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장석효,왕희정 인제대학교 1990 仁濟醫學 Vol.11 No.3
외과적 측면에서 갑상선결적의 세침흡입생검의 유용성과 그 결과에 입각한 치료 방침을 검토하기 위하여 1986년 5월부터 1990년 5월까지 세침흡입생검을 시행한 후 갑상선절제술을 시행한 70례를 비교 분석하였다. Thyroid nodules often present diagnostic difficulties. The task of carcinoma of the thyroid gland is higher for solitary nodule. Aspiration biospsy cytology(ABC) has been considered a highly effective diagnostic tool in evaluating a broad spectrum of palpable and non-palpable thyroid diseases. I reviewed 70 cases of the patient, 3 with thyroid nodule who underwent both, ABC and surgery at the department of surgery, Inje university Paik hospital at Seoul over a period of 5 years from Mar. 1986 to Mar 1990, by comparing of the histologic differences between the ABC findings and the postoperative pathologic report. The results were as followings. 1) In the 22 patients with the ABC diagnosis of adenomatous goiter, the pathologic findings were adenomatous goiter in 18, follicular adenoma in 2, and papillary carcinoma in 27cases. 2) In the 6 patients with the ABC diagnosis of "negative follicular lesion", the pathologic findings were benign follicular lesion in 3, follicular adenocarcinoma in 2, and adenomatous goiter in 1 case. 3) In the 4 patients with the ABC diagnosis of "suspicious follicular lesion", the pathologic findings were follicular adenocarcinoma in 3 and papillary carcinoma in 1case. 4) In the 25 patients with the ABC diagnosis of papillary carcinoma, the pathologic findings were the ABC diagnosis in 21 cases, and the remaining 4 cases were undifferentiated carcinoma, Hurtle cell carcinoma, malignant lymphoma, and thyroiditis 5) In the 31 patients with the ABC diagnosis of "positive" or "suspicious", malignancy, 96.8% of of the cases were confirmed as malignancy with false positive rate of 32%, and in the, 39 patient with the ABC diagnosis of "negative", 79.5% of cases were benign with false negative rate of 16.1%. 6) In this study, the accuracy of the ABC was 814%, the sensitivity was 96.8%, and the specificity was 87.2.
Carotid Endarterectomy after a Completed Storke
Chang, Surk Hyo 인제대학교 1987 仁濟醫學 Vol.8 No.1
경동맥 내막절제술은 Transient ischemic attack의 치료와 stroke의 예방 목적으로 미국 및 유럽의 여러 곳에서 시행하고 있다. 그러나 permanent neurologic dcficit가 있는 환자에서의 cerebral ischemia의 치료에 경동맥의 수술 효과에 대해서는 아직 논란이 많은 실정이다. 저자는 previous stroke가 있던 환자들에게 경동맥 내막절제술을 시행함으로써 recurrent neurologic deficit를 예방할 수 있는지를 같은 기간에 수술을 하지 않은 대조군과 비교하여 추적 조사한 결과 수술군에서 recurrent neurologic deficit의 위험을 경감 시킬 수 있었다. 저자는 경도 내지 중등도의 neurologic deficit가 있는 64명의 stroke가 있었던 환자들에게 32명은 경동맥 내막 절제술을 시행하였고 나머지 32명은 내과적인 치료(Anticoagulant, antiplatelet agent)를 하여 비교하여 보았다. 두 군의 연령, 성별 분포와 다른 질병을 가진 빈도도 비슷하였다. 비수술 요법으로 치료한 환자에서는 추적 기간 동안에 32명 중 7명에서 새로운 neurologic deficit가 있었고 이 중2명이 stroke의 합병증으로 사망하였다. 수술군에서는 수술 후 32명 중 1명에서 새로운 neurologic deficit가 있었으나 stroke에 의한 사망은 없었다. 수술군의 나머지 환자에서는 약 4년 동안 추적 조사한 결과 recurrent neurologic deficit는 나타나지 않았다. 결론적으로 경도 또는 중등도의 neurologic deficit가 있던 stroke환자에서 Carotid endarterectomy를 시행함으로써 recurrent neurologic deficit를 예방 할 수 있다는 결론을 얻었다. The merit of carotid endarterectomy for patients who previously have a sustaind completed stroke remains controversial. Between January 1982 and June 1985, 64 stroke patients with mild to severe permanent neurologic deficits were evaluate. Thirty two patients were managed nonoperatively and 32 operatively. Both cohorts were similar in age and sex distribution, incidence of hypertension (60%), diabetes mellitus (25%), and cardiac disease (38%). In the long-term follow-up (medical cohort average was 32±3.0 months; surgical cohort average,30.6 ± 2.6 months), the overall survival rate was comparable, that is there were five medical deaths and 4 surgical deaths. However, there was a signifiant difference in the development of new neurologic deficits. Seven of the 32 unoperated patients had new neurologic deficits and two patients died at 13,27 months as a result of a recurrent stoke. New neurologic deficits developed in only one of 32 surgical patients and there was no stroke-related death. When the cumulative probability of remaining free from recurrent deficits was examined in the surviving patients at 4 years, all the patients in the operated group remained free from recurrent deficits. These data suggest that stroke patients with fixed mild to moderate neurologic dificits and with carotid lesions may be protected from the recurrent neurologic complication by carotid endarterctomy.