• Journal of Yeungnam Medical Science
• /
• v.25 no.1
• /
• pp.41-49
• /
• 2008

Background : The central physiological derangement of hemorrhagic fever with renal syndrome (HFRS) caused by hantaan virus (HTNV) is a vascular dysfunction, manifested by hemorrhage, impaired vascular tone and increased vascular permeability. Platelet activating factor (PAF), whose actions are mediated through a specific receptor, is a potent bioactive lipid. PAF has diverse biological functions in the vascular system, such as increasing vascular permeability, adhesion of leukocytes to the endothelium and reduction of cardiac output, which result in hypotension and shock. The goal of the present study was to investigate whether PAF is involved in the pathogenesis of HFRS. For this purpose, we evaluated the effect of HTNV on the expression of PAF receptor (PAF-R) and on the activity of PAF-acetylhydrolase (PAF-AH) instead of PAF because PAF is rapidly degraded by PAF-AH in vivo. Materials and methods : To evaluate the expression of PAF-R, we performed reverse-transcription PCR, western blot and FACS analyses using HTNV-infected human umbilical vein endothelial cells (HUVECs) and non-infected (control) HUVECs. In addition, we measured the activity of plasma PAF-AH in HFRS patients and normal healthy persons. Results : The mRNA and protein expression of PAF-R was increased in HTNV-infected HUVECs compared with control HUVECs at 2 and 3 days post-infection (d.p.i.). FACS analysis showed that HTNV induced the surface expression of PAF-R in HUVECs from 2 d.p.i. The activity of plasma PAF-AH was 2.5-fold lower in HFRS patients than in normal healthy persons. Conclusion : Increased PAF-R expression by HTNV might increase the responsiveness to PAF in endothelial cells. Reduced PAF-AH activity in the blood of HFRS patients might delay PAF degradation. These results suggest that changes in PAF-R and PAF-AH by HTNV might influence to PAF activity and might be involved in the vascular dysfunction of HFRS.

• Journal of Oral Medicine and Pain
• /
• v.25 no.1
• /
• pp.87-97
• /
• 2000

This study was performed to investigate the effects of repetitive mandibular opening movement and change of head posture on the vibration of temporomandibular(TM) joint. For this study, 23 patients with internal derangement of TM joint were selected. All they had clinically noticeable TM joint sound. Observation of the joint vibration were performed in four head postures, namely, natural head posture (NHP), forward head posture(FHP), upward head posture(UHP), and downward head posture(DHP). For recording of joint sound vibration, Sonopak of Biopak system(Bioresearch Inc., Milwaukee, USA) was used, The author could take results related to integral higher than 300Hz, integral lower than 300Hz, ratio of integral higher than 300Hz to integral lower than 300Hz, total integral which was sum of higher and lower integral, peak amplitude, and peak frequency in each opening movement, which was carried out three times in each head posture. Integral means amount of vibration. The data obtained were analysed by SPSS windows program and the results of this study were as follows : 1. In NHP, total integral in right TM joint was 5O.3Hz in the first opening, 67.9Hz in the second opening, and 74.0Hz in the third opening movement, bur there was no significant increase of total integral with repetitive opening movement. This finding was similar in left TM joint. Integral lower than 300Hz were higher than integral higher than 300Hz in almost every opening movement. 2. There was no significant difference of total integral between right and left side of TM joint, but there was a tendency of higher total integral in right TM joint than that in left TM joint except for results in DHP. 3. Peak amplitude in NHP ranged from 2.0 to 4.7, and peak frequency in NHP were 101.4-170.0Hz. And there was no consistent findings related to increase or decrease of these value according to repetitive opening in each head posture. 4. Change of head posture did not result any difference in integral, peak amplitude, and peak frequency. In conclusion, change of head posture and repetitive mandibular opening movement did not make any significant effect on the vibration of temporo-mandibular joint, especially, on total integral, peak amplitude, and peak frequency.

• Journal of Oral Medicine and Pain
• /
• v.24 no.4
• /
• pp.439-453
• /
• 1999

This study was performed to investigate the masicatory efficiency in patients with temporomandibular disorders (TMDs), especially internal derangement of temporomandibular (TM) joint. For this study, 26 patients after treatment and 33 dental students who had no signs and symptoms of TMDs were selected as the patients group and as the normal group, respectively. Mean treatment duration of the patients was. 5.1 months. Verbal rating scale(VRS) and Visual analogue scale(VAS) were used for recording of subjective symptoms. Treatment index (VAS Ti) derived from VAS was calculated for evaluation of treatment progress and clinical examination was also performed for objective symptoms. BioEGN(Bioresearch Inc., Milwaukee, USA) was used for observation chewing movement pattern on peanut, caramel candy, and gum chewing. Chewing time in second and symptoms after chewing were recorded, and pattern of chewing stroke between in affected side and in contralateral side or between in right in left side were compared, and especially, gum chewing pattern between before and after treatment were also compared in the patients group. The data obtained were analysed by SPSS windows program and the results of this study were as follows : 1. Subjective symptoms evaluated by VAS showed no difference between the two groups, but those by VRS showed slight difference for TM joint pain, head not neck symptoms, and chewing ability. 2. There were no difference at the level of subjective symptoms between the subgroups divided by treatment duration of five months in the patients group. However, value of VAS Ti of pain was higher in subgroup of long treatment duration than that of subgroup of short treatment duration. 3. There were no difference in chewing time for peanut or caramel candy between the two groups, but on caramel candy chewing, the patients group complained slight discomfort after swallowing. Chewing velocity and range of motion on gum chewing after treatment in the patients group showed significant difference and greatly improved compared to those to before treatment, and which were not differ from those of normal subjects. In conclusion, treatment of temporomandibular disorders about for five months would greatly improve chewing ability and movement pattern in most of the patients with TMDs.

• Journal of Oral Medicine and Pain
• /
• v.24 no.4
• /
• pp.421-437
• /
• 1999

This study was performed to investigate the electromyographic(EMG) activity, firing time and sequence of the mandibular elevator muscle on gum chewing. For this study, 28 patients with temporomandibular disorders(TMD), especially internal derangement of TM joint, and 16 dental students without any signs and symptoms in the masticatory system were selected as the patients group and as the normal group, respectively. The patients group was composed of 14 right and 14 left side affected patients. For recording of EMG activity(${\mu}V$) of the anterior temporalis(TA) and the masseter muscle(MM), and measuring of firing time(millisecond) from the start of mandibular opening movement to the firing of the muscles, BioEMG, BioEGN, and Combo program integrated in the Biopak system(Bioresearch Inc., Milwaukee, USA) were used. Gum chewing stroke was performed in both right and left side for several times, and the first and the second chewing strokes were analysed and compared with regard to EMG activity, firing time, firing sequence, correlation between EMG activity and firing time. The data obtained were analysed by SPSS windows program and the results of this study were as follows : 1. In the patients group, chewing on the affected side showed higher EMG activities in the masseter of the side than those of the contralateral side, but chewing on the unaffected side showed higher EMG activity in the masseter and in the anterior temporalis of the side than those of the contralateral side. 2. There were no difference of firing time between both sides on chewing on the affected side, but firing time in the chewing side were earlier than that of contralateral side on chewing on the unaffected side in patients group. 3. In the normal group, EMG activities in the masseter and in the anterior temporalis in the chewing side were always higher than those of the contralateral side, and there were no difference of firing time between the two sides. 4. In general, firing sequence of four muscles of both sides were ipsilateral TA, ipsilateral MM, contralateral TA, and contralateral MM in earlier order of time in both groups. Correlation coefficients between EMG activity and firing time were negative value, and more significant correlation were appeared in the normal group than in the patients group.

• Investigative Magnetic Resonance Imaging
• /
• v.3 no.1
• /
• pp.73-77
• /
• 1999

Purpose : The purpose of the study was to evaluate the sensitivity and specificity of proton-weighted fast spin-echo MR imaging in diagnosing the meniscal tear of knee as an reasonable substitute for conventional spin-echo imaging. Materials and Methods : 102 consecutive patients, proved by surgery, proved by surgery, were participated in this study. All of them were suspected internal derangement of knee, examined by fast spin-echo MR imaging including sagittal and coronal images on a 1.5T MR imager and underwent arthroscopic or open surgery of knee joint within 2 months. These images were reviewed retrospectively by three radiologists. The sensitivity and specificity of meniscal tear were calculated. Results : The sensitivity and specificity of meniscal tear using proton-weighted fast spin-echo MR imaging were 94%, 93% inmedialmeniscus and 92%, 88% in lateral meniscus. Conclusion : The sensitivity and specificity of meniscal tear using proton weighted fast-spin echo MR images were as high as those using conventional spin-echo images. The proton-weighted fast-spin echo MR imaging can be an alternative to conventional spin-echo MR imaging in diagnosing meniscal tear of the knee.

• Clinics in Shoulder and Elbow
• /
• v.2 no.1
• /
• pp.41-46
• /
• 1999

Glenoid labrum acts as one of static stabilizer of the glenohumeral joint. It deepens the glenoid socket and may also serve as a chock, acting as a wedge in preventing glenohumeral translation. Two types of variations in labral anatomy were noted by Detrisac and Johnson. Type A has a superior labrum that is detached centrally but well attached peripherally. The type B labrum is well attached centrally and peripherally at all sites. A meniscoid-type labrum is thought to be normal unless there are splits or fragmentation of the overlying labral tissue. Meniscoid type labrum is different from SLAP II lesion in that it has a firm anchoring on the superior labrum. We observed four cases that had a meniscoid variant superior labrum, which covered the superior glenoid unusually larger than normal in the arthroscopic treatment of shoulder pathology including instability and rotator cuff diseases. We did arthroscopic reshaping and debridement of meniscoid variant superior labrum combined with pathologic change of the glenohumeral joint. Further study would be required for understanding the mechanism of the development of meniscoid variant labrum and its clinical significance.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.18 no.4
• /
• pp.758-770
• /
• 1996

Discectomy is the oldest and most commonly performed operation for the painful temporomandibular joint with internal derangement. It is the one operation for which there are longest follow-up study, with Eriksson, Silver, and Tolvanen et al reporting good results in patients about 30 years after discectomy. About 80% to 90% of patients clinically experience relief from pain and dysfunction after discectomy, and interestingly, the results may improve with time. However such as Myrhaug found headache and Poswillo supposed pain and limitation of movement as postoperative complications, even though this operation had the longest follow-up term, several aspects of discectomy remain unclear. The controversies to discectomy for TMJ with pain and dysfunction have laid emphasis only upon clinical results, and then the histomorphological study was planned to evaluate the morphologic change of TMJ after discectomy. To clarify the nature of the change through an observation on the morphologic changes of articular cartilage and subchondral bone of the condyle resulting from experimental unilateral discectomy in rabbit, the author excised the left articular discs of 12 male rabbits(control 4 rabbits), weighing about 3kg, and at 1, 3, 6, 9 weeks following surgery, harvested both(left surgical site and right nonsurgical sits) TMJ. The specimens were examined with light microscope after H-E and MT stain and the obtained results were as follows. 1. Histopathological features showed thickening of articular zone and active proliferation of fibrocartilaginous zone associated with slight proliferative zone in surgical site than control group. Also replacement of chondrocytes in calcified cartilaginous zone into bone cells was observed. 2. There were thinning of thickness of each zone of articular cartilage except calcified cartilagnous zone was observed in nonsurgical site. 3. In MT stain of condylar trabeculae, there was increased calcification in nonsurgical site than control and surgical site and the degree of calcification was similar in surgical site and control group. 4. In both site of experimental group no features of degenerative changes were observed. From the above results, it is presumed that the morphologic changes of surgical site discectomy are compensatory remodeling process characterized by an hyperplastic reaction of the articular zone and fibrocartilaginous zone filling the void created by removing the disc, and the bone changes are secondary to changes in the cartilage. Increased degree of calcification seen in condylar trabeculae of nonsurgical site results from the excessive use of condyle of that site.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.33 no.4
• /
• pp.367-374
• /
• 2007

Purpose: The diagnostic relevancies and characteristics and of clinical methods in the diagnosis of internal derangement(ID) were tested by comparing the results of them with those of magnetic resonance imaging(MRI). Methods: 75 patients(150 temporomandibular joints; TMJs), who were suspected to have ID by clinical diagnoses, were included. Clinical diagnoses including mouth opening pathway and TMJ sound were conducted and MRI takings were done. Accuracies, sensitivities, specificities, positive predictive values, and negative predictive values of clinical diagnosis, mouth opening pathway, and TMJ sound were calculated by comparing with diagnoses with MRIs. Results: Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clinical diagnosis were 59.3%, 83%, 49%, 81%, and 51%. They were 59%, 82%, 25%, 73%, and 35% for mouth opening pathways. Although deviation was somewhat accurate for representing disc displacement with reduction(ADDWR), other discrepancies on opening pathways were not clinically relevant. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of clicking sounds were 85%, 49%, 78%, 85%, and 37%. TMJs with crepitus were only three. But all TMJs with crepitus were diagnosed to have disc displacement without reduction(ADDWOR). Conclusion: When compared with diagnoses with MRIs, clinical diagnoses for ID were not so accurate. But they were suitable for screening tests for ID. Opening pathways and TMJ sounds were not so relevant in the diagnoses of IDs and so it was concluded that considerations for other factors must be included in the diagnoses of IDs.

• The korean journal of orthodontics
• /
• v.35 no.5 s.112
• /
• pp.398-407
• /
• 2005

The present study was conducted to examine the morphometrics and function of the disk on both sides among patients with facial asymmetry (FA) and to elucidate plausible correlations between internal derangement (ID) and FA. The sample was composed of 10 males and 27 females with FA. The disk status of all subjects was evaluated by bilateral high resolution magnetic resonance scans in the sagittal (closed and open) and coronal (closed) planes. Five types of disk displacement were identified accordingly. The disk function was diagnosed as normal disk function, disk displacement with reduction, and disk displacement without reduction. The disk shape on sagittal MRI in closed position was classified as bi-concave, biplanar, funnel/hemiconvex, and deformed. The disk position, translation and rotation were also measured. The difference between the shifted side and non-shifted side was analyzed by statistical analysis. Approximately $70\%$ of the patients in the present study showed unilateral or bilateral ID. It was found that anterior disk displacements (ADD), especially rotational ADD, occurred more frequently in the shifted side, while normal disk position was observed mainly in the non-shifted side (p<0.01). The disk of the shifted side showed significantly deformed configuration and inferior-anterior disk position. However, the disk of the non-deviated side showed hyper-mobility during jaw opening movement. These results demonstrate that in FA patients, the disks status of the shifted side is different from that of the non-shifted side, a phenomenon that could be correlated to facial asymmetry.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.4
• /
• pp.388-394
• /
• 1999

To compare the effect of hyaluronate and dexamethasone on the temporomandibular joint arthrocentesis the author investigated 22 temporomandibular joint disorder(TMD) patients with pain and limitation of mouth opening who visited at the Department of Oral and Maxillofacial Surgery. Chosun Dental Hospital and were made a diagnosis as Wilkes stage III or IV of TMJ internal derangement clinically and radiographically. The two groups consisted of 10 patients with injection of sodium hyaluronate 10mg$(Artz^{(R)})$(hyaluronate group) on the upper joint space of the affected temporomandibular joint 5 times at intervals of a week after arthrocentesis, and 12 patients with injection of dexamethasone$(Oradexon^{(R)})$ at a time(dexamethasone group). Maximum mouth opening, pain value and satisfaction value during mastication were assessed on a visual analog scale before arthrocentesis and after 6 months. Then the within-group and between-group differences were evaluated in the obtained data and the clinical success rate of each group was calculated according to our success criteria. The results were as follows. 1. the mean of maximum mouth opening before arthrocentesis and after 6 months in the hyaluronate group were 24.9mm and 39.0mm respectively, and those before arthrocentesis and after 6 months in the dexamethasone group were 25.7mm and 41.3mm respectively. 2. The mean of pain value on a visual analog scale in the hyaluronate group before arthrocentesis and after 6 months were 6.7 and 1.8 respectively, and those in the dexamethasone group before arthrocentesis and after 6 months were 7.0 and 1.8 respectively. 3. The mean of satisfaction value during mastication on a visual analog scale in the hyaluronate group before arthrocentesis and after 6 months were 2.8 and 7.7 respectively, and those in the dexamethasone group before arthrocentesis and after 6 months were 3.1 and 7.8 respectively. 4. There were statistically significant differences between all measurements before arthrocentesis and after 6 months(P<0.001), but no difference between all measurements in the hyaluronate group and those in the dexamethasone group. 5. The over all success rate of the hyaluronate group and the dexamethasone group were 60.0% and 63.6% respectively. In summary, there was significant difference between the effect of hyaluronate and dexamethasone on the temporomandibular joint arthrocentesis but hyaluronate is better than corticosteroid as the injection drug in consideration of the side effect related with repeated injection.