Clinical Outcome after Clavicular Hook Plate Fixation for Displaced Medial-End Clavicle Fractures

Background@#Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. @*Methods@#We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. @*Results@#The mean operation time was 43.8 minutes (range, 35–50 minutes) and the mean follow-up was 22.8 months (range, 12–42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6–7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6–14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p 0.05). @*Conclusions@#Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.

Breast Tissue Reconstruction Using Polycaprolactone Ball Scaffolds in a Partial Mastectomy Pig Model

BACKGROUND@#Breast cancer patients suffer from lowered quality of life (QoL) after surgery. Breast conservancy surgery (BCS) such as partial mastectomy is being practiced and studied as an alternative to solve this problem. This study confirmed breast tissue reconstruction in a pig model by fabricating a 3-dimensional (3D) printed Polycaprolactone spherical scaffold (PCL ball) to fit the tissue resected after partial mastectomy. @*METHODS@#A 3D printed Polycaprolactone spherical scaffold with a structure that can help adipose tissue regeneration was produced using computer-aided design (CAD). A physical property test was conducted for optimization. In order to enhance biocompatibility, collagen coating was applied and a comparative study was conducted for 3 months in a partial mastectomy pig model. @*RESULTS@#In order to identify adipose tissue and fibroglandular tissue, which mainly constitute breast tissue, the degree of adipose tissue and collagen regeneration was confirmed in a pig model after 3 months. As a result, it was confirmed that a lot of adipose tissue was regenerated in the PCL ball, whereas more collagen was regenerated in the collagen-coated Polycaprolactone spherical scaffold (PCL–COL ball). In addition, as a result of confirming the expression levels of TNF-a and IL-6, it was confirmed that PCL ball showed higher levels than PCL–COL ball. @*CONCLUSION@#Through this study, we were able to confirm the regeneration of adipose tissue through a 3-dimensional structure in a pig model. Studies were conducted on medium and large-sized animal models for the final purpose of clinical use and reconstruction of human breast tissue, and the possibility was confirmed.

Treatment Outcomes at Skeletal Maturity after Calcaneo-Cuboid-Cuneiform Osteotomy for Symptomatic Flatfoot Deformity in Children

Background@#The purpose of this study was to evaluate clinical and radiological outcomes at skeletal maturity after a calcaneo-cuboid-cuneiform osteotomy (triple C osteotomy) for symptomatic flatfoot deformity compared with healthy young adult controls. @*Methods@#Nineteen patients (30 feet) who undergone a triple C osteotomy for idiopathic symptomatic flatfeet from July 2006 to April 2013 were compared with 19 controls (38 feet). Radiographic measurements at preoperative examination, 1-year postoperative follow-up, and follow-up at skeletal maturity were evaluated. Functional outcomes were assessed by using the validated visual analog scale foot and ankle (VAS-FA) and the modified American Orthopaedic Foot and Ankle Surgery (AOFAS) score. @*Results@#In the triple C osteotomy group, 11 of 12 radiographic measurements were significantly improved at 1 year postoperatively and the last follow-up (p 0.05). There were no significant differences in nine of 12 radiographic measurements between the triple C osteotomy group at maturity and the control group (p > 0.05). Average VAS-FA and AOFAS scores were significantly improved at the time of skeletal maturity (p < 0.001). @*Conclusions@#Surgical correction of symptomatic flatfoot deformity in childhood resulted in favorable outcomes after the triple C osteotomy. Deformity correction was also maintained during follow-up at skeletal maturity.

Comparison According to Fusion Level in ACDF Using PEEK Cage Alone for Degenerative Cervical Disease / 대한정형외과학회잡지

PURPOSE: This study examined the clinical efficacy of an anterior cervical discectomy and fusion (ACDF) with PEEK (polyetheretherketone) cage alone with regard to the clinical and radiological outcomes, as well as the risk factors for the cage subsidence. MATERIALS AND METHODS: A total of 128 patients who underwent group A (1-level, n=48), group B (2-levels, n=57), group C (3-levels, n=23) ACDF using a PEEK cage alone were enrolled in this study. The fusion rate, segmental kyphosis were assessed by radiographs. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and Neck Disability Index (NDI). The risk factors for cage subsidence were analyzed according to the difference in incidence between the subsidence group and non-subsidence group. RESULTS: Solid fusion was achieved in 93.8% (45/48), 71.9% (41/57) and 69.6% (15/23) of subjects in group A, B and C, respectively. Segmental kyphosis was observed in 22.9% (11/48), 43.9% (25/57) and 47.8% (11/23) of subjects in group A, B and C, respectively. The VAS scores changed from 7.79+/-1.01 in group A, 7.74+/-1.09 in group B, 7.91+/-0.79 in group C preoperatively to 4.23+/-1.29 in group A, 5.25+/-1.34 in group B and 5.35+/-1.07 in group C at the last follow up. In addition, the NDI was also improved at the last follow up. The VAS score and NDI at the last follow up were similar in the subsidence and non-subsidence group. The 3-level ACDF (p=0.05), osteoporosis (p=0.01), and old age (p=0.01) were the risk factors for cage subsidence. CONCLUSION: Only 1 level ACDF with PEEK cage alone was similar in clinical and radiologic (solid fusion rate, local kyphosis) outcomes compared to ACDF with published other modalities. Old age, 3 fusion level, osteoporosis, and C6-7 fusion were risk factors for the cage subsidence with higher complication rates.

Spontaneous Dissolution of Isolated Superior Mesenteric Vein Thrombosis in Acute Pancreatitis / 대한소화기학회지

Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-year-old man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention.

A Comparison of Outcomes after Acute and Chronic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of a reconstruction with an autogenous hamstring tendon for an acute and chronic anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: We reviewed 71 patients who had undergone an ACL reconstruction with an autogenous hamstring tendon from December 2003 to June 2006. The patients were divided into two groups, reconstruction for an acute injury with 34 knees and reconstruction for a chronic injury with 37 knees. The clinical results were evaluated using the Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test, Pivot shift test, KT-1000 arthrometer, and a Cybex isokinetic test for the strength of the knee flexor and extensor. The presence of associated intra-articular lesions was also investigated. RESULTS: There were no significant differences between the two groups in terms of the stability evaluated by the Lachman test, pivot shift test and KT-1000 arthrometer at the final follow-up (p=0.732, 0.479, 0.078). However, the acute group scored significantly higher with respect to the clinical outcome measured by the Lysholm scores and IKDC rating system at the final follow-up (P=0.042, 0.012). There was a significantly higher incidence of associated intra-articular lesions in the chronic group than those in the acute group (P=0.003). CONCLUSION: A reconstruction for acute ACL injuries showed more satisfactory clinical results and less associated intraarticular lesions than a reconstruction for chronic ACL injuries.

Short-term Results of Two-stage Reimplantation Using Antibiotic-loaded Articulating Cement Spacer in Infected Total Knee Arthroplasty

PURPOSE: We reviewed the short-term clinical results of two-stage reimplantation using antibiotic-loaded articulating cement spacer in infected total knee arthroplasty (TKA). MATERIALS AND METHODS: Nineteen consecutive patients (20 knees) with chronic indolent infection after TKA from July, 2004 were treated by two-stage reimplantation using articulating antibiotic spacer and were followed them with a minimum of 18 months. We assessed infecting organism, response of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level following insertion of antibiotic spacer, elapsed time to reimplantation, and duration of parenteral antibiotics therapy. And we also evaluated clinical results using Hospital for Special Surgery (HSS) score, range of motion (ROM) and reinfection rate. RESULTS: The most common was methicillin-resistant staphylococcus epidermidis (8 patients, 53.3%) among the infecting organisms identified in 15 patients. Average ESR and CRP level were 28.9 mm/hr and 3.0 mg/L, each before reimplantation. The elapsed time to reimplantation was 9.7 weeks and the mean duration of parenteral antibiotics was 5.4 weeks. The ROM before spacer insertion was 72.5degrees, increasing to 103.3degrees and HSS score also improved from 47.8 preoperatively to 88.8 without evidence of reinfection at latest follow-up. CONCLUSION: Two-stage reimplantation using articulating antibiotic spacer in infected TKA is thought to be veryeffective surgical option to achieve excellent clinical results through controlling infection and permitting active joint motion.

Unilateral pulmonary edema during an operation in patient with undiagnosed pheochromocytoma: A case report / 대한마취과학회지

Pheochromocytoma is a rare tumor, but it can cause severe hemodynamic disturbances during anesthesia, and particularly in patients whose pheochromocytoma was not diagnosed preoperatively. We report here on a case of unilateral pulmonary edema during laparoscopic adrenalectomy, and this edema was due to pheochromocytoma that was not diagnosed preoperatively.

The Effect of Combination Therapy with Radiation and Selective Cyclooxygenase-2 Inhibitor on Xenografted Human Oral Cavity Squamous Cell Carcinoma in Nude Mice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is known that tumor cells over-expressing COX-2 have resistance to many anticancer treatments. Among those treatments, along with surgery and chemotherapy, radiation therapy plays a significant role in the treatment of head and neck cancer. However, radiosensitivity of each cancer varies according to cancer types. Especially, the cancer over-expressing COX-2 is reported to have higher radioresistance to radiation therapy. The purpose of this study is to evaluate the effect of selective COX-2 inhibitor when combined with the radiation therapy, and to assess the possibility of clinical application of the selective COX-2 inhibitor for radiation therapy in the head and neck cancer. MATERIALS AND METHOD: The human oral cavity squamous carcinoma cells were cultured and xenografted in 40 athymic nude mice (1 x 10(7), left thigh, subcutaneous injection) and the mice were divided into 4 groups: the control group (10 mice), the radiation therapy group (10 mice, Group A), the Meloxicam injection group (10 mice, Group B), and the combination therapy group with radiation and Meloxicam (10 mice, Group C). The tumor volume was measured on every five days during the treatment and the tumor specimen was taken for immunohistochemical staining when the treatment was finished. The mean tumor volume, the apoptosis index and the proliferation index were measured. RESULTS: In the combination therapy group (Group C), the tumor growth rate was decreased compared to the radiation therapy group (Group A). Also, according to the result of the apoptosis index and the proliferation index measured using immunohistochemical staining, the combination therapy group presented a higher apoptosis index but a lower proliferation index than other groups. CONCLUSION: Meloxicam, selective COX-2 inhibitor, improves the efficacy of the radiation therapy for the human oral cavity squamous carcinoma and this effect was due to apoptosis modulation by selective COX-2 inhibitor.

A Case of Rectal Bleeding Treated by Endoscopic Band Ligation / 대한소화기내시경학회지

Endoscopic band ligation has been a standard therapy in esophageal varix bleeding since it was first introduced in 1980s. However, technical problems have interrupted as a therapeutic management of lower gastrointestinal bleeding. We report a case of successful management of rectal bleeding with endoscopic band ligation in patient with chronic renal failure, who had been managed by hemodialysis since eight months before. Successful control of rectal bleeding was achieved by endoscopic band ligation. Three days later, round and shallow ulcer developed at the ligated site, which was improved at follow-up sigmoidoscopy and bleeding was not observed any more. He was discharged without complications. Herein, we report the band ligation as a useful method in treatment of rectal bleeding.

Isolated Noncompaction of the Ventricular Myocardium : Clinical features and Outcomes

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) can present as heart failure or arrhythmias in a child. It is a rare disorder, characterized by prominent trabecular meshwork and deep intertrabecular recesses. We still know little about the diagnosis, symptoms, and clinical outcomes of INVM. METHODS: We included in our study 6 patients who showed ventricular noncompaction on echocardiography. Patients were diagnosed as INVM were excessively prominent trabeculations with deep intertrabecular recesses were found on echocardiography. Patients who had other complex heart lesions such as pulmonary atresia with intact ventricular septum in addition to ventricular noncompaction, were excluded. RESULTS: Age at presentation ranged from 1 day 7 years, with follow up being as long as 6 years. Symptoms at initial presentation were heart murmur, paroxysmal supraventricular tachycardia, cyanosis, feeding intolerance, ventricular tachycardia, and cardiomegaly at fetal screening. Prominent trabeculations and intertrabecular recesses were observed at left ventricular apex in all six patients. All patients were alive at last follow-up. One patient showed WPW syndrome on electrocardiography. Echocardiography revealed decreased systolic function in 4 patients, and decreased systolic and diastolic function in 1 patient. One patient is currently asymptomatic. CONCLUSION: Six patients were diagnosed with INVM with various symptoms at initial presentation. Echocardiography is the most important tool in the diagnosis of INVM due to its morphological characteristics. INVM can rarely be the cause of long term systolic dysfunction, and early detection by echocardiographic screening may be beneficial.

A Case of Disseminated Mucormycosis after Allogenic Bone Marrow Transplantation / 감염

Disseminated mucormycosis is a rare fungal infectious disease with a high mortality rate and is infrequently diagnosed ante mortem. It is most frequently seen in immunocompromised hosts such as diabetes mellitus, hematologic malignancies, or in the long-term use of steroids or chemotherapeutic agents. Tissue invasion by the hyphae of mucormycosis must be seen microscopically to establish the diagnosis. Treatment consists of correction of the predisposing condition, surgical debridement, and amphotericin-B therapy. A 35-year-old man was admitted through the emergency room due to fever and the right flank pain. He had received an allogenic bone marrow transplantation eight months ago and had been medicated with prednisolone and cyclosporine since the procedure. He was diagnosed with disseminated mucormycosis that involved the spleen, right kidney, and right lung. He is being successfully treated with amphotericin B, flucytosine, and liposomal amphotericin B.

Quantitative Analysis of VCAM-1 mRNA Expression Levels in the Nasal Mucosa of TDI-induced Allergic Rats

Vascular cell adhesion molecule-1 (VCAM-1) has been implicated in selective eosinophil recruitment characterizing allergic inflammation. To understand the events involved in selective eosinophil migration into allergic inflammatory sites, we performed quantitative analysis of VCAM-1 mRNA expression levels in the nasal mucosa of TDI-induced allergic rats. Expression levels of VCAM-1 mRNA from inferior turbinate were examined using competitive PCR in 35 allergic rats and 5 control rats and compared with infiltrated eosinophil counts. Quantity of VCAM-1 mRNA was more increased in allergy group than in the control group, especially in group sacrificed 3 hours to 4 days after provocation. Infiltrating eosinophils were correlated with the expression levels of VCAM-1 mRNA (p<0.01). These results suggest that VCAM-1 plays a predominant role in controlling antigen-induced eosinophil recruitment into the tissue, and that the induction of VCAM-1 expression on the endothelium at the site of allergic inflammation regulates eosinophil recruitment.

Serum Eosinophil Cationic Protein (ECP) in Patients with Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Eosinophil has been reported to play important roles in the pathogenesis of allergic rhinitis as well as in bronchial asthma. This study was performed to evaluate serum ECP levels and draw a correlation with the blood eosinophil, serum total IgE in patients with allergic rhinitis. MATERIALS AND METHODS: The ECP level in serum, blood eosinophil counts, serum total IgE, and symptom scores were measured in 32 patients with allergic rhinitis, 24 patients with non-allergic rhinitis and 20 normal control subjects. RESULTS: The serum ECP concentration was significantly higher in the allergic rhinitis group than in the non-allergic rhinitis and normal control group (p<0.001). The serum ECP concentration was significantly correlated with the peripheral blood eosinophil counts in the allergic rhinitis group (r=0.532, p<0.004) and in the total patients & normal contol (r=0.676, p<0.001). Concentration of the serum ECP was significantly higher in patients with eosinophilia than in those with normal value of the eosiophils (p<0.001). The serum ECP concentration was not correlated with the total serum IgE in allergic rhinitis group. The total symptom scores in patients with allergic rhinitis was not correlated with serum ECP concentrations. CONCLUSION: The results suggest that the level of serum ECP is correlated with the increased activity of eosinophils.

A Case of Alstrom Syndrome / 대한내분비학회지

The Alstrom syndrome is inherited autosomal recessive disorder, characterized by obesity, diabetes mellitus, pigmentary retinal degeneration, normal intelligence, sensorineural hearing loss, baldness, acanthosis nigricans, male hypogonadism, hyperuricemia and hypertriglyceridemia. There is no reported case of Alstrom syndrome in Korea yet. We experienced a 29-year-old female patient with clinical characteristics similar to Alstrom syndrome who was admitted due to poorly controlled diabetes mellitus and diabetic retinopathy with hemorrhage. We report this case with the review of literatures.

Toluene Diisocyanate-Induced Allergic Rhinitis in Guinea Pigs: Investigating the Relation between Eosinophil Infiltration and Epithelial Injury

It is well known that many eosinophils are infiltrated in the bronchial and nasal mucosa of allergic patients, and that eosinophil granule proteins can injure the bronchial epithelium. But it is uncertain whether epithelial injury occurs in the nasal mucosa of patients with allergic rhinitis and, if so, whether the injury is related with the eosinophil infiltration. The present study was made with the aim of determining the correlation between eosinophil infiltration and epithelial injury in the nasal mucosa of guinea pigs with experimentally induced nasal allergy. 2,4-Toluene diisocyanate (TDI) is considered to be a causative agent of allergic pulmonary disorder and allergic rhinitis. Guinea pigs were sensitized by applying TDI onto their bilateral nasal vestibules once a day for five consecutive days. Symptom scores, peripheral blood and histopathology of the nasal mucosa in the inferior turbinate were examined in both allergy and control group. The symptom scores were significantly higher in allergy group than in control group and the eosinophils of peripheral blood were found significantly higher in the allergy groups, especially in groups sacrificed 24 and 48 hour after provocation. As well, there was a positive correlation between how heavily infiltrated the eosinophils were and the level of epithelial loss in the nasal mucosa. The correlation was prominent in groups sacrificed 24 and 48 hour after provocation. The findings indicate that the epithelial injury occurs in the nasal mucosa of guinea pigs with nasal allergy and that injury is related to the eosinophil infiltration.

A Case of Renal Hypertension with Unilateral Renal Artery Stenosis and Contralateral Hypoplastic Kidney

Hypertension may be due to either vascular (renal artery stenosis) or nonvascular (urologic) causes in hypertensives with unilateral small kidneys. Generally, the occurrence of hypertension in association with difference in kidney size suggests the presence of prolonged renal artery stenosis. This condition can result in decreased volume of the poststenotic kidney. Another cause of small kidneys is unilateral renal agenesis, renal dysplasia with or without reflux, tubular obstruction, and hydronephrosis. Hypertension can be attributed to abnormal-sized kidneys. Nephrectomy of the small kidney or correction of the stenotic artery normalizes blood pressure. De Jong and associates reported 8 cases of young women thought to have hypertension caused by unilateral renal parenchymal disease. Renal angiography, however, disclosed significant renal artery stenosis in the contralateral kidney of all 8 patients. Revascularization of the kidney with stenotic lesions cured the hypertension. The data suggests that in patients suspected of having hypertension caused by unilateral renal parenchymal disease, not only should renal venous renins be determined, but nephrectomy should not be peformed as well until renal angiography has been performed to exclude contralateral renal artery stenosis. We report a case of unilateral renal artery stenosis with contralateral hypoplastic kidney in a 22 year old woman; hypertension was corrected by successful anastomosis of the stenotic artery without nephrectomy of the contralateral small kidney.

Transvginal Sonography in the Prediction of Preterm Labor / 대한주산의학회잡지

OBJECTIVE: Preterm labor and delivery is probably the largest problem in modern perinatology. The early diagnosis of preterm labor is crucial for prevention of preterm birth. To predict the onset of preterm labor, we examined the diagnostic performance of serial cervical assessment by transvaginal sonography. METHODS: In this prospective study, we performed transvaginal sonography at approximately 30 and 34 weeks of gestation in women with singleton pregnancies. Cervical parameters evaluated included endocervical length, the presence of funneling, funnel length and funnel width. We then assessed the relation between cervical parameters and the risk of spontaneous preterm labor. RESULTS: We examined 258 women at approximately 30 weeks of gestation and 247 of these women again at approximately 34 weeks. Spontaneous preterm labor occurred in 9 of women examined at 30 weeks(Group 1) and in 13 at 34 weeks(Group 2). The endocervical length was normally distributed at 30 and 34 weeks(mean +/-SD, 38.26+/-6.82mm and 35.63+/-7.35mm, respectively). The endocervical length decreased significantly from 30weeks to 34 weeks(p=0.0001). Both groups showed significantly shorter endocervical length(p <0.05) and groupl more presence of funneling than group of term pregnancy(p<0.05). Receiver-operator characteristic curve and multiple logistic regression analyses indicated that endocervical length <-30mm at 30 weeks and <-25mm at 34 showed highest diagnostic index in predicting the onset of preterm labor(p=0.0001). Conclusions: Serial transvaginal ultrasound assessment of endocervical length during early third trimester is a useful predictor of preterm labor and delivery in low-risk patients.

A Clinical Review of 81 Cases of Total Thyroidectomy

Total thyroidectomy has been used to treat benign or malignant thyroid diseases. However, concern about the postoperative complications after the extensive and aggressive operation makes surgeons reluctant to do total thyroidectomy. Instead, in many cases, less invasive and less complicating subtotal thyroidectomy has replaced it. But total thyroidectomy is required to eradicate bilateral and multiple nodules, diffuse toxic goiter, and thyroid cancer that cannot be cured by subtotal thyroidectomy. To evaluate the effectiveness and complications of total thyroidectomy, we reviewed retrospectively 81 patients who received total thyroidectomy from June 1987 to August 1993 according to the age, sex, clinical symptoms, duration of symptom, diagnoses, operative modalities, pathologies, postoperative complications and thyroid function. The results are as follows: 1) Male to female ratio was 1 to 4.8 (male:14, female:67). The sixth decade included 27 % of patients, and showed the peak incidence. 2) The most common symptom was the palpable mass on the precervical area or in the thyroid (96%). Palpitation (15%) and voice change (12%) were present in descending order. 3) On the duration of symptom, patients' visiting hospital after one to two years occupied the largest portion (26%). Three to four years occupied 19 cases (23%), and cases of more than five years were 17 cases (21%). Masses of 2 to 3 cm in diameter were the most common size (27%) and of 2 to 5 cm occupied more than half(59%). Most of the patients visited the hospital after full-blown of mass or symptoms. 4) Sixty five cases were cancers, and 16 cases were benign diseases. Modified radical neck dissection was done in 7 cases, suspicious of local lymph node invasion during the operation. Radical neck dissection was done in 6 cases with palpable cervial nodes. 5) The order of accuracy of preoperative diagnostic modality was thyroid scan (86%), frozen section (83%), and fine needle aspiration biopsy(80%). These result seemed different compared with the recent diagnostic value of fine needle aspiration biopsy, but might be due to the technique. 6) Pathological classification is composed of differentiated cancer (80%), toxic goiter (16%), nodular goiter (6%), adenomatous goiter (2%), and Hashimoto's thyroiditis (1%). Papillary cancer occupied 92 percent of cancer. Lymph node metastasis showed diffuse distribution according to the mass size. 7) No deaths were reported. The most common complication was hypocalcemia (38%), most of which was transient and 61 per cent of which was symptomatic. It usually persisted less than 7 days, and only 3 cases continued more than 7 days (3.7%). The other complications were hoarseness (19%), bleeding (7%), and the recurrent laryngeal nerve injury(1%). 8) Follow up on the postoperative thyroid function was available on 66 patients (81%). Of those, forty six patients (70%) were euthyroid, 2 (18%) were hypothyroid, and 8 (12%) were hyperthyroid. The cause of the hyperthyroid status after total thyroidectomy might be due to the medication for the thyroid supplementation or to the time of serum measurement shortly after the medication. We think that total thyroidectomy could be done without additional risk compared with subtotal thyroidectomy, if it were done meticulously. We suggest that total thyroidectomy should be considered for the treatment of diffuse thyroid diseases and carcinomas.

Interpretation of Bronchodilator Response inPatients with Obstructive Airway Disease / 결핵

BACKGROUND: Measurement of bronchodilator response is necessary to establish reversibility of airflow obstruction that was helpful to estimate the diagnosis, treatment, and prognosis in obstructive airway disease. An useful index should be able to detect the bronchodilator response more sensitively not related with degree of airflow obstruction and also be independent of initial FEV1. METHOD: Sensitivities of bronchodilator response in each group classified by degree of airflow obstruction in FEV1, FVC, FEF25~75%, Isovolume FEF25~75%, sGaw were studied and correlation coefficients were calculated between initial FEV1 and reversibilities expressed as absolute, %initial, %predicted, %possible in FEV1. RESULT: Sensitivities of bronchodilator response were 61.5% in FVC, Isovolume FEF25~75% and sGaw, in severe group, and 56.3% in Isovolume FEF25~75% and sGaw, in moderate group, and 62.5% in FEV1 and sGaw and 50.0% in FVC and Isovolume FEF25~75%, in mild group, and 60.0% in sGaw and 58.0% in Isovolume FEF25~75% in total patients. Correlation coefficients between initial FEV1(L) and absolute, % initial, % predicted, % possible were 0.15, -0.22(p<0.05), 0.02, 0.24(p<0.05) and correlation coefficients between initial FEV1(% predicted) and absolute, % initial, % predicted, %possible were 0.06, -0.28(p<0.05), 0.08, 0.39(p <0.05). CONCLUSION: Volume related parameters were more sensitive index not related with degree of airway obstruction and the change in FEV1 expressed as % predicted was the least dependent on initial FEV1 and reversibilities, expressed as % initial or as % possible(predicted minus initial FEV1)were correlated with initial FEV1.