Radiofrequency Ablation for Benign Thyroid Nodules Performed by Surgeon / 대한내분비외과학회지

PURPOSE: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. METHODS: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. RESULTS: The median volume before ablation was 7.8 cm³ (range 1.3~43.2 cm³). After ablation, the median volume was 0.9 cm³ (range 0.0-21.6 cm³) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. CONCLUSION: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

Follicular Variant of Papillary Thyroid Carcinoma: Clinicopathological Features According to Histologic Subgroup / 대한내분비외과학회지

PURPOSE: The follicular variant of papillary thyroid carcinoma (FVPTC) is difficult to diagnose due to pathologic features. There is also debate on the optimal extent of surgery. We separated FVPTC into two groups and compared the clinical features in an attempt to apply the treatment. METHODS: All 40 patients with FVPTC who were diagnosed between 1990 and 2009 were reviewed and separated into two groups, an encapsulated group and an infiltrative group, based on whether a capsule was formed or infiltration occurred. These two different subtypes of FVPTC were compared on the traits of sensitivity of diagnosis and clinicopathologic features. RESULTS: After review by a pathologist, 21 of 40 patients (55%) were found to have encapsulated tumors, and 18 patients (45%) had infiltrative tumors. There was no difference in age, sex, or size. Patients with encapsulated FVPTC had a significantly lower rate of lymph node metastasis (4.5%), multicentric tumors (18.2%), and thyroid capsular invasion (9.1%) compared with the infiltrative tumor group (50%, 50% and 50%, P<0.05). There was no difference in FNA sensitivity between the two groups, but the sensitivity to frozen biopsy was higher in the infiltrative group. There was no recurrence in the encapsulated group, but 4 patients (22.2%) experienced recurrence in the infiltrative group. CONCLUSION: FVPTC can be separated into two subgroups by histologic features, and there are some clinicopathologic differences between the two groups. Patients who had encapsulated FVPTC had a lower rate of lymph node metastasis, multicentric tumors, and thyroid capsular invasion. They also showed a lower rate of recurrence than the infiltrative group. It is suggested that the encapsulated group can be treated with limited surgery and the infiltrative group needs aggressive treatment.

Fifteen Years or Greater Follow-Up of Pediatric Differentiated Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. METHODS: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. RESULTS: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15~28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (¹³¹I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. CONCLUSION: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up.

Initial Experience with an Endovascular Suite (A Hybrid Operating Room)

PURPOSE: Endovascular interventions have seen explosive growth over the last decade. One of the critical factors to perform safe and reliable endovascular procedures is the availability of a well-equipped endovascular suite. The aim of this study is to clarify the necessity and benefits of an endovascular suite through our initial experience. METHODS: We performed an overview of the basic equipment and the adjunctive hardware and software of an endovascular suite for performing open surgical exposures or/and endovascular procedures. We also conducted a review of the endovascular procedures that were performed for 2 months in a newly built endovascular suite. RESULTS: The endovascular suite should offer sterile conditions to provide the endovascular specialist a complete gamut of options to treat patients with complex vascular diseases. The number of vascular and endovascular treatments increased about two fold after the establishment of the endovascular suite. CONCLUSION: The establishment of a modern endovascular suite arranged in an ergonomically devised fashion is helpful to remain on the cutting edge of medical practice. A endovascular suite will undoubtedly enhance the ability of vascular surgeons to provide quality health care to the patients who have a variety of arterial and venous disorders.

Feasibility of Ultrasound-guided Fine Needle Aspiration Cytology Using Extended Tube for a Thyroid Mass / 대한내분비외과학회지

PURPOSE: Fine needle aspiration cytology (FNAC) is a very useful procedure for the diagnosis and management of thyroid disease. The use of FNAC has increased over the years. We determined the incidence of complications associated with ultrasound-guided FNAC using an extended tube for a thyroid mass and the factors that contribute to such complications. METHODS: A retrospective chart review was conducted to identify patients who underwent FNAC. Two hundred fifty-four patients underwent 325 procedures between July and September 2009. RESULTS: There were no major complications associated with ultrasound-guided FNAC using an extended tube for a thyroid mass. The most minor complication was neck pain, which occurred in 16.1% of the patients (41/254). Multiple FNACs, anti-coagulant medications, abnormal thyroid function tests, nature of the mass, and size of the mass did not contribute to the complications in this study. CONCLUSION: Using an extended tube during ultrasoundguided FNAC for a thyroid mass is safe and convenient.

The Diagnostic Value of High Resolution Ultrasonography as Examined by Surgeons for the Differentiation of Thyroid Nodules / 대한내분비외과학회지

PURPOSE: High resolution ultrasonography has recently become a useful tool to differentiate malignant thyroid nodules from benign thyroid nodules. We performed this study in order to determine the usefulness of an ultrasonography examination that's performed by endocrinologic surgeons through the analysis of the sonographic characteristics. METHODS: A retrospective review was undertaken for 312 patients who underwent surgery and a US examination by the operator before surgery due to thyroid nodules at Jesus Hospital from February 2006 to March 2008. The review consisted of the characteristics of the sonographic parameters, such as the margin, structure, shape, echogenicity, homogeneity, calcification, sponge sign and the width/height ratio. RESULTS: On univariate analysis of the non-follicular neoplasm, the significant parameters were the margin, structure, shape, echogeneity, homogeneity, calcification and the width/height ratio. On the logistic regression analysis, the margin, structure, shape and echogenecity were significant parameters. On a univariateanalysis of the follicular neoplasm, the significant parameters were the shape, echogenecity, homogeneity and calcification. On the logistic regression analysis of the total thyroid nodules, the margin, structure, shape and echogenecity were significant parameters. Especially, hypoechoic and solid structures are the most potent malignant characteristics. CONCLUSION: Among the ultrasonographic characteristics checked by surgeons before surgery, the hypoechogenecity and solid structures are the most useful ones when planning operative management of thyroid nodules.

Diagnostic Value of Ultrasound-guided Fine Needle Aspiration Cytology by a Endocrine Surgeon / 대한내분비외과학회지

PURPOSE: Fine needle aspiration is a safe and relatively accurate procedure for distinguishing benign and malignant lesions. We determined the diagnostic value of ultrasoundguided fine needle aspiration using an extension tube and examination by an endocrine surgeon. METHODS: We reviewed the medical records of 257 consecutive patients receiving surgery for thyroid nodules in the Department of Surgery, Jesus Hospital, from January, 2006, to August, 2008. All patients received ultrasound-guided fine needle aspiration with an extension tube. RESULTS: The male to female ratio was 1:5.5. Definitive histopathological diagnosis revealed benign lesions in 120 cases (47%) and malignant lesions in 137 cases (53%). Benign lesions were composed of nodular goiter (102 cases), follicular adenoma (13 cases), and Hashimoto thyroiditis (5 cases). Malignant lesions were composed of papillary carcinoma (131 cases) and follicular carcinoma (6 cases). Fine needle aspiration cytology revealed benign lesions in 103 cases and malignant lesions in 126 cases. The Overall results of ultrasound-guided FNA were: sensitivity, 94.5%, specificity, 95.0%, positive predictive value, 96.0%, negative predictive value, 93.2%, accuracy rate, 94.7%, false negative, 5.4%, and false positive, 4.9%. Most specimens (96.4%) were amenable for diagnosis. CONCLUSION: Fine needle aspiration is a good method for the differential diagnosis of thyroid nodules. High resolution ultrasound-guided FNA with an extension tube is helpful for obtaining good specimens.

A Case of Crohn's Disease Which is Diagnosed through Acute Sigmoid Colon Obstruction

Crohn's disease is an inflammatory bowel disease like ulcerative colitis. Distinct from ulcerative colitis, Crohn's disease may involve any portion of the alimentary tract from the mouth to the anus. Recently, the incidence of Crohn's disease has been increasing in Korea. The proportion of the colon type is smaller than that of the ileocecal type or the small-bowel type. In the colon, Crohn's disease affects mainly the right side. Relatively, the sigmoid colon is rarely involved. Small-bowel obstruction is the most common complication requiring surgery in Crohn's disease. On the contrary, an obstruction limited to the colon requiring surgery is less common in Crohn's disease. We experienced a case of a severe acute sigmoid colon obstruction with peritonitis. At first, we suspected colon cancer, but after an emergency laparotomy, we diagnosed it as Crohn's disease. Such a situation is rare in Korea, so we hope this case report may provide a good opportunity to reconsider Crohn's disease.

Rupture of Metastatic Omental Hepatocellular Carcinoma Following the Treatment of Ruptured HCC / 한국간담췌외과학회지

Hepatocellular carcinoma (HCC) has a tendency of rupturing, which can lead to massive hemorrhage. Although the majority of HCC ruptures occur in the liver, some reports have shown that HCC ruptures developed at various metastatic sites including the lung, pleura, rib, sternum, spleen, kidney, adrenal gland, mediastinal lymph node, peritoneum, ileum, and peripancreatic lymph node. Here, we reported a case of HBV-related HCC rupture that was treated by operation and recurred in the form of ruptured omental metastasis. A 55- year-old man, who complained of diffuse abdominal pain, was admitted to our hospital in a state of shock. Abdominal CT showed massive hemoperitoneum with a HCC of 6 cm size in diameter in the left lobe of the liver. The alphafetoprotein level was above 300 ng/ml. After transarterial chemoembolization for hemostasis, left lateral segmentectomy was performed. Resected tumor showed complete tumor necrosis. Four months later, the follow-up CT revealed an extrahepatic abdominal tumor near the transverse colon. With surgery, a ruptured tumor implanted on the great omentum near the transverse colon was found and removed along with the segmental transverse colon. The pathologic result reported that the omental tumor was a poorly differentiated hepatocellular carcinoma.