[This corrects the article DOI: 10.31486/toj.24.0101.].

Papillary thyroid carcinoma, the most common differentiated thyroid cancer, has an indolent clinical course and a good prognosis. Metastases to the gastrointestinal tract account for <1% of all distant metastases, and the pancreas is an extremely rare site for metastasis from thyroid cancer. We report the case of a patient who developed a pancreatic metastasis from a classic variant papillary thyroid carcinoma 11 years after total thyroidectomy, cervical lymphadenectomy, and radioactive iodine ablation. The patient experienced increased thyroglobulin levels, and abdominal computed tomography scan revealed a lesion in the uncinate process of the pancreas. Tissue samples obtained by endoscopic ultrasound-guided biopsy were positive for thyroglobulin and thyroid transcription factor 1. Because the patient was not a candidate for surgery, the metastatic lesion was not iodine-avid, and tyrosine kinase inhibitors could not be offered because of tumor-related symptoms, the patient was treated with stereotactic body radiotherapy only. The patient died almost 2 years after the diagnosis of metastatic papillary thyroid carcinoma to the pancreas (13 years after total thyroidectomy for the primary cancer). If pancreatic lesions are discovered during regular follow-up of patients who have previously been treated for papillary thyroid carcinoma, pancreatic metastasis must be considered, and imaging procedures other than whole-body iodine scintigraphy are required. Histopathology and iodine avidity will define the best therapeutic strategy. Radioactive iodine ablation should be considered for iodine-avid metastases, and surgery or tyrosine kinase inhibitors are promising options for non-iodine-avid lesions.

First described in 1938, Jarcho-Levin syndrome is a rare genetic disorder characterized by multiple rib and vertebral anomalies that cause thoracic constriction and severe respiratory complications. Jarcho-Levin syndrome is associated with a high mortality rate. We report the case of a 3-month-old male who was born with Jarcho-Levin syndrome to first-degree consanguineous parents. The infant presented with severe respiratory distress, scoliosis, thoracic cage deformity, and spinal dysraphism. Radiologic findings revealed multilevel vertebral segmentation defects and asymmetric rib deformities. Despite respiratory support, the infant's condition deteriorated, and he died from respiratory failure complicated by pneumonia at 7 months of age. This case highlights the life-threatening nature of Jarcho-Levin syndrome and emphasizes the critical role of early diagnosis in optimizing respiratory support and family planning. Genetic counseling is crucial and ideally recommended preconception or during early pregnancy for consanguineous families, although accessibility to counseling services varies widely. Despite advances in pediatric care, the prognosis for patients with Jarcho-Levin syndrome remains guarded, emphasizing the need for continued research into effective treatments and management strategies.

Background: Catecholamine-induced cardiomyopathy is an uncommon complication of pheochromocytoma. Pheochromocytoma is a rare tumor that predominantly occurs in adults, making catecholamine-induced cardiomyopathy secondary to pheochromocytoma in children an exceedingly rare presentation. Treatment typically consists of medical management followed by surgical resection. Mechanical support, typically salvage therapy with extracorporeal membrane oxygenation, has been used in adult patients with cardiogenic shock and after cardiac arrest, but to our knowledge, the use of mechanical support has not been described in pediatric patients. Case Report: A 16-year-old female presented with cardiogenic shock resulting from catecholamine-induced cardiomyopathy secondary to pheochromocytoma. She was treated with a percutaneous left ventricular assist device to allow myocardial recovery while medical therapy was optimized. Given the early initiation, the patient's myocardial recovery was prompt, and only 3 days of device support were required. She was discharged in good condition and subsequently underwent uncomplicated laparoscopic resection of the tumor a few weeks later. Conclusion: In pediatric patients with catecholamine-induced cardiomyopathy secondary to pheochromocytoma, aggressive measures of support-including mechanical support and infrequently used options such as percutaneous left ventricular assist devices-should be considered early in treatment to maintain adequate cardiac output, avoid cardiac arrest, and allow for prompt myocardial recovery.

<b>Background:</b> Despite the substantial expenditures on health care in the United States, persistent underperformance in health system metrics necessitates innovative approaches to address complex patient needs. The MedVantage Clinic in New Orleans, Louisiana, offers a regionally tailored, value-based primary care model targeting patients with high social and medical needs. This study provides an evaluation of the efficacy of the MedVantage Clinic in improving the cost of care and service utilization for this population. <b>Methods:</b> We conducted a retrospective case-control study using data from electronic health records and claims data from 2017 to 2018. The case group was composed of patients with high social and medical needs who were enrolled in the MedVantage Clinic, and the control group consisted of propensity-matched non-MedVantage Clinic patients. Cost and utilization metrics-including per-member, per-month costs and inpatient length of stay-were analyzed using independent sample <i>t</i> tests and difference-in-difference calculations. <b>Results:</b> The MedVantage Clinic group demonstrated a significant decrease in mean inpatient per-member, per-month cost ($4.20) compared to an increase in the control group ($280.20, <i>P</i>=0.017). Inpatient length of stay decreased by 1.7 days for MedVantage Clinic patients and increased by 8 days for control group patients (<i>P</i>=0.019). Although other metrics showed nonsignificant improvements, the MedVantage Clinic generated a total cost of care mean resource benefit of $305.44 per member, per month compared to the control group (<i>P</i>=0.112), with an estimated annual total benefit of $1,224,648 for 189 patients. <b>Conclusion:</b> Our findings highlight the potential of the MedVantage Clinic to improve health care costs and utilization for patients with high social and medical needs. Despite the limitations of the study, including study duration and patient selection biases, the MedVantage Clinic demonstrated promise as a scalable model for addressing complex patient needs. Further research is warranted to explore long-term outcomes and implementation strategies for similar models nationwide.

We write this letter in response to an article published in Ochsner Journal titled “Trends in Cigarette Smoking Among United States Adolescents” that describes the decreasing trend of cigarette smoking among high school–aged youth.[1][1] While Mejia et al shed light on very encouraging

Background: Salvage revisions of atlantoaxial (AA) joint complex posterior segmental instrumented fusion constructs require careful individualized planning to prevent occipital extension. In this case report, we describe the use of bilateral intrafacet spacer placement as a mobility-sparing bailout option for the revision surgery. Case Report: A 64-year-old male with a history of diffuse idiopathic skeletal hyperostosis, extremely limited baseline cervical mobility, and prior AA posterior segmental instrumented fusion presented with increasing pain at his 6-month follow-up. Imaging showed fusion and hardware failures and dynamic instability. To prevent occipitocervical fixation, AA intra-articular fusion via a DTRAX spinal system (Providence Medical Technology, Inc) was used as an adjunct to a navigated C1 lateral mass and C2 pars screw posterior segmental instrumented fusion construct. The patient had an uneventful postoperative course and was discharged with resolution of symptoms. Three-month postoperative follow-up confirmed persistent resolution of symptoms and absence of complaints, along with successful arthrodesis on imaging. Conclusion: AA posterior segmental instrumented fusion revision is technically challenging, particularly when partial preservation of craniovertebral junction mobility is required. Bilateral intra-articular cages may be used as an adjunct to hardware revision in construct salvage when sturdy arthrodesis is desired without occipital extension and may represent a major potential strength of intra-articular cages.

Background: Leiomyomas are benign neoplasms that originate from smooth muscle cells and most commonly occur in soft tissues, the gastrointestinal tract, and the uterus. Leiomyomas of the pancreas are exceptionally rare, with, to our knowledge, only 6 documented cases prior to this report. This case was also challenging because of the young age of the patient and an atypical initial presentation. Case Report: A 21-year-old male presented with progressive jaundice and severe anemia. Contrast-enhanced computed tomography revealed a heterogeneously hyperenhancing mass in the arterial phase in the head of the pancreas with a double-duct sign. Endoscopic biliary drainage was performed, followed by endoscopic biopsy that revealed a mesenchymal tumor; leiomyoma was confirmed with an immunohistochemical evaluation. The patient underwent pancreaticoduodenectomy, and the histopathologic and immunohistochemical examinations of the resected specimen confirmed the diagnosis of a low-grade leiomyoma arising from the ampulla of Vater. Conclusion: This case not only highlights the rarity of pancreatic leiomyomas and the potential for atypical presentation but also emphasizes the importance of considering leiomyoma in the differential diagnosis, even in young patients, and supports surgical resection as the preferred treatment approach.