PURPOSE: This clinical pilot study was performed to determine the effectiveness of dual-energy cone-beam computed tomography (DE-CBCT) in measuring bone mineral density (BMD).MATERIALS AND METHODS: The BMD values obtained using DE-CBCT were compared to those obtained using calibrated multislice computed tomography (MSCT). After BMD calibration with specially designed phantoms, both DE-CBCT and MSCT scanning were performed in 15 adult dental patients. Three-dimensional (3D) Digital Imaging and Communications in Medicine data were imported into a dental software program, and the defined regions of interest (ROIs) on the 3-dimensional surface-rendered images were identified. The automatically-measured BMD values of the ROIs (g/cm³), the differences in the measured BMD values of the matched ROIs obtained by DE-CBCT and MSCT 3D images, and the correlation between the BMD values obtained by the 2 devices were statistically analyzed.RESULTS: The mean BMD values of the ROIs for the 15 patients as assessed using DE-CBCT and MSCT were 1.09±0.07 g/cm³ and 1.13±0.08 g/cm³, respectively. The mean of the differences between the BMD values of the matched ROIs as assessed using DE-CBCT and calibrated MSCT images was 0.04±0.02 g/cm³. The Pearson correlation coefficient between the BMD values of DE-CBCT and MSCT images was 0.982 (r=0.982, P<0.001).CONCLUSION: The newly developed DE-CBCT technique could be used to measure jaw BMD in dentistry and may soon replace MSCT, which is expensive and requires special facilities.
Adult ; Bone Density ; Calibration ; Cone-Beam Computed Tomography ; Dentistry ; Humans ; Jaw ; Methods ; Miners ; Multidetector Computed Tomography ; Pilot Projects

PURPOSE: We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). MATERIALS AND METHODS: A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed. RESULTS: After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). CONCLUSION: This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.
Arm ; Chemoradiotherapy ; Compliance ; Disease-Free Survival ; Drug Therapy* ; Humans ; Induction Chemotherapy ; Methods ; Nasopharyngeal Neoplasms ; Propensity Score* ; Radiotherapy ; Recurrence ; Republic of Korea ; Retrospective Studies* ; Standard of Care ; Treatment Outcome

PURPOSE: Tertiary hyperparathyroidism (tHPT) means a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient way to treat tHPT. In this study, we reviewed our single center Experience of PTX in regard to postoperative outcomes and analyzed any differences by the types of surgery. METHODS: Among 2,589 recipients who underwent renal allograft between April. 1979 and Dec. 2006, 11 patients (0.4%) were identified to have tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX to evaluate therapeutic effect, and serum-creatinine and GFR using the Modification of Diet in Renal Disease (MDRD) equation to investigate any effect to graft function. RESULTS: One patient showed persistent hyperparathyroidism and hypercalcemia after subtotal PTX. We experienced 10 successful PTXs in which 2 total PTX with autotransplantations, 4 subtotal PTXs and 4 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Serum creatinine increased and estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. CONCLUSION: PTX can cure tHPT-specific symptoms and sign by the recovery of hypercalcemia but may carry the risk of deterioration of kidney graft function. Subtotal PTX rather than total PTX might be recommended in the surgical treatment of tHPT to prevent any risk of kidney graft deterioration.
Allografts ; Autografts ; Calcium ; Creatinine ; Diet ; Humans ; Hypercalcemia ; Hyperparathyroidism* ; Hyperparathyroidism, Secondary ; Kidney ; Kidney Transplantation* ; Parathyroid Hormone ; Parathyroidectomy ; Reference Values ; Transplants

BACKGROUND/AIMS: The long-term virologic and biochemical changes in patients with HBeAg negative HBV infection, especially in Asia, remain unclear. To address this issue, we conducted a 3 year- retrospective, cohort study. METHODS: A total of 157 patients with HBeAg negative HBV infection who were monitored without treatment were reviewed between January 1999 and March 2004. Those patients were followed up every 3 months with liver function tests and serologic tests. All patients were stratified into 3 groups; inactive carrier (IC), viremic carrier (VC) and chronic hepatitis (CH). Serum HBV DNA was measured by a hybridization assay (sensitivity: 1.4 x 10(5) genomes/mL, Digene Diagnostics, Silver Spring, USA). RESULTS: The median age of enrolled patients was 42.7 years (M:F=2.3:1). By single time-point observations, the 3 year-cohort prevalence of HBeAg negative CH varied from 12.7 to 35.8% (median 20.7%) HBeAg negative CH was accumulated over time (P=0.002) and transition rates among three groups after 3 years of follow-up are as follows: IC to CH, 6.0%; IC to VC, 4.1%; VC to CH, 23.2%. VC seems to be a disease state in the middle of transition from IC to CH. CONCLUSIONS: We demonstrated the dynamic changing patterns of HBeAg negative CH with time, of which the change from IC or VC to CH was dominant.
Middle Aged ; Male ; Humans ; Hepatitis B, Chronic/*immunology/virology ; Hepatitis B e Antigens/*blood ; Female ; Carrier State/immunology ; Adult

PURPOSE: For diagnosis of Mycoplasma pneumoniae infection, serological diagnosis, which is simple and rapid method, is uncertain to determine the reliable single serum titers. We compared serologic test, culture and polymerase chain reaction (PCR), and evaluated the reliable single titers of the specific serum antibody determination method for diagnosis of M. pneumoniae infection. METHODS: We included 73 pneumonic children between 3-11 years who were admitted to the pediatric department of St. Benedict hospital between November 2002 and July 2003. We used indirect particle agglutination test (Serodia-Myco II; Fujirebio, Tokyo, Japan) and serum specimens were obtained on admission and after 5-10 days. Fourfold rise of Mycoplasma antibody titers was considered as M. pneumoniae infection. We collected the throat swabs from all of the participants for culture and PCR. RESULTS: Of 73 patients, 41 patients met the diagnostic criteria by serologic test. PCR for M. pneumoniae was positive for 33 patients, sensitivity 80.5%, specificity 90.6%. M. pneumoniae was cultured from 24 patients, sensitivity 59%, specificity 100%. When cut-off was set at a titer of > or =1: 160, the sensitivity and specificity of PCR were significantly higher (61 % vs 68%) by receiver operation characteristic curve. (P=0.035) There was no correlation between culture method and Mycoplasma Ab titer. CONCLUSION: PCR is a highly sensitive and specific diagnostic method and enough to allow for early diagnosis in the acute phase. The single Mycoplasma Ab titer > or =1: 160 in child with respiratory symptoms is considered as M. pneumoniae infection and would be more sensitive, when combined with PCR.
Agglutination Tests ; Child ; Diagnosis* ; Early Diagnosis ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Serologic Tests*

Forty-four strains of Helicobacter pylori were isolated from Kosin Medical Center were tested of resistance to antimicrobial agents, and the mechanism of resistance to clarithromycin was investigated. We determined the MICs of amoxicillin, amoxicillin/clavulanic acid, clarithromycin, and metronidazole by agar and broth dilution method. To detect the mutations of 23S rRNA which is associated with clarithromycin resistance, a 3'-mismatched polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis with restriction enzymes BbsI and BsaI were performed. The nucleotide sequence of 23S rRNA was determined. All H. pylori strains appeared to be susceptible to amoxicillin/clavulinic acid, but 2.3% of strains (1 strain) are resistant to amoxicillin, 13.6% (6 strains) to clarithromycin, and 15.9% (7 strains) to metronidazole. No PCR products was observed by the 3'-mismatched PCR. A 291 bp of PCR product was not digested by BbsI, but was digested by BsaI, which was a characteristic of the A2143G point mutation in the 23S rRNA gene. The nucleotide sequencing analysis revealed that all resistant strains had A2143G, T2182C, and T2244C mutations in 23S rRNA gene.
Agar ; Amoxicillin ; Anti-Infective Agents ; Base Sequence ; Clarithromycin* ; Genes, rRNA ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Metronidazole ; Point Mutation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

Genital mycoplasmas are sexually transmitted. There are considerable public concern that causative agents of sexually transmitted diseases might be transmitted nonsexually through public restrooms. In the present study, Mycoplasma hominis, Ureaplasma urealyticum and M. penetrans among genital mycoplasmas were identified in 100 public restroom toilet bowls (50 men's and 50 women's public restrooms, each). Mycoplasmas were genotypically identified by two methods; (1) PCR of primary selective culture and (2) direct PCR of original specimens before primary selective culture. From 50 men's public restrooms, M. hominis, U. urealyticum and M. penetrans were identified from PCR of primary selective cultures in 6%, 4% and 0% of the specimens, respectively and M. hominis and U. urealyticum was codetected in 2% of those. And M. hominis, U. urealyticum and M. penetrans were identified by direct PCR in 20%, 16% and 0% of the original specimens, respectively and co-detection rate of M. hominis and U. urealyticum was 4% in those. From 50 women's public restrooms, 38% was positive for M. hominis, 14% for U. urealyticum, 0% for M. penetrans and 10% for both U. urealyticum and M. penetrans by PCR of primary selective culture. And 50% was positive for M. hominis, 46% for U. urealyticum and 0% for M. penetrans and 34% for both M. hominis and U. urealyticum by direct PCR of the original specimens. These results indicate that the genital mycoplasmas can survive for considerable duration in toilet bowels, and might be transmitted by through public restrooms.
Mycoplasma hominis ; Mycoplasma penetrans ; Mycoplasma* ; Polymerase Chain Reaction ; Sexually Transmitted Diseases ; Ureaplasma urealyticum

BACKGROUND/AIM: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. METHODS: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. RESULTS: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). CONCLUSION: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life.
Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms/*radiotherapy/*secondary ; Carcinoma, Hepatocellular/mortality/*radiotherapy/*secondary ; English Abstract ; Female ; Human ; Liver Neoplasms/mortality/*pathology ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate

BACKGROUND/AIM: We identified risk factors for hepatocellular carcinoma (HCC) through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver diseases. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. METHODS: We studied a total of 994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. RESULTS: 90 (9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into three groups by their risk index and probability of HCC development. These patients were classified into a low risk group (less than 5% probability), an intermediate risk group (5% to 10% probability), and a high risk group (more than 10% probability). According to this classification, 1 of 191 patients in the low risk group (0.523%), 5 of 176 patients in the intermediate risk group (2.84%), and 21 of 113 patients in the high risk group (18.6%) were diagnosed with HCC. CONCLUSION: We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC.
Carcinoma, Hepatocellular* ; Classification ; Follow-Up Studies ; Humans ; Korea* ; Liver Diseases ; Logistic Models ; Mass Screening ; Risk Factors*

BACKGROUNDS/AIMS: The relationship between HBV infection and nephropathy has been reported with some differences according to the investigators and regions studied. Liver biopsies were not performed in most of the reports. In this study both liver and kidney biopsies were performed. The histologic correlation was analyzed between chronic B viral hepatitis and nephropathy. METHODS: From January 1985 to June 2000, both liver and kidney biopsies were performed on 26 patients who had chronic hepatitis B, proteinuria, and hematuria. Also, a new histopathologic classification of chronic hepatitis was applied in the assessment of liver disease. RESULT: Light microscopy of kidneys showed IgA nephropathy in 7 cases (27%); minimal change nephrotic syndrome (MCNS) in 1 case (3.8%); and membranous glomerulonephritis (MGN) in 9 cases (34.6%), membranoproliferative glomerulonephritis (MPGN) in 9 cases (34.6%). Among the cases with a higher hepatitis activity index and fibrosis score, the frequency of MGN and MPGN was higher. The hepatitis activity index of cases with MGN was significantly higher than IgA nephropathy and MPGN (p=0.011, p=0.039). The fibrosis score of cases with MGN and MPGN was significantly higher than IgA nephropathy (p=0.011, p=0.003). The positivity of HBeAg was highest in cases with MGN. Serum C3 level was low in all cases but the serum C4 level was within normal range. Immunofluorescence studies showed granular deposition of IgG and C3 in the capillary loops in MGN. CONCLUSION: The frequency of MGN and MPGN was higher when the liver disease was more severe. It was suggested that HBeAg, IgG and C3 might contribute to the pathogenesis of MGN in HBsAg positve patients.
Biopsy ; Capillaries ; Classification ; Fibrosis ; Fluorescent Antibody Technique ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Hepatitis ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunoglobulin G ; Kidney ; Liver ; Liver Diseases ; Microscopy ; Nephrosis, Lipoid ; Proteinuria ; Reference Values ; Research Personnel