Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer

BACKGROUND: Fine-needle aspiration (FNA) of the thyroid is a widely accepted confirmatory test for thyroid cancer with high sensitivity and specificity. FNA is a simple procedure that is learned by many clinicians to enable accurate diagnosis of thyroid cancer. However, it is assumed that because the FNA test is a relatively simple procedure, its cytologic results are reliable regardless of the operator's experience. The aim of this study was to evaluate the differences in the diagnostic indices of FNA between operators with different levels of experience. METHODS: A total of 694 thyroid FNA specimens from 469 patients were reviewed, and were separated based on the experience of the clinicians who performed the procedure. One hundred and ninety were categorized in the experienced group, and 504 in the inexperienced group. All FNA results were then compared with histological data from surgically resected specimens, and the sample adequacy and diagnostic accuracy of the groups were compared. RESULTS: The age, gender, and nodule size and characteristics were similar in both groups. The sample adequacy rate was not significantly different between the experienced and nonexperienced groups (96.3% vs. 95.4%, P=0.682). However, the non-experienced group had a higher false-negative rate than the experienced group (6.4% vs. 17.2%, P=0.038), and the sensitivity of the FNA test also tended to be lower in the nonexperienced group (95.6% vs. 88.9%, P=0.065). CONCLUSION: These results suggest that FNA operators who have less experience may miss cases of thyroid cancer by performing the procedure incorrectly. As such, the experience of the FNA operator should be considered when diagnosing thyroid cancer. When clinicians are being trained in FNA, more effort should be made to increase the accuracy of the procedure; therefore, enhanced teaching programs and/or a more detailed feedback system are recommended.

Response: Insufficient Experience in Thyroid Fine-Needle Aspiration Leads to Misdiagnosis of Thyroid Cancer (Endocrinol Metab 2014;29:293-9, Jung Il Son et al.)

No abstract available.

Case of Incidental Oncocytic Adrenocortical Neoplasm / 대한내과학회지

Adrenal oncocytomas are very rare. Because most of them are benign and nonfunctioning, they are detected incidentally. Here, we report a case of nonfunctioning benign adrenocortical oncocytoma located in the left adrenal gland in a 54-year-old man who presented with no symptoms. The tumor was 4.5 x 3 x 3 cm in size and was predominantly composed of oncocytes, which exhibited abundant eosinophilic granular cytoplasm and were arranged with a nested or diffuse architecture without capsular or vascular invasion. Nuclear atypia and mitotic figures were not observed. A discussion of this case and a review of recent updates in the literature are presented. In patients with adrenocortical oncocytomas, treatment is similar to that for adrenocortical neoplasia. However, due to the risk of over-diagnosis of malignancy, and the better clinical outcomes associated with adrenocortical oncocytoma, more attention should be paid to the diagnosis of adrenocortical oncocytoma.

Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects

BACKGROUND: Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels. METHODS: Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup. RESULTS: Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05). CONCLUSION: These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects

BACKGROUND: Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels. METHODS: Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup. RESULTS: Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05). CONCLUSION: These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Two Cases of Acute Interstitial Nephritis Associated with Acute Hepatitis A / 대한신장학회잡지

Although acute renal failure is common in patients with fulminant hepatitis, it has been recognized as a rare complication of non-fulrninant acute hepatitis A. So far about 30 patients have been described in the literature who had acute hepatitis A associated with acute renal failure. Variable renal biopsy findings have been described in previous reports, including mostly acute tubular necrosis, mesangial proliferative glomerulonephritis, and interstitial nephritis. But the exact mechanism by which hepatitis A causes acute renal damage is still obscure. We describe two cases with acute hepatitis A, proven by IgM anti-hepatitis A antibodies compli- cated by acute renal failure. One patient required hemodialysis. Kidney biopsy findings showed interstitial nephritis with no evidence of glomerular involvement. Our review of these cases and the relevant literature suggests that there is strong evidence to implicate hepatitis A virus as a cause of acute renal failure. It remains to be elucidated why the histologic features are variable in the cases of hepatitis A virus induced acute renal failure and which factors predispose a patients to have immunologic involvement versus interstitial and tubular involvement.

A Case Report of Peutz - Jeghers Syndrome with an Adenomatous Malignant Change in a 44 Year Old Male Patient / 대한소화기내시경학회지

Peutz-Jeghers Syndrome, characterized by autosomal inheritance, skin pigmentation, and hamartomatous polyps, had long been considered a benign polyposis until recent studies suggested an association with increased risk of malignant neoplasia in patients who had been followed-up for long periods. The authors present a case of Peutz-Jeghers syndrome in a 44 year old man with an adenomatous malignant change in his small bowel. The patient underwent surgery following a diagnosis of intestinal intussuception. Observing the polyps resected, all the polyps had characteristics of hamartoma, excluding one which showed a malignant transformation. Although it has not been fully determined with certainty whether the adenocarcinoma developed from hamartoma, histologic examination of an excised specimen suggested, thht potency of hamartoma to undergo malignant transformation. All the members of the family were confirmed to have no evidence of Peutz-Jeghers syndrome. Our clinical experience determines the malignant potency in Peutz-Jeghers and recommends that intensive follow-up of gastrointestinal and extragastrointestinal sites is needed in patients with this syndrome.

Two Cases of Collagenous Colitis / 대한소화기내시경학회지

Collagenous colitis was first described by Lindstrom in 1976. Now this disorder is recognized as one of the more common causes of chronic diarrhea of obscure origin. This disorder is described as a disease of colon associated with chronic watery diarrhea and the typical histologic findings of a thickened subepithelial collagenous band. But in korea a few cases have been reported. We had observed a 52-year-old businessman with chronic watery diarrhea without abdominal pain in the past. And then we had reported previously that case. We also recently observed a 42-year-old housewife with chronic watery diarrhea with lower abdominal discomfort for 10 years. Colonoscopy disclosed no gross abnormalities through the entire colon ineluding the terminal ileum but we could find the pronounced thickening of subepithelial collageous band and chronic inflammation in the lamina propria in the histologic examination. We summarized the above two cases of collagenous colitis with a review of literatures.

Analysis on the Relationships among the Total Cholesterol, Fasting Blood Sugar, Hypertension and Ischemic heart disease on EKG Findings / 예방의학회지

Since the 1960's, Korea has achieved rapid economic growth, longer life expectancy, accelerated urbanization and a westernization of diet. Cardiovascular disease has become the leading cause of death; however the prevalence of ischemic heart disease(IHD) remains low. A cross-sectional multiphasic screening service for 18,426 persons aged 30 64 years in a Medical Aid Program in Kyonggi-do Province was conducted from 1991 to 1993. Total cholesterol(TC), Fasting blood glucose(FBG), blood pressure(BP), and electrocardiographic(EKG) data were collected. The result as follows; 1. On the EKG findings, the age-adjusted prevalence of myocardial ischemia and myocardial infarction was 1.45% in men and 2.06% in women. 2. The mean blood pressure was 122.9/78.8mmHg. The age-adjusted prevalence of hypertension was 11.05% in men and 9.02% in women. The prevalence of hypertension showed increasing tendency according to age increase. In all age group, the prevalence of hypertension was higher in men than women. 3. The mean total cholesterol level was 184.4mg/dl in men and 189.2mg/dl in women. The age-adjusted prevalence of hypercholesterolemia was 4.88% in men and 5.67% in women. The total cholesterol level showed increasing tendency according to age increase, except 55 64 age group in men. 4. The prevalence of hyperglycemia is 5.8%. The age-adjusted prevalence of hyperglycemia is 6.72% in men and 4.50% in women. The prevalence of hyperglycemia showed increasing tendency according to age increase. 5. On the EKG findings, the prevalence of myocardial ischemia and myocardial infarction was higher in hypertension than normal, in all age group of men and women less than 40 years-old. Only in women more than 40 years-old, the prevalence of myocardial ischemia and myocardial infarction was higher in hypercholesterolemia and hyperglycemia. Nevertheless there is not statistical association between ischemic heart disease and previous risk factors in other age group, the prevalence of myocardial ischemia and myocardial infarction was higher in hypertension, hypercholesterolemia and hyperglycemia than normal. The result of this study suggest that relationships between major risk factor of ischemic heart disease and ischemic heart disease is similar to existing theory.

Clinical study with mobactam in severe infections / 감염

No abstract available.