No abstract available.
Eustachian Tube*

PURPOSE: We performed a study on clinical benefits of Harada's scoring method, problems of present criteria and requirement of the revision of that criteria for intrvenos gamma-globulin (IVGG) treatment of Kawasaki disease (KD) in Korea. METHODS: The patients of 104 cases who visited to Department of Pediatrics of Chungnam National University Hospital and diagnosed as KD were objective group. We classified the patients to high and low risk groups as two methods of Harada's scoring method and present criteria for IVGG treatment of KD in Korea, and analyzed the results after treatment by means of echocardiogram. RESULTS: 1. Characteristics of the patients 1) Duration to diagnosis: Mean duration was 6.0 3.5days after onset of fever. 2) Age of onset and male to female ratio: the patients of 84.6% were the age of 4 years or less, and male to female ratio was 1.8 to 1. 2. Coronary aitery lesion (CAL) abnormalities according to items of Harada's scoring method and classification of risk groups 1) The age of less than 12 months and CRP of 3+ or more were significant predictive factors 2) Classification of risk groups was significantly predictive in CAL development. 3. Classification of total cases The patients reserved to administration for IVGG according to Harada's scoring method and present criteria for IVGG treatment of KD in Korea were 63.5% and 50% respectively. If so in present criteria for IVGG treatment of KD in Korea, 50% of the KD patients were excluded for that application. 4. Outcome after treatment according to selective IVGG use by two methods 1) Selective IVGG use by Harada's scoring method: There was no significant difference in development of CAL between low risk group and high risk group, resulting in 1 case (14.3%) of 7 cases and 5 cases (9.4%) of 53 cases respectively. 2) Selective IVGG use by present criteria for IVGG treatment of KD in Korea: There were more significant cases at low risk group than those at high risk group in development of CAL, resulting in 3 cases (42.9%) of 7 cases and 5 cases (12.2%) of 41 cases respectively. 3) Outcome after treatment in patients not administered IVGG as low risk groups according to two methods: There were more significant cases in low risk group at present criteria for IVGG treatment of KD in Korea than those at Harada's scoring method in the development of CAL, resulting in 3 cases (42.9%) of 7 cases and 1 case (14.3%) of 7 ases respectively. 4) Outcome after treatment in patients administered IVGG as high risk groups according to two methods: There was no significant difference between high risk groups at both methods in the CAL development, resulting in 5 cases (12.2%) of 41 cases at present criteria for IVGG treatment of KD in Korea and 5 cases (9.4%) of 53 cases at Harada's scoring method. CONCLUSIONS: Harada's scoring method had more benefits in clinical application, selection of risk group, and outcome after treatment, So we propose the revision of present criteria for IVGG treatment of KD in Korea, suggesting another method as indication for selective IVGG treatment.
Age of Onset ; Chungcheongnam-do ; Classification ; Diagnosis ; Female ; Fever ; gamma-Globulins ; Humans ; Korea* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pediatrics ; Research Design* ; Risk Factors

Racemic verapamil has been shown to have local anesthetic activity, and fast sodium channel blockade is responsible for its inhibitory effect on nerve conduction. This study de- scribes the dose response inhibition of nerve conduction hy verapamil and bupivacaine alone as well as in combination of both on an isolated rat sciatic nerve preparation. In addition, it describes the effect of caleium ion concentration on this in vitro nerve preparation. Sciat- ic nerve preparation from rats were placed in mammarian ringer solution(MRS) adjusted to pH 7.4 at 22degrees C. Each nerve was mounted in a nerve conduction chamber containing MRS in the presence of verapamil(10-5M-2X10-3 M), bupivacaine(10-6M-10-3M) or a combination of both. Each nerve was stimulated with a square wave pulse at twice threshold potential(4 -7V), 0.02msec of duration, 10Hz of frequency. Compound action potentials(CAP) were photographed and measured on a Tektronix oscilloscope. The nerve was first equilibrated in the nerve conduction chamber in MRS, (pH 7.4, 22degrees C for 30min) and CAP was recorded for control(100% recovery). Then, the nerve was exposed to increasing concentrations of verapamil and bupivacaine for 12 minutes and a CAP was measured after each exposure. All CAP were compared to the control CAP and the results were expressed as a % of control CAP. We got dose response curve of verapamil, bupivacaine and combination of both. Also, we determined EC 25%, 50%, 75% from these data(EC % : Effective concentra- tions of drug for % CAP inhibition). Each of the experiments was performed on at least 4 nerves and differences between groups were analyzed using ANOVA test. Verapamil is shown to inhibit nerve conduction with an EC 25% = 2.2X10-4M, EC 50%=3.8X10-4M, EC 75% =6.3X10-4M and EC 50% for bupivacaine was 5.0X10-5 M. When verapamil dose response curves were performed in the presence of a wide range of CaCl2 containing MRS solutions, there was no significant differences in the response curve(P>0.05). In conclusion, racemic verapamil was shown to have dose dependent local anesthetic activity with a relative potency of 1/8 of bupivacaine. When combined with bupivaeaine, local anesthetic activity inereased in an additive manner. This suggests that these two drugs act on the nerve membrane in a similar fashion. Various CaCl2 concentrations have no effect on nerve conduction inhibition of verapamil. This implicates sodium channel blockade as the mechanism of local anesthetic activity of verapamil.
Animals ; Bupivacaine* ; Hydrogen-Ion Concentration ; Membranes ; Neural Conduction* ; Rats* ; Sciatic Nerve ; Sodium Channels ; Verapamil*

PURPOSE: In recent studies, the presence of lymphocytic infiltration in patients with papillary thyroid carcinoma (PTC) was reported to be associated with a favorable prognosis. The prognostic significance of Hashimoto's thyroiditis (HT) in patients with PTC remains unclear. The aim of our study was to determine the frequency and prognostic significance of HT in patients with PTC. METHODS: From January 2005 to December 2007, 367 patients who underwent thyroid surgery for PTC were included in this study. They were divided into two groups: Group A (n=71; 19.4%) included the patients diagnosed as having PTC with HT and Group B (n=296; 80.6%) included the patients who had PTC without HT. The clinicopathologic features between Groups A and B were retrospectively reviewed via the medical records. RESULTS: Lymph node metastasis was less frequent in Group A than that in Group B (25.5% versus 41.0%, respectively, P=0.033). However, both groups had similar clinicopathologic features in terms of age, gender, the tumor size, multifocality, extrathyroidal invasion, the TNM stage and the AMES and MACIS scores. Also, the operative method did not differ significantly between the two groups. CONCLUSION: These results suggest that the presence of HT is not associated with the prognostic factors of PTC.
Humans ; Lymph Nodes ; Medical Records ; Methods ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroiditis*

PURPOSE: Incidental resection of parathyroid gland is not uncommon during thyroid surgery and may occur even in experienced thyroid surgeons. The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. METHODS: A retrospective review of patients who underwent thyroid surgery between January and December 2008 was carried out. Pathologic reports were reviewed for the presence of parathyroid tissue in resected thyroid specimen. Two groups of patients were studied: a group with incidental parathyroidectomy (Group A) and without incidental parathyroidectomy (Group B). RESULTS: Three hundred and thirty-four thyroid surgery were performed: 194 total thyroidectomies, 18 near- or subtotal thyroidectomies, 44 lobectomies, 23 endoscopic total thyroidectomies, 55 endoscopic lobectomies. Of these, 265 patients (79.3%) were preformed for malignant disease. Incidental parathyroidectomy occurred in 30.5% (102/334) of thyroid surgery. Risk factors for incidental parathyroidectomy included malignant pathology (P<0.001), operation method (P<0.001), lymph node dissection (P<0.001), and extrathyroidal invasion (P=0.001). Biochemical hypocalcemia was defined as a serum calcium levels less than 8.4 mg/dL. Symptomatic hypocalcemia was defined as patient had tingled sense or spasm of muscle and need to add more calcium replacement. In group A, 86 patients (93.5%) had a biochemical hypocalcemia (P=0.001). Symptomatic hypocalcemia developed in 35.3% (36/102) of group A, compared to 20.7% (48/232) in group B (P=0.005). CONCLUSION: Malignant pathology, total thyroidectomy, lymph node dissection, and extrathyroidal invasion were associated with a significantly higher risk of incidental parathyroidectomy during thyroid surgery. Incidental parathyroidectomy resulted in biochemical and symptomatic postoperative hypocalcemia. This study suggests that incidental parathyroidectomy may be a potential complication; therefore, parathyroid glands should be identified and preserved with more meticulous inspection during thyroid surgery.
Calcium ; Humans ; Hypocalcemia ; Incidence ; Lymph Node Excision ; Methods ; Parathyroid Glands ; Parathyroidectomy* ; Pathology ; Retrospective Studies ; Risk Factors* ; Spasm ; Surgeons ; Thyroid Gland* ; Thyroidectomy

PURPOSE: Pure papillary thyroid carcinoma (PPTC) and the follicular variant of papillary thyroid carcinoma (FVPTC) are the most common subtypes of papillary thyroid carcinoma (PTC). The aim of this study was to investigate if there are any differences in clinicopathological features of these two subgroups. METHODS: We performed a retrospective chart review of patients who were treated for PPTC and FVPTC between September 2003 and April 2008. Four hundred fifty patients were shown to have PPTC (91.8%) and forty (8.2%) had FVPTC after a histologic review. The two groups were compared in terms of the clinicopathologic features and the results of preoperative ultrasonography (USG), the fine needle aspiration cytology (FNAC), the frozen section biopsy and the surgical treatment. RESULTS: The tumor size was significantly larger in the FVPTC group than in the PPTC group (1.47 cm versus 1.08 cm, respectively P=0.024). However, both groups had similar clinicopathologic features in terms of age, gender, capsular invasion, multifocality, lymph node metastasis, the MACIS score and the TNM stage. Further, the operative method did not differ between the two groups. The sensitivities of USG and frozen section biopsy for diagnosing FVPTC were significantly lower than those for PPTC (53.85% versus 72.95%, respectively, P=0.045, 81.58% versus 97.25%, respectively, P=0.049). CONCLUSION: The FVPTC group presented with a larger tumor size, and the clinicopathologic features of the FVPTC group did not significantly differ from those of the PPTC group. Although further studies with longer follow-up are required, these results suggest that the patients in both groups should be treated identically.
Biopsy ; Biopsy, Fine-Needle ; Follow-Up Studies ; Frozen Sections ; Humans ; Lymph Nodes ; Methods ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography

Poland's syndrome is characterized by hypoplasia or absence of the breast of nipple, hypoplasia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilage or ribs. The syndrome involves a spectrum of conditions ranging from simple absence of pectoralis major muscle and breast to the defects noted by Poland as well as brachysyndactyly, ectromelia. Furthermore, there have been reports of Poland's syndrome associated with malignancies such as leukemia, malignant lymphoma,(1) and leiomyosarcoma.(2) We have experienced a 22-year-old woman presenting with asymmetric breast and abnormal position of nipple and accessory breast suggested Poland's syndrome. Treatment consisted of tissue expansion of hypoplastic breast and free nipple graft and excision of accessory breast. The purpose of the study was to review the present knowledge of Poland's syndrome and literature.
Breast ; Cartilage ; Ectromelia ; Female ; Humans ; Leukemia ; Nipples ; Poland ; Ribs ; Subcutaneous Tissue ; Tissue Expansion ; Transplants ; Young Adult

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor which is composed of spindle cells admixed with mature plasma cells and inflammatory cells. IMT is most common in the lungs and in various organs. However, it is very rare in the breast. According to the organ, there are many clinical and histological characteristics. Breast IMT usually shows developed, movable nontender mass. Radiological findings of IMT are similar to primary breast malignancy. For accurate diagnosis, histologic correlation is needed. IMT is a benign lesion and excision is the treatment of choice, but wide local excision and negative resection margin is needed due to its tendency for recurrence. Understanding of the entity and its mimicry can be helpful in avoiding any unnecessary surgical procedures, such as mastectomy with or without lymph node dissection. Herein, the case of a 29-year-old woman found to have IMT of the breast. The patient underwent a wide local excision. The gross, microscopic and immunohistochemical findings were consistent with the diagnosis of IMT of the breast.
Adult ; Breast ; Female ; Humans ; Lung ; Lymph Node Excision ; Mastectomy ; Myofibroblasts ; Plasma Cells ; Recurrence

No abstract available.
Pituitary Neoplasms*

Cardiac myxoma is the most common benign cardiac tumor and it presents various clinical symptoms and signs. Although two-thirds of patients have abnormal electrocardiographic findings, atrial flutter or conduction abnormalities are known to be rare. We report on a case of a large left atrial myxoma which was diagnosed by trans-thoracic, trans-esophageal echocardiography, chest computerized tomography, and histological examination. The myxoma was presented as atrial flutter in a 41-year old man who was complaining palpitation and dyspnea on exertion. After surgical excision of the mass, atrial flutter converted to normal sinus rhythm. We report this case with review of literatures on left atrial myxoma associated with arrhythmia.
Arrhythmias, Cardiac ; Atrial Flutter ; Dyspnea ; Echocardiography ; Electrocardiography ; Heart Neoplasms ; Humans ; Myxoma ; Thorax