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

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

OBJECTIVE: This study aimed to investigate the prevalence of metabolic syndrome, associated factors in schizophrenia patients and whether metabolic syndrome have an effect on health related quality of life (QoL) and body image. METHODS: 81 subjects were included in this study, who were diagnosed as schizophrenia defined by DSM-IV criteria and admitted in neuropsychiatric department, Wonkwang University Hospital. For each subject, anthropometric index and laboratory parameters were measured. Metabolic syndrome defined by National Cholesterol Education Program-Adult Treatment Panel III. The subjects were evaluated health related QoL with Short-Form 36 Health Survey-Korean (SF-36-K), and were evaluated body image with Body Image Scale. RESULTS: Of patients, 24.7% had metabolic syndrome. Metabolic syndrome was associated with long duration of illness. The patients with metabolic syndrome showed poorer QoL, especially role physical and bodily pain in SF-36-K. Also, the patients with metabolic syndrome had negative body image, especially body feature, compared to the patients without metabolic syndrome. CONCLUSION: This study suggests that metabolic syndrome is common among patients with chronic schizophrenia. Also It may lead to lowering of QoL and deterioration of body image. So clinicians should be cautious to aware the increased risk for the metabolic syndrome and intervene actively to prevent and treat metabolic morbidity among chronic patients with schizophrenia.
Body Image ; Cholesterol ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Prevalence ; Quality of Life ; Schizophrenia

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

PURPOSE: The increasing use of ultrasonography has allowed for an increase in the of the detection of congenital hydronephrosis, and the clinical outcomes of congenital hydronephrosis are widely varied. In this study, the necessity of voiding cystourethrography in neonate with hydronephrosis to rule out vesicoureteral reflux (VUR) was evaluated. METHODS: Between January 2004 and December 2007, we reviewed the medical record of 157 childrens with congenital hydronephrosis detected within 1 month of age. The severity of hydronephrosis was graded by SFU (Society of Fetal Urology) system, and anterior posterior pelvic diameter (APPD). We evaluated the relationship between severity of hydronephrosis and incidence of VUR by using SPSS windows version 16.0. A P-value<0.05 is considered to be statistically significant. RESULTS: Total renal unit number was 254, and 20(7.8%) renal units had VUR. We did not find any relationship between hydronephrosis grade the presence of VUR grade (P>0.05). In addition, there was no statistical significance between APPD, laterality of hydronephrosis and VUR incidence. However, renal units with VUR had lower spontaneous resolution rate (P<0.05), compared to renal units without VUR. CONCLUSION: In this study, there was no statistical significance between the severity of hydronephrosis and presence of VUR. Therefore, voiding cystourethrogram is recommended for all children with hydronephrosis to rule out VUR, regardless of the severity of hydronephrosis.
Child ; Humans ; Hydronephrosis ; Incidence ; Infant, Newborn ; Medical Records ; Vesico-Ureteral Reflux

There are a few reports about bradycardia or asystole caused by direct laryngoscopy. However, we encountered severe bradycardia in response to suspension laryngoscopy for laryngeal polypectomy after safely completing tracheal intubation using a direct laryngoscope with a curved blade. The tip of the curved blade of the direct laryngoscope is positioned at the vallecula (between the base of the tongue and the pharyngeal surface of the epiglottis) during tracheal intubation, while the blade tip of the suspension laryngoscope lifts the laryngeal surface of the epiglottis or supraglottic area during surgery. Therefore, suspension laryngoscopy can be said more vagotonic than curved-blade direct laryngoscopy. Because of the possibility of bradycardia induced by suspension laryngoscopy, clinicians must be careful about severe bradycardia even after safely completing intubation using direct laryngoscopy.
Bradycardia ; Epiglottis ; Heart Arrest ; Intubation ; Laryngoscopes ; Laryngoscopy ; Piperidines ; Tongue

PURPOSE: To assess the effect of a rectal enema on interfraction prostate movement in bone alignment (BA) for prostate radiotherapy (RT), we analyzed the spatial difference in prostates in a bone-matched setup. MATERIALS AND METHODS: We performed BA retrospectively with data from prostate cancer patients who underwent image-guided RT (IGRT). The prostate was identified with implanted fiducial markers. The setup for the IGRT was conducted with the matching of three fiducial markers on RT planning computed tomography images and those on two oblique kV x-ray images. Offline BA was performed at the same position. The coordinates of a virtual prostate in BA and a real prostate were obtained by use of the ExaxTrac/NovalisBody system, and the distance between them was calculated as the spatial difference. Interfraction prostate displacement was drawn from the comparison of the spatial differences. RESULTS: A total of 15 patients with localized prostate cancer treated with curative hypofractionated IGRT were enrolled. A total of 420 fractions were analyzed. The mean of the interfraction prostate displacements after BA was 3.12+/-2.00 mm (range, 0.20-10.53 mm). The directional difference was profound in the anterior-posterior and supero-inferior directions (2.14+/-1.73 mm and 1.97+/-1.44 mm, respectively) compared with the right-left direction (0.26+/-0.22 mm, p<0.05). The required margin around the clinical target volume was 4.97 mm with the formula of van Herk et al. CONCLUSIONS: The interfraction prostate displacement was less frequent when a rectal enema was performed before the procedure. A rectal enema can be used to reduce interfraction prostate displacement and resulting clinical target volume-to-planning target volume margin.
Enema* ; Fiducial Markers ; Humans ; Prostate* ; Prostatic Neoplasms ; Radiotherapy* ; Retrospective Studies

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

Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis resulting from an IgE-mediated hypersensitivity reaction. The diagnosis of AFS can be established by demonstrating type I hypersensitivity, presence of fungus in mucus, eosinophilic mucin, nasal polyposis, and characteristic CT scans. Although AFS is not unusual and its incidence may be increasing, few cases have been reported in Korea. Here, we report the first case of typical AFS in which Curvularia species was isolated by culture.
Eosinophils ; Fungi ; Hypersensitivity, Immediate ; Incidence ; Korea ; Mucins ; Mucus ; Sinusitis

BACKGROUND AND OBJECTIVES: Heat shock proteins (HSPs) are group of evolutionary conserved proteins whose synthesis are greatly enhanced in cells following exposure to various stressors and play an important role in cellular protection and survival. The purpose of this study was to determine whether olfactory stimulation induces the synthesis of HSP72 in olfactory system of the rat. MATERIALS AND METHODS: Animals were exposed to odorant stimuli using 2% propionic acid odorant stimuli and expression pattern of HSP72 in the olfactory system were detected by immunohistochemistry using anti-HSP72 antibody according to time course and by Western blotting. RESULTS: HSP72 immunopositive cells were expressed in the olfactory epithelium and in the olfactory bulb neurons and a 72 kD band was detected by Western blotting. CONCLUSION: These results suggest that expression of HSP72 in olfactory system of the rat following exposure to odor may serve as a marker for cellular stress and potential damage and may be involved in cellular protection against injuries.
Animals ; Blotting, Western ; Diethylpropion ; Heat-Shock Proteins* ; Hot Temperature* ; HSP72 Heat-Shock Proteins* ; Immunohistochemistry ; Neurons ; Odors* ; Olfactory Bulb ; Olfactory Mucosa ; Rats*