The Effect of Tumor Characteristics on the Repeated Nondiagnostic Fine-needle Aspiration Biopsy Results in Thyroid Nodules / 대한내분비외과학회지

PURPOSE: The management of nondiagnostic fine-needle as-piration biopsy (FNAB) of thyroid nodules has not been determined because the significance of persistent nondiagnostic FNAB has been underestimated. The purposes of the present study were to estimate the likelihood of malignancy in patients with nondiagnostic FNAB results and to evaluate whether tumor factors could affect the nondiagnostic FNAB results. METHODS: 2,400 FNABs were performed for thyroid nodules at our institution from 2001 to 2005. A total 294 patients who had initial nondiagnostic results were the subjects of this study. We retrospectively reviewed the age, gender, tumor size, the sonographic findings, the FNAB results and the pathologic reports. RESULTS: The initial nondiagnostic rate was 12.3% (294/2,400). Among the 294 initial nondiagnosted patients, FNAB was secondarily performed in only 99 patients. Seventy patients (70.7%) were diagnostic and 29 (29.3%) remained nondiagnosed. Twenty of seventy diagnosed patients had malignant FNAB results, including atypical cells, and the other 50 patients were benign. The causes of nondiagnostic FNAB results by pathologic descriptions were 43.1%: scanty cellularity, 29.2%: blood, 13.2%: fluid or colloid, 11.1%: inconclusive, and 3.5%: dry artifact. There are no differences in the nondiagnostic rate according to tumor size (P=0.2) and calcification (P=0.7). When the sonographic results could predict the pathologic results, no difference was noted according to the sonographic findings that determined malignancy (P=0.4). Ten percent of the initial nondiagnostic FNAB results were finally reported as malignancy. CONCLUSION: Scanty cellularity and blood aspiration were the major causes of nondiagnostic FNAB results (43.1% and 29.2%, respectively). Tumor characteristics such as tumor size, the presence of calcification and sonographic findings did not predict nondiagnostic FNAB results. Reaspiration biopsy for the initially nondiagnostic FNAB in the thyroid nodules had a high probability of achieving a nondiagnositc result. Because nondiagnostic FNAB of the thyroid nodules may be associated with a relatively high probability of thyroid malignancy, a nondiagnostic FNAB should not be considered as benign. So, if reaspiration biopsy is nondiagnostic, it should be the subject of concern or the patient might be considered for surgery with taking into account the other characteristics, in particularily malignant sonographic findings.

Intracranial Infection in Head Injury

We analyzed 12 cases of intracranial infection retrospectively among 951 patients admitted for head injury in Kyungpook University Hospital during the last 7 years. Overall infection rate was 1.3%. Among 259 patients who had basal skull fracture, 6 cases(2.3%) were infected. Craniotomies were performed on 488 patients for various reasons. Among them 2 patients(0.4%) were infected due to the craniotomy. Ninety one patients had compound comminuted depressed skull fracture(FCCD). No one was infected due to FCCD. Two patients were infected after ventriculoperitoneal shunt to treat the posttraumatic hydrocephalus, and one case after burr hole trephination and drainage of intracerebral hematoma. The intracranial infection were as follows:7 cases of meningitis, 3 subdural or epidural empyema, one ventriculitis, and one brain abscess. In conclusion, basal skull fracture was the main cause of intracranial infection. As for craniotomy and FCCD, intracranial infection could be effectively prevented with appropriate management. Intracranial infection was a serious complication of the head injury prolonging hospital days and leading to sequelae.

The Surgical Results of C-T Guided Stereotactic Early Aspiration with Urokinase Irrigation on Deep Seated Spontaneous Intracerebral Hemorrhage

C-T guided stereotactic early burr hole aspirations performed on 106 spontaneous deep intracerebral hematoma patients in the Department of Neurosurgery, Kyungpook University Hospital, between January 1992 and December 1993. For average five days following the operation, continual urokinase(UK) irrigation was done for complete removal of the remaining hematoma. Of the patients, 73 who were operated on within three days of bleeding ictus were chosen for analyses and evaluation by factors believed to affect the final results. Eighty six percent was found to have hypertension as it's cause. The hematoma was removed completely in 13.7% of all the patients on post operation 1st day and 45% within 7 days by urokinase irrigation. The site of hematoma in thalamocapsulo-lenticular area showed a rather poor remission rate compared with those in other locations along with a higher mortality rate. By comparison between the time of admission and discharge, the state of consciousness of patients showed much improvement with 440% of the number of alert patients on discharge:motor function also showed significant improvement with 450% good patients number. In case of poor state of consciousness or motor function on admission, the mortality rate was higher. Rebleeding after aspiration was found in 6.8% and in all the cases except one the operation was done within 24 hours of bleeding, which resulted in poor postoperative outcome without improvement. Pneumonia was most common complication during admission followed by hydrocephalus. Mortality rate was 8.2%, most of which resulted from direct brain damage through bleeding. This surgical method is simple, safe and efficient in treating spontaneous deep intracerebral hematoma with no significant outcome difference when compared with early craniotomy.

Posterior Fixation and Interbody for Lumbar Spondylolisthesis

Sixteen consecutive patients with lumbar spondylolisthesis were treated with pedicular fixation and posterior interbody fusion. There were 8 isthmic and 8 degenerative types ranging in age from 39 to 68 years with a mean age of 52 years. The percentage of slippage averaged 28.5% preoperatively and 5.8% postoperatively in the isthmic type, 12.6% preoperatively and 6.6% postoperatively in the degenerative type. At 6 to 13 months postoperatively, all exhibited radiographic fusion. Clinical results were good in 13/16, fair in 3/16.