Korean guidelines for the management of gout

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Korean guidelines for the management of gout

Gout is the most common form of arthritis, with the prevalence increasing worldwide. The present treatment guidelines provide recommendations for the appropriate treatment of acute gout, management during the inter-critical period, and prevention of chronic complications. The guidelines were developed based on evidence-based medicine and draft recommendations finalized after expert consensus. These guidelines are designed to provide clinicians with clinical evidence to enable efficient treatment of gout.

Colonic Mass Secondary to Sevelamer-associated Rectal Ulcer / 대한소화기학회지

The phosphorous balance is clinically important in increasing the long-term outcomes and preventing complications of end-stage renal disease. Sevelamer is a phosphate binder used widely to regulate hyperphosphatemia. On the other hand, gastrointestinal side effects increase with increasing sevelamer intake. A 29-year-old male with end-stage renal disease of IgA nephropathy on maintenance hemodialysis was admitted for diffuse alveolar bleeding and pneumonia. He presented with a low-grade fever and watery diarrhea tinged with blood. Initially, a Clostridioides difficile-associated diarrhea treatment was started with positive findings of Clostridioides difficile toxin and culture. Despite this, there was no improvement in the symptoms even with the appropriate antibiotic treatment. Computed tomography of the abdomen and pelvis revealed an occlusive mass in the rectum and secondary obstructive changes in the sigmoid colon. The initial suspicion was a malignancy or fungal infection. Sigmoidoscopy with a biopsy identified the mass as a lump of mucous material with the entire lumen covered with exudate. The subsequent histopathology examination revealed a colonic mucosal injury and characteristic ''fish scale"-like sevelamer crystals in the exudate. The diagnosis of a sevelamer-induced rectal ulcer was made. We report this case of a sevelamer-associated rectal ulcer of the sigmoid.

Colonic Mass Secondary to Sevelamer-associated Rectal Ulcer / 대한소화기학회지

The phosphorous balance is clinically important in increasing the long-term outcomes and preventing complications of end-stage renal disease. Sevelamer is a phosphate binder used widely to regulate hyperphosphatemia. On the other hand, gastrointestinal side effects increase with increasing sevelamer intake. A 29-year-old male with end-stage renal disease of IgA nephropathy on maintenance hemodialysis was admitted for diffuse alveolar bleeding and pneumonia. He presented with a low-grade fever and watery diarrhea tinged with blood. Initially, a Clostridioides difficile-associated diarrhea treatment was started with positive findings of Clostridioides difficile toxin and culture. Despite this, there was no improvement in the symptoms even with the appropriate antibiotic treatment. Computed tomography of the abdomen and pelvis revealed an occlusive mass in the rectum and secondary obstructive changes in the sigmoid colon. The initial suspicion was a malignancy or fungal infection. Sigmoidoscopy with a biopsy identified the mass as a lump of mucous material with the entire lumen covered with exudate. The subsequent histopathology examination revealed a colonic mucosal injury and characteristic ''fish scale"-like sevelamer crystals in the exudate. The diagnosis of a sevelamer-induced rectal ulcer was made. We report this case of a sevelamer-associated rectal ulcer of the sigmoid.

Stress distribution in premolars restored with inlays or onlays: 3D finite element analysis

PURPOSE: To analyze stress distribution in premolars restored with inlays or onlays using various materials. MATERIALS AND METHODS: Three-dimensional maxillary premolar models of abutments were designed to include the following: 1) inlay with O cavity (O group), 2) inlay with MO cavity (MO group), 3) inlay with MOD cavity (MOD group), and 4) onlay (ONLAY group). A restoration of each inlay or onlay cavity was simulated using gold alloy, e.max ceramic, or composite resin for restoration. To simulate masticatory forces, a total of 140 N static axial force was applied onto the tooth at the occlusal contact areas. A finite element analysis was performed to predict the magnitude and pattern of stresses generated by occlusal loading. RESULTS: Maximum von Mises stress values generated in the abutment teeth of the ONLAY group were ranged from 26.1 to 26.8 MPa, which were significantly lower than those of inlay groups (O group: 260.3–260.7 MPa; MO group: 252.1–262.4 MPa; MOD group: 281.4–298.8 MPa). Maximum von Mises stresses generated with ceramic, gold, and composite restorations were 280.1, 269.9, and 286.6 MPa, respectively, in the MOD group. They were 252.2, 248.0, 255.1 MPa, respectively, in the ONLAY group. CONCLUSION: The onlay design (ONLAY group) protected tooth structures more effectively than inlay designs (O, MO, and MOD groups). However, stress magnitudes in restorations with various dental materials exhibited no significant difference among groups (O, MO, MOD, ONLAY).

Complete denture rehabilitation of edentulous patient with severe alveolar bone resorption using mandibular suction denture with closed mouth technique: a clinical report

When it comes to treat patient with loss of vestibule, conventional denture impression have limitation which can cause problems of excessive border extension. Suction denture with closed mouth technique which was introduced to solve this problem, forms negative pressure being sealed denture flanges by mobile mucosa when the patient swallows and chews. Also, it can decrease patient's visiting time by taking impression and gothic arch tracing at once. In this case, considering patient's chief complain which is a loose fit of present lower denture, suction dentures with closed mouth technique was planned.

Esthetic prosthesis for a patient with the maxillary diastema: a case report

In the treatment of esthetically important areas such as maxillary anterior teeth, they should be corresponded with surrounding tissues, and shape of the smile line, soft tissue, and hard tissue, also the anatomical shape and proportion of the teeth should be considered as well. Esthetic analysis includes facial analysis which evaluates the proper parallelism between the occlusal plane and the horizontal reference line, dentolabial analysis which assesses the position of the incisal edge and the coherence between the occlusal plane and the commissural line, tooth analysis which evaluates not only esthetics but also morphology and appearance for proper function, and gingival analysis which forms ideal outline of gingival margins. A maxillary anterior diastema can be esthetically restored through the systematic diagnostic approach and treatment planning, and orthodontic, prosthetic, and conservative treatment can be applied for the treatment.

A Pyloric Gland-Phenotype Ovarian Mucinous Tumor Resembling Lobular Endocervical Glandular Hyperplasia in a Patient with Peutz-Jeghers Syndrome

We describe an ovarian mucinous neoplasm that histologically resembles lobular endocervical glandular hyperplasia (LEGH) containing pyloric gland type mucin in a patient with Peutz-Jeghers syndrome (PJS). Although ovarian mucinous tumors rarely occur in PJS patients, their pyloric gland phenotype has not been clearly determined. The histopathologic features of the ovarian mucinous tumor were reminiscent of LEGH. The cytoplasmic mucin was stained with periodic acid-Schiff reaction after diastase treatment but was negative for Alcian blue pH 2.5, suggesting the presence of neutral mucin. Immunohistochemically, the epithelium expressed various gastric markers, including MUC6, HIK1083, and carbonic anhydrase-IX. Multiple ligation-dependent probe amplification detected a germline heterozygous deletion mutation at exons 1–7 of the STK11 gene (c.1-?_920+?del) in peripheral blood leukocytes and mosaic loss of heterozygosity in ovarian tumor tissue. Considering that LEGH and/or gastric-type cervical adenocarcinoma can be found in patients with PJS carrying germline and/or somatic STK11 mutations, our case indicates that STK11 mutations have an important role in the proliferation of pyloric-phenotype mucinous epithelium at various anatomical locations.

The effect of plasma on shear bond strength between resin cement and colored zirconia

PURPOSE: To investigate the effect of non-thermal atmospheric pressure plasma (NTAPP) treatment on shear bond strength (SBS) between resin cement and colored zirconia made with metal chlorides. MATERIALS AND METHODS: 60 zirconia specimens were divided into 3 groups using coloring liquid. Each group was divided again into 2 sub-groups using plasma treatment; the experimental group was treated with plasma, and the control group was untreated. The sub-groups were: N (non-colored), C (0.1 wt% aqueous chromium chloride solution), M (0.1 wt% aqueous molybdenum chloride solution), NP (non-colored with plasma), CP (0.1 wt% aqueous chromium chloride solution with plasma), and MP (0.1 wt% aqueous molybdenum chloride solution with plasma). Composite resin cylinders were bonded to zirconia specimens with MDP-based resin cement, and SBS was measured using a universal testing machine. All data was analyzed statistically using a 2-way ANOVA test and a Tukey test. RESULTS: SBS significantly increased when specimens were treated with NTAPP regardless of coloring (P<.001). Colored zirconia containing molybdenum showed the highest value of SBS, regardless of NTAPP. The molybdenum group showed the highest SBS, whereas the chromium group showed the lowest. CONCLUSION: NTAPP may increase the SBS of colored zirconia and resin cement. The NTAPP effect on SBS is not influenced by the presence of zirconia coloring.

Stress distribution of implants with external and internal connection design: a 3-D finite element analysis

PURPOSE: This study aims to analyze the stress distribution of mandibular molar restoration supported by the implants with external hex and internal taper abutment connection design. MATERIALS AND METHODS: Models of external connection (EXHEX) and internal connection (INCON) implants, corresponding abutment/crowns, and screws were developed. Supporting edentulous mandibular bony structures were designed. All the components were assembled and a finite element analysis was performed to predict the magnitude and pattern of stresses generated by occlusal loading. A total of 120 N static force was applied both by axial (L1) and oblique (L2) direction. RESULTS: Peak von Mises stresses produced in the implants by L2 load produced 6 – 15 times greater than those by L1 load. The INCON model showed 2.2 times greater total amount of crown cusp deflection than the EXHEX model. Fastening screw in EXHEX model and upside margin of implant fixture in INCON model generated the peak von Mises stresses by oblique occlusal force. EXHEX model and INCON model showed the similar opening gap between abutment and fixture, but intimate sealing inside the contact interface was maintained in INCON model. CONCLUSION: Oblique force produced grater magnitudes of deflection and stress than those by axial force. The maximum stress area at the implant was different between the INCON and EXHEX models.

Maxillary removable partial overdenture within Locator Root Attachment in a retained root: a case report

If maintaining oral few retained root when planning the removable prosthesis, it is possible to obtain a more comfortable and functional result. In this case report, ‘Locator Root Attachment’ was used to maxillary removable overdenture in patients with a few teeth and retained root. A functionally proper clinical result from attachment after clinical and radiographic analysis was observed in this case.

Full mouth rehabilitation in a patient with partial mandibulectomy using CAD/CAM zirconia framework and monolithic zirconia / 대한치과보철학회지

Defects due to mandibulectomy often cause hard and soft tissue loss and result in esthetic problems and functional disorders such as mastication, swallowing, and pronunciation. After the mandibular reconstruction, several complications including loss of alveolar bone can cause limitations in maintenance or supporting of removable prosthesis. For these patients, implant-supported fixed restorations have been an appropriate prosthetic restorative method. In this case report, we report the patient who underwent mandibulectomy and mandibular reconstruction owing to oral cancer, and then restored the current dentition functionally and aesthetically by applying zirconia frameworks and monolithic zirconia crowns by computer-aided design and computer-aided manufacturing.

Rehabilitation using mandibular implant overdenture with CAD/CAM milled bar: A case report / 대한치과보철학회지

Long-term alveolar bone resorption in edentulous patient causes difficulty in denture use. Applying an implant overdenture with 2 to 4 implants to edentulous patient is easily approachable. Moreover, it improves denture stability, support, and retention. Milled bar, the attachment used in implant overdenture, can be used to induce better stability and retention to the supporting structure than conventional bar. It has become convenient to use due to the development of CAD/CAM system which had allowed the simplification of dental techniques. In this case, application of conventional maxillary full denture and mandibular overdenture made of CAD/CAM milled bar with 4 implants showed satisfactory results in the patient who had used upper and lower full dentures for a long time.

The implant retained overdenture by Locator attachments on the edentulous mandible using Parallel guide KIT®: a case report

Overdenture using dental implants could improve the problems of conventional complete denture function which are pain during mastication, insufficient retention and stability. Locator attachment used widely for implant-retained overdenture has advantages that it needs the smallest vertical space and also its nylon male cap allows personalized retention for each case. However its retention force decreases rapidly with function rather than the bar and ball attachment. So, implant fixture should be positioned as parallel as possible.

Maxillofacial rehabilitation of adenoid cystic carcinoma patient using full mouth fixed implant and pharyngeal obturator: a clinical report

Rehabilitation of maxillectomy patients is challenging. The maxillary defects need to functional restoration because of mastication, speech, swallowing problems. The goal of making obturator is to restore maxillary defects and give patients comfortable, esthetic prosthesis. This case report presents acquired masticatory and esthetic results and improved retention resulting from the pharyngeal obturator prosthesis using implant.

HER2-Positive Gastric Hepatoid Adenocarcinoma / 대한내과학회지

Gastric hepatoid adenocarcinoma is a rare adenocarcinoma that develops in the stomach. The prognosis of gastric hepatoid adenocarcinoma is poorer than that of ordinary gastric adenocarcinoma. Here, we report the first case of human epidermal growth factor receptor 2 (HER2)-positive gastric hepatoid adenocarcinoma in Korea. A 57-year-old male presented with abdominal distension and underwent endoscopic gastric biopsy and percutaneous core needle liver biopsy. The pathological findings were consistent with HER2-positive gastric hepatoid adenocarcinoma. He received six cycles of chemotherapy with cisplatin-capecitabine plus trastuzumab, which is a HER2 targeted agent. After chemotherapy, a follow-up abdominal computed tomography scan showed a partial tumor response. This case emphasizes the importance of using trastuzumab in a patient with HER2-positive gastric hepatoid adenocarcinoma.

Overdenture with magnetic attachments for a patient with Parkinson's disease: a case report

It is very hard for edentulous patients to satisfy retention and stability with their complete denture. Especially, for patients with systemic diseases such as Parkinson's disease causing involuntary and limited movements, fabricating complete dentures may be challenging to both dentists and patients due to functional limitations. To overcome this problem, overdentures can be used through conserving retained roots. In this case, a 45-year-old male patient had to extract numerous teeth due to dental caries, and at the time of visit he was taking drugs for diabetes and Parkinson's disease for a period of long time. A complete denture was applied to maxilla, and for mandible, an overdenture on two preserved retained roots was applied where its retention and stability were obtained by magnetic attachments. This case reports that overdenture with retained roots improved overall functional limitations.

Overdenture treatment in patient with severely worn dentition: a case report

Overdenture is one of the methods of patients with severely worn dentition. Remaining natural teeth help preserve alveolar bone and proprioception and provide rigid support. Also, overdenture distributes the concentrated stress applied to the abutment tooth and denture supporting tissues. There is an advantage that it can provide long-term stability to denture. In this case, the patient with only a few teeth due to severe wear and caries was satisfied with good function and favorable esthetics by using overdenture.

Overexpression of C-reactive Protein as a Poor Prognostic Marker of Resectable Hepatocellular Carcinomas

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant synthesized in the liver. CRP immunoreactivity is a feature of inflammatory hepatocellular adenomas with a higher risk of malignant transformation. A high serum CRP level denotes poor prognosis in hepatocellular carcinoma (HCC) patients. This study was conducted to determine whether CRP is produced in HCC and to assess the clinicopathologic significance of CRP expression in cancer cells. METHODS: CRP immunoreactivity was examined in treatment-naive HCCs (n=224) using tissue microarrays and was correlated with clinicopathologic parameters. The expression of CRP mRNA and protein was also assessed in 12 HCC cases by quantitative real-time polymerase chain reaction and immunoblotting. Hep3B and SNU-449 HCC cell lines were used for the analysis of CRP mRNA regulation by interleukin 6 (IL-6). RESULTS: CRP was expressed in 133 of 224 HCCs (59.4%) with a variable degree of immunoreactivity (grade 1 in 25.9%; grade 2 in 20.1%; grade 3 in 13.4%). There was an inverse relationship between grade 3 CRP immunoreactivity and cancer-specific survival (p=.0047), while no associations were found with other parameters, including recurrence-free survival. The CRP mRNA expression level was significantly higher in CRP immunopositive cases than in immunonegative cases (p<.05). CRP mRNA expression was increased in Hep3B cells, but was not detected in SNU-449 cells even after IL-6 treatment. CONCLUSIONS: We report the expression of CRP in HCC for the first time. CRP expression was associated with poor cancer-specific survival in patients with resectable HCC.

A Case of Severe HIV-Associated Psoriasis Successfully Treated with Acitretin Therapy / 감염과화학요법

Psoriasis is a chronic inflammatory skin disease that involves immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis in patients with HIV responds poorly to treatment and has a high morbidity rate, thus posing a challenge to clinicians. Until now, there have been no documented cases of acitretin therapy for HIV-associated psoriasis in Korea. Here, we report a case of safe and successful therapy with acitretin in a 52-year-old man with HIV-associated psoriasis that responded poorly to previous treatments including steroids and ultraviolet B phototherapy. We also review the relevant literature.