PURPOSE: We report a patient with strabismus associated with thyroid ophthalmopathy whose condition changed remarkably for 6 years of a natural course. CASE SUMMARY: A 69-year-old woman with Graves' disease presented with diplopia in April 1999. On examination, she showed left hypotropia of 50 prism diopters (Delta) accompanied by supraduction limitation and lid lag in the left eye. She was diagnosed with strabismus associated with thyroid ophthalmopathy and was observed without any intervention. In October 2000, her left hypotropia decreased to 16Delta, and esotropia of 14Delta developed. Both eyes showed limitation of supraduction, and the left eye showed limitation of abduction. In December 2003, the esotropia increased to 35Delta, and the direction of vertical strabismus changed to 40Delta of right hypotropia. Supraduction limitation of the right eye and abduction restriction of both eyes increased, and infraduction limitation of the left eye developed. In April 2005, esotropia increased to 75Delta, and the amount of right hypotropia was 35Delta. The abduction limitation of both eyes increased. CONCLUSION: The natural course of strabismus associated with thyroid ophthalmopathy can show continuous and remarkable changes.
Aged ; Diplopia ; Esotropia ; Eye ; Female ; Graves Disease ; Humans ; Strabismus ; Thyroid Gland

The purpose of this study was to develop a nutrition education website for children, especially those around the 4th-6th grade levels. Among the already existing websites providing nutritional information for children, 7 websites with comparable amounts of information were evaluated in terms of their topics, credibility, content, ease of use, and aesthetics. In addition, a survey was conducted to assess the need for nutrition information among 305 elementary students. The food pyramid was the topic offered most often on those websites. Information on nutrients, digestion, food safety, nutrition labeling, and healthy eating habits were available on the websites. Some of those websites also provided games or quizzes to attract the children's interest. However, seine of the websites did not give any information on the person responsible for providing the information, which is most important in determining the credibility of the website. Other problems were that some information was too difficult for children, and some of the websites did not provide a way to search for information. According to the survey results, the topics that children wanted to know about were 'desirable weight', 'cooking', 'correct food choice', 'weight control method', 'calories consumed during exercise' but, they did not have a high interest in 'asking questions', 'books with nutrition messages', 'under weight', 'negative effect of weight control' and 'helping hungry children'. Based on these results, we developed a new nutrition education web-site, ifood' (http://ifood.or.kr). We focused on helping children develop healthy eating habits by providing information which is easy and practical for children. However, we neither included the program to assess their dietary intake, nor provided entertaining background sounds, which children like. Also, the game section is composed mainly of quizzes. Therefore, we need to further develop exciting games to teach nutrition to children. In the near future, the newly developed website should be evaluated by children regarding understandability and coverage of the contents as well as usability and design, and then revised to improve the educational effect.
Child* ; Digestion ; Eating ; Education* ; Esthetics ; Food Labeling ; Food Safety ; Humans ; Internet

OBJECTIVE: This research is focused on modeling the diagnostic knowledge in traditional medicine. Unlike the previous studies which have dealt mainly with the standardized heuristic knowledge for diagnosis, we investigated the logical procedures and a set of source knowledge which the standardized diagnosis has been based on. These procedures and knowledge are related to Yin-Yang principle and their medical derivatives which are believed to interact with the heuristic knowledge for diagnosis through analogical reasoning. METHOD: we analyzed disorders which have been specified in traditional medicine and their signs and symptoms on the diagnostic criteria defined by Korean Institute of Oriental Medicine. Based on the conventional knowledge, all the symptoms were analyzed into elementary abstractive concepts so that we represented their properties by the principles mentioned above. And then we analyzed the procedures to link the disorders to their assigned sign and symptoms. RESULTS: Based on the proposed methodology, the diagnostic knowledge in traditional medicine was represented as rules in our ontology which was written by OpenCyc system. By applying these rules to the properties of the symptoms that have been derived from a patient, the patient's disorder can be determined. And this preliminary algorithm was implemented to be able to obtain a limited diagnostic result for individual patients. CONCLUSION: This research developed an analytic and consequently flexible diagnostic knowledge system for traditional medicine than the previous studies. These results will be extended to developing an analogical reasoning algorithm by the authors. It is also necessary, however, to improve them both by providing more practical diagnostic knowledge in such medicine and by carrying out clinical evaluations.
Aluminum Hydroxide ; Carbonates ; Expert Systems ; Humans ; Lifting ; Logic ; Medicine, East Asian Traditional ; Medicine, Traditional ; Yin-Yang

Shock thyroid is a rare manifestation of the CT hypotension complex and can be diagnosed when thyroid and perithyroidal edemas are observed on CT during the onset of shock. Shock thyroid can be a useful CT sign for decompensated shock. This condition is reversible and recovers rapidly with adequate treatment. We present the case of an 84-year-old female with septic shock, exhibiting CT features consistent with a shock thyroid. We also reviewed the clinical and radiological findings reported in the literature. The present case emphasizes that shock thyroid can be an early indicator of impending hemodynamic instability and has important prognostic and therapeutic implications.

Shock thyroid is a rare manifestation of the CT hypotension complex and can be diagnosed when thyroid and perithyroidal edemas are observed on CT during the onset of shock. Shock thyroid can be a useful CT sign for decompensated shock. This condition is reversible and recovers rapidly with adequate treatment. We present the case of an 84-year-old female with septic shock, exhibiting CT features consistent with a shock thyroid. We also reviewed the clinical and radiological findings reported in the literature. The present case emphasizes that shock thyroid can be an early indicator of impending hemodynamic instability and has important prognostic and therapeutic implications.

OBJECTIVES: Numerous studies have investigated the efficacy of whole grains; however, research on multigrain remains limited. Grains exhibit combined positive effects against various diseases. The purpose of this study was to examine the impact of multigrain and white rice consumption on periodontitis. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey V-3 and VI, collected between 2012 and 2015, which included 12,450 patients (4,859 male and 7,591 female) aged 19-64 years. The World Health Organization’s Community Periodontal Index (CPI) was utilized to assess the presence of periodontitis, with periodontitis defined as a CPI index score of ≥3. Multivariable logistic regression analysis was performed after adjusting for potential confounding variables. RESULTS: The group that consumed only multigrain rice was less likely to have periodontitis than the group that consumed only white rice (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.69 to 0.93). When stratified by sex, the risk of periodontitis demonstrated a 24% decrease in female who consumed only multigrain rice (OR, 0.76; 95% CI, 0.62 to 0.93). A similar result was observed in the age group of 40-64 years (OR, 0.84; 95% CI, 0.71 to 0.99). In the diabetes stratification model, the normal group that consumed only multigrain rice exhibited a 25% decrease in the odds of periodontitis (OR, 0.75; 95% CI, 0.62 to 0.91). CONCLUSIONS Our findings suggest that the prevalence of periodontitis may vary depending on the type of rice consumed.

Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting.
Aged ; Bile Ducts ; Biliary Tract ; Catheters ; Drainage ; Fistula* ; Humans ; Jaundice, Obstructive ; Liver ; Stents

PURPOSE: The aim of our study was to evaluate the outcomes of sonographic (US) BIRADS category 4 lesions according to subcategories 4A, 4B, and 4C and palpability. MATERIALS AND METHODS: We retrospectively reviewed the pathology results of 512 US BI-RADS category 4 lesions in 460 patients after ultrasound-guided percutaneous biopsy (n = 435) and surgical biopsy (n = 77). We analyzed the results according to subcategories 4A, 4B, 4C, and palpability, and compared outcomes of five breast radiologists. RESULTS: In BI-RADS 4A lesions (n = 302), biopsy results indicated 48 malignancies (15.9%). In BI-RADS 4B lesions (n = 113), biopsy revealed 69 malignancies (61.1%). Among BI-RADS 4C lesions (n = 97), 87 lesions were malignancies (89.7 %). Palpability had no correlation with the rate of malignancy in BI-RADS category 4 lesions, and the rate of malignancy for category 4A ranged widely from 8.1% - 26.4%. CONCLUSIONS: The outcomes of US BI-RADS category 4 lesions according to subcategories varied widely between radiologists, especially for 4A lesions. The US finding itself warrants a BI-RADS 4 subcategory. In category 4 lesions, the malignant rate was the same between palpable and nonpalpable lesions.
Biopsy ; Breast ; Humans ; Retrospective Studies

This study focuses on the importance of non-face-to-face healthcare, based on the experience with the COVID-19 pandemic, and proposes a model for oral health management services utilizing personal data, known as “my data.” The model aims to develop a comprehensive system that collects and integrates individual health records for easy access. It includes assessing oral health through oral examination records and surveys, creating risk assessment algorithms tailored to various population groups, and standardizing medical terms and data. The goal is to accurately evaluate individual oral health conditions and provide personalized services. However, the success of the model requires considerations such as platform management, user experience enhancement, and medical data security. The research proposes possibilities for further investigation to enhance the oral health service model. This study introduces a novel approach to individual health management, establishing the foundation of effective health management even in non-face-to-face settings.

OBJECTIVES: The aim of this study was to estimate the association between household income and dental flossing. METHODS: This cross-sectional study investigated the impact of household income on flossing among 9,391 adults aged 30+ with ≥20 natural teeth, utilizing data from the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Outcome measures included flossing (yeso), with income categorized into 4 levels: lowest, medium to low, medium to high, and highest. Logistic regression, adjusted for age, gender, brushing frequency, recent dental exams, periodontitis, smoking, and alcohol use, was employed to evaluate the influence of socioeconomic status on oral hygiene practices. RESULTS: In the highest income group, flossing was 62.6% more prevalent than in the lowest income group (adjusted odds ratio [aOR], 1.63; 95% CI, 1.27 to 2.08). The strongest association between income levels and flossing was observed in individuals aged ≥70 years (aOR, 3.64; 95% CI, 1.86 to 7.11), with a decreasing strength of association in the 60s (aOR, 1.72; 95% CI, 1.05 to 2.84) and 50s age groups (aOR, 1.69; 95% CI, 1.07 to 2.68). Higher-income women demonstrated a higher frequency of flossing than their lower-income counterparts (aOR, 1.67; 95% CI, 1.24 to 2.23). Higher-income individuals without periodontitis were more likely to floss (aOR, 1.64; 95% CI, 1.23 to 2.18), and among those with periodontitis, flossing was significantly associated only with the highest income category (aOR, 1.64; 95% CI, 1.10 to 2.44). CONCLUSIONS The findings of this study indicate a significant correlation between higher household income levels and an increased prevalence of flossing.