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한윤대,이용상,윤지섭,정종주,남기현,장항석,정웅윤,박정수,Yoon Dae Han,M,D,Yong Sang Lee,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3
It is well known that the thyroid gland is resistant to infection due to its anatomic and physiological characteristics. Thyroid abscess in an adult is extremely rare. It is more commonly found in children than in adults. The treatment goal of this disease is to eliminate the source of infection by incision and drainage, or by a thyroidectomy and administration of antibiotics, depending on the clinical findings.We report a case of thyroid abscess found in a 29-year-old woman. The patient presented with a painful mass in the left thyroid for 6 days duration. The patient had a history of subacute thyroiditis that was treated with steroidsand thyroid hormone. Computed tomography showed a large, fluid contained, cystic predominant mass in the left thyroid. Aspiration of the cystic fluid confirmed the presence of the thyroid abscess. Under local anesthesia, an incision and drainage was performed. The patient improved dramatically after surgery and the patient was discharged 8 days later. (Korean J Endocrine Surg 2007;7:161-163)
갑상선 절제 수술 후 Guardix-SG<SUP>Ⱂ</SUP>의 유착방지 효과
박재현,정종주,강상욱,남기현,장항석,정웅윤,박정수,Jae Hyun Park,M.D.,Jong Ju Jeong,M.D.,Sang Wook Kang,M.D.,Kee Hyun Nam,M.D.,Hang Seok Chang,M.D.,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2009 The Koreran journal of Endocrine Surgery Vol.9 No.3
Purpose: Postoperative adhesion of the surgical field seems to be troublesome not only to the patients, but also to the surgeons. Guardix-SG<SUP>Ⱂ</SUP> is a poloxamer/alginate mixture that reduced the incidence of postoperative adhesions when it is added to the abdominal surgery in animal models and also in clinical trials. This study was a randomized, prospective, double-blinded study to evaluate the antiadhesive efficacy and safety of Guardix-SG<SUP>Ⱂ</SUP> after total thyroidectomy. Methods: A total of 89 patients who underwent total thyroidectomy between July 2008 and February 2009 in Severance Hospital and Gang-Nam Severance Hospital were randomized to either the Guardix-SG<SUP>Ⱂ</SUP> treatment group (n=45) or the non-treatmentcontrol group (n=44). The patients were asked about their clinical symptoms (hypesthesia or paresthesia on the operative site (SN) and swallowing discomfort (SW)) by using a questionnaire, and the swallowing function was evaluated using Marshmallow Esophagography by one physician. The clinical symptoms and Marshmallow Esophagography were scored according to the results of assessment. The most severe state was scored as 0 and normal was scored as 3. Results: The scores of the clinical symptoms (SN and SW) were 2.67 and 2.49 in the treatment group, and 2.09 and 1.80 in the control group, respectively, at the postoperative 6th week (P=0.001, <0.001). The scores of the Marshmallow Esophagography were 2.93 in the treatment group and 2.73 in the control group (P=0.033). Abnormal findings were seen in 2 patients (4.4%) in the treatment group and in 10 patients (22.7%) in the control group (P=0.014). Conclusion: Guardix-SG<SUP>Ⱂ</SUP> seems to be effective in preventing adhesion after thyroidectomy. Further studies involving a larger number of subjects will be needed to make an application guideline. (Korean J Endocrine Surg 2009;9: 127-132)
윤지섭,이잔디,임치영,남기현,정웅윤,박정수,Ji-Sup Yun,M,D,Jandee Lee,M,D,Chi-Young Lim,M,D,Kee-Hyun Nam,M,D,Woung Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.2
Purpose: Subacute thyroiditis (SAT) is an uncommon, self- lemiting inflammatory disorder. If clinicians cannot rule out thyroid cancer in SAT patients with a thyroid nodule, surgical management can be considered. This study was performed to review the clinical characteristics of patients who were treated surgically for SAT presenting with thyroid nodule. Methods: We retrospectively reviewed the clinical features of 14 cases who underwent an operation for SAT with a thyroid nodule between January 1986 and May 2006 at our institution. Results: There were 3 male and 11 female patients, with a mean age of 47 years. All patients underwent surgical management prior to 1998. Twelve patients had thyroidal pain, 6 had viral prodromal symptoms, and 5 had hyperthyroidisms. Preoperative erythrocyte sedimentation rates (ESRs) (n=4) were elevated in 3 patients. Decreased uptake of radioiodine was reported in all 6 patients for whom scans were performed (n=6). Fine needle aspiration biopsy (FNAB) was performed in 4. In this study, the operative indications were clinically indeterminate thyroid nodule (n=14); lobectomy in 8, lobectomy with partial thyroidectomy in 2, lobectomy with near total thyroidectomy in 2, and bilateral total thyroidectomy in 2. Hoarseness occurred in one patient. Conclusion: SAT is usually managed clinically, but patients presenting with an indeterminate thyroid nodule will require surgical management even though they may have more benign characteristics. Most surgeons have to wait for the results of frozen biopsy because limited resectioning can be performed if the results are benign. (Korean J Endocrine Surg 2006;6:83-86)
정은주,윤종호<SUP>1<.SUP>,남기현,장항석,박정수,Eun-Joo Jung,M.D.,Jong Ho Yoon,M.D.<SUP>1<.SUP>,Kee Hyun Nam,M.D.,Hang-Seok Chang,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.1
Purpose: An association between primary hyperparathyroidism and well differentiated thyroid carcinoma has been frequently reported. However, there have been few reports of secondary hyperparathyroidism associated with thyroid carcinoma. This study was performed to evaluate the prevalence of thyroid nodule including thyroid carcinoma in patients with secondary hyperparathyroidism and to suggest more proper diagnostic approach for such cases. Methods: A retrospective study was performed on fifty-two patients who underwent parathyroid surgery for secondary hyperparathyroidism between March, 1986 and December, 2003. Results: In 20 patients (38.5%), thyroid surgery was added because of coexistent thyroid nodules. Five (25%) out of the 22 patients with coexistent thyroid nodule had thyroid carcinoma. Among the 5 thyroid carcinoma patients, 4 had papillary carcinomas and one had a follicular carcinoma. Mean size of thyroid carcinomas was 1.4 cm (0.3∼3.0 cm). Conclusion: The prevalence of thyroid carcinoma in patients with secondary hyperparathyroidism was higher than that in the general population. An aggressive diagnostic approach (ultrasonography and FNAB) should be considered when the patients with secondary hyperparathyroidism present with thyroid nodules. (Korean J Endocrine Surg 2004;4:48-50)
이잔디,남기현,임치영,장항석,정웅윤,박정수,Jandee Lee,M.D.,Kee-Hyun Nam,M.D.,Chi-Young Lim,M.D.,Hang-Seok Chang,M.D.,Woung Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.2
Forgotten mediastinal goiter is an extremely rare disease. It is most often the consequence of the incomplete removal of a 'plunging' goiter, but it can sometimes be attributed to a concomitant, unrecongnized primary mediastinal goiter which is not connected to the thyroid. A primary mediastinal goiter(autonomous intrathoracic goiter) essentially caused by an abnormal embryonic development of the thyroid gland and a thyroid gland formation located in the thorax or the mediastinum. The differential diagnosis with ordinary recurrence was based on the absence of parenchymatous or vascular connections with the cervical thyroid gland. It is fed by local intrathoracic vessels and observed in the absence of previous thyroidectomy. Nevertheless, for primary mediastinal goiter, sternum-splitting incision will be required in most cases as troublesome mediastinal bleeding may occur which is difficult to control from a cervical collar incision. In this study we report a case of forgotten mediastinal goiter and review the various diagnostic and therapeutic problems posed by the condition. A number of possible solutions that can be implemented for this diasease are identified. (Korean J Endocrine Surg 2005;5:114-117)
이용상,정종주,윤지섭,남기현,장항석,정웅윤,박정수,Yong Sang Lee,M.D.,Jong Ju Jeong,M.D.,Ji-Sup Yun,M.D.,Kee-Hyun Nam,M.D.,Hang Seok Chang,M.D.,Woong Youn Chung,M.D. and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.3
Although breast carcinoma has a predilection for metastasis to auxiliarylymph nodes, auxiliary nodal metastasis from papillary thyroid carcinoma is extremely rare, and to our knowledge, only 6 cases have been reported worldwide. Here, we report an extremely rare case of auxiliary lymph node metastasis from papillary thyroid carcinoma. A 41-year-old woman presented with palpable masses in her left axilla. Fourteen years previously, she had presented with a 3.0-cm sized mass in the left supraclavicular fossa, which was found to be metastatic papillary thyroid. At that time, she underwent a total thyroidectomy along with a left modified radical neck dissection. Histopathologic examination at that time revealed the presence two papillary microcarcinoma of the thyroid and multiple metastatic nodes in the left lateral neck (5 of 32, T1N1bM0). Following her recent presentation, imaging studies, including magnetic resonance imaging and positron emission tomography, revealed the presence of a small metastatic focus in the left upper lung and multiple metastatic nodes in the left auxiliaryregion. She underwent a wedge resection of the lung mass and a left radical auxiliarylymph node dissection. Histopathologic findings confirmed that both lesions were metastatic poorly differentiated papillary thyroid carcinomas. (Korean J Endocrine Surg 2007;7:168-172)
측경부 림프절 청소술을 요하는 갑상선암 환자에서 척수부신경 상측 림프절 청소술이 필요한가?
성태연,윤지섭,정종주,이용상,남기현,정웅윤,장항석,박정수,Tae Yon Sung,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Kee-Hyun Nam,M,D,Woong Youn Chung,M,D,Hang Seok Chang,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2
Purpose: Controversy still exists concerning the extent of neck nodedissection in thyroid carcinoma patients. A modified neck dissection is usually performed for the treatment of thyroid carcinoma patients with positive lateral neck nodes. When performing a neck dissection, removal of the nodes superior to the spinal accessory nerve (level IIB) is difficult and time consuming. This study was performed to determine whether level IIB node dissection is always necessary in therapeutic neck dissection for metastatic papillary thyroid carcinoma. Methods: A total of 200 neck dissections were performed in 175 papillary thyroid carcinoma patients with positive lateral neck nodes between September 2005 and June 2007. The patterns of lateral neck metastasis were analyzed with respect to neck level, but the level IIB nodes were studied as separate specimens. Potential factors predicting level IIB node metastasis were also evaluated. Results: The most common site of metastasis was level III, showing 95.0% (190/200), followed by level IV 66.0% (132/200), level IIA 54.0% (108/200), and level V 15.5% (31/200). Level IIB metastases were seen in 12 necks (6.0%) and seen only in the necks with positive level IIA nodes. In 11 of the 12 necks, the primary tumors were located in the upper pole of the thyroid. Conclusion: Level IIB node dissection is not necessary when there is no level IIA metastasis. Even when there is level IIA metastasis, level IIB node dissection is not always necessary, unlessthe primary tumors are located in the upper pole of the thyroid. (Korean J Endocrine Surg 2007;7:88-93)
이잔디,남기현,임치영,장항석,홍순원<SUP>1<.SUP>,박정수,Jandee Lee,M.D.,Kee-Hyun Nam,M.D.,Chi-Young Lim,M.D.,Hang-Seok Chang,M.D.,Soon Won Hong,M.D.<SUP>1<.SUP> and Cheong Soo Park,M.D. 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.1
Differentiated thyroid carcinoma rarely shows gross angioinvasion with intraluminal tumor thrombus. Although there was no definite result of long-term survival, a vascular invasion or thrombus indicates poor prognosis. Total thyroidectomy with en block resection of involved vessels is known as the best surgical approach, and followed by postoperative radioiodine therapy. However, the effect of adjuvant external irradiation therapy remains in debate. We report a case of differentiated thyroid carcinoma with internal jugular vein tumor thrombus treated successfully by a complete surgical resection and postoperative radioiodine therapy. (Korean J Endocrine Surg 2005;5:32-35)
김국진,이잔디,윤지섭,임치영,남기현,장항석,정웅윤,박정수,Kuk-Jin Kim,M,D,Jandee Lee,M,D,Ji Sup Yun,M,D,Chi-Young Lim,M,D,Kee-Hyun Nam,M,D,Hang-Seok Chang,M,D,Woong Youn Chung,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2006 The Koreran journal of Endocrine Surgery Vol.6 No.1
Bone metastases as the first manifestation of thyroid carci- noma are extremely rare. Interestingly, evaluation at appropriate initials and proper treatment will lead to satisfactory long-term survival. We report here on two such cases; the patients presented with back pain and fine needle aspiration cytology of spine lesion revealed a metastatic carcinoma. A wide excision of the bone lesion was carried out and the histopathology was consistent with features of metastatic carcinoma of the thyroid. The management of thyroid carcinoma and the subsequent bone metastases is reviewed and the controversial points are highlighted. (Korean J Endocrine Surg 2006;6:46-49)
장항석<SUP>1<,SUP>,박준성<SUP>2<,SUP>,정웅윤<SUP>2<,SUP>,박정수<SUP>2<,SUP>,Hang-Seok Chang,M,D,<SUP>1<,SUP>,Jun Sung Park,M,D,<SUP>2<,SUP>,Woung Youn Chung,M,D,<SUP>2<,SUP> and Cheong Soo Park,<SUP> <,SUP>M,D,<S 대한갑상선-내분비외과학회 2001 The Koreran journal of Endocrine Surgery Vol.1 No.1
Bronchogenic cyst can be found about everywhere in the mediastinum and rarely in the abdomen. Embriologically, the bronchogenic cyst, one of the primitive foregut-derived developmental anomalies, is composed of any or all of the tissue elements seen in a bronchus including respiratory epithelium, smooth muscle, mixed serous and mucose glands and cartilage. Most bronchogenic cysts are asymptomatic. The diagnosis is therefore made either as an incidental finding or, more usually is secondary to other organic complications such as infection, hemorrhage, compression of adjacent organs. Only a few of subdiaphragmatic bronchogenic cyst have been reported and their occurrence in the retroperitonum is extremely rare. We present a case of retroperitoneal bronchogenic cyst presenting as adrenal tumor which was successfully treated by laparoscopic resection. (Korean J Endocrine Surg 2001;1:122-124)