• Title/Summary/Keyword: Conservative Surgery

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Extracorporeal Shockwave Therapy for Medial or Lateral Epicondylitis of the Elbow (주관절 내, 외상과염에 대한 체외충격파 치료의 임상적 결과)

  • Yum, Jae-Kwang;Bae, Su-Young;Park, Sung-Bum
    • The Journal of Korean Orthopaedic Ultrasound Society
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    • v.2 no.2
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    • pp.79-84
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    • 2009
  • Purpose: Medial or Lateral epicondylitis is one of the most common causes of elbow pain and recently ESWT (Extracorporeal Shockwave Therapy) is welcomed as a new treatment modality and has been performed in many clinics. The purpose of this study is to report the clinical result after the ESWT treatment for the lateral or medial epicondylitis of the elbow. Materials and Methods: From Nov. 2005 to Jan. 2009, seventy four cases of seventy two (11 male, 61 female) patients diagnosed as medial or lateral epicondylitis of the elbow are included in this study. The average age was 52.4 years old. Authors used visual analogue scale (VAS) to assess the degree of pain at rest and during work, comparing the score before the ESWT treatment with that of $6^{th}$, $12^{th}$ and $24^{th}$ week after the treatment. Authors also checked the number of awakeness during sleep due to pain and compared them before and after the ESWT treatment. Results: Average resting pain score improved from 4.60 before the treatment to 2.01 at $6^{th}$ week, 0.43 at $12^{th}$ week and 0.16 at $24^{th}$ week. Average pain score during working also showed quite an improvement with time from 7.20 before the treatment to 4.05 at $6^{th}$ week, 2.01 at $12^{th}$ week and finally 0.36 at $24^{th}$ week. We checked the frequency of sleep arousal during a week, and also found similar significant treatment efficacy as the average frequency decreased from 9.64 per week before the treatment to 1.21, 0.08 and 0.09 per week at $6^{th}$ week, $12^{th}$ week and $24^{th}$ week, respectively. Conclusion: ESWT for medial or lateral epicondylitis is thought to be one of the effective treatment modalities for those patient group not quite responsive to other conservative treatment.

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Treatment of Osteochonritis Dissecans of Femoral Condyle (대퇴골과 박리성 골연골염의 치료)

  • Lee Dong-Chul;Kwon Soon;Son Wook-Jin
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.49-54
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    • 2002
  • Purpose : To analyze the clinical results of treatment for the osteochondritis dissecans of femoral condyle by age, the type of lesion and method of treatment. Methods : From March 1991 to February 2000, 17 patients (20 cases) with osteochondritis dissecans of the femoral condyle were followed up over 1 year. Three patients had bilateral lesion. There were 12 cases with trauma history (9 cases with sports injury and 3 cases with direct trauma). The initial symptoms were pain, clicking, locking, giving way in the order of frequency, pain was revealed in all cases. Clinical evaluation of IKDC and Hughston method were used for subjective and objective function. Results : The number of male patient was 12, and the mean age was 19.8 year old (11$\~$50). The location of the lesion was 14 cases in medial femoral condyle and 6 cases in lateral femoral condyle. The arthroscopic findings of the lesion in 15 cases were as follows, early separation in 6 cases, partially detachment in 4 cases, and crators and complete detachment in 5 cases. 5 cases were treated with mutiple drilling and 5 cases with Herbert screw fixation, 3 cases with Herbert screw fixation and bone graft. In early stage, 7 cases were treated with conservative method. In the grading of Hughston score, 6 cases were graded as excellent, 9 cases as good, 15 cases were graded as good to excellent. Based on the IKDC scale, 1 case was graded as normal, 6 as nearly normal, and 10 as abnormal. Conclusions : The trauma seemed to be important factor in occurrence of osteochondritis dissecans of the femoral condyle. The clinical results of juvenile period showed better than adolescence and adult period, it is necessary to detect the lesion as soon as possible. The result of subjective evaluation was worse than the Hughston evaluation. It was caused by limiting involvement of sports activity and limited activity in the adolescence.

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Relationship between the Progression of Kyphosis in Thoracolumbar Osteoporotic Vertebral Compression Fractures and Magnetic Resonance Imaging Findings (흉요추 골다공증성 압박 골절에서의 후만 변형의 진행과 자기공명영상 소견 사이의 관계)

  • Jun, Deuk Soo;Baik, Jong-Min;Kwon, Hyuk Min
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.4
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    • pp.336-342
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    • 2019
  • Purpose: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. Materials and Methods: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than -2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. Results: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. Conclusion: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.

INFLUENCES OF DRY METHODS OF RETROCAVITY ON THE APICAL SEAL (치근단 역충전와동의 건조방법이 폐쇄성에 미치는 영향)

  • Lee, Jung-Tae;Kim, Sung-Kyo
    • Restorative Dentistry and Endodontics
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    • v.24 no.1
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    • pp.166-179
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    • 1999
  • Apical sealing is essential for the success of surgical endodontic treatment. Root-end cavity is apt to be contaminated with moisture or blood, and is not always easy to be dried completely. The purpose of this study was to evaluate the influence of dry methods of retrocavity on the apical seal in endodontic surgery. Apical seal was investigated through the evaluation of apical leakage and adaptation of filling material over the cavity wall. To investigate the influence of various dry methods on the apical leakage, 125 palatal roots of extracted human maxillary molar teeth were used. The clinical crown of each tooth was removed at 10 mm from the root apex using a slow-speed diamond saw and water spray. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. After removing of the coronal 2 mm of filling material, the access cavities were closed with Cavit$^{(R)}$. Two coats of nail polish were applied to the external surface of each root. Apical three millimeters of each root was resected perpendicular to the long axis of the root with a diamond saw. Class I retrograde cavities were prepared with ultrasonic instruments. Retrocavities were washed with physiologic saline solution and dried with various methods or contaminated with human blood. Retrocavities were filled either with IRM, Super EBA or composite resin. All the specimens were immersed in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using one-way ANOVA and Duncan's Multiple Range Test. To evaluate the influence of various dry methods on the adaptation of filling material over the cavity wall, 12 palatal roots of extracted human maxillary molar teeth were used. After all the roots were prepared and filled, and retrograde cavities were made and filled as above, roots were sectioned longitudinally. Filling-dentin interface of cut surfaces were examined by scanning electron microscope. The results were as follows: 1. Cavities dried with paper point or compressed air showed less leakage than those dried with cotton pellet in Super EBA filled cavity (p<0.05). However, there was no difference between paper point- and compressed air-dried cavities. 2. When cavities were dried with compressed air, dentin-bonded composite resin-filled cavities showed less apical leakage than IRM- or Super EBA-filled ones (p<0.05). 3. Regardless of the filling material, cavities contaminated with human blood showed significantly more apical leakage than those dried with compressed air after saline irrigation (p<0.05). 4. Outer half of the cavity showed larger dentin-filling interface gap than inner half did when cavities were filled with IRM or Super EBA. 5. In all the filling material groups, cavities contaminated with blood or dried with cotton pellets only showed larger defects at the base of the cavity than ones dried with paper points or compressed air.

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A COMPARATIVE STUDY ON THE THEMATIC DISTRIBUTION OF THE ARTICLES PUBLISHED IN THE JOURNAL OF THE AMERICAN ACADEMY OF PEDIATRIC DENTISTRY AND THE JAPANESE SOCIETY OF PEDIATRIC DENTISTRY (90년대 이후 미국과 일본 소아치과학회지 게재논문의 분야별 분포에 관한 비교 연구)

  • Yeom, Junng-Hyun;Kim, Shin;Jeong, Tae-Sung
    • Journal of the korean academy of Pediatric Dentistry
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    • v.29 no.4
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    • pp.539-554
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    • 2002
  • To identify the trend of pediatric dentistry in USA and Japan, closely related to Korean pediatric dentistry. The Japanese Journal of Pediatric Dentistry(JJPD) and The Journal of the American Academy of Pediatric Dentistry(PD) were reviewed. We collected the bibliographical data of the articles published in the two journals from 1991 to 2000. We analyzed thematic distributions and chronological changes, and then compare those of two groups. The following results were obtained: 1. The 869 articles were published in JJPD and 672 in PD. This was about 30% more in JJPD. 2. In both JJPD and PD, the case reports were a quarter of scientific articles in quantity. 3. The studies on the systemic diseases had the highest proportion in both JJPD and PD. The studies on the dental caries and restorative materials also had high proportion in both journals. 4. The studies on the sedation and biochemical survey had high proportion in PD when had low proportion in JJPD. To the contrary, The studies on the behavior science in JJPD were about double of those in PD. 5. There was no statistically significant difference in quantity between JJPD and PD in the studies on the dental caries, prevention of dental caries, community dental survey, conservative treatment, restorative materials, pulp treatment, diagnosis and treatment of malocclusion, oral pathology and minor surgery, local anesthesia and nerve tissue, traumatic injuries. 6. There was statistically significant increase in the studies on the dental equipment in JJPD and in those on restorative materials in PD. 7. There was statistically significant decrease in the studies on the prevention of dental caries and local anesthesia and nerve tissue in JJPD, and those on conservative treatment in PD.

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Effect of Bronchial Artery Embolization in the Treatment of Massive Hemoptysis (대량객혈의 치료에 있어서 기관지동맥색전술의 효과)

  • Lee, Sang-Kyeong;Chun, Ho-Kee;Yoon, Ki-Heon;Yoo, Jee-Hong;Kang, Hong-Mo;Yoon, Yup
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.6
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    • pp.677-682
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    • 1993
  • Background: Massive hemoptysis is a major clinical problem with high mortality. Bronchial artery embolization is well accepted and widely used for treatment of massive and recurrent hemoptysis, especially in patients with chronic diffuse pulmonary disease who are poor candidates for surgery. We evaluated the therapeutic effect of transcatheter arterial embolization for immediate control and prevention of recurrent hemoptysis. Method: We reviewed 20 cases(M:F=13:7) of bronchial artery embolization for the management of massive hemoptysis from Jun 1989 to Aug 1992 retrospectively. Results: Underlying causes of hemoptysis were pulmonary tuberculosis(n=14), bronchiectasis(n=3), aspergilloma(n=2) and paragonimiasis(n=1). Embolization material was choosed randomly gelfoam(n=7) or Ivalon(n=11) and in 2 cases both were used simultaneously. Target arteries of embolization were bronchial artery only in 15 cases, non-bronchial systemic arteries with or without bronchial artery in 5 cases. After the arterial embolization, immediate cessation of hemoptysis was achieved in 17 cases(85%) and total recurrence rate including 3 cases of immediate treatment failure was 50%. Among recurrences 3 cases were achieved lobectomy, 1 case was expired by asphyxia due to massive hemoptysis and remained 6 were managed by medical conservative treatment with no further recurrence of hemoptysis during follow up periods. Conclusion: Bronchial artery embolization for treatment of massive or recurrent hemoptysis was effective in immediate bleeding control. Despite high recurrence rate the rebleeding after embolization was less severe and controllable by conservative management. Bronchial artery embolization is valuable as primary trial to massive hemoptysis.

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Clinical Results after Repair of Rotator Cuff Tear in Patients with Accompanying AC Joint Pathology: Clinical Comparison of Non-operative Treatment (회전근개 파열과 동반된 견봉 쇄골 관절 병변이 회전근개 봉합술 후 결과에 미치는 영향: 비수술적 치료를 통한 임상적 비교)

  • Yoo, Moon-Jib;Seo, Joong-Bae;Lee, Dae-Hee;Kim, Sung-Jin
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.86-90
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    • 2012
  • Purpose: We studied the need for distal clavicle resection by comparing rotator cuff tear patients who underwent non-surgical treatment with and without acromioclavicular joint pathology. Materials and Methods: 45 cases that had been under follow up care for at least 9 months after receiving rotator cuff repair in our hospital between Jan. 2005 and Jun. 2011 had been studied. Acromioclavicular joint pathology group and control group were classified by physical examination and MRI findings. The temporal changes in shoulder joint abduction, internal and external rotation strength, ASES and KSS score of the two groups were measured and analyzed. Results: The acromioclavicular joint pathology complicated rotator cuff injury group's strength measurements for abduction, internal rotation, external rotation were each 8.05 (${\pm}4.54$), 11.33 (${\pm}6.05$), 10.24 (${\pm}5.27$) preoperatively and improved to 13.26 (${\pm}5.50$), 17.51 (${\pm}6.80$), 15.60 (${\pm}5.37$) post operatively while the KSS score and ASES score were each 49.07 (${\pm}15.28$) and 48.65 (${\pm}13.27$) preoperatively, improving to 84.48 (${\pm}10.96$) and 84.65. (${\pm}9.86$). The measurements for the group without complicating acromioclavicular pathology are as follows. The strength for abduction, internal rotation, external rotation was each 6.42 (${\pm}3.11$), 7.59 (${\pm}4.81$) and 7.93 (${\pm}4.49$) preoperatively, improving to 15.85 (${\pm}7.35$), 19.18 (${\pm}9.14$), 16.95 (${\pm}5.70$) post operatively, while the KSS score and ASES score each went from 42.12 (${\pm}6.43$) and 41.37 (${\pm}7.42$) to 83.44 (${\pm}6.30$) and 83.17 (${\pm}7.01$) respectively. The measurements for the two groups, however, did not show a statistically significant difference (p>0.05). Conclusion: Analysis of the rotator cuff injury groups with and without AC joint pathology showed that both groups had improved strength, ASES and KSS scores with no statistical difference difference among the groups. As such, it thought that conservative treatment is an acceptable alternative to distal clavicle resection.

SELF-INJURIOUS BEHAVIOR IN A PATIENT WITH AUTISM : A CASE REPORT (자폐 환자의 자해로 인한 구강 내 손상 : 증례 보고)

  • Ji, Eun-Hye;Lee, Hyo-seol;Choi, Hyung-Jun;Kim, Seong-Oh;Choi, Byung-Jai;Son, Heung-Kyu;Lee, Jae-Ho
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.8 no.1
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    • pp.10-14
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    • 2012
  • Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could be tried initially before employing more invasive approaches.

PERIPHERAL ODONTOMA IN A CHILD: CASE REPORT (소아에서 발생한 변연성 치아종의 증례보고)

  • Lee, Young-Ho;Park, Ho-Won;Lee, Ju-Hyun;Seo, Hyun-Woo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.39 no.3
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    • pp.301-305
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    • 2012
  • The odontoma is a hamartoma of odontogenic origin and consists of enamel, dentin, cementum and pulp tissue. Two types of odonotma are histologically recognized: complex and compound. Odontoma may be the cause of noneruptoin or impaction of teeth, formation of cyst and resorption of adjacent bone. The recommended treatment for an odontoma is conservative surgical excision. No propensity for recurrence has been noted. Peripheral odontoma is relatively rare lesion and shows the histological characteristics of an intraosseous odontoma. This report described a 3-year-old Korean girl with a firm gingival mass in the posterior mandibular area, which had been gradually enlarging over 18months. Radiographic examination showed a radiopaque mass but no evidence of underlying intraosseous lesion. Excisional biopsy was performed for the mass removal and histopathological examination. The result of histopathological study was identified as hamartous supernumerary tooth germ. Based on the clinical presentation, radiographic and histopathologic findings, we concluded that the final diagnosis was peripheral odontoma. For three years after surgery, there is no clinical sign of recurrence.

A Study on Dose Distribution using Virtual Wedge in Breast Cancer (유방암 환자에서 가상 쐐기모양 보상체의 선량분포 특성에 대한 연구)

  • Yun, Sang-Mo;Kim, Sung-Kyu
    • Progress in Medical Physics
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    • v.18 no.1
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    • pp.7-12
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    • 2007
  • In the radiation therapy for breast cancer patients, wedge shaped compensators are essentially used to achieve appropriate dose distribution because of thickness difference according to breast shapes. Tangential Irradiation technique has usually been applied to radiation therapy for breast cancer patients treated with breast conservative surgery. When a primary beam is incident on wedge shaped compensators from medial direction In tangential irradiation technique, low energy scattered radiation is generated and gives additional dose to the breast surface. As a method to reduced additional dose to breast surface, the use of virtual wedge shaped compensator is possible. Eclipse radiation treatment planning (RTP) systems Installed at our institution have virtual wedge shaped compensator for radiation therapy treatment planning. The dose distributions of 15, 30, 45, 60 degree physical wedges and virtual wedges were measured and compared. Results showed that there was no significant differences In symmetry of $10{\times}10$ field among various wedge angles. When the transmission factor was compared, transmission factor Increased linearly as the wedge angle Increased. These results Indicates that the appilcation of virtual wedge in clinical use is appropriate.

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