ABSTRACT
PURPOSE: The objectives of this study were to define the prognostic factors of papillary microcarcinoma of the thyroid (PMCT), to analyse their histopathologic and epidemiologic characteristics and to investigate the optimal therapeutic management. METHODS: Our series included 254 consecutive patents who were affected by PMCT and who were operated on by the same surgeon between 1985 and 2002 among a total of 3,100 patients who underwent thyroid surgery. All the surgical specimens were examined in the same Department of Pathology. The prognostic factors were evaluated by uniand multivariate statistical analyses. RESULTS: The histopathologic characteristics such as vascular extension, infiltration into the adjacent parenchyma, a larger primary tumor (size ≥5 mm) or tumor in the thyroid capsule were all indicative of a poor prognosis. For the patents with poor prognostic factors and who were treated by partial thyroidectomy alone, the prevalence of recurrent disease was higher than that for the patients who were with treated by total thyroidectomy and 131 iodine administration. CONCLUSION: According to the prognostic factors, different therapeutic modalities could be proposed to treat patients with pillary thyroid microcarcinoma. It is reasonable to perform total thyroidectomy and 131 iodine therapy for patients with PMCT and who have high risk factors.
Subject(s)
Humans , Iodine , Pathology , Prevalence , Prognosis , Risk Factors , Thyroid Gland , ThyroidectomyABSTRACT
PURPOSE: Maturation failure after arteriovenous fistula (AVF) creation is a major problem that determines the early success of a fistula for hemodialysis. Therefore the pre-operative evaluation of venous status is widely recommended for obtaining a favorable AVF result. To assess the effectiveness and significance of venography as a pre-operative vein evaluation mode, we compared the short-term and long-term results of AVF according to the performance of pre-operative venography. METHOD: Two hundred forty patients who underwent AVF from March 2002 to May 2004 were enrolled in this study. We performed pre-operative venography on selected patients with equivocal physical findings such as small vein, interrupted venous drainage and arm edema. The clinical manifestations and AVF results such as the early failure rate and patency rate by performance of venography were reviewed retrospectively. RESULT: Pre-operative venography was performed in 86 patients (35.8%). The mean age, proportion of female gender and prevalence of diabetes was significantly higher in the venography group compared to the non-venography group. Among the 86 cases of venography, 53 cases (61.6%) contained one or more abnormal venous findings. Small or turbulent veins at the planned operation site were found in 36 cases (41.9%), thrombosis or sclerotic change of veins were found in 8 cases, disappearance of veins were found in 8 cases and stenosis of the central vein was found in one case. We changed the planned AVFs according to the venography findings in 43 cases (50.0%). For this reason, the proportion of upper fistulas and graft fistula was significantly increased in the venography group. The fistula maturation failure rate in the venography group was 5.8% (5/86), which was significantly lower than that of the non-venography group. The one-year and two-year patency rate of the venography group were 86.8% and 83.5% respectively, which was also significantly higher than those rates of the non-venography group (74.9% and 73.4%, for one-year and two-year patency rate, respectively)(P=0.03). CONCLUSION: The selective application of venography for pre-operative venous mapping is valuable for the selection of the type of AVF, and it produces good results with a superior maturation rate and patency rate.
Subject(s)
Female , Humans , Arm , Arteriovenous Fistula , Constriction, Pathologic , Drainage , Edema , Fistula , Phlebography , Prevalence , Renal Dialysis , Retrospective Studies , Thrombosis , Transplants , VeinsABSTRACT
STUDY DESIGN: This study is a retrospective evaluation of the surgical outcome by the patient satisfaction and Oswestry low back pain questionnaire. OBJECTIVE: The goal of this study was to evaluate the clinical correlations of various factors with the patient's satisfaction and with the surgical results in degenerative spinal stenosis. SUMMARY OF LITERATURE REVIEW: The patients satisfaction and surgical outcome of the degenerative spinal stenosis by the objective method have not been well described in the literature. MATERIAL AND METHODS: Mean follow-up period was 4.8 years after surgery in 114 patients. Outcome was based on subjective disability using Oswestry low back pain questionnaire. Patient satisfaction degree was rated to 'very satisfied(1)', 'somewhat satisfied(2)', 'somewhat dissatisfied(3)' and 'very dissatisfied(4)'. Several factors that might be associated with patient satisfac-tion and outcome were investigated. RESULTS: Of the one hundred and fourteen patients, 84(73.9%) were satisfied to the surgery and mean satisfaction degree was 1.94. Ninety two patients(80.7%) had excellent-to-good results with the mean Oswestry disability score 26.9. There were 7 complications including dural tear in 3 cases, pseudarthrosis in 1 case, dissociation between rod and screw in 1 case, pedicle screw breakage in 1 case and termination of operatin due to massive bleeding during operation in 1 case. CONCLUSION: Clinical results and patient satisfaction were better in the cases with short segments fusion than long segments fusion and the patients with preoperative leg symptom as major symptom had significantly lower Oswestry disability score.
Subject(s)
Humans , Follow-Up Studies , Hemorrhage , Leg , Low Back Pain , Patient Satisfaction , Pseudarthrosis , Surveys and Questionnaires , Retrospective Studies , Spinal StenosisABSTRACT
PURPOSE: The aim of this study was to determine the anatomic proximal tibial posterior slope angle by measuring the true posterior slope angle of the proximal tibia and the meniscal slope angle by MRI. MATERIALS AND METHODS: We measures 102 meniscal and tibial plateau slope angles, including 39 medial and 63 lateral sides. The average age of the patients was 33.3 years (8-66). We measured the meniscal slope angle form MRIs of the patients, with confirmed no pathologic abnormality of the meniscus by arthroscopy. We traced the line between the upper margins of the anterior and posterior horn of the medial and lateral menisci, and the proximal tibial plateau line. The angle between the two lines was considered as the meniscal slope angle. RESULTS: The medial meniscal slope angle between the medial meniscal slope and the medial tibial bony slope averaged 6.2 degrees (2.5-9) and 5.3 degrees (1-15) in the lateral, side, an overall average angle of 5.8 degrees. CONCLUSION: This results suggests that the proximal tibial meniscal slope is less oblique than the usually measured bony slope at about 5.8 degrees. The authors suggest the proximal tibial cutting slope with 5.8 degrees less posterior tilt than bony slope angle.