Appendiceal Mucocele

Appendiceal mucocele is a cystic dilatation of the appendiceal lumen with mucus, which may be caused by either benign or malignant diseases. In this report, five cases of appendiceal mucocele are reported, three of which had a preoperative diagnosis of mucocele, whereas the others were found incidentally during the operation under the diagnosis of intussusception and periappendiceal abscess. All five patients underwent surgical resections, including one ileocecal resection and four right hemicolectomies. Histopathology revealed a mucinous cystadenoma in four cases, and a mucinous cystadenocarcinoma in one. There was no disease-related death during 18 months of follow-up.

Pattern of Lymph Node Metastasis on the Prophylactic Central Neck Node Dissection in Management of Papillary Carcinoma of Thyroid / 대한내분비외과학회지

PURPOSE: In papillary thyroid carcinoma, lymph node metastasis at presentation does not seem to affect survival adversely, but does increase the risk of loco-regional tumor recurrence. The benefits of prophylactic central neck node dissection (PCND) have not been clearly demonstrated so far and should be weighed against the potential risks of the procedure. The aims of this study are as follows; to determine the frequency and the pattern of the lymph node metastasis and the risk factors influencing the metastasis to level VI lymph nodes, and to determine the necessity of the contralateral central lymph node dissection. METHODS: A retrospective analysis had been carefully performed over 68 patients with papillary carcinomas undergoing total thyroidectomy with PCND during the period from July 1, 2000 to August 31, 2002. In addition to the analyses of the incidence and the pattern of central lymph node metastasis, we statistically analyzed the correlation between lymph node metastases and the risk factors such as tumor size, age, lymphatic tumor emboli, vascular tumor emboli, perithyroidal soft tissue invasion, and multifocality, etc. RESULTS: The mean age was 46 years (22~76) and the tumor size ranged from 0.2 to 9 cm (mean 2.2 cm). The micropapillary carcinoma was detected by pathological findings in 10 patients (14.7%). The lymphatic tumor emboli and vascular tumor emboli occurred in 8 patients (11.8%) and 2 patients (2.9%) respectively. Thirty eight patients (55.9%) showed perithyroidal tissue invasion. The mean number of harvested lymph nodes in level VI was 13.7 (6~32). Among 68 patients, lymph node metastasis occurred in 49 patients (72.1%) and the mean number of metastatic lymph node was 5.4. Among the patients with metastasis, the rate of metastasis among the harvest nodes amounted to 39.0%. Metastasis to Delphian nodes was detected in 2 patients (2.9%). In addition, 15 patients (22.1%) showed metastatic contralateral central nodes. Patients less than 40 years old tend to have more metastatic lymph nodes (P=0.012). Futhermore, the patients with tumor larger than 2 cm increased incidence of lymph node metastasis (P=0.036). CONCLUSION: After the prophylactic central neck nodes dissection in case of papillary carcinoma patients, metastatic lymph nodes were found in 72.1%. In conclusion, we would like to recommend prophylactic central neck node dissection to papillary carcinoma patients in order not only to prevent local recurrence but to avoid the difficulties of reoperation, especially for those with high risk for nodal involvement (less than 40 years old or more than 2 cm of tumor size). Because of the relatively high incidence of contralateral central lymph nodes metastasis, we suggest the importance of dissection of contralateral central lymph nodes along with unilateral central.

Morbidity of Lymph Node Dissection in Central Neck Area for Operations of Differentiated Thyroid Carcinoma

PURPOSE: To date, the benefits of central neck node dissection (CND) in patients with differentiated thyroid carcinoma (DTC) have not been clearly demonstrated and must be considered against the potential risks of the procedure. However, recent papers suggest that lymph node metastasis exerts a significant influence on survival and is associated with a higher risk of recurrence. The purpose of our study was to assess the recurrent laryngeal nerve and parathyroid risks of CND following total thyroidectomy in patients with DTC and to compare the results with those obtained in patients who underwent total thyroidectomy only. METHODS: We retrospectively analysed 143 consecutive patients with DTC (116 with papillary, 24 with follicular, and 3 with Hurthle cell carcinoma) operated on by a single experienced endocrine surgeon from January 1989 to January 1999. There were 61 total thyroidectomies with CND (Group 1) and 82 total thyroidectomies only (Group 2). Group 1 patients displayed evidence of macroscopic lymph node invasion during surgery. The definitions of the two main complications in the thyroid surgery were as follows: transient and permanent recurrent laryngeal nerve palsy (persisting hoarseness over six months after thyroidecomy), transient and permanent hypoparathyroidism (non-recovery of normal parathyroid function and calcemia below 8.0 mg/dl over six momths after thyroidectomy). RESULTS: There was no difference observed in the demographic data between the two groups. Three cases (4.9%) of transient hypocalcemia were detected in Group 1 and two cases (2.4%) in Group 2. Five cases (8.2%) of transient nerve palsy were presented in Group 1 and one case (1.2%) in Group 2. However, there was no significant statistical difference between the two groups (p=0.051). None of the patients demonstrated permanent nerve palsy. CONCLUSION: Following total thyroidectomy for DTC, CND does not increase the morbidity of parathyroid gland and recurrent laryngeal nerve. Therefore, in order to decrease the incidence of regional recurrence and avoid the risk of reoperation in the central neck area, we recommend cervical neck node dissection from the central neck compartment concomitant with total thyroidectomy when overt lymph nodes are palpated.

Bilaterality and occurence of contralateral inguinal hernia following unilateral repair in pediatric patients

No abstract available.