No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Patients with acromegaly have a reduced life expectancy rnainly due to cardiovascular, respiratory or cerebrovascular diseas-. Malignancy also seems to occur with greater than the expected incidence. In particular, the published retrospective or prospective studies have suggested a strong association of colonic neoplasia with acromegaly. But, there were a few reports of thyroid cancer in acrornegaly. We report a case of thyroid papillary cancer derived from diffuse goiter in acromegaly, sugge- sting the possible carcinogenic role of growth hormone.
Acromegaly ; Bites and Stings ; Colon ; Goiter ; Growth Hormone ; Humans ; Incidence ; Life Expectancy ; Prospective Studies ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND: The relaxative response of blood vessels to acetylcholine (ACh) is known to be abnormal in diabetic rat due to changes in endothelium-derived relaxing factor (EDRF) and/or endothelium-derived hyperpolarizing factor (EDHF)-mediated action. Oxygen free radical (OFR) interferes with endothelium dependent relaxation to ACh in diabetic rats; this effect rnay be prevented by superoxide dismutase (SOD), OFR scavenger. Then, we determined the effect of SOD on modulation of OFR-induced damage to EDRF and EDHF-mediated relaxations to ACh in diabetic rat aortas. METHODS: After aortas were incubated with free radical generating system for 15 min with or without SOD pretreatment (150 U/mL) and contracted submaximally by norepinephrine (10 (-5) M), relaxative responses to cumulative concentrations (10 (-9) M to 10 (-5) M) of ACh were measured in aortas isolated from the control and 6-8 week streptozotocin-induced diabetic rat. We measured relaxative responses to ACh in these aortas treated with calmidazolium (100uM) or N-nitro-L-arginine methyl ester (luM) after exposure to OFR with/without SOD pretreatment, RESULTS: The ACh-induced relaxation (10 (-9)M to 10 (-5) M) was significantly decreased in diabetic than in control rat aortas (p<0.05). ACh-induced relaxation in diabetic rat aortas was significantly impaired from 79.3% to 71.2% after exposure to OFR (p<0.05), and the degree of ACh-induced relaxation was recovered from 71.2% to 84.0% after pretreatment with SOD (p<0.05). EDRF-mediated relaxation to ACh in diabetic rat aortas was significantly impaired from 71.2% to 61.6% after exposure to OFR (p<0.05), and the degree of impairment of ACh-induced EDRF-mediated relaxation was recovered from 61.6% to 76.0% after pretreatment with SOD. After exposure to OFR, EDHF-mediated relaxation to ACh in diabetic rat aortas was not significanlty impaired. However, the degree of impairment of EDHF-mediated relaxation to ACh was recovered from 46.0% to 59.5% after pretreatment with SOD. CONCLUSION: This study suggests that OFR may impair mainly EDRF-mediated relaxation to ACh and SOD may protect rnainly OFR-induced damage to EDRF-mediated relaxation to ACh in diabetic rat aortas.
Acetylcholine ; Animals ; Aorta* ; Blood Vessels ; Endothelium ; Endothelium-Dependent Relaxing Factors ; Free Radicals* ; Norepinephrine ; Oxygen* ; Rats* ; Relaxation* ; Superoxide Dismutase* ; Superoxides*

PURPOSE: The urinary mass screening program for the detection of proteinuria had been performed for a school age population in the city of Seoul since 1981. However, systematic evaluation for this program had never been done. We, therefore, designed a systematic evaluation in corporation with the Seoul School Health Center for students with proteinuria identified in the mass screening to determine the prevalence of asymptomatic proteinuria, and to estimate the risk of incipient renal diseases and incidences of some of them. And also, we attempted to reveal the significance of urinary mass screening. METHODS: In the period of 8 years betwen 1987 and 1994, annually about a half million students, who comprised 3 different age groups, 5th grade of elementary school, 2nd grade of junior school and 2nd grade of high school were chosen, corresponding to the approximate ages of 11, 14 and 17 years, respectively. These subjects accounted for 25% of total school children in Seoul. The screening program was carried out in 3 steps. The 1st test was performed at schools and the 2nd at the School Health Center. Those students who showed proteinuria in the 1st and 2nd tests were referred to the hospital. Laboratory examinations including renal biopsies were performed in those students with pathologic proteinuria to clarify the incipient renal diseases. RESULTS: 1) The prevalences of asymptomatic proteinuria were 0.2-0.36% (average 0.28%) in the 1st test. It peaked at the age of 14 years 0.36%, compared to 0.2% in the 11 age group and 0.25% in the 17 age group. 2) There was a difference of asymptomatic proteinuria by sex and age, higher prevalence in the female in the 11 age group but higher in the male in the 17 age group. 3) The distribution of proteinuria in accordance with various types classified by us at the 3rd test showed as follows: transient proteinuria (type 1) 17%, orthostatic proteinuria (type 2) 55%, constant proteinuria (type 3) 6%, proteinuria with hematuria (type 4) 20%, isolated proteinuria (type 5) 2%. Pathologic proteinuria comprised of type 3, 4 and 5, accounted for 28%, which was 1/10 of proteinuria in the 1st test. 4) The annual incidence of renal glomerular diseases among the age goup of 7-18 years was estimated to be 2.8 per 10,000. 5) Renal pathologic studies on 80 children with proteinuria and hematuria (66) or constant proteinuria (14) revealed IgA Nephropathy (38.9%) was the most frequent glomerular diease. MPGN 10.0%, MGN 7.5%, Reflux Nephropathy 7.5%, FSGS 6.2% were followed, respectively. HBV asssociated Nephropathy was 7.5%. 6) 4 of Reflux Nephropathy and 2 of FSGS were found in the 14 children with constant proteinuria in the screening test. Among these children, 5 progressed to chronic renal failure. 7) The annual incidence of IgA Nephropathy among the age group of 7-18 years was 1.1 per 10,000. 8) The morbidity of chronic renal failure was estimated to be 9.8 per 1 million of 7 to 18 years age group. CONCLUSIONS: 1) Most Students, approximately 90%, who were found to have asymptomatic proteinuria in the initial screening were normal so clinical evaluations for them should be very much cautious. Only 10% of them had pathologic proteinuria which denoted incipient renal diseases. 2) Annual incidences of incipient renal glomerular diseases, IgA Nephropathy and chronic renal failure were estimated to be 2.8 per 10,000, 1.1 per 10,000 and 9.8 per 1 million among school children in Seoul. 3) Because of the high incidence of significant glomerular changes and the high rate of progression to chronic renal failure in children with constant proteinuria, it should be regarded as serious one. 4) The definite conclusion that a urinary mass screening program can alter the prognosis of children with renal diseases identified in the mass screening can not be drawn with this study. Further study must be necessary.
Biopsy ; Child* ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Hematuria ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Mass Screening* ; Prevalence ; Prognosis ; Proteinuria ; School Health Services ; Seoul*

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We wanted to verify the value of radiography and gait analysis to analyze the changes of the pelvic tilt before and after gait in the patients with LDK. Summary of Literature Review: Patients with lumbar degenerative kyphosis show dynamic changes that are closely associated with the motion of pelvis. MATERIALS AND METHODS: We analyzed 18 lumbar degenerative kyphosis patients who didn't have multiple vertebral compressio fractures, a past history of spinal surgery or surgery for degenerative arthritis of the knee or hip, and obesity which causes marker errors on the gait analysis. Pelvic tilt was statistically evaluated by utilizing radiographs and dynamically utilizing the gait analysis. The linear parameters of the gait cycle and the kinematic data were obtained from the gait analysis. RESULTS: The LDK patients'mean walking velocity was 80.7 cm/s, and it was largely decreased to 65% of the normal value. The cause of the decreased walking velocity was a decrease of stride length, and not a decrease of cadence. The mean static pelvic tilt in the gait analysis was -1.3+/-8.0degrees , and there were 8 cases of anterior tilt and 10 cases of posterior tilt. The mean pelvic tilt during gait was 12.5+/-8.2degrees , and there were 17 cases of anterior tilt and 1 case of posterior tilt. It was statistically significant difference (p<0.05) between the mean static pelvic tilt in gait analysis and the mean pelvic tilt during gait and the Pearson's correlation coefficient was -0.88. CONCLUSIONS: Though there was no statistical significance, we observed anterior pelvic rotation after gait on the radiographs. As fatigue of the pelvic extensor muscles increases during gait, anterior pelvis tilt increases with statistical significance on the gait analysis. Therefore, we feel gait analysis is useful for evaluating the dynamic change of the pelvic tilt in patients with LDK.
Fatigue ; Gait ; Hip ; Humans ; Knee ; Kyphosis ; Muscles ; Obesity ; Osteoarthritis ; Pelvis ; Reference Values ; Retrospective Studies ; Walking

PURPOSE: The soft tissue injuries of the patellar area are difficult problems because of insufficient arterial blood supply and lack of muscle layer. There have been many methods for reconstructing the soft tissue injuries of the patellar area such as primary closure, skin graft, local flap and free tissue transfer. However, each method has some limitations in their application. After the first introduction, the fasciocutaneous flaps are widely used to reconstruct the soft tissue injuries. The saphenous nerve, one of the superficial sensory nerves in the lower leg, is supplied by the saphenous artery and its vascular network. We used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. METHODS: From March 2002 to May 2005, we used the saphenous fasciocutaneous island flap to reconstruct the soft tissue injuries of the patellar area. The flap was elevated with saphenous nerve, saphenous vein and saphenous artery and its vascular network. The flap donor site was reconstructed with primary closure or split-thickness skin graft. RESULTS: Five cases survived completely but 1 case developed partial necrosis of the skin on the upper margin of the flap. However, the necrosis was localized on skin layer, and we reconstructed with debridement and split-thickness skin graft only. After the operation, there was no contracture or gait disturbance in any patient. CONCLUSION: In conclusion, the saphenous fasciocutaneous island flap is safe, comfortable and effective method to reconstruct the soft tissue injuries of the patellar area.
Arteries ; Contracture ; Debridement ; Gait ; Humans ; Knee ; Leg ; Necrosis ; Saphenous Vein ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants

PURPOSE: The ultrasonography (USG) and computed tomography (CT) are popular diagnostic tools for the diagnosis of acute appendicitis in children, but there are many debates about their clinical significance. The purpose of this study is to clarify the clinical significance of USG, CT and follow-up CT performed subsequently to USG, especially in perforated acute appendicitis in children. METHODS: We have reviewed 419 cases of surgically confirmed acute appendicitis in children under the age of sixteen, who had been treated in Inje University Ilsan Paik Hospital from March 2002 to February 2006. All the clinical data including the results of USG and CT were collected and analyzed. RESULTS: Sensitivity, specificity, positive and negative predictive values of USG were 98.7%, 96.8%, 98.1%, 97.8% in non-perforation group and 90.8%, 100%, 100%, 81.9% in perforation group. Those of CT were 96.4%, 100%, 100%, 96.5% and 86.6%, 100%, 100%, 87.5% respectively. Those of follow-up CT after USG were 100%, 100%, 100%, 100% and 87.5%, 100%, 100%, 92.0% respectively. The duration of using antibiotics in seven patients showed positive correlation with the interval between two imaging studies (r=0.0472, p=0.019). There was no statistical significance of correlation when these imaging studies performed within 30 hours together. CONCLUSION: In most of the cases, single choice between USG and CT would be enough to diagnose the acute appendicitis in children. But, it may be helpful to perform CT as early as possible subsequently to USG when there is discrepancy between initial USG and clinical impression.
Anti-Bacterial Agents ; Appendicitis* ; Child* ; Diagnosis ; Follow-Up Studies* ; Humans ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND: To evaluate delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy, we studied gastric motility in 11 normal volunteers and 11 patients who had undergone a pylorus-preserving pancreaticoduodenectomy. Additionally, the 24 hour esophageal Ph recordings were examined to evaluate gastroesophageal reflux after a pylorus-preserving pancreaticoduodenectomy. METHODS: Gastric motility was evaluated by using the gastric-emptying time and electrogastrograms. The gastric-emptying time was measured using a solid meal containing 99mTc-tin colloid. The half gastric-emptying time (GET1/2) was defined as the half time (T1/2) of the fall of gastric isotopic activity from the peak. Electrogastrogram (EGG) signals were detected from the surface electrodes on the skin overlying the gastric antrum. The 24-hour esophageal Ph was monitored by using a nasoesophageal probe placed in the distal esophagus 5 cm above the lower esophageal sphincter. RESULTS: In our study, the normal volunteers showed a 99+/-35 minute half gastric-emptying time. The patients were divided into two groups by a time of 2 months after the operation, early and late postoperative groups. Delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy in the early postoperative period (272+/-176 minutes) was normalized in the late period (106+/-37 minutes), p=0.020. Abnormal early EGG patterns also normalized in the late postoperative period. There was no significant difference of total Ph<4-time % between patients in the early (0.1+/-0.1%) and the late postoperative periods (0.4+/-0.4%), p=0.064. CONCLUSIONS: It is supposed that anatomical and functional preservation of the stomach and the proximal part of the duodenum after a pylorus-preserving pancreaticoduodenectomy enabled gastric motor activity to be normal in the late postoperative period.
Colloids ; Duodenum ; Electrodes ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagus ; Gastric Emptying ; Gastroesophageal Reflux ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration ; Meals ; Motor Activity ; Ovum ; Pancreaticoduodenectomy* ; Postoperative Period ; Pyloric Antrum ; Pylorus* ; Skin ; Stomach

PURPOSE: To analyze and correlate mammographic/ sonographic features with pathologic findings in patientswith infiltrative ductal carcinoma with the mammographic 'halo sign'. MATERIALS AND METHODS: We retrospectivelyreviewed 27 cases of surgically confirmed infiltrative ductal breast carcinoma with the mammographic 'halo sign',analysing the mammographic/sonographic findings, clinical records and pathologic findings. RESULTS: Twenty-sevenpatients with infiltrating ductal breast carcinoma with the mammographic 'halo sign' were aged 32-72 (mean 49+/-12)years. For periods of between 2 days and 5 months(mean, 1.9 months), all had complained of a palpable mass.Histologic sections indicated parenchymal compression(27/27), microscopic infiltration of tumor margin(11/27) andparenchymal fat compression(15/27), without a true capsule. Infiltrating ductal carcinomas with the mammographic'halo sign' were nuclear grade 1 (17/27) or histologic grade III (14/27). Mammography (complete halo:3;partialhalo:24) showed a round(15/27) or macrolobulated (9/27) mass (size : 2.5+/-1cm) which showed partialspiculation(17/27) or-rarely-calcification(2/27). Sonography revealed a hypoechoic mass with a thinboundary(13/15);in five of these 13 cases, pathologic examination revealed microscopic infiltration of the tumormargin. Bilateral shadowing (8/15), posterior enhancement(13/15), and heterogeneous internal echogenicity(13/15)were also noted on sonography. CONCLUSION: When correlated with the histopathologic findings, infiltrating ductalbreast carcinoma with the 'halo sign' showed a relatively poor pathologic grade, which is known to be one of theprognostic factors. Surrounding parenchyma and fat compression at the margin of a tumor are considered to be oneof the causes of the mammographic 'halo sign'.
Breast Neoplasms ; Carcinoma, Ductal* ; Mammography ; Shadowing (Histology) ; Ultrasonography

A hemodialysis arteriovenous fistula may cause high output cardiac state by volume overload and decreased systemic vascular resistance. Arteriovenous fistulas for hemodialysis consist usually of either a radiocephalic fistula at the wrist or a more proximal brachiocephalic fistula at the antecubital fossa. In this study the contribution of arteriovenous fistula to cardiac function has been evaluated by comparing cardiac performance before and after the point occlusion of the anastomotic site. The results suggest that the occlusion of arteriovenous fistula may decrease end-diastolic left ventricular volume (VOLd), increase end-systolic left ventricular volume (VOLs), decrease stroke volume (SV), decrease ejection fraction (EF) and decrease cardiac output (CO). This study shows that arteriovenous fistula influences directly to cardiac performance, so careful determination of dialysis option is required for the end stage renal failure patients with marginal heart function.
Arteriovenous Fistula ; Cardiac Output ; Dialysis ; Fistula ; Heart ; Humans ; Renal Dialysis ; Renal Insufficiency ; Stroke Volume ; Vascular Resistance ; Wrist