Effect of Acculturative Stress on Multicultural Adolescents’ Life Satisfaction: Sequential Multiple Mediating Effects of Bicultural Acceptance Attitude, Self-Esteem, and Social Withdrawal -Using the 2016 Multicultural Adolescents Panel Study-

Purpose@#This study determined acculturative stress’ effect on the life satisfaction of multicultural adolescents based on Roy’s Adaptation Model and some earlier studies. Further, it examined the sequential multiple mediating effects of bicultural acceptance attitude, self-esteem, and social withdrawal on life satisfaction. @*Methods@#Participants included 1,163 multicultural adolescents who participated in the sixth Multicultural Adolescents Panel Study. A hypothesis test was conducted using Hayes’ Process Macro Model 81. @*Results@#Life satisfaction increased with a decline in acculturative stress. Each of bicultural acceptance attitude, self-esteem, and social withdrawal had a single mediating effect on the relationship between acculturative stress and life satisfaction in multicultural adolescents. The sequential multiple mediating effects of bicultural acceptance attitude and self-esteem were confirmed significant after their impact on the relationship between acculturative stress and life satisfaction was analyzed. Bicultural acceptance attitude and social withdrawal were found to have a significant sequential multiple mediating effect on the relationship, as well. @*Conclusion@#This study’s results demonstrate that acculturative stress reduction is critical to improving multicultural adolescents’ life satisfaction. Bicultural acceptance attitude, self-esteem, and social withdrawal have a single mediating or sequential multiple mediating effect on the relationship between multicultural adolescents’ acculturative stress and life satisfaction. The findings, which highlight mediating effects, indicate that by increasing bicultural acceptance attitude and self-esteem, and reducing social withdrawal, multicultural adolescents’ life satisfaction can be improved.

Effects of a Moderate Drinking Program based on Social Cognitive Theory on College Students with Drinking Problems

PURPOSE: The purpose of this study was to investigate the effect of the moderate drinking program based on social cognitive theory on changes in the drinking habits of college students with drinking problems. METHODS: This study included a total of 68 college students with drinking problems. These participants participated in 10 sessions of a moderate drinking program in which social cognitive theory was applied. Changes in the cognition and behaviors of the participants were then investigated. RESULTS: The moderate drinking program based on social cognitive theory for college students with drinking problems was effective in increasing the subjects' drinking-related knowledge (U=191.50, p<.001), enhancing their drinking refusal self-efficacy(t=8.02, p<.001), and changing their drinking-related attitudes (U=108.50, p<.001), drinking outcome expectancy (t=8.68, p<.001), amount of drinking in a single session (χ²=25.72, p<.001), number of drinking sessions per month (x2=10.05, p=.006), and problem drinking behaviors (t=5.77, p<.001). CONCLUSION: These results can be used to inform a regular on-campus intervention programs for moderate drinking, and to implement education about moderate drinking, thereby increasing the success rate of drinking reduction.

Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery / 대한마취과학회지

BACKGROUND: Hypotension remains a common clinical problem of spinal anesthesia for cesarean delivery and phenylephrine is used as a vasopressor to address this. However, phenylephrine reduces maternal cardiac output (CO) due to reflex bradycardia. Glycopyrrolate is safe for the fetus, and increases heart rate (HR). Using a noninvasive measure of CO, we compared maternal hemodynamic changes between the phenylephrine only group (group P) and the phenylephrine plus glycopyrrolate group (group PG). METHODS: In this randomized study, 60 women scheduled for elective cesarean delivery were allocated to group P (n = 30) or group PG (n = 30). In both groups, phenylephrine was infused at 50 microg/min. This infusions stopped if systolic blood pressure (SBP) was higher than the baseline value, and phenylephrine 100 microg was injected if SBP was lower than 80% of the baseline value from spinal anesthesia to delivery. In group PG, glycopyrrolate 0.2 mg was injected intravenously after spinal anesthesia. Hemodynamic parameters, such as SBP, heart rate (HR), stroke volume index (SVI), cardiac index (CI) were measured before and until 15 min after spinal anesthesia. RESULTS: There were no significant differences in SBP and SVI compared to the baseline value in each group and between the two groups. HR and CI reduced significantly from 8 min to 15 min in group P compared to the baseline value as well as group PG for each time-point. However, HR and CI were maintained in group PG. CONCLUSIONS: The use of glycopyrrolate added to phenylephrine infusion to prevent hypotension by spinal anesthesia for cesarean delivery was effective in maintaining HR and CI.

Paroxysmal supraventricular tachycardia during cesarean section under spinal anesthesia: A case report

We experienced a case of paroxysmal supraventricular tarchycardia (PSVT) in a 31-year-old pregnant woman undergoing elective cesarean section under spinal anesthesia. About 15 minutes after delivery of the baby, PSVT suddenly developed. PSVT was difficult to control with a number of medications including esmolol, adenosine and verapamil. Normal sinus rhythm was finally restored after repeated trials of biphasic cardioversion. The patient fully recovered and was discharged without any complication 5 days later.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.

A Study of HHA-8 Seroprevalence in Korean Health Care Workers

HHV-8 virus is known to be associated with Kaposi's sarcoma (KS) in HIV seropositive patients and its seroprevalence has geographic difference. In South Korea, incidence of KS is low not only in general population but also in HIV patients compared to other countries. It is speculated that low seroprevalence of HHV-8 has contributed to the low incidence of KS in South Korea. We examined the seroprevalence of anti HHV-8 IgG of HIV seronegative health care workers in one University hospital. Enzyme-linked immunosorbent assay(ELISA) was used for diagnosis. One person (0.6%, 1/164) was seropositive, six were equivocal (3.7%, 6/164) and 157 people were seronegative (95.73%, 157/164). This study revealed that seroprevalence of HHV-8 in general population was low in South Korea. Further studies are needed to be carried out to evaluate the low HHV-8 seroprevalence in Korea.

Comparison of Oral Hygiene Effects between 0.1% Chlorhexidine and Normal Saline on the Incidence of Oral Pathogens / 기본간호학회지

PURPOSE: The purpose of this study was to compare the effects of oral hygiene with 0.1% chlorhexidine or with normal saline on the incidence of pathogens in the oral cavity of patients in Intensive Care Units (ICU). METHOD: A quasi experimental design with non-equivalent control group and non-synchronized design was used. For the study 46 patients were recruited from a university hospital (24 for the experimental group, 22 for the control group). patients in the experimental group received mouth care with 0.1% chlorhexidine gluconate and those in the control group received mouth care with normal saline twice a day for 7 days in a row. Oral samples were taken for bacterial cultures on admission day, the 4th day and the 7th day for both groups. RESULTS: The incidence of oral pathogens decreased in the experimental group, and increased in the control group. There was no significant difference in the incidence of oral pathogens between the two groups. However oral hygiene using 0.1% chlorhexidine gluconate decreased the incidence of oral pathogens significantly for patients who already had pathogenic bacteria in their mouths on the admission day. CONCLUSION: The results suggest that mouth care with 0.1% chlorhexidine is effective for decreasing the incidence of oral infection for ICU patients who have oral infections.

Assessment of coronary flow reserve with transthoracic Doppler echocardiography: comparison with intracoronary Doppler method

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.

The effects of antiproliferative drugs at stenotic area associated with primary atherosclerotic lesions in apoE knockout mouse - Change of vascular remodeling

Apolipoprotein (apo) E deficient mouse can produce reproducible fixed stenotic primary atherosclerotic lesion, which reveals failure to remodel of vascular lumen, in the ascending aorta, external carotid, common carotid, iliac, femoral and popliteal arteries. To evaluate the effect of drugs in regarding to both prevention of primary atherosclerotic lesion and vascular remodeling, a systematic analysis of distribution of atherosclerotic lesions was undertaken in chow-fed, 9-momth-old apo E deficient mice, which was administrated drugs including asprin, methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) for 7 month from 3 month-old. On gross and microscopic examination, formation of primary atheroscleotic lesions could be delated and/or prevented patially by effets of these drugs. On morphometric examination, failure to remodel forming vascular stenosis could not be seen, though relatively mild atherosclerotic lesion occured at vascular tree. These data suggest that the stenotic process in advanced atherosclerotic vessels can be delayed and/or prevented by several drugs including methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) in vivo state.

Relation between Perfusion of Infarcted Myocardium and Exercise-induced ST Shift in Acute Myocardial Infarction

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.

Relation between Perfusion of Infarcted Myocardium and Exercise-induced ST Shift in Acute Myocardial Infarction

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.

Effects of Positive End-Expiratory Pressure on Hepatic Venous Oxygenation in Dogs / 대한마취과학회지

Background: Positive end-expiratory pressure(PEEP) ventilation causes reduction in cardiac output and increase of intra-thoracic pressure, hence reduction of hepatic blood flow. The purpose of this study is to evaluate the changes of hepatic venous oxygen saturation, tension and content during increase and removal of PEEP and to evaluate hemodynamic variable which has the greatest effect on hepatic oxygenation. Method: Eight dogs were anethetised with 1.0 vol% isoflurane and 100% oxygen. After 30 minutes of stabilization of vital signs, PEEP were increased from 0 cmH2O to 5 cmH2O and 10 cmH2O and lowered to 0 cmH2O again, and hemodynamic data (heart rate, arterial blood pressure, central venous pressure(CVP), pulmonary arterial pressure, pulmonary arterial occlusion pressure and cardiac output(CO)) and hepatic venous oxygenation data (hepatic venous oxygen saturation(ShvO2), tension(PhvO2) and content(ChvO2)) were measured at each step. Results: CO, ShvO2, PhvO2 and ChvO2 decreased significantly at 10 cmH2O PEEP compared to the baseline and 5 cmH2O PEEP and CO, ShvO2 and ChvO2 increased signicantly with removal of PEEP. CVP increased significantly at 10 cmH2O PEEP and decreased significantly with PEEP removal. PEEP showed close correlationship with CO and CVP considering all steps of PEEP and PEEP removal. ShvO2 and PhvO2 showed most close correlationship with CO considering all steps of PEEP and PEEP removal. Conclusion: ShvO2 with PEEP therapy is dependent upon CO. Therefore cardiac output maintenance is essential during PEEP therapy. For exact evaluation of hepatic oxygenation, it is valuable to monitor ShvO2.

Hemodynamic Responses during Dobutamine Stress Echocardiography according to Stage Duration in Normals

BACKGROUND: The 3 minutes increment of dobutamine dose protocol is most commonly used method in dobutamine stress echocardiography (DSE). But the precise hemodynamic response to dobutamine dosage and its difference by extending stage duration have not been well elucidated. MATERIALS AND METHOD: Nineteen healthy voluntary subjects with a mean age of 23.9+/-4.7 years were included. All subjects underwent 3-minutes incremental and 5-minnutes incremental protocol of DSE at random order in a same day. Heart rate, blood pressure, stroke volume, fractional shortening, rate-pressure product and cardiac output were measured every 3 minutes in 3-min protocol of DSE. In 5-min protocol, same variables were measured at 3 minutes of each stage as well as at 5 minutes. RESULTS: 1) Heart rate did not increase until 10 microgram/kg/min dose and increased thereafter by increment of dobutamine dose. 2) Fractional shortening and stroke volume increased markedly from the 5 microgram/kg/min until 20 microgram/kg/min dose and showed slow increase or plateau at a higher dobutamine dose. 3) Systolic blood pressure, cardiac output and rate-pressure product increased continuously from initial dose to maximal dose. 4) Although by extending stage duration to 5 minute in 5-min protocol produced greater hemodynamic effects than those measured at 3 minutes of each stage, there were no significant difference in the results of 3-min and 5-min protocol of DSE. CONCLUSION: The increase of cardiac contractility most contributed to increase of cardiac output until 20microgram/kg/min dose and the increase of herat rate contributed dominantly thereafter, thus the hemodynamic variables showed different responses to increment of dobutamine dose. There were no significant difference in hemodynamic effects between the two protocols. So it is considered that 3-min protocol of DSE gives similar hemodynamic information as 5-min protocol and is more time-saving method.

Optimal Balloon Inflation Pressures for Stent Deployment: High Pressure is Always Good?

BACKGROUND AND OBJECTIVES: To reduce the subacute stent thrombosis, the use of high pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound has been recommended. The purpose of this study is to compare incidence of stent thrombosis and major cardiac events (MACE) between high and moderate pressure balloon technique without using intravascular ultrasound (IVUS) guidance. MATERIALS AND METHODS: We prospectively studied 147 patients (110 males & 37 females, mean;56.9+/-9.9 years, 154 lesions) who were deployed intracoronary stents with the use of conventional technique except IVUS guidance. According to inflation pressure, patients were divided into two groups; G1 (moderate pressure group, maximum inflation balloon pressure or =14ATM, 77 lesions). We investigated the incidence of stent thrombosis and MACE between two groups during the 10 month follow up examination. RESULTS: 1) The mean inflation presure is different between two groups by definition (G1:G2 10.2+/-1.8; 15.2+/-1.3 ATM p<0.001). 2) The stenotic lesion lengths of the group of patients treated with the moderate pressure techique were longer than those treated under the high pressure technique (G1:G2 19.8+/-7.1 mm; 16.3+/-4.1 mm p=0.002). 3) There were no significant differences between the moderate pressure group and the high pressure group during the 10 month follow-up examination in terms of MACE[early event (0-14D)-subacute thrombosis G1:G2 0:0 death G1; G2 1:1/late events (15D - 10M)-repeat revascularization:G1; G2 8; 7, CABG G1; G2 1; 0, Q.M.I G1; G2 1; 0]. CONCLUSION: Onselectedpatients,itispossibletoconsidermoderatepressure technique as an other option for coronary stenting.

Plasma Homocysteine and Risk of Myocardial Infarction in Young Age:Relation with Vitamine B6, B12, and Folate

BACKGROUND AND OBJECTIVES: Myocardial infarction in young age is an uncommon condition and has few risk factors than old aged group. Hyperhomocysteinemia, which is an independent risk factor for vascular disease, is associated with myocardial infarction (MI). Therefore, we evaluate that hyperhomocysteinemia is associated with myocardial infaction in young age. MATERIALS AND METHODS: A total 64 patients [normal control 23 (young:old 13:10 mean age 54.2+/-13.8), M.I 41 (young:old=13:28 mean age 53.9+/-14.1)] measured plasma levels of total homocysteine, folate, vitamine B6, and vitamine B12 and performed coronary angiography and echocardiography. Young aged group was defined male <45 years old and premenopausal wemen. RESULTS: 1) Homocysteine concentration was higher in MI patients than in controls (control 6.35+/-1.7 mmol/L, MI 11.3+/-4.9 mmol/L, p<0.001). 2) Levels of homocysteine were not significantly correlated with vitamine B6, B12, and folate, but were correlated with vitamine B12 in myocardial infarction (r=0.388, p<0.001). 3) Homocysteine levels were correlated with age, apoprotein B, BUN (r=0.374 0.52, p=0.05, 0.689 p=0.001) but correlated inversely with gobal function (r= - 0.672, p=0.001). 4) After adjusting for age factor in MI patients, homocysteine concentration was not significantly higher in young aged than in old aged group (young age 6.78+/-2.07, old age 10.2+/-4.17 mmol/L p=0.351 by ANCOVA). CONCLUSION: Hyperhomocysteinemia is an independent risk factor of MI, but is not clear association with MI in young age.

Significance of ST Segment, R Wave, Q Wave and QRS Score for Assessing Myocardial Perfusion in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The restoration of infarct-related coronary artery (IRA) patency in acute myocardial infarction (AMI) linked to a significant improvement in survival. Because of microvascular and cellular injury, patent IRA does not always represent successful reperfusion. With progress of myocardial ischemia, standard 12 lead ECG shows evolutional changes of ST-segment, R wave and Q wave. But their relations to myocardial perfusion were uncertain. METHODS: Total 41 patients of the first anterior wall AMI were enrolled and serial ECGs were taken to measure sum of ST-segment elevation (sigma ST), sum of Q wave (sigma Q), sum of R wave (sigma R), and QRS score (QRSs) proposed by Selvester in each patients before thrombolytic therapy (i), after coronary angiography at 90 minutes of thrombolytic therapy (a), and before discharge (d). Myocardial contrast echocardiography was performed within 10 days of AMI to estimate opacification score (OS) and opacification index (OI) in segments of LAD territory. We investigate the relation between evolution of ECG changes and perfusion status of infarcted myocardium. RESULTS: 1) There was no relation between OI and sigma ST, but sigma R and QRSs showed significant relation with OI before discharge (r=0.59, - 0.33, p<0.05, respectively), post thrombolytic therapy (r=0.51, - 0.61, p<0.05), and baseline ECG (r=0.53, - 0.51, p<0.05). 2) The number of segments with OS (0.5) showed no singificant relation to the degree of sigma ST and sigma Q, but number of segments with OS (0) showed singinficant relation to that of sigma R and QRSs (r of sigma Ri, sigma Ra, sigma Rd vs number of segments with OS (0)= - 0.59, - 0.66, - 0.43, p<0.05, QRSi, QRSa, QRSd vs number of segments with OS (0)=0.58, 0.58, 0.57, p<0.05). CONCLUSION: These findings suggest that the ECG changes of R wave and QRS scores could be useful markers of perfusion state in thrombolytic era.

Retinal Hemorrhage in an Adult with P. vivax Malaria / 감염

Malaria is a worldwide febrile illness with high morbidity and mortality. High fever, jaundice, hemolysis, and hepatosplenomegaly are usual symptoms and signs of malaria, whereas retinal hemorrhage is an unusual finding. Retinal hemorrhage has been known to be one of the clinical manifestations in severe Plasmodium falciparum infection, especially in children developing cerebral malaria. However, retinal hemorrhage can occur in adult patients with severe parasitemia, shizontemia, anemia and may occur in malaria infections caused by other Plasmodium species, because it is due to dense parasitemia in deep vascular beds. A case of Plasmodium vivax malaria with retinal hemorrhage has not been reported as yet. We report a Plasmodium vivax malaria patient with retinal hemorrhage, who presented with severe schizontemia and anemia.

A Case of Parathyroid Cancer with a Local Metastatic Focus Revealed by 99mTc-sestamibi scan / 대한내분비학회지

Carcinoma of the parathyroid gland is rare, comprising only 0.1% to 5% of all patients with primary hyperparathyroidism. It presents with severe hypercalcemia, bone disease, palpable neck mass, renal involvement and etc. Since the initial operation offers the best chance for cure, preoperative localization and intraoperative recognition of parathyroid cancer are essential. Recently parathyroid imaging has been described with 99mTc-sestamibi as an alternative to 201Tl. This newer agent has many physical and dosirnetric advantages and represents higher detection sensitivity than 201Tl-99mTc subtraction scan. We experienced a 41-year-old man presenting with recurrent hyperparathyroidism in spite of 2 previous operations. In preoperative localization, there was no abnormal uptake in 201Tl-99mTc subtraction scan but 99mTc-sestamibi scan revealed metastatic foci on right cervical area. He was successfully treated with modified radical neck dissection.

Camprison of Diagnostic and Therapeutic scans in Patients with Differentiated Thyroid Cancer / 대한내분비학회지

Background: Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.

A Case of Bilateral Macronodular Adrenocortical Hyperplasia / 대한내분비학회지

Cushing's syndrome associated with nodular adrenal glands will be divided into four main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia (PPNAD) and macronodular adrenal hyperplasia(MAH). The term macronodular adrenal hyperplasia is restricted to the presence of multiple nodules visible to the naked eye, ranging in size from 0.5 to 7.0 cm. We report a case of Cushings syndrome caused by bilateral macronodular adrenal hyperplasia (MAH). A 45-year-old man presented with Cushingoid features, hypertension and diabetes mellitus. Urine free cortisol was 449.9 mmol/day(27-276) and were not suppressed after administration of low-dose and high-dose dexamethasone. Plasma ACTH was very low(1.87 pmol/L(18)) and was not stimulated by administration of ovine CRH. In abdominal CT, both adrenal glands were markedly enlarged and nodular in appearance. Pituitary MRI showed no abnormal finding. Bilateral adrenalectomy was done. Histologic examination revealed multiple nodules and internodular hyperplasia. This case and other reports suggested that because of variable biochemical, radiologic and pathologic findings, macronodular adrenal hyperplasia represents a heterogeneous group of patients with varying degrees of adrenal autonomy.