PURPOSE: A prospective comparison was made between imaging with Tc-99m pertechnetate (Tc-99m) and Ioine-131 (I-131) for the detection of residual and metastatic tissue after total thyroidectomy in patients with well-differentiated thyroid carcinoma. MATERALS AND METHODS: Initially our patients had imaging with Tc-99m, followed by I-131 within 3 days. The study included 21 patients who had ablation with high dose of I-131 ranging from 100 mCi to 150 mCi. Planar and pinhole images were acquired for both Tc-99m and I-131. Diagnostic images of Tc-99m and I-131 were compared with post-therapy images. Degree of uptake on Tc-99m and I-131 images was scored by four point scale and compared. RESULTS: The results of the Tc-99m study were: 16 of 19 studies (84%) were positive on simple planar images, but 19 of 20 studies (95%) were positive on pinhole images. Conventional I-131 diagnostic imaging on the other hand showed that all studies (100%) were positive on both planar and pinhole images. There was a significant difference in degree of uptake between Tc-99m and I-131 planar images (p<0.05). Only one case of Tc-99m scintigraphy was negative on both planar and pinhole studies (false negative). There was no distant metastasis on the therapeutic I-131 images. CONCLUSION: Tc-99m scan using pinhole in certain clinical situations is an alternative to the I-131 scan in detecting thyroid or lymph node metastasis prior to the first ablative treatment after thyroidectomy for well-differentiated thyroid carcinoma.
Diagnostic Imaging ; Hand ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prospective Studies ; Radionuclide Imaging* ; Sodium Pertechnetate Tc 99m* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

No abstract available.
Calcinosis* ; Humans ; Siblings*

BACKGROUND: Various treatment modalities for hypertrophic scars and keloids have been used. However, there is no consensus as to what the optimum approach should be. Most common treatments are corticosteroid intralesional injection (ILI) and cryotherapy as well as combination of these two modalities. To this date, however, there are no prospectively comparative, scar-split studies between steroid ILI monotherapy and combination of steroid ILI and cryotherapy. OBJECTIVE: The purpose of this article is to investigate and compare the efficacy of steroid ILI monotherapy and the combination of steroid ILI and cryotherapy. METHODS: Eighteen women who had thyroid operation scars were recruited. Patients received steroid ILI with cryotherapy on the right half, and steroid ILI monotherapy on the left half of the scar. Patients were treated for four sessions with three weeks of intervals. Subjects were evaluated on their scar status with the modified Vancouver scar scale (MVSS) and scar redness by using colorimeter at baseline and every visit day. RESULTS: After four treatment sessions, MVSS was significantly improved on both sides of scar. Significant improvement was observed after one treatment session on the right half, and after two treatment sessions on the left half. There was no significant difference between left and right side after four sessions of treatment. The scar redness of both sides of scar showed no significant differences between the baseline and at the end of the study. CONCLUSION: Both corticosteroid ILI with cryotherapy and corticosteroid ILI monotherapy are effective treatment modalities for hypertrophic scars. However, the results of the present study suggest that a combination therapy might lead to more rapid improvements.
Cicatrix ; Cicatrix, Hypertrophic ; Consensus ; Cryotherapy ; Female ; Humans ; Injections, Intralesional ; Keloid ; Thyroid Gland

Henoch-Schonlein purpura (HSP) is a leukocytoclastic vasculitis of small vessels with deposition of IgA, commonly resulting in skin, joint, gastrointestinal, and kidney involvement. HSP is an uncommon disorder in adults and accounts for 0.6% to 2% of adult nephropathy. We report a case of HSP with acute renal failure successfully treated with corticosteroid. In this case, the patient presented with vasculitic purpuric rash on lower extremity, arthralgia in the wrist, abdominal pain, hematochezia, oliguria and azotemia. Abdominal CT showed wall thickening of the small and large bowels. Skin biopsy revealed leukocytoclastic vasculitis. Percutaneous renal biopsy showed no crescent formation, but mesangial IgA and C3 deposits were observed by immunofluorescence. The patient was treated with corticosteroid (1mg/kg per day) and hemodialysis. After treatment, renal function improved and purpuric lesion, arthralgia and abdominal pain disappeared. Thus, when adults present with purpuric rash and rapidly progressive glomerulonephritis (RPGN), HSP should be a diagnostic consideration.
Abdominal Pain ; Acute Kidney Injury ; Adult ; Arthralgia ; Azotemia ; Biopsy ; Exanthema ; Fluorescent Antibody Technique ; Gastrointestinal Hemorrhage ; Glomerulonephritis ; Humans ; Immunoglobulin A ; Joints ; Kidney ; Lower Extremity ; Oliguria ; Purpura ; Purpura, Schoenlein-Henoch ; Renal Dialysis ; Skin ; Vasculitis ; Vasculitis, Leukocytoclastic, Cutaneous ; Wrist

Pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein or pulmonary capillaries. Depending on the cause, pulmonary hypertension can be a severe disease with markedly decreased exercise tolerance and right-sided heart failure. Pulmonary hypertension can present as one of five different types: arterial, venous, hypoxic, thromboembolic, or miscellaneous. Chronic obstructive pulmonary disease with severe pulmonary hypertension is a rare disease. A 52-year-old man presented with a complaint of aggravating dyspnea. The mean pulmonary arterial pressure was 61.5 mmHg by Doppler echocardiogram. The patient was prescribed diuretics, digoxin, bronchodilator, sildenafil, bosentan and an oxygen supply. However, he ultimately died of cor pulmonale. Thus, diagnosis and early combination therapy are important.
Arterial Pressure ; Blood Pressure ; Capillaries ; Digoxin ; Diuretics ; Dyspnea ; Exercise Tolerance ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Middle Aged ; Oxygen ; Piperazines ; Pulmonary Artery ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease ; Pulmonary Veins ; Purines ; Rare Diseases ; Sulfonamides ; Sulfones ; Sildenafil Citrate

PURPOSE: Surgical approaches for papillary thyroid carcinoma remain controversial. Moreover, previous reports regarding surgical strategy for papillary carcinoma of thyroid isthmus are very few. The aims of this study are to analyze the clinicopathologic features of papillary thyroid carcinoma of the isthmus and to develop more appropriate surgical strategies. METHODS: Prospectively, papillary carcinoma arising thyroid isthmus (n=35) was included in this study from June 2006 to December 2008. All of the patients had total thyroidectomy with bilateral central compartment node dissection performed. Lateral nodes were sampled for frozen biopsy when metastasis was suspected by preoperative study. Thirty-five patients, who had unilateral papillary thyroid carcinoma, had total thyroidectomy with bilateral central compartment node dissection as control group and compared with papillary thyroid carcinoma of isthmus. RESULTS: Lymph node metastasis was higher than control group in patients of isthmus cancer (51% vs 20%, P<0.05). Capsular invasion and multifocality observed in 63% and 23% respectively, but there was no significant difference compared to control group, statistically. Capsular invasion showed a positive correlation with lymph node metastasis by univariate and multivariate analysis. Analysis of ipsilateral nodal metastatic distribution revealed no definite metastatic pattern. Tracheal adhesion was observed in 4 cases of isthmus cancer group. CONCLUSION: In conclusion, it is recommended that bilateral CCND is needed as an appropriate primary surgical procedure for localized papillary carcinoma of thyroid isthmus.
Biopsy ; Carcinoma ; Carcinoma, Papillary ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Objectives: . The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms. Methods: . We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. Results: . The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065–2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303–1.030) and moderate (OR, 1.822; 95% CI, 0.995–3.339) groups. Conclusion . Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.

Objectives: . The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms. Methods: . We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. Results: . The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065–2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303–1.030) and moderate (OR, 1.822; 95% CI, 0.995–3.339) groups. Conclusion . Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.

Objectives: . The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms. Methods: . We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. Results: . The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065–2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303–1.030) and moderate (OR, 1.822; 95% CI, 0.995–3.339) groups. Conclusion . Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.

Objectives: . The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms. Methods: . We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. Results: . The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065–2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303–1.030) and moderate (OR, 1.822; 95% CI, 0.995–3.339) groups. Conclusion . Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.