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Clinical and Radiographic Outcome of Shoulder Function after Unreamed Antegrade Intramedullary Nailing for Humerus Fracture: Ultrasonographic Evaluation for Rotator Cuff Integrity (비확공성 전향적 상완골 금속정 고정술후 견관절 기능에 대한 임상적 및 방사선학적 평가: 초음파를 이용한 회전근 개 추시관찰)

  • Baek, Seung-Hoon;Choi, Chang-Hyuk
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.6 no.1
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    • pp.1-9
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    • 2013
  • Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing for humerus fracture. Materials and Methods: Seventeen patients with an average age of $55.7{\pm}18.6$ years underwent antegrade intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was $43.5{\pm}32.2$ months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union, protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function. Results: Mean VAS at last follow-up was $1.65{\pm}1.84$ points. Range of motion showed forward flexion of $137.0{\pm}33.5^{\circ}$, external rotation of $43.5{\pm}12.7^{\circ}$ and internal rotation of $16.4{\pm}2.0^{\circ}$ while KSS score and ASES score were $79.6{\pm}20.7$ and $83.7{\pm}17.0$ points, respectively. Bone union was demonstrated in all cases and average time to union was $3.4{\pm}1.3$ months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear. Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%) on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05). Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.

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Clinical Features of Symptomatic Meckel's Diverticulum (증후성 멕켈 게실의 임상적 고찰)

  • Lee, Young Ah;Seo, Ji Hyun;Youn, Hee Sang;Lee, Gyeong Hun;Kim, Jae Young;Choi, Gwang Hae;Choi, Byung Ho;Park, Jae Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.9 no.2
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    • pp.193-199
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    • 2006
  • Purpose: The proper diagnosis of Meckel's diverticulum (MD) is difficult and delayed because of the variety of clinical manifestations. We reviewed clinical characteristics of symptomatic MD to facilitate early detection. Methods: We analyzed retrospectively the clinical manifestations, diagnostic tools, histopathological findings, and operative findings in 58 patients with symptomatic MD. Results: The male to female ratio was 2.8 : 1. The most common symptom of MD was bleeding. Others symptoms included: vomiting, abdominal pain, irritability, abdominal distension and fever in the order of frequency. The clinical manifestations of symptomatic MD were lower gastrointestinal bleeding, intestinal obstruction, perforation, diverticulitis and hemoperitoneum, in the order of frequency. The causes of intestinal obstruction were intussusception, internal hernia, band, volvulus, invagination, in the order of frequency. Seventy five percent of patient with MD were diagnosed prior to 5 years of age. The most frequently used diagnostic tool was the Meckel's scan. The diverticulum was located 2 cm to 120 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 1 cm to 10 cm and 94% were less than 5 cm. The most common ectopic tissue found in the MD was gastric mucosa. Ileal resection was more frequently performed than diverticulectomy. Conclusion: In cases of unexplained gastrointestinal bleeding, obstruction and repeated intussusception, the meckel's scan, ultrasound and computed tomography shoud be considered to rule out MD, and if clinically necessary, an exploratory laparotomy when needed.

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A Ultrastructural Study on the Cerebral Ganglion of the African Giant Snail, Achatina fulica (아프리카 왕달팽이 (Achatina fulica) 뇌신경절 (Cerebral ganglion)의 미세구조)

  • Chang, Nam-Sub
    • Applied Microscopy
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    • v.29 no.3
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    • pp.303-313
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    • 1999
  • In this paper, five kinds of neurosecretory cells-light green (LG) cell, dark green (DG) cell, caudo-dorsal (CD) cell, blue green (BG) cell, and yellow (Y) cell- and neuropils in the cerebral ganglion of the African giant snail, Achatina fulica, were observed with an electron microscope. The following results were obtained. The LG cells are circular or ovoid in shape, and about $60{\mu}m$ in size. The nucleus and cytoplasm of the LG cell look light due to their electron-low density. Large granular chromatins are evenly developed in the karyolymph, where round nucleoli are also found. In the cytoplasm, electron -high dense round granules of $0.4{\mu}m$ in average size are crowded. The DG cells are ovoid in shape, and $50\sim20{\mu}m$ in size. These relatively electron-high dense cells were rarely found. In their cytoplasm, cell organelles such as rough endoplasmic reticulum and mitochondria are found together with electron -high dense round granules of $0.2{\mu}m$ in average size. The CD cells are ellipsoidal cells densely distributed in caudo-dorsal parts of the cerebral ganglion. They have large nuclei compared with the cytoplasm. The developed granular heterochromatins are observed in the karyolymph, and lots of small round granules of $0.12{\mu}m$ in average size in the cytoplasm. The 3G cells, rarely found around endoneurium of the cerebral ganglion, take the shapes of long ellipses. They look dark due to their electron -high density. In the cytoplasm, small round granules of $0.1{\mu}m$ in average size are found. The Y cells are the smallest among the neurosecretory cells($9\times6.6{\mu}m$ in size). They are found mostly between the medio-dorsal parts and the caudo-dorsal parts of the cerebral ganglion. In the cytoplasm, tiny round granules of $0.08{\mu}m$ in average size form a group. The neuropils are found in the middle of the cerebral ganglion. In the axon ending, round granules with electron -high density ($0.07\sim0.03{\mu}m$ in diameter) and lucent vesicles ($0.03{\mu}m$ in diameter) are found in large quantities. They are excreted in the state of exocytosome formed by the invagination of the limiting membrane of the axon ending.

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Reproductive Cycle of Small Filefish, Rudarius ercodes (그물코쥐치, Rudarius ercodes의 생식주기)

  • LEE Taek Yuil;HANYU Isao
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.17 no.5
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    • pp.423-435
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    • 1984
  • The reproductive cycle of the small filefish, Rudarius ercodes was investigated based on the annual variations of gonadosomatic index(GSI) and hepatosomatic index(HSI) by electronic and photic microscophy. The specimens used were collected at the coastal area of Benden island, Sizuokagen, Japan, from September 1982 to August 1983. GSI began to increase from March, starting season of longer daylength and higher water temperature, and reached the maximum value between June and August. It began to decrease from September with the lowest value appearing between November and February without any evident variation. The annual variations of HSI were not distinct in male filefish and were negatively related to GSI in female : HSI decreased in the summer season when the ovary was getting mature and reached the maximum in the winter season when the ovary was getting retrogressive. The ovary consisted of a pair of saccular structure with numerous ovarian sacs branched toward the median cavity. Oogonia divided and proliferated along the germinal epithelium of the ovarian sac. Young oocytes with basophile cytoplasm showed several scattering nucleoli along the nuclear membrane. when the oocytes growing to about 300 ${\mu}m$, nuclear membrane to disappear with nucleus migrating toward the animal pole. The regions of protoplasm were extremely confined within the animal hemisphere in which most of cytoplasms were filled with yolk materials and oil drops. After ovulation, residual follicles and growing oocytes remaining in the ovarian sacs degenerated. But perinucleatic young oocytes without follicles formed were not degenerated, and growing continuously still in the next year. Mitochondria and endoplasmic reticula in the cytoplasm remarkably increased with oocytes maturing and yolk accumulating. Those were considered to be functionally related to the yolk accumulation. Five or six layers of possible vitellogenin, oval-shaped disc structures with high electron density, appeared in the apex of follicular processes stretching to the microvilli pits of mature oocytes. Testis consisting of a pair of lobular structures in the right and left were united in the posterior seminal vesicle, Cortex of testis was composed of several seminiferous tubules, and medulla consisting of many sperm ducts connected with tubules. Steroid hormone-secreting cells with numerous endoplasmic reticula and large mitochondria of well developed cristae were recognized in the interstitial cells of the growing testis. Axial filament of spermatozoon invaginated deeply in the central cavity of the nucleus and the head formed U-shape with acrosome severely lacking, mitochondria formed large globular paranuclei at the posterior head, and microtubular axoneme of the tail represented 9+9+2 type. The annual reproductive cycles could be divided into five successive stages : growth(March to July), maturation(May to September), Spawning(mid May to early October) and resting stages(October to February). The spawning peak occurred from June to August.

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Changes in the Titer of Tooth Root Antibodies Accompanying Root Resorption Associated with Orthodontic Tooth Movement (치아이동시 치근 흡수에 따른 치근항체의 역가 변화)

  • Park, Soo-Byung;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.24 no.2
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    • pp.303-317
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    • 1994
  • This study was designed to measure the changes in the titer of tooth root antibodies accompanying root resorption associated with orthodontic tooth movement in dogs to explore a role of the specific immune response in root resorption during orthodontic tooth movement. Five adult mongrel dogs, 2 years of age, were used in the study. Six lower incisors were extracted as sources of homologous antigen in the dogs. Tooth root antigen preparations were made from a 6M Guanidine-HCl-10% EDTA(pH5.0) extract of these root dentins. Root resorption was elicited by intrusion of six maxillary incisors with 200-250gm intrusive force. In 9th week, resorbing six maxillary anterior teeth were extracted. Serum samples were taken from each dog prior to intrusion and weekly for 11 consecutive weeks. Serum autoantibody titers were determined with an enzyme-linked immunosorbent assay. As controls for antibody specificity, sera which were previously incubated with tooth root antigen as well as sera to an unrelated bacterial antigen (Porphyromonas gingivalis 33277) for 3 hours at 25 were measured in all runs. Root resorption was monitored monthly using occlusal radiographs. And then root resorption patterns were observed with a zoom stereo microscope (Model SZH-121, Olympus optical Co. Ltd.). Incisors did not show clear radiographic evidence of significant and progressive root resorption, but periodontal ligament space had widened. But root resorption was observed on the apical regions of the maxillary incisors with a zoom stereo microscope. Teeth showed the shallow depression generally accompanying deep resorption. These demonstrate a slight tendency for an immediate decrease followed by rebound to levels above the pre-treatment baseline. A peak titer of autoantibody to dentin antigen occurred on day 28, then steadily decreased during the 9th week period as the roots resorbed and then rapidly spiked in animals when the resorbing teeth were extracted. When sera is incubated with tooth root antigen, serum activity in the ELISA was almost absent. This is because serum activity in the ELISA could be removed by absorption of the serum with dog dentin antigen. Serum ELISA activity to the unrelated bacterial antigen remained essentially unchanged in all animals throughout the experimental period. When the time course of changes in autoantibody to homologous tooth root antigen prepatration and unrelated bacterial antigen was compared, no significant differences were found(${\alpha}=0.05$). In general, the overall pattern of changes in autoantibody was similar to the two antigens. These findings suggest the possibility that these immunologic changes precede a significant development of root resorption lesions rather than merely reflecting their presence. Therefore, this suggests that the changes of antibody levels may have some predictive value for root resorption.

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MORPHOLOGICAL CHARACTERISTICS OF ODONTOBLAST IN NFI-C KNOCK/OUT MICE (Nuclear Factor I-C 결손 생쥐에서 상아모세포의 형태학적 특징)

  • Ko, Seung-Bak;Lee, Chang-Seop;Lee, Nan-Young;Lee, Sang-Ho;Kim, Heung-Joong;Park, Joo-Cheol
    • Journal of the korean academy of Pediatric Dentistry
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    • v.33 no.2
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    • pp.181-191
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    • 2006
  • NFI-C null mice demonstrated aberrant odontoblast differentiation and thus abnormal dentin formation while other tissues/organs in the body, including ameloblasts, appear to be unaffected and normal. However little is known about the mechanism of NFI-C function in odontoblast differentiation and dentin formation. Odontoblasts are tall, highly polarized cells that are responsible for formation and maintenance of the predentin and dentin. An indication of their polarity is the acquisition of specialized intercellular junctions. As preodontoblasts differentiate into odontoblasts, they are Joined and attached at the apical end by well developed terminal webs of cytoskeletal actins, and associated tight as well as adherent njunctions. In this study, in order to investigate if disruption of the NFI-C gene interferes with formation of a specific or other structural proteins of the intercellular junctions, we examined morphological characteristic of the aberrant odontoblast in NFI-C null mice using light and electron microscope. In addition, we determined the expression of major structural proteins of intercellular junctions, ZO-1 and occludin, during the differentiation of odontoblasts using immunohitochemistry. The results were as follows : 1. In light microscopy, abnormal odontoblasts of incisors of the NFI-C null mice were round in shape, lost their polarity, and trapped in osteodentin-like mineralized tissue. Mutant molars have relatively normal crowns, but short and abnormal differentiating adontoblasts in root formation area. 2. Electron microscopy of abnormal odontoblasts revealed the dissociation of the round osteoblast-like cells, the loss of their cellular polarity, and the absence of an intercellular junctional complex known as the tight junctions. 3. A mutant incisor showed labeling for ZO-1 at the proximal and distal ends of secreting ameloblasts, while staining for ZO-1 was not observed in the abnormal odontoblasts. 4. A normal incisor showed immunoreactivity for occludin in the differentiating odontoblasts. However, staining for occludin was not observed in the abnormal odontoblasts of mutant incisor. These results suggest that NFI-C gene causes dissociation of odontoblast and thus abberant odontoblast differentiation and abnormal dentin formation by interfering with the formation of intercellular junctions.

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Three dimensional photoelastic study on the initial stress distributions of alveolar bone when retracted by lingual K-loop archwire (Lingual K-loop archwire를 이용한 발치공간 폐쇄시 초기응력 분포에 대한 3차원 광탄성학적 연구)

  • Byun, Bo-Ram;Kim, Sik-Sung;Son, Woo-Sung
    • The korean journal of orthodontics
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    • v.32 no.5 s.94
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    • pp.343-353
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    • 2002
  • This study was designed to investigate the stress distribution of alveolar bone in case of on masse retraction with lingual K-loop archwire using the 3-dimensional photoelastic stress analysis followed by stress freezing process. Lingual K-loop archwire which had loop in 15mm height was used and activated by retraction force of 350gm per each side. The results were as follows 1. Central incisor : As the closer side to crown, the larger tensile stress was distributed at both mesial and labial surfaces and the larger compressive stress was distributed at distal surface. As the closer side to root apex, the larger compressive stress was distributed at lingual surface. The compressive stress was distributed at root apex. 2. Lateral incisor : The tensile stress was distributed at the coronal side of mesial surface. The compressive stress was distributed at distal surface. As the closer side to crown, the larger tensile stress was distributed at labial surface. The tensile stress was distributed at coronal side and the compressive stress was distributed at apical side of lingual surface. The compressive stress was distributed at root apex. 3. Canine The tensile stress was distributed at coronal side and the compressive stress was distributed at apical side of mesial surface. The tensile stress was distributed at distal surface. As the closer side to crown, the larger tensile stress was distributed at both mesial and distal surfaces. The compressive stress was distributed at root apex. 4. Second premolar : The tensile stress was distributed at mesial surface. The compressive stress was distributed at coronal side and the tensile stress was distributed at apical side of distal surface. The compressive stress was distributed at coronal side of buccal surface. As the closer side to crown, the larger tensile stress was distributed at lingual surface. The compressive stress was distributed at root apex. 5. First molar . As the closer side to crown, the larger tensile stress was distributed at both mesial and distal surfaces. No stress was distributed at buccal surface and palatal root apex. As the closer side to crown, the larger tensile stress was distributed at both lingual surfaces. The compressive stress was distributed a4 buccal root apexes. 6. Second molar The compressive stress was distributed at all root apexes. As the closer side to crown, the larger compressive stress was distributed at both mesial and lingual surfaces, and the larger tensile stress at both distal and buccal surfaces. Transverse bowing effect was observed in on-masse retraction with lingual K-loop archwire, however vertical towing effect was not. Rather, reverse vortical bowing effect was developed.

A Study on the Traumatic Teeth Damage of Children (어린이의 외상성 치아손상에 관한 연구)

  • Yoo, Su-Min;Park, Ho-won
    • Journal of dental hygiene science
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    • v.4 no.1
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    • pp.21-25
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    • 2004
  • In modern times, children's trauma is increasing every year because of car accidents and life environment changes. There is a limit to prevent traumatic damage for oral cavity organization. The fundamental data of trauma treatment and prevention will be presented through the survey and analysis of traumatic teeth damage. I examined 113 patients from Oct. 4th, 2000 to Feb. 27th, 2004 at Dept. of Children's Dental Clinic, Kangnung National University. The results are as follows. (1) The trauma frequency of male subjects is higher than that of female at a rate of 2.05:1. The average age is 5.27 for men and 5.27 for women. The highest percentage of trauma patients is among 2 year old children. It is 21.2%. (2) A patient survey was taken at a trauma treatment hospital. On the first day 34.4% of the patients had come to receive treatment of their first set of teeth. However, after a week, 38.8% of the patients had received treatment on their permanent teeth. (3) As a result of falling, 59% of patients needing treatment on their first set of teeth. 55.1% of patients is permanent teeth. As a result of bump against physical solid, 26.6% of patients is the first set of teeth and 26.5% of patients is permanent teeth. (4) Teeth damage happened at home. 42.1% were male. 35.1% were female. According to trauma, 59.4% of teeth damage happened at home. 28.6% of permanent teeth damage happened at school or kindergarten. (5) According to trauma, the number of teeth damaged was in the first set of teeth are as follows: 56.3%, one-31.3%, three or four-6.3% each. For permanent teeth: two-46.9%, one-28.6%, four over-16.3% and three-8.2%. Over four teeth is larger number for permanent teeth. (6) 56% of first set of teeth patients and 43.4% of permanent teeth patients were male. 56.8% of first set of teeth patients and 43.2% of permanent teeth were female. Trauma happened to both male and female frequently in the first set of teeth. (7) Most of the tooth damage which was in the first set of teeth and permanent teeth was done to the upper jaw. 75% of patients are the first set of teeth. 63.8% of patients are permanent teeth. Trauma is very high in the two mid teeth of the upper jaw. (8) According to trauma survey, 30.2% is from impulse. 28.0% is from crown fracture, 14.7% is from depression. 8.9% is from concussion. 7.1% is from full dislocation of a joint. 2.2% of patients are extrusion. 1.8% is from displacement. According to teeth damage trauma, 35.8% is pulse in the first set of teeth. The breaking of the crown of a tooth happened a lot in permanent teeth. (9) According to data, 43.2% of teeth damage in the first set of teeth goes without treatment. In permanent teeth, it is 38.9%. After treatment, 22.0% of first set of teeth treatment requires a dental pulp treatment. In permanent teeth, which is used for temporary acid etching resin restoration.

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