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*

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: 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

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

BACKGROUND: Leprosy is an infectious disease with two polar forms, tuberculoid leprosy (TT) and lepromatous leprosy (LL), that are characterized by strong cell-mediated immunity (CMI) and CMI anergy, respectively. Transforming growth factor-beta (TGF-beta) is a family of growth factors involved in essential physiological processes, including development, differentiation, tissue repair, cell growth control and inflammation. Cellular signaling by TGF-beta family members is initiated by the assembly of specific cell surface receptors that activate transcription factors of the Smad family. Deregulation of the TGF-beta-Smad signaling pathway has been implicated in developmental disorders and several human diseases. Recently, ELISA & immunohistochemistry revealed high expression of TGF-beta isoforms in LL. OBJECTIVE: The purpose of this study was to investigate TGF-beta-Smad signaling in various forms of leprosy. METHODS: We investigated the involvement of TGF-beta by immunohistochemical staining for Smad 2 and 3 in skin biopsies from six patients of BL and four patients of TT. RESULTS: The inflammatory cells, keratinocytes and fibroblasts in BL showed strong positivity for both Smad 2 and 3, whereas those in TT showed little positivity. CONCLUSION: The high expression of Smad 2/3 in BL could represent high expression of TGF-beta, which possibly contributes to local CMI anergy and other clinical characteristic features of leprosy.
Biopsy ; Communicable Diseases ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; Immunity, Cellular ; Immunohistochemistry ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Physiological Processes ; Protein Isoforms ; Receptors, Cell Surface ; Skin ; Transcription Factors ; Transforming Growth Factor beta

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.
Child ; Compliance ; Diplopia ; Dizziness ; Emergency Service, Hospital ; Eyebrows ; Follow-Up Studies ; Humans ; Lacerations ; Male ; Nausea ; Orbit* ; Orbital Fractures ; Pediatrics ; Physical Examination ; Technology, Radiologic

With advances in diagnostic technology, radiologic diagnostic methods have been used more frequently, and physical examination may be neglected. The authors report a case of pediatric medial orbital trapdoor fracture in which the surgery was delayed because computed tomography (CT) findings did not indicate bone displacement, incarceration of rectus muscle, or soft tissue herniation. A healthy 6-year-old boy was admitted to the emergency room for right eyebrow laceration. We could not check eyeball movement or diplopia, because the patient was irritable. Thus, we performed facial CT under sedation, but there was normal CT finding. Seven days later, the patient visited our hospital due to persistent nausea and dizziness. We were able to perform a physical examination this time. Lateral gaze of right eye was limited. CT still did not show any findings suggestive of fracture, but we decided to perform exploratory surgery. We performed exploration, and found no bone displacement, but discovered entrapped soft tissue. We returned the soft tissue to its original position. The patient fully recovered six weeks later. To enable early detection and treatment, thorough physical examination and CT reading are especially needed when the patient shows poor compliance, and frequent follow-up observations are also necessary.
Child ; Compliance ; Diplopia ; Dizziness ; Emergency Service, Hospital ; Eyebrows ; Follow-Up Studies ; Humans ; Lacerations ; Male ; Nausea ; Orbit* ; Orbital Fractures ; Pediatrics ; Physical Examination ; Technology, Radiologic

Pilomatricoma is a common, benign, cutaneous neoplasm, differentiating towards elements of the hair matrix and shaft. It typically presents as a deep-seated, solitary, firm nodule with overlying normal epidermis. However, pilomatricoma with bullous appearance is very rare. We report two cases of pilomatricoma with bullous appearance. The first case was an 11-year-old male who presented with 6 month history of a soft, erythematous, translucent polypoid mass on the left upper arm. The other case was a 20-year-old female who presented with 12 month history of a soft, slightly-brownish, peduncluated mass with indurated nodules on the left upper arm. In both cases, the histopathologic findings revealed multiple islands of shadow cells, with small foci of basophilic cells at the periphery of the deep dermis. There was dilation of lymphatic vessels in the overlying dermis, which explained the clinical bullous appearance.
Arm ; Basophils ; Child ; Dermis ; Epidermis ; Female ; Hair ; Humans ; Islands ; Lymphatic Vessels ; Male ; Pilomatrixoma* ; Young Adult

Pilomatricoma is a common, benign, cutaneous neoplasm, differentiating towards elements of the hair matrix and shaft. It typically presents as a deep-seated, solitary, firm nodule with overlying normal epidermis. However, pilomatricoma with bullous appearance is very rare. We report two cases of pilomatricoma with bullous appearance. The first case was an 11-year-old male who presented with 6 month history of a soft, erythematous, translucent polypoid mass on the left upper arm. The other case was a 20-year-old female who presented with 12 month history of a soft, slightly-brownish, peduncluated mass with indurated nodules on the left upper arm. In both cases, the histopathologic findings revealed multiple islands of shadow cells, with small foci of basophilic cells at the periphery of the deep dermis. There was dilation of lymphatic vessels in the overlying dermis, which explained the clinical bullous appearance.
Arm ; Basophils ; Child ; Dermis ; Epidermis ; Female ; Hair ; Humans ; Islands ; Lymphatic Vessels ; Male ; Pilomatrixoma* ; Young Adult