Painful immunoglobulin G4-related thyroiditis treated by total thyroidectomy

No abstract available.

Necrotizing fasciitis of the breast in a pregnant woman successfully treated using negative-pressure wound therapy

Necrotizing fasciitis (NF) is a rare and rapidly progressive disease involving the skin, subcutaneous tissue, and deep soft tissue. Although NF can occur any part of the body, the breast is an uncommon primary site for NF, and its occurrence in the breast during pregnancy has never previously been reported. Here, we report the case of a healthy 31-year-old pregnant woman who presented with NF of the left breast that was successfully treated with breast-conserving debridement and secondary wound closure using negative-pressure wound therapy.

Early Experience of Single-Port Laparoscopic Anterior Resection for Colon Cancer / 대한내시경복강경외과학회지

PURPOSE: Single-port laparoscopic surgery (SPLS) has recently emerged as a method to improve the morbidity and cosmetic benefit of conventional laparoscopic surgery. We describe our experience of SPLS for an anterior resection (AR). The results of a prospective series of single-port laparoscopic anterior resection procedures are presented. METHODS: Anterior resections were performed on 16 cases using a single-port laparoscopic technique between March 2009 and March 2010. The surgical and oncologic outcomes were recorded on a prospective database. RESULTS: Sixteen (8 women) unselected patients (eight males, eight females), aged 43~82 years (median 66.5 years), underwent a SPLS anterior resection for sigmoid colon cancers (median 16 cm above AV, range 13~27). All patients were alive at 30 days. The surgery time ranged from 150~415 min (median 242 min) and the median wound incision length was 2.4 cm (range 1.5~4.0 cm). The median hospital stay was 7.5 days. Pathological reports from the resected specimens revealed adenocarcinoma in 15 patients and mucinous carcinoma in one. There was one case of an anastomotic leak that required reanastomosis. The median number of lymph nodes harvested was 27.5 (range 10~56). CONCLUSION: SPLS is a possible approach to an anterior resection with the potential for minimal access. A SPLS anterior resection is feasible and safe when performed by an experienced laparoscopic surgeon and team. On the other hand, the technique and oncologic safety warrants further prospective randomized studies.

HIF-1alpha Expression in BRAF(V600E)-Positive Papillary Thyroid Microcarcinoma / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: Recent studies have reported that vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF)-1alpha are up-regulated in BRAF(V600E)-positive papillary thyroid carcinoma (PTC). We investigated whether papillary thyroid microcarcinomas (PTMCs) also exhibited increased expression of VEGF and HIF-1alpha. In addition, we analyzed the relationship between BRAF(V600E) mutation and clinicopathological parameters, as well as HIF-1alpha expression in PTMC. MATERIALS AND METHODS: We retrospectively selected 225 patients with PTMC. Immunohistochemical staining for HIF-1alpha and VEGF was performed using paraffinembedded PTMC tissue microarrays. BRAF(V600E) mutation status was analyzed by dideoxy sequencing. RESULTS: PTMCs larger than 0.5 cm tend to be related to aggressive clinicopathological features such as thyroid capsular invasion (p=0.023) and bilaterality (p=0.047). Immunoreactivity to HIF-1alpha (20.7%) and VEGF (30.2%) was more prominent in PTMCs as compared to normal follicular cells. However, HIF-1alpha and VEGF expression was not correlated with clinicopathological features. BRAF(V600E) mutation was found in 70.7% (159/225) of the PTMC cases. PTMCs harboring the BRAF(V600E) mutation exhibited larger tumor sizes as compared to PTMCs without the BRAF(V600E) mutation (p=0.038). However, BRAF(V600E) mutation status did not correlate with the expression of HIF-1alpha (p=0.623) or VEGF (p=0.990). CONCLUSION: HIF-1alpha and VEGF were more frequently detected in PTMCs as compared to normal thyroid tissues. However, BRAF(V600E) mutation status was not correlated with the expression of HIF-1alpha or VEGF in PTMCs.

The Clinical Significance of Scored CT Findings for Pre-operative Prediction of Lateral Cervical Lymph Node Metastasis in Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Although ultrasound is routinely used for pre-operative evaluation of neck nodes in patients with papillary thyroid carcinoma, CT is also widely used. We designed a prediction score of lateral cervical lymph node metastasis (PSLCNM) for improving diagnostic ability of CT. The purpose of our study was to determine the clinical significance of the PSLCNM. METHODS: A total of 124 patients with thyroid carcinoma who underwent surgery of lateral cervical lymph node dissection after pre-operative CT evaluation were enrolled in this study. We retrospectively evaluated the diagnostic ability between CT findings by one radiologist and PSLCNM for prediction of lateral lymph node metastasis. RESULTS: In terms of predicting lateral cervical node metastasis, the positive predictive value of CT findings of indeterminate, suspicious, or metastatic nodes were 37.5% (21/56), 68.3% (28/41), 85.7% (18/21). Those of 1, 2, 3, 4 in sum of PSLCNM were 34% (16/47), 60% (30/50), 91% (10/11), 100% (10/10). CONCLUSION: Prediction of lateral cervical node metastasis using PSLCNM showed a better result than conventional CT findings and could decrease unnecessary surgical procedures and postoperative complications in the surgery of thyroid cancer.

Analysis of Clinicopathologic Features of Papillary Thyroid Microcarcinoma According to Cut-off of Tumor Size / 대한내분비외과학회지

PURPOSE: Although the detected incidence of papillary thyroid microcarcinoma (PTMC) has increased with development of ultrasonography and fine-needle aspiration biopsy, the best treatment has not yet been established. Treatment decisions require information on many factors including lymph node metastasis, extrathyroidal extension, and bilaterality. With this aim, the present study analyzed clinicopathologic features of PTMC according to cut-off of tumor size. METHODS: The clinicopathologic features of patients with PTMC between January 2007 and December 2009 were reviewed retrospectively from medical records. Patients were divided according to tumors lesser than or equal to cut-off (Group I) and tumors exceeding cut-off (Group II). RESULTS: Both capsule invasion and lymphovascular invasion were significantly different at all cut-off diameters (5~9 mm). Central node metastasis revealed a difference in all cut-off values except 8 mm. Extrathyroidal extension differed at all cut-off values except 5 mm. Bilaterality displayed a statistically significantdifference only at the 8 mm cut-off. CONCLUSION: cut-off of 5 mm represents a safe value to discriminate less aggressive from aggressive treatment for PTMC.

Clinical Significance of VEGF-C and COX-2 Expression in Gastric Carcinoma with Submucosal Invasion

PURPOSE: Lymph node metastasis is an important factor in determining prognosis and therapeutic options for early gastric cancer (EGC) patients. Vascular endothelial growth factor (VEGF)-C and D are known as lymphangiogenic factors, and cyclooxygenase (COX)-2 is thought to play a role in lymph node metastasis in gastric carcinoma. This study was designed to determine whether the expression of VEGF-C, VEGF-D, and COX-2 is associated with clinicopathologic factors, especially lymph node metastasis in EGCs invading the submucosa. MATERIALS AND METHODS: Tissue samples were obtained from 85 Patients undergoing standard gastrectomy with lymph node dissection between 1991 and 2007 in the Department of Surgery of Daejeon St. Mary's Hospital in Daejeon, Korea. All patients were diagnosed with gastric cancers and submucosal invasion. We examined the expression of VEGF-C, VEGF-D, and COX-2 using immunohistochemical methods. RESULTS: Of the 85 patients, 16 (18.8%) had lymph node metastasis. VEGF-C, VEGF-D, and COX-2 were positively expressed in 34.1% (29/85), 22.3% (19/85), and 37.6% (32/85) of the patients. VEGF-C and COX-2 expression was significantly correlated with lymph node metastasis (P<0.05). A positive correlation existed between VEGF-C and COX-2 expression (P<0.001). CONCLUSION: VEGF-C and COX-2 expression is associated with lymph node metastasis in gastric cancer with submucosal invasion. VEGF-C and COX-2 may thus be predictive markers for lymph node metastasis in EGC patients with submucosal invasion.

The Relationship between the p27 Expression of Papillary Thyroid Cancer Cells Obtained by FNA and Cervical Lymph Node Metastasis / 대한내분비외과학회지

PURPOSE: The p27 gene as a tumor suppressor gene is associated with colorectal cancer, gastric cancer and breast cancer. Some studies have shown a relationship between the underexpression of p27 and lymph node metastasis in papillary thyroid carcinoma. The aim of this study is to evaluate the relationship between a p27 expression of the papillary thyroid cancer cells obtained by fine needle aspiration (FNA) and cervical lymph node metastasis. METHODS: This study included 60 patients with papillary thyroid cancer and who underwent total thyroidectomy or lobectomy. Central lymph node dissection was routinely done. Out of these patients, 30 patients underwent a FNA procedure during the operation. Immunohistochemical staining for p27 antibody was performed on the papillary thyroid cancer tissues and cells. RESULTS: Cervical lymph node metastasis is correlated with the tumor size and lymphovascular invasion (P<0.001). The underexpression of p27 for the papillary thyroid cancer tissues and cells was associated with lymph node metastasis (P=0.009). CONCLUSION: An evaluation of the p27 expression for the papillary thyroid cancer cells obtained by FNA may be useful as a predictor for lymph node metastasis before surgery.

Laparoscopic Treatment of Mesenteric Castleman's Disease

Castleman's disease (CD) is an uncommon lymphoproliferative disorder of unknown origin. There are two histological types: hyaline-vascular type and plasma cell type. CD is usually located in the mediastinum, but may be seen in any site including the neck, axilla, mesentery, and retroperitoneum. A 52-year-old male complained of vague lower abdominal pain. There was no palpable mass and all laboratory data showed nonspecific findings. Abdominal computed tomography scan showed a solitary homogenous, well-defined mass in the mesentery. The laparoscopic complete resection was performed without complications. Histologic examination of resected lesion revealed the hyaline-vascular type of CD. In the hyaline-vascular type of CD, laparoscopic approach constitutes a complete treatment. We present here the case of laparoscopic treatment of isolated mesenteric CD.

Comparison of Two-port Laparoscopic Cholecystectomy with Four-port Laparoscopic Cholecystectomy

PURPOSE: In spite of its safety and fesibility, it is not completely certain whether two-port laparoscopic cholecystectomy can be applied for the same indications as four-port cholecystectomy. METHODS: We retrospectively analyzed the prospectively collected data of the patients who had undergone either two-port or four-port laparoscopic cholecystectomy at the Department of Surgery, Daejeon St. Mary's Hospital between March 2007 and August 2009. A total of 341 patients were included. For our two-port cholecystectomy, combining a transumbilical wound retractor with a surgical glove on which there was a 11 mm trocar and two pipes were attached comprised an umbilical common channel, and another port was inserted through the epigastrium. The overall procedure was similar to four-port laparoscopic cholecystectomy. RESULTS: The patients were classified into the four-port group (n=261) and the two-port group (n=80) according to the operative method. All the two-port cholecystectomies were followed by four-port procedures. The operative indications for these two procedures were identical. No significant difference was observed for the mean operation time, the conversion rate, the postoperative hospital stay and the complications between each group. Multivariate analysis revealed that the factors making two-port surgery longer than the 75 percentile of the overall operation time were the development of intraoperative complications (RR 14.3; p=0.005; C.I. 2.255-90.853), a operation for the patients who visited the emergency room (RR 10.4; p=0.012; C.I. 1.684-63.798), open conversion or making additional port(s) (RR 9.9; p=0.032; C.I. 1.219-80.958) and a body-mass index greater than 25 (RR 5.5; p=0.025; C.I. 1.244-24.731). CONCLUSION: This study documents that our two-port laparoscopic cholecystectomy seems to have the potential to replace the conventional four-port laparoscopic cholecystectomy.

Comparison of Two-port Laparoscopic Cholecystectomy with Four-port Laparoscopic Cholecystectomy

PURPOSE: In spite of its safety and fesibility, it is not completely certain whether two-port laparoscopic cholecystectomy can be applied for the same indications as four-port cholecystectomy. METHODS: We retrospectively analyzed the prospectively collected data of the patients who had undergone either two-port or four-port laparoscopic cholecystectomy at the Department of Surgery, Daejeon St. Mary's Hospital between March 2007 and August 2009. A total of 341 patients were included. For our two-port cholecystectomy, combining a transumbilical wound retractor with a surgical glove on which there was a 11 mm trocar and two pipes were attached comprised an umbilical common channel, and another port was inserted through the epigastrium. The overall procedure was similar to four-port laparoscopic cholecystectomy. RESULTS: The patients were classified into the four-port group (n=261) and the two-port group (n=80) according to the operative method. All the two-port cholecystectomies were followed by four-port procedures. The operative indications for these two procedures were identical. No significant difference was observed for the mean operation time, the conversion rate, the postoperative hospital stay and the complications between each group. Multivariate analysis revealed that the factors making two-port surgery longer than the 75 percentile of the overall operation time were the development of intraoperative complications (RR 14.3; p=0.005; C.I. 2.255-90.853), a operation for the patients who visited the emergency room (RR 10.4; p=0.012; C.I. 1.684-63.798), open conversion or making additional port(s) (RR 9.9; p=0.032; C.I. 1.219-80.958) and a body-mass index greater than 25 (RR 5.5; p=0.025; C.I. 1.244-24.731). CONCLUSION: This study documents that our two-port laparoscopic cholecystectomy seems to have the potential to replace the conventional four-port laparoscopic cholecystectomy.

Isolated Traumatic Gallbladder Rupture

Gallbladder (GB) injuries after blunt abdominal trauma are uncommon. An isolated blunt GB injury is extremely rare, due to the anatomic location of the GB that is protected by the liver, intestines, omentum and ribs. A GB injury follows a vague and insidious clinical course, and therefore GB injuries are commonly undiagnosed until an exploratory laparotomy is performed. Early diagnosis is important, as trauma to the GB should be treated surgically and a delay in treatment can result in considerable mortality and morbidity. We encountered a patient who was diagnosed with a GB rupture based on computed tomography that showed a hemoperitoneum, high-density material in the GB lumen and a leakage of contrast material. The patient underwent an exploratory laparotomy. We report a case of isolated GB rupture after blunt abdominal trauma.

Postanal Retrieval and Anastomosis in Laparoscopic Rectal Surgery: Report of 3 Cases

Laparoscopic surgery is popular and widely accepted method for colorectal cancer today. Especially in rectal cancer, laparoscopic TME made surgery safe and feasible with good outcome. But there are still some limits and difficulties in resection and anastomosis of low rectal cancer. We combined laparoscopic TME and posterior approach. Surgery was performed in three low rectal cancer patients. They were prepared in supine position and laparoscopic TME to pelvic floor muscles was performed. After changing the patient to Jack-knife position, post-anal median incision (between the external sphincter and coccyx) and distal rectal resection was done. Through this surgical window, proximal stump was retrieved and resected with the safety margin, and anastomosis with leak test was performed. After a drain keeping, patient's position was changed back to supine again and laparoscopic irrigation and inspection of operation field was done finally. In the course of recovery, two patients were uneventful, but the rest with FAP experienced postoperative anastomotic leakage and got perineal resection and permanent ileostomy. According to our experience, posterior approach after laparoscopic TME permit right angle resection of distal rectum which is difficult in laparoscopic transabdominal approach. In addition, manual anastomosis with various instruments, Lembert suture, easy drain keeping, accurate fibrin glue apply can also be achieved. No incision on abdomen adds cosmetic advantage. But frequent position changes, need of patience-demanding intracorporeal mesenteric dissection to anastomotic site, and wound discomfort during sitting position right after the operation remain as challenges to consider and solve.

Restoration of Reproductive Potential after Autotransplantation of Frozen Ovaries in Mice Pretreated with Cyclophosphamide / 한국유방암학회지

PURPOSE: Infertility due to ovarian failure that is caused by antineoplastic chemotherapeutic agents is one of the primary problems of female cancer atients who are in their reproductive years. It has become important to preserve the reproductive potential of female cancer patients. This study was conducted to determine whether autotransplantation of frozen ovaries can restore reproductive potential. METHODS: This study included 30 female mice that had normal reproductive potential. The mice were divided into 4 groups: the positive control, the negative control, the comparison group, and the experimental group. The positive control group received right total oophorectomy, and the negative control group received bilateral total oophorectomy. Greater than or equal to 90% of the left ovary was removed in the mice of the comparison group, and then cyclophosphamide was administered. In the experimental group, the right ovary taken out by right total oophorectomy, and this was crypreserved using the vitrification method. And then cyclophosphamide was administered. The cryopreserved ovary was autotransplanted to the left gonadal fat pad after greater than or equal to 90% of the left ovary was removed. The reproductive performance in each group was analyzed according to the pregnancy rate after mating. RESULTS: In the positive control group, all five mice became pregnant, and the number of fetuses was 4 to 5 (mean=4.60+/-0.55). In the comparison group, the pregnancy rate was 50%, and the mean number of fetuses was 1.40+/-0.55. In the experimental group, 7 of 10 (70%) mice became pregnant, and the mean number of fetuses was 4.71+/-2.56. There was no significant difference in the number of fetuses between the positive control and the experimental group (p=0.093), but there was a significant difference in the number of fetuses between the comparison group and the experimental group (p=0.019). CONCLUSION: The results of this study suggest that autotransplantation of frozen ovaries using the vitrification method may restore the impaired ovarian function induced by antineoplastic chemotherapeutic agents.

Analysis of the Relationship between Central Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma and the Associated Factors according to the Tumor Size

PURPOSE: The aim of this study was to analyze the relationship between central lymph node metastasis and the associated factors in patients with papillary thyroid carcinoma (PTC) according to the tumor size, and we wanted to determine an appropriate treatment for PTC. METHODS: From June 2005 to May 2007, 218 patients with PTC underwent total thyroidectomy or lobectomy, and they also received central lymph node dissection at our institution. The patients were divided into three groups: group 1 (tumor 10 mm). We retrospectively reviewed these patients to analyze the relationship between tumor size and the clinicopathological characteristics, including age, gender, lymph node metastasis, extrathyroidal extension, capsular invasion and lymphovascular invasion. RESULTS: There were 47 (21.6%) patients in group 1, 101 (46.3%) patients in group 2 and 70 (32.1%) patients in group 3. The tumor size was closely correlated with the presence of extrathyroidal extension, capsular invasion and lymph node metastasis (P<0.001). Lymph node metastasis was not only closely correlated with tumor size, but it was also significantly associated with extrathyroidal extension, capsular invasion and lymphovascular invasion (P<0.05). CONCLUSION: Our study confirmed that some factors, including central lymph node metastasis, capsular invasion and extrathyroidal extension, were frequently observed in patients with papillary thyroid microcarcinoma (PTMC), and central lymph node metastasis was related to tumor size, extrathyroidal extension, capsular invasion and lymphovascular invasion. Therefore, routine central lymph node dissection is recommended during the initial surgery for patients with PTMC.

Mesenteric Cystic Lymphangioma with Traumatic Hemorrhage

Lymphangiomas are rare benign cystic tumors and they are most often located in the head, neck, and axilla in pediatric patients. The etiology of mesenteric cystic lymphangioma is unknown and the clinical presentation is diverse, ranging from an asymptomatic abdominal tumor to symptoms of an acute abdomen. A 16-year-old male patient presented to the Emergency Department complaining of an increasingly painful abdominal mass. He hit his abdomen against friend's knee during playing soccer. CT scan showed a mesenteric cystic mass that looked like hematoma. Under the diagnosis of a mesenteric hematoma, he underwent emergency laparotomy. The mass in the mesentery was removed. Mesenteric cystic lymphangioma with hemorrhage was confirmed by the pathologic result. We present here a case of a mesenteric cystic lymphangioma with post-traumatic hemorrhage.

Internal Jugular Vein Thrombosis Associated with Metastatic Malignancy

Spontaneous venous thrombosis developing in the internal jugular vein is very unusual. The common causes usually include intravenous drug abuse, jugular vein catheterization, neck dissection, a hypercoagulable state associated with malignancies, neck injury or ovarian overstimulation syndrome. A 30-year-old woman with no remarkable past medical history visited our outpatient office due to neck swelling with pain. She underwent CT scan, Doppler sonogram and fine needle aspiration biopsy. We could confirm metastatic lymphadenopathy and internal jugular vein thrombosis. We present here the case of internal jugular vein thrombosis associated with metastatic malignancy.

Analysis of the Relationship between Bilaterality and Other Clinicopathological Factors in Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: The extent of the initial surgical treatment for patients with papillary thyroid carcinoma (PTC) is controversial. Many surgeons think thattotal thyroidectomy is the most optimal treatment for PTC because of its potential bilaterality. Therefore, bilaterality is an important factor for determining the extent of surgical resection. The aim of this retrospective study is to analyze the relationship between tumor bilaterality and the other clinicopathological factors. METHODS: We conducted a retrospective analysis of 140 patients with PTC and who underwent total thyroidectomy with central lymph node dissection from January to December 2007 at our institution. RESULTS: Among 140 patients, 50 patients (35.7%) had PTC in the bilateral lobes. Of these 50 patients, only 17 patients (34.0%) were operated on under the preoperative diagnosis of bilateral PTC. Two factors, 1) presence of the capsular invasion (P=0.007) and 2) an increase of the tumor size (P=0.023), were statistically correlated with bilaterality. There were no significant associations between bilaterality and the other clinicopathological factors,including age, extrathyroidal invasion and lymph node metastasis. CONCLUSION: For the surgical care of PTC, bilaterality must always be considered even though the tumor is diagnosed preoperatively as unilateral PTC. Furthermore, thorough preoperative evaluation is mandatory if unilateral lobectomy is regarded as a therapeutic option for PTC patients.

Leadpoints in Childhood Intussusception

Childhood intussusception is usually idiopathic, and pathological lesions as the leading point are found in limited cases. Sixteen operative cases with leadpoints among 2,889 cases of childhood intussusecption treated at the surgical departments of the affiliated hospitals of Catholic University over 19 years are reviewed. The approximate incidence of pathological lesions as the leading point was 0.6%. The male to female ratio was 2:1. The mean age was 3.5 years. There was not an age preponderance. The symptoms were vomiting (63%), abdominal pain (38%), irritability (38%), bloody stools (25%), fever (25%) and abdominal mass (6%). The average duration of the symptoms was 2.4 days (1-10days). The most common lesion was Meckel's diverticulum, followed by malignant lymphomas, polyps, ectopic pancreas, and cecal duplication. An ileocolic type was most frequent, followed by ileoileocolic and ileoileal. Segmental resection or wedge resection of the ileum was done in 10 cases, ileocecectomy in 3, and right hemicolectomy in 3. Surgical reduction was done only in an ectopic pancreas, with no later recurrence. The average hospital stay was 10 days. Postoperative adhesive ileus occurred in two cases, and in one of them adhesiolysis was performed. One case of malignant lymphoma died at 28 days after surgery due to chemotherapy related complication.