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

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

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

BACKGROUND: Low bone mineral density (BMD) increases fracture risk. Anemia is highly prevalent. Some studies suggested that anemia is an independent risk factor for osteoporosis. The aim of this study was to evaluate the association between hemoglobin (Hb) level and BMD in Korean adults. METHODS: This study was based on data from the Korea National Health and Nutrition Examination Survey 2008 to 2011. Propensity score-matching was performed to establish a dataset for analysis. Regression analyses were used to evaluate the association between Hb and BMD. Mean BMD scores were compared between normal and anemia groups, and among normal, anemia with low ferritin, and anemia without low ferritin groups. RESULTS: There were partial positive associations between Hb and BMD in men, but negative associations in women. The normal group had lower mean BMD scores than the anemia group in men. However, the anemia group had higher whole-body and lumbar-spine BMD scores than the normal group in women. In a comparison of the three groups, the anemia without low ferritin group had the lowest all-site BMD scores in men and women. However, the anemia with low ferritin group had the highest all-site BMD scores in women. In postmenopausal women, the anemia without low ferritin group had the lowest all-site BMD scores. In premenopausal women, the anemia with low ferritin group had the highest whole-body BMD scores. CONCLUSIONS: This study found that Hb and anemia status were associated with BMD scores. However, the associations were different according to sex. This may be due to the etiology of anemia or low Hb levels.
Adult* ; Anemia ; Bone Density* ; Dataset ; Female ; Ferritins ; Humans ; Korea ; Male ; Nutrition Surveys ; Osteoporosis ; Risk Factors

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: The hemodynamic changes associated with orotracheal intubation may result from direct laryngoscopy and the endotracheal intubation. This study evaluated and compared the cardiovascular changes after either Bonfils intubation fibrescope or conventional laryngoscopic endotracheal intubation. METHODS: Sixty patients, aged 20 to 30 years, were randomly allocated into two groups, the Bonfils intubation fibrescope group (BF group, n = 30) and conventional intubation using a rigid laryngoscope (LS group, n = 30). Bonfils intubation fibrescope or laryngoscopic oral endotracheal intubation was performed after inducing anesthesia. The systolic and diastolic arterial pressures, heart rate, peripheral oxygen saturation and intubation time were recorded before and after orotracheal intubation. RESULTS: In both groups, the systolic and diastolic arterial pressures increased significantly after endotracheal intubation. The heart rate increased significantly after the induction of anesthesia in both groups. However, the arterial blood pressure, heart rate and intubation time were similar in both groups. CONCLUSIONS: The use of a Bonfils intubation fibrescope does not modify the hemodynamic response associated with endotracheal intubation compared with conventional laryngoscopy.
Anesthesia ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Intubation* ; Intubation, Intratracheal* ; Laryngoscopes* ; Laryngoscopy ; Oxygen

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

BACKGROUND: Obesity is known as an important risk factor for colorectal adenoma. However, for the elderly with changes in body composition, reduced muscle, and increased fat, the body mass index (BMI), one of the most commonly used indicators of obesity, is limited in predicting a link to colorectal cancer. This study aimed to investigate the relationship between colorectal adenoma and grip strength that can predict muscle reduction in the elderly. METHODS: This study included 262 participants aged ≥65 years who underwent medical examination between June 2015 and August 2018. The control group comprised participants with normal findings or hyperplasia and other benign lesions, except adenoma on colonoscopy, whereas the adenoma group consisted of participants with more than one adenoma. Grip strength was alternately measured twice for each hand using a hydraulic dynamometer. RESULTS: The grip strength was statistically lower in the adenoma group than in the control group among women (P=0.042). For both sexes, grip strength was significantly lower in participants with ≥5 adenomas than in those with <5 adenomas (P=0.021, P=0.007). Similarly, men with large adenomas (≥7 mm) exhibited significantly lower grip strength than did those with small adenomas (<7 mm) (P=0.004). Even after correction for age, BMI, smoking status, alcohol consumption, exercise, insulin resistance, hypertension, and diabetes, the negative correlation between grip strength and number of adenomas among men and women remained (P=0.034, P=0.019). CONCLUSIONS: A significant relationship between hand grip strength and number of colorectal adenomas was noted.
Adenoma ; Aged ; Alcohol Drinking ; Body Composition ; Body Mass Index ; Colonoscopy ; Colorectal Neoplasms ; Female ; Hand Strength ; Hand ; Humans ; Hyperplasia ; Hypertension ; Insulin Resistance ; Male ; Obesity ; Risk Factors ; Smoke ; Smoking

Background: The purpose of this study was to explore the relationship between the local extinction index and total medical service utilization. Methods: A fixed effects model in panel analysis was performed for the 228 administrative districts in Korea. The statistical yearbook on the usage of medical services by region and Korean Statistical Information Service data were used from 2010 to 2019 for analysis.Medical service utilization was represented by the number of visits day, the number of inpatient days, and medical charges. Control variables were selected by using an Anderson model. The local extinction index was calculated using resident registration population data. Results: Descriptive statistics showed that the number of areas at risk of extinction increased from 61 to 95 for the study years. In addition, the number of visits, the number of inpatient days, and medical charges all increased during the study years. After controlling for variables affecting medical service utilization and doing a panel fixed effects model, the result suggested that a one-step increase in the local extinction index was significantly associated with a 12.29% decrease in medical charges of inpatients, a 7.33% decrease in medical charge of outpatient, a 5.21% decrease in the number of inpatient day, and a 5.54% decrease in the number of visits day. Conclusion This study showed that the higher the region’s extinction risks, the higher the region’s total medical service utilization.The results of this study suggested that there was a disparity in medical service utilization between areas at risk of extinction and areas not at risk of extinction, so measures should be taken to address this disparity.

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.
Aged ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors/*diagnosis/pathology/surgery ; Humans ; Ileal Neoplasms/*diagnosis/pathology/surgery ; Liver Abscess/*etiology ; Neoplasm Invasiveness ; Proto-Oncogene Proteins c-kit/analysis ; Reagent Kits, Diagnostic