In the review of a series of 71 clavicle shaft fracture that were treated with open reduction and internal fixation, we tried a direct comparison between two fixation modes, that is, the fixation with plate and screws (54 cases) and the intramedullary nailing with Knowles pin (17 cases). The average time to healing was not significantly different between the two group; 10.8 weeks after the plating and 11.7 weeks with Knowles pinning. The rate of successful healing within four months after the surgery were also high in both groups: one delayed union and one nonunion in the plate group, and one delayed union in the Knowles pin group. There was one loosening in the Knowles pin group, which needed reoperation. Intramedullary fixation has several advantages compared with fixation with a plate and screws. It can be performed through a shorter incision: less dissection of soft tissue is needed: and, after healing, the pin is easily removed through a small incision under local anesthesia.
Anesthesia, Local ; Clavicle ; Fracture Fixation, Intramedullary ; Reoperation

The crossed occlusion is unstable, and for the treatment of such occlusal conditions, it is recommended to form a balance of occlusal force between the arch in contact with occlusal contact, to secure stable vertical support by symmetrically placing the implants in the posterior area, and it is necessary to improve the distorted occlusal plane, to have a regular check-up and to check whether the occlusal conditions are maintained stably after treatment. In this case, in order to resolve unstable occlusal condition in patient with crossed occlusion, the existing occlusal vertical dimension was maintained at the state of wearing the dentures, and the implant placement positions were planned based on the diagnostic waxup, and then the implants were placed using a surgical guides, and after the temporary prostheses stage, the final fixed prostheses were fabricated by incorporating the temporary prostheses form adapted by the patient to develop a stable vertical support, and finally the anterior maxillary region was restored with implant-supported removable partial denture. In this case, the patient adapted well without discomfort during the four-month follow-up and satisfactory aesthetic and functional clinical results were obtained, leading to this report.

The crossed occlusion is unstable, and for the treatment of such occlusal conditions, it is recommended to form a balance of occlusal force between the arch in contact with occlusal contact, to secure stable vertical support by symmetrically placing the implants in the posterior area, and it is necessary to improve the distorted occlusal plane, to have a regular check-up and to check whether the occlusal conditions are maintained stably after treatment. In this case, in order to resolve unstable occlusal condition in patient with crossed occlusion, the existing occlusal vertical dimension was maintained at the state of wearing the dentures, and the implant placement positions were planned based on the diagnostic waxup, and then the implants were placed using a surgical guides, and after the temporary prostheses stage, the final fixed prostheses were fabricated by incorporating the temporary prostheses form adapted by the patient to develop a stable vertical support, and finally the anterior maxillary region was restored with implant-supported removable partial denture. In this case, the patient adapted well without discomfort during the four-month follow-up and satisfactory aesthetic and functional clinical results were obtained, leading to this report.

The crossed occlusion is unstable, and for the treatment of such occlusal conditions, it is recommended to form a balance of occlusal force between the arch in contact with occlusal contact, to secure stable vertical support by symmetrically placing the implants in the posterior area, and it is necessary to improve the distorted occlusal plane, to have a regular check-up and to check whether the occlusal conditions are maintained stably after treatment. In this case, in order to resolve unstable occlusal condition in patient with crossed occlusion, the existing occlusal vertical dimension was maintained at the state of wearing the dentures, and the implant placement positions were planned based on the diagnostic waxup, and then the implants were placed using a surgical guides, and after the temporary prostheses stage, the final fixed prostheses were fabricated by incorporating the temporary prostheses form adapted by the patient to develop a stable vertical support, and finally the anterior maxillary region was restored with implant-supported removable partial denture. In this case, the patient adapted well without discomfort during the four-month follow-up and satisfactory aesthetic and functional clinical results were obtained, leading to this report.

The crossed occlusion is unstable, and for the treatment of such occlusal conditions, it is recommended to form a balance of occlusal force between the arch in contact with occlusal contact, to secure stable vertical support by symmetrically placing the implants in the posterior area, and it is necessary to improve the distorted occlusal plane, to have a regular check-up and to check whether the occlusal conditions are maintained stably after treatment. In this case, in order to resolve unstable occlusal condition in patient with crossed occlusion, the existing occlusal vertical dimension was maintained at the state of wearing the dentures, and the implant placement positions were planned based on the diagnostic waxup, and then the implants were placed using a surgical guides, and after the temporary prostheses stage, the final fixed prostheses were fabricated by incorporating the temporary prostheses form adapted by the patient to develop a stable vertical support, and finally the anterior maxillary region was restored with implant-supported removable partial denture. In this case, the patient adapted well without discomfort during the four-month follow-up and satisfactory aesthetic and functional clinical results were obtained, leading to this report.

The crossed occlusion is unstable, and for the treatment of such occlusal conditions, it is recommended to form a balance of occlusal force between the arch in contact with occlusal contact, to secure stable vertical support by symmetrically placing the implants in the posterior area, and it is necessary to improve the distorted occlusal plane, to have a regular check-up and to check whether the occlusal conditions are maintained stably after treatment. In this case, in order to resolve unstable occlusal condition in patient with crossed occlusion, the existing occlusal vertical dimension was maintained at the state of wearing the dentures, and the implant placement positions were planned based on the diagnostic waxup, and then the implants were placed using a surgical guides, and after the temporary prostheses stage, the final fixed prostheses were fabricated by incorporating the temporary prostheses form adapted by the patient to develop a stable vertical support, and finally the anterior maxillary region was restored with implant-supported removable partial denture. In this case, the patient adapted well without discomfort during the four-month follow-up and satisfactory aesthetic and functional clinical results were obtained, leading to this report.

Pilomatricomas are rare, usually benign and solitary, asymptomatic, calcifying tumors of the hair matrix cell, which mostly appear in the first and second decade of life. However, they may occur in adulthood. The most prevalent sites of pilomatricomas in children are the head and neck but they may occur anywhere. The typical presentation is a firm, slowly enlarging, freely mobile, well-circumscribed subcutaneous nodule, measuring 0.5 to 3 cm in diameter. The tumors are generally solitary, often adherent to overlying skin. Multiple pilomatricoma is relatively rare. Spontaneous regression is never observed, complete surgical excision is a treatment of choice. We present two cases of pilomatricoma arising from the right posterior auricle and the left posterior neck, which were treated with simple excision.
Child ; Hair ; Head ; Humans ; Neck* ; Pilomatrixoma* ; Skin

Congenital middle ear cholesteatoma is a keratinizing squamous epithelial cyst that classically presents as a white "pearl" in either the anterosuperior or posterosuperior quadrants behind an intact tympanic membrane. The presenting features of congenital cholesteatoma depend upon the initial site of the disease. The most common presentation of this disease is a conductive hearing loss or a facial palsy of gradual onset. Other presentations include incapacitating vertigo with nystagmus, a feeling of fullness in the ear, frequent otalgia, an abnormal eardrum noted at physical examination for an unrelated condition and meningitis. Recently, we experienced a case of congenital cholesteatoma that was presented as a post-auricular fistula. In considering the management of such a fistula, it would be important to recognize the possibility that the disease may present in this way.
Cholesteatoma* ; Cholesteatoma, Middle Ear ; Ear ; Earache ; Facial Paralysis ; Fistula* ; Hearing Loss, Conductive ; Meningitis ; Physical Examination ; Tympanic Membrane ; Vertigo

Metronidazole-induced encephalopathy is a very rare complication of the long standing use of metronidazole. The encephalopathy is bilateral and symmetric in nature. We report on the magnetic resonance imaging (MRI) and clinical course of metronidazole-induced encephalopathy in a 60-year-old female with a persistent anaerobic brain abscess after draining of the abscess. After 3 months of metronidazole administration, the patient complained of dysarthria, tingling sense of all extremities, and left hemiparesis. MRI revealed symmetric hyperintensity lesions in medulla, pons, dentate nuclei of cerebellum, and splenium of corpus callosum, all of which represent typical findings of metronidazole-induced encephalopathy. In addition, asymmetric lesions in midbrain, thalamus, putamen and cerebral subcortical white matter were noted. The patient recovered after discontinuation of metronidazole and the remaining abscess was successfully treated with meropenem and levofloxacine.
Abscess ; Brain ; Brain Abscess ; Brain Diseases, Metabolic ; Cerebellum ; Corpus Callosum ; Dysarthria ; Extremities ; Female ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Metronidazole ; Middle Aged ; Ofloxacin ; Paresis ; Pons ; Putamen ; Thalamus ; Thienamycins

BACKGROUND: REM sleep behavior disorder (RBD) commonly occurs in old-age group and shows very good response to clonazepam. However, clonazepam can aggravate or even precipitate sleep-disordered breathings (SDBs) that is highly prevalent among elderly people. Melatonin has been known to be effective in RBD treatment and is much less likely to increase the airway resistance. The aim is to document the efficacy of melatonin therapy in RBD with co-existing significant SDB. METHODS: We recruited consecutive patients who have both RBD and significant SDB (apnea-hypopnea index, AHI>15) confirmed by nocturnal polysomnography. Melatonin was started at the dose of 0.5 mg/night and increased according to the clinical response. Successful response is defined when symptoms are free or reduced in frequency more than 90% and any physical injury or violence should not be present. RESULTS: Eleven among 16 RBD patients were eligible and enrolled (eight male, median age 69 years, range 54-89). All had significant obstructive sleep-disordered breathings (mean AHI = 28.8, range 22.6-35.2). Melatonin was prescribed(dosage 2-8 mg/night, treatment duration, 7-35 months). Nine patients showed successful response (2-8 mg/night) but two showed unsatisfactory response to 6 mg or 8 mg/night. Two of nine patients with favorable response complained of mild sleepiness. CONCLUSIONS: Melatonin can be effective for controlling RBD with co-existing SDB. Effective dosage range is variable without intolerable adverse effect.
Aged ; Airway Resistance ; Clonazepam ; Humans ; Male ; Melatonin* ; Polysomnography ; REM Sleep Behavior Disorder* ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Sleep, REM* ; Violence