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Objectives: This study aimed to compare post-treatment stability in patients with anterior open-bite (AOB) between those treated surgically (orthognathic 2-jaw surgery) and non-surgically (molar intrusion using orthodontic miniscrews). Materials and Methods: All subjects had initial overbite (OB) < -1 mm and lateral cephalograms taken before treatment (T0), immediately after AOB correction (T1), after orthodontic treatment (T2), and at least 1 year after treatment (T3). The non-surgical group was enrolled retrospectively; then, the surgical group was matched by OB, sex, and age to the non-surgical group (n = 21 each). Changes in cephalometric measurements during treatment (T1-T0), finishing (T2-T1), and retention (T3-T2) periods were compared between two groups. Results: OB increased by 4.5–5.1 mm during the treatment period with 3.3 mm upward movement of the maxillary first molar (U6) in both groups. Changes in OB were not significantly different between the groups: 0.5–0.9 mm increase during the finishing period but 1.0 mm decrease during the retention period (P > 0.05). U6 moved 0.5 mm downward in non-surgical group and 0.1 mm upward in the surgical group during the finishing period, and 1.0 mm and 0.4 mm downward in the non-surgical and surgical groups, respectively, during the retention period. Conclusions: Post-treatment stability of AOB was similar for surgical and non-surgical methods (76.8 – 78.7%), although U6 moved more downward in the non-surgical group than in the surgical group. Clinical Relevance: AOB without severe skeletal deformity can be treated by either molar intrusion or orthognathic surgery with similar treatment outcome and stability. [ABSTRACT FROM AUTHOR]

Background: The tumor, nodes and metastasis (TNM) classification and stage grouping have been updated in the 8th edition of the American Joint Committee on Cancer (AJCC) melanoma staging manual. However, restaging all the previous cases are not recommended.Aims: The aims of the study were to investigate the necessity of restaging Korean melanoma patients staged by the previous edition of the AJCC manual.Methods: Differences in the staging criteria of the 7th and 8th editions of the AJCC manual were identified. The staging of 276 primary melanomas from January 2011 to December 2018 was classified by both 7th and 8th editions of the manual and their differences were compared.Results: Staging by 7th and 8th edition of the AJCC manual differed in 64 cases (23.2%). The pathological prognostic staging changed in 35 (12.7%), and 29 (10.5%) had changes in only TNM classification but not the pathological staging. None of the patients needed additional sentinel lymph node biopsy or systemic treatment as a result of restaging. Additional counseling was needed for the patients, because melanoma-specific survival was increased in the 8th edition.Limitations: This is a retrospective study with relatively small number of patients at a single tertiary center in Korea.Conclusion: Assessment of the need for additional sentinel lymph node biopsy or systemic treatment is recommended because of the latest changes in the AJCC melanoma staging manual. Although the restaging of previously staged melanomas is not significantly needed in our patients, still the differences in TNM classification and/or pathological prognostic staging suggest the need to separately recognize the patients previously staged by 7th edition and recently staged by 8th edition. Careful counseling about melanoma-specific survival is needed for Asian patients. [ABSTRACT FROM AUTHOR]

Background: The optimal technique for plate fixation to treat type B and C periprosthetic femoral fractures (PFFs) is unclear. The purpose of this study is to evaluate the radiographic results of inner-side-out limited contact dynamic compression plate (LC-DCP) to treat PFFs during or after total hip arthroplasty (THA). Methods: This retrospective study comprised of four men and six women with an average age of 64.7 years who underwent open reduction and internal fixation with an inner-side-out LC-DCP technique to treat PFFs; the reduction was maintained preliminary with the use of contoured plate and cables, and the grooves on the undersurface of LC-DCP for limited contact was used to hold and prevent the cables from slippage during tightening the cables. There were five intraoperative and five postoperative PFFs after THA. According to the Vancouver classification, the intraoperative PFFs included type B2 in two, B3 in one and C3 in two patients while postoperative PFFs were categorized into type B1 in one, type B2 in two and type C in two patients. The mean follow-up duration was 5.9 years (range 1–10.4). We evaluated radiographic union and complications after index operation. Results: All patients demonstrated radiographic bone union at an average follow-up duration of 4.4 months (range 3–8). Two patients showed stem subsidence after revision THA and one patient demonstrated a subsequent peri-implant fracture around the distal end of plate after union of the initial PPF; one patient underwent re-revision THA for stem loosening while another patient went through refixation for the peri-implant fracture. There was no nonunion, infection, nerve injury, or dislocation. Conclusion: The inner-side-out LC-DCP technique showed satisfactory radiographic outcome. In certain situations where locking plates are not available, this technique might be a useful alternative for treating type B and C PFFs. [ABSTRACT FROM AUTHOR]

Background: In alopecia totalis (AT) and alopecia universalis (AU), the chance of full hair regrowth is known to be less than 10%. However, this information is based on a few older studies conducted in the 1950s and 1960s.Objective: We investigated the current long-term prognosis of individuals with AT/AU.Methods: A retrospective chart review was performed in patients with AT/AU between 1994 and 2005. Outcome data were collected by reviewing outpatient clinical files or by phone interviews. Finally, the long-term assessment of 70 patients with valid outcome data was performed.Results: Twelve out of 70 patients with AT/AU (17.1%) had complete hair regrowth. Five out of 24 patients with AT (20.8%) showed complete hair regrowth, and 7 of 46 patients with AU (15.2%) achieved complete regrowth. Seventeen out of 70 patients with AT/AU (24.2%) reported hair regrowth greater than or equal to 90%. Thirty patients with AU (65.2%) remained in an alopecic state without improvement, while 5 patients with AT (20.8%) showed no hair regrowth.Conclusion: Our results suggest that the long-term prognosis of AT/AU is more favorable than previously thought. However, the clinical burden of AT/AU is still substantial. [ABSTRACT FROM AUTHOR]

Purpose: To describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas.Methods: The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared with control group (77 patients) without any pathology. All patients were evaluated with CT angiography for the anatomical assessment. The laterality of the ICA, the distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured.Results: Medially located ICA was more common in the C1 bursting fracture group than control group (76.7 vs 42.8 %). There were no significant differences between 2 groups for the distance from the midline, anterior tubercle, and ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference (p < 0.01).Conclusions: Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans can give critical information to choose the ideal fixation technique and the proper trajectory of the screws for C1 bursting fracture. [ABSTRACT FROM AUTHOR]

Background: Ceramic-on-ceramic bearing couples are theoretically attractive in total hip arthroplasty (THA) because of low wear, but concerns regarding ceramic fracture and squeaking have arisen. Improved material properties of newer alumina matrix composite (AMC) materials, known as Delta ceramics, may reduce these risks. In addition, the use of thinner liners and larger femoral heads may be helpful clinically to lower the rate of dislocation. However, limited short-term clinical results are available and intermediate-term effects are unclear.Questions/purposes: (1) What is the frequency of bearing-related complications (dissociation, fracture, and noise) with ceramic-on-ceramic AMC bearings in cementless THA? (2) What other complications arose in patients treated with these bearings? (3) What are the Harris hip scores (HHS) and survivorship free from reoperation and revision at a minimum of 5 years after cementless THA performed with AMC bearings?Methods: Over a 9-month period in 2009, one surgeon performed 125 THAs, of which 100 (80% of the total) were performed with cementless, AMC bearings. During the period in question, the exclusion criteria for this implant were primary THAs with severe acetabular or femoral bone defect and revision THAs. Of these, 94 hips (95%) in 91 patients were available for analysis at a minimum of 5 years (range, 5-6 years), because five patients (six hips) had died. Mean age at the time of arthroplasty was 55 ± 14 years. Prostheses with an identical design and Biolox(®) Delta ceramics were used in all patients. Noise was classified into squeaking, clicking, grinding, and popping. Ceramic fracture, dislocation, and any other complications associated with the use of AMC ceramics were also investigated. Clinical evaluation included the modified HHS preoperatively and at each followup. Survivorship free from reoperation and revision was calculated using the Kaplan-Meier method.Results: Of 91 patients, four developed bearing-related complications, including one with liner dissociation despite initial square seating and three with clicking. No patients had ceramic fractures. A single event of perioperative dislocation occurred in one patient and postoperative periprosthetic fracture occurred in two hips. Mean HHS improved from 56 to 93 points at the final followup (p < 0.001). Survivorship at 5 years free from reoperation and revision was 96.8% and 97.9%, respectively.Conclusions: Improved material properties combined with the possible use of larger diameter heads make AMC ceramics a promising alternative bearing option with seemingly comparable clinical outcomes reported by others with conventional ceramic bearings. Despite these encouraging results, however, meticulous technical precautions such as square seating and proper impaction in particular should be taken during liner insertion, because we did observe one liner dissociation and several patients with hip noises.Level Of Evidence: Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Objective This study was performed to evaluate the relationship between cataract and vitreous degeneration on ultrasonography ( VDU) in dogs. Materials and methods Medical records of dogs were retrospectively reviewed. The dogs presented at the Veterinary Medical Teaching Hospital of Seoul National University from January 2009 to December 2011 for ocular ultrasonography to investigate the suitability of the patient for cataract surgery. A total of 97 dogs (179 eyes) were included in this study. Data collected included age, gender, ophthalmic examination, and ultrasonographic examination. Cataract was classified into five grades by ophthalmic examination (0: normal, 1: incipient, 2: immature, 3: mature, and 4: hypermature). VDU was classified into 4 grades (0: no degeneration, 1: mild vitreous degeneration, 2: moderate vitreous degeneration, and 3: marked vitreous degeneration). Results The mean rank of VDU grades increased with the progression of cataracts, and statistical significant differences were shown between cataracts grade 0 and 2 ( P = 0.010), between 0 and 3 ( P < 0.001), between 0 and 4 ( P = 0.010), between 1 and 3 ( P = 0.03), between 1 and 4 ( P = 0.02), and between 2 and 4 ( P = 0.04). There were no significant differences in age and gender according to the cataract grades. There was no statistical significant difference in the mean rank of VDU grades between cataractous eyes with lens-induced uveitis ( LIU) and those without LIU. Conclusions The results indicated that increased VDU was associated with more severe cataract grades in dogs. [ABSTRACT FROM AUTHOR]

Background Context: Awareness of vascular anomalies is crucial to avoid iatrogenic injuries during surgical procedure. Although V3 segment anomaly has been well described, the incidence of V3 segment anomaly has been rather variable in the literature, and there are few reports regarding the adequate surgical strategy for each type of V3 segment anomaly.Purpose: This study aimed to analyze the incidence of V3 segment anomaly and demonstrate the importance of recognizing vertebral artery (VA) anomaly in deciding the surgical strategy for C1 screw placement.Study Design: A retrospective cohort study was carried out.Patient Sample: The sample included 147 patients who underwent C1 posterior instrumentation and preoperative three-dimensional computed tomography angiography (3D CTA).Outcome Measures: The primary outcome of this study was the incidence of V3 segment anomaly using preoperative CTA, and the secondary outcome was the risk factor analysis of the V3 segment anomaly.Methods: There were 147 patients who underwent C1 posterior instrumentation to treat various kinds of upper cervical disease. The 3D CTA of the patients were assessed preoperatively to identify the anomaly of the VA. Each surgical technique of C1 posterior instrumentation was decided upon the shape and the course of the VA around the atlas.Results: During the study period, 11 cases of V3 segment anomaly (7.5%) were found on 3D CTA. Persistent intersegmental artery was found in nine cases and was the most common variant of VA anomaly. Early branch of posterior inferior cerebellar artery was found in three cases. Most of V3 segment anomaly was found unilaterally, but there were two cases with bilateral V3 anomaly. Seven cases (63.6%) were associated with congenital bony abnormality around craniovertebral junction (CVJ), such as occipital assimilation, Klippel-Feil syndrome, and os odontoideum. V3 segment anomaly was significantly common in the cases with bony abnormality (29.2% (7/24) vs. 3.6% (4/123), p<.05). Compared with patient without bony abnormality, the odds ratio was 10.78 (95% CI: 2.88-40.37) for those with congenital bony abnormalities. Rheumatoid arthritis was not a risk factor of V3 segment anomaly (p=.391).Conclusions: The course of the VA is heterogenous, and the V3 segment anomaly of the VA is more common in the cases with congenital bony abnormalities around CVJ. Therefore, preoperative radiological studies should be performed to identify V3 segment variations and reduce the risk of VA injury. To avoid significant morbidities associated with VA, surgical technique of C1 posterior instrumentation should be decided depending upon the V3 segment anomaly. A more optimal entry point and trajectory for C1 fixation can be selected. [ABSTRACT FROM AUTHOR]