A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol

Background@#Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. @*Methods@#This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. @*Conclusion@#The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.

A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol

Background@#Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. @*Methods@#This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 μIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 μIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. @*Conclusion@#The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.

Study Protocol of Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro)

BACKGROUND: The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups. METHODS: This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis. RESULTS: Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014). CONCLUSION: The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.

Related factors between quality of dental service and Korean net promoter score / 대한구강보건학회지

OBJECTIVES: Many people rely on recommendations from family, relatives, and other information sources in order to select the appropriate dental clinic for treatment. The object of this study was to find out the relationship between quality of dental service and Korean Net Promoter Score (KNPS). METHODS: A total of 520 patients were selected through consecutive sampling from four dental clinics in Daegu city. Informed consent of all selected patients was obtained. The patients were required to complete a questionnaire that comprised of three categories of queries related to provision of satisfactory dental service, relation quality, and personal data. Sub-categories of questions included physical and environmental factors, human service factors, patients' satisfaction with related quality and KNPS. Data was collected by interviewing all individuals on a personal basis over a period of 3 months. Statistical analysis was performed using studental t-test, ANOVA and multiple regression analysis using the SPSS 20.0 software (IBM Co., Armonk, NY, USA). RESULTS: Among the various socio-economic factors studied, income was most significantly related to KNPS while satisfaction of relation quality was the largest factor affecting the KNPS. Factors such as satisfactory physical environment, quality of human service, relation quality and income accounted for 52.4% of KNPS. In short, the three major factors that affected KNPS were patient compliance, professionalism of the attending dentist and response of hygienist to patient. Other minor factors influencing KNPS included trust upon the attending dentist, aesthetics of clinicstiinterior, and physical convenience. CONCLUSIONS: It is highly recommended that dental clinics should make strenuous efforts to increase the level of patient compliance, professionalism, and response towards patients, which can be achieved by improving the quality of service and through positive marketing of the hospital.

Clinical Outcome of Supraglottic Laryngectomy in Supraglottic Cancer : Open vs Transoral Laser Supraglottic Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When treating the supraglottic cancer, we must consider functions such as respiration, phonation, swallowing, aspiration as well as the complete eradication of the disease. Open supraglottic laryngectomy is an oncologically safe procedure that can preserve the laryngeal function. However, in immediate perioperative time, supraglottic laryngectomy requires tracheostomy and L-tube insertion. On the other hand, transoral laser supraglottic laryngectomy, while it is debated whether or not it is oncologically safe, it doesn't require tracheostomy and L-tube insertion. We compared and analyzed the outcomes and morbidity of both treatments. SUBJECTS AND METHOD: Patients who have been diagnosed as supraglottic cancer between January 1995 through December 2004 and who were treated with either open supraglottic laryngectomy or transoral laser supraglottic laryngectomy for the primary treatment were included in the study. We analyzed the overall survival and treatment results through retrospective chart review and the statistical analysis was carried out by the SPSS 10.0. RESULTS: Five-year overall survival rate was 88.5% in open surgery and 78.2% in transoral surgery. But the p-value of 0.216 indicates that there is no statistically significant differences among two groups. Five-year disease free survival rates were 83.4% in open surgery and 68.0% in transoral surgery. The p-value of 0.221 again indicates that there is no statistically significant differences among two groups. Tracheostomy and L-tube insertion were conducted in all of the patients in open surgery but conducted in 20% and 6.7% of the patients, respectively, in transoral surgery. CONCLUSION: There are no differences between the 5-year overall survival rate and 5-year disease free survival rate between the two groups. However, morbidity is lower in the transoral group, so it would be preferable to conduct transoral laser supraglottic laryngectomy in supraglottic cancer patients in the future. Further studies using more cases are recommended.

A Case of Bilateral Carotid Body Tumor / 대한이비인후과학회지

Carotid body tumor is a rare lesion of the neuroendocrine system. It typically presents as a slow growing, painless neck mass found along the anterior border of the sternocleidomastoid muscle. We present clinicoradiologic findings of a bilateral carotid body tumor from a 35-year-old woman with a review of literatures. Magnetic resonance imaging showed a vascular mass at the carotid bifurcation, displacing the external and internal carotid arteries. After embolization of feeding vessels using polyvinyl alcohol and gelfoam, we excised the mass without severe bleeding and neurologic symptoms.

Navigation Assisted Transsphenoidal Approach for Pituitary Tumor

The transsphenoidal approach is the choice of surgical approach for the treatment of pituitary tumors located on the upper portion of the sphenoid sinus. The proximity of vital anatomic structures (e.g. optic nerve, carotid artery, carvernous sinus, and anterior cranial fossa) surrounding the sphenoid sinus makes it difficult for surgeons to recognize the precise location during the transsphenoidal approach. We report 16 cases of transsphenoidal approach performed via the navigation system to identify vital anatomic structures and important surgical landmarks. We analyzed 16 patients to perform the transcrural transcolumellar approach under the guidance the navigation system for pituitary tumor resection. For the verification of important anatomic structures during operation, the navigation system demonstrates the position and direction of the probe on CT scans in real time. The intrasphenoidal septum was in the midline in only four cases but not so in the other 12 cases. However, the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus was located in the mid-portion of the sphenoid sinus in all cases. Without any serious damage to the important structures around the sella turcica, we successfully performed the pituitary tumor operation in all cases. Using the navigation system, we identified the relationship between the sella turcica and surrounding important structures on CT scan in real time, and successfully removed the pituitary tumors without complications. In addition, we suggest that the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus may be one of the available landmarks for the localization of the midline during a transsphenoidal approach.

Acute Epiglottitis in Adults: A Review of 85 Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. The incidence of acute epiglottitis in children has declined with introduction of the Haemophilus influenza type b vaccine. However, there have been few reports about acute epiglottitis in adults up until now. The aim of this study was to assess clinical characteristics of adult cases of acute epiglottitis. SUBJECTS AND METHOD: We retrospectively reviewed 85 hospitalized adult patients who had been admitted to the Department of Otolaryngology-Head and Neck surgery, Korea University Hospital from January 1998 to December 2002, and diagnosed with acute epiglottitis. RESULTS: Among the 85 patients, 23 cases (27%) and 24 cases (28%) were found in fourth and sixth decades of age, respectively. The male-to-female ratio was 1.6:1. Monthly distribution showed that 12 cases (14%) were in March and 11 (13%) in July. The most common symptom was in the order of throat pain (78%). Others were dysphagia (68%), voice change (67%) and dyspnea (42%). All patients were treated with antibiotics and steroids. About a half of all cases (54%) were hospitalized for 4 to 5 days. Tracheostomy was performed in 2 patients and orotracheal intubation in one patient. CONCLUSION: Throat pain and dysphagia were most common symptoms of acute epiglottitis. In most cases, therapies using intravenous antibiotics and short-term steroid were effective, but otolaryngologist must also suspect the possibility of sudden upper airway obstruction. We experienced emergency situations regarding airway obstruction in only three cases during the first week of hospitalization.

Analysis of Esophageal Voice: Videofluoroscopic & Acoustic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advanced laryngeal cancer is frequently treated by total laryngectomy. This operation is effective but results in gross functional disability because of the permanent loss of voice. As an alternative using voice, esophageal speech has been employed as a natural and satisfactory means of communication for laryngectomized patients. Unfortunately, during past decades the success rate has ranged 40-60%. The purpose of this study was to determine which factors contribute to the proficiency of esophageal speech. MATERIALS AND METHOD: Videofluoroscopy and voice analysis of fourteen alaryngeal male patients who had trained esophageal speech were performed. RESULTS: Aerophagia and air ejection were impossible in poor esophageal speakers. Fluent esophageal speakers had short pseudoglottis, longer maximum phonation time, more efficient jitter, shimmer and harmonic-to-noise ratio. CONCLUSION: Aerophagia and air ejection are essential for esophageal speech. Short pseudoglottis (less than 2 cm) affords better esophageal speech. Natural repetitive movements of aerophagia and air ejection with accurate articulatory motion can improve the quality of esophageal speech.

Expression of mRNA Transcripts of the Na+/H+ and Cl-/HCO3- Exchanger Isoforms in Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Electrolyte transport by nasal epithelia has been suggested to be important for controlling the quantity and composition of the nasal fluid and may play an important role in the development of nasal polyps. One of various mechanisms involving translocation of Na+ and Cl- across cell membranes includes electroneutral processes, such as Na+/H+ exchange (NHE) and Cl-/HCO3- exchange (AE). MATERIALS AND METHODS: The present study evaluated the presence of mRNAs for various members of the human NHE and AE gene families in human inferior turbinate mucosa and nasal polyp using RT-PCR and in situ hybridization. RESULTS: The mRNA for NHE1 was detected in human turbinate mucosa and nasal polyp while the mRNAs for NHE2 and NHE3 could not be detected in all samples examined. Of the AE isoforms, AE2 mRNA was expressed in inferior turbinate mucosa but not in nasal polyp. In situ hybridization revealed that NHE1 mRNA in the turbinate mucosa and nasal polyp was localized in the epithelial layer and submucosal glands. AE2 mRNA was also expressed in the epithelial layer and in the submucosal glands of inferior turbinate mucosa. CONCLUSION: These results indicate that the expression of AE2 mRNA is altered in nasal polyp, compared with inferior turbinate mucosa, suggesting that the altered expression of these genes in nasal polyp may cause impaired electrolyte and water transport across the epithelial cells.

A Case of Nonfunctioning Parathyroid Carcinoma / 대한이비인후과학회지

Parathyroid carcinoma is an uncommon endocrine tumor. Its usual clinical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathyroid hormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is very rare and more aggressive. Histologically, the neoplastic cells may be of variable size and shape but are usually uniform and not too dissimilar from normal parathyroid cells. There is a general agreement that a diagnosis of carcinoma based on cytologic detail is unreliable, and local invasion and metastasis constitute the only reliable criteria of malignancy. In both functional and nonfunctional carcinoma, early surgery has proven to be the only curative treatment approach whereas both chemotherapy and radiation therapy fail to produce systemic or regional benefit when used alone. En bloc excision of primary lesion with removal of any involved structures should be performed. This paper is a case report of a nonfunctioning parathyroid carcinoma and a review of the literature.