OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

We report the case of a patient with organized chronic subdural hematoma (OCSH) that was treated with craniotomy. A 72-year-old man was admitted with a complaint of a drowsy mental status after a generalized tonic-clonic seizure. A brain computed tomography scan acquired at a local hospital revealed a large chronic subdural hematoma (CSDH) in the left frontoparietal lobe. The patient had not experienced head trauma and had been taking clopidogrel due to angina. A neurosurgeon at the local hospital performed single burr hole trephination in the left frontal bone and drained some of the hematoma. Brain magnetic resonance imaging performed upon transfer to our hospital showed a large OCSH with a midline shift to the right side, revealing a low, heterogeneous signal on T2-weighted images (WI) and an isodense signal on T1-WI. We performed craniotomy and membranectomy to achieve adequate decompression and expansion of the brain. Following this, the patient recovered completely. Our findings support that neurosurgeons should consider the possibility of organization of a CSDH when selecting a diagnosis and treatment plan.
Aged ; Brain ; Craniocerebral Trauma ; Craniotomy* ; Decompression ; Diagnosis ; Frontal Bone ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Magnetic Resonance Imaging ; Neurosurgeons ; Seizures ; Trephining

BACKGROUND/AIMS: We evaluated the effects of a multifaceted intervention for controlling a carbapenem-resistant Acinetobacter baumannii (CRAB) epidemic in an intensive care unit (ICU) with no restrictions on carbapenem use. METHODS: This study was conducted in a medical ICU between April 2012 and June 2016. The baseline infection control programs included surveillance cultures, contact precautions, and environmental cleaning. However, increases in the detection of CRAB isolates beginning in May 2013 led to the implementation of a new protocol, consisting of universal glove and gown use with daily chlorhexidine bathing for all patients in combination with baseline programs. The efficacy of the intervention was subjected to interrupted time series (ITS) analysis. RESULTS: The multifaceted intervention led to a decrease in the incidence of CRAB from 17.65 to 0.89 cases per 1,000 patient-days, during the study period (p < 0.001). ITS analysis revealed a significant change in the trend of CRAB incidence (–0.413, p < 0.001). Over this same period, mean monthly use of carbapenems increased from 143.54 ± 95.73 to 204.95 ± 78.43 doses per 1,000 patient-days (p = 0.018). CONCLUSIONS: Our multifaceted intervention reduced the incidence of CRAB acquisition in an ICU where carbapenem use was not restricted.
Acinetobacter baumannii* ; Acinetobacter* ; Baths ; Carbapenems ; Chlorhexidine ; Critical Care* ; Drug Resistance, Bacterial ; Humans ; Incidence ; Infection Control ; Intensive Care Units* ; Interrupted Time Series Analysis

Radiofrequency ablation (RFA) has been accepted as a safe and effective treatment for unresectable hepatic tumors because of the advantages of a minimally invasive procedure and the local treatment effect. Although RFA can be performed safely in most patients, early and late complications related to mechanical or thermal damage may be observed at follow-up examination. Hemobilia is a very rare complication of RFA and most hemobilia is an immediate complication. However, delayed hemobilia is an even more rare complication after RFA and is known to be a fatal complication. We present a case of delayed fatal hemobilia after RFA for hepatocellular carcinoma.
Carcinoma, Hepatocellular ; Follow-Up Studies ; Hemobilia ; Humans

Granulomatous pancreatitis is a granulomatous inflammatory disease of the pancreas and can he described only in infectious granulomas and pancreatic involvement by systemic granulomatosis. Sarcoidosis, isolated pancreatic involvement without systemic granulomatosis or a manifestation of systemic sarcoidosis, is more common cause of granulo-mataus pancreatitis than infectious granuloma. There has been some reports show a characteristic histological finding of the pancreatic involvement of sarcoidasis. Noncaseating granuloma is thought to be the characteristic finding of pancreatic sarcoidosis. But granulomatous pancreatitis caused by syphilis in a syrnptomatic patient is a very rare disease and, till now, to our knowledge, only a case was reported in 1987, Germany. We experienced a 55-year-old female patient with granulomatous pancreatitis caused by tertiary syphilis who presented as a recent onset jaundice, diarrhea, fatigue and vague epigastric discomfort. Radical pancreaticoduo-denectomy was performed, which showed noncaseating granulomatous pancratitis with vasculitis. To our knowledge, this is the first case of granulomatous pancreatitis caused by syphilis in Korea. We hereby report a case of granulomatous pancreatitis caused by syphilis with a brief review of literature.
Diarrhea ; Fatigue ; Female ; Germany ; Granuloma ; Humans ; Jaundice ; Korea ; Middle Aged ; Pancreas ; Pancreatitis* ; Rare Diseases ; Sarcoidosis ; Syphilis* ; Vasculitis

PURPOSE: To compare the diagnostic efficacy of fast spin-echo (FSE) T2-weighted MR imaging with and without fat suppression. MATERIALS AND METHODS: Twelve patients (7 men and 5 women; mean age, 48 years) with pathologically proven cancer of the tongue were included in this study. In all of these, FSE T2-weighted MR images with and without fat suppression were obtained in the same imaging planes before surgery or biopsy. Two radiologists visually compared the images thus obtained in terms of detection, extent, and conspicuity of the tumor, and the contrast-to-noise ratio (CNR) of each tumor was also calculated. RESULTS: In all patients, both imaging modalities were equal in terms of tumor detection. In 4 of 12(33%), the extent of the tumor was greater with fat suppression, while in eight (67%), it was almost the same both with and without. In ten patients (83%), the tumor was more conspicuous with fat suppression, and percentage CNRs were significantly higher with fat suppression than without (180 +/-70% and 113 +/-61%, respectively; p = 0.02). CONCLUSION: For the evaluation of patients with tongue cancer, fat-suppressed FSE T2-weighted MR imaging is superior to its conventional equivalent.
Biopsy ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Tongue Neoplasms* ; Tongue*

PURPOSE: To compare the diagnostic efficacy of fast spin-echo (FSE) T2-weighted MR imaging with and without fat suppression. MATERIALS AND METHODS: Twelve patients (7 men and 5 women; mean age, 48 years) with pathologically proven cancer of the tongue were included in this study. In all of these, FSE T2-weighted MR images with and without fat suppression were obtained in the same imaging planes before surgery or biopsy. Two radiologists visually compared the images thus obtained in terms of detection, extent, and conspicuity of the tumor, and the contrast-to-noise ratio (CNR) of each tumor was also calculated. RESULTS: In all patients, both imaging modalities were equal in terms of tumor detection. In 4 of 12(33%), the extent of the tumor was greater with fat suppression, while in eight (67%), it was almost the same both with and without. In ten patients (83%), the tumor was more conspicuous with fat suppression, and percentage CNRs were significantly higher with fat suppression than without (180 +/-70% and 113 +/-61%, respectively; p = 0.02). CONCLUSION: For the evaluation of patients with tongue cancer, fat-suppressed FSE T2-weighted MR imaging is superior to its conventional equivalent.
Biopsy ; Female ; Humans ; Magnetic Resonance Imaging* ; Male ; Tongue Neoplasms* ; Tongue*

Progressive dysphagia in a 53 year old man was caused by a giant polypoid tumor in the lower intrathoracic esophagus. Radical transthoracic esophagectomy and esophagogastrostomy were carried out. Microscopic examination of the tumor revealed a true carcinosarcoma, composed of a mixture of basaloid squamous cell carcinoma and chondrosarcoma with multiple cartilagenous productions. Carcinoma metastases were found in the subcarinal and perigastric lymph nodes. Immunohistochemically, squamous area displayed strong positive to cytokeratin, and basaloid area showed positive immunoreaction to high molecular weight cytokeratin (34beta E12). Spindle cell sarcoma reacted to vimentin and smooth muscle actin. Chondrosarcomatous area reacted to vimentin and S-100 protein. He received postoperative chemotherpy and radiotherapy. He has been free of disease for 11 months.
Actins ; Carcinoma, Squamous Cell ; Carcinosarcoma* ; Chondrosarcoma ; Deglutition Disorders ; Esophageal Neoplasms ; Esophagectomy ; Esophagus* ; Humans ; Keratins ; Lymph Nodes ; Middle Aged ; Molecular Weight ; Muscle, Smooth ; Neoplasm Metastasis ; Radiotherapy ; S100 Proteins ; Sarcoma ; Vimentin

PURPOSE: To evaluate the use of CT in patients with vocal cord paralysis due to extralaryngeal cause s ,andto use CT for the assessment of extralaryngeal diseases causing vocal cord paralysis. MATERIALS AND METHODS: Weprospectively studied the results of CT in 41 patients with vocal cord paralysis in whom laryngoscopy revealed nolaryngeal cause and physical examination demonstrated no definite extralaryngeal cause. The extralaryngeal causeof vocal cord palsy was determined after comprehensive clinical diagnosis. Enhanced CT scans were acquired fromthe skull base and continued to the level of the aorticopulmonary window. We used CT to assess the detection ratefor extralaryngeal causes and to extimate the extent of extralaryngeal disease and the distribution of lesions. RESULTS: CT revealed that in 20 of 41 patients(49%) the extralarygeal causes of vocal paralysis were as follows :thyroid cancer(n=10), nodal disease(n=6), esophageal cancer(n=2), neurogenic tumor(n=1), aortic aneurysm(n=1).Lesions were located on the left side in 13 patients(65%), and in the tracheoesophageal groove in 15(75%). CONCLUSION: In patients with vocal cord paralysis in whom no definite lesion is seen on physical examination, CT could be a useful primary imaging method for the assessment of extralaryngeal causes.
Diagnosis ; Humans ; Laryngoscopy ; Paralysis ; Physical Examination ; Skull Base ; Thyroid Gland ; Tomography, X-Ray Computed ; Vocal Cord Paralysis* ; Vocal Cords*

The LEOPARD syndrome is an acronym and serves as a mnemonic for the features of this autosomal dominant syndrome : L - lentigines (multiple), E - electrocardiographic conduction abnormalities, O - ocular hypertelorism, P - pulmonary stenosis, A - abnormalities of genitalia, R - retardation of growth, and D - deafness (sensoryneural). The main features of the syndrome are multiple lentigines in combination with congenital heart malformations. These frequently accompanied cardiac abnormalities are pulmonary stenosis, hypertrophic cardiomyopathy, and various ECG abnormalities. It is advisable to make cardiac evaluation in a patient with LEOPARD syndrome in spite of no clinical symptoms or signs, since cardiac dysfunction may be progressive or developed later. We experienced a case of this syndrome in a 31 year-old female, presenting multiple lentigines, ocular hypertelorism, and congenital cardiac abnormalities of incomplete right bundle branch block and cor triatriatum. We report the case with brief literature review.
Adult ; Bundle-Branch Block ; Cardiomyopathy, Hypertrophic ; Cor Triatriatum* ; Deafness ; Electrocardiography ; Female ; Genitalia ; Heart ; Humans ; Hypertelorism ; Lentigo ; LEOPARD Syndrome* ; Panthera* ; Pulmonary Valve Stenosis