PURPOSE: Ultrasound is most effective study for evaluating thyroid nodules. In this review, we discuss that sonographic findings to differentiate benign from malignant nodules and suggest recommendations for indications of fine needle aspiration biopsy and thyroid nodule management. METHODS: Sonographic scans of 206 thyroid nodules in 164 patients were candidated for this study. We evaluated sonographic findings by shape, calcification, margin, and echogenicity, retrospectively. Sonographic findings that suggested malignancy included microcalcifications, a speculated margin, marked hypoechogenicity and a shape that was taller than wide. The final diagnosis of lesion as benign (n=180) or malignant (n=26) was confirmed by fine needle aspiration biopsy and follow-up (>6 months). We demonstrated the difference of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Of 206 thyroid nodules, 26 were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 84.6%, 73.9%, 31.9%, 97.0% and 75.2%. CONCLUSION: Sonography can be helpful for making the differentiation between and malignant nodules. So, when well trained surgeon find thyroid nodules on sonography, we can make correct diagnosis of malignant nodules.
Biopsy ; Biopsy, Fine-Needle ; Classification ; Diagnosis ; Follow-Up Studies ; Humans ; Methods ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.
Anti-Bacterial Agents ; Antifungal Agents ; Arm ; Catheter-Related Infections ; Ciprofloxacin ; Fungemia ; Humans ; Immunocompromised Host ; Incidence ; Itraconazole ; Leg ; Mortality ; Myelodysplastic Syndromes* ; Prognosis ; Skin ; Stem Cell Transplantation ; Trichosporon* ; Voriconazole

Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.
Anti-Bacterial Agents ; Antifungal Agents ; Arm ; Catheter-Related Infections ; Ciprofloxacin ; Fungemia ; Humans ; Immunocompromised Host ; Incidence ; Itraconazole ; Leg ; Mortality ; Myelodysplastic Syndromes* ; Prognosis ; Skin ; Stem Cell Transplantation ; Trichosporon* ; Voriconazole

Excessive exposure to several metallic elements is known to produce a variety of nephrotoxic syndromes such as glomerulonephritis, nephrotic syndrome, interstitial nephritis, structural and functional abnormalities of proximal tubule resembling the Fanconi's syndrome and acute tubular necrosis. Although the pulmonary toxicities of silicon are relatively well documented as a cause of silicoproteinosis and lung fibrosis after acute and chronic exposure to free silica(SiO2), but is little known about the nephrotoxicity of this trace element. Clinical manifestations of silicon nephropathy are similar to other heavy metal nephropathy as proteinuria, hematuria, active urinary sediments and renal failure. Diagnosis of silicon nephropathy is based on distinct exposure history to silica, variable degree of renal dysfunction and characteristic histologic findings such as cytoplasmic vacuoles and dense membrane-enclosed cytoplasmic bodies which is resembling lysosomes in proximal tubular cells. A 26-year-old man with ingestion of silicon compound(SiO2-NaOCO3) developed acute renal failure due to acute tubular necrosis. And he was recovered with conservative management to acute renal failure. So we report this case with a brief review of literature.
Acute Kidney Injury* ; Adult ; Cytoplasm ; Diagnosis ; Eating* ; Fibrosis ; Glomerulonephritis ; Hematuria ; Humans ; Lung ; Lysosomes ; Necrosis ; Nephritis, Interstitial ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Silicon Dioxide ; Silicon* ; Vacuoles

PURPOSE: The present visual and electromyographic study was designed to evaluate muscle fasciculations caused by succinylcholine in adults pretreated with either remifentanil 1.5 microgram/kg or saline. MATERIALS AND METHODS: The effect of remifentanil on succinylcholine-induced muscle fasciculations was studied using a double-blind method in 40 adults. After i.v. pretreatment with either remifentanil 1.5 microgram/kg (remifentanil group, n = 20) or an equivalent volume of i.v. saline (saline group, n = 20), patients were anaesthetized with a 2.0 mg/kg of i.v. propofol followed by i.v. succinylcholine 1.0 mg/kg. Intensity and duration of muscle fasciculation following i.v. succinylcholine administration were recorded. Electromyography (EMG) was used to quantify the extent of muscle fasciculation following i.v. succinylcholine injection. Myalgia was evaluated 24 hours after induction time. Serum potassium levels were measured five minutes after i.v. succinylcholine administration and creatine kinase (CK) levels 24 hours after induction time. RESULTS: Compared to saline treated controls, remifentanil decreased the intensity of muscle fasciculations caused by i.v. succinylcholine [fasciculation severity scores (grade 0 to 3) were 2/1/12/5 and 3/13/4/0 (patients numbers) in the saline group and the remifentanil group, respectively, p < 0.001]. The mean (SD) maximum amplitude of muscle action potential (MAP) by EMG was smaller in the remifentanil group [283.0 (74.4) microV] than in the saline group [1480.4 (161.3) microV] (p = 0.003). Postoperative serum CK levels were lower in the remifentanil group (p < 0.001). Postoperative myalgia was not different between the two groups. CONCLUSION: Remifentanil 1.5 microgram/kg attenuated intensity of muscle fasciculations by succinylcholine.

PURPOSE: Chronic constipation is not uncommon even in children. Recently biofeedback treatment (BT) is considered as a useful modality in the treatment of various types of constipation. The aim of this study was to evaulate the effectiveness of BT in children with chronic constipation. METHODS: We reviewed 24 cases of childhood constipation (17 boys, 7 girls) who visited the Jinju Hakmoon colorectal surgery clinic and GNUH1 between April, 2001 and September, 2002. Balloon-mediated anorectal manometry system was used for BT. The effects of therapy was assessed by bowel movement, defecation time, fecal soiling and balloon evacuation test in the early course of therapy. The long term follow up survey was done by telephone interview at January 2003 and the effects of therapy was assessed by bowel movement, defecation time, fecal soiling and parents' satisfaction. RESULTS: Patients received the BT for the three times on average, and as the result of the therapy, 20 patients experienced disappearance of symptoms (87%) or at least improvement of symptoms. In terms of manometric values, the mean resting pressure was 113.4 mmHg before the BT, but decreased to 86.3 mmHg after the BT (P=0.0012). Mean pushing pressure dropped to 85.98 mmHg from 130.45 mmHg (P=<0.0001). Mean sensitivity decreased from 55 ml to 35 ml (P=0.0053). Mean compliance decreased from 20.28 H2O/cm to 4.21 H2O/cm (P=0.0015). 13 patients (76%) showed disappearance or improvement of symptoms in the long term follow up. CONCLUSIONS: The Balloon mediated biofeedback therapy is effective in children with chronic constipation. It is safe, easy to administer and also improve symptoms and objective parameters of anorectal function. Balloon mediated biofeedback therapy could be the first-line therapy in child patient with chronic constipation who failed conservative management.
Biofeedback, Psychology* ; Child* ; Colorectal Surgery ; Compliance ; Constipation* ; Defecation ; Follow-Up Studies ; Gyeongsangnam-do ; Humans ; Interviews as Topic ; Manometry ; Soil

Chronic inflammation has been implicated as one of the important etiological factors in insulin resistance and type 2 diabetes mellitus (T2DM). To investigate the role of anti-inflammatory cytokines in the development of T2DM, we conducted a case-control study to assess the association between IL4/IL4R polymorphisms and disease risk. We firstly identified single nucleotide polymorphisms (SNP) at IL4 and IL4RA loci by sequencing the loci in Korean participants. Case-control studies were conducted by genotyping the SNPs in 474 T2DM cases and 470 non-diabetic controls recruited from community-based cohorts. Replication of the associated signals was performed in 1,216 cases and 1,352 controls. We assessed effect of IL4-IL4RA interaction on T2DM using logistic regression method. The functional relevance of the SNP associated with disease risk was determined using a reporter expression assay. We identified a strong association between the IL4 promoter variant rs2243250 and T2DM risk (OR=0.77; 95% CI, 0.67~0.88; p=1.65x10-4 in the meta-analysis). The reporter gene expression assay demonstrated that the presence of rs2243250 might affect the gene expression level with ~1.5-fold allele difference. Our findings contribute to the identification of IL4 as a T2D susceptibility locus, further supporting the role of anti-inflammatory cytokines in T2DM disease development.
Alleles ; Case-Control Studies ; Cohort Studies ; Cytokines ; Diabetes Mellitus, Type 2 ; Gene Expression ; Genes, Reporter ; Inflammation ; Insulin Resistance ; Interleukin-4 ; Logistic Models ; Polymorphism, Single Nucleotide

BACKGROUND: Research into the Baumann skin type (BST) has recently expanded, with growing interest in the development of an efficient and effective skin type classification system for better understanding of this skin condition. OBJECTIVE: We aimed to identify male-specific skin type characteristics with investigation into the distribution of BST by age and region in the Korean male population and to determine the intrinsic and extrinsic factors related to skin type. METHODS: A questionnaire was administered to collect information about age, region, working behavior, drinking behavior, smoking behavior, usual habit of sun protection, medical history, and the BST which consisted of four parameters; oily (O) or dry (D), sensitive (S) or resistant (R), pigmented (P) or non-pigmented (N), and wrinkled (W) or tight (T). RESULTS: We surveyed 1,000 Korean males aged between 20 and 60 years who were divided equally by age and region. Of the total respondents, OSNW type accounted for the largest percentage and ORPW type the lowest. In terms of Baumann parameters, O type was 53.5%, S type was 56.1%, N type was 84.4% and W type was 57.5%. Several behavioral factors were found to have various relationships with the skin type. CONCLUSION: The predominant skin type in the Korean male respondents was OSNW type, and the distribution of skin types with regards to age and region was reported to be distinct. Therefore, skin care should be customized based on detailed skin types considering the various environmental factors.
Classification ; Drinking Behavior ; Humans ; Male ; Skin Care ; Skin ; Smoke ; Smoking ; Solar System ; Surveys and Questionnaires