Drug holiday as a prognostic factor of medication-related osteonecrosis of the jaw

OBJECTIVES: To identify post-treatment prognostic factors for medication-related osteonecrosis of the jaw (MRONJ). MATERIALS AND METHODS: We evaluated 54 MRONJ patients who visited the Department of Dentistry, Ajou University Hospital, from May 2007 to March 2014. Twenty-one patients were surgically managed with debridement or sequestrectomy and 33 patients were conservatively managed using antibiotics. Correlations of age, sex, stage, bisphosphonate duration and type, and drug holiday with the prognosis of MRONJ were investigated. Correlations were verified by logistic regression analysis and t-tests with a significance level of 0.05. RESULTS: Clinical outcomes were evaluated on the basis of both clinical and radiographic findings. Twelve out of 21 surgically managed patients showed a favorable prognosis and nine patients relapsed. Thirty-one of the 33 conservatively managed patients showed no specific change in prognosis, and two patients worsened. Statistical analyses of the conservative management group did not reveal any correlation of the above factors with the prognosis of conservative management. Drug holiday was the only prognostic factor in the surgical management group (P=0.031 in logistic regression analysis, P=0.004 in t-test). CONCLUSION: Drug holiday is a prognostic factor in the surgical management of MRONJ. Because the drug holiday in the patients of the poor prognosis group occurred 1.5 to 4 months prior to surgical management, we recommend a drug holiday more than 4 months before surgery.

Comparative Study on Surgical and Conservative Management of Bisphosphonate-related Osteonecrosis of the Jaw (BRONJ) in Disease Stage 2

0.05).CONCLUSION: The results of the present study suggests that surgical intervention is good choice against the conservative treatment, after proper drug holidays period, while further investigation is needed for a definite solution to BRONJ.

Cephalometric Predisposing Factors of the Snoring and Obstructive Sleep Apnea

or =5) were diagnosed as OSA after the overnight PSG. To evaluate the hard and soft tissue profiles, the cephalometric radiograms were taken at the maximal intercuspation. The correlation between the patient's age, height, weight, body mass index (BMI) and AHI was inspected in the OSA and control group. The difference between the OSA and control group was evaluated (Mann-Whitney U Test). The cephalometric influencing factors to OSA were analyzed (Pearson's correlation coefficient) statistically using SPSS statistics.RESULTS: The OSA Group had a significantly higher BMI than the control group. The mean lower facial height (ANS-Me) was longer in the OSA group; however, statistically significant difference was not detected in the anteroposterior craniofacial measurements. The distance between mandibular plane and hyoid bone of the OSA group was significantly longer than that of the control group. The hyoid position (MP-Hyoid) had a positive correlation between AHI (P<0.001). However, the measurements of oropharyngeal airway were not different between the two groups. The hypothesis, that the antero-posteriorly narrow oropharyngeal airway may aggravate the airway resistance and give rise to a higher AHI, was rejected in the study.CONCLUSION: We suggest that the lateral cephalogram may be utilized as a useful method to evaluate OSA. The patients with a lower hyoid position can be expected to have higher risks of OSA. However, a comprehensive intraoral inspection, including the soft palate and tonsilar hypertrophy, is emphasized, as the lateral cepahlogram cannot visualize the oropharyngeal status completely.

Clinical Study on Outfracture Osteotomy Sinus Graft

The Role of Phosphatase and Tensin Homolog Deleted on Chromosome Ten (PTEN) in Lung Cancer

Lung cancer remains the primary cause of cancer-related death in the world, and the number of cases continues to increase. Like any other human cancer, the development of lung cancer is associated with the activation of oncogenes or inactivation of tumor suppressor genes. Phosphatase and tensin homolog, deleted on chromosome ten (PTEN), is a part of a complex signaling system that affects a variety of important cell functions. PTEN opposes the action of phosphatidylinositol 3-kinase (PI3-kinase) by dephosphorylating the signaling lipid phosphatidylinositol 3, 4, 5-triphosphate (PIP3). In addition, it displays weak tyrosine phosphatase activity, which may down modulate the signaling pathways involving focal adhesion kinase (FAK) or Shc. Functions for PTEN have been identified in the regulation of many normal cell processes, including growth, adhesion, migration, invasion and apoptosis. PTEN appears to play particularly important roles in regulating anoikis (apoptosis of cells after loss of contact with extracellular matrix) and cell migration. Many studies have suggested that the loss of PTEN expression occurs commonly in primary lung cancers and correlates with the histological type. Regulation of PTEN expression may provide a new preventive and therapeutic modality in primary lung cancer. However, there is, in our opinion, a need for further study of this gene

The Expression of Vascular Endothelial Growth Factor (VEGF)in Aplastic Anemia / 대한혈액학회지

BACKGROUND: Vascular endothelial growth factor (VEGF) is a potent angiogenic peptide with biologic effects that include regulation of hematopoietic stem cell development, extracellular matrix remodeling, and inflammatory cytokine generation. VEGF plasma levels are elevated in circulation during tumor growth and bone marrow proliferative status. In this study, to investigate the role of VEGF expression in patients with aplastic anemia (AA), VEGF protein expression and microvessel density (MVD) were evaluated. METHODS: Immunohistochemical staining for detecting VEGF protein was performed by the labeled avidin-biotin method on the formalin-fixed and paraffin embedded bone marrow biopsy samples of 25 patients with severe AA and 10 normal controls. Microvessels were scored in at least 3 areas (x200 fields) of the highest MVD in representative sections of each bone marrow biopsy specimen using immunohistochemistry for CD34 antigen. RESULTS: In AA, megakaryocytes and histiocytes expressed less intense cytoplasmic VEGF than in control (P < 0.05). However, plasma cells had higher VEGF immunoreactivity in AA than in control. MVD was significantly lower in patients with AA (21.43+/-7.24), compared to controls (27.65+/-3.44) (P < 0.05). MVD had a strong correlation with bone marrow cellularity. Also, the degree of VEGF immunoreactivity was correlated with bone marrow cellularity and MVD. CONCLUSION: Angiogenesis as assessed by MVD and VEGF expression seems to have a role in the pathogenesis of AA.

LIPOMAS OF THE MOUTH FLOOR AND SUBMANDIBULAR SPACE: REPORT OF 3 CASES

Although the lipoma, a benign lesion composed largely of mature fat cells, is a common tumor that comprises 4% to 5% of all benign neoplasms, it is rarely seen in the oral cavities. Oral lipomas represent between 0.2 and 3.2% of all benign oral tumors. While lipomas in general more commonly affect female patients(68-73%), oral lipomas seem to appear more frequently in male patients. The majority of oral lipomas is seen after the age of 40 years. They may occur anywhrere in the oral cavity, but the cheek is the most common site. Surgical excision is the only treatment recommended and the prognosis is uniformly excellent. We report our experience of 2 cases of the lipoma in the mouth floor and 1 case of the lipoma in the submandibular space.

Evaluation of condylar displacement using computer tomography after the surgical correction of mandibular prognathism

0.05). 3. There was some correlation between condylar change(T2C-T1C) and TMJ dysfunction. It seemed that postoperative condylar change had influenced postoperative TMJ dysfunction, through there was no statistical significance (p>0.05). As we have observed the change of condylar axis in the group that complained of TMJ dysfunction in cases of large amount of mandibular setback. So we consider that the more trying to conserve condylar position will decrease occurrence rate of post operational TMJ dysfunction.

Two Cases Usher's Syndrom in two Brothers

Usher's syndrome is an autosomal recessively inherited trait that characterized by a congenital nonprogressive sensorineural hearing impairment and progressive night-blinding disorder, retinitis pigmentosa, with cataract, psych psis, speech disorder, mental deficiency, and vestibular ataxia being variable additional findings. We experienced two cases of Usher's syndrome in two brothers, which has the hearing loss and night-blinding disorder that had been developed since in early childhood and 2nd decade respectively. Their ophthalmoscopic retinal and ERG findings are characteritic ones of retinitis pigmentosa. such as 1) bone corpuscle pigmentation in the periphery, narrow arteries, and a waxy, yellowish optic, disc, 2) non-recordable ERG, respectively. Their pure tone automatry confirmed the bilateral sensorineural hearing loss.

Bilateral Juvenile Retinoschisis in four Brothers of a Family

Juvenile retinoschisis is a vitreoretinal dystrophy with X-linked recessive mode of transmission that shows microcystic degeneration of the macula associated with splitting of the sensory retina, predominantly within the nerve fiber layer. We experienced X-linked juvenile retinoschisis, in four borthers within a family in which were the onset of visual disturbance between second decades and third decades, and all showed maculopathy, RPE atrophy, vitreous veils extended to vitreous, partial optic atrophy, specific electroretinographic findings.

A case of Conjunctival Tuberculosis

Conjunctival tuberculosis has become a rare disease in these days along with decreased incidence of systemic tuberculosis. We experienced a 43-year-old patient with large pinguecula-like protruding mass on the medial bulbar surface which was later diagnosed as conjuctival tuberculoma histopathologically. Evidence of systemic tuberculosis could not be found from any other organs of the body. This case raises the possibility that conjunctival tuberculoma may be misdiagnosed as a simple pingueculum unless histopathologic examination is performed. Brief history and clinical findings will be presented with pictures of the pathology findings, and some literatures will be reviewed.

Electronmicroscopic Study of the Effect of Hexamethonium on Serous Choriretinopathy in Rabbits

Stress has been regrarded as one of the causes of central serous chorioretinopathy. We studied the effect of Hexamethonium (ganglionic blocking agent) on experimentaI serous chorioretinopathy following epinephrine injection in rabbits. In group 1, we injected the 0.1 % epinephrine into the rabbits through IV route for 10 days and in group 2, we addited Hexamethonium subcutaneously prior to injection of the epinephrine same term of gorup 1. We could find slight histological changes in gorup 2 as com paired with group 1, which produced serous chorioretinopathy, under the electronmicroscopic study so we would expect the preventive effect of Hexamethonium on the stress-induced serous chorioretinopathy.

Electronmicroscopic Study of the Effect of Hexamethonium on Serous Choriretinopathy in Rabbits

Stress has been regrarded as one of the causes of central serous chorioretinopathy. We studied the effect of Hexamethonium (ganglionic blocking agent) on experimentaI serous chorioretinopathy following epinephrine injection in rabbits. In group 1, we injected the 0.1 % epinephrine into the rabbits through IV route for 10 days and in group 2, we addited Hexamethonium subcutaneously prior to injection of the epinephrine same term of gorup 1. We could find slight histological changes in gorup 2 as com paired with group 1, which produced serous chorioretinopathy, under the electronmicroscopic study so we would expect the preventive effect of Hexamethonium on the stress-induced serous chorioretinopathy.

An Experimental Study of the Corneal Epithelial Damage by Electric Welding Light on the Rabbit Cornea

The cellular alteration following the electric welding light on the rabbit corneal epithelial cells were studied in several conditions wearing various corneal contact lenses on the corneal surface exposed to the light for 5 minutes at 50 cm in each. The enucleated rabbit eyes 5 hours following the application of electric welding light were histopathologically investigated on the cellular structures of the cornea. The result were as follows: 1. The cellular alterations in a group of soft contact lens wearing consisted of multiple vacuole enlargement, separation of interdigitation and Desmosome, intracellular edema, and loss of organelles in superficial and wing cells layer. Loss of microvilli of the corneal superficial cells were observed. 2. Loss of cytoplasmic microorganelles and microvilli intercellular edema in superficial cell layer, and slight vacuoles enlargement in wing cells layer were demonstrated in a group of the direct light exposure group without contact lenses. 3. Loss of microvilli and intercellular edema with separation of interdigitation in superficial cell layer but no specific changes in wing cells layer were exhibited in a group of hard contact lens wearing. 4. The most destructive features of the corneal epithelial cells were observed in a group of soft contact lens wearing, and it was suggested that the doubtful effects of protection on the corneal superficial tissue in the case of soft contact lens wearing were noteworthy.

An Experimental Study of Development of Preretinal Membrane Following Intravitreal Hemorrhage

It has been known that proliferative vitreoretinopathy(PVR) can be developed by various intraocular diseases. Among them, the intravitreal hemorrhage would be accounted one of the causative disorders of PVR. An experimental study of the rabbit retina following intravitreal injection of auto blood was performed in order to investigate of development processes and nature of cellular alterations in PVR. The results were as follows: 1. Macrophages containing several dense bodies appeared near the inner limiting membrane of the retina and many floating red blood cells were present in the vitreous cavity on 3 days after intravitreal injection of blood. 2. One week after intravitreal injection of blood, the Miiller cells extended to the vitreous penetrating the inner limiting membrane. Many macrophages were observed between the Miiller cell processes. 3. Preretinal proliferative tissue were differentiated to the multilayered Miiller cell processes with the cellular characteristics containing glycogen granules, SER and junctional complexes in 2 weeks after intravitreal injection of blood. In these states macrophages between the Miiller cell processes had were completely disappeared. 4. It was considered that Miiller cells extend to the vitreous penetrating the inner limiting membrane in order to phagocytose the red blood cells in the vitreous which lead to processes resulting in formation of PVR.

Histopathological Study for Chronic Photic Retinal injury After Atropinization for a Long Time

The damaging effect of radiant energy to retina as observed in eclipse retinopathy, photocoagulation and laser burn was always considered the result of thermal coagulation. Pnly recently was it suspected that chronic exposure to radiant energy of low intensity may also damage the retina by mechanisms that may differ from simple transformation of light energy into heat. We suspected that long exposure to natural light through the atropinized pupil at penalisation treatment may damage the retina. So, atropinized rabbits will be exposed to more amount of light through dilated pubil and such a possibility led to speculation that some of maculopathy observed in atropinized man may be related to photic damage produced by chronic exposure to light of relatively low intensity. Therefore, we studied the changes in postesior pole histopathologically by light and electron microscopy after long exposure to natural light through dilated pupil.