PURPOSE: The rate of malignancy in the follicular neoplasm (FN) or Hürthle cell neoplasm (HCN) of the thyroid gland is estimated as approximately 20~30%. Fine-needle aspiration biopsy (FNAB) and frozen section examination are restricted in differentiating between benign and malignant. The aims of this study are to compare the differences of clinicopathologic features and to determine the risk factors for malignancy in patients with FN or HCN. METHODS: A retrospective study was conducted of patients with FN or HCN who were diagnosed by FNAB, and underwent surgery at our institution between Jan. 2005 to Jun. 2010. We analyzed the risk factors for malignancy and the differences of clinicopathologic features in patients with FN or HCN. RESULTS: A total of 290 patients were enrolledin this study; 160 (55.2%) patients underwent thyroidectomy, 97 (60.6%) patients had FN, and 63 (39.4%) had HCN. Forty one (25.6%) patients were diagnosed as malignancy of these, 22 (22.7%) patients were FN and 19 (30.2%) were HCN (P=0.29). Two (2.1%) patients with FN and 10 (15.9%) with HCN (P=0.002) comcomitant papillary thyroid carcinoma were indentified by FNAB. Classification of nodules according to ultrasonographic findings in both neoplasms (P<0.05) and galectin-3 in FN (P<0.05) were predictive factors for malignancy. In addition, galectin-3 was a predictive factor for malignancy in indeterminate nodules on ultrasonography (USG) (P=0.028). CONCLUSION: Classification of nodules according to ultrasonographic findings and galectin-3 expression is helpful in predicting carcinoma of patients with FN or HCN.
Biopsy, Fine-Needle ; Classification ; Frozen Sections ; Galectin 3 ; Humans ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography

Thyrotoxic periodic paralysis (TPP) is a transient illness characterized by muscle weakness often associated with hypokalemia during thyrotoxic state. Hypokalemia is induced by thyroid hormone excess through stimulation of Na-K ATPase which pumps extracellular potassium ions into the cell. Muscle weakness resolves when serum potassium level is corrected, but the condition may recur when there is thyrotoxicosis. TPP is most commonly reported in Asian males aged between 20 to 40 years and it is rare in children and adolescents. We report a 16-year-old patient previously diagnosed with Graves' disease who showed recurrent episodes of TPP.
Adenosine Triphosphatases ; Adolescent ; Aged ; Asian Continental Ancestry Group ; Child ; Graves Disease ; Humans ; Hyperthyroidism ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Ions ; Male ; Muscle Weakness ; Paralysis ; Potassium ; Thyroid Gland ; Thyrotoxicosis

Thyrotoxic periodic paralysis (TPP) is a transient illness characterized by muscle weakness often associated with hypokalemia during thyrotoxic state. Hypokalemia is induced by thyroid hormone excess through stimulation of Na-K ATPase which pumps extracellular potassium ions into the cell. Muscle weakness resolves when serum potassium level is corrected, but the condition may recur when there is thyrotoxicosis. TPP is most commonly reported in Asian males aged between 20 to 40 years and it is rare in children and adolescents. We report a 16-year-old patient previously diagnosed with Graves' disease who showed recurrent episodes of TPP.
Adenosine Triphosphatases ; Adolescent ; Aged ; Asian Continental Ancestry Group ; Child ; Graves Disease ; Humans ; Hyperthyroidism ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Ions ; Male ; Muscle Weakness ; Paralysis ; Potassium ; Thyroid Gland ; Thyrotoxicosis

Fetal cystic hygromas are congenital malformations of the lymphatic system manifested as single or multiloculated fluid-filled cavities in the neck region. Cystic hygroma is characterized by cystic appearance of posterior or lateral portion of the neck. A case of cystic hygroma, diagnosed antenatally by ultrasound at the 11(+1)th week of pregnancy and confirmed by autopsy, is presented with a brief review of literatures.
Autopsy ; Gestational Age* ; Lymphangioma, Cystic* ; Lymphatic System ; Neck ; Pregnancy ; Ultrasonography

Fifty nine patients who had been admitted to Seoul National University Hospital from April to October in 1986 were prospectively examined by a pulsed Doppler echocardiography on one day before cardiac catheterization. The sample volume was placed both just proximal and distal to pulmonic valve on 2-D echocardiogram. 1) Among the three morphologic patterns of the flow velocity, triangular and intermediate types indicate pulmonary hypertension (sensitivity 84%, specificity 86%), and round type indicates normal pulmonary arterial pressure (sensitivity 86%, specificity 84%). 2) In the group with pulmonary hypertension acceleration time and ejection time were measured shorter (P<0.01), and prejection period was measured longer than the group without pulmonary hypertension (P<0.05). 3) The best correlation was obtained between PEP/AT and mean pulmonary arterial pressure (r=0.77). Acceleration time alone also correlated well with mean arterial pulmonary pressure(r=-0.69). 4) In STI measurement and its correlation with pulmonary arterial pressure, no significant difference was observed when recorded in main pulmonary artery or right ventricular outflow tract. But in the latter position, late, systolic fluttering and variation in curve morphology occured less likely. 5) Our results indicate that the pulsed Doppler echocardiography is useful not only in the diagnosis of pulmonary hypertension but also in the quantitative estimation of pulmonary arterial pressure in different heart diseases. Futhermore this method may be a good tool for follow-up evaluation after surgical or medical treatment of patients with pulmonary hypertension.
Acceleration ; Arterial Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Humans ; Hypertension, Pulmonary ; Prospective Studies ; Pulmonary Artery ; Sensitivity and Specificity ; Seoul

Adult ; Anesthesia ; Colloids ; Dizziness ; Equidae ; Fluid Therapy ; Headache ; Humans ; Orthognathic Surgery ; Postoperative Period ; Pulmonary Edema ; Surveys and Questionnaires ; Sleep Stages ; Surgery, Oral ; Thirst

PURPOSE: The insulin-like growth factor II (IGF-II) gene expresses a family of transcripts in embryonic/fetal tissue, and also highly was expressed during hepatocellular carcinogenesis. In this study, we showed that IGF-II mRNA and protein levels are detected in rat embryo, HepG2 human hepatoma cells and Chang liver cells. MATERIALS AND METHODS: This study included sections of rat embryos 7~17 days post coitum (d.p.c), HepG2 cells and Chang liver cells. Using immunohistochemistry, Northern blotting and Western blotting, we observed the expression of IGF-II in the rat embryo, HepG2 cells and Chang liver cells. RESULTS: We localized IGF-II gene products in sections of rat embryo 7~17 d.p.c by performing immunohistochemistry. The IGF-II was mainly expressed in the proximal endoderm and ectoplacental cone between 7 and 9 d.p.c. At 10 d.p.c. the expression was localized at the heart primodium as well as the proximal endoderm, and at 11 d.p.c. the IGF-II was expressed in the liver and heart. After 12 d.p.c. and 14 d.p.c., the expression was also detected in the brain, muscle and bone, and head mesenchyme, respectively. While the expression of IGF-II protein was not detected in the normal adult liver, intense staining was detected in the heart, liver and choroids plexus at 17 d.p.c. CONCLUSION: These results suggest that IGF-II may act as an oncofetal protein during hepatocellular carcinogenesis and embryogenesis.
Adult ; Animals ; Blotting, Northern ; Blotting, Western ; Brain ; Carcinogenesis ; Carcinoma, Hepatocellular* ; Choroid ; Embryonic Development ; Embryonic Structures* ; Endoderm ; Female ; Head ; Heart ; Hep G2 Cells ; Humans ; Immunohistochemistry ; Insulin-Like Growth Factor II* ; Liver ; Mesoderm ; Pregnancy ; Rats* ; RNA, Messenger

INTRODUCTION: Recent investigations have demonstrated that citrus red mite is a common sensitizing allergen in children and adults living in rural areas of Cheju island. OBJECTIVE: The aims of this study were to evaluate the sensitization rate to the citrus red mite and to determine the risk factors for this sensitization in adolescents living in rural areas of Cheju island. SUBJECTS AND METHODS: A total of 3,395 adolescents (from ages 13 to 15 years old) living in rural areas of Cheju island were enrolled in this study. Each subject was evaluated by a modified ISAAC questionnaire, and a skin prick test with 11 common inhalant allergens including citrus red mite. RESULTS: On skin prick test the most common sensitizing allergen was D. pteronyssinus (27.9%), followed by D. farinae (23.9%), citrus red mite (18.3%), and cockroach (16.7%). Sensitization rate to citrus red mite was higher in those living near citrus orchards than in those living far from the orchards, and higher in those visiting citrus orchards more frequently than in those visiting less frequently. CONCLUSION: Citrus red mite is a common sensitizing allergen in adolescents living in rural areas of Cheju island. The sensitization rate to citrus red mite may be partially determined by environ- mental exposure.
Adolescent* ; Adult ; Allergens ; Child ; Citrus* ; Cockroaches ; Humans ; Jeju-do* ; Mites* ; Risk Factors* ; Skin ; Surveys and Questionnaires

PURPOSE: In order to evaluate the efficacy of PEFL (cisplatin, etoposide, 5-fluorouracil and leucovorin) chemotherapy and to identify favorable subsets, we conducted a phase II trial of PEFL regimen for patients with carcinomas of unknown primary origin (CUPO). MATERIALS AND METHODS: A total of 38 patients was enrolled in this study between May 1995 and September 1997. CUPO was defined as the presence of metastatic cancer documented in the absence of an identifiable primary site. All entered patients were treated with PEFL combination chemotherapy (cisplatin 20 mg/m(2)/day i.v, days 1-5, etoposide 100 mg/m(2)/day i.v. days 1, 3 & 5, 5-fluorouracil 800 mg/m(2)/day continuous infusion days 1-5, and leucovorin 20 mg/m(2)/day i.v, days 1-5; repeated every 4 weeks). The end points of this study were response and survival. To identify favorable subsets, univariate and multivariate analyses were perfonned. RESULTS: Among 38 patients, 29 had measurable lesions. Three (11%) out of 27 evaluable patients had a complete response and 7 (26%) had a partial response (response rate 37%; 95% confidence interval 19~55%). The median survival of the total 38 enrolled patients was 9.1 (range; 1~21.9+) months. The median progression-free survival of the 27 evaluable patients was 5.3 (range 0~ 16.0) months. Among total 132 cycles of chemotherapy, leukopenia of grade II or more was observed in 15% and thrombocytopenia of grade I in 4%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting (79%), stomatitis (70%), and neurotoxicity (33%). The prognostic factor analyses identified 2 favorable subgroups; One was the patient group whose disease had poorly differentiated histology and presented in cervical lymph node. This group of patients had better response rate than other patients (response rate; 71% vs 25%, p=0.02). The other was the patient group who had normal tumor markers (CEA, CA 125 and CA 19-9). This group of patients had better survival than other patients(median survival; 14.8 vs 8.4 months, p=0.05). CONCLUSION: PEFL chemotherapy seemed to be moderately active and tolerable in patients with CUPO. Among heterogenous patients with CUPO, the subset with cervical lymph node and poorly differentiated histology responded better to the chemotherapy and those with normal tumor markers tended toward longer survival.
Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Fluorouracil ; Humans ; Leucovorin ; Leukopenia ; Lymph Nodes ; Multivariate Analysis ; Stomatitis ; Thrombocytopenia ; Biomarkers, Tumor

BACKGROUND: This study is to evaluate the safety of ATS valve by examining the clinical results of ten-years experience. MATERIAL AND METHOD: From July 1995 to March 2005, we reviewed 305 patients with ATS valve implantation. Mean age was 49.8+/-11.7 years and 140 (45.6%) males were included. Etiologies were rheumatic diseases in 207 cases (67.4%), degenerative changes in 57 cases (18.6%), valve dysfunction in 23 cases (7.5%) and infective endocarditis in 14 cases (4.6%). AVR was performed in 72 patients (23.5%), MVR in 156 patients (50.8%), DVR (AVR+MVR) in 63 patients (20.5%) and TVR in 16 patients (5.2%). RESULT: There were 9 operative mortalities (2.9%). Follow up period was 56.5+/-34.0 (0~115) months and 96.4% patients were followed up with 9 late deaths. Five and ten years survival rates were 94.9 +/-1.3%, 91.2+/-2.3% using Kaplan-Meier's methods. Valve related event free survival rates in 5 and 10 years were 90.8+/-2.0% and 86.9+/-3.2%. There were 16 anticoagulation-related hemorrhages, 6 thromboembolisms, 3 prosthetic valve endocarditis and 1 paravalvular leakage. NYHA class improved after operation (p <0.05). Postoperative echocardiography showed significant decrease in LA size, LVEDD and LVESD (p <0.01). Patients with 19 and 21 mm valve showed significantly higher transvalvular pressure gradient in aortic position (p <0.001, p <0.001). CONCLUSION: ATS valve showed good hemodynamic results with few valve related complications and thus can be used with acceptable risk.
Disease-Free Survival ; Echocardiography ; Endocarditis ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Mortality ; Rheumatic Diseases ; Survival Rate ; Thromboembolism