PURPOSE: Parathyroid cysts are rare clinical entities of the neck and superior mediastinum. These cysts often present a difficult diagnostic challenge. They often present as a solitary thyroid nodule and may be difficult to differentiate clinically. The objectives of this study were to review our 27 cases of parathyroid cyst and to suggest the method of diagnostic approach and treatment for parathyroid cyst. METHODS: A retrospective study was performed for a 24-year period (1981~2004), on 27 patients operated of parathyroid cyst. RESULTS: Most of these patients (22/27) complained asymptomatic anterior neck mass at presentation. Preoperative radiologic examinations included ultrasonography (70.4%), computed tomography (25.9%), and (99m)Tc thyroid scan (22.2%). Hypercalcemia was detected in 3 cases with high serum calcium (11.3 mg/dl) and intact PTH (158.1 pg/mL). Fine Needle Aspiration (FNA) was performed in nineteen cases. It revealed crystal clear aspirate in non-functioning cysts and hemorrhagic in functioning cysts. In the analysis of the aspirate, mean N-terminal PTH (n=10) and intact PTH (n=9) were 22.5 pg/mL (9.3~45.0) and 686.5 pg/mL (138.0~1500.0), respectively. Mean size of the cysts was 4.0 cm (1.0~9.2) and the left inferior parathyroid glands were most commonly involved (63.0%). All parathyroid cysts were surgically removed. CONCLUSION: Parathyroid cysts need to be differentiated from other cystic lesions in the neck and superior mediastinum. Aspiration of crystal clear fluid is highly suggestive of a parathyroid cyst. The aspirate should be analyzed for PTH levels as these are always elevated in parathyroid cysts, regardless of the function. Nonfunctioning cysts may be treated with aspiration alone or sclerosing agents. Surgical excision is indicated for functioning cysts and recurrent case of nonfunctioning cysts.
Biopsy, Fine-Needle ; Calcium ; Humans ; Hypercalcemia ; Mediastinum ; Methods ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Retrospective Studies ; Sclerosing Solutions ; Thyroid Gland ; Thyroid Nodule ; Ultrasonography

BACKGROUND: Atracurium appears to be a neuromuscular blocking agent best suited for use in patients with renal failure. The influence on the neuromuscular effect of atracurium has been studied in rabbits with experimental liver cirrhosis induced by subcutaneous injection of carbon tetrachloride (CCl4). METHODS: Cirrhosis was induced in rabbits by CCl4 treatment for 11 weeks. Rabbits were randomly assigned to two groups; control group: corn oil 0.5 ml/kg/2 days sq for 11 weeks; study group: CCl4 0.5 ml/kg/2 days mixed 1 : 1 with corn oil sq for 11 weeks. The dose-response relations of atracurium were studied in sixteen rabbits during thiopental anesthesia. They received atracurium 60, 80 and 100microgram/kg in control group, and 80, 100 and 120microgram/kg in study group, respectively. The time course of atracurium 0.2 mg/kg in sixteen rabbits was evaluated in each groups. Three fragments of each liver lobe at the end of the experimental period were collected and processed for light microscopy, and performed the histological examination. RESULTS: After eleven-week CCl4 treatment, liver histology demonstrated well-defined liver cirrhosis, and increased AST and ALT compared with controls. The calculated ED50 for atracurium were 81.9+/-6.8microgram/kg and 101.1+/-9.4microgram/kg, respectively, in control and study group, and corresponding ED95 was 124.8+/-9.7microgram/kg and 156.1+/-12.1microgram/kg, respectively. There were significant difference between two groups (P < 0.001). The times after atracurium until 95% twitch recovery in control and study group were 31.7+/-6.7 min and 32.8+/-7.4 min, respectively. There were no difference between two groups. CONCLUSIONS: Atracurium in the experimental liver cirrhosis model induced by CCl4 has a decreased potency, but a similar duration of action compared with control. It is suggested that atracurium was also used with monitoring of neuromuscular function in patients with hepatic dysfunction.
Anesthesia ; Atracurium* ; Carbon Tetrachloride* ; Carbon* ; Corn Oil ; Fibrosis ; Humans ; Injections, Subcutaneous ; Liver Cirrhosis* ; Liver Cirrhosis, Experimental ; Liver* ; Microscopy ; Neuromuscular Agents ; Neuromuscular Blockade ; Rabbits* ; Renal Insufficiency ; Thiopental

PURPOSE: Here we showed that human umbilical cord blood (hUCB)-derived cells, when cultured under defined conditions, generated insulin-producing cells (IPCs). METHODS: hUCB mononuclear cells (MNCs) were cultured in serum-free low (5.5 mM glucose) DMEM at a cell density of 3x10(6)/cm2 in the presence of 1% DMSO for 3 days followed by high (25 mM glucose) DMEM supplemented with 10% FBS for 7 additional days. They were plated in plastic six well plates on slide coverslips (22x22 mm2) coated with 0.006% type I collagen. RESULTS: These IPCs formed clusters similar to islets of Langerhans. We confirmed these clusters were positive for insulin and C-peptide by immunohistochemistry. CONCLUSION: Our data demonstrated that in vitro hUCB-derived cells generated IPCs, which can be a potential source for the treatment of diabetes via a stem cell therapy approach.
C-Peptide ; Cell Count ; Collagen Type I ; Dimethyl Sulfoxide ; Fetal Blood ; Humans* ; Immunohistochemistry ; Insulin ; Islets of Langerhans ; Plastics ; Stem Cells ; Umbilical Cord*

Pennig wrist fixator (Orthofix) is a dynamic external fixator which allows wrist motion in applied state in the treatment of distal radius fracture. The authors have treated unstable distal radius fracture with Orthofix external fixator and additional percutaneous K-wire fixation from January 1990 to June 1996. Among these cases, the authors analysed the clinical result of 40 cases which were available for follow-up for more than one year. The analysis was performed on the basis of the change of radiographic findings and modified Gartland & Werley criteria. The results were as follows; 1. According to Frykmann classification, 3 cases were Type I; 1 case, Type II; 4 cases, Type III; 2 cases, Type IV; 4 cases, Type V; 5 cases, Type VI; 20 cases, Type VII; 1 case, Type VIII. 2. We could get the improved values after operation as radial inclination 22.6degrees, radial length 10.7mm and volar tilt 8.8degrees. 3. There were little differences in value between at the immediate postoperative roentgenogram and at the last follow up one; radial inlclination decreased 1.2degrees, radial length shortened 2.5mm, volar tilt decreased 2.3degrees. 4. In 3 cases, the level of the ball joint of the fixator was not adjusted appropriately, so the initial satisfactory reduction was disrupted. 5. According to modified Gartland & Werley criteria, 34 cases (85%) were excellent and good. Pennig dynamic wrist fixator (Orthofix) allows the wrist motion earlier than the static external fixator without disturbing the initial reduction state, so it could be suggested as one of the good fixation devices for the treatment of the unstable distal radius fracture.
Classification ; External Fixators* ; Follow-Up Studies ; Joints ; Radius Fractures* ; Radius* ; Wrist

PURPOSE: Stroke is the second leading cause of death and a major cause of morbidity and mortality worldwide. Evidence of variations in adiponectin(AdipoQ) genes that are associated with ischemic stroke has not been consistent, and it is unclear whether the same loci contribute to these associations in the Korean population. Using a Korean population, we tested ischemic stroke-associated AdipoQ markers. MATERIALS AND METHODS: In a preliminary genome-wide association study using 320 250 k Affymetrix NSP chips, AdipoQ was found to be associated with ischemic stroke in Koreans. To study of AdipoQ, a further 673 ischemic stroke patients and 267 unrelated individuals without a history of stroke or transient ischemic attack were examined in a case-control study. RESULTS: Six polymorphisms (rs182052G > A, rs16861205G > A, rs822391T > C, rs822396A > G, rs12495941G > T and rs3774261A > G) that had a minor allele frequency of over 1% were strongly associated with stroke (p < 0.05). Two of these, rs822391T > C and rs822396A > G showed this association on both dominant and additive logistic regression analysis after adjusting for age and sex. The haplotypes ht 1 (AGGCGG and AAGTAG) were significantly associated with susceptibility to stroke. CONCLUSION: Our findings show that polymorphisms in AdipoQ are associated with risk for ischemic stroke in the Korean population. This study lends further support to the putative role of AdipoQ in stroke.
Adiponectin/*genetics ; Aged ; Asian Continental Ancestry Group ; Female ; Genetic Predisposition to Disease/genetics ; Haplotypes ; Humans ; Male ; Middle Aged ; Polymorphism, Single Nucleotide/genetics ; Stroke/epidemiology/*genetics

BACKGROUND AND OBJECTIVES: MAGE (melanoma antigen gene) gene, coding for a tumor antigen recognized by cytotoxic T lymphocytes, is expressed specifically in a variety of cancers, but not in normal tissues that exclude those of the testis. Therefore, most studies of MAGE gene are reported for the cancer immunotherapy. There are, however, few reports for the molecular diagnosis of cancers with MAGE gene. The purpose of this study is to evaluate the MAGE common primers in discriminating the malignant from benign lesions of the head and neck. MATERIALS AND METHODS: Reverse transcriptase-polymerase chain reaction (RT-PCR) and the nested PCR with the MAGE common primers (C1/C2, C3/C4) designed to detect MAGE 1-6 genes in this study were conducted in 37 cancer tissues (27 squamous cell carcinomas and 10 nonsquamous cell carcinoma lesions) and 18 benign tumors and 20 normal tissues of the head and neck . The PCR product was also assayed by RT-PCR with the MAGE 1-6 specific primer (M1-M6) to investigate which MAGE isotypes were detected. RESULTS: At least more than one isotype of MAGE 1-6 genes were detected in 70.4% (19/27) of squamous cell carcinomas and 30% (3/10) of non-squamous cell carcinoma lesions. But there was no MAGE expression in 18 benign lesions and 20 normal tissues. CONCLUSION: MAGE common primers designed in this study showed high sensitivity and specificty in discriminating the malignant from benign lesions of the head and neck. This result suggests MAGE gene might be a potential tumor marker in the head and neck cancer.
Carcinoma, Squamous Cell ; Clinical Coding ; Diagnosis ; Head and Neck Neoplasms ; Head* ; Immunotherapy ; Neck* ; Polymerase Chain Reaction ; RNA, Messenger* ; T-Lymphocytes, Cytotoxic ; Testis ; Biomarkers, Tumor

Anti-Bacterial Agents ; Bone Marrow ; Drug Delivery Systems ; Inflammation ; Ischemia ; Mandible ; Necrosis ; Osteomyelitis ; Oxygen ; Plasma ; Polymethyl Methacrylate

OBJECTIVE: To evaluate the validity of quantitative lymphoscintigraphy as a useful lymphedema assessment tool for patients with breast cancer surgery including axillary lymph node dissection (ALND). METHODS: We recruited 72 patients with lymphedema after breast cancer surgery that included ALND. Circumferences in their upper limbs were measured in five areas: 15 cm proximal to the lateral epicondyle (LE), the elbow, 10 cm distal to the LE, the wrist, and the metacarpophalangeal joint. Then, maximal circumference difference (MCD) was calculated by subtracting the unaffected side from the affected side. Quantitative asymmetry indices (QAI) were defined as the radiopharmaceutical uptake ratios of the affected side to the unaffected side. Patients were divided into 3 groups by qualitative lymphoscintigraphic patterns: normal, decreased function, and obstruction. RESULTS: The MCD was highest in the qualitative obstruction (2.76+/-2.48) pattern with significant differences from the normal (0.69+/-0.78) and decreased function (1.65+/-1.17) patterns. The QAIs of the axillary LNs showed significant differences among the normal (0.82+/-0.29), decreased function (0.42+/-0.41), and obstruction (0.18+/-0.16) patterns. As the QAI of the axillary LN increased, the MCD decreased. The QAIs of the upper limbs were significantly higher in the obstruction (3.12+/-3.07) pattern compared with the normal (1.15+/-0.10) and decreased function (0.79+/-0.30) patterns. CONCLUSION: Quantitative lymphoscintigraphic analysis is well correlated with both commonly used qualitative lymphoscintigraphic analysis and circumference differences in the upper limbs of patients with breast cancer surgery with ALND. Quantitative lymphoscintigraphy may be a good alternative assessment tool for diagnosing lymphedema after breast cancer surgery with ALND.
Breast Neoplasms* ; Breast* ; Elbow ; Humans ; Lymph Node Excision ; Lymphedema* ; Lymphoscintigraphy* ; Metacarpophalangeal Joint ; Upper Extremity ; Wrist

No abstract available.
Acute Kidney Injury* ; Thoracic Surgery*

Meningiomas in the clival region are not common. These tumors present some of the most formidable challenges in skull base surgery. Total removal of clival meningoma has carried a significant mortality and morbidity. Several approches and combinations of approaches have been used remove clival meningiomas. Transpetrosal operations have been shown to offer distinct advantages over traditional operations in approaching lesions of the clival area. The authors report a case of a huge clival meningioma that was totally removed using posterior transpetrosal translabyrinthine approach.
Cranial Fossa, Posterior ; Meningioma* ; Mortality ; Skull Base