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*

Severe head injury results in the suppression of cellular immunity associated with dysfunctioning of effector lymphocytes, such as helper T cells(CD4) (and cytotoxic T cells(CD8). Despite progress in the management of increased intracranial pressure following head injury, infection remains the most common complication and the primary cause of prolonged hospitalization and death. This study attempts to assess the cellular immune function following head injury according to the degree of severity, and to establish the clinically available parameters of cell mediated immune(CMI) function, which can then be used for coherent prediction of infection risk. Eighteem head injury patients without severe systemic injury, who divided into three subgroups depending on the severity of head injury, were estimated with the use of CMI multitest kit(Merieux Institute, France) to test delayed-type hypersensitivity(DTH) and enumerated the circulating lymphocyte subpopulation(pan T-cell marker CD3, helper T cell marker CD4, cytotoxic T cell marker CD8 and B-cell marker CD19) on the 1st, 7th, and 21th day of injury. Patients were monitored for evidence of infection for this period. Fourteen patients had no reaction to any antigens of the DTH skin test(anergy) and the remaining four patients had also some degree of anergy. Seven patients became infected and all of them were anergic. There were significant decrease of circulating effector T lymphocytes, both CD4-positive and CD8-positive cells, within 24 hours of injury in the mild as well as the moderate and severe head injury group. CD4-positive cells were nearly completely recovered by the 7th day of injury. CD8-positive cells had sustained significant decrease even after 3 weeks of injury. There was no significant change in pan T-cells(CD3-positive cells) and B-cells(CD19-positive cells). The results suggest that DTH skin test and effector T cell enumeration are both relatively simple and highly sensitive parameters for monitoring CMI function. Especially, anergy of DTH skin test can be used for indicator to predict risk of infection. Mild as well as moderate and severe head injuries may result in the suppression of cellular immunity associated with the dysfunctioning of effector T cell.
B-Lymphocytes ; Craniocerebral Trauma* ; Head* ; Hospitalization ; Humans ; Immunity, Cellular* ; Intracranial Pressure ; Lymphocytes ; Skin ; Skin Tests ; T-Lymphocytes

In order to find out possible causes and measures for prevention of intracerebral hemorrhage remote from the site of cerebral aneurysm surgery, the authors analyzed five patients who developed such a complication following aneurysm surgery among 720 surgical cases of cerebral aneurysm. The aneurysm sites were posterior communicating artery(Pcom) in two cases, anterior communicating artery(Acom) in two, and Acom and middle cerebral artery(MMCA) in one. The hemorrhages in three cases occurred in the cerebellum. One in the contralateral hemisphere and one in the ipsilateral hemisphere to the operation site. All hemorrhages except one occurred vasospasm preoperatively. Fluctuation of blood pressure with sudden elevation to high level was noticed in three cases preoperatively and in all cases postoperatively. We conclude that sudden elevation of blood pressure during the remission stage of vasospasm seems to be possible cause for remote hemorrhage. To prevent this complication, we recommend meticulous control of blood pressure during surgery and in the postoperative period, especially in cases that showed fluctuation of blood pressure preoperatively.
Aneurysm* ; Blood Pressure ; Cerebellum ; Cerebral Hemorrhage ; Hemorrhage* ; Humans ; Intracranial Aneurysm ; Postoperative Hemorrhage ; Postoperative Period

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

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*