PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of [18F]FDG PET in the diagnosis of recurrent head and neck cancer after the completion of surgery and radiotherapy in patients with head and neck cancers. MATERIALS AND METHODS: In fifty-nine patients with head and neck cancers, whole body [18F]FDG PET studies were performed. According to the different therapeutic modalities, patients were divided into four groups (Group I; pre-treatment, Group II; surgery, Group III; radiotherapy, Group IV; both surgery and radiotherapy). [18F]FDG PET images were compared with clinical, CT and histopathologic findings. RESULTS: For detection of metastatic lymph nodes in 14 patients of pre-treatment group (group I), the sensitivity and specificity of PET were 100% (10/10) and 75% (3/4), and those of CT were 80% (8/10) and 100% (4/4). For detection of recurrence in 45 patients of post-treatment group, overall sensitivity and specificity of PET were 96.2% (25/26) and 78.9% (15/19) [(100% and 75% in group II, 80% and 50% in group III, and 100% and 100% in group IV)] without significant difference from pre-treatment group (p>0.1). In detecting recurrence, the sensitivity and specificity of [18F]FDG PET were 90.9% (10/11) and 20% (1/5) in 16 patients who underwent [18F]FDG PET within 2 months after the completion of treatment. The specificity of these patients was significantly lower than that of 29 patients (100% of sensitivity and specificity) who underwent [18F]FDG PET 2 months after treatment (p<0.05). CONCLUSION: [18F]FDG PET is an accurate diagnostic modality for the detection of recurrence in head and neck cancer. Post-therapy [18F]FDG PET should be obtained at least 2 months after the completion of surgery or radiotherapy.
Diagnosis ; Head and Neck Neoplasms ; Head* ; Humans ; Lymph Nodes ; Neck* ; Radiotherapy* ; Recurrence ; Sensitivity and Specificity

The new Mental Health and Welfare Law in Korea was revised to require additional diagnosis by a psychiatrist from another public or designated hospital for involuntary admission beyond 2 weeks. In addition, it features the newly established Admission Review Committee for better protection of human rights. The provision of the additional diagnosis by an external psychiatrist resulted from misinformation about the distinction between the second opinion for medical assessment and the review of admission by independent authorities. An additional diagnosis is not required by an external doctor since it is not for review of adequacy of admission but just for second opinion for better medical assessment. Given the limited number of qualified public hospital psychiatrists, additional diagnosis by external psychiatrists does not seem practical unless private hospital doctors are required to visit neighboring hospitals. The current method of cross checking between neighboring doctors is not in accordance with the principles that review should be done by independent authorities. The Admission Review Committee also does not seem to serve the purpose since the role of the Committee is limited to document review, while the proper role of the Committee is left to individual doctors. Admission review should be performed through a thorough interview with the patient by a judicial (or quasi-judicial) authority. Law revision is urgently needed to ensure proper judicial (or quasi-judicial) review of admission, and to streamline unnecessary procedures such as the additional diagnosis by external doctors.
Advisory Committees* ; Diagnosis* ; Hospitals, Private ; Hospitals, Public ; Human Rights ; Humans ; Jurisprudence* ; Korea* ; Mental Health* ; Methods ; Psychiatry* ; Referral and Consultation ; Unnecessary Procedures

Taxol is an active chemotherapeutic agent against a variety of solid tumors and a potentially useful drug for augmenting the cytotoxic action of radiotherapy against certain cancers. Taxol blocks cells in the mitotic phase of cell cycle. The aim of this study was to define the in vivo response of rapidly dividing cells of the small intestinal mucosa to taxol. We studied the numbers of apoptotic and mitotic cells and the expression of bcl-2 and p53 in rat jejunal crypt cells at 1, 2, 4, 8, 12, 16, and 24 hours and 3 and 5 days after intraperitoneal injection of taxol. Mitosis peaked at 2 and 4 hours and 12 and 16 hours. Apoptosis peaked at 16 hours and returned to normal after five days. The glands in crypts showed marked distortion with atypical lining cells after three days, which returned to normal at 5 days. bcl-2 expression was markedly decreased at 8 to 24 hours and subnormally recovered after three to five days. p53 showed no significant changes throughout. The histopathological changes in small intestine due to taxol were transient with complete recovery. bcl-2 expression was inversely corresponded to numbers of apoptosis. The changes were p53 independent. Further studies to understand the conditions that maximize the cell-cycle modulating effects of taxol cl-may greatly enhance its anti-tumor effectiveness.
Animals ; Apoptosis ; Cell Cycle ; Injections, Intraperitoneal ; Intestinal Mucosa ; Intestine, Small* ; Mitosis ; Paclitaxel ; Radiotherapy ; Rats*

No abstract available.
Humans ; Prothrombin Time* ; Prothrombin*

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) has often been cited as the basis for the abolition of involuntary hospitalization for persons with mental illness. Although the UNCRPD itself does not refer explicitly to the abolition of involuntary hospitalization, the General Comment prohibited all compulsory admission without adequate explanation. While the disability status alone may not justify the denial of legal capacity, the existence of impaired decision-making ability can raise issues regarding whether involuntary admission can be justified in the best interest of persons with mental illness. The General Comment, however, argues that involuntary admission does not comply with the CRPD which prohibits discrimination on the basis of disabilities. This statement defies logic since the issue is whether the existence of impaired decision-making ability may be an exceptional case. It is also against the principles of beneficence to withhold treatment for persons with mental illness just for self-determination when poor outcomes are anticipated if left untreated. The concept of supported decision making suggested by the General Comment is also ambiguous, and not clearly distinguishable from substitute decision making. Another reason for the prohibition of involuntary admission relates to doubt concerning the accuracy of assessment of mental capacity, which implies adequate assessment may justify involuntary admission. In practice, it is not always complicated to assess mental capacity in order to make treatment-related decisions. The third reason concerns the argument that psychiatric treatments lack empirical evidence concerning effectiveness. Scientific evidence supporting the effectiveness of psychiatric treatment is abundant. The rights of persons with mental illness are important ethical issues. However, it is doubtful whether the blanket prohibition of compulsory admission is appropriate and ethical. Critical review of the UNCRPD and the General Comment is urgent for timely treatment and for the well-being of persons with mental illness.
Beneficence ; Decision Making ; Denial (Psychology) ; Disabled Persons* ; Discrimination (Psychology) ; Ethics ; Evaluation Studies as Topic* ; Hospitalization ; Humans ; Logic ; United Nations*

No abstract available.
Brain Neoplasms* ; Brain* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Metformin, an oral biguanide insulin-sensitizing agent, is well known to decrease appetite. Although there is evidence that metformin could affect the brain directly, the exact mechanism is not yet known. METHODS: To evaluate whether metformin induces anorexia via the hypothalamus, various concentrations of metformin were injected into the lateral ventricle of rats through a chronically implanted catheter and food intake was measured for 24 hours. The hypothalamic neuropeptides associated with regulation of food intake were also analyzed following 1 hour of intracerebroventricular (ICV) injections of metformin. RESULTS: An ICV injection of metformin decreased food intake in a dose-dependent manner in unrestrained conscious rats. Hypothalamic phosphorylated AMP-activated protein kinase (pAMPK) increased by 3 microg with metformin treatment, but there was no further increase in pAMPK with increases in metformin dosage. The hypothalamic phosphorylated signal transducer and activator of transcription 3 (pSTAT3) increased by 3 microg with metformin treatment, but, there was no further increase in pSTAT3 level following increases of metformin dosage. Hypothalamic proopiomelanocortin was elevated with metformin treatment, while neuropeptide Y was not significantly changed. CONCLUSION: Our results suggest that metformin induces anorexia via direct action in the hypothalamus and the increase in pSTAT3, at least in part, is involved in the process. However, hypothalamic pAMPK appears not to contribute to metformin-induced appetite reduction in normal rats. Further studies exploring new pathways connecting metformin and feeding regulation are needed.
AMP-Activated Protein Kinases ; Animals ; Anorexia ; Appetite ; Brain ; Catheters ; Eating ; Hypothalamus ; Lateral Ventricles ; Metformin ; Neuropeptide Y ; Neuropeptides ; Pro-Opiomelanocortin ; Rats ; STAT3 Transcription Factor

We encountered an indigenous case of intestinal capillariasis with protein-losing enteropathy in the Republic of Korea. A 37-year-old man, residing in Sacheon-si, Gyeongsangnam-do, admitted to the Gyeongsang National University Hospital (GNUH) due to long-lasting diarrhea, abdominal pain, anasarca, and weight loss. He recalled that he frequently ate raw fish, especially the common blackish goby (Acanthogobius flavimanus) and has never been abroad. Under the suspicion of protein-losing enteropathy, he received various kinds of medical examinations, and was diagnosed as intestinal capillariasis based on characteristic sectional findings of nematode worms in the biopsied small intestine. Adults, juvenile worms, and eggs were also detected in the diarrheic stools collected before and after medication. The clinical symptoms became much better after treatment with albendazole 400 mg daily for 3 days, and all findings were in normal range in laboratory examinations performed after 1 month. The present study is the 6th Korean case of intestinal capillariasis and the 3rd indigenous one in the Republic of Korea.
Adult ; Albendazole/administration & dosage ; Animals ; Anthelmintics/administration & dosage ; Biopsy ; Capillaria/cytology/drug effects/*isolation & purification ; Diarrhea ; Enoplida Infections/drug therapy/parasitology/*pathology ; Feces/parasitology ; Female ; Helminthiasis/drug therapy/parasitology/*pathology ; Humans ; Intestinal Diseases, Parasitic/drug therapy/parasitology/*pathology ; Intestines/parasitology/pathology ; Male ; Protein-Losing Enteropathies/drug therapy/parasitology/*pathology ; Republic of Korea ; Treatment Outcome

Epithelioid hemangioendothelioma(EH) is a rare vascular tumor of low-grade malignancy. It was previously described as intravascular bronchioloalveolar tumor (IVBAT). But electron microscopic study and immunohistochemical staining results have proved endothelial origin. Patients are usually asymptomatic and the tumors are found incidentally on routine chest X-rays. Most patients show a slowly progressive clinical course, even though some patients occasionally die as results of respiratory failure or extrathoracic complications. Confirmative diagnosis is made through thoracoscopic or open-lung biopsy. There is still no effective therapeutic modality for pulmonary EH. We have experienced a 55-year-old woman whose simple chest x-ray film revealed bilateral multiple small nodules. The nodules were histopathologically and immunohistochemically diagnosed as primary epithelioid hemangioendothelioma of the lung. The possibility of metastatic disease was excluded thorough clinical, laboratory and radiological studies. Comparison of radiographic chest film taken 3 years ago showed no significant progression of the pulmonary nodular lesions. Conservative management was instituted and careful 4 months follow-up showed no significant changes.
Biopsy ; Diagnosis ; Female ; Follow-Up Studies ; Hemangioendothelioma, Epithelioid* ; Humans ; Lung ; Middle Aged ; Respiratory Insufficiency ; Thorax ; X-Ray Film

Inhibition of CD36, a fatty acid transporter, has been reported to prevent glucotoxicity and ameliorate high glucose induced beta cell dysfunction. Ezetimibe is a selective cholesterol absorption inhibitor that blocks Niemann Pick C1-like 1 protein, but may exert its effect through suppression of CD36. We attempted to clarify the beneficial effect of ezetimibe on insulin secreting cells and to determine whether this effect is related to change of CD36 expression. mRNA expression of insulin and CD36, intracellular peroxide level and glucose stimulated insulin secretion (GSIS) under normal (5.6 mM) or high glucose (30 mM) condition in INS-1 cells and primary rat islet cells were compared. Changes of the aforementioned factors with treatment with ezetimibe (20 μM) under normal or high glucose condition were also assessed. mRNA expression of insulin was decreased with high glucose, which was reversed by ezetimibe in both INS-1 cells and primary rat islets. CD36 mRNA expression was increased with high glucose, but decreased by ezetimibe in INS-1 cells and primary rat islets. Three-day treatment with high glucose resulted in an increase in intracellular peroxide level; however, it was decreased by treatment with ezetimibe. Decrease in GSIS by three-day treatment with high glucose was reversed by ezetimibe. Palmitate uptake following exposure to high glucose conditions for three days was significantly elevated, which was reversed by ezetimibe in INS-1 cells. Ezetimibe may prevent glucotoxicity in pancreatic β-cells through a decrease in fatty acid influx via inhibition of CD36.
Animals ; Anticholesteremic Agents/*pharmacology ; Antigens, CD36/antagonists & inhibitors/genetics/*metabolism ; Cells, Cultured ; Ezetimibe/*pharmacology ; Flow Cytometry ; Glucose/toxicity ; Insulin/genetics/metabolism/secretion ; Insulin-Secreting Cells/cytology/*drug effects/metabolism ; Male ; Palmitic Acid/metabolism ; RNA, Messenger/metabolism ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Real-Time Polymerase Chain Reaction