No abstract available.
Fractures, Open*

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

BACKGROUND: The bispectral index, a parameter of electroencephalography (EEG) and a tool for the measurement of sedative state has been used in general anesthesia and for the assessment of sedative degree in intensive care units. The adverse effects of inhalation agents are various although hepatic toxicity, renal toxicity, postoperative nausea, and vomiting have been reported. This study was designed to evaluate the adverse effect of inhalation agents. METHODS: Forty-four adult patients scheduled for thyroidectomy under general anesthesia were randomly assigned to one group with a BIS below 40 (BIS40 group, n = 23) or to a group with a BIS from 50 to 60 (BIS60 group, n = 21). Hgb, WBC count, PLT count, renal function, and liver function were measured pre-and post-operatively (after 24 hrs). The degree of postoperative nausea and vomiting were estimated using the Rhodes Index of Nausea, Vomiting and Retching (RINVR) in postoperative 6 hrs, 12 hrs and 24 hrs. RESULTS: The amount of fentanyl used during the operation were greates in the BIS60 group than in the BIS40 group for adequate analgesia, and the preoperative and postoperative values of Hgb, WBC count, PLT count, AST, ALT, ALP, s-BUN, and s-creatine were not significantly different between the BIS40 and BIS60 groups. 6 hrs, 12 hrs and 24 hrs post-operatively no differences were observed between groups by RINVR in terms of nausea and vomiting. CONCLUSIONS: The adverse effect of an inhalation agent appears not to be related to its concentration when sevoflurane with BIS monitoring are used to reduced the amount of agent inhaled.
Adult ; Analgesia ; Anesthesia* ; Anesthesia, General ; Electroencephalography ; Fentanyl ; Humans ; Inhalation ; Intensive Care Units ; Liver ; Nausea ; Postoperative Nausea and Vomiting ; Thyroidectomy ; Vomiting

No abstract available.
Compartment Syndromes*

PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.
Diagnosis ; Gangwon-do ; Humans ; Radiotherapy* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: There are relatively few results from studies on nodular Hashimoto's thyroiditis. In addition, some Hashimoto's thyroiditis patients present with irregular symptoms, making the distinction from malignant thyroid nodule difficult. Therefore, we performed analyses on ultrasonographic findings of nodular Hashimoto's thyroiditis. METHODS: A retrospective follow-up study was performed on 76 patients (88 nodules) diagnosed with Hashimoto's thyroiditis after undergoing fine needle aspiration biopsy from January 2009 to December 2010. A frequency analysis was performed to investigate the most common ultrasonographic findings of nodular Hashimoto's thyroiditis. In addition, patients were divided into two groups based on the presence or absence of extensive Hashimoto's thyroiditis on the parenchyma, and ultrasonographic findings were compared and analyzed for nodules in each group. RESULTS: The study was performed on 76 patients and 88 nodules. The majority of nodular Hashimoto's thyroiditis were found to be solid on ultrasonography, and echogenicity was mostly hypoechoic, with prominent hypoechoic findings being more common. Most nodules did not have a rim surrounding the margins, and absence of accompanying calcification was also noted. The comparison and analysis of ultrasonographic findings of two patient groups that were divided based on the presence or absence of Hashimoto's thyroiditis across the parenchyma, revealed no significant difference. CONCLUSION: Most nodular Hashimoto's thyroiditis cases do not present with calcification or rims and frequently present as solid and hypoechoic. It can be concluded that such findings are consistent regardless of whether there is accompanying extensive changes at the thyroid parenchyma associated with Hashimoto's thyroiditis.
Biopsy ; Biopsy, Fine-Needle ; Follow-Up Studies ; Hashimoto Disease* ; Humans ; Retrospective Studies ; Thyroid Gland ; Thyroid Nodule ; Thyroiditis ; 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

PURPOSE: Controversy still exists over in the prognostic significance of microscopic tumor cell dissemination in patients with cancer. This study evaluated the prognostic implication of isolated tumor cells in the bone marrow of patients with gastric cancer. MATERIALS AND METHODS: Four hundred nineteen (419) patients who underwent surgery for gastric cancer between June 1998 and July 2000 were enrolled in the study. Bone marrow aspirate was obtained from the iliac crest before removal of the primary tumor. Mononuclear cells were isolated and stained with AE-1/AE-3 PAN-CYTOKERATIN. RESULTS: Cytokeratin-positive cells were found in the bone marrow of 219 patients (52.3%). The incidence varied significantly with the depth of invasion (P=0.021) and the stage (P=0.026). The five-year survival rate of patients with cytokeratin-positive cells was 74.1% and that of patients without cytokeratin-positive cells was 81.1% (P=0.2481). There were no significant differences in the recurrence rate and the site of recurrence according to whether or not cytokeratin-positive cells were present in the bone marrow. CONCLUSION: The presence of cytokeratin-positive cells in the bone marrow of patients with gastric cancer did not predict outcome and recurrence. Therefore, it cannot be used as a prognostic factor.
Bone Marrow* ; Humans ; Incidence ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: Propofol has a high incidence of pain when administered by intravenous injection. Among the many different methods available, lidocaine is used most frequently to minimize this pain. Propofol also has a depressant action on hemodynamics, especially in the elderly. The present study was aimed to examine whether lidocaine affects hemodynamic changes associated with propofol injection and endotracheal intubation, and whether it attenuates propofol-induced pain. METHODS: Eighty patients, over 60 years old, ASA physical status I and II, were randomly divided into four groups of 20 each according to lidocaine dosage mixed with 2 mg/kg of propofol given over 30 seconds during the induction of anesthesia; 0 mg (control group), 20 mg, 40 mg and 80 mg. Mean arterial blood pressure (MAP), heart rate (HR), and bispectral index scale (BIS) were measured before anesthetic induction (baseline value), 1 minute after the start of induction, immediately before endotracheal intubation, and then every minute for 5 minutes. Injection pain was scored as none, mild, moderate, or severe. RESULTS: MAP decreased significantly following the propofol injection and then increased after endotracheal intubation in all four groups, the magnitude of this decrease did not differ among the groups. HR increased after the propofol injection and then decreased. It increased again after intubation in all four groups. BIS was decreased by the induction of anesthesia, but was not affected by endotracheal intubation in any group. The three lidocaine groups had a lower incidence and severity of propofol-induced pain than the control group, and the effect were comparable among the lidocaine-treated groups. CONCLUSIONS: Our results indicate that lidocaine 20, 40 or 80 mg mixed with propofol does not affect the hemodynamic changes associated with propofol and endotracheal intubation, but that they similarly attenuate the injection pain associated with propofol.
Aged* ; Anesthesia* ; Arterial Pressure ; Heart Rate ; Hemodynamics* ; Humans ; Incidence ; Injections, Intravenous ; Intubation ; Intubation, Intratracheal ; Lidocaine* ; Middle Aged ; Propofol

No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure* ; Humans