No abstract available.
Thyroid Gland

It is known that antithrombin III is a potent vasodilator and plasmin is a vasoconstrictor, and some patients with a subarachnoid hemorrhage(SAH) develop clinical vasospasm and some patients do not. Under the hypothesis that the development of clinical vasospasm might depend on the difference of the blood level of antithrombin III in each patient with SAH and that the plasmin might have a role in the development of clinical vasospasm, we repeatedly checked the levels of blood antithombin III with a single radial immunodiffusion method and CSF fibrinogen degradation products(FDP : indirect indicator of plasmin activity) with a latex-test(Thrombo-Wellcotest(R)) during the period between 1-4, 5-11 and 12-24 days after a SAH in 29 patients. 10 patients with diseases except those with a SAH were selected as a control group. First, we analyzed the difference of the average of blood antithrombin III and CSF FDP between aneurysmal SAH patients and control patients and then, between patients with clinical vasospasm(8 cases) and patients without clinical vasospasm(21 cases). Secondly, we also analyzed the difference of these data between patients with clinical vasospasm and patients without clinical vasospasm according to the sampling day after a SAH. As a result, there was no statistical difference between the average blood level of antithrombin III in control and in SAH patients(29.06+/-3.04 vs. 25.61+/-6.95, respectively), and in patients with clinical vasospasm and in patients without clinical vasospasm(26.59+/-7.65 vs. 23.67+/-7.40, respectively). The average CSF levels of FDP is higher in SAH patients than in control patients(18.16+/-14.36 vs. 1.00+/-3.16, respectively : p<0.01). It is also higher in patients with clinical vasospasm than in patients without clinical vasospasm. However, there is no statistical significance(28.75+/-9.91 vs. 21.75+/-12.07, respectively : p>0.05). In the analysis of the average CSF levels of the FDP according to the sampling day after a SAH, even though the average levels is higher in patients with clinical vasospasm than in patients without clinical vasospasm(1-4 days : 31.43+/-14.64 vs. 27.33+/-16.24, 5-11 days : 23.75+/-17.68 vs. 18.10+/-16.32, 12-24 days : 32.50+/-13.89 vs. 18.82+/-16.54, respectively), a statistical significant difference was noticed only in levels which were checked between 12 and 24 days after a SAH(p<0.05). This study concludes that the blood level of antithrombin III shows no difference between the control and SAH patients, and patients with clinical vasospasm and patients without clinical vasospasm. Although it suggests a causal relationship between the FDP itself or plasmin in CSF and the development of clinical vasospasm, it does not justify any valid conclusion.
Aneurysm* ; Antithrombin III* ; Cerebrospinal Fluid* ; Fibrinogen ; Fibrinolysin ; Humans ; Immunodiffusion ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

OBJECTIVES: Although human papillomavirus (HPV) infection is considered as a favorable prognostic factor in oropharyngeal cancer, the prognosis of HPV-associated tonsil cancer has rarely been studied especially when surgery was the main treatment. In this study, the authors investigated the effect of p16 over-expression (HPV infection) on tonsil cancer prognosis according to the type of treatment, HPV presence by PCR, and expression of p53 and epidermal growth factor receptor (EGFR) by immunohistochemistry (IHC). METHODS: Medical records of 33 tonsil cancer patients were reviewed. Using formalin-fixed and paraffin-embedded tumor specimens, PCR-based genotyping of HPV and IHC of p16, p53 and EGFR were performed. The effects of HPV presence and the expression of IHC markers were analyzed on the recurrence-free survival. Five-year disease-free survival (DFS) rates were evaluated according to p16 expression status. RESULTS: An over-expression of p16 was observed in 27 (81.9%) out of 33 cases. Surgery-based treatment was provided for 21 (63.6%) patients. There was no association between p16 immunoreactivity and HPV presence, nor with p53 and EGFR expression. Regardless of main treatment modalities, five-year DFS did not differ by p16 expression status (P=0.051). However, over-expression of p16 was associated with a lower recurrence in multivariable analyses (P=0.046). CONCLUSION: Regardless of main treatment modalities, an over-expression of p16 (HPV infection) is associated with a lower recurrence in tonsil cancers. However it is not associated with simple HPV presence or p53 and EGFR over-expression.
Disease-Free Survival ; Humans ; Immunohistochemistry ; Medical Records ; Oropharyngeal Neoplasms ; Palatine Tonsil ; Polymerase Chain Reaction ; Prognosis ; Receptor, Epidermal Growth Factor ; Recurrence ; Tonsillar Neoplasms

We reviewed 6 epidermoid and 3 dermoid tumors of the brain treated surgically for a period of 4 years. The favorite sites for epidermoids were the cerebellopontine angle, whereas dermoids were found in the cerebellar vermis. The average age was 44.2 years for the patients with epidermoid tumors and 24.6 years for the patients with dermoid tumors. Average duration of symptoms was much shorter in dermoids than in epidermoids. Computed tomography scans revealed hypodense lesions with irregular borders without contrast enhancement. Magnetic resonance imaging was performed on 3 patients;the tumors showed decreased signal intensity relative to the brain on T1-weighted images and increased signal intensity relative to the brain on T2-weighted studies. Five were removed totally and 4 subtotally. Aseptic meningitis and transient facial nerve palsy were causes of postoperative morbidity.
Brain ; Cerebellopontine Angle ; Dermoid Cyst* ; Facial Nerve ; Humans ; Magnetic Resonance Imaging ; Meningitis, Aseptic ; Paralysis

Essential thrombocythemia is one type of the related chronic myeloproliferative disorders that also include poly-cythemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is a rare disorder of unknown origin characterized by thrombocytosis, excessive megakaryocytes, hemorrhage, and thrombotic complication. Several cases of ischemic stroke in essential thrombocythemia have been reported, but cerebral infarction combined with cerebral hemorrhage has been very rare and has not been reported in Korea. We report a case of cerebral infarction and chronic subdural hematoma in a pateint with essential thrombocythemia. A 59-year-old woman with essential thrombocythemia was admitted with mild left hemiparesis that developed 3 days prior. She had a history of minor trauma 15 days prior. A brain MRI showed an infarction in the right temporal lobe and a chronic subdural hematoma in the right frontoparietal area. A cerebral angiography revealed an occlusion of the M2 portion of the right middle cerebral artery.
Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Infarction* ; Female ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Infarction ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Magnetic Resonance Imaging ; Megakaryocytes ; Middle Aged ; Middle Cerebral Artery ; Myeloproliferative Disorders ; Paresis ; Primary Myelofibrosis ; Stroke ; Temporal Lobe ; Thrombocythemia, Essential* ; Thrombocytosis

Spinal epidural abscess is a rare disorder with poor prognosis. In order to understand its clinical feature and method of treatment, a retrospective study of spinal epidural abscess spanning 8 years and encompassing 10 patients was done. There were 6 males and 4 females aged 12 to 64 years with peak incidence at the sixth decade. In one patient, epidural abscess recurred at the site previously treated 10 years ago. In addition to fever and leukocytosis in 8 patients, other frequent symptoms according to lesion site were abdominal pain and motor weakness in thoracic epidural abscess and low back pain and sciatica in lumbar epidural abscess. Staphylococcus aureus was the most common causative organism. Magnetic resonance imaging(MRI) showed variable signal on T1-weighted images and hyperintensity on T2-weighted images, which was studied in 6 patients. Two patterns in gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhancement(2 patients) gadolinium-enhanced MRI were a central focus of low signal intensity surrounded by ring enhanement(2 patients) and heterogeneous enhancement(4 patients). MRI offered the advantage of noninvasive early recognition and anatomical localization, which made it the imaging modality of choice. Although laminectomy was the standard operative procedure, the result of window laminectomy with catheter drainage for prevention of kyphosis was proven effective in a girl. Complete improvement following surgery was obtained in patients, while a man resulted in paraplegia and a boy paraparesis with mild kyphosis in thoracic abscess as sequelae.
Abdominal Pain ; Abscess ; Catheters ; Drainage ; Epidural Abscess* ; Female ; Fever ; Humans ; Incidence ; Kyphosis ; Laminectomy ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Paraparesis ; Paraplegia ; Prognosis ; Retrospective Studies ; Sciatica ; Spine* ; Staphylococcus aureus ; Surgical Procedures, Operative

OBJECTIVES: This study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma. METHODS: After reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR. RESULTS: The MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001). CONCLUSION: When the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.
Adult ; Biopsy ; Decision Making ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Lymphatic Metastasis ; Medical Records ; Multivariate Analysis ; Neck Dissection ; Neck* ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Recurrence* ; Thyroglobulin ; Thyroid Gland* ; Thyroidectomy ; Tumor Burden

In order to find out the effect of induced hypotension and temporary clipping during aneurysmal surgery on postoperative patients, we analysed 143 cases who had received surgery from September, 1982 to April, 1988. We divided these surgical cases into two groups, those without temporary clipping and those with temporary clipping during surgery, excluding cases of definite surgical complications. Of the patients in the non-temporary clipping group, we evaluated the relationship between the degree of the mean blood pressure(MBP) during surgery with the postoperative conduction of the patients according to the preoperative clinical grade. Of those in the temporary clipping group, we also evaluated the relationship between the degree of the MBP, site and duration of the temporary clipping during surgery with the postoperative condition of the patients according to preoperaitve clinical grades. The rate of temporary deterioration, delayed sequela and death, possibly from induced hypotension or the temporary clipping procedure, was higher in those whom the MBP was lowered to 60 mmHg during surgery than in those whom the MBP was maintained at 80 mmHg and 70 mmHg(temporary deterioration : 27.3% vs. 23.1% vs. 13.3%, delayed sequela : 4.5% vs. 0.0% vs. 0.0%, and death : 9.1% vs. 0.0% vs. 3.3%, respectively in non-temporary clipping group and temporary deterioration : 33.3% vs. 22.2% vs. 21.1%, and death : 22.2% vs. 0.0% vs. 10.5%, respectively in temporary clipping group). In the non-temporary clipping group, preoperative clinical grades 1,2 and 3 patients did not deteriorate until after 20 minutes of hypotension(MBP : < or = 60 mmHg). However, patients of preoperative clinical grade 4 and 5 showed temporary deterioration after 10 minutes of hypotension(MBP : < or = 60 mmHg). There was no deterioration in patients whom the duration of the temporary clipping was within 15 minutes at an intracranial internal carotid artery and a middle cerebral artery at various MBP's, but, in the cases who had a temporary clipping at the anterior cerebral artery, the safety duration of the temporary clipping was 15 minutes at 80 mmHg, 7 minutes at 70 mmHg and 3 minutes at 60 mmHg of the MBP. Induced hypotension during aneurysmal surgery had some risk and it increased in hypertensive, poor clinical grade patients, and when the MBP was lowered to 60 mmHg. The safety duration of a temporary clipping might be increased with the raising of the MBP or administration of a brain protective agent at the time of the temporary clipping during surgery.
Aneurysm ; Anterior Cerebral Artery ; Brain ; Carotid Artery, Internal ; Humans ; Hypotension* ; Intracranial Aneurysm* ; Middle Cerebral Artery

Careful evaluation of vertebral artery injuries is important after cervical translation injuries or transverse foramen fractures. Treatment of trauma can be complicated in cases of concomitant vertebral artery injuries. A 76-year-old woman was admitted to our hospital with left hemiparesis (Motor grade 3) after a motorcycle accident. Cervical spine magnetic resonance imaging (MRI) and computed tomography (CT) revealed a C3 burst fracture and a left C3 lateral mass and lamina fracture. CT angiography revealed fracture fragments that predisposed the vertebral artery to injury throughout its course in the area. CT angiography confirmed that both vertebral arteries were occluded at the C3 fracture site. Subsequent brain MRI revealed acute infarction in the right occipital area. Although both vertebral arteries were occluded, the infarction site did not correspond to the territory supplied by these vessels; therefore, we performed transfemoral cerebral angiography, which revealed collateralization of the bilateral vertebral arteries by the deep cervical artery.. The deep cervical arteries are located between the posterior muscles; therefore, a fixation operation performed using the posterior approach may have affected the collateral circulation and led to exacerbation of the infarction site. Therefore, surgery was performed using an anterior approach and it was possible to minimize the risk of cerebral infarction through preservation of collateral circulation.

Background and Objectives: For T1–T2 early glottic cancer, single modality treatment with radiation therapy (RT) or transoral laser microsurgery is the standard therapeutic option. However, the choice between surgery and RT has been debated for decades. Even though patient selection bias for each modality inherently exists in the retrospective study, this study aimed to compare the oncologic outcomes of the actual treatment of these patients between surgery-based treatment and RT.Materials and Method The medical records of 417 patients with T1–T2N0 glottic squamous cell carcinoma were reviewed who were treated at our institution between 1995 and 2014. The patients were divided into two groups; primarily surgery-based treatment (OP, n=209) or RT (n=208). Results: In the T1 stage, local failure, overall survival (OS), and disease-free survival (DFS) rates were not different between the OP and RT groups. However, in the T2 stage, the local failure rate was higher in the RT group (p<0.01). OS and DFS were higher in the OP group (p=0.019 and p=0.004, respectively). Larynx-preservation rate was similar in both groups (97.1% and 96.2%, p=0.576). Multivariate analysis showed that age (>65), presence of multiple primary cancer, and treatment modality were significant variables influencing OS and DFS. Conclusion Surgery-based treatment provided better local control rates, DFS, and OS in patients with T1–T2N0 glottic SCC. In the T1 stage, treatment outcomes were similar between OP and RT groups. In the T2 stage, OP showed better results than RT, suggesting that refined strategies are required to improve the oncologic outcomes of RT for T2 glottic cancer.