Hyang Hee Choi

Ruptured Iliac Artery Stump Aneurysm Combined with Aortic Pseudoaneurysm in a Patient with Behçet's Disease

Operative treatment of aneurysm in patients with Behçets disease frequently results in recurrent aneurysm at the anastomosis site or in the remaining artery. Herein, in a Behçets patient with aortic and iliac pseudoaneurysms, a ruptured iliac artery stump aneurysm after ligation of the right external iliac artery 1 year prior to this admission is reported. This case suggests that the ligation or interposition of aneurysms associated with Behçets disease should be done at the intact artery, remote to the diseased segment. In addition, a small pseudoaneurysm of the aorta could be monitored with close follow-up with immunosuppressive medication and surveillance at regular intervals if the aneurysm is not symptomatic and is not rapidly growing to a certain critical size.

Acute Renal Vein Thrombosis, Oral Contraceptives, and Protein S Deficiency: A Successful Catheter-Directed Thrombolysis

Acute renal vein thrombosis (RVT) is a rare but noteworthy form of venous thromboembolism. Traditional management has been systemic anticoagulation with heparin, followed by warfarin. We report a case of acute RVT with multiple pulmonary emboli that occurred in a 40-year-old woman who was taking oral contraceptives and was subsequently found to have protein S deficiency. The patient was treated with catheter-directed thrombolysis, and complete resolution of the RVT was achieved. This case suggests that oral contraceptive use in a patient with protein S deficiency may interact in a synergistic manner in the pathogenesis of thrombosis. Also, we believe that catheter-directed thrombolysis is warranted in selective cases in the absence of overriding contraindications.

Clinical Value of Visually Identifiable 18F-fluorodeoxyglucose Uptake in Primary Papillary Thyroid Microcarcinoma

Objective This study evaluates the relationship between visually identifiable 18F-fluorodeoxyglucose (FDG) uptake in primary papillary thyroid microcarcinoma (PTMC) and tumor aggressiveness. Study Design Historical cohort study. Setting Tertiary care center. Methods Clinicopathological factors and PET/CT findings of 219 PTMC surgical patients who underwent preoperative 18F-FDG positron emission tomography/computed tomography (PET/CT) were retrospectively reviewed. Results 18F-FDG uptake was observed in the tumors of 124 (56.6%) patients. Tumor size (odds ratio [OR] = 1.774; 95% confidence interval [CI], 1.416-2.223; P < .0001) and Hashimoto thyroiditis (OR = 2.815; CI, 1.237-6.404; P = .014) independently predicted 18F-FDG uptake. Tumor size (OR = 1.495; CI, 1.217-1.835; P < .0001) and BRAFV600E mutation (OR = 3.320; CI, 1.056-10.432; P = .040) independently predicted extrathyroidal invasion. Multiplicity (OR = 2.375; CI, 1.278-4.415; P = .006) independently predicted central lymph node metastasis. Conclusion 18F-FDG uptake in PTMC depends on tumor size and Hashimoto thyroiditis. Therefore, preoperative PET/CT for PTMC may not help in evaluating tumor aggressiveness.

Comparison of Laser Ablation Using Multidirectional and Forward-Firing Fiber in Human Thyroid Gland Experimental Study

The aim of this study is to evaluate the differences between forward-firing and multidirectional lasers and to evaluate the effects of exposure times and power on laser ablation of thyroid tissue. This is an experimental, ex vivo study. The experiments were conducted on 3 thyroid glands using 2 power levels (3 and 5 W) and exposure times (3 and 5 minutes) with forward-firing and multidirectional lasers. The length and width of the demarcated zone were measured to assess the size of thermal effect. NADPH staining was performed to determine tissue viability. Thermal transformation caused by the forward-firing laser produced oval necrotic zones, whereas thermal transformation caused by the multidirectional-firing laser produced clear round necrotic zones, which clearly demarcated in both hematoxylin and eosin staining and NADH staining.