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

OBJECTIVE: Delirium is very common in orthopedic elderly patients and increase comorbidity and mortality rates. By controling the risk factors of delirium, prevention strategy can be effective and reduce negative outcomes. The purpose of this study was to explore the usefulness of delirium risk assessment with some simple collateral questionaires. METHODS: The subjects were 50 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery for operations of lower extremity fractures. They were evaluated with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Confusion Assessment Method and Korean Dementia Screening Questionnaire (KDSQ) by psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. RESULTS: 27 subjects (54.0%) were diagnosed as delirium. There was a significant difference between delirium group and control group with all KDSQ scores. Depressive category of KDSQ score had the highest correlation (coefficient=0.399) and can be independent risk factor of delirium (p=0.045). CONCLUSION: Cognitive impairment and depressive symptoms have high correlation with delirium. We found that just a few questions of cognitive impairment and depressive symptoms by caregivers can evaluate the risk factors of delirium. The simple collateral questionaires can be useful tool for exploring delirium risk factors.
Aged* ; Caregivers ; Cognition Disorders ; Comorbidity ; Delirium* ; Dementia ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Lower Extremity* ; Mass Screening ; Medical Records ; Methods ; Mortality ; Orthopedics ; Psychiatry ; Risk Assessment ; Risk Factors

Mitochondrial calcium overload is a crucial event in determining the fate of neuronal cell survival and death, implicated in pathogenesis of neurodegenerative diseases. One of the driving forces of calcium influx into mitochondria is mitochondria membrane potential (ΔΨ(m)). Therefore, pharmacological manipulation of ΔΨ(m) can be a promising strategy to prevent neuronal cell death against brain insults. Based on these issues, we investigated here whether nobiletin, a Citrus polymethoxylated flavone, prevents neurotoxic neuronal calcium overload and cell death via regulating basal ΔΨ(m) against neuronal insult in primary cortical neurons and pure brain mitochondria isolated from rat cortices. Results demonstrated that nobiletin treatment significantly increased cell viability against glutamate toxicity (100 µM, 20 min) in primary cortical neurons. Real-time imaging-based fluorometry data reveal that nobiletin evokes partial mitochondrial depolarization in these neurons. Nobiletin markedly attenuated mitochondrial calcium overload and reactive oxygen species (ROS) generation in glutamate (100 µM)-stimulated cortical neurons and isolated pure mitochondria exposed to high concentration of Ca²⁺ (5 µM). Nobiletin-induced partial mitochondrial depolarization in intact neurons was confirmed in isolated brain mitochondria using a fluorescence microplate reader. Nobiletin effects on basal ΔΨ(m) were completely abolished in K⁺-free medium on pure isolated mitochondria. Taken together, results demonstrate that K⁺ influx into mitochondria is critically involved in partial mitochondrial depolarization-related neuroprotective effect of nobiletin. Nobiletin-induced mitochondrial K⁺ influx is probably mediated, at least in part, by activation of mitochondrial K⁺ channels. However, further detailed studies should be conducted to determine exact molecular targets of nobiletin in mitochondria.
Animals ; Brain ; Calcium* ; Cell Death ; Cell Survival ; Citrus ; Fluorescence ; Fluorometry ; Glutamic Acid ; Membrane Potential, Mitochondrial ; Membrane Potentials ; Membranes* ; Mitochondria ; Neurodegenerative Diseases ; Neurons ; Neuroprotective Agents ; Rats ; Reactive Oxygen Species

Atypical insufficiency fracture of the femur following prolonged bisphosphonate use is well described. Regardless of the cause, insufficiency fracture of the acetabulum is extremely rare, and no reports have described insufficiency fractures of the acetabulum that are associated with prolonged bisphosphonate use. This report demonstrates the possibility of insufficiency fracture at the acetabulum following long-term alendronate use and the necessity of particular care in managing insufficiency fractures in “frozen” bone. We describe two cases of insufficiency fracture of the acetabulum following 6 years of alendronate use. Given the patients' medical histories and bone biopsy findings, these insufficiency fractures were thought to be attributable to alendronate use. One case involved the left hip and the presence of pelvic fractures on the opposite side. The patient was treated using cementless total hip arthroplasty (THA), which failed 1 year after surgery. The hip was revised with a massive bone graft and a supportive wire mesh. The other case was managed via THA with a Ganz reinforcement ring due to concerns regarding the use of a cementless implant.
Acetabulum* ; Alendronate* ; Arthroplasty, Replacement, Hip* ; Biopsy ; Femur ; Fractures, Stress* ; Hip ; Humans ; Transplants

Hepatic portal venous gas (HPVG) is a rare disease presenting as acute abdomen. There were first described in children with necrotizing enterocolitis in 1955. HPVG is caused by mesenteric ischemia but may have various etiologies. Predisposing factors that develop mesenteric ischemia include gastric ulcer disease, bowel obstruction, diverticulitis and sepsis. The presence of the air in the portal and mesenteric vein on radiographics has been associated with a mortality rate of more than 75% in earlier studies. Abdominal computed tomography has proven useful for detecting portomesenteric venous gas and pneumatosis intestinalis. We report a case of the patient with hepatic portal venous gas with pneumatosis intestinalis, which showed rapid progress of the disease and eventually died within 24 hours of admission.
Abdomen, Acute ; Child ; Diverticulitis ; Enterocolitis, Necrotizing ; Humans ; Ischemia ; Mesenteric Veins ; Portal Vein ; Rare Diseases ; Sepsis ; Stomach Ulcer

PURPOSE: Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group. CONCLUSION: Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.
Colon ; Colostomy ; Decompression ; Emergencies ; Fees and Charges ; Humans ; Length of Stay ; Neoplasm Metastasis ; Retrospective Studies ; Stents

PURPOSE: The extent of the loss of heterozygosity (LOH) has been used as the genetic parameter for the classification and staging of some solid tumors. Breast cancers such as ductal carcinoma in situ (DCIS), and invasive and metastatic lesions, are frequently observed to contain heterogeneous tumor foci. To delineate the relation between the LOH and the progression of breast cancers, three successive histological sites in a tumor lesion were analyzed for LOH events. METHODS: We tested 111 tumor site including DCIS, and invasive, and metastatic lymph nodes from 50 breast cancers for LOH using 5 microsatellite makers on 8 chromosomal arms (3p, 4p, 5q, 8p, 9p, 13q, 17p, & 18q). RESULTS: Twenty-four of 34 breast cancers showing intratumoral histological heterogeneity had common chromosomal losses in the heterogeneous tumor sites, as well as having divergent losses that were restricted to a part of tumor lesion (mean divergent loss, 2.32). The number and frequency of heterogeneous chromosomal losses were not significantly related with age, tumor size, and stage. Overall, at least one chromosomal loss was detected in 48 cases, and incidences of LOH in each chromosome were 27.1~63.3%. A large fraction (58%) of breast cancer patients had 2 to 4 chromosomal losses, and chromosome 8p was most frequently lost (63%). When comparing the number of chromosomal losses in nine cases with all of three progressive lesions, the lost extent was greater in the DCIS (mean losses, 4.44) than in the invasive sites (mean losses, 3.1) and the metastatic lymph nodes (mean losses, 2.9). Moderate-level chromosomal losses involving 3-5 chromosomes were significantly related with lymph node metastasis (p=0.006) and the advanced tumor stage (p<0.005), whereas low-level losses involving 1~2 chromosomes and high-level losses involving 6~7 chromosomes were more common in DCIS and early-stage diseases. CONCLUSION: The DCIS, invasive, and metastatic sites of a breast cancer patient contained common and divergent chromosomal losses. This indicates the concurrent expansion of different subclones was derived from a common ancestor clone, in which an optimal range of chromosomal losses, rather than high-level chromosomal losses, was more frequently associated with lymph node metastasis and the advanced tumor stages.
Arm ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Classification* ; Clone Cells ; Humans ; Incidence ; Loss of Heterozygosity ; Lymph Nodes ; Microsatellite Repeats ; Neoplasm Metastasis ; Population Characteristics

PURPOSE: This study was performed to evaluate the efficacies and the reliabilities of methods used to measure acetabular anteversion in plain radiographs. MATERIALS AND METHODS: Three orthopedic surgeons measured prosthetic acetabular anteversions in three plain AP and three translateral radiographs of ten patients who underwent total hip arthroplasty. In each film, we measured anteversions three times using three methods in AP and a direct method in translateral radiographs. Data were collected and analyzed statistically with CT axial and planar anteversion measured by a radiologist. RESULTS: All methods with plain AP film showed very low inter and intraobserver variances and correlated well with CT planar and axial anteversions. Although the data obtained from translateral radiographs were showed low variances, they did not correlate with those of the other methods. CONCLUSION: Simple estimation alone or mathematical methods can be reliably and reproducibly used to assess planar anteversion in a clinical setting. Data from translateral radiographs were unreliable and did not correlated well with the other methods, and they are not recommended for clinical use.
Acetabulum* ; Arthroplasty* ; Arthroplasty, Replacement, Hip* ; Humans ; Orthopedics

Among objectives of periodontal therapy, the principal one is the morphological and functional reconstruction of lost periodontal supporting tissues. This includes de novo formation of connective tissue attachment and the regrowth of alveolar bone. The use of enamel matrix derivative(EMD) may be a suitable means of regeneration new periodontal attachment in the infrabony defects. Implant used to replace lost tooth but, implantitis occurred after installation. The purpose of this study was to investigate the effects of EMD on differentiation and growth of osteoblast in titanium disc. Twentyfive millimeter diameter and 1mm thick Ti disc which was coated 25, 50, 100, 200microgram/ml of EMD(Emdogain(R)) used as experimental group, 25, 50, 100, 200ng/ml of rhBMP-2 as positive control group, and no coat as negative control group. A human osteosarcoma cell line Saos-2 was cultured in Ti disc and cell proliferation and Alkaline phosphatase (ALP) activity were measured at 1 and 6 days. PCR was performed at 2 and 8 hours. Semi-quantitative RT-PCR for mRNA expressions of various osteoblastic differentiation markers - type I collagen, ALP, osteopontin, and bone sialoprotein - were performed at appropriate concentrations based upon the results of MTT and ALP assay. Cultured cell-disc complexes were prepared for scanning electron microscopy (SEM) at 2 hour. Data were analyzed using Mann-Whitney and repeated- measures 1-way analysis of variance(SPSS software version 10,SPSS, Chicago, IL). After culture, there was more osteoblast in EMD100microgram/ml than in EMD50, 200microgram/ml on day 6. There was significant difference in experimental and positive control group compared control group, as times go by(1 and 6 days). Alkaline phosphatase activity was different significantly in EMD100, 200microgram/ml and BMP100, 200ng/ml on day 6. The results of reverse transcriptase-polymerase chain reaction (RT-PCR) showed that expression of mRNA for ALPase, collagen type I, osteopontin, bone sialoprotein and BMP-2 was detected at 2 hour and 8 hour in EMD200microgram/ml subgroup and BMP100ng/ml subgroup. The results of this study suggest that application of enamel matrix derivative on osteoblast attached to titanium surface facilitate the expression of bone specific protein and the differentiation and growth of osteoblast.
Humans