Adrenocortical oncocytoma is a rare adrenal neoplasm with only 25 cases having been reported in the English medical literature, of which only seven were functional tumors. Since these adrenal tumors are usually nonfunctional, they are mostly incidentally detected, and most of them are benign. Herein, we report on a rare case of a functional adrenocortical oncocytoma of an uncertain malignant potential and this tumor was located in the left adrenal gland in a 59-year-old woman who presented with hypertension. The tumor size was large with foci of necrosis in the cut surface and it exclusively had oncocytic histologic features.
Adenoma ; Adenoma, Oxyphilic ; Adrenal Gland Neoplasms ; Adrenal Glands ; Female ; Humans ; Hypertension ; Middle Aged ; Necrosis

Primary iliopsoas abscess, without a causative infection focus, is a very rare kind of retroperitoneal abscess. Immunocompromised patient, such as elderly patients, diabetics and patients with chronic disease, are susceptible to this kind of infection. Because early diagnosis of priiliopsoas abscess is usually delayed due to nonspecific clinical presentation, proper treatment is also delayed which causes high mortality and morbidity. Recently we experienced three cases of primary iliopsoas abscess due to Staphylococcus aureus. Diagnosis of these cases was belatedly confirmed by using a abdominal-pelvic computerized tomography (CT) scan. Open surgical drainage via an extraperitoneal approach and administration of appropriate systemic antibiotics were required to save these patients. Based on a review of the literature, we evaluated the diagnosis and treatment of primary iliopsoas abscess.
Abscess ; Aged ; Anti-Bacterial Agents ; Chronic Disease ; Diagnosis ; Drainage ; Early Diagnosis ; Humans ; Immunocompromised Host ; Mortality ; Psoas Abscess* ; Staphylococcus aureus* ; Staphylococcus*

PURPOSE: The main issue with the current ultrasonography (US) guidelines is the overestimation of malignant and indeterminate nodules as they do not aid in making decisions to treat patients. To overcome this, new US guidelines for thyroid nodules that have been shown to be better correlated with cytologic results have been proposed. We also suggested specific indications for US-guided fine needle aspiration (FNA) using the new US guidelines. METHODS: Clinical and pathologic data from 925 patients and 1,419 thyroid nodules were retrospectively collected. All subjects underwent US- and US-guided FNA at Department of Surgery, Wonju Christian Hospital, between March 2010 and July 2011. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both the current guidelines and the new guidelines. RESULTS: The accuracy, sensitivity, specificity, PPV, and NPV for the current guidelines in predicting malignancy were 24.1%, 99.3%, 62.2%, 25.0%, and 99.8%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV for the new guidelines in predicting malignancy were 66.0%, 96.0%, 86.7%, 47.7%, and 99.4%, respectively. CONCLUSION: The use of the new US guidelines allow for a more accurate and specific diagnosis and a better treatment plan than the current guidelines. Additionally, the use of the new FNA guidelines may help prevent unnecessary FNAs and promote cost-effective follow-up for patients.
Biopsy, Fine-Needle ; Follow-Up Studies ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule

Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.
Abdomen ; Abdominal Injuries ; Diagnosis ; Physical Examination ; Rare Diseases ; Tuberculosis*

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: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. METHODS: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. RESULTS: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. CONCLUSION: If the mortality rate of trauma patients is to be reduced , the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.
Cause of Death ; Emergencies ; Humans ; Korea ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Shock ; Transportation

PURPOSE: Trauma is the leading cause of death among children age 1 to 15 years. The initial assessment of injured children is also important for the adequate treatment and transfer of these patients when required. A number of trauma scoring systems have been applied to the pediatric trauma population, with the Pediatric Trauma Score (PTS) being specifically developed as a triage tool for specifically for children. The ability of the PTS to predict the severity of an injury and mortality, and the value of the PTS were evaluated. METHODS: Seventy patients younger than 16 years of age, with multiple organ injuries, were assessed for 5 years, from January 1, 1997 to December 31, 2001. The demographic and clinical variables were retrospectively analyzed and the PTS assessed. RESULTS: Motor vehicle related injuries caused the majority of the multiple organ injuries the children, with liver injuries accounting for the greatest numbers. The survivals showed differences in relation to age, sex, number of injured organs and PTS, but no statistical significance was proved from a univariate analysis. From the multivariated analysis, only the PTS showed statistical significance. There were 5 deaths where the PTS was more than 9 points, was accounting for 55% of all mortalities. CONCLUSION: The PTS is an important triage for injured children, but could not reflect the prognosis of the injured patients when the clinical appearances were not reflected.
Cause of Death ; Child* ; Humans ; Liver ; Mortality ; Motor Vehicles ; Multiple Trauma* ; Prognosis ; Retrospective Studies ; Triage

PURPOSE: Although thyroid diseases have a high prevalence, controversy over their diagnosis and treatment continues owing to the difficulties in the differentiation between malignant and benign states in the thyroid nodule and in the decision of medical treatment, surgical intervention, and surgical method and extent. METHODS: We researched the clinical features, prevalence of malignant thyroid cancer and difference of prognosis between two groups of patients: group 1 was treated primarily with TSH suppression management or observation and then surgery, while group 2 underwent immediate surgery. In addition, we studied the proper management and diagnostic method for patients with thyroid nodule. RESULTS: The research comparison between group 1 (301 cases) and group 2 (920 cases) produced the following results. There was a relatively high prevalence of malignancy in group 1 managed improper TSH suppression as compared with group 2, postoperatively (38.9: 18.7%). AMES classification showed a high ratio of the high risk group in group 1 (papillary cancer, 47.6: 28.4%; follicular cancer, 41.7: 18.4%) and a prolonged treatment period in group 1 (64.6: 20.8 days). In addition, group 1 required a more aggressive operation method (bilateral thyroidectomy, 49.2: 37.2%). CONCLUSION: These data confirm that the accurate and early diagnosis of patients with thyroid nodule is essential to decide the management method and the patient prognosis, and emphasize the importance of the decision for proper treatment course. We therefore concluded that to decide the management course for patients with thyroid nodule, the selection of high risk group patients through routine examination and fine needle aspiration is very important. Furthermore, for patients with a very hard nodule, consideration should be given to enlarged nodule, past history of irradiation, status of attachment on the local tissue, and cervical lymph node enlargement. Finally, after the selection of the patient group, proper surgical management should be considered primarily.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Early Diagnosis ; Humans ; Lymph Nodes ; Prevalence ; Prognosis ; Thyroid Diseases ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy

PURPOSE: Fine needle aspiration cytology (FNAC) has become a standard diagnostic tool for thyroid nodules. The purpose of this study is to analyze the correlation between FNAC and the final histology to improve the diagnostic value. METHODS: We collected 792 patients who had undergone thyroidectomy, and we selected 549 patients who had undergone preoperative FNAC. The FNAC results were classified as non-diagnostic, malignancy, indeterminate and benign. The final pathologic reports were classified into two categories: malignant or benign. The individual histology was also identified. We retrospectively analyzed the pathologic result, the sensitivity, the specificity and the predictive value of the FNAC. RESULTS: Among 549 patients, their FNACs showed 47 non diagnostic results, 189 malignancies,136 indeterminate results and 177 benign results. The false positive rate was 1.1% and the false negative rate was 12.9%. The final pathology reports were 262 malignancies and 287 benign lesions. There were 42 (30.9%) malignancies among the 136 indeterminate cases. Adenomatous hyperplasia was the most common benign lesion and papillary carcinoma (containing micropapillary carcinoma) was the most common benign lesion. CONCLUSION: FNAC is an easy and safe diagnostic tool, but it still has many limitations. It is necessary to reduce the number of non diagnostic results. Technical advances, classification of the advanced categories of cytology and other staining methods can provide more specific results, and this can reduce the rate of performing unnecessary surgery.
Biopsy, Fine-Needle* ; Carcinoma, Papillary ; Classification ; Humans ; Hyperplasia ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Nodule ; Thyroidectomy* ; Unnecessary Procedures

PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.
Diagnosis ; Gangwon-do ; Humans ; Radiotherapy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy