No abstract available.
Thyroid Gland* ; Thyroid Nodule*

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

Endoprosthetic replacement was performed in 38 patients at the department of orthopedic surgery, Seoul National University Hospital in the past ten years from May, 1968, and following results were obtained. 1. Among 38 patients, fracture was in 33 patients, avascular necrosis in 3,and osteoarthritis in 2. 2. Austin-M oore prosthesis was used in 31 patients and Thompson prosthesis in 7. 3. The youngest age was 34 years old and the oldest 85, and the peak incidence was in 7th decade in male and 8th decade in female. 4. The most common type of femur neck fracture was transcervical (60.6%) followed with basal neck (21.1%) and subcapitel (18.2%) 5. Of 33 cases of femur neck fracture, 21 patients (63.6%) was admitted more than 3 weeks after injury. 6. Moore type Southern approach was used most frequently (55.2%). 7. In 36 patients (94.6%), early weight bearing was permitted within 3 weeks, and 25 patients (65.7%) were discharged within 2 weeks after surgery. 8. Minor complications were encountered in 12 patients (31.5%), and none were severe. 9. In follow up of more than 3 months, good to excellent results were obtained in 75%.
Female ; Femoral Neck Fractures ; Follow-Up Studies ; Hip Joint ; Hip ; Humans ; Incidence ; Male ; Neck ; Necrosis ; Orthopedics ; Osteoarthritis ; Prostheses and Implants ; Seoul ; Weight-Bearing

The anatomical characteristics of the tibia, which is covered by subcutaneous tissue anteriorly, emphasize the vulnerability of the tibia to trauma and frequently result in open comminuted fracture. Open fractures add to the risk of infection and nonunion and require treatment that prevent infection, provide skin coverage, and maintaine reasonable fixation during the early healing phase. 50 cases of tibia shaft fractures were reviewed from May 1978 to December 1983, managed with the modified Vidal-Adrey frame of Hoffmann extemal fixator, at the Orthopaedic Department of Kyung Hee University Hospital. The results obtained were as follows; 1. In 50 cases of tibia fractures, 46 cases are open injuries and 43 cases (86.0%) among them were Grade II and IU open fractures. 2. 31 operative procedures were performed for the coverage of soft tissue injury; 13 cases of rotation and cross-leg pedicle flaps were effective aids, but futher good results could be expected with the micmvascular free flap. 3. 17 operative procedures for acceleration of bony union and reconstruction of bone defect were performed. In cases of massive bone defect, vascularized fibular transplantation and free vascularized fibular graft should be employed, and additional bone shortening and electric stimulation would contribute to the enhancement of the bony union process. 4. The mean period of extemal immobilization with the frame was 15.4 weeks and that of bone union was 31.7 weeks. The periods of bone union were markedly delayed in cases of Grade II andIII open fracture than those of closed and Grade I open fractures. 5. Nonunion developed in 17 cases (34.0%); 4 cases in Grade II and 13 cases in Grade III injury. 6. 12 cases of wound infection developed. 7. 12 cases of pin tract infection happened. More careful pin tract management could diminish this troublesome complication.
Acceleration ; Electric Stimulation ; Fractures, Comminuted ; Fractures, Open ; Free Tissue Flaps ; Immobilization ; Skin ; Soft Tissue Injuries ; Subcutaneous Tissue ; Surgical Procedures, Operative ; Tibia ; Transplants ; Wound Infection

Renal tubular dysgenesis (RTD) is a rare fatal disorder in which there is poor development of proximal tubules, leading to oligohydramnios and the Potter sequences. RTD occurs secondary to renin-angiotensin system (RAS) blockade during the early stages of fetal development or due to autosomal recessive mutation of genes in the RAS pathway. A boy born at 33+1 weeks due to cord prolapse was found to be anuric and hypotensive. Pregnancy was complicated by severe oligohydramnios from gestational age 28+4 weeks. Abdominal sonography revealed diffuse globular enlargement of both kidneys with increased cortical parenchymal echogenicity. Infantogram showed a narrow thoracic cage and skull X-ray showed large fontanelles and wide sutures suggestive of ossification delay. Basal plasma renin activity was markedly elevated and angiotensin-converting enzyme was undetectable. Despite adequate use of medications, peritoneal dialysis, and respiratory support, he did not recover and expired on the 23rd day of life. At first, autosomal recessive polycystic kidney disease was suspected, but severe oligohydramnios along with refractory hypotension, anuria, skull ossification delay and high renin levels made RTD suspicious. ACE gene analysis revealed compound heterozygous pathogenic variations of c.1454.dupC in exon 9 and c.2141dupA in exon 14, confirming RTD. Based on our findings, we propose that, although rare, RTD should be suspected in patients with severe oligohydramnios and refractory hypotension.

No abstract available.
DNA*

Antagonists for spinal N-methyl-D-aspartate (NMDA) and amino-hydroxy-methtyl-isoxazolepropionate (AMPA) receptors are effective in attenuating acute nociception or injury-induced hyperalgesia. The antinociception of spinal gabapentin is developed in injury-induced hyperalgesia without affecting acute nociception. The authors evaluated the effects of intrathecal gabapentin, NMDA antagonist (MK801) and AMPA antagonist (NBQX) in the formalin test which shows injury-induced hyperalgesia as well as acute pain. We further assessed the interactions between gabapentin and either MK801 or NBQX. Male Sprague-Dawley rats were implanted with intrathecal catheters. To evoke pain, 50 microliter of 5% formalin solution was injected into the hindpaw. The interaction was investigated by a fixed dose analysis or an isobolographic analysis. MK801 and NBQX suppressed flinching responses during phase 1 of the formalin test, while gabapentin had little effect on phase 1. All three agents decreased the phase 2 flinching response. A fixed dose analysis in phase 1 showed that gabapentin potentiated the antinociceptive effect of MK801 and NBQX. Isobolographic analysis in phase 2 revealed a synergistic interaction after coadministration of gabapentin-MK801 or gabapentin-NBQX. Correspondingly, spinal gabapentin with NMDA or AMPA antagonist may be useful in managing acute pain and injury-induced hyperalgesia.
Amines/administration & dosage/*pharmacology ; Analgesics/*pharmacology ; Animals ; Cyclohexanecarboxylic Acids/administration & dosage/*pharmacology ; Dizocilpine Maleate/*pharmacology ; Drug Interactions ; Excitatory Amino Acid Antagonists/*pharmacology ; Hyperalgesia/drug therapy ; Injections, Spinal ; Male ; Quinoxalines/*pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, AMPA/drug effects/physiology ; Receptors, N-Methyl-D-Aspartate/drug effects/physiology ; Research Support, Non-U.S. Gov't ; gamma-Aminobutyric Acid/administration & dosage/*pharmacology

No abstract available.
Erythropoietin* ; Humans* ; Kidney Failure, Chronic*

BACKGROUND: Several drugs have been used to reduce the hemodynamic responses evoked by skull-pin head-holder application and skin incision in neurosurgery. This study evaluated the effects of levobupivacaine infiltration on hemodynamics followed by the skull-pin head-holder application and the skin incision. METHODS: Eighty-eight patients who had been scheduled for neurosurgery under general anesthesia were randomly divided into five groups. Saline or different concentrations of levobupivacaine (1, 2.5, 5, 7.5 mg/ml) were infiltrated into skull-pin head-holder insertion sites and the skin incision sites. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate were measured just before skull-pin head-holder application and 30 sec, 1 min, 3 min and 5 min after skull-pin head-holder application and skin incision. Changes in hemodynamics were compared. RESULTS: SBP, DBP and heart rate significantly increased after skull-pin head-holder application. The range of increase was diminished by local application of levobupivacaine. However, 5 mg/ml and 7.5 mg/ml levobupivacaine group decreased blood pressure or heart rate to below the baseline after skin incision. CONCLUSIONS: These results indicate that 7.5 mg/ml levobupivacaine attenuates the hemodynamic responses evoked by skull-pin head-holder application, but decreases blood pressure and heart rate after skin incision in craniotomy. Therefore, 5 mg/ml levobupivacaine was effective minimum local concentration to attenuate the change of hemodynamics by skull-pin head-holder application and skin incision in craniotomy if the level of anesthesia is maintained properly.
Anesthesia ; Anesthesia, General ; Blood Pressure ; Craniotomy* ; Heart Rate ; Hemodynamics* ; Humans ; Neurosurgery ; Skin

Endoscopic ultrasonography(EUS) has been used in assessing the depth of cancer invasion of the stomach. However, there are pathologic findings coexisting cancers which are unable to be detected by EUS resulting in mis-staging preoperatively. To find out the causes of mis-staging in determining the depth of cancer invasion, we analysed the pathologic findings of mis-staged cases of gastric cancer by EUS. (continue...)
Endosonography* ; Stomach ; Stomach Neoplasms*