• Title/Summary/Keyword: GTR

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Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity

  • Lee, Sang-Hyo;Park, Jae-Sung;Lee, Song;Kim, Sung-Won;Hong, Yong-Kil
    • Journal of Korean Neurosurgical Society
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    • v.59 no.6
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    • pp.577-583
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    • 2016
  • Objective : The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas. Methods : From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated. Results : The intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A. Conclusion : Although the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates.

$BBPY^{(R)}$ graft for periodontal intrabony defects and molar furcation lesions: Case Report (다양한 치주 골내낭과 이개부 병변의 처치를 위한 $BBP^{(R)}$ 이식재의 임상적 효과)

  • Kim, Myung-Jin;Lee, Ju-Youn;Kim, Sung-Jo;Choi, Jeom-Il
    • Journal of Periodontal and Implant Science
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    • v.38 no.1
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    • pp.97-102
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    • 2008
  • Purpose: Periodontal intrabony defects have great deal of importance since they contribute to the development of periodontal disease. Current treatment regimens for intrabony defects involve grafting of numerous bony materials, GTR using biocompatible barriers, and biomodification of root surface that will encourage the attachment of connective tissue. Xenograft using deproteinized bovine bone particles seems to be very convenient to adjust because it doesn't require any donor sites or imply the danger of cross infections. These particles are similar to human cancellous bone in structure and turned out to be effective in bone regeneration in vivo. We here represent the effectiveness of grafting deproteinized bovine bone particles in intrabony defect and furcation involvements that have various numbers of bony walls. Materials and methods: Open flap debridement was done to remove all root accretions and granulation tissue from the defects within persisting intrabony lesions demonstrating attachment loss of over 6mm even 3 months after nonsurgical periodontal therapy have been completed. Deproteinized bovine bone particles($BBP^{(R)}$, Oscotec, Seoul) was grafted in intrabony defects to encourage bone regeneration. Patients were instructed of mouthrinses with chlorohexidine-digluconate twice a day and to take antibiotics 2-3 times a day for 2 weeks. They were check-up regularly for oral hygiene performance and further development of disease. Probing depth, level of attachment and mobility were measured at baseline and 6 months after the surgery. The radiographic evidence of bone regenerations were also monitored at least for 6 months. Conclusion: In most cases, radio-opacities increased after 6 months. 2- and 3-wall defects showed greater improvements in pocket depth reduction when compared to 1-wall defects. Class I & II furcation involvements in mandibular molars demonstrated the similar results with acceptable pocket depth both horizontally and vertically comparable to other intrabony defects. Exact amount of bone gain could not be measured as the re-entry procedure has not been available. With in the limited data based on our clinical parameter to measure pocket depth reduction following $BBP^{(R)}$ grafts, it was comparable to the results observed following other regeneration techniques such as GTR.

Effects of the Guided Tissue Regeneration Using Polylactic/Polyglycolic Copolymer Membrane in the Furcation Involvement (Polylactic/Polyglycolic copolymer 차단막의 이개부 병소의 치유 효과)

  • Huh, Ji-Sun;Kim, Hyun-Young;Kim, Chang-Sung;Choi, Seong-Ho;Cho, Kyoo-Sung;Chai, Jung-Kiu;Kim, Chong-Kwan
    • Journal of Periodontal and Implant Science
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    • v.31 no.2
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    • pp.345-356
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    • 2001
  • The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were $2.2{\pm}1.6mm$ and $2.4{\pm}1.1mm$ respectively in the control group, while they were $2.4{\pm}1.3mm$ and $3.0{\pm}1.2mm$ respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.

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IMMUNOHISTOCHEMICAL STUDY ON THE DISTRIBUTIONS OF GROWTH FACTORS RECEPTORS IN THE NEWLY FORMING GRANULATION TISSUES (신생치주조직의 성장인자 수용채 분포에 대한 면역조직화학적 연구)

  • Kim, Keun-Seock;Kim, Sung-Jo;Choi, Jeom-Il
    • Journal of Periodontal and Implant Science
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    • v.25 no.3
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    • pp.518-528
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    • 1995
  • The immunohistochemical study has been performed on the distribution of receptors for various growth factors in the newly forming granulation tissues following the guided tissue regeneration procedures. Two specimens from 2 different patients were collected from the newly forming granulation tissues at 2 weeks following GTR procedures using Gore-tex menbrane and rubber dam, respectively. For immunohistochemical localization of each recptor, anti-platelet-derived growth factor $receptor-{\alpha}$, anti-platelet-derived growth factor $receptor-{\beta}$. anti-insulin-like growth factor receptor, anti-basic fibroblast growth factor receptor, anti-transforming growth $factor-{\beta}$ receptor and anti-fibronectin receptor were incubated onto the specimens as primary antibodies. After the reaction, FITC-conjugated second antibodies have been applied. When the total numbers of immunoreactive cells and the true positive cells were counted, there were high variability among receptors tested in the present study. The mean number of immunoreactive cells were highest in the case for anti-IFG-1 receptor. However the number of true positive cells were highest in the case for $TGF-{\beta}$ receptor. The present investigation indicated that the receptor for $TGF-{\beta}$ were stongly expressed in the newly forming granulation tissues following the guided tissue regeneration therapy.

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Development and Validation of FE Adult Headform Impactor for Pedestrian Protection (성인 머리모형 임팩터의 FE 모델 개발)

  • Choi, Ji-Hun;Park, Bu-Chang;Kim, Jong-Sun
    • Transactions of the Korean Society of Automotive Engineers
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    • v.20 no.2
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    • pp.64-69
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    • 2012
  • Head injury is one of the most common cause of deaths in car-to-pedestrian collisions. To reduce the severity of such injuries, many international safety committees have performed headform impact test for pedestrian protection. In this paper, an adult headform impactor model is developed based on the finite element (FE) method and validated through the numerical simulation. The skin material of headform impactor is known as polyvinyl chloride skin (PVC) and its material was assumed as viscoelastic. The viscoelastic parameters of headform skin are identified by a series of trial and error methods. The new developed FE adult headform impactor is verified by the drop test and FE JARI adult headform impactor provided by Madymo program.

Preparation and Characterization of Nanofibrous Membranes of Poly(D,L-lactic acid)/Chitin Blend for Guided Tissue Regenerative Barrier

  • Kim, Hong-Sung;Kim, Jong-Tae;Jung, Young-Jin;Hwang, Dae-Youn;Son, Hong-Joo;Lee, Jae-Beom;Ryu, Su-Chak;Shin, Sang-Hun
    • Macromolecular Research
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    • v.17 no.9
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    • pp.682-687
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    • 2009
  • Nanofibrous membranes of poly(D,L-lactic acid)/chitin blend were prepared by electro spinning for a barrier of guided tissue regeneration. A miscible solution was obtained by the blending chitin-salt complex into 1-methyl-2-pyrrolidone solution of poly(D,L-lactic acid). The properties of the blend were examined for nanofibrous fabrication. The viscosity of the blend solution was increased significantly due to chain entanglement despite the low ratio of chitin to poly(D,L-lactic acid). An interaction between two polymeric compositions was confirmed by Fourier transform infrared spectroscopy. X-ray diffraction detected an appreciably ordered microstructure in the nanofiber of the blend. A membrane of thinner nanofibers was fabricated by electro spinning the chitin blend. The permeability of the membranes was examined using bioactive model compounds.

Research on Standards for Protection against Electric Shock in Global Technical Regulations of Fuel Cell Vehicle (연료전지 자동차 세계기술규정의 감전보호기준 연구)

  • HwangBo, Cheon;Lee, Kyu-Myong;You, Kyeong-Jun
    • Journal of Hydrogen and New Energy
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    • v.21 no.3
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    • pp.167-183
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    • 2010
  • This paper analyzes the backgrounds of the standards for protection against electric shock in Global Technical Regulations (GTR) of Fuel Cell Vehicle (FCV). Targets on research were high voltage criteria, safety current, isolation and grounding resistance, time limitation, energy, adequate clearance, and test procedure. Based on human impedance and effect of current in IEC 60479-1, safety of human was examined. Then, isolation and grounding circuit model of FCV were analyzed theoretically. The results give several suggestions: touch voltage less than 25V, AC energy less than 0.0813J, separation considering middle finger length, grounding resistance less than $0.2\Omega$, maximum AC ground voltage of 1V (rms), and isolation resistance between earth and electrical chassis. In MATLAB/Simulink environment, error characteristics of isolation resistance measurement procedure using internal DC sources were analyzed under variations of internal resistance of voltmeter and isolation resistance.

A Comparative Study of Clinical Healing Aspects in GTR Treatment on Class II Furcation Defects (치근이개부 II급 병변에서 조직유도재생술의 임상적 치유양상의 비교)

  • Moon, Sun-Young;Lee, Jae-Mok;Suh, Jo-Young
    • Journal of Periodontal and Implant Science
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    • v.29 no.3
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    • pp.519-540
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    • 1999
  • The purpose of this study is to compare the healing aspects of the use of ePTFE membrane alone versus combination treatment of ePTFE membrane and bone grafts on class II furcation defects. Seventeen defects were applied ePTFE membrane alone on mxillary molar buccal class II furcation defects as Group I, seventeen defects were applied ePTFE membrane and bone grafts on maxillary molar buccal class II furcation defects as Group II, twenty-three defects were applied ePTFE membrane alone on mandibular molar buccal class II furcation defects as Group III, twenty defects were applied ePTFE membrane and bone grafts on mandibular molar buccal class II furcation defects as Group IV . Measurements were made to determine clinical attachment level, probing depth, gingival depth, SBI, mobility at baseline, 3, 6, 12 months postoperatively. Additional measurements were made to determine membrane exposure level at surgery, 1, 2, 6 weeks postoperatively. And then healing patterns and postoperative complications were evaluated. The result as follows : There were statistically significant differences in probing depth reduction, clinical attachment gain, mobility reduction at values of 3, 6, 12 months postoperatively compared to values of baseline(p<0.05), whereas no significant differences in SBI and gingival recession. In group II, membrane exposure level was increased at 1, 2, 6 weeks postoperatively compared to value of baseline(p<0.05). There were statistically significant differences in changes of probing depth at 3, 6, 12 months postoperatively in combination groups of ePTFE membrane and bone graft compared to groups of ePTFE membrane alone(p<0.05). The vast majority of cases fall into typical healing and delayed healing response when membranes were removed in all groups. Pain and swelling were common postoperative complications. In conclusion, this study was showed more effective healing aspects in combination treatment of ePTFE membrane and bone graft than ePTFE membrane alone and on mandibular molar class II furcation defects than maxillary molar.

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Treatment of cemental tear associated with periapical lesion using regenerative surgery; A case report (재생술식을 이용한 치근단 병소를 동반한 백악질 열리의 치료)

  • Kang, Hyo-Jin;Jung, Gyu-Un;Pang, Eun-Kyoung
    • The Journal of the Korean dental association
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    • v.54 no.5
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    • pp.365-373
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    • 2016
  • Purpose: Cemental tear is a specific type of root surface fracture characterized by a complete separation of a cemental fragment along the cementodentinal junction or a partial split within the cementum along an incremental line. It is suggested to be a factor for periodontal or periapical tissue destruction. The aim of this study is to present a diagnosis and treatment of cemental tear associated with periapical lesion with root canal treatment and regenerative periodontal surgery. Treatments: A 60-year-old male who had a history of sports trauma on the mandibular right central incisor about 10 years ago presented with apical cemental tear. Clinical examination showed a slightly dark yellowish discoloration and sinus tract that was located on the apical labial mucosa. The mobility and percussion were also assessed on the diseased tooth and recorded as $Miller^{\circ}{\phi}s$ Class II and tenderness to percussion. The probing depth was within the normal limit (<3 mm). Radiographic examination revealed a radiolucent lesion at the apical area and extended to distal aspect of the tooth along the fragment of cemental tear. After root canal treatment, periapical surgery was performed. The bony defect was exposed and then the detached root fragment was removed. Apical root resection and retrograde filling with Mineral Trioxide Aggregate (MTA) were accomplished and the bony defect was filled with deproteinized bovine bone mineral (DBBM) and covered with biodegradable collagen membrane. Results: After 9-month follow-up, healing of the mandibular right central incisor was uneventful and no swelling, purulence or pain was revealed in the associated area. Probing pocket depth was favorably stable, and the tooth mobility was decreased to the Miller's Class I. Conclusions: Apical cemental tear associated periapical lesion could be successfully treated with removal of the detached cementum in combination with apical surgery and GTR procedure.

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HEALING PATTERN OF BONE REGERNERATION IN PERIIMPLANT SPACE AFTER IMMEDIATE IMPLANT PLACEMENT;AN EXPERIMENTAL STUDY IN DOGS (발치후 즉시 임프란트 식립시 임프란트 주위공간의 치유양상에 관한 실험적 연구)

  • Choi, Mee-Sook;Kim, Jong-Eon;Kang, Bo-Won;Kim, Sung-Moon;Rim, Jae-Suk;Kwon, Jong-Jin
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.16 no.4
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    • pp.499-507
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    • 1994
  • The aim of this experiment is to compare the healing process of extraction sockets after immediate implant placement with those using autogenous bone grafts and guided tissue regeneration with Gore-Tex. The first lower premolars and the second premolars of six experimental dogs were extracted and Stryker fin type implants were placed into the extraction sockets immediately after extraction. In the control group, any graft materials were'not used and the dead space around implants was left in itself and covered with only periosteum. In the experimental group A, implants were covered with Gore tex without any bone grafts, and in the experimental group B, the dead space around implants was filled with the bone chips gained from drilling procedure. Each experimental dogs were sacrificed at the 1st, 2nd, 3rd, 6th, and 8th week and the specimens were observed by gross examination, radiological examination, and light microscopic examination. The following results were obtained. 1. Well healed soft tissue and no mobility of the implants were observed in control and two experimental groups. 2. In the radiogical examination, radiopacity around implants had been increased gradually. 3. In the microscopic examination, there were good healing process and active new bone formation in both in the experimental groups, Especially the more amount of new bone formation occurred in the experimental group B using bone chips. 4. Bone chip grafts and guided tissue regeneration (GTR) using Gore-Tex may be one of the successful methods in the immediate implantation.

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