STUDY DESIGN: This biomechanical study was designed to perform flexibility tests in multiple loading directions to compare the stabilizing effects of supplemental hook or pedicle screw fixation on short segment pedicle instrumentation system. OBJECTIVE: To compare biomechanical flexibilities of short segment pedicle instrumentation constructs added by hook or pedicle screw fixation in an unstable calf spine model. SUMMARY OF BACKGROUND DATA: Short segment pedicle instrumentation is using recently for the surgical treatment of the unstable burst fractures of the thoracolumbar spine, but a high incidence of early screw tai lure in short segment pedicle instrumentation has reported. MATERIALS AND METHODS: Ten fresh frozen calf spines (T10-L3) were loaded with pure uncosstrained moments in flexion, extension, axial rotation, and lateral bending directions. A maximum moment of 6.4 Nm was achieved in 5 steps using dead weights. After removal of L1 vertebral body, testing was performed on intact specimens first and then each specimen after laminar hook or pedicle screw insertion on the short segment pedicle instrumentation of ISOLA implant. Any kinds of graft material or transfixation device were not used to make the worst possible case of instability of an injured spine. Three different fixation methods were instrumented. These included: (1) one level aboye and one level below with pedicle screw, (2) 2 levels above with pedicle screw and hook and one level below with pedicle screw, and (3) 2 levels abode and one level below with pedicle screws. RESULTS: At the level of corpectomy, all fixation methods significantly reduced motions in flexion, extension, and lateral bending as compared to the intact motion (P<0.001). The differences between all constructs were not statistically significant. The addition of a hook or screw on the short segment pedicle screw construct was not significantly reduced the flexibi lite as compared to the short segment pedicle screw construct. Axial rotational motions in groups I, II, and III were similar with each other and with intact motion as well and there were no significant statistical difference. The addition of the hook or screw on the short segment pedicle construct showed more stability as compared to the pedicle screw construct, but statistical difference was not. The addition of hook or screw on the short segment pedicle screw construct showed similar stability in all motions with each other. At the level above corpectomyl all tested fixation methods did not improve the axial rotational stability beyond the intact case, but reduced flexion, extension, and lateral bending motions significantly (p<0.001). The addition of hook or screw on the short segment pedicle screw construct showed significant stability in all motions (p<0.001) as compared to the short segment pedicle screw construct and their stabilities were similar with each other. CONCLUSIONS: All fixation methods showed more stabilities in all motions than normal specimen. The addition of pedicle screw on the short segment pedicle screw constructs are more stable than the addition of hook, but there was no statistical difference. Adding one level of fixation cranial to the fracture using pedicle screws or hooks may be necessary to decrease the rate of clinical failure and to enhance the stability of the construct with short segment pedicle instrumentation
Incidence ; Pliability ; Spine ; Transplants ; Weights and Measures

No abstract available.

No abstract available.
Biofeedback, Psychology* ; Electric Stimulation*

BACKGROUND: Hypotension occurs frequently after epidural anesthesia. Intravenous fluid or vasopressors are among treatment methods to many suggested causes. This study was undertaken retrospectively to determine if the age, weight and height of parturients are related to the local anesthetic dosage in epidural anesthesia for the cesarean section, and if the dosage of local anesthetic influence the change of blood pressure and the requirement of fluid or epherine. METHODS: Sixty-nine parturients were studied by reviewing patients' anesthetic records. During lumbar epidural anesthesia to T4 sensory level, all patients were monitored with mean arterial blood pressure, and prevented from hypotension by administration of Ringer's lactated solution. But if hypotension has been sustained in spite of rapid fluid loading, intermittent ephedrine was injected. We studied the correlation of local anesthetic dosage, decrement of mean blood pressure and total required intravenous fluid volume, and difference of these variables between cases using ephedrine and not using. RESULTS: The volume of local anesthetic to achieve a T4 sensory level was 21.20 3.81ml, which did not correlate with age, weight and height, and did not influence the decrease of mean blood pressure and the volume of administered fluid. But the patients (n=30) who needed ephedrine were adminstered significantly larger dose of the local anesthetic and showed more decrease in the mean blood pressure than those (n=39) who did not. CONCLUSIONS: The dose requirement of local anesthetic during epidural anesthesia for the cesarean section is not determined by the age, weight and height of parturients. But when larger dose of local anesthetic is administered, the patients seem to be more hypotensive and need ephedrine as well as intravenous fluid administration.
Anesthesia, Epidural* ; Arterial Pressure ; Blood Pressure ; Cesarean Section* ; Ephedrine* ; Female ; Humans ; Hypotension ; Pregnancy ; Retrospective Studies

The present study was performed to evaluate the clinical effects following local application of 30% minocycline strip(polycaprolactone), 2% minocycline gel(hydro-carbon gel) and 12% minocycline strip(polylactide, Minodent) to augment scaling and root planing in patients with chronic adult periodontitis. Forty teeth with periodontitis were enrolled in the study anddistributed into 4 groups including control group. All patients performed standardized oral hygiene instructions and mechanical debridement at the beginning of the study and then each local delivery drugs were inserted into periodontal pocket in each groups. Examinations regarding plaque index(PI), papillary bleeding index (PBI), probing pocket depth (PPD) were carried out at 0, 2, 4 weeks. All experimental groups showed statistically significant differences between baseline and 2 and 4 weeks in every clinical indices. Especially, 30%minocycline strip and Minodent group showed a significant improvement in PBI at 2 weeks and in PPD at 2 and 4 weeks. In conclusion, highly bio-resorbable Minodent delivered subgingivally as an adjunct to scaling and root planing induces better clinical effects for periodontal health than 2% minocycline gel and control group.
Adult ; Male ; Female ; Humans

No abstract available.
B-Lymphocytes* ; Humans*

No abstract available.
Female ; Laparoscopy* ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic*

Pancreatic carcinoma constitutes to be a major unsolved health problems worldwide. Because of difficulties in diagnosis, the aggressiveness of pancreatic cancers, and the lack of effective systemic therapies, only less than 5% of patients with pancreatic cancer will be alive 5 years after diagnosis. At the time of diagnosis of pancreatic cancer, less than 20% of patients present with tumors that are confined to the pancreas, and therefore only 10~20% undergo resection with curative intent. The majority of patients present with locally advanced and metastatic disease, whose median survival is only 6~9 months and 3~6 months, respectively. The result of chemotherapy, mainly based on 5-FU, have documented low response rate and little impact on survival or quality of life. However, during the past 10 years, a real progress has been made in the area of chemotherapy for pancreatic cancer with the introduction of gemcitabine. Gemcitabine have shown improved overall survival (5.65 months vs. 4.41 months) and clinical benefit response (23.8% vs. 4.8%) compared with standard 5-FU-based chemotherapy. Therefore, gemcitabine has replaced 5-fluorouracil-based chemotherapy as the standard of care. Subsequent trials have also suggested that combinations of gemcitabine with other agents, such as cisplatin, irinotecan or capecitabine, may further improve clinical benefits in patients with advanced pancreatic cancers. One promising combination is gemcitabine plus oxaliplatin (GEMOX), that was reported in 2003. The response rate of GEMOX and gemcitabine alone was 25.8% and 16.1% (p=0.05). The time to progression was also significantly prolonged in GEMOX arm compared to gemctabine (25 weeks vs 16 weeks). In addition, other several efforts including alternative method of gemibitabine infusion as well as novel drug-combination have been made to improve the prognosis. Novel drugs include pemetrexed, S-1, cetuximab, and bevacizumab, etc. For instance, the response rate and 1-year survival of patients who treated with gemicitabine plus bevacizumab, a monoclonal blocking antibody of VEGF, was 38% and 54%, respectively. In conclusion, a shift in paradigms has occurred in the management of pancreatic cancer with respect to systemic therapy. The use of chemotherapy improved survival, reduced tumor-related symptoms, and achieved significant clinical benefit response in one third of patients. New targets for therapy through rapidly evolving understanding of the molecular biology of pancreatic cancer hold promise for even more effective treatment in the near future.
Arm ; Carcinoma, Pancreatic Ductal ; Cisplatin ; Diagnosis ; Drug Therapy* ; Fluorouracil ; Humans ; Molecular Biology ; Pancreas ; Pancreatic Neoplasms* ; Prognosis ; Quality of Life ; Standard of Care ; Vascular Endothelial Growth Factor A ; Bevacizumab ; Capecitabine ; Cetuximab ; Pemetrexed

Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.
Anesthesia ; Blindness ; Dental Clinics ; Diplopia* ; Enophthalmos ; Humans ; Mandibular Nerve* ; Miosis ; Mydriasis ; Physiology* ; Reflex

BACKGROUND: There are many rating scales for assessment of geriatrics. But each of these scales were not sufficient to evaluate comprehensive geriatric assessment, physical and psychologic efforts for care. METHODS: We developed new scales to comprehensive geriatric assessment for care of geriatric patients. The Geriatrics Physical Support Scale(GPSS) evaluates physical effort consists of 10 areas and the Geriatrics Global Support Scale(GGSS) evaluates general condition of patients consist of 6 areas. Eighty probable and possible AD patients received the Clinical Dementia Rating Rating Scale(CDR), Korearn version of Mini-Mental State Examination(K-MMSE), Barthel Activity of Daily Living Index(B-ADL) GPSS, GGSS. We tested internal consistency, correlation among dementia rating scales. RESULTS: The GPSS correlated to CDR -0.63(p<0.01), B-ADL -0.90(p<0.01) and the GGSS correlated to CDR -0.60(p<0.01), B-ADL -0.75(p<0.01). The internal consistency were 0.69(GGSS), 0.92(GPSS). CONCLUSION: The Geriatrics Global Support Scale evaluate general condition of patients and the Geriatrics Physical Support Scale evaluate physical efforts needed for care of geriatric patients. These scales an also brief and easy rating scales to grade degree of caregiver`s burden.
Dementia ; Geriatric Assessment ; Geriatrics* ; Humans ; Physical Exertion ; Reproducibility of Results* ; Weights and Measures