OBJECTIVES: The aims of this study were to know the prevalence of cognitive disorders in patients with thyroid cancer, and identify related variables to them. METHODS: Subjects were consisted of fourty-two patients with thyroid cancer, who were admitted for radioiodine ablative therapy at 6-12 months after total thyroidectomy. The data were obtained from interviews about history and assessments of depression and cognitive function(Korean Version of the Montreal Cognitive Assessment, MoCA-K). RESULTS: 1) Among subjects, those with below 22 of total score of the MoCA-K were twenty-one(50.0%). 2) Upon age, education, Pre-radioiodine therapy thyroid stimulating hormone(TSH), there were statistically significant difference between subgroup with above 23 of the total MoCA-K score and those below 22. 3) The total scores of the MoCA-K in subjects had significant correlation with age, education, comorbidity, Pre-radioiodine therapy TSH, total score of the HDRS-17. CONCLUSIONS: Cognitive disorders were more prevalent among patients with thyroid cancer before radioiodine therapy. Therefore, further study should be needed to clarify the mechanism for the cognitive disorders in thyroid cancer. Furthermore, physicians should pay attention to the cognitive function and prepare preventative measures for cognitive disorder during management of thyroid cancer.
Carcinoma, Papillary* ; Comorbidity ; Depression ; Education ; Humans ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin

The hypokalemic periodic paralysis is characterized by intermittent falccid paralysis of extremities with spontaneous recovery. It is rarely accompanied by cardiac arrhythmia, especially fatal ventricular tachycardia or torsades de pointes. We observed a 29 year old man, who had suffered from intermittent periodic paralysis and fatal ventricular tachyarrhythmia. He had the first episode of muscle weakness in his low grade of elementary school, which lasted for 20 -30 hours. Similar episodes of muscle weakness occurred 1 -7 times per year, especially after carbohydrate rich food. On admission to emergency room, his chief complaints were generalized weakness and chest tightness, serum potassium level was 1.6mEq/l, and four extremities showed Grade 0 motor weakness. His electrocardiography(ECG) showed Atrioventricular dissociation due to sinus tachycardia and accelerated junctional rhythm, intraventricular conduction distrubance. During intravenous potassium administration, ECG showed sustained ventricular tachycardia and cardiovascular collapse occurred. So we carried out resuscitation and cardioversion. After resuscitation, he recovered from cardovascular collapse and ECG showed sinus tachycardia. But during continuous monitoring ECG showed torsades de pointes with cardiovascular collapse. We carried out resuscitation and defibrillation repeatedly. Serum potassium level was 1.7 - 1.8mEq/L at that time. After successful resuscitation, ECG showed sinus rhythm, and his mental status was fully recovered. After he admitted to intensive care unit, paralytic attack and cardiac arrhythmia did not occurred any more. Serum potassium level was maintained between 3.9 -6.1lmEq/L during his hospital days. He was fully recovered but could not take any medications(e.g. acetazolamide, potassium supplying agent and antiarrhythmic drugs) due to severe gastrointestinal disturbances. During the 30 months of postdischarge period, he experienced three mild paralysis attacks, but they were not accompanied by chest tightness, palpitation or syncope.
Acetazolamide ; Adult ; Arrhythmias, Cardiac* ; Electric Countershock ; Electrocardiography ; Emergency Service, Hospital ; Extremities ; Heart Block ; Humans ; Hypokalemia ; Hypokalemic Periodic Paralysis* ; Intensive Care Units ; Muscle Weakness ; Paralysis ; Potassium ; Resuscitation ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Thorax ; Torsades de Pointes

BACKGROUND: Low levels of serum vitamin D is associated with several lung diseases. The production and activation of matrix metalloproteinases (MMPs) may play an important role in the pathogenesis of emphysema. The aim of the current study therefore is to investigate if vitamin D modulates the expression and activation of MMP-2 and MMP-9 in human lung fibroblasts (HFL-1) cells. METHODS: HFL-1 cells were cast into three-dimensional collagen gels and stimulated with or without interleukin-1beta (IL-1beta) in the presence or absence of 100 nM 25-hydroxyvitamin D (25(OH)D) or 1,25-dihydroxyvitamin D (1,25(OH)2D) for 48 hours. Trypsin was then added into the culture medium in order to activate MMPs. To investigate the activity of MMP-2 and MMP-9, gelatin zymography was performed. The expression of the tissue inhibitor of metalloproteinase (TIMP-1, TIMP-2) was measured by enzyme-linked immunosorbent assay. Expression of MMP-9 mRNA and TIMP-1, TIMP-2 mRNA was quantified by real time reverse transcription polymerase chain reaction. RESULTS: IL-1beta significantly stimulated MMP-9 production and mRNA expression. Trypsin converted latent MMP-2 and MMP-9 into their active forms of MMP-2 (66 kDa) and MMP-9 (82 kDa) within 24 hours. This conversion was significantly inhibited by 25(OH)D (100 nM) and 1,25(OH)2D (100 nM). The expression of MMP-9 mRNA was also significantly inhibited by 25(OH)D and 1,25(OH)2D. CONCLUSION: Vitamin D, 25(OH)D, and 1,25(OH)2D play a role in regulating human lung fibroblast functions in wound repair and tissue remodeling through not only inhibiting IL-1beta stimulated MMP-9 production and conversion to its active form but also inhibiting IL-1beta inhibition on TIMP-1 and TIMP-2 production.
Collagen ; Emphysema ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts* ; Gelatin ; Gels ; Humans ; Interleukin-1beta ; Lung Diseases ; Lung* ; Matrix Metalloproteinase 9 ; Matrix Metalloproteinases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Trypsin ; Vitamin D* ; Wounds and Injuries

No abstract available.
Animals ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rats*

No abstract available.
Hepatocytes* ; Macrophages* ; Muscle, Smooth, Vascular* ; Nitric Oxide* ; Rhodiola*

Wernicke's encephalopathy (WE) is a neurological disorder induced by a dietary vitamin B1 (thiamine) deficiency which is characterized by encephalopathy, gait ataxia, and variant ocular motor dysfunction. In addition to these classical signs of WE, a loss of the horizontal vestibulo-ocular reflex (VOR) is being reported as the major underdiagnosed symptoms in WE. In this retrospective single center study, we report four cases of WE initially presented with impaired horizontal VOR in addition to the classical clinical presentations, and imaging and neurotological laboratory findings were described.
Ataxia ; Brain Diseases ; Dizziness ; Gait Ataxia ; Nervous System Diseases ; Reflex ; Reflex, Vestibulo-Ocular ; Retrospective Studies ; Thiamine ; Wernicke Encephalopathy

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by bilateral stenosis or occlusion of the terminal portions of the internal carotid arteries. MMD is also accompanied by typical net-like collateral vessels in the basal ganglia. Although the etiology of MMD remains unknown, hereditary, immunogenic, and hemodynamic factors have been implicated as underlying mechanisms of MMD. Here, the authors report on one patient with a rare combination of Graves' disease-associated thyrotoxicosis, myasthenia gravis, and MMD, where cerebrovascular ischemic events occurred during a thyrotoxic state.
Basal Ganglia ; Brain Ischemia ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Constriction, Pathologic ; Graves Disease ; Hemodynamics ; Humans ; Moyamoya Disease ; Myasthenia Gravis ; Thyrotoxicosis

Malignant mesenchymomas by definition are composed of two or more cellular types that would ordinarily derive from primitive mesenchyme. They grow rapidly, recur frequently, metastasize, and can be found in a wide variety of locations. Malignant mesenchymomas as primary cardiac tumor are extremely rare with poor prognosis. Only 15 cases of cardiac malignant mesenchymoma were reported in worldwide literature in 1961-1992. We report a case of primary cardiac malignant mesenchymoma in 58 year-old female patient admitted due to hemoptysis and mild exertional dyspnea.
Dyspnea ; Female ; Heart Neoplasms ; Heart* ; Hemoptysis ; Humans ; Mesenchymoma* ; Mesoderm ; Middle Aged ; Prognosis

Ruptured aneurysm of sinus of Valsalva is an uncommon congenital lesion, which was first reported in 1840 by Thurman. Its incidence is representing up to 3.5% of patients undergoing congenital heart disease surgery. Predominant symptoms are dyspnea, palpitation, and chest pain, present above the half. An early diagnosis is helpful because of the favorable surgical prognosis. Echocardiography remains useful in detecting abnormalities, and provides important information prior to cardiac catheterization and surgery. Cardiac catheterization and angiography are necessary for diagnosis of receiving chamber and associated lesions such as ventricular septal defect, aortic regurgitation, and other congenital abnormalities. The effective treatment is surgery. Without operation, cause of death are heart failure or bacterial endocarditis. We report two cases of asymptomatic ruptured aneurysm of sinus of Valsalva, confirmed by transesophageal echocardiography, and cardiac catheterization. The corrective surgery was performed without complication.
Aneurysm, Ruptured* ; Angiography ; Aortic Valve Insufficiency ; Cardiac Catheterization ; Cardiac Catheters ; Cause of Death ; Chest Pain ; Congenital Abnormalities ; Diagnosis ; Dyspnea ; Early Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis, Bacterial ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Prognosis ; Sinus of Valsalva*

BACKGROUND: In patients with acute myocardial infarction(MI), dysfunctional myocardium at rest after successful reperfusion may represent either necrotic or viable myocardium. And the latter can be recovered contractility after revascularization or medication. OBJECTIVE: To evaluate the efFectiveness of the dobutamine stress echocardiography(DSE) for identifying viable but dysfunctional myocardium in acute MI before revascularization. METHOD: Twelve patients with acute MI after thrombolytic therapy underwent Tc-99m-tetrofosmin dipyridamole myocardial SPECT(Single Photon Emission Computed Tomography) and DSE before coronary angiography in 7~12 hospital days, and they were followed up for recovery of contractile reserve by two-dimensional echocardiography after revascularization procedure or medication. Regional wall motion abnorrnality was scored from l(normal) to 4(dyskinesia). Dobutamine responsiveness was defined as irnprovement or aggravation of regional wall motion in dyssynergic segment during any stage of dobutamine infusion. Reversible ischemia by SPECT was defined as increased perfusion defect after dipyridamole and interpreted by radiologist. Dobutamine responsiveness on DSE and reversible ischemia on myocardial SPECT were matched and compared each other. RESULTS: Of 69 dyssynergic segments, 38(55%) recovered contractility during follow up echocardiography after revascularization or medication. In 30(79%, sensitivity) of these latter segments, regional wall motion had changed during dobutamine. However, 31(45%) did not recovered contractility and 25(81%, specificity) of thern had not changed during dobutamine. Of 36 dobutamine responsive dyssynergic segments, 30(83%, positive predictive accuracy) had recorved contractility. In 25(76%, negative predictive accuracy) of 33 dobutamine non-responsive segments had not recovered contractility. Reversible ischemia on myocardial SPECT showed less sensitive(67%) and specific(56%) for detection of potentially recoverable myocardium than DSE. And positive(68%) and negative predictive accuracy(56%) also showed significantly lower than DSE. CONCLUSION: DSE can identify dyssynergic but recoverable myocardial segement for risk stratification before intervention in acute MI. Dobutamine responsiveness of dyssynergic segment is superior to reversible ischemia on myocardial SPECT for prediction of wall motion improvement after MI irrespective of intervention or medical therapy.
Coronary Angiography ; Dipyridamole ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Follow-Up Studies ; Humans ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion ; Reperfusion ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon