Comparison of Voice Outcomes Between Minimally Invasive Open Hemithyroidectomy and Conventional Hemithyroidectomy

Background and Objectives@#Voice change after thyroidectomy is a common complication that affects a patient’s quality of life. In this study, we aimed to compare voice outcomes between minimally invasive open hemithyroidectomy (MIOT) and conventional hemithyroidectomy.Materials and Method We enrolled 215 patients who underwent hemithyroidectomy performed by an experienced surgeon at our institute between June 2017 and December 2021. All patients underwent voice evaluations, including subjective and objective assessments, preoperatively and 2 weeks and 2 months postoperatively. @*Results@#Sixty-one patients underwent MIOT (M group) and 154 patients underwent conventional hemithyroidectomy (C group). There were 50 female (82.0%) and 11 male (18.0%) in the M group, and 129 female (83.8%) and 25 male (16.2%) in the C group. In both groups, the thyroidectomy-related voice questionnaire score increased at 2 weeks and 2 months postoperatively. However, no statistically significant differences were observed between the two groups. Voice parameters were analyzed according to sex. There were some changes in the parameters in both groups. However, no statistically significant differences were observed between the two groups. @*Conclusion@#Our study showed no differences in the acoustic results between MIOT and conventional hemithyroidectomy.

Risk Factors for Local Recurrence in Patients With N1b Papillary Thyroid Carcinoma / 대한이비인후과학회지

Background and Objectives@#Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.Subjects and Method This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS). @*Results@#A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant. @*Conclusion@#PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.

The Effect of N-acetyl cysteine (NAC) loading on the bone formation surrounding sandblastedand large-grit and acid-etched implants in the dog: A pilot study / 대한치과보철학회지

The aim of the present study was to investigate the effects of N-acetyl cysteine (NAC) loading on the bone formation surrounding sandblasted, large-grit and acidetched(SLA) implants. Materials and methods: Implantation of NAC loaded SLA implants (NSI group) and SLA implants (SI group) was performed bilaterally in themandible of 4 adult beagle dogs (each group, n = 8). The animals were sacrificed after a healing period of 3 and 6 weeks, respectively (n = 2 animal each). Dissected blockswere processed for histomorphometrical analysis. Bone to implant contact percentage (BIC%) and bone volume (BV%) were assessed histomorphometrically. Results:BIC% of NAC loaded SLA implants were about 50% higher than that of SLA implants at 3 weeks of bone healing, but not significantly (51.79 vs 35.43%; P=.185). BV% ofNAC loaded SLA implants were significantly higher than that of SLA implants at 3 weeks of bone healing (45.09 vs 37.57 %; P=.044). At 6 weeks of bone healing, BIC%and BV% of two experimental groups were similar (P>.05). Conclusion: Within the limits of the present study, NAC loading have a positive effects on the early bone formationsurrounding SLA implants. So, it might be concluded that NAC loading enhance the osseointegration and shorten the healing time after implantation of the SLAimplants. (J Korean Acad Prosthodont 2020;58:77-85)

Investigation of Floor Surface Finishes for Optimal Slip Resistance Performance

BACKGROUND: Increasing the slip resistance of floor surfaces would be desirable, but there is a lack of evidence on whether traction properties are linearly correlated with the topographic features of the floor surfaces or what scales of surface roughness are required to effectively control the slipperiness of floors. OBJECTIVE: This study expands on earlier findings on the effects of floor surface finishes against slip resistance performance and determines the operative ranges of floor surface roughness for optimal slip resistance controls under different risk levels of walking environments. METHODS: Dynamic friction tests were conducted among three shoes and nine floor specimens under wet and oily environments and compared with a soapy environment. RESULTS: The test results showed the significant effects of floor surface roughness on slip resistance performance against all the lubricated environments. Compared with the floor-type effect, the shoe-type effect on slip resistance performance was insignificant against the highly polluted environments. The study outcomes also indicated that the oily environment required rougher surface finishes than the wet and soapy ones in their lower boundary ranges of floor surface roughness. CONCLUSION: The results of this study with previous findings confirm that floor surface finishes require different levels of surface coarseness for different types of environmental conditions to effectively manage slippery walking environments. Collected data on operative ranges of floor surface roughness seem to be a valuable tool to develop practical design information and standards for floor surface finishes to efficiently prevent pedestrian fall incidents.

The Factors Involved in Bilateral Central Lymph Node Metastasis of Isthmus Papillary Thyroid Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the rate and risk factors involved in bilateral central lymph node metastasis in patients with papillary thyroid cancer (PTC) found in the isthmus and compared them to tumors located in other thyroid regions, using those findings to establish a surgical strategy for treating these tumors. SUBJECTS AND METHOD: We compared the clinical and pathological data of 48 patients with isthmic PTC and 141 patients with PTC found in other thyroid regions, all of whom underwent total thyroidectomy and bilateral central neck dissection. RESULTS: The rates of bilateral central lymph node metastasis were higher in the isthmus group than in the non-isthmus group (29.2% vs. 9.9%; p=0.001). On multivariate analysis, the isthmic location of the tumor was an independent risk factor for bilateral central lymph node metastasis (OR=3.458; p=0.005). But the positional relationship between the tracheal midline and the nodule was not clear in lymph node metastasis in the isthmus group. CONCLUSION: Bilateral central neck dissection should be considered for isthmic PTC regardless of the relation between nodule and tracheal midline because of the high rate of bilateral central lymph node metastasis.

Ectopic ACTH syndrome caused by pulmonary carcinoid tumor mimicking long-standing sclerosing hemangioma

No abstract available.

Assessment of Denosumab in Korean Postmenopausal Women with Osteoporosis: Randomized, Double-Blind, Placebo-Controlled Trial with Open-Label Extension

PURPOSE: The efficacy and safety of denosumab was compared with placebo in Korean postmenopausal women with osteoporosis in this phase III study. MATERIALS AND METHODS: Women aged 60 to 90 years with a T-score of <-2.5 and ≥-4.0 at the lumbar spine or total hip were randomized to a single 60 mg subcutaneous dose of denosumab or placebo for the 6-month double-blind phase. Eligible subjects entered the 6-month open-label extension phase and received a single dose of denosumab 60 mg. RESULTS: Baseline demographics were similar in the 62 denosumab- and 64 placebo-treated subjects who completed the double-blind phase. Treatment favored denosumab over placebo for the primary endpoint {mean percent change from baseline in lumbar spine bone mineral density (BMD) at Month 6 [3.2% (95% confidence interval 2.1%, 4.4%; p<0.0001)]}; and secondary endpoints (mean percent change from baseline in lumbar spine BMD at Month 1, total hip, femoral neck, and trochanter BMD at Months 1 and 6, and median percent change from baseline in bone turnover markers at Months 1, 3, and 6). Endpoint improvements were sustained over 12 months in the open-label extension (n=119). There were no new or unexpected safety signals. CONCLUSION: Denosumab was well tolerated and effective in increasing BMD and decreasing bone turnover markers over a 12-month period in Korean postmenopausal women. The findings of this study demonstrate that denosumab has beneficial effects on the measures of osteoporosis in Korean postmenopausal women.

Vitamin D Repletion in Korean Postmenopausal Women with Osteoporosis

PURPOSE: Up to 71% of South Korean postmenopausal women have vitamin D deficiency {serum 25-hydroxyvitamin D [25(OH) D] level <50 nmol/L}. Data on vitamin D supplementation was collected during the screening phase of an efficacy/safety study of denosumab in Korean postmenopausal women with osteoporosis. This report describes the effect of vitamin D supplementation on repletion to 25(OH)D levels ≥50 nmol/L in Korean postmenopausal women with osteoporosis. MATERIALS AND METHODS: Vitamin D levels of Korean postmenopausal women (60-90 years old) were measured by extracting 25(OH)D2 and 25(OH)D3 from serum samples via protein precipitation and using liquid chromatography with tandem mass spectrometry detection. Calibration curves were constructed from the mass chromatograms to obtain total vitamin D levels. Subjects with serum 25(OH)D levels <50 nmol/L were supplemented with 1000 IU of vitamin D tablets during the 2.5-month-long screening period. Dose, frequency, and duration were determined by the investigator. If repletion was achieved (≥50 nmol/L) on retest, subjects were eligible to be rescreened for study entry. RESULTS: Of 371 subjects screened, 191 (52%) required vitamin D supplementation, and 88% (168 of 191) were successfully repleted. More than half of the subjects (58%) who were successfully repleted received doses of 2000 IU daily. The mean time to successful repletion was 31 days (standard deviation 8.4 days; range 11-48 days). CONCLUSION: Supplementation with daily median doses of 2000 IU vitamin D successfully repleted 88% of Korean postmenopausal women with osteoporosis within 48 days to a serum vitamin D level of 50 nmol/L.

Mandibular implant-supported overdenture using CAD-CAM Konus type attachment: A case report / 대한치과보철학회지

In edentulous mandible, implant supported overdenture was considered as a first treatment option. Konus type attachment supplies rigid support and cross arch stabilization so that more favorable force transmission and distribution can be attained. In the dentistry, computer aided design-computer aided manufacturing (CAD-CAM) system makes it possible to fabricate restorations with high precision and effectiveness. Recently, Palladium-silver (Pd-Ag) alloy which is millable has been developed. This article presents that application of CAD-CAM Konus type attachment can be provide satisfactory stability and function on four-implant supported mandibular overdenture.

Implant-supported maxillary full-arch fixed prosthesis opposing mandibular natural dentition: A clinical report / 대한치과보철학회지

When an implant-supported maxillary full-arch fixed prosthesis is planned for patients with the horizontal and vertical bone resorption induced by periodontal disease, it is necessary to consider the masticatory function, esthetics and phonetics when placing implants. For this reason, thorough clinical and radiological diagnosis is necessary. Extensive bone and soft tissue grafting may be required as well. Since there is no clear guideline for proper number of implants, segment or splinting of substructure and method of retaining prosthesis, these should be considered during diagnostic process. This clinical report describes a patient who has experienced several tooth extractions and periodontal treatment due to severe periodontitis on maxilla and mandible. With bone and soft tissue graft before dental implant placement, the patient have satisfactory result in esthetic and functional aspect with the implant-supported maxillary full-arch fixed prosthesis opposing mandibular natural dentition.

Association of the Preoperative Neutrophil-to-ymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer

BACKGROUND: Several inflammatory biomarkers, especially a high preoperative neutrophil-to-lymphocyte count ratio (NLR) and platelet-to-lymphocyte count ratio (PLR), are known to be indicator of poor prognosis in several cancers. However, very few studies have evaluated the significance of the NLR and PLR in papillary thyroid cancer (PTC). We evaluated the association of the preoperative NLR and PLR with clinicopathological characteristics in patients with PTC. METHODS: This study included 1,066 female patients who underwent total thyroidectomy for PTC. Patients were stratified into 4 quartiles by preoperative NLR and PLR. And the combination of preoperative NLR and PLR was calculated on the basis of data obtained value of tertile as follows: patients with both an elevated PLR and an elevated NLR were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. RESULTS: The preoperative NLR and PLR were significantly lower in patients aged > or =45 years and in patients with Hashimoto's thyroiditis. The PLR was significantly higher in patients with tumor size >1 cm (P=0.021).When the patients were categorized into the aforementioned four groups, the group with the higher preoperative PLR was found to have a significantly increased incidence of lateral lymph node metastasis (LNM) (P=0.018). However, there are no significant association between the combination of preoperative NLR and PLR and prognostic factors in PTC patients. CONCLUSION: These results suggest that a preoperative high PLR were significant associated with lateral LNM in female patients with PTC.

Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study

OBJECTIVE: To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. METHODS: One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. RESULTS: The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale > or =10 and Beck Depression Inventory > or =10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). CONCLUSION: PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression.

Distant subcutaneous recurrence of a parathyroid carcinoma: abnormal uptakes in the 99mTc-sestamibi scan and 18F-FDG PET/CT imaging

We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50-year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc-sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.

Co-Occurrence of Papillary Thyroid Carcinoma and Mucosa-Associated Lymphoid Tissue Lymphoma in a Patient with Long-Standing Hashimoto Thyroiditis

Papillary thyroid carcinoma (PTC) is a common affliction of the thyroid gland, accounting for 70% to 80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland is uncommon. The simultaneous occurrence of both malignancies is extremely rare. We report the case of a patient with both PTC and MALT lymphoma in the setting of Hashimoto thyroiditis. An 81-year-old female patient was first admitted with goiter and hoarseness, which was attributed to an ultrasonographic thyroid nodule. Subsequent fine-needle aspirate, interpreted as suspicious of papillary thyroid cancer, prompted total thyroidectomy. MALT lymphoma was an incidental postsurgical finding, coexisting with PTC in the setting of Hashimoto thyroiditis. Although the development of MALT lymphoma is very rare, patients with longstanding Hashimoto thyroiditis should undergo careful surveillance for both malignancies.

The Diagnosis and Management of Hyperthyroidism Consensus - Report of the Korean Thyroid Association / 대한갑상선학회지

No abstract available.

The Relationship between the Number of Preserved Parathyroid Glands and Clinical Aspects after Total Thyroidectomy and Central Lymph Node Dissection in Papillary Thyroid Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To identify the relation between the preservation status of the parathyroid glands and the risk of hypoparathyroidism after total thyroidectomy and central lymph node dissection in papillary thyroid carcinoma. SUBJECTS AND METHOD: A retrospective review was carried out for the medical records of 63 patients with papillary thyroid carcinoma (PTC), who satisfied our inclusion criteria and received treatment at the Department of Otolaryngology-Head and Neck Surgery, Hospital from May 2010 to December 2011. Patients with PTC who underwent total thyroidectomy with central lymph node dissection (CLND) were included and grouped according to the number of preserved parathyroid glands as follows: Group 1 (with four intact glands), Group 2 (three intact glands), Group 3 (less than two intact glands). The total and ionized serum calcium and intact parathyroid hormone levels of each group were monitored after the surgery. Patients with postoperative symptomatic hypocalcemia were considered to have postoperative hypoparathyroidism and received calcium/vitamin D therapy. The hypoparathyroidism was considered to be permanent when calcium/vitamin D therapy was still required six months after surgery. RESULTS: Out of 63 cases of total thyroidectomy with CLND, 31 (49.2%) showed postoperative hypoparathyroidism as demonstrated by laboratory findings. Permanent hypoparathyroidism, however, was not observed in these cases. The development of hypoparathyroidism was not significantly related with the number of preserved parathyroid glands. CONCLUSION: To prevent postoperative hypoparathyroidism following total thyroidectomy and CLND, at least two parathyroid glands should be preserved in situ with an intact blood supply in order to prevent permanent hypoparathyroidism after the surgery.

A Case of Papillary Thyroid Cancer Recurring as an Esophageal Submucosal Tumor / 전남의대학술지

A 75-year-old woman who underwent a total thyroidectomy for papillary thyroid cancer 7 years previously presented with a palpable neck mass. Computed tomography (CT) showed two metastatic masses on the thyroid bed and another mass that looked benign originating from the esophageal wall. Endoscopic ultrasonography (EUS) showed a hypoechoic mass in the esophageal wall that looked similar to a gastrointestinal stromal tumor. The mass on the esophagus had intense fluorodeoxyglucose (FDG) uptake in positron emission tomography-computed tomography (PET-CT), which suggested the possibility of malignancy. Subsequently, after surgery, the mass in the esophagus was confirmed as a metastasis from the thyroid papillary carcinoma. Here we report this unusual case of papillary thyroid cancer that recurred as an esophageal submucosal tumor.

Relationships between Brachial-Ankle Pulse Wave Velocity and Peripheral Neuropathy in Type 2 Diabetes

BACKGROUND: Brachial-ankle pulse wave velocity (baPWV) is known to be a good surrogate marker of clinical atherosclerosis. Atherosclerosis is a major predictor for developing neuropathy. The goal of this study was to determine the relationship between baPWV and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes. METHODS: A retrospective cross-sectional study was conducted involving 692 patients with type 2 diabetes. The correlation between increased baPWV and DPN, neurological symptoms, and neurological assessment was analyzed. DPN was examined using the total symptom score (TSS), ankle reflexes, the vibration test, and the 10-g monofilament test. DPN was defined as TSS > or =2 and an abnormal neurological assessment. Data were expressed as means+/-standard deviation for normally distributed data and as median (interquartile range) for non-normally distributed data. Independent t-tests or chi-square tests were used to make comparisons between groups, and a multiple logistic regression test was used to evaluate independent predictors of DPN. The Mantel-Haenszel chi-square test was used to adjust for age. RESULTS: Patients with DPN had higher baPWV and systolic blood pressure, and were more likely to be older and female, when compared to the control group. According to univariate analysis of risk factors for DPN, the odds ratio of the baPWV > or =1,600 cm/sec was 1.611 (95% confidence interval [CI], 1.072 to 2.422; P=0.021) and the odds ratio in female was 1.816 (95% CI, 1.195 to 2.760; P=0.005). CONCLUSION: Increased baPWV was significantly correlated with peripheral neuropathy in patients with type 2 diabetes.

Radiation Safety in the Treatment of Patients with Thyroid Disease by 131I / 대한갑상선학회지

Radioactive iodine (131I) therapy is a well established treatment modality for patient with hyperthyroidism and differentiated thyroid cancer after total thyroidectomy. Patients may sometimes need to be hospitalized to reduce radiation exposure of other people and relatives from radioactive patients receiving 131I therapy. This review was prepared to present suggestions and recommendations to health providers with reasoned instructions on radiation safety for patients, their families, caregivers, and the public after 131I therapy. The recommendations should help to ensure compliance and reduce the potential for harmful radiation exposure to others, and also to recognize that required actions may differ when attaining compliance with existing local regulations of other jurisdictions. Most of reported suggestions and recommendations are based on data derived from relevant measurements of radiation exposure, 131I clearance and excretion, and reports of the impact of precautions in limiting radiation exposure. We have quoted many descriptions from American Thyroid Association Guidelines in this review, which was published recently and emphasize the roles of the treating physician and the radiation safety officer in individualizing the precautions for each patient while allowing the referring physician to assist in preparing appropriate and adequate pre- and post-therapy actions. We tried to summarize the reported scientific papers and recommendations to provide general principle of radiation protection and some delicate issues in radiation safety after radioiodine therapy for the thyroid disease, to lower radiation exposure from patients to public and medical.

A Follicular Thyroid Carcinoma Presenting as Single Bone Metastasis to Distal Femur with Pathologic Fracture: a Case Report / 대한갑상선학회지

Follicular carcinomas are the second most common form of thyroid cancer. There are a few cases regarding initial presentation of a patient with distant metastasis leading to the diagnosis of follicular thyroid carcinoma. Most follicular thyroid carcinomas present as asymptomatic thyroid nodules, but the first sign of the disease is occasionally lymph-node metastases or in rare cases lung or bone metastases. Thirteen percentage of patients had distant metastasis at presentation, and bone metastasis constituted the majority. Vertebrae, pelvis, ribs, and femur were common sites of bone metastasis. Thus, case of metastasis to the femur only from follicular thyroid carcinoma is very rare. We recently experienced a case of follicular thyroid carcinoma with metastasis to the femur who presented with bone pain and pathologic fracture. We present this case with a review of the literature.