Behcet's disease (BD) is a chronic inflammatory condition involving several organs, such as skin, mucous membrane, eye, joint, intestine, lung and central nervous system. Ankylosing spondylitis (AS) is a prototype of seronegative spondyloarthropathy, and a chronic systemic inflammatory disorder of the axial skeleton, mainly affecting the sacroiliac joint and spine. In the latter, systemic complications may develop in addition to joint involvement. The coexistence of BD and AS has been rarely reported in the literature. The inclusion of BD among seronegative spondyloarthritides and whether sacroiliitis (SI) develops in BD are still being debated. We describe a 28-year-old man who has fulfilled the diagnostic criteria for BD and AS as well.
Adult ; Angiography ; Anti-Inflammatory Agents/administration +ACY- dosage ; Behcet's Syndrome/drug therapy ; Behcet's Syndrome/diagnosis+ACo- ; Behcet's Syndrome/complications+ACo- ; Case Report ; Drug Therapy, Combination ; Human ; Magnetic Resonance Imaging ; Male ; Spondylitis, Ankylosing/drug therapy ; Spondylitis, Ankylosing/diagnosis+ACo- ; Spondylitis, Ankylosing/complications+ACo- ; Treatment Outcome

OBJECTIVES: This study evaluated the availability of mandibular symphysis corticocancellous block grafts in patients treated for reconstruction of intraoral jaw defects. MATERIALS AND METHODS: 8 patients with mandibular and maxillary bony defects were treated with corticocancellous block of symphysis. The types of defects included 4 pathologic jaw defects and 4 vertical and/or horizontal alveolar deficiencies. The age ranged from 13 to 45 years. Additional treatments such as plate fixation, alloplastic bony substitutes, and/or barrier membrane application were perfomred. They were evaluated for complications and healing of defects. Follow-up period ranged from 6 to 15 months. RESULTS: 2 patients experienced complications such as wound dehiscence and mild resorption of exposed bone. None of the patients needed secondary operation. Paresthesia of lip, chin, and teeth were recovered completely by 6 months postoperatively. Reconstructed wound showed favorable healing and bony consolidation. CONCLUSION: Corticocancellous block of mandibular symphysis can be used for the reconstruction of a variety of intraoral local jaw defects selectively. Advantages were easy fixation of graft, possibility of restoration of original alveolar contour, and decreased donor site morbidity.
Chin ; Follow-Up Studies ; Humans ; Jaw* ; Lip ; Membranes ; Paresthesia ; Tissue Donors ; Tooth ; Transplants ; Wounds and Injuries

Dental Clinics ; Diagnosis ; Female ; Hearing ; Humans ; Mastication ; Middle Aged ; Osteochondroma ; Skeleton ; Temporomandibular Joint ; Trismus

STATEMENT OF PROBLEM: Adequate bone quality and quantity were important to achieve initial stability and to prevent early failures. However there were few published data available regarding the actual effect of dimensional change in implant geometry on initial stability. PURPOSE: The purpose of the current study was to investigate the influence of diameter and length changes on initial stability of implants. MATERIAL AND METHODS: Four types of dummy bone (D1, D2, D3 and D4) consisted of cortical and cancellous layers with different thickness were simulated. Implants which had similar surface area to each other (3.5 x 13.0-mm, 4.0 x 11.5-mm, 4.5 x 10.0-mm, 5.0 x 8.5-mm) were inserted in dummy bones. Implant stability as a function of peak insertion torque and resonance frequency values were recorded for each implant. RESULTS: 1. Bone quality was a major influential factor to achieve initial stability (P < .05). 2. In D1, D2 and D3 dummy bones, implant stability quotient values were not significantly different to each other (P > .05), however insertion torques were increased with wider and shorter implants (P < .05). 3. In D4 dummy bone, implant stability quotient values and insertion torques were decreased with wider and shorter implants (P <. 05). CONCLUSION: From a point of view of initial stability, it is suggested that use of wide and short implant may be helpful in avoiding bone augmentation procedures in area of adequate bone quality.
Torque

PURPOSE: Gastric cancer surgery is a common operation in East Asia, such as Korea and Japan, and there has been a significant increase in the need for this procedure due to the aging population. As a result, surgery for the treatment of gastric cancer for elderly patients is expected to increase. This study examined the effect of old age on gastric cancer surgery, and analyzed the operative risk factors for elderly patients. MATERIALS AND METHODS: From November 2008 to August 2010, 590 patients, who underwent a curative resection for gastric cancers, were enrolled. Patients who underwent palliative or emergency surgery were excluded. A retrospective analysis of the correlation between surgical outcomes and age was performed. The elderly were defined as patients who were over the age of 65 years. RESULTS: The mean age of all patients was 58.3 years, and complications occurred in 87 cases (14.7%). The most common complication was wound infection and severe complications requiring surgical, endoscopic, or radiologic intervention developed in 52 cases (8.8%). The rate of complications increased with increasing age of the patients. Univariate analysis revealed age, comorbidity, extent of resection, operation time, and combined resection to be associated with surgical complications. In particular, age over 75 years old, operation time, and comorbidity were predictive factors in multivariate analysis. In the elderly, only comorbidity was associated with surgical complications. CONCLUSIONS: The patients' age is the most important factor for predicting surgical complications. Surgeons should pay an attention to the performance of gastric cancer surgery on elderly patients. In particular, it must be performed carefully for elderly patients with a comorbidity.
Aged ; Aging ; Comorbidity ; Emergencies ; Far East ; Gastrectomy ; Humans ; Japan ; Korea ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Wound Infection

STUDY DESIGN: The authors retrospectively analysed the recovery of clinical symptoms after surgical treatment of lumbar HIVD. OBJECTIVES: To investigate the incidence of clinical symptoms, the recovery rate and time after surgical treatment and the difference between L4-5 and L5-S1 lesion. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of surgical treatment for the HIVD. They usually describe the result as excellent, good, fair and poor. We can't get any information about the recovery rate and recovery time of each clinical symptom from the reports . MATERIALS AND METHODS: Thirty-eight patients were treated by one level open discectomy from march 1991 to december 1995, The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: In preoperative examination, SLR was positive in 82%, motor deficit in 76%, sensory deficit in 74%, DTR change in 50%, and radiating pain in 100%. The recovery rate of SLR was 96.8%, motor deficit ; 93.6%, sensory deficit ,78.6%, DTR change ; 21% and radiating pain ,84.2%. The average recovery time of SLR was 3.4 months, motor deficit ; 1.9 months, sensory deficit ; 5.3 months, DTR change ; 4.1 months and radiating pain ; 3.2 months. Motor and sensory deficit was more frequent in L4-5 lesion but DTR change was usually noted in L5-S1 lesion. The recovery rate and time showed no great difference between the two level. CONCLUSIONS: The recovery rate was higher in SLR, motor deficit and radiating pain rather than sensory deficit and DTR change. The recovery time was fastest in radiating pain but variable nature was noted in sensory deficit. Above results may be helpful to explain the prognosis of the lumbar HIVD.
Diskectomy ; Humans ; Incidence ; Prognosis ; Retrospective Studies

Krukenberg tumor is comparatively rate in metastatic ovarian tumor and is almost metastasized from gastrointestinal tract. We have experienced one case of tumor of unidentified primary focus and two coases of metastatic Krukenberg tmor from stomach and report this cases with a brief review of literatures.
Gastrointestinal Tract ; Krukenberg Tumor* ; Stomach

PURPOSE: We analyzed the oncologic characteristics and outcome of patients with inflammatory myofibroblastic tumor of extremities. MATERIALS AND METHODS: Among the soft tissue tumor patients who were treated between 1999 and 2012, 5 patients who were pathologically confirmed as the inflammatory myofibroblastic tumor of extremities were analyzed retrospectively. RESULTS: There were 1 man and 4 women with mean age of 44 years (37-55 years). The average follow up was 34.6 months (8-87 months). All patients underwent surgical treatment. Only 1 patient had wide resection margin and remaining 4 had marginal (3) or intralesional (1) resection margin. All of 4 patients without wide resection margin developed local recurrence at 10.3 months (8-19 months). Malignant transformation to fibrosarcoma was occurred in 2 patients who developed local recurrence, and 1 patient developed multiple metastases to lung, liver and lymph nodes and expired at 37 months. Three of 5 patients had tumor location abutted to or invasion to major arteries and 1 patient had tumor invading sciatic nerve. CONCLUSION: It is observed that inflammatory myofibroblastic tumor of extremities is usually located near the major neurovascular structure. Wide resection should be considered as the initial surgical treatment because this tumor showed a high local recurrence rate and possibility of malignant transformation.
Arteries ; Extremities ; Female ; Fibrosarcoma ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Myofibroblasts ; Neoplasm Metastasis ; Recurrence

The changes of arterial carbon dioxide partial pressure considerably influence cerebral blood flow and different anesthetic agents have different effects on cerebrovascular physiology. However the importance of these differences in neuroanesthetic practice are unclear. Transcranial Doppler ultrasonography allows the noninvasive direct measurements of cerebral blood flow velocity and direction in the basal brain arteries. The authors performed transcranial Doppler ultrasonography to measure the blood flow velocity of middle cerebral artery in 12 patients who were anesthetized with 10 mcg/kg of fentanyl and 66 % nitrous oxide in oxygen(fentanyl group) and 12 patients with 1.0 vo1% isoflurane and 66 % nitrous oxide in oxygen(isoflurane group) during normocapnia(P(ET)CO(2)=38 mmHg) and hypocapnia(P(ET)CO(2)=28 mmHg)state. The carbon dioxide reactivity was expressed as the changes in mean blood flow velocity per unit changes in endtidal carbon dioxide partial pressure(P(ET)CO(2)). Mean blood flow velocity of middle cerebral artery decreased from 46.6+/-8.9 cm/s to 30.0+/-5.3 cm/s in the fentanyl group and 42.7+/-5.6 cm/s to 32.5+/-4.6 cm/s in the isoflurane group as the P(ET)CO(2) decreased from 38 mmHg to 28 mmHg. There was a significant difference between the CO2 reactivity of fentanyl group(1.7+/-0.7 cm/s/mmHg) and isoflurane group(1,0+/-0,2 cm/s/mmHg) (p<0.05). It is concluded that hyperventilation is more likely to affect cerebral blood flow during fentanyl-nitrous oxide anesthesia than during isoflurane-nitrous oxide anesthesia.
Anesthesia ; Anesthetics ; Arteries ; Blood Flow Velocity ; Brain ; Carbon Dioxide ; Fentanyl* ; Humans ; Hyperventilation ; Isoflurane* ; Middle Cerebral Artery ; Nitrous Oxide ; Partial Pressure ; Physiology ; Ultrasonography, Doppler, Transcranial

PURPOSE: The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure. MATERIALS AND METHODS: From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases. RESULTS: Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group. CONCLUSIONS: Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.
Cosmetics ; Gastrectomy ; Gastroenterostomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Pain, Postoperative ; Stomach Neoplasms