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Difficult evaluation of thyroid cancer due to cervical paraffin injection
이용상,손은주,김법우,장항석,박정수 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.81 No.6
Paraffinoma is a well known complication of previous paraffin injection into the subcutaneous layer that presents as various conditions including firm mass formation, edema, induration, ulceration, and skin necrosis. Paraffinoma can mimic neoplasm on physical examination and imaging studies and may complicate ultrasonographic diagnoses due to typical posterior shadowing and high echogenicity. When paraffinomas involve around the thyroid gland, the diagnosis of thyroid tumors is very difficult. We present a case of thyroid cancer, the evaluation of which was complicated by the presence of cervical paraffinoma.
The Clinical Significance of the Right Para-Oesophageal Lymph Nodes in Papillary Thyroid Cancer
장호진,장항석,유리나,김석모,김법우,이용상,이승철,박정수 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.6
Purpose: Although guidelines indicate that routine dissection of the central lymph nodes in patients with thyroid carcinomashould include the right para-oesophageal lymph nodes (RPELNs), located between the right recurrent laryngeal nerve and thecervical oesophagus and posterior to the former, RPELN dissection is often omitted due to high risk of injuries to the recurrent laryngealnerve and the right inferior parathyroid gland. Materials and Methods: We retrospectively identified all patients diagnosed with papillary thyroid carcinoma who underwenttotal thyroidectomy with central lymph node dissection, including the RPELNs, between January 1, 2009 and December 31, 2013at the Thyroid Cancer Center of Yonsei University College of Medicine, Seoul, Korea. Results: Of 5556 patients, 148 were positive for RPELN metastasis; of the latter, 91 had primary tumours greater than 1 cm(p<0.001). Extrathyroidal extension by the primary tumour (81.8%; p<0.001), bilaterality, and multifocality were more common inpatients with than without RPELN metastasis; however, there were no significant differences in age and sex between groups. Atotal of 95.9% of patients with RPELN metastasis had central node (except right para-oesophageal lymph node) metastasis, andthe incidence of lateral neck node metastasis was significantly higher in patients with than without RPELN metastasis (63.5% vs. 14.3%, p<0.001). Forty-one patients underwent mediastinal dissection, with 11 patients confirmed as having mediastinal lymphnode metastasis with RPELN metastasis on pathological examination. Conclusion: RPELN metastasis is significantly associated with lateral neck and mediastinal lymph node metastasis.
Perioperative Antibiotic Prophylaxis May Not Be Required Routinely in Thyroid Surgery
이관범,김수영,김석모,장호진,김법우,이용상,장항석,박정수,임치영 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.4
Purpose: Although perioperative antibiotic prophylaxis is used to prevent surgical site infection (SSI), thyroid surgery is classified as a clean surgical procedure and routine use of perioperative antibiotic prophylaxis is not recommend. The purpose of this study is to evaluate the therapeutic benefits of using perioperative antibiotic prophylaxis in thyroid surgery. Methods: We evaluated medical records of 1,895 patients who underwent thyroid surgery between January 2013 and December 2013. We divided 2 groups with or without perioperative antibiotic prophylaxis. Clinical factors including sex, age, body mass index (BMI), and comorbidity and surgical factors for SSI were analyzed. Results: The male to female ratio was 1:3.3, the average age was 43 (14–82) years old. The numbers of groups without and with antibiotic prophylaxis were 593 and 1,303. Thirty-seven cases (2.0%) of postoperative complications were observed including chyle leakage, SSI, and nerve injury. The SSI was occurred in 10 patients (0.5%). Clinical factors with SSI were analyzed and there was no statistical significance between 2 groups. Conclusion: In thyroid surgery, perioperative antibiotic prophylaxis may not be required routinely once the surgical procedure underwent with aseptic condition and the patients care was performed appropriately.
전학훈,장항석,김석모,김법우,이용상,박정수 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1
Purpose: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. Materials and Methods: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. Results: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients,the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). Conclusion: To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
김국진,홍순원,이용상,김법우,이승철,장항석,박정수 대한의학회 2011 Journal of Korean medical science Vol.26 No.3
Histologic patterns at tumor margins may be related to prognosis in several malignancies. We investigated tumor aggressiveness with respect to tumor margin histology in patients with papillary thyroid carcinoma (PTC). Five hundred fourteen consecutive patients who underwent surgery for primary PTC between January and July 2009 were assigned to two groups, one with an infiltrative pattern (I-type, n = 347) at tumor margins and one with an expanding pattern (E-type, n = 167). Tumor aggressiveness was assessed by analyzing relationships between these patterns and known prognostic factors. The analysis showed that unfavorable prognostic factors such as tumor multiplicity (P = 0.002), extrathyroidal extension (P < 0.001), lateral neck lymph node metastasis (P < 0.001) and advanced TNM stage (P = 0.001) were significantly more prevalent in patients with I-type PTC than in those with the E-type. Central neck node metastases were more prevalent without statistical significance in the I-type patients (P = 0.376). Tumor margin histology was not related to gender or tumor size. These results suggest that histologic patterns at tumor margins predict aggressiveness in PTC.
중앙 경부 수술의 과거력이 있는 환자에서의 방사능 유도 최소 침습 부갑상선 절제술의 유용성
이성환(Sung Hwan Lee),김법우(Bup Woo Kim),김국진(Kuk Jin Kim),이용상(Yong Sang Lee),정종주(Jong Ju Jeong),남기현(Kee-Hyun Nam),정웅윤(Woong Youn Chung),장항석(Hang-Seok Chang),박정수(Cheong Soo Park) 대한두경부종양학회 2009 대한두경부 종양학회지 Vol.25 No.2
Introduction :Althouth bilateral exploration has been thought to be the standard therapeutic modality for primary hyperparathyroidism(pHPT) due to the admirable cure rate, questions have remained as to whether bi-lateral neck exploration for all patients with pHPT is needed because 80-85% of patients with pHPT have a single parathyroid adenoma. If the diseased parathyroid can be determined preoperatively, a directed and min-imal operation is appropriate using the recent innovations of preoperative diagnosis and operation techniques for parathyroid diseases, the radio-guided parathyroid surgery(RGPS) is one of the standards. In especial, RGPS has been reported beneficial in special circumstances, such as in recurrent disease, ectopic parathyroid, and in mediastinal parathyroid. It can be also useful for the parathyroid disease in previously explored or irradiated neck. Material and Methods :We experienced 2 cases of pHPT successfully treated by RGPS in who previously un-derwent extensive neck dissection and concomitant external or internal radiotherapy. We adopted and modified the technique described by Dr. James Norman at the University of South Florida-the minimally invasive para-thyroidectomy using intraoperative nuclear mapping with 99mTc-sestamibi scanning and radioactivity detection probe. Results :We acquired the successful results for these patients. Conclusion :RGPS is thought to be the alternative technique for the patients with prior central neck exploration and irradiation.
갑상선암 수술 후 유착방지제(Guardix-SGⓇ) 사용과 배액량과의 관계
김형규,김석모,장호진,전기원,김법우,이용상,장항석,박정수 대한갑상선-내분비외과학회 2013 The Koreran journal of Endocrine Surgery Vol.13 No.4
Purpose: This study was conducted to investigate whether the use of HA-CMC solution in thyroid surgery influences drainage amount and hospital stay. Methods: Between November 2012 and December 12, 147 patients with thyroid cancer who underwent total thyroidectomy with central compartment neck dissection were analyzed retrospectively. The patients were divided into four groups; those with or without HA-CMC solution application and high or low output drainage. Results: There were no differences in hospital stay and mean total drainage between the with and without HA-CMC solution application groups (P=0.230, P=0.732). The mean hospital stay was 2.2±0.4 days for the low output of drainage group and 3.1±0.6 days for the high output drainage group (P<0.001). There was no significant difference in the use of HA-CMC solution (41.1% vs. 56.8%, P=0.070). Conclusion: The use of HA-CMC solution in thyroid cancer surgery might not increase drainage amount and make hospital stay longer.
Treatment Outcomes of Brain metastasis from Papillary Thyroid Cancer
배현우,김석모,김수영,장호진,김법우,이용상,장항석,박정수,Bae, Hyeonwoo,Kim, Seok-Mo,Kim, Soo Young,Chang, Ho Jin,Kim, Bup-Woo,Lee, Yong Sang,Chang, Hang-Seok,Park, Cheong Soo The Korean Society for Head and Neck Oncology 2018 대한두경부 종양학회지 Vol.34 No.1
Background/Objectives: Brain metastasis (BM) is a rare form of distant metastasis with papillary thyroid cancer (PTC). Patients with BM of PTC carry a poor prognosis. The aim of this study was to contribute to the understanding of this disease by analyzing patients with BM of PTC. Materials & Methods: Between March 2003 and December 2013, the patient database was conducted to identify thyroid cancer patients treated. Among the 22,758 thyroid cancer patients, 14 (0.06 %) were identified to have metastasis to the brain during follow-up. The medical records of 14 patients with BM were retrospectively reviewed, focusing on the following: patient characteristics, synchronous or previous distant metastasis, treatments including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgery, and characteristics on radiologic findings, time interval between first diagnosis of primary thyroid cancer and BM and survival after BM. Results: The mean age at initial diagnosis and BM were $50.9{\pm}15.8years$ and $61.3{\pm}12.7years$. The mean duration between initial diagnosis and BM was $10.4{\pm}7.9years$. Patients were treated with varied combinations of surgery, SRS and WBRT except 4 patients who had refused treatment. The median overall survival (OS) time after BM diagnosis was 10 months (range 1 - 19). Patients receiving treatment (WBRT and/or surgery, SRS) had a significant longer median OS of 16.5 months in comparison to 3.5 months for those treated without treatment. (p = 0.005) Conclusion: Patients who received aggressive treatment had a longer OS than those with only supportive care. Treatment such as surgery, SRS and WBRT should be considered in patients with BM.