The presence of an ectopic supernumerary tooth in the nose is an uncommon phenomenon. A supernumerary tooth may be asymptomatic but must be given special attention as it has the potential to cause significant morbidity. Bilateral intranasal supernumerary teeth are an extremely rare disease entity. We report the clinical and radiologic findings of bilateral ectopic supernumerary teeth erupted from the nasal floor.
Nose ; Rare Diseases ; Tooth, Supernumerary*

Acute visual loss caused by an infected mucocele in an Onodi cell is extremely rare. The Onodi cell is a pneumatized posterior ethmoid cell located laterally and superiorly to the sphenoid sinus and closely related to the optic nerve. Therefore, a mucocele affecting the Onodi cell that has encroached on the adjacent sphenoid bone forming the optic canal can rarely present with visual loss. We describe a rare case of retrobulbar optic neuritis caused by an infected mucocele in the Onodi cell. A 54-year-old male complained of headache and visual loss in his right eye. A computed tomography scan and magnetic resonance image demonstrated a mucocele occupying the Onodi cell on the right side. Surgical treatment with an endoscopic sinus approach was performed, resulting in improvement of visual acuity. A lesion in an Onodi cell may be associated with ocular symptoms even if the lesion is isolated or small. Imaging studies should be considered for the differential diagnosis because early diagnosis and prompt surgical treatment for mucocele are needed for recovery of visual function.
Diagnosis, Differential ; Early Diagnosis ; Eye ; Headache ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Mucocele ; Optic Nerve ; Optic Neuritis ; Sphenoid Bone ; Sphenoid Sinus ; Visual Acuity

PURPOSE: The purpose of this study was to develop a wellness index for workers (WIW) and examine the validity and reliability of the WIW for assessing workers' wellness. METHODS: The developmental process for the instrument included construction of a conceptual framework based on a wellness model, generation of initial items, verification of content validity, preliminary study, extraction of final items, and psychometric testing. Content validity was verified by 4 experts from occupational health nursing and wellness disciplines. The construct validity, convergent validity and discriminant validity were examined with confirmatory factor analysis. The reliability was examined with Cronbach's alpha. The participants were 494 workers from two workplaces. RESULTS: Eighteen items were selected for the final scale, and the results of the confirmatory factor analysis supported a five-factor model of wellness with acceptable model fit, and factors named as physical . emotional . social . intellectual . occupational wellness. The convergent and discriminant validity were also supported. The Cronbach's alpha coefficient was .91. CONCLUSION: The results indicate that the WIW is a valid and reliable instrument to comprehensively assess workers' wellness, and to provide basic directions for developing workplace wellness program.
Adult ; Female ; *Health Promotion ; Health Status ; Humans ; Male ; Middle Aged ; *Occupational Health Services ; Program Development ; Program Evaluation ; Psychometrics ; Surveys and Questionnaires ; Workplace

Cutaneous squamous cell carcinoma is the second-most common skin cancer and represents 20% of all skin cancers. Cutaneous squamous cell carcinoma often spreads to the parotid gland through lymph nodes, but, direct invasion of an adjacent organ may also occur. We present the case of 78-year-old man with ulcerated mass on the right infra-auricular area. The histopathologic finding was squamous cell carcinoma. There was no evidence of distant metastasis, but the mass was found to invade the superficial lobe of the right parotid gland. The mass was widely excised and superficial parotidectomy was performed while preserving the facial nerve. The defect was covered by primary closure. Postoperative radiotherapy was performed. At 20 months after surgery, our patient had no facial palsy, local recurrence, or metastasis. Cutaneous squamous cell carcinoma involving the parotid gland is an aggressive, rapidly advancing lesion, which if not recognized and treated early will result in high morbidity and mortality. Squamous cell carcinoma of the parotid gland has shown that patients who receive adjuvant radiotherapy have a lower recurrence rate and a higher survival rate than patients treated with surgery alone. The role of elective neck dissection remains controversial.
Aged ; Carcinoma, Squamous Cell* ; Facial Nerve ; Facial Paralysis ; Humans ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Parotid Gland* ; Radiotherapy, Adjuvant ; Recurrence ; Skin Neoplasms ; Survival Rate ; Ulcer

Objective: : Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have not yet been clearly identified and studies have reported varying results. Methods: : We analyzed 230 patients with CSDH who were treated with burr-hole trephination and drainage at our institution from March 2011 to March 2016. The patients were divided into recurrence and non-recurrence groups and the medical records of each group were used to analyze the risk factors associated with CSDH recurrence. Results: : After burr-hole trephination and drainage, CSDH recurrence was observed in 49 (21.3%) of the 230 patients. In univariate analysis, none of the factors showed statistical significance with respect to CSDH recurrence. In multivariate analysis, preoperative antithrombotic medication was the only independent risk factor for CSDH recurrence (odds ratio, 2.407; 95% confidence interval, 1.047–5.531). Conclusion : The present study found that preoperative antithrombotic medication was independently associated with CSDH recurrence.

Objective: : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods: : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results: : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

Objective: Aneurysmal subarachnoid hemorrhage (aSAH) has a high mortality rate, and hemorrhage amounts and perioperative rebleeding importantly determines prognosis. However, despite adequate treatment, prognosis is poor in many ruptured aneurysm cases. In this study, we identified and evaluated factors related to perioperative rebleeding in patients with aSAH. Methods: The medical and surgical records of 166 patients that underwent endovascular embolization for a ruptured cerebral aneurysm at a single institution from 2014 to 2016 were retrospectively analyzed to identify risk factors of rebleeding. All patients were examined for risk factors and evaluated for increased hemorrhage by brain computed tomography at 3 days after surgery. Results: This series included 54 men (32.5%) and 112 women (67.5%) of mean age 58.3±14.3 years. After procedures, 26 patients (15.7%) experienced rebleeding, and 1 of these (0.6%) experienced an intraoperative aneurysmal rupture. External ventricular drainage (EVD) (odds ratio [OR] 5.389, [95% confidence interval (CI) 1.171- 24.801]) and modified Fisher grade (OR 2.037, [95% CI 1.077-3.853]) were found to be independent risk factors of rebleeding, and perioperative rebleeding was strongly associated with patient outcomes (p＜0.001). Conclusions We concluded the rebleeding risk after aSAH is greater in patients with large hemorrhage amounts and a high pre-operative modified Fisher grade, and thus, we caution neurosurgeons should take care in such cases.

BACKGROUND/AIMS: In some cases, chronic diarrhea is unexplained, and small bowel disorders may be one of the causes. The aim of this study was to assess the diagnostic yield and clinical impact of video capsule endoscopy (VCE) in patients with chronic diarrhea. METHODS: We retrospectively analyzed records from October 2002 to August 2013 in the VCE nationwide database registry (n=2,964). Ninety-one patients from 15 medical centers (60 males and 31 females; mean age, 47±19 years) were evaluated for VCE as a result of chronic diarrhea. RESULTS: The duration of chronic diarrhea was 8.3±14.7 months. The positive diagnostic yield of VCE was 42.9% (39/91). However, 15.4% (14/91) exhibited an inconsistent result, and 41.8% (38/91) were negative. Abnormal findings consistent with chronic diarrhea included erosions/aphthous ulcers (19.8%), ulcers (17.6%), mucosal erythema (3.3%), edema (1.1%), and luminal narrowing (1.1%). The most common diagnoses were functional diarrhea associated with irritable bowel syndrome in 37 patients (40.7%) and Crohn’s disease in 18 patients (19.8%). After VCE examination, the diagnosis was changed in 34.1% of the patients (31/91). Hematochezia (odds ratio [OR], 8.802; 95% confidence interval [CI], 2.126 to 36.441) and hypoalbuminemia (OR, 4.811; 95% CI, 1.241 to 18.655) are predictive factors of a positive diagnostic yield. CONCLUSIONS: VCE had a favorable diagnostic yield and clinical impact on the management of patients with chronic diarrhea.
Capsule Endoscopy* ; Diagnosis ; Diarrhea* ; Edema ; Erythema ; Female ; Gastrointestinal Hemorrhage ; Humans ; Hypoalbuminemia ; Irritable Bowel Syndrome ; Male ; Phenobarbital ; Retrospective Studies ; Ulcer