AESTHETICS
Bilgee J ; Gantsetseg L ; Enkhjargal N ; Khorolbayar Sh ; Temuulen B ; Orkhon B ; Urjinlkham J
Innovation 2018;12(4):40-44
BACKGROUND. The Dahl Concept refers to the relative axial tooth movement that is observed when a localized restorations are placed in supra-occlusion in dental hard tissue worn anterior area and posterior full arch occlusal contacts re-establishes over a period of time irrespective of age and gender. The literature reports that the objectives of the Dahl concept are achieved in the majority of cases (94%-100%). Some minor and transient adverse events, such as initial difficulty with mastication could develop. If dental arch is crowded and some of the teeth are pushed away, they tends to be pushed more even they were visually aligned by a heavy preparation under the ceramic restorations such as crowns and veneers. To avoid these costly and teeth-harmful treatment options for patients with anterior crowding and who wants straighter and beautiful looking teeth, we use a conservative approach of Align+Bleach+Bonding technique.
MATEREALS AND METHOD. For tooth alignment we used Inman Aligner, Clear Aligner and Clear Smile Braces (fixed ceramic braces with super elastic Ni-Ti wires) or their combination. After short orthodontics a Dahl concept was applied to improve patients’ functional occlusion and anterior guidance. A “free-hand” and “no-any-drill” composite restoration technique was used to restore worn anterior teeth. For proper orthodontic diagnosis, assessment and treatment planning Spacewise analysis and Digital Caliper measurement were performed using models, their digital scans and intra/extraoral photos. We use Inman Orthodontic Lab in Florida for Inman Aligner fabrication and IAS Laboratory in London for Clear smile braces set up. Clear aligners (Scheu Dental, Germany) are planned and fabricated at the Digital Dental Office’s Clear Aligner certified laboratory. All treatments are start only after thorough diagnostic analysis, case discussion and acceptance from technical experts and orthodontists from UK, USA and Germany and acceptance of planned results from the patients. A course of home bleaching was then performed followed by resin bonding of anterior teeth edges to stabilize anterior guidance.
RESULTS. More than 200 cases of upper and lower anterior crowding have been treated in comparably short period of time. From those we are introducing 3 different cases which were treated using above mentioned three appliances as an example. Average orthodontic treatment lasted 8-16 weeks depending on degree of crowding and type of appliances used. The arch crowding were less than 4 mm in all of them. No any teeth were extracted. After orthodontic treatment patients had double retentions (fixed+clear retainers). Dahl concept was performed in patients with anterior attrition and few patients experienced minor difficulty with chewing for their first week only. To control results of molar extrusion we measured space between occlusal surfaces of opposing molars in the SAM 3 articulator positioned in the centric relation.
CONCLUSION. In order to get a long term proper stability of dento-facial function with a bonus of beautiful smile the concept of keeping own teeth and its structure became essential in cosmetic and restorative dentistry. The good thing of Dahl technique is its simplicity if it is done properly and its cost effectiveness. And as it was described the edge bonding itself could be a permanent retainer which prevents a future relapse in ortho-aligned teeth. Moreover patients were highly satisfied due to fast alignment, opportunity of keeping their teeth untouched and getting aesthetically pleasant result with a stable function.