PURPOSE: To analyze the causes, success rate, and the changes of Jones tube length in endoscopic conjunctivodacryocystorhinostomy (CDCR) reoperation cases. METHODS: The medical records of 40 patients (41 eyes, a total of 52 cases) who underwent reoperation of CDCR with Jones tube reinsertion using an endoscope from January 2013 to December 2018 were retrospectively reviewed. We analyzed the success rate, causes of reoperation, changes in lengths of used tubes, and the average interval times between operations. RESULTS: The most common cause of reoperation was medial tube migration (53.8%). As in other causes, tube loss (17.3%), obstructions related with conjunctival overgrowth or granulation (13.46%), lateral tube migration (11.53%), iatrogenic removal (1.92%), and acute dacryocystitis (1.92%) followed. In patients with medial tube migration, the average tube length used in reoperations decreased by approximately 1.11 mm compared to prior operations. In cases of lateral tube migration, the average tube length increased approximately 1.00 mm after the reoperation. The success rate of reoperations was 78.04%. The average interval time between the initial operation and the first reoperation was 52 months. In cases with several reoperations, the interval time decreased as the number of reoperations increased. CONCLUSIONS Because medial tube migration was found to be the most common cause of reoperations, it should be considered as a potential problem when performing surgery. The changes in the lengths of inserted Jones tubes were related to certain types of complication, which affected the prognoses. In endoscopic CDCR reoperations, the success rate was favorable. In recurrent cases, the average interval time between reoperations decreased as the number of operations increased.

PURPOSE: Reports from several case series have described the feasibility and safety of robotic surgery (RS) for colonic cancer. Experience is still limited in robotic colonic surgery, and a few meta-analysis has been conducted to integrate the results for colon cancer specifically. We conducted a systematic review of the available evidence comparing the surgical safety and efficacy of RS with that of conventional laparoscopic surgery (CLS) for colonic cancer. METHODS: We searched English databases (MEDLINE, Embase, and Cochrane Library), and Korean databases (KoreaMed, KMbase, KISS, RISS, and KisTi). Dichotomous variables were pooled using the risk ratio, and continuous variables were pooled using the mean difference (MD). RESULTS: The present study found that the RS group had a shorter time to resumption of a regular diet (MD, -0.62 days; 95% CI, -0.97 to -0.28), first passage of flatus (MD, -0.44 days; 95% CI, -0.66 to -0.23) and defecation (MD, -0.62 days; 95% CI, -0.77 to -0.47). Also, RS was associated with a shorter hospital stay (MD, -0.69 days; 95% CI, -1.12 to -0.26), a lower estimated blood loss (MD, -19.49 mL; 95% CI, -27.10 to -11.89) and a longer proximal margin (MD, 2.29 cm; 95% CI, 1.11-3.47). However, RS was associated with a longer surgery time (MD, 51.00 minutes; 95% CI, 39.38-62.62). CONCLUSION: We found that the potential benefits of perioperative and short-term outcomes for RS than for CLS. For a more accurate understanding of RS for colonic cancer patients, robust comparative studies and randomized clinical trials are required.
Colon* ; Colonic Neoplasms* ; Defecation ; Diet ; Flatulence ; Humans ; Laparoscopy* ; Length of Stay ; Odds Ratio ; Robotic Surgical Procedures

Background: Delayed emergence after general anesthesia may significantly affect a patient’s condition. We present the case of a patient who experienced prolonged delayed recovery of consciousness, language, and motor response due to catatonia after eight hours of total elbow arthroplasty under general anesthesia.Case: A 68-year-old woman with neuropsychiatric disorders and Parkinson’s disease did not respond adequately during recovery after more than eight hours of general anesthesia. Following the operation, the patient was semi-comatose and appeared to have nonconvulsive status epilepticus upon awakening from anesthesia. However, subsequent examinations did not reveal any organic causes. The patient was subsequently diagnosed with catatonia, treated, and discharged following gradual improvement. Conclusions Although rare, patients taking psychiatric drugs for an extended period may experience delayed emergence after prolonged general anesthesia without identifiable causes. Catatonia should be considered in the differential diagnoses of these patients.

Objective: To develop and validate a model using radiomics features from apparent diffusion coefficient (ADC) map to diagnose local tumor recurrence in head and neck squamous cell carcinoma (HNSCC). Materials and Methods: This retrospective study included 285 patients (mean age ± standard deviation, 62 ± 12 years; 220 male, 77.2%), including 215 for training (n = 161) and internal validation (n = 54) and 70 others for external validation, with newly developed contrast-enhancing lesions at the primary cancer site on the surveillance MRI following definitive treatment of HNSCC between January 2014 and October 2019. Of the 215 and 70 patients, 127 and 34, respectively, had local tumor recurrence. Radiomics models using radiomics scores were created separately for T2-weighted imaging (T2WI), contrast-enhanced T1-weighted imaging (CE-T1WI), and ADC maps using non-zero coefficients from the least absolute shrinkage and selection operator in the training set. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of each radiomics score and known clinical parameter (age, sex, and clinical stage) in the internal and external validation sets. Results: Five radiomics features from T2WI, six from CE-T1WI, and nine from ADC maps were selected and used to develop the respective radiomics models. The area under ROC curve (AUROC) of ADC radiomics score was 0.76 (95% confidence interval [CI], 0.62–0.89) and 0.77 (95% CI, 0.65–0.88) in the internal and external validation sets, respectively. These were significantly higher than the AUROC values of T2WI (0.53 [95% CI, 0.40–0.67], p = 0.006), CE-T1WI (0.53 [95% CI, 0.40– 0.67], p = 0.012), and clinical parameters (0.53 [95% CI, 0.39–0.67], p = 0.021) in the external validation set. Conclusion The radiomics model using ADC maps exhibited higher diagnostic performance than those of the radiomics models using T2WI or CE-T1WI and clinical parameters in the diagnosis of local tumor recurrence in HNSCC following definitive treatment.