Cervical lymph node metastasis is common in patients with differentiated thyroid carcinoma (DTC). Lateral neck node metastases are a significant consideration in surgical management of patients with DTC. However, the optimal extent of therapeutic lateral neck dissection remains controversial. Optimizing the surgical extent of lymph node dissection is fundamental to balancing the surgical morbidity and oncological benefits in DTC patients with lateral neck metastasis. Consideration of the individualized appropriate surgical extent of lateral lymph node is important in treatment of DTC patients.
Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Thyroid Neoplasms*

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

The clinical trial was carried out with carteolol in 30 patients with essential hypertension. The results were as follows : 1) Before medication and after 2,4,6 and 8 weeks of medications, the overall average systolic and diastolic blood pressure were 175+/-17.7/105+/-9.3, 144+/-8.9/92+/-6.9, 143+/-11.2/90+/-6.6, 141+/-8.4/88+/-6.9, and 142+/-9.0/88+/-7.1 mmHg. As a result, blood pressure significantly fell with carteolol treatment. 2) In 80+/- of all cases, marked or moderate degree of hypotnesive effect was observed within 2 weeks of treatment. 3) Before medication and after 2, 4, 6 and 8 weeks of medication, the overall average heart rates were 75+/-11.8, 73+/-9.0, 71+/-8.7, 71+/-8.2 and 71+/-8.6 beats/minute. There was no significant changes in heart rates before and after treatment. 4) Dizziness or fatigability were complained in 4 patients (13+/-) each while receiving carteolol. These side effects were mild in 3 patients, but one patient discontinued treatment due to dizziness. On the basis of these results, carteolol was evaluated to be promising hypotensive drug.
Blood Pressure ; Carteolol* ; Dizziness ; Heart Rate ; Humans ; Hypertension

Arteriovenous malformation (AVM) consists of an abnormal connection between artery and vein without any interposed capillary bed, and is usually congenital. However, acquired AVM is quite rare, and is usually caused by injury, which induces direct arteriovenous shunting. Acquired digital AVM is a distinct entity, which was first described by Kadono et al. in 2000, and was thought to result from shunts between an artery and a vein in a finger tip. We report a case of acquired digital AVM in a 44-year-old women. The patient showed punctate hyperketatotic ectasia on the pulp of the right thumb. Histological finding showed dilated venous and arterial vessels in upper and lower dermis, and shunts between arteriols and venules.
Adult ; Arteries ; Arteriovenous Malformations* ; Capillaries ; Dermis ; Dilatation, Pathologic ; Female ; Fingers ; Humans ; Thumb ; Veins ; Venules

PURPOSE: The aim of this study was to evaluate the impact of extended resection of primary tumor on survival outcome in unresectable colorectal cancer (UCRC). METHODS: A retrospective analysis was conducted for 190 patients undergoing palliative surgery for UCRC between 1998 and 2007 at a single institution. Variables including demographics, histopathological characteristics of tumors, surgical procedures, and course of the disease were examined. RESULTS: Kaplan-Meier survival curve indicated a significant increase in survival times in patients undergoing extended resection of the primary tumor (P < 0.001). Multivariate analysis showed that extra-abdominal metastasis (P = 0.03), minimal resection of the primary tumor (P = 0.034), and the absence of multimodality adjuvant therapy (P < 0.001) were significantly associated poor survival outcome. The histological characteristics were significantly associated with survival times. Patients with well to moderate differentiation tumors that were extensively resected had significantly increased survival time (P < 0.001), while those with poor differentiation tumors that were extensively resected did not have increase survival time (P = 0.786). CONCLUSION: Extended resection of primary tumors significantly improved overall survival compared to minimal resection, especially in well to moderately differentiated tumors (survival time: extended resection, 27.8 ± 2.80 months; minimal resection, 16.5 ± 2.19 months; P = 0.002).
Colorectal Neoplasms* ; Colorectal Surgery ; Demography ; Humans ; Multivariate Analysis ; Neoplasm Metastasis ; Palliative Care ; Retrospective Studies

PURPOSE: To evaluate the role of combination therapy of external radiotherapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. METHODS AND MATERIALS: A retrospective review of evaluable 55 esophageal cancer patients referredto the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul. 1983 and Dec.1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group(ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fiffy patients had squamous cell carcinomas. Radiation doses of 2520-6480cGy were delivered over a period of 4-7weeks. using 4MV LIVAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1,2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. RESULTS: Median follow up period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months(20 days-73 months) in B group. The 1,2 YSRs were 26.7%, 8.9% in A group. 12.7%, 4.3% in B group (p>0.05), respectively. The 1,2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose(5000cGy more or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000cGy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were 43.8%, 25.0%, respectively. Complete response rate of 25.0% in A and 8.3% in B were achieved. The local failure and distant metastsis were 52.4%, 23.8% in A group. 64.3%, 14.3% in B group, respectively. The combination therapy revealed more freguent leukopenia and nausea/vomiting than radiation alone group, but degree of side effects was only mild to modereate. CONCLUSION: The combined external radiotherapy and chemotherapy for advanced esophageal cancer appears to improve the response rate, local control rate and survival rate, but the improvement was not statistically significant. The side effects of combined modalities were mild to moderate without significant morbidity. Therefore it may be worthwhile to continue the present combined external radiotherapy and chemotherapy in the management of advanced esophageal cancer to confirm our result.
Aged ; Carcinoma, Squamous Cell ; Drug Therapy ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Leukopenia ; Male ; Middle Aged ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate

Cor triatriatum is a rare anomaly in old age. This is a case report of a 66 year-old man who had been preoperatively diagnosed as coronary artery disease and cor triatriatum. The operative findings revealed that the left atrium had an intra-atrial septum with one small opening 10mm in diameter, the upper compartment received both pulmonary veins, and there were no other anomalies like anormalous pulmonary venous connection or atrial septal defect. The patient successfully underwent open heart surgery ; the anomalous septum was resected, the mitral valve was reconstructed using French technique with Carpentier-Edwards ring, and coronary artery bypass grafting was performed.
Aged ; Cor Triatriatum* ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Heart Atria ; Heart Septal Defects, Atrial ; Humans ; Mitral Valve ; Pulmonary Veins ; Thoracic Surgery