PURPOSE: The aims of this study were to determine the incidence and evaluate the risk factors for hypocalcemia after total thyroidectomy and to investigate how many parathyroid glands should be preserved to prevent postoperative hypocalcemia. METHODS: From March 2007 to February 2011, a retrospective review of 866 patients who underwent total thyroidectomy and node dissection for thyroid cancer was performed. The incidence and predisposing factors for hypocalcemia were analyzed. Among them, a total of 191 cases had four of their parathyroid glands identified intraoperatively. These patients were then divided into one preserved parathyroid gland group (group I, n = 22) and two or more preserved parathyroid glands group (group II, n = 169). The incidence of hypocalcemia with regards to the number of preserved parathyroid glands was determined and the results between the two groups were compared. The total calcium, ionized calcium and parathyroid hormone levels were compared between the two groups. RESULTS: The overall incidence of transient and permanent hypocalcemia was 9.2% and 0.5%, respectively. The decreased number of preserved parathyroid gland and increased number of removed central lymph node were the significant risk factors for developing postoperative hypocalcemia. In 191 cases identified with four parathyroid glands, the incidence of hypocalcemia was related to the number of preserved glands (group I, 22.7%; group II, 3.0%; P < 0.001). CONCLUSION: The insufficient number of preserved parathyroid glands is the only cause of hypocalcemia after total thyroidectomy and node dissection. At least one preserved parathyroid gland may prevent postoperative permanent hypocalcemia.
Calcium ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Neck ; Neck Dissection ; Parathyroid Glands ; Parathyroid Hormone ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; Thyroidectomy

Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.
Adult ; Amniotic Fluid* ; Anoxia ; Embolism ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Pregnancy ; Respiratory Distress Syndrome, Adult

Parathyroid carcinoma is a rare disease in pediatric patients. We present a case of a 13-year-old girl who presented to the Thyroid Department for an asymptomatic palpable neck mass for 1 year. The high levels of calcium, ionized calcium, and parathyroid hormone level along with parathyroid scintigraphy studies suggested primary hyperparathyroidism. Parathyroid carcinoma was confirmed by biopsy and pathologic examination after resection. Six months postoperatively, persistent hypercalcemia and multiple lung metastases were found on computed tomography. Bilateral lung wedge resection was performed. En bloc resection for primary parathyroid carcinoma and aggressive resection of metastatic disease is the most effective treatment to control hypercalcemia.
Adolescent ; Biopsy ; Calcium ; Child ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary ; Lung ; Neck ; Neoplasm Metastasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Rare Diseases ; Thyroid Gland

PURPOSE: Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4< or =~<6 g and > or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.
Follow-Up Studies ; Graves Disease ; Hemorrhage ; Hoarseness ; Humans ; Hyperthyroidism ; Hypocalcemia ; Hypothyroidism ; Korea ; Postoperative Complications ; Recurrence ; Thyroid Gland ; Thyroidectomy

PURPOSE: The extent of prophylactic lateral neck lymph node dissection is very controversial in medullary thyroid cancer. This retrospective study was undertaken to evaluate the efficacy of prophylactic lateral neck lymph node dissection. METHODS: A total of 29 patients underwent curative operation for medullary thyroid carcinoma at our institution. Of these 29 patients, 13 patients had prophylactic lateral neck dissection and 16 patients had non-prophylactic lateral neck dissection. Among 13 patients, one-compartment prophylactic lymph node dissection was performed in 10 patients and two-compartment prophylactic lymph node dissection was performed in 3 patients. Postoperative calcitonin level was evaluated between these groups. RESULTS: A normalized calcitonin level was detected after surgery in 74% of patients without lateral neck lymph node metastases, and in 10% of patients with lateral neck lymph node metastases. In comparison of prophylactic node dissection group and non-prophylactic node dissection group, the rate of normalized calcitonin level after surgery is 100%, 66.7% in stage 1, 100%, 50% in stage 2, 0%, 80% in stage 3, 14.3%, 0% in stage 4. In the patients who one-compartment prophylactic lymph node dissection was performed, 40% of patients had positive lymph node metastasis, and 70% had persistent hypercalcitoninemia. However, there was no postoperative hypercalcitoninemia in the patients with twocompartment prophylactic lymph node dissection although lymph node metastasis was not identified with pathologic examination. CONCLUSION: Prophylactic lymph node dissection was more effective in the early stage of medullary thyroid carcinoma than late stage. The two or more compartment lymph node dissection is more effective than just one-compartment dissection for the normalization of serum calcitonin level.
Calcitonin ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection* ; Neck* ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: Multiple endocrine neoplasia type I is rarely reported in Korea. The purpose of this study is to analyze the clinical features and the treatment of MEN1 which had been carried out in our institution. METHODS: Eight patients underwent surgery for MEN1-related hyperparathyroidism, duodenopancreatic tumors and pituitary tumors at our institution and were reviewed retrospectively. RESULTS: Of the eight patients, all patients had hyperparathyroidism. There were 5 total parathyroidectomy patients and 3 subtotal parathyroidectomy patients, none of them had persistent and recurrent hyperparathyroidism after operation. However, one of total parathyroidectomy patients had persistent hypoparathyroidism. Of the 8 patients, seven had duodenopancreatic tumors; four of them had pancreatic islet-cell tumors, two had malignant gastrinoma and one had Zollinger-Ellision syndrome. Pituitary tumors were observed in 6 patients among the 8; four of them had prolactinoma, and 2 had adenoma which was confirmed by magnetic resonance imaging. Of the eight patient, only one patient was confirmed to have another MEN1 family member and the mutation of MEN1 gene on chromosome 11q13 was proved on gene study. CONCLUSION: The clinical features of these patients were similar to those in other reports and the results of surgical treatment were relatively satisfactory. However, the detection of other MEN1 patients among the family members was relatively poor. Close follow up of family members and gene study will be required.
Adenoma ; Follow-Up Studies ; Gastrinoma ; Humans ; Hyperparathyroidism ; Hypoparathyroidism ; Korea ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Parathyroidectomy ; Pituitary Neoplasms ; Prolactinoma ; Retrospective Studies

The congenital cystic adenomatoid malformation of the lung is an unusual pulmonary entity, and usuallysymptomatic in infancy with sign of resiratory distress. This abnormality consists of enlarged, multicystic lobewith smooth-walled cysts of variable sized, which can communicate with major bronchi through malformed air passagethat usually lacks in cartilage. Roentgenographic findings are three types. First type is multicystic patternshowing various sized of cysts and causing mediastinal shift with pulmonary herniation. Second type is dominantcystic pattern underlying multicystic lesion, Third type is solid homogenous mass. Prompt surgical resection ischoice of treatment. We recently experienced a case of congenital cystic adenomatoid malformation of the lung of27 day female in fant and report with reviwe of literatures.
Bronchi ; Cartilage ; Cystic Adenomatoid Malformation of Lung, Congenital ; Female ; Humans ; Lung

Benign tumors of the mendible are uncommon lesions. That were classifed into odontogenic tumors and nonodontogenic tumors. Author reviewed the radiological evaluation and pathological microscopic finding from 33 benign tumors of the mandible that were comfirmed by the biopsy during last 10 years in Dental Clinics, Ewha Womans University Hospital and Seoul Natinal University Dental Hospital. Following results were obainend; 1.Benign tumors of the mandible were classified into odontogenic (66.7%) and non-odontogenic tumors (33%). 2. The range of the age distribution was between 6 years and 67 years old. The commonest age group was the second decade(39.4%). 3. There was no difference to sex distribution. 4. The most frequent locatio was the body of the mandible (42.4%). 5. Radiographic findings were relatively characteristic in odontogenic tumors rather thannon-odontogenic tumors. 1) Radiolucent cystic lesions-ameloblastoma, odontogneic myxoma, odontogneic fibroma,aneurysmal bone cyst and neurofibroma. 2) Radiopaque mass lesions-odontoma, cementoma and osteoma. 3) Mixed patterns-ossifying fibroma, cementifying fibroma, calcifying odontogenic epithelial tumor and hemangioma. It was concluded that the radiographic examination was of value to diagnose the benign tumos of tee mandible in symptomless patients.
Age Distribution ; Biopsy ; Bone Cysts ; Cementoma ; Dental Clinics ; Female ; Fibroma ; Hemangioma ; Humans ; Mandible ; Myxoma ; Neurofibroma ; Odontogenic Tumors ; Osteoma ; Seoul ; Sex Distribution

PURPOSE: Parathyroid injury and metabolic events are known causes of post thyroidectomy hypocalcemia and many other clinical risk factors are also noted. This retrospective study was undertaken to determine the main causative factor of transient hypocalcemia after total thyroidectomy. METHODS: 237 patients underwent total thyroidectomy and 10 patients underwent lobectomy were enrolled in this study. The incidence of transient and permanent hypocalcemia was investigated and we evaluate the risk factors. In 36 patients who underwent total thyroidectomy and 10 patients who underwent lobectomy, serum total calcium and, ionized calcium, i-PTH were measured at post operative day 1, 3, 7 and compared according to the number of preserved parathyroid glands. RESULTS: The incidence of transient and permanent hypocalcemia after total thyroidectomy was 3.4% (8/237) and 0.4% (1/237) respectively. Among the investigated risk factors, the number of preserved parathyroid gland was the only significant factor for hypocalcemia and, tumor extent, extent of central lymph node dissection and, lateral lymph node dissection were not the significant risk factors. The incidence of hypocalcemia was closely related to the number of preserved parathyroid gland (0 (66.7%), 1 (5.2%), 2 (0.7%), 3 (0%), 4 (0%))(P<0.001). The levels of serum total calcium, ionized calcium and, i-PTH were significantly different between the patients in whom only 1 parathyroid gland was preserved and more than 1 gland preserved at post operative day 1, 3. However there was no difference between two groups at post operative day 7. CONCLUSION: The technical aspect of parathyroid preservation is the most important factor for post thyroidectomy hypocalcemia.
Calcium ; Humans ; Hypocalcemia* ; Incidence ; Lymph Node Excision ; Parathyroid Glands ; Retrospective Studies ; Risk Factors* ; Thyroidectomy*

A 49-year-old woman visited the clinic because of acute hepatitis and acute kidney injury with decreased urine output presenting microscopic hematuria and proteinuria. An abdominal computed tomography revealed a localized, hypoattenuated lesion in a hepatic lateral segment, and kidney biopsy showed oxalate crystal deposition with tubular necrosis. In addition, the patient's 24-hour urinary excretion of oxalate was increased. Her kidney and liver injury improved after sessions of hemodialysis, and urinary oxalate excretion was normalized. Major mutations in primary hyperoxaluria have not been proven. A full sequencing of target genes may be helpful to diagnose a rare form of primary hyperoxaluria.
Acute Kidney Injury ; Biopsy ; Female ; Hematuria ; Hepatitis ; Humans ; Hyperoxaluria* ; Hyperoxaluria, Primary ; Kidney* ; Liver* ; Middle Aged ; Necrosis ; Proteinuria ; Renal Dialysis