No abstract available.
Ischemic Contracture*

Thyroid nodules are the most common endocrine disease requiring surgical management. Various techniques for evaluating thyroid nodules have been developed and are being utilized, but it is difficult to differentiate the few malignant lesions from the numerous benign nodules. We reviewed 187 patients with thyroid nodules who were admitted to and operated on at the Department of General Surgery, Buchon Sejong General Hospital, from January 1990 to December 1996. The results are summarized as follows: 1) The incidence of benign nodules was 83.9%, and that of malignant nodules was 16.0% among the 187 cases of thyroid nodules. 2) The sexual distribution revealed female preponderance of 6.5:1 for benign nodules and 14:1 for malignant nodules. 3) The peak-incidence was in the 4th decade to both patients with benign nodules and patients with malignant nodules. 4) As to the duration of illness, 39.6% of cases were resolved within 3 months, 77.5% of cases within 1 year. 5) The most common subjective symptoms were a palpable mass (100%), fatigue, palpitation, and headache, in order of frequency. 6) Eight four percent (84%) of the nocules were unilateral, 46.5% were on the right, 37.4% were on the left, and 12.8% were bilateral. 7) The most common (36.9%) nodule size was 2~3 cm. 8) There was a single nodule in 142 (75.9%) cases and multiple nodules in 45 (24.1%) cases. There was no difference in the incidence of cancer between single and multiple nodules. Also, 35.7% of the benign tumors and 80.0% of the malignant ones were solid. 9) On thyroid scanning, 86.0% of the benign nodules and 93.3% of the malignant nodules were cold nodules. 10) The histopathologic classifications of the benign nodules in decreasing order of frequency were adenomatous goiter, 121 cases (77.1%); follicular adenoma, 20 cases (12.7%); Graves' disease, 6 cases (3.8%); Hashimoto's thyroiditis, 6 cases (3.8%), cyst, 3 cases (1.9%); and subacute thyroiditis, 1 case (0.6%). The malignant diseases were papillary carcinoma, 26 cases (86.7%); follicular carcinoma, 3 cases (10.0%); and medullary carcinoma, 1 case (3.3%). 11) Benign nodules were treated with a lobectomy (69.4%), a lobectomy with isthmectomy (17.8%), a near total thyroidectomy (11.5%) or a total thyroidectomy (1.3%). Malignant nodules were treated with a lobectomy (23.3%), a lobectomy with isthmectomy (20.0%), a total thyroidectomy (20%), a total thyroidectomy with radical neck dissection (20%) a near total thyroidectomy (13.3%), or a near total thyroidectomy with radical neck disection(RND) or modified RND (3.3%). 12) The postoperative complications were transient hypocalcemia (6.4%), permanent hypocalcemia (2.1%), transient hoarseness (1.6%), permanent hoarseness (0.5%), and hematoma (0.5%).
Adenoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Classification ; Endocrine System Diseases ; Fatigue ; Female ; Goiter ; Graves Disease ; Headache ; Hematoma ; Hoarseness ; Hospitals, General ; Humans ; Hypocalcemia ; Incidence ; Neck ; Neck Dissection ; Postoperative Complications ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Subacute

Thyroid nodules are the most common endocrine disease requiring surgical management. Various techniques for evaluating thyroid nodules have been developed and are being utilized, but it is difficult to differentiate the few malignant lesions from the numerous benign nodules. We reviewed 187 patients with thyroid nodules who were admitted to and operated on at the Department of General Surgery, Buchon Sejong General Hospital, from January 1990 to December 1996. The results are summarized as follows: 1) The incidence of benign nodules was 83.9%, and that of malignant nodules was 16.0% among the 187 cases of thyroid nodules. 2) The sexual distribution revealed female preponderance of 6.5:1 for benign nodules and 14:1 for malignant nodules. 3) The peak-incidence was in the 4th decade to both patients with benign nodules and patients with malignant nodules. 4) As to the duration of illness, 39.6% of cases were resolved within 3 months, 77.5% of cases within 1 year. 5) The most common subjective symptoms were a palpable mass (100%), fatigue, palpitation, and headache, in order of frequency. 6) Eight four percent (84%) of the nocules were unilateral, 46.5% were on the right, 37.4% were on the left, and 12.8% were bilateral. 7) The most common (36.9%) nodule size was 2~3 cm. 8) There was a single nodule in 142 (75.9%) cases and multiple nodules in 45 (24.1%) cases. There was no difference in the incidence of cancer between single and multiple nodules. Also, 35.7% of the benign tumors and 80.0% of the malignant ones were solid. 9) On thyroid scanning, 86.0% of the benign nodules and 93.3% of the malignant nodules were cold nodules. 10) The histopathologic classifications of the benign nodules in decreasing order of frequency were adenomatous goiter, 121 cases (77.1%); follicular adenoma, 20 cases (12.7%); Graves' disease, 6 cases (3.8%); Hashimoto's thyroiditis, 6 cases (3.8%), cyst, 3 cases (1.9%); and subacute thyroiditis, 1 case (0.6%). The malignant diseases were papillary carcinoma, 26 cases (86.7%); follicular carcinoma, 3 cases (10.0%); and medullary carcinoma, 1 case (3.3%). 11) Benign nodules were treated with a lobectomy (69.4%), a lobectomy with isthmectomy (17.8%), a near total thyroidectomy (11.5%) or a total thyroidectomy (1.3%). Malignant nodules were treated with a lobectomy (23.3%), a lobectomy with isthmectomy (20.0%), a total thyroidectomy (20%), a total thyroidectomy with radical neck dissection (20%) a near total thyroidectomy (13.3%), or a near total thyroidectomy with radical neck disection(RND) or modified RND (3.3%). 12) The postoperative complications were transient hypocalcemia (6.4%), permanent hypocalcemia (2.1%), transient hoarseness (1.6%), permanent hoarseness (0.5%), and hematoma (0.5%).
Adenoma ; Carcinoma, Medullary ; Carcinoma, Papillary ; Classification ; Endocrine System Diseases ; Fatigue ; Female ; Goiter ; Graves Disease ; Headache ; Hematoma ; Hoarseness ; Hospitals, General ; Humans ; Hypocalcemia ; Incidence ; Neck ; Neck Dissection ; Postoperative Complications ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Thyroiditis ; Thyroiditis, Subacute

PURPOSE: To investigate the clinical manifestations and treatments of parafoveal telangiectasis. METHODS: Twenty-two eyes of fifteen patients diagnosed as parafoveal telangiectasis were selected who had visited Kong Eye Center from September 1999 to August 2003 complaining of decreasing visual acuity. Visual acuity was checked and fluorescein angiography and optical coherence tomography were done. Authors treated six eyes of six patients experienced decreasing visual acuity due to macular edema with argon laser photocoagulation and one eye of one patient accompanying with choroidal neovascularization with photodynamic therapy. RESULTS: Among fifteen patients, group 1 cases were eight (1B eight) and group 2 cases were seven by classification of Gass and Blodi. Visual acuity improved in two eyes of six eyes and maintained in four eyes of six eyes and optical coherence tomography showed decrease of macular edema in six eyes of six patients all after argon laser photocoagulation. Visual acuity improved and optical coherence tomography showed decrease of macular edema in one eye of one patient after photodynamic therapy. CONCLUSIONS: Group 1 cases were more than group 2 cases. Argon laser photocoagulation can be effectively used to treat decreasing visual acuity due to macular edema in parafoveal telangiectasis patients. Photodynamic therapy seems to be effective in parafoveal telangiectasis accompanied with choroidal neovascularization but we think that additional studies with more cases are needed.
Argon ; Choroidal Neovascularization ; Classification ; Fluorescein Angiography ; Humans ; Light Coagulation ; Macular Edema ; Photochemotherapy ; Telangiectasis* ; Tomography, Optical Coherence ; Visual Acuity

BACKGROUND: Preemptive analgesia is an antinociceptive treatment that prevents the establishment of central sensitization, which amplifies the postoperative pain. In this study, we investigated the preemptive effect of local infiltration of bupivacaine on postoperative pain after inguinal herniorrhaphy. METHODS: Thirty adult patients scheduled for inguinal herniorrhaphy were randomly assigned to one of two groups. 0.25% bupivacaine 20 ml was infiltrated in the surgical wound site either 15 min before skin incision or immediately after skin closure. Postoperatively, visual analogue scale (VAS) at rest and movement were assessed. Also the time to the first request for postoperative analgesic and the total dose of postoperative analgesics were assessed. In addition, the number of patients who didn't require any analgesics during the postoperative period were assessed. RESULTS: The VAS at rest and movement was not significantly different between the two groups. The time to the first request for postoperative analgesic, the total dose of supplemental analgesics and the number of patients who didn't require any analgesics were not significantly different. CONCLUSIONS: In pain after inguinal herniorrhaphy, we could not demonstrate the pre-emptive analgesic effect of preincisional bupivacaine infiltration. Traction pain after inguinal herniorrhaphy was sustained during the study period and this kind of pain was not inhibited (or prevented) by local infiltration of bupivacaine.
Adult ; Analgesia ; Analgesics ; Bupivacaine* ; Central Nervous System Sensitization ; Herniorrhaphy* ; Humans ; Pain, Postoperative* ; Postoperative Period ; Skin ; Traction ; Wounds and Injuries

The aim of the study was to evaluate the frequency of needed shunt surgeries in 514 patients who underwent surgery for a ruptured intracranial aneurysms. The patients were consisted of 207 patients who were treated from 1986 to 1988(historical control group) and 307 patients treated from 1994 to 1996(study group). In the study group, an earlier aneurysm surgery and more frequent use of adjunctive procedures applied(lumbar and cisternal drainage, and opening of the lamina terminalis and the Liliequist membrane) compared to the control group(p<0.005). Twent-one patients(6.8%) required shunt operations in the study group, while it was necessary in 32 patients(15.5%) of the control group(p<0.005). However, occurrence of a hydrocephalus in both groups were similar. It is concluded that the frequency of a shunt operation has been decreased in the study group presumably due to an earlier surgical intervention, and an aggressive drainage of the bloody cerebrospinal fluid from the cisterns and the ventricles during or after an aneurysm surgery.
Aneurysm* ; Cerebrospinal Fluid ; Drainage ; Humans ; Hydrocephalus ; Hypothalamus ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage

Heart disease is one of the major cause of death in diabetic patients, but the thogenesis of diabetic cardio-myopathy remains unclear. In this experiment, to sess the significance of G protein signaling pathways in the pathogenesis of abetic cardiomyopathy, we analyzed the expression of G proteins and the tivities of second messenger dependent protein kinases: cAMP-dependent protein nase (PKA), DAG-mediated protein kinase C (PKC), and calmodulin dependent otein kinase II (CaM kinase II) in the streptozotocin induced diabetic rat art. The expression of Galphaq was increased by slightly over 10% (P<0.05) in abetic rat heart, while Galphas, Galphai, and Gbeta remained unchanged. The A activity in the heart did not change significantly but increased by 27%<0.01) in the liver. Insulin treatment did not restore the increased activity the liver. Total PKC activity in the heart was increased by 56% (P<0.01), and sulin treatment did not restore such increase. The CaM kinase II activity in e heart remained at the same level but was slightly increased in the liver 4% increase, P<0.05). These findings of increased expression of Galphaq in the reptozotocin-diabetic rat heart that are reflected by the increased level of C activity and insensitivity to insulin demonstrate that alteration of Galphaq y underlie, at least partly, the cardiac dysfunction that is associated with abetes. Copyright 2000 Academic Press.
Animal ; Ca(2+)-Calmodulin Dependent Protein Kinase/metabolism ; Cyclic AMP-Dependent Protein Kinases/metabolism ; Diabetes Mellitus, Experimental/metabolism* ; Diabetes Mellitus, Experimental/drug therapy ; Diabetes Mellitus, Experimental/chemically induced ; GTP-Binding Proteins/metabolism* ; Insulin/pharmacology ; Liver/metabolism ; Liver/drug effects ; Male ; Myocardium/metabolism* ; Protein Kinase C/metabolism ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; Streptozocin

Breaking bad news to patients with a advanced cancer is a difficult task for physicians. Some strategies can be used when breaking bad news to patients with advanced cancer. However, many doctors were not trained sufficiently. 43-year old male complaining of general weakness and melena was diagnosed as an advanced gastric cancer with hepatic metastasis. We could deliver this bad news to the patient and his family step by step. Honest discussion allowed patient to be reassured about many points of concern and helped them to be calmer and to plan and readjust hopes and aims. Bad news cannot be broken gently, but it can be given in a sensitive manner and at the individual's pace. Sometimes doctor's own anxiety can be barrier to tell the truth. When we give the information, we always keep in mind about the respect for truth, the patient's rights, the duty to inform, main taining hope, and the sanctity of the individual contract between patient and doctor.
Adult ; Anxiety ; Diagnosis* ; Hope ; Humans ; Male ; Melena ; Neoplasm Metastasis ; Patient Rights ; Stomach Neoplasms

BACKGROUND: Clinically rocuronium, a muscle relaxant, has no significant inhibitory effect on the autonomic nervous system in the healthy population. However, there has been no study done on rocuronium in diabetic patients. Therefore, we used heart rate variability (HRV) as a biomarker to investigate cardiac autonomic function after rocuronium administration to diabetic patients. METHODS: In 21 diabetic adult patients, heart rate (HR), mean arterial blood pressure (BP), low frequency (LF, 0.04-0.15 Hz) power, high frequency (HF, 0.15-0.4 Hz) power, LF/HF ratio, SD1 and SD2 in the Poincare plot before induction of anesthesia, and immediately before and after rocuronium administration were calculated and compared. RESULTS: HR, mean BP, LF, LF/HF ratio and SD2 after rocuronium administration did not differ significantly from the measurements taken before rocuronium administration. HF and SD1 decreased significantly after rocuronium administration (P = 0.022, P = 0.019 respectively). Covariates such as age, gender, weight, duration of diabetes mellitus and hypertension did not alter the effect of rocuronium on the autonomic nervous system. CONCLUSIONS: Rocuronium produced a significant decrease in parasympathetic activity. Therefore, further study will be needed to determine whether vagal reduction caused by rocuronium could have potential to deteriorate hemodynamics in diabetic patients.
Adult ; Androstanols ; Anesthesia ; Arterial Pressure ; Autonomic Nervous System ; Diabetes Mellitus ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Muscles ; Syndactyly

Antioxidant properties have been proposed as a mechanism for the putative anti-inflammatory effects of phenolic compounds. To reveal the relationship between antioxidant activity and anti-inflammatory effects of various antioxidants, we measured 1, 1-diphenyl-2-picryhydrazyl (DPPH)-reducing activity and examined the inhibitory effects on LPS-induced inflammation-related gene expression in the BV2 microglial cell line. Lipopolysaccharide (LPS) (0.2microgram/ml) was used with or without antioxidants to treat cells, and the regulation of iNOS and cytokine gene expression was monitored using an RNase protection assay (RPA). Although, all tested antioxidants had similar DPPH-reducing activity and inhibited nitrite production, but the curcuminoid antioxidants (ferulic acid, caffeic acid, and curcumin) inhibited LPS-induced gene expression (iNOS, TNF-alpha, IL-1beta, IL-6, and IL-1 Ra) in a concentration-dependent manner. Other tested antioxidants did not exhibit the same effects; N-acetylcysteine (NAC) only began to suppress IL-1beta gene expression just below the concentration at which cytotoxicity occurred. Moreover, the antioxidant potency of curcuminoids appeared to have no correlation with anti-inflammatory potency. Only curcumin could inhibit LPS-induced microglial activation at a micromolar level. These data suggest that curcumin may be a safe antioxidant possessing anti-inflammatory activity.
Acetylcysteine ; Antioxidants* ; Cell Line* ; Curcumin ; Gene Expression ; Interleukin-1 ; Interleukin-6 ; Nitric Oxide ; Phenol ; Ribonucleases ; Tumor Necrosis Factor-alpha