ABSTRACT
PURPOSE: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. MATERIALS AND METHODS: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). RESULTS: The age range was 26–87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. CONCLUSION: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.
Subject(s)
Humans , Esophagus , Follow-Up Studies , Incidence , Iodine , Neoplasm Metastasis , Radiotherapy , Recurrence , Survival Rate , Thyroid Gland , Thyroid Neoplasms , Trachea , XerostomiaABSTRACT
Metastasis to the thyroid gland from distant cancer is rare, and, in some cases, is a diagnostic challenge. Here, we report a case of metastatic renal cell carcinoma of the thyroid gland. A 77-year-old man presented with a neck mass detected about 1 month previously. He had undergone a right nephrectomy owing to renal cell carcinoma 14 years previously. Fine needle aspiration cytology showed a few atypical follicular cells with nuclear atypia. Under a tentative diagnosis of papillary thyroid carcinoma, a total thyroidectomy was performed. The histologic and immunohistochemical studies of the surgical specimens indicated that the thyroid masses were metastatic renal cell carcinoma to the thyroid.
Subject(s)
Aged , Humans , Biopsy, Fine-Needle , Carcinoma , Carcinoma, Renal Cell , Neck , Neoplasm Metastasis , Nephrectomy , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
Metastasis to the thyroid gland from distant cancer is rare, and, in some cases, is a diagnostic challenge. Here, we report a case of metastatic renal cell carcinoma of the thyroid gland. A 77-year-old man presented with a neck mass detected about 1 month previously. He had undergone a right nephrectomy owing to renal cell carcinoma 14 years previously. Fine needle aspiration cytology showed a few atypical follicular cells with nuclear atypia. Under a tentative diagnosis of papillary thyroid carcinoma, a total thyroidectomy was performed. The histologic and immunohistochemical studies of the surgical specimens indicated that the thyroid masses were metastatic renal cell carcinoma to the thyroid.
Subject(s)
Aged , Humans , Biopsy, Fine-Needle , Carcinoma , Carcinoma, Renal Cell , Neck , Neoplasm Metastasis , Nephrectomy , Thyroid Gland , Thyroid Neoplasms , ThyroidectomyABSTRACT
We report a very rare case of colonic varix with massive bleeding. A 43-year-old male patient was transferred to our hospital for hematochezia. The patient had a history of chronic liver disease associated with alcohol use. The initial blood pressure was 93/73 mmHg, and the hemoglobin level was 8.4 g/dL. Severe hepatomegaly and periportal fatty infiltration were seen on abdominal computed tomography. Markedly ectatic veins protruded from the luminal side of the proximal ascending colon and drained to the dilated ileocecal and retroperitoneal veins. Emergent colonoscopy failed because of continuous hematochezia and hypovolemic shock, despite massive transfusion. Markedly dilated colonic varices were noticed around the ileocecal and ascending colon on superior mesenteric arteriography. An emergent right hemicolectomy was performed. The presumed bleeding focus was a protruding varix with a red clot on the top of a denuded vein on the anteromedial wall of the proximal ascending colon.
Subject(s)
Adult , Humans , Male , Alcoholics , Angiography , Blood Pressure , Colon , Colon, Ascending , Colonoscopy , Gastrointestinal Hemorrhage , Hemoglobins , Hemorrhage , Hepatomegaly , Liver Cirrhosis , Liver Cirrhosis, Alcoholic , Liver Diseases , Phenobarbital , Shock , Varicose Veins , VeinsABSTRACT
BACKGROUNDS/AIMS: The hepatitis C virus (HCV) genotype affects clinical outcomes of HCV infection, in terms of the response to antiviral therapy and progression of chronic liver diseases, and shows geographic differences in distribution. The aim of this study was to elucidate the HCV genotypes in patients with chronic HCV infection in Jeju, which is an island off the Korean peninsula. METHODS: The study population consisted of 162 patients with anti-HCV antibodies and HCV-RNA. HCV genotypes were determined using genotype specific primers. RESULTS: HCV genotype 2a predominated (62.3%), followed by genotype 1b (34.0%) and 2b (3.7%). The prevalence of genotypes differed significantly with age, with HCV genotypes 1 and 2 being more frequent in older and younger subjects (P=0.035), respectively. HCV-RNA levels were higher in patients with genotype 1 than in those with genotype 2 (P=0.001). HCV genotype was not significantly related to sex, clinical diagnosis and potential risk factors. CONCLUSIONS: HCV genotype 2a is most common in Jeju, followed by genotype 1b. Our results suggest that the distribution of the HCV genotype differs between regions in Korea.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Enzyme-Linked Immunosorbent Assay , Genotype , Hepacivirus/classification , Hepatitis C, Chronic/epidemiology , Korea , RNA, Viral/blood , Rural PopulationABSTRACT
Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy, associated with symmetrical muscle weakness, areflexia, and ascending paralysis. Although it has been reported during all the three trimesters of pregnancy and in the post-partum period, the occurrence of GBS in the third trimester presents a high maternal risk because of respiratory complications and the risk of premature delivery. We report the successful anesthetic management of a parturient with GBS.
Subject(s)
Female , Humans , Pregnancy , Anesthesia , Cesarean Section , Guillain-Barre Syndrome , Muscle Weakness , Paralysis , Polyneuropathies , Pregnancy Trimester, ThirdABSTRACT
Systemic lupus erythematosus (SLE) is a multisystem inflammatory disorder characterized by autoantibody production. It has a strong female preponderance and occurs primarily in the reproductive years. Although involvement of the respiratory system is common in SLE, pneumothorax is one of the less frequently reported pulmonary complications and carries with it a grave prognosis. We report a successful anesthetic management of a parturient with SLE complicated by pneumothorax.
Subject(s)
Female , Humans , Pregnancy , Anesthesia , Cesarean Section , Lupus Erythematosus, Systemic , Pneumothorax , Prognosis , Respiratory SystemABSTRACT
Lamotrigine (LTG) is a relatively safe and new antiepiletic drug which is effective for bipolar depression and partial or generalized seizures. However, administration of LTG in combination with valproic acid may lead to fatal Stevens-Johnson syndrome (SJS)or Toxic Epidermal Necrolysis (TEN). Valproic acid may increase serum LTG levels or induce accumulation of a toxic intermediate metabolite by doubling the plasma half-life of LTG, due to competition with hepatic glucuronidation of LTG. Although there are several published case reports of LTG-induced SJS or TEN in Western countries, we have failed to find any corresponding cases in the Korean literature until now. Herein, we present two cases of SJS associated with concomitant use of LTG and valproic acid.
Subject(s)
Bipolar Disorder , Half-Life , Plasma , Seizures , Stevens-Johnson Syndrome , Valproic AcidABSTRACT
Acute onset of shock presented in a 23 years old male patient due to gastrointestinal bleeding. He had been in a car crash 49 days before presentation. On initial presentation, a small amount of intraperitoneal hemorrhage had been seen on a CT scan. An emergency selective superior mesenteric artery (SMA) arteriography revealed a pseudoaneurysm in the branch of SMA, but successive embolization of the terminal branch controlled the bleeding. It is hard to initially diagnose an aneurysm as the cause of spontaneous gastrointestinal bleeding in a patient that has suffered an abdominal trauma, so it poses a therapeutic challenge. Recognition of an aneurysm, and its early diagnosis based on the patient's past history, and its adoption as a judicious diagnostic tool are essential in the management of such patients.
Subject(s)
Humans , Male , Young Adult , Aneurysm , Aneurysm, False , Angiography , Early Diagnosis , Emergencies , Hemorrhage , Mesenteric Artery, Superior , Shock , Tomography, X-Ray ComputedABSTRACT
PURPOSE: Epidemiological studies have shown that regular ingestion of a nonsteroidal anti-inflammatory drug reduces the risk of fatality from colon cancer. Cyclooxygenase-2 (COX-2) has been found to be overexpressed in various types of tumor, including colorectal cancer. It has been suggested that the COX-2 enzyme may play an important role in carcinogenesis and tumor progression. The aims of this study were to find the relationship between COX-2 expression and bile duct carcinogenesis and its clinical significance in bile duct cancer. METHODS: The COX-2 expression was determined using three methods, reverse transcription polymerase chain reaction (RT-PCR), Western blotting and immunohistochemical staining. mRNA and proteins were extracted from the tissue specimens of 22 bile duct cancer patients. RESULTS: RT-PCR and western blotting found COX-2 expressions in all the cancers and their paired noncancerous tissues. Immunohistochemistry revealed the highest levels of COX-2 expressed in bile duct carcinoma cells, mainly in the cytoplasm, and a weak reactivity of the COX-2 protein was observed in noncancerous bile duct epithelial cells. CONCLUSION: Based on this study, it is postulated that the carcinogenesis mechanism of COX-2 expression may be initiated from a noncancerous condition, such as chronic inflammation, and may advance to bile duct cancer progression.
Subject(s)
Humans , Bile Duct Neoplasms , Bile Ducts , Bile , Blotting, Western , Carcinogenesis , Colonic Neoplasms , Colorectal Neoplasms , Cyclooxygenase 2 , Cytoplasm , Eating , Epithelial Cells , Immunohistochemistry , Inflammation , Polymerase Chain Reaction , Prostaglandin-Endoperoxide Synthases , Reverse Transcription , RNA, MessengerABSTRACT
Superior oblique myokymia refers to a disorder characterized by involuntary torsional and vertical oscillation of one eye, lasting several seconds to minutes with an irregular interval. We report a 44-year-old woman with superior oblique myokymia, who presented with quivering sensation and oscillopsia of the left eye. Magnetic resonance imaging of the brain was normal. The involuntary eye movement and oscillopsia responded to carbamazepine.
Subject(s)
Adult , Female , Humans , Brain , Carbamazepine , Eye Movements , Magnetic Resonance Imaging , Sensation , Trochlear Nerve DiseasesABSTRACT
Retrohepatic caval injuries are a difficult problem to surgeons as its mortality approaching 50~80%. Several bypass techniques was advocated to reduce operative bleeding and to improve the prognosis of the traumatized patients. We successfully managed a case of retro hepatic caval injury using venovenous bypass and total hepatic vascular isolation. A 28 year old female patients was admitted to Cheju Medical Center injured in a traffic accident. At exploration, a retrohepatic caval injury was suspected. So patient was emergently transferred to Seoul National University Hospital, after gauze packing. On arrival, vital signs were stable. Reexploration was undertaken. There was gush out of blood from retrohepatic space. After clamping suprahepatic and infrahepatic vena cava, venovenous bypass was introduced to left axillary vein and left femoral vein using Biomedicus pump. Systemic heparinization was not used. Avulsion between vena cava and common trunk of left and middle hepatic veins was repaired and left hepatectomy was done. Gauze packing was done due to ongoing oozing by coagulopathy from massive transfusion. Total venovenous bypass time was 30 min. On 10th operative day, reexploration was undertaken to assure hemostasis and to remove packed gauze. On 54th postoperative day patient discharged without any morbidity.
Subject(s)
Adult , Female , Humans , Accidents, Traffic , Axillary Vein , Constriction , Femoral Vein , Hemorrhage , Hemostasis , Heparin , Hepatectomy , Hepatic Veins , Mortality , Prognosis , Seoul , Vital SignsABSTRACT
Mal de debarquement syndrome refers to the prolonged sensation of rocking and swaying that is experienced on the return to land following a sea voyage or an air travel. We report a man who developed mal de debarquement syndrome after a 4-day-boat-trip. Apogeotropic nystagmus during head turning in supine position was the only finding. Mal de debarquement syndrome should be considered in the differential diagnosis of direction-changing positional nystagmus, especially when patients do not complain of vertigo with nystagmus.
Subject(s)
Humans , Diagnosis, Differential , Head , Nystagmus, Physiologic , Sensation , Supine Position , VertigoABSTRACT
Twenty-three isolates of Fusarium spp. were obtained from decayed citrus fruits in the fields and storages in 1998-1999. Of them, six and five isolates belonged to F. proliferatum and F. moniliforme, respectively, which were the most common. F. solani and F. sambucinum had each two isolates, F. equiseti had one isolate and seven isolates were unidentified. They produced symptoms of two types in pathogenicity test: those with leathery, beige to light or dark brown, and sunken lesions without surface mycelium (type-1) and those with lesions covered with white, beige or pink surface mycelium (type-2). Four of six isolates identified to F. proliferatum and two unidentified isolates produced type-1 lesions, and all isolates identified to F. moniliforme, F. solani, F. sambucinum, F. equiseti and five unidentified isolates produced type-2 lesions.
Subject(s)
Citrus , Fruit , Fusarium , Mycelium , VirulenceABSTRACT
No abstract available.
Subject(s)
Animals , Rats , Bacteremia , Cerebrospinal Fluid , Haemophilus influenzae , Haemophilus , Interleukin-6 , Kinetics , Meningitis , Models, Animal , Tumor Necrosis Factor-alphaABSTRACT
The effects of subarachnoid administration of 0.5% bupivacaine in 5% and 10% glucosesolution were investigated in a randomized 30 cases undergoing a low limb and low abdominal surgery in the Department of Anesthesiology at the Hanyang University Hospital from October 1st, 1984 to March 31st, 1985. The results are as follows: 1) These were no significant differences between the patients of the three groups in relation to sex, age, weight, height and operation time. 2) The oneset time of the maximum segmental spread of analygesia in the control group was 5 to 10 minutes and 10 to 15 minutes in the experimental groups. 3) The spread of sensory blockade in the experimental groups was lowered 2~3 segment compared with control group. 4) The onset time of complete motor blockade in the control group was 5 minutes and 5~10 minutes in the experimental group. 5) Duration of complete motor blockade in experimental groups was shorter than the control group. 6) The cardiovascular changes were investigated with no significant differences between the patients of the three groups. 7) The minimal complications such as mild hypotension in three cases, micturition difficulty in one case, mild translent headache in one case were investigated in the three groups. According to our investigation of subarachnoid blockade with 0.5% bupivacain 2ml in 5% and 10% glocose solution, it considered that the spread was limited and produced intense sensory and motor block of long duration which was suitable of the low limbs and low abdominal surgery.