The effect of Tamoxifen on Patients with Gynecomastia

PURPOSE@#Gynecomastia is the most common cause of male breast enlargement and is a disease which can occur in men of all ages. The purpose of this study was to evaluate the effect of tamoxifen on size reduction of breast tissue in gynecomastia patients, regardless of age and symptoms. We also, aimed to investigate the advantages and disadvantages of tamoxifen compared to surgery and other medications.@*METHODS@#Twenty patients diagnosed with gynecomastia at the Breast and Thyroid Surgery Department, of Wonkwang University Hospital from January 2013 to February 2019 were included. All patients received tamoxifen 20 mg once a day or 10 mg twice a day; two months of treatment was planned, and medication was administered. The diameter and depth of the gynecomastia tissue were followed up with breast ultrasound before and after treatment. A survey of age, nationality, location, symptoms, duration of symptoms, previous history, and causes was also conducted.@*RESULTS@#Breast tissue size was measured by ultrasound when the gynecomastia patients first visited and after using tamoxifen. As a result, mean diameter decreased by 41.9%, mean thickness decreased by 41.0%, and estimated mean volume decreased by 74.3%, except for one patient with recurrence. No side effects of tamoxifen were found in this study.@*CONCLUSION@#Since tamoxifen treatment has few side effects and recurrence is rarely reported at the time of discontinuation, it is a good primary treatment. But secondary treatment should be considered if there is no subsequent reaction. Surgical treatment may also be considered for gynecomastia patients with Tanner's breast stage higher than 4, or who want an immediate reduction in breast size.

Technical Feasibility and Cosmetic Superiority of Far Lateral Approach Using Natural Skin Fold of Lateral Neck for Thyroidectomy / 대한내분비외과학회지

PURPOSE: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems. Therefore, several approaches in thyroid surgery have been developed to avoid large scars on the anterior neck. Since the first report of endoscopic subtotal parathyroidectomy, various endoscopic approaches have been reported. However, to be able to perform these procedures using endoscopic instruments in a skillful manner, sufficient training time and effort is required. We assessed the feasibility and cosmetic benefit of the far lateral neck approach using natural skin fold thyroidectomy. METHODS: From July 2011 to February 2014, 123 patients underwent thyroidectomy via far lateral neck approach by one surgeon. An approximately 5 to 6 cm incision was created on the natural skin fold at the far lateral neck, so that the scar can be completely hidden by a V-shaped collar shirt. Thyroidectomy was performed using a Harmonic scalpel(R) and conventional tie technique. RESULTS: The mean operation time was 89.6+/-18.4 min for benign tumors and 79.1+/-30.1 min for malignant tumors. The number of retrieved lymph nodes (mean) was 5.4+/-3.5 in the central neck compartment dissection group, and 26.9+/-13.1 in the lateral neck lymph node dissection group. The 3, 6, and 12 month cosmetic satisfaction score (mean) after the operation was 7.47, 7.68, and 8.81. There were no hypertrophic scars or keloid on the neck. CONCLUSION: Far lateral approach using natural skin fold for thyroidectomy is safe and patients expressed high cosmetic satisfaction. In addition, the technique is suitable for inexperienced surgeons in endoscopic thyroidectomy. It can be a feasible alternative to conventional or endoscopic thyroidectomy.

Robotic Endoscopic Thyroidectomy; Experience with 256 Consecutive Cases in a Single Institution / 대한내분비외과학회지

PURPOSE: Conventional thyroidectomy through a skin crease incision in the anterior neck sometimes causes a visible scar. Minimally invasive surgical techniques have been developed, and, recently, more various techniques of remote access surgery such as endoscopic and robotic thyroidectomy have been suggested and actively applied. Robotic thyroid surgery has several advantages over endoscopic thyroid surgery. These advantages include three-dimensional magnified view, tremor-filtering system, multi-articulated motion, and more comfortable surgeon position, and assistants are unnecessary for performance of the robotic thyroid surgery. METHODS: From November 2008 to July 2014, 256 patients underwent robotic endoscopic thyroidectomies through a transaxillary approach. An approximately 5 cm long incision was created on the axillary natural crease, so that the scar can be completely hidden by the arm. Patients' characteristics, postoperative clinical results, complications, and pathologic details were assessed. RESULTS: The mean age of patients was 40.9+/-10.1 years. For benign tumors, we performed 56 less-than total thyroidectomies. For malignant tumors, we performed 175 less-than total thyroidectomies with central compartment node dissection, 21 total thyroidectomies with central compartment node dissection, and four total thyroidectomies with lateral neck node dissection (Benign=56, Malignant=200). The mean actual operation time (console time) was 91.5+/-48.7 min for benign tumors and 103.0+/-65.8 min for malignant tumors. The number of retrieved lymph nodes was 5.1+/-4.1 (mean) in malignant tumors. Internal jugular vein tearing occurred in two patients. Transient hypocalcemia (four patients) and transient hoarseness (six patients) occurred, but recovered within six months. CONCLUSION: Robotic endoscopic thyroidectomy is technically safe and feasible and also shows excellent cosmetic outcome.

Fenofibrate, a peroxisome proliferator-activated receptor alpha-agonist, blocks lipopolysaccharide-induced inflammatory pathways in mouse liver

BACKGROUNDS/AIMS: During the acute phase response, cytokines induce marked alterations in lipid metabolism including an increase in serum triglyceride levels and a decrease in hepatic fatty acid oxidation, in bile acid synthesis, and in high-density lipoprotein levels. METHODS: Peroxisome proliferator-activated receptors (PPARs: PPARalpha, beta/delta, and gamma) regulate fatty acid metabolism, glucose homeostasis, cell proliferation, differentiation and inflammation. Proinflammatory profiles including tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin-6 (IL-6) are the important pathological factors in inflammatory responses during the pathological progression of the acute phase response. Lipopolysaccarides (LPS) induced the expression of TNF-alpha, IL-1beta, and IL-6. LPS-induced inflammation decrease the expression of peroxisome proliferator-activated receptor alpha (PPARalpha), PPARbeta/delta, PPARgamma, and coactivators PPARgamma co-activator 1 alpha (PGC-1alpha), PGC-1beta messenger RNA (mRNA) in the liver of Balb/c mouse. In addition, LPS-induced inflammation diminishes the protein level of PPARalpha, PPARbeta/delta, and PPARgamma. Proinflammatory cytokines including TNFalpha, IL-1beta, and IL-6 are the principal reducer of PPARs. However, the knockout mouse model against TNFalpha and IL-6 does not block decrease of PPARs in serum and liver. The mice were pretreated with fenofibrate at 100 mg/kg for 2 days. RESULTS: These treatment protocols increased the amount of PPARs mRNA in the liver. Fenofibrate inhibited LPS-induced TNF-alpha, IL-1beta, and IL-6 production in the serum and liver. Similar results were obtained when human hepatoma HepG2 cells exposed to LPS were co-incubated with fenofibrate. LPS-treated HepG2 cells decreased expression of IkappaB. Moreover, activation of PPARs abrogated LPS-induced degradation of IkappaB, thus suppressing LPS-induced NF-kappaB activities. CONCLUSIONS: Therefore, fenofibrate decreases the expression and secretion of TNF-alpha, IL-1beta, and IL-6 via the NF-kappaB signaling pathway, thus serving as therapeutic targets to attenuate inflammation that is involved in hepatic pathological progression.

A Prospective Comparison Study of the Two-port and Three Port Techniques for Performing Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: Various methods have evolved for laparoscopic cholecystectomy: the four-port, three-port or two-port methods. Some authors have recently recommended 2 port laparoscopic cholecystectomy as a useful method. We compared the clinical characteristics of the two-port method and the three-port method, and we estimated the usefulness of each method. METHODS: We performed a prospective analysis of 40 patients who underwent laparoscopic cholecystectomy by a single surgeon from September 2008 to January 2009. The two port and 3 port techniques were alternatively done during the study period by one surgeon who had adequate experience with laparoscopic surgery at Wonkwang university hospital. We compared the two groups according to the parameters of the operation time, the intraoperative complications, the conversion rate, the postoperative complications, the postoperative hospital stay, the pain at the trocar sites and the patients' satisfaction. RESULTS: There were significant differences between the two and three port groups in terms of the mean operation time, the conversion rate and the intraoperative events. The mean operation time (2 port; 38.95+/-10 min., 3 port; 23.25+/-5 min.: p<0.01), conversion rate (2 port; 5 cases, 3 port; 0 case: p=0.016) and there were fewer intraoperative events using the three port technique that that of the two port technique (2 port; 14 events, 3 port; 2 events: p<0.01). There were no significant differences of the trocar site pain, the hospital stay and the patients' satisfaction. CONCLUSION: Considering our results, the tree port technique could be regarded as the optimal surgical technique compared to the 2 port technique for performing laparoscopic cholecystectomy, or at least until new instruments for gall bladder traction and new port were not developed.

A New Classification of the Right Portal Vein Using 64 Channel Multi-dectector CT (MDCT)

PURPOSE: Portal branching patterns (ramification) that differ from those previously described are occasionally encountered during liver surgery. We studied the portal vein branching patterns by performing 64 MDCT. METHODS: A total of 100 patients with normal liver underwent MDCT during arterial portography. Next, the 3 dimensional portograms were reconstructed and the portal branching patterns were assessed. RESULTS: In 80 (80%) of the 100 patients we examined, the right anterior portal vein bifurcated into the ventral and dorsal branches. Only 20 percent of the patients showed the classic pattern, that is, bifurcating into the right anterior superior (P8) and right anterior inferior branches (P5). The portal branches in segment 5 showed many variations in their origins and numbers. The portal branches in segment 7 originated from both the right anterior and posterior portal veins, and not just the right posterior portal vein. CONCLUSION: Instead of dividing the right liver into the superior and inferior segments, we proposed that the right liver can be divided into 3 segments, which are designated as the right anterior, middle and posterior segments. In the view of the vascular watershed, the division of the right anterior and posterior sections by using the right hepatic vein might be inaccurate.