25-hydroxyvitamin D Levels was not Associated with Blood Pressure and Arterial Stiffness in Patients with Chronic Kidney Disease

BACKGROUND: We investigated the effect of vitamin D deficiency on cardiovascular risk profiles in an Asian population with chronic kidney disease (CKD). METHODS: A total of 210 participants (62 non-dialysis CKD patients and 148 hemodialysis [HD] patients) were enrolled between December 2009 and February 2010. Vitamin D deficiency was determined using the serum 25-hydroxyvitamin D [25(OH)D] concentration. Blood pressure and arterial stiffness were measured. Subjects were divided into groups according to 25(OH)D concentration based on a cut-off of 13.5 ng/mL in non-dialysis CKD patients and 11.3 ng/mL in HD patients. RESULTS: The mean age was 61.7±12.3 years in non-dialysis CKD patients and 57.0±12.7 years in HD patients. In the non-dialysis CKD group, mean estimated glomerular filtration rate (eGFR) was 29.7±15.4 mL/min/1.73 m2. Mean 25(OH)D concentration was 13.6±7.8 ng/mL in non-dialysis CKD patients and 11.3±6.7 ng/mL in HD patients. More than half of the subjects had vitamin D deficiency (67.6% in non-dialysis CKD patients and 80.4% in HD patients). There were no significant differences in systolic blood pressure, pulse pressure, and arterial stiffness between higher and lower 25(OH)D groups among non-dialysis CKD and HD patients. Multivariate analysis revealed that female sex (odds ratio [OR]: 5.890; 95% confidence interval [CI]: 2.597–13.387; p<0.001) and presence of diabetes (OR: 2.434; 95% CI: 1.103–5.370; p=0.028) were significantly associated with lower serum 25(OH)D levels in HD patients. CONCLUSION: The prevalence of vitamin D deficiency was high in both nondialysis CKD patients and HD patients. Serum 25(OH)D concentration was not a significant factor associated with blood pressure and arterial stiffness among non-dialysis CKD and HD patients.

Clinical Analysis of Elderly Thyroid Cancer Patients Following Thyroidect / 대한내분비외과학회지

PURPOSE: This study analyzes the clinical characteristics of thyroid cancer patients over 70 years of age following thyroidectomy. We identified the differences among previous studies and investigated the significance of thyroidectomy for elderly thyroid cancer patients. METHODS: Information was abstracted from the charts of fifty-six patients treated during the period of Jan. 1995 to Dec. 2015. The abstraction included gender, age, surgical method, location with size of the main lesion, extent of lymph node metastasis, pathological features, gene mutation, complication, stage and most recent visit. RESULTS: Our study showed a frequent occurrence (96.4% of the study group) of papillary thyroid cancers in elderly patients. There were three cases of postoperative complications. None had recurrence, and there was only one death due to complications of pneumonia. There were 11 advanced cases of cancer stage IV. CONCLUSION: Previous studies show that postoperative prognosis of elderly thyroid cancer patients is favorable. Average life expectancy is rising in South Korea, and therefore, the number of elderly thyroid cancer patients is increasing. Our study is meaningful in that it confirms the results of previous studies by surveying elderly patients over a 20 year period. It is deemed necessary that thyroidectomy be performed on elderly patients.

Overcoming the Limitations of Fine Needle Aspiration Biopsy: Detection of Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma

PURPOSE: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age 1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION: To reduce the false negative rate of FNAB, patient age (1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.

Cervical bronchogenic cysts mimic metastatic lymph nodes during thyroid cancer surgery

PURPOSE: Although congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are rare, distinguishing them from other cervical cystic lesions (e.g., thyroglossal duct and branchial cleft cysts) and metastatic cervical lymph nodes is difficult preoperatively. Additionally, cystic degeneration of metastatic lymph nodes is common in patients with thyroid cancer. We investigated the clinical characteristics and proper treatment for individuals with cervical bronchogenic cysts. METHODS: Of the 18,900 patients treated for thyroid cancer, 18 patients with pathologically confirmed bronchogenic cysts were retrospectively reviewed. Bilateral total thyroidectomy or less than total thyroidectomy with central compartment node dissection, including cystic mass excision was done and cystic mass was confirmed by postoperative pathologic examination. RESULTS: All cervical bronchogenic cysts were asymptomatic. Their mean size was 1.2 cm (range, 0.3 to 3 cm). Of these 18 patients, 15 did not have any abnormal radiological findings, except for lymphadenopathy during preoperative evaluations. Most bronchogenic cysts were detected around the thyroid and paratracheal areas. On preoperative imaging and intraoperatively, most were indistinguishable from metastatic cervical lymph nodes or other cystic lesions. CONCLUSION: Although cervical bronchogenic cysts are rare and benign, they should be distinguished from other cystic cervical masses, especially metastatic cervical lymph nodes associated with thyroid cancer. Possible cervical bronchogenic cysts found during thyroid cancer evaluation or surgery should be surgically excised.

Single Institutional Experience of Thyroglossal Duct Cyst; A Comparison between Children and Adults / 대한내분비외과학회지

PURPOSE: Thyroglossal duct cyst (TGDC) is known to be the most common midline neck mass in children, but the adult population still has this abnormality. The most common symptom of TGDC is a simple neck mass, and differential diagnosis among other abnormalities is important. The aim of this study is to perform a retrospective view of TGDC in order to describe any differences in clinical features, diagnostic tools, treatment, and outcomes in children and adults who underwent surgery in a single institution, and to determine its clinical implications. METHODS: We performed a retrospective chart review on 75 pathologically diagnosed TGDC patients from 1995 to 2013 who were divided into two groups: children (< or =18 years) and adults. Comparison analysis was performed for age, sex, site and location of cyst, size, diagnostic tool, surgical method, and postoperative outcome. RESULTS: Our study showed frequent occurrence of TGDC in adults. There was no significant sex, site, or location difference in the occurrence of TGDC in children and adults, however, the size of cyst in adults was larger than that in children (mean, 2.80 cm vs 2.15 cm) (P<0.001). Four patients (5.3%) had postoperative recurrence of TGDC, and Sistrunk operation showed lower recurrence rate than excision (3.1% vs 18.2%) (P<0.040). Two malignancy cases were identified postoperatively in adults. CONCLUSION: Particularly in adults, the possibility of carcinoma would make it important to perform fine-needle aspiration for differential diagnosis. Sistrunk procedure will remain the treatment of choice for most TGDC patients considering recurrence risk.

Acute Left-sided Appendicitis with Intestinal Malrotation in a Child

Appendicitis is a common disease in children. But left lower abdominal pain in acute appendicitis is a rare clinical feature. A 6 year-old-girl complained of left sided abdominal pain for 2 days. Past medical history was not contributory. Abdominal tenderness and guarding in left lower quadrant were noticed. Abdominal sonography and abdominal computed tomography scan demonstrated reversed position between superior mesenteric artery and vein, and a mass in the left lower quadrant abdomen suggesting appendicitis. Acute appendicitis in left lower quadrant, associated with intestinal malrotation, was found at laparatomy.

Usefulness of Ad Lib Feeding for Hypertrophic Pyloric Stenosis

Infantile hypertrophic pyloric stenosis (HPS) is a relatively common entity. A number of studies for the postoperative feeding schedule has been studied to allow for earlier hospital discharge and improve cost-effectiveness in the treatment of HPS. The purpose of this study was to compare 3 feeding-methods and to evaluate the usefulness of ad lib feeding for HPS. The authors retrospectively reviewed the records of 116 patients who underwent pyloromyotomy for HPS from 1995 to 2004. Three cases were excluded because of the duodenal perforation during pyloromyotomy. Three feeding-methods were defined as: Conventional feeding (>10 hours nothing by mouth and incremental feeding every 2 hours, C), Early feeding(for 4 to 8 hours nothing by mouth and incremental feeding every 2 hours, E), and Ad lib feeding (for 4 hours nothing by mouth and ad lib feeding, A). Time to normal feeing in C, E and A were 51+/-24, 34+/-12 and 24+/-6 hours, respectively. Hospital-stay in C, E and A were 72+/-17, 55+/-13 and 43+/-12 hours, respectively. There were statistically significant differences according to the method of feeding. Frequency of postoperative emesis in C, E and A were 38%, 47% and 53%, but was not significant statistically. Ad lib feeding decreased time to normal feeding and hospital stay, and did not increase postoperative emesis. We conclude that ad lib feeding is recommended for patient with pyloromyotomy in HPS.