Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary.

Tubulointerstitial nephritis (TIN) is the most common form of renal involvement in IgG4-related disease. It is characterized by a dominant infiltrate of IgG4-positive plasma cells in the interstitium and storiform fibrosis. Demonstration of IgG4-positive plasma cells is essential for diagnosis, but the number of IgG4-positive cells and the ratio of IgG4-positive/IgG-positive plasma cells may vary from case to case and depending on the methods of tissue sampling even in the same case. IgG4-positive plasma cells can be seen in TIN associated with systemic lupus erythematosus, Sjogren syndrome, or anti-neutrophil cytoplasmic antibody-associated vasculitis, which further add diagnostic confusion and difficulties. To have a more clear view of IgG4-TIN and to delineate differential points from other TIN with IgG4-positive plasma cell infiltrates, clinical and histological features of IgG4-TIN and its mimickers were reviewed. In the rear part, cases suggesting overlap of IgG4-TIN and its mimickers and glomerulonephritis associated with IgG4-TIN were briefly described.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis ; Diagnosis ; Fibrosis ; Glomerulonephritis ; Glomerulonephritis, Membranous ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Nephritis, Interstitial* ; Plasma Cells ; Sjogren's Syndrome ; Tin

C3 glomerulopathy is a renal disorder involving dysregulation of alternative pathway complement activation. In most instances, a membranoproliferative pattern of glomerular injury with a prevalence of C3 deposition is observed by immunofluorescence microscopy. Dense deposit disease (DDD) and C3 glomerulonephritis (C3GN) are subclasses of C3 glomerulopathy that are distinguishable by electron microscopy. Highly electron-dense transformation of glomerular basement membrane is characteristic of DDD. C3GN should be differentiated from post-infectious glomerulonephritis and other immune complex-mediated glomerulonephritides showing C3 deposits.
Complement Activation ; Complement Pathway, Alternative ; Dichlorodiphenyldichloroethane ; Glomerular Basement Membrane ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Microscopy, Electron ; Microscopy, Fluorescence ; Pathology ; Prevalence

OBJECTIVE: The purpose of this study was to evaluate the relationship between the visual acuity and visual evoked potentials of the amblyopia patients and normal persons for the demonstration of the visual disability. METHOD: We performed visual evoked potential study, in 49 eyes of the 43 amblyopia patients and in 76 eyes of 38 normal young adults. Our study was carried out to evaluate the relationship of the visual acuity with N1, P1, N2, P2 latency, P1-N2 amplitude and to compare the latency of N1, P1, N2, P2, and P1-N2 amplitude in amblyopia patients and normal young adults. RESULTS: The mean values of N1, P1, N2, P2 latency were prolonged in amblyopia patients compared to normal young adults (p <0.05). There was no correlation between the visual acuity and P1 latency (p> 0.05), but significant correlation was noted between the visual acuity and P1-N2 amplitude (p <0.05). CONCLUSION: These results showed prolonged latency of N1, P1, N2, P2 in amblyopia group as well as significant correlation between visual acuity and P1-N2 amplitude in both groups. So, P1 latency and P1-N2 amplitude are good parameters in evaluating the visual disability.
Amblyopia* ; Evoked Potentials, Visual* ; Humans ; Visual Acuity ; Young Adult

OBJECTIVE: To assess the reliability of triple marker screening test in midtrimester pregnancy for fetal Down syndrome. METHODS: From October 1, 1996 to May 31, 1998 at Nowon Eulji Hospital, 3700 Pregnant women underwent serum tiple marker screening for Down syndrome during 15-20weeks of gestational age. The results of serum triple marker screenig tests for Down syndrome and the outcomes of pregnancies were retrospectively assesed. RESULTS: Sixty seven of 3700 cases(1.81%) were positive in screening test, and 3633(98.18%) cases were negative. Among 67 cases of positive screening test, 1 case(1.49%) was diagnosed as Down syndrome. Among 3633 cases of negative screening test, 4 cases(0.1%) were diagnosed as chromosomal abnormalies postnatally. Two of these 4 cases of chromosomal abnormalies were Down syndrome. CONCLUSION: With this results, sensitivity of triple marker screeing test for Down syndrome is very low as 33.3%. In order to increase the sensitivity, some compensatory adjustment is required in triple marker screening test.
Down Syndrome* ; Equidae ; Female ; Gestational Age ; Humans ; Mass Screening* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second* ; Pregnant Women ; Retrospective Studies

PURPOSE: Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. METHODS: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. RESULTS: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. CONCLUSION: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.
Clinical Clerkship* ; Humans ; Internal Medicine ; Pediatrics ; Schools, Medical ; Seoul ; Students, Medical

The selective targeting of an integrin alphavbeta3 receptor using radioligands may enable the assessment of angiogenesis and integrin alphavbeta3 receptor status in tumors. The aim of this research was to label a peptidomimetic integrin alphavbeta3 antagonist (PIA) with 99mTc(CO)3 and to test its receptor targeting properties in nude mice bearing receptor-positive tumors. PIA was reacted with tris-succinimidyl aminotriacetate (TSAT) (20 mM) as a PIA per TSAT. The product, PIA-aminodiacetic acid (ADA), was radiolabeled with [99mTc(CO)3(H2O)3](+1), and purified sequentially on a Sep-Pak C-18 cartridge followed by a Sep-Pak QMA anion exchange cartridge. Using gradient C-18 reverse-phase HPLC, the radiochemical purity of 99mTc(CO)3-ADA-PIA (retention time, 10.5 min) was confirmed to be > 95%. Biodistribution analysis was performed in nude mice (n = 5 per time point) bearing receptor-positive M21 human melanoma xenografts. The mice were administered 99mTc(CO)3-ADA-PIA intravenously. The animals were euthanized at 0.33, 1, and 2 hr after injection for the biodistribution study. A separate group of mice were also co-injected with 200 microg of PIA and euthanized at 1 hr to quantify tumor uptake. 99mTc(CO)3-ADA-PIA was stable in phosphate buffer for 21 hr, but at 3 and 6 hr, 7.9 and 11.5% of the radioactivity was lost as histidine, respectively. In tumor bearing mice, 99mTc(CO)3-ADA-PIA accumulated rapidly in a receptor-positive tumor with a peak uptake at 20 min, and rapid clearance from blood occurring primarily through the hepatobiliary system. At 20 min, the tumor-to-blood ratio was 1.8. At 1 hr, the tumor uptake was 0.47% injected dose (ID)/g, but decreased to 0.12% ID/g when co-injected with an excess amount of PIA, indicating that accumulation was receptor mediated. These results demonstrate successful 99mTc labeling of a peptidomimetic integrin antagonist that accumulated in a tumor via receptor-specific binding. However, tumor uptake was very low because of low blood concentrations that likely resulted from rapid uptake of the agent into the hepatobiliary system. This study suggests that for 99mTc(CO)3-ADA-PIA to be useful as a tumor detection agent, it will be necessary to improve receptor binding affinity and increase the hydrophilicity of the product to minimize rapid hepatobiliary uptake.
Animals ; Chromatography, High Pressure Liquid ; Histidine ; Humans ; Hydrophobic and Hydrophilic Interactions ; Integrin alphaVbeta3 ; Melanoma ; Mice ; Mice, Nude ; Radioactivity ; Succinimides ; Transplantation, Heterologous ; Ursidae

PURPOSE: This study was conducted to know the applications and limitations of three dimensional volume rendering virtual endoscopy of the ossicles using a multi-row detector CT. MATERIALS AND METHODS: This study examined 25 patients who underwent temporal bone CT using a 16-row detector CT as a result of hearing problems or trauma. The axial CT scan of the temporal bone was performed with a 0.6 mm collimation, and a reconstruction was carried out with a U70u Sharp of kernel value, a 1 mm thickness and 0.5-1.0 mm increments. After observing the ossicles in the axial and coronal images, virtual endoscopy was performed using a three dimensional volume rendering technique with a threshold value of -500 HU. The intra-operative otoendoscopy was performed in 12 ears, and was compared with the virtual endoscopy findings. RESULTS: Virtual endoscopy of the 29 ears without hearing problems demonstrated hypoplastic or an incomplete depiction of the stapes superstructures in 25 ears and a normal depiction in 4 ears. Virtual endoscopy of 21 ears with hearing problems demonstrated no ossicles in 1 ear, no malleus in 3 ears, a malleoincudal subluxation in 6 ears, a dysplastic incus in 5 ears, an incudostapedial subluxation in 9 ears, dysplastic stapes in 2 ears, a hypoplastic or incomplete depiction of the stapes in 16 ears and no stapes in 1 ear. In contrast to the intra-operative otoendoscopy, 8 out of 12 ears showed a hypoplastic or deformed stapes in the virtual endoscopy. CONCLUSION: Volume rendering virtual endoscopy using a multi-row detector CT is an excellent method for evaluation the ossicles in three dimension, even though the partial volume effect for the stapes superstructures needs to be considered.
Ear ; Endoscopy* ; Hearing ; Humans ; Incus ; Malleus ; Stapes ; Temporal Bone ; Tomography, X-Ray Computed

PURPOSE: To assess the agreement and compare the performance of glaucoma diagnosis of peripapillary retinal nerve fiber layer (RNFL) thickness measurements between two different spectral-domain optical coherence tomography (SD-OCT) devices. METHODS: Eighty nine eyes of 56 patients with glaucoma and 42 eyes of 25 healthy individuals were imaged with Cirrus and Spectralis OCT in a single visit. Agreement between RNFL thickness measurements was assessed using intraclass coefficient (ICC) and Bland-Altman plots. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC) for quadrants and average RNFL thickness. RESULTS: ICC values for agreement between both instruments were good for quadrants and average RNFL thickness (all ≥ 0.81). However, Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant (difference = 4.27 µm in normal group, 3.91 µm in glaucoma group, p < 0.001 for both). The RNFL thickness parameter with the largest AUCs was the average RNFL thickness for the Spectralis OCT and the Cirrus OCT (0.85 vs. 0.87, p = 0.30). The pair-wise comparison among the receiver operating characteristic curves showed no statistical difference for all parameters. CONCLUSIONS: Although Spectralis OCT measurements were significantly greater than Cirrus OCT for temporal quadrant, agreement of RNFL measurement between both the devices was generally good and there was no statistically significant difference in the performance of glaucoma diagnosis between both instruments.
Area Under Curve ; Diagnosis ; Glaucoma ; Humans ; Nerve Fibers* ; Retinaldehyde* ; ROC Curve ; Tomography, Optical Coherence*

No abstract available.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Eye Diseases ; Humans ; Thyroid Gland