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Background@#Mounier-Kuhn syndrome (MKS) is a rare disorder characterized by abnormal dilation of the trachea and main bronchi. MKS can be easily missed on chest X-rays, making diagnosis difficult. Under general anesthesia, challenges such as airway leakage or collapse during mechanical ventilation may prevent the achievement of adequate tidal volumes in patients with MKS.Case: A 94-year-old woman requiring emergency hemiarthroplasty of the hip under general anesthesia was admitted. Preoperative chest X-rays revealed dilation of the trachea and main bronchi, but the patient exhibited no respiratory symptoms. We diagnosed her with MKS and opted for an 8.0-mm-inner-diameter reinforced tracheal tube. We positioned the cuff in the subglottic area, inflating it while monitoring for air leakage. Throughout the surgery, we ensured that adequate air leak and tidal volume were maintained. @*Conclusions@#Anesthesiologists must conduct a comprehensive evaluation of patients with MKS, including a review of chest radiographs, and establish a meticulous anesthesia plan prior to surgery.
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Background@#Glenoid position and inclination are important factors in protecting against scapular notching, which is the most common complication that directly affects the longevity of reverse shoulder arthroplasty (RSA). This study aimed to investigate the biomechanical characteristics of glenosphere orientation, comparing neutral tilt, inferior overhang with an eccentric glenosphere at the same placement of baseplate, and inferior tilt after 10° inferior reaming in the lower part of the glenoid in RSA. @*Methods@#Nine cadaveric shoulders were tested with 5 combinations of customized glenoid components: a centric glenosphere was combined with a standard baseplate (group A); an eccentric glenosphere to provide 4-mm inferior overhang than the centric glenosphere was combined with a standard baseplate (group B); a centric glenosphere was combined with a wedge-shaped baseplate tilted inferiorly by 10° with the same center of rotation (group C); an eccentric glenosphere was attached to a wedge-shaped baseplate (group D); and 10° inferior reaming was performed on the lower part of the glenoid to apply 10° inferior tilt, with a centric glenosphere secured to the standard baseplate for simulation of clinical tilt (group E). Impingement-free angles for adduction, abduction, forward flexion, external rotation, and internal rotation were measured. The capability of the deltoid moment arm for abduction and forward flexion, deltoid length, and geometric analysis for adduction engagement were evaluated. @*Results@#Compared with neutral tilt, inferior tilt at the same position showed no significant difference in impingement-free angle, moment arm capability, and deltoid length. However, group D resulted in better biomechanical properties than a central position, regardless of inferior tilt. Group E demonstrated a greater range of adduction, internal and external rotation, and higher abduction and forward flexion capability with distalization, compared to corresponding parameters for inferior tilt with a customized wedgeshaped baseplate. @*Conclusions@#A 10° inferior tilt of the glenosphere, without changing the position of the baseplate, had no benefit in terms of the impingement-free angle and deltoid moment arm. However, an eccentric glenosphere had a significant advantage, regardless of inferior tilt. Inferior tilt through 10° inferior reaming showed better biomechanical results than neutral tilt due to the distalization effect.
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Artificial intelligence (AI) has rapidly transformed various aspects of life, and the launch of the chatbot “ChatGPT” by OpenAI in November 2022 has garnered significant attention and user appreciation. ChatGPT utilizes natural language processing based on a ”generative pre-trained transfer” (GPT) model, specifically the transformer architecture, to generate human-like responses to a wide range of questions and topics. Equipped with approximately 57 billion words and 175 billion parameters from online data, ChatGPT has potential applications in medicine and orthopedics. One of its key strengths is its personalized, easy-to-understand, and adaptive response, which allows it to learn continuously through user interaction. This article discusses how AI, especially ChatGPT, presents numerous opportunities in orthopedics, ranging from preoperative planning and surgical techniques to patient education and medical support. Although ChatGPT’s user-friendly responses and adaptive capabilities are laudable, its limitations, including biased responses and ethical concerns, necessitate its cautious and responsible use. Surgeons and healthcare providers should leverage the strengths of the ChatGPT while recognizing its current limitations and verifying critical information through independent research and expert opinions. As AI technology continues to evolve, ChatGPT may become a valuable tool in orthopedic education and patient care, leading to improved outcomes and efficiency in healthcare delivery. The integration of AI into orthopedics offers substantial benefits but requires careful consideration and continuous improvement.
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The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.
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Spinal epidermoid cysts are extremely rare benign tumors and can be congenital or acquired.Acquired spinal epidermoid cysts are found in the lumbosacral region. To our knowledge, no case of epidermoid cyst related to spinal cord stimulator insertion has yet been reported. We report the MRI findings of a rare case of thoracic intradural epidermoid cyst acquired after spinal cord stimulator insertion in a 50-year-old female.
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Purpose@#To demonstrate the changes in reading speed after anti-vascular endothelial growth factor (VEGF) treatment in wet age-related macular degeneration (wAMD) patients. @*Methods@#This retrospective study enrolled wAMD patients who were treated with intravitreal anti-VEGF injection from May 2019 to September 2019. The reading speed was measured before anti-VEGF treatment and at the next injection visit using an iPad application for the assessment of reading speed. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were also analyzed. In addition, we investigated whether the improvement in optical coherence tomography (OCT)-related biomarkers affected the change in reading speed after anti-VEGF injection. As a subgroup analysis, patients were further divided into a loading dose group and a maintenance group. @*Results@#Seventy-four patients were enrolled in this study. In the loading dose group (n = 38), there were significant improvements in BCVA (p = 0.01) and CRT (p = 0.001); additionally, the reading speed improved significantly in two of the four areas (words per minute (WPM) reading [p = 0.035] and WPM speaking [p = 0.013]) after anti-VEGF injection. In the maintenance group (n = 36), BCVA, CRT, and reading speed showed some improvement; however, the results were not statistically significant. In the maintenance group, reading speed improved significantly as the size of the pigment epithelial detachment decreased after anti-VEGF injection. @*Conclusions@#Reading speed may be useful as an index for measuring visual function related to the quality of life of wAMD patients. Precise evaluation and continuous monitoring of OCT biomarkers are necessary for the treatment of wAMD especially in the maintenance group because they can be predictors of reading speed improvement.
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Congenital myasthenic syndromes are a genetically and clinically heterogeneous group of neuromuscular disorders linked by abnormal signal transmission at the motor endplate caused by various genetic defects. Major clinical symptoms include weakness and fatigue during the first years of life but patients may also present with hypotonia, facial weakness, swallowing difficulties, respiratory dysfunction, ptosis and ophthalmoparesis. Here we report a 10-year-old boy who presented with mild developmental delay and bilateral ptosis caused by a frameshift mutation in the CHRNA1 gene that co-segregated within the family, and finally diagnosed as autosomal dominant congenital myasthenic syndrome.
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Adventitial cystic disease of the vein is a rare vascular disease. Herein, we report a case of adventitial cystic disease of the common femoral vein that was initially misdiagnosed as deep venous thrombosis in a 41-year-old male who presented with leg swelling. We focused on the imaging findings and compared them with those of deep venous thrombosis.
الملخص
Congenital myasthenic syndromes are a genetically and clinically heterogeneous group of neuromuscular disorders linked by abnormal signal transmission at the motor endplate caused by various genetic defects. Major clinical symptoms include weakness and fatigue during the first years of life but patients may also present with hypotonia, facial weakness, swallowing difficulties, respiratory dysfunction, ptosis and ophthalmoparesis. Here we report a 10-year-old boy who presented with mild developmental delay and bilateral ptosis caused by a frameshift mutation in the CHRNA1 gene that co-segregated within the family, and finally diagnosed as autosomal dominant congenital myasthenic syndrome.
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Adventitial cystic disease of the vein is a rare vascular disease. Herein, we report a case of adventitial cystic disease of the common femoral vein that was initially misdiagnosed as deep venous thrombosis in a 41-year-old male who presented with leg swelling. We focused on the imaging findings and compared them with those of deep venous thrombosis.
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Purpose@#To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. @*Methods@#International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A metaanalysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. @*Results@#Five RCTsand six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. @*Conclusions@#This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. @*Results@#of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.
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Medical sociology has a long history, and it has been institutionalized and developed since the 1940s. This paper is about the history, trends, and prospects of medical sociology from the perspective of concepts as well as its interface with medical humanities. Sociology is a discipline that conceptualizes and theorizes social phenomena on the basis of collected data to best understand them. For this reason, we think that one of the best ways to understand medical sociology is to track the changes and developments in the concept and theory of medical sociology over time. Moreover, the development of concepts and theories does not occur only within the discussion of experts but also actively in interactions with the institutional position of medical sociology, medical knowledge and institutions and society.By reflecting on the changes in the theory and concept of medical sociology over the past 70 years from the 1950s to the present, we were able to understand the changes in research interests and research subject of medical sociology. Medical sociology has developed in response to the needs of the medical community and society. On the one hand, it developed a diverse understanding of healthcare, one of the key elements of the structure and culture of modern society, and on the other hand, it developed an understanding of how each individual experiences medical care as a dominant power. Since the 1990s, these seemingly conflicting two areas integrated into one through research subjects such as the growth of the general population and the health and social movement. Furthermore, the emergence of biotechnology, which began to develop in earnest beginning in the 1980s, presented a challenge for medical sociology.If the role of Parsons in the 1950s was to reflect the American medical system based on bacteriology and therapeutic drugs, after the 1960s, chronic disease became an important health problem due to changes in American society, and the experiences of patients suffering from chronic diseases became an important research subject. However, the rapid development of biotechnology from the 1980s was powerful enough to change the way we perceive our bodies. Our society has regarded our body as a sum of cells and a combination of various organs and body parts since the birth of modern medicine, but with the development of biotechnology, including genetics, we began to recognize our body as an expression of information contained in genes. The capitalist force driving biotechnology has degraded our bodies to the extent of our resources for the accumulation of genomic information.Finally, the concepts and theories developed by medical sociology can also be applied to understand the trends of medical history in the Korean Journal of Medical History provided that medical sociology and the medical history were embedded in the particular Korean historical context. Therefore, we hope these two medical disciplines cooperate further on the medical issues in Korea.
الملخص
Medical sociology has a long history, and it has been institutionalized and developed since the 1940s. This paper is about the history, trends, and prospects of medical sociology from the perspective of concepts as well as its interface with medical humanities. Sociology is a discipline that conceptualizes and theorizes social phenomena on the basis of collected data to best understand them. For this reason, we think that one of the best ways to understand medical sociology is to track the changes and developments in the concept and theory of medical sociology over time. Moreover, the development of concepts and theories does not occur only within the discussion of experts but also actively in interactions with the institutional position of medical sociology, medical knowledge and institutions and society.By reflecting on the changes in the theory and concept of medical sociology over the past 70 years from the 1950s to the present, we were able to understand the changes in research interests and research subject of medical sociology. Medical sociology has developed in response to the needs of the medical community and society. On the one hand, it developed a diverse understanding of healthcare, one of the key elements of the structure and culture of modern society, and on the other hand, it developed an understanding of how each individual experiences medical care as a dominant power. Since the 1990s, these seemingly conflicting two areas integrated into one through research subjects such as the growth of the general population and the health and social movement. Furthermore, the emergence of biotechnology, which began to develop in earnest beginning in the 1980s, presented a challenge for medical sociology.If the role of Parsons in the 1950s was to reflect the American medical system based on bacteriology and therapeutic drugs, after the 1960s, chronic disease became an important health problem due to changes in American society, and the experiences of patients suffering from chronic diseases became an important research subject. However, the rapid development of biotechnology from the 1980s was powerful enough to change the way we perceive our bodies. Our society has regarded our body as a sum of cells and a combination of various organs and body parts since the birth of modern medicine, but with the development of biotechnology, including genetics, we began to recognize our body as an expression of information contained in genes. The capitalist force driving biotechnology has degraded our bodies to the extent of our resources for the accumulation of genomic information.Finally, the concepts and theories developed by medical sociology can also be applied to understand the trends of medical history in the Korean Journal of Medical History provided that medical sociology and the medical history were embedded in the particular Korean historical context. Therefore, we hope these two medical disciplines cooperate further on the medical issues in Korea.
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Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.
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Ascariasis is an intestinal disease caused by Ascaris lumbricoides. Most patients with ascariasis are asymptomatic; however, the presence of many larvae in the bowel can cause gastrointestinal complications, such as intestinal obstruction, obstructive jaundice, cholangitis, cholecystitis, and pancreatitis. Herein, we report a case of ascariasis presenting as hematoma and active bleeding in the sigmoid mesocolon of a 74-year-old man on computed tomography (CT). Sigmoid colon perforation was also detected on follow-up CT. Laparoscopic low anterior resection was performed; there was a large hematoma in the sigmoid mesocolon. Roundworms were microscopically identified in the mesenteric adipose tissue. The clinical and CT findings of this unusual presentation of ascariasis revealed serial complications during parasite migration from the intestinal lumen to the peritoneal cavity.
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Lipoblastoma is a rare benign tumor with 80–90% occurring in children less than 3 years of age and 40% occurring in children less than 1 year of age. The most common site of incidence is limb, and then trunk. Neck is the rare site of incidence. The main symptom that the patient complains about is a rapidly growing neck mass without pain. When the size of mass increases, it can cause dyspnea, Horner's syndrome. Lipoblastoma is usually diagnosed as a lipoma in the fine needle aspiration. Since it is not differentiated from lipoma, liposarcoma, and hibernating adenoma in CT and MRI, the definitive diagnosis is histologic diagnosis through surgical resection. The treatment is complete surgical resection. And recurrence rate is 9–25% due to incomplete resection. Authors report this case with a review of literatures since we experienced a case of lipoblastoma diagnosed histopathologically after surgical treatment of neck mass.
الموضوعات
Child , Humans , Adenoma , Biopsy, Fine-Needle , Diagnosis , Dyspnea , Extremities , Horner Syndrome , Incidence , Lipoblastoma , Lipoma , Liposarcoma , Magnetic Resonance Imaging , Neck , Pediatrics , Recurrenceالملخص
Skull base chordomas are rare, malignant tumors arising from primitive notochord remnants of the axial skeleton and comprise approximately 25–35% of all chordoma cases. Nasal endoscopy in previous case reports has characterized nasopharyngeal chordomas as firm, semi-translucent masses protruding from the posterior nasopharyngeal wall with a pink, “meaty” appearance. However, the nasopharyngeal chordoma in the present case had a soft, cystic appearance, unlike the tumors previously described. Herein, an unusual case of an incidentally discovered nasopharyngeal chordoma is reported in a patient with papillary thyroid cancer; the discovered chordoma had a benign cystic appearance with no abnormal positron emission tomography-computed tomography (PET-CT) uptake.
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Humans , Chordoma , Cranial Fossa, Posterior , Electrons , Endoscopy , Notochord , Skeleton , Skull Base , Thyroid Gland , Thyroid Neoplasmsالملخص
Burning mouth syndrome (BMS) is defined as the xerostomia, burning sensation and various discomfort of tongue and oral mucosa. BMS can occur in both men and women, but is more frequent in middle-aged menopausal women. Because exact cause can't be identified clearly and it is hard to make diagnosis in clinic, the purpose of the treatment have been to relieve symptoms. Etiology of BMS is divided into local, systemic, and psychological factors. α-lipoic acid, clonazepam, supplemental therapy and cognitive behavior therapy can be prescribed for BMS. Nowdays, many experts focus attention on effect of combination therapy. It is necessary to solve the symptoms of the patients by combination of pharmacological approach and psychotherapy with cognitive behavior therapy considering the factors in various aspects.
الموضوعات
Female , Humans , Male , Burning Mouth Syndrome , Burns , Clonazepam , Cognitive Behavioral Therapy , Diagnosis , Mouth Mucosa , Psychology , Psychotherapy , Sensation , Tongue , Xerostomiaالملخص
The purpose of this research is to describe how Hansen's disease patients experienced the modern system of control of Hansen's disease introduced by Japan, and the inimical attitude of society against them in colonial Korea. The study also seeks to reveal the development of the system to eliminate Hansen's disease patients from their home and community to larger society and leprosarium in this era. Sorokdo Charity hospital (SCH), a hospital for Hansen's disease patients, was built in 1916, and vagrant Hansen's disease patients began to be isolated in this hospital beginning in 1917 by the Japanese Government-General of Korea (JGGK). Once the police detained and sent vagrant Hansen's disease patients to SCH, stigma and discrimination against them strengthened in Korean society. Because of strong stigma and discrimination in Korean society, Hansen's disease patients suffered from daily threats of death. First, their family members were not only afraid of the contagiousness of Hansen's disease but also the stigma and discrimination against themselves by community members. If a family had a Hansen's disease patient, the rest of community members would discriminate against the entire family. Furthermore, because Hansen's disease patients were excluded from any economic livelihood such as getting a job, the existence of the patients was a big burden for their families. Therefore, many patients left their homes and began their vagrancy. The patients who could not leave their homes committed suicide or were killed by their family members. The victims of such deaths were usually women, who were at the lower position in the family hierarchy. In the strong Confucian society in Korea, more female patients were killed by themselves than male patients. Moreover, all of patients victims in the murder were women. This shows that the stigma and discrimination against Hansen's disease patients within their families were stronger against women than men. Strong stigma and discrimination made the patients rely on superstition such as cannibalism. Patients believed that there were not any effective medicine. There were a few reports of patients who were cured, and many were treated with chaulmoogra oil in the modern Hansen's disease hospitals. Eating human flesh was known as a folk remedy for Hansen's disease. As such, patients began to kill healthy people, usually children, to eat their flesh. Increased stigma led to increased victims. Hansen's disease patients who left their homes faced many threats during their vagrancy. For survival, they established their own organizations in the late 1920's. The patients who were rejected to be hospitalized in the Western Hansen's disease hospital at Busan, Daegu, and Yeosu organized self-help organizations. The purpose of these organizations was first to secure the medicine supply of chaulmoogra oil. However, as stigma and discrimination strengthened, these organizations formed by Hansen's disease patients demanded the Japanese Government-General of Korea to send and segregate them on Sorok island. They did not know the situation of the inside of this island because news media described it as a haven for patients, and very few patients were discharged from this island to tell the truth. On this island, several hundreds of patients were killed by compulsory heavy labor, starvation, and violence. They were not treated as patients, but as something to be eliminated. Under strong suppression on this island, the patients resisted first by escaping this island. However, in 1937, some patients tried to kill a Korean staff but failed. Attempted murderers were all put in the jail, also located on this island. In 1941, a patient murdered another patient who had harassed other patients, and in 1942, Chunsang Lee, a patient, killed the director of Sorok island. These instances show that there was a system to eliminate Hansen's disease patients in colonial Korea.
الموضوعات
Child , Female , Humans , Male , Asian People , Cannibalism , Charities , Discrimination, Psychological , Eating , Homicide , Japan , Korea , Leprosy , Medicine, Traditional , Police , Starvation , Suicide , Superstitions , United Nations , Violenceالملخص
Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract that has both exocrine and neuroendocrine components. There are only 5 case reports about this combined tumor in the small bowel, arose in a background of long-standing Crohn's disease. Here, we report a case of small bowel MANEC in a 54-year-old male with Crohn's disease, who presented a heterogeneous enhancing, asymmetric small bowel wall thickening with small bowel obstruction and had a difficulty in differential diagnosis before surgery.