No abstract available.
Ischemia* ; Skin*

The treatment of articular cartilage and bone defect has been challenging for many years. Autologous osteochondral grafting represents the most physiologic procedure for reconstructing joint defects but is severely limited by the availability of donor material. Allogenic osteochondral grafting differs from the other grafting method in obtaining almost unlimited amounts of material of exact size and form for complex joint reconstructions. An alternative approach that may improve allograft revascularization and incorporation was to combine an autologous muscle flap with an allograft and vascularized osteochondral allografts that have reported excellent long term results. The vascular characteristics of muscle flaps, with their capacity as a source for mesenchymal stem cells, provide the muscle flap with the ability to initiate bone formation and repair in transplanted allografts in response to osteogenic factors. Forty adult New Zealand White rabbits underwent complete resection of the proximal 2/3 of the humerus. The defects were immediately grafted following substance: (1) lyophilized osteochondral allografts (n=10); (2) lyophilized osteochondral allograft with a muscle flap filling the bone marrow cavity(n=10); (3) OP-1(Osteogenic protein-1) treated lyophilized osteochondral allografts (n=10); (4) OP-1 treated lyophilized osteochondral allograft with OP-1 injected muscle flap filling the bone marrow cavity(n=0). All the examinations were operated under aseptic conditions, and follow-up evaluations were performed in the 4th, 6th, 8th, 10th, 12th, and 24th week. Range of motion showed no difference between the groups, but more limited in OP-1 treated allograft groups. Under the histologic examination, the groups of lyophilized osteochondral allograft with a muscle filling the bone marrow cavity regenerated more articular cartilage than that of OP-1 treated allograft. These results suggest that using OP-1 treated lyophilized osteochondral allograft with OP-1 injected muscle flap filling the bone marrow cavity could get more organized articular cartilage and bone regeneration.
Adult ; Allografts* ; Bone Marrow ; Bone Regeneration ; Cartilage, Articular ; Follow-Up Studies ; Humans ; Humerus ; Joints ; Mesenchymal Stromal Cells ; Osteogenesis ; Rabbits ; Range of Motion, Articular ; Tissue Donors ; Transplants

The purpose of this study was to investigate the effects of smoking on adult periodontitis after non-surgical periodontal therapy. The study population consisted of 40 patients with moderate to advanced periodontitis. Smokers(n=20) were defined as individuals smoking at least twenty cigarettes per day at the time of the initial examination. The non-smoking group(n=20) second and the fourth weeks after periodontal non-surgical therapy. The results were as follows; 1. Clinical indices including plaque index, gingival index, and pocket depth were decreased in both smoking and non-smoking group at the first, the second, and the fourth weeks. Especially, clinical indices of non-smokers were more significantly decreased than those of smokers. 2. Non-motile rods were increaseed and motile rods were reduced at the fourth week. spirochetes were reduced significantly in the non-smoking group at the fourth week. These results suggest that smoking play a minor role in adult periodontitis after non-surgical periodontal therapy.
Adult* ; Chronic Periodontitis* ; Humans ; Periodontal Index ; Periodontitis ; Smoke* ; Smoking* ; Spirochaetales ; Tobacco Products

Over the years, many surgeons have used various natural and synthetic materials to bridge the nerve defect. However, none of these materials has surpassed the effectiveness of the nerve autograft. Among natural materials, a vein graft has been used as conduit for nerve regeneration in both research protocols and clinical situations. Unfortunately, the comparison of various research reports is difficult, for each research has employed a different experimental model and method of evaluation for the study of the nerve regeneration. This study introduced various modifications of the vein graft technique, and investigated several vein graft models in an attempt to find the most effective formulation . Four vein graft models were employed: 1) the empty vein graft, 2) the inside-out pattern vein graft, 3) the vein graft filled with skeletal muscle strips, 4) the inside-out pattern vein graft filled with skeletal muscle strips. Regeneration was assessed with gross appearance, histologic examination and electromyography(EMG). In the vein graft filled with muscle strips, there was the increased axonal diameter, myelin sheath thickness, ratio of myelinated axon to unmyelinated axon, and conduction velocities. The result showed that any vein graft filled with muscle strips is superior to the empty vein graft and the inside-out pattern vein graft model which are not filled with muscle strips. It is concluded that the nerve repair using a vein graft filled with skeletal muscle strips can be effectively employed in the clinical field. Further study should be aimed at the regeneration of a longer distance nerve gap and its clinical application.
Animals ; Autografts ; Axons ; Models, Theoretical ; Muscle, Skeletal ; Myelin Sheath ; Nerve Regeneration* ; Rats* ; Regeneration ; Research Report ; Transplants ; Veins*

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.
Acidosis ; Back Pain ; Diagnosis ; Dialysis ; Female ; Fever ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Malnutrition ; Middle Aged ; Renal Dialysis* ; Rifampin ; Spine ; Spondylitis* ; Tomography, X-Ray Computed ; Tuberculosis ; Uremia ; Weight Loss

The zygoma is essential key element determining midface contour and symmetry. The height and width of the zygoma are changed during midfacial surgery such as reduction of fractured zygoma, esthetic malar reduction and correction of congenital midfacial deformity. The exact preoperative and postoperative evaluation of the zygoma is very important step in midfacial surgery. The estimation of height and width of the zygoma usually depends on gross feature analysis or radiographic measurement. But the results are not accurate and subjective. Several device were used for measuring the height and width of the zygoma, but those are inconvenient and difficult to use. The fracture of the zygoma is frequently combined with blow out fracture resulting enophthalmos. The simultaneous measurement of accurate malar height and degree of enophthlmos is helpful. For this reason, we developed a new zygometer with the function of exophthalmometer. This device is convenient to use and easy for comparative measurement of malar height preoperatively and immediate postoperative period, and the degree of enothphalmos is measured simultaneously with this device. This new zygometer will be applied to many midfacial surgery and craniofacial study.
Congenital Abnormalities ; Enophthalmos ; Postoperative Period ; Zygoma

BACKGROUND AND OBJECTIVES: We investigated in patients with coronary vasospastic angina whether the exercise ECG test results are influenced by the different modes of exercise load and compared the clinical characteristics including coronary risk factors between patients with positive and negative exercise tests. MATERIALS AND METHODS: This study comprised 34 patients with documented coronary artery spasm without significant stenosis (coronary artery luminal diameter narrowing <70%) and treadmill exercise test. Treadmill exercise ECG test was performed based on Bruce's protocol (graded exercise test, GET) and sudden rapid exercise protocol (non-graded exercise test, NGET) in the morning of the same day. RESULTS: 1) Of 29 patients who underwent both GET and NGET, 19 patients manifested positive result by NGET, whereas only 11 patients did by GET (66 vs. 38%, P=0.04). All patients with positive GET had positive NGET and 8 of 18 patients with negative GET had positive NGET. 2) Of 34 patients who underwent GET, there was no significant difference in frequency of hypertension, diabetes, current smoking, presence of effort chest pain by history, mixed disease (fixed stenosis >50%, <70% of luminal diameter) or total cholesterol level between patients with positive and negative results. In 18 typical variant angina patients by clinical history, 8 of 10 patients with high disease activity (5 times or more attack per week) manifested positive result by GET or NGET, whereas 4 of 8 patients with low disease activity (80 vs. 50%, P=NS). CONCLUSION: In patients with coronary vasospastic angina, sudden rapid exercise could induce more frequently coronary artery spasm than multistage exercise. The result of an exercise test may not be correlated with coronary risk factors, coronary anatomy, effort chest pain, and the disease activity.
Arteries ; Chest Pain ; Cholesterol ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Exercise Test* ; Humans ; Hypertension ; Phenobarbital ; Risk Factors ; Smoke ; Smoking ; Spasm

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.
Auditory Pathways ; Autonomic Nervous System ; Cochlear Nucleus ; Massage ; Music Therapy ; Otoacoustic Emissions, Spontaneous ; Tinnitus

Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis, and angina pectoris. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by urination and angina pectoris as an initial manifestation. This case study suggests that thunderclap headache and angina pectoris occurring concurrently with sudden blood pressure elevation during or immediately after urination are important diagnostic clues of bladder pheochromocytoma.
Angina Pectoris* ; Blood Pressure ; Diagnosis ; Female ; Headache ; Headache Disorders, Primary* ; Humans ; Hypertension ; Neuroendocrine Tumors ; Pheochromocytoma* ; Strikes, Employee ; Tachycardia ; Urinary Bladder* ; Urination*

The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.
Ascites* ; Caregivers ; Diagnostic Imaging ; Drainage ; Humans ; Hydrothorax* ; Liver Cirrhosis* ; Peritoneal Dialysis ; Pleural Effusion