PURPOSE: Because of complex inguinal structures, we cannot overcome the neurogenic complications in open inguinal herniorrhaphy. Nowadays, there are few studies of anatomical danger zones in open herniorrhaphy. So, in this study we would cover the danger zones in hernia surgery with a cadaver. METHODS: We studied the anatomic structures of three male cadavers. There was no anatomical variation among them. We can ascertain the running of the ilioinguinal nerve, iliohypogastric nerve, and genitofemoral nerve. RESULTS: We can see that the ilioinguinal nerve runs anterior to the spermatic cord in the inguinal canal and lies beneath the external oblique aponeurosis. The iliohypogastirc nerve runs on the anterior surface of the internal oblique muscle, and aponeurosis medial and superior to the internal ring. The genital branch of the genitofemoral nerve lies on the iliopubic tract and accompanies the cremaster vessels to form a neurovascular bundle. In these areas, we often suture the anchor in open herniorrhaphy, increasing probability of these nerves suffering injury. CONCLUSION: In open inguinal herniorrhaphy, surgeons must have a comprehensive understanding of the neural anatomy of the groin to reduce post-operative complications. Moreover, we must consider not only anatomical understanding but also surgical procedures reducing neurogenic complications. So, we suggest certain procedures to reduce nerve injury such as three dimensional mesh or the use of fibrin glue.
Cadaver ; Fibrin Tissue Adhesive ; Groin ; Hernia ; Herniorrhaphy ; Humans ; Inguinal Canal ; Male ; Muscles ; Running ; Spermatic Cord ; Stress, Psychological ; Sutures

There has been a great interest in the use of titanium for fixed and removable prostheses in recent because of its excellent biocompatibility. However, the high melting temperature and chemical reactivity of titanium necessitates casting systems different from those used in conventional casting. The current titanium casting systems are based on an electricarc design for melting the metal in an argon atmosphere and its exclusive investment. Despite the new developments in Ti casting systems, inadequate mold filling and internal porosity are frequently observed casting defects. Therefore, the study on the fabrication technique including sprue design to solve these casting defects is still necessary. In this study, to evaluate the effect of sprue design on the castability of simulated cast titanium crowns, 10 cylindrical cast crowns for each group with four different sprue design(Single group, Double group, Runner bar group, Reservoir group) were fabricated. An impression of the entire casting margin was made and cut at 90 degrees intervals, and the sections were photographed in a microscope at 100 X magnification to record marginal discrepancy. The internal porosities of the cast crowns were disclosed by radiographs. Within the limits of this study, the following conclusions were drawn: 1. The overall mean marginal discrepancies for each group were as follows: Double group, 43.65 micrometer; Reservoir group, 50.27 micrometer; Single group, 54.17 micrometer; Runner bar group,58.90 micrometer (p<0.05). 2. The mean of marginal discrepancies for wax patterns was 10.65 micrometer. 3. The numbers of internal porosity showed the most in Runner bar group followed by Single group, Reservoir group, and Double group.
Argon ; Atmosphere ; Celiac Disease* ; Crowns* ; Freezing ; Fungi ; Investments ; Porosity ; Prostheses and Implants ; Titanium*

STATEMENT OF PROBLEM: Dental implant procedure has been recognized as a very effective treatment to rehabilitate fully or partially edentulous patients. However, mechanical failures such as screw loosening, screw fracture have been still reported frequently. PURPOSE: The purpose of this study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on implant-abutment screw loosening of three different joint connections after one million cyclic loading. MATERIAL AND METHODS: The values of detorque before and after loading were measured in three different joint connections (Osstem Implant, Korea), one external butt joint, US II implant system and two internal cones, SS II and GS II system. The values of detorque before loading was analyzed by one-way ANOVA, and two-way ANOVA and Scheffe'test were performed for the value of detorque after loading. RESULTS: 1. The values of initial detorque of tungsten carbide/carbon coated Ti alloy screw were smaller those of Ti alloy screw (P<.01), and there were no differences among implant systems in each screw (P>.05). 2. In comparison of loss rate of detorque value after cyclic loading, US II system was greater than SS II and GS II system but there was no difference between SS II and GS II system (P<.01). 3. Loss rates of detorque value after cyclic loading decreased consistently at tungsten carbide/carbon coated Ti alloy screw comparing with Ti alloy screw in all implant systems (P<.01), and there were no differences among three systems in reduction of loss rates by using tungsten carbide/carbon coated Ti alloy screw (P>.05). CONCLUSION: Tungsten carbide/carbon coating to increase preload with reduction of friction resistance was a effective way to decrease screw loosening by functional loading.
Alloys ; Dental Implants ; Friction ; Hardness ; Humans ; Joints ; Tungsten

STUDY DESIGN: Retrospective study of clinical experiences. OBJECTIVES: The correct discrimination of a compressed root is very important for proper decompression. With a foraminal disc herniation, the cephalad root is compressed. The diagnostic importance of the clinical and radiological findings was investigated. SUMMARY OF LITERATURE REVIEW: A compressed root, due to a herniated disc, is known as a caudal root (i. e. L5 root compressed by L4-5 disc herniation). In some cases, a prolapsed disc may compress the cephalad root, resulting in a difficult diagnosis. MATERIAL AND METHOD: The medical records, plain X-ray and MRI of 17 patients were reviewed, and the physical examination and MRI findings were carefully evaluated to retrospectively document the efficacy of the diagnoses. Every MRI image of each patient was graded according to the 4 point ranking system of diagnostic efficacy devised by the authors. The clinical outcomes and postoperative complications were also investigated. RESULTS: Ten, 5 and 2 of the 17 patients had L4-5, L5-S1 and L3-4 foraminal disc herniations, respectively. Eight of 10 L4-5 cases showed a positive femoral nerve stretching test. The knee jerk reflex was diminished in 7 patients, with bilateral hyporeflexia in the other 3. The body-cut axial MRI image was the most effective, and the coronal images were also very helpful, whereas the routine axial images were of least value. Most cases achieved a satisfactory clinical result. CONCLUSIONS: Foraminal disc herniations seem to be reasonably common. For the accurate discrimination of a compressed root, a thorough physical examination seems to be very important. When MRI is performed for these cases, in addition to routine studies, the body-cut axial and coronal MRI images are effective and useful, and their use is strongly recommended.
Decompression ; Diagnosis ; Discrimination (Psychology) ; Femoral Nerve ; Humans ; Intervertebral Disc Displacement ; Knee ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Postoperative Complications ; Reflex ; Reflex, Abnormal ; Retrospective Studies

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.
Diskectomy ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fusion*

STUDY DESIGN: A retrospective radiological assessment was conducted. OBJECTIVES: An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration. METHODS: This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test. RESULTS: Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group. CONCLUSIONS: The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.
Diskectomy ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Retrospective Studies ; Spinal Fusion*

PURPOSE: The safety of MMR(Measles, Mumps, and Rubella) immunization to children with egg allergies has been debated for decades because the live attenuated virus used in the vaccine is grown in cultured chick-embryo fibroblasts. Many studies that investigated adverse reactions to MMR vaccine have been reported abroad, but there has been no report in Korean children. So, this study is aimed at determining the prevalence of positive reactions to skin test with the diluted MMR vaccine and the safety of MMR immunization in Korean children with egg allergies. METHODS: Twenty children who have atopic dermatitis or urticaria associated with egg allergies in Samsung Medical Center underwent prick and intradermal tests with diluted MMR vaccine. Then, we administered the vaccine to the children subcutaneously. RESULTS: One patient(5.0%) had a positive result on the prick test and five(25.0%) on the intradermal test. Urticaria was elicited after MMR immunization in two children(10%) who had past illness of urticaria. One of them had a positive result on the prick and intradermal tests, but the other had negative results on both tests. CONCLUSION: Although anaphylaxis did not appear in our study, adverse reactions to MMR vaccination can occur in children with egg allergies, regardless of skin test result to MMR vaccine, prick or intradermal. Thus, in children with a history of severe systemic allergic reaction to egg, it is safe to perform MMR vaccination in a tertiary medical center where emergency care can be taken appropriately.
Anaphylaxis ; Child* ; Dermatitis, Atopic ; Egg Hypersensitivity* ; Emergency Medical Services ; Fibroblasts ; Humans ; Hypersensitivity ; Immunization* ; Intradermal Tests ; Measles* ; Measles-Mumps-Rubella Vaccine ; Mumps* ; Ovum* ; Prevalence ; Rubella* ; Skin Tests ; Urticaria ; Vaccination

BACKGROUND: Atopic dermatitis(AD) and urticaria(UR) are common allergic diseases associated with various food allergens. We evaluated possible differences of sensitization rates to egg, milk, and soy bean according to the age in children with AD and UR. MATERIALS AND METHOD: One hundred and thirty-six patients(n=100 in AD, n=36 in UR) who had visited Samsung Medical Center from January 1998 to February 2000 were enrolled and divided into 3 groups by age: gruop I, children under 1year of age (45 in AD, 17 in UR); group II, between 1 and 3 years of age (32 in AD, 12 in UR); and group III, children over 3 years of age (23 in AD, 7 in UR). Total and specific IgE to cow milk, a-lactalbumin(a-LA), beta-lactoglobulin(beta-LG), casein, soy, egg white(EW) and egg yolk(EY) were measured by RAST or CAP system. RESULTS: Total IgE was highest in group III of AD patients(p<0.05), while there were no significant differences among the three groups of UR patients(p>0.05). The most common allergen among AD patients was EW(54%) for all age groups (51.1% in group I, 56.3% in group II, 56.5% in group III), while among UR patients, beta-LG(22.2%) was the most common food allergen, especially beta-LG(35.3%) in Group I, CM/casein(27.3%) in Group II, and CM/alpha-LA/casein/EW(12.5%) in Group III. Sensitization rate to EW, EY and soy bean were higher in AD than in UR(p<0.05). CONCLUSION: Sensitization rate to egg was higher in patients with AD than in those with UR. Restriction of eggs maybe helpful in management of infants with a family history of AD.
Allergens ; Caseins ; Child* ; Dermatitis, Atopic* ; Eggs ; Humans ; Immunoglobulin E ; Infant ; Milk* ; Ovum* ; Soy Milk* ; Soybeans ; Urticaria*

PURPOSE: There are fewer patients with gastroesophageal reflux disease (GERD) in Korea compared with Western countries. The incidence of GERD has increased in recent years however, concerning many physicians. Here, we report our early experiences of using a recently introduced method of laparoscopic antireflux surgery for the treatment of GERD in Korean patients. METHODS: Fifteen patients with GERD were treated using antireflux surgery between May 2009 and February 2012 at the University of Ulsan College of Medicine and Asan Medical Center. Laparoscopic Nissen fundoplication with 360degrees wrapping was performed on all patients. RESULTS: Eleven male and four female patients were evaluated and treated with an average age of 58.1 +/- 14.1 years. The average surgical time was 118.9 +/- 45.1 minutes, and no complications presented during surgery. After surgery, the reflux symptoms of each patient were resolved; only two patients developed transient dysphagia, which resolved within one month. One patient developed a 6-cm hiatal hernia that had to be repaired and reinforced using mesh. CONCLUSION: The use of laparoscopic surgery for the treatment of GERD is safe and feasible. It is also an efficacious method for controlling the symptoms of GERD in Korean patients. However, the use of this surgery still needs to be standardized (e.g., type of surgery, bougienage size, wrap length) and the long-term outcomes need to be evaluated.
Deglutition Disorders ; Female ; Fundoplication ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Incidence ; Korea ; Laparoscopy ; Male ; Operative Time

PURPOSE: To compare the results of open fixation and closed percutaneous pinning in managing Jakob stage II lateral condylar fractures of children's elbow. MATERIALS AND METHODS: Since Febuary 2000, We operated 21 children with Jakob stage II lateral condylar fractures of elbow. Eleven of the 21 were treated with closed percutaneous pinning, open fixation was done to the other 10 children. Each patient was evaluated about range of motion, carrying angle, scar satisfaction and radiologic findings for comparison between closed pinning and open fixation groups. RESULTS: Open fixation group showed 3.8 degrees decrease of elbow motion while closed pinning group showed no significant decrease. Carrying angle and radiologic findings were not different between the two groups. Open fixation group expressed dissatisfaction to their scars (average 5.2 cm) whereas all the patients of closed pinning group were satisfied with their functional and cosmetic outcomes. CONCLUSION: In managing Jakob stage II lateral condyle fractures of children's elbow, closed percutaneous pinning was thought to be superior to open fixation because of the same functional outcome and much better cosmetic results.
Child* ; Cicatrix ; Elbow ; Humans ; Range of Motion, Articular