Longitudinal Stress Fracture of the Ulna: Forearm Splint in a Military Cook With Wok Pot Use

Stress fractures of the upper extremities are rare. Here we report the case of a 20-year old man who presented with left forearm pain for 6 weeks. He worked as a military cook and used a wok pot. Plain radiography showed periosteal reaction with cortical thickening at the midportion of the ulnar shaft without a transverse fracture line. Magnetic resonance imaging showed diffuse bone marrow edema along the ulnar shaft. Segmental cortical thickening with periosteal edema was observed on the volar side of the midshaft of the ulna. Although a typical transverse fracture line was not clearly visible, T2-hyperintense curvilinear foci were observed within the cortical thickening. Coronal T1-weighted enhanced imaging demonstrated an obliquely elongated abnormality within the cortical thickening. A longitudinal stress fracture of the ulna, of the intracortical subtype, was diagnosed. Follow-up plain radiography and computed tomography confirmed an ongoing solid union after plaster cast application. The non-neutral posture while using a straighthandled wok for flipping and repeated action likely caused cumulative trauma to the patient’s upper extremity. Clinical history taking and imaging studies using cross-sectional images may facilitate the early and accurate diagnosis of an unusual pattern of ulnar stress fracture.

Malignancy risk of thyroid nodules with minimal cystic changes: a multicenter retrospective study

Purpose@#The aim of this multicenter study was to investigate the malignancy risk of minimally cystic thyroid nodules (MCTNs) using cyto-histopathologic diagnoses as the reference standard. @*Methods@#From June 2015 to September 2015, 5,601 thyroid nodules (≥1 cm) from 4,989 consecutive patients who underwent thyroid ultrasonography (US) at 26 institutions were retrospectively analyzed. Each thyroid nodule was categorized according to its cystic proportion: purely solid, minimally cystic (≤10%), and partially cystic (>10%). The malignancy risk of MCTNs was compared with those of purely solid nodules and partially cystic thyroid nodules (PCTNs). The malignancy risk of MCTNs was assessed according to echogenicity and the presence of suspicious US features. @*Results@#The prevalence of MCTNs was 22.5%. The overall malignancy risk of MCTNs was 8.8%, which was significantly lower than that of purely solid nodules (29.5%) (P0.05). MCTNs were associated with a higher risk of malignancy in hypoechoic nodules than in isohyperechoic nodules and in nodules with suspicious US features than in those without suspicious US features (all P<0.001). @*Conclusion@#The malignancy risk of MCTNs was significantly lower than that of purely solid nodules. MCTNs could be categorized as PCTNs rather than as solid nodules to increase the accuracy of the risk stratification system for thyroid nodules.

Development of Korean NOVA Food Classification and Estimation of Ultra-Processed Food Intake Among Adults: Using 2018 Korea National Health and Nutrition Examination Survey / 대한지역사회영양학회지

Objectives@#In this study, we suggest a Korean NOVA food classification that can be applied to food consumption among Korean. Based on this suggestion, the nutritional intake of Korean adults from ultra-processed foods (UPFs) was estimated. @*Methods@#Korean commercial food was categorized based on the NOVA food classification criteria through the Korea Food Code and expert meetings. Then, the nutrient intake status of 6,991 participants in the 2018 National Health and Nutrition Examination Survey was analyzed according to the food processing level. Then, 4,152 adult participants (age 19-65) were divided into quartiles on the basis of their intake of UPFs, and the nutrient intakes from UPFs were compared. @*Results@#Korean NOVA Food Classification defines with priority Group I (Unprocessed/ Minimally processed foods) and Group II (Processed culinary ingredients) foods based on the food cooking or consumption. Then, Group III (Processed foods) and Group IV (UPFs) are classified according to whether the characteristics of the raw materials used are maintained or whether the food was consumed before the 1970s. Our analysis results showed that most of the calories in the diet were consumed by Group I (52.7%), followed by Group IV (29.3%). After categorization of the adult participants into four groups according to their energy consumption from UPFs, we found that the highest consumption group (Q4) was younger and had higher percentage of men than women. The comparative analysis of the consumption of ultra-processed foods by Korean adults revealed that participants of a younger age and men consumed higher energy from UPFs than older participants and women, respectively (P < 0.01). Furthermore, the larger intake of UPFs was associated with an increasing trend for a higher intake of energy, sugar, saturated fat (P for trend < 0.001), total fat (P for trend = 0.021), and sodium (P for trend = 0.005), whereas the intake of carbohydrate, protein, and dietary fiber had a decreasing trend (P for trend < 0.001). @*Conclusions@#With the current increase in the consumption of processed and ultra-processed foods, it is important to carefully consider not only nutrient intake but also the level of food processing.

Partial-Thickness Tear of Supraspinatus and Infraspinatus Tendon Revisited:Based on MR Findings

The interpretation of MRI of partial-thickness rotator cuff tears can be challenging. This review describes the anatomic considerations for diagnosing partial-thickness tears, especially supraspinatus and infraspinatus tendon and summarizes the classification of partial-thickness rotator cuff tears, as well as provides an overview on partial-thickness tears with delamination.

Diagnostic Performance of the Modified Korean Thyroid Imaging Reporting and Data System for Thyroid Malignancy: A Multicenter Validation Study

Objective@#To evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS), and compare it with the 2016 version of K-TIRADS using the Thyroid Imaging Network of Korea. @*Materials and Methods@#Between June and September 2015, 5708 thyroid nodules (≥ 1.0 cm) from 5081 consecutive patients who had undergone thyroid ultrasonography at 26 institutions were retrospectively evaluated. We used a biopsy size threshold of 2 cm for K-TIRADS 3 and 1 cm for K-TIRADS 4 (modified K-TIRADS 1) or 1.5 cm for K-TIRADS 4 (modified K-TIRADS 3). The modified K-TIRADS 2 subcategorized the K-TIRADS 4 into 4A and 4B, and the cutoff sizes for the biopsies were defined as 1 cm for K-TIRADS 4B and 1.5 cm for K-TIRADS 4A. The diagnostic performance and the rate of unnecessary biopsies of the modified K-TIRADS for detecting malignancy were compared with those of the 2016 K-TIRAD, which were stratified by nodule size (with a threshold of 2 cm). @*Results@#A total of 1111 malignant nodules and 4597 benign nodules were included. The sensitivity, specificity, and unnecessary biopsy rate of the benign nodules were 94.9%, 24.4%, and 60.9% for the 2016 K-TIRADS; 91.0%, 39.7%, and 48.6% for the modified K-TIRADS 1; 84.9%, 45.9%, and 43.5% for the modified K-TIRADS 2; and 76.1%, 50.2%, and 40.1% for the modified K-TIRADS 3. For small nodules (1–2 cm), the diagnostic sensitivity of the modified K-TIRADS decreased by 5.2–25.6% and the rate of unnecessary biopsies reduced by 19.2–32.8% compared with those of the 2016 K-TIRADS (p 2 cm), the modified K-TIRADSs maintained a very high sensitivity for detecting malignancy (98%). @*Conclusion@#The modified K-TIRADSs significantly reduced the rate of unnecessary biopsies for small (1–2 cm) nodules while maintaining a very high sensitivity for malignancy for large (> 2 cm) nodules.

Acute High-Altitude Cerebral Edema Presenting as Extensive Microbleeds along the Corpus Callosum without T2 Hyperintensity: A Case Report and Literature Review

High-altitude cerebral edema (HACE) is a potentially fatal neurological syndrome that develops in persons traveling to a high altitude. We report the case of a 49-year-old male who had traveled to a high altitude, and lost consciousness for a few hours. Susceptibility-weighted images revealed multiple, fine black pepper like microbleeds along the corpus callosum with several microbleeds in the left frontal and parietal subcortical white matter. The T2-weighted images did not show any abnormal signal intensities along the corpus callosum. The diffusion-weighted images revealed small nodular high signal intensities in the basal ganglia. This report describes the atypical radiologic findings of HACE showing multiple microbleeds along the corpus callosum, without abnormal high-signal intensity on T2-weighted images.

Immunoglobulin G4-Related Disease Involving the Pterygopalatine Fossa, Mimicking Invasive Aspergillosis: A Case Report and Literature Review

We report a case of Immunoglobulin G4 (IgG4) related disease involving the pterygoplataine fossa. A 83-year-old male presented with left ocular pain and visual disturbance. CT showed an isodense soft tissue lesion in the left pterygopalatine fossa with bony sclerotic changes and erosion. MRI revealed an infiltrative soft tissue mass in the left pterygopalatine fossa as a T2 slightly low signal intensity and heterogeneous enhancement. The patient underwent left ethmoidectomy, and biopsy of the mass was conducted. The histopathological diagnosis was IgG4-related disease. In this case, it was difficult to differentiate invasive aspergillosis, which is common in immunocompromised patients, considering the patient’s clinical history of diabetes mellitus. This report describes the imaging findings of IgG4-related disease mimicking invasive sinusitis such as invasive aspergillosis.

Diagnostic Performance of the Modified Korean Thyroid Imaging Reporting and Data System for Thyroid Malignancy: A Multicenter Validation Study

Objective@#To evaluate the diagnostic performance of the modified Korean Thyroid Imaging Reporting and Data System (K-TIRADS), and compare it with the 2016 version of K-TIRADS using the Thyroid Imaging Network of Korea. @*Materials and Methods@#Between June and September 2015, 5708 thyroid nodules (≥ 1.0 cm) from 5081 consecutive patients who had undergone thyroid ultrasonography at 26 institutions were retrospectively evaluated. We used a biopsy size threshold of 2 cm for K-TIRADS 3 and 1 cm for K-TIRADS 4 (modified K-TIRADS 1) or 1.5 cm for K-TIRADS 4 (modified K-TIRADS 3). The modified K-TIRADS 2 subcategorized the K-TIRADS 4 into 4A and 4B, and the cutoff sizes for the biopsies were defined as 1 cm for K-TIRADS 4B and 1.5 cm for K-TIRADS 4A. The diagnostic performance and the rate of unnecessary biopsies of the modified K-TIRADS for detecting malignancy were compared with those of the 2016 K-TIRAD, which were stratified by nodule size (with a threshold of 2 cm). @*Results@#A total of 1111 malignant nodules and 4597 benign nodules were included. The sensitivity, specificity, and unnecessary biopsy rate of the benign nodules were 94.9%, 24.4%, and 60.9% for the 2016 K-TIRADS; 91.0%, 39.7%, and 48.6% for the modified K-TIRADS 1; 84.9%, 45.9%, and 43.5% for the modified K-TIRADS 2; and 76.1%, 50.2%, and 40.1% for the modified K-TIRADS 3. For small nodules (1–2 cm), the diagnostic sensitivity of the modified K-TIRADS decreased by 5.2–25.6% and the rate of unnecessary biopsies reduced by 19.2–32.8% compared with those of the 2016 K-TIRADS (p 2 cm), the modified K-TIRADSs maintained a very high sensitivity for detecting malignancy (98%). @*Conclusion@#The modified K-TIRADSs significantly reduced the rate of unnecessary biopsies for small (1–2 cm) nodules while maintaining a very high sensitivity for malignancy for large (> 2 cm) nodules.

Acute High-Altitude Cerebral Edema Presenting as Extensive Microbleeds along the Corpus Callosum without T2 Hyperintensity: A Case Report and Literature Review

High-altitude cerebral edema (HACE) is a potentially fatal neurological syndrome that develops in persons traveling to a high altitude. We report the case of a 49-year-old male who had traveled to a high altitude, and lost consciousness for a few hours. Susceptibility-weighted images revealed multiple, fine black pepper like microbleeds along the corpus callosum with several microbleeds in the left frontal and parietal subcortical white matter. The T2-weighted images did not show any abnormal signal intensities along the corpus callosum. The diffusion-weighted images revealed small nodular high signal intensities in the basal ganglia. This report describes the atypical radiologic findings of HACE showing multiple microbleeds along the corpus callosum, without abnormal high-signal intensity on T2-weighted images.

Immunoglobulin G4-Related Disease Involving the Pterygopalatine Fossa, Mimicking Invasive Aspergillosis: A Case Report and Literature Review

We report a case of Immunoglobulin G4 (IgG4) related disease involving the pterygoplataine fossa. A 83-year-old male presented with left ocular pain and visual disturbance. CT showed an isodense soft tissue lesion in the left pterygopalatine fossa with bony sclerotic changes and erosion. MRI revealed an infiltrative soft tissue mass in the left pterygopalatine fossa as a T2 slightly low signal intensity and heterogeneous enhancement. The patient underwent left ethmoidectomy, and biopsy of the mass was conducted. The histopathological diagnosis was IgG4-related disease. In this case, it was difficult to differentiate invasive aspergillosis, which is common in immunocompromised patients, considering the patient’s clinical history of diabetes mellitus. This report describes the imaging findings of IgG4-related disease mimicking invasive sinusitis such as invasive aspergillosis.

Factors contributing to the reduction of sodium intake by food manufacture and cooking venues according to the national sodium reduction policies / 한국영양학회지

Purpose@#Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. @*Methods@#The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. @*Results@#Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. @*Conclusion@#The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

Factors contributing to the reduction of sodium intake by food manufacture and cooking venues according to the national sodium reduction policies / 한국영양학회지

Purpose@#Sodium intake is persistently decreasing because of the government's sodium reduction policy. This study aimed to identify foods and dishes that contributed to the reduction of sodium intake and evaluate the effects of the sodium reduction policy. @*Methods@#The subjects were 57,809 participants in the Korea National Health and Nutrition Survey from 2010 to 2017. To identify food and dish sources of sodium intake, the food and dish groups were classified into 23 and 21 groups, respectively. Foods and dishes that contributed to sodium intake were categorized according to the production and cooking venues: production by manufacturers, home cooking, cooking at catering service, and restaurant cooking. @*Results@#Sodium intake was 4,876 mg in 2010 to 3,477 mg in 2017, showing a 29.7% decrease in intake in 2010. Sodium intake was decreased mainly in foods produced by manufacturers and home-cooked foods. The main contributory factors to sodium from the food and dish groups differed according to the food manufacturer and cooking venue. The kimchi produced by manufacturers, cooked soup/tang/jjigae/hotpot at home and catering services, and cooked noodles/dumplings in restaurants were the main contributors to the sodium intake. @*Conclusion@#The type of foods and dishes that contribute to sodium intake tended to expand over the years from specific foods and dishes to various groups of foods and dishes. These results provide evidence for the development and production of low-salt foods and dietary education related to low-salt intake.

Restoration of Large Skin Defect on Nose Dorsum using Nasalis Island Pedicle Flap with Bilevel Undermining / 대한피부과학회지

Reconstruction of defects on the lower third of the nose is always a challenge, as dissection of tissues in this area is not simple due to both a lack of elasticity and the structural complexity of the mid-facial area. When the defect size is less than 1.5 cm on the nose, primary closure or a bilobed flap is widely-used, while a skin graft is required for reconstruction of larger defects. Here we present two cases of a nasalis myocutaneous island pedicle flap with bilevel undermining with a relatively large nasal dorsum defect (>2 cm). The nasalis myocutaneous island pedicle flap with bilevel undermining was performed in order to maximize the movement of skin flaps and minimize the secondary movement of flaps after surgery. The nasal tip showed a slight upward movement immediately after surgery that subsequently moved down to a normal level. This technique can be utilized for reconstruction of the lower part of the nose for defects 2 cm or larger in size by maximizing the movement of the flap within the nasal structure. A major advantage is a higher flap survival rate due to proper arterial supply and the procedure results in relatively reduced secondary motion of the flap after the surgery.

Treatment of Melasma with the Photoacoustic Twin Pulse Mode of Low-Fluence 1,064 nm Q-Switched Nd:YAG Laser

BACKGROUND: Low-fluence 1,064 nm Q-switched Nd:YAG laser has been widely used for the treatment of melasma. Although new Q-switched Nd:YAG lasers with photoacoustic twin pulse (PTP) mode have been recently developed for high-efficiency, there is limited information available for the new technique. OBJECTIVE: This study was designed to investigate the efficacy and adverse effects after few sessions of repeated low fluence 1,064 nm Q-switched Nd:YAG laser treatment with PTP mode in Asian women with melasma. METHODS: Twenty-two Korean women were treated with a total of five sessions of low-fluence PTP mode Nd:YAG laser treatment (Pastelle®) at 2 weeks interval. Responses to treatments were evaluated by using Melasma Area and Severity Index (MASI) scoring, colorimeter measurement, and the investigators' and patients' overall assessments. Adverse events were recorded at each visit. RESULTS: Investigators' and patients' overall assessment showed that 'significantly improved' was assessed by 13 (59.1%) and 19 of 22 patients (86.4%), respectively. MASI scores were significantly reduced by 20.4%. The lightness, measured by using a colorimeter, was significantly increased by 1.3 point. Notable adverse events were not observed. CONCLUSION: After 5 sessions of laser therapy alone, about 60% of the subjects showed significant improvement. Few sessions of repeated laser toning treatment using the PTP mode is a safe and effective way to treat facial melasma.

A Nonpregnant Woman with Group B Streptococcal Meningitis and Multifocal Embolic Infarctions

No abstract available.

Clinical Applicability of Newly Developed Image-based Cell Counter for Counting CD34+ Cells: Comparison with Flow Cytometric Analysis / 임상소아혈액종양

BACKGROUND: Flow cytometric analysis is the standard method for enumerating CD34+ stem cells in hematopoietic stem cell transplantation. However, it has some limitations such as expensive instrumentation, high reagent costs, and discrepancies between technicians and laboratories. We compared counts of total nucleated cells (TNCs) and CD34+ cells counts obtained from a flow cytometer with a newly-developed image-based microscopic cell counter (ADAM II) to evaluate the possibility of clinical application of the ADAM II.METHODS: We used 18 samples of circulating peripheral blood (PB) and waste tube fractions of peripheral blood stem cells (PBSCs) harvested by apheresis after G-CSF mobilization from adult volunteer donors. We assessed the reproducibility and linearity of the new procedure and compared the numbers of TNCs and viable CD34+ cells determined with the ADAM II and two different flow cytometers (FACSCalibur, FACSCanto II).RESULTS: Numbers of viable CD34+ cells determined with the ADAM II were accurate over the expected range; the intra-assay coefficient of variation was ≤19.8%. Linearity was also satisfactory (R²=0.99). TNC counts obtained with the ADAM II were highly correlated with those obtained with the FACSCalibur (R²>0.9841, P<0.0001) and FACSCanto II (R²>0.9620, P<0.0001), as were the numbers of viable CD34+ cells obtained with the ADAM II and the FACSCalibur and FACSCanto II (R²>0.9911, P<0.0001 and R²>0.9791, P<0.0001), respectively.CONCLUSION: The newly developed image-based microscopic cell counter (ADAM II) appears to be suitable for enumerating TNCs and viable CD34+ cells.

Enhancement of Optic Nerve in Leukemic Patients: Leukemic Infiltration of Optic Nerve versus Optic Neuritis

PURPOSE: To identify magnetic resonance imaging (MRI) findings of leukemic infiltration of optic nerve and optic neuritis in leukemic patients with emphasis of clinical findings as reference standard to differentiate them. MATERIALS AND METHODS: MRI and clinical findings of 7 patients diagnosed as leukemic infiltration of optic nerve (n = 5) and optic neuritis (n = 2) in our institution between July 2006 and August 2015were reviewed retrospectively. In particular, MR imaging findings involved perineural enhancement and thickening of optic nerve and its degree, signal intensity, laterality (unilateral/bilateral), intraconal fat infiltration and its degree, and associated central nervous system abnormalities. RESULTS: Of 5 cases of leukemic infiltration of optic nerve, 4 cases showed positive cerebrospinal fluid (CSF) study for leukemia relapse and 1 case was positive on bone marrow (BM) biopsy only. Moreover, of 5 leukemic infiltration of optic nerve, 2 cases showed the most specific MR findings for leukemic central nervous system involvement including 1 prominent leptomeningeal enhancement and 1 chloroma. However, other MR imaging findings of the patients with leukemic infiltration or optic neuritis such as thickening and perineural enhancement of optic nerves are overlapped. CONCLUSION: Enhancement and thickening of optic nerve were overlapped MR findings in leukemic infiltration of optic nerve and optic neuritis. Our findings suggest that enhancing optic nerve thickening with associated central nervous system MR abnormality favors the diagnosis of leukemic infiltration of optic nerve, especially in patients with history of acute lymphoblastic leukemia. However, CSF and BM study were required for differentiation between leukemic infiltration of optic nerve and optic neuritis.

Halo Congenital Nevus Developed after a Laser Treatment / 대한피부과학회지

No abstract available.

Clinical Applicability of Newly Developed Image-based Cell Counter for Counting CD34+ Cells: Comparison with Flow Cytometric Analysis / 임상소아혈액종양

BACKGROUND: Flow cytometric analysis is the standard method for enumerating CD34+ stem cells in hematopoietic stem cell transplantation. However, it has some limitations such as expensive instrumentation, high reagent costs, and discrepancies between technicians and laboratories. We compared counts of total nucleated cells (TNCs) and CD34+ cells counts obtained from a flow cytometer with a newly-developed image-based microscopic cell counter (ADAM II) to evaluate the possibility of clinical application of the ADAM II. METHODS: We used 18 samples of circulating peripheral blood (PB) and waste tube fractions of peripheral blood stem cells (PBSCs) harvested by apheresis after G-CSF mobilization from adult volunteer donors. We assessed the reproducibility and linearity of the new procedure and compared the numbers of TNCs and viable CD34+ cells determined with the ADAM II and two different flow cytometers (FACSCalibur, FACSCanto II). RESULTS: Numbers of viable CD34+ cells determined with the ADAM II were accurate over the expected range; the intra-assay coefficient of variation was ≤19.8%. Linearity was also satisfactory (R²=0.99). TNC counts obtained with the ADAM II were highly correlated with those obtained with the FACSCalibur (R²>0.9841, P0.9620, P0.9911, P0.9791, P<0.0001), respectively. CONCLUSION: The newly developed image-based microscopic cell counter (ADAM II) appears to be suitable for enumerating TNCs and viable CD34+ cells.

Tsutsugamushi Disease and Acute Bilateral Hearing Loss / 대한피부과학회지

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The main symptoms of scrub typhus are fever, eschar, generalized rash, and swelling of the lymph nodes. Complications include pneumonia, myocarditis, meningitis, hepatitis, acute renal failure, and hearing loss. We report a rare case of Tsutsugamushi disease with acute bilateral hearing loss in a 65-year-old woman. The antibodies against O. tsutsugamushi were detected which led to the diagnosis of scrub typhus. She was treated immediately with oral doxycycline for 9 days and had a rapid and complete recovery. Scrub typhus can be associated with hearing loss, which is present in approximately one-third of the cases, but it is rare in Korea, therefore it is easy to misdiagnose scrub typhus as any other otological abnormalities. When patients present with fever, rash, and sensorineural hearing loss, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.