Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

Purpose: Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT. Methods: In total, 587 patients with breast cancer who underwent a total mastectomy (TM) with IBR after NACT between 2008 and 2017 at a single institution were retrospectively reviewed. The reviewed patients with IBR following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) were matched 1:3 to patients who underwent TM alone after NACT. Matching variables included age, clinical T and N stages before NACT, response to NACT, pathologic T and N stages, and molecular subtypes. Results: After propensity score matching, 95 patients who underwent IBR following SSM/ NSM after NACT (IBR group) and 228 patients who underwent TM alone after NACT (TM group) were selected. The median follow-up period was 73 (range, 5–181) months after matching. After matching, there were no significant differences between the two groups in 5-year locoregional recurrence-free survival (88.8% vs. 91.2%, p = 0.516), disease-free survival (67.3% vs. 76.6%, p = 0.099), distant metastasis-free survival (71.9% vs. 81.9%, p = 0.057), or overall survival (84.1% vs. 91.5, p = 0.061) rates. In multivariate analyses, conducting IBR was not associated with increased risks for locoregional recurrence, any recurrence, distant metastasis, or overall death. Conclusion Our findings suggest that IBR following SSM/NSM elicits comparable long-term oncologic outcomes to those of TM alone in the setting of NACT.

Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion IBR rate in patients undergoing TM increased after NHI reimbursement.

Background: Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). Methods: We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into “uninsured” and “insured” groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. Results: Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38–48] vs. 45 [40–50] years; P < 0.001).Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. Conclusion IBR rate in patients undergoing TM increased after NHI reimbursement.

BACKGROUND/AIMS: Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease. Endoscopic assessment of LPR is needed for convenient diagnosis and documentation of treatment efficacy. The aim of this study was to investigate the interrater reliability of LPR among endoscopists based on endoscopic laryngeal images. MATERIALS AND METHODS: Nineteen endoscopists participated in this study. Before the test, they completed an intensive education program by an otorhinolaryngologist on the reflux finding score (RFS), which is a validated laryngoscopic assessment of LPR. A total of 100 endoscopic laryngeal images were used for 3 tests of RFS. Cohen's and Fleiss' kappa coefficients were used to determine the degree of interrater agreement in the diagnosis of LPR. RESULTS: In the first test, the mean of Cohen's kappa coefficients for LPR diagnosis between the otorhinolaryngologist and each of the 19 endoscopists was 0.3. In the second test, after additional education, the mean kappa value was 0.32. Fleiss' kappa coefficients for diagnosis of LPR among the 19 endoscopists in the first and second tests were 0.30 and 0.26, respectively. CONCLUSIONS: A short-term education program for endoscopists did not result in an improvement of accuracy in the diagnosis of LPR. Further studies using advanced educational programs for endoscopists are required.
Diagnosis* ; Education ; Endoscopy* ; Gastroesophageal Reflux ; Laryngopharyngeal Reflux* ; Treatment Outcome

PURPOSE: This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies. METHODS: The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed. RESULTS: A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases. CONCLUSION: Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.
Bacteria ; Bronchoalveolar Lavage ; Bronchoscopy* ; Child* ; Fungi ; Humans ; Immunocompromised Host ; Korea ; Male ; Medical Records ; Pediatrics ; Pneumonia ; Seoul ; Tracheomalacia

BACKGROUND: From May to July 2015, the Republic of Korea experienced the largest outbreak of Middle East respiratory syndrome (MERS) outside the Arabian Peninsula. A total of 186 patients, including 36 deaths, had been diagnosed with MERS-coronavirus (MERS-CoV) infection as of September 30th, 2015. MATERIALS AND METHODS: We obtained information of patients who were confirmed to have MERS-CoV infection. MERS-CoV infection was diagnosed using real-time reverse-transcriptase polymerase chain reaction assay. RESULTS: The median age of the patients was 55 years (range, 16 to 86). A total of 55.4% of the patients had one or more coexisting medical conditions. The most common symptom was fever (95.2%). At admission, leukopenia (42.6%), thrombocytopenia (46.6%), and elevation of aspartate aminotransferase (42.7%) were observed. Pneumonia was detected in 68.3% of patients at admission and developed in 80.8% during the disease course. Antiviral agents were used for 74.7% of patients. Mechanical ventilation, extracorporeal membrane oxygenation, and convalescent serum were employed for 24.5%, 7.1%, and 3.8% of patients, respectively. Older age, presence of coexisting medical conditions including diabetes or chronic lung disease, presence of dyspnea, hypotension, and leukocytosis at admission, and the use of mechanical ventilation were revealed to be independent predictors of death. CONCLUSION: The clinical features of MERS-CoV infection in the Republic of Korea were similar to those of previous outbreaks in the Middle East. However, the overall mortality rate (20.4%) was lower than that in previous reports. Enhanced surveillance and active management of patients during the outbreak may have resulted in improved outcomes.
Antiviral Agents ; Aspartate Aminotransferases ; Coronavirus Infections* ; Disease Outbreaks ; Dyspnea ; Extracorporeal Membrane Oxygenation ; Fever ; Humans ; Hypotension ; Leukocytosis ; Leukopenia ; Lung Diseases ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Republic of Korea* ; Respiration, Artificial ; Thrombocytopenia

PURPOSE: Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression. METHODS: Among 286 children admitted to Seoul St. Mary's Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review. RESULTS: Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO2)/fraction of inspiratory oxygen (FiO2), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence. CONCLUSION: For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO2/FiO2 can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor.
Child* ; Disease Progression ; Humans ; Incidence ; Intensive Care Units* ; Logistic Models ; Lung Diseases ; Mortality ; Oxygen ; Patient Readmission ; Respiratory Tract Diseases* ; Retrospective Studies ; Risk Factors* ; Seoul

In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice.
Age Factors ; Anticoagulants/adverse effects/*therapeutic use ; Asian Continental Ancestry Group ; Evidence-Based Medicine ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; *Mechanical Thrombolysis ; Neoplasms/complications/surgery ; Republic of Korea ; Risk Assessment ; Surgical Procedures, Operative/adverse effects ; Venous Thromboembolism/etiology/prevention & control/*therapy

PURPOSE: Human metapneumovirus (hMPV) is known to result in clinical manifestation similar to respiratory syncytial virus (RSV) in children. But some recent studies showed different features. This study compared the clinical manifestation of respiratory disease between hMPV and RSV. METHODS: A total of 801 children who admitted to Seoul St. Mary's Hospital for respiratory infection from January to June, 2012 were enrolled. Respiratory viral polymerase chain reaction (PCR) using nasopharyngeal swab was performed in all children. We grouped hMPV positive children and RSV positive children and compared clinical features between them by retrospective chart review. RESULTS: Among 801 children, 365 showed one virus PCR positive with 44 showing hMPV and 41 showing RSV. Respiratory diseases were upper respiratory infection, acute bronchitis, acute bronchiolitis and pneumonia. The peak season was March and April for hMPV and February and March for RSV. Fever incidence, fever duration and neutrophil percent of complete blood cell count were higher in hMPV group than RSV group (P<0.05). The mean age of hMPV group was higher than RSV group (P<0.05). But in acute bronchiolitis children, there was no mean age difference between two group. Acute bronchiolitis incidence declined with increased age for both group (P<0.05). The hMPV group showed relatively lower bronchiolitis and higher pneumonia incidence than RSV group, suggesting relation with age. CONCLUSION: Respiratory infection by hMPV developed at late winter and spring, slightly later than RSV and at older age. The lower incidence of acute bronchiolitis for hMPV infection than RSV is maybe due to older age than RSV.
Blood Cell Count ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Metapneumovirus ; Neutrophils ; Pneumonia ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Seasons ; Viruses