PURPOSE: This study analyzed clinicopathologic features in patients with thyroid papillary carcinoma, who were younger than thirty, compared with patients aged thirty and forty-five. METHODS: The clinical records of 337 patients who underwent thyroidectomy because of papillary thyroid carcinoma were reviewed. Among them, 62 patients who were younger than thirty were placed in group I. And 275 patients between thirty and forty-five were placed in to group II. Clinicopathologic features between the two groups were analyzed. RESULTS: There was no significant difference between two groups in age, gender, tumor extension, and multifocality. Symptoms before detection of papillary thyroid carcinoma such as palpable mass, compressive symptoms or hoarseness were significantly higher in group I (P=0.008). In tumor size, rate of microcarcinoma is significantly higher in group II (P=0.024). Lymph node metastasis was found to be more significant in group I (P=0.010). The operative methods were different between the two groups. Rate of total thyroidectomy was increased in group I (P=0.021). CONCLUSION: This study shows that patients with thyroid papillary carcinoma, younger than thirty have more clinical symptoms and more large sized masses, more lymph node metastases at the time of surgery compared with those aged between thirty and forty-five.
Aged ; Carcinoma ; Carcinoma, Papillary ; Hoarseness ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: Papillary thyroid microcarcinoma (PTMC) is defined as a papillary thyroid carcinoma <10 mm in greatest dimension without palpation. In general, prognosis of PTMC is very favorable. PTMC can present with advanced features like papillary thyroid carcinoma >10 mm. Indication of FNAC based only on tumor size is still in debate. Some favor the criteria of a size <5 mm without FNAC and some argue for more study of the indication of FNAC according to tumor size. We analyzed the relationship of prognostic factors and number of FNACs prior to surgery for PTMC according to 5 mm size criterion. METHODS: Three hundred seven patients diagnosed with PTMC after surgery were enrolled. Based on tumor size, patients were divided into group 1 (≤5 mm, n=151) and group 2 (>5 mm, n=156) and the prognostic factors and number of pre-surgical FNAC procedures were compared. RESULTS: There were no significant differences in gender, age, site, accompanying benign disease, multifocality and bilaterality. Group 2 patients displayed more advanced features than group 1 patients concerning capsular invasion, lymph node metastasis and tumor stage. The number of FNAC procedures prior to the decision of surgery was not different in the two groups. CONCLUSION: PTMC exceeding 5 mm in size showed advanced features than smaller tumors. Further study about the use of FNAC according only to the size of thyroid nodules is warranted.
Biopsy, Fine-Needle* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Palpation ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: This study evaluated the risk factors for hypothyroidism after lobectomy for low risk papillary thyroid carcinoma according to existence of thyroiditis, especially on preoperative thyroid stimulating hormone (TSH) level and remnant thyroid volume. METHODS: The clinical records of 169 patients who underwent thyroid lobectomy due to papillary thyroid carcinoma were reviewed. We maintain the TSH level between 0.10~0.50 mU/L with thyroid hormone until 6 to 12 months after lobectomy. Then we stopped medication and check TSH level at intervals of 2~6 months. The patients were divided into 2 groups; hypothyroid (n=63) and euthyroid (n=106) state after lobectomy. Euthyroid state was defined as an TSH level between 0.50~5.0 mU/L, hypothyroid state as an elevated TSH level above 10 mU/L and need thyroid hormone. RESULTS: Factor for age, sex, type of operation, result of biopsy were not significant to postoperative hypothyroidism. Presence of thyroid autoantibody was significantly different (P<0.01) in the patients with thyroiditis compared with the patients without thyroiditis. When patient had thyroiditis, there was high possibility of postoperative hypothyroidism regardless of preoperative TSH level and remnant thyroid volume (P>0.05). When patient didn't have thyroiditis, there was high possibility of postoperative hypothyroidism when preoperative TSH is in high normal level and remnant thyroid volume ratio is below 50% (P<0.01). CONCLUSION: One can check the presence of thyroiditis with thyroid autoantibody and can predict the possibility of postoperative hypothyroidism after lobectomy in patients with low risk papillary thyroid carcinoma with preoperative TSH level and remnant thyroid volume.
Biopsy ; Humans ; Hypothyroidism* ; Risk Factors* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyroiditis* ; Thyrotropin

PURPOSE: Owing to the trend of a nuclear family the concern and protection are still more increasing than before. The patients admitted to hospital for intussusception, as well as their parents, seem to be under great stress when non- operative treatments fail. In order to identify those patients likely to fail an attempted non-operative treatment, and to administer prompt treatment, the patients that came to our hospital for pediatric intussusception were analyzed. METHODS: 285 cases, between 2000 and 2003 were reviewed. They were divided into two groups from their medical records, and retrospectively compared. Group I included 243 pneumoreduction cases and group II 42 operation cases. To find the probability of non-operative treatment failure, an attempt was made to analyze and score the risk factors that increase the possibility of operative treatment. RESULTS: The factors contributing to an increased possibility of operative treatment were fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms. CONCLUSION: This study revealed that fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms contributed to an increased possibility of operative treatment. An increase in the sum of the scores of each factor increased the possibility of operative treatment. This simple scoring system could eliminate excessive and repeated pneumoreduction, thus indicating its potential value as a useful aid in surgical decision making for high failure rate cases of pneumoreduction in intussusception.
Decision Making ; Fever ; Humans ; Intussusception* ; Leukocyte Count ; Medical Records ; Nuclear Family ; Parents ; Retrospective Studies ; Risk Factors ; Treatment Failure

Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.
Accidents, Traffic ; Adult ; Arm ; Arm Injuries ; Dislocations ; Elbow ; Humans ; Male ; Monteggia's Fracture ; Prognosis ; Radius ; Radius Fractures ; Wrist

BACKGROUND AND OBJECTIVES: Pulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period. SUBJECTS AND METHODS: A total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure. RESULTS: Percent stenosis of stenotic lesions were decreased from 54.1+/-10.7% to 22.8+/-12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7+/-8.0% to 10.3+/-9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case. CONCLUSION: This series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.
Arrhythmias, Cardiac ; Cardiac Catheterization ; Cardiac Catheters ; Catheterization ; Constriction, Pathologic ; Death, Sudden ; Follow-Up Studies ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Lung ; Perfusion ; Pulmonary Artery ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Stents ; Ventricular Pressure

The intracranial hematoma following cerebral aneurysmal rupture makes patient's clinical status and outcome worse by pressure effect on the brain structure. It's incidence has varied with authors between 5-30% of patients with ruptured cerebral aneurysms. Several authors emphasized the importance of early operation to obtain better results by early removal of hematoma and reducing intracranial pressure. The authors retrospectively evaluated seventy-six patients with intracranial hematomas in 370 patients with ruptured aneurysms from Jan. 1987 to Dec. 1992. The incidence of hematoma resulting from ruptured aneurysm was 20.5%. The most frequent site of aneurysm which was accompanied by intracranial hematoma was the middle cerebral artery, and the next was the anterior cerebral artery. The amount of hematoma and/or evidence of midline shift were the important factors in predicting the clinical outcome. The most favorable outcome was found in cases with intracerebral hematoma only, and the worst was in cases with intracerebral hematoma associated with intraventricular hemorrhage. Fifty out of 76 patients with intracranial hematomas were operated on. Their outcomes were more favorable than in the patients who were not operated on. Aggressive surgical intervention was especially effective in patients with poor Hunt & Hess grades(IV or V) .
Aneurysm ; Aneurysm, Ruptured* ; Anterior Cerebral Artery ; Brain ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Intracranial Pressure ; Middle Cerebral Artery ; Retrospective Studies ; Rupture

The bipolar coagulator has been frequently used in reducing the size of aneurismal neck or dissecting the aneurismal sac. However the effects of bipolar current on the wall of vessels have not been adequately documented. The author studied the histopathological changes of the renal arterial wall after bipolar coagulation. Thirty one Sprague-Dawley strain rats of both sexes and of various age were used. Under penthobarbital anesthesia, the left renal artery was coagulated with bipolar forcep just distal to it's origin from the aorta. The rats were divided into two groups:Group A was coagulated for two seconds:Group B for one second. The coagulation sites of vessels were examined grossly and microscopically in three and six months, respectively. The results were summarized as followings: 1) In both three and six months groups:the internal elastic membrane and elastic fibers were destructed, fragmented and thinned;the medial smooth muscle cells were damaged and decreased in number. 2) While the endothelial cells were severely desquamated and scattered in three months group, but there was an evidence of partial regeneration of endothelium and reduction of inflammatory reaction in six months group. Fibrosis was more augmented in six month group than three month group. 3) Between group A and B, There weemed to be no definite discrepancy in histopathological findings. 4) Pseudoaneurysms were developed in 72.2% of three months group and in 61.5% of six months group, but there was no significant statistical difference in the rate of pseudoaneurysm formation between the two groups(p>0.05, chi2=0.393). 5) Above findings suggest that the pseudoaneurysm which might be produced by bipolar coagulation of vessels in the neurosurgical operation, would be progressed to the true aneurysm if continuous hemodynamic factors are exerted upon the pseudoaneurysm. Therefore, it is desirable that the bipolar current should be used very catiously during the surgery of cerebrovascular disease.
Anesthesia ; Aneurysm ; Aneurysm, False ; Animals ; Aorta ; Elastic Tissue ; Endothelial Cells ; Endothelium ; Fibrosis ; Hemodynamics ; Membranes ; Models, Animal* ; Myocytes, Smooth Muscle ; Neck ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Renal Artery ; Surgical Instruments

PURPOSE: Features of epidermal growth factor receptor (EGFR) expression in osteosarcoma and in vitro efficacies of EGFR inhibitors against osteosarcoma cells were evaluated. MATERIALS AND METHODS: Thirty biopsy samples of osteosarcoma patients were retrospectively analyzed for EGFR protein expression by immunohistochemistry. Relationships between EGFR expression and clinicopathologic characteristics and treatment outcomes were evaluated. Four osteosarcoma cell lines were analyzed for EGFR and p-EGFR expression by western blotting. Efficacies of gefitinib and BIBW2992 on osteosarcoma cells were evaluated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Tyrosine kinase domains in exons 18 to 21 were sequenced and gene expression analyses of EGFR and PTEN were performed in four osteosarcoma cell lines. RESULTS: EGFR protein was expressed in 27 (90%) samples (6 low, 12 intermediate, 9 high) and in three cell lines. Intermediate or high staining for EGFR was related to a tumor volume<150 mL (p<0.001) and histologic subtype other than osteoblastic type (p=0.03). However, EGFR expression was not associated with histologic response to preoperative chemotherapy or survival. Gefitinib and BIBW 2992 did not have any significant inhibitory effect on cell viabilities. DNA sequencing analysis revealed three osteosarcoma cell lines have single base changes at codon 2361 of exon 20 (G to A), without affecting translation results. Furthermore, no mutation was found to be associated with constitutive EGFR activation. CONCLUSION: In the present study, gefitinib and BIBW2992 were not effective against osteosarcoma cells. However, as osteosarcoma cells express EGFR, further studies are necessary to explore the potential of other therapeutic agents targeting EGFR.
Biopsy ; Blotting, Western ; Cell Line ; Cell Survival ; Codon ; Epidermal Growth Factor ; Exons ; Gene Expression ; Humans ; Immunohistochemistry ; Osteoblasts ; Osteosarcoma ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Sequence Analysis, DNA ; Tetrazolium Salts ; Thiazoles

PURPOSE: To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: 31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union. RESULTS: 22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively. CONCLUSION: The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.
Aged ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Femur* ; Hip Fractures ; Humans ; Knee Joint ; Postoperative Complications ; Walking