Injury to the recurrent laryngeal nerve is the most common and serious complication after thyroid surgery. Many different techniques have been described in the literature and interest in intraoperative neuromonitoring (IONM) has increased in an effort to prevent adverse events. IONM implicated for identification of the nerve and evaluation of its function during the operation. Continuous IONM was recently introduced and looks promising for early recognition and safe operation in the end. This paper describes the role of IONM, and its current and future issues.
Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy

No abstract available.
Pericardial Effusion* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate*

In addition to severe deficits in speech production and auditory comprehension, patients with global aphasia general-ly have a dense hemiplegia. However, acute global aphasia without hemiparesis (GAWH) occurs rarely and only a few cases of GAWH have been reported with variable conclusions regarding lesion localization, etiology, and prognosis. We report an unusual case of GAWH in which magnetic resonance imaging (MRI) and single photon emission comput-ed tomography (SPECT) revealed only a single lesion of the left superior temporal area. Our case supports the notion that the functional anatomy of aphasia may be complex and that GAWH may have a more benign prognosis than typi-cal global aphasia with hemiparesis.
Aphasia* ; Comprehension ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Paresis* ; Prognosis ; Tomography, Emission-Computed, Single-Photon

Hypercalcemia in accelerated phase of chronic myelogenous leukemia (CML) is very rare. Its pathogenesis is considered humoral hypercalcemia of malignancies mediated by parathyroid hormone-related protein (PTHrP). In severe hypercalcemia, calcifications in kidneys, skin, vessels, heart, and stomach may occur. Our two cases were admitted because of severe hypercalcemia in accelerated phase of CML. On Tc-99m methylene diphosphonate (MDP) bone scintigraphies, a marked tracer accumulation was seen in the lung, heart, stomach and kidney. We report increased tracer accumulation of multiple organs on Tc-99m MDP bone scintigraphy in two rare hypercalcemic patients with CML.
Adult ; Bone Diseases/radionuclide imaging* ; Bone Diseases/etiology* ; Calcinosis/radionuclide imaging ; Calcinosis/etiology ; Case Report ; Human ; Hypercalcemia/radionuclide imaging* ; Hypercalcemia/etiology* ; Leukemia, Myeloid, Chronic/metabolism ; Leukemia, Myeloid, Chronic/complications* ; Male ; Middle Age ; Proteins/metabolism ; Technetium/diagnostic use

The effects of epidural anesthesia for normal vaginal delivery on maternal cardiovascular system and boood gas analysis, and newborn umbilical arterial blood gas analysis and Apgar scores were studied in 24 paturients. The paturients were divided into two groups by random sampling, and one group underwent epidurial anesthesia and the other did not. Maternal systolie pressure, heart rate and cardiac output were measured at the time of 4 cm of cervical dilation (preanesthetic), 8 cm of cervical dilation, and immediate postpartum. PH, Pco, Po and bicarbonate levels of maternal atrerial blood were measured at the time of 4 cm and 8 cm of cervical dilation. PH, Pco, Po, and bicarbonate levels of newborn umbilical arterial blood were measured immediately after delivery. One minute and 5 minute Apgar scores of newborn were measured. Systolic blood presssures did not change in both groups. In non-epidural group diastolic and mean blood pressures decreased after delivery. In epidural group its slightly increased at the time of 8 cm of cervical dilation and returned to preanesthetic level after delivery. Heart rate and cardiac output also slightly increased at the time of 8 cm of cervical dilatior. and returned to preanesthetic level after delivery. Maternal pH slightly decreased at the time of 8 cm of cervical dilation in epidural group. Pco2 decreased in both groups, but the rate of decrease was smaller in epidural group. Po increased at the time of 8 cm of cervical dilation in epidural group. Bicarbonate ion level did not changed in both groups. Newborn umbilical arterial blood gas analysis and l minute and 5 minute Apgar scores were not different in both group.
Anesthesia ; Anesthesia, Epidural* ; Bicarbonates ; Blood Gas Analysis ; Cardiac Output ; Cardiovascular System ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mothers* ; Postpartum Period

PURPOSE: Metallothionein is an intracellular cystein-rich thiol-containing protein. Increased metallothionein content in tumor cells has been suggested to be a mechanism of resistance to cisplatin. In most of previous studies evaluating the role of metallothionein in cisplatin resistance, tumor cells were usually exposed to cadmium to increase metallothionein content. Therefore, cisplatin resistance of the cells may be related to cadmium exposure itself, which induces various changes in cell characteristics, but not to increased metallothionein content. The purpose of this study is to evaluate the role of metallothionein content alone in cellular resistance to cisplatin without exposure of cells to cadmium. MATERIALS AND METHOD: We measured the toxicity of cisplatin in mouse NIH/3T3 cells that vary in their content of metallothionein as a consequence of transfection with a plasmid that result in the constitutive expression of metallothionein. MT cells were derived from NIH/3T3 cells by transfection with a plasmid containing the genome of bovine papilloma virus and the mouse metallothionein-I, derived by the promoter for the glucose-regulated protein of 78kD. Control cells were similary transfected with bovine papilloma virus-based plasmids with the gene for metallothionein inverted and thus separated from the promoter (TM), or deleted, along with promoter (BPA). The number of copies of the plasmid were similar in each kind of transfected cells. Expression of metallothionein required neither selection nor maintenance of cells in the presence of heavy metals. RESULTS: Synthesis of metallothionein was 15-fold greater in the MT cells than in the TM or BPA cells. The concentration of cisplatin sufficient to reduce the cells per well by one-half (IC-50) was 0.40+/-0.075 uM in MT cells. In TM and BPA cells, it was 0.36 0.035 uM and 0.423+/-0.032 uM. There were no significant differences in IC-50 between three cell lines. CONCLUSION: In spite of large differences between MT and control cells in their cellular content of metallothionein, no differences in resistance to cisplatin were observed.
Animals ; Cadmium ; Cell Line ; Cisplatin* ; Genome ; Metallothionein* ; Metals, Heavy ; Mice* ; Papilloma ; Plasmids ; Transfection

Medical insurance, which is mandatory in Korea, has been progressed in the way of expanding the relevant population and intensifying the guarantee. However, rapid increases in medical expenses led national health insurance into a state of financial crisis. The government considered the reason of financial crisis as fee-for-service and started reorganizing the terms of payment from fee-for-service to case-payment. Therefore, an expanded diagnosis related group (DRG) payment system is carried out to decrease the expense on health and to secure financial stability. At the same time, the new case-payment system, apposite to the medical case in Korean society, is under demonstration. DRG payment system is in execution for the 7 disease entities of the four departments requested for now. However, it is supposed to be carried out in all the hospitals from the second half of 2012 and be expanded to all the general hospitals from 2013. The new case-payment system is under development because it is difficult to apply DRG to all disease entities. These shake-ups in the payment system will be conducted from the year 2015, combining both the DRG and new case-payment system. Basically, the introduction of the new case-payment system will cause doctors' passive attitude in the treatment of patients. This would be an especially serious problem for the department of surgery whose charge for operation is very low. It would be worse for the vascular surgeons because only 80% of operational or interventional procedures will be compensated, the fee for ultrasound is included in the new case-payment system, and age-related severity is not reflected in the disease entity. If relaunch is inevitable, vascular surgeons should understand the new case-payment system exactly and point out the problems. Also, standard guidelines on treatment per procedure should be set up and used for the established case-payment system, which would be helpful in reducing unnecessary medical expenses.
Diagnosis-Related Groups ; Fee-for-Service Plans ; Fees and Charges ; Hospitals, General ; Humans ; Insurance ; Korea ; National Health Programs

Cold agglutinins are autoantibodies activated at low temperature to produce red blood cell agglutination and hemolysis. Systemic hypothermia and cold cardioplegia which are employed commonly in modern cardiac operations are a potential danger to patients with the cold agglutinin disease. We report a successful use of a continuous warm retrograde delivery of cardioplegia with systemic hypothemia in a patient with cold agglutinin disease detected incidentally. Hemagglutination was found in the cold (4oC) blood cardioplegic circuit before the delivery of the cardioplegic solution. Hemagglutination was not detected in the mixture of blood and the warm cardioplegic solution (36.5oC). Therefore, cold agglutinin disease was suspected. The patient was only mildly cooled systemically. The coronary system was perfused with a normothemic cardioplegic solution. With this technique, the patient underwent an uneventful mitral valve replacement operation.
Agglutination ; Agglutinins ; Anemia, Hemolytic, Autoimmune* ; Anesthesia* ; Autoantibodies ; Cardioplegic Solutions ; Erythrocytes ; Heart Arrest, Induced ; Hemagglutination ; Hemolysis ; Humans ; Hypothermia ; Mitral Valve ; Thoracic Surgery*

Familial adenomatous polyposis(FAP) is a rare hereditary disorder characterized by the development of hundreds to thounds polyps throughout the colon and rectum. Moreover, several extracolonic manifestations are seen. Recently, this disease is recognized as a adenomatous polyposis syndrome which can involve the entire astrointestinal tract. Several reports have demonstrated a high incidence of gastroduodenal polyps in patients with familial adenomatous polyposis. These colon polyps can be eventually developed as colon cancer, if not be treated. So early diagnosis is needed and prophylactic surgery should be erformed. We experienced a case of familial adenomatous polyposis with a large sentinel polyp on the sigmoid colon, presenting hematochezia and mucoid diarrhea. He was early treated before progression to carcinoma by total colectomy, rectal mucosectomy and J pouch ileoanal anastomosis.
Adenomatous Polyposis Coli* ; Colectomy ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonic Pouches ; Diarrhea ; Early Diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Polyps* ; Rectum

BACKGROUND: South Korea has the fastest growing aging population in the world, and older people require more healthcare services. Unmet healthcare needs still exist in Korea due to several complex reasons. This study aimed to evaluate the factors associated with unmet healthcare needs of the older Korean population. METHODS: This cross-sectional study included 1,194 older adults, aged 65 years and older, who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2017. Sociodemographic factors, lifestyle and health status, comorbidity, and unmet healthcare needs were included in this study's analysis. Multiple logistic regression analysis was used to evaluate the association between unmet healthcare needs and other factors. RESULTS: The prevalence of unmet healthcare needs in this study population was 7.8%. After adjusting for age, sex, education level, household income, living alone, private health insurance, regular walking, body mass index, unintended weight loss, and osteoarthritis, women (adjusted odds ratio [aOR], 1.921; 95% confidence interval [CI], 1.061–3.479) and unintended weight loss (aOR, 2.218; 95% CI, 1.105–4.453) were more likely to have unmet healthcare needs than their counterparts. The group with general obesity (aOR, 1.691; 95% CI, 1.015–2.816) was more likely to have unmet healthcare needs than the group with normal body mass index. CONCLUSIONS: Among the older Korean population, being a woman, general obesity, and unintended weight loss may be risk factors for unmet healthcare needs.
Adult ; Aging ; Body Mass Index ; Comorbidity ; Cross-Sectional Studies ; Delivery of Health Care ; Education ; Family Characteristics ; Female ; Humans ; Insurance, Health ; Korea ; Life Style ; Logistic Models ; Needs Assessment ; Nutrition Surveys ; Obesity ; Odds Ratio ; Osteoarthritis ; Prevalence ; Risk Factors ; Walking ; Weight Loss