ObjectivesThe extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question.MethodsA retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes.ResultsOn pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence.ConclusionECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.

Background and ObjectivesZZIn aging society, interest in idiopathic sudden sensorineural hearing loss (ISSNHL) in elderly have been increased. However, as there has been little discussion about prognostic factors of ISSNHL in old age, this study aims to investigate clinical factors related with prognosis of ISSNHL in elderly and compare with that in adults. Subjects and MethodZZA retrospective medical chart review was performed in patients over 19 years old who diagnosed with ISSNHL from Jan. 2010 to Dec. 2012. Patients were categorized into the old age group (over 65 years old, n=62) and the control group (aged 19 to 64 years old, n=218). Clinical findings, audiological result and treatment outcomes were compared between two groups. And possible prognostic factors of SSNHL in elderly were also investigated. ResultsZZSignificant difference of hearing recovery was identified between the old age group (33.9%, 21/62) and control group (50.9%, 111/218) according to Siegel's criteria (p=0.021). Multivariate analysis concluded that delayed treatment and low speech discrimination score (SDS) might lead to poor prognosis in elderly. The presence of tinnitus or dizziness, audiometric configurations, hypertension and diabetes mellitus did not affect the treatment results of ISSNHL in the old age group. ConclusionZZOnset of treatment and initial SDS could be possible prognostic factors of ISSNHL in elderly. Early diagnosis and urgent treatment are more important in old age.

Background and ObjectivesZZMost secondary hyperparathyroidism is caused by chronic kidney disease. The purpose of this study is to evaluate the effectiveness of subtotal parathyroidectomy in the surgical treatment of renal hyperparathyroidism. Subjects and MethodZZWe studied twelve patients with renal hyperparathyroidism who underwent parathyroidectomy from Dec. 2002 to Mar. 2007. We measured the amount of serum, intact parathyroid hormone, calcium, ionized calcium, inorganic phosphorus, and alkaline phosphatase preoperatively and postoperatively. ResultsZZSubtotal parathyroidectomy was performed in nine patients, and three enlarged parathyroid glands were removed from three patients. Hyperparathyroidism was observed in four patients (33.3%), normal parathyroid function in six patients (50.0%) and hypoparathyroidism in two patients (16.7%) at 5 years after surgery. All of three patients who had removed three enlarged parathyroid glands showed persistent hyperparathyroidism. Serum ionized calcium was normal in 10 patients and two patients showed hypocalcemia after operation. ConclusionZZBased on the results of this study, we conclude that subtotal parathyroidectomy may be effective in the surgical treatment of renal hyperparathyroidism. However, further studies are necessary to determine the optimal amount of remnant parathyroid tissue in subtotal parathyroidectomy to maintain normal parathyroid function postoperatively.