Technical feasibility and efficacy of a standard needle magnetization system for ultrasound needle guidance in thyroid nodule-targeting punctures: a phantom study

Purpose@#The aim of this study was to assess the feasibility and efficacy of an ultrasound needle guidance system (NGS) based on standard needle magnetization in a phantom study of thyroid nodule (TN)-targeting punctures. @*Methods@#Six trainees and a staff radiologist performed TN-targeting punctures with or without the NGS in phantom models (group 1, experience <50 cases; group 2, experience ≥50 cases and <100 cases; group 3, experience ≥100 cases of TN-targeting punctures). The feasibility, technical success rate, number of punctures, and procedure time were recorded. @*Results@#The feasibility of NGS was 98.6% (138/140). In group 1, the technical success rate increased from 60.0%±8.2% to 80.0%±8.2% when the NGS was used (P=0.046), with a reduction in the number of punctures from 2.2 to 1.2 (P=0.005). In group 2, the rate changed from 95.0%±5.8% to 100.0%±0.0% with the NGS (P=0.157), with a minimal decrease in the number of punctures from 1.1 to 1.0 (P=0.157). The procedure time significantly decreased in both groups (P=0.041 and P=0.010, respectively) when the NGS was used. In group 3, there were no significant differences in the technical success rate and the number of punctures according to whether the NGS was used (P=0.317 and P=0.317, respectively). @*Conclusion@#NGS using standard needle magnetization is technically feasible and has potential to improve the efficacy of TN-targeting punctures for less-experienced operators, especially beginners, according to the findings of this phantom study.

Remodeling of Traumatic Sternal Segment Dislocation in a 13-Year-Old Boy / 대한정형외과학회잡지

A traumatic sternal segment dislocation in children is very rare. Of the few cases reported, some recommended surgical treatment, while others reported good results by conservative treatment. Therefore, the treatment remains unclear. This paper reports a case of completely remodeled traumatic sternal segment dislocation in a 13-year-old boy treated by the restriction of activity and periodic observations.

Esophageal Perforation after Anterior Cervical Spine Surgery

STUDY DESIGN: Retrospective case analyses.PURPOSE: To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis.OVERVIEW OF LITERATURE: To date, few studies have addressed these issues.METHODS: A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups.RESULTS: In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis.CONCLUSIONS: The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.

Computer-Aided Diagnosis of Thyroid Nodules via Ultrasonography: Initial Clinical Experience

OBJECTIVE: To prospectively evaluate the diagnostic performance of computer-aided diagnosis (CAD) for detection of thyroid cancers via ultrasonography (US). MATERIALS AND METHODS: This study included 50 consecutive patients with 117 thyroid nodules on US during the period between June 2016 and July 2016. A radiologist performed US examinations using real-time CAD integrated into a US scanner. We compared the diagnostic performance of radiologist, the CAD system, and the CAD-assisted radiologist for the detection of thyroid cancers. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CAD system were 80.0, 88.1, 83.3, 85.5, and 84.6%, respectively, and were not significantly different from those of the radiologist (p > 0.05). The CAD-assisted radiologist showed improved diagnostic sensitivity compared with the radiologist alone (92.0% vs. 84.0%, p = 0.037), while the specificity and PPV were reduced (85.1% vs. 95.5%, p = 0.005 and 82.1% vs. 93.3%, p = 0.008). The radiologist assisted by the CAD system exhibited better diagnostic sensitivity and NPV than the CAD system alone (92.0% vs. 80.0%, p = 0.009 and 93.4% vs. 88.9%, p = 0.013), while the specificities and PPVs were not significantly different (88.1% vs. 85.1%, p = 0.151 and 83.3% vs. 82.1%, p = 0.613, respectively). CONCLUSION: The CAD system may be an adjunct to radiological intervention in the diagnosis of thyroid cancer.

Post EST Papillary Restenosis: A Case Report / 대한소화기내시경학회지

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.