STUDY DESIGN: Ninty eight patients with multilevel spinal stenosis who were treated with posterior decompression and instrumented posterolateral fusion were reviewed retrospectively. All patients were divided two groups by pathologic level and surgery level. One is complete level decompression group (whole pathologic levels were decompressed) and the other is limited level decompression group (less than pathologic levels were decompressed). SUMMARY OF BACKGROUND DATA: Many patients with spinal stenosis haute multilevel pathology, which is very difficult problem to make surgical strategy for determination of decompression level. METHOD: Patients were reviewed using combination of clinical records, follow-up examinations and radiographs. Posterior decompression and instrumented posterolateral fusion were performed in all patients using pedicle screw fixation (TSRH 49 cases, Diapason 37 cases, CCD 12 cases) and either autogenous bone graft alone or autograft with allograft. The average follow-up period was 19.7 months. RESULTS: In the clinical results by the criteria of Kirkalldy-Willis, there was no difference between complete level decompression group and limited level decompression group. By the bone graft mothorts, fusion rate was no difference between autograft alone group and autograft with allograft group, but fusion periods were more shorter in autograft alone group than in autograft with allograft group(P>0.05). CONCLUSION: In multilevel spinal stenosis, the segments that associated with neurologic symptoms or seyeie stenosis on radiograph must be decompressed but the segments that not associated with neurologic symptoms and mild stenosis on radiograph do not need preventive decompression.
Allografts ; Autografts ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Pathology ; Retrospective Studies ; Spinal Stenosis* ; Transplants*

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.
Amides ; Analgesia ; Herpes Zoster ; Humans ; Ketamine ; Morphine ; Myoclonus ; Neuralgia ; Neuralgia, Postherpetic ; Punctures

PURPOSE: The aim of this study was to evaluate the periodontal and prosthodontic complications of multiple freestanding implants in the posterior jaws for up to 1 year of function. MATERIAL AND METHODS: Eight patients received 20 implants posterior to canines. Two or more implants were consecutively inserted to each patient. Single crowns were delivered onto the implants. Marginal bone loss, implant mobility, probing depth, and screw loosening were examined to evaluate the clinical success of such restorations for maximum 1 year of functional loading. RESULTS: All the implants performed well during the observation period. Neither periodontal nor prosthodontic complications were found except a slight porcelain chipping. While the marginal bone level was on average 0.09 mm lower around the implant after 6 months of loading, it was 0.15 mm higher after 1 year. CONCLUSION: Within the limits of this investigation, separate single-tooth implant restorations to replace consecutive missing teeth may clinically function well in the posterior jaw.
Cohort Studies ; Crowns ; Dental Implants, Single-Tooth ; Dental Porcelain ; Humans ; Jaw ; Prospective Studies ; Prosthodontics ; Tooth

STATEMENT OF PROBLEM: Many dental clinicians are concerned about immediate loading of inserted implants. However, there have been few clinical studies surveying the success rates of immediate loading, based on Korean implant systems. PURPOSE: The aim of this study was to evaluate the outcome of immediate functional loading of the implant (SinusQuick(TM) EB, Neobiotech Co., Seoul, Korea) in partially edentulous maxilla or mandible. MATERIAL AND METHODS: Total 15 implants were placed. Within 2 weeks after implant insertion, provisional implant-supported fixed partial dentures were delivered to the patients. Quantitatively, marginal bone loss was measured at the time of immediate loading, after 3-months of continued loading and at the last follow-up. The mean follow-up period was 4.8 months. RESULTS: Mean marginal bone loss from implant surgery to early loading, 3-months follow-up and last follow-up was 0.03 +/- 0.07 mm, 0.16 +/- 0.17 mm and 0.29 +/- 0.19 mm. No implant failed up to 6 months after insertion, resulting in a 100% survival rate. CONCLUSION: Immediate loading exhibited high success rate in partial edentulism for up to 6 months. Well-controlled long term clinical studies with large sample size are necessary to confirm this finding.
Dental Implants ; Denture, Partial, Fixed ; Follow-Up Studies ; Humans ; Mandible ; Maxilla ; Prospective Studies ; Sample Size ; Survival Rate

Cubitus varus deformity following elbow fracture in children rarely limits the function of the upper extremity, but the patients and/or their parents often request an operation for the aesthetic purpose. Various surgicsl techniques have been proposed to correct the deformity, however, the complications following operation are still common. We critically reviewed 55 patients with cubitus varus deformity treated by supracondylar closing osteotomy at Seoul National University Hospital between January, 1980 and April, 1989, and report on 25 patients who had at least one year follow-up (average 4.0 years). The results were graded as excellent (13 cases), good (8 cases), and poor (4 cases). The average amount of correction was 29.1 degrees by humero-elbow-wrist angle. There were two cases with ulnar nerve palsy and one case with radial nerve palsy, however, all of which were spontaneously recovered with time. The factors related to poor results were age at operation, degree of deformity, improper wedge size, and nerve palsy. In this article, we also illustrate our new, simple and safe technique of supracondylar closing spring (incomplete) osteotomy based on careful preoperative planning and special attention to surgical details.
Child ; Congenital Abnormalities ; Elbow ; Follow-Up Studies ; Humans ; Humerus ; Osteotomy ; Paralysis ; Parents ; Radial Nerve ; Seoul ; Ulnar Neuropathies ; Upper Extremity

BACKGROUND: Nonsteroidal anti-inflammatory agents are associated with a high incidence of gastrointestinal side effects due to nonspecific inhibition of cyclo-oxygenase (COX) enzymes, COX-1 and 2. Selective inhibition of COX-2 would minimize the potential for gastrointestinal toxicity without compromising efficacy. This study was conducted to investigate 1) the clinical efficacy and 2) the safety of meloxicam, a preferential inhibitor of COX-2, compared with piroxicam in chronic osteoarthritis patients. METHODS: This was designed as a randomized, open labeled, multi-clinic prospective trial. Patients received either meloxicam 7.5 mg or piroxicam 10 mg twice daily for two weeks. Parameters measured were demographic data, disease characteristics, static and dynamic visual analog scale scores (VAS score: 0 = no pain, 10 = extremely severe pain), side effects and their incidences, weekly drop out rates, global efficacy assessed by patients and physicians (1 = extremely satisfactory, 2 = satisfactory, 3 = unsatisfactory, 4 = extremely unsatisfactory), and the changes of disease status assessed by the patients (1 = remarkably improved, 2 = improved, 3 = no change, 4 = worse). RESULTS: There were no significant differences between the two groups in respect to demographic data and disease status. VAS scores at one week showed significant decrease from the baseline, but had no further improvement when compared with those at two weeks. These trends were similar in both groups. At the first week, the meloxicam group had lower incidences of side effects, but at the end of the study, these numbers were compatible between the two groups. Global efficacy evaluated by patients and physicians were highly satisfactory. The changes of disease status assessed by patients also revealed good improvements in both groups. Conclusion: Meloxicam had an analgesic effect for chronic osteoarthritis comparable to piroxicam. It appeared to have a better safety profile for short term therapy, but not in long term.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Osteoarthritis* ; Piroxicam ; Prospective Studies ; Prostaglandin-Endoperoxide Synthases* ; Visual Analog Scale

For the regeneration of osseous defect on the furcation area, autogeneous bone graft has been primarily used. But it has the limitation of donor site, additive surgical operation etc. Recently anorganic xenogenic bone graft materials of removing all organic components are commonly used for the regeneration of periodontal defects. This study was the comparison of the effect on the regeneration with two types xenografts(Bio-oss(R) and Ca-P thin coated Bovine bone powder) on the furcation involvement in Beagle dogs. After surgically induced chronic periodontitis in bifurcation area of premolar, Bio-oss(R) and Ca-P BBP were grafted on the osseous defects. Tissue blocks including defects with soft tissues were harvested following a four-& eight-week healing interval and prepared for histologic analysis. The results of this study were as follows: 1. Bio-oss(R) group: there were significant differences among the Bio-oss? group at 4weeks and 8weeks, but the control group had various appearances : new bone formation, resorption of graft materials by multinuclear giant cells, connective tissue cells intervention in the bone graft sites etc. 2. Ca-P BBP group: lots of new bone formation were observed but the arrangement of periodontal ligament was not completed at 4weeks. New bone were replaced mature bone and the periodontal ligaments showed the functional arrangement at 8weeks. 3. By reason of undergrowing the epithelium within the osseous defects, new bone formation was not happened in the upper area of bifurcation in Bio-oss(R) group. 4. In Ca-P BBP group, epithelial undergrowth was not seen and generally showed much more new bone formation. 5. Ca-P BBP group showed the osteocyte-like cells at the inner portion of the graft materials 6. Both groups were similar to resorptive appearances of graft materials, but Ca-P BBP group had the better effects of osteoconduction.
Animals ; Bicuspid ; Bone Regeneration ; Chronic Periodontitis ; Connective Tissue Cells ; Dogs* ; Epithelium ; Giant Cells ; Heterografts* ; Humans ; Osteogenesis ; Periodontal Ligament ; Regeneration* ; Tissue Donors ; Transplants

This study was carried out to assess the perception of decisional balance of Korean subjects about 4 health behaviors and to identify the influencing factor of decisional balance for exercise acquisition, smoking cessation, mammography screening and Kegel's exercise acquisition. All are representative health behaviors nurses can intervene in Korea based on the Transtheoretical model. Convenient samples of 2,484 subjects (191; exercise, 169; smoking cessation, 1903; mammography screening and 221; Kegel's exercise) were selected from cities and counties over 9 provinces throughout Korea, and the data was collected from January 1, 1999 to February 29, 2000. The research instrument were the Decisional Balance Measure for Exercise (Marcus & Owen., 1992), Smoking Cessation (Velicer et al., 1985), Mammography Screening (Rakowski et al.,1992) and Kegel Exercise (Lim, 1999) and Stage of Change Measure for Exercise (Marcus et al, 1992), Smoking Cessation (DiClemente et al., 1991), Mammography Screening (Rakowski et al.,1992) and Kegel's Exercise (Lim, 1999). The data was analyzed by the SAS Program. The results are as follows; 1. According to the stage of change measure, 2,484 subjects were distributed in each stage of change for four health behaviors: 1,233 subjects (49.8%), 745 subjects (30.2%), 113 subjects (4.7%), 156 subjects (6.5%), and 216 (8.7%) belonged to the pre- contemplation stage, contemplation stage, preparation stage, action stage and maintenance stage. They were all series of stages of change in their efforts to do health behavior. 2. Factor analysis identified 3 factors (1 of Pros, 2 of Cons) for the exercise, 4 factors for smoking cessation (2 of Pros, 2 of Cons), 2 factors (1 of Pros, 1 of Cons) for the mammogram screening and 2 factors (1 of Pros, 1 of Cons) for Kegel's exercise of decisional balance. 3. The analysis of variance and multiple comparison analysis showed that for all 4 samples, the Cons of changing the problem behaviors outweighed the Pros for subjects who were in the pre- contemplation stage, The opposite was true for subjects in action and maintenance stage. 4. Through the discriminant analysis, it was found that one factor of Pros for exercise, one factor of Cons for smoking cessation, 1 factor of Cons for mammogram screening and one factor of Cons for Kegel's exercise were the more influencing factors, than others in discriminating the stages of change. Results are consistent with the applications of the Transtheoretical model, which have been used to understand how people change health behaviors. This results provide some evidence that subject's report of his/her health behavior corresponds to beliefs about usefulness of related health behaviors. The results of this study have implications for patients' health education and health intervention strategies. The findings of this study give useful information for nursing educators for 4 health behaviors, especially the factors relating to decision making in the different stages of change.
Decision Making ; Health Behavior ; Health Education ; Korea* ; Mammography* ; Mass Screening* ; Nursing ; Smoke* ; Smoking Cessation* ; Smoking*

BACKGROUND: The toxicity of paraquat has been known to be caused by oxygen free radicals which leads to the lipid peroxidation and multiple organ failure. Although vitamin C has been known to be a potent antioxidant, recently there are numerous data which have shown that a low dose of vitamin C may act as a prooxidant due to the stimulation of the Fenton reaction with metal ions, which produces hydroxyl radicals. It has been reported that a deferoxamine in paraquat intoxication could reduce the production of the hydroxyl radicals by the inhibition of the Fenton reaction through the reduction of iron ion in tissue. The aim of this study was to evaluate the effect of the high and low dose of vitamin C and deferoxamine on lipid peroxidation and plasma TNF-alpha in paraquat intoxication. METHODS: Female Sprague-Dawley rats were divided into seven groups: control group which was not given paraquat(20mg/kg), P group which was given paraquat only, PVH group given paraquat and high dose of vitamin C(100mg/kg), PVL group given paraquat and low dose of vitamin C(10mg/kg), PVHD given paraquat, high dose of vitamine C and deferoxamine(100mg/kg), PVLD given paraquat, low dose of vitamin C and deferoxamine, and PD given paraquat and deferoxamine. Animals were killed at 6 and 24 hours after treatment. Malondialdehyde(MDA), superoxide dismutase(SOD) and glutathione(GSH) contents, catalase activity, plasma TNF-alpha, and histologic changes in the lung and liver tissue were measured. RESULTS: The lung histology in the PVH and PD or PVHD groups showed the significant decreases in the alveolar edema and interstitial thickness compared to the P group. The liver histology in the PVH and PVHD groups demonstrated marked differences in the central venous and sinusoidal dilatation compared to that of the P group. While the MDA levels of the lung and liver in the PVH and PD groups showed the significant reduction compared to that of the P group at 6 hours after treatment, all groups showed the significant changes compared to the P group at 24 hours. There was no significant change of the SOD levels of the lung and liver at 6 hours among all groups. At 24 hours, the SOD levels of the lung in PVH, PVL, and PVHD groups showed the significant increases compared to the P group. The increase of the SOD level in groups combined with deforoxamine, however, revealed a little reduction. The SOD level of the liver in PVH group only significantly increased compared to the P group at 24 hours. There was no significant change of the GSH level of the lung and liver among all groups at 6 hours. At 24 hours, the GSH level of the lung and liver were significantly increased in both PVH and PD group and PVH group, respectively, compared to the P group. Although the catalase activity of the lung was not significantly increased, that of liver was significantly increased in both PVHD and PD groups compared to the P group at 6 hours. The catalase activities of the lung and liver were significantly increased in PVH, PD, and PVHD at 24 hours. The concentrations of the Plasma TNF-alpha were slightly decreased at 6 hours and slightly increased at 24 hours compared to that of the P group, but they were not significant. CONCLUSION: This study showed that although the low dose of vitamin C had no effect, the high dose of vitamin C revealed a decrease of the MDA level and an increase of SOD, GSH, and catalase activity in the lung and lung and liver tissues, and the effect of the high dose of vitamin C increased with time. The administration of the deferoxamine with or without high dose of vitamin C, however, significantly showed the inhibition of the lipid peroxidation and antioxidant effect and low dose vitamin C decreased the effect of deferoxamine. The effects of the vitamin C and deferoxamine on plasma TNF-alpha were not clearly shown.
Animals ; Antioxidants* ; Ascorbic Acid* ; Catalase ; Deferoxamine* ; Dilatation ; Edema ; Female ; Free Radicals ; Humans ; Ions ; Iron ; Lipid Peroxidation* ; Liver ; Lung ; Multiple Organ Failure ; Oxygen ; Paraquat* ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Superoxides ; Tumor Necrosis Factor-alpha ; Vitamins*

PURPOSE: The purpose of this study was to compare the marginal fit of three-unit zirconia fixed dental prostheses (FDPs) fabricated using CAD/CAM and MAD/MAM system. MATERIALS AND METHODS: Dentiform maxillary central and lateral incisor were prepared for 3-unit FDP and fixed in yellow stone. This model was duplicated to epoxy resin die. On the resin die, fifteen 3-unit FDPs were fabricated. Metal-ceramic group was three-unit metal-ceramic FDPs, Everest(R) group was zirconia three-unit FDPs fabricated using the Everest(R) system (Kavo Dental GmbH, Biberach, Germany) and Rainbow(TM) group was zirconia three-unit FDPs fabricated using the Rainbow(TM) system (Dentium Co. Inc., Seoul, South Korea). They were cemented to resin dies with adhesive resin cement. After removing pontics, each retainers were separated and observed under measuring machine (Presize 440C) and analyzed through one-way ANOVA and Duncan test (alpha= .05). RESULTS: Mean values and standard deviations of marginal gap dimensions in each group for three-unit FDPs were 78.5 +/- 11.05 microm for the metal-ceramic group, 59.30 +/- 11.63 microm for the Everest(R) group and 70.34 +/- 13.98 microm for the Rainbow(TM) group. CONCLUSION: 1. The Everest(R) group in comparison with metal-ceramic group showed better marginal fit, which had significant differences (P<.05). 2. The mean marginal gap values between Everest(R) and Rainbow(TM) group did not showed significant differences (P>.05). 3. The mean marginal gap values between Rainbow(TM) group and metal-ceramic group did not showed significant differences (P>.05). 4. The mean marginal gaps of each group were within clinically acceptable range (120 microm).
Adhesives ; Dental Prosthesis ; Denture, Partial, Fixed ; Formycins ; Incisor ; Resin Cements ; Ribonucleotides ; Zirconium