Tumor Size Is Still a Useful Prognostic Factor for the Therapeutic Plan of Papillary Thyroid Carcinoma / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: Papillary thyroid microcarcinoma (PTMC) was regarded as early-stage carcinoma, but its aggressiveness has been frequently reported. We performed this study to compare the clinicopathologic characteristics of PTMC with those of papillary thyroid carcinoma (PTC) >1 cm. We evaluated the association of clinicopathologic parameters of PTMC with tumor size divided by each millimeter. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 1,139 patients with PTMC and 1,296 patients with PTC >1 cm who underwent thyroidectomy from 1995 to 2004 at Samsung Medical Center. The aggressive variants of PTC were excluded in the subjects. RESULTS: Multifocality, extrathyroidal invasion (ETI), lymph node invasion (LNI), and distant metastasis (DM) were significantly less frequent in PTMC than PTC >1 cm (p1 cm (recurrence 2.9% vs. 8.1%, p<0.001; mortality 0.5% vs. 1.5%, p<0.05). Tumor size was correlated with the rates of multifocality, ETI, LNI, and DM in all PTC (p<0.01). All patients with DM had the tumor size 0.6 cm in diameter or more. Among PTMC, the rates of LNI, multifocality, and N1b significantly increased when tumor size exceeded 0.3 cm, 0.4 cm, and 0.6 cm, respectively (p<0.05). CONCLUSION: Recurrence and mortality rates of PTMC were extremely low, although local invasion was detected on the level of subcentimeter. Tumor size was well correlated with the aggressiveness of PTC. We suggest that tumor size is still a useful prognostic factor for the therapeutic plan of PTC.

Autosomal Dominant Hypocalcemia Caused by an Activating Mutation of the Calcium-Sensing Receptor Gene: The First Case Report in Korea

Hypoparathyroidism is an abnormality of calcium metabolism characterized by low serum levels of parathyroid hormone in spite of hypocalcemia. The causes of hypoparathyroidism are numerous. Activating mutations in the calcium-sensing receptor (CaSR) gene are well-known causes of familial isolated hypoparathyroidism, also known as autosomal dominant hypocalcemia (ADH). Here we describe members of a Korean family with a heterozygous Pro221Leu mutation causing ADH. This case is the first report in Korea.

A Case of Synchronous Triple Primary Cancer of Gastric Adenocarcinoma, Carcinoid Tumor of the Ampulla of Vater and Renal Cell Carcinoma / 대한소화기내시경학회지

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma.

A Case of Cavitary Lung Lesion as a Consequence of Smoke Inhalation Injury / 결핵및호흡기질환

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences.

The Findings of Pulmonary Function Test in Patients with Inhalation Injury / 결핵및호흡기질환

BACKGROUND: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. METHODS: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. RESULTS: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial PaO2/FiO2ratio and COHb were 286.4+/-129.6 mmHg and 7.8+/-6.6 %. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. CONCLUSIONS: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period.

A Case of Carbamazepine-induced Acute Interstitial Nephritis / 대한신장학회잡지

We report a case of acute interstitial nephritis associated with carbamazepine in a 45-year-old woman who developed acute renal failure. The patient has been taken valproic acid and carbamazepine to control the recurrent episodes of seizure after the surgery for meningioma. The patient developed acute renal failure with fever and skin rash. The patient stopped all medications except valproic acid, and was examined by ultrasonography, gallium scan and renal biopsy. Renal biopsy revealed severe interstitial infiltration of neutrophils in glomeruli without inflammation. After discontinuation of carbamazepine, acute renal failure of the patient improved and serum creatinine returned to normal.

The relationship of adiponectin, leptin and ghrelin to insulin resistance and cardiovascular risk factors in human obesity / 대한내과학회지

BACKGROUND: Adiponectin, letin and ghrelin are considered to take part in the regulation of energy metabolism. We investigated the relationship between these adipokines and body mass index (BMI), regional adiposity, insulin resistance and cardiovascular risk factors in human. METHODS: Eighty six (Male : Female = 36 : 50, Age = 21-71 year old, BMI : 18 - 39.5 kg/m2) subjects without known medical problems participated in this study. Subjects were grouped based on BMI or visceral fat area (VFA) and gender. We measured lipid concentration, fasting glucose, fasting insulin, insulin resistance (HOMA-IR) and high sensitivity CRP (hsCRP). Body fat distribution was determined by computed tomography. Fasting serum adiponectin, leptin, and ghrelin were measured by ELISA. RESULTS: The group of BMI over 25 kg/m2 showed significant difference in waist circumference (WC), total fat area (TFA), subcutaneous fat area (SFA), VFA, Triglyceride (TG), hsCRP and leptin. Visceral fat dominant (VFD) group (VFA>or=100 cm2 or VFA/SFA>or=0.4) showed significant difference in age, BMI, WC, TFA, SFA, free fatty acid, HOMA-IR, hsCRP, adiponectin, leptin and ghrelin. Leptin was positively correlated with BMI, waist hip ratio (WHR), TFA, VFA, SFA, low-density lipoprotein cholesterol (LDL-C), HOMA-IR and fasting insulin. Adiponectin was negatively correlated with BMI, WHR, TFA, VFA, HOMA-IR and positively correlated with High-density lipoprotein cholesterol (HDL-C). Ghrelin level was negatively correlated with WHR, VFA, fasting glucose, HOMA-IR and positively correlated with HDL-C. And leptin was negatively correlated with ghrelin. As regional adiposity, SFA was positively correlated with leptin, and VFA was negatively correlated with adiponectin and ghrelin and positively correlated with leptin. CONCLUSIONS: This study demonstrated that VFA had more significant association with lipid metabolism and adipokine secretion than BMI and leptin levels were inversely correlated with ghrelin level.