Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC).Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups (23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; p=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; p=0.008) and bilaterality (HR, 11.477; p=0.022) as significant risk factors for DFS. Conclusion Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.

Background/Objectives: Pediatric & Adolescent thyroid cancer is a steadily increasing malignancy. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence in pediatric & adolescent patients with differentiated thyroid carcinoma (DTC).Materials & Methods: The data of 42 pediatric & adolescent patients (aged ≤19 years) with DTC who underwent thyroidectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between December 1997 and February 2019 were retrospectively reviewed. Clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews. Results: The mean age was 16.6 years. A total of 6 (14.3%) patients experienced recurrence after initial treatment. The recurrence rate was significantly different between total thyroidectomy (TT) and lobectomy groups (23.1% vs. 0%, p=0.038). However, no statistically significant differences were found in the recurrence rate according to lymph node ratio (LNR) of 0.4 (10.7% vs 21.4%; p=0.383). Multivariate analysis confirmed age (hazard ratio [HR], 0.443; p=0.008) and bilaterality (HR, 11.477; p=0.022) as significant risk factors for DFS. Conclusion Pediatric & Adolescent thyroid cancer is a rare malignancy and TT is recommended as the treatment of choice. However, lobectomy may be considered for Pediatric & Adolescent patients with age >16 years, tumor size <1 cm, and no bilateral disease.

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC.Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months. Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092) Conclusion When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

Osteogenesis imperfecta is a relatively rare genetic condition of breakable bones with an incidence of 1 per 20,000~60,000. The clinical, genetic, and biochemical heterogeneity in osteogenesis imperfecta allows to least four subtypes to be distinguished. Prenatal diagnosis of osteogenesis imperfecta type II have been reported several times with ultrasonography. We recently experienced a case of osteogenesis imperfecta diagnosed in uterus by ultrasonogram and confirmed after termination and autopsy. We report here with a brief review of the literature.
Autopsy ; Incidence ; Osteogenesis Imperfecta* ; Osteogenesis* ; Population Characteristics ; Prenatal Diagnosis ; Ultrasonography* ; Uterus*

PURPOSE: The primary objective of the current study was to investigate the characteristics of synchronous cancers in gastric cancer patients. MATERIALS AND METHODS: We analyzed the 2,237 patients who were diagnosed between December 2000 and December 2003 with gastric cancer and synchronous cancers of organs other than the stomach. RESULTS: 73 (3.3%) of a total of 2,237 gastric cancer patients had synchronous primary cancers. Among these 73 patients, 71 had one synchronous cancer, and two patients had double synchronous cancers. Colorectal cancer (26 patients, 34.7%) was the most frequently encountered synchronous cancer, followed by cancer of the lung (16 patients, 21.3%), esophagus (13 patients, 17.2%), and liver (8 patients, 10.7%). Synchronous can-cers were detected with increased frequency in the elderly, in the patients with multiple gastric cancers, in the patients with differentiated gastric cancer, and in the patients with early gastric cancer, as determined on univariate analysis, but the differentiation of gastric cancers was the only risk factor for synchronous cancers on the multivariate analysis. CONCLUSIONS: The differentiation of gastric cancer cells may be a risk factor for synchronous cancers in gastric cancer patients. Careful surveillance by the physician for synchronous cancer is warranted for the patients suffering from gastric cancer.
Aged ; Colorectal Neoplasms ; Esophagus ; Humans ; Liver ; Lung Neoplasms ; Multivariate Analysis ; Risk Factors ; Stomach ; Stomach Neoplasms*

Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.
Acromioclavicular Joint ; Anesthesia, General ; Arm ; Braces ; Brachial Plexus* ; Electromyography ; Female ; Head-Down Tilt ; Humans ; Hysterectomy, Vaginal* ; Middle Aged ; Myoma ; Needles ; Neural Conduction ; Paralysis* ; Sensation ; Shoulder ; Uterus

Ophthalmoplegia, ataxia, and areflexia are a classical triad of Miller Fisher syndrome (MFS). The experience of dizziness secondary to ophthalmoplegia is also not uncommon. However, nystagmus is rare and vertigo, a symptom of vestibulocerebellar dysfunction, has not been reported yet. A 56-year-old woman visited our hospital due to sudden vertigo. Initial examination revealed nystagmus evoked by a bilateral horizontal gaze with left side dysmetria. The next day, her symptoms rapidly aggravated to ophthalmoplegia, severe ataxia, areflexia, and quadriplegia. She was diag-nosed with MFS and was treated with intravenous immunoglobulin. On the fourth day, she developed respiratory fail-ure and a ventilator was applied. Twenty-eight days after her admission, she recovered to the point of walking without any aid and was discharged with minimal disability. There are still controversies surrounding the nosology of MFS and many investigators have reported evidence for brainstem involvement. Vertigo can be additional evidence for the involvement of the central nervous system in MFS.
Ataxia ; Brain Stem ; Central Nervous System ; Cerebellar Ataxia ; Dizziness ; Female ; Humans ; Immunoglobulins ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia ; Quadriplegia ; Research Personnel ; Ventilators, Mechanical ; Vertigo* ; Walking

PURPOSE: The rate of malignancy in the follicular neoplasm (FN) or Hürthle cell neoplasm (HCN) of the thyroid gland is estimated as approximately 20~30%. Fine-needle aspiration biopsy (FNAB) and frozen section examination are restricted in differentiating between benign and malignant. The aims of this study are to compare the differences of clinicopathologic features and to determine the risk factors for malignancy in patients with FN or HCN. METHODS: A retrospective study was conducted of patients with FN or HCN who were diagnosed by FNAB, and underwent surgery at our institution between Jan. 2005 to Jun. 2010. We analyzed the risk factors for malignancy and the differences of clinicopathologic features in patients with FN or HCN. RESULTS: A total of 290 patients were enrolledin this study; 160 (55.2%) patients underwent thyroidectomy, 97 (60.6%) patients had FN, and 63 (39.4%) had HCN. Forty one (25.6%) patients were diagnosed as malignancy of these, 22 (22.7%) patients were FN and 19 (30.2%) were HCN (P=0.29). Two (2.1%) patients with FN and 10 (15.9%) with HCN (P=0.002) comcomitant papillary thyroid carcinoma were indentified by FNAB. Classification of nodules according to ultrasonographic findings in both neoplasms (P<0.05) and galectin-3 in FN (P<0.05) were predictive factors for malignancy. In addition, galectin-3 was a predictive factor for malignancy in indeterminate nodules on ultrasonography (USG) (P=0.028). CONCLUSION: Classification of nodules according to ultrasonographic findings and galectin-3 expression is helpful in predicting carcinoma of patients with FN or HCN.
Biopsy, Fine-Needle ; Classification ; Frozen Sections ; Galectin 3 ; Humans ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography

PURPOSE: This assesses the current workings of multidisciplinary team (MDT) meetings across Korea through surgeons' reports and their current commitments to MDT meetings pertaining to breast cancer, and to determine any perceived areas of potential improvement. METHODS: A questionnaire was sent out to 307 members of The Korean Breast Cancer Society (KBCS) who worked at comprehensive or university medical centers in Korea. The mailing lists of the KBCS members were obtained with the approval of the society. From December 2008 to February 2009, the survey was distributed by surface and electronic mail, with an initial mailing followed by another distribution to non-responders eight weeks later. RESULTS: Sixty-five individuals (21.2%) returned the completed survey. Of these, 38 responders (62.3%) participated in MDT meetings. Most (97.4%) breast health specialists regarded MDT meetings as an effective method for treatment planning. Most responders (94.7%) reported that the MDT leader was a breast surgeon. CONCLUSION: The MDT approach is perceived as an effective method for breast cancer treatment planning and is a feature in most major centers in Korea. Further work is needed to ensure that the MDT approach operates as intended and that all breast cancer patients have access to an MDT.
Academic Medical Centers ; Breast ; Breast Neoplasms ; Dietary Sucrose ; Electronic Mail ; Humans ; Korea ; Postal Service ; Surveys and Questionnaires ; Specialization