BACKGROUND AND OBJECTIVES: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to have poor prognostic impact in variable malignancies. However, studies evaluating the clinical significance of blood NLR in patient with papillary thyroid carcinoma (PTC) has been relatively rare, and the outcomes were inconsistent. In this study, we sought to analyze the clinical value of NLR in patients with PTC who had cervical lymph node metastasis. MATERIALS AND METHODS: Retrospective chart review was conducted with 174 patients with confirmed neck metastasis of PTC after initial thyroidectomy. Blood NLR was estimated by dividing the absolute number of blood neutrophil with that of lymphocyte. Statistical analysis was conducted to evaluate correlation between NLR and clinicopathologic factors, patterns of metastatic lymph nodes, and recurrence. RESULTS: Higher NLR (>1.74) was correlated to younger age of patients ( < 45 years, p=0.045) and smaller size of tumor ( < 1 cm, p=0.017). Blood NLR had no impact on patterns of lymph node metastasis or recurrence. CONCLUSION: Blood NLR may not be considered as a predictive factor for clinical aggressiveness or prognosis in patients with PTC with lymph node metastasis.
Humans ; Lymph Nodes* ; Lymphocytes* ; Neck* ; Neoplasm Metastasis* ; Neutrophils* ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

BACKGROUND: The purpose of this study was to elucidate the effects of fluid on the acid-base and electrolytes status and renal function after kidney transplantation (KT). METHODS: We retrospectively analyzed 103 patients who underwent KT. Analyses were performed separately according to the donor type (living, 52; deceased, 51). In the living donor KT group, 28 patients received normal saline solution (NS) and 24 patients received Hartmann's solution (HS). In the deceased donor KT group, 27 patients received NS, and 24 received HS. The acid-base and electrolyte status, urine volume, and renal function between patients receiving NS and patients receiving HS were compared in each group. RESULTS: Regardless of donor type, there were no differences in potassium, pH, base excess, PCO2 and HCO3 between HS and NS on immediate postoperative and postoperative day 1. However, changes to neutral acid-base balance in terms of pH, HCO3, and base excess were significantly higher in HS than in NS. In living donor KT, NS increased serum potassium and chloride significantly during fluid therapy. On postoperative day 7, renal function showed no difference between two groups but urine volume was significantly larger in NS than in HS. CONCLUSIONS: HS does not increase the incidence of hyperkalemia after KT. The use of HS resulted in less metabolic acidosis than the use of NS. Renal function was similar but polyuria was more severe in patients who received NS than in those who received HS.
Acid-Base Equilibrium ; Acidosis ; Electrolytes* ; Fluid Therapy ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Incidence ; Kidney Transplantation* ; Kidney* ; Living Donors ; Polyuria ; Potassium ; Retrospective Studies ; Sodium Chloride* ; Tissue Donors

OBJECTIVE: This study aims to provide the information of the stigmas of mental illness such as psychosis, alcoholism, attempt suicide, and depression among North Korean defectors. METHODS: We examined stigma for the mental illnesses of 639 North Korean defectors aged 19 to 65 years who live in the Settlement Support Center for North Korean Refugees. The stigmas of mental illnesses were assessed using the Perceived Devaluation-Discrimination Scale We directly compared the stigma level between North Korean defectors and the general population of South Korea. RESULTS: North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Perceived stigma associated with attempted suicide was similar for North Korean defectors and South Koreans. Only marital status in sociodemographic variables had associations with higher perceived stigma of psychosis, alcoholism, and depression in the North Korean defectors. North Korean defectors, who spent more than one year in transit country, had associations with lower perceived stigma of psychosis and alcoholism. North Korean defectors, who had the experience of compulsory repatriation to North Korea or North Korean family in South Korea, had an association with higher perceived stigma of depression. CONCLUSION: North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Further studies are needed to document serial changes in stigmas for mental illnesses associated with the receipt of education at the Settlement Support Center for North Korean defectors.
Alcoholism ; Democratic People's Republic of Korea ; Depression ; Education ; Humans ; Korea ; Marital Status ; Psychotic Disorders ; Refugees ; Suicide ; Suicide, Attempted

In some dizzy patients the apogeotropic direction changing positional nystagmus (DCPN) can be caused by a central disorder such as a mass lesion near the fourth ventricle or infaction. We have recently encountered a patient who showed a central DCPN mimicing a horizontal canal cupulolithiasis benign paroxysmal positional vertigo (BPPV). A 4.1 cm sized tumor was filling the fourth ventricle before the operation. When the head was turned to the left side vigorous right beting nystagmus was found. When the head was turned to the right side vigorous left beting nystagmus was found. But unlinke the typical horizontal canal BPPV, bowing and lying down position did not elicit any nystagmus. In order to see if the central DCPN was a transient finding or a persistent finding, we checked the nystagmus 3 weeks after the first testing. The same pattern of nystagmus was found again. The video head impulse test gain of all six canals were within the normal limit. In this article we discuss the points how to suspect a central DCPN in such cases.
Benign Paroxysmal Positional Vertigo ; Brain Neoplasms ; Deception ; Dizziness ; Fourth Ventricle ; Head ; Head Impulse Test ; Humans ; Nystagmus, Physiologic ; Vertigo

BACKGROUND AND OBJECTIVES: Various methods to induce tracheal stenosis in an animal model have been introduced. However, most methods use non-physiologic mechanical or chemical injury to tracheal mucosa or cartilage. In this study, we sought to develop an animal model of tracheal stenosis using a segmented endotracheal tube. MATERIALS AND METHOD: Nine New Zealand White Rabbits were included in this feasibility study. A segmented 1.5 cm LEVIN-Tube (16 French) was inserted into tracheal lumen via tracheotomy site and fixed with a nylon tape circumferentially tied around the trachea. The tube was removed transorally one week later and the tracheal lumen was observed with bronchoscopy every week. Rabbits were sacrificed two weeks after the tube removal and the trachea was evaluated with histologic image. Three rabbits underwent tracheotomy and closure only to evaluate possible impact of tracheotomy procedure to tracheal stenosis (sham surgery). RESULTS: None of the 6 rabbits showed significant complications or death during the study. No significant change of tracheal lumen was identified in 3 sham models. The mean grade of stenosis was 57.2±9.9% (range, 43-70%). Histologic image showed thickening and fibrosis of lamina propria with relatively intact tracheal cartilage framework. CONCLUSION: We developed an animal model of tracheal stenosis using a segmented endotracheal tube fixed with a nylon tape. Since this model has similar pathophysiology to prolonged endotracheal intubation, it may be used in various studies related to tracheal stenosis.
Animals* ; Bronchoscopy ; Cartilage ; Constriction, Pathologic ; Feasibility Studies ; Fibrosis ; Intubation, Intratracheal ; Methods ; Models, Animal* ; Mucous Membrane ; Nylons ; Rabbits ; Trachea ; Tracheal Stenosis* ; Tracheotomy

STUDY DESIGN: Case report. OBJECTIVES: We report a very rare case of the inferior accessory ossicle of the anterior arch of the atlas misdiagnosed as anterior arch fracture. SUMMARY OF LITERATURE REVIEW: It is necessary to know the existence of inferior accessory ossicle of the anterior arch of the atlas, even though it is extremely rare. MATERIALS AND METHODS: A 29-year-old woman was referred to our emergency service unit with symptoms of neck pain and scalp laceration, after being involved in a car accident. She was diagnosed as the inferior accessory ossicle of the anterior arch of the atlas, by multiple diagnostic mordalities. RESULTS: The symptom of neck pain was relieved spontaneously, and her symptom has been relieved at her latest visit, as a follow up within 3 months. CONCLUSIONS: It is important to be aware of cervical anatomical variants because we commonly confuse it with other pathologic conditions, such as a fracture and thus, misdiagnose the condition.
Adult ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Lacerations ; Neck Pain ; Scalp

PURPOSE: The purpose of this study was to evaluate the CT findings of peripheral small cell carninoma of the lung. MATERIALS AND METHODS: Of 45 patients with pathologically proven small cell carcinoma, with a solitary nodule in the peripheral lung distal to the segmental bronchus were included in this study. We retrospectively reviewed clinical data and CT findings including size, location, margin, enhancement pattern, lymph node enlargement, and metastasis. RESULTS: All ten masses examined had a well-defined margin, while a lobulated margin was seen in seven patients. The mean diameter was 3.8cm (2.5 -7 .0 cm), and the enhancement pattern was homogeneous in three cases and inhomogeneous in seven. Calcification or air-bronchogram was not present, and focal air density was seen in one case. In five patients, only lung mass was present, and lung mass with lymph node enlargement was seen in one patient. Distant metastasis without lymph node enlargement was noted in two patients and another two showed lymph node enlargement and distant metastasis. CONCLUSION: In ten of 45 cases of small cell carcinoma (22.2 %), the location of the nodule indicated that peripheral small cell carcinoma is not rare. The most frequent CT finding is a well-defined, lobulated mass with inhomogeneous enhancement.
Bronchi ; Carcinoma, Small Cell* ; Humans ; Lung* ; Lymph Nodes ; Neoplasm Metastasis ; Retrospective Studies

The surgical management of complete transposition of the great arteries, ventricular septal defect, and pulmonary stenosis still remain a significant challenge. The Rastelli (REV procedure) remains the most widely applied procedure for surgical repair of these lesions. Although the Rastelli procedure can be performed with good early results, the intermediate- and long-term results have been less than satisfactory because of deterioration of the hemodynamic performance of the LVOT or RVOT. We performed a modified Nikaidoh procedure as an alternative surgical procedure in a 19-month-old boy weighing 10.4 kg with this anomaly. Aortic translocation with biventricular outflow tract reconstruction resulted in a more "normal" anatomic repair and postoperative echocardiography showed straight, direct, and unobstructed ventricular outflow.
Arteries ; Echocardiography ; Heart Septal Defects, Ventricular ; Hemodynamics ; Humans ; Infant ; Pulmonary Valve Stenosis

There still is debates on the effect and the value of HLA matching on graft survival in clinical renal transplantation. A few reports were presented in Korea about the effect, where over 95% of kidneys have been taken from living donor, and the results are inconclusive. So, we analysed 329 cyclosporine treated first living donor renal transplantation performed in Keimyung University Dongsan medical center, from Nov. 1982 to Feb. 1996 to determine the effect of HLA matching on graft outcome. Significant survival benefits were observed at 5 years between HLA-B 0 mismatch(MM) and more than 0 MM (89.73% vs 64.68, 60.26%, p<0.05), A+B 0 MM and more than 0 MM(94.28% vs 63.94, 63.43, 56.25%, p<0.05), B+DR 0 MM and 2, 3 MM(89.59% vs 61.82, 64.98%, p<0.05), and A+B+DR 0 MM and 3, 4 MM(92.57% vs 56.82, 63.19%, p<0.05). But HLA-A or DR mismatch alone seemed to have no effect on graft survival. Our results showed some beneficial effect of HLA match on renal graft survival but yet inconclusive due to small size of the number.
Cyclosporine* ; Graft Survival* ; HLA-A Antigens ; HLA-B Antigens ; Humans ; Kidney ; Kidney Transplantation* ; Korea ; Living Donors* ; Transplants*

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.
Aged ; Bile Duct Neoplasms/complications/*diagnosis/surgery ; Carcinoma, Small Cell/complications/*diagnosis/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography/radionuclide imaging/surgery ; Fatal Outcome ; Humans ; Liver Neoplasms/diagnosis/secondary ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed