Lipomas are among the most common of all benign neoplasma and occur more frequently over the back, between the shoulders, and on the back of the neck. They are usually subcutaneous in origin, and characteristically multilobulated masses of fatty tissue that vary from small nodules to large masses weighing several kilograms.A mass in the anterior part of the neck may be initially thought to be thyroid nodules and then other cervical masses should be considered. Ultrasonographic examination of benign lipoma demonstrates solid and echogenic mass and may differentiate nonthyroid from thyroid masses. When lipoma is clinically suspected, the use of CTs can establish the correct diagnosis without the use of thyroid hormone suppression or the need for urgent surgery.We experienced a case of anterior cervical mass in a 51-year-old male patient presenting a non-tender and soft mass rapidly growing for recent several months and moved with swollowing, and diagnosed his case as benign lipoma using ultrasonography, computed tomographic scan, and fine niddle asperation biopsy and therefore when we encounter patients with anterior neck mass, we should consider benign lipoma mimicking thyroid nodule.
Adipose Tissue ; Biopsy ; Diagnosis ; Humans ; Lipoma ; Male ; Middle Aged ; Neck ; Shoulder ; Thyroid Gland ; Thyroid Nodule ; Ultrasonography

BACKGROUND: Glucocorticoid-induced osteoporosis is characterized by decreased osteoblastic activity and replacement of bone marrow with adipocytes. Since osteoblast and adipocytes are derived from the same mesenchymal stem cell, one might speculate that there is an interaction between these two cells types. In fact, leptin that is secreted from adipocytes is known to stimulate differentiation of osteoblasts, while it inhibits the differentiation of adipocytes. Furthermore, it has been demonstrated that PPAR is present in osteoblasts and it is increased by leptin in adipocytes. However, the role of PPAR and leptin remains unknown in glucocorticoid-induced osteoporosis. The aims of this study are to investigate the effect of glucocorticoid on bone mineral density and gene expression in osteoblasts and adipocytes, and to study the role of PPAR and leptin in the mechanism of glucocorticoid-induced osteoporosis. METHODS: Methylprednisolone, 1 mg/200 g-weight, was injected into five rats (steroid group) and saline was given to five rats (control group) for eight weeks. The bone mineral density was determined by dual energy X-ray absoptiometry. Gene expression of osteocalcin, alkaline phosphatase, lipoptrotein lipase, and PPAR -2 was assessed by RT-PCR. Serum leptin level was measured using a commercial radioimmunoassay kit. RESULTS: 1) The body weight of the steroid group was significantly lower than that of the control group (451.4+/-12.9 g vs. 247.6+/-19.8 g, p<0.05). The bone mineral density of the steroid group tended to be lower than that of the control group (0.27+/-0.01 g/cm2 vs. 0.26+/-0.01 g/cm2, p>0.05). 2) In the steroid group, the gene expressions of osteocalcin (1.00+/-0.08 vs. 0.23+/-0.16, p<0.05) and alkaline phosphatase (0.47+/-0.07 vs. 0.33+/-0.18, p<0.05) were decreased significantly compared to those in controls. 3) In the steroid group, the gene expression of lipoprotein lipase (0.23+/-0.06 vs. 0.39+/-0.12, p>0.05) and+/-PAR 2 (0.17+/-0.08 vs. 0.22+/-0.12, p>0.05) tended to be increased compared to that in the contol group. 4) The serum leptin level of the steroid group tended to be lower than that of the control group (0.20+/-0.12 g/L vs. 0.10+/-0.09 g/L, p>0.05). CONCLUSION: These data suggest that long-term administration of a large dose of glucocorticoid suppresses differentiation of osteoblasts and enhances the differentiation of adipocytes, which may be mediated by increased expression of PPAR and decreased synthesis of leptin.
Adipocytes ; Alkaline Phosphatase ; Animals ; Body Weight ; Bone Density ; Bone Marrow* ; Gene Expression ; Leptin ; Lipase ; Lipoprotein Lipase ; Mesenchymal Stromal Cells* ; Methylprednisolone ; Osteoblasts ; Osteocalcin ; Osteoporosis ; Peroxisome Proliferator-Activated Receptors ; Radioimmunoassay ; Rats

BACKGROUND: GH3 cells are a well characterized and widely used model used for the in vitro study of growth hormone (GH) secretion. Thyrotropin releasing hormone (TRH) binds to receptors belonging to the family of G protein-coupled receptors, and secrets both GH & prolactin. Phospholipase D (PLD) is an enzyme that hydrolyses phosphatidylcholine to yield phosphatidic acid and choline, and plays important roles in cellular proliferation and hormonal secretion. To elucidate the pathway of the action of TRH in GH3 cells, we investigated the activities of PLC and PLD in GH3 cells treated with TRH or phorbor 12-myristate 13-acetate (PMA). METHODS: GH3 cells were labeled with [3H] myristate, followed by incubation of with 0.3% ethanol, prior to before the addition of the agonists. The total lipids were extracted from the harvested cells following treatment with the agonists. The PLD activity was assessed by measuring [3H] phosphatidylethanol from the [3H] phospholipid using thin layer chromatography. RESULTS: TRH (1 muM) stimulated the PLC activity by 44-fold over that of the control values. TRH (1 microM), mastoparan (5 muM), and PMA (500 muM) for 30 minutes increased PLD activity by 1.9, 1.5 and 2.2 fold, respectively, in comparison to the controls. The PLD activities after 15, 30, 60, 120 and 240 min treatments of TRH (1 microM) were 142%, 170%, 172%, 160% and 115%, respectively. CONCLUSION: These results suggest that TRH stimulates not only the PLC activity, but also the PLD activity in GH3 cells.
Cell Proliferation ; Choline ; Chromatography, Thin Layer ; Ethanol ; Growth Hormone ; Humans ; Myristic Acid ; Phosphatidic Acids ; Phosphatidylcholines ; Phospholipase D* ; Phospholipases* ; Prolactin ; Thyrotropin-Releasing Hormone

Hyperhomocysteinemia is an independent risk factor for cerebrovascular disease. Hyperhomocysteinemia can be caused by the defect of the remethylation pathway including the 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene or the transsulfuration pathway including the cystathionine beta-synthase (CBS) gene of homocysteine metabolism. The major cause of severe hyperhomocysteinemia is CBS gene mutation. A 16-year-old male was admitted with vertigo. Brain MRI showed right cerebellar infarction. The plasma homocysteine level was 175 mocro mol/L. According to a genetic evaluation, the patient had the MTHFR 677TT and CBS 1080TT genotypes.
Adolescent* ; Brain ; Cystathionine beta-Synthase ; Genotype* ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Infarction ; Magnetic Resonance Imaging ; Male ; Metabolism ; Oxidoreductases ; Plasma ; Risk Factors ; Stroke* ; Vertigo

BACKGROUND AND OBJECTIVES: A preoperative differential diagnosis between follicular adenoma and follicular carcinoma of thyroid is very difficult, and the standard basis for distinction is the presence of capsular and/or vascular invasion. In this study, we analyzed the findings of preoperative tests and clinical features to facilitate the differential diagnosis and treatment of the follicular neoplasm. SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 104 patients who had undergone thyroid surgery and had been diagnosed with thyroid follicular adenoma or carcinoma from 1995 through 2004. The final pathologic diagnosis was compared to the various clinical data including the result of fine needle aspiration cytology (FNAC) and ultrasonographic findings. RESULTS: Of total 104 cases, 82 were follicular adenoma and 22 were follicular carcinoma. The incidence of carcinoma was significantly higher in male than in female. The result of FNAC were divided into 6 cytodiagnostic groups, namely, inadequate, colloid nodule without atypia, colloid nodule with atypia, follicular neoplasm without atypia, follicular neoplasm with atypia, or highly suspicious malignancy. The incidence of carcinoma was significantly higher in the groups with atypia such as colloid nodule with atypia, follicular neoplasm with atypia, and highly suspicious malignancy than in the groups without atypia. The incidence of follicular carcinoma was significantly higher in ill-defined marginal cases. Calcification on ultrasonography also indicated the possibility of malignancy. CONCLUSION: The incidence of follicular carcinoma was significantly high in male patients, atypia in FNAC, and ill-defined margin and calcification on ultrasonography.
Adenoma ; Biopsy, Fine-Needle ; Colloids ; Diagnosis ; Diagnosis, Differential* ; Female ; Humans ; Incidence ; Male ; Medical Records ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Ultrasonography

BACKGROUND AND OBJECTIVES: With the advance in serum chemical analyses, the diagnosis of primary hyperparathyroidism has become more common, and patients without signs or symptoms attributable to the disease have increased. We performed this study to obtain further understanding and more supporting ideas for the diagnosis and treatment of primary hyperparathyroidism. SUBJECTS AND METHOD: A retrospective study of 19 patients with primary hyperparathyroidism who were treated by surgery from march 1999 to June 2005 was performed. RESULTS: Preoperative localization was performed with computerized tomography, ultrasonography and 99m Tc-sestamibi scan. A 99m Tc-sestamibi scan has an accuracy of 84% and ultrasonography has an accuracy of 67% for parathyroid tumors. Combination of ultrasonography and 99m Tc-sestamibi scan had the accuracy of 93%. All patients were treated by surgery. After surgery, serum calcium and intact parathyroid hormone levels returned rapidly to normal. Parathyroid carcinomas were firm in consistency and adhered to the surrounding tissue and thyroid gland. CONCLUSION: Ultrasonogram and 99m Tc-sestamibi scan was effective for preoperative localization of tumor. If parathyroid carcinoma is suspected, the mass with potential local invasion or regional metastasis should be removed with en bloc resection.
Calcium ; Diagnosis* ; Humans ; Hyperparathyroidism, Primary* ; Neoplasm Metastasis ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Retrospective Studies ; Thyroid Gland ; Ultrasonography

Pseudohypoparathyroidism is a rare disease that is characterized by target cell resistance to the effects of parathyroid hormone and this disease is classified into various types depending on the phenotypic and biochemical findings. The patients with pseudohypoparathyroidism present with the clinical and biochemical features of hypoparathyroidism, but they have an increased serum level of parathyroid hormone. We experienced a case of pseudohypoparathyroidism in a 24 years old woman who had Graves' disease at that time. She had hypocalcemia, hyperphosphatemia, an elevated serum parathyroid hormone level and a normal urinary basal cyclic AMP(adenosine monophosphate) level. She also had a normal phenotypic appearance. Therefore, she was classified as suffering with pseudohypoparathyroidism type II. The clinical and laboratory abnormalities were improved by calcium supplementation in addition to vitamin D. To the best of our knowledge, this is the first case of pseudohypoparathyroidism combined with Graves' disease in Korea.
Calcium ; Female ; Graves Disease ; Humans ; Hyperphosphatemia ; Hyperthyroidism ; Hypocalcemia ; Hypoparathyroidism ; Korea ; Parathyroid Hormone ; Pseudohypoparathyroidism ; Rare Diseases ; Stress, Psychological ; Vitamin D

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. Many electrocardiographic abnormalities have been described in hyperthyroidism, including sinus tachycardia, atrial fibrillation, and atrial or ventricular extrasystoles and the increase in resting heart rate are characteristics of hyperthyroidism. In the middle aged or elderly patients, often with mild but prolonged elevation of plasma thyroid hormone, symptoms and sign of heart failure and complicating atrial fibrillation may eliminate the classical clinical feature and mask the more classical endocrine manifestation of the disease. Though rare in hyperthyroidism, the development of heart block is important to recognize in clinical practice. The mechanism of variable delayed conduction (from 1st degree to complete heart block) in hyperthyroidism is not well documented until now. We experienced 67-year-old female patient who complained of loss of body weight. After work-up with thyroid function test and electrocardiogrpahy, we found that she had hyperthyroidism with complete atrioventricular block. We started antithyroid drug and continued to monitor electrocardiophy. We are going to give the radioactive iodine theraphy and in the case of symptomatic atrioventricular block, we will make a insertion of pacemaker.
Aged ; Atrial Fibrillation ; Atrioventricular Block* ; Body Weight ; Cardiovascular System ; Electrocardiography ; Female ; Heart ; Heart Block ; Heart Failure ; Heart Rate ; Humans ; Hyperthyroidism* ; Iodine ; Masks ; Middle Aged ; Plasma ; Tachycardia, Sinus ; Thyroid Function Tests ; Thyroid Gland ; Ventricular Premature Complexes

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.
Adult ; Alcohol Drinking ; Body Mass Index ; Esophagitis, Peptic/complications/*diagnosis ; Female ; Gastroesophageal Reflux/complications/*diagnosis ; Gastroscopy ; Hernia, Hiatal/complications ; Humans ; Male ; Middle Aged ; Obesity/complications ; Republic of Korea ; Risk Factors ; Sex Factors ; Smoking/adverse effects ; Triglycerides/blood ; Waist-Hip Ratio

BACKGROUND: Abdominal obesity is an essential component of metabolic syndrome and it causes insulin resistance. In contrast to women, the serum testosterone level has an inverse relationship with the visceral fat mass in men. Therefore, we investigated the relation of the serum testosterone concentration with metabolic syndrome and coronary artery disease in Korean middle-aged and elderly men. METHODS: 211 male subjects who were admitted to the cardiology department due to chest pain at Hanyang University Hospital from January to December, 2005 (mean age: 59.1+/-10.7 yrs) were enrolled in this study. All the blood samplings for laboratory tests, including the testosterone and estradiol tests, were done between 6 AM to 8 AM. Coronary artery disease was defined when there was more than 50% narrowing of the vascular lumen on the coronary angiography. Metabolic syndrome was defined according to the NCEP-ATP III guidelines. RESULTS: Among the other cardiovascular risk factors, metabolic syndrome was the most important contributor to coronary artery disease (adjusted OR=4.32, 95% CI: 1.96-9.52). Even after adjustment for age, BMI, smoking, alcohol consumption and hypertension, lower testosterone was associated with a higher fasting glucose level (p<0.01) and higher insulin resistance (p<0.05). Each SD (1.88 ng/mL) increase in the total testosterone was associated with a 51% reduced risk of having metabolic syndrome (OR=0.49; 95% CI, 0.36-0.68). Although men with coronary artery disease tended to have lower testosterone levels, there was no statistical significance. CONCLUSIONS: Lower testosterone levels might have a causative role in the development of metabolic syndrome and possibly coronary artery disease through the induction of insulin resistance.
Aged* ; Alcohol Drinking ; Cardiology ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Estradiol ; Fasting ; Female ; Glucose ; Humans ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Male ; Obesity, Abdominal ; Risk Factors ; Smoke ; Smoking ; Testosterone*