Objectives: . The impacts of ventilation tube (VT) type and effusion composition on the VT extrusion rate and complications in children with otitis media remain unclear. This part II study evaluated the factors affecting the extrusion rate, recurrence rate, and complications of VT insertion. Methods: . A prospective study was conducted between June 2014 and December 2016 (the EVENT study [analysis of the effectiveness of ventilation tube insertion in pediatric patients with chronic otitis media]), with follow-up data collected until the end of 2017. Patients aged <15 years diagnosed with otitis media with effusion who received VT insertion were recruited at 15 tertiary hospitals. The primary outcomes were time to extrusion of VT, time to effusion recurrence, and complications. Results: . Data from 401 patients were analyzed. After excluding the results of long-lasting tubes (Paparella type II and T-tubes), silicone tubes (Paparella type I) exhibited a significantly longer extended time to extrusion (mean, 400 days) than titanium tubes (collar-button-type 1.0 mm: mean, 312 days; P<0.001). VT material (hazard ratio [HR], 2.117, 95% confidence interval [CI], 1.254–3.572; P=0.005), age (HR, 3.949; 95% CI, 1.239–12.590; P=0.02), and effusion composition (P=0.005) were significantly associated with the time to recurrence of middle ear effusion. Ears with purulent (mean, 567 days) and glue-like (mean, 588 days) effusions exhibited a shorter time to recurrence than ears with serous (mean, 846 days) or mucoid (mean, 925 days) effusions. The revision VT rates during follow-up were 3.5%, 15.5%, 10.4%, and 38.9% in ears with serous, mucoid, glue-like, and purulent effusions, respectively (P<0.001). The revision surgery rates were higher among patients aged <7 years than among those aged ≥7 years. Conclusion . Silicone tubes (Paparella type I) were less prone to early extrusion than titanium 1.0 mm tubes. VT type, patient age, and effusion composition affected the time to recurrence of effusion.

Developmental venous anomalies (DVAs) are cited as the most common intracranial vascular anomaly. In the majority of cases, it has a benign clinical course, and complications such as intracranial hemorrhage (ICH) are rarely reported. In the rare cases of DVAs presenting ICH, the causes of hemorrhage are usually by a combined vascular anomaly, mostly cavernous malformation (CM) or complicated DVAs, such as thrombosis in the vein of DVAs. We report a rare case of uncomplicated DVA presenting hemorrhage without accompanied vascular anomaly, such as CM. The cause of hemorrhage is suggested to be a specific form of DVA, arterialized DVA. Arterialized DVAs should be noted that they have a greater risk of hemorrhage than classic DVAs.

Purpose: This study compared the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS) for thyroid malignancy with three international guidelines. Methods: From June to September 2015, 5,708 thyroid nodules (≥1.0 cm) in 5,081 consecutive patients who underwent thyroid ultrasound (US) at 26 institutions were evaluated. The US features of the thyroid nodules were retrospectively reviewed and classified according to all four guidelines. In the modified K-TIRADS, the biopsy size threshold was changed to 2.0 cm for K-TIRADS 3 and 1.0 or 1.5 cm for K-TIRADS 4 (K-TIRADS1.0cm and K-TIRADS1.5cm, respectively). We compared the diagnostic performance and unnecessary fine-needle aspiration biopsy (FNAB) rates for thyroid malignancy between the modified K-TIRADS and three international guidelines. Results: Of the 5,708 thyroid nodules, 4,597 (80.5%) were benign and 1,111 (19.5%) were malignant. The overall sensitivity was highest for the modified K-TIRADS1.0cm (91.0%), followed by the European (EU)-TIRADS (84.6%), American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.5%), American College of Radiology (ACR)-TIRADS (76.1%), and modified K-TIRADS1.5cm (76.1%). For large nodules (>2.0 cm), the sensitivity increased to 98.0% in both the modified K-TIRADS1.0cm and K-TIRADS1.5cm. For small nodules (≤2.0 cm), the unnecessary FNAB rate was lowest with the modified K-TIRADS1.5cm (17.6%), followed by the ACR-TIRADS (18.6%), AACE/ACE/AME (19.3%), EU-TIRADS (28.1%), and modified K-TIRADS1.0cm (31.2%). Conclusion The modified K-TIRADS1.5cm can reduce the unnecessary FNAB rate for small nodules (1.0-2.0 cm), while maintaining high sensitivity for detecting malignancies >2.0 cm.

Purpose: This study aimed to analyze the clinical outcomes of venous thromboembolism (VTE) patients and identify the risk factors for VTE-related unfavorable outcomes, major bleeding, and 30-day all-cause mortality. Materials and Methods: From January 2016 to December 2020, 198 patients with confirmed VTE were enrolled. Potential risk factors for unfavorable outcomes, major bleeding, and all-cause mortality were analyzed. Results: VTE-related unfavorable outcomes developed in 13.1%, while 30-day all-cause mortality was 8.6%. In the multivariate analysis, a pulse ≥110/min and respiratory rate ≥30/min were statistically significant predictors for VTE-related unfavorable outcomes. Diabetes was a significant risk factor for major bleeding. In addition, a history of malignancy, no anticoagulation treatment, and need for mechanical ventilation were significant predictors of all-cause mortality. Conclusion VTE-related mortality and morbidity rates remained high. In cases of tachycardia and tachypnea, early aggressive treatment is needed to prevent unfavorable outcomes. Patients with risk factors should be closely monitored.

Developmental venous anomalies (DVAs) are cited as the most common intracranial vascular anomaly. In the majority of cases, it has a benign clinical course, and complications such as intracranial hemorrhage (ICH) are rarely reported. In the rare cases of DVAs presenting ICH, the causes of hemorrhage are usually by a combined vascular anomaly, mostly cavernous malformation (CM) or complicated DVAs, such as thrombosis in the vein of DVAs. We report a rare case of uncomplicated DVA presenting hemorrhage without accompanied vascular anomaly, such as CM. The cause of hemorrhage is suggested to be a specific form of DVA, arterialized DVA. Arterialized DVAs should be noted that they have a greater risk of hemorrhage than classic DVAs.

We report a case of the transradial approach for carotid artery stenting (CAS) as a useful alternative to the traditional transfemoral approach when femoral access is not available. A 50-year-old male visited our emergency room with dysarthria and right-side weakness. Magnetic resonance imaging showed acute cerebral infarction on the left middle cerebral artery territory and carotid stenosis on both sides. CAS for each carotid stenosis was attempted by the usual femoral access, but there was no pulse on either side of the femoral artery, and computed tomography angiogram of the lower extremity revealed Leriche syndrome, which is an aortoiliac occlusive disease. So, we changed the access to the radial artery and was successfully performed.

We report a case of the transradial approach for carotid artery stenting (CAS) as a useful alternative to the traditional transfemoral approach when femoral access is not available. A 50-year-old male visited our emergency room with dysarthria and right-side weakness. Magnetic resonance imaging showed acute cerebral infarction on the left middle cerebral artery territory and carotid stenosis on both sides. CAS for each carotid stenosis was attempted by the usual femoral access, but there was no pulse on either side of the femoral artery, and computed tomography angiogram of the lower extremity revealed Leriche syndrome, which is an aortoiliac occlusive disease. So, we changed the access to the radial artery and was successfully performed.

Minimally invasive treatment of symptomatic thyroid nodules is now commonplace. Ethanol ablation (EA) of thyroid cystic nodules has been performed since the 1990s, but there is no global consensus or guideline. Although various limitations of EA have been described, recommendations for practical application are necessary. Therefore, the Task Force Committee of the Korean Society of Thyroid Radiology initiated the present consensus statement and here we provide recommendations for the role of EA in the management of symptomatic thyroid nodules. These recommendations are based on evidence to date from the literature and expert opinion.
Advisory Committees ; Consensus ; Ethanol ; Expert Testimony ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
Advisory Committees ; Catheter Ablation* ; Consensus ; Humans ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.
Anti-Bacterial Agents ; Bacteria ; Child ; Ear ; Ear, Middle* ; Haemophilus influenzae ; Hearing ; Humans ; Influenza, Human ; Korea ; Middle Ear Ventilation ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Prospective Studies ; Staphylococcus ; Tertiary Care Centers ; Tympanic Membrane ; Ventilation*