Bisphosphonates have been approved for Paget's disease, cancer - related hypercalcemia, bone involvement in multiple myeloma or solid tumors and osteoporosis. Although, underlying pathophysiological mechanisms remain unclear, it seems that bisphosphonates inhibit osteoclast precursor cells, modulate migratory and adhesive characteristics and induce apoptosis of osteoclasts. Furthermore impacts on angiogenesis, microenvironment and signal transduction between osteoclasts and osteoblasts. In this report, we present a case of oral bisphosphonates induced osteonecrosis of the mandible in a 84-year-old patient who received for two years. Two tapered screw vent implants(Zimmer, USA) were placed in the area of first and second molar. Two weeks later after crowns restored, some inflammatory signs and symptoms were observed on the second molar area. Sequestrum was formed and the sequestrum was removed with the implant. Frequent follow-up checks and oral hygiene maintenances were done and the first molar implant was restored. There is insufficient evidence suggests that duration of oral bisphosphonate therapy correlates with the development and severity of osteonecrosis. Therefore, dentists should not overlook the possibility of development of bisphosphonate induced osteonecrosis in patients who have taken oral forms of medication for less than three years.
Adhesives ; Aged, 80 and over ; Apoptosis ; Crowns ; Dentists ; Diphosphonates ; DNA-Directed DNA Polymerase ; Follow-Up Studies ; Humans ; Hypercalcemia ; Mandible ; Molar ; Multiple Myeloma ; Oral Hygiene ; Osteoclasts ; Osteonecrosis ; Osteoporosis ; Signal Transduction

PURPOSE: Laparoscopy is a standard treatment for many diseases. We developed a laparoscopy training protocol that provides a learning experience equivalent to that of an animal laboratory based laparoscopic training course. We proved that the rabbit can be used as an appropriate model for a laparoscopy training program. MATERIALS AND METHODS: Three operators undertook laparoscopic procedures on 15 rabbits using our developed protocol. We checked both objective and subjective parameters, such as operation times and complications for the former, and hand-eye coordination, tactile sensation, tool handling and total skill difficulty for the later, using visual analogue scores. RESULTS: For the first 5 rabbits, the mean operative times (min.) for the 3 operators were 41, 48 and 46.2 for a simple nephrectomy (SN), 62, 68.2 and 66.2 for a partial nephrectomy (PN), 28.8, 36 and 31.8 for an adrenalectomy (Ax) and 65.4, 69 and 60.6 for a simple cystectomy (SC). For the second 5 rabbits the mean operative times (min.) were; SN 32.2, 46.2 and 40.2, PN 57.8, 66.2 and 61.8, Ax 22.8, 32.6 and 32 and SC 65.4, 64.2 and 57.4. For all 15 rabbits the mean operative times (min.) were; SN 20.6, 35.4 and 30, PN 48.6, 54.6 and 53.4, Ax 15.8, 26.2 and 26.2 and CS 48.2, 53.6 and 47.6. CONCLUSIONS: Our laparoscopic training model, using a small animal, provides practicing urologist with the concepts of laparoscopy concept. The rabbit model is appropriate for addressing laparoscopic procedures, with economic benefits. Based on this model, it would be possible for residents to familiarize themselves with laparoscopic procedures.
Adrenalectomy ; Animals* ; Cystectomy ; Education ; Laparoscopy ; Learning ; Models, Animal* ; Nephrectomy ; Operative Time ; Rabbits ; Sensation ; Urology*

STUDY DESIGN: A case report. OBJECTIVES: To document that Gelfoam(R) (Pharmacia & Upjohn, Kalamazoo, MI) contributes to granuloma formation and spinal cord irritation by immune response. SUMMARY OF LITERATURE REVIEW: The Gelfoam(R) or microfibrillar collagen applied during various operation for hemostasis. Some complications of Gelfoam(R), such as mechanical cord compression, postoperative swelling and mass effect in closed cavity have been reported. MATERIALS AND METHODS: The patient was underwent posterior decompression and instrumented posterolateral fusion under the diagnosis of the ossification of ligamentum flavum at T10-11 and T11-12. In operation, Gelfoam(R) was used at epidural space. She complained of sensory deterioration and muscle weakness around lower extremities after 10days postoperatively. A second operation was performed. RESULTS: Postoperatively, the patient immediately improved motor grade except spasticity. She is under observation. CONCLUSIONS: Gelfoam(R) at epidural space after posterior decompression can result hyperactive immune reaction and irritate spinal cord.
Collagen ; Decompression ; Epidural Space ; Gelatin Sponge, Absorbable ; Granuloma ; Hemostasis ; Humans ; Ligamentum Flavum ; Lower Extremity ; Muscle Spasticity ; Muscle Weakness ; Spinal Cord ; Spinal Cord Diseases ; Spinal Fusion

PUROPOSE: It is known that anticholinergics induces cognitive dysfunction and may aggravate the state of it. Tolterodine tartrate (detrusitol(R)) is a widely known selective anticholinergics to bladder, which does not cause a cognitive dysfunction. This study was designed to analyze the change of cognitive function of brain disease patients, whom are taking anticholinesterase inhibitor with tolterodine for overactive bladder (OAB). MATERIAL AND METHODS: From January 2001 to December 2004, with the patients whom have been followed for the brain disease in the department of neurology, we have analyzed 79 patients with tolterodine administered for OAB. We used K-MMSE (Korea minimental status examination) and SNSB (seoul neuropsychological screening battery) to analyze the state of cognition. Mean age of patients was 67.3+/-4.5 (yrs), mean administration period was 4.7+/-9.5 (mon). RESULTS: 7 patients made complaints for the decline of memory, 2 of them with Parkinsonism and 2 with cerebral infarction, 1 with progressive supranuclear palsy and, 2 dementia with lewy body (DLB). Patients with DLB was excluded in this study because the disease had fluctuation of cognitive function. CONCLUSIONS: The result of these studies demonstrates tolterodine tartrate caused the decline of cognitive function in only a few patients with brain disease. We concluded that prospective studies are needed to change the cognitive functions of the brain disease patients with OAB after administration of tolterodine tartrate.
Brain Diseases* ; Cerebral Infarction ; Cholinergic Antagonists ; Cognition ; Dementia ; Humans ; Lewy Bodies ; Mass Screening ; Memory ; Neurology ; Parkinsonian Disorders ; Supranuclear Palsy, Progressive ; Urinary Bladder ; Urinary Bladder, Overactive* ; Tolterodine Tartrate

STUDY DESIGN: Retrospective study. OBJECTIVES: We studied the clinical results and prognostic factors for the postoperative caudaequinasyndrome (CES). Summary of Literature Review: The CES is a rare complication, but its aftereffects are serious. And no satisfactory discussion about its accurate treatment guidelines and prognosis has been provided yet. MATERIALS AND METHODS: 10 patients who were diagnosed with a postoperative CES were enrolled from June 2004 to February 2011. Patients were classified into group I with a favorable neurologic prognosis and groupII without neurologic improvement. The medical history, diagnosis, involved segmentand duration till CES was obtained, the duration was performed till second decompression and the clinical symptoms and the outcome of surgical treatment were investigated. RESULTS: Group I contained of 6cases and group 4 of cases.On average were 1.25(0.5-3) hours required for group I and 22(8-38) hours for group II until CES was diagnosed. The time span for the second operation was 7(3-12) hours for group I and 12.25(5-24) hours for group II. Of 6 cases showing motor losswere 4 cases classified as group II at the last follow-up. Of 10 cases with voiding difficulties belonged 4 cases to the group II. Voiding difficulty was continued as clinical symptom in 4 patients of group II after the secondary decompression. CONCLUSION: The less the motor loss and voiding difficulty before the secondary decompression and the faster diagnosis and surgical decompression, the better the prognosis. In particular, as voiding difficulty showed the lowest recovery rate, it is considered to affect prognosis and satisfaction most seriously.
Cauda Equina* ; Decompression ; Decompression, Surgical ; Diagnosis ; Follow-Up Studies ; Humans ; Polyradiculopathy* ; Prognosis ; Retrospective Studies

OBJECTIVES: To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. METHODS: We retrospectively examined 792 patients aged > or =18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale> or =+1 at any time were considered to have emergence agitation. RESULTS: The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)> or =5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS> or =5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation. CONCLUSION: Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients.
Adult* ; Anesthesia ; Anesthesia Recovery Period ; Anesthesia, General* ; Dihydroergotamine* ; Humans ; Incidence ; Nasal Surgical Procedures* ; Pain, Postoperative ; Psychomotor Agitation ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Urinary Catheters

OBJECTIVES: This study evaluated whether the symptoms of laryngopharyngeal reflux (LPR) change after multilevel surgery for obstructive sleep apnea (OSA). METHODS: Patients who underwent multilevel surgery for OSA between April 2009 and September 2014 were enrolled in this study. All patients underwent preoperative polysomnography prior to surgery and were asked to complete the reflux symptom index (RSI) questionnaire before and after surgery. RESULTS: Of 73 enrolled patients, 24 (33%) reported an RSI score >13 and were thus classified as having reflux. The mean RSI score before surgery was 11.48±7.95; this number decreased to 4.95±6.19 after surgery (P < 0.001). The rate of positive RSI responses was 33% before surgery and 9% after surgery. Each variable that comprised the RSI improved significantly after surgery, except for difficulty with swallowing. Regarding the degree of RSI improvement after surgery, there were no significant differences between subgroups according to sex, age, body mass index, OSA severity, or surgical outcome. CONCLUSION: LPR symptoms are prevalent in OSA patients. Treatment for OSA using multilevel surgery potentially reduces the symptoms of LPR.
Body Mass Index ; Deglutition ; Humans ; Laryngopharyngeal Reflux ; Polysomnography ; Sleep Apnea, Obstructive*

BACKGROUND: Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath. METHODS: A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score. RESULTS: The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 +/- 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease. CONCLUSIONS: The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Range of Motion, Articular ; Retrospective Studies ; Shoulder Joint/physiopathology/*ultrasonography ; Synovitis/*ultrasonography ; Tendons/*ultrasonography

OBJECTIVES: Pregabalin is used to treat neuropathic pain and has shown analgesic properties in postoperative pain. The aim of this study was to investigate the effectiveness and safety of pregabalin in reducing postoperative pain in patients after septoplasty. METHODS: Forty-seven patients scheduled for elective septoplasty were randomly assigned to groups that received either pregabalin (150 mg) or placebo, both one hour before surgery and 12 hours after the initial dose. Pain (verbal numerical rating scale, VNRS) and side effect assessments were performed at 6, 12, 12 to 24, and 24 to 48 hours postoperatively. RESULTS: From 1 to 12 hours postoperatively, VNRS scores for pain were lower in the pregabalin group (n=24) than in the placebo group (n=23; P<0.05). The number of patients who needed rescue analgesics was lower in the pregabalin group (P=0.042). The incidence of nausea and vomiting did not differ between groups (P=0.666), and the incidence of sedation was higher in the placebo groups (P=0.022). CONCLUSION: The perioperative administration of oral pregabalin (150 mg twice) is an effective and safe way to reduce early postoperative pain in patients undergoing septoplasty.
Analgesia* ; Analgesics ; Humans ; Incidence ; Nausea ; Neuralgia ; Pain, Postoperative ; Vomiting ; Pregabalin

PURPOSE: We investigated the clinical difference between single infection and coinfection with respiratory virus in hospitalized children with acute respiratory tract infections. METHODS: We reviewed 727 patients who were admitted with the diagnosis of acute respiratory infection at the Department of Pediatrics, Bundang Jesaeng Hospital between January and December of 2014. Diagnoses were made using the multiplex reverse transcriptase polymerase chain reaction (RT-PCR) assay targeting 16 viruses in nasopharyngeal swabs. Subjects were classified as the single virus infection and coinfection groups. RESULTS: A total of 439 patients were enrolled; 359 (77.2%) under 24 months. Single virus was detected in 279 (63.6%). Coinfection with multiple virus was detected in 160 (36.4%): 126 (28.7%) with 2 viruses, 30 (6.8%), and 4 (0.9%) with 3 to 4 viruses. Viral coinfection was detected in 28 samples (17.5%), with respiratory syncytial virus (RSV) A and rhinovirus being the most dominating combination. There were no clinical differences between the single infection and coinfection groups, except sputum and the frequency of high RSV load. Sputum was significantly more frequent in the coinfection group (P=0.043), and the frequency of high RSV load was significantly higher in the single infection group (P=0.029). Disease severity (high fever, the duration of fever [≥5 days], and the length of hospital stay [≥5 days], O₂ therapy) did not differ significantly between both groups. RSV was a frequent virus of single infection during winter. Coinfection was most common in winter. CONCLUSION: There were no clinical differences between single infection and coinfection, except sputum and the frequency of high RSV load.
Child ; Child, Hospitalized ; Coinfection* ; Diagnosis ; Fever ; Humans ; Length of Stay ; Multiplex Polymerase Chain Reaction ; Pediatrics ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Reverse Transcriptase Polymerase Chain Reaction ; Rhinovirus ; Sputum