Thyroglossal duct cysts develop in the persistent remnants of the thyroglossal tract between the origin of the thyroid at the foramen cecum and the final position of the thyroid gland. Thyroglossal duct cyst can present anywhere from the base of the tongue to the manubrium, but its occurrence within the thyroid gland is very rare. We report here on a 41-year-old woman who presented with a cystic thyroid nodule that was due to an intrathyroid thyroglossal duct cyst. The sonogram, showed a hypoechoic nodule that measured 0.7 x 0.6 cm in the left thyroid lobe. Left lobectomy of the thyroid gland was performed and microscopic examination revealed a cyst lined by non-keratinized squamous epithelium, which was consistent with a thyroglossal duct cyst in the thyroid gland. Intrathyroid thyroglossal duct cyst should be considered in the differential diagnosis of a cystic thyroid nodule. This is the first reported case of a intrathyroid thyroglossal duct cyst in a Korean adult.
Adult ; Cecum ; Diagnosis, Differential ; Epithelium ; Female ; Humans ; Manubrium ; Thyroglossal Cyst* ; Thyroid Gland ; Thyroid Nodule ; Tongue

PURPOSE: To evaluate the relationship between factors of metabolic syndrome(MS) to prostate volume and lower urinary tract symptom in men over sixties. MATERIALS AND METHODS: A total of 624 male subjects aged 60 to 90 years were enrolled. Prostate volume, urinary flow rate, voided volume, post void residual urine volume, voiding symptoms and MS-related parameters were investigated. Patients were divided into two groups; those with MS (n=223) and those without(n=401). Prostate volume, urodynamic factors and voiding symptoms were compared based upon MS categories. RESULTS: The MS and control group showed no significant differences with respect to age(74.8+/-5.6 vs. 74.0+/-5.4, respectively, p=0.083) and prostate specific antigen levels(1.8+/-1.5 vs. 1.7+/-1.5, respectively, p=0.248). However, the MS group had significantly greater waist circumference, blood pressure, fasting blood sugar level, hypertriglyceridemia and lower high density lipoprotein(HDL) cholesterol than the control group(p<0.05). Patients with MS showed significantly larger total prostate volume(p=0.008) and transitional zone volume(p=0.012). There were no differences between two groups respect to maximum flow rate, voided volume and residual volume (p>0.05). There was a significant relationship between prostate volume and obesity(p=0.016), however other MS factors such as low HDL, hypertension, non-insulin dependent diabetes mellitus and hypertriglyceridemia were not associated with prostate volume(p>0.05).CONCLUSIONS: Metabolic syndrome is associated with prostate volume related factors, but not to voiding dysfunction in Korean men over sixties. Among subcategories of MS, obesity is the most strongly related factor to prostate volume.
Aged ; Blood Glucose ; Blood Pressure ; Cholesterol ; Diabetes Mellitus ; Fasting ; Humans ; Hypertension ; Hypertriglyceridemia ; Male ; Metabolic Syndrome X ; Obesity ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Residual Volume ; Urinary Tract ; Urination Disorders ; Urodynamics ; Waist Circumference

The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with TrivexTM Irrigated Illuminator(Smith and Nephew ) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TrivexTM Resector(Smith and Nephew ) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84%. The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions repuired to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long term complications.
Anesthesia ; Extremities ; Female ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Lighting ; Operative Time ; Recurrence ; Retrospective Studies ; Skin ; Transillumination ; Varicose Veins* ; Veins

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary ve..ous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfuly with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.
Blood Cell Count ; Cardiomegaly ; Chemistry ; Conus Snail ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Atria ; Humans ; Leg ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Paresthesia ; Thoracic Surgery ; Thorax ; Thrombosis*

BACKGROUND: We investigate an interhemispheric reorganization of memory functions using Wada test in patients with unilateral mesial temporal lobe epilepsy (MTLE). METHODS: We included 70 patients with unilateral MTLE and 37 with neocortical epilepsy (NE). The Wada memory stimuli were composed of 10 items. Scores for each injection were calculated with 1 and 0.5 points assigned for each correct free recall and recognition, respectively. A cut-off asymmetry score for lateralization of memory deficit was defined as 2 points. We statistically analyzed the proportion of memory asymmetry and the average memory score according to the type of epilepsy and the lateralization of seizure focus. RESULTS: The lateralizations of memory deficit determined by Wada memory asymmetry were evenly distributed in the left MTLE (n=34): left in 12 (36%), right in 11 (32%), and undetermined in 11 (32%). However, most (92%) of the right MTLE (n=36) were correctly lateralized to the side of seizure focus. More than 90% of patients with NE were lateralized to right hemisphere regardless of the seizure laterality. The average total (left plus right) memory score were not significantly different between each group. However, right memory score in left MTLE or left memory score in right MTLE were significantly higher than those in NE. The earlier age at seizure onset and the longer duration of epilepsy were observed in patients with left MTLE who had ipsilateral memory deficit comparing to those who had contralateral memory deficit. CONCLUSIONS: A pure interhemispheric reorganization of memory functions could occur in some patients with MTLE. It may be influenced by age at the onset of a seizure and the duration of epilepsy.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Memory Disorders ; Memory* ; Seizures ; Temporal Lobe*

BACKGROUND: We investigate an interhemispheric reorganization of memory functions using Wada test in patients with unilateral mesial temporal lobe epilepsy (MTLE). METHODS: We included 70 patients with unilateral MTLE and 37 with neocortical epilepsy (NE). The Wada memory stimuli were composed of 10 items. Scores for each injection were calculated with 1 and 0.5 points assigned for each correct free recall and recognition, respectively. A cut-off asymmetry score for lateralization of memory deficit was defined as 2 points. We statistically analyzed the proportion of memory asymmetry and the average memory score according to the type of epilepsy and the lateralization of seizure focus. RESULTS: The lateralizations of memory deficit determined by Wada memory asymmetry were evenly distributed in the left MTLE (n=34): left in 12 (36%), right in 11 (32%), and undetermined in 11 (32%). However, most (92%) of the right MTLE (n=36) were correctly lateralized to the side of seizure focus. More than 90% of patients with NE were lateralized to right hemisphere regardless of the seizure laterality. The average total (left plus right) memory score were not significantly different between each group. However, right memory score in left MTLE or left memory score in right MTLE were significantly higher than those in NE. The earlier age at seizure onset and the longer duration of epilepsy were observed in patients with left MTLE who had ipsilateral memory deficit comparing to those who had contralateral memory deficit. CONCLUSIONS: A pure interhemispheric reorganization of memory functions could occur in some patients with MTLE. It may be influenced by age at the onset of a seizure and the duration of epilepsy.
Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Memory Disorders ; Memory* ; Seizures ; Temporal Lobe*

PURPOSE: An outbreak of ESBL-producing Shigella sonnei enteritis was unprecedented not only in Korea but throughout the world in the past. We intended to devise a management guideline for ESBL-producing shigellosis based on analysis of clinical manifestations and response to therapy. METHODS: We analyzed 103 patients who were admitted to the hospital with acute GI symptoms and were shown positive result for S. sonnei on stool culture. We performed sensitivity test to the antibiotics and DNA sequencing of ESBL gene in the isolated S. sonnei colonies. In addition, we retrospectively analyzed their clinical characteristics, laboratory results, and clinical and microbiological responses to the antibiotics. RESULTS: Among the clinical manifestations, fever was the most frequent (96.1%), followed by diarrhea (93.2%), abdominal pain (76.7%), headache (71.8%), vomiting (65.0%), and nausea (41.7%). The fever was sustained for average of 2.0 days and diarrhea for 3.9 days. Watery diarrhea was the most common (69%) followed by mucoid (26%), and bloody stool (5%). On peripheral blood smear, leukocytosis was noted in 53.4% of patients, and 78.6% of patients tested positive for serum CRP response. On stool direct smear, 11.7% of patients showed more than 50 WBCs/HPF, and 9.7% of patients between 5 to 20 WBCs/HPF. Stool occult blood was positive in 71% of patients. Production of CTX-M-14 type ESBL was reported for all S. sonnei strains isolated from this outbreak. Microbiological eradication rates to various antibiotics were as follows: 100% (9/9) to ciprofloxacin, 100% 5/5) to azithromycin, 6.9% (5/72) to cefdinir, 0% (0/8) to ceftriaxone, 12.5% (1/8) to ceftizoxime, 0% (0/ 8) to TMP/SMX, 42.9% (3/7) to ampicillin/sulbactam, 20% (1/5) to amoxicillin/clavulanic acid, and 68.8 % (11/16) to imipenem/cilastatin. CONCLUSION: It is presumed that azithromycin can be an attractive option for the treatment of ESBL-producing S. sonnei enteritis in pediatric population, given its cost-effectiveness and safety. Although ciprofloxacin is another cost-effective agent, its use in pediatric population may be a bit too premature.
Abdominal Pain ; Anti-Bacterial Agents ; Azithromycin ; beta-Lactamases* ; Ceftizoxime ; Ceftriaxone ; Ciprofloxacin ; Diarrhea ; Dysentery* ; Dysentery, Bacillary ; Enteritis ; Fever ; Headache ; Humans ; Korea ; Leukocytosis ; Nausea ; Occult Blood ; Retrospective Studies ; Sequence Analysis, DNA ; Shigella sonnei* ; Shigella* ; Vomiting

BACKGROUND: The aim of this study was to examine the survivin expression pattern in benign lesions, atypical ductal hyperplasias (ADH), ductal carcinomas in situ (DCIS) and in invasive carcinomas of the breast and to evaluate the effect of expression of this marker on the malignant progression of breast cancers. In addition, the relationship between the expression of the marker and the clinicopathological characteristics for invasive carcinomas were investigated. METHODS: Immunohistochemical staining using a tissue microarray method for survivin was performed for 103 benign lesions, 30 ADHs, 26 DCISs and 116 invasive carcinomas. RESULTS: The expression of cytoplasmic survivin was higher for invasive carcinomas than for ADHs and DCISs (p<0.05). For breast invasive carcinomas, expression of cytoplasmic survivin significantly correlated with tumor size, lymph node metastasis and stage (p<0.05). CONCLUSIONS: These results suggest that overexpression of cytoplasmic survivin may be involved in the development of the late stage of breast malignancy, especially invasiveness. In breast invasive carcinomas, expression of survivin may be a useful indicator for the evaluation of patient prognosis.
Breast* ; Carcinoma, Ductal ; Cytoplasm ; Humans ; Hyperplasia ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

BACKGROUND: The pathophysiology of migraine has not been fully understood. One of the hypotheses is cortical hyperexcitability. Transcranial magnetic stimulation (TMS) is a noninvasive electrophysiologic tool for the investigation of cortical excitability. Divalproex sodium may prevent migraine attacks by increasing the GABA-ergic tone. We examined the phosphene generation using TMS in migraine patients in order to investigate the cortical excitability and its response by valproate prophylaxis. METHODS: We applied TMS to 27 migraineurs and 27 control subjects. TMS was performed by a Magstim Rapid Stimulator connected to a 70 mm figure-of-eight coil to examine the phosphene threshold between migraineurs and controls on primary (V1) and bilateral secondary (V5) visual cortices. Twelve migraine patients completed a one month administration of divalproex sodium 500 mg/day. We compared the phosphene threshold between pre- and post-treatment with devalproex sodium in these patients. RESULTS: The prevalence of the phosphene generation was significantly higher in migraineurs compared with controls in V1 and V5. The phosphene average thresholds were significantly lower in migraineurs compared with controls in V1 and V5. The phosphene average thresholds in the same areas were significantly higher in post-treatment compared with pre-treatment in migraineurs. CONCLUSIONS: The differences of the phosphene threshold in the visual cortex between migraineurs and controls comply with the theory of cortical hyperexcitability for the pathophysiology of migraine. Valproate might play a significant role in the prophylaxis of migraine by decreasing cortical hyperexcitability.
Humans ; Migraine Disorders* ; Phosphenes ; Prevalence ; Sodium ; Transcranial Magnetic Stimulation* ; Valproic Acid* ; Visual Cortex*

BACKGROUND: HLA antibodies have been shown to be associated with graft loss of organ transplants in prior studies. This study was designed to analyze the results of ELISA- panel reactive antibody (ELISA-PRA) in kidney transplant patients and the impact of this test on the clinical outcome. METHODS: We have investigated ELISA-PRA results from 110 living donor renal transplant patients from Nov. 2001 to Apr. 2004. RESULTS: ELISA-PRA positivity was found in 22 (20%) patients and was higher in the female patients than male (P<0.05). Pretransplant transfusion, pregnancy or transplantation history was not significantly correlated with ELISA- PRA result. ELISA-PRA (+)patients had more rejection episodes of 41% (n=9) (P=0.0005) and graft failures of 18% (n=4) (P=0.028) than ELISA-PRA (-), which had 8% (n=7) and 3% (n=3), respectively. Patients group with a result of ELISA-PRA/flowcytometric crossmatch (FCXM) (+/ -) or (+ / +) had worse clinical outcome than ELISA- PRA/FCXM ( -/- ). ELISA-PRA/FCXM (+ /+ ) correlated with higher incidence of allograft rejection than ELIS- PRA/FCXM (+ /- ) or ( -/+ ). CONCLUSION: These results suggest that in conjunction with FCXM results, pretransplant ELISA-PRA test is useful predictor of clinical outcome in renal transplant recipients.
Allografts ; Antibodies ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Incidence ; Kidney* ; Living Donors ; Male ; Pregnancy ; Transplantation ; Transplants