Clinicopathological factors increased the risk of malignancy in thyroid nodules with atypical or follicular lesions of undetermined significance (AUS/FLUS) risk factor of malignancy in thyroid nodule with AUS/FLUS

PURPOSE: Ultrasound-guided fine needle aspiration (US-FNA) in thyroid nodules is presently most commonly used to identify whether these nodules are benign or malignant. However, atypical or follicular lesions of undetermined significance (AUS/FLUS), as categorized in the Bethesda System for reporting the results of FNA, cannot be classified as benign or malignant. Therefore, several clinical factors should be considered to assess the risk of malignancy in patients with AUS/FLUS. The purpose of the present study was to determine which clinical factor increased the risk of malignancy in patients with AUS/FLUS. METHODS: A retrospective study was done on 129 patients with fine needle aspiration categorized as AUS/FLUS from January 2011 through April 2015. Univariate and multivariate analyses were performed to assess the independent effect of risk factors such as age, sex, size of nodule, atypical descriptors, and ultrasonography criteria for malignancy. RESULTS: We identified that the presence of spiculated margin (odds ratio [OR], 5.655; 95% confidence interval [CI], 2.114-15.131; P = 0.001), nuclear grooving (OR, 3.697; 95% CI, 1.409-9.701; P = 0.008), irregular nuclei (OR, 3.903; 95% CI, 1.442-10.560; P = 0.001) were shown to be significantly related to malignancy on univariate and multivariate analyses. CONCLUSION: We recommend that surgical resection of thyroid nodules be considered in patients with AUS/FLUS showing the histologic findings such as nuclear grooving, irregular nuclei along with spiculated margin of ultrasonographic finding.

Effectiveness of Endovascular Treatment of Acute Thrombosis of Arteriovenous Graft for Hemodialysis by Primary Endovascualr Treatment Strategy / 대한혈관외과학회지

PURPOSE: Acute thrombosis of arteriovenous graft (AVG) has been treated by surgical thrombectomy; however, endovascular treatment became an alternative treatment option recently. The purpose of this study is to evaluate the effectiveness of endovascular treatment for acute thrombosis of AVG (EndoAVG) by primary endovascular treatment strategy. METHODS: This is a retrospective study of patients who underwent EndoAVG from January 2003 to December 2010 in Inha University Hospital. The patients' clinical characteristics and EndoAVG procedures were reviewed by electronic charts and X-ray films. Clinical success was defined as the residual stenosis below 30% or success of hemodialysis. RESULTS: Thirty-eight patients were enrolled. The mean age was 64+/-15.4 years in the success group and 58+/-17.2 years in the failed group. The mean duration from AVG formation to endovascular thrombectomy was 19.2+/-29.5 months. The success rate of EndoAVG was 84.2% (32/38). There were three complications after EndoAVG: two brachial artery thromboses and one rupture of a vein at the ballooning site. Six months, twelve months and twenty-four months secondary patency rate were 77.5%, 65.5%, and 42.5%, respectively. CONCLUSION: The success rate of EndoAVG was 84.2%. Its result is compatible with open thrombectomy and can be a good alternative option for the treatment of acute thrombosis of AVG. Larger number of cases is required for stronger study.

The Effect of Duodenojejunal Bypass for T2DM Patients Below BMI 25 kg/m2 in Early Postoperative Period

PURPOSE: Diabetes mellitus refers to one of several risk factors for cardiovascular diseases, renal failure and so on. Medical treatments of T2DM cannot suggest a perfect cure. But gastric bypass resulting in the exclusion of the duodenum and proximal jejunum has been shown to improve or resolve T2DM. The goal of this study is to evaluate the effect of duodenojejunal bypass for T2DM patients below BMI 25 kg/m2 in early postoperative period. METHODS: Duodenojejunal bypass was performed on 25 patients at Inha University Hospital from July 2009 to April 2010. We compared 75 g OGTT, insulin, C peptide to those 7 days postoperative. The definitions for improvement are serum glucose level below 200 mg/dl of 75 g OGTT at 120 min or below 200 mg/dl at every other time in spite of over 200 mg/dl at 120 min. RESULTS: A total of 25 patients (15 men and 10 women) were included. Median value BMI was 23.17 kg/m2 and the mean duration of T2DM was 8.3 years. There was a significant decrease of postoperative 75 g OGTT levels from 176, 268, 345, 373, 371 mg/dl to 125, 170, 200, 225 and 241 mg/dl, respectively (P<0.001). Only patients' age was an independent factor resolution of T2DM based on this study. CONCLUSION: Duodenojejunal bypass could be one viable treatment modality for improving or resolving of T2DM although these are early results. This study has preliminary meanings only and the results of longer follow-up and a larger number of patients are necessary, by which we should be able to determine the effect and indications for surgical treatment of T2DM.

Brain Language Network and Lateralization Using for Spoken and Written Korean Words in Normal Adults: A Functional MRI Study

OBJECTIVE: This study involves an experiment using functional magnetic resonance imaging (fMRI) to delineate neural network and laterality of language related brain activation for spoken and written Korean words in normal adults. METHOD: Eight normal right-handed Korean males, aged 20~33 years, were investigated. Language tasks consisted of auditory and visual verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software. The number of activated voxels were counted in each hemisphere to calculate the laterality index according to each language task. RESULTS: In auditory verb generation task, inferior frontal gyrus and superior temporal region were activated in the left side. Right temporal lobe was also activated in the superior and middle temporal areas. Other activated area included medial frontal lobe. Lateralization index of auditory verb generation task was +78.6 +/-30.7. In visual verb generation task, inferior frontal gyrus was activated in the left side. Medial frontal lobe, both lateral occipital lobe, and left parietal lobe were also activated. The laterality index was +87.6 +/- 10.1. CONCLUSION: We could delineate cortical regions subserved for spoken and written Korean language and laterality of language related brain activation using fMRI. These results can contribute to understand underlying mechanism of language disorders in brain injury patients and to investigate the pattern of reorganization of language network after rehabilitation.

A Functional MRI Study of Brain Language Network in Korean Adult

OBJECTIVES: To report the results of functional magnetic resonance imaging (fMRI) experiment to delineate brain network for auditory language tasks in normal Korean adults. METHOD: Five normal right-handed Korean males, aged 20~33 years, were investigated using fMRI technique. Language tasks consisted of auditory listening and verb generation tasks. In fMRI, twenty slices were obtained for each functional volume using single shot echoplanar image sequences. Eighty-four volumes were obtained for each functional run. Data were motion corrected, coregistered, normalized, and statistically analyzed using SPM-96 software (Wellcom Department of Cognitive Neurology, Oxford, UK). RESULTS: Functional activation were detected in superior temporal region (coordinates: x= 64, y= 42, z=2) in the left side and superior to middle temporal lobe (coordinates: x=50, y= 20, z=2) in the right side for auditory listening task. Auditory verb generation task activated inferior frontal gyrus (coordinates: x= 56, y=16, z=14), superior temporal region, and medial frontal region in the left side. Right temporal lobe was also activated in the superior to middle temporal areas. Activation was more extensive in the left side for both language tasks. CONCLUSION: Our results can remarkably delineate cortical and subcortical regions subserved for auditory language processing. These results can be contributing to understand the underlying mechanism of language disorders in brain-injured patients and to investigate the pattern of reorganization of language network after rehabilitation.