A 57-year-old woman presented with sudden onset of whirling vertigo associated with nausea and vomiting. The neurological examination showed left-beating horizontal nystagmus on the lying-down test and right-beating horizontal nystagmus on the head bending test. Geotropic direction-changing horizontal nystagmus was demonstrated on both sides during the supine roll test. Benign paroxysmal positional vertigo (BPPV) was the most common vestibular disorder in patients after head trauma. The authors experienced a case of right horizontal canal BPPV occurred after a yoga practice, thereby we report the case with a review of the related literatures.
Benign Paroxysmal Positional Vertigo ; Craniocerebral Trauma ; Female ; Head ; Humans ; Middle Aged ; Nausea ; Neurologic Examination ; Nystagmus, Pathologic ; Vertigo ; Vomiting ; Yoga

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: Follicular thyroid carcinoma (FTC) is a relatively rare form of thyroid carcinoma that often presents at a more advanced stage of disease with a higher incidence of distant metastases because of its propensity for vascular invasion. However, FTC and papillary thyroid carcinoma (PTC) have similar prognoses when they are matched for age and stage. Therefore, this study was conducted to evaluate the useful prognostic factors and determine the optimal management of FTC. METHODS: This study was conducted on 216 patients with FTC who underwent thyroidectomy at our institutions between April 1986 and August 2006. The patients included 174 women and 42 men with a mean age of 41 (4~87) years, and patients underwent follow-up evaluation for a mean period of 114 (6~253) months. The potential risk factors for treatment outcome were calculated using multivariate analysis, and the prognostic accuracy of UICC/AJCC pTNM staging, AMES, AGES, MACIS, and Degroot classification for predicting survival were compared. RESULTS: During the follow-up period, 13 (6.0%) patients developed locoregional recurrences and 8 patients (3.7%) showed distant metastases. In addition, cause specific mortality was seen in 8 patients (3.7%). The overall survival and cause-specific survival (CSS) rates at 10 years were 95.4% and 89.3%, respectively, and these cases were accurately predicted by the AMES and pTNM staging systems. The Cox proportional hazards revealed that gender (P=0.015), angioinvasion (P=0.013), invasion to adjacent structure (P=0.003), widely invasive carcinoma (P=0.028), and distant metastases at the time of presentation (P<0.001) were independent prognostic factors for survival. CONCLUSION: The extent of surgery in cases of FTC should be individualized based on the clinicopathologic findings; Conservative surgery should be adequate for cases of minimally invasive FTC without angioinvasion, however total or near-total thyroidectomy should be conducted in cases of widely invasive and minimally invasive FTC with angioinvasion.
Adenocarcinoma, Follicular ; Carcinoma ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

PURPOSE: The clinical implications of long-term suppressive thyroxine (TSH) therapy on the skeletal system are critical, largely because of the favorable prognosis of differentiated thyroid carcinomas (DTC). However, the potentialdeleterious effects of TSH suppressive therapy on the bone metabolism remain controversial. The aim of this prospective study was to assess the effects of chronic L-thyroxine (LT4) treatment with supraphysiologic doses of TSH on the bone mineral density (BMD) and biochemical bone remodeling markers. METHODS: This cross-sectional study was designed to compare patients with DTC and who were treated with LT4 for more than 2 years after thyroidectomy with an age-matched and gender-matched healthy control group. A total of 100 female outpatients (mean age: 47.5±13.8; 38 pre and 62 post-menopausal) who were on LT4 for between 2 and 10 yearswere enrolled. One hundred and three age-matched healthy volunteers were recruited as a control group. Laboratory tests were performed to exclude other possible factors for secondary osteoporosis. We measured the BMD by dual energy X-ray absorptiometry (DEXA), and bone turnover was assessed by several biochemical parameters. RESULTS: Our data showed no significant difference between the bone markers for the study group and the control group that had a premenopausal status. However, for the patients with a postmenopausal status, the serum levels of bone alkaline phosphatase were significant higher in the study group than that in the control group (P=0.038). We also found no significant difference between the study patients and the age- and weight-matched controls for the BMD at any site of measurement. CONCLUSION: This preliminary report suggests that bone turnover and accelerated bone loss might be related to the long-standing TSH suppression in postmenopausal women. Future prospective studies with an increased number of studied patients and a prolonged time of observation will be necessary in order to better assess the relative risk of osteoporosis in patients who are undergoing TSH suppressive treatment.
Absorptiometry, Photon ; Alkaline Phosphatase ; Bone Density* ; Bone Remodeling ; Cross-Sectional Studies ; Female ; Healthy Volunteers ; Humans ; Metabolism* ; Osteoporosis ; Outpatients ; Prognosis ; Prospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroxine

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

The clinical behaviors and treatment outcomes of thyroid carcinomas in patients with Graves' disease is a matter of controversy. This study aimed to identify the clinicopathologic features, treatment outcome, and the indicators for predicting recurrence, and to suggest the optimal extent of surgery in these patients. We retrospectively analyzed data of 58 patients who underwent surgical treatment for differentiated thyroid cancer and concurrent Graves' disease. The follow-up period ranged from 23 to 260 months (mean+/-standard devuation, 116.8+/-54.0). In our series, the mean age was 40.8+/-12.7 yr (range, 15-70), with a male-to-female ratio of 1: 6.25. The mean tumor size was 13+/-9 mm (range, 3-62). The surgical methods included 19 cases of total thyroidectomy, 38 cases of subtotal thyroidectomy, and 1 case of completion total thyroidectomy. Locoregional recurrence occurred in four patients (6.9%). The 10-yr overall survival and disease-free survival of patients were 95.8% and 91.1%, respectively. Age over 45 yr (p=0.031), tumor size over 10 mm (p=0.049), multiplicity (p=0.007), extracapsular invasion (p=0.021), and clinical cancer (p=0.035) were significantly more prevalent in patients with locoregional recurrence than in those without recurrence. We recommend that Graves' disease patients should undergo regular ultrasonography screening for early detection of thyroid carcinoma. We also suggest that the choice of extent of surgery should depend on the diagnostic timing (clinical or incidental) and factors for predicting recurrence.
Adult ; Comorbidity ; Disease-Free Survival ; Female ; Graves Disease/*complications/*therapy ; Humans ; Male ; Middle Aged ; Recurrence ; Thyroid Neoplasms/*complications/*therapy ; Time Factors ; Treatment Outcome

PURPOSE: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. MATERIALS AND METHODS: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared. RESULTS: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups. CONCLUSION: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Colectomy/*adverse effects/methods ; Female ; Humans ; Inflammation/etiology/metabolism ; Insulin-Like Growth Factor Binding Protein 3/blood ; Interleukin-6/blood ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Period ; Sigmoid Neoplasms/*surgery ; Treatment Outcome ; Vascular Endothelial Growth Factor A/blood

BACKGROUND: Thyroidectomy has been a surgical procedure associated with a high incidence of postoperative nausea and vomiting (PONV), and conventional antiemetics cannot prevent PONV effectively. In this study, we compared the efficacy and safety of ondansetron 70 microgram/kg, droperidol 10 microgram/kg and combination of both drugs to placebo in the prevention of PONV. METHODS: Seventy-six patients undergoing thyroidectomy were randomized to receive placebo (Group I, n=20), ondansetron 70 microgram/kg (Group II, n=19), droperidol 10 microgram/kg (Group III, n=18) and combination of both drugs (Group IV, n=19). The effects of these regimens on the incidence and severity of PONV and adverse events were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. RESULTS: In the 0 to 1 hour postoperative periods, the incidence of symptom free (no nausea and retching or vomiting) paients were 60% for placebo, 68.4% for ondansetron (p>0.05 versus placebo group), 88.9% for droperidol (p<0.05 versus placebo group), and 94.7% for combination of both drugs (p<0.05 versus placebo and ondansetron group). In the 1 to 24 hours postoperative period, the incidence of symptom free patients were 35% for placebo, 52.6% for ondansetron (p>0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo group), and 78.9% for combination of both drugs (p<0.05 versus placebo group). Overall, during the first 24 hours postoperatively, the incidence of symptom free patients were 30% for placebo, 42.1% for ondansetron (p>0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo and ondansetron group), and 73.7% for combination of both drugs (p<0.05 versus placebo and ondansetron group). Also, there were no significant differences between the droperidol and droperidol plus ondansetron group. Among the side effects associated with antiemetics, headache and dizziness incidence was higher. CONCLUSIONS: Droperidol and combination of ondansetron plus droperidol was superior to placebo, and ondansetron for prevention of PONV during the first 24 hours postoperative period.
Antiemetics* ; Dizziness ; Droperidol* ; Headache ; Humans ; Incidence ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting ; Postoperative Period ; Thyroidectomy*

PURPOSE: Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.METHODS: Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.RESULTS: There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).CONCLUSION: There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.
Antineoplastic Agents ; Colon ; Colonic Neoplasms ; Drug Therapy ; Humans ; Methods ; Neoplasm Metastasis ; Patient Selection ; Postoperative Complications

OBJECTIVE: To evaluate the effects of orthostatic stress with a head-up tilt on the autonomic nervous system and to determine how a cerebral stroke influences the cardiac autonomic function, using the power spectral analysis(PSA) of heart rate variability(HRV). METHOD: We studied 11 stroke patients with a left hemiplegia and 14 patients with a right hemiplegia. Their hemispheric brain lesions were confirmed by the MRI. The ECG and respiration signals were recorded at the tilt angle of 0o and 70o for 5 minutes under the condition of frequency controlled respirtaion(0.25 Hz). Data were compared with the age- and sex-matched 12 healthy controls. RESULT: In a control group, the normalized high frequency power showed a significant decrease during the head-up tilt(p<0.05), whereas the normalized low frequency power showed a significant increase(p<0.05). But for the left and right hemiplegia groups, there were no significant changes of normalized high and low frequency power under the orthostatic stress(p>0.05). Compared with the right hemiplegia and control groups, the left hemiplegia group was associated more with a reduced low and high frequency power and showed no significant changes under the orthostatic stress. CONCLUSION: PSA of HRV can identify the reduced cardiac autonomic activity in stroke patients, with a greater reduction in the left hemiplegia group than in the right hemiplegia group, which may cause a high risk of cardiac arrhythmias and sudden death.
Arrhythmias, Cardiac ; Autonomic Nervous System ; Brain ; Death, Sudden ; Electrocardiography ; Heart Rate* ; Heart* ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Respiration ; Stroke*