Oral Bisphosphonate Related Osteonecrosis of the Jaws: A case report

Bisphosphonates are the most widely prescribed medications for the treatment of osteoporosis. However, bisphosphonate-related osteonecrosis of the jaw (BRONJ) is recently recognized as a serious complication among patients receiving bisphosphonate therapy. Most reports relate to BRONJ result from intravenous bisphosphonate or dental procedure. We report a case of mandible osteonecrosis related with oral bisphosphonate medication. A-63-year old woman suffered from toothache, cheek swelling and heating sense visited our dental clinic. She had taken oral alendronate and antihypertensive agents for 4 years because of osteoporosis and hypertension. Dental physical examination, radiologic study and pathologic study showed the severe inflammation and osteonecrosis of the mandible. Therefore we diagnosed the patient as having BRONJ and she stopped to take bisphosphonate and received surgical treatment with bone curettage. After surgical treatment and stopping bisphosphonate, her symptoms were improved.

Anatomical Relation of Ulnar Nerve and Flexor Carpi Ulnaris Muscle at the Wrist

OBJECTIVE: To verify proper stimulation point of ulnar nerve at the wrist by investigating anatomical relation of ulnar nerve and flexor carpi ulnaris (FCU) muscle. METHOD: Cadaver dissection of 9 wrists was done to identify gross anatomical relation of ulnar nerve and FCU muscle. Ultrasonography of 17 healthy volunteers was done for the measurement of distance from lateral border of FCU muscle to ulnar nerve at three sites. Ratios of these distances to total width of FCU muscle and FCU tendon were calculated. RESULTS: FCU muscle was composed of lateral tendinous and medial muscular portion, and all ulnar nerves were located under the tendinous portion of FCU muscle on cadaver dissection. Ultrasonographic distances from lateral border of FCU muscle to ulnar nerve were 4.6+/-3.3 mm, 4.8+/-4.0 mm and 5.9+/-3.1 mm from distal to proximal sites. The ratios to total width of FCU muscle were 31.02+/- 23.31%, 24.30+/-26.12% and 24.48+/-13.01%, which showed that the ulnar nerve was closer to the lateral border than the medial border. The ratios to total width of FCU tendon were 49.63+/-41.35%, 51.30+/-50.46% and 64.59+/-36.79%, which showed progressive increment from distal to proximal sites. CONCLUSION: Proper stimulation point of ulnar nerve at the wrist is the lateral border of FCU muscle than the medial border. However, the proximity of ulnar nerve to the medial or lateral border was not conclusive, because the ratio to FCU tendon was not consistent in three sites of the wrist. Further electrophysiologic study is necessary for the comparison of proper stimulation point based on FCU tendon.

Epidural Abscess and Vertebral Osteomyelitis Induced by Epidural Injection: A case report

Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection.

Nocturnal Polyuria Developed in Patients with Central Pontine Myelinolysis: A case report

Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin.