Primary role of ultrasound in patients with thyroid nodule is to determine the multiplicity and detect occult carcinoma. We analyzed US findings of 53 thyroid carcinomas with multiple nodular lesions from january 1988 to december 1991. The results were as follows: 1. 109 malignant nodules in 53 cases and 24 benign in 23 were comfirmed. 2. The nature of the masses were solid in 72 malignant nodules (74.2%), and complex in 25 (25.8%) of which 19 were predominantly solid. 3. The echo pattern of the solid and solid predominant masses were hypoechoic in 78 malignant nodules (80.4%), hyperechoic in 10 (10.3%), and isoechoic in 3 (9.3%) 4. Internal punctate calcifications within the masses were observed in 31 malignant nodules (31.9%). 5. Halo sign was present in 16 malignant nodules(16.5%). 6. The preoperative sonographic diagnosis of thyroid carcinoma was made in 39.4% of 53 cases with multiple nodules on US. In conclusion, the number, and halo formation of nodules were insignificant to differentiate the benign nodule from the malignant. The heterogeneous hypoechoic nodules with size greater than 4cm, multiple stippled calcifications, displacement of the trachea or other surrounding structures of combined lymph node enlargements seem to indicate the possibility of malignancy.
Diagnosis ; Goiter* ; Humans ; Lymph Nodes ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Trachea ; Ultrasonography

Hematuria is defined by the presence of red blood cells in the urine, usually treated by primary care physicians. Various urologic conditions cause this common finding. While malignancies are often considered in the differential diagnosis, benign urologic conditions also need to be recognized as potential causes of hematuria. A better understanding of these benign conditions can help avoid unnecessary diagnostic procedures and improve patient outcomes.Current Concepts: This review provides an overview of the current concepts regarding benign urologic conditions associated with hematuria. These include urinary tract infections, urolithiasis, benign prostatic hyperplasia, vascular conditions affecting the urinary tract, and hemorrhagic cystitis. Based on the latest literature, we discuss the epidemiology, clinical presentation, diagnostic evaluation, and management options for each benign condition.Discussion and Conclusion: Clinical presentation, diagnostic evaluation, and management of each condition are discussed. A comprehensive understanding of these benign urologic conditions is essential for accurately diagnosing and effectively managing hematuria.

Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

The use of interlocking intramedullary nail is accepted one of treatment choices in the comminuted fractures of humeral shaft. The insertion of distal interlocking screws remains technically problematic. The use of intrageon's hands during the procedure. In order to reduce technical difficulty and radiation exposure, it is necessary to compare the rigidity of intramedullary nail according to the number of distal interlocking screws. The purpose of study is to compare the stability of interlocking intramedullary nail according to the number of distal screws by means of torsional compliance measurements in the simulated humeral shaft fractures. Simulated fractures were made in 20 humora from 10 cadavera at the mid-junction of humeral shaft. All humora were fixated with titaium humeral nail system. Interlocking screws were placed at proximal and distal screw holes by standard procedure. Group I consisted of 10 humora fixated with one distal interlocking screw and group II consisted of 10 humora fixated with two distal intterlocking screws. Torsional compliance was measured with single-end of 10 humora fixated with two distal interlocking screws. Torsional compliance was measured with single-end double arm torquing machine. The torsional compliance analog was 0.0294+/-0.0033 mm/N mm for one screw and 0.0241+/-0.0045 mm/N mm for two distal screws. The torsional compliance analog between two groups was found to be statistically insignificant(p=0.23). In conclusion, One distal interlocking screw was not inferior to two interlocking screws in terms of biomechanical characteristics, especially torsional compliance analog.
Arm ; Compliance ; Fracture Fixation, Intramedullary* ; Fractures, Comminuted ; Hand

PURPOSE: In advanced prostate cancer, malignant cells generally tend to spread into the bone, and metastasis into nonregional lymph nodes (NRLNs) at the time of initial diagnosis is relatively rare. We investigated the prognostic significance of NRLN metastasis in patients receiving hormonal therapy and chemotherapy. MATERIALS AND METHODS: From February 2005 to August 2011, we identified 105 patients who had metastatic prostate cancer. First, we assessed the prognostic effect of NRLN metastasis on the prostate-specific antigen response through logistic regression and the progression-free time to castration-resistant prostate cancer (CRPC) by using the Cox proportional hazard regression model. Second, we investigated the prognostic influence of NRLN metastasis on the chemotherapy response through logistic regression and on cancer-specific survival of CRPC patients receiving chemotherapy by using Cox proportional analysis. RESULTS: Of these 105 patients, 12 patients (11.4%) had only NRLN metastases without bone metastases. Progression-free time to CRPC was significantly less in patients with NRLN metastases by Cox proportional hazard regression multivariate analysis (p=0.020). However, NRLN metastasis was not an independent factor for predicting the response to chemotherapy in CRPC patients, and NRLN metastasis did not reduce cancer-specific survival in the multivariate analysis. CONCLUSIONS: Twelve (11.4%) of 105 patients with NRLN metastases had lymph node metastases without bone metastases. In addition, NRLN metastasis was a significant prognostic factor for predicting reduced progression-free time to CRPC. Thus, although we speculate that prostate cancer with NRLN metastasis exhibits unique tumor biology, additional molecular and genetic studies are needed.
Biology ; Humans ; Logistic Models ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms

BACKGROUND: Clonidine is an alpha2-adrenergic drug used for analgesic effect, reducing sympathetic stimulation and anesthetic requirement. We examined the analgesic effect of clonidine on incisional pain after its intrathecal administration using a rat postincisional model. METHODS: After an intrathecal (IT) catheter insertion in 20 Spraw Dawley rats, they were divided into two groups; one group (Group S, n = 10) received a saline 20microl injection through an IT catheter, and another (Group C, n = 10) received clonidine 20microgram in 10microl volume followed by another 10microl of saline for washing the catheter. The measurements of the threshold of tactile allodynia (TTA) were performed at 20, 40, 60, 80, 120, 180 and 240 mins after the IT injection. Additionally, 1, 2 and 3 days after the first IT injection, IT injection and the measurements of TTA of pre- and post-injection were repeated. The measurements of TTA were performed in both areas, 5 mm (N-area) and 10 mm (R-area) away from incision by using von Frey hair and up-down method. RESULTS: TTA (N-area) and TTA (R-area) during 4 hours after IT injection in Group C were greater than those in Group S (P< 0.05). TTA (N-area) of post-injection 2 and 3 days after the first IT injection were greater than those of pre-injection in Group C (P< 0.05), and TTA (R-area) after the IT injection 1, 2 and 3 days after the first IT injection were greater than those of pre-injection in Group C (P< 0.05). CONCLUSIONS: A single IT injection of clonidine 20microgram had analgesic effects lasting more than 4 hours in the rat postincisional model. Additional IT clonidine could show antiallodynic effects during three days after the first IT clonidine.
Animals ; Catheters ; Clonidine* ; Hair ; Hyperalgesia ; Rats*

We aimed to evaluate the safety and clinical responses in Korean ankylosing spondylitis (AS) patients after three months of etanercept therapy. AS patients satisfying the Modified New York Criteria were enrolled. They were assessed for safety and clinical responses at enrollment and after three months of etanercept therapy. A total of 124 patients completed the study. After three months, the rate of ASsessment in AS International Working Group 20% improvement (ASAS 20) response was 79.8%. The rates of ASAS 40 and ASAS 5/6 responses were 58.5 and 62.8%, respectively. Significant improvement of Korean version of Bath AS Disease Activity Index (KBASDAI) (p<0.0001), Bath AS Functional Activity Index (BASFI) (p<0.0001), and Bath AS Metrology Index (BASMI) (p=0.0009) were achieved after three months. Quality of life was also significantly improved after three months, as demonstrated by scores for SF-36 (p<0.0001) and EQ-5D (p<0.0001). Erythrocyte sedimentation rate and C-reactive protein were significantly decreased (p<0.0001, p<0.0001, respectively). None of the patients developed tuberculosis and there were no serious adverse event. AS patients with inadequate response to conventional therapy showed significant clinical improvement without serious adverse events after three months of etanercept therapy.
Adult ; Blood Sedimentation ; C-Reactive Protein/metabolism ; Cohort Studies ; Female ; Humans ; Immunoglobulin G/*pharmacology ; Immunosuppressive Agents/pharmacology ; Korea ; Male ; Prospective Studies ; Quality of Life ; Receptors, Tumor Necrosis Factor ; Remission Induction ; Spondylitis, Ankylosing/*therapy ; Treatment Outcome

PURPOSE: To evaluate the embolic effect and pathologic change in the kidney after infusion of 50% acetic acidin the renal artery. MATERIALS AND METHODS: Five kidneys were embolized with 50% acetic acid mixed with saline(group A) and five were embolized with 50% acetic acid mixed with contrast medium (group B). Four rabbits(2 fromgroup A and 2 from group B) were sacrificed during the first day and the remaining six, 28 days afterembolization. To determine the effect of embolization and pathologic findings, the two groups were compared. RESULTS: Complete occlusion of the renal artery was observed in both groups; histologic findings indicatingtubular necrosis and blood clots within the renal artery were noted one day after embolization. After four weeks,complete necrosis of the renal arterial wall and tubular cells had occurred. The procedures required forembolization were easier in group B because the extent of embolization could be controlled by fluoroscopy. CONCLUSION: At 50% dilution after mixing with contrast medium, the embolie effect of acetic acid isperfect;because the embolic material is visualised the procedure was easier to control than embolization withalcohol. acetic acid can, threrfore, be used as an effective embolic agent in renal artery embolization.
Acetic Acid* ; Fluoroscopy ; Kidney ; Necrosis ; Rabbits* ; Renal Artery*