Sternal metastasis of poorly differentiated thyroid carcinoma (PDTC) is rare, and only a few cases have been reported in the literature. Here, we report a case of sternal metastasis of PDTC in an 83-year-old woman, 2 years after right hemithyroidectomy, treated with sternal resection and reconstruction.

Reversible cerebral vasoconstriction syndrome (RCVS) is a heterogeneous group of cerebrovascular disease. The pathophysiology of RCVS is unknown, but a disturbance in cerebral vascular tone is one of hypothesis. Long-term use of Gonadotropin-releasing hormone (GnRH) agonists can induce a pseudomenopausal state in which estrogen production are suppressed. It might lead to reduced arterial relaxation by estrogen withdrawal. We report a case of RCVS after the injection of synthetic analogue of GnRH.
Cerebral Hemorrhage ; Cerebrovascular Disorders ; Estrogens ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Hemorrhage* ; Injections, Subcutaneous* ; Relaxation ; Vasoconstriction*

PURPOSE: The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH. METHODS: A retrospective study was performed on 27 women (mean age, 49.2+/-9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated. RESULTS: Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00). CONCLUSION: The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.
Biopsy* ; Biopsy, Large-Core Needle ; Breast* ; Calcinosis ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Female ; Humans ; Hyperplasia* ; Mammography ; Mastectomy, Segmental ; Retrospective Studies

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 +/- 9.7; range, 30-89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 +/- 30.8 cm3, 383.8 +/- 205.2 cm3, and 15.8% +/- 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% +/- 6.7% for the 30s (n = 1,484), 91.4% and 17.2% +/- 6.8% for the 40s (n = 2,706), 72.2% and 12.4% +/- 6.2% for the 50s (n = 1,138), 44.0% and 8.6% +/- 4.3% for the 60s (n = 89), 39.1% and 8.0% +/- 3.8% for the 70s (n = 138), and 39.1% and 8.0% +/- 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.
Adult ; Aged ; Aged, 80 and over ; Aging ; Asian Continental Ancestry Group ; Automation ; Breast/*diagnostic imaging ; Breast Neoplasms/diagnostic imaging ; Female ; Humans ; Image Processing, Computer-Assisted ; *Mammography ; Menopause ; Middle Aged ; Republic of Korea

Background: and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. Methods: In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. Results: The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). Conclusions The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery. Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge. Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002). Conclusions Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

PURPOSE: We investigated the feasibility of using surgical clips as markers for tumor localization and their effect on the imaging evaluation of treatment responses after neoadjuvant chemotherapy (NAC). METHODS: A total of 16 breast cancers confirmed by needle biopsy in 15 patients were included in this study from October 2012 to June 2014. Under ultrasonography (US)-guidance, the surgical clips were placed prior to NAC. Additional mammography, breast US, and breast magnetic resonance examinations were performed within 10 days before surgery. The time period from marker insertion to operation date was documented. Images acquired via the three modalities were evalu-ated for the following parameters: location of clip, clip migration (>1 cm), the presence of complications from clip placement, and the effect of clips on the assessment of treatment. RESULTS: The mean time period was 128.6+/-34.4 days (median, 132.0 days) from the date of clip insertion to the date of surgery. The mean number of inserted clips was 2.3+/-0.7 (median, 2.0). Clip migration was not visualized by imaging in any patient, and there were no complications reported. Surgical clips did not negatively affect the assessment of treatment responses to NAC. CONCLUSION: Surgical clips may replace commercial tissue markers for tumor localization in breast cancer patients undergoing NAC without migration. Surgical clips are well tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective.
Biopsy, Needle ; Breast ; Breast Neoplasms* ; Drug Therapy* ; Humans ; Image-Guided Biopsy ; Mammography ; Neoadjuvant Therapy ; Surgical Instruments* ; Ultrasonography

OBJECTIVE: The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). MATERIALS AND METHODS: We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. RESULTS: All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). CONCLUSION: Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Classification ; Consensus ; Constriction, Pathologic ; Echocardiography ; Humans ; Magnetic Resonance Imaging ; Membranes ; Multidetector Computed Tomography ; Retrospective Studies

Background: and Purpose Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. Methods: A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. Results: Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period.The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. Conclusions During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportivecare program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.

Background: Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time. Conclusions Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.