Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult

OBJECTIVES: This study was designed to investigate the effect of delivery nursing care using essential oils on labor stress response, labor anxiety and postpartum status anxiety for primipara. METHODS: This study used nonequivalent control group pretest-posttest design. The subjects of this experiment consisted of forty eight primipara with single gestation, full term, & uncomplicated pregnancies. Twenty four primipra were in the experimental and control group each. Their mean age was 27.9 years old, their mean gestation period 279.9 days. As a treatment, delivery nursing care using essential oils was applied by nurses. Data collected epinephrine, norepinephrine, anxiety during labor. In the 24 hours after birth, the data for the postpartum mother's status anxiety was collected. Data was analyzed by t-test, repeated measures ANOVA, Mann-Whitney U test, & Wilcoxon signed ranks test with SPSS Program. RESULTS: Plasma epinephrine, norepinephrine were significantly low in the experimental group (P=0.001, P=0.033, respectively). There was no significant difference between the two groups in anxiety during labor and postpartum mother's status anxiety. CONCLUSION: These findings indicate that delivery nursing care using essential oils could be effective in decreasing plasma epinephrine, norepinephrine. But, that could not be verified in decreasing mother's anxiety.
Stress/*prevention & control ; Pregnancy ; Postpartum Period/*psychology ; Oils, Volatile/*therapeutic use ; Norepinephrine/blood ; Labor, Obstetric/*psychology ; Humans ; Female ; Epinephrine/blood ; Delivery, Obstetric/*nursing ; *Aromatherapy ; Anxiety/*prevention & control ; Adult

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.
Adult ; Female ; Humans ; Hypoparathyroidism/etiology ; Male ; Middle Aged ; Paralysis/etiology ; Parathyroid Glands/surgery ; *Postoperative Complications ; Retrospective Studies ; Seroma/etiology ; Thyroid Neoplasms/*complications/pathology/*surgery

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

Cribriform-morular variant (CMV) is a rare histologic subtype of papillary thyroid carcinoma (PTC). Patients with familial adenomatous polyposis (FAP) could be associated with several comorbid diseases including thyroid cancer. Most thyroid cancers in them are PTCs, but infrequently CMV types can occur. The FAP concomitant CMV-PTCs are found predominantly in young women and reveals lower recurrence rate. Moreover, this variant shows circumscribed morphology and rarely metastasizes to node. Because the incidence of thyroid carcinoma is higher than that in general population, comprehensive evaluation of thyroid gland should be performed for the patients with FAP. Because thyroid cancer could be first manifestation of FAP, colonic screening should be considered in CMV-PTC patient. We report two cases of CMV-PTCs concurrent with FAP.
Adenomatous Polyposis Coli* ; Carcinoma, Papillary* ; Colon ; Female ; Humans ; Incidence ; Mass Screening ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: The clinical importance of papillary microcarcinoma (PTMC) is debatable. Because PTMC is being diagnosed with increasing frequency, it is important to describe the clinical and histological characteristics that confer aggressive behavior to this cancer. This study was carried out to evaluate the clinical and histological characteristics of PTMC and to determine an appropriate treatment strategy for such cases. METHODS: From Jan. 2000 to Dec. 2005, 1,255 patients with small papillary carcinoma, which measured less than 2.0 cm in its greater dimension, underwent total thyroidectomy at our institution. Among these patients, 633 (50.4%) had a thyorid carcinoma less than or equal to 1 cm in diameter (Group A). The clinicopathologic features and treatment outcome of these patients were evaluated and compared with the remaining 622 cases (49.6%) (Group B). RESULTS: For the patients with PTMC (Group A), there were 70 men and 563 women with a median age of 44 years (range; 12~86). During a mean follow-up of 32.5+/-18.2 months, 6 patients (0.9%) developed locoregional recurrences and 3 patients (0.5%) showed distant metastases. There was no disease-related mortality in both groups. The disease of group B was more likely to show extracapsular invasion (P < 0.001), invasion to adjacent structures (P < 0.001), and lateral neck node metastasis (P < 0.001) than that of group A. However, there were no significant differences in multifocality (P=0.189), bilaterality (P=0.203), the locoregional recurrence rate (P=0.065) and the distant meta-stasis rate (P=0.325) between the two groups. On multivariate analysis, locoregional recurrent disease was associated with central lymph node metastases (P=0.033) and lateral neck node metastases (P=0.022). CONCLUSION: Despite PTMC having less aggressive clinicopathologic parameters as compared with clinical cancer (>1 cm), some PTMCs show aggressive clinical behavior and locoregional recurrence. The treatment of PTMC should be individualized based on its tumor risk profiles and the clinical presentations. Moreover, performing close follow-up is essential, especially for those patients who present with cervicolateral lymph node metastases.
Carcinoma, Papillary ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Neck ; Neoplasm Metastasis ; Recurrence ; Thyroid Gland* ; Thyroidectomy ; Treatment Outcome

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

PURPOSE: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems, such as prominent scars, adhesions and hypesthesia, as well as paresthesia of the neck. To overcome these problems we performed a gasless endoscopic thyroidectomy via an axillary approach. METHODS: Between November 2001 and April 2005, 141 patients underwent a gasless endoscopic thyroidectomy via an axillary approach. The surgical outcomes were evaluated in terms of the operating time, length of hospital stay and the incidence of perioperative complications. Patient opinions were assessed using a verbal response scale at two and four months after surgery. RESULTS: The mean operating time and length of hospital stay were 122.7+/-32.8 minutes and 3.4+/-0.9 days, respectively. No cases required either conversion to open surgery or involved significant intraoperative complications. Two months after surgery, 75 patients (53.2%) complained of hypesthesia or paresthesia in the anterior chest wall. The number of patients with such complaints (9.9%) had decreased 4 months after surgery (P<0.001). Four months after surgery, only 4 patients (2.8%) complained of hypesthesia or paresthesia in the neck, and 10 (7.1%) complained of discomfort while swallowing. All patients were satisfied with the cosmetic results. CONCLUSION: A gasless endoscopic thyroidectomy via an axillary approach is feasible and safe, and provides excellent cosmetic results, with a minimal degree of postoperative complaints. This procedure provides another surgical option for the treatment of benign thyroid disease in selected patients.
Cicatrix ; Conversion to Open Surgery ; Deglutition ; Humans ; Hypesthesia ; Incidence ; Intraoperative Complications ; Length of Stay ; Neck ; Paresthesia ; Skin ; Thoracic Wall ; Thyroid Diseases ; Thyroidectomy*

Laparoscopic adrenalectomy has become a gold standard in adrenal gland surgery. More recently, some minimally invasive trials have been conducted on single access surgery on the adrenal gland. In this study, we introduce our first experiences of robot-assisted posterior retroperitoneoscopic adrenalectomy using single-port access and the da Vinci system.
Adrenal Glands ; Adrenalectomy ; Retroperitoneal Space ; Robotics

PURPOSE: Hurthle cell carcinoma (HCC) of the thyroid gland is a rare disease that represents 3% of all thyroid carcinomas. HCC has been known as a more aggressive disease than the usual differentiated thyroid carcinoma. However, the biologic behavior and optimal treatment have come under considerable debate in recent years. This study was performed to evaluate the clinicopathologic features and treatment outcome of HCC. METHODS: From April 1986 to August 2006, 18 patients with HCC and 216 patients with pure follicular carcinoma (PFC) underwent thyroidectomy at our institutions with a mean follow-up of 114 (range: 6~253) months. The clinicopathologic characteristics and treatment outcome of each group were compared, and the prognostic factors for disease-free survival were analyzed. RESULTS: There were 14 women and 4 men with a mean age of 50 (range: 26~76) years. Compared with PFC patients, all of clinicopathologic features of HCC patients were different (gender, age, tumor size, multifocality, angioinvaion, invasion to adjacent structures, the subclassification and initial distant metastasis), but the high incidence of bilaterality was similar to the PFC patients (P<0.0001). The cause- specific survival (CSS) rates at 10 years were 83.4% in the HCC patients and 89.3% in the PFC patients (P=0.702). Older age (greater than 45) (P=0.0125) and initial distant metastasis (P<0.0001) in the HCC patients, and an older age (P<0.0001), male gender (P=0.0039), angioinvasion (P= 0.0122), invasion to adjacent structures (P<0.0001), a widely invasive type (P=0.004) and initial distant metastasis (P<0.0001) in the PCC patients were independent prognostic factors for survival. CONCLUSION: After accounting for important biologic behaviors, patients with HCC had similar clinicopathologic characteristics and prognosis compared with that of the PFC patients. Therefore, HCC should be managed using the same treatment strategy as PFC.
Accounting ; Adenocarcinoma, Follicular ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome