Won Sang Yoo

The role of ultrasound findings in the management of thyroid nodules with atypia or follicular lesions of undetermined significance

Atypia or follicular lesions of undetermined significance (AUS/FLUS) is a broad cytological category in the Bethesda system for classifying thyroid cytology. This study investigated the diagnostic accuracy of ultrasound (US) analysis of thyroid nodules with AUS/FLUS.

Efficacy and Safety of Radiofrequency Ablation for Treatment of Locally Recurrent Thyroid Cancers Smaller than 2 cm

PURPOSE To evaluate the efficacy and safety of radiofrequency ablation (RFA) for localized small recurrent thyroid cancers less than 2 cm by comparing them with those at repeat surgery. MATERIALS AND METHODS This retrospective study was institutional review board-approved, and informed consent was waived. From December 2008 to December 2011, this study evaluated 73 patients (17 men and 56 women; age, 50.3 years ± 13.6) with recurrent thyroid cancer who had been treated with RFA (n = 27) or repeat surgery (n = 46) who met the following criteria: (a) three or fewer recurrences or lesions with high probability of recurrence at ultrasonography; (b) no tumor other than the target tumors; and (c) at least 1 year of follow-up. RFA was recommended and performed in cases of surgical ineligibility, such as patient refusal and poor medical condition. Recurrence-free survival rates and posttreatment complication rates (eg, hoarseness and hypocalcemia) were compared between RFA and reoperation groups after adjustment with weighted analysis by using inverse probability of treatment weights. RESULTS After this adjustment, the 1- and 3-year recurrence-free survival rates were comparable (P = .681) for RFA (96.0% and 92.6%, respectively) and reoperation (92.2% and 92.2%, respectively) groups. The posttreatment hoarseness rate did not differ between the RFA (7.3% [1.8 of 24]) and reoperation (9.0% [3.6 of 39.5]) groups (P = .812), and posttreatment hypocalcemia occurred exclusively in the reoperation group (11.6% [4.6 of 39.5]) but not in the RFA group (0% [0 of 24]) (P = .083). CONCLUSION RFA may be an effective and safe alternative to repeat surgery in patients with locally recurrent small thyroid cancers.

Early detection of asymptomatic coronary artery disease in patients with type 2 diabetes mellitus.

Background/Aims In type 2 diabetic patients, coronary artery disease (CAD) is usually detected at an advanced stage due to a lack of symptoms. The aim of this study was to define which clinical parameters or non-invasive tests predict CAD in asymptomatic type 2 diabetic patients. Methods One hundred fourteen asymptomatic type 2 diabetic patients were divided into two groups based on the number of cardiovascular disease (CVD) risk factors (group A ≥2, group B ≤1). Treadmill exercise ECG tests (TMT) were conducted in all cases, and coronary artery angiography was performed on TMT-positive patients. Clinical parameters, diabetic status, and coronary angiographic findings were analyzed. Results The prevalence of CAD was 41.0% in group A and 16.7% in group B. The number of risk factors was significantly correlated with the prevalence of CAD, but not with the severity of CAD. Multivariate analysis showed that family history of CAD (odds ratio [OR]=9.41; 95% confidence interval [CI], 1.60-55.49) and diabetes duration ≥10 years (OR=3.28; 95% CI, 1.29-8.84) were independent CAD risk factors in asymptomatic patients. Conclusions We recommend a routine screening for CAD in type 2 diabetic patients who have a longer (≥10 years) diabetic duration or a family history of CAD, even if they are asymptomatic for CAD.

Clinical Characteristics and Metabolic Predictors of Rapid Responders to Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Sulfonylurea and Metformin

Background Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients. Methods We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with ≥25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks. Results At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level ≤7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of β-cells. Conclusion An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.