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Background and Objectives@#Some reports propose an increased risk of otitis media and hearing impairment after total laryngectomy. However, the incidence of otitis media following laryngectomy and the mechanism remain unclear. This study aimed to identify the incidence and risk factors of otitis media after total laryngectomy. @*Subjects and Methods@#This retrospective cohort study assessed 77 patients who underwent total laryngectomy from 2010 to 2020 in a tertiary referral center. Serial imaging studies (computed tomography [CT], magnetic resonance imaging, and positron emission tomography-CT) were used to assess otitis media. @*Results@#The study enrolled 58 patients (mean age, 67.0±7.7 years; male, 56 [96.6%]); nine (15.5%) underwent a gastrostomy tube (four preoperatively and five postoperatively). Otitis media was confirmed in seven (12.1%) patients. Gastrostomy tube insertion was the only significant risk factor for otitis media (p=0.012). Of the nine patients who underwent gastrostomy tube insertion, four developed otitis media; all four had the procedure after laryngectomy. @*Conclusions@#This study found an increased incidence of otitis media after total laryngectomy. Swallowing difficulties likely contribute to otitis media as it occurred more frequently in patients requiring postoperative gastrostomy tube insertion.
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Purpose@#The measurement of stool elastase (SE) level is useful for evaluating pancreatic exocrine function. This study aimed to determine the risk factors for severe exocrine pancreatic insufficiency (EPI) after pancreatoduodenectomy (PD), and analyze serial changes in nutritional markers and weight based on the SE level. @*Methods@#Among patients who underwent PD for periampullary disease, patients whose preoperative and postoperative SE levels were measured were included in the study. The deteriorated (exocrine function) group comprised patients whose SE levels decreased from ≥100 µg/g preoperatively to <100 µg/g postoperatively. Patients whose weight 12 months postoperatively was greater than that 3 months postoperatively were classified into the weight-recovery group. @*Results@#Of the 202 included patients, the deteriorated group had a higher incidence of preoperative SE level above 200 μg/ g, benign pathology, and the presence of a clinically relevant postoperative pancreatic fistula than the maintained group. Patients who did not undergo weight recovery had a higher rate of history of adjuvant radiotherapy compared to the norecovery group. @*Conclusion@#The evaluation of EPI by measuring SE alone is not sufficient because it does not reflect the nutritional status of patients, and a comprehensive approach that considers other parameters is required for EPI management.
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Timely analysis of imaging data is critical for diagnosis and decision-making for proper treatment strategy in the cases of ischemic stroke. Various efforts have been made to develop computer-assisted systems to improve the accuracy of stroke diagnosis and acute stroke triage. The widespread emergence of artificial intelligence technology has been integrated into the field of medicine. Artificial intelligence can play an important role in providing care to patients with stroke. In the past few decades, numerous studies have explored the use of machine learning and deep learning algorithms for application in the management of stroke. In this review, we will start with a brief introduction to machine learning and deep learning and provide clinical applications of machine learning and deep learning in various aspects of stroke management, including rapid diagnosis and improved triage, identifying large vessel occlusion, predicting time from stroke onset, automated ASPECTS (Alberta Stroke Program Early CT Score) measurement, lesion segmentation, and predicting treatment outcome. This work is focused on providing the current application of artificial intelligence techniques in the imaging of ischemic stroke, including MRI and CT.
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Purpose@#: Since the era of COVID-19, face-to-face contact has been reduced to prevent the spread of infectious diseases around the world, and hospitals are applying various methods to prevent the spread of infection. However, when writing a consent form essential during the treatment process, it had to be done face-to-face. We developed a non-face-to-face communication device to enable real-time consent writing. This study aims to evaluate the usefulness of the non-face-to-face communication device when writing a consent form. @*Methods@#: From December 28, 2021 to February 2, 2022, electronic medical records of patients visited the severance hospital emergency center and had a central venous catheter inserted were collected retrospectively. There were 56 consent forms included in the study, 43 face-to-face and 13 non-face-to-face. We checked the difference between the details explained in the non-face-to-face consent form and the face-to-face by the average score and the explanation of each item. The score was measured from a minimum of 0 points to a maximum of 13 points, with 1 point for explained items and 0 points for unexplained. @*Results@#: The average score for the face-to-face consent form was 4.3, and for the non-face-to-face was 3.0 (p=0.148). There was no significant difference in the explanation of each item. @*Conclusion@#: It was confirmed writing a consent form through the non-face-to-face communication device can perform a similar role compared to the face-to-face. It is expected unnecessary contact can be reduced by applying the device to hospital rooms, and enabling a non-face-to-face rounds system for new infectious diseases.
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Renovascular hypertension (RVHT) is a major cause of surgically correctable secondary hypertension. Refractory hypertension despite multiple antihypertensive drugs requires angioplasty, surgical revascularization, or even nephrectomy. Herein, we report a pediatric patient who had been treated with angioplasty, nephrectomy, and aortorenal bypass surgery for RVHT due to fibromuscular dysplasia and re-do endoaneurysmal graft replacement for a vein graft aneurysm. This case highlights the various treatment modalities for RVHT and the recurrent nature of the disease with a rare presentation of a vein graft aneurysm after aortorenal bypass.
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Background and Objectives@#Previous studies reported abnormalities in MRI as a poor prognostic indicator of sudden sensorineural hearing loss (SSNHL). Since abnormalities in three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) are strongly correlated with the initial hearing function, the prognostic value of the 3D FLAIR images should be carefully evaluated to avoid collinearity. We aimed to evaluate abnormalities on the 3D FLAIR images as an independent prognostic factor in the matched SSNHL groups.Subjects and Method We retrospectively reviewed medical records of 179 patients with SSNHL who underwent temporal MRI, including the 3D FLAIR sequence, between January 2015 and December 2019. Patients were divided based on the presence of cochlear abnormalities on the 3D FLAIR images. Hearing prognosis was evaluated with and without matching for initial hearing and treatment interval. @*Results@#The groups were similar in sex (p=0.091), age (p=0.925), treatment interval (p= 0.216), and MRI interval (p=0.828). Notably, patients with cochlear abnormalities on the 3D FLAIR images showed distinctly more severe hearing loss (p<0.001) at the initial pure tone average (PTA) assessment and poorer outcomes (p<0.001) compared to those without abnormality. After matching for initial hearing and treatment interval, the hearing outcome, measured by PTA, was similar between the groups (p=0.681). @*Conclusion@#Cochlear signal abnormality in 3D FLAIR MRI was associated with poor initial hearing. However, it did not affect hearing recovery outcomes when the groups were matched.
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Merkel cell carcinoma is an extremely rare neuroendocrine neoplasm of the external auditory canal (EAC) skin, which requires wide excision and adjuvant radiation due to a high recurrence rate. In this report, we describe a case of Merkel cell carcinoma arising from the EAC which was successfully treated with endoscopic excision. A 32-years-old female patient with a history of papillary thyroid cancer was diagnosed with an EAC tumor incidentally. There was a erythematous papular lesion on the posterior EAC without any evidence of locoregional metastasis. The patient underwent endoscopic tumor resection under general anesthesia, and the final pathologic report confirmed the diagnosis of Merkel cell carcinoma. There was no clinical or radiographic evidence of recurrence or metastasis of Merkel cell tumor for 41 months after surgical resection alone.
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Vitamin B12 deficiency results in the occurrence of systemic diseases in our nervous system. One of the most common manifestations of Vitamin B12 deficiency is subacute combined degeneration (SCD), which is characterized by paralysis and sensory changes of limbs, and disturbance of gait and position sense. SCD can be caused by the abuse of Happy Balloon, which comprises nitrous oxide and is used as a party hallucinogen. Diagnosis of SCD is achieved by combining the clinical symptoms, laboratory study, electrophysiological study and imaging findings. However, neurological symptoms observed during laboratory examinations are insufficient to diagnose SCD without the characteristic magnetic resonance imaging (MRI) findings. This is due to ambiguity of the symptoms and delayed report time of laboratory results in the emergency department. The ‘Inverted V sign’, observed towards the rear of the cervical and thoracic spine in T2 emphasis MRI images, is the most prominent finding of SCD. In most cases, the T1 image shows the same signal strength as the surrounding tissue. In the current report, we present an SCD case with an enhanced T1 phase of the MRI.
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Background@#The poultry red mite, Dermanyssus gallinae, is a serious problem in the laying hen industry worldwide. Currently, the foremost control method for D. gallinae is the implementation of integrated pest management, the effective application of which necessitates a precise monitoring method. @*Objectives@#The aim of the study was to propose an accurate monitoring method with a reliable protocol for caged-layer poultry farms, and to suggest an objective classification for assessing D. gallinae infestation on caged-layer poultry farms according to the number of mites collected using the developed monitoring method. @*Methods@#We compared the numbers of mites collected from corrugated cardboard traps, regarding with length of sampling periods, sampling sites on cage, and sampling positions in farm buildings. The study also compared the mean numbers of mites collected by the developed method with the infestation levels using by the conventional monitoring methods in 37 caged-layer farm buildings. @*Results@#The statistical validation provided the suitable monitoring method that the traps were installed for 2 days on feed boxes at 27 sampling points which included three vertical levels across nine equally divided zones of farms. Using this monitoring method, the D. gallinae infestation level can be assessed objectively on caged-layer poultry farms. Moreover, the method is more sensitive than the conventional method in detecting very small populations of mites. @*Conclusions@#This method can be used to identify the initial stages of D. gallinae infestation in the caged-layer poultry farms, and therefore, will contribute to establishment of effective control strategies for this mite.
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Background@#: Effective communication between doctors and patients is very important not only for diagnosis and treatment but also for building trust. Although teaching communication skills is very important in medical schools, there are limitations such as the number of students and the uncertainty of the patient population. Therefore, this study evaluates the effect of Fishbowl method to teach communication skills to medical students, which involves the medical students communicating with standardized patients in front of a large classroom and being observed by rest of the students. @*Methods@#: This study involves 10 weeks of educating 126 fourth grade medical students and graduates. During this period, total 8 classes were taken by subjects, where each class lasts 2 hours and is conducted by observing treatments of the standardized patients on 14 clinical topics by randomly selected medical students and giving feedback on the communication skills of the selected medical students. The educational effect was evaluated based on the scores of the clinical performance examination before and after the classes. @*Results@#: The scores assessed for medical history taking before and after the training are increased by 2.45 (p<0.001) and the scores for patient-doctor relationship is increased by 7.56 (p<0.001). @*Conclusions@#: It is expected to improve the communication skills of medical students by large scale lectures with standardized patients.
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Background@#It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication. @*Methods@#: We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparenton-transparent mask was randomly allocated to each participant. @*Results@#: In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001). @*Conclusions@#This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.
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Blood group determination in dogs is an important factor in transfusion medicine to minimize immediate or delayed adverse reactions after red blood cells transfusion in small animal clinics. Dog erythrocyte antigen (DEA) 1 is the most important blood type due to its high degree of antigenicity causing acute transfusion adverse reactions. The aim of this study was to investigate the prevalence of DEA 1 in various dog breeds in Korea. As a result of testing 592 blood samples from more than 35 dog breeds, DEA 1 blood typing for each breed showed that 57.8% of Malteses, 63.3% of Poodles, 76.2% of Mastiff-like dogs, 72.5% of Pomeranians, 47.7% of Shih Tzus, 70.3% of mixed breeds, 60.0% of Yorkshire Terriers, and 71.4% of Beagles were DEA 1-positive. Miniature Schnauzers and Jindo breeds had a significantly high prevalence (100%) of DEA 1-positive dogs compared to that in other small breed dogs. This is the first report of immunochromatography-detected DEA 1 prevalence in various domestic dog breeds. Although additional studies need clarifying the potential blood transfusion risks in domestic breed dogs with DEA 1, the results of this study may be useful when selecting a blood donor.
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Animals , Dogs , Humans , Blood Donors , Blood Group Antigens , Blood Grouping and Crossmatching , Blood Transfusion , Erythrocytes , Chromatography, Affinity , Korea , Prevalence , Transfusion Medicine , Transfusion ReactionABSTRACT
Blood group determination in dogs is an important factor in transfusion medicine to minimize immediate or delayed adverse reactions after red blood cells transfusion in small animal clinics. Dog erythrocyte antigen (DEA) 1 is the most important blood type due to its high degree of antigenicity causing acute transfusion adverse reactions. The aim of this study was to investigate the prevalence of DEA 1 in various dog breeds in Korea. As a result of testing 592 blood samples from more than 35 dog breeds, DEA 1 blood typing for each breed showed that 57.8% of Malteses, 63.3% of Poodles, 76.2% of Mastiff-like dogs, 72.5% of Pomeranians, 47.7% of Shih Tzus, 70.3% of mixed breeds, 60.0% of Yorkshire Terriers, and 71.4% of Beagles were DEA 1-positive. Miniature Schnauzers and Jindo breeds had a significantly high prevalence (100%) of DEA 1-positive dogs compared to that in other small breed dogs. This is the first report of immunochromatography-detected DEA 1 prevalence in various domestic dog breeds. Although additional studies need clarifying the potential blood transfusion risks in domestic breed dogs with DEA 1, the results of this study may be useful when selecting a blood donor.
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Brachyspira (B.) hyodysenteriae is a causative agent of swine dysentery that is responsible for death and economic losses in the pig industry. It is imperative that clinical samples be delivered fresh for accurate diagnosis. The viability and DNA detection of B. hyodysenteriae using lab-made (phosphate buffered saline and modified tryptic soy broth) or commercial transport media (C, D, and E) were compared by culturing and real-time PCR at 4degrees C or room temperature (RT), respectively. B. hyodysenteriae grown in D (Anaerobe Systems, USA) and E (Starplex Scientific, Canada) media was viable for 4 days at 4degrees C and RT. However, B. hyodysenteriae in A, B, and C (culture swab; BD Biosciences, USA) media were not recovered after 2 days at RT. Ct values for real-time PCR at 4degrees C and RT ranged from 27.2 +/- 2.1 (C) to 29.6 +/- 0.5 (B), and 28.0 +/- 0.9 (E) to 30.2 +/- 1.5 (B), respectively. Considering the field conditions, it is important that transport media is used for specimen isolation and PCR to obtain an accurate diagnosis of swine dysentery.
Subject(s)
Brachyspira , Brachyspira hyodysenteriae , Diagnosis , DNA , Dysentery , Polymerase Chain Reaction , Real-Time Polymerase Chain Reaction , SwineABSTRACT
We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.
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Angiography , Cardiovascular Diseases , Echocardiography , Heart Septal Defects, Atrial , Vascular Diseases , Vena Cava, SuperiorABSTRACT
We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.
Subject(s)
Angiography , Cardiovascular Diseases , Echocardiography , Heart Septal Defects, Atrial , Vascular Diseases , Vena Cava, SuperiorABSTRACT
OBJECTIVES: To identify the factors that are most significantly associated with the decline of Activities of Daily Living (ADL) status in subjects with Mild Cognitive Impairment (MCI) and early dementia of primary degenerative cause. METHODS: Medical records, results of neuropsychological tests, and Activities of Daily Living scale were retrospectively analyzed in 134 subjects meeting the diagnostic criteria of MCI or early dementia, respectively. Demographic factors, memory functions, depressive symptoms and executive functions of the participants were also analyzed. RESULTS: Correlations revealed that measures of executive functions were significantly associated with ADL status in participants with MCI, while both memory and executive functions were significantly associated in early demented elderly. Stroop test which measures the ability of inhibition showed the closest relation to executive function. Depressive symptoms did not have a significant influence on ADL status. CONCLUSION: Among participants with MCI, the early functional difficulties are associated mainly with executive function, which enables inhibition in particular. In participants with early dementia, on the contrary, the ADL status was associated with both executive function and memory. Further studies on the symptom pattern and related neuropathology in process of dementia progression are needed for Quality of Life (QoL) in elderly population.
Subject(s)
Aged , Humans , Activities of Daily Living , Dementia , Demography , Depression , Executive Function , Medical Records , Memory , Cognitive Dysfunction , Neuropsychological Tests , Quality of Life , Retrospective Studies , Stroop TestABSTRACT
Supernumerary ectopic limb(s) (SEL) is a congenital anomaly defined as the presence of accessory limb(s) attached to various body regions. This paper describes a case of SEL with ectopic lung and ectopia cordis in a newborn calf, based on macroscopic, microscopic and radiographic findings. External features of multiple congenital anomalies included an ectopic lung growing over the middle of the backbone and covered with normal haired skin. Ectopia cordis was found in the abdominal cavity and attached to the liver. Two extra abnormal limbs originated separately from within the ectopic lung. Most of the abdominal organs were exposed to the outside through the opened abdominal cavity. Microscopically the ectopic lung tissue had edema in the connective tissue around the bronchus and artery. Changes in other organs included congestion of the renal medulla, infiltration of inflammatory cells (lymphocytes and eosinophils) around the hepatic portal tract, and edema surrounding blood vessels and neurons in the brain. The rudimentary humerus of the forelimb was attached to the thoracic spine, as viewed radiographically. The hindlimb was consisted of an irregularly shaped femur, short tibia and fibula, two tarsal bones, one metatarsal bone, and three phalanges. This is the first description of congenital anomalies involving the SEL, ectopic lung and ectopia cordis in a calf.
Subject(s)
Animals , Humans , Infant, Newborn , Abdominal Cavity , Arteries , Blood Vessels , Body Regions , Brain , Bronchi , Connective Tissue , Ectopia Cordis , Edema , Estrogens, Conjugated (USP) , Extremities , Femur , Fibula , Forelimb , Hair , Hindlimb , Humerus , Liver , Lung , Metatarsal Bones , Neurons , Skin , Spine , Tarsal Bones , TibiaABSTRACT
OBJECTIVES: The purpose of this study was to investigate the characteristics of attention, intellectual functioning and adaptation of girls with attention-deficit hyperactivity disorder (ADHD). METHODS: The scores of the ADHD Diagnostic System (ADS), the Korean Wechsler Intelligence Scale for Children-III (K-WISC-III) and the Korean Personality Inventory for Children (KPI-C) were compared between 26 girls with ADHD and 26 boys with ADHD. RESULTS: 1)There was no significant gender difference in the intellectual functioning, except for the picture completion subscale. 2) Compared to the boys, the girls responded more slowly on the ADS visual task. 3) The girls were rated higher by their parents for the depression and social relationship problems of the KPI-C. CONCLUSIONS: The results suggest that there are noticeable gender differences for the attention problems and social functioning of children with ADHD.