Acute Coronary Syndrome ; epidemiology ; therapy ; Humans

Acute Disease ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; pathology ; Pancreatitis ; diagnosis ; pathology

Acute myocardial infarction (AMI) in pregnant women is a rare but potentially lethal occurrence that should be carefully managed, especially in consideration of cardiac conditions being a rising cause of maternal deaths. Risk factors for AMI occurrence, in addition to typical cardiac-related risk factors, include medical conditions such as (pre) eclampsia, blood transfusions, thrombophilia and postpartum infections. Being older, multigravida or in the third trimester of pregnancy is also associated with an increased risk. The pathophysiological causes underlying AMI in pregnancy are diverse but generally associated with the coagulative and physiological changes related to the pregnancy. The selection of diagnostic modality and treatment options require careful consideration for pregnancy-related changes as well as risk of harm to the patient and fetus. This paper serves to review available literature regarding an extensive range of management issues that directly impact on maternal and fetal outcomes.
Adult ; Female ; Humans ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; therapy ; Young Adult

No abstract available.

Cribriform-morular variant (CMV) is a rare histologic subtype of papillary thyroid carcinoma (PTC). Patients with familial adenomatous polyposis (FAP) could be associated with several comorbid diseases including thyroid cancer. Most thyroid cancers in them are PTCs, but infrequently CMV types can occur. The FAP concomitant CMV-PTCs are found predominantly in young women and reveals lower recurrence rate. Moreover, this variant shows circumscribed morphology and rarely metastasizes to node. Because the incidence of thyroid carcinoma is higher than that in general population, comprehensive evaluation of thyroid gland should be performed for the patients with FAP. Because thyroid cancer could be first manifestation of FAP, colonic screening should be considered in CMV-PTC patient. We report two cases of CMV-PTCs concurrent with FAP.
Adenomatous Polyposis Coli* ; Carcinoma, Papillary* ; Colon ; Female ; Humans ; Incidence ; Mass Screening ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

Differentiated thyroid carcinoma rarely shows gross angioinvasion with intraluminal tumor thrombus. Although there was no definite result of long-term survival, a vascular invasion or thrombus indicates poor prognosis. Total thyroidectomy with en block resection of involved vessels is known as the best surgical approach, and followed by postoperative radioiodine therapy. However, the effect of adjuvant external irradiation therapy remains in debate. We report a case of differentiated thyroid carcinoma with internal jugular vein tumor thrombus treated successfully by a complete surgical resection and postoperative radioiodine therapy.
Jugular Veins* ; Prognosis ; Thrombosis* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

No abstract available.
Gastrointestinal Tract* ; Leiomyosarcoma*

PURPOSE: Only limited information exists on the clinicopathological profiles and the treatment outcomes of bone metastases from differentiated thyroid carcinomas. Therefore the impact of treatment strategies has been inadequately investigated. The aims of this study were to evaluate the proper management and the prognostic factors that influence the long-term outcomes of patients treated for bone metastasis from differentiated thyroid carcinoma. METHODS: Twenty-two cases of bone metastases out of 3, 775 differentiated thyroid carcinomas treated at Yonsei University Medical Center between Jan. 1986 and Dec. 2004 were analyzed. The overall incidence of bone metastases from differentiated thyroid carcinomas in our series was 0.6%. There were 11 women and 11 men, with a mean age at the time of primary diagnosis of 51 years (25~71 years). The mean follow-up after diagnosis of bone metastases was 83 months (1~358 months). RESULTS: The histological diagnoses of primary tumor were 21 and 1 papillary and follicular cancers, respectively. Metastases restricted to the skeleton alone were found in 13 patients, whereas 9 patients showed associated extraskeletal distant metastases. Seventeen patients had multiple bone metastases. In 6 patients, the bone metastases were surgically removed with intention of cure. The overall survival rates at 10 years was 44.4%. From univariate log-rank survival rates analyses, capsular invasion (P=0.0014), preoperative vocal cord palsy (P=0.0097), multiple organ involvement (P=0.024) and the impossibility of surgical treatment for skeletal metastaisis (P=0.0471) were related with a poor prognosis. CONCLUSION: From the results, the survival rate was shown no significantly decline in the patients with poor prognostic factors. Therefore the therapeutic options should be individualized according to the initial clinical state and the prognostic factors. Our data also suggest that surgical resection for metastatic bone lesions and postoperative adjuvant therapy should be performed to obtain better survival rates.
Academic Medical Centers ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intention ; Male ; Neoplasm Metastasis* ; Prognosis ; Skeleton ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Vocal Cord Paralysis

PURPOSE: In case of well-differentiated thyroid carcinoma, a mediastinal lymph node metastasis is extremely rare, but can be life threatening due to its proximity to the vital organs. The consequence of radical extirpation must be balanced against the issues of tumor control, survival outcomes, functional morbidity, and the sequelae of an excessive surgical resection. The aim of this study was to clarify the clinicopathological characteristics, treatment and outcomes of patients with mediastinal lymph node metastasis in differentiated thyroid carcinoma. METHODS: Nineteen consecutive differentiated thyroid carcinoma patients with a mediastinal lymph node metastasis between June 1998 and Feb. 2004 were included in this study. All the patients underwent a trans-sternal mediastinal lymph node dissection in addition to thyroid cancer surgery. The median follow-up was 40.7 months (range, 18~97). RESULTS: The mean age was 49 years (range 31~72 years) with a male-to-female ratio of 8: 11. The surgical treatment included 11 cases of an upper mediastinal lymph nodes dissection via a partial sternotomy and 7 cases of a whole mediastinal lymph nodes dissection via a total longitudinal sternotomy. In 6 cases, the combined resection of the involved organ was added. Major postoperative complications occurred in two patients, one with leakage from a tracheoesophageal fistula and the other with a pulmonary embolism. During the follow-up period, local recurrences in the lateral cervical nodes were observed in 5 cases. The 5 year overall survival and 5 year disease-free survival were 90.5% and 63.6%, respectively. There was only one surgical mortality. CONCLUSION: These results suggest that the prognosis for mediastinal lymph node metastasis in differentiated thyroid carcinoma can be improved by an aggressive mediastinal node dissection and the appropriate thyroid cancer surgery.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Postoperative Complications ; Prognosis ; Pulmonary Embolism ; Recurrence ; Sternotomy ; Thyroid Gland* ; Thyroid Neoplasms* ; Tracheoesophageal Fistula

Forgotten mediastinal goiter is an extremely rare disease. It is most often the consequence of the incomplete removal of a ‘ plunging’ goiter, but it can sometimes be attributed to a concomitant, unrecongnized primary mediastinal goiter which is not connected to the thyroid. A primary mediastinal goiter(autonomous intrathoracic goiter) essentially caused by an abnormal embryonic development of the thyroid gland and a thyroid gland formation located in the thorax or the mediastinum. The differential diagnosis with ordinary recurrence was based on the absence of parenchymatous or vascular connections with the cervical thyroid gland. It is fed by local intrathoracic vessels and observed in the absence of previous thyroidectomy. Nevertheless, for primary mediastinal goiter, sternum-splitting incision will be required in most cases as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision. In this study we report a case of forgotten mediastinal goiter and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this diasease are identified.
Diagnosis, Differential ; Embryonic Development ; Female ; Goiter* ; Hemorrhage ; Mediastinum ; Pregnancy ; Rare Diseases ; Recurrence ; Thorax ; Thyroid Gland ; Thyroidectomy