PURPOSE: The aims of this study were to introduce an alternative surgical technique using a ballooning catheter and assess the outcomes of its use in patients with an upper mediastinal mass originated from the thyroid gland. METHODS: Between May 2001 and April 2004, 8 patients undewent an operation via a cervical approach using a ballooning catheter were enrolled in this study. The study group was reviewed by their clinical characteristics, diagnostic methods, postoperative results, histopathological findings and prognosis. Instead of a sternotomy, a ballooning catheter technique was used to assist in the transcervical delivery and extraction of these huge or deep mediastinal masses. The ballooning catheter was placed at the base of the mediastinal mass via a narrow plane which could not be reached by the surgeon's fingers. When the mediastinal mass was freed up by careful dissection with traction using an inflated ballooning catheter, could the mass was able to be delivered without injury to the surrounding tissues. RESULTS: There were 3, 2 and 3 cases of substernal goiters, substernal goiters combined with a papillary microcarcinoma and metastatic papillary carcinoma from thyroid cancer, respectively. The mean operation time and period of hospitalization were 121 minutes, (ranging from 70 to 195 minutes), and 6 days, (ranging from 3 to 10 days), respectively. In the 5 cases with a substernal goiter, the average size of the resected specimen was 9.9 cm, (ranging from 5.5 to 17.6 cm), with an average weight of 100.2 g, (ranging from 45 to 172.2 g). In the 3 cases of metastatic mediastinal lymph nodes, the postoperative 131I scan and serum thyroglobulin level showed no evidence of remnant metastatic tissue or cancer spillage. The median follow up duration was 24.8 months (ranging from 13 to 42 months). No major complications were documented, and no evidence of recurrence was encountered. CONCLUSION: The use of the ballooning catheter was found to be helpful in the transcervical removal of an upper mediastinal mass, and useful for substernal goiters. Furthermore, for mediastinal lymph node metastasis, this technique can be adopted as an alternative method in carefully selected cases.
Carcinoma, Papillary ; Catheters* ; Fingers ; Follow-Up Studies ; Goiter, Substernal ; Hospitalization ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Sternotomy ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms ; Traction

Fractures of the mandible occur with a greater frequency in the elderly. This study reports three cases of edentulous atrophic mandible fracture in elderly patients treated with open reduction technique. Three patients who presented with edentulous atrophic mandible fractures underwent surgical management using open reduction and internal fixation. After treatment, clinical evaluations and postoperative complications were examined with postoperative x-ray. Patients were followed with clinical and radiographic examinations. In the postoperative clinical evaluation, two male patients healed well, but one female patient complained of pain and swelling. In radiographic examinations, no union delay or lack of fusion was observed in the edentulous area. Open reduction technique is a viable treatment option for the edentulous atrophic mandible fractures in geriatric patients.
Aged* ; Bone Plates ; Female ; Humans ; Jaw, Edentulous ; Male ; Mandible* ; Mandibular Fractures ; Mandibular Reconstruction ; Postoperative Complications

BACKGROUND: This study uses the relevance index to understand the condition of regional medical service use for cardiovascular surgery and to identify the medical service use imbalance between regions. METHODS: This study calculated the relevance index of 16 metropolitan cities and provinces using resident registration address data from the Ministry of Government Administration and Home Affairs and the 2010–2014 health insurance, medical care assistance, and medical benefits claims data from the Health Insurance Review and Assessment Service. We identified developments over the 5-year time period and analyzed the level of regional imbalance regarding cardiovascular surgery through the relative comparison of relevance indexes between cardiovascular and other types of surgery. RESULTS: The relevance index was high in large cities such as Seoul, Daegu, and Gwangju, but low in regions that were geographically far from the capital area, such as the Gangwon and Jeju areas. Relevance indexes also fell as the years passed. Cardiovascular surgery has a relatively low relevance index compared to key types of surgery of other fields, such as neurosurgery and colorectal surgery. CONCLUSION: This study identified medical service use imbalance between regions for cardiovascular surgery. Results of this study demonstrate the need for political intervention to enhance the accessibility of necessary special treatment, such as cardiovascular surgery.
Colorectal Surgery ; Daegu ; Gangwon-do ; Gwangju ; Insurance, Health ; Neurosurgery ; Seoul

PURPOSE: Graves' disease presenting concurrently with thyroid cancer is a rare condition. The clinical behaviors and the extent of surgery in this condition is still controversial. This study examined the prognostic factors influencing the long-term outcomes as well as the appropriate treatment modalities in patients with Graves' disease presenting concurrently with thyroid cancer. METHODS: Forty nine patients who underwent surgery for thyroid cancer with Graves' disease were enrolled in this study. The outcomes of various types of surgical treatments as well as the factors associated with the long-term outcome were retrospectively analyzed. RESULTS: There were 42 women and 7 men with a median age 39 years (15~70 years). The surgical procedures included a bilateral subtotal thyroidectomy (n=17), a bilateral total thyroidectomy (n=16), and a total and contralateral subtotal thyroidectomy (n=16). The mean follow-up period was 83 months (4~218 months) after surgery. Disease-free survival at 5 and 10 years were 97.6% and 88.9%, respectively. Univariate log-rank survival analyses revealed that the age at diagnosis, the size of the thyroid cancer, capsular invasion, multiplicity, lymph node involvement, and clinical cancer to be poor prognostic factors. However, the extent of the surgical treatment was not significant for survival. CONCLUSION: The prognosis is expected to be poor when thyroid cancer presenting concurrently with Graves' disease is clinically apparent or has invaded the thyroid capsule. Patients with Graves' disease should be screened with ultrasonography to detect thyroid cancer. A total thyroidectomy or completion total thyroidectomy is not necessary in patients who do not have any of the poor prognostic factors, such as incidentally detected microcarcinoma postoperatively.
Diagnosis ; Disease-Free Survival ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Lymph Nodes ; Male ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Ultrasonography

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15–2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in postPCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

BACKGROUND: The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea are limited. OBJECTIVE: The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. METHODS: The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. The relative frequency of the major diagnostic group according to WHO classification was as follows: mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone lymphoma, 1%; angioimmunoblastic lymphadenopathy, 1%. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma.
Academies and Institutes ; Classification ; Continental Population Groups ; Geography ; Humans ; Immunoblastic Lymphadenopathy ; Korea* ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Follicular ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, T-Cell ; Lymphoma, T-Cell, Peripheral ; Pathology ; Retrospective Studies

BACKGROUND: Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. OBJECTIVE: The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. METHODS: The Dermatopathology Research Group conducted a review of nationwide collection of 109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. RESULTS AND CONCLUSION: The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. .Major component tumor cell was spindle cell type. Clark level of tumor was III or more and Breslow depth was 2mm or more at the time of the first diagnosis in many cases (62%). Pre-existing melanocytic nevus was present in a few cases (3 cases). All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor.
Academies and Institutes ; Diagnosis ; Humans ; Hutchinson's Melanotic Freckle ; Korea* ; Melanoma* ; Nevus, Pigmented ; Pathology ; Retrospective Studies

BACKGROUND: Data on the clinicopathologic features of hair follicle tumors in Korea are limited. OBJECTIVE: The purpose was to investigate the clinical and histopathologic characteristics of hair follicle tumors in Korea. METHODS: Two hundred sixty four cases of hair follicle tumors seen from 1999 to 2001 in Korea were analyzed clinically and histopathologically. RESULTS AND CONCLUSION: The most common hair follicle tumor in Korea was pilomatricoma(81.0%), followed by trichoepithelioma(6.4%), dilated pore of Winer(3.8%), and proliferating trichilemmal tumor(2.2%). Hair follicle tumors usually occurred as a solitary skin-colored nodule. The most commonly involved site was the face, and the peak age of presentation was 10 to 19. Pilomatricoma usually occurred as a solitary skin-colored nodule. The most commonly involved site was the arm, and more than 50% of tumors occurred before the age of 20. Histopathologically, the tumor was often surrounded by fibrous capsule and was composed of basophilic and shadow cells. It was usually located in the dermis and extended into the subcutis. Retraction spaces between tumor nests and stroma were frequently observed. Trichoepithelioma usually occurred as multiple skin-colored papules on the face. Histopathologically, the tumor was usually located in the dermis with sometimes connected to the epidermis. It frequently showed peripheral palisading. Dilated pore of Winer usually occurred as a solitary brownish to pigmented papule on the face in middle-aged persons. Proliferating trichilemmal tumor occurred as a solitary or multiple tumors. Histopathologically, the tumor was usually surrounded by incomplete fibrous capsule. Tumor cells frequently showed clear cell formation, nuclear atypia, mitosis, peripheral palisading, trichilemmal keratinization, and individual keratinization.
Arm ; Basophils ; Dermis ; Epidermis ; Hair Follicle* ; Hair* ; Humans ; Korea ; Mitosis ; Pilomatrixoma

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires