Dislocation of the temporomandibular joint(TMJ) is fairly frequent but backward dislocation of TMJ during induction of anesthesia is rarely reported. The causes include congenital weakness of the capsule or malformation of the condyles of both. The physical causes are as follows ; The joint may be strained or injured during general anesthesia, 1) possible straing or injureyto the joint, 2) yawning, 3) attempts by children to insert large objects into the mouth, 4) and positional pressures during sleep. Acase of backward dislocation of TMJ occureed during induction of anesthesia and treated with nanual reduction and subsequent intermaxillary fixation.
Anesthesia* ; Anesthesia, General ; Child ; Dislocations* ; Humans ; Joints ; Mouth ; Temporomandibular Joint* ; Yawning

Background: Current guidelines recommend using nirmatrelvir-ritonavir for coronavirus disease 2019 (COVID-19) treatment, but its potential drug interactions and contraindications limit its applicability in certain categories of patients. The aim of the study was to evaluate the real-world effectiveness of molnupiravir and nirmatrelvir-ritonavir in managing COVID-19 among hospitalized patients. Methods: We conducted a retrospective cohort study among hospitalized COVID-19 patients who received molnupiravir or nirmatrelvir-ritonavir and did not require baseline supplemental oxygen from February 2022 to January 2023. We compared the effectiveness of molnupiravir and nirmatrelvir-ritonavir with a focus on disease progression. Results: The study included 401 high-risk, hospitalized adult COVID-19 patients who received molnupiravir or nirmatrelvir-ritonavir. No significant difference was found in disease progression, the composite outcome of disease progression (4.0% vs. 1.4%, P = 0.782), and O2 supplementation via nasal prong (21.8% vs. 14.8%, P = 0.115) between the patients treated with molnupiravir and those treated with nirmatrelvir-ritonavir. This finding was similar after 1:1 propensity-score matching. In the multivariate analysis, molnupiravir treatment was not significantly associated with progression to severe disease. Conclusion In conclusion, our findings suggest that similar to nirmatrelvir-ritonavir, molnupiravir has a distinct potential role in COVID-19 treatment, transcending its current perceived status as only a secondary option.

Primary aldosteronism, is defined as a group of disorders characterized by the excess of aldosteron, with suppressed rennin activity, resulting in hypertension and hypokalemia. In most cases, primary aldosteronism is sporadic due to a unilateral adrenal adenoma or bilateral adrenal hyperplasia. Familial hyperaldosteronism is a rare cause of primary aldosteronism and its prevalence has not been established well. We describe two cases of primary aldosteronism in a family involving a sister and brother due to an aldosterone producing adenoma in the left adrenal gland. Their hypokalemia and hypertension were cured by complete resection of the adrenal adenoma. Genetic analyses could not be done because of patients' rejection.
Adenoma ; Adrenal Glands ; Adrenocortical Adenoma ; Aldosterone ; Chymosin ; Humans ; Hyperaldosteronism ; Hyperplasia ; Hypertension ; Hypokalemia ; Prevalence ; Rejection (Psychology) ; Siblings

Many fungi including Penicillium, Aspergillus, Gliocladium, and Thermoascus produce an epipolythiodioxopiperazine class of fungal metabolite, gliotoxin, which contirbutes the pathogenesis of fungal infection as an immunomodulator and cytotoxic agent. This study is designed to define the mechanism by which gliotoxin exerts the cytotoxic effect of gliotoxin on human promyelocytic leukemic cells, HL-60. Gliotoxin induces the apoptosis of HL-60 cells which is characterized by the ladder pattern fragmentation of DNA. Gliotoxin induces the activation of DEVD-specific cysteine protease in a time- and dose-dependent rnanner. It also increases the phosphotransferase activities of c-Jun N-terminal kinase1 (JNK1) and p38 in gliotoxin-treated HL-60 cells. Furthermore, gliotoxin decreases the activation of transcriptional activator, actiating protein (AP-1) and NF-kB. These results suggest that gliotoxin induces the apoptotic death of HL-60 cells via activation of DEVD- specific caspase as well as mitogen activated protein kinases (MAP kinases) including JNK1 and p38, and inhibition of transcriptional activators, AP-1 and NF-kB.
Apoptosis* ; Aspergillus ; Caspase 3 ; Cysteine Proteases ; DNA ; Fungi ; Gliocladium ; Gliotoxin* ; HL-60 Cells* ; Humans ; Mitogen-Activated Protein Kinases ; NF-kappa B ; Penicillium ; Thermoascus ; Transcription Factor AP-1 ; Transcription Factors

The authors report a case of posterior fossa dural arteriovenous malformation with increased intracranial pressure. It was fed left occipital artery, posterior auricular artery, posterior meningeal branch of vertebral artery, and meningohypophyseal artery of left internal carotid artery. Treatment has been tried with transcatheter embolization using gelfoam and ivalon, intracranial clipping of feeders, ligation of external carotid artery, and radiation therapy. The unusual clinical manifestations such as visual disturbance and hearing impairment are discussed.
Arteries ; Arteriovenous Malformations* ; Carotid Artery, External ; Carotid Artery, Internal ; Gelatin Sponge, Absorbable ; Hearing Loss ; Intracranial Pressure ; Ligation ; Vertebral Artery

. This study aims to compare the marginal fitness of two types of implant-supported fixed dental prosthesis, i.e., cementless fixation (CL.F) system and cement-retained type. MATERIALS AND METHODS. In each group, ten specimens were assessed. Each specimen comprised implant lab analog, titanium abutment fabricated with a 2-degree tapered axial wall, and zirconia crown. The crown of the CL.F system was retained by frictional force between abutment and relined composite resin. In the cement-retained type, zinc oxide eugenolcement was used to set crown and abutment. All specimens were sterilized with ethylene oxide, immersed in Prevotella intermedia culture in a 50 mL tube, and incubated with rotation. After 48 h, the specimens were washed thoroughly before separating the crown and abutment. The bacteria that penetrated into the crownabutment interface were collected by washing with 500 μL of sterile saline. The bacterial cell number was quantified using the agar plate count technique. The BacTiter-Glo Microbial Cell Viability Assay Kit was used tomeasure bacterial adenosine triphosphate (ATP)-bioluminescence, which reflects the bacterial viability. The t-test was performed, and the significance level was set at 5%. RESULTS. The number of penetrating bacterial cells assessed by colony-forming units was approximately 33% lower in the CL.F system than in the cement-retained type (P<.05). ATP-bioluminescence was approximately 41% lower in the CL.F system than in the cementretained type (P<.05). CONCLUSION. The CL.F system is more resistant to bacterial penetration into theabutment-crown interface than the cement-retained type, thereby indicating a precise marginal fit.

We experienced a case of secondary renal amyloidosis diagnosed by renal biopsy in a patient who had been diagnosed as RA two years ago. A 62-year old man was admitted to neurology departement because of right hemiplegia. During conservative care at neurology department, he was consulted to us because of aggravated generalized edema and proteinuria. He was diagnosed as rheumatoid arthritis and ulcerative colitis two years ago, and then he had taken prednisolone, methotrexate, mesalazine regularly. At physical examination, there was no abnormal finding except pretibial pitting edema and right hemiplegia. In urinalysis, specific gravity was 1.025, pH was 5.5, protein was 4+ and RBC 0-1/ HPF and WBC 0-1/HPF. Total protein of 24 hour's urine was 5.5 g/day. The blood BUN and creatinine level were 16.4 mg/dL, 0.4 mg/dL and cholesterol level were 154 mg/dL, total protein and albumin were 4.4 g/dL and 1.9 g/dL. Serum RA factor and CRP showed high level as 94.90 IU/mL and 118.00 mg/L. On urine electrophoresis, albuminuria was dominant but M-spike was not founded. On urinalysis taken at the time of first diagnosis of rheumatoid arthritis two years ago, proteinuria was negative and serum albumin levels was 3.6 g/dL. At that time, there was no evidence of nephropathy. In renal biopsy, electron microscope showed heavy nonbranching amyloid fibrils accumulated in mesangium and polarized light microscopy after Congo-red staining revealed apple-green birefringent amyloid deposits in glomeruli and blood. So we diagnosed renal amyloidosis associated with RA.
Albuminuria ; Amyloid ; Amyloidosis* ; Arthritis, Rheumatoid* ; Biopsy ; Cholesterol ; Colitis, Ulcerative ; Creatinine ; Diagnosis ; Edema ; Electrophoresis ; Hemiplegia ; Humans ; Hydrogen-Ion Concentration ; Mesalamine ; Methotrexate ; Microscopy, Polarization ; Middle Aged ; Neurology ; Physical Examination ; Plaque, Amyloid ; Prednisolone ; Proteinuria ; Serum Albumin ; Specific Gravity ; Urinalysis

5-Aminosalicylate agents are the main therapeutic agents for ulcerative colitis. Balsalazide is a prodrug of 5-aminosalicylate and has fewer side effects than the other 5-aminosalicylate agents. Pulmonary complications resembling granulomatosis with polyangiitis in ulcerative colitis are extremely rare. Here, we report a patient with ulcerative colitis on balsalazide presenting respiratory symptoms and multiple pulmonary nodules from a chest radiography that was pathologically diagnosed with a limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant. To our knowledge, this is the first report of a balsalazide-induced limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant.
Bronchiolitis ; Bronchiolitis Obliterans ; Colitis, Ulcerative ; Humans ; Mesalamine ; Multiple Pulmonary Nodules ; Phenylhydrazines ; Thorax ; Ulcer ; Wegener Granulomatosis

Primary liver cancer has traditionally been classified as either hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCC). However, primary liver cancer occasionally consists of elements from both HCC and CCC. Intermediate hepatic carcinoma and primary liver cancer of the intermediate type are extremely rare subtypes of primary liver cancer that show features intermediate between HCC and CCC. First reported in 1998, the clinical, radiologic, and histopathologic characteristics of this entity remain unclear. In this case report, we describe the clinical, magnetic resonance imaging, histopathological, and immunohistochemical findings in a patient with intermediate hepatic carcinoma who was initially thought to have intrahepatic cholangiocarcinoma.
Carcinoma, Hepatocellular ; Chlormequat ; Cholangiocarcinoma ; Humans ; Liver Neoplasms ; Magnetic Resonance Imaging

BACKGROUND/AIMS: The eradication rate of the first-line triple therapy (a proton pump inhibitor, clarithromycin, and amoxicillin) for Helicobacter pylori infection has gradually decreased in Korea. We evaluated whether clinical parameters, clarithromycin resistance, and CYP2C19 genotype can affect the eradication failure. METHODS: A total of 203 patients with H. pylori-positive chronic gastritis were consecutively enrolled. They received clarithromycin-based triple therapy for 7 days. A clarithromycin resistance test was performed by detection of A2142G and A2143G point mutations in H. pylori 23S rRNA. The CYP2C19 genotype was examined for polymorphism G681A of exon 5 and G636A of exon 4 by polymerase chain reaction with restriction fragment length polymorphism. Eradication was assessed by a ¹³C-urea breath test 4 weeks after treatment. RESULTS: Of 203 patients, 190 completed the study. The eradication rate was 64.0% according to intention-to-treat analysis and 68.4% by per-protocol analysis. CYP2C19 genotypes were identified as follows: 75 poor metabolizers, 75 intermediate metabolizers, and 40 rapid metabolizers. Nonetheless, this polymorphism was not significantly associated with eradication failure (p = 0.682). Clarithromycin resistance was detected in 33/190 patients (17.4%), and their eradication rate was zero. Clarithromycin resistance (odds ratio [OR], 19.13; 95% confidence interval [CI], 9.35 to 35.09) and female gender (OR, 1.73; 95% CI, 1.15 to 4.25) were significantly associated with eradication failure. The other clinical parameters such as age, cigarette smoking, alcohol intake, the body mass index, hypertension, and diabetes were not significantly associated with eradication. CONCLUSIONS Clarithromycin resistance and female gender are factors affecting H. pylori eradication failure in patients with chronic gastritis.