The Pattern of Cervical Lymph Node Metastases in Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Cervical lymph node metastases are quite common in papillary thyroid cancer and the spreading route of a metastasis is usually in a sequential fashion. However, skip metastasis is not uncommon in node-positive papillary thyroid cancer. The goal of this study was to evaluate the pattern of cervical lymph node metastases in papillary thyroid cancer. METHODS: A total of the 265 patients with papillary thyroid carcinoma that underwent a total thyroidectomy and cervical lymph node dissection between January 2006 and August 2007 were enrolled in the study. Medical records were reviewed for analyses of the pattern of cervical lymph node metastasis. RESULTS: Cervical lymph node metastases were noted in 39.2% of the total cases and in 27.9% of the 197 patients that had only central lymph node dissection and 48.5% of the 68 patients that had central and lateral lymph node dissections. Among the cases of central and lateral node dissection, skip metastasis, lateral lymph node metastasis without central lymph node metastasis, was observed in 4 (5.8%) of the cases and a false positive result of node dissection was confirmed in 19 (28.1%) cases. CONCLUSION: For complete surgery of papillary thyroid carcinoma, a thorough examination of the cervical lymph node is required. Acareful consideration of the possibility of skip metastasis and false positive results in cervical lymph node dissection, especially in the lateral compartment, is necessary.

Retroperitoneal Hematoma Caused by Ruptured Pancreaticoduodenal Artery Aneurysm

A ruptured aneurysm of the pancreaticoduodenal arteries is an emergency condition, with a high mortality rate. Therefore, early diagnosis and adequate management are needed. Recently, treatment with a transcatheter arterial embolization has decreased the mortality rate. A 68-year-old man presented with persistent abdominal pain and dyspnea. Contrast abdominal computed tomography revealed a large retroperitoneal hematoma, with an actively bleeding focus. An urgent celiac and superior pancreaticoduodenal arteriogram showed a contrast extravasation, about 15 X 8 mm in size, with a saccular aneurysm of the distal anterior superior pancreaticoduodenal artery; therefore transcatheter arterial embolization was performed. The patient's condition improved without complication after the embolization.

Clinicopathological Analysis of Antibiotic Treatment after Appendectomy: A Randomized Prospective Trial

PURPOSE: The optimal antibiotic regimen for appendicitis still remains poorly defined. The aim of this study was to define the optimal duration and route of antibiotics after an appendectomy, with regard to the clinicopathololgical aspects. METHODS: This study was performed on 73 consecutive patients who underwent an appendectomy. Groups A and B, which were composed of cases of simple appendicitis (phlegmonous and suppurative type) and complicated appendicitis (gangrenous and perforated type), respectively. Group A was randomized after the appendectomy into either A1 (n=17), a 1-day course of a combination of IV first generation cephalosporin and tobramycin; or to A2 (n=26), a 3-day course of the same regimen. Group B was randomized into either B1 (n=16), a 3-day course of a combination of IV cephalosporin, tobramycin, and metronidazole, followed by conversion to a 4-day course of a combination of PO third generation cephalosporin and metronidazole; or B2 (n=7), a 7-day course of a combination of IV cephalosporin and metronidazole, along with a 5-day course of tobramycin. The total leukocyte count (WBC), neutrophil count, and C-reactive protein (CRP) were analyzed preoperatively and on POD #3 and #7. An intraoperative culture of the surface of the appendix was also performed. RESULTS: The most common cultured organism was Escherichia coli (n=30). Ampicillin and first generation cephalosporin were 73% and 49% resistant to Gram-negative organisms, respectively. Third generation cephalosporin and imipenem were 100% sensitive. The subjects in group A were all under normal limits in the postoperative laboratory analyses, and had no complication. Groups B1 and B2 showed no significant differences in their WBC (P=0.301), neutrophil count (P=0.730), and complications (P=0.907), with the exception of CRP (P=0.040). CONCLUSION: After the appendectomy, simple appendicitis was treated with antibiotics for 24 hrs, with no complications. For complicated appendicitis, a 3-day IV course, followed by a conversion to 4-day PO antibiotics, was found to be safe. Surveillance of the WBC and neutrophil counts, CRP values, and body temperature permitted safe utilization of this regimen.

Portal Vein and Superior Mesenteric Vein Thrombosis following Cholecystectomy and Choledochostomy

Acute thrombosis of the portal and superior mesenteric vein (SMV) due to inflammation of abdominal organs is a rare condition, but delayed diagnosis causes severe problems and serious long term complications. Therefore the early diagnosis and adequate management of the underlying disease and thrombus is very important. Here a case of an 84-year-old man with portal vein and SMV thrombosis on Doppler ultrasonography and computed tomography (CT) after cholecystectomy and choledochostomy by the 10th day is reported. The patient's condition improved without complication after the treatments with an anticoagulant regimen and antimicrobials. In the follow up, there was no thrombus on the CT or sign of a recurrent disease.