The occurrence of squamous metaplasia(morule) in colorectal mucosa and adenocarcinoma, althrough rare, has been well documented. In contrast, very little mention has been given to mature squamous cells seen in colorectal polyps or adenomas. A 42-year-old woman presented with a 2-month history of diarrhea and melena. Proctosigmoidoscopy revealed a 4 cm-sized polypoid tumor 20 cm above the anal verge. Colonoscopic biopsy showed tubular adenoma, and a segmental resection of sigmoid colon was done. Microscopically, the tumor was c classical tubular adenoma containing multiple solid nests of squamous cells scattered only in the neoplasm; the squamous nests were generally small, and some showed direct continuity with adenomatous glands. The squamous cells were keratinizing and had regular nuclei with no mitotic activity. The importance of this phenomenon lies in its pathologic recognition, and the findings suggest that awareness of this rare occurrence in colorectal polyps should avert such overdiagnosis, and consequently prevents unnecessary radical surgery.
Female ; Humans ; Adenoma ; Biopsy

BACKGROUND: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. METHODS: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. RESULTS: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. CONCLUSIONS: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.
Acromioclavicular Joint ; Acromion ; Clavicle* ; Dislocations ; Humans ; Joints ; Osteolysis ; Outcome Assessment (Health Care) ; Retrospective Studies ; Shoulder ; Statistics as Topic

The definition of drooling is very broad, Drooling is characterized by saliva flowing out of the mouth or moving behind the pharynx unintentionally due to various reasons. Drooling is affected by increased salivation, and oral motor and swallowing functions. The amount depends on the situation, place, mood, and concentration. There is a need for comprehensive evaluation and treatment since drooling could be stimulated by various causes, such as sensory, motor, cognitive, and behavioral. Drooling evaluation is divided into objective and subjective evaluations. The objective evaluation mainly measures the amount of saliva secretion using a towel, a container, and a dental swab, and assessing the frequency of drooling at a fixed time. Subjective evaluation usually evaluates the subject’s severity and frequency of drooling during certain periods. A comprehensive evaluation that identifies the effects of salivation on the subject’s daily life, social interaction, psychology, and self-esteem, and evaluates the degree of drooling according to various postures, situations, and conditions, also needs to be considered. Nevertheless, there are several difficulties in developing standardized drooling assessment tools. The evaluation contents and results may vary depending on the treatment approach, such as botulinum toxin treatment or oral exercise therapy. The current article will help understand and select drooling assessment tools for identifying and measuring outcomes in clinical settings and studies.

Drooling is defined as the unintentional flow of saliva out of the mouth or to the back of the pharynx due to salivary control problems and swallowing difficulties. Drooling is caused by posture, oral sensori-motor and cognitive problems, and medical symptoms. Treatments of drooling are defined under two criteria: 1) non-invasive treatment, which includes posture and oral motor therapy, and 2) invasive treatment, including botox injection and surgery.Drooling treatment should be initiated non-invasively and in a step-wise manner in all individuals. This mode of treatment is safe, age-free, and is considered the first line of therapy, before subjecting to invasive treatment.Clinical professionals provide non-invasive treatment via manual approaches, through passive sensori-motor stimulation to active oral motor activities. Comprehensive therapy protocols such as oral motor facilitation technique (OMFT) for oral sensory normalization, head and neck postural control, and oral motor function improvements, are required to help control drooling. Clinical professionals therefore need to deeply understand the reason for drooling, and provide qualified non-invasive treatment for intensifying drooling control.

Drooling is defined as the unintentional flow of saliva out of the mouth or to the back of the pharynx due to salivary control problems and swallowing difficulties. Drooling is caused by posture, oral sensori-motor and cognitive problems, and medical symptoms. Treatments of drooling are defined under two criteria: 1) non-invasive treatment, which includes posture and oral motor therapy, and 2) invasive treatment, including botox injection and surgery.Drooling treatment should be initiated non-invasively and in a step-wise manner in all individuals. This mode of treatment is safe, age-free, and is considered the first line of therapy, before subjecting to invasive treatment.Clinical professionals provide non-invasive treatment via manual approaches, through passive sensori-motor stimulation to active oral motor activities. Comprehensive therapy protocols such as oral motor facilitation technique (OMFT) for oral sensory normalization, head and neck postural control, and oral motor function improvements, are required to help control drooling. Clinical professionals therefore need to deeply understand the reason for drooling, and provide qualified non-invasive treatment for intensifying drooling control.

Objective: This study was undertaken to identify the effect of Oral Motor Facilitation Technique (OMFT) on the drooling control ability of children afflicted with Cerebral Palsy (CP). Methods: Totally, 21 CP children with drooling problems participated in the study. OMFT was provided for 16 weeks (30 minutes, 1 session a week, 16 sessions). The drooling control ability was assessed by determining the severity and frequency using the Drooling Severity and Frequency Scale (DSFS) before, at 8 weeks, and 16 weeks after OMFT administration. The effectiveness of OMFT was analyzed at the time intervals using the Friedman test. Post hoc analyses were conducted by the Wilcoxon signed rank test and Kruskal Wallis test. Results: Drooling control ability showed significant improvement after 16 weeks of OMFT. Although the severity of drooling significantly increased after 8 weeks, the frequency was unchanged. Our results indicate that OMFT is a useful oral motor treatment protocol to manage the drooling control ability of children with CP. We recommend at least 8 weeks of OMFT administration. Conclusion Drooling is an important problem in dysphagia. Clinicians need to show more importance in controlling drooling, and a comprehensive oral motor treatment like OMFT should be considered for children afflicted with CP.

BACKGROUND AND OBJECTIVES: Various phonation patterns yield various voice characteristics. Voice therapy using nasal stimulatory sounds seems to facilitate phonation in voice disodered patients. Under the hypothesis that nasalance may be influenced by the pattern of phonation, we studied the relationship between nasalance and voice disorders by observing abnormal supraglottic movements and vocol cord gaps in phonation. SUBJECTS AND METHOD: There were 143 patients who complained of voice problems and showed abnormal false vocal cord movements under stroboscopy. In addition to the four previously described types of MTD (muscle tension dysphonia), we described two more types of MTD (V: false vocal cord contracted posteriorly, VI: false vocal cord dilated laterally). We measured the vocal cord gaps in phonation and analyzed nasalance. RESULTS: Among those groups showing the pattern of false vocal cord (MTD 1, 2, 4), the vocal cord gaps in phonation were increased and nasalance was significantly decreased in MTD types, III and IV, and showed a tendency to decrease in MTD types, II and V, compared to the normal group. CONCLUSION: The supraglottis has a tendency to contract as the vocal cord gap in phonation increases, and this movement reduces nasalance.
Dysphonia ; Humans ; Phonation* ; Stroboscopy ; Vocal Cords ; Voice ; Voice Disorders

One complication related to local anesthesia in the dental clinic is a broken needle. Although rare, a broken needle may be difficult to retrieve. Dental radiographs and 3D CT have been used in the past to confirm the location of a broken needle. We present the case of a broken needle, which was successfully removed using a careful, microscopic approach.
Anesthesia, Local ; Dental Clinics ; Needles*

Sparganosis, an infection due to the plerocercoid of Spirometra erinacei, are found worldwide but the majority of cases occur in East Asia including Korea. This report is on a recurred case of sparganosis in the subcutaneous tissue of the right lower leg 1 year after a surgical removal of a worm from a similar region. At admission, ultrasonography (USG) of the lesion strongly suggested sparganosis, and a worm was successfully removed which turned out to be a sparganum with scolex. Since sparganum has a variable life span, and may develop into a life-threatening severe case, a patient once diagnosed as sparganosis should be properly followed-up for a certain period of time. Although imaging modalities were useful for the diagnosis of sparganosis as seen in this case, serological test such as ELISA should also be accompanied so as to support the preoperative diagnosis.
Animals ; Antibodies, Helminth/blood ; Asia ; Asian Continental Ancestry Group ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Korea ; Leg/parasitology/pathology/ultrasonography ; Middle Aged ; Recurrence ; Sparganosis/*diagnosis/surgery ; Spirometra/*isolation & purification

STUDY DESIGN: Retrospective. OBJECTIVES: To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF LITERATURE REVIEW: Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures. MATERIALS AND METHODS: The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI. RESULTS: Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly. CONCLUSIONS: Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.
Asian Continental Ancestry Group ; Comorbidity ; Deglutition Disorders ; Delirium ; Female ; Hematoma ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Orthopedics ; Pneumonia ; Postoperative Complications* ; Pulmonary Embolism ; Retrospective Studies ; Seizures ; Smoke ; Smoking ; Spinal Cord Diseases* ; Wounds and Injuries