Zinc is an antioxidant trace mineral, scavenging free radicals and known to be involved in inflammatory reactions. The prevalence of atherogenic diseases such as coronary heart disease (CHD) are increasing in Korean adults of middle age and elderly. The increased cell damage from free radicals and inflammation have been implicated in etiology of CHD, and the evidence is accumulating that low zinc status is involved in the prevalence of this inflammatory atherogenic disease. However, little is known about the zinc status of Korean CHD and its relationship with dietary zinc intake and zinc bioavailabilty. In this study the serum zinc levels of male patients with CHD over 40 yrs. were compared with that of healthy adult males and its associations with dietary zinc intake and zinc bioavailabilty affecting factors were examined. Serum zinc level was measured by HANARO research reactor using neutron activation analysis (NAA) method. The overall proportion of patients with zinc deficiency, serum zinc concentrations below 74.0 microgram/dL was 32.8% compared to the 10.3% in healthy group. The average serum zinc levels were 80.7 microgram/dL and 88.3 microgram/dL in patients and healthy group, respectively, showing significantly low zinc status in CHD patients compared to healthy group. The intake of nutrients such as energy, carbohydrate, iron, and copper of CHD patients was significantly higher compared to that of the healthy group. In addition, the intake of calcium, iron, and protein from vegetable foods was significantly higher in CHD patients than that of healthy group. The dietary zinc intake was 12.7+/-4.5 mg and 11.5+/-6.9 mg in CHD patients and control group, respectively, which showed no difference. The phytate intake of patients group, which is 1389.0 mg, was significantly higher than the control group which showed 1104.8 mg. However, the ratio of phytate :zinc or phytate *calcium :zinc per 1000 kcal energy intake did not show any difference between two groups. The serum zinc levels did not show any correlation with zinc or factors that affect the bioavailability of zinc. The dietary factors influencing the zinc status were not found in CHD patients.
Adult ; Aged ; Biological Availability ; Calcium ; Copper ; Coronary Disease* ; Energy Intake ; Free Radicals ; Humans ; Inflammation ; Iron ; Male* ; Middle Aged ; Neutron Activation Analysis ; Phytic Acid ; Prevalence ; Vegetables ; Zinc*

PURPOSE: Although papillary thyroid microcarcinoma (PTMC) has very excellent prognosis, lymph node metastases are found frequently. This study identifies the risk factors of clinically negative cervical lymph node metastasis (cN0) and investigates the need for central lymph node dissection in cN0 PTMC. METHODS: From Jan. 1(st) 2007 to Dec. 30(th) 2013, 1593 patients received surgery for papillary thyroid carcinoma. Seven hundred and eleven patients were diagnosed with cN0 PTMCs. They all received thyroidectomy (total thyroidectomy or lobectomy) with prophylactic central neck dissection. We reviewed the medical records and analyzed the risk factors affecting central lymph node metastasis (CLNM). RESULTS: Of 711 PTMCs patients without clinical lymph node metastasis, 170 (23.9%) patients had CLNM. CLNM was frequent in males than females (P<0.001). The larger the primary tumor, the higher the risk of CLNM (P<0.001). Extra-thyroidal extension was an independent risk factor of CLNM (P<0.001). Recurrence rates in the CLNM negative group was 1.3%, and in the CLNM positive group 2.4%. The CLNM positive group recurred at a slightly higher rate, but not statistically significantly (P=0.329). Five year disease free survival in the CLNM negative was 96.8%, and in the positive group 94.1%, not a statistically significant (P=0.630). CONCLUSION: In this study, male gender, the size of primary tumor, and extra-thyroidal extension were the risk factors of occult LNM but occult LNM in PTMC was not associated with recurrence rate or five-year disease free survivals. Therefore, we can omit prophylactic central lymph node dissection in patient with cN0 PTMC.
Disease-Free Survival ; Female ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Male ; Medical Records ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: Medullary thyroid cancer (MTC) is a rare disease and the clinical course of MTC many vary. In this study, we analyzed the factors influencing the prognosis of MTC. METHODS: The study group consisted of 37 patients with MTC seen at KNUH between July 1985 and July 2003. We analyzed the medical records of MTC surgical cases in a retrospective study to analyze treatment results and utilized the Kaplan-Meier and chi-squred tests to determine the correlation of prognosis and recurrence. RESULTS: The median age of patients was 39 years and 7 patients had a family history and accompanying disease. No metastases were detected at the time of diagnosis. The majority of the sizes of tumors were under 4 cm in 22 cases and 24 cases (64.9%) showed unilateral tumor locations. Twenty cases (48.6%) showed lymph node metastasis, and invasion of the surrounding organs was seen in 5 cases (13.5%) of these cases. A total thyroidectomy and central neck dissection was performed in all cases. In 17 cases, a modified radical neck dissection was performed initially. Recurrence was detected in 13 out of 37 cases. The most common site of recurrence was the neck, followed by the lung and liver. We analyzed the factors that affected recurrence and it was found that lymph node metastasis and the TNM stage had a statistically significant relationship. No factor showed relevance to prognosis by multivariate analysis. The survival rates were 89.2% for 5 years and 83.8% for 10 years. CONCLUSION: We could not find any statistical significance for a factor relevant to the prognosis of the patients by multivariate analysis. However, as the 10 year-survival rate was 83.8%, we can expect improvement in the treatment of MTC with surgical management (total thyroidectomy and central neck dissection) and constant follow-up.
Diagnosis ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lymph Nodes ; Medical Records ; Multivariate Analysis ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Prognosis ; Rare Diseases ; Recurrence ; Retrospective Studies ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Anaphylaxis usually develop immediately after wasp sting, but may develop even after few days later. Neurological complications after stings are uncommon, although several cases have been reported involving central and/or peripheral nervous system. Although wasp sting-induced encephalitis has been rarely reported, all reported cases showed mental change and severe neurological deterioration. Herein, we report an atypical case who showed biphasic anaphylaxis and delayed-onset cerebellar ataxia following a wasp sting, characterized by mild cerebellar ataxia and excellent response to corticosteroids.
Adrenal Cortex Hormones ; Anaphylaxis ; Bites and Stings ; Cerebellar Ataxia ; Encephalitis ; Peripheral Nervous System ; Wasps

Objective: There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. Methods: We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. Results: A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. Conclusion This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

BACKGROUND: Interictal spikes in gelastic epilepsy-hypothalamic hamartoma syndrome are mainly in the fronto-temporal area. Current source analysis of the interictal spikes has not been done enough. We tried the current source analysis in 2 patients with gelastic epilepsy-hypothalamic hamartoma syndrome using both of the discrete and distributed models. METHODS: Twenty 1 sec epochs including the negative peak of the spikes, were selected from one or two electroencephalographic recordings respectively in each patient. These 20 epochs were averaged into a single spike. The current dipole sources of the averaged spike were analyzed and located on a spherical head model. The current source density of the negative peak point of the averaged spike was located on the Talairach human brain map. RESULTS: The current dipole sources were in the right subcallosal gyrus, or the right or left anterior cingulate gyri. The current source density was distributed in the bilateral medial frontal area including the anterior cingulate gyri. CONCLUSIONS: The interictal spikes of patients with gelastic epilepsy-hypothalamic hamartoma syndrome may be generated by the current sources located in the bilateral medial frontal area.
Brain ; Hamartoma ; Head ; Humans

The presence of primary intraventricular hemorrhage (IVH) without vascular lesion is very rare. We experienced solitary IVH without subarachnoid hemorrhage due to aneurysmal rupture in a 58-year-old man treated with coil embolization, which contributed to his good prognosis. After 33 days of hospitalization, he had mild right hemiplegic symptoms remaining, and he was transferred to a rehabilitation institute for further treatment. In cases of primary IVH, computed tomography angiography seems worthwhile for making a differential diagnosis, although the possibility of IVH due to cerebral aneurysmal rupture is very low. Endovascular intervention is a good option for diagnosis and treatment.
Aneurysm ; Angiography ; Cerebral Angiography ; Diagnosis ; Diagnosis, Differential ; Embolization, Therapeutic ; Endovascular Procedures ; Hemorrhage ; Hospitalization ; Humans ; Intracranial Aneurysm ; Middle Aged ; Prognosis ; Rehabilitation ; Rupture ; Subarachnoid Hemorrhage