With the growth of the population of older adults, cement-augmented pedicle screws (CAPS) have become more commonly employed. Although CAPS are considered safe, cement leakage can occur, leading to complications. Neurological symptoms resulting from bone cement leakage pose significant challenges in both diagnosis and treatment. Unilateral biportal endoscopy (UBE) offers a minimally invasive solution for these issues. UBE enables a thorough exploration of potential compression sites, allowing precise visualization of the entire nerve roots without necessitating removal of the instrument or compromising spinal stability. Additionally, it facilitates the removal of cement fragments under direct vision. Herein, we present the case of an 84-year-old female patient who underwent endoscopic interbody fusion of L4–5. After surgery, she presented with radiating pain in the right lower extremity. Postoperative magnetic resonance imaging indicated indirect evidence of cement leakage under the right L5 pedicle screw. The patient underwent UBE exploration under spinal anesthesia. During the procedure, the cement fragment was detected and removed without complication. UBE can also be performed under local or regional anesthesia, significantly reducing the anesthetic risk for medically fragile individuals. Using UBE, it is also possible to monitor neurological function while manipulating the neural tissue. UBE is a viable option for both the diagnosis and treatment of cement leakage following CAPS placement.

Objective: With advances in endoscopic surgery, L5–S1 foraminotomy has become a readily accessible surgical technique. However, symptom relief is often short-lived, and recurrence is common. As an alternative, biportal endoscopic fusion at L5–S1 can improve symptoms. However, it can be challenging and may lead to fusion-related complications. Therefore, we aimed to compare 2 procedures for L5–S1 foraminal stenosis. Methods: A total of 37 patients diagnosed with L5–S1 foraminal stenosis were divided into 2 groups for this study. Group 1, comprising 18 patients, underwent L5–S1 foraminotomy via a paraspinal approach from 2017 to 2019. Group 2, comprising 19 patients, underwent biportal endoscopic L5–S1 fusion with the facet-sacrificing approach from January 2021 to August 2023. A comprehensive evaluation of both groups was conducted using various metrics, including image findings, operation time, hospital stay, visual analogue score (VAS) back, VAS leg, Oswestry Disability Index (ODI), and the MacNab criteria. Postsurgical complications were meticulously recorded. The statistical analysis was performed using the Wilcoxon signed-rank test, and differences between the 2 surgical approaches were assessed using the Mann-Whitney U-test. Results: No statistically significant difference was found in VAS back or ODI improvement between the 2 groups. However, the foraminotomy group exhibited a statistically significant advantage in terms of operation time and hospital stay. Conversely, the fusion group demonstrated statistically significant improvements in VAS leg and McNab criteria in comparison to the foraminotomy group. The most prevalent complication observed in the foraminotomy group was early symptom recurrence, while the fusion group experienced complications related to screw-related issues and infections. Conclusion Leg symptoms recurred more frequently in the foraminotomy group. Biportal endoscopic facet-sacrificing transforaminal lumbar interbody fusion surgery has been demonstrated to be a valuable technique for L5–S1 fusion with lower recurrence of leg symptoms; however, it is associated with complications specific to fusion.

Fungal sinusitis is relatively rare, but it has become more common in recent years. When fungal sinusitis invades the orbit, it can cause proptosis, chemosis, ophthalmoplegia, retroorbital pain, and vision impairment. We present a case of an extensive orbital floor defect due to invasive fungal sinusitis. A 62-year-old man with hypertension and a history of lung adenocarcinoma, presented with right-side facial pain and swelling. On admission, the serum glucose level was 347 mg/dL, and hemoglobin A1c was 11.4%. A computed tomography scan and a Waters’ view X-ray showed right maxillary sinusitis with an orbital floor defect. On hospital day 3, functional endoscopic sinus surgery was performed by the otorhinolaryngology team, and an aspergilloma in necrotic inflammatory exudate obtained during exploration. On hospital day 7, orbital floor reconstruction with a Medpor Titan surgical implant was done. In principle, the management of invasive sino- orbital fungal infection often begins with surgical debridement and local irrigation with an antifungal agent. Exceptionally, in this case, debridement and immediate orbital floor reconstruction were performed to prevent enophthalmos caused by the extensive orbital floor defect. The patient underwent orbital floor reconstruction and received intravenous and oral voriconazole. Despite orbital invasion, there were no ophthalmic symptoms or sequelae.

Objective: The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology. Methods: Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs: bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal–Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups. Results: Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR. Conclusions The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

Objective: The purpose of this study was to evaluate the relationship between rotational disk displacement (DD) of the temporomandibular joint (TMJ) and the dentoskeletal morphology. Methods: Women aged > 17 years were included in this study. Each subject had a primary complaint of malocclusion and underwent routine cephalometric examinations. They were divided into five groups according to the findings on sagittal and coronal magnetic resonance images of their TMJs: bilateral normal disk position, bilateral anterior DD with reduction (ADDR), bilateral rotational DD with reduction (RDDR), bilateral anterior DD without reduction (ADDNR), and bilateral rotational DD without reduction (RDDNR). Twenty-three cephalometric variables were analyzed, and the Kruskal–Wallis test was used to evaluate differences in the dentoskeletal morphology among the five groups. Results: Patients with TMJ DD exhibited a hyperdivergent pattern with a retrognathic mandible, unlike those with a normal disk position. These specific skeletal characteristics were more severe in patients exhibiting DD without reduction than in those with reduction, regardless of the presence of rotational DD. Rotational DD significantly influenced horizontal and vertical skeletal patterns only in the stage of DD with reduction, and the mandible exhibited a more backward position and rotation in patients with RDDR than in those with ADDR. However, there were no significant dentoskeletal differences between ADDNR and RDDNR. Conclusions The results of this study suggest that rotational DD of TMJ plays an important role in the dentoskeletal morphology, particularly in patients showing DD with reduction.

Objective: This aim examined the outcomes of resuscitation and the clinical characteristics of patients with pre-hospitaltraumatic cardiac arrests (TCA). Methods: The charts of patients with pre-hospital TCA who visited the various emergency department (ED) in Gangwondofrom January 2013 to December 2017 were reviewed retrospectively. Results: TCA patients comprised 0.3% of patients transferred by 119. A total of 367 patients were enrolled in the study.Traffic accidents were the leading cause of the arrest. The initial field and ED rhythm were mostly asystole (field, 79.6%;ED, 82.3%). It took 11.24±9.95 minutes from the call to the field. From the field to ED, it took 22.87±15.37 minutes. Thetotal CPR time before ED arrival was 21.62±15.29 minutes. The causes of TCA were brain injury (35.7%), hypovolemicshock (29.2%), and severe lung injury (16.3%). Seventy TCA patients experienced at least one return of spontaneous circulation(ROSC). Twenty-six patients (7.14%) were admitted to the ward, and their average injury severity score was38.96. Eight patients expired before 12 hours after transient ROSC. Four more patients expired before 24 hours. Fourpatients were discharged alive among patients who lived for more than 24 hours. Conclusion In this study, 1.5% of patients were discharged alive. The possibility of ROSC was higher as the time to ED,and the cardiopulmonary resuscitation time of 119 was shorter. Pulseless electrical activity rather than asystole tends topromote ROSC. The survival rate increased when ROSC occurred before arriving at the ED.

BACKGROUND: The objective of this study was to compare the impact of citrate dialysate (CD) and standard acetate dialysate (AD) in hemodialysis by central delivery system (CDS) on heparin demand, and clinical parameters. METHODS: We retrospectively evaluated 75 patients on maintenance hemodialysis with CDS. Patients underwent hemodialysis with AD over a six-month period (AD period), followed by another six-month period using CD (CD period). Various parameters including mean heparin dosage, high sensitivity C-reactive protein (hsCRP), calcium-phosphate product (CaxP), intact parathyroid hormone (iPTH), and urea reduction ratio (URR) were collated at the end of each period. RESULTS: Patients were 60.5 ± 14.7 years old, of whom 62.7% were male. Patients required less heparin when receiving CD (AD period: 1,129 ± 1,033 IU/session vs. CD period: 787 ± 755 IU/session, P < 0.001). After the CD period (Δ(CD)), pre-dialysis total CO₂ increased to 1.21 ± 2.80 mmol/L, compared to −2.44 ± 2.96 mmol/L (P < 0.001) after the AD period (Δ(AD)). After the CD period, concentrations of iPTH (Δ(AD): 73.04 ± 216.34 pg/mL vs. Δ(CD): −106.66 ± 251.79 pg/mL, P < 0.001) and CaxP (Δ(AD): 4.32 ± 16.63 mg²/dL² vs. Δ(CD): −4.67 ± 15.27 mg²/dL², P = 0.015) decreased. While hsCRP levels decreased after the CD period (Δ(AD): 0.07 ± 4.09 mg/L vs. Δ(CD): −0.75 ± 4.56 mg/L, P = 0.705), the change was statistically insignificant. URR remained above clinical guideline of 65% after both periods (Δ(AD): 72.33 ± 6.92% vs. Δ(CD) period: 69.20 ± 4.49%, P = 0.046). CONCLUSION: Our study confirmed that the use of CD in CDS required lower heparin doses compared to the use of AD. The use of CD also provided a more stable acid-base status.
Acetates ; C-Reactive Protein ; Citric Acid ; Heparin ; Humans ; Male ; Parathyroid Hormone ; Renal Dialysis ; Retrospective Studies ; Urea

Secretory carcinoma of the breast is an extremely rare, clinically and histologically distinct variant of invasive ductal carcinoma, with an indolent growth pattern and a more favorable prognosis than that of typical ductal carcinoma. Few studies have described its imaging features. Herein, we report on a secretory breast carcinoma with findings from various imaging modalities, especially including the MRI findings, which appears a well-defined complex cystic mass. Awareness of its imaging features using various modalities will be helpful for the differential diagnosis.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a potential cause of hyponatremia of the central nervous system (CNS). Although SIADH has been reported to be associated with many other central nervous disorders, its association with neuromyelitis optica (NMO) or NMO spectrum disorders are rare. NMO is a demyelinating disorder characterized by optic neuritis and transverse myelitis. Aquaporin-4 (AQP4), which is the target antigen for a NMO autoantibody, is the predominant CNS water channel. However, some NMO patients show seronegative AQP4 antibody results. The spectrum of NMO has been changed, and new findings about the disease have been reported. Here, we report a case of seronegative NMO spectrum disorder associated with SIADH.
Central Nervous System ; Demyelinating Diseases ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis ; Water

Primary Sjögren's syndrome (pSS) is characterized by lymphocytic infiltration of the exocrine glands resulting in decreased saliva and tear production. It uncommonly involves the kidneys in various forms, including tubulointerstitial nephritis, renal tubular acidosis, Fanconi syndrome, and rarely glomerulonephritis. Its clinical symptoms include muscle weakness, periodic paralysis, and bone pain due to metabolic acidosis and electrolyte imbalance. Herein, we describe the cases of two women with pSS whose presenting symptoms involve the kidneys. They had hypokalemia and normal anion gap metabolic acidosis due to distal renal tubular acidosis and positive anti-SS-A and anti-SS-B autoantibodies. Since one of them experienced femoral fracture due to osteomalacia secondary to renal tubular acidosis, an earlier diagnosis of pSS is important in preventing serious complications.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Renal Tubular* ; Autoantibodies ; Diagnosis ; Exocrine Glands ; Fanconi Syndrome ; Female ; Femoral Fractures ; Glomerulonephritis ; Humans ; Hypokalemia ; Kidney ; Muscle Weakness ; Nephritis, Interstitial ; Osteomalacia ; Paralysis ; Saliva ; Tears