Radioactive iodine (131I) targets the thyroid gland and has been proven to play an effective role in the treatment of differentiated thyroid cancers. However, this radioisotope is simultaneously absorbed on the salivary glands where it is concentrated and secreted into the saliva. Dose related damage to the salivary parenchyma results from the 131I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of 131I and/or months later and progress in intensity with time. Prevention of the 131I-induced sialadenitis includes the use of sialagogic agents to enhance the transit time of the 131I through the salivary glands. However, many studies are not available to delineate the efficacy of this approach. Recently, amifostine has been advocated to prevent the effects of irradiation. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialagogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration.
Amifostine ; Anti-Bacterial Agents ; Iodine ; Massage ; Mouthwashes ; Oral Hygiene ; Radioactivity ; Saliva ; Salivary Glands ; Sialadenitis* ; Thyroid Gland

An acquired tracheoesophageal fistula (TEF) is a rare complication that can occur in the treatment of laryngeal cancer. Explosive coughing from the tracheostomy-opening site after swallowing is a warning sign of the TEF. A 68-year old male laryngeal cancer patient showed delayed TEF after chemoradiotherapy with a total laryngectomy.The clinicians carrying out a videofluoroscopic swallowing study should be familiar with the total laryngectomy state, as well as the findings and initial general management of TEF. This report discusses the pathophysiology and management of TEF and the needs for dysphagia care team after chemoradiation in laryngeal cancer patients.

PURPOSE: The prognosis for early gastric cancer (EGC) is favorable, and the 10-year disease-specific survival rate is reported to be around 90%. The absolute number of recurred EGC is too small to assess the risk factors, so recruitment of a large number of cases for statistical analysis is very difficult. We carried out this study to analyze the incidence and the patterns of recurrence of EGC and to identify the clinicopathological risk factors for recurrence of EGC. MATENRIALS AND METHODS: The authors retrospectively investigated the follow-up records of 1418 patients who underwent a curative resection for EGC from Jan. 1984 to Dec. 1999 at the Korea Cancer Center Hospital and analyzed them with special reference to cancer recurrence. Results: In this retrospective study of 1418 cases, 43 patients died of a recurrence of gastric cancer, and 105 patients died of unrelated causes. The five-year and the ten-year overall survival rates were 89.6% and 81.7%, respectively, while the five-year and the ten-year disease- specific survival rates were 96.5% and 94.3%, respectively. The recurrence patterns of the 45 recurred EGC were hematogenous metastasis (19 cases), lymph node (L/N) metastasis (8 cases), locoregional recurrence (2 cases), peritoneal seeding (3 cases), and combined form (13 cases). The mean time interval to recurrence was 38.6 months, and the number of delayed recurred cases after 5 years was 10 (22.2%). Of the clinicopathologic factors, depth of invasion, L/N metastasis, macroscopic type, lymphatic invasion, and vessel invasion, were significant risk factors in the univariate analysis. However, in the multivariate analysis, only L/N metastasis was an independent prognostic factor. CONCLUSION: Based on the results of this study, L/N metastasis is an independent prognostic factor. Thus, in patients with node-positive disease, adjuvant therapy might be considered, and long-term close follow-up might facilitate early detection and treatment of recurrent disease due to delayed recurrence.
Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate

PURPOSE: The prognosis for early gastric cancer (EGC) is favorable, and the 10-year disease-specific survival rate is reported to be around 90%. The absolute number of recurred EGC is too small to assess the risk factors, so recruitment of a large number of cases for statistical analysis is very difficult. We carried out this study to analyze the incidence and the patterns of recurrence of EGC and to identify the clinicopathological risk factors for recurrence of EGC. METHODS: The authors retrospectively investigated the follow- up records of 1,418 patients who underwent a curative resection for EGC from Jan. 1984 to Dec. 1999 at the Korea Cancer Center Hospital and analyzed them with special reference to cancer recurrence. RESULTS: In this retrospective study of 1418 cases, 43 patients died of a recurrence of gastric cancer, and 105 patients died of unrelated causes. The five-year and the ten-year overall survival rates were 89.6% and 81.7%, respectively, while the five-year and the ten-year disease-specific survival rates were 96.5% and 94.3%, respectively. The recurrence patterns of the 45 recurred EGC were hematogenous metastasis (19 cases), lymph node (L/N) metastasis (8 cases), locoregional recurrence (2 cases), peritoneal seeding (3 cases), and combined form (13 cases). The mean time interval to recurrence was 38.6 months, and the number of delayed recurred cases after 5 years was 10 (22.2%). Of the clinicopathologic factors, depth of invasion, L/N metastasis, macroscopic type, lymphatic invasion, and vessel invasion, were significant risk factors in the univariate analysis. However, in the multivariate analysis, only L/N metastasis was an independent prognostic factor. CONCLUSION: Based on the results of this study, L/N metastasis is an independent prognostic factor. Thus, in patients with node-positive disease, adjuvant therapy might be considered, and long-term close follow-up might facilitate early detection and treatment of recurrent disease due to delayed recurrence.
Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence* ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms* ; Survival Rate

Papillary carcinoma is the most common type of thyroid cancer, usually presenting as a thyroid mass. Presentation in cervical nodes alone, with no clinical suspicion of thyroid tumor, also occurs. Lymph node metastasis from papillary carcinoma of the thyroid may undergo cystic transformation. This occurrence is seldom encountered in clinical practice and in cases of microcarcinomas the diagnosis may be difficult, resulting in a delay of the correct diagnosis and of therapy for the primary tumor. We present a rare case of solitary cystic lymph node metastasis of papillary microcarcinoma of the thyroid.
Bone Cysts ; Carcinoma, Papillary ; Lymph Nodes ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms

The effect of intranasal nifedipine drops in 20 randomly chosen patients with diethyl-ether induced hypertension by inhalation anesthesia was observed. Patients were placed in two groups: the first group received intranasal nifedipine at the time of induction and the second group received intranasal nifedipine at the time to skin incision. The change in mean arterial pressure in the first group was not significant, but in the second group, the increase in mean arterial pressure was significant immediately after intranasal administration of nifedipine at the time of skin incision. An increase in pulse rate was noted with the increase in mean arterial pressure and this is thought to result from the stimulation of catecholamine secretion and baroreceptor reflex. Since the difference in mean arterial pressure between the two groups was minimal at ten minutes and twenty minutes after skin incision, it is suggested that the onset of intranasal nifedipine is quite fast. Based on the authors' experience, intranasal administration of nifedipine is very useful in preventing or treating hypertension during inhalation anesthesia using diethyl-ether.
Administration, Intranasal* ; Anesthesia, Inhalation ; Arterial Pressure ; Baroreflex ; Ether* ; Heart Rate ; Humans ; Hypertension ; Nifedipine* ; Skin

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.
Adenocarcinoma* ; Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Medical Records ; Mucins* ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

Toxoplasmosis is a ubiquitous protozoan infection caused by coccidian Toxoplasma gondii. In an immunocompetent host, the primary infection is generally oligosymptomatic and self-limiting. Fewer than 10% of infected subjects are symptomatic, with lymphadenopathy as the most frequent clinical finding. Here, two cases of Toxoplasmic lymphadenitis are reported for otolaryngologists to consider the clinical findings and natural history aspects of this infection.
Head* ; Lymphadenitis* ; Lymphatic Diseases ; Natural History ; Neck* ; Protozoan Infections ; Toxoplasma ; Toxoplasmosis

Percutaneous dilatational tracheostomy (PDT) is an increasingly popular method with several advantages, such as being able to perform at bedside with a simple kit, with a less number of medical staff and less amount of time. PDT is easier to perform, offers less bleeding risks and post-operative infection rates compared to conventional surgical tracheotomy. However, PDT is being performed more in the pulmonology and intensive care medicine than in otolaryngology. Herein, we introduce PDT and share our experiences, hoping otolaryngologists use our procedure more.

BACKGROUND: BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence. METHODS: The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed. RESULTS: Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.179) and systemic relapse (p=0.266). Young age (< or =40) (p=0.01) and lymph node metastasis (p=0.0001) were proven to be risk factors of local recurrence. Large tumor size (>2 cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse. CONCLUSION: The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status followed by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.
Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Recurrence* ; Risk Factors