PURPOSE: Tuberculosis of the thyroid gland is very rare and some cases were reported in Korea since 1968. We experienced a case of tuberculous thyroiditis and found a old case in our medical center. This report is about the two case and the review of all cases reported about tuberculosis of the thyroid gland in Korea. METHODS: We present the case of a 55-year-old woman with thyroid tuberculosis who has been treated with antituberculous medication because of tuberculous meningitis during 6 months. We performed thyroid isthmectomy and she is now taking the antituberculous drugs. We found a case of 40- year-old woman who underwent extended thyroid lobectomy, Lt. in 1985 at our medical center. We reviewed the 18 literatures with 29 cases of tuberculosis of the thyroid gland reported in Korea and analyzed total 31 cases (reported 29 cases and our 2 cases). RESULTS: 28 patients were women and only 2 patients were over 60 years old. 26 patients had complained the neck mass. Duration of symptoms were below 6 months in 18 cases. There were associated symptoms like as weight loss, easy fatigue or generalized weakness, dysphagia, palpitation, fever, chills and/or anorexia. Only 9 patients had underlying tuberculosis - 2 meningitis, 2 pneumonia, 3 lymphadenopathy and 2 pneumonia combined with meningitis. But 3 patients were newly diagnosed as old or active pulmonary tuberculosis at the time of diagnosis of thyroid tuberculosis. Thyroid function was normal in 9 cases and abnormal in 5 cases. 3 cases were diagnosed nonoperatively and 15 patients of surgically treated 28 cases were underwent lobectomy. AFB stain was positive in only 13 cases and 2 cases were positive of culture with negative AFB stain. All of cases were diagnosed by pathology as granulomatous tuberculosis with caseous necrosis. CONCLUSION: Either surgical resection plus antituberculous medications or only medications are effective and recurrences were not reported after any initial treatments. So preoperative evaluation is very important and will guide the patient and the surgeon to the most effective management.
Anorexia ; Chills ; Deglutition Disorders ; Diagnosis ; Fatigue ; Female ; Fever ; Humans ; Korea ; Lymphatic Diseases ; Meningitis ; Middle Aged ; Neck ; Necrosis ; Pathology ; Pneumonia ; Recurrence ; Thyroid Gland* ; Thyroiditis ; Tuberculosis* ; Tuberculosis, Meningeal ; Tuberculosis, Pulmonary ; Weight Loss

The main cause of ischemic heart disease combined with aortic valve disease is the systemic atherosclerotic process. Coronary artery embolism by a particle from the calcified aortic valvular tissue is very rare. A 73-year-old female patient was admitted due to chest tightness of recent onset. Two dimensional echocardiogram showed severe calcific aortic valve stenosis. Preoperative coronary angiogram exhibited a stenotic lesion at the distal right coronary artery, which seemed to be embolic in origin. The coronary embolus was removed through the coronary arteriotomy and then the arteriotomy site was repaired by onlay patch angioplasty technique. Aortic valve was replaced by a bioprosthetic valve. The embolus was reported as a fibrocalcified particle of diseased valve.
Aged ; Angioplasty ; Aortic Valve ; Aortic Valve Stenosis ; Constriction, Pathologic* ; Coronary Vessels* ; Embolism* ; Female ; Humans ; Inlays ; Myocardial Ischemia ; Thorax

Patient death with a functioning graft(DFG) has been a predominant cause of graft loss. According to conventional graft survival(C-GS) analysis, DFG is considered as a graft failure. However, such survival analysis may obscure immunologic graft loss and distort the overall graft results as well as risk factors affecting the graft survivals. In functional graft survival(F-GS) analysis, the DFG is considered as censored data(in which the graft survived until patient death) which is more closely related with the immunologic graft loss. We designed our study to identify the differences and significance of F-GS compared to C-GS. From April 1984 to October 1995, 1242 living donor kidney transplantations under cyclosporine were performed at Yonsei University Medical Center. At least a 1-year follow-up was possible in all the patients. The graft survival rate was calculated by both C-GS and F-GS analyses. The recipient's and the donor's ages, the donor-recipient relationship, the degree of HLA matching, the degree of ABO blood type matching, the episodes of acute rejection within 1 year, and the presence of diabetes mellitus were monitored as risk factors affecting the graft survival in the two analysis methods. Univariate and multivariate analyses for risk factors were done by the Kaplain-Meier method and the Cox proportional harzard model. The C-GS rate were 96.3% at 1 year, 81.8% at 5 years, and 58.4% at 10 years compared to 98.5%, 88.1%, and 67.9%, respectively in the F-GS analysis. Elderly recipients(> or =50), elderly donors(> or =50), presence of acute rejection within 1 year post-transplant, ABO blood type minor mismatching, and diabetic recipients were risk factors affecting long-term graft survival in the C-GS analysis. However, elderly recipients and diabetic recipients were no longer considered as risk factors in the F-GS analysis. In fact, elderly recipients or diabetic recipients showed equal or even better graft survivals in the F-GS analysis compared with younger or non-diabetic recipients. The differences between the C-GS and the F-GS analyses in such subgroups suggests that the primary cause of graft loss in these groups was non-immunologic. Death with functioning graft(DFG) needs to be considered in analyzing kidney-transplant outcomes. Hence, we propose that all transplant graft survival data be presented in two ways, by conventional and functional graft analyses.
Academic Medical Centers ; Aged ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Graft Survival* ; Humans ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Risk Factors ; Transplants*

BACKGROUND/AIMS: Rectal carcinoid tumors can be resected with endoscopy, and it is important to assess their prognostic factors. We evaluated the potential of Ki-67 expression as a prognostic factor in rectal carcinoid tumors. METHODS: We retrospectively reviewed the medical records of 37 patients with rectal carcinoid tumors who got endoscopic resection from January 2001 to January 2011 at Inje University Seoul Paik Hospital. We analyzed their endoscopic and histologic findings, Ki-67 expression, clinical outcome, and prognosis. RESULTS: The mean age (+/-SD) of the patients was 56.3+/-10.7 years, and the male : female ratio was 3.6:1. The mean tumor size was 0.5+/-0.4 cm, 33 patients showed grade 1 tumors (89.2%) and the average Ki-67 expression was 0.7+/-1.2%. Thirty five patients underwent endoscopic mucosal resection, and two required endoscopic submucosal dissection. Eight patients had positive margins after resection, but no cases of lymphovascular invasion were identified. The median follow-up duration was 21.4+/-25.4 months, and no recurrences were observed. CONCLUSIONS: In low grade rectal carcinoid tumors which are lack of central depression on colonoscopy, the expression of a molecular marker of malignant potential, Ki-67, was low. Therefore, endoscopic resection seemed to be a safe and effective treatment for these tumors.
Adult ; Age Factors ; Aged ; Carcinoid Tumor/*diagnosis/metabolism/pathology ; Colonoscopy ; Female ; Humans ; Immunohistochemistry ; Ki-67 Antigen/*metabolism ; Male ; Middle Aged ; Prognosis ; Rectal Neoplasms/*diagnosis/metabolism/pathology ; Retrospective Studies ; Sex Factors

Endoscopic mucosal resection with a ligation device (EMR-L) has become important in the curative treatment of precancerous lesions and early gastric cancers (EGCs), but little is known of the long-term efficacy and survival rates of EMR-L compared with surgical resection. We analyzed the therapeutic efficacy and safety of EMR-L in cases of EGC and precancerous lesions and compared the results of EMR-L with those of gastrectomy in patients with EGC over the same periods. EMR-L was performed on 20 EGCs and 54 precancerous lesions including tubular adenomas with or without severe dysplasias in 74 patients. Macroscopic type, size and location of the lesion were determined by endoscope, and the depth of invasion in EGCs was determined by endoscopic ultrasonography and confirmed by pathologic examination of the resected specimens. All the EGC cases were endoscopically followed up for at least 18 months (range, 18-66 months). Patients were selected that underwent subtotal gastrectomy and the survival rates were compared with those that underwent EMR-L. Complete resection was made in a single EMR-L treatment session in 61 cases (82.4%; 91.5%, were precancerous lesions and 65% were EGCs). After a repeat trial of EMR-L, the total rate of complete resection of precancerous lesions and EGCs was 92.6% and 85.0%, respectively. The survival rate of EGCs showed that complete resection by EMR-L resulted in 2 and 5 year survival rates of 100% and 95%, which are comparable to those of surgery (100% and 100%). This study suggests that EMR-L is a technically simple, minimally invasive and highly safe and effective treatment modality for selective EGCs, and offers an alternative to surgical treatment.
Adult ; Aged ; Aged, 80 and over ; Comparative Study ; Endoscopy, Digestive System* ; Female ; Gastrectomy ; Human ; Ligation/instrumentation* ; Male ; Middle Age ; Precancerous Conditions/surgery* ; Stomach Neoplasms/surgery* ; Time Factors

PURPOSE: Nephrotoxicity of cyclosporin A (CsA) remains a major obstacle for the clinical use of this potent immunosuppressant. It is likely that the transforming growth factor-beta(TGF-beta) and endothelin-1 (ET-1) play a central role in initiation and/or progression of CsA induced nephropathy in renal ischemia-reperfusion injury. It is proposed that the new immunosuppressive drug mycophenolate mofetil (MMF) reduces the incidence of acute rejection in comparison with azathioprine. Thus, the aim of the present study was to analyze the expression of TGF-beta and ET-1 in renal ischemia-reperfusion injured rats and to see the effect of CsA or MMF on the expression of these mediators. Effects of coadministration of CsA and MMF were also evaluated. METHODS: Sprague-Dawley rats (N=60) performed right nephrectomy were classified into five groups according to experimental methods. Control group underwent right nephrectomy. After the right nephrectomy, to induce renal ischemia, the left renal vascular pedicle was occluded for 30 minutes with vascular clamps in all experimental groups. After 30 minutes, the clamps were removed to undergo reperfusion. In control group, ischemic injury wasn't done. CsA group was administered CsA (10 mg/kg/ day, S.C) after the operation. CsA and MMF group was coadministered CsA (10 mg/kg/day, S.C) and MMF (10 mg/kg/day, P.O). MMF group was administered MMF (10 mg/kg/day, P.O). After 7 days, the left kidney was removed and processed for histological, immunohistochemical, immunofluorescent and molecular analyses for TGF-beta 1 and histological, immunohistochemical, immunofluorescent analyses for ET-1. RESULTS: The immunohistochemical and immunofluorescent expression density for TGF-beta1 in CsA group was higher than control and other experimental groups. The immunohistochemical and immunofluorescent expression density and mRNA production for ET-1 in CsA group was higher than control and other experimental groups. The expression density for TGF-beta1 and ET-1 in CsA and MMF group was less than in CsA group. The expression density for TGF-beta 1 and ET-1 in MMF group was less than in CsA group and CsA and MMF group, was similar to ischemia-reperfusion group. CONCLUSION: These results suggest that MMF does not seem to have nephrotoxic effects, and seems to have a reno-protective effect from CsA induced nephrotoxicity in the ischemia-reperfusion model. The present study might partially explain that MMF is going to contribute to the improvement of the survival rate of the transplanted kidney associated with acute and/or chronic rejection and to the reduction of CsA dosage and its complications.
Animals ; Azathioprine ; Cyclosporine* ; Endothelin-1* ; Incidence ; Ischemia ; Kidney ; Nephrectomy ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Reperfusion Injury ; RNA, Messenger ; Survival Rate ; Transforming Growth Factor beta ; Transforming Growth Factor beta1

BACKGROUND: The accurate pathogenetic mechanism of dialysis associated pericarditis remain uncertain, but its clinical significance is very important from a therapeutic and prognostic point of view. Clinical features of the disease weren't reported well in Korea. So, we analyzed the clinical characteristics of the dialysis associated pericarditis. METHODS: Thirty-five patients were included in this study. The study group was divided into two groups (a minimal group and moderate to large group) according to the amount of the pericardial effusion on echocardiogram. We reviewed and compared the clinical appearance, laboratory data and echocardiogram findings. RESULTS: There were 18 cases (51.4%) of minimal amount pericardial effusion and 17 cases (48.5%) of moderate to large amount. Cardiac tamponade developed in 2 patients. There was a significant difference in urea reduction rate between minimal group (42+/-20.%) and moderate to large group (24.3+/-21.2%) (p<0.05). A time to pericardial effusion development from dialysis initiation was 3.6+/-8.3 months, 17.6+/-21.0 months, respectively and the difference showed statistical significance (p<0.05). The Left ventricular dimension at systole was 4.8+/-0.7 cm, 3.8+/-1.1 cm, respectively. This difference is statistically significant (p<0.05). In the minimal amount group, 16 (89.9%) cases were treated conservatively and 2 cases (10.1%) were treated surgically. In the moderate to large amount group, 10 cases (58.8%) were treated surgically. CONCLUSION: These results show that the dialysis associated pericarditis with moderate to large amount of pericardial effusion have lesser urea reduction rate, longer dialysis treatment period and require further surgical approach than minimal amount group. We suggest that the sufficient and adequate dialysis and the regular echocardiography are needed. This need is more eminent as the duration of dialysis become longer. It is possible to prevent the development of pericarditis and its complication.
Cardiac Tamponade ; Dialysis* ; Echocardiography ; Humans ; Korea ; Pericardial Effusion ; Pericarditis* ; Renal Dialysis* ; Systole ; Urea

BACKGROUND: The accurate pathogenetic mechanism of dialysis associated pericarditis remain uncertain, but its clinical significance is very important from a therapeutic and prognostic point of view. Clinical features of the disease weren't reported well in Korea. So, we analyzed the clinical characteristics of the dialysis associated pericarditis. METHODS: Thirty-five patients were included in this study. The study group was divided into two groups (a minimal group and moderate to large group) according to the amount of the pericardial effusion on echocardiogram. We reviewed and compared the clinical appearance, laboratory data and echocardiogram findings. RESULTS: There were 18 cases (51.4%) of minimal amount pericardial effusion and 17 cases (48.5%) of moderate to large amount. Cardiac tamponade developed in 2 patients. There was a significant difference in urea reduction rate between minimal group (42+/-20.%) and moderate to large group (24.3+/-21.2%) (p<0.05). A time to pericardial effusion development from dialysis initiation was 3.6+/-8.3 months, 17.6+/-21.0 months, respectively and the difference showed statistical significance (p<0.05). The Left ventricular dimension at systole was 4.8+/-0.7 cm, 3.8+/-1.1 cm, respectively. This difference is statistically significant (p<0.05). In the minimal amount group, 16 (89.9%) cases were treated conservatively and 2 cases (10.1%) were treated surgically. In the moderate to large amount group, 10 cases (58.8%) were treated surgically. CONCLUSION: These results show that the dialysis associated pericarditis with moderate to large amount of pericardial effusion have lesser urea reduction rate, longer dialysis treatment period and require further surgical approach than minimal amount group. We suggest that the sufficient and adequate dialysis and the regular echocardiography are needed. This need is more eminent as the duration of dialysis become longer. It is possible to prevent the development of pericarditis and its complication.
Cardiac Tamponade ; Dialysis* ; Echocardiography ; Humans ; Korea ; Pericardial Effusion ; Pericarditis* ; Renal Dialysis* ; Systole ; Urea

BACKGROUND: Several clinical scoring systems are currently being used to predict the outcome of sepsis, but they all have certain limitations. Therefore, we sought to identify the proteomic biomarkers, with wsing proteomic tools, that differed according to the outcome of sepsis patients. METHODS: Upon admission to the ICU, blood samples were obtained from the 16 patients with sepsis who were enrolled in this study. Surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) was used to identify the markers that could predict the outcome of sepsis. RESULTS: We found six peaks, by using cation and anion chips, that statistically differed between those patients who died and those who survived. CONCLUSION: The biomarkers we found by using proteomic tools may help predict the prognosis and also plan the treatment of sepsis.
Biomarkers ; Humans ; Mass Spectrometry ; Prognosis ; Protein Array Analysis* ; Proteomics ; Sepsis* ; Treatment Outcome

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
Anti-Bacterial Agents/therapeutic use ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Gastroscopy ; Hematemesis/complications/diagnosis ; Humans ; Male ; Mediastinal Emphysema/complications/*diagnosis/drug therapy ; Middle Aged ; Tomography, X-Ray Computed