After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.
Head* ; Humeral Fractures ; Humerus* ; Incidence ; Intra-Articular Fractures ; Surgeons ; Ulnar Nerve*

Fractures of the acetabulum are relatively uncommon. But if fractures of the acetubulum are not accurately evaluated, classified, and reduced anatomically, major sequalae and complications are frequently developed. Because of complicated anatomy, difficulty with surgical exposure, severe comminution, and major associated injuries, the treatment of displaced acetabular fractures between conservative and operative methods is still controversial. We reviewed thirty five cases of displaced acetabular fracture treated operaively from January 1984 to December 1991. The prevalent age was the fourth decade. There was twenty seven cases of associated injuries, twenty two dislocations of the hip. According to the Letournel's classification, the most common fracture type was posterior wall and both column type. The fracture was fixed internally with only screws in thirteen cases and with plate and screws in twenty two cases. Among thirty five patients, five patients were lost in the follow up and another five patients had followed up lesser than one year. The mean duration of follow-up afrer the operation was three years (range, one to eight years). Among twenty five patients who had followed up more than one year, the satisfactory results were achieved in nineteen patients (76%) and the poor results were achieved in three patients (8%). The complications were post-traumatic arthritis, avascular necrosis of femoral head, osteomyelitis in iliac bone, skin necrosis, and heterotopic ossification.
Acetabulum ; Arthritis ; Classification ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Ossification, Heterotopic ; Osteomyelitis ; Skin

No abstract available.
Hyperostosis, Cortical, Congenital*

BACKGROUND: Generalized aggressive periodontitis (GAP) is a destructive periodontal disease that can develop in young age. Only a few cases of full mouth rehabilitation, using dental implants, have been reported in a patient with aggressive periodontitis. CASE DESCRIPTION: This clinical report describes the treatment procedures and results of full mouth rehabilitation in a patient with aggressive periodontitis. After all teeth were extracted, 6 implants were placed in the maxilla and mandible, respectively. Fixed detachable implant prostheses were made. The patient was satisfied with the final results. She was followed for 10 months postloading. CLINICAL IMPLICATION: For a long-term success, continuous maintenance care is critical, as the contributing factors of the disease (such as immune factors or periodontal pathogens) may not be controlled adequately.
Aggressive Periodontitis ; Dental Implants ; Humans ; Immunologic Factors ; Mandible ; Maxilla ; Mouth ; Mouth Rehabilitation ; Periodontal Diseases ; Prostheses and Implants ; Tooth

BACKGROUNDS/AIMS: Prognostic factors for colorectal cancer with hepatic metastasis are not well-established. We investigated the factors that predicted survival following surgical resection of hepatic metastases in patients with colorectal cancer. METHODS: Fifty-three patients underwent resection of hepatic metastases of colorectal cancer between January 2000 and December 2005, with follow-up periods that ranged from 3 to 119 months. In this retrospective study, the effects of sex, age, type of hepatic resection, T stage and N stage of the primary cancer, number and size of metastatic hepatic tumors, synchronicity or metachronicity of the liver metastases, surgical resection margins, and preoperative carcinoembryonic antigen (CEA) levels on 1-year and 3-year survival were analyzed using the Kaplan-Meier method and the log rank test. RESULTS: Median survival was 39.9 months and the 3-year survival rate was 62.2%. Twenty patients died during the follow-up period of 3 to 119 months (mean, 48.8+/-34.24). In univariate analysis, only the surgical margin of the hepatic metastasis resection correlated significantly with 3-year survival. Sex, age, T stage and N stage of the primary cancer, synchronicity or metachronicity of the metastases, number and size of hepatic metastases, type of hepatic resection and preoperative CEA levels did not predict long-term outcome. CONCLUSIONS: Hepatic resection provides a safe and effective treatment in patients with hepatic metastasis from colorectal cancer. In this study, only the surgical resection margin of the hepatic metastasis of colorectal cancer significantly predicted survival.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Liver ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate

This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea’s unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.

Background: Recognizing the seriousness of the misuse and abuse of medical narcotics, the South Korean government introduced the world's first narcotic management system, the Narcotics Information Management System (NIMS). This study aimed to explore the recent one-year opioid prescribing patterns in South Korea using the NIMS database. Methods: This study analyzed opioid prescription records in South Korea for the year 2022, utilizing the dispensing/ administration dataset provided by NIMS. Public data from the Korean Statistical Information Service were also utilized to explore prescription trends over the past four years. The examination covered 16 different opioid analgesics, assessed by the total number of units prescribed based on routes of administration, type of institutions, and patients’ sex and age group. Additionally, the disposal rate for each ingredient was computed. Results: In total, 206,941 records of 87,792,968 opioid analgesic units were analyzed. Recently, the overall quantity of prescribed opioid analgesic units has remained relatively stable. The most prescribed ingredient was oral oxycodone, followed by tapentadol and sublingual fentanyl. Tertiary hospitals had the highest number of dispensed units (49.4%), followed by community pharmacies (40.2%). The highest number of prescribed units was attributed to male patients in their 60s. The disposal rates of the oral and transdermal formulations were less than 0.1%. Conclusions Opioid prescription in South Korea features a high proportion of oral formulations, tertiary hospital administration, pharmacy dispensing, and elderly patients. Sustained education and surveillance of patients and healthcare providers is required.

Accurate estimation of the exposure-response relationship between ambient urban particulate matters (PM) and public health is important for regulatory perspective of ambient urban particulate matters (PM). Ambient PM contains various transition metals and organic compounds. PM10 (aerodynamic diameter less than 10 microgram) is known to induce diverse diseases such as chronic cough, bronchitis, chest illness, etc. However, recent evaluation of PM2.5 (aerodynamic diameter less than 2.5 microgram) against health outcomes has suggested that the fine particles may be more closely associated with adverse respiratory health effects than particles of larger size. This study was performed to evaluate PM2.5-induced oxidative stress in rat lung epithelial cell in order to provide basic data for the risk assessment of PM2.5. PM2.5 showed higher cytotoxicity than PM10. Also, PM 2.5 induced more malondialdehyde (MDA) formation than PM10. In Hoechst 33258 dye staining and DNA fragmentation assay, apopotic changes were clearly detected in PM2.5 treated cells in compared to PM10. Expression of catalase mRNA was increased by PM2.5 rather than PM10. PM2.5 induced higher Mth1 mRNA than PM10. In pBR322 DNA treated with PM2.5, production of single strand breakage of DNA was higher than that of PM10. In Western blot analysis, PM2.5 induced more Nrf-2 protein, associated with diverse transcriptional and anti-oxidative stress enzymes, compared to PM10. Our data suggest that PM2.5 rather than PM10 may be responsible for PM-induced toxicity. Additional efforts are needed to establish the environmental standard of PM2.5.
Air Pollutants/chemistry/*toxicity ; Animals ; Apoptosis/physiology ; Benzimidazoles/metabolism ; Blotting, Western ; Cell Line ; Cell Survival/physiology ; DNA Fragmentation/physiology ; DNA Repair Enzymes/genetics/metabolism ; DNA-Binding Proteins/metabolism ; Epithelial Cells/drug effects/enzymology/pathology ; Formazans/metabolism ; GA-Binding Protein Transcription Factor ; Lipid Peroxides/metabolism ; Lung Diseases/*chemically induced/enzymology/pathology ; Oxidative Stress/*physiology ; RNA, Messenger/chemistry/genetics ; Rats ; Reverse Transcriptase Polymerase Chain Reaction ; Tetrazolium Salts/metabolism ; Transcription Factors/metabolism

Background: We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). Methods: We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. Results: Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. Conclusions MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Purpose: The opacity of zirconia sometimes requires a veneering material; thus lithium disilicate, a veneer material with excellent strength, can be used. This study investigated the fracture resistance of zirconia–lithium disilicate (Zr-LS2) bi-layered crowns according to the design of the substructure. Materials and Methods: Five groups of posterior Zr-LS2 restorations (Zirtooth and Amber LiSi-POZ) were fabricated with different zirconia substructure coverage (control group, groups half occlusal zirconia coverage; 1/2OZ, and three-quarter occlusal zirconia coverage; 3/4OZ) and margin designs (control group, groups collar margin; C-M, and collarless margin; Cl-M). All restorations were cemented with self-adhesive resin cement followed by 24-h water storage and thermocycling (10,000 cycles, 5°C and 55°C). The fracture load was measured, and failure mode analysis, fractography, and elemental analysis were performed. The one-way analysis of variance and Fisher’s exact test were performed for statistical analyses (α=.05). Results: A significant difference was found in the fracture load of Zr-LS2 restorations according to the zirconia coverage of the occlusal area and margin design (P<.05). Group 3/4OZ was significantly larger than the control group C and 1/2OZ (P<.05). The C-M group had greater fracture loads based on margin design than the control group C and Cl-M (P<.05). Conclusion The fracture resistance of posterior Zr-LS2 restorations increased with the zirconia coverage, occlusal thickness, and collar margin.