Purpose: Implant-supported restorations have become the standard treatment for edentulous patients. However, several complications have been reported, including implant-fixture fracture. This study aimed to determine the risk factors for dental implant-fixture fracture by evaluating 43 fractured implant fixtures in 33 patients. Materials and Methods: This study included patients referred from local clinics owing to implant fracture between 2006 and 2023. The implant type and location, method for removal, and risk factors for implant fracture were investigated. Results: This study included 22 men and 11 women (mean age, 60.8 years; range, 33–82 years). Implant fracture was twice as common in men than in women. Fractures were more common in fixtures with internal connections rather than in those with external connections. More implant fractures were observed in patients with single implants than in those with multiple implants. Conclusion Since the only solution to implant fracture is removal, regular follow-up and biomechanical and biological considerations to reduce dental implant fracture are necessary.

Purpose: Implant-supported restorations have become the standard treatment for edentulous patients. However, several complications have been reported, including implant-fixture fracture. This study aimed to determine the risk factors for dental implant-fixture fracture by evaluating 43 fractured implant fixtures in 33 patients. Materials and Methods: This study included patients referred from local clinics owing to implant fracture between 2006 and 2023. The implant type and location, method for removal, and risk factors for implant fracture were investigated. Results: This study included 22 men and 11 women (mean age, 60.8 years; range, 33–82 years). Implant fracture was twice as common in men than in women. Fractures were more common in fixtures with internal connections rather than in those with external connections. More implant fractures were observed in patients with single implants than in those with multiple implants. Conclusion Since the only solution to implant fracture is removal, regular follow-up and biomechanical and biological considerations to reduce dental implant fracture are necessary.

Purpose: Implant-supported restorations have become the standard treatment for edentulous patients. However, several complications have been reported, including implant-fixture fracture. This study aimed to determine the risk factors for dental implant-fixture fracture by evaluating 43 fractured implant fixtures in 33 patients. Materials and Methods: This study included patients referred from local clinics owing to implant fracture between 2006 and 2023. The implant type and location, method for removal, and risk factors for implant fracture were investigated. Results: This study included 22 men and 11 women (mean age, 60.8 years; range, 33–82 years). Implant fracture was twice as common in men than in women. Fractures were more common in fixtures with internal connections rather than in those with external connections. More implant fractures were observed in patients with single implants than in those with multiple implants. Conclusion Since the only solution to implant fracture is removal, regular follow-up and biomechanical and biological considerations to reduce dental implant fracture are necessary.

PURPOSE: We compared the efficacy of radical cystectomy (RC) and non-RC treatment [transurethral resection of bladder tumor (TURB) only, partial cystectomy, or TURB followed by radiotherapy] in octogenarians with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS: A total of 177 patients aged 80 years or more underwent TURB at our institute, and 41 patients had MIBC according to the histologic examination. Fourteen patients with lymph node or distant metastasis were excluded, and 27 patients were ultimately included. Patients were stratified by treatment modality (RC vs. non-RC), Charlson Comorbidity Index (low CCI vs. high CCI), and clinical tumor stage (organ-confined disease vs. extravesical disease). The effects of several variables on cancer-specific and overall survival were assessed. RESULTS: Of the 27 patients, 11 (41%) underwent RC and 16 (59%) underwent non-RC treatment. Patients in the RC group were younger and more likely to have low CCI scores. There were no significant differences in overall or cancer-specific survival in the RC and non-RC groups. Patients with clinically organ-confined disease had better survival outcomes than did those with extravesical disease. Stratification of patients by CCI indicated that overall survival was better in patients with low CCI scores (p=0.013), although cancer-specific survival was similar in the two CCI groups. Univariate and multivariate analysis indicated that clinical tumor stage and CCI were independently associated with overall survival. CONCLUSIONS: RC in octogenarians with MIBC does not improve overall survival compared with other treatment modalities. However, clinically organ-confined disease and low CCI score were associated with better overall survival.
Aged ; Aged, 80 and over ; Comorbidity ; Cystectomy ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Urinary Bladder ; Urinary Bladder Neoplasms

Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial pressure without any abnormal findings. In the present study, we report a rare case of IIH in a patient after ventriculoperitoneal shunt (VPS) due to infant hydrocephalus. A 13-year-old girl with a history of VPS due to infant hydrocephalus was admitted to emergency room with the complaint of severe headache and visual disturbance. Brain computed tomography showed normal findings. However, based on the measurement by lumbar puncture, her cerebrospinal fluid (CSF) pressure was observed to be very high. The shunt function test revealed a VPS malfunction. Thus, we conducted VPS revision in this patient. All symptoms improved immediately after the revision. Thus, it is proposed that IIH should be considered for patients with visual disturbance and severe headache after VPS due to infant hydrocephalus without ventriculomegaly.

Intracranial plasmacytoma is a rare neoplasm and a subtype of malignant plasma cell tumor. Most patients with plasma cell tumors are diagnosed with multiple myeloma, but 5%–10% of patients are not. This report includes descriptions of radiologic and clinical findings in a patient with intracranial plasmacytoma. Intracranial extra-axial plasmacytomas can be easily misdiagnosed as meningioma in radiologic and clinical findings. A 69-year-old woman presented with exophthalmos and diplopia, and MRI indicated meningioma. Thus, she underwent gross total resection, and her pathologic diagnosis was plasmacytoma. Exophthalmos and diplopia were fully recovered. She was finally diagnosed with multiple myeloma based on systemic evaluation and treated with targeted chemotherapy. MRI conducted at 3 months after surgery showed no local recurrence or remnant tumor. Although intracranial plasmacytomas are difficult to distinguish from meningiomas in preoperative evaluation, gross total resection is recommended for the same purposes as meningiomas. If the pathologic diagnosis is a plasmacytoma, it is essential to have a systemic evaluation for multiple myeloma.

Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial pressure without any abnormal findings. In the present study, we report a rare case of IIH in a patient after ventriculoperitoneal shunt (VPS) due to infant hydrocephalus. A 13-year-old girl with a history of VPS due to infant hydrocephalus was admitted to emergency room with the complaint of severe headache and visual disturbance. Brain computed tomography showed normal findings. However, based on the measurement by lumbar puncture, her cerebrospinal fluid (CSF) pressure was observed to be very high. The shunt function test revealed a VPS malfunction. Thus, we conducted VPS revision in this patient. All symptoms improved immediately after the revision. Thus, it is proposed that IIH should be considered for patients with visual disturbance and severe headache after VPS due to infant hydrocephalus without ventriculomegaly.

A 27-year-old male patient, previously diagnosed with Hodgkin lymphoma (HL), presented with gait disturbance. Brain MRI showed a 4.5 cm mass lesion in the right occipital lobe, suggesting either intracranial involvement of HL or a potential meningioma. Despite high-dose methotrexate and steroid treatment, the patient’s symptoms persisted, and imaging showed an enlarging mass, leading to surgical intervention. Histopathological examination confirmed central nervous system (CNS) involvement of HL. Postoperatively, the patient underwent whole-brain radiotherapy and demonstrated marked clinical improvement. Our literature review from 1980 to 2023 identified only 46 cases of intracranial HL (IC-HL), underscoring its rarity. Lymphomas represent 2.2% of brain tumors, with 90%–95% being diffuse large B-cell lymphoma (DLBCL). In contrast, the incidence of CNS-HL patients is a mere 0.02%. Notably, IC-HL and intracranial DLBCL have differences in their typical locations and treatment strategies. Unlike DLBCL, which predominantly appears in the supratentorial region (87%), IC-HL is found there in 61.5% of cases. Additionally, 33.3% of IC-HL cases occur in the cerebellum, with 43.5% associated with posterior circulation regions. Furthermore, while biopsy followed by chemotherapy induction is a common strategy for DLBCL, 81.8% of IC-HL cases underwent surgical resection, and only 18.1% had a biopsy alone. The distinct characteristics of IC-HL tumors, including their larger size, attachment to the dura, and fibrotic nature with clear boundaries, might account for the preference for surgical intervention. The unique features of IC-HL compared to DLBCL highlight the need for distinct considerations in diagnosis and management.

This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.
Carcinoma, Renal Cell ; Comorbidity ; Follow-Up Studies ; Humans ; Ischemia ; Methods ; Nephrectomy* ; Propensity Score ; Renal Insufficiency, Chronic

PURPOSE: The prognosis of patients with malignant pheochromocytoma is poor, but the predictive factors are not well understood. We aimed to identify the clinical characteristics predictive of malignancy after initial surgical removal in patients with pheochromocytoma. MATERIALS AND METHODS: We retrospectively reviewed the records of 152 patients diagnosed with pheochromocytoma, including 5 (3.3%) with metastasis at the time of the initial surgical excision and 12 (7.9%) who developed metastasis during follow-up. To determine the factors predictive of malignancy, we compared clinical, radiographical, and urinary chemical findings between patients with benign and malignant disease. Mean follow-up was 41.5 months (range, 0.9-298 months) after surgery. RESULTS: Malignant tumors were significantly larger than benign tumors (11.1+/-4.0 cm vs. 6.2+/-3.4 cm, p<0.001), and postoperative persistence of arterial hypertension was more frequent after removal of malignant than benign tumors (p=0.001). Among the 147 patients without metastatic disease at diagnosis, those who developed metastasis had significantly lower concentrations of urinary catecholamine metabolites per unit of tumor, including vanillylmandelic acid (1.2 vs. 3.7 mg/day/cm, p=0.049), epinephrine (4.5 vs. 168.9 microg/day/cm, p=0.008), and norepinephrine (13.1 vs. 121.8 mg/day/cm, p<0.001). The overall 5-year metastasis-free survival rate was 84.4% and was significantly higher in patients with smaller tumors (< or =5.5 vs. >5.5 cm; 90.6% vs. 81.2%, p=0.025) and higher 24-hour secretion of vanillylmandelic acid (>2.1 vs. < or =2.1 mg/day/cm; 94.9% vs. 70.9%, p=0.019). CONCLUSIONS: Large tumor size (>5.5 cm) and minimally elevated 24-hour urinary vanillylmandelic acid (< or =2.1 mg/day/cm) were significantly associated with a higher probability of a malignant pheochromocytoma portending a lower metastasis-free survival and mandating more rigorous follow-up after surgery.
Adrenal Gland Neoplasms ; Catecholamines ; Epinephrine ; Follow-Up Studies ; Humans ; Hypertension ; Neoplasm Metastasis ; Norepinephrine ; Pheochromocytoma ; Prognosis ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Vanilmandelic Acid