We report here on a rare case of concurrent papillary thyroid carcinoma and medullary thyroid carcinoma on each of the lobes of the thyroid gland. A 43-year-old female presented with a one-week history of throat discomfort. A neck ultrasonogram (US) was done, along with fine needle aspiration biopsy (FNAB) of the left thyroid nodule, and the results showed papillary cancer. This patient underwent total thyroidectomy and central compartment neck dissection. The pathologic diagnosis of the nodule at the left lobe of the thyroid was papillary thyroid carcinoma (PTC) and the right thyroid nodule was medullary thyroid carcinoma (MTC).
Adult ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Medullary* ; Diagnosis ; Female ; Humans ; Neck ; Neck Dissection ; Pharynx ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Ultrasonography

Implant assisted removable partial denture (IARPD) has been practiced in various forms for a long time, and among them, implant surveyed crown RPD is gaining predictability as well as being considered as a treatment option for patients with anatomical and financial disadvantages. The position of implant could be divided as posterior placement or anterior placement according to the purpose of the treatment and should be planned in consider to the alveolar ridge of patient, anticipated prognosis of remaining teeth, and opposing dentition. This case report describes a treatment for mandibular Kennedy class I partial edentulous patient with two implant-supported surveyed crown and implant assisted removable partial denture. Given the difficulty of posterior placement in this patient and the prognosis of the residual teeth, the plan was to place two implants in close proximity to the residual teeth, which were placed in the planned position, angle, and depth using guided surgery. The process of fabricating the fixed prosthesis was carried out in parallel with the maxillary edentulous tooth arrangement process to increase predictability, and when fabricating the localized tooth, the implant was designed in a form that allows the patient to perform functional movements by preventing excessive loading as the last supporting tooth, and was fabricated through a secondary impression process. Each treatment procedure was proceeded as planned, with aesthetically and functionally satisfactory results for both patient and operator.

PURPOSE: Recently, laparoscopic appendectomy (LA) has been widely performed in developed countries. In addition, minimally invasive surgery such as LA is a challenge to surgical residents. The aim of this study is to evaluate learning curve of residents in comparison to that of experienced surgeons. METHODS: Fifty cases of LA that were performed by experienced surgeons (group A) and forty-seven cases of LA that were performed by 8 residents (group B) were reviewed retrospectively. RESULTS: Operative time was longer in group B (50.8+/-12 vs. 82.8+/-40 min. P<0.001). Hospital days of group B was shorter (4.8+/-2.4 vs. 3.7+/-2.1 days P=0.021). No other parameters were statistically significant. In group A, wound infection developed in 1 case. In group B, wound infection developed in 4 cases, intraabdominal abscess in 1, subcutaneous emphysema in 1. CONCLUSION: Inexperienced surgeons can perform laparoscopic appendectomy easily in the early days of individual laparoscopic training course.
Abscess ; Appendectomy ; Developed Countries ; Learning Curve ; Operative Time ; Retrospective Studies ; Subcutaneous Emphysema ; Wound Infection

PURPOSE: Most cases of papillary microcarcinomas of the thyroid (PMC) are not palpable and are clinically asymptomatic. The natural history of the microcarcinoma is unclear and remains debatable. There is continued discussion of whether thyroid microcarcinomas should be treated surgically and to what extent surgical removal should be extended. The main goal of this study was to analyze the clinical features and to determine the appropriate surgical treatment for well differentiated PMC in one lobe of the thyroid with favorable features in regard to consideration of radical surgery. METHODS: We studied 134 patients with the histological diagnosis of PMC from March 2003 to January 2006. The tumor was defined as 10 mm or less in the greatest diameter according to the World Health Organization guidelines. For all patients we confirmed the diagnosis by ultrasoundguided fine-needle aspiration biopsy (US-FNAB) preoperatively. There were 11 men and 123 women. The age at initial treatment ranged from 22 to 74 years (mean 46). Thyroid resection was lobectomy in 31 (23.1%) and total thyroidectomy (TT) in 103 (76.9%). CCND was performed routinely at the time of thyroidectomy. Lateral neck dissection was carried out in eight patients (5.9%) who had biopsy-proven metastatic cervical lymphadenopathy demonstrated clinically or by imaging. Patient records were reviewed retrospectively. Categorical variables were analyzed using the chi-square test or Fisher's exact test. Two-sided Student's t-test was used to compare paired data. RESULTS: The mean tumor size was 6.77 mm. PMC was associated in 36.6% (49/134) with lymph node metastasis, in 20.1% (27/134) with multifocality and in 26.9% (36/134) with capsular invasion. The mean tumor size differences influenced lymph node metastasis (LNM) (P<0.05). Capsular invasion (38.8%, 19/49) and multifocality (30.6%, 15/49) were associated with LNM (P=0.018, 0.022 respectively). The subdivision of primary tumors according to size (5 mm) influenced multifocality (P=0.031). The frequency of LNM, in the contralateral central compartment of patients with lesions in one lobe of thyroid, without capsular invasion, underwent TT with CCND in 1.7% (1/59). CONCLUSION: Currently, thyroidectomy with lymph node dissection has been the recommended first line treatment for microcarcinoma of the thyroid because of the high incidence of multifocality and lymph node metastasis. However, when we excluded patients with aggressive prognostic features we could successfully perform lobectomy and isthmusectomy with ipsilateral CCND based on considerations of radical surgery (98.3%, 58/59). However, subsequent surgery for contralateral nodes or lobe metastasis would not be easy and a longer follow-up period would be required to confirm our hypothesis with regard to the long term recurrence and mortality.
Biopsy, Fine-Needle ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Male ; Mortality ; Natural History ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroidectomy ; World Health Organization

PURPOSE: The main purpose of this study was to achieve a broad perspective of the clinical problem with regard to its overall presentation and relation to anticoagulant and antiplatelet therapy, and to describe common management strategies and clinical outcomes. METHODS: We initially screened 262 patients who were admitted from the Emergency Department between June, 1996 and June, 2013, with International Classification of Diseases code of K66.1 (hemoperitoneum), R58 (retroperitoneal hemorrhage) and D68.3 (hemorrhagic disorder due to anticoagulants). We excluded patients with retroperitoneal hemorrhage (RH) associated with trauma, vascular lesions, tumors, liver cirrhosis, renal failure, and surgical complications. A total of 24 adult patients were found to have retroperitoneal hematoma due to spontaneous lumbar artery rupture and were included in the study for further analysis. RESULTS: Male to female ratio was 14:10 and the mean age was 75.3+/-10.4 years old. Overall, 19 patients (79.1%) were taking warfarin, 20 patients (83.3%) were taking aspirin and/or clopidogrel, and 15 patients (62.5%) were taking both anticoagulant and antiplatelet medications. The most common presenting symptom was acute back pain. CT scan showed extravasation of contrast in 20 patients. The mean hematoma size was 12.5+/-6.4 cm. Eleven patients (55%) underwent arterial embolization and 22 patients (91.6%) received blood transfusion. No surgical intervention was performed. CONCLUSION: Retroperitoneal hematomas caused by spontaneous rupture of the lumbar artery showed a strong association with use of anticoagulant and/or antiplatelet therapy. For patients, particularly elderly patients, who present with acute back pain or hemodynamic instability and who are on anticoagulant and/or antiplatelet therapy, ER physicians should consider retroperitoneal hematoma as a differential diagnosis and to rule it out vigilantly.
Adult ; Aged ; Anticoagulants ; Arteries* ; Aspirin ; Back Pain ; Blood Transfusion ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Hematoma* ; Hemodynamics ; Hemorrhage ; Humans ; International Classification of Diseases ; Liver Cirrhosis ; Male ; Platelet Aggregation Inhibitors ; Renal Insufficiency ; Retroperitoneal Space ; Retrospective Studies* ; Rupture ; Rupture, Spontaneous* ; Tomography, X-Ray Computed ; Warfarin

Laccases (EC 1.10.3.2), a group of multi-copper oxidases (MCOs), play multiple biological functions and widely exist in many species. Fungal laccases have been extensively studied for their industrial applications, however, there was no database specially focused on fungal laccases. To provide a comparative genomics platform for fungal laccases, we have developed a comparative genomics platform for laccases and MCOs (http://laccase.riceblast.snu.ac.kr/). Based on protein domain profiles of characterized sequences, 3,571 laccases were predicted from 690 genomes including 253 fungi. The number of putative laccases and their properties exhibited dynamic distribution across the taxonomy. A total of 505 laccases from 68 genomes were selected and subjected to phylogenetic analysis. As a result, four clades comprised of nine subclades were phylogenetically grouped by their putative functions and analyzed at the sequence level. Our work would provide a workbench for putative laccases mainly focused on the fungal kingdom as well as a new perspective in the identification and classification of putative laccases and MCOs.

The rice blast fungus, Magnaporthe oryzae, is an important pathogen of rice plants. It is well known that genes encoded in the genome have different evolutionary histories that are related to their functions. Phylostratigraphy is a method that correlates the evolutionary origin of genes with evolutionary transitions. Here we applied phylostratigraphy to partition total gene content of M. oryzae into distinct classes (phylostrata), which we designated PS1 to PS7, based on estimation of their emergence time. Genes in individual phylostrata did not show significant biases in their global distribution among seven chromosomes, but at the local level, clustering of genes belonging to the same phylostratum was observed. Our phylostrata-wide analysis of genes revealed that genes in the same phylostratum tend to be similar in many physical and functional characteristics such as gene length and structure, GC contents, codon adaptation index, and level of transcription, which correlates with biological functions in evolutionary context. We also found that a significant proportion of genes in the genome are orphans, for which no orthologs can be detected in the database. Among them, we narrowed down to seven orphan genes having transcriptional and translational evidences, and showed that one of them is implicated in asexual reproduction and virulence, suggesting ongoing evolution in this fungus through lineage-specific genes. Our results provide genomic basis for linking functions of pathogenicity factors and gene emergence time.
Base Composition ; Bias (Epidemiology) ; Child ; Child, Orphaned ; Codon ; Fungi* ; Genome ; Humans ; Magnaporthe ; Methods ; Oryza ; Reproduction, Asexual ; Virulence ; Virulence Factors

Proteins in DNAJ/K families are ubiquitous, from prokaryotes to eukaryotes, and function as molecular chaperones. For systematic phylogenomics of the DNAJ/K families, we developed the Eukaryotic DNAJ/K Database (EDD). A total of 12,908 DNAJs and 4,886 DNAKs were identified from 339 eukaryotic genomes in the EDD. Kingdom-wide comparison of DNAJ/K families provides new insights on the evolutionary relationship within these families. Empowered by 'class', 'cluster', and 'taxonomy' browsers and the 'favorite' function, the EDD provides a versatile platform for comparative genomic analyses of DNAJ/K families.
Eukaryota ; Genome ; HSP40 Heat-Shock Proteins ; HSP70 Heat-Shock Proteins ; Humans ; Molecular Chaperones ; Proteins

OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH. METHODS: We divided 177 patients, presenting with ASDH (managed conservatively initially) between January 2008 to December 2013, into two groups; 'CSDH progression group' (n=16) and 'non-CSDH progression group' (n=161). Patient's data including age, sex, past medical history, medication were collected and brain computed tomography was used for radiologic analysis. RESULTS: Our data demonstrated that no significant intergroup difference with respect to age, sex ratio, co-morbid conditions, medication history, ischemic heart disease, liver disease and end-stage renal disease was found. However, Hounsfield unit (hematoma density) and mixed density was higher in the 'ASDH progression group' (67.50+/-7.63) than in the 'non-CSDH progression group' (61.53+/-10.69) (p=0.031). Midline shifting and hematoma depth in the 'CSDH progression group' were significantly greater than the 'non-CSDH progression group' (p=0.067, p=0.005). CONCLUSION: Based on the results of this study, the risk factors that are related to progression of initially non-operated ASDH to CSDH are higher Hounsfield unit and hematoma depth. Therefore, we suggest that ASDH patients, who have bigger hematoma depth and higher Hounsfield unit, should be monitored and managed carefully during the follow-up period.
Brain ; Follow-Up Studies ; Hematoma ; Hematoma, Subdural, Acute* ; Hematoma, Subdural, Chronic* ; Humans ; Kidney Failure, Chronic ; Liver Diseases ; Myocardial Ischemia ; Neurologic Manifestations ; Risk Factors* ; Sex Ratio