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

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.
Adult ; Antibodies, Monoclonal ; Antibodies, Monoclonal, Murine-Derived ; Blood Pressure ; Consciousness ; Female ; Glomerulonephritis ; Headache ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Leukoencephalopathies ; Living Donors ; Neurologic Manifestations ; Plasmapheresis ; Posterior Leukoencephalopathy Syndrome ; Recombinant Fusion Proteins ; Rejection (Psychology) ; Seizures ; Tacrolimus ; Transplants ; Unconsciousness ; Rituximab

Focal segmental glomerular sclerosis (FSGS) is known to recur in 20-40% of the renal allografts with graft loss in about half of these cases. We report a successful treatment of a recurrent FSGS after kidney transplantation with rituximab and plasmapheresis. An 16-year-old patient whose primary kidney disease was FSGS developed recurrence of proteinuria after living donor kidney transplantation despite preemptive plasmapheresis and one dose of rituximab (375 mg/m2). After kidney transplantation, nephrotic range proteinuria was detected. Kidney biopsy was done and showed recurrent FSGS. She undergone 11 times of plasmapheresis in the first 4 week post transplantation. In addition, she received additional one dose of rituximab (375 mg/m2) on day 14. Proteinuria was decreased below nephrotic range at 37 day. Ten months later, proteinuria was at 30 mg/day with excellent graft function. No significant adverse events related to rituximab or plasmapheresis were observed. Rituximab with plasmapheresis may be another option for recurrent FSGS after kidney transplantation.
Adolescent ; Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney ; Kidney Diseases ; Kidney Transplantation ; Living Donors ; Plasmapheresis ; Proteinuria ; Recurrence ; Sclerosis ; Transplantation, Homologous ; Transplants ; Rituximab

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

PURPOSE: We investigated the efficacy and safety of a combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line palliative chemotherapy for elderly patients with metastatic or recurrent gastric cancer. MATERIALS AND METHODS: The study patients were chemotherapy-naive patients (> 65 years old) with histologically confirmed, metastatic or recurrent gastric cancer. Chemotherapy consisted of oxaliplatin 100 mg/m2 and FA 100 mg/m2 (2-hour infusion), and then 5-FU 2400 mg/m2 (46-hour continuous infusion) every 2 weeks. RESULTS: A total of 37 patients were studied between April 2004 and October 2006. Of the 34 evaluable patients, none achieved a complete response (CR) and 14 achieved a partial response (PR), resulting in an overall response rate of 41.2%. The median time to progression (TTP) was 5.7 months (95% CI: 4.2~6.3 months) and the median overall survival (OS) was 9.8 months (95% CI: 4.4~12.0 months). The main hematologic toxicities were anemia and neutropenia, which were observed in 56.7% and 32.4% of the patients, respectively. Grade 3/4 neutropenia was observed in 8.1% of the patients. None of the patients experienced febrile neutropenia. Peripheral neuropathy occurred in 35.1% of the patients and all were grade 1/2. CONCLUSION: This oxaliplatin/5-FU/FA regimen showed good efficacy and an acceptable toxicity profile in elderly patients with metastatic or recurrent gastric cancer.
Aged* ; Anemia ; Drug Therapy* ; Febrile Neutropenia ; Fluorouracil* ; Humans ; Leucovorin* ; Neutropenia ; Peripheral Nervous System Diseases ; Stomach Neoplasms*