Comparative Study of Endoscopic Thyroidectomy: Total Thyroidectomy versus Near Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: The aim of this study was to evaluate and compare the surgical outcomes of endoscopic total and near-total thyroidectomies in patients with thyroid cancer. METHODS: Between February 2000 and January 2009, among 387 patients who underwent endoscopic thyroidectomy in our hospital, we evaluated 50 patients who underwent endoscopic total or near-total thyroidectomy. Thirtyfive and 15 patients underwent endoscopic total thyroidectomy and near-total thyroidectomy, respectively. We analyzed the patients' clinicopathologic characteristics and post-operative complications between the two groups. RESULTS: The mean size of tumors was 1.08 cm (range, 0.1 ~3.5 cm) and the mean operative time was 192 minutes. Forty-nine tumors were papillary cancers and 1 tumor was a follicular cancer. Two patients in the endoscopic total thyroidectomy group underwent re-operation because of bleeding. In the near-total thyroidectomy group, one patient had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. In the total thyroidectomy group, nine patients had transient hypocalcemia and one patient had temporary recurrent laryngeal nerve palsy. There was no statistical difference in the post-operative complicationrates between the two groups (P=0.254 for hypocalcemia and P=0.470 for injury to the recurrent laryngeal nerve). CONCLUSION: Based on our experience, endoscopic total thyroidectomy is a safe and feasible alternative to endoscopic near-total thyroidectomy.

Analysis of the Diagnostic Maneuver and Timing of Operation in Adult Intussusception

PURPOSE: Intestinal intussusception in adults is a rare entity and its clinical course and etiology differ from pediatric counterpart. About 90% have a primary pathologic lesion, especially malignancy consists of etiology as 30% in small bowel and 66% in large bowel. The purpose of this study is to investigate of accurate diagnosis, treatment, and timing of operation by review of clinical symptom, physical examination, laboratory finding, pathologic finding, and operation finding of adult intussusception patients. METHODS: We studied 20 adult patients who were diagnosed as intussusception between July 1993 and September 2005. Intussusception by operation and rectal prolapse were excluded. Clinicopatholgic findings were analyzed retrospectively through the medical record. RESULTS: There was 15 males and 5 females in all 20 patients, and mean age was 52.3 years with a range of 29 to 78 years. Preoperative diagnosis was suspected in 14 of 20 patients (70%). We performed emergency operation in 8 cases (40%) and elective operation in 12 cases (60%). Two cases of them which preoperative diagnosis were strangulation and peritonitis accompanied with small bowel necrosis and leukocytosis. There were 12 small bowel lesions (60%) and 6 colonic lesions (30%). In two cases, there were no primary lesions. Of the cases with a defined cause, 12 cases were malignant (60%) and 6 cases were benign (30%). CONCLUSION: The most useful diagnostic method is computed tomography to reveal adult intussusception. Two cases of all were strangulated and also had a leukocytosis. In adult intussusception, most common cause is malignancy. If there is no evidence of strangulation such as leukocytosis, we recommend that elective surgery is adequate.

An Outbreak of Glutaraldehyde Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Disinfecting solutions of endoscope, including glutaraldehyde cause colonic damage if allowed to contact mucosa. Glutaraldehyde colitis occurs due to inadvertent contact during colonoscopy and sigmoidoscopy. We experienced unexpectedly glutaraldehyde colitis. We describe symptoms, signs and clinical courses of glutaraldehyde colitis. METHODS: Colonoscopy and sigmoidoscopy were performed at one session after bowel cleaning with polyethylene glycol ingestion 2~3 liters. Within 24 hours, all of them visited emergency room because of bloody diarrhea, vomiting and colicky abdominal pain. We performed sigmoidoscopy again in one patient. RESULTS: Sigmoidoscopic findings was diffuse edematous, hyperemic mucosa and shallow ulcerations similar to the findings of ischemic colitis. But, un-contacted mucosa was normal findings which can be completely distinguished from contacted mucosa. Microscopically, colonic mucosa showed edema, polymorphonuclear leukocytes infiltration and fibroprulent exudates with surface erosions. Laboratory findings were non-specific except leukocytosis of peripheral blood. Both bacterial cultures of blood and stool were negative in all patients. Symptoms subsided within 7 days and duration of admission is almost within 9 days. All of patients recovered completely without any complication. CONCLUSIONS: The clinical features of glutaraldehyde colitis resembled colonic ischemia in symptoms and endoscopic findings. This complication should be suspected in patients who develop hemorrhagic colitis suddenly after undergoing colonoscopy.

Mesenteric and Omental Cysts in Children

Mesenteric and omental cysts are rare intra-abdominal lesions in childhood, and may present various clinical features such as an asymptomatic mass or an acute abdomen. Therefore, these entities are frequently misdiagnosed preoperatively or are found only incidentally at operation for other conditions. We analyzed our experiences of 19 cases in a 19 year period from 1981 to 1999, at College of Medicine, Catholic University of Korea. There were 12 boys and 7 girls with a mean age of 4.8 years (range, 3 days to 15 years). Common presenting symptoms were abdominal pain (47%), abdominal distension (31%), abdominal mass (24%), vomiting (15%) and fever (10%). Ultrasonography was the most preferred method of diagnosis. Other diagnostic modalities include CT, MRI, and abdominal ascites tapping in selected patients. Location of the mesenteric cysts was small bowel mesentery in nine, the right mesocolon and retroperitoneum in one, the left mesocolon in one, and the jejunum, sigmoid-colon mesentery in one. Most of the patients underwent cyst excision, but six patients required concomitant bowel resection for complete removal of the lesions, and two patients underwent unroofing and simple aspiration respectively. There was one mortality case due to sepsis.

A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.

A case of hypereosinophilic syndrome with eosinophilic pneumonia, and bronchitis / 천식및알레르기

Idiopathic hypereosinophilic syndrome is characterized by multiorgan involvement without any cause, and peripheral eosinophilia(1,500/microliter) for more than 6 months. Clinically, many organs can be involved, but the heart is the most commonly involved organ. Although lung involvement is usual(20-30%)1) in hypereosinophilic syndrome, there are few reports of eosinophilic pneumonia proven by biopsy confirmation in Korea. We experienced a case of hypereosinophilic syndrome with eosinophilic pneumonia and bronchitis confirmed by biopsy, and we report it here with a review of the literature.

A Case of Secondary Amyloid Colitis in Rheumatoid Arthritis

Amyloidosis is known as a disease caused by the deposition of a insoluble and fibrous amyloid protein in the extracellular space of various organs and tissue. Intestinal amyloid deposition may develop motility disturbance, malabsorption, bleeding and perforation. A 70-year old woman with lower abdominal pain, watery diarrhea was admitted and had the past history of diabetes mellitus, hypertension for 8 years and rheumatoid arthritis for 10 year. On colonoscopic examination for evaluation of diarrhea, multiple edematous and shallow ulcers was found from distal sigmoid to terminal ileum. A green colored positive birifringent stained amorphous material was found in polarizing microscopy of colon biopsy specimen stained with Congo-red on microscopic examination,. We report a case of amyloidosis causing colon ulcers confirmed by colonoscopic biopsy with review literature.