Sonographic Analysis of Malignant Thyroid Nodules by Surgeon / 대한내분비외과학회지

PURPOSE: Ultrasound is most effective study for evaluating thyroid nodules. In this review, we discuss that sonographic findings to differentiate benign from malignant nodules and suggest recommendations for indications of fine needle aspiration biopsy and thyroid nodule management. METHODS: Sonographic scans of 206 thyroid nodules in 164 patients were candidated for this study. We evaluated sonographic findings by shape, calcification, margin, and echogenicity, retrospectively. Sonographic findings that suggested malignancy included microcalcifications, a speculated margin, marked hypoechogenicity and a shape that was taller than wide. The final diagnosis of lesion as benign (n=180) or malignant (n=26) was confirmed by fine needle aspiration biopsy and follow-up (>6 months). We demonstrated the difference of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Of 206 thyroid nodules, 26 were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 84.6%, 73.9%, 31.9%, 97.0% and 75.2%. CONCLUSION: Sonography can be helpful for making the differentiation between and malignant nodules. So, when well trained surgeon find thyroid nodules on sonography, we can make correct diagnosis of malignant nodules.

Colonoscopic Perforations: 4 Years' Experience / 대한소화기내시경학회지

BACKGROUND/AIMS: Many physicians agree that colonoscopy is the best modality for either the diagnostic evaluation or use in therapy for colorectal disease. Although the incidence of perforations that occur after colonoscopy is low, the increasing number of performed colonoscopies may pose a relevant health problem with including the often lethal consequences. This study aimed to determine the frequency of perforation and the management of colonoscopic perforation. Modern Korean society has adopted westernized dietary habits, and this has led to an increased incidence of colorectal disease such as colorectal cancer, polyps and diverticulosis. METHODS: We conducted a retrospective review of the medical records of all the patients who underwent colonoscopy complicated by colon perforation between January 2004 and December 2007. The patients' demographics, the purpose of colonoscopy, the location of the perforation, the management and the outcome were compared. RESULTS: A total of 5254 patients underwent either a diagnostic or therapeutic colonoscopy procedure during four consecutive years at a single institution. Iatrogenic colonoscopic perforations (0.2%) were diagnosed in 11 patients (seven males and four females). Perforations occurred in six patients during a diagnostic colonoscopy and these occurred in five patients during a therapeutic colonoscopy. Free air in the peritoneum or retroperitoneum was seen in all the patients, as depicted on plain X-rays. Seven patients were treated with surgical intervention and four patients were treated with conservative management. One of the 11 patients with a perforation expired on postoperative day 47 due to infective endocarditis. CONCLUSIONS: The rate of iatrogenic colonoscopic perforation is still very low. Although perforation is a very serious complication and it can be a lethal malady, early recognition and treatment are very critical factors to optimize the patient outcome. Although a gold standard therapeutic modality has not been established, the patients who present with the signs and symptoms of generalized peritonitis are recommended to undergo early surgical intervention.

18F-FDG-Avid Adenocarcinoma of the Rectum Presenting as a Subtle Filling Defect on Maximum Intensity Projection Image: Report of a Case / 핵의학분자영상

No abstract available.

A Case of Thoraco-abdominal Penetrating Injury with an Scaffolding Pipe following a Falling

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.

A Case of Thoraco-abdominal Penetrating Injury with an Scaffolding Pipe following a Falling

An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.

A Case of Meconium Hydrocele Presenting as Inguinal Mass in a Female Newborn

Meconium peritonitis results from in-utero perforation of gastrointestinal tract, with subsequent leakage of meconium into the peritoneal cavity. Patent processus vaginalis of male or female fetus may lead to migration of meconium into inguinal canal, and these infants may present meconium filled hydroceles at birth. The predominance of meconium hydrocele in the male infant may be due to the obliteration of processus vaginalis occuring later than in the female fetus. We report a rare case of bilateral meconium hydrocele in the female newborn, which mimic clinical symptoms and ultrasonographic findings of incarcerated hernia.

Abdominal Pregnancy Presenting as Massive Lower Gastrointestinal Bleeding

An ectopic pregnancy in the abdominal organs is very rare. Primary intestinal pregnancy is considered the rarest form of extrauterine pregnancy, and only a few well-documented cases have been reported. Herein, a case of an abdominal pregnancy in a 25-year-old woman, with massive lower gastrointestinal bleeding, is reported. The source of bleeding could not be identified, despite gastroscopy, ultrasonography and angiography investigations. A diagnostic laparotomy disclosed an abdominal pregnancy, causing an erosion of the jejunal wall at the site of the pregnancy, with massive lower gastrointestinal bleeding. An abdominal pregnancy is seldom included in the differential diagnosis of lower gastrointestinal bleeding. The possibility of intestinal erosion in an abdominal pregnancy should be borne in mind in cases of lower gastrointestinal bleeding.

Clinical Study of Perforated Duodenal Ulcer

PURPOSE: There has been considerable controversy about whether acid reduction surgery is a definitive surgical treatment for perforated duodenal ulcer with numerous methods having been described. The controversy has increased with the development of the Proton Pump inhibitor and the discovery of Helicobacter Pylori (HP), because the recurrence and morbidity have been shown to decrease with simple closure followed by a good medical therapy against HP and the ulcer. This study is an evaluation of simple closure as an alternative treatment of perforated duodenal ulcer. METHODS: This retrospective study reviewed the records of 288 patients with surgically-treated ulcer perforation. After 62 patients were excluded, 128 patients treated with simple closure were compared with 98 patients treated with definitive surgery. In the simple closure group, we compared 50 patients treated with Proton Pump inhibitor and 78 patients treated with H2 blocker. Also, the influence of various factors such as age, delayed operation, size of ulcer perforation, operative methods, associated diseases, and complications were analyzed to evaluate recurrence, morbidity and mortality. RESULTS: After mean follow up for 53.7 months, 56.6% of patients treated with simple closure had fewer post operative complications and a lower recurrence rate compared with definitive surgery. The infection rate by HP of 81.6% in our study was similar to that of other studies. Some factors as age (>60), duration of symptoms (>24 hours), size of ulcer perforation (>10 mm), associated disease and operative time showed an influence on the mortality. CONCLUSION: Recent advances in the treatment of perforated peptic ulcer such as the development of the Proton Pump inhibitor and the discovery of HP have shown that after simple closure, an adequate medical treatment of ulcer can effectively decrease the recurrence rate, morbidity and mortality.

Comparison Transilluminated Powered Phlebectomy with the Conventional Surgical Treatment of Primary Varicose Vein of the Lower Limbs

PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer -Comparison with T1 Invasive Ductal Carcinoma- / 한국유방암학회지

PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, P=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, P<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, P<0.001) and estrogen receptor positivity (45.7% vs 59.2%, P=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, P=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, P=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, P<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, P<0.001). There were no significant difference in the cumulative 5-year overall and disease-free survival rates (93.1% vs 90.1%, P=0.78; 89.5% vs 86%, P=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (P=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.

Clinical Significance of Invasive Ductal Carcinoma with Predominant Intraductal Component in Breast Cancer: Comparison with T1 Invasive Ductal Carcinoma

PURPOSE: In the WHO classification of breast carcinoma, invasive ductal carcinoma with predominant intraductal component (IDC with PIC) has been defined as carcinomas in which the component of ductal carcinoma in situ amounts to four times more than the invasive element in area. This study was designed to evaluate the clinicopathological significance of IDC with PIC. METHODS: Five hundred and seventy nine patients with breast cancer (154 IDC with PIC and 425 with T1 invasive ductal carcinomas) treated with mastectomy or breast conserving surgery between 1989 and 1998 at the Asan Medical Center were divided into two study groups (IDC with PIC and T1 IDC) and compared the clinicopathological characteristics and survival of both groups. RESULTS: By comparison with the T1 IDC, the IDC with PIC has several distinct features including younger mean age of occurrence (45.3 years vs 48.3 years, p=0.002), larger mean tumor size (3.5 cm vs 1.6 cm, p<0.001), lower incidence of axillary lymph node metastasis (15.7% vs 31.3%, p<0.001) and estrogen receptor positivity (45.7% vs 59.2%, p=0.03), higher incidence of low histologic grade (78.7% vs 61.7%, p=0.002) and cancer detection rate by screening without symptom (21.6% vs 11.5%, p=0.003) or clinical manifestation of nipple discharge (17.3% vs 4.3%, p<0.001) and microcalcification with or without mass on mammography (58.7% vs 30.2%, p<0.001). There were no significant difference in the cumulative 5-year overall and disease-freesurvival rates (93.1% vs 90.1%, p=0.78; 89.5% vs 86%, p=0.23). In the IDC with PIC group, tumors larger than 2 cm in size were more frequently metastasized to axillary lymph nodes than tumors smaller than 2 cm, but this finding was not significant (p=0.07). CONCLUSION: Invasive ductal carcinoma with predominant intraductal component showed less invasive and more low-grade malignant characteristics than T1 invasive ductal carcinoma. Survival was not statistically different.

Patterns of Locoregional and Systemic Failure after a Mastectomy in Breast Cancer and Risk Factors Predicting Failure

PURPOSE: In spite of improved local control and adjuvant therapy in breast cancer, many patients after a modified radical mastectomy suffer from locoregional or systemic failure. The purpose of this study was to assess both the patterns of failure following a mastectomy and the predictive factors affecting the risks of locoregional or systemic failure. METHODS: The study population consisted of 195 patients who developed locoregional or systemic failure from among 1,187 patients treated by using a modified radical mastectomy between July 1989 and October 1998 at the Asan Medical Center's Breast Clinic. The median follow-up time following the mastectomy was 41 months (range; 1-119 months). RESULTS: Isolated locoregional recurrence (LRR) developed in 46 patients (24%), LRR with distant metastasis in 43 (22%), and only distant metastasis in 106 (54%). The sites of LRR were as follows: the chest wall, 52%; the ipsilateral supraclaviclar node, 22%; and the axillary node, 15%; etc. The first sites of distant metastasis were as follows: bone, 46%; lung, 38%; liver, 12%; brain, 6%; and pleura, 6%; etc. Local or systemic failure appeared within the first 3 years following the mastectomy in 75-82% of the patients, and within 5 years in 95-98%. Multivariate analysis showed that increasing initial tumor size, increasing number of involved nodes, negative progesterone receptor, and increasing histologic grade were significant factors for increased risks of LLR or distant metastasis. CONCLUSION: Half of the locoregional recurrences following a mastectomy are isolated. T-stage, nodal status, progesterone receptor, and histo logic grade may help to identify patients at risk for locoregional or systemic failure after a mastectomy.

A Clinical Study of Hemorrhoids

BACKGROUND: Various surgical techniques are used for the cure of hemorrhoid according to the extent of disease and severity of symptom. Purpose : We compared the postoperative clinical course after submucosal hemorrhoidectomy and ligation and excision of hemorrhoids. MATERIAL AND METHODS: Between February 1995 and May 1997, 221 patients underwent submucosal hemorrhoidectomy and 111 patients underwent ligation and excision of hemorrhoids at the Department of Surgery, Eulji General Hospital. We compared the hospital course and postoperative complications in two group. RESULTS: For submucosal hemorrhoidectomy group, mean operation time was 38 minutes, the improvement of postoperative pain, is based on no needs of analgesics after 48 hours of postoperation, was seen in 115 patients(52.0%), wound healing took 19.5 days in average, and mean hospital stay was 6.4 days. For ligation and excision group, these findings were mean operation time 21 minutes, the improvement of postoperative pain in 47 patients(42.3%), wound healing 25.4 days, and hospital stay 7.2 days. Postoperative complications such as skin tag, edema, and were more common in submucosal hemorrhoidectomy group. But anal fissure, stenosis were more frequent in ligation and excision group, although they did not occur later. CONCLUSION: We think that submucosal hemorrhoidectomy is a better method than ligation and excision in respect of postoperative course and complications.

Clinical Review of Surgical Geriatric Patients over 65 Years of Age

In order to identify the relationship between the patient's age and the presence of another disease, and the postoperative complications and mortality, we reviewed the medical records of 6156 patients admitted to the Department of Surgery, Dae Jeon Eul Ji General Hospital, during the period from January 1991 through December 1995. There were 1546 geriatric patients(>65 years of age) and 4610 adult patients (age between 16 and 64). Six hundred sixty-five patients (43%) in the geriatric group had one or more concurrent diseases preoperatively, whereas 1127 patients (24.4%) in adult group did. Postoperative complications were more frequent in the geriatric group: 21.6% (310 patients) in the geriatric group vs 15.2%(217 patients) in the adult group. Geriatric patients who had more than one concurrent disease and who underwent an emergency operation showed a higher postoperative complication rate than those who had only one concurrent disease and who underwent elective surgery. The postoperative mortality was also higher in the geriatric group: 3.8%(48 patients) in the geriatric group vs 0.7% (32 patients) in the adult group. The most frequent cause of postoperative death in the geriatric group was sepsis. The geriatric patients who had a concurrent disease account for 16.4% of postoperative complications and 1.5% of the mortalities, whereas those who did not have any concurrent disease account for 2.67% and 0.2%, respectively. Among 1127 adult patients who had a concurrent disease, 124 (11.0%) had postoperative complications and 24 (2.2%) died postoperatively. In conclusion, the elderly patients more frequently had one or more concurrent diseases, and these patients had higher postoperative complication and mortality rates, especially after emergency operations. Accordingly, it is crucial for the surgeon to completely evaluate and manage any concurrent diseases in elderly patients preoperatively.