• Korean Journal of Radiology
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• 제24권9호
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• pp.903-911
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• 2023

Objective: Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. Materials and Methods: We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. Results: Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. Conclusion: Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.

• Journal of Chest Surgery
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• 제39권12호
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• pp.953-956
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• 2006

절제 가능한 폐암에서 수술 절제가 가장 효과적인 치료이나 환자의 전신 상태가 불량하여 수술의 위험이 높은 경우 저침습적인 국소 치료방법을 적용한다. 냉동수술요법은 간, 전립선 암의 치료에서 우수한 암치료 효과와 안전성이 있는 치료 방법으로 폐암의 치료에서도 기관지 암종의 제거에 사용되며 폐실질의 종양에도 적용되고 있다. 본원에서는 양측폐에 각각 발생한 폐암으로 두 차례의 우상엽 및 좌상엽 폐절제 수술을 받고 치료 중에 남은 폐의 우하엽에 발생한 폐암으로 내원한 환자에게 저침습 수기로 냉동 치료를 실시하였고 2년간 추적 관찰하였다. 본 증례에서 적용한 냉동 치료의 방법과 결과를 보고한다.

• Journal of Chest Surgery
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• 제50권3호
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• pp.171-176
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• 2017

Background: In elderly patients who have atrial fibrillation (AF), surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP), the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. Methods: From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was $8{\pm}11$ (high risk). Results: Only 1 hospital death occurred (4%). The Kaplan-Meier method showed a high 5-year cumulative survival rate (92%). At mean follow‐up of 51 months, 23 patients (89%) had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium ($53.4{\pm}7.5cm$) and the 19 patients who did not have reduction plasty ($48.7{\pm}5.7cm$). Conclusion: In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3567-3570
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• 2014

Background: Hepatocellular carcinoma (HCC) is one of the most common cancers in men and the third most common cancer in woman in Thailand. This retrospective study was designed to assess the prevalence, clinical manifestations, treatment outcomes and prognosis of HCC in the central region of Thailand. Materials and Methods: The authors retrospectively reviewed all HCC patients aged more than 15 years old in Thammasat university hospital (TUH) during the period from January 2007 to December 2012. Clinical information, biochemical tests and radiologic findings were collected from review of medical records. Results: There were 308 patients with HCC, which accounted for the prevalence of 5.19% of all cancers diagnosed in TUH during the study period. Of these, 125 (40.5%) had complete information retrievable from their medical records and met the inclusion criteria, 99 (79.2%) were males. The mean age was 57.4 years. A quarter of HCC patients in this study presented without any symptom before diagnosis. The common clinical presentations in the remaining patients were hepatomegaly 64/125 (51.2%), abdominal pain 56/125 (44.8%) and ascites 16/125 (20.8%). Cirrhosis was seen in almost all patients (92.8%). The most common causes of HCC in this study were chronic hepatitis B (49.6%) and C (19.2%). Based on Barcelona Clinic Liver Cancer staging, 75.4% presented at intermediate or late stage. Patients receiving curative therapy with either surgical treatment or radiofrequency ablation had significantly longer survival time after the HCC diagnosis than the palliative therapy group (11.0 months vs 4.0 months, p value= 0.004). The mean survival time after the HCC diagnosis was 10.5 months. Conclusions: The common causes of HCC in central region of Thailand were chronic hepatitis B and C. Surgical therapy or RFA seemed to provide better outcomes than other treatments but only in patients with early stage lesions. Most of the patients in this study presented with advanced diseases and had grave prognosis. Appropriate screening patients at risk for HCC might be an appropriate way to achieve early diagnosis and improve the treatment outcome.

• Journal of Chest Surgery
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• 제31권1호
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• pp.59-65
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• 1998

심방세동은 심부정맥중 가장 흔한 질환이다. 이환율과 사망율에 있어서 심각한 문제를 일으킬 수 있으며 약물치료에 반응을 않하는 경우가 많다. 실험적 및 임상적 연구의 측면에서 볼 때, 거대회귀성 회로의 존재와 소회귀성 회로 혹은 심방의 자동성의 결핍을 근거로 심방세동에 대한 수술적 절제가 가능하다고 확신한다. maze III술식을 통해서 술후 동성 율동으로의 회복 빈도 증가, 장기적으로 볼 때 동방결절의 기능 향상, 인공심박동기의 사용 감소, 부정맥의 재발 감소, 심방의 전달 기능의 장기적 측면에서의 향상 등의 효과를 기대할 수 있다. 본원에서는 만성 심방세동을 가진 4명의 환자를 치험했다. 심방중격결손증 및 심방세동을 가진 환자에대해 Hioki술식을 시행했으며 술후 심전도상 정상 동방율동을 보였으나 술후 3년후에 접합부율동 및 서맥을 보였다. 승모판막질환 및 심방세동을 가진 나머지 3명의 환자에 대해서는 maze III술식을 시행했으며, 수술직후 2명의 환자에서는 규칙적인 동방율동을 보였으며, 1명의 환자에서는 심방세동을 보여서 amiodarone으로 조절하였다. 술후 3개월후 규칙적인 동방율동을 보이는 2명의 환자에 대해 심초음파를 실시한 결과 우심방의 수축은 양호하나 좌심방의 수축은 미미한 편이였다.

• Archives of Plastic Surgery
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• 제47권1호
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• pp.20-25
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• 2020

Background Ultrasonic dissection devices cause less thermal damage to the surrounding tissue than monopolar electrosurgical devices. We compared the effects of using an ultrasonic dissection device or an electrocautery device during prosthetic breast reconstruction on seroma development and short-term postoperative complications. Methods We retrospectively reviewed the medical records of patients who underwent implant-based reconstruction following mastectomy between March 2017 and September 2018. Mastectomy was performed by general surgeons and reconstruction by plastic surgeons. From March 2017 to January 2018, a monopolar electrosurgical device was used, and an ultrasonic dissection device was used thereafter. The other surgical methods were the same in both groups. Results The incidence of seroma was lower in the ultrasonic dissection device group than in the electrocautery group (11 [17.2%] vs. 18 [31.0%]; P=0.090). The duration of surgery, total drainage volume, duration of drainage, overall complication rate, surgical site infection rate, and flap necrosis rate were comparable between the groups. Multivariate analysis revealed that the risk of seroma development was significantly lower in the ultrasonic dissection device group than in the electrocautery group (odds ratio for electrocautery, 3.252; 95% confidence interval, 1.242-8.516; P=0.016). Conclusions The findings of this study suggest that the incidence of seroma can be reduced slightly by using an ultrasonic dissection device for prosthesis-based breast reconstruction. However, further randomized controlled studies are required to verify our results and to assess the cost-effectiveness of this technique.

• 대한수의학회지
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• 제62권3호
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• pp.26.1-26.7
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• 2022

This study was aimed to evaluate the prophylactic anti-glaucoma effect of topical 5% betaxolol (BTX) and 2% dorzolamide (DRZ) on the second eye in dogs with unilateral primary angle closure glaucoma (PACG). Medical records of 60 dogs with unilateral PACG who received prophylactic anti-glaucoma eyedrops in the second eye, from 2016 to 2021, were reviewed. The prophylactic effects of BTX were maintained on 28/60 (46.7%) eyes until last visit and BTX failure was observed on median 510 (range, 53-1,927) days in 32/60 (53.3%) eyes. After DRZ instillation in BTX failure eyes, the prophylactic effects were extended at median 610 (range, 157-2,270) days in 21/32 (65.6%) eyes. DRZ failure eyes (17/21, 81.0%) eyes required chemical ablation or surgical intervention due to uncontrolled intraocular pressure. The duration of prophylactic effects was decreased with aging (R² = 0.334, p = 0.006). The predominant breeds were Shih-Tzu (41.9%) and American Cocker Spaniel (30.6%) with no significant differences in survival curves (p = 0.210). The average prophylactic effects of BTX persisted more than 1.5 year and could be selected the first prophylactic eye drop in unilateral PACG. Also, early surgical intervention should be considered in prophylactic medications failure cases.

• Journal of Digestive Cancer Reports
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• 제7권1호
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• pp.26-30
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• 2019

Pancreatic cancer has a very poor prognosis. Complete surgical resection remains the only current curative treatment. Locally advanced pancreatic cancer (LAPC) is considered as unresectable because of involvement of celiac and/or mesenteric vessels. The treatment of LAPC is a challenge. Current guidelines suggest systemic therapy. However, the majority of patients will never experience conversion to surgical resection. Thus, in these patients, ablation is an alternative therapy for local control, which causes local destruction while ideally avoiding injury to surrounding healthy tissue. Irreversible electroporation (IRE) is an energy delivery system, effective in ablating tumors by inducing irreversible membrane destruction of cells. IRE demonstrated to be safe in previous studies. However, it is not free from complications, even serious. Here, we reported two cases of the IRE in LAPC patients.

• 대한두개안면성형외과학회지
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• 제16권3호
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• pp.105-113
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• 2015

The main challenge in pharyngoesophageal reconstruction is the restoration of swallow and speech functions. The aim of this paper is to review the reconstructive options and associated complications for patients with head and neck cancer. A literature review was performed for pharynoesophagus reconstruction after ablative surgery of head and neck cancer for studies published between January 1980 to July 2015 and listed in the PubMed database. Search queries were made using a combination of 'esophagus' and 'free flap', 'microsurgical', or 'free tissue transfer'. The search query resulted in 123 studies, of which 33 studies were full text publications that met inclusion criteria. Further review into the reference of these 33 studies resulted in 15 additional studies to be included. The pharyngoesophagus reconstruction should be individualized for each patient and clinical context. Fasciocutaneous free flap and pedicled flap are effective for partial phayngoesophageal defect. Fasciocutaneous free flap and jejunal free flap are effective for circumferential defect. Pedicled flaps remain a safe option in the context of high surgical risk patients, presence of fistula. Among free flaps, anterolateral thigh free flap and jejunal free flap were associated with superior outcomes, when compared with radial forearm free flap. Speech function is reported to be better for the fasciocutaneous free flap than for the jejunal free flap.

• Clinical and Experimental Pediatrics
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• 제53권6호
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• pp.680-687
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• 2010

Patients with congenital heart diseases (CHD) are confronted with early- and late-onset complications, such as conduction disorders, arrhythmias, myocardial dysfunction, altered coronary flow, and ischemia, throughout their lifetime despite successful hemodynamic and/or anatomical correction. Rhythm disturbance is a well-known and increasingly frequent cause of morbidity and mortality in patients with CHD. Predisposing factors to rhythm disturbances include underlying cardiac defects, hemodynamic changes as part of the natural history, surgical repair and related scarring, and residual hemodynamic abnormalities. Acquired factors such as aging, hypertension, diabetes, obesity, and others may also contribute to arrhythmogenesis in CHD. The first step in evaluating arrhythmias in CHD is to understand the complex anatomy and to find predisposing factors and hemodynamic abnormalities. A practical stepwise approach can lead to diagnosis and prompt appropriate interventions. Electrophysiological assessment and management should be done with integrated care of the underlying heart defects and hemodynamic abnormalities. Catheter ablation and arrhythmia surgery have been increasingly applied, showing increasing success rates with technological advancement despite complicated arrhythmia circuits in complex anatomy and the difficulty of access. Correction of residual hemodynamic abnormalities may be critical in the treatment of arrhythmia in patients with CHD.