The presence of extranodal invasion in patients with thyroid papillary carcinoma is an indicator of distant metastasis and poorer prognosis.

Seventy‐one cases of papillary adenocarcinoma of the thyroid were operated on from January 1967 to July 1968. in 14 cases, the diagnosis of carcinoma was established postoperatively, so that 57 patients underwent systematic lymph node excision. Among these 57 cases, 90% had evidence of metastasis. a majority of metastatic deposits were small, i.e., 57% of them were less than 3 mm in diameter. There was no relationship between the location of primary tumor and metastasis; the initial metastases were most commonly observed in the pre‐ and paratracheal nodes, and subsequently, metastases were noted in the deep inferior and lateral cervical nodes. in patients who had a small number of metastatic deposits, the metastases were concentrated in the following sequence: pre‐ and paratracheal nodes, deep lower and lateral, and deep upper submandibular nodes. in those who had extensive metastases, the sequence of concentration was as follows: pre‐ and paratracheal, paraglandular and deep upper cervical, deep lower and lateral, and submandibular. From these observations, it can be concluded that metastasis of papillary thyroid carcinoma occurs first in paratracheal nodes, regardless of the location of the primary tumor. in the early stages, metastases are more frequent in the lower part of the neck. in later stages, when lymphatic obstruction has occurred, metastases appear in upper and submandibular nodes.

Purpose: Assessment of the proliferative ability of cancer cells is necessary not only for the biologic characterization of tumors, but also for the selection of treatment and evaluation of prognosis. Recently, there have been several studies examining the proliferative activity of various malignant tumors using immunohistochemical methods. PCNA is a nuclear protein related to the cell cycle and found with high expression in proliferative tissues, including cancers. Methods: In our study, to evaluate whether PCNA expression was useful as a prognostic factor in patients with pa-pillary thyroid carcinoma, we quantitated the immunohisto-chemical expression of PCNA in the formalin-fixed paraffin embedded tissue from 55 patients with papillary thyroid car-cinoma and correlated the results with established clinico-pathologic parameters. Results: The results were as follows. 1) PCNA expression in papillary thyroid carcinoma did not correlate with the age, sex or metastatic L/N activity of the patient, nor with the size, invasion, or recurrence of the tumor. 2) There was a close relationship between the expression rate of PCNA in thyroid tumor cells and that in metastatic L/N cells (p=0.056, in p0.1). 3) The expression of PCNA in the metastatic L/N (+) group was higher than in the metastatic L/N (-) group (p=0.045). Conclusion: It is suggested that PCNA expression is not an appropriate prognostic factor in papillary thyroid carcino-ma. (Korean J Endocrine Surg 2001;1:61-66)

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BackgroundAntimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan.MethodsThe infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses.ResultsProlonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship.ConclusionExtensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay.