BACKGROUND AND OBJECTIVES: Previous studies have shown that uptake of 18Fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value (SUV) on positron emission tomography scan (PET scan), is associated with the biology of tumor. The aims of this study were to confirm the association with the biology of tumor and to establish whether a high SUV had prognostic significance. MATERIALS AND METHOD: Thirty patients with the head and neck cancer diagnosed as squamous cell carcinoma underwent a PET scan before treatment. SUVs were analyzed for possibility correlated with diseasefree survival. RESULTS: In univariate survival analysis, when patients were divided into two groups based on the SUV cut-off value of 8, the group whose SUV was greater than 8 in the pre-treatment PET scan showed significantly worse outcome (p=0.029). Correlation analysis demonstrated that SUV provided prognostic information independent of the tumor size, pathologic differentiation and stage. CONCLUSION: We conclude that high FDG uptake on PET (SUV >8 in pre-treatment PET scan) is an important prognostic indicator for poor outcome. Identified patients are thought to require intensive treatment protocol and more careful follow up.
Biology ; Carcinoma, Squamous Cell ; Head and Neck Neoplasms* ; Head* ; Humans ; Positron-Emission Tomography*

BACKGROUND: Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. METHOD: Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. RESULTS: 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. CONCLUSION: In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.
Biopsy* ; Biopsy, Fine-Needle ; Chest Tubes ; Diagnosis ; Hemoptysis ; Humans ; Lung* ; Pneumothorax

Axis, Cervical Vertebra* ; Celiac Artery ; Constriction, Pathologic* ; Ultrasonography*

Orthopedic surgical procedures are associated with a variety of complications due to em- bolic phenomena. Fat embolism syndrome is associated with multiple trauma injuries and surgery involving longbone fractures. The pathogenesis of syndrome is not clear and treatment remains supportive. We experienced a case of pulmonary embolism associated with total hip replacement. We suspected embolism on pulmonary perfusion scan and diagnosed fat embolism with criteria for diagnosis of fat embolism syndrome by Gurd.
Arthroplasty, Replacement, Hip* ; Diagnosis ; Embolism ; Embolism, Fat ; Femur Neck* ; Femur* ; Multiple Trauma ; Orthopedic Procedures ; Perfusion ; Pulmonary Embolism*

OBJECTIVE: To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage. MATERIALS AND METHODS: We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. RESULTS: The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. CONCLUSION: Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.
Adult ; Female ; Humans ; Hysterectomy ; Leiomyoma/blood supply/*surgery ; Middle Aged ; Postoperative Hemorrhage/*therapy ; Retrospective Studies ; Treatment Outcome ; Uterine Artery Embolization/adverse effects/*methods ; Uterine Neoplasms/blood supply/*surgery ; Uterus/blood supply/surgery

PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.
Appendectomy* ; Appendicitis* ; Body Mass Index ; Demography ; Humans ; Length of Stay ; Retrospective Studies ; Surgeons ; Surgical Instruments ; Surgical Wound Infection

BACKGROUND AND OBJECTIVES: Differentiated thyroid carcinoma (DTC) is a known malignant tumor arising from the follicular epithelium in thyroid gland. Although the prognosis for patients with DTC is generally good, appropriate surgical management can further reduce recurrence and cancer death rates significantly. The therapeutic methods performed are total thyroidectomy plus radioactive iodine (131I) therapy and life-long thyroid-stimulating hormone (TSH) suppression. Histopathologically, DTC contains papillary and follicular adenocarcinoma. In numerous studies, staging systems-AMES, AGES, MACIS, etc-have been created to evaluate prognostic outcome. By applying staging systems, we have treated 394 patients with DTC since 1998. The purpose of our study was to analyze characteristics of recurrent cases and evaluate remission rates of recurrent cases according to diagnostic methods. MATERIALS AND METHOD: From January 1998 to December 2001, we performed 630 thyroidectomies and 487 malignant tumors (421 papillary, 28 follicular, 20 medullary, 12 undifferentiated carcinoma and 6 other malignant tumors). We analyzed 394 DTC cases; excluding other malignancy, 65 cases were recurrent cancer (58 papillary and 7 follicular carcinoma). The medical records of 394 patients with DTC treated at our hospital were reviewed retrospectively. We analyzed impact of primary surgery on recurrence in 65 recurrent patients and compared the remission rates of those patients using physical examination with those using laboratory tests and imaging studies. RESULTS: 347 patients with DTC were treated initially in our hospital and 18 patients showed recurrence. Among them, lobectomy was performed as a primary surgery in 69 patients of whom one (1.4%) had recurrence. Forty-seven patients with DTC treated initially in other hospitals were referred to our hospital. Lobectomy was performed as a primary surgery in 23 patients (54.7%). Recurrence of 32 patients was detected by palpation. Of these patients, the remission rate was 25.0%, whereas patients diagnosed by laboratory tests and imaging systems showed 53.3% remission rate (p=0.056). CONCLUSION: The extent of primary thyroid resection appeared to have significant impact on the recurrence of DTC. In view of this, we should apply staging system strictly in treating DTC-total thyroidectomy and central neck dissection in high-risk groups. In following up patients, we should check the thyroglobulin level and use image tests like computed tomography and positron emission tomography to detect recurrence earlier.
Adenocarcinoma, Follicular ; Adenocarcinoma, Papillary ; Carcinoma ; Epithelium ; Humans ; Iodine ; Medical Records ; Mortality ; Neck Dissection ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Palpation ; Physical Examination ; Positron-Emission Tomography ; Prognosis ; Recurrence* ; Retrospective Studies ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin

OBJECTIVE: Arsenic trioxide (As2O3) can be used as a possible pharmaceutical alternative that augments radiofrequency (RF) ablation by reducing tumor blood flow. The aim of this study was to assess the effect of intraarterial and intravenous administration of As2O3 on RF-induced ablation in an experimentally induced liver tumor. MATERIALS AND METHODS: VX2 carcinoma was grown in the livers of 30 rabbits. As2O3 (1 mg/kg) was administered through the hepatic artery (n = 10, group A) or ear vein (n = 10, group B), 30 minutes before RF ablation (125 mA +/- 35; 90 +/- 5degrees C). As a control group, 10 rabbits were treated with RF ablation alone (group C). RF was intentionally applied to the peripheral margin of the tumor so that ablation can cover the tumor and adjacent hepatic parenchyma. Ablation areas of the tumor and adjacent parenchymal changes among three groups were compared by the Kruskal-Wallis and Mann-Whitney U test. RESULTS: The overall ablation areas were 156 +/- 28.9 mm2 (group A), 119 +/- 31.7 (group B), and 92 +/- 17.4 (group C, p < 0.04). The ablation area of the tumor was significantly larger in group A (73 +/- 19.7 mm2) than both group B (50 +/- 19.4, p = 0.02) and group C (28 +/- 2.2, p < 0.01). The ratios of the tumoral ablation area to the overall ablation area were larger in group A (47 +/- 10.5%) than that of the other groups (42 +/- 7.3% in group B and 32 +/- 5.6% in group C) (p < 0.03). CONCLUSION: Radiofrequency-induced ablation area can be increased with intraarterial or intravenous administration of As2O3. The intraarterial administration of As2O3 seems to be helpful for the selective ablation of the tumor.
Animals ; Arsenicals/*pharmacology ; Catheter Ablation/*methods ; Combined Modality Therapy ; Contrast Media/diagnostic use ; Disease Models, Animal ; Liver/radiography ; Liver Neoplasms, Experimental/*drug therapy/radiography/*surgery ; Oxides/*pharmacology ; Rabbits ; Statistics, Nonparametric ; Tomography, X-Ray Computed

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) is increasingly performed worldwide. Accordingly, the Konyang Standard Method (KSM) for SILC has been developed over the past 6 years. We report the outcomes of our procedures. METHODS: Between April 2010 and December 2016, 1,005 patients underwent SILC at Konyang University Hospital. Initially 3-channel SILC with KSM was changed to 4-channel SILC using a modified technique with a snake retractor for exposure of Calot triangle; we called this a modified KSM (mKSM). Recently, we have used a commercial 4-channel (Glove) port for simplicity. RESULTS: SILC was performed in 323 patients with the KSM, in 645 with the mKSM, and in 37 with the commercial 4-channel port. Age was not significantly different between the 3 groups (P = 0.942). The postoperative hospital days (P = 0.051), operative time (P < 0.001) and intraoperative bleeding volume (P < 0.001) were significantly improved in the 3 groups. Drain insertion (P = 0.214), additional port insertion (P = 0.639), and postoperative complications (P = 0.608) were not significantly different in all groups. Postoperative complications were evaluated with the Clavien-Dindo classification. There were 3 cases (0.9%) over grade IIIb (bile duct injury, incisional hernia, duodenal perforation, or small bowel injury) with KSM and 3 (0.5%) with mKSM. CONCLUSION: We evaluated the evolution of the KSM for SILC. The use of the mKSM with a commercial 4-channel port may be the safest and most effective method for SILC.
Cholecystectomy, Laparoscopic* ; Classification ; Hemorrhage ; Humans ; Incisional Hernia ; Laparoscopy ; Methods* ; Operative Time ; Postoperative Complications ; Snakes

OBJECTIVE: To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). MATERIALS AND METHODS: From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. RESULTS: There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. CONCLUSION: Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in US-invisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.
Carcinoma, Hepatocellular* ; Catheter Ablation* ; Humans ; Iodized Oil ; Liver Neoplasms* ; Liver* ; Multivariate Analysis ; Risk Factors ; Ultrasonography