Background and Objectives: The clinical implications of the BRAF V600E mutation in papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm of tumor size, remain controversial. We investigated the association between the BRAFV600E mutation and PTMC recurrence in a retrospective cohort of patients with thyroid cancer. Materials and Methods: This study included 2319 patients with PTMC (median age, 50 years [interquartile range (IQR), 41-57 years]) who underwent thyroid surgery from 2010 to 2019 at a single tertiary medical center. The median follow-up time was 75 months (IQR, 30-98 months). Tumor recurrence was confirmed by histological, cytological, radiographic, and biochemical criteria, combined with persistent and recurrent disease. Results: A total of 60.2% (1395/2319) patients with PTMC had the BRAF V600E mutation. The tumor recurrence rate was 2.1% (19/924) in BRAF mutation-negative patients and 2.9% (41/1395) in BRAF mutation-positive patients, with a hazard ratio (HR) of 1.05 (95% confidence interval [CI], 0.61-1.84) after adjusting for clinicopathological risk factors. Similar results were found in patients with high-risk PTMC (adjusted HR, 1.09; 95% CI, 0.56-2.11) who had lymph node metastasis (LNM), extrathyroidal extension (ETE), or distant metastasis (DM) at diagnosis and in patients with low-risk PTMC (adjusted HR, 1.00; 95% CI, 0.35-2.83) who had no LNM, ETE, or DM. Conclusion The finding that the BRAF V600E mutation was not associated with tumor recurrence in our cohort of Korean patients with PTMC, especially in patients with low-risk PTMC, suggests that its value in the prediction of disease progression is limited.

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.
Aged ; Biliary Fistula/complications/*diagnosis/surgery ; Cholecystectomy ; Endoscopy, Gastrointestinal ; Female ; Gastric Fistula/complications/*diagnosis/surgery ; Gastrointestinal Hemorrhage/complications/*diagnosis ; Humans ; Intestinal Fistula/complications/*diagnosis/surgery ; Tomography, X-Ray Computed

Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.
Anti-Bacterial Agents ; Aspergillosis ; Aspergillus ; Bacterial Infections ; Cellulitis ; Gastritis

Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.
Anti-Bacterial Agents ; Aspergillosis ; Aspergillus ; Bacterial Infections ; Cellulitis ; Gastritis

Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.
Abdominal Pain ; Analgesics, Opioid ; Anxiety ; Celiac Plexus ; Humans ; Nausea ; Pancreatic Neoplasms ; Sleep Initiation and Maintenance Disorders ; Substance Withdrawal Syndrome ; Vomiting

OBJECTIVE: To compare the treatment thresholds for osteoporosis medication based on bone mineral density (BMD) results and fracture risk assessment tool (FRAX) risks in patients with a distal radius fracture. METHODS: The data of 116 consecutive women aged 50~89 years (mean 64.5 years) with a distal radius fracture were collated to identify clinical risk factors, which were inserted into the FRAX algorithm to calculate 10-year fracture risks. Proportions of patients indicated for osteoporosis medication based on BMD alone and based on FRAX risks were determined. Sensitivity estimation was done with FRAX plus BMD as a gold standard measurement for osteoporosis treatment. RESULTS: Of the 116 patients, 38% needed osteoporosis medication based on BMD alone, and 41% were indicated for treatment based on FRAX plus BMD. These proportions were not significantly different (P = 0.481). However, 56% of patients were indicated for treatment based on FRAX excluding BMD, which was significantly larger than the proportion determined by BMD alone (P = 0.001) or FRAX plus BMD (P = 0.003). Sensitivity, specificity, positive predictive value, negative predictive value for BMD alone were 75%, 93%, 90%, 82% and those for FRAX without BMD were 83%, 70%, 69%, 84%. CONCLUSION: No difference was found in the proportion of patients that need osteoporosis medication based on BMD results alone and FRAX plus BMD risks, suggesting BMD measurement can be sufficient to detect candidates for osteoporosis medication in patients with a distal radius fracture. FRAX excluding BMD may include too many patients that do not need osteoporosis treatment.
Aged ; Bone Density ; Female ; Humans ; Osteoporosis ; Radius ; Radius Fractures ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity

PURPOSE: To evaluate the minimum 10-year follow up results of primary total hip arthroplasty (THA) performed using a sandwich-type (alumina-polyethylene-titanium) ceramic bearing. MATERIALS AND METHODS: Thirty four patients (40 hips) who underwent a THA with sandwich typed liners from November 1998 to December 2000 were analyzed. Among the 34 patients, 25 were men and nine were women. Mean follow-up was 134 months (range, 120~145 months) and mean patient age at the time of THA was 47.1 years (range, 24~65 years). The clinical results were evaluated using the Harris hip score and level of thigh pain with a limping gait. The radiographic evaluation was done in terms of the endosteal new bone formation, radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: The mean preoperative Harris hip score of 50.2 points (range, 31~87 points) was improved to 90.9 points (range, 75~99 points) at the final follow-up and thigh pain with limping gait in one case. All cases had fixation by bony ingrowth. No radiographically detectable loosening was observed in any hip. Fracture of ceramic liner in one case required change of the polyethylene liner. CONCLUSION: At the minimum 10-year follow up, survival rate as the end-point was favorable. However, fracture of the ceramic is still a major problem. Satisfactory results can be obtained by more precise surgical technique for acerabular inclincation and anteversion, and by improving the quality of the ceramic.
Arthroplasty ; Ceramics ; Female ; Follow-Up Studies ; Gait ; Hip ; Humans ; Male ; Osteogenesis ; Polyethylene ; Survival Rate ; Tacrine ; Thigh

Enchondroma is a benign tumor mainly developed in the hand and uncommon in the foot. Even if it is in the foot, most are in the phalanges and distal metatarsals of the foot. Enchondroma in the calcaneus is very rare. A 44-year-old male suffered from left heel pain for several months, authors treated it with curettage and bone graft, it was histologically confirmed as an enchondroma in the calcaneus. The authors presented a rare case presentation of an enchondroma in the calcaneus with pain.
Adult ; Calcaneus ; Chondroma ; Curettage ; Foot ; Hand ; Heel ; Humans ; Male ; Metatarsal Bones ; Transplants

PURPOSE: To analyze the causes of fixation failure of compression hip screw and evaluate outcomes of hip arthroplasty for reconstruction. MATERIALS AND METHODS: We reviewed 108 femoral intertrochanteric fractures that underwent compression hip screw between January 1997 and December 2007. Failure group (group I) contained 28 cases who had hip arthroplasty for failed compression hip screw and the control group (group II) contained 80 cases who had successive compression hip screw. We analyzed the causes of failure of compression hip screw and evaluated the results of hip arthroplasty for reconstruction. RESULTS: In group I, 21 cases (75%) were unstable fractures. Group II, 14 cases (17%) were unstable fractures. Tip-apex distance was 26.5 (18~35) mm in group I and 18.6 (8~22) mm in group II. Lateral wall fracture of greater trochanteric area was combined in 24 cases (85.7%) in group I and 9 cases (11.3%) in group II. Harris Hip Score improved from 33.5 (22~43) points to 84.2 (75~93) points after salvage hip arthroplasty. CONCLUSION: We considered the causes of failed compression hip screw to be fracture instability, increased tip-apex distance and presence of lateral wall fracture of greater trochanter. Hip arthroplasty was found to be a useful method for failed compression hip screw.
Arthroplasty ; Femur ; Hip ; Hip Fractures

BACKGROUND: Upper gastrointestinal diseases are relatively important in Korea. There are various studies on upper gastrointestinal diseases, especially relationships with Helicobacter pylori, but studies on young adults are relatively fewer. Therefore, we conducted this study in order to know the prevalence of various upper gastrointestinal diseases and the association with Helicobacter pylori among young policemen. METHODS: Diagnosis and classification of upper gastrointestinal diseases were made 260 policemen, who visited the outpatient department of family medicine at one general hospital in Seoul from March 2, 2001 to December 31, 2002. RESULTS: The frequencies of upper gastrointestinal diseases were gastritis (62.2%), duodenal ulcer (14.4%), gastric ulcer (7.5%), duodenitis (6.9%), and no active lesion (9.0%). The frequency of multiple upper gastrointestinal disease was chronic superficial gastritis and duodenal ulcer (37%), chronic superficial gastritis and duodenitis (21.9%), and acute gastritis and duodenal ulcer (16.4%), and these groups comprised the most with 75.3%. The location of the lesion was found at antrum (62.2%) and duodenum (21.6%). Ulcer stages in gastric and duodenal ulcer were mostly in active stage. Helicobacter pylori infection in gastric and duodenal ulcer were 36% and 85.4%, respectively. CONCLUSION: Most symptomatic patients had lesions which were found at antrum and duodenum as in other studies. Ulcer diseases in duodenum were much more frequent than those in stomach, which probably be associated with Helicobacter pylori. Therefore, suitable examination and treatment are necessary.
Classification ; Diagnosis ; Duodenal Ulcer ; Duodenitis ; Duodenum ; Gastritis ; Gastrointestinal Diseases* ; Helicobacter pylori ; Hospitals, General ; Humans ; Korea ; Outpatients ; Peptic Ulcer ; Prevalence ; Seoul ; Stomach ; Stomach Ulcer ; Ulcer ; Young Adult