No abstract available.

Background : It is not easy to diagnose sporadic medullary thyroid carcinoma(MTC) before surgery and this might lead the patient reoperation and/or lowered chance of definite cure. Methods : The prevalence of sporadic MTC in Korean was studied in patients with thyroid nodules. A prospective study of 1048 consecutive patients with thyroid nodules was performed. In all patients, measurements of basal serum calcitonin, thyroid hormones, TSH, anti-thyroglobulin antibody and anti-thyroperoxidase antibody were undertaken along with technetium-99m thyroid scintigraphy and fine needle aspiration cytology. In patients with elevated basal calcitonin levels, calcium stimulated calcitonin level was determined. Results: Two patient had markedly elevated calcitonin levels(over 3,200 pg/mL and 1,763 pg/ mL) and another one slightly elevated calcitoni#n(71.9 pg/mL). Fine needle aspiration cytology was suggestive of MTC in one and nodular hyperplasia in the other two. They underwent surgery and histological examination revealed MTC in those two with markedly elevated calcitonin levels. The patient with slightly elevated calcitonin, who was on the maintenance hemodialysis due to chronic renal failure, had nodular hyperplasia. Conclusion: MTC was found in 0.19% of patients with thyroid nodules, which was not different with the previously reported prevalence in Europe. Routine measurements of serum calcitonin might be of value to detect sporadic MTC; however, the cost-effectiveness of routine measurement of serum calcitonin is not clear, considering the relatively low prevalence of MTC in Koreans.
Biopsy, Fine-Needle ; Calcitonin ; Calcium ; Carcinoma, Medullary ; Europe ; Humans ; Hyperplasia ; Kidney Failure, Chronic ; Mass Screening ; Prevalence ; Prospective Studies ; Radionuclide Imaging ; Renal Dialysis ; Reoperation ; Thyroid Gland ; Thyroid Hormones ; Thyroid Nodule

BACKGROUND: Ventricular remodeling after myocardial infarction increase mortality and morbidity. Two-dimensional echocardiography in acute myocardial infarction provides a useful diagnostic tool for evaluation of ventricular remodeling. The aims of this study were to verify whether follow-up two-dimensional echocardiography could detect ventricular enlargement after acute myocardial infarction and to find early echocardiographic predictors and clinical charateristics of ventricular enlargement. METHODS: Two-dimensional echocardiography was done prospectively at 2 week, 3 month, and 6 month after the first Q-wave acute myocardial infarction in 18 patients. The control group was 11 patients of a normal chest roentgenogram and echocardiogram who were studied for chest pain or arrhythmia. The patients were divided by the mean value of the control group left ventricular end-diastolic volume index(LVEDVI) 56.8ml/m2. The group A was more than 60ml/m2(the control group LVEDVI 56.8ml/m2) and the group B was less than 60ml/m2 of LVEDVI at 2 week post myocardial infarction. The left vantricular volume was measured by the modified disk method at the apical four chamber view. The wall motion abnormality of left ventricle was examined by the recommendation of the American Society of Echcardiography. RESULTS: The left vntricular end-diastolic volume and the left ventricular end-systolic volume were enlarged after 3 month of acute myocardial infarction in the group A compare with those of the control group. There was no ventricular enlargement during 6 month after myocardial infarction in the group B. The frequency of ventricular enlargement was increased in anterior myocardial infarction. There was no difference in left ventricular ejection fraction at 2 week post myocardial infarction between the group A(51.4+/-15.7%) and the group B(50.8+/-10.3%). The wall motion score index more than 1.5 at 2 week post myocardial infarction means the enlarged LVEDVI more than 60ml/m2 and the group of ventricular enlargement. CONCLUSION: The left ventricular enlargement could be diagnosed by the follow-up two-dimensional echocardiography in acute myocardial infarction. The echocardiographic early predictors of ventricular enlagement were the left ventricular end-diastolic volume greater than 60ml/m2 and increased wall motion score index more than 1.5 at 2 week post myocardial infarstion. The anterior myocardial infarction was the electrocardiographic predictor of ventricular dilatation. Therefore these early predictors could identify the patients of ventricular enlargement and these patients could be a candidate of follow-up echocardiography and of a specific treatment for limiting ventricular remodeling.
Arrhythmias, Cardiac ; Chest Pain ; Dilatation ; Echocardiography* ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mortality ; Myocardial Infarction* ; Prospective Studies ; Stroke Volume ; Thorax ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: Diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms of diabetic cardiomyopathy have not been defined, but is associated with early left ventricular (LV) diastolic dysfunction following an altered LV contractile performance. However, less attention has been paid to the right ventricular (RV) diastolic function in diabetes. Therefore, the changes in the RV ans LV filling dynamics, in patients with early type 2 diabetes, were investigated. SUBJECTS AND METHODS: The transtricuspid and trans-mitral flows were assessed by transthoracic Doppler echocardiography, at maximal inspiration and expiration, in 48 subjects (mean age: 62+/-9 years, M:F=16:32) with type 2 diabetes (Type 2 DM group) and 34 normal subjects (control group ; mean age:59+/-9 years, M:F=15:19, ranging from 45-75 years of age) with normal LV systolic function and ECG at rest. Subjects with diabetic complication, nephropathy (Cr >1.5 mg/dL), LVH and COPD were excluded. RESULTS: The mitral E/A ratio and DT (deceleration time) showed no significant difference between the type 2 DM and control groups. The LV and RV systolic functions also showed no significant difference between the two groups. However, the type 2 DM group had a lower tricuspid E/A ratio (0.98+/-0.25 vs. 1.17+/-0.21, p<0.001) and a longer tricuspid DT (241+/-65 msec vs. 208+/-51 msec, p=0.016) than the control group. CONCLUSION: The right ventricular diastolic function is frequently abnormal in early type 2 diabetes. This suggests that right ventricular diastolic dysfunction may be an important predictor for the early detection of diabetic cardiomyopathy.
Atherosclerosis ; Cardiomyopathies ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Diastole ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Heart Ventricles ; Humans ; Pulmonary Disease, Chronic Obstructive

In modern society, characterized by variability of daily life, complicated industrial structure and surprisingly increased traffics, the danger of unexpected accident if always threatening the people. In America, for instance, almost 0.5% of the whole population annually suffers from head injury. About two thirds of traffic accident patients have head injury of various forms. Among the head injury patients due to traffic accidents, the commonest cause of death is head injury itself in about 70%. In this study, 585 cases of adult head injury patients over 15 years of age, observed at the Department of Neurosurgery, Seoul National University Hospital during the period from January, 1966 till September, 1971 were reviewed. 1) There were 447 men and 138 women; male female ratio was 3:1.2) The commonest cause of head injury was traffic accident (57.3% of the total patients). A second common cause was "falls"(25.5%). 3) In skull fracture patients, vault fractures were twice as frequent as basal skull fracture. The incidence of simple fractures was remarkably higher than that of compound fractures, the ratio being 7:4. The incidence of linear fractures was slightly higher than that of depressed fractures, the ratio being 6:5. Most of linear fractures were simple fractures, but about 79% of depressed fractures were compound fractures. 4) Among the intracranial hemorrhagic lesion, subdural hematoma occupied about half of the total cases, most of whom were acute cases. The predilection site of subdural hematoma was the cerebral convexity (frontal, parietal and temporal areas). The epidural hematoma , of which the predilection site was temporal area, occupied about 30 % of the total intracranial hemorrhage lesions. Temporal lobe was the predilection site of intracerebral hematoma. 5) About half of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures. About 28% of the cases with skull fractures were accompanied by intracranial hemorrhagic lesions. 6) Altered consciousness was observed in about 90% of the total patients. Lucid interval was observed in 26% of the cases with intracranial hemorrhagic lesion. Vomiting occurred in a quarter of the total patients and early convulsive attacks were noticed in 5%. 7) Overall mortality rate of all the head injury patients was 12.3% and their operative mortality rate was 20.1%. The mortality rate in the patients with skull fractures was five times as high as in the patients without skull fractures. The mortality rate in the patients with intracranial hemorrhagic lesions was nearly three times as high as in those without. The mortality rate in the patients with linear skull fractures was about three times as high as in those with depressed skull fractures. 8) Sequelae were noticed in about half of the total patients. The most frequent one was postconcussion syndrome, the incidence being 36% of the total patients. 9) Associated injuries were found in about 10% of the total patients. The frequent ones were clavicle fracture, tibia/fibula fracture and mandible fracture, in order.
Accidents, Traffic ; Adult* ; Americas ; Cause of Death ; Clavicle ; Consciousness ; Craniocerebral Trauma* ; Female ; Fractures, Open ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Mandible ; Mortality ; Neurosurgery ; Rabeprazole ; Seoul ; Skull Fracture, Depressed ; Skull Fractures ; Temporal Lobe ; Vomiting

The medulloblastoma, a neoplastic emtity which was first identified and described in 1925 by Bailey and Cushing, is a highly malignant, rapidly growing tumor mainly confined to the first decade of life. The medulloblastoma rarely calcifies. Many investigator have reported that medulloblastoma may exhibit calcification only on microscopic examination. Roentgenographic evidence of calcification was found in one case of 54 patients with medulloblastomas by McRae, and in only one case of 96 patients with medulloblastomas by Kalan. A twelve-year-old Korean male was admitted to Seoul National University Hospital on May 1, 1972 with the complaints of severe occipital headache, vomiting, and unsteady gait of five months duration. Neurological examination revealed bilateral papilledema of 3 diopters, signs of cerebellar dysfunction on the left side including truncal ataxia, adiadochokinesia, positive Romberg test and markedlv distured tandem gait. Horizontal nystagmus with quick component directed to the left side was also found. Plain skull films showed suture separation and an abnormal calcific shadow measuring about 2 by 2.5cm in the posterior fossa. Reflux brachial angiogram showed marked bowing of anterior cerebral artery, and elevation of middle and posterior cerebral arteries suggesting a large mass in the posterior fossa causing obstruction of CFS pathways resulting in marked dilatation of ventricular system. Exploring the posterior fossa, a soft grayish tumor mass was removed partially. Microscopic diagnosis was medulloblastoma of desmoplastic type with calcification. Postoperatively CSF leakage through the incision site was encountered, but was controlled to be healed up by compression bandage. The patient showed no significant change of neurological status by the time of discharge. The patient was scheduled to undergo Co60 radiation therapy after discharge.
Anterior Cerebral Artery ; Ataxia ; Cerebellar Diseases ; Compression Bandages ; Diagnosis ; Dilatation ; Gait ; Gait Disorders, Neurologic ; Headache ; Humans ; Male ; Medulloblastoma* ; Neurologic Examination ; Nystagmus, Pathologic ; Papilledema ; Posterior Cerebral Artery ; Research Personnel ; Seoul ; Skull ; Sutures ; Vomiting

BACKGROUND: The continuous use of biologic agents in the treatment of psoriasis has been reported to result in successful and sustained therapeutic effects and safety. However, some patients choose intermittent and repetitive treatment. OBJECTIVE: To determine the factors for selecting intermittent and repetitive ustekinumab treatment for the management of psoriasis. METHODS: From January 2011 to October 2016, we enrolled 30 psoriasis patients who discontinued ustekinumab treatment and were followed up for psoriasis treatment. We reviewed data regarding patients' clinical characteristics and the treatment they received, and investigated the factors for selecting intermittent treatment. RESULTS: A total of 52 ustekinumab treatment periods were administered to the 30 patients. Of the 52 treatment periods, 34.6% were covered by insurance and 82.4% were discontinued after sufficient improvement had been made or at the patient's request. Further analysis comparing the first and second ustekinumab treatments revealed that the patients who used ustekinumab in second treatment were more likely to be insured. In addition, the rate of patients reaching psoriasis area and severity index (PASI)75 and PASI90 was similar between the first and subsequent ustekinumab treatments. CONCLUSION: We found that the patients who used ustekinumab intermittently were those who were satisfied with the outcome of ustekinumab treatment but could not afford the treatment. These results suggested that economic burden can be a factor for the patients' choice of short-term intermittent treatment. The expansion of insurance coverage can increase the effectiveness of, and patients' satisfaction with, the management of psoriasis.
Biological Factors ; Cost of Illness ; Drug Administration Schedule ; Humans ; Insurance ; Insurance Coverage ; Psoriasis* ; Therapeutic Uses ; Ustekinumab*

Breast metastases from extra-mammary malignancies are unusual. In particular, the characteristics of breast metastasis from gastric cancer are rarely reported and there is no common specific finding among the reported cases. Breast metastases from extra-mammary malignancies are often misdiagnosed as benign lesions due to the absence of characteristic finding in imaging studies; however, they also resemble inflammatory breast cancer clinically sometimes. Therefore, differential diagnosis between the primary breast cancer and the metastatic disease is considered difficult. In order to hasten the diagnosis, to avoid unnecessary mastectomy, and to determine appropriate options of treatment, it is important that physicians understand the clinicopathological and radiologic features of breast metastases and consider its possibility in patients with a history of extra-mammary malignancies. Herein, we report a case of breast metastases from gastric cancer.

BACKGROUND: The assessment of the severity of psoriasis is often subjective because of the lack of quantitative laboratory diagnostic tools. Histopathological examination is the most commonly performed procedure for psoriasis diagnosis; however, it is usually descriptive. Thus, there is currently no quantitative method of determining psoriasis severity. The clinical types of psoriasis are correlated with the severity of the disease, and a lesional severity index, such as the psoriasis severity index (PSI), could be used as a quantitative tool for assessing gross severity. OBJECTIVE: To correlate the histopathological findings of psoriasis with the PSI. METHODS: Psoriatic lesions in 98 patients were evaluated. The lesions were classified into the guttate, papular, small plaque, and large plaque types according to morphology, and were scored according to the PSI. Ten common histopathological features of psoriasis were evaluated for correlation with gross severity. RESULTS: The clinical types of psoriasis showed significant correlations with the histopathological severity. However, the PSI score showed no correlation with histopathological severity. CONCLUSION: In the future, subjective gross assessment should be modified by using objective measuring devices with detailed scales, in order to correlate the findings with the histological severity.
Adult ; Classification ; Diagnosis ; Evidence-Based Practice ; Humans ; Pathology ; Psoriasis* ; Weights and Measures

OBJECTIVES: Delphinidin is one of the anthocyanidins. It is believed to have anti-inflammatory property including antioxidant, antiangiogenic, and anti-cancer properties. However, the anti-inflammatory effect of delphinidin in mucin-producing human airway epithelial cells has not been determined. Therefore, this study was conducted in order to investigate the effect and the brief signaling pathway of delphinidin in lipopolysaccharide (LPS)-induced MUC8 and MUC5B expression in human airway epithelial cells. METHODS: In mucin-producing human NCI-H292 airway epithelial cells and primary cultures of normal nasal epithelial cells, the reverse transcriptase-polymerase chain reaction (RT-PCR), real-time PCR, enzyme immunoassay were used for investigating the expressions of MUC8, MUC5, and Toll-like receptor 4 (TLR4), after LPS treatment and delphinidin treatment. And the signaling pathway of delphinidin on LPS-induced MUC8 and MUC5B expression was investigated using the RT-PCR, and immunoblot analysis. To confirm the involvement of TLR4 in LPS-induced MUC8 and MU5B expression, the cells were transfected with TLR4 siRNA. RESULTS: In NCI-H292 airway epithelial cells, LPS (100 ng/mL) significantly induced TLR4, MUC8, and MUC5B expression. TLR4 siRNA significantly blocked LPS-induced MUC8 and MUC5B mRNA expression. LPS (100 ng/mL) significantly activated the phosphorylation of extracellular signal related kinase (ERK) 1/2 and p38 mitogen-activated protein kinase (MAPK). Delphinidin (50 and 100 microM) inhibited LPS-induced TLR4, MUC8, and MUC5B expression and LPS-induced phosphorylation of ERK1/2 and p38 MAPK. In the primary cultures of normal nasal epithelial cells, delphinidin (50 and 100 microM) significantly inhibited LPS-induced TLR4, MUC8, and MUC5B gene expression. CONCLUSION: These results suggest that delphinidin attenuates LPS-induced MUC8 and MUC5B expression through the TLR4-mediated ERK1/2 and p38 MAPK signaling pathway in human airway epithelial cells. These findings indicated that delphinidin may be a therapeutic agent for control of inflammatory airway diseases.
Anthocyanins ; Epithelial Cells* ; Gene Expression ; Humans ; Immunoenzyme Techniques ; Lipopolysaccharides ; p38 Mitogen-Activated Protein Kinases* ; Phosphorylation ; Phosphotransferases ; Protein Kinases ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; RNA, Small Interfering ; Toll-Like Receptor 4 ; Toll-Like Receptors*