Being described first 1912 by Hashimoto, Chronic lymphocytic thyroiditis has been most commonly diagnosed as inflammatory thyroid disease. Despite of worldwide reports about the concomitant malignancy with Hashimoto's thyroiditis, the definite incidence of coexsiting malignancy and the etiologic relationship between these different pathologic conditions remains to be brought out. Analyzing 18 cases of coexisting thyroid carcinoma among 80 cases of Hashimoto's thyroiditis, confirmed by pathologic study at Presbyterian medical center in Chonju between 1991 and 1995, the authors intended to make guideline of management for them. The results are as follows: 1. The incidence of coexisting carcinoma with HT was 18/80(22.5%). 2. The average age of patients with coexisting carcinoma was 44.1 years and all of them were female.3. Cold nodules on thyroid scan were noticed in 23 cases(22.7%) of HT and 7 cases(33.8%) of coexisting carcinoma with HT. 4. Calcified lesions on thyroid sonography were detected in 0 cases of HT and 4 cases(50%) of coexisting carcinoma. 5. The pathologic types of carcinoma were papillary(17/18, 94.4%) and follicular(1/18, 5.6%). 6. 3 cases of coexisting carcinoma had metastatic lesions on peritracheal lymph nodes and another 3 cases had on ipsilateral jugular nodes. 7. The carcinoma of smaller than 0.5cm were 7 cases, of 0.6-1.0cm were 3 cases, of 1.1-1.5cm were 5 cases, and so 15 cases(83.3%) were occult carcinoma. Only 3 cases were larger than 1.6cm. 8. Coexisting carcinoma patients with HT underwent subtotal thyroidectomy (4 cases), subtotal thyroidectomy & anterior compartment dissection (ACD, 6 cases), subtotal thyroidectomy & modified RND (2 cases), thyroid lobectomy & ACD (4 cases), thyroid lobectomy & modified RND (1 cases), or near total thyroidectomy & ACD (1 case).
Hashimoto Disease ; Humans ; Incidence ; Jeollabuk-do ; Lymph Nodes ; Protestantism ; Thyroid Diseases ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyroiditis*

Foreign body aspiration into the airway causes airway obstruction that may be acutely life-threatening or if undected result in severe lung damage. In case of bilateral bronchial obstruction, the impairment of gas exchange is usually severe enough to threaten the patient's life. And the gas exchange will become worsen during bronchoscopy. So, anesthesia and bronchoscopy for removal of the foreign body should be carried out by skilled personel with appropriate equipment, especially in case of bilateral bronchial obstruction. A 16 month old, cyanotic and dyspneic female infant was brought to operating room for removal of bronchial foreign bodies . The anesthesia was induced and maintained with enflurane(1-2%) -oxygen(100%)- vecuronium using Jackson- Rees breathing system which was connecting to the side arm of ventilating brochoscope. Foreign bodies (peanut), which were two pieces of peanut 4X4X6 mm sized from right and 4X8X12 mm sized from left main bronchus, were sucessfully removed.
Airway Obstruction ; Anesthesia* ; Arm ; Bronchi* ; Bronchoscopes ; Bronchoscopy ; Female ; Foreign Bodies* ; Humans ; Infant ; Lung ; Operating Rooms ; Respiration ; Vecuronium Bromide

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

BACKGROUND: The wall lift method (W), which was introduced to reduce the adverse effects of CO2 pneumoperitoneum (P), induces an excessive stress response and may be imposed for significant adverse reactions. This study was undertaken to compare the physiologic response of the CO2 pneumoperitoneum and wall lift methods. METHODS: Thirty-two patients were randomly divided into two groups (the P and W). Gastric intramucosal PrCO2, CO2 gap, intramucosal pH (pHi), and plasma concentration of epinephrine and norepinephrine were measured: after the induction of anesthesia, during operation, at the end of the operation, and after operation. Serum concentrations of TNF-alpha and IL-6 were measured at 24 hours before operation, and 24 hours, and 72 hours after operation. The TNF-alpha and IL-6 levels of peritoneal macrophages were also measured. Urine output was measured during operation. RESULTS: PrCO2 and CO2 gap increased during and after the operation in P, and after the operation in W, and pHi decreased during and after operation in P, and after operation in W. Urine output was higher in W. Epinephrine and norepinephrine increased in both groups, but epinephrine was higher in W at the end of the operation. TNF-alpha and IL-6 increased postoperatively and the magnitude of these increases were similar in both groups. The level of TNF-alpha and of IL-6 in peritoneal macrophage were similar in both groups. CONCLUSIONS: We conclude that; CO2 pneumoperitoneum induces intestinal mucosal acidosis, the wall lift method induces more significant stress response, and the magnitude of immune response is similar for both methods.
Acidosis ; Anesthesia ; Cytokines ; Epinephrine ; Humans ; Hydrogen-Ion Concentration ; Interleukin-6 ; Macrophages, Peritoneal ; Norepinephrine ; Plasma ; Pneumoperitoneum* ; Tumor Necrosis Factor-alpha

Light and electron microscopic obserbations of developing heart wall of zebrafish, which has been recently used for developmental studies of many organs, were performed. Heart tissue was obtained from adult and 24, 48 and 72 hour embryos of zebrafish. Heart wall of adult zebrafish was composed of 3 typical layers, endocardium, myocardium and epicardium, as ones of other vertebrates. Heart wall of 24 hour embryo was composed of primitive myocytes. Myofibrils in myocytes at this period was found as assembly of myofilaments, 500~1,000 nm sized and 5~10 layered. Heart of 48 hour embryo has ventricle and atrium. Ventricular wall of was composed of endocardium, myocardium and incomplete epicardium. Atrial wall at 48 hour embryo was composed of endocardium and myocardium. Development of myocytes in ventricle was earlier than those of atrium, and myofibrils with Z disc were found first at 48 hour embryo. Heart wall of 72 hour embryo was morphologically similar to that of 48 hour embryo, but development of myocytes was more progressed. Specific atrial granules of 100~200 nm size appeared very rarely at 24 hour embryo and its numbers increased gradually at 48 and 72 hour embryos in myocytes of atrium as well as the ventricle. Specific atrial granules were consider as ones containing atrial natriuretic peptide (ANP).
Adult ; Embryonic Structures ; Endocardium ; Heart* ; Humans ; Muscle Cells ; Myocardium ; Myofibrils ; Pericardium ; Vertebrates ; Zebrafish*

Introduction: Lung Injury Score (LIS) provides a quantitative method for scoring acute lung injury that usually occurs after sepsis. The aim of this study is to evaluate the LIS in prediction the patients outcome and determine the relationship between the LIS and mortality rate, acute physiology and chronic health evaluation II (APACHE II) score and multiple organ failure (MOF) score. METHODS: Patients admitted to Intensive Care Unit (ICU), Severance Hospital Yonsei University College of Medicine from November 1995 to March 1996 were included. LIS at admission and discharge, APACHE II score with MOF score and duration of ICU stay between survivors and nonsurvivors were compared. Relationship of LIS between mortality rate and APACHE II score and MOF score were evaluated. RESULTS: LIS is higher in nonsurvivors than survivors at admission and discharge with statistical significance. LIS of survivors and nonsurvivors at discharge was lower and higher than those at admission (p<0.05) respectively. Correlation coeffcient of LIS with mortality rate, MOF score and APACHE II score were 0.60 (p<0.05), 0.23 and 0.17. CONCLUSIONS: LIS score was highly correlated with mortality rate. Therefore LIS is a good predictor of outcome in the intensive care unit.
Acute Lung Injury ; APACHE ; Humans ; Intensive Care Units* ; Critical Care* ; Lung Injury* ; Lung* ; Mortality ; Multiple Organ Failure ; Sepsis ; Survivors

Anaphylaxis is an acute onset, potentially fatal systemic allergic reaction. Multiple agents can cause anaphylaxis in the perioperative setting. Ketorolac is a potent analgesic drug and has been widely used for postoperative pain control. A 38-year-old male patient, who had surgery under general anesthesia without any problems, was scheduled for a spinal fusion. There were no problems during anesthesia. In post anesthetic care unit, he was given 30 mg of ketorolac intravenously. After the ketorolac injection, severe hypotension and tachycardia developed and delayed skin rash and wheel appeared. The patient was given epinephrine, antihistamine and steroid. The patient recovered without any significant complications.
Adult ; Anaphylaxis ; Anesthesia ; Anesthesia, General ; Anti-Inflammatory Agents, Non-Steroidal ; Epinephrine ; Exanthema ; Humans ; Hypersensitivity ; Hypotension ; Ketorolac ; Male ; Pain, Postoperative ; Spinal Fusion ; Tachycardia

Behcet's disease is a chronic multi-systemic disease of unknown origin that includes mucocutaneous, ocular, cardiac, vascular, renal, gastrointestinal, neurologic and cutaneous involvement. The disease is spread throughout the world, but it is most prevalent in the eastern Mediterranean region-along the Silk Road-, and in Japan, China, and Korea. Recently, we treated a Mongolian patient who had complete-type Behcet's disease. As far as we know, this case is the first report of a Mongolian with Behcet's disease in the English literature. HLA typing in this patient revealed A2, A24; B51, B35; Cw4, Cw7; DR9, DR11. Study of the MICA genetype showed *5, *6 positive. Our data provided adequate evidence, from an epidemiological aspect, to support the belief that Behcet's disease is most prevalent along the old Silk Road.
Adult ; Alleles ; Behcet Syndrome/*genetics/immunology ; Genotype ; HLA-B Antigens/*genetics ; Histocompatibility Antigens Class I/*genetics ; Human ; Male

Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease that is characterized by multiple tiny flask-shaped outpouching lesions of the esophageal wall. The etiology is unknown, but the pathologic findings include dilatation of excretory ducts of submucosal glands. The predominant symptom is dysphagia, and esophageal stricture occurs frequently. Diseases such as diabetes mellitus, esophageal candidiasis, gastroesophageal reflux disease, and chronic alcoholism are often combined. Since most EIP cases are benign, the mainstream treatment is symptom relief by endoscopic dilatation or medical treatment of accompanied diseases. This report describes the case of a 68-year-old male patient who suffered from chest tightness for 2 months and was diagnosed with EIP. This symptom disappeared after 2 months of medical treatment, and the patient is now being regularly followed up.
Aged ; Alcoholism ; Candidiasis ; Deglutition Disorders ; Diabetes Mellitus ; Dilatation ; Esophageal Neoplasms ; Esophageal Stenosis ; Gastroesophageal Reflux ; Humans ; Male ; Thorax

OBJECTIVE: To estimate false-negative rate of cervical smears in histologically confirmed squamous intraepithelial lesion and squamous cell carcinoma METHOD: From 1993 to 1998, total 186 cases of cervical smear performed within 1 year before histological confirmation squamous intraepithelial lesion and squamous cell carcinoma, were reviewed and the false negative rate of the each group was analyzed. RESULTS: 1. Histologic diagnosis of 186 cases includes 8 cases of low grade SIL, 87 cases of high grade SIL, 91 cases of squamous cell carcinoma. 2. Overall false negative rate was 18.8% (35/186). False negative rate of LSIL was higher (50%; 4/8) compared with the other two groups. (HSIL:23% ;20/87, SCC:12.1% ;11/91) 3. 18 of 35 false negative cases were reviewed. 8 cases(44.4%) were sampling error and 10 cases(55.6%) were interpretation error. 4. Estimated overall sampling error was 8-9% ; interpretation error 10-11%. CONCLUSION: Reducing the false negative rate of cervical smears, especially in cervical intraepithelial neoplasia lesion is important to save the patients from invasive cervical cancer. Further studies on the causes of false negatives and the efforts to eliminate these barriers are actually needed.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Diagnosis ; Humans ; Selection Bias ; Uterine Cervical Neoplasms ; Vaginal Smears*