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

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

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: Postoperative hypocalcemia is a common complication compared with the other complications following total thyroidectomy due to thyroid carcinoma. We evaluated the incidence of transient and permanent hypocalcemia and the preservation status of the parathyroid glands following total thyroidectomy due to thyroid carcinoma. METHODS: We analyzed a total of 145 cases of total thyroidectomy due to thyroid carcinoma. The preservation status of the prarathyroid glands after total thyroidectomy was classified as intact preservation or ischemic change, according to the number of intact preserved parathyroid glands in group 1 (more than 2), group 2 (1) or group 3 (0). RESULTS: Permanent hypocalcemia was not found in group 1. The rate of transient or permanent hypocalcemia was significantly lower in group 2 than that in group 3 (P< 0.05). CONCLUSION: The parathyroid glands should be preserved to minimize the occurrence of hypocalemia after performing total thyroidectomy. The number of intact preserved parathyroid glands can be a good indicator for predicting the occurrence of post-total thyroidectomy hypocalcemia.
Humans ; Hypocalcemia* ; Incidence ; Parathyroid Glands ; Thyroid Gland* ; Thyroid Neoplasms* ; 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: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.
Carcinoma, Papillary* ; Diagnosis ; Gangwon-do ; Humans ; Lymph Node Excision ; Neck ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Ultrasonography

PURPOSE: This study evaluated the association of the BRAF(V600E) mutation with known prognostic factors and ultrasonographic characteristics in cases of papillary thyroid carcinoma. METHODS: Subjects included 169 patients who received thyroidectomy at Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from February 2010 to October 2011. RESULTS: Of the total patients who received thyroidectomy, there were 128 cases (75,7%) of BRAF(V600E) mutation. Neither age nor sex were associated with the BRAF(V600E) mutation. Tumor size, shape, margin, extrathyroidal extension, central node metastasis and lateral node metastasis were found not to be associated with the BRAF(V600E) mutation. Tumor calcification, echogenicity and vascularity were also not associated with the mutation. CONCLUSION: As debate remains about the association between the BRAF(V600E) mutation and clincopathologic factors and ultrasonographic characteristics in cases of papillary thyroid carcinoma, further study is needed.
Diagnosis ; Gangwon-do ; Humans ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy