Granular cell tumor is not uncommon and is a well recognized entity which may arise at virtually any site of the body. However, occurrence in the thyroid is extremely rare and has not been described well. Only three cases could be found in the English literatures. We report a case of granular cell tumor of the thyroid in a 30 year-old woman. The tumor was illdefined, infiltrative and was composed of diffuse sheets of polygonal to fusiform cells with abundant eosinophilic granular cytoplasm. The tumor showed evidence of Schwann cell differentiation in immunohistochemical and ultrastructural examinations. Differentiation from more common thyroid tumors having oncocytic granular cytoplasm should be made by immunohistochemistry or electron microscopy.
Adult ; Cell Differentiation ; Cytoplasm ; Eosinophils ; Female ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Microscopy, Electron ; Thyroid Gland*

OBJECTIVES: This study examined the use of health impact assessment (HIA) as a tool for intersectoral collaboration using the case of an HIA project conducted in Gwang Myeong City, Korea. METHODS: A typical procedure for rapid HIA was used. In the screening step, the Aegi-Neung Waterside Park Plan was chosen as the target of the HIA. In the scoping step, the specific methods and tools to assess potential health impacts were chosen. A participatory workshop was held in the assessment step. Various interest groups, including the Department of Parks and Greenspace, the Department of Culture and Sports, the Department of Environment and Cleansing, civil societies, and residents, discussed previously reviewed literature on the potential health impacts of the Aegi-Neung Waterside Park Plan. RESULTS: Potential health impacts and inequality issues were elicited from the workshop, and measures to maximize positive health impacts and minimize negative health impacts were recommended. The priorities among the recommendations were decided by voting. A report on the HIA was submitted to the Department of Parks and Greenspace for their consideration. CONCLUSIONS: Although this study examined only one case, it shows the potential usefulness of HIA as a tool for enhancing intersectoral collaboration. Some strategies to formally implement HIA are discussed.
*Health Policy ; Humans ; Organizational Case Studies ; Politics ; *Public Health ; Public Policy ; Urban Health

To evaluate the effect of Morphine during spinal anesthesia with alpha-adrenergic agonist, we used 0.18 mg of epinephrine, 90 ug of clonidine and 0.3 mg of morphine with 12 mg of T-cain respectively and compared hemodynamic and analgesic effects of each drug. Eighty patients were divided into four groups as follows; Group I (n=20); T-cain with clonidine, Group II (n=20); T-cain with epinephrine, Group III (n=20); T-cain with clonidine and morphine, and Group IV (n=20); T-cain with epinephrine and morphine. The results were as follows; 1) The onset time of analgesia and the time reached to the highest level of sensory loss were most rapid in the epinephrine and morphine group. 2) The duration of analgesia was significantly prolonged in the group of epinephrine and morphine than the group of epinephrine and clonidine. 3) It was more likely complicated in the morphine groups than others but there was no significance. 4) Although the heart rate was gradually decreased over 60 min. after anesthesia, there was no significance between the groups. 5) Systolic and diastolic blood pressure were decreased mainly over 30~45 min. after anesthesia, but there was no significance. In conclusion, epinephrine can be sustituted for clonidine because analgesic duration was not significantly changed, and the duration of analgesia was prolonged by morphine.
Adrenergic alpha-Agonists ; Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Clonidine* ; Epinephrine* ; Heart Rate ; Hemodynamics ; Humans ; Morphine*

PURPOSE: The Purposes of this study are to identify the circulating etiologic viruses of acute lower respiratory tract infection in children and to understand the relation with clinical diagnosis. METHODS: We obtained a total of 418 nasopharyngeal aspirates from children admitted for their acute lower respiratory tract infections at three tertiary hospitals in Seoul from September 2008 to March 2009. We performed multiplex RT-PCR to identify 14 etiologic viruses and analyzed their emerging patterns and clinical features. RESULTS: Average age of patients was 16.4 months old and the ratio of male to female was 1.36. Viruses were detected in 56.2% of a total of 418 samples. Respiratory syncytial virus (35%) was the most frequently detected and followed by human rhinovirus (22%), human bocavirus, adenovirus, human metapneumovirus, parainfluenza virus, influenza virus and human coronavirus. Co-infection reached 21.9% of positive patients. CONCLUSION: When we manage the patients with acute lower respiratory infectious diseases, we should remind the role of various viral pathogens, which might be circulating by seasons and by local areas.
Adenoviruses, Human ; Child ; Coinfection ; Communicable Diseases ; Coronavirus ; Female ; Human bocavirus ; Humans ; Male ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Respiratory Syncytial Viruses ; Respiratory System ; Respiratory Tract Infections ; Rhinovirus ; Seasons ; Tertiary Care Centers ; Viruses

The fallowing study was performed in 100 patients undergoing gynecologic lower abdominal surgery. Analgesic efficacy, changes in arterial blood pressure and heart rate, and incidence of side effect were observed after epidural injection of the drugs. The patients were devided into two groups (N=50). Group I was given a bolus dose of 1 mg morphine in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of morphine 0.05 mg/ml in 0.15% bupivacaine at 2 ml/hr. Group II was given a bolus dose of 100 ug fentanyl in 10 ml of 0.25% bupivacaine followed by continuous epidural infusion of fentanyl 5 ug/ml in 0.15% bupivacaine at 2 ml/hr. The results were as follows. 1) The pain score (visual analogue pain scale) measured at postoperation 1 hr was significantly decreased in Group II (1.51+/-1.0) compared to group I (2.20+/-1.1). Percentage of patients needed supplemental analgesics within postoperation 20 min was significantly lower in Group II (4%) than Group I (16%). 2) The cardiovascular changes for 2 hrs after epidutal injection were not occurred significant in both groups. 3) The incidence of nausea or vomiting was significantly lower in Group II (8%) than Group I (28%). Pruritus occurred also significantly less often in Group lI (6%) than group I (30%). Urinary retention and respiratory depression were not observed.
Analgesia, Epidural ; Analgesics ; Arterial Pressure ; Bupivacaine ; Fentanyl ; Heart Rate ; Humans ; Incidence ; Injections, Epidural ; Morphine ; Nausea ; Pain, Postoperative* ; Pruritus ; Respiratory Insufficiency ; Urinary Retention ; Vomiting

Purpose: To compare the visual outcomes and corneal aberrations between wavefront-optimized (WFO) and corneal wavefront-guided (WFG) photorefractive keratectomy (PRK) in low to moderate myopia. Methods: Twenty-seven eyes treated with WFO and 29 eyes treated with WFG PRK using a Schwind Amaris 750S Excimer laser were included after 6 months of postoperative follow-up. Uncorrected distance visual acuity, corrected distance visual acuity, refractive errors, corneal higher-order aberrations (HOA) and corneal thickness obtained using a Scheimpflug system, and central ablation depth and volume were evaluated during the preoperative period and again at the postoperative 6-month visits. Results: Postoperatively, uncorrected distance visual acuity, corrected distance visual acuity, manifest spherical equivalent, and refractive astigmatism were improved in both groups, and there was no statistically significant difference between the two groups. There was no significant difference in safety, efficacy, or predictability of the refractive outcome. Postoperative total corneal HOA root mean square (RMS), coma RMS, and spherical aberration were significantly increased in both groups. Among these, only spherical aberration showed a significant difference between the two groups, with greater increase in the WFO group at 6 months postoperatively. The changes in corneal HOA RMS and spherical aberration were smaller in the WFG group, and this benefit was marked in eyes with high HOA RMS (≥0.4 μm) and spherical aberration (≥0.2 μm). Even though ablation volume in the WFG group was much larger than that of the WFO group, there was no significant difference in postoperative central and peripheral corneal thickness between the two groups. Conclusions Both WFO and WFG PRK using a Schwind Amaris 750S laser for low to moderate myopia were safe and effective at improving visual and refractive outcomes. However, WFG PRK induced fewer spherical aberrations than WFO PRK and may be more advantageous for eyes with high HOA root mean square or spherical aberration.

Angioleiomyoma is a benign mesenchymal neoplasm composed of smooth muscle cells and thick-walled vessels. It usually originates in the extremities or the head. Thus angioleiomyoma of the uterus is a very rare so that there were only 10 cases in the available English literature. Angioleiomyoma cause no serious problems with regard to diagnosis and are simply recognized as benign leiomyomas. These tumors happen to be found only after the surgery through histologic findings. It is therefore extremely difficult to diagnose angioleiomyoma by its shape through preoperative sonography test. We experienced a case of angioleiomyoma with massive vaginal bleeding causing severe anemia which seemed as a benign leiomyoma before the surgery. Hence, we report this case with a brief review of literature.
Anemia ; Angiomyoma ; Extremities ; Head ; Leiomyoma ; Myocytes, Smooth Muscle ; Uterine Hemorrhage ; Uterus

Laryngeal dysfunction, previously referred to as vocal cord dysfunction or paradoxical vocal cord movement, is characterized by inappropriate, transient, and reversible narrowing of the larynx in response to external triggers, without any structural or neurological defects. This condition can manifest in various clinical ways and can be mistaken for other respiratory diseases, such as asthma. It is crucial to accurately recognize and diagnose laryngeal dysfunction to ensure the provision of appropriate treatment. Laryngoscopy with provocation, which is a standard tool for the diagnosis of laryngeal dysfunction, has been designated as a new medical technology in Korea in July 2022. In this review, we discuss the concept, epidemiology, diagnosis, and treatment of laryngeal dysfunction as well as introduce the diagnostic procedure using laryngoscopy with provocation.

BACKGROUND: There are evidences that uPA and its inhibitor play a key role in tumor spread. We studied whether uPA and PAI-1 expressions could serve as prognostic parameters along with clinical, gross and microscopic findings in gallbladder carcinomas. METHODS: We analyzed 42 cases of gallbladder carcinomas by immunohistochemical staining and clinicopathologic parameters. RESULTS: uPA and PAI-1 were more frequently expressed in the adenocarcinoma than in the normal or benign gallbladder tissue. The uPA expression in the glands of low grade adenocarcinoma was significantly correlated with both distant and lymph node metastases. The uPA expression in the stroma around the low grade adenocarcinoma was significantly correlated with either distant or lymph node metastasis. The PAI-1 expression was significantly correlated with lymph node metastasis only for both distant and lymph node metastases. In multivariate analysis, the lymphatic invasion was significantly related to poor survival (p= 0.0115). In univariate analysis, the cases without lymphatic invasion had prolonged survival. Positive expression of uPA in the glands of low-grade adenocarcinoma was significantly correlated with poor survival (p=0.0391). CONCLUSION: In conjunction with clinicopathologic findings, expressions of uPA and PAI-1 may be useful prognostic markers in gallbladder carcinomas.
Adenocarcinoma ; Gallbladder* ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators* ; Plasminogen* ; Prognosis ; Urokinase-Type Plasminogen Activator*

BACKGROUND: In many cases, spinal anesthesia is performed in cesarean section. Many women want postoperative pain control. The purpose of this study was to compare the effects of intravenous patient-controlled analgesia (IV-PCA) and epidural patient-controlled analgesia (Epi-PCA) in patients undergoing cesarean section with spinal anesthesia. METHODS: Forty healthy women were randomly assigned to receive IV-PCA or Epi-PCA after cesarean section with spinal anesthesia. The IV-PCA group received ketorolac 30 mg and butorphanol 0.5 mg intravenously when the peritoneum was sutured, followed by IV-PCA with 0.15% ketorolac and 0.005% butorphanol 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The Epi-PCA group received 0.01% morphine 10 ml via an epidural catheter when the peritoneum was sutured, followed by Epi-PCA with 0.004% morphine and 0.1% bupivacaine 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The degree of pain was subjectively evaluated using a visual analogue scale (VAS). Patients were evaluated at 2, 6, 12, 24 and 48 hours after operation. Statistical analyses were performed using T-test, Mann White U test and the Chi-square test. RESULTS: VAS was not significantly different at any time, and the incidences of pruritus and sensory and motor changes of the lower extremities were significantly higher in Epi-PCA than IV-PCA. CONCLUSIONS: Although VAS in the two groups was not significantly different, we conclude that IV-PCA is more beneficial than Epi-PCA in patients undergoing cesarean section with spinal anesthesia, because of the side effects of Epi-PCA.
Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Bupivacaine ; Butorphanol ; Catheters ; Cesarean Section* ; Female ; Humans ; Incidence ; Ketorolac ; Lower Extremity ; Morphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Pruritus