Fifteen Years or Greater Follow-Up of Pediatric Differentiated Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Thyroid cancer is rare in childhood. Although thyroid cancer is biologically more aggressive in children because of the high incidence of lymph node metastasis and distant metastasis when compared with that of adults, the prognosis is better. This study investigated the prognosis of pediatric differentiated thyroid cancer with 15 years or greater follow-up and we consider the proper treatment of pediatric differentiated thyroid cancer. METHODS: From January, 1979 to December, 1994 during 16 years, 17 patients younger than 17 years old and who underwent thyroid surgery for well differentiated thyroid cancer at the Department of Surgery at Presbyterian Medical Center were retrospectively reviewed by the medical records and they were interviewed by telephone. RESULTS: Total thyroidectomy was performed in 4 patients (23.5%), subtotal thyroidectomy was performed in 10 patients (58.8%) and lobectomy was performed in 3 patients (17.7%). The mean follow-up period was 23.5 years (range: 15~28.2 years) and recurrence was found in 7 cases (41.3%). Five cases (29.5%) showed locoregional recurrence and 2 cases (11.8%) showed distant metastasis. Postoperative radioiodine (¹³¹I) therapy was done in 6 cases (35%) and 6 cases (35%) underwent radioiodine therapy as a therapeutic modality for metastasis. CONCLUSION: The pediatric well differentiated thyroid cancer in this study showed high rates of lymph node metastasis at the time of diagnosis and a high recurrence rate, but the prognosis was good (100% overall survival rate during the follow-up period). Therefore, total thyroidectomy, radical lymph node dissection and postoperative radioiodine therapy are considered the initial patient management. This aggressive therapeutic management can decrease of the recurrence rate and increase the therapeutic effect. A radioiodine scan and thyroglobulin can used for follow-up.

The Use of Extension Tube in Sono-guide FNAC / 대한내분비외과학회지

PURPOSE: Sono-guided FNAC (fine needle aspiration cytology) is a safe and accurate diagnostic procedure for thyroid nodules. We examined the use of an extension tube in FNAC as useful. METHODS: We reviewed 175 cases of patients with thyroid nodules where an extension tube was used in sono-guide FNAC and 153 cases where a syringe holder was used in Jeonju Jesus hospital, from July 2005 to September 2006. RESULTS: For cases with an extension tube, tumor size was smaller than 1 cm (38%), from 1 cm to 2 cm (27%), or larger than 2 cm (35%), with cytology results of benign (73%), intermediate (8%), malignant (7%), or nondiagnostic (12%). In cases with a syringe holder, tumor size was smaller than 1 cm (40%), from 1 cm to 2 cm (40%), or larger than 2 cm (20%), with cytology results of benign (51%), intermediate (4%), malignant (3%), or nondiagnostic (42%). The nondiagnostic percentage in cases where an extension tube was used was lower than in cases using a syringe holder. However, the number of tumors larger than 2 cm was significantly larger in the syringe group than the extension tube group. CONCLUSION: The use of an extension tube or a syringe holder in FNAC produce similar results.

A Case of Crohn's Disease Which is Diagnosed through Acute Sigmoid Colon Obstruction

Crohn's disease is an inflammatory bowel disease like ulcerative colitis. Distinct from ulcerative colitis, Crohn's disease may involve any portion of the alimentary tract from the mouth to the anus. Recently, the incidence of Crohn's disease has been increasing in Korea. The proportion of the colon type is smaller than that of the ileocecal type or the small-bowel type. In the colon, Crohn's disease affects mainly the right side. Relatively, the sigmoid colon is rarely involved. Small-bowel obstruction is the most common complication requiring surgery in Crohn's disease. On the contrary, an obstruction limited to the colon requiring surgery is less common in Crohn's disease. We experienced a case of a severe acute sigmoid colon obstruction with peritonitis. At first, we suspected colon cancer, but after an emergency laparotomy, we diagnosed it as Crohn's disease. Such a situation is rare in Korea, so we hope this case report may provide a good opportunity to reconsider Crohn's disease.