Implant overdenture using a locator bar system by drill and tapping technique in a mandible edentulous patient: a case report

Various options have been introduced for the selection of implant overdenture attachments. Attachment wear due to the repeated insertion and removal of dentures has caused problems such as decreased retention and the requirement for suprastructure remanufacturing. In these cases, a Locator bar system was applied using the drill and tapping technique to achieve total retrievability. In a 55-year-old female patient who showed three degrees of mobility in most of her teeth due to severe alveolar bone loss, a complete denture in the maxilla and an implant supported type overdenture in the mandible were planned after extracting all the remaining teeth. Six implants were placed from canine region to the distal molar region, and the locator was connected to the milled bar using the drill and tapping technique. For a 61-year-old female edentulous patient who complained of poor retention with old denture, a complete denture in the maxilla and an implant-tissue supported type overdenture in the mandible were planned. Four implants were placed in front of mental foramen, and the Locator was also connected to the Hader bar using the drill and tapping technique. With this technique, female parts can be easily replaced, and retention can be continuously maintained.     

Chemerin levels are positively correlated with abdominal visceral fat accumulation

Objective Chemerin, a recently discovered adipocytokine, may be linked to obesity and obesity‐associated metabolic complications. However, the relationship between visceral fat accumulation and chemerin is still unknown. Therefore, we investigated the relationship between serum chemerin levels and body composition as measured by computed tomography (CT). Patients We recruited 173 men and women without histories of diabetes or cardiovascular disease. Measurements Biomarkers of metabolic risk factors and body composition by computed tomography were assessed. Serum chemerin levels were measured by enzyme‐linked immunosorbent assay. Results Chemerin levels correlated with body mass index (BMI), waist circumference, abdominal visceral fat area, blood pressure, fasting insulin, homoeostasis model of assessment‐insulin resistance, total cholesterol, triglyceride, creatinine, aspartate aminotransferase and alanine aminotransferase. By stepwise multiple regression analysis, abdominal visceral fat area, blood pressure and total cholesterol levels independently affected chemerin levels. Conclusions Abdominal visceral fat accumulation, blood pressure and lipid profile were significantly associated with serum chemerin levels. Our findings suggest that chemerin may be a mediator that links visceral obesity to cardiovascular risk factors.     

Novel GCH-1 mutations and unusual long-lasting dyskinesias in Korean families with dopa-responsive dystonia

ObjectiveTo describe the long-term follow-up data of Korean patients with GTP cyclohydrolase (GTPCH) I deficient dopa-responsive dystonia (DRD) with novel mutations and unusual long-lasting dyskinesias.MethodsClinical features and genetic testing results of GCH1 from 19 patients that included 4 families who have been followed-up for up to 25 years were analyzed.ResultsGCH1 mutations were confirmed in all our symptomatic subjects including 3 novel point mutations. All the subjects except for one family had typical manifestations of autosomal dominant GTPCH-I deficient DRD including early childhood onset dystonia predominantly in the legs, marked diurnal variation, intact cognition, no other systemic symptoms, and excellent sustained response to levodopa. The one family who was the exception had two gene positive members of DRD and one with dopa-unresponsive cervical dystonia with negative GCH1 mutation. One family and a sporadic case had been reported as gene negative in a previous study, but they typically had preserved dopamine transporter binding and low neopterin levels in cerebrospinal fluids; thus, GCH-1 mutation had been highly suspected, which was now confirmed by repeating the genetic testing this time. An early childhood-onset patient developed choreiform dyskinesias right after administration of levodopa. The dyskinesia had lasted for more than 4 years regardless of the levodopa dosages and then subsided while maintaining levodopa.ConclusionThis report emphasizes the usefulness of the neopterin level in cerebrospinal fluids and dopamine transporter imaging in the differential diagnosis of DRD syndromes and a possible mechanism of levodopa-induced-dyskinesia in early childhood onset case.     

Immunopathogenesis of Allergic Asthma: More Than the Th2 Hypothesis

Asthma is a chronic obstructive airway disease that involves inflammation of the respiratory tract. Biological contaminants in indoor air can induce innate and adaptive immune responses and inflammation, resulting in asthma pathology. Epidemiologic surveys indicate that the prevalence of asthma is higher in developed countries than in developing countries. The prevalence of asthma in Korea has increased during the last several decades. This increase may be related to changes in housing styles, which result in increased levels of indoor biological contaminants, such as house dust mite-derived allergens and bacterial products such as endotoxin. Different types of inflammation are observed in those suffering from mild-to-moderate asthma compared to those experiencing severe asthma, involving markedly different patterns of inflammatory cells and mediators. As described in this review, these inflammatory profiles are largely determined by the involvement of different T helper cell subsets, which orchestrate the recruitment and activation of inflammatory cells. It is becoming clear that T helper cells other than Th2 cells are involved in the pathogenesis of asthma; specifically, both Th1 and Th17 cells are crucial for the development of neutrophilic inflammation in the airways, which is related to corticosteroid resistance. Development of therapeutics that suppress these immune and inflammatory cells may provide useful asthma treatments in the future.     

Hepatoid adenocarcinoma of the stomach: an unusual case of elevated alpha-fetoprotein with prior treatment for hepatocellular carcinoma

Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.     

Acute brain reaction to DBS electrodes after deep brain stimulation: chronological observation

Background

As increasing numbers of deep brain stimulation (DBS) procedures are performed, rare abnormal findings on postoperative images that are not attributable to well-known complications are reported. Between 2005 and 2012, we encountered several symptomatic patients with transient abnormal low-attenuation lesions on postoperative computed tomography (CT) scans. The aim of this study was to clarify this rare phenomenon using chronological observations and to suggest a feasible mechanism.

Results

In this period, seven (3.2 %) patients displayed transient increased low-attenuation signals, circumferentially surrounding the DBS electrodes and extending into the subcortical white matter. All these patients suffered from unexpected but transient neurological symptoms during the postoperative period. The abnormal low-attenuation lesions only disappeared completely a considerable time after the clinical symptoms had disappeared, without treatment in most patients.

Conclusions

We report here our chronological observations of acute brain reactions after DBS procedures, which we believe are neither infectious nor vascular, but are possibly caused by the mechanical breakdown of the blood–brain barrier by microelectrode recordings or by anchored DBS electrodes. These lesions are thought to constitute a self-limiting disorder requiring no further treatment.     

Association of VKORC1-1639G>A polymorphism with susceptibility to ossification of the posterior longitudinal ligament of the spine: a Korean study

Background

Abnormalities of bone metabolism may be involved in the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) of the spine. Besides its hemostatic effect, vitamin K epoxide reductase complex subunit 1 (VKORC1) plays a pivotal role in bone mineralization. The aim of this study is to investigate whether single nucleotide polymorphisms (SNPs) of the VKORC1 gene are associated with the occurrence of OPLL in a Korean population.

Method

A total of 98 patients with OPLL and 200 controls were genotyped for the VKORC1-1639G>A SNP (rs9923231) by polymerase chain reaction and restriction fragment length polymorphism analysis. All the patients (n?=?98) in this study underwent surgery (60, posterior-only approach; 36, anterior-only approach; 2, combined anterior and posterior approach) during their admission. We analyzed this association separately according to the gender and OPLL subgroup: OPLL continuous group (continuous type plus mixed type) and OPLL segmental group (segmental and localized type).

Results

We found that the genotype VKORC1-1639G>A frequency was significantly associated with the occurrence of the OPLL in the female group (adjusted odds ratio?=?5.22, 95 % confidence interval: 1.675 to 16.269, p?=?0.004). However, there was no overall association between the OPLL susceptibility and VKORC1-1639G>A polymorphism. A subgroup analysis did not show any significant correlation between VKORC1-1639G>A polymorphism and subgroup of OPLL either.

Conclusion

Our results suggest that the VKORC1-1639G>A SNP may increase susceptibility to OPLL in women. However, there was only a statistical association in the female group despite a number of stratified analyses. Therefore, the findings should be interpreted with caution, and further genetic study is needed to improve our understanding of the role of VKORC1 polymorphisms in determining the risk of OPLL occurrence.