Bisphosphonate-associated osteonecrosis (BRONJ) is an adverse event associated with bisphosphonate drug treatment. An 81-year-old female has been taking bisphosphonates orally once a month for three years complained of pain in the left mandibular molar area after implant placement. Tenderness and fistula were formed. Extensive osteosclerosis in posterior area of the left mandible and bone resorption around distal side of #37i were shown on radiographs. She was given oral antibiotics for 6 weeks and bone resorption was improved. A 70-year-old male had a history of intravenous injection of bisphosphonates for blood cancer complained of #46i implant mobility. There was buccal fistula on #45 site. Radiographically, severe bone resorption and extensive osteosclerosis were shown. He was treated with removal of implant and inflammatory tissue. Patients who have taken bisphosphonates may develop BRONJ after tooth extraction or implant placement and are needed to meticulous plaque control for preventing BRONJ.

In severe acute pancreatitis, accompanied by local complications such as acute peripancreatic fluid collection, pancreatic pseudocyst, acute necrotic collection and walled-off necrosis, the mortality rate is as high as 12-25%. In many cases, interventional procedure or surgical treatment are required at an appropriate time. Conservative treatment is considered for acute peripancreatic fluid collection. Endoscopic drainage could be considered preferentially for the treatment of pancreatic pseudocysts with clinical symptoms or complications. In the case of necrotizing pancreatitis, conservative treatment is preferred, but therapeutic intervention should be considered if infectious pancreatic necrosis with clinical deterioration is suspected. For therapeutic intervention, it is recommended to proceed with a step-up approach in which drainage is first performed and, if necessary, necrosectomy is performed. The optimal timing of intervention is considered 4 weeks after the onset of pancreatitis when necrosis become walled-off, but early drainage within 4 weeks can be considered depending on the patient's condition. This guideline provides an overview of current treatment strategies for local complications of acute pancreatitis.

The purpose of this study was to identify the oral bacterial species in sequestra from patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Fifteen patients with BRONJ (2 males and 13 females) were evaluated. Clinical features, radiographic findings, and bisphosphonate intake history were investigated. All patients were treated with surgical methods (curettage or sequestrectomy). Infected bone samples were collected from the affected BRONJ site. Ten bacterial species were selected for polymerase chain reaction (PCR) detection. Two to nine bacterial species were detected by PCR. Gram-negative species were predominant and all identified bacteria were anaerobes. Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were detected at high levels. These are major pathogenic species in periodontal disease. Orthopantomographic radiographs showed generalized alveolar bone loss in most patients. These radiographic findings may provide evidence of chronic periodontitis as a pre-existing inflammatory disease. Most patients had experienced a predisposing dental procedure, such as tooth extraction. Sequestra (necrotic bone) infected with oral bacterial species may be an important risk factor for BRONJ. As such, prevention and management of BRONJ may rely on effective control of bacteria in the oral cavity.

51세 여자가 갑자기 발생한 심한 복통으로 응급실에 내원하였다. 환자는 1년 전 유방암으로 수술을 시행받았고 6개월 전부터 저용량(하루에 10 mg)의 타목시펜을 복용하기 시작했다. 환자의 복통은 중증의 궤사성 췌장염이 원인으로 밝혀졌다. 환자는 특별한 기저질환이나 약물 복용력은 없었으며 음주도 하지 않았다. 내시경 초음파에서 담석은 보이지 않았다. 환자의 6개월 전 중성지방의 수치는 정상이었으나 응급실 내원 당시의 수치는 2,534 mg/dL로 확인되었다. 고중성지방혈증과 췌장염의 원인으로 타목시펜이 가장 의심되었기에 타목시펜 중단 후 보존적 치료를 시행하였고 회복되어 퇴원하였다. 퇴원시 환자의 중성지방 수치는 정상이었다. 타목시펜은 유방암 치료에 효과적인 약이나 처방 후 지질대사에 대한 추적관찰과 관심이 반드시 필요하다.

This study was planned to evaluate the efficacy of surgical treatment in stage 2 medication related osteonecrosis of jaw(MRONJ) patients. Retrospective analysis was performed about patients who were treated with medication related osteonecrosis of jaw from 2015 to 2017. 25 Patients were treated by a single surgeon at the Department of Oral Surgery, Dental Hospital, Pusan National University. The treatment methods they received were conservative or surgical. The results of treatment were classified as "fail" and "success" and the prognosis according to the treatment method was compared. Conservative treatment 14.29% (2 cases), sequestrectomy 64.29% (9 cases) and saucerization 21.43% (3 cases) were performed in the MRONJ group, and 2 treatment failures were encountered after conservative treatment and 1 after saucerization. Surgical treatment resulted in better outcomes in stage 2 MRONJ patients. Furthermore, treatments were deemed successful when surrounding necrotic bone containing sequestrum was reliably removed. Therefore, this study suggests that the treatment of "stage 2" MRONJ should actively consider surgical treatment.

중증 급성 괴사성 췌장염은 높은 합병증 발생률과 사망률을 보인다. 급성 괴사성 고임이 4주가 지나면서 구역성 췌장 괴사로 발전하는데 합병증을 동반한 구역성 췌장 괴사는 치료를 필요로 한다. 최근에는 수술보다는 경피적 혹은 내시경을 통한 배액술과 괴사조직 제거술을 시행하고 있으며 특히 내시경초음파를 이용한 배액술의 발전으로 덜 침습적인 방법으로 보다 효과적인 치료가 가능해 졌다.

The purpose of this study is to evaluate the clinical and radiographic features of Bisphosphonate-related osteonecrosis of the jaws(BRONJ). The clinical and radiographic features of 27 patients diagnosed with BRONJ from 2008 to 2012 were evaluated on the basis of the charts and panoramic radiographs and cone beam computed tomographs. As for clinical features, the following contents were evaluated; type of dental treatments before occurrence of BRONJ, the cause of taking bisphosphonate medicine, undergoing dental treatment, interval between dental treatments and symptom expression. As for radiological features, location of BRONJ, size of bone destructions and sclerosing of the surrounding bone, locational relationship between mandibular canal and inferior border of bone destruction, and effect on the maxillary sinus. In clinical features, extraction was done in 18 patients(66.7%), as the most common dental treatment before occurrence of BRONJ. The most common cause of taking bisphosphonate medicine was osteoporosis(20 pateints, 70.4%). The patients treated during bisphosphonate administration was 17(63.0%). The interval between dental treatments and symptom in the most patients(14 patients, 51.8%) was within 1 month. In radiological features, sequestrum was seen in 11 patients(40.7%) and bony sclerosing in 15(55.6%). The mean width of sclerosing was 32.9±12.4mm and mean height 17.5±4.4mm. Bone destruction invaded to inferior border of mandibular canal in 88.2%(15 among 17 mandibles),. Maxillary sinusitis was diagnosed in 57.1% among the evaluated maxillae(4 among 11 maxillae). In diagnosing BRONJ, clinicians should be cautious about medical history of patients and have well-knowledge of radiographic features.

The fruit of Kochia scoparia Scharder is traditionally used as a medicinal ingredient to treat allergic skin diseases and inflammatory diseases in China, Japan and Korea. Recently, several studies reported that K. scoparia had potential for the cytotoxicity of human cancer cells. To investigate the anti-cancer effect of K. scoparia on oral cancer and to determine the specific type of cell death induced by MEKS treatment. We investigated the anti-cancer effects of K. scoparia, methanol extract (MEKS) in HSC4 human oral cancer cells. We examined the effects of MEKS on the proliferation rate, cell cycle arrest, 7-AAD-ANNEXIN V double stain, reactive oxygen species (ROS) generation and activation of apoptosis and necroptosis-associated proteins in HSC4 cells. MTT assay results demonstrated that MEKS decreased the proliferation rates of HSC4 cells in a dose-dependent manner with an IC50 value of 45.3 μg/ml. MEKS at 50 μg/ml significantly increased the sub-G1 DNA contents of HSC4 cells to 84.8%, versus untreated cells. However, the activation of apoptosis-associated proteins such as cleaved caspase 3, cleaved caspase 8, cleaved caspase 9 and cleaved Poly (ADP-ribose) polymerase (PARP) did not detect. The level of Bax protein markedly increased in MEKS-treated HSC4 cells. In addition, the cell viability of the DPQ pre-treated HSC4 cells with MEKS treatment was significantly greater than that of MEKS treated-cells. These results suggest that MEKS inhibits cell proliferation and induces necroptosis in oral cancer cells and that MEKS may have potential chemotherapeutic value for the treatment of human oral cancer.

급성 췌장염은 대부분의 경우 보존적 치료만으로 수 일 이 내에 호전되는 경과를 보이며, 전체의 60-70%가 담석, 음주 에 의해 발생하는 것으로 알려져 있다. 드물지만 고칼슘혈증 에 의해서도 급성 췌장염이 발생할 수 있으며, 의인성 고칼슘 혈증 또한 급성 췌장염을 유발할 수 있다. 지금까지 보고된 의인성 고칼슘혈증에 의한 급성 췌장염의 증례는 모두 경증 으로, 수일간의 보존적 치료 및 혈중 칼슘 농도의 정상화를 통해 합병증 없이 호전되었다. 저자들은 27세 여성에서 의인 성 고칼슘혈증에 의해 발생한 급성 괴사성 췌장염과 여러 합병증에 관한 증례를 문헌 고찰과 함께 보고하고자 한다.

Infected walled-off pancreatic necrosis (WOPN) is dangerous complication of acute pancreatitis. Open necrosectomy and post-operative irrigation of necrotic cavity have been conventional treatment for infected pancreatic necrosis, however, recently minimally invasive techniques such as endoscopic necrosectomy has been regarded as preferred treatment method for infected WOPN. Endoscopic necrosectomy provides a targeted approach with a reduction in the systemic inflammatory response and avoidance of wound complications. Non alcohol related Wernicke encephalopathy is rare disease caused by thiamine deficiency due to intravenous feeding, and presented an encephalopathy, oculomotor dysfunction, gait ataxia. We report herein a case of Wernicke encephalopathy after successful endoscopic necrosectomy for infected WOPN.

L-아스파라기나제는 급성 림프모구백혈병 환자에서 사 용이 증가하는 약물로, 췌장염은 이 약제의 중요한 합병증 중 하나이며, 항암화학치료 중 이에 대한 주의가 필요하다. 급성 췌장염은 드물지만 치명적 합병증인 괴사성 췌장염 으로 진행할 수 있으며 빠른 진단과 적절한 처치가 중요하다. 본 증례는 괴사성 췌장염에 동반된 췌관 누출 그리고 췌장가성낭이 경유듀적 췌관 스텐트 삽입으로 호전되었던 증례이다. 향후 이러한 L-아스파라기나제 유발 췌장염 및 췌관 누출의 치료를 위한 다양한 접근 및 안전성에 대해 추가적인 연구가 요구된다.

괴사성 췌장염은 사망률이 높고 괴사된 췌장 부위에 감염이 동반되어 있을 경우에 패혈증과 다발성 장기 부전이 발생 하여 사망률이 더욱 증가하는 중대한 질환으로 과거에는 수술적 괴사 제거술이 많이 시행되었지만 최근에는 경피적 배액술 또는 내시경적 괴사 제거술과 같은 최소 침습 시술이 치료에 널리 이용되고 있다. 저자들은 경피적 배액술과 내시 경적 배액술을 시행하였으나 치료 반응이 없고 임상적으로 악화 경과를 보이는 환자에서 직경이 넓은 식도 금속 스텐트 를 사용하여 경피적 내시경적 괴사 제거술을 시행하여 대장 주변(paracolic gutter)에 있는 막으로 둘러싸인 괴사를 성공 적으로 치료한 사례들을 경험하였고 식도 금속 스텐트를 사 용하여 경피적 내시경적 괴사 제거술이 시행된 증례는 국내 에서 이전에 보고된 바가 없기에 이를 문헌 고찰과 함께 보고하는 바이다.

Osteonecrosis is defined as non-vital bone tissue as a result of abnormal process of osseous healing, and is caused by several reasons such as infection, radiation, and medication. Osteomyelitis, osteoradionecrosis, and medication related osteonecrosis of the jaws (MRONJ) which have necrotic bone in common are confused clinically due to similar symptoms and radiographic findings, and are difficult to diagnose definitively. Because each disease represents a separate clinical progress and requires a different treatment approach, it is very important to distinguish each disease. The aim of this study was to analyze the histopathologic features of osteomyelitis, osteoradionecrosis, MRONJ and to understand their different pathogenesis.

The prolonged bisphosphonate (BP) uptakes are frequently resulted in BP-related osteonecrosis of jaws (BRONJ). The previous study reported that the BP-involved bones were stained blue by Masson trichrome and showed weak birefringence compared to the normal bone1). Using the representative twenty cases of BRONJ osteomyelitis the present study examined the ultrastructure of BP-involved bone by scanning electron microscope (SEM) using decalcified bone microsections. As the BP-involved bones showed different features from adjacent normal bone by blue staining in Masson trichrome method and by rare birefringence under polarizing microscope, the ultrastructure of BP-involved bone matrixes were distinguishable histologically in comparison with normal bone. The normal bone showed the tight attachment of interdigitating dendritic bone matrixes, producing many Haversian canaliculi, while the BP-involved bone showed the compact alignment of granular bone matrixes, resulted in the abortive Haversian canaliculi. The osteocytes in the lacunar spaces of BP-involved bone became shrunken and necrotic, and the BP-involved bone showed many tunnel-like spaces produced by direct chemical resorptions and proteolytic degradation of bone matrixes. Taken together, it was conspicuous that the BP-involved bones were abnormal in their stainability of Masson trichrome, birefringence under polarizing microscope, and ultrastructure under SEM. These findings of BP-involved bone may have an implication for the pathogenetic roles of BRONJ, and can be applicable for the differential diagnosis of BRONJ from other osseous lesions.

감염성 췌장괴사의 고전적인 치료는 개복 수술이었다. 하지만 개복 수술 후 합병증, 사망률의 유의한 증가가 보고되면서 항생제와 보존적 치료가 일차적 치료로서 우선적으로 선택되고 있다. 보존 치료에 반응이 없는 경우에는 다양한 경로를 통한 배액법 및 괴사제거술 등의 최소 침습시술이 대두되고 있으며, 이러한 최소 침습 시술의 선택은 환자의 임상 양상, 보존적 치료에 대한 치료 반응, 괴사 조직과 위장관의 해부학적 위치 관계에 대한 정확한 평가 및 그에 따른 시술 방법의 선택이 이루어져야 한다. 저자들은 급성 감염성 췌장 괴사에서 항생제 등의 보존적 치료와 경피적 배액술을 시행하였으나 치료반응이 없는 환자에서 경피적 내시경적 괴사 제거술을 통한 성공적인 괴사 치료1예를 경험하였기에 보고하는 바이다.

'흑구슬' 포도에서 발생되는 빈가지의 발생 원인을 구명하고 눈의 기본 특성 및 괴사 유형을 구분하여 괴사 발생에 미치는 영향을 구명하고자 하였다. 1번마디부터 4번 마디에서는 결과모지에 가까울수록 눈의 크기는 작았으나 4번 마디 상부에 위치한 눈에서는 차이가 없었다. 1번 마디의 눈괴사율이 32.0%로 가장 높았으며, 4~10번 마디의 눈은 84.0~96.0%가 정상눈이었다. 시기별 눈의 크기는 7월이 6.40mm로 가장 컸으며 8월에서 10월까지는 차이를 보이지 않았다. 눈괴사와 주아괴사는 10월에 가장 많았으나 부아괴사는 7월부터 발생하여 이후에는 차이가 없었다. 가지 세력과 액아의 괴사발생간의 관계를 알아보기 위하여 상관분석을 실시한 결과, 가지 굵기 및 마디 길이는 괴사발생과 상관관계가 나타내지 않았으나 눈의 크기와 괴사 발생간에는 음의 상관관계를 나타내었으며 부아괴사와 가장 밀접하였다. 따라서 '흑구슬' 포도에서 눈의 괴사발생이 적고 충실함에도 불구하고 꽃송이 출현이 적은 것은 1번 눈의 괴사가 원인이므로 단초전정시 3마디를 남기고 전정을 할 경우 수량확보에 도움이 될것으로 생각된다.