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

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

BACKGROUND: To determine the relationship between superior disc-endplate complex injury and correction loss after surgery in a group of young adult patients with a stable thoracolumbar burst fracture. METHODS: The study group was comprised of young adult patients who had undergone short-segment posterior fixation and bone grafting under the diagnosis of a stable thoracolumbar burst fracture from March 2008 to February 2014. Follow-up was available for more than 1 year. Before surgery, magnetic resonance imaging was performed to determine injury to the anterior longitudinal ligament, posterior longitudinal ligament, and superior and inferior intervertebral discs and endplates. Correction loss was evaluated by the Cobb angle, intervertebral disc height, upper intervertebral disc angle, vertebral wedge angle, and vertebral body height. RESULTS: No significant relation was noted between correction loss and an injury to the anterior longitudinal ligament, posterior longitudinal ligament, inferior intervertebral disc/endplate, and fracture site, whereas an injury to the superior endplate alone and superior disc-endplate complex showed a significant association. Specifically, a superior intervertebral disc-endplate complex injury showed statistically significant relation to postoperative changes in Cobb angle (p = 0.026) and vertebral wedge angle (p = 0.047). CONCLUSIONS: A superior intervertebral disc-endplate complex injury may have an influence on the prognosis after short-segment fixation in young adult patients with a stable thoracolumbar burst fracture.
Body Height ; Bone Transplantation ; Diagnosis ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Prognosis ; Young Adult*

PURPOSE: Drug resistance is one of the major obstacles to treatment of cancer. Multidrug resistance (MDR) caused by overexpression of p-glycoprotein (Pgp) in cancer cell membrane is a well-known mechanism of drug resistance in in vitro system and was reported to be a significant mechanism of resistance in non-Hodgkins lymphoma (NHL). Verapamil, a calcium channel blocker, is proven in vitro to overcome the MDR caused by Pgp. We performed a phase II trial of verapamil in patients with NHL refractory to EPOCH regimen (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin) to overcome the MDR caused by Pgp. MATERIALS AND METHODS: Verapamil was administered via intravenous route from 1 hour before to 12 hour after the 96-hour infusion of etoposide, doxorubicin, and vincristine which were known to be substrates of Pgp in EPOCH regimen. The dose of verapamil was 0.15 mg/Kg in bolus and 0.2 mg/Kg/hr in infusion at the beginning and escalated by 0.05 mg/Kg/hr every 24 hours if there was no dose-limiting toxicities such as 2nd or 3rd degree AV block, hypotension, or congestive heart failure. Plasma verapamil concentrations were measured every 24 hour by gas chromatography. Mdrl expression level in tumor tissues was measured by RT-PCR. RESULTS: From Feb. to Nov. 1994, 14 patients were treated with this protocoL However, poor tolerability and no response in these patients led to early closure of the study at this 1st stage of patient accrual according to Gehans method. Among 14 patients, 12 experienced 2nd or 3rd degree AV block and/or hypotension and required temporary cessation of infusion and reduction of verapamil dose. However, there was no congestive heart failure or treatment-related death. The peak concentrations of verapamil were 0.29-1.94 pM (mean 0.93 pM) and mean concentrations during the 4-day infusion were 0.22-1.21 pM (mean 0.6 pM). Mdrl expression levels measured in 6 patients were 0.99-14.43 U (median 4.39). CONCLUSION: These results suggest that verapamil in this dose and schedule was neither tolerable nor effective for the reversal of drug resistance in NHL patients.
Appointments and Schedules ; Atrioventricular Block ; Calcium Channels ; Cell Membrane ; Chromatography, Gas ; Cyclophosphamide ; Doxorubicin ; Drug Resistance* ; Drug Resistance, Multiple ; Etoposide ; Heart Failure ; Hodgkin Disease* ; Humans ; Hypotension ; Lymphoma, Non-Hodgkin ; P-Glycoprotein ; Plasma ; Prednisolone ; Verapamil* ; Vincristine

PURPOSE: The objective of this study is to determine whether application of ventilation in line with compression rate in performance of CPR for cardiac arrest patients was helpful in maintaining an adequate ventilation rate. METHODS: Volunteers who received education on the revised 2010 CPR guidelines were randomly assigned to either a conventional ventilation (CV) group or a compression-adjusted ventilation (CAV) group. During performance of CPR, compression rate and ventilation rate were measured every minute, and the participants' roles were changed every two minutes; CPR was performed for a total of eight minutes. RESULTS: A total of 57 volunteers participated in this study. No statistically significant difference was observed between the compression rate of the CV group and that of the CAV group. However, regarding adequacy of the ventilation rate, greater improvement was observed in the CAV group, compared with the CV group (adequate ventilation: 86.2% vs. 46.4%, p<0.001). In addition, the median value of the ventilation rate was 8.4/min (IQR: 7.7-9.6) in the CV group and 9.5/min (IQR: 9.0-10.0) in the CAV group (p=0.003). CONCLUSION: When no other valid approach is available, use of the CAV method is conducive to maintenance of an adequate ventilation rate.
Cardiopulmonary Resuscitation ; Heart Arrest ; Humans ; Manikins ; Ventilation

BACKGROUND: Sympathetic blocking agent, esmolol (selective beta 1 blocker) or labetalol ( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. METHODS: Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control (n=10), Group II:esmolol (n=11) and Group III: labetalol (n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure (RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. RESULTS: Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation ( p<0.05). Esmolol reduced the heart rate and the rate-pressure product than labetalol, but statistically there were no significance (P > 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups ( p<0.05). But there were no difference among groups (P>0.05). The side effects of esmolol and labetalol did not appear at all. CONCLUSION: 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation.
Adult ; Anesthesia, Inhalation ; Blood Pressure ; Catecholamines ; Dopamine ; Epinephrine ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Labetalol* ; Norepinephrine ; Operating Rooms ; Plasma ; Tachycardia

Typhlitis is one of the most ominous complications in immunocompromised patients. Neutropenic enterocolitis or typhlitis is a clinical syndrome characterized by fever, diarrhea and abdominal pain that occurs in neutropenic patients. It has been reported as a complication of childhood leukemia, but is now known to occur in adults with solid malignancies, acquired immunodeficiency syndrome (AIDS) or bone marrow transplantation (BMT). The association of typhlitis and propylthiouracil has not been previously reported. We report a case of a 42-year-old female patient with typhlitis due to propylthiouracil patient with hyperthyroidism.
Abdominal Pain ; Acquired Immunodeficiency Syndrome ; Adult ; Bone Marrow Transplantation ; Diarrhea ; Enterocolitis, Neutropenic ; Female ; Fever ; Humans ; Hyperthyroidism* ; Immunocompromised Host ; Leukemia ; Propylthiouracil* ; Typhlitis*

OBJECTIVES: We conducted this study to investigate the relationship between the blood concentration of cadmium and cognitive function in elderly Koreans. METHODS: This research is a part of the Korean Elderly Environmental Panel Study (KEEPS). A total of 403 subjects were enrolled and analyzed from August 2008 through August 2010. Demographic information and medical histories were obtained using a questionnaire. Blood concentration of cadmium and Mini-Mental State Examination (MMSE) with Functional Activities Questionnaire (FAQ) were evaluated for each subject. RESULTS: The mean age of subjects was 70.67 (SD 5.18, n=403) and 72% were female. The mean blood cadmium level was 1.22 microg/dl (SD 0.56), mean MMSE score was 25.12 out of 30 and mean FAQ score was 2.03 out of 30. Using linear regression analysis to estimate the relationship between blood cadmium concentration and MMSE and FAQ, we observed a significant association between log transformed values of blood cadmium levels and MMSE (p<0.002) or FAQ (p=0.005) scores. After adjusting for age, sex, level of education, alcohol consumption and smoking habits, the relationship between blood cadmium concentration and MMSE and FAQ scores ramained statistically significant (p=0.033 and 0.029, respectively). CONCLUSIONS: These results suggest that blood cadmium concentration is strongly associated with cognitive function and functional activity in the elderly.
Aged ; Alcohol Drinking ; Cadmium ; Female ; Humans ; Linear Models ; Questionnaires ; Smoke ; Smoking

Band heterotopia is a rare neuronal migration disorder, resulting in epilepsy and mental retardation. Epilepsy in band heteropopia, of which Lennox-Gastaut syndrome constituted about 20%, varied in nature and degree of severity. Band heterotopia can be diagnosed by brain magnetic resonance imaging (MRI), showing another diffuse layer of gray matter underlying the normal-looking cortex with intervening thin rim of white matter. While positron emission tomography (PET) with [18F]-fluorodeoxyglucose revealed glucose uptake similar to the overlying cortex, single photon emission computerized tomography (SPECT) findings of band heterotopia have not been reported. We report a 8-year-old girl who presented with variable types of generalized seizures and mild mental retardation. She was diagnosed as having band heterotopia with Lennox-Gastaut syndrome by MRI and interictal electroencephalogram (EEG) showing immature background and generalized 2 Hz slow spike and wave complexes. Interictal SPECT, using Tc 99m hexamethyl propylenamine oxime (Tc 99m-HMPAO), revealed the same degree of perfusion in both the areas of band heterotopia and the overlying cortex. By using valproate and lamotrigine, she is now in stable condition with a significant decrease in seizure frequency.
Brain ; Child ; Electroencephalography ; Epilepsy ; Female ; Glucose ; Humans ; Intellectual Disability ; Magnetic Resonance Imaging ; Neuronal Migration Disorders ; Perfusion ; Positron-Emission Tomography ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Valproic Acid

PURPOSE: Pancreaticoduodenectomy for mass-like lesions that are suspicious of malignancy sometimes reveals only nonneoplastic disease, especially in those cases where adequate tissues for biopsy are unavailable. In this study, we evaluated the outcomes and quality of life (QOL) after pancreaticoduodenectomy for treating nonneoplastic disease. METHODS: The clinical data of 28 patients who underwent pancreaticoduodenectomy for nonneoplatic disease and trauma from Jan. 1992 to Feb. 2006 were reviewed retrospectively. The QOL was evaluated using the FACT-Hep questionnaire. The patients who underwent laparoscopic cholecystectomy for benign gallbladder disease were utilized as the control group. RESULTS: 13.8% (28/203) of all the pancreaticoduodenectomized patients had nonneoplatic disease and trauma. Male patients were predominant (25/28) and all the trauma patients were male. The mean age was 48 (23~72) years old. The indications for surgery included lesions suspicious for malignancy (16 cases), pancreaticoduodenal artery aneurysm (1 case), and pancreatoduodenal injury (11 cases). The histologic findings of the nonneoplastic lesions revealed benign inflammation of the bile duct (6 cases), chronic pancreatitis (8 cases), pancreatic pseudocyst (1 case), and fibrosis of the Ampulla of Vater (1 case). No surgical mortality occurred. However, the trauma patients group had higher morbidity (72.7% Vs 23.5%, respectively, P=0.01) and a longer hospital stay (68.0 days Vs 32.6 days, respectively, P=0.02) after surgery compared to the nonneoplastic disease patient group. The QOL of the patient who underwent pancreaticoduodenectomy for nonneoplatic disease was not different from that of the control group. CONCLUSION: Since pancreaticoduodenectomy for nonneoplastic disease was safe and the QOL of the patients was acceptable, it should be performed more often when malignancies can not be excluded from the differential diagnosis.
Ampulla of Vater ; Aneurysm ; Arteries ; Bile Ducts ; Biopsy ; Cholecystectomy, Laparoscopic ; Diagnosis, Differential ; Fibrosis ; Gallbladder Diseases ; Humans ; Inflammation ; Length of Stay ; Male ; Mortality ; Pancreatic Pseudocyst ; Pancreaticoduodenectomy* ; Pancreatitis, Chronic ; Quality of Life* ; Surveys and Questionnaires ; Retrospective Studies