Clinical Significances of the Unintentional Parathyroidectomy during Operation for Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Many surgeons intend to preserve all of the parathyroids during a thyroid operation; however, they have had the unpleasant experience of achieving unintentional parathyroidectomy. We studied the risk factors for unin-tentional parathyroidectomy and whether these unintentional parathyroidectomies caused symptomatic hypocalcemia. METHODS: We conducted a retrospective review of the medical records and pathologic reports of 95 papillary carcinoma patients who underwent operations between January 1994 and December 2003. We statistically analyzed the correlation between unintentional parathyroidectomy and the risk factors such as tumor size, capsular invasion, including extra-thyroidal extension, and the operation method. RESULTS: Of the total 95 procedures, 14 (14.7%) produced patho-logy reports stating that incidental parathyroid tissue was identified within the thyroidectomy specimen. The majority of the 14 reported cases contained only a single focus of inci-dental parathyroid tissue; however, one of these thyroidectomy specimens contained two foci of parathyroid tissue. The factors such as tumor size, capsular invasion and extensive surgery were not correlated with the prevalence of unintentional parathyroidectomy. There was no association of unintentional parathyroidectomy with postoperative hypocalcemia (P=.449). CONCLUSION: Unintentional parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. The factors such as tumor size, capsular invasion or extensive surgery are not risk factors for unintentional parathyroidectomy.

A Case Report and Systemic Analysis of Articles for Morgagni Diaphragmatic Hernia

It was difficult to determine the clinical situations of Morgagni diaphragmatic hernias of adults on account of its rarity. The aim of this study was to propose diagnostic and therapeutic guidelines for adult Morgagni diaphragmatic hernias. A computerized `Korean study information co.' and `medical research information center' literature search of domestic articles published since 1950 was carried out. These 10 cases in addition to ours were analyzed. The average age at treatment was 68.7 years of age ranging from 51 to 83 years with 90.9% of patients being female. 18.2% of patients had symptoms immediately after trauma. 27.3% of patients were incorrectly diagnosed preoperatively. 90.9% of all treated Morgagni hernias were located on the right side just behind the sternum with hernia sacs. The most common contents of the hernias were the greater omentum and transverse colon. The preferred method of surgery was the trans-abdominal approach. The mortality rate of the hernias was 9.1%. Morgagni diaphragmatic hernias once diagnosed should be referred for surgical repair due to the risk of bowel perforation. The transabdominal approach or laparoscopic surgery is preferred in accurately diagnosed Morgagni diaphragmatic hernias prior to surgery.

A Case of a Tailgut Cyst

The tailgut is a blind extension of the hindgut into the tail fold just distal to the cloacal membrane. Remnants of this structure may form a tailgut cyst. This is prone to infection and chronic fistula formation and has a long-term risk of malignancy. Non-recognition and incomplete treatment leads to morbidity. A twenty one year-old female patient visited our hospital with repeated perianal pain and discharge. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal cyst suggestive of a tailgut cyst. She underwent a complete excision of the retrorectal mass through a presacral approach. She recovered uneventfully. This report includes the case and a brief review of tailgut cysts.