Spontaneous intracranial hypotension (SIH) is believed to be a benign disease. However, numerous studies have reported serious complications related to SIH, including subdural hematoma. In this case report, a 54-year-old male patient visited the emergency room with orthostatic headache. A brain magnetic resonance imaging (MRI) study showed diffuse mild thickening and enhancement of pachymeninges, with a suspicious minimal amount of subdural fluid collected in the left posterior parietal area. His orthostatic headache showed no improvement with conservative treatment; but his pain was almost completely relieved after two trials of cervical epidural blood patch. On the 74th day after the onset of his pain, the patient showed a drowsy mental status and slurred speech when he visited the pain clinic. Brain computerized tomography indicated a left subdural hemorrhage, and he underwent emergency operation to drain the SDH. In conclusion, pain clinicians should pay attention to abrupt changes in mental status as well as continuous headache, for the early diagnosis of SDH in SIH patients.
The suboccipital triangle (ST) is a clinically relevant landmark in the posterior aspect of the neck and is used to locate and mobilize the horizontal segment of the third part of the vertebral artery before it enters the cranium. Unfortunately, this space is not always a viable option for vertebral artery exposition, and consequently a novel triangle, the inferior suboccipital triangle (IST) has been defined. This alternative triangle will allow surgeons to locate the artery more proximally, where its course is more predictable. The purpose of this study was to better define the anatomy of both triangles by measuring their borders and calculating their areas. Ethical clearance was obtained from the University of Pretoria (reference number: 222/2021) and both triangles were subsequently dissected out on both the left and right sides of 33 formalin-fixed human adult cadavers. The borders of each triangle were measured using a digital calliper and the areas were calculated using Herons Formula. The average area of the ST is 969.82±153.15 mm2, while the average area of the IST is 307.48±41.31 mm2. No statistically significant differences in the findings were observed between the sides of the body, ancestry, or sex of the cadavers. Measurement and analysis of these triangles provided important anatomical information and speak to their clinical relevance as surgical landmarks with which to locate the vertebral artery. Of particular importance here is the IST, which allows for mobilisation of this artery more proximally, should the ST be occluded.
This study aimed to objectively classify the lateral torso posture types and functions of older women. We used 3D body scan data of 119 women aged 70-85 years from the 6th SizeKorea project. First, we defined three torso axes to represent the lateral torso posture types: posterior waist-back, back-cervical, and whole torso axes. Next, we asked experts to select one of four lateral torso posture types-stooped, straight, leaning back, and swayback postures-by looking at the lateral photographic data of 119 older women. To identify the axis that best represented each lateral torso posture type, a discriminant analysis was conducted using the angle of each of the three torso axes as an independent variable and an expert's visual classification as a dependent variable. Based on the analysis, the whole torso and backcervical axis angles were selected as variables for judging lateral torso posture types. Subsequently, we developed a classification function to determine which of the four lateral torso posture types of a particular participant was applicable for a new individual. The method developed in this study is significant in that it enables the objective classification of the lateral torso postures types of older women.
Objective : Anterior odontoid screw fixation is a safe and effective method for the treatment of odontoid fractures. The surgical technique is recommended for perforation of the apical cortex of the dens by the lag screw. However, overpenetration of the apical cortex may lead to potentially serious complications such as damages of adjacent vascular and neural structures. The purpose of this study was to assess the role of three-dimensional computed tomography (CT) scan to evaluate the safe margin beyond dens tip to ventral dura for anterior odontoid screw fixation. Methods : We retrospectively analyzed the three-dimensional CT scans of the cervical spines in 55 consecutive patients at our trauma center. The patients included 38 males and 17 females aged between 22 and 73 years (mean age${\pm}$standard deviation, $45.8{\pm}14.2years$). Using sagittal images of 3-dimensional CT scan, the safe margins beyond dens tip to ventral dura as well as the appropriate screw length were measured. Results : The mean width of the apical dens tip was $9.6{\pm}1.1mm$. The mean lengths from the screw entry point to the apical dens tip and posterior end of dens tip were $39.2{\pm}2.6mm$ and $36.6{\pm}2.4mm$. The safe margin beyond apical dens tip to ventral dura was $7.7{\pm}1.7mm$. However, the safe margin beyond the posterior end of dens tip to ventral dura was decreased to $2.1{\pm}3.2mm$, which was statistically significant (p<0.01). There were no significant differences of safe margins beyond dens tip to ventral dura with patient gender and age. Conclusion : Extension by several millimeters beyond the dens tip is safe, if the trajectory of anterior odontoid screw is targeted at the apical dens tip. However, if the trajectory of the screw is targeted to the posterior end of dens tip, extension beyond dens tip may lead to damage immediately adjacent to the vental dura mater.
Without proper treatment on the multiple tooth missing area, the lack of posterior support and the supra-eruption of the teeth cause many severe complications of occlusion, vertical dimension and masticatory function. This report is a case of full-mouth rehabilitation of a patient with loss of posterior support and collapsed occlusion due to missing teeth area left untreated for a long time. The patient who is 68-year old male patient had some teeth fallen out while removing his old maxillary denture and was complaining about pain in the region of anterior teeth due to traumatic contact. The vertical dimension was corrected by 4 mm from the top cervical point of the canine through various evaluations and the edentulous area was treated with the implant fixed prostheses through computer guided implant surgery based on the diagnosis and treatment plan for definitive prostheses supported by computed tomography (CT) data analysis and CAD-CAM (Computer-aided design/computer-aided manufacturing) technique. After full mouth rehabilitation, the patient was very satisfied with remarkable improvements in mastication, function, and aesthetics.
A survey of the internal parasites in 115 fishes of Ophicephalus argus was carried out in Kyungpook province during the period from January 1995 to November 1997. A species of trematode from the stomach and a species of nematode from the caeca of the fishes was discovered respectively. The trematode was identified as Azygia hwangtsinyi (Tsin, 1993) and the nematode as Pingus sinensis ($Hs\ddot{u}$, 1993). The fluke was pressed at thick of 0.1mm~0.2mm between slide glasses and fixed in 70% ethyl alcohol solution. The fluke was washed with tap water after fixation and stained with hematoxylin-carmin and mounted in balsam through routine methods. The nematode was fixed in 5% formalin solution and mounted with lactophnol or glycerine jelly. Morphology : Arygia hwantsinyi ; The fluke is elongate body with approximately parallel margins and rounded extremities in pressed preparations(Fig 1). The cuticle is unarmed. The oral sucker is ventro-subterminal in position. The ventral sucker is slightly smaller than oral sucker and positioned at 14.2% of body length from the oral sucker. The cirrus sac and genital pore is in mid-ventral line, slightly anterior to the ventral sucker. The oral sucker is succeeded by a well developed muscular pharynx. It is succeeded by a short inverted Y-shaped oesophagus. The inner wall of oesophagus is consisted of many fine folded membrane. The fine tubes of esophagus pass into the intestinal heads which are distended and presented a marked borderline between the fine tube and intestinal heads. The Intestinal heads start at level of pharynx and pass caudad in a zigzag course to end quite near caudal margin. The uterine coils occupy the intercecal area between the level of the cephalic margin of the ovary and about the level of the ventral sucker. The uterus is filled with many eggs. The testes are round or oval and placed one behind the other generally a little diagonally. The posterior testis is placed at level of 75.1% of body length. The ovary is oval, placed ahead the anterior testis. The shell gland not discernible outline is contacted with ovary ahead it. The vitelline glands are consisted of small oval vesicles. The vesicles occupy extracecal regions and between a little posterior of the ventral sucker and near caudal margin. Pingus sinensis : Female ; The cuticle is smooth and the cervical alae are well developed. The mouth opening is small, triangular, and without lips. The anterior end bears four sub-medial papillae. The oesophagus is divided into a muscular and glandular portion. The nerve ring is situated just at the junction of the muscular and glandular portions of the oesophagus. The vulva which has a prominent flap, is placed behind the middle of the body about one-third of the length of the worm from the posterior extremity. The vagina is strongly muscularised and after running anteriorly about $68{\mu}$, divides itself into two broad uterine tubes with an anterior and a posterior one. There are a few eggs in the uterine tubes. The tail is slender, straight and pointed. The ovary extends almost to the posterior extremity. Male : Male is smaller than female. The tail is pointed, curved and carrying well-developed caudal alae. A prominent muscular precloacal sucker is characteristic. The spicules are equal and short. There are four pairs of pedunculated pre-anal papillae, of which the most anterior pair are situated just at the level anterior to the muscular sucker. Two pairs of pedunculated papillae are present before the anus. There are five pairs of post-anal papillae of which the most anterior pair and the second counted from the posterior end are ventral and more marked than the ones which are situated laterally.
Kim, Hyo-Young;Choi, Hyun-Gue;Kim, Eun-Kyung;Kim, Jong-Ghee
The korean journal of orthodontics
/
v.27
no.5
s.64
/
pp.733-741
/
1997
As a result of surgical orthodontic treatment of mandibular prognathism, changes take place in the skeletal and soft orofacial components. Although some investigators had stated that permanent reduction of airway space was observed after mandibular setback surgery, it was not clear that this permanent reduction was sustained during long-term follow-up. The purpose of this study was to assess the changes in oropharyngeal airway space and soft tissue orofacial component following the mandibular setback surgery and during the follow-up period. The correlation between the changes of the oropharyngeal airway space and the changes of other soft tissue orofacial component was also assessed. The findings of this study were as follows ; 1. The oropharyngeal airway space area decreased following mandibular setback surgery for mandibular prognathism and continued to decrease during the follow-up period(p<0.05). 2. The pharyngeal depth at Xi point level and the 2nd cervical vertebra point level decreased after the surgery and remained during the follow-up period(p<0.05). The decrease of these pharyngeal depth was correlated with the decrease of oropharyngeal airway space area(p<0.01). 3. The decrease of pharyngeal depth at the 3rd and 4th cervical vertebra point level was not significant after the surgery and during the follow up period. 4. The hyoid bone moved downward after the surgery(p<0.05), but returned to its original position during the follow-up period. 5. The length & height of tongue and the Position of epiglottis base did not change significantly(p>0.05). 6. The soft palate was displaced posteriorly after the surgery and remained to its changed position during the follow-up period(p<0.05) due to posterior displacement of tongue. The changes of soft palate were significantly correlated with the decrease of oropharyngeal airway space area(p<0.01). 7. The narrowing of oropharyngeal airway space was due to the posterior displacement of tongue above the level of epiglottis tip. The posterior displacement of tongue following mandibular setback osteotomy remained during the follow-up period.
The Journal of the Korean bone and joint tumor society
/
v.15
no.2
/
pp.138-145
/
2009
Purpose: Giant cell tumor of the spine is very rare, and the treatment is very difficult. However, surgical techniques and diagnostic modalities are developed, and postoperative functional results are improved. To evaluate the efficacy of total spondylectomy for giant cell tumor of the spine, the clinical results of the surgical treatments for the giant cell tumor of the spine with intralesional curettage or total spondylectomy were evaluated. Materials and Methods: From April 1987 to March 2006, 10 patients who were underwent surgical treatments using total spondylectomy or intralesional curettage were studied. There were 3 men and 7 women. The mean age of the patients was 32 years (range, 25~44 years). The mean duration of follow-up was 8 years (range, 3~15 years). Locations of the tumor were 2 cervical spines, 4 thoracic spines, 2 lumbar spines and 2 sacrum. Initial main symptom of 10 patients was pain, and 7 patients had neurologic impairments too. Four patients were treated with total spodylectomy using anterior and posterior combined approach, 1 patient was treated with total sacrectomy using posterior approach only, and 5 patients were treated with intralesional curettage using anterior approach. Results: Nine patients improved pain and neurologic impairments. Local recurrences developed in 4(40%) patients (2 cervical spines, 1 thoracic spine, 1 sacrum). While a local recurrence developed from 5 total spondylectomy, 3 local recurrences developed from 5 intralesional curettage. Conclusion: Local recurrence rate after surgical treatment with intralesional curettage for the giant cell tumor of the spine was very high. Total spondylectomy using anterior and posterior approach is advisable to prevent the local recurrence after surgical treatment.
Journal of the korean academy of Pediatric Dentistry
/
v.27
no.1
/
pp.98-102
/
2000
Ectopic eruption is out of a normal position by local eruption disturbance in the developing permanent molar. The prevalence of ectopic eruption is reported to be the between 2 and 6%, most often associated maxillary first permanent molar whereas, the occurrence for the mandibular is quite rare. The etiologic factors of ectopic eruption are inadequate arch length, lack of growth in the posterior region of the jaw, mesially inclined eruption path of first permanent molars, abnormally large first permanent molars, hereditary factor and a stainless steel crown which has been improperly restored. Ectopic eruption can be treated by the use of brass wire, separating elastics, distal disking and Humphrey appliance and the use of removable appliance and cervical traction headgear after extraction of the second primary molar. This case was that lower right first permanent molar was mesially tilted state by locking on the stainless steel crown of a lower right second primary molar. The stainless steel crown was removed and Humphrey appliance was set. Like this case, ectopic eruption could be happened by the stainless steel crown which improperly restored. In restoration of the stainless steel crown, selection of proper size, trimming and contouring are very important.
Objective : This study is a retrospective clinical study over more than 4 years of follow up to understand the mechanism of load sharing across the graft-bone interface in the static locking plate (SLP) fixation compared with non-locking plate (NLP). Methods : Orion locking plates and Top non-locking plates were used for SLP fixation in 29 patients and NLP fixation in 24 patients, respectively. Successful interbody fusion was estimated by dynamic X-ray films. The checking parameters were as follows : screw angle (SA) between upper and lower screw, anterior and posterior height of fusion segment between upper and lower endplate (AH & PH), and upper and lower distance from vertebral endplate to the end of plate (UD & LD). Each follow-up value of AH and PH were compared to initial values. Contributions of upper and lower collapse to whole segment collapse were estimated. Results : Successful intervertebral bone fusion rate was 100% in the SLP group and 92% in the NLP group. The follow-up mean value of SA in SLP group was not significantly changed compared with initial value, but follow-up mean value of SA in NLP group decreased more than those in SLP group (p=0.0067). Statistical analysis did not show a significant difference in the change in AH and PH between SLP and NLP groups (p>0.05). Follow-up AH of NLP group showed more collapse than PH of same group (p=0.04). The upper portion of the vertebral body collapsed more than the lower portion in the SLP fixation (p=0.00058). Conclusion : The fused segments with SLP had successful bone fusion without change in initial screw angle, which was not observed in NLP fixation. It suggests that there was enough load sharing across bone-graft interface in SLP fixation.
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