No abstract available.
Hysterectomy*

PURPOSE: Central compartment reoperation for recurrent thyroid carcinoma is challenging to surgeons due to the scar tissues and adhesions and the distortion of the normal anatomic relationships. This study was carried out to investigate the central neck recurrence patterns and the surgical morbidity of reoperation for patients with papillary thyroid carcinoma. METHODS: The study population was comprised 68 papillary thyroid carcinoma patients (15 males and 53 females, median age: 50.8 years [range: 12~78 years]) who underwent reoperation for recurrent tumors in the central compartment of the neck between January 1999 and June 2007. All of the patients had undergone prior total thyroidectomy. RESULTS: Of the 68 patients, 21 recurrences occurred in the proper thyroid tissue of the thyroid bed, 43 in the central neck nodes and 4 in a combination of the central nodes and proper thyroid tissue. The common recurrent site from the proper thyroid tissue were at the berry ligaments and at the level of the upper one-third of the recurrent laryngeal nerves, while the common nodal recurrence sites were the lower-most portion of the paratracheal nodes and the right paraesophageal nodes (the lymph nodes posterior to the right recurrent laryngeal nerve). Eleven cases of transient hypocalcemia (17.5%, 11/63) and 3 cases of permanent hypocalcemia (4.3%, 3/63) were noted after reoperation. Recurrent laryngeal nerve injury occurred in 5 patients (8.1%, 5/62), but three of them were intentionally resected with the recurrent cancers. CONCLUSION: Reoperation for central neck recurrence of papillary thyroid carcinoma is associated with a higher complication rate. Meticulous surgical dissection of the central compartment based on the recurrent patterns is important to reduce injury to the recurrent laryngeal nerves and parathyroid glands.
Carcinoma ; Cicatrix ; Female ; Fruit ; Humans ; Hypocalcemia ; Intention ; Ligaments ; Lymph Nodes ; Male ; Neck ; Recurrence ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Reoperation ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: Follicular thyroid carcinoma (FTC) is a relatively rare form of thyroid carcinoma that often presents at a more advanced stage of disease with a higher incidence of distant metastases because of its propensity for vascular invasion. However, FTC and papillary thyroid carcinoma (PTC) have similar prognoses when they are matched for age and stage. Therefore, this study was conducted to evaluate the useful prognostic factors and determine the optimal management of FTC. METHODS: This study was conducted on 216 patients with FTC who underwent thyroidectomy at our institutions between April 1986 and August 2006. The patients included 174 women and 42 men with a mean age of 41 (4~87) years, and patients underwent follow-up evaluation for a mean period of 114 (6~253) months. The potential risk factors for treatment outcome were calculated using multivariate analysis, and the prognostic accuracy of UICC/AJCC pTNM staging, AMES, AGES, MACIS, and Degroot classification for predicting survival were compared. RESULTS: During the follow-up period, 13 (6.0%) patients developed locoregional recurrences and 8 patients (3.7%) showed distant metastases. In addition, cause specific mortality was seen in 8 patients (3.7%). The overall survival and cause-specific survival (CSS) rates at 10 years were 95.4% and 89.3%, respectively, and these cases were accurately predicted by the AMES and pTNM staging systems. The Cox proportional hazards revealed that gender (P=0.015), angioinvasion (P=0.013), invasion to adjacent structure (P=0.003), widely invasive carcinoma (P=0.028), and distant metastases at the time of presentation (P<0.001) were independent prognostic factors for survival. CONCLUSION: The extent of surgery in cases of FTC should be individualized based on the clinicopathologic findings; Conservative surgery should be adequate for cases of minimally invasive FTC without angioinvasion, however total or near-total thyroidectomy should be conducted in cases of widely invasive and minimally invasive FTC with angioinvasion.
Adenocarcinoma, Follicular ; Carcinoma ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

BACKGROUND: Changes in acid-base balance and serum electrolytes by infusion of lactated Ringer's solution in liver cirrhosis patienst during liver surgery are poorly characterized. In this study, we evaluated the effects of infusing large amount of lactated Ringer's solution on acid-base and serum electrolytes during liver surgery in cirrhosis patients. METHODS: Thirty-two patients were divided into two groups. Group I (n = 21) was made up of patients who had received liver lobectomy without cirrhrosis. Group II (n = 11) was made up of patients who had received liver lobectomy with cirrhosis above a moderate level. Arterial blood gas and serum electrolyte levels were checked 4 times during the study in each patient: just after the operation start, after infusing 3,000 ml and 6,000 ml of lactated Ringer's solution during operation, and 30 minutes after arrival at the postanesthesia care unit. RESULTS: pH and base excess decreased according to the amount of lactated Ringer's solution used in both groups and these results were significant. Serum electrolyte levels were not changed and only Ca2+ levels were significantly different in the two groups. The cause of changing of Ca2+ levels found out by intravenous infusion of Ca2+ solution. CONCLUSIONS: In liver surgery patients with or without liver cirrhosis decreased pH and base excess in serum by increased amount of used lactated Ringers solution during liver surgery but in serum electrolytes and others acid-base parameters, CVP, changes on there were not any statistical significant. When a large amount of LR solution is used in liver surgery, we recommend regular arterial blood gas analyses for acid-base balance and an infusing speed of 20 ml/kg/h.
Acid-Base Equilibrium ; Blood Gas Analysis ; Electrolytes ; Fibrosis* ; Humans ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Liver Cirrhosis ; Liver*

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) has been broaden in reccent years. However,we considered many aspects in performing angioplasty in patient with multivessel disease. There were procedural success rate, complication, risk, restenosis and long-term effect. So we evaluated the initial success rate, safety and follow-up results. METHODS: To assess the likelihood of initial success in patients with multivessel coronary artery disease, single or multiple site angioplasy were performed at 449 lesions from 273 patients(Male 202,Female 71, Mean age 60.0+/-9.4 years). To evaluate the restenosis rate of angioplasty in multivessel disease, follow-up coronary angiogram were performed at 164 lesions from 95 patients at average 6months after angioplasty. RESULTS: The extent of coronary artery disease revealed that two vessel disease were 200(73.3%) and triple vessel disease were 73(26.7%). Single vessel angioplasty(SVA) was performed in 180(40.1%) lesions and multivessel angioplasty(MVA) was performed in 269(59.9%) lesions. Procedural success was achieved 377(84.0%) out of total 449 lesions. The proccdural success rate was 81.1% in SVA and 85.9% in MVA. According to major epicardial coronary artery, procedural success rate of left anterior descending artery was 82.0%, left circumflex artery 92.4% and right coronary artery 79.4%. According to angiographic morphology of lesions, procedural success rate of type A was 95.7%, type B 88.9% and type C 56.4%. Complete revascularization was done in 87 patients(31.9%) out of 273 patients. Major cause of failure of angioplasty in multivessel disease was inability to pass the guide wire cross the lesion due to total occlusion. Complications included dissection in 101, acute closure in 7(9.7%), coronary artery perforation in 2, cardiogenic shock in 1 and ventricular fibrillation in 1. Follow-up coronary angiography revealed the restenosis rate was 42.2%. CONCLUSION: Coronary angioplasty in selected patients with multivessel coronary artery disease might be useful and have relatively good immediate and long-term results.
Angioplasty* ; Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Shock, Cardiogenic ; Ventricular Fibrillation

Hemimegalencephaly is a rare congenital malformation of the cortical development arising from abnormal proliferation of anomalous neuronal and glial cells. The characteristic clinical manifestations are macrocephaly, psycomotor retardation, intractable seizure and hemihypertrophy of face, body and extremities, but musculoskeletal deformities are reported only in case of epidermal nevus syndrome. We report a case of hemimegalencephaly that was associated with foot deformity, without symptoms and signs of epidermal nevus syndrome.
Congenital Abnormalities ; Extremities ; Foot Deformities ; Foot Deformities, Congenital ; Macrocephaly ; Malformations of Cortical Development ; Neuroglia ; Neurons ; Nevus ; Nevus, Sebaceous of Jadassohn ; Seizures

OBJECTIVES: Air pollution causes various disease in exposed populations, and can lead to premorbid health effects manifested as both physical and psychological functional impairment. The present study investigated the subjective stress level in daily life in relation to the level of air pollution. METHODS: Data from the Community Health Survey (2013), comprising 99,162 men, and 121,273 women residing in 253 healthcare administrative districts, were combined with air pollutant concentration modelling data from the Korean Air Quality Forecasting System, and were stratified by subjective stress levels into five strata for multiple logistic regression. Levels of exposure were divided into five quintiles according to the annual concentration of nitrogen dioxide (NO2), and were analyzed using a single-pollutant model using NO2 concentration only, and a multi-pollutant model adjusted for the concentration of particulate matter < 10 µm in diameter. RESULTS: Analysis of men and women in various age groups showed the highest odds ratio (OR) for subjective stress level at the highest NO2 concentration quintile in men and women aged 30–64 years (men: 2.91; 95% confidence interval [CI], 2.12 to 4.01; women: 1.82; 95% CI, 1.32 to 2.51). As the NO2 concentration quintile increased, the OR increased. Men showed higher ORs than women in all strata. CONCLUSIONS: In the present study, annual NO2 concentrations were found to be associated with subjective stress levels. This association was especially clear among socioeconomically active men and women aged 30–64 years.
Air Pollution ; Delivery of Health Care ; Female ; Forecasting ; Health Surveys* ; Humans ; Korea* ; Logistic Models ; Male ; Nitrogen Dioxide ; Odds Ratio ; Particulate Matter ; Quality of Life

Restrictive dermopathy is a rare autosomal recessive disorder in which rigidity or tautness of the skin from the second trimester causes a fetal akinesia deformation sequence (FADS) and early death. Characteristic features include taut skin with prominent subcutaneous vessels, widely open fontanelles and cranial sutures, distinctive facies, flexion contractures, pulmonary hypoplasia, sparse eyelashes and and eyebrows, thin dysplastic clavicles. The histologic abnormalities of the skin are located in a thin dermis, consisting of compactly arranged collagen fibers, scanty elastic fiber. The dermoepidermal junction is flat, and epidermal appendages are absent, miniaturized or immature. The presence of adipose tissue may be increased. We report on the first Korean case of restrictive dermopathy with typical clinical features and histological findings.
Adipose Tissue ; Clavicle ; Collagen ; Contracture ; Cranial Sutures ; Dermis ; Elastic Tissue ; Eyebrows ; Eyelashes ; Facies ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Skin

Aortic intramural hematoma(AIH) is known as a variant of acute dissection due to rupture of the vasa vasorum without a intimal tear. In elderly hypertension patients patients with aortic dissection but without the characteristic echocardiographic findings of a double-channel aorta, this disease entity should be suspected and attention should be given to find segmental wall thickening of the aorta >0.7cm. AIH may progress to typical dissection or to rupture in considerable number of the patients, so careful follow-up is necessary and the same management principles for the patients with dissection can be applied in this variant. We report two cases of AIH showing typical eccentric mural thickening without dissection membrane with transesophageal echocardiographic follow-up.
Aged ; Aorta ; Echocardiography ; Echocardiography, Transesophageal* ; Follow-Up Studies ; Hematoma* ; Humans ; Hypertension ; Membranes ; Rupture ; Vasa Vasorum

OBJECTIVES: Air pollution causes various disease in exposed populations, and can lead to premorbid health effects manifested as both physical and psychological functional impairment. The present study investigated the subjective stress level in daily life in relation to the level of air pollution. METHODS: Data from the Community Health Survey (2013), comprising 99,162 men, and 121,273 women residing in 253 healthcare administrative districts, were combined with air pollutant concentration modelling data from the Korean Air Quality Forecasting System, and were stratified by subjective stress levels into five strata for multiple logistic regression. Levels of exposure were divided into five quintiles according to the annual concentration of nitrogen dioxide (NO2), and were analyzed using a single-pollutant model using NO2 concentration only, and a multi-pollutant model adjusted for the concentration of particulate matter < 10 µm in diameter. RESULTS: Analysis of men and women in various age groups showed the highest odds ratio (OR) for subjective stress level at the highest NO2 concentration quintile in men and women aged 30–64 years (men: 2.91; 95% confidence interval [CI], 2.12 to 4.01; women: 1.82; 95% CI, 1.32 to 2.51). As the NO2 concentration quintile increased, the OR increased. Men showed higher ORs than women in all strata. CONCLUSIONS In the present study, annual NO2 concentrations were found to be associated with subjective stress levels. This association was especially clear among socioeconomically active men and women aged 30–64 years.