Background: Fine needle aspiration and biopsy(FNAB) has known the most accurate test(about 90%) in the preoperative evaluation of patients with a thyroid nodule. The false negative findings of thyroid cancer by FNAB are mainly due to the aspiration of cystic fluid in cystic degeneration of thyroid cancer and the ipossibility of differentiation between follicular adenoma and carcinoma by aspiration or FNAB because of the failure to evaluate the capsule invasion or angioinvasion of the tumor. Actually more than 80% of the nodules are found as benign nodules in aspiration or FNAB and the findings of follieular lesions are found about half of the samples tested, so limiting the cancer incidence in surgically resected samples up to 50% of the surgical resection. Sa reasonable guidelines to manage the benign nodules on aspiration or FNAB are needed which can select the maligna~nt nodules with false negative findings on aspiration or FNAB. We tried to evaluate whether the thyroxine suppression therapy can increase the malignancy rates on thyroidectomy, Methods: We treated the benign thyroid nodules in FNAB with thyroxine for 1 year and cornpared the nodule volume change before and after treatment (every 6 month) with ultrasonogram. We performed thyroidectomy on 1~7 thyroid nodules wbich showed less than 50% decrease of nodule volume after 1 year of thyroxine suppression therapy. Results: The results were as follows. 1) Of all 17 patients, surgical resection revealed malignant thyroid nodule(Group I) in 10 cases (58.82%, papillary cancer. 6 cases, follicular cancer: 4 cases) and benign thyroid nodule(Group II) in 7 cases(41.18%, follicular adenoma: 4 cases, adenomatous goiter: 3 cases). 2) Between group I and II, there was no significant differences in serum T, T and TSH levels before and after thyroxine suppression therapy. Also, there were no significant difference in TSH suppression % between group I and group II(5.60+5.39%, 14.64+11.48%, respectively). 3) Thyroid nodule volume decrease percent before and after thyroxi~ne therapy showed no significant difference between group I and group II (124.80+54.18% vs 159.42+79.82%, p>0.05). Conclusion: Our data suggested that the benign thyroid nodules on aspiration or FNAB which were not suppressed in volume after thyroixine therapy revealed more than 50% incidence of malignancy on surgical resection, so these nodules were highly reeommended to surgical exploration.
Adenoma ; Biopsy, Fine-Needle ; Goiter ; Humans ; Incidence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy ; Thyroxine ; Ultrasonography

Hemolysis is one of the side effects of cyclosporine(CsA). Some experimental and clinical data have strongly suggested that CsA-induced hemolysis is resulted from the increased production of free radical species by CsA. Melatonin, a pineal secretory product, acts as a highly efficient free radical scavenger. Thus, melatonin may have a protective effect on the CsA-induced hemolysis. To test this hypothesis, the final concentration of 4.2x106/mL with human erythrocytes was incubated in test tube at 37 degrees C water bath with 1.67 mg/mL of CsA and 72 nmol/mL of melatonin. The degree of hemolysis and the amount of malondialdehyde which gives an indirect index of oxidative injury were measured in group 1 containing only isotonic buffer solution, in group 2 containing only CsA, and in group 3 containing both CsA and melatonin. The degrees of hemolysis in group 2 were higher than those of group 1. The degrees of hemolysis in group 3 were higher than those of group 1, and lower than those of group 2. The amounts of malondialdehyde in group 2 were higher than those of group 1. The amounts of malondialdehyde in group 3 were higher than those of group 1, and lower than those of group 2. These results indicate that the direct contact of erythrocytes with CsA results in free radical mediated hemolysis and the hemolysis by CsA can be prevented with melatonin.
Humans

The sieving coefficient(S) representing convective transport of glucose during peritoneal dialysis(PD) with glucose containing dialysis solution has been reported to be anomalous, lower than 0 or higher than 1. During peritoneal dialysis using glucose containing dialysis solution, diffusive transport of glucose is from dialysate to blood, and convective transport in the opposite direction i.e., from blood to dialysate. Glucose intolerance and hyperinsulinemia are well known adverse effects of PD using glucose containing dialysis solutions. Insulin is required for glucose transport from extracelluar fluid to intracelluar fluid in adipocytes and muscell cells. Hyperinsulinemia in PD may alter peritoneal glucose transport. If extra to intracellular glucose transport mediated by insulin is involved in the peritoneal glucose transport during PD with conventional glucose containing dialysis solutions, the diffusive and convective transport characteristics for glucose calculated using membrane model between two well-mixed compartments may not represent true values. S can be calculated best when diffusion is minimized. Male Sprague-Dawley rats were used. To minimize the diffusive transport the glucose isochratic solutions containing approximately the same concentration as in serum were used. To maximize ultrafiltration 3.86% mannitol was used as an osmotic agent. To evaluate the effect of insulin on glucose transport two different glucose concentrations, 100mg/dl(NI) and 300mg/dl(HI), were used. During the dialysis with HI solution glucose clamp technique was performed to keep blood glucose level approximately 300mg/dl. A 2 hour peritoneal dialysis was performed in 13 rats(7 Nl and 6 Hl). Serum and dialysate insulin levels were measured in 3rats in Nl, 2 rats in Hl, and 4 rats without dialysis(NC). Intraperitoneal volume(VD) was calculated using volume marker, RISA, dilution method. The diffusive mass transport coefficient(KBD) and S for urea and glucose were calculated using the modified Babb- Randerson-Farrell model. D/P glucose in Nl was 0.61+/-0.05 due to high blood glucose level 187.2+/-17.9mg/dl vs. 114.3+/-7.6 mg/dl in dialysate and 0.99+/-0.26 in Hl(360.6+/-55.6mg/dl in blood vs. 345.0+/-55.6mg/dl in dialysate). VD did not differ between the two groups. KBD for urea and glucose, and S for urea did not differ between the two groups. S for glucose in Hl was negative value and significantly lower than that in Nl(-0.903+/-0.960 vs. 1.036+/-0.137, P<0.001). Plasma insulin level was significantly higher in Hl compared with values in Nl and NC. Dialysate insulin level was similar in Nl and Hl. Dialysate insulin level in Nl was higher than plasma insulin level. The present result that S for glucose at hyperinsulinemic condition was anomalous indicates that not only simple passive transport but also other transport mechanisms mediated by insulin such as glucose influx into cells may be involved in peritoneal glucose transport. The finding of dialysate insulin level higher than plasma concentration in Nl may suggest direct leakage of insulin from pancreas or portal vein into the peritoneal cavity.
Adipocytes ; Animals ; Blood Glucose ; Dialysis ; Dialysis Solutions ; Diffusion ; Glucose Clamp Technique ; Glucose Intolerance ; Glucose* ; Humans ; Hyperinsulinism ; Insulin ; Male ; Mannitol ; Membranes ; Pancreas ; Peritoneal Cavity ; Peritoneal Dialysis* ; Plasma ; Portal Vein ; Rats ; Rats, Sprague-Dawley ; Ultrafiltration ; Urea

Central neurogenic hyperventilation (CNH) is characterized by sustained tachypnea inspite of an elevated arterial PaO2, pH and a low arterial PaCO2. CNH is common in patients with brainstem injury accompanied by a decreased level of consciousness but this also has been described in some alert patients with an invasive brainstem tumor. We report one case with CNH resulting from a unilateral pontine infarction. His consciousness was clear, and CNH spontaneously disappeared without any medication.
Brain Stem ; Brain Stem Neoplasms ; Consciousness ; Humans ; Hydrogen-Ion Concentration ; Hyperventilation* ; Infarction* ; Tachypnea

Sick sinus syndrome (SSS) is an abnormality of sinus nodal impulse formation by intrinsic or extrinsic causes. Patients with SSS often are asymptomatic, or have mild or nonspecific symptoms, including dizziness, palpitations, fatigue, and confusion related to the decreased cardiac output. SSS can rarely cause conditions like syncope, congestive heart failure, thromboembolism, pulmonary edema, cardiac arrest, or sudden death. We report here on a severe bradycardia during general anesthesia for aneurysmal clipping and tachycardia-bradycardia syndrome followed by cardiac arrest postoperatively in the ICU, which was subsequently diagnosed as SSS with 24-hour Holter monitoring.
Anesthesia, General ; Aneurysm ; Bradycardia ; Cardiac Output ; Death, Sudden ; Dizziness ; Edema, Cardiac ; Electrocardiography, Ambulatory ; Fatigue ; Heart Arrest ; Heart Failure ; Humans ; Pulmonary Embolism ; Sick Sinus Syndrome ; Syncope

The lateral medullary syndrome, I. E. Wallenberg syndrome, presents with several forms of sensory deficits. However, the correlation between the sensory deficits and the MRI findings of the medulla has been rarely attempted. We studied 16 patients with lateral medullary infarction who showed appropriate MRI lesions and correlated their sensory findings with the MRI results. In order to examine the extent of lesion of medulla in the MRI, we divided the medulla into three parts, namely upper, middle, and lower parts. The patients exhibited six types of sensory manifestation. In brain MRI, five patients with uncrossed sensory deficit; three patients with contralateral sensory deficit involving only body; and one patient with contralateral sensory level on trunk showed a diagonal band, lateral, or combined lesion in the medulla. Four patients with crossed sensory deficit and one patient with ipsilateral sensory deficit involving only face showed a large, laterodorsal lesion in the medulla. Two patients without sensory deficit exhibited a dorsal lesion in the medulla. In conclusion, lateral medullary syndrome usually has a characteristic lesion in the MRI according to the sensory deficits.
Brain ; Humans ; Infarction ; Lateral Medullary Syndrome* ; Magnetic Resonance Imaging*

No abstract available.
Adrenal Glands* ; Ganglioneuroma* ; Hyperplasia*

BACKGROUND: Benign pathologic findings are shown in 800% of thyroid nodules by fine needle aspiration cytology (FNAC) or needle biopsy. About half of these benign nodules are follicular lesions which are presented only as thyroid follicles or thyroid cell clumps. Differential diagnosis of follicular adenoma, follicular carcinoma and adenomatous goiter is impossible by FNAC or needle biopsy. Thyroxine suppression therapy has been performed traditionally in order to discriminate malignant nodules, but few studies are available which confirmed the efficacy of thyroxine suppression therapy in thyroid nodules of those the initial pathologic findings were follicular lesions. So we tried to evaluate the efficacy of thyroxine suppression therapy in benign thyroid nodules and also the incidence of thyroid cancer of the thyroid nosules which were not decreased on thyroxine suppression therapy after surgical resection. METHODS: Total 1027 patients with thyroid nodules were evaluated by FNAC or needle biopsy at Soonchunhyang university hospital from 1990 to 1996. Among 1027 patients, 507 patients showed follicular lesions in FNAC or needle biopsy and they received thyroxine suppression therapy. Thyroid nodule volume was measured before and after thyroxine suppression therapy using ultrasonography. We studied 184 patients who were followed up for more than 1 year. Serial changes of thyroid function tests, thyroid nodule volume, serum thyroglubulin (Tg) level before and after therapy were analyzed. RESULTS: l. In 80 (43.5%) of the 184 patients, nodule volumes decreased more than 50 percent after thyroxine suppression therapy. 2. There was no significant difference in serum T3, T4, TSH levels before and after thyroxine suppression therapy between group I (nodule volume decreased less than 50%) and group II (nodule volume decreased more than 50%). 3. In group II patients, thyroid nodule volumes were decreased continuously at 12 month, 18 month and 30 month after thyroxine suppression (p<0.05). 4. There was no significant difference between the group I and group II in the frequency of multiple thyroid nodules on ultrasonography. 5. Among 37 patients who underwent thyroidectomy, 19 cases (51.4%) were revealed as malignant thyroid nodules (papillary cancer 4 cases, follicular cancer 15 cases). Eighteen cases (48.6%) were revealed as benign thyroid nodules (follicular adenoma 10 cases, adenomatous goiter 8 cases). 6. There was no significant difference in the frequency of multiple nodules on ultrasonography between benign and malignant nodules. CONCLUSION: Our data suggested thyroxine suppression therapy was effective in discriminating malignant thyroid nodules from benign nodules, especially in selecting follicular carcinoma from follicular lesion by FNAC or biopsy.
Adenoma ; Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle ; Diagnosis, Differential ; Goiter ; Humans ; Incidence ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Thyroxine* ; Ultrasonography

A pathologic rupture of the flexor pollicis longus tendon secondary to Kienbock disease is extremely rare with only three cases being reported in the literature. We encountered a case of a pathological rupture of the flexor pollicis longus tendon secondary to longstanding Kienbock disease. The treatment included tendon ball insertion after excising the collapsed lunate and a flexor pollicis longus tendon reconstruction with autogenous palmaris longus tendons. Satisfactory results with a restoration of the active motion of the interphalangeal joint of the thumb, maintenance of the preoperative active range of motion of the wrist and markedly reduced pain was achieved after a one year follow up. We describe this case with a review of the relevant literature.
Follow-Up Studies ; Joints ; Osteonecrosis ; Range of Motion, Articular ; Rupture* ; Tendons* ; Thumb ; Wrist

The mechanisms underlying opiate tolerance and dependence are not fully understood. We used human neuroblastoma SH-SY5Y cells as a model system for studying effects of morphine tolerance and withdrawal on c-myc induction and cAMP levels. It has been reported that regulation of c-fos by acute and chronic morphine withdrawal is mediated through alterations in CREB transcription factor. In this study, we examined the effects of morphine tolerance on c-myc expression and cAMP concentrations. The activation of opiate receptors by an acute morphine administration resulted in an increase in c-myc mRNA and a decrease in cAMP concentrations in a dose-dependent manner (5, 10, 15, and 20 muM). On the other hand, the chronic treatment of morphine (10 muM for six days) did not induce the elevated expression of c-myc mRNA. The c-myc expression was slightly inhibited in comparison with that of the acute morphine response. However, cAMP concentrations were increased with regard to morphine withdrawal response. These results suggest that the alterations in c-myc expression might imply a significant opiate regulation relating to morphine tolerance. This observation differs from increased expression of c-fos via regulation of cAMP pathway.
Hand ; Humans* ; Morphine ; Neuroblastoma* ; Receptors, Opioid ; RNA, Messenger ; Transcription Factors