Surgical Results of Minimally Invasive Percutaneous Plate Fixation in the Treatment of Clavicle Shaft Fracture

PURPOSE: This study analyzed the results of the midclavicle fracture treatment using the minimally invasive percutaneous plate osteosynthesis (MIPO) technique in a retrospective manner. MATERIALS AND METHODS: Between March 2013 and March 2017, this study analyzed 40 patients who received MIPO surgery. Excluding 1 patient who underwent surgery on another body part injury, and 4 patients who were lost to follow-up over 1 year, 40 patients were analyzed for their operation time, bone union, functional American Shoulder and Elbow Surgeons score, scar lengths, pain relief (visual analogue scale), and complications. RESULTS: All patients over a 1 year of follow-up achieved bone union, and American Shoulder and Elbow Surgeons score 97.6 (94–100) on their shoulder functional scores. Their average operation time was 42.7 minutes, and the average scar length was 6.1 cm. Eighteen patients successfully received metal removal using the previous scar without additional incision. The clavicle length was similar in the normal and operated group. CONCLUSION: Despite its small sample size, clavicle fixation using the MIPO technique can be considered an effective treatment because of its limited number of complications, such as nonunion and rotational angulations.

Estimation of the Relative Risk for Breast Cancer in Korean Women Using Gail Model / 대한폐경학회지

OBJECTIVES: The aim of this study is to estimate the relative risk for breast cancer using the Gail model and to observe the relationship between mammographic density and the 5-year risk of breast cancer. METHODS: A total of 600 women who visited the Department of Obstetrics and Gynecology in Chung-Ang University Yongsan Hospital were screened using the Gail model to estimate their relative risk for breast cancer. The correlation between the 5-year risk of breast cancer and the mammographic density of 462 women who had performed mammography within 1 year of the study was analyzed. RESULTS: The mean age of the study subjects was 56.7 +/- 8.2 years. The estimated mean values for the 5-year risk and lifetime risk for breast cancer were 1.23 +/- 0.46% and 7.90 +/- 2.76% respectively in all study subjects. The estimated mean value of the 5-year risk for breast cancer increased with age. Otherwise, the estimated lifetime risk for breast cancer decreased with age. Ninety-two women (15.3%) were classified as high-risk because their estimated 5-year risk was over 1.67% or their lifetime risk was over 20%. High risk percentages according to age were 10.5% in the thirties, 0.84% in the forties, 7.2% in the fifties, 32.7% in the sixties, and 35.7% in the seventies. Among the high risk postmenopausal women, 52.2% were taking hormone therapy. Mammographic density was not significantly correlated with the estimated 5-year risk for breast cancer. CONCLUSION: About fifteen percent of study subjects were at high risk for breast cancer according to the estimated 5-year risk or lifetime risk for breast cancer using Gail model. Mammographic density was not correlated with the 5-year risk for breast cancer.

The Impact of Mitral Annular Calcification on Left Ventricular Function in Nonagenarians

BACKGROUND AND OBJECTIVES: Mitral annular calcification (MAC) is known to be associated with degenerative processes of the cardiac fibrous skeleton and cardiovascular disease mortality. However, MAC has not been evaluated in an extreme age group (patients > or =90 years of age). In this study, the clinical significance of MAC associated with aging was examined in this age group and compared with MAC associated with aging in a younger (20 to 50 years of age) group of patients. SUBJECTS AND METHODS: We assessed echocardiographic parameters in 43 nonagenarians and 51 young patients. In the nonagenarian group, patient's age was 92+/-2 years and 27% were male; in the young control group, patient's age was 36+/-9 years and 51% were male. Comprehensive M-mode and Doppler echocardiography, including tissue Doppler imaging, were performed. The frequency and severity of MAC was assessed from the leading anterior to the trailing posterior edge at its largest width for least 3 cardiac cycles. RESULTS: Echocardiography showed that the left ventricular (LV) end-diastolic dimension was larger in the young controls (p=0.007); however, the ejection fraction (EF) was lower in the nonagenarian group (p=0.001). The frequency of MAC was greater in nonagenarians {42/43 (97%)} than in controls {9/51 (17%), p<0.0001}. The maximal width of MAC was larger in nonagenarians (0.52+/-0.17 mm and 0.05+/-0.13 mm, p<0.0001). MAC was correlated with LV mass index (g/m2) (r=0.280, p=0.014) and EF (%) (r=-0.340, p=0.001). More importantly, early mitral inflow velocity/early diastolic mitral annulus velocity (E/E') was strongly correlated with MAC in non-agenarians (r= 0.683, p<0.0001). CONCLUSION: MAC may be associated with extreme age and increased LV filling pressure in nonagenarians. Further study is necessary to assess the cardiovascular mortality and structural changes related to mitral annulus calcification associated with aging.

Benign Phyllodes Tumor Mimicking a Malignancy in a Turner Syndrome Woman with Hormone Replacement Therapy: A Case Report

Phyllodes tumor of the breast is a relatively rare fibroepithelial tumor. Turner syndrome is a condition that affects approximately 50 per 100,000 females and includes total or partial absence of one X chromosome in all or part of the cells, reduced final height, absence of female sex hormone, and infertility. In this case report, we describe the first case of a benign phyllodes tumor mimicking a malignancy at breast US in a 26-year-old woman with Turner syndrome who had been undergoing hormone replacement therapy.

Phase Contrast Microradiography of Mouse Lung Using Synchrotron X-ray: Correlation with Optical Microscopy

PURPOSE: The purpose of this study is to evaluate the feasibility of phase contrast X-ray microtomography and microradiography, using a polychromatic synchrotron X-ray, for analysis of the mouse lung microstructure. MATERIALS AND METHODS: Normal mice were used for experiments. Some of the mouse lungs were prepared by the lung fixation-inflation method. The resulting sponge-like inflated lung samples were used for microtomography. The remaining mouse lungs were cut into 10 um sections and were used for microradiography and optical microscopic correlation. The experiments on mouse lung samples were performed at the 7B2 beamline of the Pohang Light Source in Korea. RESULTS: Phase contrast X-ray microtomography of inflated lung samples showed individual alveolar structure on 3-D reconstruction. Phase contrast microradiographs of thin lung samples showed microstructure of lung, such as alveoli and bronchioles, and were well correlated with optical microscopic images. CONCLUSIONS: The results indicate that the phase contrast X-ray microtomography and microradiography using polychromatic synchrotron X-ray is feasible for evaluation of microstructure of the lung.

Miliary Tuberculosis with Concurrent Brain and Spinal Cord Involvement: A Case Report

Central nervous system involvement by tuberculosis is rare, and intramedullary involvement is even more rare. A patient that developed intermittent amnesia during anti-tuberculous therapy underwent brain CT and MRI and spine MRI. The latter showed multiple small enhancing nodules in the brain and spinal cord. The patient was treated with anti-tuberculous medication and steroids under the suspected diagnosis of miliary tuberculosis. Follow-up CT showed decreased nodule size and number. We report a case of miliary tuberculosis in the brain and spinal cord and present a review of the literature related to similar cases.

Noninvasive Assessment of In-Stent Restenosis of the Coronary Artery with Using 16-Slice Computed Tomography

PURPOSE: We strove to evaluate in-stent restenosis of the coronary artery by measuring the in-stent CT attenuation with using 16-multislice CT. MATERIALS AND METHODS: We analyzed the coronary CT angiography, with using 16-slice CT, in 45 stents of 30 patients. The CT attenuation was measured in the lumen of the stented segments and in the lumen of the segment proximal to the stents, and this attenuation was compared with each other. The CT attenuation difference between them was analyzed in relation to the presence of significant in-stent restenosis. Conventional coronary angiography was used as a standard of reference for in-stent restenosis. RESULTS: 12 stents in 12 patients revealed significant restenosis on the conventional coronary angiography. In 6 (50%) of them, the CT attenuation value of the in-stent lumen was lower than that of the proximal segments (373.8 HU vs. 497.1 HU, respectively, p=0.77). In the other 6 stents, a small stent diameter (n=3) and adjacent severe calcification (n=2) accounted for the higher CT attenuation value of the in-stent lumen. In all the stents without significant restenosis, the CT attenuation values of the in-stent lumens were higher than those of their proximal segments. CONCLUSION: The measurement of CT attenuation with using 16-slice CT at the in-stent lumen as compared to the attenuation of the proximal segment provides an objective, confident method for the diagnosis of in-stent restenosis.

Feasibility and Diagnostic Accuracy of Whole Heart Coronary MR Angiography Using Free-Breathing 3D Balanced Turbo-Field-Echo with SENSE and the Half-Fourier Acquisition Technique

OBJECTIVE: We wanted to assess the feasibility and diagnostic accuracy of whole heart coronary magnetic resonance angiography (MRA) with using 3D balanced turbo-field-echo (b-TFE) with SENSE and the half-Fourier acquisition technique for identifying stenoses of the coronary artery. MATERIALS AND METHODS: Twenty-one patients who underwent both whole heart coronary MRA examinations and conventional catheter coronary angiography examinations were enrolled in the study. The whole heart coronary MRA images were acquired using a navigator gated 3D b-TFE sequence with SENSE and the half-Fourier acquisition technique to reduce the acquisition time. The imaging slab covered the whole heart (80 contiguous slices with a reconstructed slice thickness of 1.5 mm) along the transverse axis. The quality of the images was evaluated by using a 5-point scale (0 - uninterpretable, 1 - poor, 2 - fair, 3 - good, 4 - excellent). Ten coronary segments of the heart were evaluated in each case; the left main coronary artery (LM), and the proximal, middle and distal segments of the left anterior descending (LAD), the left circumflex (LCX) and the right coronary artery (RCA). The diagnostic accuracy of whole heart coronary MRA for detecting significant coronary artery stenosis was determined on the segment-by-segment basis, and it was compared with the results obtained by conventional catheter angiography, which is the gold standard. RESULTS: The mean image quality was 3.7 in the LM, 3.2 in the LAD, 2.5 in the LCX, and 3.3 in the RCA, respectively (the overall image quality was 3.0+/-0.1). 168 (84%) of the 201 segments had an acceptable image quality (> or = grade 2). The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of the whole heart coronary MRA images for detecting significant stenosis were 81.3%, 92.1%, 91.1%, 97.9%, and 52.0%, respectively. The mean coronary MRA acquisition time was 9 min 22 sec (+/-125 sec). CONCLUSION: Whole heart coronary MRA is a feasible technique, and it has good potential to evaluate the major portions of the coronary arteries with an acceptable image quality within a reasonable scan time.

Noninvasive Follow-Up of Coronary Artery Bypass Graft Patency Using Multi-Slice Computed Tomography

PURPOSE: We wanted to evaluate the utility of multi-slice computerized tomography (MSCT) for assessing coronary artery bypass graft patency and/or occlusion. MATERIALS AND METHODS: For 24 patients, both conventional angiography and CT angiography with 4-MSCT were performed within seven days of one another in order to evaluate the accuracy of MSCT with regard to graft patency and/or occlusion. A follow-up CT angiogram was performed in patients with and without symptoms (n=11, n=34, respectively) with 4- or 16-MSCT. We retrospectively compared the results of MSCT to those of conventional coronary graft angiography. RESULTS: Sixty-five grafts were evaluated for the accuracy of MSCT. Six of those 65 were occluded. The sensitivity, specificity, positive predictive value and negative predictive values of MSCT for the diagnosis of graft occlusion were 100% (6/6), 98% (58/59), 86% (6/7) and 100% (58/58), respectively. Patency could not be determined by angiography in two grafts; however, the grafts proved to be patent on MSCT. On follow-up, new graft occlusions in the asymptomatic patients were detected by MSCT in 8.2% of the previously patent grafts at the two years post-op, and in 15.2% at the three years post-op. CONCLUSION: MSCT is a practical and accurate noninvasive diagnostic tool for following up coronary artery bypass grafts.

CT Findings of Aortic Intramural Hematoma with or without associated Penetrating Aortic Ulcer

PURPOSE: To analyze the CT findings of aortic intramural hematoma (IMH) with or without associated penetrating aortic ulcer (PAUH), as seen on initial and follow-up CT scans. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of 36 cases diagnosed clinically and radiologically as IMH (n=7) and PAUH (n=29) after initial and follow-up CT scanning. The period between initial and follow-up scanning-which was performed between two and four times-ranged from 1 week to 91 months (mean: IMH, 18.4 months;PAUH, 16.2 months). RESULTS: With regard to maximal thickness and extension of IMH, maximal diameter of the involved aorta, inward displacement of intimal calcification, Stanford type of IMH, and pleural and pericardial effusion between IMH & PAUH, the results were not statistically significant, but PAUH tends to develop in older patients and shows a more frequent incidence of aortic atherosclerosis. Only PAUH involved abdominal aortic a-neurysm and focal right renal infarction, each in one case. Penetrating aortic ulcers (PAU) were more frequently found in the proximal descending thoracic aorta (n=24) than in the mid(n=11) to distal(n=10) descending thoracic aorta. Among 53 cases of PAU, seven could not be detected on initial CT scans; this was due to excessive scan thickness (n=4) and masking of the aortic ulcer by IMH(n=3), circumstances which were visualized after resolution of IMH. Follow-up CT scanning showed that PAU progressed to fusiform or saccular aortic dilatation (n=15) or localized aortic dissection (n=4), and that in 34 cases, there was no interval change. Follow-up CT findings of IMH in cases of PAUH were as follows: Type A (n=8), with four resolutions after surgery and four after conservative treatment; Type B (n=21), with 21 resolutions after conservative treatment. Follow-up CT findings of IMH were as follows: Type A (n=2), with one resolution after surgery and one after conservative treatment; Type B (n=5), with progression of typical aortic dissection in two cases, and three resolutions after conservative treatment. CONCLUSION: PAUH is characterized by its occurrence in older patients, a more frequent incidence of aortic atherosclerosis and abdominal aortic aneurysm, but no difference in the extension of IMH and other CT findings between PAUH and IMH. Branch vessel involvement was noted in one case of PAUH but not in cases of IMH. Follow-up CT scanning showed that in the absence of surgery, IMH progressed to aortic dissection or resolution. In all patients who did not undergo surgery, PAU progressed to saccular or fusiform aortic dilatation, localized aortic dissection and no interval change, with resolution of IMH after conservative treatment. Initial and follow-up thin-slice spiral CT scanning can provide correct diagnosis and treatment planning (especially ascending aorta is involved), and permit differentiation between PAUH and IMH.

Patellar Tendon to Patella Ratio: Evaluation with Flexion and Extension MR Imaging

PURPOSE: To determin whether radiographic assessment of patella position abnormalities (such as patella altaor baja) using the 'patellar tendon : patella ratio' (Insall & Salvati's method) can be applied to flexion andextension sagittal MR images of the knee MATERIALS AND METHODS: Both flexion (55-90 degrees, mean 62 degrees) and extensionT2-weighted sagittal images of 58 knees (54 patients;age:19-72 years:M:F=40:18 were obtained and reviewed by meansof routine lateral radiographs (flexion of knees:30-60 degrees). Patellar tendon and diagonal length were measured onroutine radiographs and on flexion and extension MR images;length was measured by sagittal T2-weighted MR imagingfrom the inner aspect of patellar insertion to the inner asspect of tibial insertion, an approach whichdemonstrated the even thickness of the patellar tendon and the greastest diameter of the patella. Usingcorrelation analysis, the ratio of patellar tendon to diagonal length was compared between examination methods andbetween the non-wavy and wavy forms of patellar tendon. RESULTS: The mean length of the respectirely, 'patella,patellar tendon and patellar tendon to patella ratio' were 4.15+/-0.38, 4.04+/-0.49 and 0.9+/-0.12, respectively, onroutine radiographs; 4.32+/-0.36, 3.8+/-0.47 and 0.89+/- 0.12, respectively, on flexion MR images;and 4.3+/-0.36,3.93+/-0.44 and 0.92+/-0.12, respectively on extension MR images. Between these three different modes of assessment,a high degree of correlation of mean patella length (r=0.89-0.92) and of mean patellar tendon length (r=0.71=0.85)were found. In addition, correlation of 'patella to patellar tendon ratios' was excellent : radiographs andflexion MRimages(r=0.76);radiographs and extension MR images(r=0.76);flexion and extension MR images(r=0.84).According to the form of patellar tendon, radiographs correlated better with extension MR images (r-0.71) thanwith flexion images (r=0.62) in the non-wavy form of patellar tendon, whereas in the wavy form, correlation withflexion images (r=0.83) was better than with extension images(r=0.78). CONCLUSION: MR asessment of 'patellartendon to patella ratio's correlated well with radiographic assessment, and the latter can therefore be used forthe evaluation of abnormal patellar position. Radiographs correlated better with extension MR images in thenon-wavy form of patellar tendon, whereas in the wavy form, correlation with flexion images was better.

Infiltrating Ductal Carcinoma with Mammographic 'Halo Sign' Correlation with Histopathology

PURPOSE: To analyze and correlate mammographic/ sonographic features with pathologic findings in patientswith infiltrative ductal carcinoma with the mammographic 'halo sign'. MATERIALS AND METHODS: We retrospectivelyreviewed 27 cases of surgically confirmed infiltrative ductal breast carcinoma with the mammographic 'halo sign',analysing the mammographic/sonographic findings, clinical records and pathologic findings. RESULTS: Twenty-sevenpatients with infiltrating ductal breast carcinoma with the mammographic 'halo sign' were aged 32-72 (mean 49+/-12)years. For periods of between 2 days and 5 months(mean, 1.9 months), all had complained of a palpable mass.Histologic sections indicated parenchymal compression(27/27), microscopic infiltration of tumor margin(11/27) andparenchymal fat compression(15/27), without a true capsule. Infiltrating ductal carcinomas with the mammographic'halo sign' were nuclear grade 1 (17/27) or histologic grade III (14/27). Mammography (complete halo:3;partialhalo:24) showed a round(15/27) or macrolobulated (9/27) mass (size : 2.5+/-1cm) which showed partialspiculation(17/27) or-rarely-calcification(2/27). Sonography revealed a hypoechoic mass with a thinboundary(13/15);in five of these 13 cases, pathologic examination revealed microscopic infiltration of the tumormargin. Bilateral shadowing (8/15), posterior enhancement(13/15), and heterogeneous internal echogenicity(13/15)were also noted on sonography. CONCLUSION: When correlated with the histopathologic findings, infiltrating ductalbreast carcinoma with the 'halo sign' showed a relatively poor pathologic grade, which is known to be one of theprognostic factors. Surrounding parenchyma and fat compression at the margin of a tumor are considered to be oneof the causes of the mammographic 'halo sign'.

Nonpalpable Breast Cancer: Mammographic and Clinical findings

PURPOSE: To evaluate the mammographic and clinical findings of nonpalpable breast cancer. MATERIALS AND METHODS: In 28 of 607 breast cancer patients examined between January 1994 and April 1997, lesions werenonpalpable. We retrospectively analyzed the mammographic, clinical and pathologic features of 25 patients (28lesions) whose mammograms we obtained. RESULTS: Among these 25 patients (28 lesions) screening was abnormal in22; other symptoms were bloody nipple discharge(n=4), and nipple eczema(n=2). The patients were 34-62 (mean 52)years old. Invasive ductal carcinoma(n=13), DCIS(ductal carcinoma in situ, n-12), Paget's disease (n=2), andLCIS(lobular carcinoma in situ, n=1) were found during surgery. Six of 28 lesions(21%) showed evidence of axillarynodal metastasis;the majority arose from the upper outer quadrant of the breast (n=21). The mammographic findingswere mass (50%), (and mass with microcalcification, 11%); microcalcification(29%); asymmetrical density(14%); andnormal (7%). According to the mammographic density of breast parenchyma, the major finding in the low densitygroup(N1+P1) was mas (9/9), and in the high density group(P2+DY) was microcalcification (12/19). CONCLUSION: Themost common mammographic findings of nonpable breast cancer were mass (50%) and microcalcification(29%). Itsfeatures varied according to the mammographic density of breast parenchyma;mass was the main finding in the lowdensity group and microcalcification in the high density group.