Influence of Alendronate and Endplate Degeneration to Single Level Posterior Lumbar Spinal Interbody Fusion

OBJECTIVE: Using alendronate after spinal fusion is a controversial issue due to the inhibition of osteoclast mediated bone resorption. In addition, there are an increasing number of reports that the endplate degeneration influences the lumbar spinal fusion. The object of this retrospective controlled study was to evaluate how the endplate degeneration and the bisphosphonate medication influence the spinal fusion through radiographic evaluation. METHODS: In this study, 44 patients who underwent single-level posterior lumbar interbody fusion (PLIF) using cage were examined from April 2007 to March 2009. All patients had been diagnosed as osteoporosis and would be recommended for alendronate medication. Endplate degeneration is categorized by the Modic changes. The solid fusion is defined if there was bridging bone between the vertebral bodies, either within or external to the cage on the plain X-ray and if there is less than 5degrees of angular difference in dynamic X-ray. RESULTS: In alendronate group, fusion was achieved in 66.7% compared to 73.9% in control group (no medication). Alendronate did not influence the fusion rate of PLIF. However, there was the statistical difference of fusion rate between the endplate degeneration group and the group without endplate degeneration. A total of 52.4% of fusion rate was seen in the endplate degeneration group compared to 91.3% in the group without endplate degeneration. The endplate degeneration suppresses the fusion process of PLIF. CONCLUSION: Alendronate does not influence the fusion process in osteoporotic patients. The endplate degeneration decreases the fusion rate.

O-arm(R) Imaging System Coupled with Navigation Guided Posterior Atlantoaxial Screw Fixation in the Patient with Ponticulus Posticus, an Anatomical Variation of Atlas

Ponticulus posticus is an abnormal bony bridge of posterior arch of atlas. The resulting foramen contains the vertebral artery and has clinical significance in lateral mass screw insertion into the first cervical vertebra. The authors report an atlantoaxial subluxation case showing a ponticulus posticus, which was surgically treated with posterior atlantoaxial screw fixation under the guidance of O-arm(R) imaging system coupled with navigation.

Convexity Meningioma En Plaque Presenting with Diffuse Hyperostosis of the Skull

Although meningioma is a common and benign intracranial tumor, meningioma en plaque is a rare tumor, especially in the cranial vault. Meningioma en plaque(MEP) usually occurs in the area of the sphenoid wing, and it causes cosmetic and visual problems, as well as the problems that are due to its mass effect. The authors present here a case of convexity meningioma en plaque that involved the skull and scalp with diffuse hyperostosis as the presenting salient radiological findings, which caused marked intraoperative bleeding.

Role of the periosteum on bone regeneration in rabbit calvarial defects / 대한치주과학회지

The role of the periosteum on osteointegration of Bio-Oss(R)(Geistlich, Wolhusen/Switzerland) was studied in rabbit calvarial defect. 12 New Zealand white male rabbits between 2.8 and 4 kg were included in this randomized, blinded, prospective study. Each rabbit was anesthetized with Ketamine HCl(5 mg/kg) and Xylazine HCl(1.5 ml/kg). An incision was made to the bony cranium and the periosteum was reflected. Using a 6-mm trephine bur(3i. USA), four 8-mm defects were created with copious irrigation. The defects were classified into barrier membrane(Tefgen(R), Lifecore Biomedical, Inc, U.S.A.) only group as a control, Bio-Oss(R) with barrier membrane group, Bio-Oss(R) with periosteum covering group, and Bio-Oss(R) without periosteum covering group. There were 2 rabbits in each group. The wound was closed with resorbable suture materials. Rabbits were sacrificed using phentobarbital(100 mg/kg) intravenously at 1, 2, and 4 weeks after surgery. The samples were fixed in 4% paraformaldehyde, and decalcified in hydrochloric acid decalcifying solution(Fisher Scientific, Tustin, CA) at 4degrees C for 2-4 weeks. It was embedded in paraffin and cut into 6 micrometer thickness. The sections were stained with H & E and observed by optical microscope. The results were as follows; 1. The periosteum played an important role in osteointegration of Bio-Oss(R) in bone defects. 2. When the periosteum remained intact and Bio-Oss(R) was placed on the defect, Bio-Oss(R) with periosteum covering has been incorporated into the newly formed bone from 2-week postoperatively. 3. When the periosteum was removed at the surgical procedure, invasion of connective tissue took place among the granules, and new bone formation was delayed compared to periosteum covering group. Therefore, when the bone grafting was performed with periosteal incision procedure to achieve tension-free suture, the integrity of the overlying periosteum should be maintained to avoid fibrous tissue ingrowth.

Expression of PDL-specific protein;PDLs22 on the developing mouse tooth and periodontium / 대한치주과학회지

The periodontal ligament(PDL) is a unique tissue that is crucial for tooth function. However, little is known of the molecular mechanisms controlling PDL function. PDL-specific protein;PDLs22 had been previously identified as a novel protein isolated from cultured human PDL fibroblasts using subtraction hybridization between human gingival fibroblasts and PDL fibroblasts. The aim of this study was to examine the expression pattern and tissue localization of PDLs22 protein in embryonic and various postnatal stages of developing mouse using immunohistochemical staining. Embryos (E18) and postnatal (P1, P4, P5, P15, P18) were decapitated and the heads were fixed overnight in a freshly prepared solution of 4% paraformaldehyde. Some specimens were decalcified for 2~4 weeks in a solution containing 10% of the disodium salt of ethylenediamine-tetraacetic acid (EDTA). Next, tissues were dehydrated, embedded in paraffin and sectioned serially at 6micrometer in thickness. Polyclonal antiserum raised against PDLs22 peptides, ISNKYLVKRQSRD, were made. The localization of PDLs22 in tissues was detected by polyclonal antibody against PDLs22 by means of immunohistochemical staining. The results were as follows; 1. Expression of PDLs22 protein was not detected in the tooth germ of bud and cap stage. 2. At the late bell stage and root formation stage, strong expression of PDLs22 protein was observed in developing tooth follicle, osteoblast-like cells, and subodontoblastic cells in the tooth pulp, but not in gingival fibroblasts, ameloblasts and odontoblasts of tooth germ 3. In erupted tooth, PDLs22 protein was intensely expressed in PDL and osteoblast-like cells of alveolar bone, but not in gingival fibroblasts, mature osteocytes and adjacent salivary glands. 4. In the developing alveolar bone and mid-palatal suture, expression of PDLs22 protein was seen in undifferentiated mesenchymal cells and osteoblast-like cells of developing mid-palatal suture, but not in mature osteocytes and chondrocytes. These results suggest that PDLs22 protein may play an important role in the differentiation of undifferentiated mesenchymal cells in the bone marrow and PDL cells, which can differentiate into multiple cell types including osteoblasts, cementoblasts, and PDL fibroblasts. However, more researches should be performed to gain a better understanding of the exact function of PDLs22 protein which related to the PDL cell differentiation.

Effect of tetracycline-HCl root conditioning on gingival epithelial cell attachment to root surface / 대한치주과학회지

The ultimate goal of periodontal therapy is directed to arresting the progression of the disease, and regenerating the fibrous attachment. In order to achieve such treatment aim, the plaque and calculus must be eliminated and the physiological conditions of the root surface must be changed to facilitate the attachment and migration of the new fibroblasts, The method of changing the proper root surface conditions to promote the healing of periodontal tissue involves mechanical procedures, such as scaling and root planing, and chemical procedures such as tetracycline-HCl. However, the formation of a long junctional epithelium was most frequently observed type of healing. Thus, the aim of this study was to examine in vitro the influence of surface conditioning of dentin by TC-HCl on human gingival epithelial cell attachment. Human gingival epithelial cells were obtained from healthy retromolar pad area(under the age 23 years). Seventy two teeth extracted from severe periodontitis were used as study material. To evaluate the epithelial cell attachment to dentin, the prepared specimen was divided to four groups. For the control group, only scaling and root planing were carried out, and for the test group, 1 to 3, the concentration of the TC-HCl was 50, 125 and 250mg/ml, respectively. After cell cultivation time of 1-, 3-. 24 hour, for the indirect quantitative assessment of gingival epithelial cell attached to dentin sample, the absorbance of epithelial cell unattached to dentin was measured. The results were as follows; 1. There was no statistically significant difference between scaling and root planing group and TC-HCl 50mg/ ml, 125mg/ml and 250mg/ml group about absorbance of unattached epithelial cell to dentin sample(p>0.5). 2. As time passes, the absorbance of unattached gingival epithelial cell to dentin sample was decreased statistically significant(p0.05) We concluded that there was similar effect on gingival epithelial cell attachment between TC-HCl conditioning on root surface and only scaling and root planing treatment

Investigation of Age and Treatment Modalities in the Periodontally Treated(1981-1995) Patients / 대한치주과학회지

The aim of this study was to recommend the optimal age for prevention of periodontal disease and to investigate the trend of treatment modality according to different period. From the chart recordings of the patients who had been treated periodontally from Jan. 1981 to Dec. 1995 in the dept .of periodontics, Chosun University Dental Hospital, those of the periodontally treated patients on more than 4 sixtants were selected for the present study. The distribution of the patients was counted according to the age group and the gender. And they were divided into 3 groups(group 1: 1981-1985, group 2: 1985-1990, group 3: 1991-1995) by 5 year interval according to the treated year. The periodontal treatment modalities were classified into non-surgical therapy, pocket elimination surgery, regenerative periodontal surgery, mucoginigival surgery, clinical crown lengthening, and others. The results were as follows; 1.In the distribution of the periodontally treated patients according to the age group, 40's age group was the highest, and 30's, 40's, and 50's age groups occupied more than two thirds(73%). 2.The sexual distribution of the periodontally treated patients showed that males(53.4%) were a little more than females(46.6%). Within 20's group female was higher, but within 40's male was higher. 3.Regardless of the age group and the gender, pocket elimination surgery was the most frequent treatment modality. 4.In group 1 and 2(1981-1990) the main treatment modality was pocket elimination surgery and non-surgical therapy, but in group 3(1991-1995) it was regenerative periodontal surgery and pocket elimination surgery. The above results suggest that the prevention of periodontal disease should be initiated from early twenties, and the most frequent treatment modality may be closely related with development of new material and method.

Clinical Evaluation After Periodontal Flap Surgery with/without Non-Surgical Periodontal Therapy / 대한치주과학회지

In the treatment of chronic adult periodontitis, scaling and root planing have been generally performed prior to periodontal flap surgery. The purpose of this study was to evaluate the clinical significance of non-surgical periodontal therapy prior to periodontal flap surgery in patients with chronic adult periodontitis. Fifty six molars showing bilateral bony defects and 4-6mm periodontal pocket in twelve patients with chronic adult periodontitis were selected. By randomized split-mouth design, in one side, flap operation was performed 4 weeks after scaling and root planing, in the other group, flap operation was only performed without scaling and root planing. Probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index, and tooth mobility were measured at baseline, before flap operation and post-operation 12 weeks. The difference of clinical parameters between groups and between each measuring time was statistically analyzed. The results were as follows; 1. At 12 weeks after flap operation, there was no significant difference in probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index and tooth mobility between groups(p<0.05). 2. In both groups, probing pocket depth, gingival recession, clinical attachment level, gingival index, plaque index and tooth mobility were significantly improved at 12 weeks after flap operation compared to baseline(p<0.05). Within the limitation of short period, the results failed to demonstrate that the non-surgical periodontal therapy prior to periodontal flap surgery could have clinical significance in improvement of clinical parameters compared to periodontal surgery without non-surgical periodontal therapy.

The Inhibitory Effect of Metronidazole and Doxycycline-HCl on proMMP-3 Production in Gingival Fibroblast / 대한치주과학회지

No abstract available.

A case of pancytopenia secondary to low-dose pulse methotrexate therapy in a patient with rheumatoid arthritis and renal insufficiency

Most reports on serious MTX toxicity have focused on hepatic abnormalities, while other effects, including hematologic reactions, have not been emphasized. We experienced a case of pancytopenia secondary to MTX therapy in a patient with RA and renal insufficiency. A 67-year-old woman with a 12-year history of active seropositive RA that was a response to non-steroidal anti-inflammatory drugs, hydroxychloroquinine and intra-articular steroid injections, had been followed up and was diagnosed as early chronic renal failure in October, 1993. Recently, because of significant morning stiffness and polyarthralgia, the decision was made to institute MTX treatment. This was begun as a single oral dose of 5mg/week. After 2 doses, the patient was admitted to the hospital with general weakness. Laboratory tests showed a hemoglobin level of 7.9 g/dl, WBC count 1800/mm3 and platelet count of 64000/mm3. The serum creatinine level was 6.1 mEq/dl and the BUN level was 82 mEq/dl. Liver function test results were normal, but the serum albumin level was 2.7 g/dl. The patient subsequently developed fever and blood transfusions, granulocyte colony stimulating factor (G-CSF) and intravenous prophylactic antibiotic therapy were required. Her condition was improved. In summary, Low-dose MTX-related adverse hematologic side effects, including fatal pancytopenia, are rare but are a cause of increasing concern in patients with RA and renal insufficiency. Close monitoring of associated risk factors, particularly impaired renal function, should be mandatory for all patients who are receiving MTX therapy.

A Case of Acute Cortical Necrosis Associated with Uterine Leiomyoma / 대한신장학회잡지

Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.

Effect of Tetracycline Analogues on The Activity of Matrix Metalloproteinase-3 in Gingival Fibroblasts / 대한치주과학회지

Extracellular matrix component is degraded by enzymes of thematrix metalloproteinases(MMPs). MMPs are produced by both hemopoietic and structural cells. Increased activity of MMP-3 in periodontium is strongly associated with inflammatory periodontal disease. The purpose of the present study was to determine the effect of tetracycline analogues on the activity of MMP-3. Tetracycline-HCl, doxycycline-HCl, and minocycline-HCl were applied to huamn gingival fibroblasts at various concentrations of 10, 25, 50, 100, 200microgram/ml, and 1 hour later IL-1beta of 25ng/ml was added. After incubation for 24 hours the cells were reacted by enzyme-linked immunosorbent assay using proMMP-3 ELISA kit. The optical density was measured by microwell plate reader at 450nm. The relative activity of MMP-3 was calculated as the percentage of the optical density of each experimental group to that of the control. The difference of the optical density and the relative activity of MMP-3 between the experimental groups and the control wasstatistically analyzed by one way ANOVA. The results were as follows: 1. Tetracycline-HCl showed the tendency to inhibit the activity of MMP-3 at the concentration lower than 25 microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 2. Doxycycline-HCl inhibited significantly the activity of MMP-3 at the concentration lower than 100microgram/ml, but increased significantly the activity of MMP-3 at the concentration of 200microgram/ml(p<0.05). 3. Minocycline-HCl inhibited the activity of MMP-3 at the concentration in the range of 10 to 200microgram/ml. Within the limit of the present study, the above results suggested that the low concentration of tetracycline analogues could inhibit the activity of MMP-3 induced by IL-1beta in human gingival fibroblasts.

Effect of Changes of Inferior Vena Cava Diameter on Left Ventricular Hypertrophy in Hemodialysis Patients / 대한내과학회지

BACKGROUND: Volume overload is one of the most important, correctable factor for blood pressure control in hemodialysis patient. But objective parameter for the ideal body weight is not available in clinical field yet. Recently inferior vena caval examination became a possible candidate for an objective parameter for intravascular volume status. Therefore we investigated how inferior vena cava changes during hemodialysis compared with total amount of ultrafiltration and ANP, and also the effect of changes of IVC diameter on LVH. METHODS: 43 patients on stable maintainance hemodialysis were enrolled. Among them, 21 patients were on antihypertensive medication. Just before and after the hemodialysis, inferior vena cava diameter, plasma atrial natriuretic peptide and left ventricular mass index were measured for each patient. Inferior vena cava was examined at the level just below the hepatic vein during quiet respiration and left ventricular mass index was calculated. RESULTS: Inferior vena cava at expiration (IVCe) was significantly decreased during hemodialysis (before hemodialysis 21.9 4.9 mm, after hemodialysis 18.3 4.4 mm, p = 0.02). Collasibility index was significantly increased during hemodialysis (before hemodialysis 0.24 0.15, after hemodialysis 0.41 0.19, p < 0.001). Atrial natriuretic peptide (ANP) was significantly decreased during hemodialysis (before hemodialysis 252.3+/-119.0 pg/ml, after hemodialysis 185.6+/-93.2 pg/ml, p<0.001). Total ultrafiltration amount was significantly correlated with collapsibility change (r = - 0.40) and change of ANP (r = -0.41). Left ventricular mass index was correlated with interdialysis weight gain (r=0.39, p<0.05), IVCe after hemodialysis (r=0.48, p < 0.05) in univariate analysis but not in multivariate analysis. CONCLUSION: Collapsibility index of inferior vena cava, IVC diameter and ANP changes reflect the volume change during the hemodiaylsis. Therefore IVC examination can be an objective parameter for volume change during hemodialysis. Postdialysis IVCe correlates weakly with left ventricular mass index but it cannot be an independant risk factor for left ventricular hypertrophy in our study.

Systemic lupus erythematosus with obstructive uropathy: Case report and review

We report a case of patient with documented SLE who displayed dysuria, gastrointestinal (GI) symptoms and renal insufficiency associated with the unusual occurrence of bilateral hydroureteronephrosis due to urterovesical junction stricture (obstructive uropathy). Pathologic investigations disclosed chronic interstitial cystitis (IC) with evidence of focal immune complex deposition in the blood vessel walls of the bladder. The GI symptoms and dysuria regressed with initial therapy for SLE with steroids. However, the persistent obstructive uropathy (OU) and renal insufficiency required bilateral nephrostomy followed by steroids plus intravenous pulse injection of cyclophosphamide. The obstructive uropathy was relieved even after removing the nephrostomy tube and renal function remained stable. Including this case, nineteen SLE patients associated with clinical and radiographic findings of OU were found in the world literature and reviewed to find any consistent pattern of clinical features. Most of the patients with OU in SLE were female (mean age, 31.7 yr) and orientals (63%), and had interstitial cystitis (89%) as a common underlying cause with concomitant involvement of the GI tract (89%) and WHO class IV or V advanced glomerulonephritis (67%). Despite the remarkable response (68%) to steroids in majority of OU patients associated with SLE, certain patients still required surgical correction (32%) and some even died (32%). OU, potentially reversible, was not an exception in patients with SLE, which might be overshadowed by other major organ involvement of SLE.