Background: Patients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict. Methods: We prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients’ decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip. Results: The test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, p = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores. Conclusions This study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Background: Spinal intramedullary cavernous angioma is a rare form of spinal cord tumorthat is associated with myelopathy and significant morbidity and surgical treatment is almostalways required.Case: We report a case of spinal intramedullary cavernous angioma in a pain clinic with initialsymptoms of unilateral interdigital space sensory change. Morton’s neuroma and piriformissyndrome were clinically suspected, however, symptoms acutely aggravated, andparaplegia developed following the patient’s COVID-19 vaccination. Vaccine-associated sideeffects were ruled out and spinal intramedullary cavernous angioma was confirmed throughmagnetic resonance image. The patient underwent surgery for complete mass excision. Conclusions Recent reports of COVID-19 vaccine-associated side effects have raised sensitiveconcerns to both health care providers and the public, that in some cases when thesymptoms coincide with vaccination history, it may delay time-sensitive diagnosis and treatmentand spend unnecessary costs.

BACKGROUND: To determine whether olecranon fractures have osteoporotic features such as age-dependent, low bone attenuation and low-energy trauma as a cause of injury. METHODS: Elbow computed tomography (CT) and medical record review were performed in 114 patients (53 males and 61 females) with acute olecranon fractures. The mean age was 57 years. Bone attenuation was measured on the central part of the olecranon on sagittal CT images avoiding the fracture, and on the distal humerus (distal metaphysis and medial and lateral condyles) on coronal CT images. We compared bone attenuation and causes of injury (high or low energy trauma) between younger (<50 years) and older (≥50 years) patients in each gender. Multiple regression analysis was performed to determine the effect of age and gender on bone attenuation. RESULTS: Mean bone attenuation in older male and female patients was significantly lower than in younger patients, except at the medial condyle in men. The proportion of low-energy trauma in older male patients was significantly higher than in younger male patients. In female patients, low-energy trauma was predominant in both younger and older patients. Age and female gender had significantly negative effects on bone attenuation. CONCLUSIONS: This study demonstrated that olecranon fractures have osteoporotic features, including age-dependent low bone attenuation and low-energy trauma as the predominant cause of injury. Our results suggest that osteoporosis evaluation should be considered for patients aged 50 years or more with olecranon fractures.
Elbow ; Female ; Humans ; Humerus ; Male ; Medical Records ; Olecranon Process* ; Osteoporosis ; Osteoporotic Fractures*

Background: Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. Methods: We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. Results: The mean age of patients with VCP was 51.28 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. Conclusions We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.

Peripheral nerve injury frequently leads to neuropathic pain like hyperalgesia, spontaneous pain, mechanical allodynia, thermal allodynia. It is uncertain where the neuropathic pain originates and how it is transmitted to the central nervous system. This study was performed in order to determine which peripheral component may lead to the symptoms of neuropathic pain. Under halothane anesthesia, male Sprague-Dawley rats were subjected to neuropathic surgery by tightly ligating and cutting the tibial and sural nerves and leaving the common peroneal nerve intact. Behavioral tests for mechanical allodynia, thermal allodynia, and spontaneous pain were performed for 2 weeks postoperatively. Subsequently, second operation was performed as follows: in experiment 1, the neuroma was removed; in experiment 2, the dorsal roots of the L4-L6 spinal segments were cut; in experiment 3, the dorsal roots of the L2-L6 spinal segments were cut. Behavioral tests were performed for 4 weeks after the second operation. Following the removal of the neuroma, neuropathic pain remained in experiment 1. After the cutting of the L4-L6 or L2-L6 dorsal roots, neuropathic pain was reduced in experiments 2 and 3. The most remarkable relief was seen after the cutting of the L2-L6 dorsal roots in experiment 3. According to the fact that the sciatic nerve is composed of the L4-L6 spinal nerves and the femoral nerve is composed of the L2-L4 spinal nerves, neuropathic pain is transmitted to the central nervous system via not only the injured nerves but also adjacent intact nerves. These results also suggest that the dorsal root ganglion is very important in the development of neuropathic pain syndrome.
Animal ; Ganglia, Spinal/physiopathology ; Male ; Nervous System Diseases/physiopathology* ; Nervous System Diseases/complications ; Pain/physiopathology* ; Pain/etiology ; Rats ; Rats, Sprague-Dawley ; Spinal Nerve Roots/physiopathology ; Spinal Nerves/physiopathology