Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma

OBJECTIVES: The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question. METHODS: A retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes. RESULTS: On pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence. CONCLUSION: ECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.

Clinical Characteristics and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss in Old Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In aging society, interest in idiopathic sudden sensorineural hearing loss (ISSNHL) in elderly have been increased. However, as there has been little discussion about prognostic factors of ISSNHL in old age, this study aims to investigate clinical factors related with prognosis of ISSNHL in elderly and compare with that in adults. SUBJECTS AND METHOD: A retrospective medical chart review was performed in patients over 19 years old who diagnosed with ISSNHL from Jan. 2010 to Dec. 2012. Patients were categorized into the old age group (over 65 years old, n=62) and the control group (aged 19 to 64 years old, n=218). Clinical findings, audiological result and treatment outcomes were compared between two groups. And possible prognostic factors of SSNHL in elderly were also investigated. RESULTS: Significant difference of hearing recovery was identified between the old age group (33.9%, 21/62) and control group (50.9%, 111/218) according to Siegel's criteria (p=0.021). Multivariate analysis concluded that delayed treatment and low speech discrimination score (SDS) might lead to poor prognosis in elderly. The presence of tinnitus or dizziness, audiometric configurations, hypertension and diabetes mellitus did not affect the treatment results of ISSNHL in the old age group. CONCLUSION: Onset of treatment and initial SDS could be possible prognostic factors of ISSNHL in elderly. Early diagnosis and urgent treatment are more important in old age.

Efficacy of Subtotal Parathyroidectomy in Secondary Renal Hyperparathyroidism: Long-Term Follow-Up Result / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Most secondary hyperparathyroidism is caused by chronic kidney disease. The purpose of this study is to evaluate the effectiveness of subtotal parathyroidectomy in the surgical treatment of renal hyperparathyroidism. SUBJECTS AND METHOD: We studied twelve patients with renal hyperparathyroidism who underwent parathyroidectomy from Dec. 2002 to Mar. 2007. We measured the amount of serum, intact parathyroid hormone, calcium, ionized calcium, inorganic phosphorus, and alkaline phosphatase preoperatively and postoperatively. RESULTS: Subtotal parathyroidectomy was performed in nine patients, and three enlarged parathyroid glands were removed from three patients. Hyperparathyroidism was observed in four patients (33.3%), normal parathyroid function in six patients (50.0%) and hypoparathyroidism in two patients (16.7%) at 5 years after surgery. All of three patients who had removed three enlarged parathyroid glands showed persistent hyperparathyroidism. Serum ionized calcium was normal in 10 patients and two patients showed hypocalcemia after operation. CONCLUSION: Based on the results of this study, we conclude that subtotal parathyroidectomy may be effective in the surgical treatment of renal hyperparathyroidism. However, further studies are necessary to determine the optimal amount of remnant parathyroid tissue in subtotal parathyroidectomy to maintain normal parathyroid function postoperatively.

Binocular Fixation Patterns in Children with Horizontal Strabismus

In children with horizontal strabismus, we observed and analysed binocular fixation pattern (BFP) pf each eye and the results of BFP were compared with visual acuity of each eye to evaluate the effect of BFP examination for diagnosis of the preferred eye. In BFP of the esotropes and intermittent exotropes with or without amblyopa, most of patients showed grade I of BFP in the preferred eyes and grade IV of BFP in the non-preferred eyes. The exotropes showed no significant amblyopia, and BFP of the preferred eyes were variable from grade I to IV while most of the non-preferred eyes showed grade IV of BFP. In the patients with visual improvement after occlusion therapy, about half of them showed an improvement in BFP. Therefore, the preferred and non-preferred eyes may be distinctive according to BFP in strabismic patients with amblyopia or not. The measurement of BFP may be an eefective method for diagnosis of the preferred eye in children with horizontal strabismus if it is combinded with the examination for visual acuity.

Binocular Fixation Patterns in Children with Horizontal Strabismus

In children with horizontal strabismus, we observed and analysed binocular fixation pattern (BFP) pf each eye and the results of BFP were compared with visual acuity of each eye to evaluate the effect of BFP examination for diagnosis of the preferred eye. In BFP of the esotropes and intermittent exotropes with or without amblyopa, most of patients showed grade I of BFP in the preferred eyes and grade IV of BFP in the non-preferred eyes. The exotropes showed no significant amblyopia, and BFP of the preferred eyes were variable from grade I to IV while most of the non-preferred eyes showed grade IV of BFP. In the patients with visual improvement after occlusion therapy, about half of them showed an improvement in BFP. Therefore, the preferred and non-preferred eyes may be distinctive according to BFP in strabismic patients with amblyopia or not. The measurement of BFP may be an eefective method for diagnosis of the preferred eye in children with horizontal strabismus if it is combinded with the examination for visual acuity.

A Case of New Vessels on the Optic Disc(NVD) Associated with Idiopathic Thrombocytopenic Purpura(ITP)

The most common ocular finding of the idiopathic thrombocytopenic purpura(ITP) is superficial retinal hemorrhages in both eyes. But the descriptions of new vessel on the optic disc(NVD) associated with ITP are scarcely found in literatures. A 17-year-old girl who managed for ITP complained of visual distrubance of the right eye and floaters of the left eye. On fundoscopy the right eye was failed to examine due to thick vitreous hemorrhage and the left eye showed NVD and preretinal hemorrhage. After panretinal photocoagulation of the left eye, NVD was regressed.

A Clinical Evaluation of Intraocular Foreign Bodies

Penetrating ocular injuries with retined intraocular foreign bodies(IOFB) may result in significant visual morbidity. Although appropriate use of microsurgical and vitreoretinal surgical techniques can salvage a high percentage of even the most severely traumatized globes with retained IOFB, questions remain about optimal care for these eyes. The authors analysed the results and prognostic factors in 78 cases of penetrating oculr injuries with retained IOFB who were managed at the Pusan National University Hospital from Jan. 1985 to Dec. 1989. The majority of patients were young adult males in their twenties and thirties. The nature of the IOFB was mostly a magnetic property(88.5%), and the causes of injury were hammering in 67.9% of all cases. The majority of the size of IOFB(maximal length) was over 2mm, and most of the IOFB(75.6%) was located at the posterior segment of the eyeball; and the larger the object, the more it was posteriorly located. Success rate of IOFB removal was 91.0%, and 59.0% of all cases were removed through pars plana. Preoperative complications included cataract(48.7%), vitreous hemorrhage(38.5%), and the most common postoperative complication was retinal detachment(10.3%). In our study, better visual result was obtained in cases of better initial visual acuity, smaller size of IOFB, shorter retention time of IOFB in eyeball, and anterior rather than posterior location of the IOFB in the eyeball.

Surgical Attempt for Elimination of Transphyseal Closure after Physeal Damage (II) / 대한정형외과학회잡지

Partial closure of an epiphyseal plate can reduce growth in length and cause angular deformationof the bone. The bone bridge between the epiphysis and the metaphysis, which inhibits growth, can be removed operatively, leaving a cavity, and improvement of the deformity by normal growth is then possible. Previous study have shown that silastic or bone cement diminished both the angular deformity and growth retardation to a highly significant degree. In the present study we wanted to test whether indomethacin and iliac apophysis as an interposition material could prevent bone bridge recurrence following operative removal in adolescent rabbits. It was designed by the concept that cartilage(iliac apophysis) has a specific inhibitory effect on bone formation and indomethacin inhibits bone resorption and bone formation in both heterotopic and orthotopic bone in rabbits. The following experimental groups were designed. Group 1 (N = 7) control group; no interposition material Group 2 (N = 7) iliac apophysis as an interposition material Group 3 (N = 7) only bone wax as an interposition material Group 4 (N = 7) bone wax with administration of indomethacin 10mg/kg/day The results of the study are as follows: 1. In control group, an osseous bridge were revealed as early as 2 to 3 weeks, and this bridging was found consistently in all control groups for the duration of the study. 2. The gmup using iliac apophysis as interposition material was found ineffective for prevention of the formation of epiphyseometaphyseal bone bridge. It was probably resulted from difficulty of its taking from iliac bone. 3. The group using administration of indomethacin after application of bone wax reduced both the angular deformity and growth retardation to a highly significant degree. From the results, it is recommended administration of indomethacin after insertion of silastic or bone cement as an interposition meterial in the elimination of transphyseal closure after physeal damage.