シカヨウ レーザー ノ リンショウ オウヨウ ニツイテ

Several types of lasers have been developed and tried to be clinically applied to the oral area. Lasers have been used for various clinical practices, diagnosis and prevention of dental caries, treatment for periodontal disease, hypersensitive dentin, relieving pain, and root canal infections. The Er:YAG laser is the only dental laser that has the potential to ablate both dental hard tissue and soft tissue. In this report, I introduce the practical procedure of some cases using the Er:YAG laser, and discuss the utility of Er:YAG laser application on oral soft tissue or hard tissue

Frontal/Lateral Mandibular Translations-masticatory Movement Relationship

Objective: This study aimed to clarify whether crown restorations with adjusted occlusal surfaces that were formed using frontal/lateral mandibular translations, functioned without interference during mastication. Materials and Methods: In 10 adult volunteers who had healthy normal dentition, frontal and lateral border movement was measured during unilateral mastication and free mastication, using an ultrasound digital mandibular measuring system (ARCUS digma2). Additionally, precise impressions of the upper and lower dental arch were taken, and dental casts were made. These casts were measured using a CAD/CAM scanning system (ARCTICA). For the fabrication of crown restorations, the functionally generated path technique (FGP technique) was used on the monitor for the lower first and second molar. The movement of the opposite teeth on the occlusal surface during frontal and lateral border movement, during unilateral mastication, and during free mastication was considered the functional occlusal surface. The data of the functional occlusal surface generated by frontal/lateral mandibular translations and that of each of the masticatory functional occlusal surfaces were superimposed using three-dimensional data evaluation software (GOM). The difference between these surfaces was evaluated to determine the interference area, maximum interference difference, and average interference difference. Results: Interference was present for all functional occlusal surfaces created by mastication as well as those determined by frontal/lateral mandibular translations. The average interference values, in order of free masticatory movement, habitual masticatory side, and non-habitual masticatory side, were as follows. Interference area: 167.5±20.8 mm2, 121.9±28.5 mm2, 144.6±28.0 mm2; maximum interference distance: 345.0±43.1 μm, 189.0±39.9 μm, 309.0 ± 46.8 μm; average interference distance: 130.0±15.7 μm, 64.0±10.6 μm, 130.0±21.9 μm. Statistically significant differences were found for the maximum interference distance and average interference distance (both p<0.05). Conclusions: The functional occlusal surfaces for each form of mastication demonstrated interference with the functional surface of frontal/lateral mandibular translations. Thus, crown restorations of which the occlusal surfaces were adjusted and formed by frontal/lateral mandibular translations may interfere with mastication

イリョウ カソ チイキ デノ エンカク シンリョウ シエン システム オ モチイタ ノウコウソク キュウセイキ イリョウ

Introduction : The validity of intravenous rt-PA therapy for acute ischemic stroke patients within ４．５ hours after onset is reported, but the rate of the delivery of rt-PA therapy is assumed lower due to its lack of stroke specialists and its geographic location in depopulated areas. In February ２０１３, we developed the telemedicine system in our medically under-served area as a potential solution of medical disparities. Objects and Methods : After the introduction for １６ months, ９５ acute ischemic stroke patients were transferred to our hospital, seven （７．３７％） of which were subjected to the “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine （k-support）. We examined the time course after onset and the treatment outcome of these seven cases. Results : Seven cases had rt-PA infusion started in the depopulated area. In five cases, recanalization of occluded vessels were demonstrated resulting in improved clinical symptoms. Conclusion : It was able to give a standard therapy using rt-PA infusion for acute ischemic stroke and the quality of the cerebral infarction medical treatment was improved by building the telemedicine system in the depopulated area

Educational effects using a robot patient simulation system for development of clinical attitude

Introduction: The aim of this study was to assess the effectiveness of improving the attitude of dental students toward the use of a full-body patient simulation system (SIMROID) compared to the traditional mannequin (CLINSIM) for dental clinical education. Materials and methods: The participants were 10 male undergraduate dental students who had finished clinical training in the university hospital 1 year before this study started. They performed a crown preparation on an upper premolar tooth using SIMROID and CLINSIM as the practical clinical trials. The elapsed time for preparation was recorded. The taper of the abutment teeth was measured using a 3-dimensional shape-measuring device after this trial. In addition, a self-reported questionnaire was collected that included physical pain, treatment safety, and maintaining a clean area for each simulator. Qualitative data analysis of a free format report about SIMROID was performed using text-mining analysis. This trial was performed twice at 1-month intervals. Results: The students considered physical pain, treatment safety, and a clean area for SIMROID significantly better than that for CLINSIM (P < 0.01). The elapsed time of preparation in the second practical clinical trial was significantly lower than in the first for SIMROID and CLINSIM (P < 0.01). However, there were no significant differences between the abutment tapers for both systems. For the text-mining analysis, most of the students wrote that SIMROID was similar to real patients. Conclusion: The use of SIMROID was proven to be effective in improving the attitude of students toward patients, thereby giving importance to considerations for actual patients during dental treatment

スマートフォン ト インターネット オ モチイタ トクシマ ケンリツ カイフ ビョウイン エンカク イリョウ シエン システム k-support ノ ドウニュウ

Because a specialist in general medical treatment lacked the Kaifu area of South Tokushima absolutely, we forced a limited doctor to many burdens and performed medical treatment while I always carried risks on my back for the disease except the specialty domain. A stroke specialist in particular is an absent medical depopulated area, and it is difficult to perform the rt-PA IV therapy that is a standard therapy for a stroke for the immediate nature period. Using remote video diagnosis treatment supporting system SYNAPSE ERm that was the smartphone application that FUJIFILM developed for the purpose of canceling these, we introduced smartphone and Tokushima Prefectural Kaifu Hospital remoteness medical treatment support system （k-support） by the Internet as area medical treatment support in February, 2013. This system can provide image information and patient information such as CT or the MRI to a tablet phone and the smartphone of Tokushima Prefectural Kaifu Hospital full-time employment doctors and the doctors who support it, and work in a House in real time. In other words, we can obtain necessary information without asking the when and where and can send appropriate instructions, advice to the Tokushima Prefectural Kaifu Hospital medical attendant from a specialist for it. After introduction, the treatment with this system in 58 emergency patients was carried out in seven months until August 31. The example letting the wide area present the smartphone such as this system and a remote medical treatment support system using the Internet in the medical depopulated area is the first trial in this country

Cerebral infarction associated with benign mucin-producing adenomyosis: report of two cases

Abstract Background Cerebral infarction associated with a malignant tumor is widely recognized as Trousseau syndrome. In contrast, few cases of cerebral infarction associated with benign tumors have been reported. We present two cases of embolic stroke that seemed to be caused by mucin-producing adenomyosis. Case presentation The patients were women aged 42 and 50 years old. Both patients developed right hemiparesis and aphasia, and cerebral infarctions were detected in the left cerebral hemisphere. There were no other abnormal findings, except for elevation of CA125 and D-dimer. Trousseau syndrome was suspected in both cases, but whole body examinations did not reveal any malignant tumors. However, uterine adenomyosis was detected in both patients. Conclusions From our findings and a review of the literature, both mucin-producing malignant tumors and mucin-producing benign tumors such as adenomyosis may cause hypercoagulability and cerebral infarction. This mechanism should be considered in a case of a young to middle-aged woman with embolic stroke of an undetermined origin

Idiopathic basal ganglia calcification associated with cerebral micro-infarcts: a case report

Abstract Background Idiopathic basal ganglia calcification (IBGC) is a rare neurodegenerative disorder characterized by symmetric intracranial calcium deposition. We report a patient with IBGC associated with cerebral infarction due to impairment of cerebrovascular reactivity based on single-photon emission computed tomography (SPECT) with acetazolamide challenge. Case presentation A 66-year-old male presented with right conjugate deviation, right hemiparesis and total aphasia due to a convulsive seizure. Brain computed tomography showed symmetric calcifications in the bilateral basal ganglia, thalamus, cerebellar dentate nuclei, which were consistent with IBGC. Diffusion-weighted brain magnetic resonance imaging showed multiple small infarctions in the bilateral cerebral subcortical area. In the search for the cause of cerebral infarction, SPECT with acetazolamide challenge revealed heterogeneous impairment of cerebrovascular reactivity in the whole brain, despite the absence of evidence for steno-occlusive changes in proximal arteries. Conclusion Cerebrovascular insufficiency due to the lack of elasticity caused by microvascular calcification might have been one of the pathophysiological features of IBGC in this case. Thus, vascular calcification may cause cerebrovascular disturbance and could lead to ischemic stroke in patients with IBGC

Snapping knee caused by the gracilis tendon: A case report with an anatomical study

We report the case of a patient exhibiting the snapping phenomenon during flexion/extension motion caused by the gracilis tendon flipping over the posteromedial corner of the medial femoral condyle. A 30-year-old woman presented with a 2-year history of pain accompanied by snapping over the medial aspect of the left knee. Snapping was observed at the posteromedial corner of the medial femoral condyle at around 30° of flexion during active and passive flexion/extension. Imaging examination, including radiography, magnetic resonance imaging (MRI), and computed tomography, revealed no abnormalities. Considering the persistent discomfort and disability associated with the snapping, surgery was indicated. During surgery, the gracilis tendon was observed to move over the posterior edge of the medial femoral condyle during flexion/extension of the knee. The gracilis tendon was transected and the proximal cut end was sutured to the neighboring semitendinosus tendon in a proximally retracted position. After the surgery, the snapping symptom was resolved. We hypothesized that the anteriorly deviated location of the gracilis tendon in relation to the medial femoral condyle was a causative factor for the snapping phenomenon in this patient. In order to investigate whether the gracilis tendon of this patient passes along the aberrant route, the location of the gracilis tendon in our patient population with knee injuries (26 patients) was examined on axial MRI. In this study population, the gracilis tendon was located posterior to the medial femoral condyle in 21 of the 26 knees (81%), and at the posteromedial corner of the medial femoral condyle in 5 of the 26 knees (19%). However, passage of the gracilis tendon anterior to the posterior edge of the medial femoral condyle was not observed in any of the cases in this population. Based on this investigation, the aberrant route of the gracilis tendon was thought to be a primary factor for snapping observed in this patient

Possibility and Future of Intraoral Scanner

Impression taking for treatment is indispensable in dental practice. Many types of impression materials have been researched and developed in the past, with the advantages of convenience, high precision, and accurate impression. In recent years, digital imaging devices have become smaller, and their image quality has improved with the development of digital technology. This technology has been applied for development of an intraoral scanner (IOS), which captures the state of the intraoral region in three dimensions. Therefore, optical impressions using IOSs have been attracting attention. The use of IOS is expected to reduce the risk of various errors and infections compared to the use of conventional techniques using alginate and silicone. Furthermore, not using impression materials has many advantages, such as eliminating the risk of aspiration, cost reduction by not using materials such as gypsum, convenience of data exchange due to the use of digital data, and ease of use with dental computer-aided design/computer-aided manufacturing systems. In contrast, the precision and accuracy of IOS are comparable to those of silicone impression material in the posterior segment, but they are inferior in the cross arch. Training for effective use and capital investment is required to use IOSs. Further research on IOSs is warranted as it is a developing technology