Jae-Yong Park

Total Thyroidectomy Plus Neck Dissection in Differentiated Papillary Thyroid Carcinoma Patients: Pattern of Nodal Metastasis, Morbidity, Recurrence, and Postoperative Levels of Serum Parathyroid Hormone

Objective:To investigate the pattern of nodal metastasis, morbidity, recurrence rates of papillary thyroid carcinoma (PTC), and parathyroid hormone (PTH) responses following neck dissection (ND) plus total thyroidectomy (TT). Summary Background Data:While hypoparathyroidism develops after TT plus ND, little is known of postoperative PTH response. Methods:Of 155 PTC patients, 82 underwent TT plus bilateral central ND with/without lateral ND, while 73 underwent TT alone. The nodal metastasis pattern was determined and the recurrence, morbidity, and postoperative levels of serum calcium and PTH were compared between 2 groups. Results:Of the 82 node dissection patients, metastatic nodes were present in the central neck of 51 (62.2%) and the lateral neck of 21 (25.6%) patients, most frequently in the ipsilateral and pretracheal central nodes and lateral jugular nodes. Four regional recurrences (2.6%) were found in 3 patients of the no node dissection group and one of the node dissection group (P = 0.37) during the follow-up lasting a mean 52 months. Overall morbidity and hypocalcemia was higher in the node dissection group than the no node dissection group (41 of 82, 50%; vs. 9 of 73, 12.3%; P < 0.001; 25 of 82, 30.5%; vs. 7 of 73, 9.6%; P = 0.001). Serum PTH levels significantly decreased immediately postoperatively in the node dissection group and remained low for several weeks thereafter. Conclusions:Serum PTH levels were significantly reduced following ND in PTC patients. Our data suggest that, when performing therapeutic ND plus TT, particular effort should be made to preserve the parathyroid glands and to monitor their function.

Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection.

Routine oral calcium and vitamin D supplementation may prevent hypocalcemic crisis, but its efficacy has not been studied in patients undergoing thyroidectomy plus central neck dissection (CND). The authors therefore prospectively evaluated the clinical usefulness of routine oral calcium and vitamin D supplementation for prevention of hypocalcemia after total thyroidectomy and CND.

Use of preoperative ultrasonography as guidance for neck dissection in patients with papillary thyroid carcinoma.

Preoperative neck ultrasonography (US) may detect nodal metastases of papillary thyroid carcinoma (PTC) but its utility in detecting metastases at specific neck subsites and levels is not known. We therefore evaluated preoperative US in detecting cervical metastases of PTC according to neck subsites and levels.

Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma

Although the pattern of cervical lymph node metastases from papillary thyroid carcinoma (PTC) has been described, little is known about the pattern of lateral cervical nodal recurrence. The aim of this study was to establish the optimal strategy for neck dissection in patients who underwent reoperation for lateral cervical recurrence of PTC.

Prediction of Occult Central Lymph Node Metastasis in Papillary Thyroid Carcinoma by Preoperative BRAF Analysis Using Fine-Needle Aspiration Biopsy: A Prospective Study

CONTEXT Few reports have determined whether preoperative detection of the BRAF V600E mutation in fine-needle aspiration biopsy (FNAB) may influence determination of surgical extent such as prophylactic central lymph node dissection (CLND) in patients with papillary thyroid carcinoma (PTC). OBJECTIVES Our objectives were to investigate whether preoperative BRAF analysis may assist determination of surgical extent, including prophylactic CLND with variable clinicopathological risk factors for central lymph node metastasis, in patients with PTC and clinically node-negative neck. PATIENTS AND METHODS From July 2009 to May 2011, we prospectively enrolled 148 PTC patients with clinically node-negative neck who received a total thyroidectomy and prophylactic CLND. BRAF mutation by pyrosequencing was tested on preoperative FNAB specimens. The relationships between occult central lymph node metastasis and preoperative BRAF mutation or clinicopathological factors were analyzed. Additionally, we assessed the associations between preoperative BRAF mutation status and various clinicopathological characteristics of PTC revealed postoperatively. RESULTS The prevalence of the BRAF V600E mutation was 53.4%, and the rate of occult central lymph node metastasis was 25.7%. Multivariate analysis showed that tumor size over 1 cm [P = 0.006; odds ratio (OR) = 3.559], perithyroidal invasion (P = 0.023; OR = 2.893), and preoperative positive BRAF mutation (P = 0.029; OR = 2.727) were independent risk factors for the presence of occult central lymph node metastasis. BRAF mutation examined in FNAB specimens, compared with the wild-type allele, strongly predicted perithyroidal invasion (48 vs. 29%; P = 0.017), extracapsular spread (65 vs. 45%; P = 0.017), occult central lymph node metastasis (35 vs. 15%; P = 0.004), and advanced TNM stage (44 vs. 28%; P = 0.035). In the multivariate analysis, patients with preoperative positive BRAF mutation were significantly more likely (P = 0.023; OR = 2.848) to have occult central lymph node metastasis. CONCLUSION Preoperative BRAF analysis by FNAB and primary tumor size based on ultrasonography may assist in predicting occult central lymph node metastasis in patients with PTC and clinically node-negative neck.

External vs endoscopic approach for inverted papilloma of the sino-nasal cavities: a retrospective study of 136 cases

Conclusion. Endoscopic removal, with or without external technique, can be performed in a majority of inverted papilloma cases. This method has subsequent recurrence rates that are comparable to those of more aggressive external techniques and it is more cost efficient with less morbidity. Objectives. To analyze the clinical outcomes of our 21-year experience (1986–2006) in treating inverted papillomas using different treatment modalities. Patients and methods. The patients were divided into a conventional surgery group (CSG) and an endoscopic surgery group (ESG) and were staged according to the system developed by Krouse. A retrospective assessment was performed. Results. The recurrence rates were 4.3% in ESG and 9.5% in CSG. There was no significant difference in the recurrence rates according to the treatment modality used and the Krouse stage in the two groups. Mean operation time was 72.93±18.51 min in the ESG and 112.02±56.52 min in the CSG. Mean period of hospital stay was 4.66±1.75 days in the ESG and 9.54±4.79 days in the CSG. The complication rate was 3.2% in the ESG and 33.3% in the CSG. There was a significant difference in the operation time, length of hospital stay, and complication rate in the two groups.

The preventive effect of halofuginone on posterior glottic stenosis in a rabbit model.

Objective The aim of this study was to investigate the preventive effect of halofuginone on posterior glottic stenosis (PGS) in an animal model. Study Design A randomized, controlled animal study. Subjects and Methods Sixteen male New Zealand White rabbits were used for this study. After the mucosa of posterior glottis was removed for producing PGS, the study group (eight rabbits) was given intraperitoneal halofuginone at 0.1 mg/kg/day for 4 weeks and saline was injected into peritoneum in the control group. At 4 weeks after injury, postsurgical changes of posterior glottis were evaluated by gross and histologic examination. Results PGS was induced by the mucosal stripping of the posterior glottis. The halofuginone-treated group showed less scarring and granulation tissue formation. Also, the degree of synechia was significantly less than that of control group. Histologic analysis showed the decreased fibrosis in the halofuginone-treated group. Conclusion This study suggests that halofuginone can be helpful in preventing PGS after laryngeal injury.

The preventive effect of mitomycin-C on the external auditory canal fibrosis in an experimentally induced animal model

OBJECTIVE The aim of this study was to investigate the preventive effect of mitomycin-C (MMC) on external auditory canal (EAC) fibrosis in an animal model. STUDY DESIGN This is a randomized, controlled animal study. SUBJECTS AND METHODS Sixteen guinea pigs were used for this study. After the skin of cartilaginous EAC was injured with an electrocautery, the cottonoid soaked in MMC solution with concentration of 0.4 mg/mL was topically applied for 5 minutes to the injured EAC in an MMC-treated group (n = 8). In addition, saline was applied in the control group (n = 8). At 4 weeks after injury, postsurgical changes of EAC were evaluated by histologic examination. RESULTS External auditory canal fibrosis was induced by injury with electrocautery. The MMC-treated group showed less degree of fibrosis without differences in epithelialization and inflammatory cell infiltration. CONCLUSION This study suggests that MMC can be helpful in preventing EAC fibrosis after injury.

Iatrogenic ear lobule ischemic injury from pressure dressing as an unusual complication of parotidectomy

The use of compressive dressing is usually spread to enhance neovascularization of the dissected facial flap by elimination of dead space between the flap and the dermis in parotid surgery through facelift incision. The author reports a clinical case of compressive dressing after parotidectomy that was inappropriately performed to folding of the ear lobule, leading to ischemic injury. This iatrogenic complication resulted in the development of contracture of ear lobule and deformity of auricle. Consequently, careful compressive dressing after parotidectomy through facelift incision must be applied; and the wound must be inspected daily for early detection and prompt treatment of local complications.