No abstract available.
Crohn Disease*

We tested the hypothesis that the extent of necrosis at the initial MRI predicts the subsequent risk of collapse of the femoral head in a randomized clinical trial conducted to compare the core decompression to the conservative treatment. After the initial clinical evaluation including plain roentgenography and MRI, 37 hips of early-stage osteonecrosis (ON) in 33 patients were randomly assigned to core decompression group or conservative treatment group. All the patients were regularly followed by clinical evaluation including plain roentgenography and MRI at three-month intervals. The extent of ON was estimated on the basis of the percentage of abnormal signal intensity in the weight-bearing portion of the femoral head as determined on a combination in coronal aod sagittal MR images. The angle of necrotic portion in mid-coronal image (A) and that in mid-sagittal image (B) were used to quantify the extent of necrotic portion by the formula; (A/180) x (B/180) x 100%. A strong association was observed between the percentage of necrotic portion and the development of collapse. We concluded that the extent of necrotic portion is a major risk factor of the collapse and proposed a systematic method of classifying the percentage of necrotic portion, which might be useful as a predictive index for the fate of early-stage ON.
Classification* ; Decompression ; Head* ; Hip ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Osteonecrosis* ; Radiography ; Risk Factors ; Weight-Bearing

Purpose: There are many studies on the indications and efficacy of splint therapy commonly used in patients with temporomandibular disorders (TMD). However, there have been no studies on the splint weaning in terms of the splint use tapering period in relation to symptom improvement of TMD. This retrospective study aims to analyze a proper splint weaning method in patients with TMD based on symptom improvement. Materials and Methods: The authors examined 130 TMD patients with TMJ disorders, masticatory muscle disorders, and clenching/bruxism who had received splint therapy (occlusion stabilization splint, anterior positioning splint) of patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital from 2015 to 2020. They were evaluated according to the method to wean splints. Results: The mean splint therapy period was 29.0 months, during which patients wore splints 7 days a week for 8.4 months, 3 - 4 days a week for 9.5 months, and finally 1 - 2 days a week for 11.1 months (a total of 29.0 months, about 2.5 years). Conclusion It seems that TMD symptoms can be alleviated and side effects such as occlusal change can be minimized if patients wear a splint 7 days a week for the first 6 months, followed by 3 - 4 days a week for the next 6 to 18 months, and finally 1 - 2 days a week after 18 months.

No abstract available.
Angiomyolipoma* ; Tuberous Sclerosis*

PURPOSE: The aim of this study was to determine the force distribution and pattern of mastication after injection of botulinum toxin type A (BTX-A) into both masseter muscles. The hypothesis to be tested was that the difference between right and left balance of occlusal force diminishes over time following BTX-A injection. MATERIALS AND METHODS: Fifteen patients were submitted to BTX-A injection therapy for subjective masseter hypertrophy. A total of 25 U of BTX-A (50 U in total) was injected into two points located 1 cm apart at the center of the lower one-third of both masseter muscles. All patients were examined using the T-Scan occlusion analysis system before and 4, 8, 12, and 24 weeks after BTX-A injection. RESULTS: A significant change in force balance was found between the right and left sides over time and the difference between the two sides decreased with the time post-injection, reaching a minimum at 12 weeks. Comparison of the force balance between the anterior and posterior occlusions revealed no significant difference at any of the time points. The occlusion and disclusion times (right and left sides) did not differ significantly with time since BTX-A injection. CONCLUSION: A decline in the difference in the clenching force between the left and right sides was found with increasing time up to 12 weeks following BTX-A injection.
*Bite Force ; Botulinum Toxins, Type A/administration & dosage/*pharmacology/therapeutic use ; Female ; Humans ; Hypertrophy/drug therapy ; Injections ; Male ; Masseter Muscle/abnormalities/drug effects ; Neuromuscular Agents/administration & dosage/*pharmacology/therapeutic use

PURPOSE: In advanced case of periodontitis, surgical treatment without bone contouring may result in residual pockets inaccessible to proper cleaning during post-treatment maintenance. This problem can be avoided or reduced by applying guided tissue regeneration. MATERIALS AND METHODS: All of 3 patients had deep periodontal pocket depth and bleeding on probing, and radiograph revealed osseous defect, so we planned guided tissue regeneration using resorbable membrane with or without xenograft. RESULT: 6 months later, periodontal pocket depth and bleeding on probing was improved and gingiva was stable. CONCLUSION: Guided tissue regeneration using resorbable membrane with or without xenograft in osseous defect is predictable.
Gingiva ; Guided Tissue Regeneration ; Hemorrhage ; Humans ; Membranes ; Periodontal Pocket ; Periodontitis ; Transplantation, Heterologous

PURPOSE: The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.
Adenocarcinoma ; Breast Neoplasms ; Colon ; Colorectal Neoplasms ; Drainage ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mesentery ; Methylene Blue ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Rectum

INTRODUCTIONThis study was conducted to provide an overview of the community-based hypertension and diabetes control programme of 19 cities in Korea and to evaluate its effectiveness in controlling hypertension at the community level.

MATERIALS AND METHODSIn this longitudinal observational study, we analysed the data of 117,264 hypertensive patients aged ≥65 years old from the time of their first enrolment in July 2012 to October 2013 (up to their 2-year follow-up).

RESULTSThe hypertension control rate of 72.5% at the time of enrolment increased to 81.3% and 82.4% at 1 and 2 years after enrolment. Treatment continuity, completion of hypertension self-management education, and longer enrolment duration in the programme contributed to improvements in hypertension control rate.

CONCLUSIONThis programme was characterised by a public health-clinical partnership at the community level. Despite its simplicity, the programme was evaluated as a successful attempt to control hypertension among patients aged >65 years at the community level.

Aged ; Community Networks ; Humans ; Hypertension ; drug therapy ; Longitudinal Studies ; Patient Education as Topic ; Program Evaluation ; Republic of Korea ; Self Care

BACKGROUND: Adequate exposure of skull base lesion and intraoral lesion occupying the posterior oral cavity, base of tongue, tonsil, superior hypopharynx, anterior skull base, and infratemporal space for wide-field primary surgical resection is critical to tumor ablation. The division of mandible for resection of tumor was first undertaken by Roux in 1836, and many studies renewed the interest of mandible sparing procedure for surgical treatment of oropharyngeal carcinoma. OBJECTIVES: Mandibular swing approach for gaining access to oral cavity, oropharynx, and skull base for excision of tumor, provides excellent exposure with low complication rate when there is intervening grossly normal tissue between the tumor and bone. We studied mandibular swing approach with our surgical experience, with special emphasis on its subtypes related to osteotomy sites and forms. MATERIALS AND METHOD: The records of 20 patients underwent mandibular swing approach at Hanyang University Hospital, were studied by chart review. The patients were retrospectively reviewed to assess age, sex, tumor site origin, stage of disease, types of neck dissection and methods of the reconstruction, types of the mandibular osteotomies, and difference of complication rates between symphyseal and parasymphyseal osteotomy. RESULTS: Post-operative complications occured in 6 patients(30%). But osteotomy related complication rate was 15%. Complications of osteotomy site occurred at a rate of 20% in the symphyseal osteotomy group, but no complications arose in parasymphyseal osteotomy group. CONCLUSIONS: We believe that, if the mandible is clinically and radiologically clear of malignant involvement, midline mandibulotomy is more feasible surgical approach method for treatment of oral cavity, oropharyngeal, skull base lesion.
Humans ; Hypopharynx ; Mandible ; Mandibular Osteotomy ; Mouth* ; Neck Dissection ; Oropharynx* ; Osteotomy ; Palatine Tonsil ; Retrospective Studies ; Skull Base* ; Skull* ; Tongue

PURPOSE: Despite the fact that there are several reports of single-port laparoscopic distal gastrectomy (SPDG), no analysis of its learning curve has been described in the literature. The aim of this study was to investigate the favorable factors for SPDG and to analyze the learning curve of SPDG. MATERIALS AND METHODS: A total of 125 cases of SPDG performed from November 2011 to December 2015 were enrolled. All operations were performed by 2 surgeons (surgeon A and surgeon B). The moving average method was used for defining the learning curve. All cases were divided into 10 cases in a sequence, and the mean operative time and estimated blood loss data were extracted from each group. RESULTS: Surgeon A performed 68 cases (female-to-male sex ratio, 91.1%:8.82%), and surgeon B performed 57 cases (female-to-male sex ratio, 61.4%:38.5%). The operative time of surgeon B significantly decreased after 30 cases (157.8±38.4 minutes vs. 118.1±34.5 minutes, P=0.003); that of surgeon A did not significantly decrease before and after around 30 cases (160.8±51.6 minutes vs. 173.3±35.2 minutes, P=0.6). The subgroup analysis showed that the operative time significantly decreased in the patients with body mass index (BMI) of < 25 kg/m2 ( < 25 kg/m2:≥25 kg/m2, 159.3±41.7 minutes: 194.25±81.1 minutes; P=0.001). CONCLUSIONS: Although there was no significant decrease in the operative time for surgeon A, surgeon B reached the learning curve upon conducting 30 cases of SPDG. BMI of < 25 kg/m2 was found to be a favorable factor for SPDG.
Body Mass Index ; Gastrectomy* ; Humans ; Laparoscopy ; Learning Curve* ; Learning* ; Methods ; Operative Time ; Sex Ratio ; Stomach Neoplasms* ; Surgeons