Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck 99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, 18F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0-26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. 18F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.

BACKGROUND: Ventilation is a major determinant of the alveolar concentration of inhaled anesthetics. Hyperventilation accelerates the equilibration of anesthetic in the lungs, but decelerates it in the brain. We evaluated this phenomenon for desflurane. METHODS: Twenty healthy subjects were enrolled after IRB approval. End-tidal concentrations of desflurane (P.DESF) were recorded during 10 minutes of mask induction with 8% desflurane. P.DESF was modeled with time and end-tidal concentrations of CO2 (P.ETCO2) using a two-exponential pharmacokinetic equation. Bispectral index (BIS) values were also measured to find out the component reflecting the cerebral concentration of desflurane. RESULTS: During induction, the rise of P.DESF could be separated into two components: early and late rises. Individual BIS values showed a higher correlation with the late component of P.DESF (P = 0.000). P.ETCO2 had two different effects on the rise of P.DESF. CONCLUSIONS: Hyperventilation hastened the early rise and delayed the late rise of P.DESF (P = 0.00, P = 0.00). Hyperventilation should be avoided to obtain rapid anesthesia induction with desflurane.
Anesthesia ; Anesthesia, Inhalation ; Anesthetics ; Brain ; Ethics Committees, Research ; Hyperventilation ; Isoflurane ; Lung ; Masks ; Nonlinear Dynamics ; Ventilation

Hypersensitivity myocarditis may result from an allergic reaction to a variety of agents such as antibiotics, anticonvulsants and diuretics. A diagnosis of hypersensitivity myocarditis should be considered in any patient with an ongoing allergic reaction to a drug, evidence of peripheral eosinophilia, an appearance of new electrocardiographic changes, mildly elevated cardiac enzyme, mild cardiomegaly on chest X-ray or unexplained tachycardia. This condition is rarely recognized clinically although it is occasionally diagnosed on endomyocardial biopsy. We report a 25 year-old woman with hypersensitivity myocarditis, which was diagnosed by endomyo-cardial biopsy and successfully treated by immunosuppression therapy with corticosteroids.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Anticonvulsants ; Biopsy ; Cardiomegaly ; Diagnosis ; Diuretics ; Electrocardiography ; Eosinophilia ; Female ; Glucocorticoids ; Humans ; Hypersensitivity* ; Immunosuppression ; Myocarditis* ; Tachycardia ; Thorax

Background/Aims: We aimed to assess the validity of the Korean translated version of the Clinical Frailty Scale (CFS) in determining the frailty status in geriatric outpatients. Methods: The records of 123 ambulatory outpatients who had undergone CFS and comprehensive geriatric assessments (CGAs) including measurements for the Cardiovascular Health Study (CHS) frailty scale and the frailty index (CGA-FI) were analyzed. Correlations between CFS, CHS frailty scale, and CGA-FI were assessed. The ability of CFS to classify frailty status was calculated using the CHS frailty scale and CGA-FI as references. Results: The mean CFS score was 3.2 in the study population, with a mean age of 77.49 years (45.5% men). Individuals with higher CFS scores were older, had a greater burden of chronic diseases, and worse daily functions and cognitive performance. CFS scores positively correlated with CGA-FI (B = 0.78, p < 0.001) and CHS frailty scale (B = 0.67, p < 0.001) scores. For CFS, C-statistics to classify frailty by CGA-FI and CHS scale were 0.905 and 0.826, respectively. The cut-off value of CFS ≥ 4 maximized Youden’s J to classify frailty by both the CHS scale and CGAFI. Conclusions The CFS is a valid screening tool to assess the frailty status in outpatients of a geriatric clinic in Korea. As a simple and quick measure, the CFS may facilitate frailty assessments in real-world clinical practice.

Background/Aims: We aimed to assess the validity of the Korean translated version of the Clinical Frailty Scale (CFS) in determining the frailty status in geriatric outpatients. Methods: The records of 123 ambulatory outpatients who had undergone CFS and comprehensive geriatric assessments (CGAs) including measurements for the Cardiovascular Health Study (CHS) frailty scale and the frailty index (CGA-FI) were analyzed. Correlations between CFS, CHS frailty scale, and CGA-FI were assessed. The ability of CFS to classify frailty status was calculated using the CHS frailty scale and CGA-FI as references. Results: The mean CFS score was 3.2 in the study population, with a mean age of 77.49 years (45.5% men). Individuals with higher CFS scores were older, had a greater burden of chronic diseases, and worse daily functions and cognitive performance. CFS scores positively correlated with CGA-FI (B = 0.78, p < 0.001) and CHS frailty scale (B = 0.67, p < 0.001) scores. For CFS, C-statistics to classify frailty by CGA-FI and CHS scale were 0.905 and 0.826, respectively. The cut-off value of CFS ≥ 4 maximized Youden’s J to classify frailty by both the CHS scale and CGAFI. Conclusions The CFS is a valid screening tool to assess the frailty status in outpatients of a geriatric clinic in Korea. As a simple and quick measure, the CFS may facilitate frailty assessments in real-world clinical practice.

Background: When suspicious lesions are observed on computer-tomography (CT), invasive tests are needed to confirm lung cancer. Compared with other procedures, bronchoscopy has fewer complications. However, the sensitivity of peripheral lesion through bronchoscopy including washing cytology is low. A new test with higher sensitivity through bronchoscopy is needed. In our previous study, DNA methylation of PCDHGA12 in bronchial washing cytology has a diagnostic value for lung cancer. In this study, combination of PCDHGA12 and CDO1 methylation obtained through bronchial washing cytology was evaluated as a diagnostic tool for lung cancer. Methods: A total of 187 patients who had suspicious lesions in CT were enrolled. PCDHGA12methylation test, CDO1 methylation test, and cytological examination were performed using 3-plex LTE-qMSP test. Results: Sixty-two patients were diagnosed with benign diseases and 125 patients were diagnosed with lung cancer. The sensitivity of PCDHGA12 was 74.4% and the specificity of PCDHGA12 was 91.9% respectively. CDO1 methylation test had a sensitivity of 57.6% and a specificity of 96.8%. The combination of both PCDHGA12 methylation test and CDO1 methylation test showed a sensitivity of 77.6% and a specificity of 90.3%. The sensitivity of lung cancer diagnosis was increased by combining both PCDHGA12 and CDO1 methylation tests. Conclusion Checking DNA methylation of both PCDHGA12 and CDO1 genes using bronchial washing fluid can reduce the invasive procedure to diagnose lung cancer.

This study aims to analyze the color distribution of maxillary permanent incisors in Korean pediatric patients and determine the effects of age and root developmental stage on tooth color. The L*a*b* values of 404 sound and fully erupted maxillary incisors without dental caries, restorations, trauma history or discoloration from 101 Korean patients between ages 7 and 15, with a mean age 10.0 ± 1.5, were analyzed with a spectrophotometer. CIE L*a*b* values were 84.01, 0.17, and 24.07 in maxillary central incisors, and 82.33, 0.31, and 25.99 in maxillary lateral incisors. L* values of maxillary central incisors were higher, and b* values of maxillary central incisors were lower than those of maxillary lateral incisors (p < 0.001). The color differences among the subregions exceeded the clinical perceptibility threshold in both of the maxillary central and lateral incisors. L* value for children at age 10 and younger was 84.13 in maxillary central incisors and 84.04 in maxillary lateral incisors, and those of older patients were 80.62 and 80.56, respectively. L* value of maxillary incisors of children at age 10 and younger was significantly higher than that of older patients. The root developmental stage did not affect tooth color. This study suggests that the color differences between maxillary central and lateral incisors and among the subregions of a tooth and the effects of age should be considered for aesthetic restorations of permanent incisors in pediatric patients.