Analysis of Clinicopathologic Factors Associated with Bilateral Thyroid Micro Papillary Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma is the most common malignant tumor originating from the thyroid. The recent increase in frequency of thyroid ultrasonography is increasing the diagnostic rate of thyroid cancer, especially of the small-sized cancer. The appropriate extent of surgery for thyroid micropapillary carcinoma is still under debate, and bilaterality of the tumor may be an important factor determining the extent. Therefore, this study analyzed the clinicopathologic factors related to tumor bilaterality in order to help decide the extent of treatment. METHODS: Subjects included 134 patients who received total thyroidectomy and central neck lymph node dissection at Wonju Christian Hospital under the diagnosis of thyroid micropapillary cancer from January 1(st), 1994 to December 31(st), 2009. The frequency of bilateral tumor among the subjects were studied, and the relationship between bilaterality and clinicopathologic factors, including patients' gender, age, tumor size, multiple mass in single lobe, capsule invasion, extrathyroidal extension, lymphovascular space invasion, central neck node invasion and lateral neck node invasion was analyzed. RESULTS: There were 32 cases (23.9%) of bilateral tumor. Statistically significant factors related to bilaterality included two or more mass in a single lobe, perithyroidal soft tissue invasion. CONCLUSION: When we plan thyroidectomy for thyroid micropapillary cancer, one cannot rule out the possibility of bilateral thyroid micropapillary cancer in patients with clinicopathologic factors related to bilaterality. Closer preoperative examination is thought to be required for such patients.

Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance / 대한내분비외과학회지

PURPOSE: The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication. METHODS: Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study. RESULTS: According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant. CONCLUSION: A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment.

Traumatic Liver Injury in Pediatric Patients

PURPOSE: Trauma is an important cause of death in children. In particular, the liver is the second most commonly organ injured by blunt abdominal trauma. Treatment of patients with liver injury is has changed, and non-operative treatment is the major treatment method at present. In this study, we reviewed traumatic liver injury in pediatric patients. METHODS: Seventy-seven patients younger than 16 years of age with traumatic liver injury were assessed for 10 years from July 1999 to June 2009 at Wonju Christian hospital. Records of the patients were reviewed retrospectively. Demographic and clinical data were analyzed. RESULTS: The median age was 6 years, and the male-to-female ratio was 1.2 : 1. The most common injury grade was grade I. The majority of injuries were caused by was traffic accidents, and the second most common cause of injuries was falls. Twenty-four patients had liver injuries alone, and the most common accopaning injury was a lung injury. The average hospital stay was 20.7 days, and the average ICU stay was 4.8 days. Four patients died (5.2%). There were 6 patients with under 10 points on the Glasgow coma scale (GCS). Among these patients, three died. All mortality cases had over 16 points on the Injury Severity Score (ISS). Two patients were treated surgically, one of whom died. Of the 75 patients with non-operative management, three died due to associated injuries. CONCLUSION: Most pediatric patients with liver injury have good results with non-operative management. Associated injuries and hemodynamic instability are predictive of patient outcome, and those with isolated liver injuries can be successfully managed non-operatively.

Prognosis and Clinical Outcome of Alcohol Withdrawal Syndrome in Trauma Patients

PURPOSE: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. METHODS: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. RESULTS: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (p<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (p<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (p<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (p<0.783), or in the duration of sedative use (p<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. CONCLUSION: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with postoperative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.

Predicting Factors for Acute Renal Failure Induced by Rhabdomyolysis at the Early Stage of Multiple Trauma

BACKGROUND: Acute renal failure(ARF) is a serious complication of rhabdomyolysis after multiple trauma, and may increase morbidity and mortality. The aim of this study was to elucidate predicting factors for the development of ARF induced by rhabdomyolysis at an early stage of multiple trauma. METHODS: This prospective, observational study was conducted at the emergency department of a level I trauma center. Patients with acute multiple trauma, whose plasma levels of creatine phosphokinase(CPK) were higher than 1,000 IU, were included in this study. We excluded patients with any history of myocardial infarction, stroke, underlying renal disease, and/or infectious disease. We collected clinical and laboratory data including age, heart rate, mean arterial blood pressure, injury severity score, serum myoglobin, lactic dehydrogenase, creatine phosphokinase, and base excess. Collected data were compared between patients who had ARF and patients who did not have ARF. RESULTS: Eighty-eight patients were enrolled in this study. Eighteen patients(20.5%) developed ARF. The injury severity score(ISS)(p=0.001), the base excess(p<0.001), CPK(p=0.003), and myoglobin(p<0.001) were higher in patients with ARF than in patient without ARF. Logistic regression analysis revealed that early predictors for ARF were high ISS, high base excess, high CPK, and high myoglobin. CONCLUSION: We could identify early predicting factors for acute renal failure induced by rhabdomyolysis, these factors included ISS, serum CPK and myoglobin, and base excess in the arterial blood gas analysis performed at the emergency department.

On Fat Embolism Syndrome Occurred in the Recovery Room after an Intramedullary Nailing of Femur Fracture: A case report / 대한마취과학회지

The fat embolism syndrome is a serious and potentially life threatening complication of long bone trauma, blunt trauma and intramedullary manipulation. A 26-year-old woman underwent an intramedullary nailing of the femur under general anesthesia 45 hours after a traffic accident. The operation ended uneventfully and the patient was extubated in the operatirg room. About one hour after the patient arrived at the recovery room, she progressively developed tachycardia, tachypnea, cyanosis and drowsiness. The fat embolism syndrome was suspected because of the above clinical signs, and because pulmonary edema appeared on a simple chest A-P. During six days of intensive treatment in response to the fat embolism syndrome, the patient,s vital signs and ventilatory status progressively improved. The patient was uneventfully discharged from the hospital 19 days after her operation.

Analysis of korean disaster plan with the review of three cases of disasters

No abstract available.

Intrapulmonary shunt and effect of PEEP therapy on pulmonary contusion

No abstract available.

The problems of rural interhospital transfer of injured patients to a referal emergency center

No abstract available.