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

In order to evaluate the effect of the lumbar epidural steroid injection in the low back pain and/or radicular pain. We studied 66 patients who were treated and followed for an average of 8.6 months. In the initial evaluation, main pain sites were as follows: low back pain in 41 patients, buttock pain in 7 patients, and leg pain. In 18 patients. Immediate response and delayed response in the patients were studied. Immediate response within 1 day after injection revealed the following : dramatic improvement in 3.0%;some improvement in 56.1%; no improvement in 27.3%; and more aggravated in 13.6%. Delayed response after 1 month revealed the following : 15.2% continuously maintained improvement; 9.1 showed progressive improvement;36.4% experienced recurring pain; 27.3% had no improvement; and 10.6% had aggravating pain. The effect of the lumbar epidural steroid injection was not affected by the severity of pain in the initial evaluation. Better improvements were noted in patients who suffered radicular pain than those who suffered low back or buttock pain. Good prognostic factors were young age and male. Complications that the patients suffered were transient injection pain(6), edema of the face or extremity(10), transient leg weakness(5) and dural puncture(1). The number of patients who wanted to recommend this procedure to others were 22(33.3%). In conclusion, epidural steroid injection was one of the methods in the management of the patients who suffered low back pain and/or radicular pain and had no effect by any other therapies.
Buttocks ; Edema ; Humans ; Leg ; Low Back Pain* ; Male

Kindling development is a good animal model of epilepsy and neural plasticity. It is induced by repeated subconvulsive electrical or chemical stimulations. This leads to progressive and permanent amplification of seizure activity resulting in permanent brain changes. Immediate early genes(IEGs) are proposed as the master switch for turning on molecular events in long term neural plasticity. The role of c-myc, an IEG, in the development of kindling is not known. This study was conducted to investigate the role of c-myc in the neural plastic changes underlying kinding. Among 115 adult male Spargue-Dawley rats, 51 were kindled by repeated administrations of subconvulsive doses(15-25mg/kg) of pentylenetetrazol(PTZ). Twenty-eight rats experienced various degree of convulsions induced by a single injection of convulsive dose(30-60mg/kg) of PTZ. Eighteen rats experienced mild or severe convulsions induced by a single injection of convulsive dose(30-60mg/kg) of PTZ. Eighteen rats experienced mild or severe convulsion by a single electroconvulsive shock(ECS). Eighteen rats received normal saline as a control group. Animals were sacrificed in 30 minutes, 1 hour and 48 hours after convulsion. C-myc mRNA levels in the hippocampus were quantified using slot-blot hybridization analysis. In the experiment of PTZ kindling, c-myc mRNA expression 30 minutes after convulsion was elevated about 3-8 times compared with controls. C-myc mRNA expression 1 hour after convulsion was elevated about 4 times at stage I, II, and V, ut was not elevated at stage III and IV. C-myc mRNA expression 48 hours after convulsion was elevated about 2-3 times compared with controls. In the experiment of PTZ-induced seizures, c-myc mRNA expression 30 minutes after convulsion was elevated 5-6 times compared with controls. C-myc mRNA expression 1 hour after convulsion was elevated 4-6 times. C-myc mRNA expression 48 hours after convulsion was elevated approximately 2 times. In the experiment of ECS-induced seizures, c-myc mRNA expression was elevated 4 times at 30 minutes and 1 hour after mild convulsion, but decreased at 30 minutes and 1 hour after severe convulsion compared with control. C-myc mRNA expression 48 hours after convulsion was elevated approximately 2 times. These results suggest that the enhanced expression of c-myc mRNA is a non-specific consequence in the development of PTZ kindling. In addition, c-myc does not seem to play an important role in turning on a molecular program underlying kindling.
Adult ; Animals ; Brain ; Epilepsy ; Hippocampus* ; Humans ; Male ; Models, Animal ; Pentylenetetrazole* ; Plastics ; Rats* ; RNA, Messenger* ; Seizures ; Stimulation, Chemical

Cancer may be a disease of genes, arising from genetic damage of diverse sorts-recessive and dominant mutations, large rearrangement of DNA and gene translocation on chromosomes, all leading to distorisions of either the expression or biochemical function of genes. The search for these genetic damage in neoplastic cells now is the most important in cancer research. It has been found that the cancer relevant genes were located on the specific regions of chromosomes. To determine whether epidermal growth factor receptor(EGFR), P53 and bcr genes located in chromosomes 7, 17 and 22 are altered, we examined 12 neuroepithelial tumor with Southern blot analysis(five low grade astrocytoma, two high grade astrocytoma, two medulloblastoma, on oligodendroglioma, one ependymoma, one choroid plexus papilloma). The loss of heterozygosity(LOH) of EGFR gene was detected in two cases of medulloblastoma. The rearrangement of EGFR gene was detected in a case of ependymoma. The LOH of P53 gene was found in a case of choroid plexus papilloma and low grade astrocytoma. The rearrangement of P53 gene was founs id a case of oligodendroglioma. The LOH of bcr gene was observed in two cases of medulloblastoma and low grade astrocytoma. The rearrangement of bcr gene was observed in two cases of high grade astrocytoma. These results suggested that tumorigenesis and tumor development in the neuroepithelial tumor may invlove specific gene changes in chromosomes 7, 17 and 22.
Astrocytoma ; Blotting, Southern ; Carcinogenesis ; Choroid Plexus ; DNA ; Ependymoma ; Epidermal Growth Factor ; Genes, erbB-1 ; Genes, p53 ; Loss of Heterozygosity ; Medulloblastoma ; Neoplasms, Neuroepithelial* ; Oligodendroglioma ; Papilloma, Choroid Plexus

No abstract available.
Carpal Tunnel Syndrome*

The author studied the relationship of age, Glasgow coma scale, Glasgow outcome scale and appearance of basal cisterns as seen on intial computerized tomography on 95 patients with severe diffuse head injury. The results were as follows : 1) The poor outcome rates were 76.8%, 41.2% and 16.6% among those absent, compressed, and normal basal cisterns, respectively. 2) The correlation with the initial GCS score and the status of basal cistern indicated significant difference of poor outcome rate in the patients with absent or compressed basal cisterns between GCS score 3-5 group and GCS 6-8 group while the patients with normal basal cisterns indicated significantly reduced poor outcome rate regardless of GCS score. 3) When outcome was observed in connection with the patient's age and the status of the basal cisterns, a good recovery was significantly increased in the children with normal basal cisterns while the poor outcome rate was very high in the elderly patients even if the basal cisterns were normal. Therefore, the status of the basal cisterns on CT Scan should be used as non-invasive method for predicting the outcome of severe diffuse head injured patients.
Aged ; Child ; Craniocerebral Trauma* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head* ; Humans ; Tomography, X-Ray Computed*

Symptomatic vasospasm is still one of the major causes of death and disability in patients who suffer an aneurysmal subarachnoid hemorrhage(SAH). To identify risk factors related to symptomatic vasospasm, to determine the outcome in patients with SAH, and to determine the differences identified risk factors between patients with good and bad outcomes, we performed this retrospective study. From a total of 279 SAH patients who were admitted to our hospital between January 1993 and December 1995, 212 were chosen for study. These were patients who had been admitted within 7 days of SAH, had undergone brain computed tomography(CT) within 3 days of SAH and had survived more than 6 days after SAH. Nine variables were examined as to their relationship to symptomatic vasospasm: age, sex, admission day after SAH, hypertension history, frequency of SAH, clinical grade, CT grade, operation day after SAH, and outcome. Data were analyzed by the univariate and multivariate logistic regression method using the Statistical Analysis System(SAS). Symptomatic vasospasm was demonstrated in 30 cases(14.2%). Univariate analysis showed that admission more than 4 days after SAH(p=0.07), clinical grades III-V(p=0.001), and CT grade III(p=0.00001) were associated with a higher risk of symptomatic vasospasm. When study cases were grouped into either good or bad outcome groups, and multivariate logistic regression analysis was performed, these factors were associated with a higher risk of symptomatic vasospasm only in the good outcome group. This suggests that there is a group of patients with a predisposition to symptomatic vasospasm that is independent of these risk factors, and that in these patients, the outcome may be worse.
Aneurysm* ; Brain ; Cause of Death ; Humans ; Hypertension ; Intracranial Aneurysm ; Logistic Models ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage*

Among 875 patients with intracranial aneurysm operated on during the past 14 years, the authors encountered eleven who had experienced recurrent hemorrhage caused by the rupture of aneurysms which had not been noticed at the time of the initial operation and the interval between initial and recurrent hemorrhage varied between 4 and 16 years. Age at the time of initial hemorrhage was relatively young(average 43.7 years). Multiple aneurysms occurred in four cases and hypertension in four others. Clinical grades at the time of the second admission were relatively poor, and in eight patients there were complications with intracerebral hematomas, intraventricular hemorrhages or acute subdural hematoma. Retrospective evaluation of the first angiograms disclosed suspicious tiny aneurysms in five cases, and these grew and ruptured at recurrent hemorrhage. In eight patients, the outcome was good; One remained moderately disabled, and two died. We conclude that the possibility of recurrent hemorrhage, after the clipping of a ruptured aneurysm, should be considered in all aneurysmal patients, especially in those who are young or have multiple aneurysms. To defermine whether or not suspicious tiny aneurysms are present in these patients, their angiograms should be subjected to detailed examination. Late postoperative follow-up angiography to determine the growth or development of another aneurysm might also be needed.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural, Acute ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Aneurysm* ; Retrospective Studies ; Rupture

Spinal epidural abscess is a rare disorder with poor prognosis. In order to understand its clinical feature and method of treatment, a retrospective study of spinal epidural abscess spanning 8 years and encompassing 10 patients was done. There were 6 males and 4 females aged 12 to 64 years with peak incidence at the sixth decade. In one patient, epidural abscess recurred at the site previously treated 10 years ago. In addition to fever and leukocytosis in 8 patients, other frequent symptoms according to lesion site were abdominal pain and motor weakness in thoracic epidural abscess and low back pain and sciatica in lumbar epidural abscess. Staphylococcus aureus was the most common causative organism. Magnetic resonance imaging(MRI) showed variable signal on T1-weighted images and hyperintensity on T2-weighted images, which was studied in 6 patients. Two patterns in gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhancement(2 patients) gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhanement(2 patients) and heterogeneous enhancement(4 patients). MRI offered the advantage of noninvasive early recognition and anatomical localization, which made it the imaging modality of choice. Although laminectomy was the standard operative procedure, the result of window laminectomy with catheter drainage for prevention of kyphosis was proven effective in a girl. Complete improvement following surgery was obtained in patients, while a man resulted in paraplegia and a boy paraparesis with mild kyphosis in thoracic abscess as sequelae.
Abdominal Pain ; Abscess ; Catheters ; Drainage ; Epidural Abscess* ; Female ; Fever ; Humans ; Incidence ; Kyphosis ; Laminectomy ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Paraparesis ; Paraplegia ; Prognosis ; Retrospective Studies ; Sciatica ; Spine* ; Staphylococcus aureus ; Surgical Procedures, Operative

OBJECT: This study was conducted to evaluate whether short-term intravenous infusion of tranexamic acid (AMCA) was able to improve the management outcome by preventing rebleeding without increasing vasospasm and hydrocephalus associated with the long-term administration of this agent in the patients with aneurysmal subarachnoid hemorrhage(SAH) who were planned for the early surgery. METHODS: During the period from June, 1996 to May, 1998, 137 patients admitted within 3 days of their SAH and planned for early surgical intervention were subject to study population. Of these, 60 patients who had been treated with AMCA were classified as AMCA treated group and 77 patients without AMCA treatment as AMCA untreated group. Initially, prognostic factors for rebleeding, vasospasm, hydrocephalus and outcome following SAH including age, sex, clinical grade, CT grade, site of ruptured aneurysms, admission day after SAH, surgery day after SAH, number of aneurysms and hypertension history, were analyzed and compared between AMCA treated group and untreated group. Secondly, the incidence of rebleeding, symptomatic vasospasm and hydrocephalus were compared between the two groups. Also, the management outcome of the patients was compared between the two groups. RESULTS: There were no significant differences in prognostic factors between the two groups. The rebleeding rate was 0% in the AMCA treated group whereas the rate was 7.8% in the untreated group. This difference was statistically significant. The incidences of symptomatic vasospasm and hydrocephalus were found not to be significantly different between the two groups. Of the treated group, 31.7% of patients developed hydrocephalus compared to 32.5% of those at the untreated group. Fourteen(23.3%) patients in treated group developed symptomatic vasospasm and 6 of them(10%) suffered stroke whereas incidences of these in untreated group were 25.9% and 11.7%, respectively. The AMCA treated group showed more favorable outcome than that of untreated group. There was no case of death by rebleeding in the AMCA treated group while one of the main causes of death in the untreated group was rebleeding. CONCLUSION: Short-term high-dose AMCA administration is considered beneficial in improving outcome and diminishing the risk of rebleeding in the patients who suffer from an aneurysmal SAH prior to early surgical intervention.
Aneurysm* ; Aneurysm, Ruptured ; Cause of Death ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Infusions, Intravenous ; Stroke ; Tranexamic Acid