BackgroundEndoscopic thyroidectomy has been applied prudently to malignant thyroid tumors. The purpose of our study was to compare the surgical outcomes of endoscopic thyroidectomy (ET) and conventional open thyroidectomy (COT) for micropapillary thyroid carcinoma.MethodsFrom October 2002 to December 2008, 78 patients underwent unilateral lobectomy and isthmectomy with central lymph node dissection for papillary thyroid microcarcinoma. Of these, 37 patients underwent ET and 41patients COT. Surgical outcomes, including operation time, number of retrieved lymph nodes, postoperative complication rate and patients’ satisfaction with the cosmetic results, were analyzed.ResultsThe mean age of the patients was 42.3 ± 7.6 years in the ET group and 49.0 ± 10.8 years in the OT group (P = 0.003). The operation time was shorter in the COT group (112.3 ± 14min) than in the ET group (138.4 ± 36.9 min, P< 0.01). However, there were no significant differences in tumor size (0.5 ± 0.231vs. 0.41 ± 0.264cm, P = 0.116), number of retrieved lymph nodes (3.63 ± 2.1vs. 3.82 ± 3.28, P = 0.78) or postoperative hospital stay (3.35 ± 0.94vs. 3.17 ± 1.16 days, P = 0.457). Patients in the ET group experienced more pain than those in the COT group at 1 and 7 days after the operation as evaluated by a visual analog scale (P = 0.037, 0.026). Cosmetically, patients in the ET group were very satisfied with the operative procedure according to the questionnaire we used (1.43 ± 0.55vs. 3.21 ± 0.72, P< 0.001). The mean follow-up period was 54.3 months in the ET group and 47.4 months in the COT group, and each group exhibited one case of tumor recurrence detected at the other thyroid lobe within 2 years.ConclusionsLarge series of prospective studies and long-term follow-up are needed, but the results of ET using the axillary approach for micropapillary thyroid carcinoma were not inferiortothose using COT, and it might be a safe and feasible procedure with good cosmetic results.

PurposeThe laparoscopic appendectomy has become popular for the treatment of acute appendicitis. A single-incision laparoscopic appendectomy offers better cosmesis. We present the results of single-incision laparoscopic appendectomies in our hospital as initial experience.MethodsA single-incision laparoscopic appendectomy was performed in 75 patients at The Catholic University of Korea, Bucheon St. Mary's hospital. The operating time, operation type, hospital stay, surgical morbidities, and body mass index were compared.ResultsThis retrospective study revealed equal operation times in both the suppurative and the perforated appendicitis group. There was an increase in the hospital stay in the perforated appendicitis group. The postoperative complication rate was 4%, and the median operation time was 58.55 ± 31.79 minutes.ConclusionThe single-incision laparoscopic appendectomy was easy and safe procedure for treating acute appendicitis. There were no differences in degree of inflammation and body mass index.

Introduction. Chlorfenapyr is commonly used for food crops in Korea. However, chlorfenapyr toxicity in humans has not yet been studied. Case. A 74-year-old man was admitted to the emergency room after he intra-abdominally injected 20 mL of chlorfenapyr in an attempt to commit suicide. Emergency surgery was performed and accumulation of approximately 500 mL of reactive fluid in the abdomen was observed. The entire small intestine showed congestion. After surgery, additional surgery to drain the fluid was performed on POD 12. But immediately after administration of general anesthesia, flat rhythm was observed by electrocardiogram (ECG) monitoring, requiring cardiopulmonary resuscitation (CPR). Discussion. The color of the bowel was purple, indicating ischemic injury. This could be attributed to direct absorption of the substance through the peritoneum, leading to chemical injury to the small intestine serosa, unlike in the case of oral ingestion. This resulted in an ischemic change in the small intestine, eventually leading to sepsis. Conclusion. Only a few cases of chlorfenapyr toxicity have been reported in the literature, and death occurred in all cases, including our case. Therefore, careful and aggressive treatments are necessary. This is the first reported case of intra-abdominal injection of chlorfenapyr.

We incidentally discovered a case of deep neck infection during the treatment of a patient who presented with complaints of decreased consciousness, abdominal distension, and electrolyte imbalance. The patient had neither clinical symptoms nor radiologic findings indicative of deep neck infection; rather, the findings indicated intra-abdominal sepsis and adrenal crisis, for which the symptomatic treatment was provided. When the expected improvement was not observed, we retrospectively reviewed the patient's test records and discovered deep neck infection. Empiric parenteral antibiotic therapy and infection source control, as appropriate for this patient, were administered within 72 hours of hospital admission, without which the condition may have proved fatal. In this report we discuss the best approach for the management of unresolved infectious disease and review the clinical features of deep neck infection.