No abstract available.

No abstract available.
Amniotic Fluid* ; Female ; Iron* ; Meconium* ; Staphylococcus aureus* ; Staphylococcus*

No abstract available.
Amniotic Fluid* ; Female ; Staphylococcus aureus* ; Staphylococcus*

Hirsutoid papillomas of vulvae present as smooth or filiform papules located on the inner surfaces of the labia minora. This disease is usually considered as anatomical variants of the vestibular mucosa. Differentiation from condyloma acuminata is important to avoid unnecessary treatment. Herein we report a case of hirsutoid papillomas of vulvae in a 21-year-old female who complained of pruritic papules on the vulva of one year's duration. Papules were located on the inner surfaces of the left labia minora and vestible of the vulva. Clinically, they were quite similar to condyloma acuminata. Histologically, however, the epithelium was devoid of features of human papillomavirus(HPV) infections such as koilocytosis, double nucleation, and dyskeratosis.
Epithelium ; Female ; Humans ; Mucous Membrane ; Papilloma* ; Vulva* ; Young Adult

The columnar cell variant of papillary thyroid carcinoma is an aggressive tumor associated with wide spread dissemination and a fatal outcome. We report two cases of columnar cell carcinoma occurring in two women aged 27, 66 years, respectively. The histologic feature of both cases showed focal papillary growth with columnar cell and nuclear stratification. Recognizing the columnar cell variant of the thyroid is important in light of the aggressive nature of the lesion and its apparent resistance to standard therapeutic interventions. These tumors occur over a wide age range, can metastasize widely, and are not usually responsive to radioactive iodine or chemotherapy. The presence or absence of extrathyroidal invasion represents the single most important parameter in predicting the behavior of these tumors. A large series of these tumors is needed to more fully appreciate the clinicopathologic spectrum of this aggressive thyroid neoplasm.
Drug Therapy ; Fatal Outcome ; Female ; Humans ; Iodine ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: The result of embolization via an external superior ophthalmic vein approach of carotid cavernous sinus fistula was first described around 1970s. We report a case of coil embolization of carotid cavernous sinus fistula using a superior ophthalmic vein approach. METHODS: A 70-year-old female had a 3-month history of headache, periocular pain, and diplopia. Diagnostic orbital contrast-enhanced CT, brain MRI and contrast-angiography and cerebral angiography revealed a carotid cavernous sinus fistula. Fistula occlusion via transfemoral endovascular embolization failed, so we then tried coil embolization using an external superior ophthalmic vein approach of carotid cavernous sinus fistula. RESULTS: The coil embolization via an external superior ophthalmic vein approach was difficult because of venous tortuosity and poor exposure of part of orbital roof area. But, X-ray-guided direct puncture of the superior ophthalmic vein was successful. We thus had good results with coil embolization of carotid cavernous fistula. CONCLUSIONS: The coil embolization via superior ophthalmic vein approach is an effective and challengeable treatment when surgical cauterization or conventional endovascular embolization fails. We suggest that there is need to training ophthalmologists to be experienced in external orbital surgery.
Aged ; Brain ; Carotid-Cavernous Sinus Fistula* ; Cautery ; Cerebral Angiography ; Diplopia ; Embolization, Therapeutic* ; Female ; Fistula ; Headache ; Humans ; Magnetic Resonance Imaging ; Orbit ; Punctures ; Tomography, X-Ray Computed ; Veins*

PURPOSE: Subacute thyroiditis (SAT) is an uncommon, self-lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. METHODS: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. RESULTS: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. CONCLUSION: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign.
Biopsy ; Biopsy, Fine-Needle ; Blood Sedimentation ; Female ; Hoarseness ; Humans ; Male ; Prodromal Symptoms ; Retrospective Studies ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis, Subacute*

PURPOSE: In case of well-differentiated thyroid carcinoma, a mediastinal lymph node metastasis is extremely rare, but can be life threatening due to its proximity to the vital organs. The consequence of radical extirpation must be balanced against the issues of tumor control, survival outcomes, functional morbidity, and the sequelae of an excessive surgical resection. The aim of this study was to clarify the clinicopathological characteristics, treatment and outcomes of patients with mediastinal lymph node metastasis in differentiated thyroid carcinoma. METHODS: Nineteen consecutive differentiated thyroid carcinoma patients with a mediastinal lymph node metastasis between June 1998 and Feb. 2004 were included in this study. All the patients underwent a trans-sternal mediastinal lymph node dissection in addition to thyroid cancer surgery. The median follow-up was 40.7 months (range, 18~97). RESULTS: The mean age was 49 years (range 31~72 years) with a male-to-female ratio of 8: 11. The surgical treatment included 11 cases of an upper mediastinal lymph nodes dissection via a partial sternotomy and 7 cases of a whole mediastinal lymph nodes dissection via a total longitudinal sternotomy. In 6 cases, the combined resection of the involved organ was added. Major postoperative complications occurred in two patients, one with leakage from a tracheoesophageal fistula and the other with a pulmonary embolism. During the follow-up period, local recurrences in the lateral cervical nodes were observed in 5 cases. The 5 year overall survival and 5 year disease-free survival were 90.5% and 63.6%, respectively. There was only one surgical mortality. CONCLUSION: These results suggest that the prognosis for mediastinal lymph node metastasis in differentiated thyroid carcinoma can be improved by an aggressive mediastinal node dissection and the appropriate thyroid cancer surgery.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Postoperative Complications ; Prognosis ; Pulmonary Embolism ; Recurrence ; Sternotomy ; Thyroid Gland* ; Thyroid Neoplasms* ; Tracheoesophageal Fistula

PURPOSE: Distant metastases, as the initial sign of a differentiated thyroid carcinoma, are extremely rare. The clinical characteristics for such cases remain to be established. This study was performed to characterize the clinical presentation, treatments, and outcome in such patients. METHODS: Between January 1986 and February 2005, of 4,525 differentiated thyroid cancer patients, 18 presented with distant metastases as the initial sign (0.4%). These comprised of 6 men and 12 women, with a median age of 49 years (range 9~66). Of the 18 patients, 8 (44.4%), 7 (38.9%), and 3 (16.7%) disclosed symptoms from lung, bone, and brain (16.7%) metastases, respectively. The median follow-up was 92 months, ranging from 18 to 198. RESULTS: The symptoms included cough and sputum (n=5), hemoptysis (n=2) and a lung mass (n=1) from lung metastases, back pain (n=3), a palpable mass (n=2) and a pathologic fracture (n=2) from bone metastases, as well as a headache with nausea (n=3) in all cases with brain metastases. The sites of metastases were the lung only in 7 (38.9%), bone only in 7 (38.9%) and multi-organ in 4 (22.2%). The histological diagnoses were a papillary carcinoma in 10 and a follicular carcinoma in 8. All patients underwent a total thyroidectomy followed by therapeutic radio-iodine therapy (RAI) and TSH suppressive treatment. For the metastatic lesions, aggressive treatment modalities, including surgical resection (n=9), external beam radiation (n=11), gamma-knife surgery (n=1) and a combination of these, were performed. The 10 year overall and disease-free survivals were 91.7 and 51.4%, respectively. There was only one disease-related death (1.6%). Tumor multiplicity (p=0.023) and multi-organ metastasis (p=0.009) were significant predictors of a poor prognosis. CONCLUSION: Clinical symptoms, history, physical examination, imaging studies and histological confirmation of distant metastatic lesions are important in the initial diagnostic approach. Even though distant metastasis presented as the initial sign, a 10-year disease-free survival rate of 50% was obtained. Radical resection of primary and metastatic lesions combined with high dose RAI treatment and/or external irradiation lead to long-term survival.
Back Pain ; Brain ; Carcinoma, Papillary ; Cough ; Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; Headache ; Hemoptysis ; Humans ; Lung ; Male ; Nausea ; Neoplasm Metastasis ; Physical Examination ; Prognosis ; Sputum ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Forgotten mediastinal goiter is an extremely rare disease. It is most often the consequence of the incomplete removal of a ‘ plunging’ goiter, but it can sometimes be attributed to a concomitant, unrecongnized primary mediastinal goiter which is not connected to the thyroid. A primary mediastinal goiter(autonomous intrathoracic goiter) essentially caused by an abnormal embryonic development of the thyroid gland and a thyroid gland formation located in the thorax or the mediastinum. The differential diagnosis with ordinary recurrence was based on the absence of parenchymatous or vascular connections with the cervical thyroid gland. It is fed by local intrathoracic vessels and observed in the absence of previous thyroidectomy. Nevertheless, for primary mediastinal goiter, sternum-splitting incision will be required in most cases as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision. In this study we report a case of forgotten mediastinal goiter and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this diasease are identified.
Diagnosis, Differential ; Embryonic Development ; Female ; Goiter* ; Hemorrhage ; Mediastinum ; Pregnancy ; Rare Diseases ; Recurrence ; Thorax ; Thyroid Gland ; Thyroidectomy