Internal Jugular Lymph Node Sampling for Papillary Thyroid Carcinoma

PURPOSE: The aim of this study was to evaluate the risk factors for cervical lymph node (LN) metastasis and the clinical role of internal jugular LN (IJLN) sampling in patients with papillary thyroid carcinoma (PTC) and who had a preoperatively undetected cervical LN. METHODS: One-hundred sixty-three patients with PTC (1 cm in diameter) without clinical evidence of cervical LN involvement were entered the study. All patients the received central compartment node dissection (CCND) and IJLN sampling after total thyroidectomy. We retrospectively analyzed the correlation between the metastatic rate of IJLN and the known risk factors for cervical LN metastasis in the PTC patients. The correlation between the status of the central compartment LN and IJLN metastasis was analyzed. RESULTS: The overall metastatic rate of the central compartment LN and the IJLN was 74.8% and 50.3%, respectively. The metastatic rate of the IJLN was significantly associated with the male gender (P=0.046), primary tumor size (>2 cm, P=0.003) and multiplicity (P=0.006) of the PTC. A young patient age, bilaterality and extracapsular invasion did not achieve statistical significance (P>0.05). The presence of central compartment LN metastasis was a statistically significant risk factor for IJLN metastasis, especially when the rate of central compartment LN metastasis was higher than 50% in the individual patients. CONCLUSION: According to our study, male gender, a large tumor size (>2 cm), multiplicity and the presence of central compartment LN metastasis is considered to be important risk factors for IJLN metastasis in PTC patients. IJLN sampling might be proposed as a relevant tool for making the decision to perform lymphadenectomy in PTC patients with a preoperatively undetected cervical LN.

The Effects of Foam Sclerotherapy for the Treatment of Lower Limb Varicose Veins

PURPOSE: To evaluate the effectiveness of foam sclerotherapy, we compared the clinical data and results of foam sclerotherapy with conventional sclerotherapy. METHOD: Ninety-three cases of varicose veins were retrospectively reviewed; these were treated by sclerotherapy from January 2000 to September 2005 (women: 82 cases, men: 12 cases, mean age: 43.7 years old). The enrolled cases were divided into the conventional sclerotherapy (CS) group (n=53) and the foam sclerotherapy (FS) group (n=40) according to the applied technique. We assessed the results with the disappearance scoring scale (DSS) and the satisfaction scoring scale (SSS). RESULT: In DSS, complete disappearance was reported as 28.3% by physicians and 30.2% by the patients in CS group and as 47.5% and 52.5% in the FS group, respectively. On the SSS, a satisfaction score scale above 3 (4: Good, 5: Very good) was reported for 79.1% in the CS group and 90.0% in the FS group, retrospectively. The average amounts of sclerosants used were significantly lower in the FS group (1.2+/-0.4 vials) than in the CS group (2.1+/-0.5 vials)(P=0.001). Post injection complications were retrospectively observed in 16.1% of all the patients, in 20.7% of the CS group and in 10.0% of the FS group. CONCLUSION: Sclerotherapy is a very effective and sufficient treatment for telangiectases or reticular varicose veins. Especially, foam sclerotherapy is more effective than conventional liquid sclerotherapy for the clinical results and the patient satisfaction, and it shows a with lower incidence of complications.

The Effects of Foam Sclerotherapy for the Treatment of Lower Limb Varicose Veins

PURPOSE: To evaluate the effectiveness of foam sclerotherapy, we compared the clinical data and results of foam sclerotherapy with conventional sclerotherapy. METHOD: Ninety-three cases of varicose veins were retrospectively reviewed; these were treated by sclerotherapy from January 2000 to September 2005 (women: 82 cases, men: 12 cases, mean age: 43.7 years old). The enrolled cases were divided into the conventional sclerotherapy (CS) group (n=53) and the foam sclerotherapy (FS) group (n=40) according to the applied technique. We assessed the results with the disappearance scoring scale (DSS) and the satisfaction scoring scale (SSS). RESULT: In DSS, complete disappearance was reported as 28.3% by physicians and 30.2% by the patients in CS group and as 47.5% and 52.5% in the FS group, respectively. On the SSS, a satisfaction score scale above 3 (4: Good, 5: Very good) was reported for 79.1% in the CS group and 90.0% in the FS group, retrospectively. The average amounts of sclerosants used were significantly lower in the FS group (1.2+/-0.4 vials) than in the CS group (2.1+/-0.5 vials)(P=0.001). Post injection complications were retrospectively observed in 16.1% of all the patients, in 20.7% of the CS group and in 10.0% of the FS group. CONCLUSION: Sclerotherapy is a very effective and sufficient treatment for telangiectases or reticular varicose veins. Especially, foam sclerotherapy is more effective than conventional liquid sclerotherapy for the clinical results and the patient satisfaction, and it shows a with lower incidence of complications.

Repeat Hepatectomy of Recurrent Tuberculous Hepatic Abscess

Isolated tuberculous hepatic abscess is rare and surgical treatment is often needed when the size of abscess is large or increasing, when abscess is resistant to antituberculous medication or undergoing secondary change. We report an unusual case of recurrent tuberculous hepatic abscess following surgical resection and antituberculous medication. A 67-year-old woman was admitted due to right upper abdominal pain. She had operation history of segmental resection of the liver due to tuberculous hepatic abscess refractory to antituberculous medication. Preoperative abdominal CT scan demonstrated a enlarging multifocal cystic lesion at segment 8 of the liver in spite of antituberculous medication. Right lobectomy was done and the biopsy revealed caseous necrosis and acid-fast bacilli on microscopic finding. Second- line antituberculous medication was started and no evidence of recurrence was noted.