Impact of the COVID-19 Pandemic on the Diagnosis and Surgery of Breast Cancer: A Multi-Institutional Study / 한국유방암학회지

Purpose@#The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the rates of screening, case identification, and referral for cancer diagnosis. We investigated the diagnosis and surgery status of breast cancer before and after the COVID-19 pandemic at a multi-institutional level. @*Methods@#We collected breast cancer data from the clinical data warehouse which contained the medical records of patients from six academic institutions in South Korea. Patients were divided into two groups: February to April (period A) and May to July (period B). The data from the two groups were then compared against the same periods in 2019 and 2020. The primary objective was to investigate the differences in breast cancer stages before and after the COVID-19 pandemic. @*Results@#Among 3,038 patients, there was a 9.9% reduction in the number of diagnoses in 2020. This decrease was more significant during period A than period B. The breast cancer stage was not statistically different in period A (p = 0.115), but it was in period B (p = 0.001). In the subset analysis according to age, there was a statistical difference between 2019 and 2020 in period B for patients under the age of 65 years (p = 0.002), but no difference was observed in the other groups. @*Conclusion@#The number of breast cancer cases declined during the pandemic, and the staging distribution has changed after the pandemic peak.

Clinical and Radiological Outcomes of Polished Cemented Bipolar Hemiarthroplasty for Intertrochanteric Fractures in Elderly Patients

Purpose@#To evaluate the clinical and radiological outcomes of bipolar hemiarthroplasty using a polished cemented femoral stem for intertrochanteric fractures in elderly patients. @*Materials and Methods@#From July 2005 to May 2015, 48 patients diagnosed with intertrochanteric fractures underwent bipolar hemiarthroplasty. The mean age and follow-up period were 80.5 years and 30.5 months, respectively. The postoperative results were evaluated clinically and radiologically. @*Results@#The mean operation time was 100 minutes (range, 90-120 minutes), and the mean amount of blood loss was 334 ml (range, 170-500 ml). At the last follow-up, the mean Harris hip score (HHS), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 82.2 (range, 76-90), 0.8 (range, 1-3), and 36 (range, 30-40), respectively. Walking was initiated using a walker for partial weight-bearing, and the mean walking time was 5.8 days (range, 3-14 days). Ambulatory ability was restored to a walking state before the injury in 36 cases (75.0%), and wheelchair ambulation was possible in 12 cases (25.0%). The instrumental activities of daily living (IADLs) were 17 patients (35.4%), and the basic activities of daily living (BADLs) were 31 patients (64.6%). @*Conclusion@#Polished cemented bipolar hemiarthroplasty can achieve secure fixation with no postoperative thigh pain. Restoring the preoperative walking ability will be more helpful for intertrochanteric fractures in elderly patients.

Breakage of Cephalomedullary Nail Used in the Treatment of Proximal Femur Fractures: Case Report

Internal fixation using a cephalomedullary nail as treatment for proximal femur fracture has recently been popular for early ambulation and rehabilitation. However metal breakage at the lag screw insertion site was reported due to non-union, delayed-union, and early weight bearing. In our orthopedic department, we experienced 2 cases of nail breakage at the lag screw insertion site, therefore we report on evaluation of the cause of metal failure and prevention of complications with literature review.

Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

PURPOSE: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. MATERIALS AND METHODS: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. RESULTS: Using the MMWS, 13 cases were classified as 'good', 10 'fair', and 5 'normal'. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as 'good', 14 'fair', and 7 'normal'. CONCLUSION: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.

Atypical Ocular and Optical Coherence Tomographic Findings With Presumed Miliary Tuberculosis

PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.

Wyburn-Mason Syndrome: A Case Report

PURPOSE: To describe a case of Wyburn-Mason Syndrome, which is characterized by arteriovenous malformations in the central nervous system and the retina. CASE SUMMARY: A 13-year-old girl who underwent neurosurgical intervention for intraventricular hemorrhage was referred to our ophthalmic clinic because brain angiogram and MRI finding revealed arteriovenous malformations (AVMs) that extended from the orbit and optic chiasm along the optic pathway. Fundus and fluorescein angiography of the left eye showed marked dilation and tortuosity of the retinal vessels. Fluorescein angiographic findings showed rapid filling of all vessels and no dye leakage. CONCLUSIONS: Retinal racemose hemangioma should be considered for Wyburn-Mason syndrome, and the finding of retinal AVMs should warrant cerebral imaging studies including MRI and angiography.

Evaluation of the Functional Nasolacrimal Duct Obstruction with Digital Subtraction Dacryocystography

PURPOSE: We evaluated the structural abnormality of the lacrimal drainage system by using digital subtraction dacryocystography in patients with functional nasolacrimal obstruction. METHODS: From April 2001 to March 2002, digital subtraction dacryocystography was performed in 17 eyes of 11 patients who had patent lacrimal systems on syringing with no known underlying cause of epiphora. RESULTS: Six eyes of 5 patients showed a diffuse incomplete nasolacrimal duct obstruction inferior to the lacrimal sac, and one eye of 1 patient had a filling defect in lacrimal sac. Fifteen eyes of 10 patients were received silicone tube intubation and one eye of 1 patient underwent dacryocystorhinostomy. CONCLUSIONS: There might be anatomical abnormalities in the lacrimal drainage system although it is clinically diagnosed as functional nasolacrimal obstruction. Digital subtraction dacryocystography will provide a better understanding on various causes of epiphora, and give a precise diagnosis and proper treatment.

Long-term Clinical Result and Patient Satisfaction after LASIK

PURPOSE: To evaluate the long-term clinical result and patient satisfaction after laser in situ keratomileusis. METHODS: This is a long term (over 3 years) retrospective analysis of 107 eyes (54 patients) that has undergone LASIK since February 1996. RESULTS: Mean preoperative Spherical Equivalent(SE) was -7.81 +/- 4.07D and mean postoperative SE was -0.88 +/- 1.74D at 1 week, -1.18 +/- 1.17D at 1 month, -1.32 +/- 1.71D at 3 month and -2.44 +/- 2.20D after 3 years. At the last visit, uncorrective visual acuity was 0.5 or better in 83.1% and 26.2% of manifest SE was within the +/- 1D. However, in high myopic group (>-10.D), it has decreased to 41.7% and 0% respectively. Myopic progression occurred also in reoperation cases, 81.3% had uncorrective visual acuity of 0.5 or better and 31.3% had manifest SE within +/- 1D at the last visit. In the survey of subjective satisfaction, 80.2% of patient was satisfied with the surgery, which has decreased to 46.2% after long term follow-up. CONCLUSIONS: In conclusion, the higher the preoperative SE, the more myopic regression has occurred (p0.05). The patient subjective satisfaction has significantly decreased after long term follow-up compared to immediate postoperative visit.

A Case of Xanthoma Presenting with Blepharoptosis

PURPOSE: Xanthoma in the eyelids is a common dermatologic disorder. Generally these lesions do not affect the function of the eyelids. We report a case of xanthoma that has caused lid edema and ptosis. METHODS: A 46-year-old woman presented with ptosis and mass of the right upper eyelid for several months. We tried oral corticosteroid treatment, but the lesion was not lessened. We performed an excisional biopsy for the mass and ptosis correction. RESULTS: Histopathological examination of the mass revealed xanthoma. Lipid-laden histocytes infiltrated through the subcutaneous tissue, dermis, muscle layer and the preaponeurotic fat tissue. After surgical treatment, the patient was treated with Fenofibrate. There was a mild recurrence after a 18 months of follow-up.