Cervical Fusion-Requiring Mineral and Bone Disorder Disguised as Osteoporosis in a Chronic Kidney Disease Patient on Hemodialysis: A Case Report

Bony deformities and fragility fractures in end-stage renal disease (ESRD) patients on long-term hemodialysis can be caused by either osteoporosis or chronic kidney disease-mineral and bone disorder (CKD-MBD). Correct identification of the underlying mechanism is critical since the treatment methods differ, and one treatment approach could negatively affect the other. Cervical kyphosis, severe enough to require immediate surgical treatment, can be caused by uncontrolled CKD-MBD, albeit in limited cases. This report presents the case of a 61-year-old female with an 11-year history of hemodialysis treatment and severe cervical kyphosis with myelopathy, which required 2-stage spinal surgeries. Our report calls for a careful diagnostic approach in ESRD patients with skeletal disorders, the points to consider before calcium replacement, and early detection of fragility fractures in them. Moreover, early mobilization and weight-bearing after the surgical procedure may lead to better neurological and functional improvements.

Recurrent Cerebral Infarctions and Multi-Vessel Thrombosis in a Male Patient with Refractory Idiopathic Thrombocytopenic Purpura: a Case Report

Idiopathic thrombocytopenic purpura (ITP) mostly presents with bleeding tendencies, and thrombotic events are very uncommon. Our case report presents a male patient with ITP refractory to standardized therapies who continuously showed thrombocytopenia and hematuria. With no evidence of autoimmune diseases or other secondary causes of ITP, he developed recurrent cerebral infarctions and deep venous thrombosis. Our report calls for attention to possible thrombotic events, as well as more common bleeding tendencies in patients with ITP and outlines rehabilitation treatment specially designed for ITP patients with rare thrombotic complications.

Reassessment of Inclusion Criteria in the 2013 the American College of Cardiology and the American Heart Association Cholesterol Guidelines for Cardiovascular Disease Prevention

Background@#and Purpose The American College of Cardiology and the American Heart Association (ACC-AHA) have released new guidelines and expanded indications for statin treatment. We aimed to reveal the clinical efficacy of each indication in the guidelines using a large-scale national cohort. @*Methods@#We used National Health Screening Cohort data to determine the proportions of participants for whom statin therapy would be recommended using the different guidelines.We assessed the cumulative incidence rates of major adverse cardiovascular events (MACE) using the Cox proportional-hazards model. @*Results@#Under the 2013 ACC-AHA guidelines, 111,600 participants were additionally eligible to receive statins, compared with 50,023 participants according to the Third Adult Treatment Panel (ATP-III). Most of the additional statin-eligible participants in the ACC-AHA guidelines were indicated by their 10-year cardiovascular disease risk. The increase in statineligible participants in the ACC-AHA guidelines mainly involved elderly patients aged 60–75 years. Among participants not requiring statin, participants who were eligible for a statin under the ACC-AHA guidelines had a significantly higher hazard ratio of MACE when compared with those eligible under the ATP-III guidelines. Among the not-recommended groups, patients with diabetes and low-density lipoprotein <70 mg/dL constituted the group with the highest risk of MACE. @*Conclusions@#The 2013 ACC-AHA guidelines increase the number of statin-eligible participants, especially among the elderly. These guidelines provide a stronger recommendation for statins to high-risk groups, but it remains necessary to consider the characteristics of the population in the risk equation. In addition, the aggressive use of statin in diabetes patients and further studies of older subjects are needed.

Seasonal distribution of cockroaches, a major source of indoor allergens, in seoul metropolitan area / 천식및알레르기

PURPOSE: Home exposure to aeroallergens are an important environmental factor in allergic sensitization and in the development and exacerbation of asthma. Most studies of aeroallergens were dust mite in Korea, but cockroach distribution was little been known in Korea. The aim of this study was to evaluate species of cockroaches and seasonal distribution of cockroaches in Seoul area. METHODS: The study was performed during April 2000 through January 2001, from 63 houses in Korea. The total of 63 residential homes from different districts in Seoul were selected for the home environment survey. Bait traps (10 x 20 x 4 cm2, Zoro Zoro, Taisho Pharmacy, Tokyo, Japan) were placed on four different places of kitchen floor and one in the side of balcony in the house and left for 5 days to capture cockroaches. RESULTS: The cockroaches were captured in 23 houses(36.5%) out of 63 houses. And the inhabitant density of cockroaches was highest in the autumn(43.3%) followed by summer (29.2%), spring(18.3%) and winter(9.2%). In only 3 species were collected in Seoul area. The most common species were Blattella germanica showing 72.5% of the collected cockroaches, followed by Periplaneta japonica(25.2%) Periplaneta americana(2.3%). The total number of captured cockroaches was 504 and the number of nymph was 314(62.2%). Isolated house type showed higher trapping rates than the apartment. Positive skin test rates were 46.2% in the healthy control group and 43.8% in the allergy patients. CONCLUSION: Periplaneta americana was captured in Seoul area, which had not been found previously. The inhabitant density of cockroaches was the lowest in the winter.

Effect of different application modalities of EDTA on dentinal tubule opening: a SEM study / 대한치주과학회지

Root conditioning has been introduced to dissolve the smear layer, and to aid in detoxification following root planing. It produces surface demineralization, resulting to exposure of dentin collagen fibrils and opening of dentinal tubules. The purpose of the present study was to examine the possibility of obtaining root conditioning effect by using ethylenediamine tetraacetic acid(EDTA) solution instead of low pH etchants such as citric acid and tetracycline hydrochloride(Tc-HCl). Total 48 root specimens(4x5x2mm) were prepared from the mesial and distal root of 24 periodontitisaffected human mandibular molars after scaling and root planing. The specimens were treated with EDTA(17%, neutral pH, Pulpdent?, Pulpdent Co., USA) for 1 min., 2 min., and 3 min., and tetracycline hydrochloride(100mg/ml) for 5 min. using the rubbing technique and the placement technique without rubbing. The dentinal tubules of the specimens were examined under a scanning electron microscopy(JEOL, JSM- 840A, Japan). On the microphotographs taken at x3,000 magnification, the number of identifiable dentinal tubules, opened dentinal tubules, and fully opened dentinal tubules(over 0.9micrometer in diameter) per the unit area(1,067?m2) were counted. And the rate of opened dentinal tubule and the rate of fully opened dentinal tubule were calculated. The difference of those rates among all groups was statistically analyzed by ANOVA and Dunkan test. The results were as follows; 1. In the specimens applied with EDTA, the rate of opened dentinal tubule was not significantly different between each group regardless of application technique and application time(p>0.1). 2. In the specimens applied with EDTA, the rate of fully opened dentinal tubule had tendency to be increased in proportion to application time regardless of application technique. 3. In the specimens applied with EDTA within 2 min., the rate of fully opened dentinal tubule failed to show significant difference between the two techniques(p>0.1). But, in the specimens applied for 3 min., the rate of fully opened dentinal tubule was significantly higher in the specimens applied by the rubbing technique than those by the placement technique(p0.1). The results demonstrate that 17% EDTA solution can replace low pH etchants for root conditioning, and the rubbing technique for at least 3 min. is recommendable.

Clinical experience of opponensplasty (4-case report)

No abstract available.