No abstract available.
Adenocarcinoma, Clear Cell* ; Vagina*

Objective: This study aimed to clarify differences in the positions of cone-beam computed tomography (CBCT) landmarks according to different midsagittal planes (MSPs) in patients with skeletal Class III facial asymmetry. Methods: Pre-treatment CBCT data from 60 patients with skeletal Class III were used.The patients were classified into symmetric (menton deviations of < 2 mm) or asymmetric (menton deviations of > 4 mm) groups. Six MSPs were established based on previous studies, and three-dimensional analyses were performed for the planes in both the groups. The measurement outcomes were compared statistically. Results: A statistically significant interaction (p < 0.01) was observed between MSPs and facial asymmetry. No significant differences were observed among MSPs in the symmetric group. However, significant differences in linear measurements were identified among MSPs in the asymmetric group. Specifically, the upper facial MSP revealed both maxillary and mandibular transverse asymmetries. On the other hand, anterior nasal spine (ANS)-associated MSP could not identify maxillary asymmetry. Furthermore, the menton deviation was approximately 3 mm lower when estimated using the ANS-associated MSP than that using upper facial MSP. Conclusions The choice of MSP can significantly affect treatment outcomes while diagnosing patients with asymmetry. Therefore, care should be taken when selecting MSP in clinical practice.

Objective: This study assessed the differences in soft tissue deviations of the nose, lips, and chin between different mandibular asymmetry types in Class III patients. Methods: Cone-beam computed tomography data from 90 Class III patients with moderate-to-severe facial asymmetry were investigated. The sample was divided into three groups based on the extent of mandibular rolling, yawing, and translation. Soft tissue landmarks on the nose, lips, and chin were investigated vertically, transversely, and anteroposteriorly. A paired t test was performed to compare variables between the deviated (Dv) and nondeviated (NDv) sides, and one-way analysis of variance with Tukey’s post-hoc test was performed for intergroup comparisons. Pearson’s correlation coefficient was calculated to assess the relationship between the soft and hard tissue deviations. Results: The roll-dominant group showed significantly greater differences in the vertical positions of the soft tissue landmarks between the Dv and NDv than other groups (P < 0.05), whereas the yaw-dominant group exhibited larger differences in the transverse and anteroposterior directions (P < 0.05). Moreover, transverse lip cant was correlated with the menton (Me) deviation and mandibular rolling in the roll-dominant group (P < 0.001); the angulation of the nasal bridge or philtrum was correlated with the Me deviation and mandibular yawing in the yaw-dominant group (P < 0.01). Conclusions The threedimensional deviations of facial soft tissue differed based on the mandibular asymmetry types in Class III patients with similar amounts of Me deviation. A precise understanding of soft tissue deviation in each asymmetry type would help achieve satisfactory facial esthetics.

The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.
Diagnosis ; Early Diagnosis ; Female ; Hemoperitoneum ; Hemorrhage* ; Incidence ; Laparotomy ; Maternal Death ; Mortality ; Pregnancy* ; Pregnancy, Ectopic

The incidence of ectopic pregnancy has been increasing for many years and ectopic pregnancy is still a leading cause of maternal death although its mortality is reduced significantly with improved early diagnosis and treatment. Intraligamentous pregnancy, a subset of ectopic pregnancy, is one of the most unusual accident so that the diagnosis of intraligamentous pregnancy is hardly ever made prior to laparotomy. We experienced intraligamentous pregnancy with hemoperitoneum. So we presented a case with brief review of literature.
Diagnosis ; Early Diagnosis ; Female ; Hemoperitoneum ; Hemorrhage* ; Incidence ; Laparotomy ; Maternal Death ; Mortality ; Pregnancy* ; Pregnancy, Ectopic

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.

To determine the optimal administration route of calcitriol in CAPD patients with secondary hyperparathyroidism, we conducted a prospective study on 33 patients who performed CAPD for more than 6 months an d whose intact parathyroid hormone(iPTH) level was higher than 250pg/mL. The patients were randomized into 3 groups:IP(n=11); 1.0 microgram of calcitriol once daily via intraperitoneal route by overnight retention with dialysate, SC(n=11); 1.0 microgram of calcitriol three times a week via subcutaneous route, and PO (n=11); 1.0 microgram of calcitriol three times a week by ingestion. 11 out of 33 patients(6 in IP, 4 in SC, and 1 in PO) dropped out during the 6-months study period, and 5 among the 6 patients in IP were due to recurrent peritonitis. Biochemical data including calcium, phosphorus, iPTH, alkaline phosphatase, bone-specific alkaline phosphatase, osteocalcin and 1,25(OH)2D3 were measured regularly, and the data of 22 patients who had completed the 6-months study were analyzed. There was a statistically significant decrease in iPTH level(pg/mL) in the three groups after 6-months calcitriol therapy(IP; 812.0+/-276.7 vs. 354.7+/-129.4, PO; 571.8+/-330.7 vs. 159.6+/-192.3, SC; 786.1+/-535.0 vs. 551.8+/-729.9, respectively, P<0.05), but there were no differences in the percentage of decrease in iPTH from baseline values among the three groups. Alkaline phosphatase, bone- specific alkaline phosphatase and osteocalcin also decreased significantly in all three groups(IP; 50.1+/-14.6, 33.5+/-11.6, 52.3+/-10.9% of baseline value; SC; 80.9+/-14.8, 67.4+/-20.80, 54.4+/-11.1% of baseline value; PO; 48.8+/-24.4, 36.6+/-23.5, 54.2+/-11.6% of baseline value, respectively, P<0.05), but they were not different with each other. Among 22 patients who completed the 6-months study, hypercalcemia(Ca>=10.5 mg/dL) occurred in 7 patients(31.8%). IP(2/5, 40%) and SC groups(5/7, 71.4%) had significantly higher incidence of hypercalcemia than PO group(0/10, 0%) (P<0.05). IP group(2/5, 40%) also experienced significantly higher incidence of hyperphosphatemia than SC(1/7, 14.3%) and PO groups(1/10, 10%). Peritonitis occurred significantly more in IP than in SC and PO groups(P<0.05). In conclusion, calcitriol treatment resulted in a significant decrement in iPTH levels in CAPD patients and no significant differences were noted in the iPTH-suppressive effect of calcitriol according to the administration route. Because of higher incidence of peritonitis and hypercalcemia in IP and SQ groups, oral ingestion may be the most optimal route for calcitriol treatment in CAPD patients with secondary hyperparathyroidism.
Alkaline Phosphatase ; Calcitriol* ; Calcium ; Eating ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Incidence ; Osteocalcin ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Phosphorus ; Prospective Studies*

BACKGROUND/AIMS: Anomalous connection between the choledochus and the pancreatic duct is considered to be a factor in the development of carcinoma of the biliary tract. There is especially a malignant potential for gallbladder cancer without dilatation of bile duct. We intend to find the clinical significance of anomalous pancreaticobiliary ductal union (APBDU) and biliary malignancy, and the correlation between type of APBDU and that of biliary malignancy (gallbladder of bile duct). Our purpose is to certificate the propriety of prophylactic cholecystectomy and to recall operation. METHOD AND RESULTS: We reviewed 880 ERCP cases from September 1994 through February 1996. There were fifteen cases of APBDU and six cases of biliary tumor associated with APBDU. They consisted of three gallbladder cancer with all P-C type union, two bile duct cancer with C-P type union and one villous adenoma in dilated bile duct. In one reoperation case in which cystojejunostomy had already been performed, there was no evidence of malignancy, but one was inoperable due to multiple liver metastasis. CONCLUSION: The patients with APBDU showed an increase of gallbladder cancer occurrence and furthermore those with the C-P type of APBDU, not associated with bile duct dilatation had a higher occurrence. And therefore were censidered preventive cholecystectomy and in operation to divide the biliary duct and pancreatic duct. Preoperative CA 19-9 test is helpful in finding the hidden cancer and is a guide to preventive operation in APBDU patients and to post-operative follow-up.
Adenoma, Villous ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Common Bile Duct ; Dilatation ; Follow-Up Studies ; Gallbladder Neoplasms ; Humans ; Liver ; Neoplasm Metastasis ; Pancreatic Ducts ; Reoperation

BACKGROUND: The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). METHODS: In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. RESULTS: Mean SAAG of HA was >1.1(1.49+/-0.40) gm/dL, and mean concentration of total protein of HA was >2.5(4.26+/-0.58) gm/dL. The mean of weekly Kt/Vurea of patients with HA(2.61+/-0.85) was significantly lower than that of patients without HA(3.48+/-0.90)(p<0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p<0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p<0.05). CONCLUSION: It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.
Ascites* ; Exudates and Transudates ; Humans ; Inflammation ; Liver Function Tests ; Osmolar Concentration ; Renal Dialysis ; Retrospective Studies ; Urea*