No abstract available.
Flail Chest*

BACKGROUND: Pertechnetate ( Tc) has been widely employed for thyroid imaging. While pertechnetate and radioiodide have usually similar results in identifying thyroid nodules, occasionally differences have been noted. We intended to observe that the thyroid nodules which appeared to be hot on pertechnetate and to compare them with the images by radioiodide. METHODS: 'I scan was performed to thirty-eight cases (mean age: 48.9 +/- 13.2) presenting as hot nodule on Tc scan. Thyroid function test and pathologic diagnosis were obtained in all patients. RESULTS: Of the 38 patients, 24 had euthyroidism, 13 had hyperthyroidism, and 1 had hypothyroidism. Thirty patients had adenomatous goiter, 4 papillary carcinoma, 3 Hashimotos thyroiditis, and 1 had HQrthle cell tumor. 28 of 38 patients showed similar images, but the remaining 10 patients(26.3%) revealed discordant images on Tc and 131I scan. Among the concordant cases, 23 had adenomatous goiter, 3 had papillary carcinoma, and 2 had Hashimotos thyroiditis. Among the discordant cases, 7 had adenomatous goiter, 1 had papillary carcinoma, 1 had Hashimotos thyroiditis, and 1 had HQrthle cell tumor. The incidence of malignancy was 10.7% of concordant cases, and 20% of discordant cases and was revealed statistically insignificant (p>0.05). CONCLUSION: We observed higher incidence of malignancy in patients presenting hot nodules on 99mTc scan than ever reported. Fine needle aspiration should be performed to all patients with hot nodules and the 'I scan would not be recommended for further diagnostic study.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Goiter ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Sodium Pertechnetate Tc 99m ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Nodule ; Thyroiditis

The origins of medullary carcinoma and papillary carcinoma of thyroid are embryologically different. We report a case of simultaneous occurrence of medullary carcinoma and papillary carcinoma of the thyroid in the same thyroid gland. In this case, the occurrence of the two tumors may be a coincidence, does not have embryological or genetical significance.
Carcinoma, Medullary ; Carcinoma, Papillary* ; Thyroid Gland*

There have been several reports of more than one type of porokeratosis occurring in the same family or the same individual. We hope to support the view of different phenotypic expressions of a common genetic aberration by describing an additional case of porokeratosis of Mibelli on the perianal area and DSAP on the face, forearms occurring in a 45-year-old man.
Actins* ; Forearm ; Hope ; Humans ; Middle Aged ; Porokeratosis*

BACKGROUND: Hypertension is one of the common diseases which family physicians encounter to manage. Various research proved that appropriate aerobic exercise had effect on lowering blood pressure efficiently. This study was to find out the status of exercise, the change of exercise according to time and its predicting factors in hypertensive patients. METHODS: A total of 193 of the followed-up hypertensive patients of family physicians in Seoul and kyoungkido from May 11, 2001 to June 10, 2001 were interviewed by doctor according to the previously designed structured questionnaire. RESULTS: Eighty two patients (42.57) were male and mean and was 57.4 +/- 9.9 fears. Using Kaplan-Meier's method, 8% of non-exercise group (N= 115) in diagnosing hypertension started exercise after 1 fear and 40%, after 5 years. Otherwise, 5% of exercise group(N=78) stopped exercise after 1 year and 30%, after 5 years. The characteristics of 5 exercise groups according to sex, age, level of education and adequacy of exercise showed significant difference. In average blood pressure, lately started group showed the lowest (137/84 mmHg) and non-exercise group, the highest (146/91 mmHg) In the degree of recommendation. sporadic group showed the highest and non-exercise group, the lowest which showed significant difference (p =0.0024) . CONCLUSION: I conclude that lately started group among non-exercise group and continuous exercise group were mainly affected by recommendation to exercise of physician. As well as exercise, other nonpharmacologic treatment should be promoted by physician as an important strategy for treatment of hypertension.
Blood Pressure ; Education ; Exercise ; Gyeonggi-do ; Humans ; Hypertension ; Male ; Physicians, Family* ; Seoul ; Surveys and Questionnaires

Ninety three patients, who sustained craniocerebral injuries were studied and followed up for detection of syndrome of inappropriate secretion of antidiuretic hormone from their admission to the time of their recovery. Their electrolytes in serum and urine, and fluid balance were examined at frequent intervals. Ten cases have manifested. "The Syndrome of the Inappropriate Secretion of Antidiuretic Hormone"(S.I.S.A.D.H.). 1. For the detection of the presence of S.I.S.A.D.H., body weight, fluid balance, central venous pressure, sodium, potassium, chloride, B.U.N. and creatinine content of the serum as well as sodium, potassium, chloride, B.U.N. and creatinine content of the serum as well as sodium, potassium, chloride and 17-ketesteroid content of 24 hours urine specimen had been measured every 2 or 3 days interval, from their admission. 2. To establish the diagnosis of S.I.S.A.D.H., the following conditions were observed. First, there was no evidence of dehydration, second, the level of the sodium content of the serum was decreased below 125mEq/L and third, the amount of urinary sodium was persistently increased. However the functions of the kidney and adrenal gland were normal. 3. In the cases of S.I.S.A.D.H. among Korean craniocerebral injuries, the amount of sodium excreted in the urine was above 110mEq/L. On the other hand, 27 Koreans without craniocerebral injury or pulmonary complication, who had hospital diet which contained about 15gms. of NaCl, the average value of sodium excreted in the urine was 95mEq/L although there had been great individual differences. 4. Out of 33 patients with brain contusion, 4 manifested S.I.S.A.D.H., 27 with epidural hematoma there were 4 cases, of 15 cases of subdural hematoma, there was one case and also one cases of S.I.S.A.D.H. was found among the 11 cases of compound comminuted depressed fracture of the skull. 5. Among the 93 cases of craniocerebral injuries, 10 of them which is equivalent to 10.8% developed S.I.S.A.D.H. In there cases, improvement of the syndrome was observed in a few days by limitation of daily in take to 600cc. The patient who has shown rather severe hyponatremia, the condition was improved by parenteral injection of 3% saline solution with fluid restriction. 6. Among the cases with S.I.S.A.D.H. it was discovered that 3 of them had infection or complications of the lung. 7. Clinical findings among these patients with S.I.S.A.D.H. were:Three cases had mental disturbance, two with anorexia, one had vomiting and one with convulsions. In all the cases consciousness and muscular activity were somewhat impaired. 8. Aside from the patients with craniocerebral injuries, S.I.S.A.D.H. was observed in one case of aneurysm of the anterior communicating artery.
Adrenal Glands ; Aneurysm ; Anorexia ; Arteries ; Body Weight ; Brain Injuries ; Central Venous Pressure ; Consciousness ; Craniocerebral Trauma ; Creatinine ; Dehydration ; Diagnosis ; Diet ; Electrolytes ; Hand ; Hematoma ; Hematoma, Subdural ; Humans ; Hyponatremia ; Individuality ; Kidney ; Lung ; Potassium ; Seizures ; Skull ; Sodium ; Sodium Chloride ; Vomiting ; Water-Electrolyte Balance

No abstract available.

No abstract available.
Fractures, Spontaneous* ; Prostheses and Implants*

MEN type 1 is characterized primarily by the presence of functioning and nonfunctioning tumors or hyperplasia of the pituitary gland, parathyroid glands, and pancreatic islet cells. Pancreatic islet tumors in MEN type 1 produce different kinds of hormone which were pancreatic polypeptide, gastrin, glucagon, insulin and so on. To date, ten cases had been reported in Korea. We report another case with MEN type 1 having prolatin-secreating pituitary adenoma, parathyroid hyperplasia and insulinoma. A 36-year-old woman was admitted because of long-standing amenorrhea and recently diagnosed osteoporosis. Otherwise, she had been in good health except experiencing one episode of loss of consciousness after skipped meal. The blood chemistries were normal except hypercalcemia and hypophosphatemia. Hormonal studies revealed elevated levels of intact PTH and prolactin and decreased value of estradiol with low LH and FSH. The neck CT revealed 1 cm-sized nodule at posterior portion of right thyroid gland and 99mTc-sestamibi sintigraphy showed a increased uptake in left lower and right lower parathyroid glands. The sella MRI showed 0.7 cm-sized enhanced lesion in the left pituitary gland. The ratio of immunoreactive insulin to glucose was elevated and 3-4 pancreatic masses of variable size were identified by endoscopic ultrasonography and angiography. Subtotal parathyroidectomy and pyrolus-preserving pancreaticoduodenectomy with spleen-preserving distal pancreatectomy was done. Postoperative she had been doing well with normocalcemia and normoglycemia. Transsphenoidal adenonectomy was done 5 months later. Histologic examination of removed tissues revealed a single insulinoma, prathyroid hyperplasia and prolactin-secreating pituitary adenoma.
Adult ; Amenorrhea* ; Angiography ; Endosonography ; Estradiol ; Female ; Gastrins ; Glucagon ; Glucose ; Humans ; Hypercalcemia ; Hyperplasia ; Hypophosphatemia ; Insulin ; Insulinoma ; Islets of Langerhans ; Korea ; Magnetic Resonance Imaging ; Male ; Meals ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Neck ; Osteoporosis* ; Pancreatectomy ; Pancreatic Polypeptide ; Pancreaticoduodenectomy ; Parathyroid Glands ; Parathyroidectomy ; Pituitary Gland ; Pituitary Neoplasms ; Prolactin ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Unconsciousness

PURPOSE: To determine whether dynamic or conventional MR imaging is most useful for the detection of pituitary microadenoma. MATERIALS AND METHODS: The study involved 20 patients (M:F=1:19, mean age=37 years) in whom a pituitary microadenoma had been identified. Routine unenhanced coronal T1-weighted MR imaging was followed by dynamic imaging (repetition time/echo time/excitation=200/10/1, 3-mm-thick sections, 256X128 or 256 ma-trix,14X14-cm field of view, scan time=30 or 60 seconds, spin-echo pulse sequence), and contrast-enhanced coronal T1-weighted imaging was then immediately performed. Temporal changes in signal intensity were quantified with manually placed ROIs (regions of interest, circular, 3 mm 2), and tissue contrast between the pituitary gland and microadenoma was calculated. Conspicuity of the tumor margin was graded by three radiologists working independently as either 4 (excellent clear margin), 3 (good clear margin), 2 (relatively clear mar-gin), or 1 (unclear margin). RESULTS: Average peak enhancement of the pituitary gland and microadenoma occurred at 58.5 and 91.5 seconds, respectively. Maximum enhancement of the pituitary gland occurred within 30 to 60 seconds of contrast infusion (signal intensity range: 426-442), but during dynamic MR imaging, the microadenoma showed rela-tively constant enhancement (signal intensity range: 230 -250). Maximal contrast between normal pituitary gland and the microadenoma was seen at 60 seconds or in the first three sequential images. Dynamic MR images were superior to conventional T1-weighted images, with or without contrast infusion, not only in terms of tissue contrast between the pituitary gland and the microadenoma (p=0.0048), but also as regards tumor margin conspicuity (p=0.0035). CONCLUSION: Dynamic MR imaging is a useful technique in the detection of pituitary microadenoma.
Humans ; Magnetic Resonance Imaging* ; Pituitary Gland