• Journal of Periodontal and Implant Science
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• v.35 no.1
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• pp.123-132
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• 2005

중등도 이상의 치주염 환자에서 치은 열구액내의 MMPs 및 TIMP-1 과 치주염과의 연관성을 규명하고, 치주 수술이 MMPs 및 TIMP-1의 정량에 미치는 영향을 연구하고자 하였다. 총 14명의 치주낭 깊이 6mm 이상의 중등도 이상의 치주 질환 이환자에서 치아를 선정하여, 치주낭 심도, 치은 지수(gingival index)를 측정하고, 치은의 조직학적 염증의 정도를 측정하기 위해, 해당 치아의 치주낭 연조직을 절취하여 H-E염색을 하고, 치은 절편에서 염증세포 침윤의 정도 및 분포를 비교하였다. Perio-paper를 이용하여 치은열구액을 얻고, pyrogen-free water에서 추출하였다. 채취한 치은 열구액에서 ELISA-kit를 이용하여 MMP-1, 8, 9, 13과 TIMP-1을 측정하여 수술 전과, 수술 후, 그리고 건강한 조직인 대조군을 비교하였으며, 통계처리는 Wilcoxon 검정을 사용하였다. 또한 MMPs 혹은 TIMP-1이 치주낭 심도나 치은지수등의 임상적 지표와 가지는 연관성을 Spearman's correlation coefficient를 이용하여 알아보았다. TIMP-1을 제외한 MMP-1, 8 ,9, 13 에서 수술 전보다 수술 후에 치은 열구액 내의 양이 현저하게 줄어든 것을 관찰할 수 있었으나, MMP-1(p=0.025), MMP-9(p=0.016) 와 MMP-13(p=0.009) 에서만 통계적으로 유의성있는 차이를 보였다. 한편 MMP-9 (p=0.011) 나 MMP-13(p=0.026) 은 건강한 대조군과 수술 전 사이에도 유의성있는 차이를 보였다. 연조직의 조직학적 관찰을 통하여 치은지수의 임상적 신뢰도를 평가한 결과 통계학적으로 유의한 결과를 얻을 수 있었으며, 치주 치료 전의 치주낭 심도와 치은지수와의 관계나, 수술 전과 수술 후의 치주낭 심도등의 변화도 통계적으로 유의성있는 결과를 보였다. 하지만 치주낭 심도나 치은지수등의 임상적 지표는 MMPs나 TIMP의 정량과는 별다른 연관성을 보이지 않았다. 이 실험의 결과로 보아 MMP-1, MMP-9나 MMP-13을 치주 수술 전과 수술 후의 치주염의 심도 변화를 반영할 수 있는 지표로 생각할 수 있으며, 특히 MMP-9와 MMP-13가 치주염과 가지는 연관성은 크다고 할 수 있겠다.

• Archives of Plastic Surgery
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• v.36 no.4
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• pp.437-444
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• 2009

Purpose: Transgender is a disorder of gender identity, who have appropriate chromosomal, hormonal and anatomical characteristics corresponding to their sexual phenotype but feel strongly with respect to their sexual identity, that they belong to the opposite sex. There is a persistence discomfort and sense of inappropriateness about one's assigned sex in a person who has reached puberty. Transgender is a psychiatric problem, but surgical method provides more satisfactory adjustment for patients. In gender reassignment surgery for female to male transgender, mastectomy, nipple reduction, hysterectomy, oophorectomy and phalloplasty are included. And as the final operation, recommended for scrotoplasty and artificial testes insertion. So we investigated the necessity and method of scrotoplasty in the final operation of female to male transgender. Method: The authors have long term follow-up of 75 cases female to male transgender during January, 1991 to February, 2008. Among them, 13 cases were evaluated in this study. During phalloplasty, the labium major skin preserved. And this labium majoral skin flap was made for the neoscrotum. At least six months later, artificial testes were inserted in neoscrotum with local anesthesia. Middle sized (3 cm diameter) artificial testes(silicon gel or carving soft silicone implant) were used because of the limitation of the neoscrotum. We evaluated the questionnaire and interview about the postoperative satisfaction in configuration of reconstructed scrotum, and the necessity of operation, the postoperative psychosocioeconomic improvement and limitation of body exposure activities such as swimming, public bathing. Results: Based on this study, satisfaction of reconstructed scrotum after scrotoplasty was improved(92%). The necessity of scrotoplasty was in 92.3% and the postoperative psychosocioeconomic well - being improvement was 77% in answers. Less limitation of activities requiring body exposure was 54% in answers. Most of the patients were satisfied with the results of surgical operation inspite of the operative procedure had some postoperative complications. Conclusion: This study was reported that the scrotoplasty in female to male transgender is not only a conversion of external genitalia but also an improvement of psychosocial state. Most patients sincerely hope to this operation, so we improve our surgical method for more good results.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.111-124
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• 2013

Purpose: We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries. Methods: Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery. Results: All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases. Conclusion: The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.

• Archives of Plastic Surgery
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• v.44 no.6
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• pp.482-489
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• 2017

Background Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. Methods This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension ($TcPO_2$) was evaluated using the Periflux System 5000 with $TcPO_2/CO_2$ unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. Results Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P<0.01), day 14 (P<0.001), and day 28 (P<0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. Conclusions In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.169-174
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• 1998

Background: To avoid the major mobidity associated with bilateral radical neck dissection, modified radical neck dissection has become established as an effective adjunctive procedure in the management of head and neck cancer. But several studies reported early postoperative internal jugular vein(IJV) occlusion in patients who underwent modified radical neck dissection. Objectives: To determine internal jugular vein patency following modified radical neck dessection performed in various head and neck cancer and to identify factors associated with venous occlusion. Materials and Methods: From Aug. 1996 to Oct. 1997, twenty three patients underwent either unilateral or bilateral modified radical neck dissection; 19 males and 4 females, ranging in age from 28 to 75 were retrospectively examined. All patients had a preoperative doppler imaging or CT or both for their initial evaluation. A follow-up examination was obtained(after a minimum postoperative period of 2 months and a maximum one of 4 months). Results: Thirty-four IJVs were examined. All but six IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in modified radical neck dissection was found to be high(28 of 34 IJVs or 82%). Conclusion: The preservation rate of patency of the IJV in modified radical neck dissection was found to be high. These results favor the use of modified radical neck dissection for IJV preservation, particularly in bilateral neck dissection. A retrospective chart review revealed that trauma of the vessel and extrinsic compression of the vein by the musculocutaneous flap or recurrent carcinoma in the neck may be the cause of the vein occlusion.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.55-61
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• 2009

Purpose: To analyze the clinical and radiologic results of the shoulder arthrodesis in brachial plexus injury patients with flail upper extremity. Material and Method: From Aug 1978 to April 2008, 29 shoulders in 29 patients with brachial plexus injury with shoulder fusion, we evaluated 20 shoulders in 20 patients, more than 1 year follow up. The average follow-up period was 6.45years (range: 1year~24years). There were 13 men and 7 women, and the mean age at the time of trauma was 32.0years(2~65 years). The type of injury was a motorcycle accident in 11 patients, in car accident in 5, pedestrian accident in 3, and fall from a height in 1. The lesion of injury was root and trunk in 1 patient, trunk and cord in 1, trunk in 18. Surgery was performed on the whole arm type paralysis in 12 patients, lower arm type paralysis in 8 patients. The preoperative visual analog scale score was 8.7(7~10). When the trapezius and serratus anterior muscle were in function, operation was performed. 18 patients were processed to the additional operation. Gracilis free flap in 6 patients, neurotization in 3, Steindler flexor plasty in 6, and tendon transfer in 3 were performed. Fixation was conducted with cancellous screws in 13 patients, Knoles pins in 5, and cancellous screws and Knoles pins in 2. The position of the arthrodesis at operation was $28.5^{\circ}$($20~45^{\circ}$) in abduction, $30.3^{\circ}$($20~45^{\circ}$) in flexion, and $30.8^{\circ}$($20~40^{\circ}$) in internal rotation. Result: The follow up visual analog scale score was 3.4(0~7). Postoperatively, shoulder spica cast was applied for 15.3weeks(8-20weeks). The median time to bony union was 17.7weeks(9~28weeks). Average range of motion was $32.0^{\circ}$($15~40^{\circ}$) of abduction, $24.0^{\circ}$($10~40^{\circ}$) of flexion, and $18.5^{\circ}$($10~30^{\circ}$)of internal rotation. Conclusion: The shoulder fusion in brachial plexus injury patients is one of the good methods to relieve pain, improve the function and stabilize the flail shoulder joint.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.2
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• pp.138-141
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• 2006

Introduction : In recent years, vascularized, i.e., living bone grafts, have been widely applied in the field of oral and maxillofacial surgery, as a method of treatment of congenital or acquired non-unions, and a large defects in mandible. The vascularized fibular graft has been especially used for this purpose because of its shape and mechanical strength. The postoperative hypertrophy of grafted fibula is of particular interest to us. Material and methods : This study was undertaken to determine the volume change(indirect methods) and radiographic appearance of a free vascularized fibular graft as it responds to the mechanical and physiologic features of its new environment. In order to elucidate the long term effect on fibular mass after mandibular reconstruction, change in various method of volume change was utilized as indirect measure of change in long-term. Results : The younger the patient, the more prominent and rapid the hypertrophy of the graft. the hypertrophy of the graft never exceeded the diameter of the recipient bone, except for callus enlargement after stress fracture of the grafted bone. Conclusion : Etiologic explanations for this phenomenon have not been clarified in the previeous literature. some of the factors implicated include a periosteal reaction or new bone formation, as seen at the onset of bone union after a fracture in a child, a reaction to the mechanical loading on the graft and a reaction to the circulatory changes resulting from the grafting procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.6
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• pp.263-268
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• 2013

Objectives: The interforminal region, between the mandibular foramen, is known as a relatively safe area that is free of anatomic structures, such as inferior alveolar nerve, submandibular fossa, and lingual side of the mandible is occasionally neglected for its low clinical importance. Even in the case of a severely constricted alveolus, perforation of the lingual cortical bone had been intended. However, anterior extension of the inferior alveolar canal, important anatomic structure, such as concavity of lingual bone, lingual foramina, and lingual canal, has recently been reported through various studies, and untypical bleeding by perforation of the lingual plate on implantation has also been reported. Therefore, in this study, we performed radiographic and statistical analysis on distribution and appearance frequencies of the lingual foramina that causes perforation of the mandibular lingual cortical bone to prevent complications, such as untypical bleeding, during surgical procedure. Materials and Methods: We measured the horizontal length from a midline of the mandible to the lingual foramina, as well as the horizontal length from the alveolar crest to the lingual foramina and from the lingual foramina to the mandibular border by multi-detector computed tomography of 187 patients, who visited Dankook University Dental Hospital for various reasons from January 1, 2008 to August 31, 2012. Results: From a total of 187 human mandibles, 110 (58.8%) mandibles had lingual foramina; 39 (20.9%) had bilateral lingual foramen; 34 (18.2%) had the only left lingual foramen; and 37 (19.8%) had the only right lingual foramen. Conclusion: When there is consistent bleeding during a surgical procedure, clinicians must consider damages on the branches of the sublingual artery, which penetrate the lingual foramina. Also, when there is a lingual foramina larger than 1 mm in diameter on a pre-implantation computed tomography, clinicians must beware of vessel damage. In order to prevent these complications and progress with a safe surgical procedure, a thorough radiographic examination before the surgery is indispensable. Further, clinicians should retract lingual flap definitely to confirm the shape of the lingual bone and existence of the lingual foramina.

• Journal of Periodontal and Implant Science
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• v.31 no.4
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• pp.737-747
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• 2001

Regeneration of Periodontium with PRP does not only improve regeneration rate and density of bone but have a possibility to estimate faster healing process for soft tissue. And also, synthetic bone and xenogenic bone graft are effective on regeneration of periodontium. The purpose of this study is to evaluate the effectiveness of synthetic bone ($Biogran^{(R)}$) and xenogenic bone ($BBP^{(R)}$) grafts with the PRP technique on regeneration of periodontium. 52 Generally healthy Pt. who had pocket depth 5mm at any of 6 surfaces of the teeth were in the study at Dept. of Perio. in Dankook Dental Hospital. Open Flap was treated for 18 infra-bony pockets as control group, $Biogran^{(R)}$ with PRP was inserted for 25 infrabony pockets as first test group, and $BBP^{(R)}$ with PRP was inserted for 22 infrabony pockets as 2nd test group. Then evaluation was made after 3 and 6 months 1. 6 months after surgery, each difference of average probing pocket depth was $2.61{\pm}0.23$ for control, $3.40{\pm}0.30$ for 1st test, and $3.45{\pm}0.37$ for 2nd test group. 2. 6 months after surgery, each difference of clinical probing attachment level was $1.39{\pm}0.12$ for control, $2.88{\pm}0,24$ for 1st, and $2.86{\pm}0,27$ for 2nd test group. 3. 6 months after surgery, each difference of Maximal probing attachment level was $1.11{\pm}0.16$ for control, $3.28{\pm}0.30$ for 1st, and $3.27{\pm}0.35$ for 2nd test group. 4. There were significant differences for clinical change of each three group which were between average probing pocket depth and clinical attachment level of 3,6 months and minimal and maximal attachment level after 6 months 5. There were significant differences for average probing pocket depth which were only at control group and 2nd test group between 1 and 6months. For clinical attachment level and minimal and maximal proving attachment level, there was a significant difference after 6month of surgery. 6. There was no significant difference between two test groups for average probing depth, clinical attachment level, and minima1 and maximal probing attachment level. As the result, PRP with bone graft is very effective for regeneration of periodontium and there is no difference between xenogenic bone and synthetic bone.

• Journal of Periodontal and Implant Science
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• v.36 no.3
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• pp.653-659
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• 2006

Oral malodor may cause a significant social or psychological handicap to those suffering from it. Oral malodor has been correlated with the concentration of volatile sulfur compounds (VSC) produced in the oral cavity. Specific bacteria identified in the production of VSC have been reported and many of these bacteria are commonly suspected periodontal pathogens. The aim of this study was to estimate the change of the VSC concentration after periodontal treatment, Twenty subjects with probing depth $(PD)\;{\geq}5mm$ (experimental group) and 20 subjects with PD<5mm (control group) participated. VSC concentration measurement was made with gas chromatography. VSC concentration was measured at pre-treatment, 2 weeks after scaling and 1 month after periodontal treatment(root planning and flap operation). Maximum probing depth and bleeding on probing(BOP) were also examed at pretreatment and 1 month after periodontal treatment, The conclusions were as follow: 1. In the experimental group VSC concentration and CH3SH/H2S ratio were higher than control group. (p<0.05) 2. Both VSC concentration and CH3SH/H2S ratio showed decrease after periodontal treatment, But only CH3SH/H2S ratio after 1 month periodontal treatment was statistically significantly different from pre-treatment. (p<0.05) 3. CH3SH/H2S ratio tended to be on increase according to maximum probing depth and bleeding on probing. Periodontal disease could be a factor that caused oral malodor and oral malodor could be decreased after periodontal treatment.