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Purpose@#This retrospective study aimed to clarify the relation between nutritional index and length of hospital stay in elderly patients undergoing pancreatic cancer surgery, and to identify factors affecting the length of hospital stay. @*Methods@#Total 102 patients aged over 65 years who underwent pancreaticoduodenectomy were retrospectively enrolled from January 1, 2010 to September 30, 2020. All patients were subjected to nutritional screening using Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI). @*Results@#The GNRI average was 95. 66±6.95, with 67.6% of patients having a low GNRI score (malnutrition group). The average regarding PNI was 45.46±5.65, with 54.9% of patients having a low PNI (malnutrition group). The average total length of hospital stay was 23.12±10.69 days. Total length of hospital stay according to the nutritional indexes of the subjects was longer in the low GNRI (t=-2.09, p=.039) and low PNI (t=-2.29, p=.024) groups. @*Conclusion@#Poorer preoperative nutritional status increased total length of hospital stay in elderly patients with pancreatic cancer. Assessment of nutritional status of patients using GNRI and PNI is a good strategy for evaluating elderly patients at high risk of having to stay in hospital for more extended periods of time.
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Angiomyolipomas are usually found in the kidneys of patients with tuberous sclerosis. They occur less frequently in organs such as the liver, the oral cavity, the nasal cavity, the heart, the large intestines, and the lungs. Angiomyolipomas of the skin are extremely rare, and cutaneous angiomyolipomas generally occur on the elbow, the ends of digits, the ear, and the glabella. Herein we present a rare case of angiomyolipoma occurring on the face—specifically, the right upper eyelid. We propose that upper eyelid angiomyolipoma is a hamartomatous, rather than neoplastic, lesion. Although angiomyolipoma in the periocular area is rare, it should be considered in the differential diagnosis of clinically benign masses. and regular follow-up is warranted.
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The cheek, a highly visible and significant aspect of an individual’s appearance, is situated adjacent to several structures involved in facial expressions, including the eye, mouth, and surrounding facial muscles. Consequently, aesthetic reconstruction for large cutaneous defects of the cheek remains a challenge for plastic surgeons. We experienced a case of an 83-year-old woman with a large (7×10 cm) facial defect following the removal of squamous cell carcinoma. We elevated a cervicofacial skin flap containing the superficial layer of the superficial musculoaponeurotic system and a blood supply via the dermal plexus in a random pattern. Through this method, we achieved aesthetically favorable reconstruction of a large facial defect using a cervicofacial transposition skin flap. By avoiding extensive dissection, we achieved adequate coverage for even a quite sizable facial defect, with a short recovery time. This method prevented facial nerve injury and made it possible to simultaneously obtain an aesthetically favorable outcome.
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Purpose@#As thyroid cancer patients are experiencing longer disease-free survival periods, evaluating their quality of life after surgery has become crucial. However, studies on this topic have primarily focused on Western populations, leaving a gap in understanding the Korean patient population’s experiences and needs. This study aims to address this gap and provide insights into the quality of life of thyroid cancer patients in Korea. @*Methods@#This cross-sectional study evaluated the quality of life of Korean thyroid cancer patients who underwent thyroid lobectomy or total thyroidectomy. Patients were surveyed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30, ver. 3.0) during outpatient clinic visits from January to September 2015. The results were analyzed by comparing them to scores of the general population and based on the time elapsed since surgery. This approach allowed for a comprehensive evaluation of the quality-of-life outcomes in this patient population. @*Results@#The study found that thyroidectomy had a notable impact on patients’ role and cognitive functions. Patients also experienced worsened symptoms such as fatigue, dyspnea, and constipation, which improved over time and returned to normal levels. However, there were no significant changes in other functions and symptoms after surgery. @*Conclusion@#The study’s findings showed that thyroidectomy had a relatively minor impact on the functional and symptomatic well-being of patients. Therefore, the results suggest that thyroid surgery may be a safe and effective treatment option for thyroid cancer patients seeking to maintain a good quality of life.
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The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. These guidelines provide the grade of recommendations, which includes both the strength of recommendations and the level of evidence. In the absence of sufficient evidence, recommendations are based on expert opinion. These guidelines have been revised and supplement the previous guidelines "Clinical Guidelines for Precocious Puberty 2011," and are drawn from a comprehensive review of the latest domestic and international research and the grade of recommendation appropriate to the domestic situation. This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty.
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Purpose@#The overall incidence of central precocious puberty (CPP) has increased in recent decades, and brain magnetic resonance imaging (MRI) evaluations are recommended in cases of suspected brain lesions. This study aimed to investigate the prevalence of MRI abnormalities and to evaluate the need for routine brain MRI in patients with newly diagnosed CPP. @*Methods@#This retrospective study reviewed the data of patients newly diagnosed with CPP who underwent routine pituitary MRI at Korea University Anam Hospital from March 2020 to September 2021. A total of 199 girls and 24 boys was enrolled in this study. Positive MRI findings were categorized as abnormal pituitary, nonpituitary incidental, and pathological. In addition, we investigated the incidence of MRI abnormalities and evaluated their associations with clinical and biochemical factors. @*Results@#Positive brain MRI findings were observed in 84 patients (37.7%). Pituitary abnormalities were found in 54 patients (24.2%), with Rathke cleft cysts being the most common (16.1%). Incidental nonpituitary findings were observed in 29 patients (13.0%), while a pathological brain lesion (diagnosed as hypothalamic hamartoma) was observed in only 1 female patient (0.4%). No significant differences in sex or age were found in incidence of pituitary abnormalities or nonpituitary incidental findings. Compared with headache controls, significant associations were observed between abnormal pituitary findings on MRI and CPP (unadjusted odds ratio, 3.979; 95% confidence interval, 1.726–9.173). @*Conclusion@#True pathological findings were rare, even though the prevalence of abnormalities on pituitary MRI in patients with CPP was relatively high. Considering its cost-effectiveness, MRI screenings should be carefully considered in patients with CPP.
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Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.
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Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of pathological fibril aggregation of proteins in the skin without systemic involvement.Macular amyloidosis, lichen (papular) amyloidosis, and nodular amyloidosis are three different subtypes of PLCA. Although the pathological mechanism of PLCA has not yet been clarified, it is assumed that a nucleus formation of amyloid fibril is formed due to repeated external stimulation, such as subcutaneous injection, which often poses diagnostic challenges. Herein, we present a 54-year-old Korean male patient with cutaneous localized amyloidosis which occurred after repeated local insulin injections, and discuss the relationship between insulin therapy in patients with diabetes mellitus and dermal amyloid deposition.
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Objective@#To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. @*Materials and Methods@#A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. @*Results@#The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593–14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719–65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07–420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%–100%) and positive predictive value (PPV) (91.8%–100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. @*Conclusion@#Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.
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Epithelioid blue nevus (EBN) is a rare variant of blue nevus characterized by large polygonal pigmented melanocytes. As EBN was first described in patients with Carney complex, familial lentiginosis, and low-grade multi-organ neoplasia syndrome, sporadic cases without such clinical features have been reported and debated as having considerable histopathological overlap with animal-type melanoma. A 34-year-old male presented with a well-defined, 2.0-×1.8-cm-sized, dome-shaped, grayish mass on the anterior aspect of the left ankle. A complete surgical resection of the lesion was performed. Histopathological findings revealed a well-circumscribed round tumor in the reticular dermis. Heavily pigmented epithelioid melanocytes were admixed with the collagen bundles. The lesion was diagnosed as EBN. A follow-up period of 9 months showed no evidence of recurrence or metastasis.Here, we report a sporadic case of EBN, which is rare in the Korean population.
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Pilomatricoma is a common benign tumor that originates from hair matrix cells. Bullous pilomatricoma (BP) is a rare variant that often occurs on the upper extremities. A 23-year-old male presented with a cyst on the left upper arm for 6 months. He received the BNT162b2 (Pfizer) mRNA COVID-19 vaccine in the same location approximately 6 months prior to presentation. The lesion appeared 1 week after inoculation and gradually enlarged.Physical examination revealed a 2.5-×2.0-cm-sized, pinkish cystic nodule on the left upper arm. The lesion was excised, and histopathological examination showed a well-circumscribed nodule composed of basophilic cells and eosinophilic shadow cells. Finally, the patient was diagnosed with BP. The exact cause of BP formation following vaccination is yet to be determined; however, this report presents the possibility of BP occurrence in individuals with chronic skin lesions at the site of vaccination.
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This case report describes the hematological and radiological examination of urinary bladder rupture and complete urethral obstruction. associated with urolithiasis in Hanwoo.Hyponatremia, hypochloremia, azotemia, and hyperglycemia were observed in both urethral obstruction and urinary bladder rupture. However, cattle with urethral obstruction showed hyperkalemia and mild hyperglycemia, whereas cattle with bladder rupture showed marked hyperglycemia and normal potassium levels. In ultrasonography, the urethral obstruction showed a dilated bladder with a thick bladder wall. In contrast to previous literature, in this study, severe electrolyte changes such as severe hyponatremia, hypochloremia, and hyperkalemia occurred in a case of complete urethral obstruction.
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Objectives@#The purpose of this study was to compare the fracture strength and traslucency of 3D printing resin crowns according to different thicknesses. @*Methods@#Resin crowns were designed with CAD software and a 3D scanner, using scanned data of the #61 tooth model. Resin Crowns with different thicknesses were printed using a 3D printer, and subsequently divided into four groups according to thickness (0.3, 0.5, 0.7, and 1.0 mm). Fracture strength was compared among groups with a resin strip crown of 1.0 mm thickness. Compressive force was applied using a universal testing machine at 30° along the lingual surface at 1 mm/min cross head speed. For translucency evaluation, thin square specimens were printed of thicknesses 0.3, 0.5, 0.7, and 1.0 mm, and translucency was measured using a spectrophotometer. @*Results@#As a result of fracture strength measurement, fracture strength increased as thickness increased, and a significant difference was observed solely between thicknesses of 0.3 and 0.5 mm, and the thicknesses of 0.3 and 0.5 mm (P<0.05). Translucency decreased as thickness increased, and similarly, a significant difference was observed only between thicknesses of 0.3 and 0.5 mm and the thicknesses of 0.7 and 1.0 mm (P<0.05). @*Conclusions@#A 3D printing resin crown can be used as a clinical option for restoring a primary anterior tooth affected by caries.
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This study explores the internal standards for hearing tests and benefits of implementing international standard protocols, including the International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC), and discusses how ISO and IEC standards provide a framework for designing, calibrating, assessing hearing test instruments and methods, and exchanging and comparing data globally. ISO and IEC standards for hearing tests improve accuracy, reliability, and consistency of test results by applying standardized methods and environments. Moreover, they promote international harmonization and data interoperability, enabling information exchange and research collaboration. Those standards for hearing tests are beneficial but have challenges and limitations, such as variation in equipment and calibration, lag in updating standards, variation in implementation and compliance, and lack of coverage of clinical aspects, cultural diversity, and linguistic diversity. These affect the quality and interpretation of test results. Adapting ISO or IEC standards locally would improve their applicability and acceptability, while balancing customization and compatibility with global standards.
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Recently, ex-vivo gene therapy has emerged as a promising approach to enhance the therapeutic potential of mesenchymal stem cells (MSCs) by introducing functional genes in vitro. Here, we explored the need of using selection markers to increase the gene delivery efficiency and evaluated the potential risks associated with their use in the manufacturing process. We used MSCs/CD that carry the cytosine deaminase gene (CD) as a therapeutic gene and a puromycin resistance gene (PuroR) as a selection marker. We evaluated the correlation between the therapeutic efficacy and the purity of therapeutic MSCs/CD by examining their anti-cancer effect on co-cultured U87/GFP cells. To simulate in vivo horizontal transfer of the PuroR gene in vivo, we generated a puromycin-resistant
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Therapeutic efficacy of mesenchymal stem cells (MSCs) is determined by biodistribution and engraftment in vivo.Compared to intravenous infusion, biodistribution of locally transplanted MSCs are partially understood. Here, we performed a pharmacokinetics (PK) study of MSCs after local transplantation. We grafted human MSCs into the brains of immune-compromised nude mice. Then we extracted genomic DNA from brains, lungs, and livers after transplantation over a month. Using quantitative polymerase chain reaction with human Alu-specific primers, we analyzed biodistribution of the transplanted cells. To evaluate the role of residual immune response in the brain, MSCs expressing a cytosine deaminase (MSCs/CD) were used to ablate resident immune cells at the injection site. The majority of the Alu signals mostly remained at the injection site and decreased over a week, finally becoming undetectable after one month. Negligible signals were transiently detected in the lung and liver during the first week. Suppression of Iba1-positive microglia in the vicinity of the injection site using MSCs/CD prolonged the presence of the Alu signals.After local transplantation in xenograft animal models, human MSCs remain predominantly near the injection site for limited time without disseminating to other organs. Transplantation of human MSCs can locally elicit an immune response in immune compromised animals, and suppressing resident immune cells can prolong the presence of transplanted cells. Our study provides valuable insights into the in vivo fate of locally transplanted stem cells and a local delivery is effective to achieve desired dosages for neurological diseases.
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Purpose@#The aim of this study was to assess the diagnostic role of fine-needle aspiration cytology (FNAC) and analyze factors associated with false-negative FNAC results in patients with parathyroid incidentaloma who were referred for ultrasonography (US)-guided fine-needle aspiration (FNA) of thyroid nodules. @*Methods@#In this study, 121 patients with suspected parathyroid lesions were enrolled. The patients underwent US-guided FNAC with measurements of washout parathyroid hormone (PTH) between January 2015 and May 2020. The diagnostic performance of FNAC for the diagnosis of parathyroid lesions was assessed using surgical results and elevated washout PTH as a reference standard. The clinical and radiologic features associated with false-negative results on FNAC for the diagnosis of parathyroid lesions were evaluated. @*Results@#Among the 121 nodules assessed, 38 were parathyroid lesions (31.4%), and 83 were non-parathyroid lesions (68.6%). The diagnostic performance of FNAC for parathyroid incidentaloma showed a sensitivity of 31.6% (12/38), specificity of 100% (83/83), positive predictive values of 100% (12/12), negative predictive values of 76.1% (83/109), and accuracy of 78.5% (95/121). The FNAC results of non-parathyroid lesions included thyroid nodules, lymph nodes, neurogenic tumors, and fat tissue. True-positive results on FNAC were significantly associated with performing FNA twice (58.3% vs. 23.1%, P=0.043). @*Conclusion@#Considering the low sensitivity of FNAC, measuring washout PTH in addition to FNAC may help accurately diagnose parathyroid incidentaloma on thyroid US. Further, the falsenegative rate for FNAC can be reduced by obtaining two or more FNA samples.
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Background@#Oral acitretin (ACT) has been approved for the treatment of psoriasis (PSO), whereas alitretinoin (ALI) has been prescribed off-label. Few studies have compared the efficacy of these two therapeutics. @*Objective@#To evaluate the clinical outcomes of oral ACT versus ALI for treating PSO. @*Methods@#Sixty-five patients diagnosed with PSO and treated with ACT or ALI were reviewed. Patient demographics, clinical efficacy, and adverse effects were evaluated. Treatment efficacy was assessed using physician’s global assessment (PGA) and psoriasis area and severity index (PASI). @*Results@#A total of 38 cases in the ACT group and 27 cases in the ALI group in PSO were retrospectively reviewed. No significant intergroup differences were noted in the proportion of patients achieving PGA score of “clear” or “almost clear” (18.42% vs. 22.22%; p=0.71). The reduction rate of PASI from baseline was higher in the ALI group (24.30% vs. 22.74%; p=0.68), while the rate of achieving 75% improvement in PASI was higher in the ACT group (18.42% vs. 14.81%; p=0.75); no significantly differences were noted. The ALI group had fewer adverse effects (6/27 [22.22%]) than the ACT group (10/38 [26.32%]), and no severe events occurred in either group. @*Conclusion@#ALI can be considered an off-label treatment option for a limited patient population.
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Background@#Double-lumen endobronchial tube (DLT) displacement, defined as migration of the DLT > 15 mm from optimal position, may threaten patient safety. Lateral decubitus positioning (LDP) of the patient can induce DLT displacement; however, little is known regarding the predictors for DLT displacement after this maneuver. Obesity may further aggravate DLT displacement by distorting mediastinal anatomy, but no comprehensive data exist concerning the impact of obesity on DLT displacement after LDP. Therefore, we evaluated the predictive value of preoperative risk factors, including obesity, for DLT displacement after LDP in patients who underwent pulmonary resection. @*Methods@#Data of patients who underwent pulmonary resection between July 2020 and July 2021 were retrospectively reviewed. Age, sex, height, weight, body mass index, left main bronchus diameter, DLT size, lateral decubitus direction, DLT depth, patient height divided by the DLT depths in supine and lateral decubitus positions (H/Dsupine and H/Dlateral, respectively), and extent of DLT dislocation were assessed. Logistic regression analysis identified risk factors, and the optimal cutoff values for continuous variables were determined using receiver operating characteristic curve analysis. @*Results@#Data from 428 patients were analyzed. DLT displacement was observed in 52 patients (12.1%). Obesity and H/Dsupine were independent predictors for DLT displacement after LDP (odds ratio [OR]: 5.69, 95% CI [2.89, 11.23], P < 0.001 and OR: 8.28, 95% CI [2.92, 23.48], P < 0.001, respectively). @*Conclusions@#Obesity was significantly associated with DLT displacement after LDP. Pre-emptively advancing the DLT from its optimal position before LDP may be advantageous in patients with obesity.
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Although differentiated thyroid cancer has an excellent prognosis and low mortality, its recurrence rate has been reported to be very high. While surgery is recommended as the standard treatment for recurrent thyroid cancer, reoperation may increase the incidence of complications due to fibrosis and anatomical distortion. In patients with high surgical risk or those who refuse repeated surgery, ultrasonography-guided ablation techniques including radiofrequency ablation, ethanol ablation, and laser ablation are suggested as alternative treatments. In this manuscript, we introduce an anatomy-based management concept for radiofrequency ablation for recurrent thyroid cancer, and present a review of the relevant literature, including indications, basic techniques, clinical outcomes, and complications.