Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.

BACKGROUND: The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. METHODS: A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015. The prior breast reconstruction methods were latissimus dorsi (LD) flap (28 cases), transverse rectus abdominis myocutaneous (TRAM) flap (10 cases), or tissue expander/implant (12 cases). The nipple reconstruction technique involved the use of local flaps, including the C-V flap or star flap. A 1×2-cm acellular dermal matrix was placed into the core with O-, I-, and L-shaped struts for prior LD, TRAM, and expander/implant methods, respectively. The projection of the reconstructed nipple was measured at the time of surgery and at 3, 6, and 9 months postoperatively. RESULTS: The nine-month average maintenance of nipple projection was 73.0%±9.67% for the LD flap group using an O-strut, 72.0%±11.53% for the TRAM flap group using an I-strut, and 69.0%±10.82% for the tissue expander/implant group using an L-strut. There were no cases of infection, wound dehiscence, or flap necrosis. CONCLUSIONS: The application of an acellular dermal matrix with a different kind of strut for each of 3 breast reconstruction methods is an effective addition to current techniques for improving the maintenance of long-term projection in primary nipple reconstruction.
Acellular Dermis* ; Breast* ; Female ; Mammaplasty* ; Methods* ; Necrosis ; Nipples* ; Rectus Abdominis ; Superficial Back Muscles ; Wound Infection

Ginsenosides are the major components of ginseng, which is known to modulate blood pressure, metabolism, and immune function, and has been used to treat various diseases. It has been reported that ginseng and several ginsenosides have immunoregulatory effects on the innate and T cell-mediated immune response. However, their effects on the humoral immune response have not been fully explored. The present study examined the direct effects of red ginseng extract (RGE) and ginsenosides on mouse B cell proliferation and on antibody production and the expression of germline transcripts (GLT) by mouse B cells in vitro. RGE slightly reduced B cell proliferation, but increased IgA production by LPS-stimulated B cells. Furthermore, ginsenoside Rg1 and 20(S)-Rg3 selectively induced IgA production and expression of GLTalpha transcripts by LPS-stimulated B cells. Collectively, these results suggest that ginsenoside Rg1 and 20(S)-Rg3 can drive the differentiation of B cells into IgA-producing cells through the selective induction of GLTalpha expression.
Animals ; Antibody Formation ; B-Lymphocytes* ; Blood Pressure ; Cell Proliferation ; Ginsenosides ; Immunity, Humoral ; Immunoglobulin A* ; Metabolism ; Mice* ; Panax

BACKGROUND/AIMS: The palliative prognostic index (PPI) was designed to predict life expectancy based on clinical symptoms. In this study, a PPI was constructed and used with other biological parameters to predict 3-week survival in patients with advanced cancer. METHODS: The study included 222 patients. The PPI was constructed with five variables (performance status, oral intake, edema, dyspnea at rest, and delirium). PPI scores were grouped as follows: 4 (group 1); > 4 and < or = 6 (group 2); and > 6 (group 3). At admission, seven biological variables (white blood cell count, lymphocyte, C-reactive protein [CRP], bilirubin, albumin, creatinine, and lactate dehydrogenase) were measured. RESULTS: The overall survival duration was 50 days in group 1, 22 days in group 2, and 14 days in groups 3. Using the PPI, a survival of < 3 weeks in group 3 was predicted with a sensitivity of 76.5% and a specificity of 65.4%. The important factors significantly affecting the 3-week survival rate were a PPI score > 6 and increases in serum bilirubin and CRP levels. Furthermore, the 3-week survival rate in patients with hepatopancreatobiliary cancer was more accurately predicted using a combination of the PPI, CRP, and serum bilirubin levels. CONCLUSIONS: Although a PPI has limitations, it can be quickly applied to determine survival duration in patients admitted to hospice and accurately predicts 3-week survival. Furthermore, bilirubin and CRP are useful factors for predicting 3-week survival in patients with gastrointestinal cancer, including hepatopancreatobiliary cancer.
Bilirubin ; Blood Cell Count ; C-Reactive Protein ; Creatinine ; Dyspnea ; Edema ; Gastrointestinal Neoplasms ; Hospice Care ; Hospices ; Humans ; Lactic Acid ; Life Expectancy ; Lymphocytes ; Prospective Studies ; Sensitivity and Specificity ; Survival Analysis ; Survival Rate ; Terminally Ill

BACKGROUND/AIMS: OROS hydromorphone is a synthetic opioid agent. While clinical studies have tested its effectiveness at controlling cancer-associated pain in patients who have received other strong opioids, no clinical studies have tested its effectiveness at managing cancer pain in strong opioid-naive patients. We performed the present study to evaluate the efficacy and tolerability of OROS hydromorphone in strong opioid-naive cancer patients. METHODS: We administered OROS hydromorphone to patients who had not received strong opioids during the previous month. The starting dose was 8 mg/day. The dose was increased every 2 days in patients who experienced more than four episodes of breakthrough pain per day (more than four times in patients being treated with short-acting opioids). We evaluated the efficacy, safety and tolerability of ORS hydromorphone. We also evaluated patient satisfaction and investigators' global assessments. RESULTS: We enrolled 23 patients to the study. The decrease in the numeric rating scale (NRS) was 59%. NRS variation had decreased markedly during the previous 24 h. All patients achieved stable pain control. The side effects were similar to those of other strong opioids. In total, 26% of patients were very satisfied with the treatment and 47% satisfied, and 74% of the investigators deemed OROS hydromorphone to be very effective or effective at controlling cancer pain. CONCLUSIONS: OROS hydromorphone is an osmotically driven, controlled-release preparation that is very effective and safe when administered once daily to strong opioid-naive cancer patients.
Analgesics, Opioid ; Breakthrough Pain ; Delayed-Action Preparations ; Electrolytes ; Humans ; Hydromorphone ; Patient Satisfaction ; Prospective Studies ; Research Personnel

In case of blow-out fracture involving floor or inferomedial wall, the fracture site can be accessed by methods such as subcilliary incision, mid-lower eyelid incision, infra-orbital incision and transconjunctival incision. Meanwhile, in case of orbital fracture involving supero-medial wall or roof, above-mentioned methods have the limitation of fracture site exposure, and bicoronal incision is required to overcome the difficult approach. The authors exposed fracture site widely and executed accurate reduction through extended transconjunctival approach and transpalpebral approach, instead of the approach by bicoronal incision. We executed 118 cases of orbital reconstruction by above method among 96 patients who consulted doctors to reconstruct blow-out fracture and enophthalmos from September 1997 to May 2001. Among the 118 cases were 50 cases of orbital floor fracture, 4 cases of orbital roof fracture, 48 cases of orbital medial wall fracture, 13 cases of complex type and 3 cases of enophthalmos. The authors made wide dissection of antero-superial medial wall of orbit and roof fracture of orbit enabled by above methods, which allowed enough exposure and approach to orbital fracture site and prevented side effects such as post operative lower eyelid scar or ectropion and scleral show.
Cicatrix ; Ectropion ; Enophthalmos ; Eyelids ; Humans ; Orbit* ; Orbital Fractures

Osteointegration with titanium implant has become a highlight having titanium implant tightly fixed in the bone with prosthesis attaching over it. The procedure is relatively simple with no morbidity of donor site and ensues superior shape aesthetically. However, the stability of it has been in question, therefore an experiment was performed to study the actual stability and periosteal formation around the implant. This study presents a histomorphometric and biomechanical comparison of bone response between titanium and stainless steel placed in the tibia of 5 rabbits. Two implants were placed in tibia of rabbit; titanium implant in left and stainless steel implant as a control in right. As a titanium implant, Brnemark implant with depth of 4 mm and diameter of 3.75 mm which has actually been used in the reconstruction of ears was used, and the stainless steel was manufactured in the same way as titanium implant. After a healing period of 3 months, the average removal torque was 8.2 Ncm for the stainless steel implants and 26.5 Ncm for the titanium implant. Histomorphometric study revealed that the stainless steel screw demonstrated rough and irregular contact surface with partial formation of new bone and the titanium implant demonstrated smooth contact surface with a good formation of new bone. In conclusion, the results indicated that titanium surfaces achieved greater periosteal bone formation over stainless steel surfaces and provided enhanced mechanical interlocking.
Ear ; Humans ; Osteogenesis ; Prostheses and Implants ; Rabbits ; Stainless Steel ; Tibia ; Tissue Donors ; Titanium* ; Torque

With the introduction of smaller metallic plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. However, this metallic plating system had problems associated with the use of plates and screw in infants and children. These problems include intracranial migration of material, cranial growth restriction, foreign body reaction and infection. Absorbable plating system has been used as solution of these problems. In this study, absorbable plates (BioSorbFX, BIONX IMPLANTS inc.) composed of a copolymer of polylactic and polyglycolic acid were used in the reconstruction of pediatric craniofacial deformities. In 4 patients who were diagnosed with craniosynostosis between 10 and 36 months of age, absorbable plates were implanted. Follow-up periods were from 6 months to 18 months. Postoperatively, circumferential length of head was increased and cranial bone growth was symmetric. No complications were seen with this use, including infection, overlying soft tissue reaction, reconstructive instability, or underlying osteolysis around the screws. In secondary reconstructive surgery of patient with Crouzon's disease, we found out that no residual traces of polymer were evident visually and all osteotomy sites were healed completely without underlying osteolysis. These results demonstrate the safety and effectiveness of this copolymeric material for pediatric craniofacial applications.
Bone Development ; Child ; Congenital Abnormalities ; Craniofacial Dysostosis ; Craniosynostoses* ; Follow-Up Studies ; Foreign-Body Reaction ; Head ; Humans ; Infant ; Osteolysis ; Osteotomy ; Polyglycolic Acid ; Polymers

PURPOSE: To compare magnetization transfer ratios (MTR) among various cerebral edemas with different pathophysiologic processes. MATERIALS AND METHODS: Cerebral edemas seen on MR images in 45 patients were classified as one of three types: vasogenic (n=22; tumor[n=9], contusion[n=3], hemangioma[n=4], hemorrhage[n=4], others[2]); cytotoxic (n=18; all acute infarction), and interstitial edema (n=5). In all cases, both T2-weighted images with and without magnetization transfer were obtained using off-set pulses of 600Hz. MTRs in each cerebral edema were measured and compared. RESULTS: The mean MTRs of vasogenic edema, cytotoxic edema and interstitial edema were 22 +/- 5%, 26 +/- 4 % and 19 +/- 2%, respectively. There was no statistically significant difference among the three types (p>0.05). CONCLUSION: Mean MTR was highest in cytotoxic edema and lowest in interstitial edema, but the differences were not significant.
Brain Edema* ; Edema ; Humans

PURPOSE: To evaluate the CT appearance of normal variations in the minute central skull base foramina in infants and children. MATERIALS AND METHODS: One hundred and fourteen children under the age of 17 years without skull base abnormality underwent CT scanning. A high spatial frequency algorithm was used, and contiguous axial scanning parallel to the orbitomeatal line was performed from the foramen magnum to the orbital roof, with a 1-mm slice thickness. The presence or absence of eight foramina, pseudoforamina, or ossification centers including anterior presphenoidal foramen, posterior presphenoidal foramen, rostro-orbital pseudoforamen, intralateromedial postsphenoidal pseudoforamen, intrapostsphenoidal pseudoforamen, spheno-occipital pseudo-foramen, canalis basilaris medianus and intrasynchondral ossified bodies was analysed according to age. The presence of foramina or pseudoforamina was indicated if a ring-shaped structure was seen on two or more CT scans at the location anatomically predicted, and intrasynchondral ossified bodies were indicated if linear or dot-like structures with high attenuation accompanied spheno-occipital synchondrosis. RESULTS: CT indicated that within a certain age range, various kinds of foramina, pseudoforamina, and ossification centers were frequent. The anterior presphenoidal foramen was most commonly seen in infants aged 1-12 months (16/17, 94 %); the posterior presphenoidal foramen in children less than 2 years old(27/37, 73 % ) ; the rostro-orbital pseudoforamen in children aged 2 -5 years (9/17, 53%); intrapostsphenoidal pseudoforamen in children 6 -12 years old(20/37, 54%) and spheno-occipital pseudoforamen and intrasynchondral ossified bodies in children aged 13 -16 years. The canalis basilaris medianus was identified in about 20 % of all subjects regardless of age. CONCLUSION: Development of the minute central skull base foramina varied greatly according to age. Knowledge of the CT appearances of such embryologic variants of the central skull base should not only help Provide an understanding of complex skull base anatomy but also identify abnormal skull base development.
Child ; Foramen Magnum ; Humans ; Infant ; Orbit ; Skull Base* ; Skull* ; Tomography, X-Ray Computed