Background: This study focuses on the establishment and operation of a stroke patient hotline program to help patients and their caregivers determine when acute neurological changes require emergency attention.Method: The stroke hotline was established at the Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, in June 2016. Patients diagnosed with stroke during admission or in outpatient clinics were registered and provided with stroke education. Consulting nurses managed hotline calls and made decisions about outpatient schedules or emergency room referrals, consulting physicians when necessary. The study analyzed consultation records from June 2016 to December 2020, assessing consultation volumes and types. Outcomes and hotline satisfaction were also evaluated. Results: Over this period, 6,851 patients were registered, with 1,173 patients (18%) undergoing 3,356 hotline consultations. The average monthly consultation volume increased from 29.2 cases in 2016 to 92.3 cases in 2020. Common consultation types included stroke symptoms (22.3%), blood pressure/glucose inquiries (12.8%), and surgery/procedure questions (12.6%). Unexpected outpatient visits decreased from 103 cases before the hotline to 81 cases after. Among the 2,244 consultations between January 2019 and December 2020, 9.6% were recommended hospital visits, with two cases requiring intra-arterial thrombectomy. Patient satisfaction ratings of 9–10 points increased from 64% in 2019 to 69% in 2020. Conclusion The stroke hotline program effectively reduced unexpected outpatient visits and achieved high patient satisfaction.Expanding the program could enhance the management of stroke-related neurological symptoms and minimize unnecessary healthcare resource utilization.

Pheochromocytoma and paraganglioma (PPGLs) are rare catecholamine-secreting neuroendocrine tumors but can be life-threatening. Although most PPGLs are benign, approximately 10% have metastatic potential. Approximately 40% cases are reported as harboring germline mutations. Therefore, timely and accurate diagnosis of PPGLs is crucial. For more than 130 years, clinical, molecular, biochemical, radiological, and pathological investigations have been rapidly advanced in the field of PPGLs. However, performing diagnostic studies to localize lesions and detect metastatic potential can be still challenging and complicated. Furthermore, great progress on genetics has shifted the paradigm of genetic testing of PPGLs. The Korean PPGL task force team consisting of the Korean Endocrine Society, the Korean Surgical Society, the Korean Society of Nuclear Medicine, the Korean Society of Pathologists, and the Korean Society of Laboratory Medicine has developed this position statement focusing on the comprehensive and updated diagnosis for PPGLs.

Pheochromocytoma and paraganglioma (PPGLs) are rare catecholamine-secreting neuroendocrine tumors but can be life-threatening. Although most PPGLs are benign, approximately 10% have metastatic potential. Approximately 40% cases are reported as harboring germline mutations. Therefore, timely and accurate diagnosis of PPGLs is crucial. For more than 130 years, clinical, molecular, biochemical, radiological, and pathological investigations have been rapidly advanced in the field of PPGLs. However, performing diagnostic studies to localize lesions and detect metastatic potential can be still challenging and complicated. Furthermore, great progress on genetics has shifted the paradigm of genetic testing of PPGLs. The Korean PPGL task force team consisting of the Korean Endocrine Society, the Korean Surgical Society, the Korean Society of Nuclear Medicine, the Korean Society of Pathologists, and the Korean Society of Laboratory Medicine has developed this position statement focusing on the comprehensive and updated diagnosis for PPGLs.

BACKGROUND: Endotracheal intubation in patients with compromised cervical vertebrae and limited mouth opening is challenging, however, there are still limited options available. Among devices used for managing difficult airways, the Clarus Video System (CVS) might have considerable promise due to its semi-rigid tip. We evaluated the performance of CVS in patients with simulated difficult airways. METHODS: Philadelphia cervical collars were applied to 74 patients undergoing general anesthesia. The degree of simulated difficult airway was assessed by observing laryngeal view using McCoy laryngoscope; modified Cormack and Lehane grade (MCL) ≥ 3a (high-grade group, n = 38) or ≤ 2b (low-grade group, n = 36). Subsequently, patients were intubated using CVS by a blinded practitioner. We evaluated total time to intubation, intubation success rate, and conditions of intubation. RESULTS: Intubation took significantly longer time for the high-grade group than that for the low-grade group (38.2 ± 25.9 seconds vs. 27.9 ± 6.2 seconds, time difference 10.3 seconds, 95% confidence interval: 1.4–19.2 seconds, P < 0.001). However, CVS provided similar high intubation success rates for both groups (97.4% for the high-grade and 100% for the low-grade group). During intubation, visualization of vocal cords and advancement into the glottis for the high-grade group were significantly more difficult than those for the low-grade group. CONCLUSIONS: Although intubation took longer for patients with higher MCL laryngeal view grade, CVS provided high intubation success rate for patients with severely restricted neck motion and mouth opening regardless of its MCL laryngeal view grade.
Anesthesia, General ; Cervical Vertebrae ; Female ; Glottis ; Humans ; Intubation ; Intubation, Intratracheal* ; Laryngoscopes ; Mouth ; Neck ; Vocal Cords

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.
Anesthesia ; Anesthesia, General ; Esophageal Sphincter, Lower ; Esophagectomy ; Gravitation ; Humans ; Hypopharyngeal Neoplasms ; Incidence ; Intubation ; Respiratory Aspiration ; Stomach

PURPOSE: To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients with NVI following acute central retinal artery occlusion (CRAO). METHODS: A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital between January 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excluding patients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, or NVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusion was achieved, typically within 1 to 3 months. RESULTS: The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in seven patients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15 months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severely narrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients (75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or central retinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patients with NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0% [NVI] vs. 17.3% [no NVI], p = 0.017). CONCLUSIONS: CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia from reperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinal artery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulation should be considered if retinal arterial perfusion is not recovered.
Carotid Arteries ; Diabetic Retinopathy ; Diagnosis ; Fluorescein Angiography ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Incidence* ; Iris* ; Ischemia ; Light Coagulation ; Perfusion ; Prevalence ; Reperfusion ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinal Vein ; Retinaldehyde ; Retrospective Studies ; Tertiary Care Centers

Granulocytic sarcoma is a localized extramedullary solid tumor composed of immature myeloid cell and is usually associated with acute myeloid leukemia or myelodysplastic syndrome. Although it can involve any site, commonly in lymph nodes, skin, bone and soft tissue, the involvement of breast is unusual. Especially, the involvement of the breast as a pattern of relapse after bone marrow transplantation is extremely rare. We have experienced 2 cases of granulocytic sarcoma after bone marrow transplantation. One case was a 39-year-old woman with right breast mass diagnosed with granulocytic sarcoma. She had received an unrelated bone marrow transplantation due to biphenotype acute leukemia 3 years before our presentation. Another case was a 48-year-old woman with acute myeloid leukemia, who was diagnosed with granulocytic sarcoma on both breasts 8 months after allogenic bone marrow transplantation. We also discuss the clinicopathologic features of granulocytic sarcoma in breast after bone marrow transplantation.
Bone Marrow ; Bone Marrow Transplantation ; Breast ; Female ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lymph Nodes ; Myelodysplastic Syndromes ; Myeloid Cells ; Recurrence ; Sarcoma, Myeloid ; Skin

Hypochondroplasia (HCH) is an autosomal dominant inherited skeletal dysplasia, usually caused by a heterozygous mutation in the fibroblast growth factor receptor 3 gene (FGFR3). A 27-year-old HCH woman with a history of two consecutive abortions of HCH-affected fetuses visited our clinic for preimplantation genetic diagnosis (PGD). We confirmed the mutation in the proband (FGFR3:c.1620C>A, p.N540K), and established a nested allele-specific PCR and sequence analysis for PGD using single lymphocyte cells. We performed this molecular genetic analysis to detect the presence of mutation among 20 blastomeres from 18 different embryos, and selected 9 embryos with the wild-type sequence (FGFR3:c.1620C). A successful pregnancy was achieved through a frozen-thawed cycle and resulted in the full-term birth of a normal neonate. To the best of our knowledge, this is the first report of a successful pregnancy and birth using single-cell allele-specific PCR and sequencing for PGD in an HCH patient.
Blastomeres ; Bone and Bones ; Dwarfism ; Embryonic Structures ; Female ; Fetus ; Humans ; Infant, Newborn ; Limb Deformities, Congenital ; Lordosis ; Lymphocytes ; Molecular Biology ; Parturition ; Polymerase Chain Reaction ; Pregnancy ; Preimplantation Diagnosis ; Prostaglandins D ; Receptor, Fibroblast Growth Factor, Type 3 ; Sequence Analysis

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: The daily activities and performance of the working population can be threatened by sleep disturbances, including insomnia. This study evaluated the sleep patterns, sleep problems, daytime sleepiness, and lost productivity time (LPT) resulting from sleep quality and sleep duration issues among workers. METHODS: The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Health and Work Performance Questionnaire (HPQ) were completed by 653 workers in an urban area. Statistical analyses were performed using independent t-tests. RESULTS: The average sleep duration among the subjects was 6 h 37 min. While 19.6% of the subjects complained of poor sleep quality, 53.4% were affected during the day by insomnia. The estimated annual cost of LPT due to presenteeism (Won13,892,545 vs. Won11,840,140 ; p=0.033) and the total annual cost of LPT (Won14,040,968 vs. Won11,961,302 ; p=0.032) were higher in poor sleepers than in good sleepers. Furthermore, workers with a shorter sleep duration had a higher annual LPT due to presenteeism (747.83 vs. 648.57 h ; p=0.046) and a higher total annual LPT (754.48 vs. 657.99 h ; p=0.049) than workers with a longer sleep duration. CONCLUSION: Sleep deprivation among workers caused 1 h 51 min LPT per week. This suggests that sleep disturbance affects workers' performance in an organization, as well as in terms of individual health.
Efficiency ; Korea ; Occupational Health ; Surveys and Questionnaires ; Sleep Deprivation ; Sleep Initiation and Maintenance Disorders