Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

Purpose: We report two cases of tacrolimus-related transplant-associated thrombotic microangiopathy (TA-TMA) retinopathy in leukemia patients who had undergone allogenic peripheral blood stem cell transplantation (PBSCT).Case summary: (Case 1) A 58-year-old woman with a history of PBSCT due to acute myelocytic leukemia and taking tacrolimus was referred to the ophthalmology clinic with visual disturbance. Her visual acuity (VA) was 0.4 in the right eye and 0.5 in the left eye. Multiple cotton wool spots and retinal hemorrhages were found in both eyes on fundus examination. Multiple capillary non-perfusions were seen on fluorescein angiography (FA). Tacrolimus-related TA-TMA retinopathy was suspected. Tacrolimus was discontinued and plasmapheresis was performed. After 3 months, neovascular glaucoma developed and her VA became “counting fingers” at 20 cm in both eyes. (Case 2) A 20-year-old man with a history of PBSCT due to acute lymphocytic leukemia and taking tacrolimus was referred to our clinic because of decreased VA in both eyes. His VA was 0.05 in the right eye and 0.025 in the left eye. Fundus and FA findings were the same as in Case 1, and the patient was suspected to have tacrolimus-related TA-TMA retinopathy. Tacrolimus was discontinued and plasmapheresis was performed. His VA was 0.2 in the right eye and 0.4 in the left eye at 1 month after treatment. Conclusions It is necessary to consider TA-TMA retinopathy in leukemia patients taking calcineurin inhibitors, such as tacrolimus, who have decreased VA. Early diagnosis and treatment are important.

The purpose of this study is to propose learning objectives in social dental hygiene by analyzing and reviewing learning objectives in oral health administration area of the existing public oral health. This study is a cross-sectional study. The subjects of the study selected with convenience extraction were 15 members of the social dental hygiene subcommittee of the Korean Society of Dental Hygiene Science. Data collection was conducted by self-filling questionnaire. The research tool is from 48 items of A division in the book of learning objectives in the dental hygienist national examination, and this study classified each of them into ‘dental hygiene job relevance’, ‘dental hygiene competency relevance’, ‘timeliness’, and ‘value discrimination of educational goal setting’ to comprise 192 items. Also, to collect expert opinions, this study conducted Delphi survey on 7 academic experts. Statistical analysis was performed using the IBM SPSS Statistics ver. 23.0 program (IBM Co., Armonk, NY, USA). Recoding was performed according to the degree of relevance of each learning objective and frequency analysis was performed. This study removed 18 items from the whole learning objectives in the dental hygienist national examination in the oral health administration area of public oral health. Fifteen revisions were made and 15 existing learning objectives were maintained. Forty-five learning objectives were proposed as new social dental hygiene learning objectives. The topics of learning objectives are divided into social security and medical assistance, oral health care system, oral health administration, and oral health policy. As a result of this study, it was necessary to construct the learning objectives of social dental hygiene in response to changing situation at the time. The contents of education should be revised in order of revision of learning objectives, development of competency, development of learning materials, and national examination.
Cross-Sectional Studies ; Data Collection ; Dental Hygienists ; Discrimination (Psychology) ; Education ; Expert Testimony ; Humans ; Hygiene ; Learning* ; Medical Assistance ; Oral Health* ; Oral Hygiene* ; Social Security

Drug-eluting stents (DES) dramatically reduce the rate of restenosis and the need for repeat revascularization. Despite these promising results, stent thrombosis seems to occur more frequently with DES and often seems to be associated with premature discontinuation of antiplatelet agents. We experienced a case of recurrent stent thrombosis with separate lesions. Recurrent stent thrombosis is a very rare event, and simultaneous stent thrombosis is also rare. Here, we report a case of recurrently developing stent thrombosis involving separate lesions.
Coronary Thrombosis ; Coronary Vessels ; Drug-Eluting Stents ; Platelet Aggregation Inhibitors ; Stents ; Thrombosis

Type B insulin resistance syndrome is rare autoimmune disease that is characterized by various abnormalities of glycemic homeostasis, from hyperglycemia caused by extreme insulin resistance to fasting hypoglycemia. It can combine with other autoimmune diseases, most commonly systemic lupus erythematosus. It usually occurs in women and accompanies acanthosis nigricans, hyperandrogenism, and, in many cases, ovary dysfunction. The diagnosis of type B insulin resistance syndrome is based largely on the presence of insulin receptor autoantibodies and hyperglycemia, or hypoglycemia and hyperinsulinemia. In some cases, patients with the type B insulin resistance have been successfully treated with immunosuppressive therapy and plasmapheresis. We experienced type B insulin resistance syndrome in a patient with chronic hepatitis B and used only plasmapheresis for treatment. The immunosuppressive therapy was omitted due to the state of activation of chronic hepatitis B. We present this case with a review of relevant literature.
Acanthosis Nigricans ; Autoantibodies ; Autoimmune Diseases ; Female ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Homeostasis ; Humans ; Hyperandrogenism ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Insulin ; Insulin Resistance ; Lupus Erythematosus, Systemic ; Ovary ; Plasmapheresis ; Receptor, Insulin

BACKGROUND: Since May 2009, a pandemic influenza A (H1N1) virus has emerged and spread nationwide. We describe the epidemiological characteristics of the confirmed deaths related with the 2009 H1N1 influenza pandemic in Korea from May 2009 to mid December 2009. METHODS: This study was based on an analysis of the reports from the deaths of confirmed cases pandemic H1N1 virus until 7 December 2009 in Korea. These reports were compiled by the epidemic intelligence team at the Korea Centers for Disease Control & Prevention (KCDC) or at the provinces. The epidemic intelligence team used an identical, well-defined investigate form for reviewing the medical records and for interviewing the physicians in charge of the cases. RESULTS: The first confirmed death occurred on August 15, 2009. Until December 7, 2009, 139 deaths had been reported. Eighty cases (57.6%) were individuals more than 60 years old. Sixty two cases (47.0%) were dead within 7 days from the onset of symptoms. One hundred three cases (74%) had underlying diseases, and cancer was the most common underlying disease. The proportion of patients using antivial medications before confirmation among the patients with underlying diseases was greater than the proportion of patients using antivial medications among the patients with no underlying diseases. CONCLUSIONS: During the evaluation period, serious underlying diseases were present in nearly three quarters of the cases of confirmed death. We suggest that health providers consider using antiviral drugs before confirmation of pandemic H1N1 in hospitalized patients, and especially in those with underlying diseases.
Antiviral Agents ; Centers for Disease Control and Prevention (U.S.) ; Fees and Charges ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Intelligence ; Korea ; Medical Records ; Pandemics ; Viruses

STUDY DESIGN: Retrospective study. PURPOSE: To more accurately determine the incidence and clarify risk factors. OVERVIEW OF LITERATURE: Superior mesenteric artery syndrome is one of the possible complications following correctional operation for scoliosis. However, when preliminary symptoms are vague, the diagnosis of superior mesenteric artery syndrome may be easily missed. METHODS: We conducted a retrospective study using clinical data from 118 patients (43 men and 75 women) who underwent correctional operations for scoliosis between September 2001 and August 2007. The mean patient age was 15.9 years (range 9~24 years). The risk factors under scrutiny were the patient body mass index (BMI), change in Cobb's angle, and trunk length. RESULTS: The incidence of subjects confirmed to have obstruction was 2.5%. However, the rate increased to 7.6% with the inclusion of the 6 subjects who only showed clinical symptoms of obstruction without confirmative study. The BMI for the asymptomatic and symptomatic groups were 18.4+/-3.4 and 14.6+/-3, respectively. The change in Cobb's angle for the asymptomatic and symptomatic groups were 24.8+/-13.6degrees and 23.4+/-9.1degrees, respectively. The change in trunk length for the asymptomatic and symptomatic groups were 2.3+/-2.1 cm and 4.5+/-4.8 cm, respectively. Differences in Cobb's angle and the change in trunk length between the two groups did not reach statistical significance, although there was a greater increase in trunk length for the symptomatic group than for the asymptomatic group. CONCLUSIONS: Our study shows that the incidence of superior mesenteric artery syndrome may be greater than the previously accepted rate of 4.7%. Therefore, in the face of any early signs or symptoms of superior mesenteric artery syndrome, prompt recognition and treatment are necessary.
Body Mass Index ; Humans ; Incidence ; Male ; Mesenteric Artery, Superior ; Retrospective Studies ; Risk Factors ; Scoliosis ; Superior Mesenteric Artery Syndrome

BACKGROUND AND OBJECTIVES: Cancer of the thyroid is the sixth common cancer in Korea, and fourth common among the Korean women, in particular. Aming the prevalent carcinomas of thyroid, the papillary thyroid carcinoma is the most frequent type. Genomic instability is the characteristic of nearly all tumors as well as thyroid cancers. However, despite the high frequency of papillary thyroid carcinomas, their chromosomal alterations are poorly characterized in Korea. Comparative genomic hybridization (CGH) is a new fluorescence in situ hybridization (FISH) technique to identify genomic imbalances in cancers. In this study, CGH was carried out with the aim of analyzing non-random chromosomal aberrations involved in papillary thyroid carcinomas. MATERIALS AND METHOD: CGH was carried out. Biotin-labeled tumor DNA and digoxigenin-labeled normal DNA were co-hybridized to normal metaphase cells. Then, the ratio of fluorescence was analyzed by an image analyzer. In array-CGH, Cy3 labeled tumor DNA and Cy5 labeled normal DNA were hybridized to microarray template, and then image analysis was performed by microarray image analyzer. RESULTS: Gains of 22q13, 6p24, 7p13, 7q21, 7q31, 8q24, 17q24 and 19p13.3 were found frequently. CONCLUSION: Non-random aberrations which were disclosed in this study might be candidate regions for the abnormal genes involved in papillary thyroid cancer.
Carcinoma, Papillary* ; Chromosome Aberrations* ; Comparative Genomic Hybridization* ; DNA ; Female ; Fluorescence ; Genomic Instability ; Humans ; Hybridization, Genetic ; In Situ Hybridization ; Korea ; Metaphase ; Thyroid Gland* ; Thyroid Neoplasms

BACKGROUND: Cardiovascular disease (CVD), especially ischemic heart disease (IHD) and vascular access occlusion (VAO) is the most common morbidity in dialysis patients. Hyperhomocysteinemia (HHcy) is regarded as an independent risk factor of atherosclerosis in general population, however clinical implication of HHcy in dialysis patients is controversial. Nutritional status of dialysis patients is also known to be closely linked to CVD. METHODS: To investigate the impact of the presence of HHcy and malnutrition on cardiovascular events, especially ischemic heart disease (IHD) and vascular access occlusion (VAO). We measured plasma levels of Hcy and other biochemical parameters with an evaluation of nutritional status using subjective global assessment (SGA) in 44 HD patients and gender-matched control subjects of comparable age. RESULTS: Mean plasma Hcy was 18.6 microM/L (range 5-28), which was significantly higher than normal control (8.6+/-2.0 microM/L, p< 0.05). There was no significant correlation between plasma Hcy and the levels of folate or vit B12. Mean Hcy was significantly higher in patients with normal nutritional status compared to mild-to-moderately malnourished patients (22.0+/-3.2 vs. 15.1+/-4.1 microM/L, p<0.05), and there was a significant positive correlation of Hcy level with serum albumin or nPNA. There was no significant difference in plasma Hcy level according to the presence of IHD or VAO. However, interestingly, in HD patients group with lower serum albumin (<3.9 g/ dL), frequency of VAO was significantly correlated with Hcy (r2=0.68, p<0.001) whereas no significant correlation was observed in patients with higher albumin level. CONCLUSION: The clinical implication of HHcy in HD patients may be different from general healthy population. Nutritional status can be one of the important factors influencing plasma Hcy level. And, high plasma level of Hcy in malnourished HD patients has to be carefully followed up in terms of the development of atherosclerotic CVD and VAO.
Atherosclerosis ; Cardiovascular Diseases ; Dialysis ; Folic Acid ; Humans ; Hyperhomocysteinemia* ; Malnutrition ; Myocardial Ischemia ; Nutritional Status* ; Plasma ; Renal Dialysis* ; Risk Factors ; Serum Albumin

We report an unusual case of adult minimal change nephrotic syndrome relapsed after 15-year of complete remission. In this case, the disease had occurred to the patient for the first time when he was 52 years old; relatively high age, and had been remitted with steroid therapy. After 15 years of complete remission, he visited our hospital with the symptoms of the generalized edema and the pitting edema of both lower extremities that occurred 15 days ago. Massive proteinuria(15, 865 mg/day) and hypoalbuminemia(1.7 g/dL) were detected. The pathologic evaluation of the biopsied specimen of the kidney showed the global sclerosis in 19% of glomeruli in light microscopic finding and the fusion of epithelial foot processes in electron microscopic finding. He was treated with pulse steroid therapy (methylprednisolone 500 mg/day iv for 3 days) and then, with oral prednisolone (60 mg/day). Generalized edema and proteinuria disappeared after 14 days of treatment, and there has been no relapse ever since. Adult-onset minimal change nephrotic syndrome relapses within 4 years after complete remission in 90 % of relapsed patients. The relapse after more than 5 years of complete remission, like this case, is very rare, especially in the case of late-onset disease. However, the possibility of relapse of the minimal change nephrotic syndrome after several years of its remission should be considered constantly and the long-term follow-up more than 10 years may be needed.
Adult ; Edema ; Follow-Up Studies ; Foot ; Humans ; Kidney ; Lower Extremity ; Middle Aged ; Nephrosis, Lipoid* ; Prednisolone ; Proteinuria ; Recurrence ; Sclerosis