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Background The purpose of this study was to evaluate the incidence and pattern of chyle leakage after thyroidectomy and/or cervical lymph node dissection and to establish management protocols for chyle leakage. Methods Patients who underwent surgical management for thyroid cancer were analyzed retrospectively. Results For this study, 131 patients with chyle leakage were identified; the overall incidence was 0.9%. Of them, 43.7% of patients underwent central neck dissection without lateral neck dissection, and chyle leakage was easily controlled with conservative management. Patients whose chyle drainage was reduced by >50% after dietary modification had a significantly shorter hospital stay ( P < .001); NPO was the most effective dietary modification. Conclusion The occurrence of chyle leakage after central compartment dissection even without lateral neck dissection was not rare, but was easily controlled with conservative management. Surgical management should be considered if the drainage amount does not decrease by >50% of the original amount of the day of detection after 2 days of NPO. [ABSTRACT FROM AUTHOR]

Background: The failure to preserve parathyroid function in patients who have undergone total thyroidectomy is of major concern, because hypocalcemia is difficult to prevent and remains a common postoperative complication. Here, we describe procedures designed to preserve the vasculature supplying the parathyroid glands and examine both recent outcomes and retrospective reports of results obtained prior to the application of these preservation techniques. Methods: Our technique for preserving parathyroid function during thyroidectomy was adopted in 2009 and involves separating a relatively long segment of a vessel distally from the thyroid gland. We reviewed the medical records of 1,411 patients who underwent total thyroidectomy, with or without lateral neck dissection, at the Samsung Medical Center from January 2006 through June 2014 to determine outcomes. Patients were divided into three groups according to the time period during which the surgery took place: Group A, 2006-2008 (before the vasculature-preserving technique was applied); Group B, 2009-2011 (the time when the technique was first adopted); and Group C, 2012-2014 (more recent results of the technique). We analyzed the incidence of hypoparathyroidism in the three groups, as well as risk factors that influenced its development. Results: The rates of transient and permanent hypoparathyroidism in Group A were 25.4 and 4.3 %, respectively. However, the incidence of hypoparathyroidism decreased significantly over time after the vasculature-preserving procedure was adopted. Transient hypoparathyroidism developed in 4.8 % of Group C patients, and only four (0.7 %) of the 565 patients in this group required calcium supplementation, despite the fact that a greater number of patients were included who underwent total thyroidectomy combined with lateral neck dissection. Although female sex and lateral neck dissection tended to increase the rate of transient hypoparathyroidism, multivariate analysis showed that the vasculature-preserving procedure was the only significant risk factor related to postoperative hypoparathyroidism. Conclusion: The blood flow of the final branch to the parathyroid gland is mostly in the lateral-to-medial direction; therefore, mobilization and preservation of the vessels lateral to the gland is essential to prevent devascularization of the parathyroid gland. [ABSTRACT FROM AUTHOR]

Background The necessity of prophylactic central neck dissection is one of debating issues in the treatment of papillary thyroid carcinoma (PTC). In a previous study, the predictive value of BRAF mutation for lymph node metastasis was only significant in 0.5 to 1.0 cm PTC. Thus, we assess the predictive value of BRAF mutation for central lymph node metastasis according to tumor size. Methods Medical records of 3107 patients with PTC who underwent thyroidectomy with central neck dissection were retrospectively reviewed. Results BRAF mutation was a predictor for central lymph node metastasis in 2.0 to 4.0 cm PTC (odds ratio [OR] = 3.494; p = .002). Although BRAF mutation was associated with central lymph node metastasis in 0.5 to 1.0 cm PTC in univariate analysis (OR = 1.334; p = .047), this significance was not observed in multivariate analysis (OR = 1.232; p = .163). BRAF mutation was not associated with central lymph node metastasis in other tumor sizes. Conclusion Prophylactic central neck dissection could be considered in 2.0 to 4.0 cm PTC with positive BRAF mutation. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1203-E1209, 2016 [ABSTRACT FROM AUTHOR]

The evidential belief function ( EBF) model was applied and validated for analysis of groundwater-productivity potential ( GPP) in Boryeong and Pohang cities, agriculture region in Korea using geographic information systems ( GIS). Data about related factors, including topography, lineament, geology, forest, soil, and groundwater data were collected and input into a spatial database. Additionally, in the Boryeong area, specific capacity ( SPC) data not lower than 4.55 m3/d/m were collected, corresponding to 300 m3/d yield from 72 well locations. In the Pohang area, SPC data of ≥ 6.25 m3/d/m were collected, corresponding to a yield of 500 m3/d from 44 well locations. By using the constructed spatial database, 19 factors related to groundwater productivity were extracted. The relationships between the well locations and the factors were identified and quantified by using the EBF model. Four relationships were calculated: belief (Bel), disbelief (Dis), uncertainty (Unc), and plausibility (Pls). The relationships were used as factor ratings in the overlay analysis to create GPP indices and maps. The resulting GPP maps showed 83.41% and 77.53% accuracy in Boryeong and Pohang areas, respectively. The EBF model was found to be more effective in terms of prediction accuracy. [ABSTRACT FROM AUTHOR]