Fiberoptic intubation is an important method of tracheal intubation, especially in patients with difficult airway. As fiberoptic bronchoscopy relies on clear airspace ahead of the fiberscope tip, increasing airway obstruction may cause increasing difficulty. A clear airway that allows the passage of the fiberscope is usually present in awake patients, whereas in anesthetized patients the airspace in the oropharynx is reduced; the soft palate, base of tongue and epiglottis may be applied to the posterior pharyngeal wall due to the reduction in muscle tone. Hence, fiberoptic intubation may be difficult in anesthetized patients, and maneuvers to open the airway may be required. We report a simple and useful two-person intubation technique that uses the fiberoptic bronchoscope and conventional laryngoscope, which facilitated tracheal intubation in patients who had unanticipated difficult intubation.
Airway Obstruction ; Anesthesia, General* ; Bronchoscopes ; Bronchoscopy ; Epiglottis ; Humans ; Intubation* ; Laryngoscopes ; Oropharynx ; Palate, Soft ; Tongue

Background: Preauricular sinus (PAS) is a common congenital anomaly, and complete excision is recommended to prevent recurrence. However, PAS has a high recurrence rate as a result of incomplete removal due to the high variability of the sinus ramifications, making its treatment challenging. In this study, we standardized the surgical procedure to reduce the complications and recurrence rate and compared the postoperative results between the non-standardized and the standardized groups. Methods: This retrospective study included 97 patients (120 ears) who had undergone PAS excision by a single surgeon between October 2014 and September 2022 and underwent at least 6 months of follow-up. After October 2018, all patients were treated using the standardized method, which comprised the use of magnifying glasses, exploration with a lacrimal probe, the use of methylene blue staining, and excision of a piece of surrounding normal tissue and related cartilage in continuity with the specimen. There were 38 patients (45 ears) in the non-standardized group and 59 patients (75 ears) in the standardized group. Results: Recurrence was observed in six of 120 ears, indicating an overall recurrence rate of 5.0%. Recurrence occurred in five ears (11.1%) in the non-standardized group and one ear (1.3%) in the standardized group. The standardized group had a significantly lower recurrence rate (p= 0.027) than the non-standardized group. Conclusion We defined a standardized sinectomy protocol and used it for the surgical treatment of PAS. With this standardized method, we were able to reduce the rates of complications and recurrence without the use of a long incision.

PURPOSE: To optimize the timing of scans using cardiac magnetic resonance contrast-enhanced timing robust angiography (CMR-CENTRA) for electroanatomic mapping (EAM) of the right atrium (RA) and left atrium (LA) in patients with atrial fibrillation (AF). MATERIALS AND METHODS: Fifty patients with AF (38 men; mean age, 59.6 ± 9.3 years) underwent CMR-CENTRA in preparation for EAM. The CMR-CENTRA data were acquired at five different scan times: 0 seconds, 5 seconds, 10 seconds, 15 seconds, and 20 seconds after an intravenous injection of contrast media. To evaluate the degree of contrast enhancement, right atrial relative contrast (RA-RC) and left atrial relative contrast (LA-RC) on the CMR-CENTRA scans were assessed at each time point. The three-dimensional (3D) reconstruction of the RA and LA for the EAM system was performed using the CMR-CENTRA data. RESULTS: A CMR-CENTRA at a scan time of 10 seconds showed significantly greater LA-RC (P < 0.05) compared with all other scan times. A CMR-CENTRA at a scan time of 15 seconds showed significantly greater RA-RC (P < 0.05) compared with all other scan times. In the 3D reconstruction of the RA, the success rates of CMR-CENTRA at scan times of 10 seconds and 15 seconds were 18% and 100%, respectively. In the 3D reconstruction of the LA, the success rates of CMR-CENTRA at 10- and 15-second scan times were 100%. CONCLUSION: The CMR-CENTRA data acquired at 15 seconds after the injection of contrast media is appropriate for the preparation of an EAM system that is focused on the RA and LA in patients with AF.
Angiography* ; Atrial Fibrillation* ; Contrast Media ; Heart Atria ; Hemodynamics ; Humans ; Injections, Intravenous ; Magnetic Resonance Imaging ; Male

A 72-year-old woman was diagnosed with Kümmell's disease of the T12 and L3 vertebrae. During bone cement injection under continuous fluoroscopic guidance, bone cement spread beyond the posterior border of the T12 vertebral body. We halted the injection immediately. A few minutes later, the patient complained of increasing right lower quadrant abdominal pain. This was diagnosed as a preceding sign of neurological complication due to thermal injury. Consequently, we administered an epidural steroid injection, followed by cooled normal saline irrigation through an epidural catheter to minimize and treat the thermal injury. The pain gradually decreased after saline irrigation and completely disappeared after approximately 10 minutes. After completing the percutaneous vertebroplasty, the patient's lower back pain improved without neurological complications. In conclusion, immediate epidural steroid injection followed by cooled normal saline irrigation through epidural catheterization can be used to treat thermal injury due to bone cement leakage.
Abdominal Pain ; Aged ; Catheterization ; Catheters ; Female ; Humans ; Low Back Pain ; Polymethyl Methacrylate ; Spine ; Vertebroplasty

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.

A 5-year-old, 28 kg castrated male Border Collie was referred for surgical intervention following complications from a prior total hip replacement. A physical examination revealed reduced weight-bearing and metallic crepitus on the affected limb. A radiographic assessment confirmed a fractured femoral stem. Extended trochanteric osteotomy (ETO) was performed to extract the well-fixed stem, followed by the removal of the acetabular cup. ETO stabilization was achieved with cerclage wires and a locking plate. Six months postoperatively, the radiographs indicated successful bone healing, and the dog exhibited improved limb function. The ETO technique can provide enhanced surgical access to extract well-fixed implants.

Among the several rotenoids, amorphigenin is isolated from the leaves of Amopha Fruticosa and it is known that has anti-proliferative effects and anti-cnacer effects in many cell types. The main aim of this study was to investigate the effects of amorphigenin on osteoclast differentiation in vitro and on LPS treated inflammatory bone loss model in vivo. We show here that amorphigenin inhibited RANKL-induced osteoclast differentiation from bone marrow macrophages in a dose dependent manner without cellular toxicity. Anti-osteoclastogenic properties of amorphigenin were based on a down-regulation of c-fos and NFATc1. Amorphigenin markedly inhibited RANKL-induced p38 and NF-kappaB pathways, but other pathways were not affected. Micro-CT analysis of the femurs showed that amorphigenin protected the LPS-induced bone loss. We concluded that amorphigenin can prevent inflammation-induced bone loss. Thus we expect that amorphigenin could be a treatment option for bone erosion caused by inflammation.
Bone Marrow ; Down-Regulation ; Femur ; Inflammation ; Macrophages ; NF-kappa B ; Osteoclasts ; Osteoporosis ; Rotenone ; T-Lymphocytes