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*

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

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

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

BACKGROUND: Local anesthetics combined with an opiate are frequently used as a postoperative epidural PCA regimen. Ropivacaine is known to have a selective blockade of the sensory nerve without motor blockade. This study is designed to show advantages of ropivacaine over bupivacaine. METHODS: Patients undergoing elective abdominal and orthopedic surgeries were randomly selected and divided into two groups, B and R. The patients in group B and R received 0.2% bupivacaine and 0.2% ropivacaine respectively through an epidural catheter using a PCA pump. Both local anesthetic solutions were mixed with 4 microgram/ml of fentanyl. The PCA pumps of both groups were set in the same manner. A basal rate of 2 ml/hr was infused from 1hour after the onset of surgery. This basal rate was continued postoperatively. A bolus dose and lock out time were set at 2 ml and 20 minutes respectively. The Visual analogue pain scale (VAS), demand dose, complication and additional intramuscular analgesic requirements were checked up to 24 hours after surgery in 6-hour interval. RESULTS: The VAS was significantly lower in group R than in group B at 6, 12, 18 and 24 hours after the surgery (P < 0.05). Total additional bolus doses of the PCA pump were not significantly different in either group at 6, 12, 18 and 24 hours after surgery. The patients in group R showed more satisfaction and less additional intramuscular injections. CONCLUSIONS: 0.2% Ropivacaine, mixed with 4microgram/ml of fentanyl, was more effective than bupivacaine, mixed with the same concentration of fentanyl, in controlling postoperative pain using an epidural PCA pump.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthetics, Local ; Bupivacaine* ; Catheters ; Fentanyl ; Humans ; Injections, Intramuscular ; Orthopedics ; Pain Measurement ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis

BACKGROUND/AIMS: This study assessed the antiviral efficacy and safety of tenofovir disoproxil fumarate (TDF) for up to 12 months in Korean treatment-naive chronic hepatitis B (CHB) patients. METHODS: A total of 411 treatment-naive CHB patients who had been treated with TDF for at least 3 months (median 5.6) were consecutively enrolled. Clinical, biochemical, virological parameters and treatment adherence were routinely assessed every 3 months. RESULTS: The median age was 51.3 years, 63.0% of the patients were male, 49.6% were HBeAg (+), and 210 patients had liver cirrhosis. The median baseline HBV DNA was 5.98 (SD 1.68) log10 IU/mL. Among the patients completing week 48, 83.3% had a complete virologic response (CVR, <12 IU/mL by HBV PCR assay), and 88.2% had normalized levels of alanine aminotransferase (ALT). The cumulative probabilities of CVR at 3, 6, 9 and 12 months were 22.8%, 53.1%, 69.3% and 85.0%. During the follow-up period, 9.8% patients achieved HBeAg loss and 7.8% patients achieved HBeAg seroconversion. There was no virological breakthrough after initiating TDF. The most common TDF-related adverse event was gastrointestinal upset, and three patients discontinued TDF therapy. However, no serious life-threatening side effect was noted. CONCLUSIONS: In a clinical practice setting, TDF was safe and highly effective when administered for 12 months to Korean treatment-naive CHB patients.
Adenine/adverse effects/*analogs & derivatives/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Antiviral Agents/adverse effects/*therapeutic use ; Cohort Studies ; DNA, Viral/blood ; Female ; Gastrointestinal Diseases/epidemiology/etiology ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*drug therapy/virology ; Humans ; Liver Cirrhosis/etiology ; Male ; Middle Aged ; Organophosphonates/adverse effects/*therapeutic use ; Republic of Korea ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: This study aimed to evaluate the prognostic value of each component of the revised American Fertility Society (rAFS) classification system for the first recurrence of endometriosis after conservative laparoscopy. MATERIALS AND METHODS: As this was a retrospective cohort study, data were collected by reviewing medical records. A total of 379 women ages 18 to 49 years were included. Women who underwent conservative laparoscopy with histologic confirmation of endometriosis at Gangnam Severance Hospital between March 2003 and May 2010 were included. Individual components of the rAFS classification system as well as preoperative serum CA-125 levels were retrospectively analyzed to assess their prognostic values for recurrence of endometriosis. RESULTS: Of 379 patients, 80 (21.2%) were found to have recurrence of endometriosis. The median duration of follow-up was 19.0 months, and the mean age at the time of surgery was 31.8+/-6.7 years. In endometriosis of advanced stage, younger age at the time of surgery, bilateral ovarian cysts at the time of diagnosis, a rAFS ovarian adhesion score >24, and complete cul-de-sac obliteration were independent risk factors of poor outcomes, and a rAFS ovarian adhesion score >24 had the highest risk of recurrence [hazard ratio=2.948 (95% CI: 1.116-7.789), p=0.029]. CONCLUSION: Our results suggest that of the rAFS adnexal adhesion scores, the ovarian adhesion score rather than the tubal adhesion score was associated with a significantly increased risk of recurrent endometriosis. The preoperative serum CA-125 level may be also a significant prognostic factor for recurrence, as known. However, it seemed to only have borderline significance in affecting recurrence in the current study.
Adolescent ; Adult ; Cohort Studies ; Endometriosis/*classification/*surgery ; Female ; Fertility ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Laparoscopy/*methods ; Middle Aged ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; *Tissue Adhesions ; Treatment Outcome ; United States