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Joon-Hyop Lee,Yoo Seung Chung,Young Don Lee 대한종양외과학회 2017 Korean Journal of Clinical Oncology Vol.13 No.1
Purpose: Although many Koreans consume traditional alternative remedial products to alleviate symptoms of fatigue, there have been no studies on their effect on thyroid function levels in thyroidectomized patients on levothyroxine replacement. The aim of this study was to assess the effect of Korean traditional alternative remedies on thyroid function levels in post total thyroidectomy patients. Methods: A retrospective review of medical records from a single tertiary referral center was performed on patients who received total thyroidectomy from 2010 to 2015 and became euthyroid postoperatively. Gender, age, body mass index, preoperative thyroid function test results, interval to first hypothyroidism occurrence, recurrence of hypothyroidism, number and types of alternative remedy were evaluated. Results: Postoperative hypothyroidism occurred among 174 out of 917 patients (18.9%) and 100 (57.5%) of them had a history of alternative medication usage. The first episode of hypothyroidism occurred at median of 38.5 months after operation in the 100 patients. Six of the 100 patients received an increased dosage of levothyroxine due to severe hypothyroidism but the rest received the same dose and were requested not to consume alternative products. All patients recovered to euthyroid status afterwards. Thirty-three patients subsequently experienced recurrence even after being restricted from consuming alternative remedial products. Apart from thyroiditis on pathology reports (P=0.001), there were no variables significantly related to the recurrent hypothyroidism. Conclusion: This pilot study demonstrated the possible role of consumption patterns of traditional alternative remedial products in thyroidectomized patients under hormone supplement in restoring euthyroid status without levothyroxine increase.
Early experience of laparoscopic choledochal cyst excision in children
Joon-Hyop Lee,Soo-Hong Kim,Hyun-Young Kim,Young Hoon Choi,Sung-Eun Jung,Kwi-Won Park 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.85 No.5
Purpose: Laparoscopic choledochal cyst excision with Roux-en-Y hepati cojejunostomy (LCE) in children is being attempted more frequently around the world, and although it has been performed in Korea, no publication has been published on it. However, cholangitis and/or pancreatitis are limitations that make open conversion more likely. The aims of this study, through a retrospective clinical analysis, were to prove the efficacy of LCE in children and to validate that preoperative management expands its indications. Methods: From May 2011 to November 2012, 13 pediatric LCEs were performed. Demo graphics, preoperative findings, management, operative and postoperative outcomes were reviewed. Results: The mean age at operation was 48.5 months and mean bodyweight 19.0 kg. Ultrasonography was conducted in all patients followed by either magnetic resonance cholangiopancreatography (8 cases) or computed tomography (5 cases). The mean diameter of the cysts was 30.2 mm. Eight patients with cholangitis and/or pancreatitis were given antibiotics preoperatively. Four had their condition resolved by administration of antibiotics, 3 underwent additional endoscopic retrograde biliary drainage or percutaneous transhepatic biliary drainage, and one, due to aggravating tenderness, underwent surgery after 4 days of administrating antibiotics without improvement of the inflammation. Two faced open conversions, one because of a very narrow bile duct, and the other because of remnant inflammation after inadequate preoperative management already mentioned above. Patients were discharged on the eighth postoperative day. There were no complications. Conclusion: Pediatric LCE is a feasible option for choledochal cyst. Proper preoperative management such as antibiotics and drainage procedures enhances its efficacy by broadening its indications, even with concomitant cholangitis and/or pancreatitis.
Lee, Joon-Hyop,Suh, Yong Joon,Song, Ra-Yeong,Yi, Jin Wook,Yu, Hyeong Won,Kwon, Hyungju,Choi, June Young,Lee, Kyu Eun Williams & Wilkins Co 2017 Medicine Vol.96 No.22
<P><B>Abstract</B></P><P><B>Background:</B></P><P>Clinical trials on bilateral axillo-breast approach (BABA) thyroidectomy show that levobupivacaine and ropivacaine significantly reduce postoperative pain, but they focused on BABA robotic thyroidectomy only and did not identify specific sites of significant pain relief. Our objective was to assess the pain reduction at various sites and safety of ropivacaine-epinephrine flap injection in BABA thyroidectomy.</P><P><B>Methods:</B></P><P>This prospective double-blinded randomized controlled trial was conducted in compliance with the revised CONSORT statement (ClinicalTrials.gov registration no. NCT02112370). Patients were randomized into the ropivacaine-epinephrine arm or control (normal saline) arm.</P><P><B>Results:</B></P><P>From January 2014 to May 2016, 148 patients participated. The primary endpoint was site-specific pain, as measured by numeric rating scale 12 hours after surgery. The ropivacaine-epinephrine group exhibited significantly less swallowing difficulty (<I>P</I> = .008), anterior neck pain (<I>P</I> = .016), and right (<I>P</I> = .019) and left (<I>P</I> = .035) chest pain. Secondary endpoints were systolic (<I>P</I> = .402), diastolic (<I>P</I> = .827) blood pressure, and pulse rate (<I>P</I> = .397) after injection before incision and during surgery. The vital signs of the groups just after injection did not differ. During surgery, the ropivacaine-epinephrine patients had higher pulse rates (99 ± 13.3 vs 88 ± 16.1, <I>P</I> < .001) but within normal range. There were no adverse events such as postoperative nausea and vomiting. There was no significant difference in pain scores in either patient group between patients who underwent robotic or endoscopic interventions.</P><P><B>Conclusion:</B></P><P>BABA flap-site injection with ropivacaine and epinephrine mix before incision effectively and safely reduced postoperative pain. Future studies should focus on tailoring ropivacaine and epinephrine dosage for individuals.</P>