We report a case of metastatic renal cell carcinoma to thyroid. A 56-year-old woman was presented with multiple nodules in the thyroid with the history of left radical nephrectomy 4 years ago due to renal cell carcinoma(stage I). During postnephreectomy follow-up period, no recurrence nor metastasis to other organs were noted. She had euthyroid function and multiple cold nodules in bilateral lobes on thyroid scan. Total thyroidectomy was done, and multiple nodules in the thyroid were bilaterally. The pathology reports showed the findings of metastatic renal cell carcinoma to the thyroid. The postoperative course was uneventual.
Carcinoma, Renal Cell* ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy ; Pathology ; Recurrence ; Thyroid Gland* ; Thyroidectomy

OBJECTIVE: This study had three objectives: 1) to investigate the rehabilitation professionals' way of thinking on physical, psychological and social characteristics of older patients: 2) to assess their actual knowledge level about aging; and, 3) to deduce and analyze the influences that cause these different kinds of perceptions and attitudes. METHOD: Total 239 rehabilitation professionals (including rehabilitation doctors, nurses, physical therapists, occupational therapists, speech therapists, social workers, psychologists, prosthetists & orthotists) responded to our questionnaire were included in this study. Self-addressed questionnaires were composed of two categories: 1) the perception of older patients compared with younger patients: and 2) the actual knowledge level about aging. RESULTS: 1) There were significant (p<0.05) differences by job classification on a speculative disposition with the physical characteristics, motive of treatment, emotional characteristics, and discharge problem of older patients. 2) There were also significant (p<0.05) differences by job classification in the actual knowledge level about aging by job classification. A higher score on the questionnaire correlated with a more optimistic view of the motive of treatment, emotional characteristic and discharge problem. CONCLUSION: Many rehabilitation professionals have a misconceptions about older patients due to insufficient knowledge on aging. Therefore we propose an objective understanding of older patients along with proper education on aging to provide an effective rehabilitation treatment.
Aging* ; Classification ; Education ; Humans ; Physical Therapists ; Psychology ; Surveys and Questionnaires ; Rehabilitation* ; Social Workers ; Sociology ; Thinking

Intimal hyperplasia is considered to be a most frequent cause attributing to occlusion of a blood flow after vascular surgeries such as endarterectomy, bypass surgery and angioplasty. Clearly this response is a significant cause of morbidity in patients undergoing vascular procedures and studies to find out the strategy for avoid intimal hyperplasia are of great importance. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been yet clear. The initial event is thought to be damage to the vascular intimal endothelium. Intimal hyperplasia is the characteristic fibromuscular cellular response on intimal injury and some author advocated the "response-to-injury" hypothesis of atherogenesis to be inducing factors of intimal hyperplasia. Endothelial cells release a number of vasoactive substances such as relaxing factor, including nitric oxide(NO). The NO has not only relaxing effect to the smooth muscle cells, but also inhibitory effect to intimal hyperplasia. In this study, we investigated on rat inhibitory effect of NO donor(SNAP, SNP) to intimal hyperplasia on endothelial denudation and reversed by coadministration of the NO synthase inhibitor, L-NAME. Balloon catheter denudation of common carotid artery was performed in 35 rats pharmacologically treated from 3 days before to 14 days after surgery(5 mg/kg/day, intraperitoneally) and divided into 5 groups: control group, without any medical treatment; SNAP group, S-Nitroso-N- acetylpenicillamine; SNP group, sodium nitroprusside; SNAP+L group, both SNAP and N(G)-Nitro-L-arginine methylester; SNP+L group, both sodium nitroprusside and N(G)-Nitro-L-arginine methylester. Animals were killed and left common carotid arteries were perfused and fixed with 10% formalin solution at 14 days after endothelial denudation. Cross sectional intima-to-media area ratios(I-M ratio, intimal area/[intimal area medial area]x100) were calculated by an image analyzer system and serum level of NO was measured directly by electrochemical methods. The results of the this experimental study were as follows: 1) Morphometric analysis of cross sections showed marked intimal thickening in the control group with an mean I-M ratio of 64.71+/-4.96%. In contrast, the I-M ratios in the SNAP group were significantly reduced by 53.14+/-7.86%(P<0.05) and in the SNP group by 43.43+/- 9.32%(P<0.05). The IM ratios of animals treated with L-NAME in group SNAP-L and group SNP-L were 68.43+/-3.91% and 67.71+/-5.50% respectively(P=NS). No significant change was noted when L-NAME was coadministered with SNAP and SNP compared to control group. 2) The serum level of NO in SNAP group(2509.7+/-354.95 nM) and SNP group(3430.4+/-236.70 nM) were significantly increased compare to control group(1339.2+/-101.04 nM)(P<0.05). Coadministration of L-NAME in group SNAP-L(1719.8+/-483.65 nM) and group SNP-L(1415.7+/-219.04 nM)were no significant changed compare to control group(1339.2+/-101.04 nM). These experiments suggest that SNAP and SNP reduced intimal hyperplasia and increased serum level of NO, reversed by coadministration of L-NAME. The relation between the intimal hyperplasia suppression and NO increase should be speculated.
Angioplasty ; Animals ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Endarterectomy ; Endothelial Cells ; Endothelium ; Formaldehyde ; Humans ; Hyperplasia ; Microelectrodes ; Myocytes, Smooth Muscle ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide ; Nitroprusside ; Rats

No abstract available.
Joints*

OBJECTIVES: It is well known that many chronic alcoholics manifest diastolic dysfunction of left ven tricle in its early stage. But the effects of chronic alcohol drinking on right ventricular function are not well understood. Thus left ventricular filling impair ment and its effects to right ventricular diastolic function were evaluated in young chronic alcoholics. METHODS: For the evaluation of left and right ventricular diastolic function in chronic alcoholics, 30 young chronic alcoholics and 28 control subjects were studied by pulsed Doppler echocardiography at the left and right ventricular inflow. Peak E velocity, peak A velocity, E/A velocity ratio, acceleration time and deceleration time were measured as diastolic filling parameters. RESULTS: 1) In the chronic alcoholics, the interventricular septum and posterior wall were thicker and left ventricular muscle mass was significantly increased than that in controls. 2) Among 30 cases of chronic alcoholics, 8 cases(26.7%) showed that the E/A ratio of the left ventricle was less than 1.0 and the deceleration time of the left ventricle was more than 240msec, where as 12 cases(40.0%) showed that the E/A ratio of the left ventricle was less than 1.0. 3) Among 30 cases of chronic alcoholics, 8 cases (26.7%) showed that the E/A ratio of the right ventri cle was less than 1.0 and the deceleration time of the right ventricle was more than 232msec, whereas 14 cases(46.7%) showed that the E/A ratio of the right ventricle was less than 1.0. 4) The RV E/A ratio was significantly correlated with the LV E/A ratio(r=0.697, p<0.001). 5) Blood pressure, ejection fraction, left ventricular mass, E/A ratio and deceleration time of both ventricles were not significantly different in comparison with the daily average amount, duration of ingestion, and total lifetime dose of alcohol. CONCLUSION: In all chronic alcoholics less than 50 years of age, the left ventricular systolic function was normal. But Doppler echocardiography showed that diastolic dysfunction of the left and right ventricles was present in 8 cases of 30 chronic alcoholics. Right ventricular diastolic dysfunction was closely related with left ventricular diastolic dysfunction. In conclu sion, diastolic dysfunction of both ventricle in chronic alcoholics may be the earliest functional sign of preclinical alcoholic cardiomyopathy.
Acceleration ; Alcohol Drinking ; Alcoholics* ; Blood Pressure ; Cardiomyopathy, Alcoholic ; Deceleration ; Eating ; Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed ; Heart Ventricles ; Humans ; Ventricular Function, Right

Colorectal varix (CRV) is a rare cause of lower gastrointestinal bleeding and usually associated with portal hypertension from liver cirrhosis or portal venous obstruction. Idiopathic CRV have no identifiable underlying cause and can only be diagnosed after the cause of portal or mesenteric vein circulation have been excluded. We report a case of idioipathic CRV presented with rectal bleeding for a week. Colonoscopy revealed markedly dilatated tortuous, and bluish veins in the rectum as well as coexistent adenomatous polyp and internal hemorrhoid. Despite extensive investigation, there was no evidence of portal hypertension or any other cause. Family history was also negative. Although blood transfusions were required, the patient remained asymptomatic without further rectal bleeding.
Adenomatous Polyps ; Blood Transfusion ; Colonoscopy ; Hemorrhage ; Hemorrhoids ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Mesenteric Veins ; Rectum ; Varicose Veins* ; Veins