Search

Background: Recently, the modified facelift incision (FLI) has gained increasing popularity for its cosmetic benefits in parotidectomy. However, many surgeons remain concerned with the adequacy of the exposure and are unwilling to use the FLI for anterior or superior tumors of the parotid gland because these tumors are closer to the superficially positioned facial nerve branch. To evaluate the changing trends in parotidectomy incisions for benign lesions at a single institute, and to compare the surgical outcomes between the modified Blair incision (BI) and FLI, and determine the adequacy and possible indications or limitations of the FLI, especially for tumors located in the anterior or superior parotid gland., Materials and Methods: Retrospective study analyzed 357 patients who had various benign parotid diseases and underwent parotidectomy at Severance Hospital between January 2005 and December 2009. Revisions or recurrences and histologically confirmed malignancies were excluded. Tumor location was divided into superficial and deep lobes. The superficial lobe was subdivided into anterior, superior, inferior, and middle portions. Patients' profiles, surgical outcomes, and cosmetic satisfaction score on a scale of 0 (extremely dissatisfied) to 10 (extremely satisfied) were compared., Results: In all, 344 patients underwent BI or FLI. The FLI was performed increasingly each year. For anterior (n = 58) or superior tumors (n = 32), there was no significant difference between the type of incision and tumor size or complications. No facial nerve palsy occurred in either group. For deep-lobe tumors (n = 67), the mean tumor size was significantly larger in the BI group (p = 0.025). There was a significant difference between facial nerve palsy and tumor size (p < 0.001) but no significant difference between facial nerve palsy and tumor location (p = 0.145) or the type of incision (p = 0.530). The mean scar satisfaction score was significantly higher in the FLI group (p <0.001). There was a positive correlation between the scar and deep hollow satisfaction score (Pearson coefficient of correlation = 0.547; p < 0.001), Conclusions: The modified facelift incision is feasible for most benign parotid lesions regardless of tumor location, even for anterior or superior tumors. Using the modified facelift incision may be extended with a surgeon's accumulated experience, but for a large deep-lobe tumor, the modified Blair incision is still considered useful.

Purpose: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas., Materials and Methods: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups., Results: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group)., Conclusion: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.

Conclusions: We suggest that contralateral level IV dissection is not necessary in patients with cN0 hypopharyngeal squamous cell carcinoma (HPSCC)., Objectives: Elective treatment of neck nodes is very important in the management of cN0 HPSCC. A selective neck dissection neck level II to IV (SND II-IV) is widely accepted as an elective neck treatment of cN0 HPSCC. However, there has been a lot of effort to reduce the extent of surgery. Therefore, we investigated the incidence of level IV metastasis and regional recurrence in cN0 HPSCC., Methods: We performed a retrospective review of 40 patients who underwent SND II-IV as an elective treatment for cN0 HPSCC from 1992 to 2010., Results: In all, 30 bilateral and 10 unilateral SND II-IVs were performed in 40 patients. Of the 70 SND II-IV specimens, 15 specimens from 14 patients (21%) were revealed to have positive lymph node metastasis. Level IV was involved in 3 of 70 necks (4.2%), but no isolated or contralateral level IV metastasis was observed. Every case that had level IV metastasis also had positive nodes in level II or III. There was no case of postoperative chylous leakage and only one case of phrenic nerve palsy.

Amplification of the human epidermal growth factor receptor 2 (HER2) gene occurs in 20-25% of breast cancers, and is recognized as a prognostic and predictive marker. HER2 gene amplification, evaluated as a change in protein expression or gene copy number, can be identified by a number of methods. Fluorescence in situ hybridization (FISH) is considered the gold standard for HER2 gene copy number determination; however, a number of impediments prevent its wider use in a clinical setting. The aims of our study were to compare dual-color silver-enhanced in situ hybridization (SISH) with single-color SISH and FISH on formalin-fixed, paraffin-embedded sections, and to validate its use as a routine method for assessing HER2 status in breast cancers. A total of 146 invasive breast carcinoma cases were assessed for HER2 gene amplification by FISH and dual-color SISH. Dual-color SISH and FISH results exhibited a concordance rate of 97% (κ=0.912). A comparison of the single-color SISH method with dual-color SISH showed that 142 of 146 cases were in agreement (97%, κ=0.930). Our results showed that dual-color SISH is a viable alternative to FISH that offers a number of advantages in a clinical setting.

Background: Hepatocyte growth factor (HGF) can promote proliferation, invasion, and angiogenesis in various tumor cells. However, the prognosis according to expression of HGF/c-Met has not been reported in patients with squamous cell carcinoma of the oral tongue (SCCOT)., Methods: Tumors from 61 patients with SCCOT were evaluated for the expression of HGF and c-Met by immunohistochemistry. For Western blot, we used fresh normal and cancer tissues from 3 patients with SCCOT., Results: The positive rates of HGF and c-Met immunostaining in SCCOT were 57.3% and 54.1%, respectively. The c-Met staining was significantly correlated with lymph node metastasis (p = .005), tumor classification (p = .004), and recurrence (p = .018). Survival was significantly affected in patients with positive c-Met expression (p = .003). HGF and c-Met were strongly expressed in cancer tissues on Western blot., Conclusion: The c-Met expression may play an important role in the progression and the survival outcome of patients with SCCOT.

Study Design: A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively., Purpose: To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS's final treatment recommendation., Overview of Literature: Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system., Methods: Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received., Results: The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making., Conclusions: The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.

Objectives: The aims of this study were to evaluate the prevalence of otolaryngologic diseases in Korea., Methods: We obtained data from the 2008 Korea National Health and Nutrition Examination Surveys (KNHANES), which were cross-sectional surveys of the civilian, non-institutionalized population of South Korea (n=4,930). A field survey team that included an otolaryngologist, nurses, and interviewers moved with a mobile examination unit and performed otolaryngologic interviews and physical examinations., Results: The prevalence of subjective hearing loss, tinnitus, preauricular fistua, tympanic membrane perforation, and cholesteatoma were 11.97%, 20.27%, 2.08%, 1.60%, and 1.18%, respectively. Dizziness and vestibular dysfunction were common among Korean adults, since 23.33% of the participants reported symptoms of dizziness or imbalance, and the prevalence of vestibular dysfunction was 3.86%. The prevalence of nasal diseases was relatively high, as the prevalence of allergic rhinitis, chronic rhinosinusitis, and a deviated nasal septum were 28.01%, 7.12%, and 42.94%, respectively. Subjective dysphonia was found in 6.60% of the participants, and the prevalence of subjective dysphonia increased with age., Conclusion: This is the first nation-wide epidemiologic study to assess the prevalence of otolaryngologic diseases by both the Korean Otolaryngologic Society and the Ministry of Health and Welfare. Considering the high prevalence of otolaryngologic diseases in Korea, the results call for additional studies to better prevent and manage otolaryngologic diseases.

Background: The harmonic scalpel (HS) has been used in endoscopic thyroidectomy with encouraging results. However, additional instruments are frequently required to complete hemostasis. The current study aimed to assess the safety and efficacy of the clipless and sutureless technique using the HS in endoscopic thyroidectomy without supplementary instrumentation., Methods: A total of 114 patients underwent endoscopic hemithyroidectomy (HT) or total thyroidectomy (TT) via a unilateral axillo-breast approach. In all cases, hemostasis was achieved solely by the HS. Perioperative complications, surgery-related outcomes, and pathologic outcomes were examined., Results: The operating time in the TT group (170.23 +/- 45.63 min; n = 22) was longer than in the HT group (111.63 +/- 38.44 min; n = 92; p = 0.0000). After the first 50 cases, the operating time decreased significantly (145.60 +/- 52.72 min vs. 105.23 +/- 30.14 min, p = 0.0000). Postoperative minor hematomas from the skin flap were experienced by three patients (3.3%) in the HT group. No postoperative hemorrhage or hematoma was noted in the thyroidectomy field using the HS. Four patients in the HT group (4.3%) and one patient in the TT group (4.5%) experienced transient unilateral vocal cord palsy. Temporary hypocalcemia was observed in eight patients in the TT group (36.4%). No permanent recurrent laryngeal nerve palsy or hypoparathyroidism occurred in either group., Conclusion: The HS alone in clipless and sutureless endoscopic thyroidectomy provides a good alternative to the conventional ligation or clipping technique because it is associated with a shorter operating time and a relatively low incidence of complications.

Background: This prospective study investigated the efficacy of injection laryn-goplasty in the management of postthyroidectomy vocal cord paralysis (VCP)., Methods: From March 2005 to December 2008, 174 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. This included 34 patients with post-thyroidectomy VCP: 15 with temporary VCP and 19 with permanent VCP. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25G-long needles through the cricothyroid membrane or directly through the thyroid cartilage. Patients completed the acoustic, aerodynamic, perceptual, stroboscopic, and voice handicap index evaluations before and at 3 and 6 months after the injection., Results: All injection laryngoplasty could be performed under local anesthesia without morbidity. Acoustic and perceptual parameters (overall grade of hoarseness, roughness, breathiness, asthenia, and strain), maximum phonation time, jitter, and shimmer, voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection and they remained stable over 6 months in both the temporary VCP and permanent groups (p < 0.05)., Conclusions: Based on these preliminary results, injection laryngoplasty improved the voice, and voice-related quality of life in patients with post-thyroidectomy VCP. It is a simple, safe, and useful method for rehabilitating post-thyroidectomy VCP patients.

Objectives: These days, the main injection laryngoplasty technique is cricothyroid (CT) approach. However, patients who have previously undergone other neck treatments, such as thyroidectomy or neck dissection have distorted anatomical landmark makes this approach more difficult. The aim of this study is to determined the efficiency of transcartilaginous (TC) approah as compared with CT approach for unilateral vocal fold paralysis patients, especially for previously neck treated patients., Methods: From March 2005 to February 2008, 137 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25 G 4 cm long needles through the cricothyroid membrane or directly through the thyroid cartilage. Of the 137 patients, 124 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 3 months after the injection., Results: In the 124 patients, the CT and TC approaches were used in 94 and 30 patients, respectively. Acoustic and perceptual parameters (GRBAS, MPT, jitter, shimmer), voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection in both the CT and TC groups (P<0.05). Only two patients (6.6%) had penetration difficulties, because of ossification of the thyroid cartilage. The overall success rates of the CT and TC approaches were 86.2%, 93.3%, respectively. However, the success rate of the TC approach in patients who had previously undergone neck treatments was significantly higher than that of the CT approach (100% vs. 65% P<0.05)., Conclusion: Based on the preliminary results of this trial, injection laryngoplasty using a TC approach was an effective alternative to the CT approach, especially in patients who had previously undergone neck surgeries.

Background: Recently, various endoscopic approaches have been applied to thyroid surgery. However, few specific data exist on endoscopic thyroidectomy with central neck dissection (CND) for micropapillary thyroid carcinoma. This study aimed to evaluate the feasibility and safety of endoscopic hemithyroidectomy (HT) plus CND., Methods: In this study, 29 consecutive patients underwent endoscopic HT with ipsilateral CND via a unilateral axillo-breast approach (endo group), and 30 matched control patients underwent conventional open HT with ipsilateral CND (open group). The following variables were compared between these two groups: perioperative complications, surgery-related outcomes, and pathologic outcomes., Results: The operating time in the endo group was longer than in the open group (p = 0.012). In terms of parathyroid gland (PTG) preservation, there were no statistically significant differences between the two groups. The mean numbers of dissected central lymph nodes and metastatic central lymph nodes were similar in the two groups (p = 0.506 vs. 0.975). The endo group had a significantly longer mean hospital stay (6.21 +/- 0.94 days) than the open group (4.30 +/- 1.02 days; p = 0.000). No significant difference was observed in the overall perioperative complications between the two groups., Conclusions: This study demonstrates that the endoscopic approach of CND plus HT is feasible for selected unilateral, intrathyroidal, micropapillary carcinomas. In the future, prospective and comparative studies on the surgical techniques of total thyroidectomy and CND are needed to verify their oncologic safety.

Background: The usefulness of various endoscopic thyroid surgery techniques has been reviewed. Recently, the authors developed a unilateral axillo-breast approach for endoscopic hemithyroidectomy to minimize the visible scar in a natural position and to overcome the limitation of instrumentation. The feasibility and safety of endoscopic thyroid surgery was examined via a novel approach without gas insufflation., Methods: This study enrolled 52 consecutive patients undergoing endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation. A skin incision parallel to the skin crease was made in the axillary fossa for insertion of a 10-mm 30 degrees rigid endoscope and endoscopic instruments. To create a working space, an external retractor was inserted through the skin incision in the axilla and raised using a lifting device. A second 1.0-cm skin incision was made along the upper margin of the mammary areola on the tumor side for insertion of a 12-mm trocar., Results: Postoperative pathology showed 11 follicular adenomas, 1 follicular carcinoma, and 40 benign thyroid lesions. The operating time for the first 10 hemithyroidectomies was 154 +/- 64.88 min, which was 34.77 min longer than for the last 42 hemithyroidectomies (119.23 +/- 31.47 min; p = 0.1314). The amount of postoperative drainage was 236.63 +/- 118.67 ml, and the duration of drainage was 4.54 +/- 1.42 days. The postoperative hospital stay was 6.37 +/- 2.83 days. Overall, seven patients (7/52, 13.5%) experienced perioperative complications, including one transient recurrent laryngeal nerve palsy (1.9%), five seromas (9.6%), and one hematoma (1.9%), which arose from a subplatysmal skin flap., Conclusion: Although the aspect of invasiveness could be improved, endoscopic hemithyroidectomy via a unilateral axillo-breast approach without gas insufflation is safe and effective and appears to provide better cosmetic results and a shorter operation time than other endoscopic methods for managing selective unilateral benign thyroid lesions.

Extranodal NK/T-cell lymphoma is a recently recognized distinct entity within the World Health Organization classification of lymphoid tumors. It is relatively prevalent in Asian and South American populations. It most commonly occurs in the nasal or paranasal areas and less frequently in the skin, the soft tissue, and the gastrointestinal tract. Among these, extranodal NK/T-cell lymphoma of the gastrointestinal tract has shown an aggressive clinical course. We report a case of CD56+ extranodal NK/T-cell lymphoma presenting as a duodenal ulcer bleeding. A 62-year-old male patient presented with melena and abdominal pain. Endoscopic examination of the upper gastrointestinal tract showed the duodenal ulcer covered by blood clot. Pathologic examination revealed the diffuse infiltration of atypical lymphocytes with an angiocentric growth pattern, which was positive for CD3, CD56, and granzyme. The patient showed rapid deteriorating clinical course and died on day 14 after admission. Thus, we report this case with the review of literatures.

Background: Moderate resection of the soft palate results in suboptimal outcomes in terms of postoperative velopharyngeal function. We propose the radial forearm tenocutaneous free flap incorporating the palmaris longus tendon for reconstruction of the levator sling in these cases., Methods: Twenty-six patients underwent reconstruction with this method. Group I defect involved up to one-fourth of the soft palate. Group II defect involved up to one-half of the soft palate whether or not including the uvula. Group III defect involved more than three-fourths of the soft palate. Postoperative function was assessed by means of speech intelligibility, swallowing performance, nasalance score, and nasoendoscopy., Results: Groups I and II showed normal results for speech intelligibility and swallowing function at 44 months. In group III, both parameters proved to be suboptimal., Conclusions: Moderate-sized soft palatal resection cases (group II) benefited most from this particular method of dynamic reconstruction using the radial forearm tenocutaneous free flap.

Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder characterized by branchial cleft fistulae or cysts, preauricular pits, ear malformations, hearing loss, and renal anomalies. Mutations in the human homologue of the Drosophilia eyes absent gene (EYA1) are the most common cause of BOR syndrome. In this study, we found a Korean family showing clinical features of the disease. Mutation analysis of the EYA1 gene revealed a novel one-base-pair deletion resulting in truncated protein (c.321delT; p.Ala107fs). This is the first report of BOR syndrome caused by deletion mutation of the EYA1 gene in Korea.

It is well known that higher-order Hopfield nets called multispin models can increase memory capacity to some extent by extending the direct product of spin states to more than second order. However, a group of neurons can then respond degenerately to different loaded patterns, resulting in many spurious states due to cross-talk effects. We present an idea to increase the number of attracting basins for patterns while suppressing the associated spurious states, by introducing coherent and collective firing in multispin groups. We numerically implement the method and test the number, stability, and basin size of the attractors thus created. Increasing the size of a group of coherent excitation suppresses spurious states, stabilizes loaded patterns, and dramatically increases the number of pattern attractors.

Background: Thyroid surgery is usually performed under general anesthesia, but thyroid surgery under monitored anesthesia care (MAC) has become re-introduced. We report our experiences of 40 cases of thyroid surgery under MAC., Methods: Forty patients were enrolled in this study. Bilateral superficial cervical plexus block (BSCPB) was performed by using 1% mepivacaine with 1 : 200,000 epinephrine. After BSCPB, patients were sedated with propofol and fentanyl. Postoperative pain, sore throat, hoarseness, and postoperative nausea and vomiting (PONV) were assessed., Results: Mean postoperative pain VAS were 1.3, 1.2, 1.0, 0.8 and postoperative sore throat VAS 1.4, 1.4, 1.1, 0.9 at PACU (post-anesthesia care unit) and postoperative 3, 6, 12 h, respectively. The incidence of hoarseness was 25, 5, 2.5%, and 0% and PONV were 0, 5, 10%, and 7.5% at PACU and postoperative 3, 6, 12 h, respectively., Conclusions: Thyroid surgery under MAC may be a suitable alternative to general anesthesia.

Congenital absence of the salivary glands is an uncommon disorder. Isolated aplasia of a unilateral submandibular gland is rare and only 6 cases have been reported. The formation of a sialolith within the remaining Wharton's duct, associated with isolated aplasia of a unilateral submandibular gland, has not been reported previously. The authors report two cases of sialolithiasis within the ipsilateral remaining Wharton's duct in patients with isolated aplasia of a unilateral submandibular gland.

Castleman disease (CD) is an uncommon benign condition of uncertain etiology that causes progressive lymph node enlargement. Although the mediastinum is their common location, they also occur in other areas of the body, usually where lymph nodes are normally found. In addition, CD (the hyaline-vascular type) of the parotid gland is very rare, especially in childhood. We report a new case of CD arising from the parotid gland in 9-year-old male child. The clinical course, histopathological findings, radiological findings, and management of CD are reviewed.

Objectives: To compare the efficacy and safety of BiClamp forceps tonsillectomy (BT) with standard electrocautery tonsillectomy (ET) in terms of postoperative pain and complication rates., Study Design: Prospective randomized study., Subjects and Methods: The following variables were examined: postoperative complications, intraoperative blood loss, operating time, postoperative pain and diet scores using visual analog scales, and time until return to normal activity., Results: The mean operating time and the grade of intraoperative blood loss were significantly lower in the BT group than in the ET group for both pediatric and adult patients. For adult patients, the overall complication rates were significantly lower in the BT group. In addition, a significant early decrease in the pain score and significant improvement in dietary intake until postoperative day 14 were observed in the BT group for both pediatric and adult patients., Conclusions: The use of BiClamp forceps in tonsillectomy reduces the intraoperative blood loss and postoperative pain score, and facilitates an early return to normal diet and activity.

Objective: To investigate the safety and efficacy of the no-tie (NT) technique using the harmonic scalpel (HS) in terms of the operating time and complications in total thyroidectomy with central neck dissection (CND)., Summary Background Data: Recently, the HS has been used as an alternative to conventional hand-tied ligation for hemostasis in thyroid surgery, which is a time-consuming procedure. Limited data have been published on the evidence of its safety in total thyroidectomy accompanied by CND without supplementary hand-tied ligation., Methods: Sixty-five consecutive thyroidectomized patients were enrolled in this study. The final pathology in all the patients was thyroid papillary carcinoma. All patients underwent total thyroidectomy with CND. The NT technique using HS group consisted of 31 patients. The conventional hand-tied ligation technique group comprised 34 patients. The following variables were examined: operating time, intraoperative bleeding, incidence of perioperative complications (hemorrhage, hematoma, seroma, recurrent laryngeal nerve palsy, hypoparathyroidism, and injury to the adjacent structures including the trachea and esophagus), the number of pathologically proven lymph nodes, total amount of drainage, duration of drain placement, and time of hospital discharge., Results: The use of the HS reduced the operating time of total thyroidectomy with CND by an average of 43.12 minutes (P < 0.001). The number of pathologically proven lymph nodes was 7.32 +/- 1.66 in the NT group and 6.85 +/- 1.76 in the CT group (P = 0.274). No significant difference was observed in the overall perioperative complications, such as postoperative bleeding, temporary recurrent laryngeal nerve palsy, and temporary hypoparathyroidism, between the 2 groups. No permanent recurrent laryngeal nerve palsy and hypoparathyroidism occurred in either group., Conclusions: The NT technique with the HS is a relatively safe and effective method in total thyroidectomy combined with CND. Moreover, the HS significantly reduced the operating time.

The possibility of postsurgical hypothyroidism after hemithyroidectomy is no longer a new subject. Although many previous studies have mentioned posthemithyroidectomy hypothyroidism, the incidence and contributing factors for hypothyroidism remain uncertain. We intended to evaluate the incidence and the time of development of hypothyroidism after hemithyroidectomy and to analyze the relationship of posthemithyroidectomy hypothyroidism with preoperative biochemical parameters and postoperative histopathological findings. From February 2001 through December 2004, 287 consecutive cases of hemithyroidectomized patients were retrospectively analyzed; 136 of these patients were included in this study after the exclusion criteria were applied. The relationship between posthemithyroidectomy hypothyroidism and several parameters such as sex, age, preoperative free T4, TSH, microsomal antibody (Ab), thyroglobulin antibody (Ab) levels and lymphocytic infiltration of the resected gland was statistically analyzed. Postoperative hypothyroidism developed in 58 patients (42.6%). In hypothyroid group, 11 patients (19%) showed overt hypothyroidism and 47 patients (81%) showed subclinical hypothyroidism. Preoperative TSH value was significantly higher in the hypothyroid group (2.15+/-1.30 microU/ml) compared to the euthyroid group (1.29+/-0.9 microU/ml). Positive ratio of preoperative microsomal Ab and thyroglobulin Ab were significantly higher in hypothyroid group (38.9 and 41.9%) compared to euthyroid group (3.6 and 19.3%) (P <0.05). In addition, patients with a higher grade of lymphocytic infiltration were found to have a higher probability of developing hypothyroidism. About 85% of postoperative hypothyroidism was detected between 1 and 6 months postoperatively. We might predict the possibility of developing the posthemithyroidectomy hypothyroidism especially in case of preoperatively positive microsomal antibody, thyroglobulin antibody and high-grade lymphocytic infiltration of the resected gland. In addition, our findings support the recommendation for regular serum TSH follow-up at least for 12 months after hemithyroidectomy.

Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer.

We describe a 60-year-old woman who developed extensive emphysema, bilateral pneumothorax, and pneumomediastinum after total thyroidectomy and central neck dissection with sacrifice of a recurrent laryngeal nerve. In this report, we discuss the possisle etiology of those rare complications.

Methods to search for periodic orbits are usually implemented with the Newton-Raphson type algorithms that extract the orbits as fixed points. When used to find periodic orbits in flows, however, many such approaches have focused on using mappings defined on the Poincaré surfaces of section, neglecting components perpendicular to the surface of section. We propose a Newton-Raphson based method for Hamiltonian flows that incorporates these perpendicular components by using the full monodromy matrix. We investigated and found that inclusion of these components is crucial to yield an efficient process for converging upon periodic orbits in high dimensional flows. Numerical examples with as many as nine degrees of freedom are provided to demonstrate the effectiveness of our method.

Fractures of the clavicle following radical neck dissection (RND) and/or radiation therapy have been previously noted in the literature. Interestingly, we experienced three cases of clavicular fracture, which were considered to have resulted from pectoralis major myocutaneous flap (PMMCF). All of these three cases had received the combined treatment of RND, PMMCF and postoperative radiotherapy on the side of fracture. In all three cases, ipsilateral lower neck received 4,500 cGy and island type of PMMCF was used for reconstruction of surgical defect in head and neck area. All fractures noted between 1 and 3 years postoperatively occurred on the medial portion of the clavicle. Devascularization after stripping of periosteum and altered mechanics of the clavicle following resection of clavicular head of pectoralis major muscle may contribute to develop this rare complication in addition to the effect of radiotherapy and RND. We present three cases of the clavicle fracture following the island type PMMCF with a review of literature.

The mechanism of energy quantization is studied for classical dynamics on a highly anharmonic potential, ranging from integrable, mixed, and chaotic motions. The quantum eigenstates (standing waves) are created by the phase factors (the action integrals and the Maslov index) irrespective of the integrability, when the amplitude factors are relatively slowly varying. Indeed we show numerically that the time Fourier transform of an approximate semiclassical correlation function in which the amplitude factors are totally removed reproduces the spectral positions (energy eigenvalues) accurately in chaotic regime. Quantization with the phase information alone brings about dramatic simplification to molecular science, since the amplitude factors in the lowest order semiclassical approximation diverge exponentially in a chaotic domain.

Aims: The goal of this study was to investigate the incidence of occult metastasis in perivascular lymph node and nodal recurrence in these nodal pads in squamous cell carcinoma (SCC) of the tongue and floor of mouth., Methods: We performed a prospective analysis of the incidence of an occult metastasis in the perivascular lymph nodes in 55 patients (41 with an oral tongue carcinoma and 14 with a mouth floor carcinoma) who underwent an elective supraomohyoid neck dissection (SOHND) for SCC of the tongue and floor of mouth, from 1997 to 2002. 99 SOHND procedures were performed as follows: 72 in tongue carcinomas and 27 in the mouth floor carcinomas., Result: Clinically occult, but pathologically positive perivascular lymph nodes occurred in four of 72 of the tongue carcinomas and two of 27 of the mouth floor carcinomas. The incidence of the regional recurrence at level I was three of 45., Conclusions: This preliminary report reveals a small incidence of perivascular lymph-node metastases and the infrequent nodal recurrence in this area after SOHND in early-staged tongue and floor of mouth SCC.

Objective: Atrophy and a high T2 signal of the hippocampus are known to be the principal MR imaging findings of hippocampal sclerosis. The purpose of this study was to determine whether or not individual MRI findings correlate with surgical outcome in patients with this condition., Materials and Methods: Preoperative MR imaging findings in 57 consecutive patients with pathologically-proven hippocampal sclerosis who underwent anterior temporal lobectomy and were followed-up for 24 months or more were retrospectively reviewed, and the results were compared with the postsurgical outcome (Engel classification). The MR images included routine sagittal T1-weighted and axial T2-weighted spin-echo images, and oblique coronal T1-weighted 3D gradient-echo and T2-weighted 2D fast spin-echo images obtained on either a 1.5 T or 1.0 T unit. The images were visually evaluated by two neuroradiologists blinded to the outcome; their focus was the presence or absence of atrophy and a high T2 hippocampal signal., Results: Hippocampal atrophy was seen in 96% of cases (55/57) [100% (53/53) of the good outcome group (Engel class I and II), and 50% (2/4) of the poor outcome group (class III and IV)]. A high T2 hippocampal signal was seen in 61% of cases (35/57) [62% (33/53) of the good outcome group and 50% (2/4) of the poor outcome group]. All 35 patients with a high T2 signal had hippocampal atrophy. 'Normal' hippocampus, as revealed by MR imaging, occurred in 4% of patients (2/57), both of whom showed a poor outcome (Engel class III). The presence or absence of hippocampal atrophy correlated well with surgical outcome (p<0.01). High T2 signal intensity did not, however, significantly correlate with surgical outcome (p>0.05)., Conclusion: Compared with a high T2 hippocampal signal, hippocampal atrophy is more common and correlates better with surgical outcome. For the prediction of this, it thus appears to be the more useful indicator.

Human thrombopoietin (hTPO) variant cDNAs truncated in the C-terminal regions of wild-type hTPO (332 amino acids) were constructed by PCR and expressed in Trichoplusia ni (Tn5) insect cells using a baculovirus expression system. Each variant, hTPO163 (amino acids 1-163), hTPO198 (1-198) and hTPO245 (1-245), was produced in insect cells with very low efficiency in comparison with wild-type hTPO. Immunoblot analysis showed that the predicted 20, 25 and 34 kDa molecular sizes corresponding to hTPO163, hTPO198 and hTPO245, respectively, were barely detected in culture medium and most of the proteins remained within the cell. These results suggest that C-terminal regions containing potential N-glycosylation sites of hTPO are required for the secretion of hTPO into culture medium as well as expression in insect cells.

We investigated the polarization characteristics of a mode-locked fiber laser gyroscope (MLPLG) formed with a Nd-doped fiber as an optical gain medium and a Sagnac loop mirror. The output pulse patterns and the polarization states were found to be determined by fiber birefringence in the different sections of the MLPLG. We describe the conditions for the MLPLG to operate with automatic reciprocity leading to the possibility of phase-error-free operation.

The spectral, interferometric, and polarization properties of mode-coupling fiber gratings under strain are described. The grating is formed by photosensitivity that uses modal interference in the two-mode fiber. Theoretical and experimental results show the possibilities of using the fiber grating for optical switches, tunable filters, interferometric sensors, and polarizers.