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Background: The current position of robotic surgery in the field of minimally invasive surgery remains ambiguous. We evaluated long-term trends of robotic general surgery and the future direction of its development. Methods: Data on robotic cancer surgeries between 2005 and 2014 were retrospectively collected by volunteer institutions in the Republic of Korea. Spearman's correlation and logistic regression analyses were used to compare robotic and laparoscopic surgery trends in general surgery. Results: The odds that robotic surgery was performed instead of laparoscopic surgery significantly decreased in the fields of colorectal, stomach, and hepato-biliary-pancreatic surgery (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.93–0.97; OR: 0.90, 95% CI: 0.88–0.92; and OR: 0.71, 95% CI: 0.65–0.78, respectively), except for thyroid surgery (OR: 1.28, 95% CI: 1.25–1.30). Of the total numbers of each procedure, proportions of robotic intersphincteric resections, abdominoperineal resections, and pylorus-preserving surgery performed significantly increased (r = 0.98, P

Endoscopic thyroidectomy is a technically challenging procedure. Robot-assisted thyroidectomy has been recently introduced and offers improved visualization and dexterity. The present study compared conventional endoscopic and robotic thyroidectomy for thyroid cancer patients in terms of perioperative outcomes and learning curve. All operations were performed by the same surgeon.Between April 2007 and March 2010, 96 patients underwent endoscopic thyroidectomy (endoscopy group) and 163 patients underwent robotic thyroidectomy (robot group). A gasless transaxillary approach was used in both groups. The 2 groups were compared in terms of patient characteristics, perioperative clinical results, complications, and pathologic details. Learning curves for the 2 procedures were compared based on the number of cases required to reach a consistent operation time.Patient characteristics were similar for both groups. The mean total operation time for thyroidectomy with central compartment neck dissection was 142.7 ± 52.1 min in the endoscopy group and 110.1 ± 50.7 min in the robot group (P = .041). Both patient groups were similar in terms of pathological features including TNM stage, intraoperative blood loss, length of hospital stay, and complication rate. However, the mean number of retrieved central lymph nodes was 2.4 ± 1.9 for the endoscopy group and 4.5 ± 1.5 for the robot group (P = .004). The learning curve was 55-60 cases for endoscopic thyroidectomy and 35-40 cases for robotic thyroidectomy.Robotic thyroidectomy was found to be superior to endoscopic thyroidectomy in terms of operation time, lymph node retrieval, and learning curve. Complication rates and postoperative hospital stay were similar for the 2 procedures.

The purpose of this study was to evaluate the combined role of ultrasound (US) and frozen section (FS) in the surgical management of thyroid nodules that are suspicious for papillary thyroid carcinoma (PTC) on US-guided fine-needle aspiration biopsy (US-FNAB). Between 2006 and 2008, 217 patients with thyroid nodules classified as suspicious for PTC on US-FNAB underwent intraoperative FS and surgery. A thyroid nodule with any suspicious US findings of marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, or taller than wider in shape was defined as positive and that without was defined as negative. FSs were classified as malignant, indeterminate, defer, and benign. We compared the results of US groupings, FS, and final histopathologic diagnosis. Twenty-one (52.5%) of 40 patients with a negative US revealed malignancy. In contrast, 168 (94.9%) of 177 patients with a positive US had malignancy. Fourteen (50%) of 28 patients with benign pathology on FS had malignancy, and 166 (97.6%) of 170 patients with malignancy on FS proved malignancy on histopathology. Of 40 patients with negative US, 13 (92.9%) of 14 with malignancy on FS proved malignancy. The malignancy rate of thyroid nodules read as “suspicious for PTC” on US-FNAB was 87.1%. When a thyroid nodule with “suspicious for PTC” on US-FNAB has suspicious malignant US features, FS may be unnecessary due to a very high risk of malignancy (94.9%). In contrast, when a thyroid nodule read as “suspicious for PTC” on US-FNAB has no suspicious malignant US features, FS can help surgeons determine the extent of surgery.

The clinical behaviors and treatment outcomes of thyroid carcinomas in patients with Graves' disease is a matter of controversy. This study aimed to identify the clinicopathologic features, treatment outcome, and the indicators for predicting recurrence, and to suggest the optimal extent of surgery in these patients. We retrospectively analyzed data of 58 patients who underwent surgical treatment for differentiated thyroid cancer and concurrent Graves' disease. The follow-up period ranged from 23 to 260 months (mean+/-standard deviation, 116.8+/-54.0). In our series, the mean age was 40.8+/-12.7 yr (range, 15-70), with a male-to-female ratio of 1: 6.25. The mean tumor size was 13+/-9 mm (range, 3-62). The surgical methods included 19 cases of total thyroidectomy, 38 cases of subtotal thyroidectomy, and 1 case of completion total thyroidectomy. Locoregional recurrence occurred in four patients (6.9%). The 10-yr overall survival and disease-free survival of patients were 95.8% and 91.1%, respectively. Age over 45 yr (p=0.031), tumor size over 10 mm (p=0.049), multiplicity (p=0.007), extracapsular invasion (p=0.021), and clinical cancer (p=0.035) were significantly more prevalent in patients with locoregional recurrence than in those without recurrence. We recommend that Graves' disease patients should undergo regular ultrasonography screening for early detection of thyroid carcinoma. We also suggest that the choice of extent of surgery should depend on the diagnostic timing (clinical or incidental) and factors for predicting recurrence.

Irrespective of ultrasound (US) features, surgery is usually recommended for patients who have a fine-needle aspiration biopsy (FNAB) read as suspicious for papillary carcinoma (PTC). The aim of the present study was to evaluate the role of US in the management of thyroid nodules with a FNAB reading suspicious for PTC.Between August 2002 and May 2006, 303 patients who had thyroid nodules with a FNAB reading suspicious for PTC underwent surgery. The sonographic findings in the patients were classified as suspicious for malignancy or probably benign based on the US reading. The US readings and final pathological diagnoses of thyroid nodules were analyzed in these patients.The malignancy rate was 84.2% in patients with a FNAB specimen suspicious for PTC. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the US were 96.4%, 74.5%, 92.7%, 94.9%, and 80.9%, respectively, in nodules read as suspicious for PTC on FNAB. Whereas 243 (96.4%) lesions were found to be malignant at surgery, in the 252 lesions that had ultrasound findings suspicious for malignancy, only 13 (25.5%) lesions were malignant out of the 51 that had US readings of probably benign (p0.05).The probability of malignancy is much lower in thyroid nodules with benign US findings even if the FNAB is read as suspicious for PTC. Therefore, US may be useful in planning the extent of surgery in patients with a FNAB reading of suspicious for PTC. As thyroid malignancy occurs in approximately 26% of patients with cytology readings suspicious for PTC and benign-appearing US, the US reading alone is not sufficient to determine the need for surgery. The US and FNAB are complementary to each other and should be useful when providing informed consent before thyroid surgery.

To evaluate the potential effect of estrogens in premenopausal female thyroid cancer, the concentrations of 14 estrogens were quantitatively determined in the urine of pre- and post-operative patients with thyroid papillary cancer (18 patients case, 26 approximately 54 years) and normal female subjects (20 cases, 31 approximately 52 years). The highly sensitive gas chromatography-mass spectrometry-selected ion-monitoring method was used for estrogens analysis. And an estrogen-oxidative metabolism and 16alpha-hydroxyestrone to 2-hydroxyestrone (16alpha-OH E1/2-OH E1) which is the two primary and competing site of estrogen-oxidation, were determined. Catechol estrogens, including 2-OH E1, were also increased without significant changes of the other estrogen metabolites in pre-operative patients with thyroid papillary cancer compared with normal subjects. The lowest mean value of 16alpha-OH E1/2-OH E1 was remarked in pre-operative patients, and it was significantly different from the ratio of post-operative cases. As a result, it is suggested that the increase of 2-hydroxylation in estrogen metabolism may have a significant association with female thyroid cancer.

This study was carried out to clarify the sensitivity of ultrasonographic mass screening for thyroid carcinoma. Between December 1997 and July 1998, a total of 1401 subjects who were scheduled to undergo either a breast examination or a follow-up examination for breast cancer were enrolled in this study. Patients with thyroid nodules were classified into two groups according to their potential risk for malignancy based on the ultrasonographic findings. Ultrasonographic high-risk patients for thyroid cancer underwent an ultrasound guided fine-needle aspiration biopsy (FNAB) and were advised to undergo a thyroidectomy based on the FNAB results. The characteristics of the thyroid cancer patients detected by mass screening were then compared with those of 106 consecutive female patients with clinical thyroid cancer during the same period. Thyroid nodules were detected in 353 (25.2%) of the subjects, 94 (26.6%) of whom were placed in the high-risk group for thyroid cancer. Among the 94 high-risk patients, 43 underwent a thyroidectomy and 37 turned out to have thyroid carcinomas. The detection rate for thyroid cancer was 2.6% for all subjects. The tumor size was significantly smaller than that of the clinically detected cancer group (P < 0.05). Ultrasonographic mass screening for thyroid carcinoma in women who require breast examinations is thus considered to be effective for the detection of subclinical thyroid carcinoma.

We recently developed a new surgical technique for carrying out thyroidectomy, to minimize tissue trauma by obviating unnecessary neck exploration. This report describes our technique of performing minimally invasive open thyroidectomy and compares the results with those of conventional thyroidectomy. Minimally invasive open thyroidectomy was performed by making a small skin incision, 3.0-4.5cm long, and approaching the thyroid directly via a transverse division of the strap muscles without raising skin flaps. The outcomes of 466 patients who underwent a minimally invasive open thyroidectomy were retrospectively compared with those of 437 patients who underwent conventional thyroidectomy for various types of thyroid nodules. There was no significant difference in the extent of surgery between the group of patients who underwent minimally invasive thyroidectomy and the group of patients who underwent conventional thyroidectomy. However, the length of the skin incision, at 3.7 +/- 0.7 vs 9.6 +/- 3.3 cm, respectively, operative time, at 57.6 +/- 11.7 vs 85.2 +/- 32.3 min, respectively, blood loss, at 18.4 +/- 15.3 vs 43.1 +/- 21.8 ml, respectively, and hospital stay, at 1.6 +/- 0.5 vs 4.3 +/- 1.6 days, respectively, were significantly reduced in the minimally invasive open thyroidectomy group (P < 0.05). Moreover, the number of patients who required postoperative analgesia was significantly less in the minimally invasive open thyroidectomy group. These results show that minimally invasive open thyroidectomy provides surgeons with a clear operative field, and that it has proven to be simple, safe, and practical for selected patients.

More efficient and faster separation conditions for qualitative as well as quantitative analysis of neuropeptides in human plasma using capillary zone electrophoresis (CZE) have been developed. The analysis method for neuropeptides has been improved specifically to study thyroid hormone related neuropetides for the regulation of thyroid disease. In this study, we investigated the pretreatment methods, composition of the running buffer and rinsing procedures between runs in order to obtain more sensitive and faster separation of trace neuropeptides in plasma by CZE. The tested neuropeptides were somatostatin (SOMA), vasopressin (VP), neurotensin (NT), and thyrotropin-releasing hormone (TRH). Plasma samples were pretreated by deproteinization and solid-phase extraction method. The fraction of neuropeptides was reconstituted in 40% acetonitrile followed by ultrafiltration, and then analyzed by CZE. Resolution and sensitivity was improved using the separation buffer composition with 100 mM Tris-phosphate buffer (pH 2.0) while the sensitivity was further improved via a stacking method using the sample buffer of 40% acetonitrile. These sample pretreatment methods and buffer condition permit quantitative analysis on tested neuropeptides at the 20 ng/mL level. The rinsing procedures between runs using 90% ethanol dramatically shortened the rinsing time to 30 min.

Background This phase II study investigated the efficacy and safety of everolimus, an inhibitor of mammalian target of rapamycin (mTOR), in locally advanced or metastatic thyroid cancer. Patients and methods Patients with thyroid cancer of any histology that was resistant or not appropriate for 131I received everolimus 10 mg daily orally until unacceptable toxicity or disease progression. The primary end point was disease control rate [partial response (PR) + stable response ≥12 weeks]. Secondary end points included response rates, clinical benefit (PD + durable stable disease (SD)], progression-free survival (PFS), overall survival, duration of response, and safety. Results Thirty-eight of 40 enrolled patients were evaluable for efficacy. The disease control rate was 81% and two (5%) patients achieved objective response; their duration of response was 21+ and 24+ weeks. Stable disease (SD) and progressive disease was reported in 76% and 17% of patients, respectively. Seventeen (45%) patients showed durable SD (≥24 weeks) and clinical benefit was reported in 19 (50%) patients. Median PFS was 47 weeks [95% confidence interval (CI) 14.9–78.5]. Calcitonin, CEA, and thyroglobulin concentrations were ≥50% lower than baseline in three (30%) and four (44%) patients with medullary thyroid cancer and five (33%) patients with PTC, respectively. The most common treatment-related adverse events were mucositis (84%), anorexia (44%), and aspartate transaminase/alanine transaminase elevation (26%). Conclusions Everolimus had a limited activity with low response rate in locally advanced or metastatic thyroid cancer. Reasonable clinical benefit rate and safety profile may warrant further investigation. ClinicalTrials.gov number NCT01164176.

Nerve blocks and infiltration with local anesthetics are commonly employed methods for postoperative pain control. This prospective, randomized trial was conducted to determine whether bilateral superficial cervical plexus block (BSCPB) is effective for reducing acute postoperative pain after robot-assisted endoscopic thyroidectomy (RAET) and to compare its effects with that of local wound infiltration (LWI).Ninety-seven patients who were to undergo RAET were randomly assigned to one of three groups to receive BSCPB with either 20 mL of 0.525% ropivacaine (BSCPB group, n=32) or 20 mL of isotonic sodium chloride solution (Control group, n=32) or LWI with 20 mL of 0.525% ropivacaine (LWI group, n=33). Postoperative pain scores were assessed at the postoperative anesthesia care unit (PACU) and at 6, 24, and 48 h postoperatively using a visual analog scale (VAS). Patients with VAS scores of ≥40 were administered rescue analgesics according to a standardized protocol. The main outcome variables were pain scores during the first postoperative 24 h and the number of patients requiring postoperative analgesic rescue.The BSCBP and LWI groups showed lower pain scores compared with the Control group at the PACU. The BSCPB group continued to show significantly lower pain scores compared with the LWI and Control groups at postoperative 6 and 24 h. The number of patients requiring analgesic rescue at the PACU was lower in the BSCPB and LWI groups than in the Control group. The number of patients requiring additional rescue analgesics after discharge from the PACU until the first 24 postoperative h was lower in the BSCPB group than in the LWI group.BSCPB and LWI are effective for reducing pain scores and analgesic requirements during the immediate postoperative period in patients who undergo RAET, with BSCPB being superior to LWI at postoperative 6-24 h.

Introduction. Breast augmentation with implants is a common cosmetic procedure. Some endoscopic thyroid procedures can pose a risk of damage to the augmented breast. The aim of this study was to evaluate the safety of transaxillary gasless endoscopic thyroidectomy in patients with augmented breast. Materials and Methods. Between January 2009 and December 2010, 120 patients underwent endoscopic thyroidectomies. Of those, 6 patients had previously undergone breast augmentation. Augmented breasts were evaluated preoperatively and postoperatively in terms of shape and stability. Results. All patients were female, and the mean age was 40.8 years. All patients received breast augmentation with silicone cohesive gel 2 to 10 years prior to thyroidectomy. Postoperatively, the authors found that there were no changes to the breasts in terms of anterior–posterior projections and internal angles. The augmented breasts remained stable. Conclusions. Endoscopic thyroidectomy via a transaxillary approach is safe and effective for patients who have undergone silicone breast implant augmentation.

Background: BRAF V600E, the most common BRAF gene mutation, is detected in approximately 50% of sporadic papillary thyroid carcinoma (PTC) and may be associated with triggering tumorigenesis of PTC. The aim of our study was to discover additional mutations to increase the diagnostic performance of molecular tests in screening for thyroid cancer from fine needle aspiration biopsy (FNAB) specimens. Methods: DNA was extracted from 120 freshly obtained FNAB specimens selected according to cytopathology grades of the Bethesda system. A conventional BRAF V600E test was carried out with real-time PCR, and further mutation screening for BRAF mutations in codons 464, 466, 469, NRAS and KRAS codons 12/13 and 61 was done by pyrosequencing. Histopathology reports were reviewed for those who underwent thyroidectomy (n=83). Results: The real-time PCR method detected 45 BRAF V600E- positive cases whereas pyrosequencing detected 30 cases. Additional BRAF (n=4), NRAS (n=11) and KRAS (n=3) mutations were detected in 17 cases (one overlapping BRAF and NRAS mutation). Among 11 NRAS-mutated cases, eight were confirmed as PTC and one as FVPTC on histopathology reports. Five PTC-confirmed cases with BRAF V600E mutation showed additional mutations, all of which were NRAS mutations. Discussion: Despite the higher sensitivity of real-time PCR for detecting BRAF V600E mutations, pyrosequencing easily detected additional point mutations. NRAS mutations were the most prevalently identified additional mutations and were highly associated with malignancy. In conclusion, our findings demonstrate that additional mutations identified by pyrosequencing may help in the pre-operative process in determining the possibility of malignancy and further studies on the occurrence of simultaneous mutations of BRAF, KRAS and NRAS may be warranted.

Implantation of thyroid cells (ITC) into extrathyroidal locations is a rare complication of thyroid fine-needle biopsy (FNB) and thyroid surgery. Here we review the prevalence, likely pathogenesis, treatment, and likely ways to minimize this complication of invasive thyroid procedures and present an illustrative patient.Tumor aggressiveness more likely leads to ITC after FNB. Large needle size may be associated with increased risk of ITC. Number of passages during biopsy, excessive suction, needle withdrawal without releasing suction, and injection of tumor cells during biopsy may be associated with ITC after FNB. This statement is based on rational hypotheses. Cutting or rupture of a thyroid nodule during surgery leads to ITC into extrathyroidal soft tissue.ITC occurs rarely with needles smaller than 23 gauge. Some authorities suggest the use of gentle suction and release suction during extraction and a reduced number of passes based on entirely theoretical grounds. In conventional surgery, lobectomy for all thyroid nodules rather than nodulectomy or partial lobectomy should be performed. If endoscopic surgery is performed on larger nodules, the surgeon should take great care to avoid rupturing the tumor.

A 63-year-old woman complained of a growing neck mass. Sonography revealed a solid and cystic mass in the right thyroid lobe. Color Doppler study and computed tomography revealed anechoic cystic portions within the thyroid nodule to be a pseudoaneurysm arising from the right inferior thyroid artery. The only identifiable risk factor was a past thyroid needle biopsy performed approximately 5 years previously according to the patient's recollection. Right lobectomy was performed and the pseudoaneurysm was treated without complication.

The chronic use of immunosuppressive therapy in transplant recipients increases the long-term risk for carcinoma. However, there is insufficient knowledge regarding the incidence and biological behavior of papillary thyroid carcinomas (PTC) in renal allograft recipients. In the present study we examined the incidence and biological behavior of PTCs among 1739 patients transplanted between January 1986 and December 1999 who had been followed for a mean period of 137 months (range, 84-238 months). During the follow-up, 129 (7.4%) recipients were identified to display posttransplantation malignancies, including 12 (0.7%) with PTCs. The 6 male and 6 female patients had a mean age of 41 years (range, 23-57 years). Nine cases (incidentalomas) were diagnosed based on ultrasonographic (US) screening. Eight of those 9 were TNM stage I, 2 of the 3 clinical carcinomas were TNM stage IVa. During a mean follow-up of 94 months (range, 18-159 months), 2 (16.7%) PTC patients developed locoregional recurrence, but no patients showed distant metastases. These data showed that recipients had a higher incidence of PTC compared with the general Korean population (0.7% vs 0.02%). Posttransplantation PTC tended to show no difference in gender distribution, and was often associated with aggressive lymphatic metastasis. However, most incidentalomas showed favorable treatment outcomes. In conclusion, routine surveillance of the thyroid gland using US screening is recommended to ensure early detection, treatment, and favorable prognosis of PTC.

Papillary thyroid carcinoma (PTC) patients show a high rate of cervical lymphatic metastasis. However, there are no universal binding guidelines for the extent of lateral cervical lymph node dissection (LND) in such cases. In particular, the need for LND above the spinal accessory nerve (SAN) remains controversial. The present study examined whether level IIb lymph node (LN) dissection is always necessary in PTC patients with lateral cervical LN metastasis. The study prospectively examined 167 PTC patients with lateral cervical LN metastasis who underwent modified radical neck dissection (MRND) in our institution from November 2005 to March 2007. The MRND was bilateral in 24 cases. All patients underwent level II, III, IV, and V LND. Levels IIa and IIb LNs were individually dissected in all cases. All LND was performed using strict leveling criteria by a single operating team. The patterns of lymphatic metastasis and potential risk factors for level IIb LN involvement were evaluated. The most common site of metastasis was level III (80.6% of cases), followed by level IV (74.9%) and II (55.5%). The metastasis rates in level IIa and IIb were 55.5% and 6.8%, respectively; all level IIb LN metastasis was accompanied by level IIa metastasis (p = 0.001). In addition, level IIb LN metastasis was found to be associated with the aggressiveness of lymphatic metastasis (i.e., the total number of metastatic LNs) (p

Medullary thyroid carcinoma (MTC) originates from parafollicular C cells. Estrogen receptor beta(ERbeta) expressionwas detected in normal parafollicular C cells and MTC tumor tissue, but ERalpha expression in MTC tumors still remains undetermined. The appearance and loss of ERalpha or ERbeta expression has been known to play a role in the development and progression of many human cancers. We performed immunohistochemical studies of ERalpha, ERbeta, and Ki67, a mitotic index, in 11 human MTC tissue samples. ERalpha was detected in 10 cases (91%), and ERbeta expression was observed in 8 cases (72.7%). A majority (8/10) of ERalpha-positive tumors showing ERbeta Ki67 expression was detected in three cases (27.3%). Neither clinical parameters nor tumor node metastasis (TNM) tumor staging was correlated with the positivity for ERs or Ki67. To investigate the biological role of each ER, we used ER-negative MTC TT cells and adenoviral vectors carrying ERalpha (Ad-ERalpha), ERbeta (Ad-ERbeta), estrogen response element (ERE)-Luc (Ad-ERE-Luc), and activator protein 1 (AP1)-Luc (Ad-AP1-Luc). Estrogen stimulated and anti-estrogen, ICI 182 780, suppressed ERE reporter activity in TT cells expressing ERalpha or ERbeta, suggesting that both ERs use the same classical ERE-mediated pathway. Ad-ERalpha infection stimulated TT cell growth; in contrast, Ad-ERbeta infection suppressed their growth. Apoptosis was detected in Ad-ERbeta-infected TT cells. Estrogen and anti-estrogen suppressed AP1 activity in Ad-ERalpha-infected cells, whereas upon Ad-ERbeta infection estrogen further stimulated AP1 activity which in turn is suppressed by anti-estrogen, suggesting that each ER acts differently through a non-ERE-mediated pathway. Our results suggest that ERalpha and ERbeta may play different roles in MTC tumor growth and progression.

Patients undergoing thyroidectomy with neck fully extended usually experience occipital headache and posterior neck pain. We have attempted to evaluate the effect of preoperative greater occipital nerve (GON) block on occipital headache and posterior neck pain after thyroidectomy. Eighty-two patients undergoing elective total thyroidectomy were randomly allocated to two groups. In block group, bilateral GON blocks with 0.25% bupivacaine were performed. The control group did not have any prior block. Occipital headache and posterior neck stiffness were assessed using the visual analogue scale (VAS) and verbal rating scale. VAS of occipital headache and posterior neck pain in block group was significantly lower compared to that in the control group at postoperative 12 and 24 hours (p < 0.05). In addition, the proportion of patients reporting moderate or severe occipital headache and posterior neck pain at postoperative 12 and 24 hours in block group was significantly lower than that in control group (p < 0.001). No side effects were observed during and after GON block. We conclude that preoperative GON block with 0.25% bupivacaine is an effective technique to reduce occipital headache and posterior neck pain after thyroid surgery.

To explore the possible involvement of a relationship between steroids and polyunsaturated fatty acids (PUFAs) in thyroid cancer, we studied the concentration levels of 21 endogenous urinary androgens and glucocorticoids, and 6 urinary PUFAs in female patients with thyroid cancer (n=29, 49.4+/-12.6 years) and in normal female subjects (n=20, 48.3+/-11.9 years). Using gas chromatography-mass spectrometry in selected ion-monitoring mode, we performed quantification of androgens, glucocorticoids, and PUFAs. In the case of the urinary androgens and the glucocorticoids, the concentration of androgens was not altered between patients with thyroid cancer and normal controls. However, the concentration of glucocorticoid significantly decreased in patients with thyroid cancer compared to that of the normal controls. Also, in case of urinary PUFAs, the precursor of cholesterol, the concentration of linoleic acid, arachidonic acid, and docosahexaenoic acid (DHA) were decreased in patient with thyroid cancer (P

We have adopted OK-432 as a sclerosing agent in the treatment of cystic predominant thyroid nodules and have analyzed our findings to assess the efficacy of intralesional instillation of OK-432. From 1992 through 1993, 48 patients with recurrent or progressive cystic thyroid nodules after 2 or 3 aspirations alone, and whom were cytologically negative for malignancy, were used for this study. The OK-432 solution was prepared by dissolving 0.1 mg of OK-432 in 2 ml of physiologic saline and it was instilled in the amount of 1/10-to-1/5 of the aspirated cystic fluid. A repeated course of therapy was given up to 3 times when sufficient resolution was not obtained 4-to-6 weeks after treatment. The mean number of treatment sessions per patient was 1.5. Throughout the follow-up period from 30-to-45 months (mean, 38 months), 32 (66.7%) patients experienced an almost complete disappearance (0.05 cm in diameter) of the cystic lesion, and 12 (25%) patients responded partially by having it decrease by more than half (0.5 cm in diameter) of the initial cyst size, and none of these patients required further treatment. The remaining 4 (8.3%) patients showed insufficient resolution despite 3 courses of therapy and 2 of these patients underwent thyroidectomy, in which the lesion proved benign in both cases. All of the patients tolerated the sclerotherapy well. No significant local complications attributed to this treatment were observed. However, a low-grade fever was observed in 26 (54.2%) patients for 2 to 5 days after instillation, which subsided with symptomatic treatment. On the basis of our experience, OK-432 sclerotherapy appears to be safe, simple and effective, and can be a useful alternative treatment for cystic thyroid nodules.

Recently, the rearrangement of RET proto-oncogene has been reported to be the most common genetic change in papillary thyroid carcinoma (PTC). However, its prevalence has been reported variably and its relation to clinical outcome has been controversial. The characteristic nuclear features of PTC usually render the diagnosis, but problem arises with equivocal cytologic features that are present focally. Although there remains some controversy, CK19 has been reported to be a useful ancillary tool for diagnosis of PTC. To evaluate the expression rate of RET/PTC rearrangement and CK19 in PTCs in a Korean population, we studied 115 papillary thyroid carcinomas in 3 mm-core tissue microarray based immunohistochemical analysis. The prevalence of Ret protein expression was 62.6% and the CK19 immunoreactivity was 80.9%. There was no statistically significant association between the Ret positivity and CK19 immunoreactivity, although the percent agreement of the two was relatively high. The clinicopathological variables did not correlate with the expression of Ret. In conclusion, the prevalence of Ret protein expression and its clinicopathological implications in a Korean population are not much different from those reported in previous studies. However, its detection via immunohistochemistry can be a useful diagnostic tool for diagnosing papillary thyroid carcinoma in conjunction with CK19.

Background: During thyroidectomy, the patient's neck is fully extended for good surgical exposure. After thyroidectomy, patients usually complain of posterior headache and posterior neck pain. It has been known that the greater occipital nerve block is a means of effective medical treatment for occipital headache and posterior neck pain. Therefore, we examined the effects of a greater occipital nerve block on postthyroidectomy headache and neck pain. Methods: This study was randomized and double-blinded. After anesthesia induction, patients were administered greater occipital nerve block by the same anesthesiologist;0.25% bupivacaine 5 ml was used for each greater occipital nerve block. Patients in the control group did not receive a greater occipital nerve block. After thyroidectomy, another anesthesiologist evaluated patients' headaches and neck pains at 4, 12, and 24 hours postoperatively by using a VAS. Results: Forty four patients were included. The number of patients in the control and the block group were 27 and 17, respectively. VAS scores of occipital headache after 4, 12, and 24 hours in the control group were 3.52 2.75, 3.67 2.75, and 2.95 1.96, respectively. VAS scores of occipital headache after 4, 12, and 24 hours in the block group were 0.05 0.65, 0.50 0.85, and 0.43 0.64, respectively. VAS scores of posterior neck pain after 4, 12, and 24 hours in the control group were 4.09 2.79, 3.81 2.60, and 3.00 2.02. VAS scores of posterior neck pain after 4, 12, and 24 hours in the block group were 1.29 2.20, 1.00 1.66, and 0.79 1.25, respectively. The pain experienced by the block group was significantly lower than that of the control group. Conclusions: We conclude that greater occipital nerve block is an effective modality for reducing post-thyroidectomy headache and posterior neck pain.