The effect of Korean traditional alternative medicine products on thyroid function level in post-total thyroidectomy patients: A pilot study

PURPOSE: Although many Koreans consume traditional alternative remedial products to alleviate symptoms of fatigue, there have been no studies on their effect on thyroid function levels in thyroidectomized patients on levothyroxine replacement. The aim of this study was to assess the effect of Korean traditional alternative remedies on thyroid function levels in post total thyroidectomy patients.METHODS: A retrospective review of medical records from a single tertiary referral center was performed on patients who received total thyroidectomy from 2010 to 2015 and became euthyroid postoperatively. Gender, age, body mass index, preoperative thyroid function test results, interval to first hypothyroidism occurrence, recurrence of hypothyroidism, number and types of alternative remedy were evaluated.RESULTS: Postoperative hypothyroidism occurred among 174 out of 917 patients (18.9%) and 100 (57.5%) of them had a history of alternative medication usage. The first episode of hypothyroidism occurred at median of 38.5 months after operation in the 100 patients. Six of the 100 patients received an increased dosage of levothyroxine due to severe hypothyroidism but the rest received the same dose and were requested not to consume alternative products. All patients recovered to euthyroid status afterwards. Thirty-three patients subsequently experienced recurrence even after being restricted from consuming alternative remedial products. Apart from thyroiditis on pathology reports (P=0.001), there were no variables significantly related to the recurrent hypothyroidism.CONCLUSION: This pilot study demonstrated the possible role of consumption patterns of traditional alternative remedial products in thyroidectomized patients under hormone supplement in restoring euthyroid status without levothyroxine increase.

Prognostic Value of p53 and Cyclin D1 in Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: P53 and cyclin D1 have been evaluated as a prognostic marker in papillary thyroid carcinoma (PTC). However, the relationship between p53/cyclin D1 and PTC prognosis has not yet been confirmed. Therefore, we investigated the relationship between p53/cyclin D1 and PTC prognostic factors. METHODS: 919 patients with PTC were enrolled. Immunohistochemistry slides were reviewed for p53 and cyclin D1 immunoreactivity. Patients were classified into two groups according to the p53 and cyclin D1 grade: negative for 5%. Medical records were reviewed to evaluate the prognostic factors, lymph node metastatic ratio (LNMR), and MACIS score. We analyzed patients based on p53/cyclin D1(-/-), p53/cyclin D1(-/+), p53/cyclin D1(+/-), p53/cyclin D1(+/+) separately for evaluation of independent effect of p53 and cyclin D1. RESULTS: Mean age of the patients was 49.73 years (range 15~87), and tumor size was 1.19 cm (range 0.1~5.0). P53 was positive in 809 (88.0%) and cyclin D1 was positive in 748 (81.4%). Positivity of p53 and cyclin D1 were correlated (r=0.448). There was no statistical significance in MACIS score. Positivity of p53 and cyclin D1 were related with larger tumor size, older age, early T stage, more tumor capsulation, and female. LNMR was higher in p53/cyclin D1(+/-) than p53/cyclin D1(-/-) (P=0.036), p53/cyclin D1(-/+) than p53/cyclin D1(-/-) (P=0.034), and p53/cyclin D1(+/+) than p53/cyclin D1(-/-) (P=0.007). CONCLUSION: There was no consistent relationship between p53/cyclin D1 and worse prognostic factors of PTC. However, LNMR was higher in p53(+) and cyclin D1(+) cases independently, much more in p53/cyclin D1(+/+) than p53/cyclin D1(-/-).

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy / 대한내분비외과학회지

On ultrasonography, medullary thyroid carcinoma (MTC) shows hypoechogenicity, an irregular margin, a predominantly solid composition, and microcalcifications, similar to those observed in papillary thyroid carcinoma (PTC). MTC presenting as a cystic lesion is rare, and endoscopic thyroidectomy can be performed for benign thyroid masses and early stage PTC, however it is inappropriate for MTC regardless of cystic change. The authors report a case of cystic MTC found after endoscopic thyroid lobectomy and provide a review of the literature on this topic.

A Method for Generate a Mouse Model of Stroke: Evaluation of Parameters for Blood Flow, Behavior, and Survival

Stroke is one of the common causes of death and disability. Despite extensive efforts in stroke research, therapeutic options for improving the functional recovery remain limited in clinical practice. Experimental stroke models using genetically modified mice could aid in unraveling the complex pathophysiology triggered by ischemic brain injury. Here, we optimized the procedure for generating mouse stroke model using an intraluminal suture in the middle cerebral artery and verified the blockage of blood flow using indocyanine green coupled with near infra-red radiation. The first week after the ischemic injury was critical for survivability. The survival rate of 11% in mice without any treatment but increased to 60% on administering prophylactic antibiotics. During this period, mice showed severe functional impairment but recovered spontaneously starting from the second week onward. Among the various behavioral tests, the pole tests and neurological severity score tests remained reliable up to 4 weeks after ischemia, whereas the rotarod and corner tests became less sensitive for assessing the severity of ischemic injury with time. Further, loss of body weight was also observed for up 4 weeks after ischemia induction. In conclusion, we have developed an improved approach which allows us to investigate the role of the cell death-related genes in the disease progression using genetically modified mice and to evaluate the modes of action of candidate drugs.

Simultaneous deletion of floxed genes mediated by CaMKIIalpha-Cre in the brain and in male germ cells: application to conditional and conventional disruption of Goalpha

The Cre/LoxP system is a well-established approach to spatially and temporally control genetic inactivation. The calcium/calmodulin-dependent protein kinase II alpha subunit (CaMKIIalpha) promoter limits expression to specific regions of the forebrain and thus has been utilized for the brain-specific inactivation of the genes. Here, we show that CaMKIIalpha-Cre can be utilized for simultaneous inactivation of genes in the adult brain and in male germ cells. Double transgenic Rosa26(+/stop-lacZ)::CaMKIIalpha-Cre(+/Cre) mice generated by crossing CaMKIIalpha-Cre(+/Cre) mice with floxed ROSA26 lacZ reporter (Rosa26(+/stop-lacZ)) mice exhibited lacZ expression in the brain and testis. When these mice were mated to wild-type females, about 27% of the offspring were whole body blue by X-gal staining without inheriting the Cre transgene. These results indicate that recombination can occur in the germ cells of male Rosa26(+/stop-lacZ)::CaMKIIalpha-Cre(+/Cre) mice. Similarly, when double transgenic Gnao(+/f)::CaMKIIalpha-Cre(+/Cre) mice carrying a floxed Go-alpha gene (Gnao(f/f)) were backcrossed to wild-type females, approximately 22% of the offspring carried the disrupted allele (Gnao(Delta)) without inheriting the Cre transgene. The Gnao(Delta/Delta) mice closely resembled conventional Go-alpha knockout mice (Gnao(-/-)) with respect to impairment of their behavior. Thus, we conclude that CaMKIIalpha-Cre mice afford recombination for both tissue- and time-controlled inactivation of floxed target genes in the brain and for their permanent disruption. This work also emphasizes that extra caution should be exercised in utilizing CaMKIIalpha-Cre mice as breeding pairs.

The prognosis and treatment of primary thyroid cancer occurred in breast cancer patients: comparison with ordinary thyroid cancer

PURPOSE: Due to the increased prevalence of thyroid cancer, it has been frequently detected in breast cancer patients recently. The aim of this study was to evaluate the clinicopathologic characteristics of thyroid cancer in breast cancer patients with respect to prognosis and treatment. METHODS: From August 1998 to September 2012, 101 breast cancer patients were diagnosed with thyroid cancer (BT group). One hundred ninety-three female patients with a thyroid malignancy that underwent thyroidectomy in 2008 were recruited as controls (oT group). The clinicopathologic results of these two groups were compared. RESULTS: Patients were older (51.40 vs. 47.16, P < 0.001), mean tumor size was smaller (0.96 cm vs. 1.43 cm, P < 0.001), and extrathyroidal extension was less common in the BT group. In both groups, papillary thyroid carcinoma was the most common type of thyroid malignancy. T and N classifications of thyroid cancer were less severe in the BT group, but group TNM stages were similar. Endoscopic thyroid surgery was performed in 12.9% of patients in the BT group and in 6.7% of patients in the oT group. Postoperative radioactive iodine ablation was performed less often in the BT group (P < 0.001). Group recurrence rates were not significantly different. CONCLUSION: Thyroid cancer in breast cancer patients was diagnosed at earlier status than ordinary thyroid cancer. However, the prognosis of thyroid cancer in breast cancer patients was not superior to that in patients with thyroid cancer alone. Radioactive iodine ablation was performed less often and endoscopic surgery could be performed in breast cancer patients.

Surgical Strategy for Papillary Thyroid Microcarcinoma / 대한갑상선학회지

It is generally agreed that papillary thyroid microcarcinoma (PTMC) demonstrates indolent biological behavior. But PTMCs include at least two biologically distinct subpopulations: indolent tumors with minimal or no potential for progression, and tumors with the propensity for aggressive behavior and dissemination. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate clinical management. Risk factors such as tumor size, age, sex, tumor multifocality, vascular or capsular invasion, extrathyroidal extension, lymph node metastases, histological variants of papillary thyroid cancer (PTC), the presence of mutational markers, and incidentalness need to be considered for a risk-adapted algorithmic approach that would hope to achieve minimal morbidity while still anticipating optimal outcomes at less cost to the patient and to society. But risk factors for recurrence have not been confirmed because of such low recurrence rates, rare mortality rate, and several selection (or therapeutic) biases present in any retrospective series. Larger scale cohort studies showed that recurrence rates did not differ statistically between patients treated with unilateral lobectomy and those treated with bilateral resection, so long as complete tumor resection was achieved. Similarly, more aggressive nodal dissection failed to yield the anticipated reduction in recurrence rates. In conclusion, selection of the minority of PTMC who deserves more aggressive surgery is important, reserving less aggressive treatments for the other, the large majority cases. The ability to stratify those relatively few patients with aggressive PTMC from the vast majority who are low-risk is crucial to offer most appropriate surgical strategy.

Erratum: A Method for Generating Mouse Model of Stroke: Evaluation of Parameters for Blood Flow, Behavior, and Survival

We correct a typo in the title.

The pattern and significance of the calcifications of papillary thyroid microcarcinoma presented in preoperative neck ultrasonography

PURPOSE: To analyze the incidence and patterns of calcification of papillary thyroid microcarcinoma (PTMC) on neck ultrasonography (NUS) and assess the clinical implications of calcification, especially for neck node metastasis. METHODS: The clinical data of 379 patients with PTMC who underwent thyroidectomy between January and December 2011 were retrospectively analyzed. PTMC lesions were classified into four subgroups according to their calcification patterns on preoperative NUS: microcalcification, macrocalcification, rim calcification, and noncalcification. The clinicopathologic characteristics were compared between the patients with and without calcification, and among the four subgroups. RESULTS: Calcifications were detected on NUS in 203 patients (53.5%) and central neck node metastasis was observed in 119 patients (31.3%). Calcification was associated with larger tumor size (0.68 cm vs. 0.54 cm), higher rate of lymph node metastasis (38.6% vs. 23.2%) and higher lymph node ratio (0.11 vs. 0.06) compared to noncalcification (All P < 0.05). In addition, the extent of calcification correlated with lesion size (0.67 cm vs. 0.69 cm vs. 0.85 cm). Further, the likelihood of lymph node metastasis also correlated with the extent of calcification in the order of non-, micro- and macrocalcification (23.3%, 36.8%, and 44.1%, respectively). The calcification rate was higher in patients with lymph node metastasis than those without it (65.5% vs.47.7%) (All P < 0.05). CONCLUSION: PTMC patients positive for calcification on NUS had a higher rate of lymph node metastasis, and a higher lymph node ratio compared to noncalcification patients. Calcification patterns should be assessed carefully in patients with PTMC by preoperative NUS.

Clinical Characteristics for Early Recovery from Temporary Hypoparathyroidism in Patients Undergoing Total Thyroidectomy / 대한내분비외과학회지

PURPOSE: Several reports have examined the predictors of temporary hypoparathyroidism after total thyroidectomy; however, few have assessed the clinical predictors of early recovery from the condition. Here, we compared the clinical factors of early and late recovery groups of patients with temporary hypoparathyroidism. METHODS: The electronic medical records of 248 patients who underwent total thyroidectomy from January 2012 to July 2013 and had parathyroid hormone (PTH) levels <10 pg/mL on the first postoperative day were examined retrospectively. The early recovery group showed recovery from PTH at two weeks postoperatively and the late recovery group showed recovery from PTH at one month postoperatively. RESULTS: The early recovery group included a lower proportion of males (8.6% vs. 23.7%, P<0.01) and a higher proportion of patients with more than three parathyroid glands saved (83.8% vs. 76.8%, P<0.04). There were no significant differences in the other variables examined. CONCLUSION: The early recovery group of patients with temporary hypoparathyroidism included a lower proportion of males and a higher proportion of patients with more than three parathyroid glands saved intraoperatively. These findings can be used as clinical indicators when discharge medication is prescribed.

Comparative Analysis of Three Lobectomy Methods for Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: The current study examined the validity and outcomes of three lobectomy methods for papillary thyroid carcinoma (PTC), open surgery, minimally invasive videoassisted thyroidectomy (MIVAT), and endoscopic surgery. METHODS: Between January 2006 and June 2011, 360 patients underwent lobectomy for treatment of PTC. Clinical data were collected and analyzed retrospectively. Open lobectomy, MIVAT, and endoscopic lobectomy were performed in 170 (47.2%, Group A), 81 (22.5%, Group B), and 109 patients (30.3%, Group C), respectively. Median tumor size was 0.5 cm. RESULTS: No significant differences in tumor size, lymphovascular invasion, extrathyroidal extension, and metastatic lymph node number were observed among the groups. However, the mean number of retrieved central lymph nodes was higher in the open surgery group than in the other groups (8.9, 4.9, and 5.8 in Groups A, B, and C, respectively P<0.05). Postoperative bleeding occurred in one patient each in Group A. Temporary hypoparathyroidism developed in ten, three, and three patients in Groups A, B, and C, respectively. Recurrence occurred in five cases (1.4%), however, no significant difference in short-term recurrence (median duration of follow up: 1,109 days) was observed among the three groups. CONCLUSION: The number of retrieved central lymph nodes was higher in the open surgery group. However, no differences in the incidence of complications or short-term recurrence were observed among the groups, indicating that either one of these methods can be recommended as limited surgery for PTC.

Assessment of Postoperative Scar Using Modified Vancouver Scar Scale of 283 Patients Who Underwent Open Thyroidectomy in a Single Institution / 대한내분비외과학회지

PURPOSE: The postoperative scar of open thyroidectomy is one of the clinical issues in patients diagnosed with thyroid disease. The aim of this study was to analyze postoperative scars in patients who underwent thyroidectomy based on the Modified Vancouver Scar Scale and to find factors for use in predicting formation of hypertrophied scars and keloids. METHODS: Clinical data from 283 patients who underwent thyroidectomy were collected randomly and analyzed retrospectively. All postoperative scars were classified according to five categories; excellent, good, moderate, hypertrophied, and keloid, using the Modified Vancouver Scar Scale according to the assessment of pliability, height of the scar, vascularity, and pigmentation. For analysis, hypertrophied and keloid were classified as bad status and others were classified as good status. RESULTS: According to our results, 84.8% of scars were classified as good status and 15.2% of scars were classified as bad status. Forty percent of patients who were in their twenties, 17.8% of patients who were in their thirties, and 22.1% of patients who were in their forties showed bad status; 92.9% of patients who were in their fifties and 89.2% of patients who were in their sixties showed good status (P=0.003). The only statistically significant factor influencing the scar status was the weight of the thyroid (P=0.022). CONCLUSION: Postoperative scars from thyroid surgery were evaluated using the Modified Vancouver Scar Scale. Age was the most important factor in formation of hypertrophied and keloid scar and the weight of the excised thyroid also influenced the scar status. Preoperative prediction of the status of the scar might be possible considering the age and size of the thyroid gland.

Retrovirus-mediated transduction of a cytosine deaminase gene preserves the stemness of mesenchymal stem cells

Human mesenchymal stem cells (MSCs) have emerged as attractive cellular vehicles to deliver therapeutic genes for ex-vivo therapy of diverse diseases; this is, in part, because they have the capability to migrate into tumor or lesion sites. Previously, we showed that MSCs could be utilized to deliver a bacterial cytosine deaminase (CD) suicide gene to brain tumors. Here we assessed whether transduction with a retroviral vector encoding CD gene altered the stem cell property of MSCs. MSCs were transduced at passage 1 and cultivated up to passage 11. We found that proliferation and differentiation potentials, chromosomal stability and surface antigenicity of MSCs were not altered by retroviral transduction. The results indicate that retroviral vectors can be safely utilized for delivery of suicide genes to MSCs for ex-vivo therapy. We also found that a single retroviral transduction was sufficient for sustainable expression up to passage 10. The persistent expression of the transduced gene indicates that transduced MSCs provide a tractable and manageable approach for potential use in allogeneic transplantation.

The Utility of Clinical Findings Including Serum TSH and Neck Ultrasonography for Predicting Thyroid Malignancy in Atypia of Undetermined Significance/Follicular Lesions of Undetermined Significance / 대한내분비외과학회지

PURPOSE: Neck ultrasonography (NUS) is one of the most commonly used methods for evaluating thyroid nodules and preoperative higher TSH levels are known to be associated with differentiated thyroid cancers. This study was conducted to assess whether serum TSH levels and neck ultrasonography are of value in predicting malignancy in patients with atypia of undetermined significance/follicular lesions of undetermined significance (AUS). METHODS: A total of 62 patients (7 men, 55 women; mean age 48.4±11.9 years) who had indeterminate cytologic results indicating AUS underwent thyroidectomy. Preoperative clinical data including serum TSH and the findings of NUS were analyzed retrospectively between malignant and non-malignant groups. RESULTS: The final pathologic results of malignancy were reported in 53 of 62 (85.5%) patients with AUS. There was no significant difference in the mean value of preoperative serum TSH between malignant and non-malignant groups (1.5±1.3 vs. 1.9±1.2, P=NS). In NUS, the patients diagnosed with malignancy in histology showed a higher proportion of calcification, taller-than-wide shape, hypoechoic texture and irregular margin (58.5% vs. 22.2%, P=0.044; 34% vs. 0%, P=0.038; 98.1% vs. 44.4%, P<0.01; 47.2% vs. 0%, P=0.008). CONCLUSION: Serum TSH was not related to malignancy in thyroid nodules showing AUS. However, ultrasonographic features including calcifications, taller-than-wide shape, hypoechoic pattern and irregular margin could be used to predict malignancy. Ultrasonography should be the first useful methods when making decisions regarding management of thyroid nodules showing indeterminate cytologic results as AUS.

Significance of Surgical Treatment for Toxic Thyroid Nodule / 대한내분비외과학회지

PURPOSE: Autonomous hyperfunctioning thyroid nodules produce thyroid hormone independently of TSH. Of these, toxic thyroid nodules provoke hyperthyroidism and can be treated by surgery or radioactive iodine therapy. The aim of this study was evaluating the role of each treatment method in Korean patients with toxic thyroid nodule. METHODS: From July 2008 to June 2013, 10 patients were diagnosed with toxic thyroid nodule. We diagnosed toxic thyroid nodule by thyroid function test and thyroid scan. Thyroid function test showed hyperthyroidism. Hot nodule and suppressed uptake surrounding thyroid tissue was observed on thyroid scan. We analyzed medical records of 10 patients retrospectively. RESULTS: 9 patients were women and 1 patient was man. Median follow-up duration was 22 months. Most common symptom was neck mass (80%) and the median tumor size was 2.66 cm. 99mTc uptake increased by 6.41% on thyroid scan. All 10 patients refused radioactive iodine therapy and 3 of these denied even operation. In 7 patients underwent thyroidectomy, 4 patients were proved having thyroid malignancy (3 papillary thyroid carcinomas and 1 follicular thyroid carcinoma). CONCLUSION: In Korean patients, toxic thyroid nodule was likely to accompany thyroid malignancy and radioactive iodine therapy is contraindicated in this case. Therefore, we suggested that surgery has to be considered in the first place in treatment of toxic thyroid nodule.

Ankle-brachial blood pressure differences before and during anesthesia

BACKGROUND: In surgeries involving the upper extremities and breast, the blood pressure is frequently measured at the ankles. As the blood pressure is used as a pain indicator in the full surgical anesthesia, the ankle blood pressure higher than the brachial blood pressure may be misinterpreted by the anesthesiologist, in determining the depth of the anesthesia. This paper investigated whether the ankle blood pressure is significantly higher than the brachial blood pressure before the anesthesia induction, during induction, and after tracheal intubation. METHODS: Two hundred seventeen patients requiring general anesthesia for elective surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before the anesthesia induction, during induction, and after tracheal intubation. RESULTS: The ankle blood pressure was higher than the brachial blood pressure before induction, during induction, and after tracheal intubation. Ankle-brachial blood pressure differences were significantly higher before induction and after intubation as compared to that during induction. The correlation coefficient between the systolic ankle-brachial blood pressure difference before induction and that after tracheal intubation was 0.623. In 33 child patients with an ankle-brachial blood pressure index > or =1 before induction, there were no significant differences in the ankle-brachial blood pressure during induction. The brachial systolic blood pressure could be predicted by simple and multiple regression equations (R2 = 0.349-0.828). CONCLUSIONS: The results of the study suggest that the anesthesiologists need to consider the ankle-brachial blood pressure differences in monitoring the anesthesia, in cases where the brachial blood pressure cannot be measured during surgery.

Terminology and Classification System of Lateral Neck Node Dissection in Differentiated Thyroid Carcinoma / 대한내분비외과학회지

The standard radical neck dissection, introduced at the turn of the 20th century, became the uniformly-accepted treatment of cervical metastatic disease through the 1960s. Functional or modified radical neck dissection was developed in the 1950s and 1960s. This procedure became the accepted treatment for suitable tumors by the 1970s. Now, the concept of selective neck dissection, removal of only the node levels likely to be involved with tumor, gained acceptance by the late 1980s as a definitive elective, and eventually, therapeutic neck dissection for suitable cases. In response to the increasing variations of neck dissection procedures, a number of classification systems were proposed and subsequently established. The system of the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery was revised in 2002 and 2008. The neck dissections are grouped into four broad categories: radical, modified radical, selective, and extended neck dissection. The Japan Neck Dissection Study Group presented a new system for the classification of neck dissections based on a system of letters and symbols. The system permits a comprehensive and shorthand method of precise designation of neck dissection procedure, but has the disadvantage of departing radically from previously employed systems, by utilizing an entirely new terminology and designation of lymph node groups. In 2011, an international group proposed a classification which conveys precisely the extent of the lymphatic and non-lymphatic structures removed in a neck dissection. So they contended it is logical, simple, and easy to remember, and prevents possible confusion associated with the ambiguous terminology previously mentioned. And they also maintained it allows the recording of neck dissection procedures that cannot be classified under the existing systems. In 2012, the American Thyroid Association proposed the consensus of lateral neck dissection in DTC. They defined again that a selective neck dissection refers to removal of less than all five nodal levels directed by the patterns of lymphatic drainage from the primary tumor while preserving CN XI, IJV, and SCM. And they also insist that selective neck dissection is the most commonly-used neck dissection in the management of lateral neck metastasis for thyroid cancer, and should be reported with a designation of the side and nodal levels and sublevels dissected (i.e. selective neck dissection of levels IIa, III, IV, and Vb). But most classification systems have some limitations and disadvantages to describe the exact procedures of lymphatic and non-lymphatic structure resection. It is a necessary component of a new systemic classification and nomenclature system for neck dissection, not only because the method of describing operative procedures must be unified to allow comparisons of therapeutic methods, but also because of the need to customize therapies individually. A new neck dissection classification system in thyroid cancer has to overcome all these limitations and will facilitate communication around the world with reliable reporting and comparison of outcomes among different surgeons and institutions.

Level V Lymph Node Dissection in PTMC Patients: Is This Necessary? / 대한내분비외과학회지

PURPOSE: Cervical lymphadenectomy is frequently performed in papillary thyroid carcinoma (PTC) patients with lateral node metastasis to improve regional control, but the cervical levels that require dissection remain controversial. We conducted this study to investigate the necessity of the routine dissection of level V in papillary thyroid microcarcinoma (PTMC). METHODS: To identify the relation between PTMC and level V metastases, we analyzed 90 patients who underwent lateral neck dissection (ND). Twenty-five patients underwent lateral ND when metastasis was detected during follow-up, whereas the other 65 patients underwent total thyroidectomy with central and lateral ND at initial surgery. RESULTS: There were 18 PTMC patients and 72 patients with a PTC of >1 cm. Metastasis at level III or IV was detected in 80.0% and 78.9%, respectively, whereas metastasis at level V was only detected in 12.2%, and metastasis at level II occurred in 30%. In PTMC patients, metastatic rates at levels II, III, IV, and V were 11.1%, 61.1%, 61.1%, and 5.6%, respectively, and in patients with a PTC of >1 cm, metastatic rates at levels II, III, IV, and V were 34.7%, 84.7%, 83.3% and 13.9%, respectively. PTMC was not found to be significantly associated with level V metastasis (P=0.452). CONCLUSION: The level V metastatic rate in PTMC was no different from that of PTC>1 cm statistically. However, the metastatic rate was only 5.6% in PTMC. Therefore, we recommend that care be taken when deciding whether to perform level V dissection when dissecting the lateral cervical nodes in PTMC.

Langerhans Cell Histiocytosis in the Thyroid and Draining Lymph Nodes: A Case Report

A 53-year-old woman was presented with several 0.3-0.6 cm-sized nodules within the right lobe of the thyroid. Histologic sections of the thyroid demonstrated multiple papillary microcarcinomas in the background of lymphocytic thyroiditis, with a small focus of Langerhans cell histiocytosis (LCH). Small LCH nodules were also found in the draining cervical lymph nodes. Although the association of LCH with papillary thyroid carcinoma in the thyroid has been reported, their co-existence with LCH in the draining lymph nodes is very rare.

Ankle-brachial blood pressure differences in the beach-chair position of the shoulder surgery / 대한마취과학회지

BACKGROUND: During shoulder surgery, blood pressure is frequently measured at the ankle. Anesthetic complications may result when ankle blood pressure is higher than brachial blood pressure and anesthesiologists misinterpret ankle blood pressure as brachial blood pressure. Therefore, we investigated whether ankle blood pressure is significantly higher than brachial blood pressure before anesthesia induction, during induction, after tracheal intubation, before beach chair position, and in the beach chair position. METHODS: Thirty patients requiring general anesthesia for shoulder surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before induction, during induction, after intubation, before beach chair position, and in the beach chair position. RESULTS: Ankle blood pressure was higher than brachial blood pressure before induction, during induction, after intubation, before beach chair position, and in the beach chair position. Ankle-brachial blood pressure differences in the beach chair condition were much higher than in four other conditions. The correlation coefficient between mean ankle-brachial blood pressure differences before the beach chair position and mean ankle-brachial blood pressure differences in the beach chair position was 0.616. Brachial systolic blood pressure could be predicted by regression equations (R2 = 0.306-0.771). CONCLUSIONS: These results suggest that anesthesiologists should consider these ankle-brachial blood pressure differences when monitoring anesthesia in the beach chair position.