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: The renin-angiotensin-aldosterone system activation has been suggested as a potential risk factor for renal progression in autosomal dominant polycystic kidney disease (ADPKD). This study was performed to evaluate urinary angiotensinogen as a biomarker of renal progression in ADPKD. METHODS: Patients with estimated glomerular filtration rate (eGFR) > or =30 mL/min/1.73m2 were enrolled in the study. Specimens (blood and urine) and computed tomography (CT) were taken from each subject. The eGFR was calculated by 4-variable MDRD equation and total kidney volume (TKV) was measured from CT images by modified ellipsoid method. Urinary angiotensinogen (AGT) and neutrophil gelatinaseassociated lipocalin (NGAL) were measured by ELISA. The concentration of AGT was adjusted with random urine creatinine (Cr). The association between urinary biomarkers, TKV and eGFR were evaluated. RESULTS: A total of 59 (M:F=31:28) subjects were enrolled in the study and their mean age was 46 years. The eGFR and TKV at the enrollment were 77.3+/-15.6 mL/min/1.73m2 and 1389.8+/-925.1 mL, respectively. Log AGT/Cr was associated with TKV (r2=0.117, p=0.01) in the earlier stage of disease (TKV<3,000 mL). However, it did not show significant correlation with eGFR. Log NGAL was not associated with either TKV or eGFR. Urinary AGT/Cr was closely related to the number of anti-hypertensive medication, TKV, and the presence of albuminuria, although there was no correlation with plasma renin activity or aldosterone level. CONCLUSION: Urinary angiotensinogen may be a useful biomarker of disease progression in ADPKD patients.
Albuminuria ; Aldosterone ; Angiotensinogen ; Biomarkers ; Creatinine ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Glomerular Filtration Rate ; Humans ; Kidney ; Lipocalins ; Neutrophils ; Organ Size ; Plasma ; Polycystic Kidney Diseases ; Polycystic Kidney, Autosomal Dominant ; Renin ; Renin-Angiotensin System

Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.
Alkalies ; Child ; Dilatation ; Eating* ; Esophageal Stenosis* ; Esophagus ; Humans ; Inflammation ; Lye* ; Middle Aged ; Mitomycin* ; Mucous Membrane ; Stents*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

PURPOSE: This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. METHODS: The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. RESULTS: In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. CONCLUSION: Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.
Bronchiolitis ; Child* ; Cough ; Dyspnea ; Epidemiology ; Fluorescent Antibody Technique, Direct ; Humans ; Lung ; Medical Records ; Prevalence ; Respiratory Sounds ; Respiratory Syncytial Viruses* ; Respiratory System* ; Respiratory Tract Infections* ; Seasons ; Thorax ; Ventilators, Mechanical

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*

Crohn 's disease is characterized by a chronic relapsing inflammation of the bowel in which pro-inflammatory cytokines play an important role. Rebamipide is an anti-gastric ulcer drug with anti-inflammatory properties in vivo and in vitro. The effects of rebamipide on Crohn 's disease have not been carefully evaluated. This study investigated the potential of rebamipide to protect Crohn 's disease using a murine model of colitis induced by trinitrobenzene sulfonic acid (TNBS). Rebamipide dramatically improved histopathological symptom involving myeloperoxidase (MPO)activation and increase of microscopic damage score in TNBS induced colitis. Rebamipide suppressed IL-8 secretion, ICAM-1 induction and nuclear factor-kappaB (NF-kappaB) activation by TNF-alpha and induced heme oxygenase-1(HO-1)in HT-29 cells. HO-1 inducer cobalt protoporphyrin IX (CoPPIX)suppressed NF-kappaB activation by TNF-alpha in HT-29 cells like rebamipide, and mimicked the protective effects of rebamipide on TNBS induced colitis. This suggests that rebamipide exerts anti-inflammatory effects by down-regulating NF-kappaB activity via inducting HO-1 expression. In conclusion, this study suggests that rebamipide represents a potential therapeutic agent and HO-1 is an important therapeutic target for the treatment of Crohn's disease.
Cobalt ; Colitis ; Colon* ; Crohn Disease ; Cytokines ; Down-Regulation* ; Heme Oxygenase (Decyclizing)* ; Heme* ; HT29 Cells ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interleukin-8 ; NF-kappa B* ; Peroxidase ; Tumor Necrosis Factor-alpha ; Ulcer

An intussusception in adulthood is an unusual cause of bowel obstruction. It accounts for up to 5% of all intussusception. Approximately 90% of cases are secondary to a definite lesion such as malignancy or lipoma. Most patients are asymptomatic and the lesion is often detected incidentally at colonoscopy, operation and autopsy. Strangulated intussuscetion is a rare case and also requires emergency operation. A 32-year-old woman visited our emergency room because of severe epigastric pain. Abdominal CT revealed a low density mass in bowel loop and distended small bowel loops filled with fluid. Colonoscopic finding showed huge purple-colored coil-spring lesion in the ascending colon. From this findings, we diagnosed a strangulated intussusception. Surgically removed specimen revealed a small intestinal lipoma.
Adult ; Male ; Female ; Humans

Heme oxygenase-1 (HO-1) is a stress-inducible enzyme with anti-inflammatory activity, but the mechanisms underlying this activity are incompletely understood. Nuclear transcription factor kappa B (NF-kappa B) activation is an important factor in the pathogenesis of inflammatory bowel disease (IBD). We investigated the suppressive effects of HO-1 on the activation of NF-kappa B by pro-inflammatory cytokines in cultured colonic epithelial cells and by trinitrobenzene sulfonic acid (TNBS) in the colon of mice. The expression level of HO-1 in the colonic epithelium of a patient with inflammatory bowel disease and pseudo-membranous colitis was lower than that in a healthy control subject. In cultured human colonic epithelial HT-29 cells, pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha ) and IL-1 beta down-regulate HO-1 expression. The HO-1 inducer, cobalt protoporphyrin IX (CoPPIX), dramatically down-regulated NF-kappa B activation in HT-29 cells by TNF-alpha. In addition, bilirubin-a product of heme catabolism by HO-1-and the carbon monoxide donor tricarbonyldichlororuthenium (II) dimer also suppressed NF-kappa B activation by TNF-alpha. However, iron, another heme metabolite, did not suppress NF-kappa B activation by TNF-alpha. Furthermore, CoPPIX diminished the macroscopic and histopathological symptoms of TNBS-induced colitis and down-regulated NF-kappa B activation in mice. In conclusion, this study suggests that HO-1 plays an important role in the down-regulation of NF-kappa B activation, which is a key factor in the pathogenesis of IBD and is thus an excellent therapeutic target for the treatment of IBD.
Animals ; Carbon Monoxide ; Cobalt ; Colitis ; Colon* ; Cytokines ; Down-Regulation* ; Epithelial Cells ; Epithelium* ; Heme Oxygenase-1* ; Heme* ; HT29 Cells ; Humans ; Inflammation* ; Inflammatory Bowel Diseases ; Interleukin-1beta ; Iron ; Metabolism ; Mice ; NF-kappa B ; Tissue Donors ; Transcription Factors* ; Tumor Necrosis Factor-alpha