The elucidation of the signal-transduction pathways that drive neoplastic transformation has led to novel rationally designed cancer therapeutics (targeted therapy). Several compounds directed against different molecular pathways are being tested in patients with advanced thyroid carcinoma. Anticancer drugs that target protein kinases include small molecule inhibitors and monoclonal antibodies. Feedback loops and cross talk between signaling pathways impact significantly on the efficacy of cancer therapeutics, and resistance to targeted agents is a major barrier to effective treatments. Increasingly, therapies are being designed to target multiple kinase pathways. This can be achieved using a single agent that inhibits multiple signaling pathways or a combination of highly selective agents. In this review we discuss the principles of specifically targeting multiple kinase pathways with particular reference to targeted therapy for thyroid cancer.
Antibodies, Monoclonal ; Humans ; Phosphotransferases ; Protein Kinases ; Thyroid Gland ; Thyroid Neoplasms

No abstract available.
Hyperparathyroidism*

Pulmonary edema is a rare adverse reaction to the iodinated contrast medium. Complaining of huge abdominal mass, a 52 years-old female was admitted to the Hangang Sungsim Hospital. On physical examination, the patient appeared to be healthy. She had stable vital Signs, i.e. BP: 120/80 mmHg, pulse rate: 80/min. etc. An adult head sized mass was palpated in the left mid and lower abdomen. Otherwise nonspecific. On laboratory studies, the positive findings were 8-10 WBC/HPF in urine, 25.6 mg/dl for BUN and PVC in EKG. It was negative for urine protein, serum creatinine and liver function test. We injected 100ml and 30 ml for Urografin 60 through the abdominal aortadividing 3 times and major branches of the abdominal aorta, respectively. Immediately after completing angiography, interstitial pulmonary edema was found, showing blurring of the vascular margins, perivascular haziness and thickening of the interiobular septal lines in the both lower lung fields. The blood pressure was dropped to 80/60 mmHg, but pulse rate was normal. She did not complian of dyspnea, and cyanosis was not developed. The urine volume was normally maintained. She was treated for pulmonary edema, which was completely absorbed after 20 hours. And the blood pressure was also normalized. We has experienced a case of pulmonary edema developed after intraarterial injection of the iodinated contrast medium without underlying cardiac, renal and hepatic problems, and reviewed the literatures on mechanisms of pulmonary edema caused by intravascular injection of the iodinated contrast materials.
Abdomen ; Adult ; Angiography ; Aorta, Abdominal ; Blood Pressure ; Contrast Media ; Creatinine ; Cyanosis ; Diatrizoate Meglumine ; Dyspnea ; Electrocardiography ; Female ; Head ; Heart Rate ; Humans ; Injections, Intra-Arterial ; Liver Function Tests ; Lung ; Physical Examination ; Pulmonary Edema ; Vital Signs

BACKGROUND AND OBJECTIVES: Supraglottic partial laryngectomy (SPL) is contraindicated when lower margin of the tumor invades the anterior commissure or encroaches on it. Those cases are usually treated with supracricoid laryngectomy or near- total or total laryngectomy. But all these procedures have to sacrifice innocent true vocal cords, not because of oncological concerns but because of reconstruction concerns. We designed a new Y-shape partial laryngectomy with preserving vocal cords for this particular situation. PATIENTS AND METHODS: Thyrotomy consists of two incisions, upper and lower. The upper incision was made oblique from superior cornu down to the anterior commissure. When this incision was made 5 mm lateral to the midline, it went down to the inferior border of thyroid cartilage. This modification enables resection enbloc anterior commissure region with SPI. specimen. At closure, both ends of the true cord is anchored to the thyrotomy margin. Each lamina is connected with one miniplate with 6 holes. Then the closure is reinforced with elevated thyroid perichondrium and strap muscles. RESULTS: Two patients were treated with this type of surgery. Both had negative surgical margins. In the postoperative period, no specific complications were noted. Roth of them could decannulate and swallow without aspiration on the 20th day following the surgery. They retained their voices from the true vocal cords. CONCLUSION: This new partial laryngectomy technique could apply to supraglottic carcinoma cases with anterior commissure invasion or encroachment without sacrificing true cords. This procedure provides satisfactory swallowing and postoperative phonatoty function even with resection of the supraglottic structure.
Deglutition ; Humans ; Laryngectomy* ; Muscles ; Postoperative Period ; Thyroid Cartilage ; Thyroid Gland ; Vocal Cords ; Voice

Background: This study described the surgical technique of a robot-assisted retroauricular anterior scalenectomy and assessed clinical outcomes and complications for patients with neurogenic thoracic outlet syndrome (nTOS). Methods: Between February 2014 and August 2016, 5 patients underwent robot-assisted retroauricular anterior scalenectomy using the da Vinci Xi system for nTOS. For clinical assessment, visual analog scale (VAS) symptom score, pinch and grip strength, and disabilities of arm, shoulder and hand (DASH) score were assessed to compare preoperative and postoperative outcomes. Postoperative complications were also reviewed. Results: The VAS symptom, pinch and grip strength, and DASH scores improved 1 year after the operation. All patients were satisfied with the surgical scars. Temporary postoperative complications, which spontaneously resolved within 3 months, were noticed in 2 patients: one with vocal cord palsy and the other with upper brachial plexus palsy. Conclusions The robot-assisted retroauricular anterior scalenectomy for patients with nTOS seems feasible and safe, providing satisfactory cosmetic results.

No abstract available.
Thyroid Diseases* ; Thyroid Gland*

No abstract available.
Thyroid Diseases* ; Thyroid Gland*

No abstract available.
Perfusion* ; Peripheral Arterial Disease*

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/*pathology/*surgery ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms/mortality/*pathology/*surgery ; Neck/surgery ; *Neck Dissection ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Little information about the surgical anatomy and technique for retropharyngeal node dissection has been published. The purpose of this study was to review our surgical technique and results of retropharyngeal lymph node dissection. MATERIALS AND METHODS: Eleven advanced oropharyngeal and hypopharyngeal squamous cell carcinoma patients who had been treated with resection of primary tumor and standard neck dissection including retropharyngeal lymph node dissection from 1994 to 1999 were evaluated retrospectively. RESULTS: One of 11 patients had positive retropharyngeal lymph node. The surgical technique used for retropharyngeal lymph node dissection were total laryngopharyngectomy, mandibular splitting or mandibulectomy approach. There was no specific complication of retropharyngeal lymph node dissection except one case of Horner's syndrome. CONCLUSION: Retropharyngeal lymph node dissection was a safe procedure, bet it required total laryngopharyngectomy, madibular splitting or mandibulectomy approach. It was possible to remove retropharyngeal lymph made en-bloc with primary tumor in most cases.
Carcinoma, Squamous Cell ; Horner Syndrome ; Humans ; Hypopharyngeal Neoplasms ; Lymph Node Excision* ; Lymph Nodes* ; Neck Dissection ; Oropharyngeal Neoplasms ; Retrospective Studies