The authors report two cases of suddenly deteriorated accommodative esotropia with amblyopia during part-time occlusion therapy. A 7-year-old girl with right accommodative esotropia, which was well controlled, showed marked increase in esodeviation after part-time occlusion and regained orthophoria without occlusion. This phenomenon was repeated. Recession of both medial recti was performed and orthophoria was well maintained at both distant and near targets. Accommodative esotropia of a 9-year-old boy with glasses also showed a striking increase in esodeviation after part-time occlusion. The authors recommended wearing only glasses without occlusion or surgery and he recovered fusion. Three months later, orthophoria was maintained at distant target, with 8PD esophoria at near target with glasses. Although this complication should be considered before occlusion therapy, it must be taken continuously if needed, because an increase of the deviation size with occlusion may simply reflect a true deviation and may not be a poor prognostic sign.
*Accommodation, Ocular ; Amblyopia/physiopathology/therapy ; Child ; Esotropia/*etiology/physiopathology ; Eyeglasses ; Female ; Humans ; Male ; *Sensory Deprivation

PURPOSE: To report a patient with adsence of the superior oblique (SO) muscle of the right eye, who showed improvement after surgery for hyperdeviation and exotropia. METHODS: A four-year-old girl who presented with 14 PD exotropia, and 25 PD hypertropia of the right eye had a history of myectomy of the right inferior oblique (IO) muscle for bilateral SO palsy as a two-year-old. At the time of surgery, severely fibrotic pseudotendon of IO and Tenon's capsule attached to the insertional area of the inferior rectus muscle was found. IO was remyectomized with adhesiolysis. Lateral rectus and superior rectus (SR) muscles were recessed 6.5mm and 7mm, respectively. After exposure of SR, the absence of SO was found. MRI taken at postoperative one day showed definite SO absence. RESULTS: Three weeks after surgery, 4 PD of left hyperphoria at distant and 5 PD of left hyperphoria at near were observed. Right hyperdeviation was not detected. At postoperative 7 months, 4 PD of exophoria, 6 PD of right dissociated vertical deviation (DVD) and 10 PD of left DVD were seen at distant. A small left hyperdeviation was intermittently noted at upgaze and was cautiously followed. CONCLUSIONS: Absence of the superior oblique muscle is rare. However, such absence should be suspected when apparent superior oblique palsy accompanies with severe hyperdeviation and horizontal deviation. MRI or CT is helpful in the diagnosis of this condition and direct confirmation is needed.
Diagnosis ; Exotropia ; Female ; Humans ; Magnetic Resonance Imaging ; Muscles ; Paralysis ; Strabismus ; Tenon Capsule

To verify the postoperative ultrastructural changes of the myotendinous nerve endings of feline extraocular muscles, which are known as proprioceptors. Sixteen recti of four cats were used and divided into three groups. In group A, eight lateral recti were recessed. In group B, four medial recti were resected by 10 mm from insertion to include the myotendinous junction. In group C, four medial recti were resected by 4 mm of muscle bellies only, without disturbing the myotendinous junction. Four weeks after surgery, specimens were examined with electron microscopy. In group A, overall neural structures were well maintained with slight axonal degeneration. In group B, only muscle fibers were observed without any regeneration of neural sprouts. In group C, axonal disintegration and shrinkage were evident. These results indicate that myotendinous nerve endings can be damaged in strabismus surgery, and that resection was more invasive than recession in disrupting myotendinous nerve endings.
Animals ; Cats ; Motor Neurons/ultrastructure ; Nerve Endings/*ultrastructure ; Neuromuscular Junction/*ultrastructure ; Oculomotor Muscles/*innervation/surgery ; Oculomotor Nerve/*ultrastructure ; *Ophthalmologic Surgical Procedures ; Receptors, Sensory/ultrastructure ; Strabismus/surgery ; Tendons/*innervation/ultrastructure

Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck 99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, 18F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0-26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. 18F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.

The purpose of this study was to compare factors causing stress in pediatric and general dentists when treating pediatric patients and to evaluate their overall occupational stress level. A total of 191 dentists participated in the online survey, consisting of 66 pediatric dentists and 125 general dentists. The questionnaire was conducted using Google Form. Both groups were stressed due to poor cooperation of patient and caregiver, uncertain prognosis of treatment, and low cost of pediatric dental treatment. The pediatric dentists felt relatively high stress due to poor cooperation from caregivers and an uncertain prognosis of treatment (p < 0.05). Overall occupational stress was high in both groups in the order of patient, time, job environment, and income-related stress, and the degrees of pediatric dentists were lower than general dentists. Among the 3 sub-factors of occupational burnout, more than 98% of both groups showed burnout in “depersonalization”, and more than 69% of both groups showed burnout in “emotional exhaustion”. Both groups showed a low burnout rate in “reduced sense of accomplishment” and pediatric dentists showed a higher sense of accomplishment than general dentists (p < 0.05). This study showed that both groups were under high occupational stress due to various factors, and efforts were required to relieve stress.

Purpose: To investigate the postoperative changes in diplopia and evaluate factors that affect diplopia after isolated inferior orbital wall fracture. Methods: A retrospective study was conducted on 200 patients who underwent reconstruction surgery for isolated inferior orbital wall fracture between March 2001 and December 2020. Diplopia was categorized into peripheral, central, and full-degree types based on the history and binocular single vision. The natural course of diplopia was analyzed pre-operatively and at 1 day, 6 weeks, and 6 months postoperatively. We analyzed the orbital computed tomography images to determine fracture size (small, medium, or large), fracture site (anterior, middle, posterior, or mixed), extraocular muscle (EOM) size (swelling or deformity), EOM site (incarcerated or prolapsed), and EOM tenting. Results: Diplopia was seen in 144 out of 200 patients (72.0%) before surgery; peripheral diplopia was seen in 57 patients (39.6%), central diplopia in 46 (24.3%), and full-degree diplopia in 20 (13.9%). Pre-operative diplopia differed according to the pre-operative limitation of range of motion (LOM) (p < 0.001) and EOM site (p = 0.022). Pre-operative diplopia type differed according to the LOM direction (p = 0.018) and EOM size (p = 0.020). Diplopia persisted in 33 patients (16.5%) 6 months after the surgery. Recovery was faster in patients with peripheral diplopia compared to those with central or full-degree diplopia. Conclusions The presence of diplopia was associated with the pre-operative LOM and EOM site but the type of diplopia was associated with LOM direction and EOM size. These factors can be used to predict the progression of diplopia in patients with isolated inferior orbital wall fracture.

Artificial intelligence (AI) is being used in many areas of healthcare, including disease diagnosis and personalized treatment and rehabilitation management. Medical AI research and development has primarily focused on diagnosis, prediction, treatment, and management as an aid to patient care. AI is being utilized primarily in the areas of personal healthcare and diagnostic imaging. In the field of urology, significant investments are being made in the development of urination monitoring systems in the field of personal healthcare and ureteral stricture and urinary stone diagnosis solutions in the field of diagnostic imaging. In addition, AI technology is also being applied in the field of neurogenic bladder to develop risk monitoring systems based on video and audio data. This paper examines the application of AI to urological diseases and discusses the current trends and future prospects of AI research.

Purpose: Swyer-James-Macleod syndrome (SJMS) is a rare disorder characterized by the hyperlucency of a unilateral lung due to ipsilaterally arrested lung growth. No sufficient information on progressive lung function changes during growth is available in SJMS. Methods: We retrospectively reviewed SJMS cases using a clinical database from January 2000 to August 2018. Results: A total of 40 patients were enrolled in this study. The median age of the patients was 4.8 years (interquartile range [IQR], 2.7–9.0 years), boys (n = 21, 52.5%) were more affected, and left lungs (n = 27, 67.5%) were more involved. The interval between infection and diagnosis was 1.8 years (IQR, 0.7–6.4 years). Mycoplasma pneumoniae (n = 14) and adenovirus (n = 5) were most prevalent among the 21 subjects with presumably identifiable causes. Most of the 16 patients with available pulmonary function data presented moderate obstructive lung function (z-score, median; FEV 1: -4.320 [IQR, -5.955 to -3.400] and FVC: -2.600 [IQR, -3.590 to -1.570], respectively) with the more decreased median in forced expiratory flow between 25% and 75% of FVC (FEF 25%–75%) (z-score, -4.470; IQR, -5.330 to -3.170). Linear mixed effect models indicated that younger age at first infectious insult was significantly related to decreased FEV1 z-score (P = 0.041), and that the FEV 1/FVC and FEF 25%–75% z-scores were reduced by 0.082 (P = 0.005) and 0.069 (P ≤ 0.001) per year. Conclusion In children with SJMS, the initial infectious insult occurs in the early life with M. pneumoniae being the most common pathogen. Lung function may deteriorate with an obstructive pattern during growth. The impairment can progress slowly not in the FEV1, but in the FEV1/FVC or FEF25%–75%

PURPOSE: To report antielevation syndrome with restriction of elevation on abduction in the operated eye and overaction (OA) of the inferior oblique muscle (IO) of the contralateral eye after unilateral IO anteriorization (AT). METHODS: Medical records were reviewed retrospectively in 8 of 24 patients who underwent unilateral IOAT. Four patients were referred from other hospitals after the same surgery. RESULTS: Four patients had infantile esotropes. The rest showed accommodative esotropia, superior oblique palsy, exotropia, and consecutive exotropia. The mean amount of hyperdeviation was 16.3 PD (10~30). The mean restriction of elevation on abduction in the operated eye was -1.6 (-1~-4) and IOOA of the contralateral eye was +2.7 (+2~+3). IOAT of nonoperated eyes in 4 patients, IO weakening procedure of anteriorized eyes in 2 patients, and IO myectomy on an eye with IOAT in 1 patient were performed. Ocular motility was improved after surgery in all patients. CONCLUSIONS: Unilateral IOAT may result in antielevation syndrome. Therefore bilateral IOAT is recommended to balance antielevation in both eyes. A meticulous caution is needed when performing unilateral IOAT.
Syndrome ; Retrospective Studies ; Reoperation ; Postoperative Complications ; *Ophthalmologic Surgical Procedures ; Oculomotor Muscles/physiopathology/*surgery ; Ocular Motility Disorders/*etiology/physiopathology/surgery ; Infant ; Humans ; Follow-Up Studies ; Female ; Eye Movements/*physiology ; Exotropia/surgery ; Esotropia/surgery ; Child, Preschool ; Child ; Adult

This randomized controlled trial study aimed to investigate the effects of a lifestyle intervention on metabolic syndrome (MetS) among middle-aged Koreans. A total of 243 middle-aged Koreans with MetS were randomly assigned to either of 2 types of lifestyle intervention for MetS and followed for 12 months. Health examinations and interventions were implemented at 16 regional branch facilities of a Korean medical institution from 2010, following the NCEP-ATP III criteria and recommendations. Lifestyle intervention (LI) group (n = 137) participated in a 12-week multi-component intervention including individual counseling, group sessions, and self-help materials. Basic usual intervention (BI) group (n = 106) was provided with one-page health information sheet on MetS and MetS management at baseline. Prevalence of MetS and each of MetS components, except for low HDL-cholesterol, in both groups were significantly reduced and maintained after the intervention. Notably, prevalence of hypertension and abdominal obesity continued to improve during the follow-up period. Between-group differences in results were not found. Both interventions were effective when they were accompanied with repeated check-ups and notification of MetS status. It is recommended to design clear guidelines for the notification of MetS after MetS screening and to encourage checking MetS status periodically for effective MetS management (KCT 0000446).
Adult ; Combined Modality Therapy ; Directive Counseling/*methods ; Female ; Humans ; Male ; Mass Screening/*methods ; Metabolic Syndrome X/*diagnosis/epidemiology/*therapy ; Middle Aged ; Patient Education as Topic/methods ; *Risk Reduction Behavior ; *Self-Help Groups ; Treatment Outcome