Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.

Application of a Scoring System to the Diagnosis of Acute Appendicitis

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.

Comparative Study of the Clinical Features and Treatment for Right and Left Colonic Diverticulitis

PURPOSE: Colonic diverticulitis is an uncommon disease in Korea, but the incidence of the disease is increasing. The right colon is the more preferred site for diverticulitis in Korea, but the incidence of left diverticulitis is increasing. Therefore, comparing the clinical features and treatments for right diverticulitis with those for left diverticulitis may help us to treat the disease more properly. METHODS: This study was performed retrospectively by reviewing the medical records of 96 patients with colonic diverticulitis, in whom either conservative or operative treatments were performed. RESULTS: Eighty-six patients had right diverticulitis (RD), and 10 patients had left diverticulitis (LD). The mean age of the patients was older for LD. Sixteen patients (18.6%) with RD had complications, and 7 patients (8.1%) underwent operations. On the other hand, 4 patients (40%) with LD had complications, and 3 patients (30%) underwent operations. The rates of complications and operations among old-aged patients were higher. The operations for 7 patients with RD who underwent surgery were 6 ileocecectomies and 1 diverticulectomy. On the other hand, the operations for the 3 patients with LD who underwent surgery were 2 resections and anastomoses and 1 diverticulectomy. The reasons for the operations were abscess formation, recurrence, perforation, and development of generalized peritonitis without response to conservative treatment. CONCLUSION: The incidence of LD is lower than that of RD in Korea, but the rate of complications and operations seems higher in LD. Therefore, patients who complain of left lower abdominal pain need to be thoroughly examined for LD.

High Ligation for Indirect Inguinal Hernia in Young Adults

PURPOSE: The aim of this study was to compare three methods of hernioplasty: high ligation (HL), tissue repair (TR), and tension free (TF) and to determine the usefulness of high ligation for repair of indirect inguinal hernia in young adults. METHODS: One hundred thirty two patients who were under the age of 25 and who underwent repair of their inguinal hernia between January 2001 and December 2005 were reviewed retrospectively by using their inpatient and outpatient records and phone calls. Sixty seven, 23 and 42 patients underwent HL, TR and TF, respectively. The clinical features that were analyzed included location, type, signs and symptoms, operation method, complications and recurrence. RESULTS: The operation times were (mean+/-SD) 46.2+/-19.1, 56.0+/-11.5, and 61.8+/-14.9 minutes for HL, TR and TF, respectively. For the post-operative complications, there was 1 case of wound infection (1.5%) and 1 case of scrotal hematoma (1.5%) for HL; 1 case of wound infection (4.4%) and 1 case of scrotal swelling (4.4%) for TR; 3 cases of wound infection (7.0%), 2 cases of scrotal swelling (4.7%), 1 cases of intermittent pain (2.3%) and 1 case of scrotal hematoma (2.3%) for TF. Two patients in the HL group had recurrences, but there was no recurrence in the TR and TF groups. CONCLUSION: High ligation hernioplasty in young adults showed a shorter operation time, but there were no differences in the rate of complications between the methods. In the case of recurrence, it can be corrected by performing tissue repair or tension free hernioplasty because the normal anatomy may be preserved even after operation. Therefore, high ligation hernioplasty proved to be a useful method for repair of indirect inguinal hernia in young adults. In contrast, for the recurred or older age patients, tissue repair or tension free hernioplasty may be a more useful method.