BACKGROUND: Multiple myeloma (MM) is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Bisphosphonates (BP) are used as supportive therapy in the management of MM. This study aimed to analyze the incidence, risk factors, and clinical outcomes of medication-related necrosis of the jaw (MRONJ) in MM patients. METHODS: One hundred thirty MM patients who had previous dental evaluations were retrospectively reviewed. Based on several findings, we applied the staging and treatment strategies on MRONJ. We analyzed gender, age, type of BP, incidence, and local etiological factors and assessed the relationship between these factors and the clinical findings at the first oral examination. RESULTS: MRONJ was found in nine male patients (6.9%). The mean patient age was 62.2 years. The median BP administration time was 19 months. Seven patients were treated with a combination of IV zoledronate and pamidronate, and two patients received single-agent therapy. The lesions were predominantly located in the mandible (n = 8), and the most common predisposing dental factor was a history of prior extraction (n = 6). Half of the MRONJ were related to diseases found on the initial dental screen. Patients with MRONJ were treated with infection control and antibiotic therapy. When comparing between the MRONJ stage and each factor (sign, location, etiologic factor, BP type, treatment, and outcome), there were no significant differences between stages, except for between the stage and sign (with or without purulence). CONCLUSIONS: For prevention of MRONJ, we recommend routine dental examinations and treatment prior to starting BP therapy.
Bone Marrow ; Diagnosis, Oral ; Diphosphonates ; Humans ; Incidence ; Infection Control ; Jaw* ; Male ; Mandible ; Multiple Myeloma* ; Necrosis ; Osteonecrosis* ; Plasma Cells ; Retrospective Studies* ; Risk Factors

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

PURPOSE: The purpose of this study was to determine the correlation and ratio between the calcaneal length and width for predicting the width of calcaneus. MATERIALS AND METHODS: A total of 190 feet (190 patients) were included based on computed tomography scans. The length of calcaneus (CL) was measured on the line connecting the center of a circle tangent to the cortical margin in the anterior and posterior parts of the calcaneus in a sagittal plane (W1, W2). The width of the calcaneus was defined as the horizontal line of each part (W1, W2, W3) on the same axial plane. The relationship between the measurement was determined through a correlation analysis. The reliability was assessed based on intraclass correlation coefficients. RESULTS: The CL and widths of calcaneus (W1, W2, W3) had a good positive correlation (r=0.848 [W1/CL], r=0.738 [W2/CL], r=0.769 [W3/CL]; p<0.001). The mean CL and widths ratios were 0.33 (W1/CL), 0.37 (W2/CL), and 0.37 (W3/CL). Using these ratios to estimate the widths by multiplying each ratio by the measured calcaneal length, we found a difference between the estimated calcaneal widths and the actual measured calcaneal widths values was 0.25 mm, 0.43 mm, and 0.16 mm. All measurements showed good-to-excellent inter- and intraobserver reliability. CONCLUSION: This study analyzed the correlation and ratio between the length and width of the calcaneus. The results will help orthopedic surgeons fixate screws in a stable manner to prevent iatrogenic injuries to the medial neurovascular structures of the calcaneus.
Calcaneus ; Foot ; Orthopedics ; Surgeons

Abdominal obesity is a major risk factor of chronic kidney disease (CKD). Conventional obesity-related indicators, included body mass index (BMI), waist circumference (WC), and conicity index (C-index), have some limitations. We examined the usefulness of trunk/body fat mass ratio (T/Br) to predict negative effect of abnormal fat distribution on excretory kidney function. We analyzed anthropometric, biochemical and densitometric data from a nation-wide, population-based, case-control study (the Korean National Health and Nutrition Examination Survey [KNHANES] IV and V). A total of 11,319 participants were divided into 2 groups according to estimated glomerular filtration rate (eGFR, mL·min⁻¹·1.73 m⁻²) as follows: Group I (n = 7,980), eGFR ≥ 90 and ≤ 120; and group II (n = 3,339), eGFR ≥ 60 and < 90. Linear regression analysis revealed that T/Br was closely related to eGFR (β = −0.3173, P < 0.001), and the correlation remained significant after adjustment for age, gender, BMI, WC, C-index, systolic blood pressure (BP), hemoglobin, and smoking amount (β = −0.0987, P < 0.001). Logistic regression analysis showed that T/Br (odds ratio [OR] = 1.046; 95% confidence interval [CI] = 1.039–1.054) was significantly associated with early decline of kidney function, and adjustment for age, gender, BMI, C-index, systolic BP, hemoglobin, serum glucose level, high-density lipoprotein (HDL)-cholesterol, and smoking amount did not reduce the association (OR = 1.020; 95% CI = 1.007–1.033). T/Br is useful in estimating the negative impact of abdominal obesity on the kidney function.

Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an out-patient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.
Adult ; Anemia* ; Breast ; Diagnosis, Differential ; Dizziness ; Drug Therapy ; Endoscopy, Digestive System ; Female ; Hemorrhage ; Humans ; Neoplasm Metastasis* ; Outpatients ; Phyllodes Tumor* ; Stomach*

Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an out-patient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.
Adult ; Anemia* ; Breast ; Diagnosis, Differential ; Dizziness ; Drug Therapy ; Endoscopy, Digestive System ; Female ; Hemorrhage ; Humans ; Neoplasm Metastasis* ; Outpatients ; Phyllodes Tumor* ; Stomach*

Recently, we reported that Artemisia annua (AA) has anti-adipogenic properties in vitro and in vivo. Reduction of adipogenesis by AA treatment may dampen systemic inflammation and protect neurons from cytokine-induced damage. Therefore, the present study was undertaken to assess whether AA increases neuronal maturation by reducing inflammatory responses, such as those mediated by cyclooxygenase 2 (COX-2). Mice were fed normal chow or a high-fat diet with or without chronic daily oral administration of AA extract (0.2 g/10 mL/kg) for 4 weeks; then, changes in their hippocampal dentate gyri were measured via immunohistochemistry/immunofluorescence staining for bromodexoxyuridine, doublecortin, and neuronal nuclei, markers of neuronal maturation, and quantitative western blotting for COX-2 and Iba-1, in order to assess correlations between systemic inflammation (interleukin-6) and food type. Additionally, we tested the effect of AA in an Alzheimer's disease model of Caenorhabditis elegans and uncovered a potential benefit. The results show that chronic AA dosing significantly increases neuronal maturation, particularly in the high-fat diet group. This effect was seen in the absence of any changes in COX-2 levels in mice given the same type of food, pointing to the possibility of alternate anti-inflammatory pathways in the stimulation of neurogenesis and neuro-maturation in a background of obesity.
Adipogenesis ; Administration, Oral* ; Alzheimer Disease ; Animals ; Artemisia annua ; Blotting, Western ; Caenorhabditis elegans ; Cyclooxygenase 2* ; Dentate Gyrus* ; Diet, High-Fat ; In Vitro Techniques ; Inflammation ; Mice* ; Neurogenesis ; Neurons* ; Obesity* ; Prostaglandin-Endoperoxide Synthases*

PURPOSE: Homeobox (HOX) genes are essential developmental regulators that should normally be in the silenced state in an adult brain. The aberrant expression of HOX genes has been associated with the prognosis of many cancer types, including glioblastoma (GBM). This study examined the identity and role of HOX genes affecting GBM prognosis and treatment resistance. MATERIALS AND METHODS: The full series of HOX genes of five pairs of initial and recurrent human GBM samples were screened by microarray analysis to determine the most plausible candidate responsible for GBM prognosis. Another 20 newly diagnosed GBM samples were used for prognostic validation. In vitro experiments were performed to confirm the role of HOX in treatment resistance. Mediators involved in HOX gene regulation were searched using differentially expressed gene analysis, gene set enrichment tests, and network analysis. RESULTS: The underexpression of HOXA11 was identified as a consistent signature for a poor prognosis among the HOX genes. The overall survival of the GBM patients indicated a significantly favorable prognosis in patients with high HOXA11 expression (31±15.3 months) compared to the prognoses in thosewith low HOXA11 expression (18±7.3 months, p=0.03). When HOXA11 was suppressed in the GBM cell lines, the anticancer effect of radiotherapy and/or temozolomide declined. In addition, five candidate mediators (TGFBR2, CRIM1, TXNIP, DPYSL2, and CRMP1) that may confer an oncologic effect after HOXA11 suppression were identified. CONCLUSION: The treatment resistance induced by the underexpression of HOXA11 can contribute to a poor prognosis in GBM. Further investigation will be needed to confirm the value of HOXA11 as a potential target for overcoming the treatment resistance by developing chemo- or radiosensitizers.
Adult ; Brain ; Cell Line ; Genes, Homeobox ; Glioblastoma* ; Humans ; In Vitro Techniques ; Microarray Analysis ; Prognosis* ; Radiotherapy

No abstract available.
Adenocarcinoma* ; Gastrectomy* ; Humans

BACKGROUND/AIMS: Approximately 30% of esophageal cancer (EC) patients cannot complete endoscopic ultrasonography (EUS) due to malignant stricture (EUS non-traversability). This study examines clinical implications of EUS non-traversability in patients with advanced locoregional squamous EC receiving preoperative chemoradiotherapy (CRT) followed by esophagectomy. METHODS: We retrieved data on 89 consecutive patients with advanced locoregional squamous EC (stage II or III). Relevant clinical and tumor-specific parameters were reviewed retrospectively. Significant factors affecting survival was determined by Cox regression analysis. RESULTS: EUS non-traversable EC was observed in 26 of 89 patients (29.2%). Median serum albumin level (3.6 g/dL vs. 3.9 g/dL, p = 0.028), tumor length (6.0 cm vs. 4.0 cm, p = 0.002), and percentage of clinical stage III disease (65.4% vs. 38.1%, p = 0.019) were significantly different between the patients with EUS non-traversable and traversable EC, respectively. Patients with EUS non-traversable EC demonstrated a significantly lower 5-year overall survival than patients with EUS traversable EC (30.8% vs. 49.3%, p = 0.023). In multivariate analysis, weight loss ≥ 10% (p = 0.033), EUS non-traversability (p = 0.003), non-response to preoperative CRT (p = 0.002), and incompletion of esophagectomy (p = 0.002) were significant negative factors of survival. CONCLUSIONS: EUS non-traversability has significant negative prognostic implications in patients with advanced locoregional squamous EC receiving preoperative CRT followed by esophagectomy.
Carcinoma, Squamous Cell ; Chemoradiotherapy ; Constriction, Pathologic ; Endosonography* ; Esophageal Neoplasms* ; Esophagectomy ; Humans ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Serum Albumin ; Weight Loss