Functional aphonia is a disease in which normal vocal ability is suddenly lost. When voice therapy is started at an early stage, the prognosis is good. However, if the functional aphonia persists for a long time, there is a possibility that the voice disorder may become fixed, though reports of these characteristics are rare. The authors experienced a patient with functional aphonia that occurred in adolescence and lasted for 7 months and reported the result of treatment.

Background: and PurposeThe correlation between dopamine transporter (DAT) imaging and neuromelanin-sensitive magnetic resonance imaging (NM-MRI) in early-stage Parkinson’s disease (PD) has not yet been established. This study aimed to determine the correlation between NM-MRI and DAT positron-emission tomography (PET) in patients with early-stage PD. Methods: Fifty drug-naïve patients with early-stage PD who underwent both 0.8-mm isovoxel NM-MRI and DAT PET were enrolled retrospectively. Using four regions of interest (nigrosome 1 and nigrosome 2 [N1 and N2] regions) from a previous study, the contrast ratios (CRs) of 12 regions were measured: N1, N2, flipped N1, flipped N2, combined N1 and N2, and whole substantia nigra pars compacta [SNpc] (all on both sides). The clinically more affected side was separately assessed. The standardized uptake value ratios (SUVRs) were measured in the striatum using DAT PET. A partial correlation analysis was performed between the SUVR and CR measurements. Results: CR of the flipped left N1 region was significantly correlated with SUVR of the right posterior putamen (p=0.047), and CR values of the left N1 region, left N2 region, flipped right N1 region, and combined left N1 and N2 regions were significantly correlated with SUVR of the left posterior putamen (p=0.011, 0.038, 0.020, and 0.010, respectively). SUVR of the left anterior putamen was significantly correlated with CR of the left N2 region (p=0.027). On the clinically more affected side, the CR values of the N1 region, combined N1 and N2 regions, and the whole SNpc were significantly correlated with SUVR of the posterior putamen (p=0.001, 0.024, and 0.021, respectively). There were significant correlations between the SUVR of the anterior putamen and the CR values of the N1 region, combined N1 and N2 regions, and whole SNpc (p=0.027, 0.001, and 0.036, respectively). Conclusions This study found that there were significant correlations between CR values in the SNpc on NM-MRI and striatal SUVR values on DAT PET on both sides in early-stage PD.

A granular cell tumor (GCT) is an uncommon mesenchymal lesion that rarely occurs in the colon and the rectum. We describe the case of 51-year-old man with a 2-cm-sized rectal GCT 10 cm above the anal verge that was incidentally detected after a screening colonoscopy. Preoperative radiologic studies demonstrated a suspicious submucosal rectal mass with mesorectal fat infiltration, but without circumferential resection margin threatening, extramural vessel invasion, and regional lymph-node enlargement. The tumor was resected by using a transanal endoscopic operation (TEO) without immediate postoperative complications. The final pathology revealed that the tumor consisted of a GCT that had invaded the subserosa with clear margins. It had no other risk factors for malignancy according to Fanburg-Smith criteria. We systematically reviewed the English literature by using PubMed and Google Scholar. This report may be the first documented case in the literature to describe a TEO for a GCT that had invaded the subserosa in the rectum.
Colon ; Colonoscopy ; Gastrointestinal Tract ; Granular Cell Tumor* ; Humans ; Mass Screening ; Middle Aged ; Pathology ; Postoperative Complications ; Rectum* ; Risk Factors

Cowden's disease (CD) is rare multiple hamartoma-neoplasia syndrome. Lhermitte-Duclos disease (LDD) is well known to be a hamartoma of the cerebellum. CD may be accompanied with LDD and other multiple systemic neoplasias. We report here on a case of CD-LDD complex with multiple systemic neoplasia.
Brain ; Cerebellum ; Hamartoma ; Hamartoma Syndrome, Multiple*

This study was designed to investigate the stress distribution of alveolar bone in case of en masse retraction with lingual K-loop archwire using the 3-dimensional photoelastic stress analysis followed by stress freezing process. Lingual K-loop archwire which had loop in 15mm height was used and activated by retraction force of 350gm per each side. The results were as follows: 1. Central incisor: As the closer side to crown, the larger tensile stress was distributed at both mesial and labial surfaces and the larger compressive stress was distributed at distal surface. As the closer side to root apex, the larger compressive stress was distributed at lingual surface. The compressive stress was distributed at root apex. 2. Lateral incisor: The tensile stress was distributed at the coronal side of mesial surface. The compressive stress was distributed at distal surface. As the closer side to crown, the larger tensile stress was distributed at labial surface. The tensile stress was distributed at coronal side and the compressive stress was distributed at apical side of lingual surface. The compressive stress was distributed at root apex. 3. Canine: The tensile stress was distributed at coronal side and the compressive stress was distributed at apical side of mesial surface. The tensile stress was distributed at distal surface. As the closer side to crown, the larger tensile stress was distributed at both mesial and distal surfaces. The compressive stress was distributed at root apex. 4. Second premolar: The tensile stress was distributed at mesial surface. The compressive stress was distributed at coronal side and the tensile stress was distributed at apical side of distal surface. The compressive stress was distributed at coronal side of buccal surface. As the closer side to crown, the larger tensile stress was distributed at lingual surface. The compressive stress was distributed at root apex. 5. First molar: As the closer side to crown, the larger tensile stress was distributed at both mesial and distal surfaces. No stress was distributed at buccal surface and palatal root apex. As the closer side to crown, the larger tensile stress was distributed at both lingual surfaces. The compressive stress was distributed at buccal root apexes. 6. Second molar: The compressive stress was distributed at all root apexes. As the closer side to crown, the larger compressive stress was distributed at both mesial and lingual surfaces, and the larger tensile stress at both distal and buccal surfaces. Transverse bowing effect was observed in en-masse retraction with lingual K-loop archwire, however vertical bowing effect was not. Rather, reverse vertical bowing effect was developed.
Bicuspid ; Crowns ; Freezing ; Incisor ; Molar

Inverted nipple presents both cosmetic and functional problems. Various surgical treatments have been introduced to correct the deformity, but frequently ended up with recurrences. To reduce the recurrence rate, stable suspension is required during wound healing period after surgical correction. Authors present a new suspension device using a biopsy bottle. To apply this device, first of all, the retracted nipple is held with 2 traction sutures using 4-0 nylon, and then the surgical correction is performed. After the correction is completed, the traction sutures are tied to bottom of biopsy bottle through the previously prepared holes. The biopsy bottle covers areolar and nipples complex with suspension of traction sutures. The suspension goes on for 1 week. From August of 1997 to December of 2002, we corrected inverted nipples in 75 patients. After operation, we applied these devices to all nipples for suspension. 54 cases of corrected nipples in 58 cases, which could be followed up, were kept corrected for more than 6 months. The authors feel that this idea is not only useful but also provides a simple, economical and efficient to suspend nipple after surgery.
Biopsy* ; Congenital Abnormalities ; Humans ; Nipples* ; Nylons ; Recurrence ; Sutures ; Traction ; Wound Healing

Purpose: This study aimed to determine whether limited T2-weighted-only lumbar spine MRI is clinically available to patients visiting pain intervention clinic for radicular pain. Materials and Methods: A total of 110 patients (mean age: 63.5 ± 16.1 years) with low back pain (LBP) or sciatica who underwent limited T2-weighted-only lumbar MRI using T2-weighted sagittal and axial sequences were enrolled. All MRI scans were reviewed by two radiologists for degenerative spinal lesions that most correlated with each patient’s symptoms. All patients received spinal injections. Treatment response was recorded based on patients’ subjective evaluations and an 11-point numerical rating scale. Clinical characteristics and changes in the diagnosis of patients who had undergone previous MRI or additional MRI within six months were also analyzed. Results: Using limited T2-weighted-only lumbar spine MRI, acquisition time and cost for imaging examinations were effectively reduced. Pathologic lesions corresponding to clinical symptoms were detected in most (95%) patients. Symptoms had improved in 78.1% of patients at the 6-month follow-up. Further imaging work-up was not performed for any subject during the study period because there was clear indication (no doubt) for other diagnoses on the limited T2-weighted-only lumbar spine MRI or during the clinical follow-up. Conclusion Limited T2-weighted-only lumbar spine MRI comprising T2-weighted sagittal and axial images may sufficiently detect degenerative changes of the lumbar spine in patients with LBP and sciatica. Treatment responses are satisfactory, effectively reducing scan time and costs.

Purpose: Intracorporeal anastomosis (IA) in laparoscopic right hemicolectomy has been associated with faster recovery in bowel function compared to extracorporeal anastomosis (EA). However, the technical difficulty of laparoscopic suturing technique and intraabdominal fecal contamination hinder many surgeons from implementing such a procedure. We introduce and compare a bridging technique designated as “semi-extracorporeal” anastomosis (SEA), which embraces the advantages and amends the drawbacks of IA and EA. Methods: Between May 2016 and October 2022, 100 patients who underwent laparoscopic right hemicolectomy were analyzed. All patients who received laparoscopic right hemicolectomy underwent one of the 3 anastomosis methods (EA, SEA, and IA) by a single colorectal surgeon at a single tertiary care hospital. Data including perioperative parameters and postoperative outcomes were analyzed by each group. Results: A total of 100 patients were reviewed. Thirty patients underwent EA; 50 and 20 patients underwent SEA and IA, respectively. Operation time (minute) was 170 (range, 100–285), 170 (range, 110–280), and 147.5 (range, 80–235) in EA, SEA, and IA, respectively (P = 0.010). Wound size was smaller in SEA and IA compared to EA (P < 0.001). IA was associated with a shorter time (day) to first flatus compared to SEA and EA (4 [range, 2–13] vs. 4 [range, 2–7] vs. 2.5 [range, 1–4], P < 0.001).Postoperative complication showed no statistical significance between the 3 groups. Conclusion Semi-extracorporeal was an attractive bridging option for colorectal surgeons worrisome of the technical difficulty of IA while maintaining faster bowel recovery and smaller wound incisions compared to EA.

PURPOSE: The purpose of this study is to analyze the incidence and causes of false-positive intracranial aneurysms on MR angiography (MRA). MATERIALS AND METHODS: We retrospectively evaluated 210 cases that were incidentally diagnosed as intracranial aneurysms on MRA. All the cases were confirmed by CT angiography (CTA) or digital subtraction angiography (DSA). We investigated the incidence, location, size, and causes of the false-positive aneurysms on MRA. RESULTS: Of 210 cases, 28 cases were confirmed as false-positive aneurysms. Most of the lesions were located on the middle cerebral artery (n = 9, 7 lesions located in the bifurcation and 2 lesions located in the trunk) and the anterior communicating artery (n = 5). The diameters of most of the lesions (78.6%) were smaller than 3 mm. Causes were junctional dilatation (n = 14), vascular tortuosity (n = 6), normal variation (n = 3) and unknown causes (n = 3). CONCLUSION: Understanding the risks and pitfalls of false-positive intracranial aneurysms determined on MRA would be helpful for improving the diagnostic accuracy of screening MRA and for reducing the number of unnecessary invasive examinations.
Aneurysm ; Angiography* ; Angiography, Digital Subtraction ; Arteries ; Dilatation ; False Positive Reactions ; Incidence* ; Intracranial Aneurysm* ; Magnetic Resonance Angiography ; Mass Screening ; Middle Cerebral Artery ; Retrospective Studies

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.