OBJECTIVES: The aims of this study were to know the prevalence of cognitive disorders in patients with thyroid cancer, and identify related variables to them. METHODS: Subjects were consisted of fourty-two patients with thyroid cancer, who were admitted for radioiodine ablative therapy at 6-12 months after total thyroidectomy. The data were obtained from interviews about history and assessments of depression and cognitive function(Korean Version of the Montreal Cognitive Assessment, MoCA-K). RESULTS: 1) Among subjects, those with below 22 of total score of the MoCA-K were twenty-one(50.0%). 2) Upon age, education, Pre-radioiodine therapy thyroid stimulating hormone(TSH), there were statistically significant difference between subgroup with above 23 of the total MoCA-K score and those below 22. 3) The total scores of the MoCA-K in subjects had significant correlation with age, education, comorbidity, Pre-radioiodine therapy TSH, total score of the HDRS-17. CONCLUSIONS: Cognitive disorders were more prevalent among patients with thyroid cancer before radioiodine therapy. Therefore, further study should be needed to clarify the mechanism for the cognitive disorders in thyroid cancer. Furthermore, physicians should pay attention to the cognitive function and prepare preventative measures for cognitive disorder during management of thyroid cancer.
Carcinoma, Papillary* ; Comorbidity ; Depression ; Education ; Humans ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin

PURPOSE:Autonomic neuropathy in adult diabetics is known to be common and poor in prognosis. Cardiac autonomic neuropathy increases sudden cardiac death and is present before apparant cardiac symptoms. Subclinical diabetic peripheral neuropathy is common with type 1 diabetes. In children, few studies for subclinical peripheral neuropathy and cardiac autonomic neuropathy were reported but the results were inconsistent. The authors investigated subclinical cardiac and peripheral neuropaties and evaluated correlation between nerve conduction velocity(NCV) and cardiac autonomic function(CAF) test in type 1 diabetic children and adolescents METHODS:Over 5 years from 1997 to 2002, 27 IDDM without clinical neuropathy were registered. Total 57 CAF and NCV were tested every 2 or 3 years. Duration of diabetes, average HbA1c during 1 year prior to the test, and urinary microalbumin excretion for 24 hours were assessed. Diabetic autonomic nervous function was evaluated by cardiovascular reflex test:falling systolic blood pressure in response to standing, heart rate changes in response to standing, beat-to-beat rate variation during deep breathing, RR interval change during and after Valsalva maneuver. Subclinical peripheral neuropathy was evaluated by NCV in both upper and lower extremities. Correlation of parameters according to NCV abnormality and microalbuminuria were analyzed. RESULTS:The age, duration of diabetes and microalbuminuria were not statistically different between children with normal and abnormal NCV. The level of HbA1c was associated with NCV abnormality. In a multivariate logistic model for NCV abnormality, level of HbA1c showed statistical significance after controlling the effects of age, duration of diabetes, and urinary microalbumin level, and the odd ratio was 1.532. The degree of CAF abnormality was marginally significant in the logistic model. Children with microalbuminuria showed older age and longer duration of diabetes than those without microalbuminuria. However, mean HbA1c level was not significantly different between the two groups. Degree of CAF abnormality was not significantly associated with microalbuminuria, either. In a general linear model including urinary albumin level as the dependent variable, none of independent variables was statistically significant. CONCLUSION: Therapy against neuropathy should be considered in patients with high HbA1c and abnormal CAF test even without clinically apparent neuropathy.
Adolescent ; Adult ; Blood Pressure ; Child* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 1 ; Diabetic Neuropathies ; Heart Rate ; Humans ; Linear Models ; Logistic Models ; Lower Extremity ; Neural Conduction ; Peripheral Nervous System Diseases ; Prognosis ; Reflex ; Respiration ; Valsalva Maneuver

To investigate effects of cytokines on rheumatoid synovial cells, proliferation and expression of cytokine and metalloproteinase genes were studied with the primary culture of rheumatoid synovial cells which was treated with TNF-alpha, GM-CSF, TGF-alpha, PDGF and IL-B. By [3H] thymidine incorporation assay, TGF-beta and PDGF increased proliferation of synovial cells by 1.5 and 2.5 folds respectively. Cytokine gene expression was assessed by RT-PCR. Rheumatoid synovial cells expressed constitutively TGF-beta and IL-B at a high level and IL-1B, GM-CSF, and MIP-1a at a relatively low level. TGF-beta, GM-CSF and PDGF increased IL-B expression. Expression of pro-inflammatory cytokines and chemokines was increased by GM-CSF and PDGF. Both GM-CSF and PDGF increased the expression of IL-1B, GM-CSF MIP-la and IL-8. In addition, GM-CSF enhanced expression of TNF-alpha. Stromelysin and collagenase are the major proteinases responsible for destruction ot joints in rheumatoid arthritis (RA). These genes were expressed constitutivefy in rheumatoid synovial cells. In summary, PDGF and GM-CSF may piay an important role by inducing or increasing expression of IL-1B, TGF-beta and PDGF by increasing proliferation of rheumatoid synovial cells.
Tumor Necrosis Factor-alpha

In cases of L4-5 spinal fusions, L5-S1 segment used to be included in the fusion traditionally for fear of progressive deterioration of the lumbosacral motion segment after fusion above. The purpose of this study was to evaluate the advisability of extension to L5-S1 segment in cases of L4-5 fusion for an isolated pathologic condition in L4-5 sement. A retrospective review of 72 patients with spinal fusion for an isolated pathologic condition in L4-5 segment was undertaken to compare the clinical results and adverse effects in two groups. One group consisted of 39 patients with floating L4-5 fusion(SF), and the other group consisted of 33 patients with L4-S1 fusion(LSF). The age, pathologic condition at L4-5, and the fusion method(lateral fusion) were matched in two groups. The mean follow-up period was 43.6 months(ranging 24-69 months). Comparisons were made for operative problems, post-operative complications, the amount of changes in angular motion at the adjacent segments to fusion at the last follow-up compared to the pre-operative motion, and the clinical results of treatment. The LSF group took 38 more minutes and lost 245 grams of more blood in averages to complete the additional surgical procedures compared with those in SF group. Several considerable post-operative complications were one deep infection in SF group and three metal failures of sacral fixation with subsequent two fusion failures in LSF group which were mostly concerned with the sacral fixations. The changes of angular motion at follow up compared to pre-operative motion in SF group were 1.5° gain in average (ranging 3° loss-6° gain) in L3-4 segment and 0.6° gain in average (ranging 5° loss-5° gain) in the L5-S1 segment. Those in L3-4 segment of LSF were 2.8° gain in average (ranging 2°-loss 9° gain). Therefore the higher stress and subsequent degeneration are more likely expected above the L4-S1 fusion rather than below the L4-5 fusion. The satisfactory clinical results were 89.7% in SF group and 87.9% in LSF group without significant difference between two groups. In conclusion there is no need to include the L5-S1 segment in the L4-5 fusion when the pathology is limited to L4-5 segment.
Follow-Up Studies ; Humans ; Pathology ; Retrospective Studies ; Spinal Fusion

PURPOSE: It has been a common medical practice to use prophylactic antibiotics to prevent recurrent urinary tract infections (UTI) in high risk situations such as urinary tract obstruction, vesicoureteral reflux, neurogenic bladder, or urinary stones. But sometimes, we meet difficult situation of breakthrough infections (BI) which might cause new or progressive renal scarring. The clinical characteristics of children contracting breakthrough UTI experienced in a single center were studied. METHODS: The study was done retrospectively through medical records of 150 pediatric patients who had been cared in pediatric and urologic clinics of Pusan National University Hospital from Jan. 2001 till June 2006 and had prophylactic antibiotics to prevent recurrent UTI. RESULTS: The starting age of prophylactic antibiotics of 150 patient was 1-76 months, and median age was 5 months. The BI developed 61 times in 43 patients (28.7%), 1.5 times per 100 patient-months. The BI occurred more frequently in patients with higher grade of VUR, and in the cases with abnormal DMSA scan. Co-trimoxazole was more effective than 2nd and 3rd generation cephalosporins to prevent UTI. The distribution of causative organisms was more diverse than usual UTI. The causative organisms were sensitive to the antibiotics used for prophylaxis in 29.5%, and resistant in 59.1%. After experience of BI, 40 percents of patients went to the surgical treatment including endoscopic injection of Deflux, 35% to new antibiotics for prophylaxis, 26% remain on the same antibiotics as the previous one. CONCLUSION: Based on our study results, preexisting renal scar might be one of the factors which should be considered in favor of early surgical interventions of VUR. Poor compliance and wrong selection of antibiotics such as cephalosporins are important underlying causes of breakthrough UTIs.
Anti-Bacterial Agents ; Cephalosporins ; Child ; Cicatrix ; Compliance ; Contracts ; Dextrans ; Humans ; Hyaluronic Acid ; Medical Records ; Retrospective Studies ; Succimer ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Bladder, Neurogenic ; Urinary Calculi ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Whether indwelling urethral catheter should be removed after urethroplasty or visual internal urethrotomy in patients with posterior urethral injured is still controversial. From May 1990 to February 1995, 28 patients with posterior urethral injury underwent retrograde pericatheter urethrography for the purpose of the evaluation of urethral continuity in the timing of the removal of indwelling urethral catheter. The indwelling catheter was removed in 24 patients whose urethra did not have any extravasation, and 4 patients had detectable extravasation. We conclude that retrograde pericatheter urethrogram is the most useful radiologically diagnostic method to evaluate in the timing of the removal of indwelling urethral catheter and to obtain the objective parameter of urethral patency in posterior urethral injured patients, postoperatively.
Catheters* ; Catheters, Indwelling ; Humans ; Urethra ; Urinary Catheters

Moyamoya disease is a cerebrovascular condition that results in the narrowing of the vessels of the circle of Willis and collateral vessel formation at the base of the brain. Although relationships between Graves' disease and cerebrovascular accidents in Moyamoya disease are obscure, the coexistence of the two diseases is noteworthy. Moyamoya disease has been rarely reported in adolescent patients with thyrotoxicosis. Recently, we encountered two adolescent Korean patients with Moyamoya disease associated with Graves' disease who presented with episodic right-sided hemiparesis and syncope. These two girls who had Graves' disease had no history of other diseases or head trauma. A thyroid function test revealed a euthyroid state and a high thyroid-stimulating hormone (TSH) receptor antibody titer at that time. The patients were diagnosed with Moyamoya disease based on brain magnetic resonance angiography and cerebral four-vessel angiography. The patients underwent cranial revascularization by encephalo-duroarterio-synangiosis as soon as a diagnosis was made, which resulted in successful symptom resolution. They fared well and had no additional neurological symptoms as of their last follow-up visits. Here, we report these two cases of confirmed Moyamoya disease complicated by Graves' disease with a review of the literature, and discuss the possible association between the two diseases. To our knowledge, this is the first report in South Korea on Moyamoya disease associated with Graves' disease in adolescents with a euthyroid.
Adolescent* ; Angiography ; Brain ; Circle of Willis ; Craniocerebral Trauma ; Diagnosis ; Female ; Follow-Up Studies ; Graves Disease* ; Humans ; Hyperthyroidism ; Korea ; Magnetic Resonance Angiography ; Moyamoya Disease* ; Paresis ; Stroke ; Syncope ; Thyroid Function Tests ; Thyrotoxicosis ; Thyrotropin

Stress urinary incontinence is mainly treated by major surgical procedures. Bolstering the urethra with injectable compound is an attractive, although not new, procedure for stress urinary incontinence. Recently it has been popularized to use the autologous fat for injection. A total of 6 women with stress urinary incontinence underwent periurethral injection of autologous fat. Patients' age ranged from 41 to 69 years( mean 55.8). The fat was harvested from the low abdominal wall by liposuction unit. Follow up was 2 to 10 months( mean 6.8). of the patients, 5(83%) are cured, 1 is improved significantly( from Grade III to I). We conclude that the periurethral autologous fat injection is a reliable, safe, low-cost, and high benefit procedure.
Abdominal Wall ; Female ; Follow-Up Studies ; Humans ; Lipectomy ; Urethra ; Urinary Incontinence*

PURPOSE: There has been several studies about pathological findings of the asymptomatic urinary abnormalities (AUA) in children. But most of them are based on collaboratively collected data. That kinds of studies might have some bias due to different criteria for renal biopsy. We analyzed histopathological findings of AUA patients experienced in a single hospital and analyzed the efficacy of renal biopsy according to the clinical findings. METHODS: We reviewed the pathological reports and clinical data of 171 patients with AUA who had renal biopsies for the last 20 years. Patient were divided into 3 groups based on the urinalysis: hematuria group, proteinuria group, combined hematuria and proteinuria group. To analyze the efficacy of renal biopsy, we defined "modifiable diseases" as those diseases of which early treatment can alter the prognosis, including IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulonephritis and focal segmental glomerulosclerosis. RESULTS: Male to female ratio was 2.2 to 1, and the highest incidence was in the age group of 6 to 10 years. IgA nephropathy (49%) was the most frequent pathological diagnosis. The incidence of "modifiable diseases" were higher in the group of combined proteinuria and hematuria, compared to isolated hematuria or proteinuria group. CONCLUSION: IgA nephropathy was most frequent pathological diagnostic entity in AUA. The efficacy of renal biopsy, which can be defined as the possibility of diagnosing "modifiable disease" by renal biopsy, is greater in the combined hematuria and proteinuria group than hematuria or proteinuria group.
Bias (Epidemiology) ; Biopsy ; Child ; Female ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Hematuria ; Humans ; Incidence ; Male ; Prognosis ; Proteinuria

Artifact corrections including normalization and attenuation correction were important for quantitative analysis in Nuclear Medicine Imaging. Normalization is the process of ensuring that all lines of response joining detectors in coincidence have the same effective sensitivity. Failure to account for variations in LOR sensitivity leads to bias and high-frequency artifacts in the reconstructed images. Attenuation correction is the process of the correction of attenuation phenomenon lies in the natural property that photons emitted by the radiopharmaceutical will interact with tissue and other materials as they pass through the body. In this paper, we will review the several approaches for normalization and attenuation correction strategies.
Artifacts ; Bias (Epidemiology) ; Enzyme Multiplied Immunoassay Technique ; Nuclear Medicine ; Photons