Hyperfunction Thyroid Nodules: Their Risk for Becoming or Being Associated with Thyroid Cancers

OBJECTIVE: To retrospectively evaluate the risk of thyroid cancer in patients with hyperfunctioning thyroid nodules through ultrasonographic-pathologic analysis. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent was waived. From 2003 to 2007, 107 patients consecutively presented with hot spots on thyroid scans and low serum thyroid-stimulating hormone levels. Among them, 32 patients who had undergone thyroid ultrasonography were analyzed in this study. Thyroid nodules depicted on ultrasonography were classified based on size and categorized as benign, indeterminate, or suspicious malignant nodules according to ultrasonographic findings. The thyroid nodules were determined as either hyperfunctioning or coexisting nodules and were then correlated with pathologic results. RESULTS: In 32 patients, 42 hyperfunctioning nodules (mean number per patient, 1.31; range, 1-6) were observed on thyroid scans and 68 coexisting nodules (mean, 2.13; range, 0-7) were observed on ultrasonography. Twenty-five patients (78.1%) had at least one hyperfunctioning (n = 17, 53.1%) or coexisting (n = 16, 50.0%) nodule that showed a suspicious malignant feature larger than 5 mm (n = 8, 25.0%), or an indeterminate feature 1 cm or greater (n = 20, 62.5%) in diameter, which could have been indicated by using fine needle aspiration (FNA). Seven patients were proven to have 11 thyroid cancers in 3 hyperfunctioning and 8 coexisting nodules. All of these had at least one thyroid cancer, which could have been indicated by using FNA. The estimated minimal risk of thyroid cancer was 6.5% (7/107). CONCLUSION: Patients with hyperfunctioning nodules may not be safe from thyroid cancer because hyperfunctioning nodules can coexist with thyroid cancer nodules. To screen out these cancers, ultrasonography should be performed.

A Case of Recurrent Eosinophilic Granuloma in the Maxilla / 대한이비인후과학회지

Langerhans cell histiocytosis is global term for a spectrum of diseases which include eosinophilic granuloma, Hand-Schuller-Christian disease and Letterer-Siwe disease. Eosinophilic granuloma of bone usually presents as a solitary lytic lesion and responds well to conservative treatment. It may involve the femur, humerus, ribs, and other bones, but is most common in the skull and jaws, and it may be solitary or multifocal: the latter form is more likely to recur or be associated with systemic disease. In the maxillofacial region, the disease may present in a variety of ways including swelling, bone pain, gingival inflammation, ulceration, mobile teeth and even pathological fracture. Treatment of this disease usually requires a multidisciplinary approach. In cases of solitary bone lesion, surgery is indicated as the first treatment modality. All other disease situations with multiple organ involvement or multiple bone lesions usually requires multiple surgical as well as non-surgical interventions, such as chemotherapy and radiotherapy. We report, with a review of literature, a case of recurrent eosinophilic granuloma of the maxilla, the patient have presented a history of previous eosinophilic granuloma with skull lesion teated by craniectomy.

Combination Therapy of Earlobe Keloids / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Keloids are proliferative growths of dermal collagen which extends beyond the original wound. Many modalities are available for treatment of keloids but there is no desirable modality to prevent the recurrence of keloids until now. The authors suggest that the combination therapy of surgical excision, steroid injection and compression therapy is an effective method for prevention of recurrence. MATERIALS AND METHOD : Eleven patients who underwent surgical excision for earlobe keloids in the period from June of 2003 to July of 2005 were selected for clinical analysis. We injected steroid at the surgical margin after excision and compressed it by aluminum splint after skin closure. RESULTS : There were four men and seven women, ranging in age from 13 to 60 years (mean age, 29.2 years). The causes of keloids were earring in seven cases, trauma in two cases and middle ear surgery in two case. The keloids appeared at 1 to 17 years (mean, 3.9 years) after earring, trauma or middle ear surgery, and follow-up period ranged from 3 to 28 months (mean, 9.3 month). The sizes of keloids varied from 0.6x0.3x0.2 cm to 3.4x2.3x1.3 cm. Only one out of the 11 cases recurred and the remaining 10 cases had good results without recurrence. CONCLUSION : We believe that the combination therapy of surgical excision, steroid injection and compression by aluminum splint is a very effective therapy for treatment of earlobe keloids.

A Case of Augmentation Rhinoplasty with Abdominal Keloid Tissue

The nose is an important aesthetic projection affecting the profile of the face. In general, east and South East Asians have noses characterized by a wide flat dorsum, a bulbous thick nasal tip, thick subcutaneous tissues with alar flare and a short, retracted columella. Such anatomical characteristics have resulted in augmentation rhinoplasty to be the most popular procedure for Far East Asian noses. Various materials have been used for augmenting the nasal dorsum from the past. But several kinds of problems still exist after these augmentations and there are no desirable materials until now. A case of augmentation rhinoplasty with keloid tissue for the first time in Korea is being reported.

Quantification of Brain Images Using Korean Standard Templates and Structural and Cytoarchitectonic Probabilistic Maps / 대한핵의학회잡지

PURPOSE: Population based structural and functional maps of the brain provide effective tools for the analysis and interpretation of complex and individually variable brain data. Brain MRI and PET standard templates and statistical probabilistic maps based on image data of Korean normal volunteers have been developed and probabilistic maps based on cytoarchitectonic data have been introduced. A quantification method using these data was developed for the objective assessment of regional intensity in the brain images. Materials and METHODS: Age, gender and ethnic specific anatomical and functional brain templates based on MR and PET images of Korean normal volunteers were developed. Korean structural probabilistic maps for 89 brain regions and cytoarchitectonic probabilistic maps for 13 Brodmann areas were transformed onto the standard templates. Brain FDG PET and SPGR MR images of normal volunteers were spatially normalized onto the template of each modality and gender. Regional uptake of radiotracers in PET and gray matter concentration in MR images were then quantified by averaging (or summing) regional intensities weighted using the probabilistic maps of brain regions. Regionally specific effects of aging on glucose metabolism in cingulate cortex were also examined. RESULTS: Quantification program could generate quantification results for single spatially normalized images per 20 seconds. Glucose metabolism change in cingulate gyrus was regionally specific: ratios of glucose metabolism in the rostral anterior cingulate vs. posterior cingulate and the caudal anterior cingulate vs. posterior cingulate were significantly decreased as the age increased. 'Rostral anterior'/ 'posterior' was decreased by 3.1% per decade of age (P< 10 (-11), r=0.81) and 'caudal anterior'/ 'posterior' was decreased by 1.7% (P< 10 (-8), r=0.72). CONCLUSION: Ethnic specific standard templates and probabilistic maps and quantification program developed in this study will be useful for the analysis of brain image of Korean people since the difference in shape of the hemispheres and the sulcal pattern of brain relative to age, gender, races, and diseases cannot be fully overcome by the nonlinear spatial normalization techniques.

Changes of Apoptosis according to the Site and Clinical Stage of Experimental Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Aural cholesteatoma is a destructive disease of the middle ear caused by progressive expansion of keratinizing squamous epithelium. Previous studies reported that apoptosis of keratinizing squamous epithelium was increased in cholesteatoma which involves various genes in the regulation process. In the present study, we investigated the degree of apoptosis using expression of bcl-2, p53 and bax in various sites of experimental cholesteatomas. We also investigated the degree of apoptosis in different clinical stages of cholesteatoma. MATERIALS AND METHOD: Using canal ligation cholesteatoma in mongolian gerbil, we performed immunohistochemical stainings of bcl-2, p53 and bax. Labeling indices of bcl-2 and p53 expressoin and subjective grading of bax expression were measured and analyzed according to the site and clinical stage of cholesteatoma. RESULTS: 1) Expression of bcl-2 and p53 were significantly increased at lateral external auditory canal compared with those at the tympanic membrane. 2) Expression of bax of cholesteatoma was significantly increased compared with that of the normal external auditory canal. 3) Expression of bcl-2 and bax were significantly increased in the stage I and expression of p53 was increased in the stage III of cholesteatoma. CONCLUSION: Changes of bcl-2, p53 and bax expression in experimental cholesteatoma may be related with various apoptosis according to the different sites and different clinical stages of cholesteatoma.

A Case of Eosinophilic Granuloma of the Temporal Bone / 대한이비인후과학회지

Eosinophilic granuloma is characterized by osteolytic skeletal lesions which are infiltrated by abnormal histiocyte, eosinophil and giant cells. Eosinophilic granuloma has been described as Histiocytosis X in 1953 by Lichtenstein. Eosinophilic granuloma generally implies osseous disease alone. Single solitary site of the bone is typically affected, although multifocal involvement can occur. This lesion involves long or flat bone. The skull bone, especially the temporal or frontal bone are the most frequent site of the body for involvement of this lesion. Prognosis is relatively favorable. We report, with a review of relevant literature, a case of eosinophilic granuloma of the temporal bone which was treated surgically in a 5-year-old male.

A Case of Meningioma Invading the Middle Ear / 대한이비인후과학회지

Frequency of meningioma is reported to be 18 percent of all incidences of intracranial primary tumors, and tumor extension to the extracranial structures occurred in about 20 percent of intracranial meningiomas. Involvement of the middle ear is quite rare and meningioma in the middle ear can be seen either as a primary tumor or an extension of intracranial tumors. Since predominant symptoms of meningioma are hearing loss, otorrhea and other otologic symptoms, one can be mislead to chronic otitis media with diagnosis. Recently, we incidentally found a meningioma in the middle ear during chronic ear surgery in a 40-year-old female, who was confirmed by histopathologic diagnosis to have meningioma. We report herewith this case with the review of literatures.

The Effect of Tonsillectomy and Adenoidectomy on Nasality in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillar and adenoid hypertrophy is one of the common causes of nasal obstruction, mouth breathing, snoring and sleep apnea in children. Tonsillectomy and adenoidectomy (T & A) could relieve these symptoms but may also cause voice changes after the operation. The aim of this study was to evaluate the voice changes objectively by nasometric and acoustic rhinometric analyses. MATERIALS AND METHODS: Thirty-eight patients who underwent T & A and twenty-two control children who had no sinonasal or tonsillar hypertrophy problems were selected. A visual analogue scale was used for determining the subjective nasality changes and nasometric analyses were used to determine the objective nasalance differences. Acoustic rhinometry was used to measure the nasopharyngeal volume changes and the removed adenoid tissue were directly measured. Data were collected prior to the operation, and on the second, 7th and 14th days after the operation. Data were compared and analyzed statistically. RESULTS: The volume of removed adenoid tissue was not statistically related with the subjective nasality changes which increased significantly after T R. A. Nasalance in the patient group increased significantly after the operation compared to that in the control group. The voiume of nasopharynx increased significantly after adenoidectomy, but it had a minimal statistical correlation with the volume of the removed adenoid tissue. CONCLUSION: Nasometric and acoustic rhinometric tests can serve as objective tools for evaluating the subjective nasality changes after T 5z A.

A Case of Allergic Mucin Sphenoiditis without Fungus

Allergic fungal sinusitis is characterized by eosinophilic allergic mucin with fungal hyphae in histopathologic aspect. "Allergic mucin sinusitis without fungus" or "Allergic fungal sinusitis-like syndrome" is a new term used to describe patients who have clinical and histopathologic features of allergic fungal sinusitis but fail to demonstrate fungi in histopathologic sections or cultures of sinus tissue. In this study, we report on a case of allergic mucin sinusitis which involved only sphenoid sinus of the left side in a 31 year old female.

Differentiation of Medial or Lateral Temporal Lobe Epilepsy by F-18-Fluorodeoxyglucose Positron Emission Tomography: Comparative Study with Magnetic Resonance Imaging in 113 Surgically and Pathologically Proven Patients / 대한핵의학회잡지

PURPOSE: As mesial temporal lobe epilepsy (TLE) shows hypometabolism of medial and lateral tempora lobe, we investigated whether symmetric uptake of F-18-FDG in medial temporal lobes can differentiat mesial from lateral TLE. MATERIALS AND METHODS: In 113 patients (83 mesial TLE, 30 lateral TLE) wh underwent anterior temporal lobectomy and/or corticectomy with good surgical outcome, we performe F-18-FDG PET and compared F-18-FDG uptake of medial and lateral temporal lobes. All the patients wi mesial TLE had hippocampal sclerosis except one congenital abnormal hippocampus. Patients with latera TLE revealed cerebromalacia, microdysgenesis, arteriovenous malformation, old contusion, and cortical dys plasia. RESULTS: Sensitivity of F-18-FDG PET and MR for mesial TLE was 84% (70/83) and 73% (61/83 respectively. Sensitivity of F-18-FDG PET and MR for lateral TLE was 90% (27/30) and 66% (20/30 respectively. Twelve patients were normal on F-18-FDG PET. 101 patients had hypometabolism of latera temporal lobe. Among 88 patients who showed hypometabolism of medial temporal lobe as well as later temporal lobe, 70 were mesial TLE patients and 18 were lateral TLE on pathologic examination. Positive predictive value of medial temporal hypometabolism for mesial TLE was 80%. Among 13 patients wh showed hypometabolism of only lateral temporal lobe, 4 were mesial TLE and 9 were lateral TLE. Positive predictive value of hypometabolism of lateral temporal lobe for the diagnosis of lateral TLE was 69% ( 13). Normal MR findings stood against medial TLE, whose negative predictive value was 66%. Conclusion Lateral temporal lobe epilepsy should be suspected when there is decreased F-18-FDG uptake in latera temporal lobe with normal uptake in medial temporal lobe.

The Prevalence of Nasal Septal Deformities among Children in Kindergarten and First Grade in Anyang and Kunpo Cities

Nasal septal deformity (NSD) is a common nasal disorder, but its prevalence among children has not been reported in Korea. The aim of this work was to study the prevalence of NSD among children in kindergarten and first grade in Anyang and Kunpo cities and to evaluate whether the occurrence of NSD in children was affected by school activity or correlated with sex. We examined 1,646 nasal septa of 1,491 students (average age : 7.5 years ; range : 6.3-8.9 years) at three elementary schools and 155 children (average age : 6.5 years ; range : 5.9-7.1 years) at two public kindergartens. The overall prevalence of NSD was 13.6%. A significant difference in prevalence was found between male and female children and between male and female firstgraders. No difference was found between the children in kindergarten and the children attending first grade and between male and female children in kindergarten. The most common type of NSD, based on the Mladina's classification, was type 1, followed by types 2 and 5.

Neuronal migration disorders: MRI, SPECT and PET findings

BACKGROUND: With the aid of high-resolution MRI, the identification of neuronal migration disorder(NMDs) is increasing and NMDs are considered as one of the major causes of extrahippocampal epilepsy. However, MRI has some limitatons in detecting small cortical lesion of NMDs. We have studied the diagnostic value and findings of brain SPECT and PET in the patients with NMDs. METHODS: Nineteen NMD patient with intrac table and partial epilepsy were studied. Diagnosis of NMDs was based on neuroimaging and pathology. Proton, Tl and T2-weighted axial, saggital and coronal MR image were obtained by 1.5 Tesla unit. Interictal and ictal SPFCT and PET imagings were performed with 99mTc-HMPAO and 18F-fluorodeoxyglucose. RESULT: Focal cortical dysplasia (FCD) and schizencephaly were detected in 4 patients, heterotopias in 3(one with 3 isolated lesions and one with bilateral temporal lobe lesions), polymicrogyria in 3, hemi-megalencephaly in 2, pachygyria in 2, forme fruste of tuberculous sclerosis(FFTS) in 1. Heterotopia was also combined with other lesions as schizencephaly, FFS and pachygyria. The MRI detected the lesions in 14 patients(73.7%). Of the 5 patients without definite abnormalities on MRI, 3 had focal polymicrogyda and 2 had FCD on pathologic examination. The interictal SPECT revealed abnormalities in 9 of 12 patients(75.0%), but could not detect 2 FCDs and one heterotopia. The ictal SPECT detected the lesions in all 11 patients. PET showed the compatible abnormalities in 17 patients(89.5%), but there was no abnormal finding in 2(1 with FCD and 1 with heterotopia). The abnormal lesions in PET were more extensive than those in MRI in the 8 patients with focal NMDs. Heterotopia showed cortical gray matter activity on PET in 6 out of 11 lesions. All other NMDs showed hypometabolism or metabolic detect in the interictal SPECT and PET. CONCLUSION: Functional imaging as SPECT & PET may be more selective than MRI to detect focal cortical lesions in NMD. NMDs show, variable metabolic pattern on functional imagings and in general the derangement in the functional imaging is more widespread than the lesions detected by MRI. We recommend the functional neuroimaging in the patients who are suspected to have partial seizure of neocortical origin and have no abnormal findings on brain MRI.

Cerebellar Arteries Originating from the Internal Carotid Artery: Angiographic evaluation and Embryologic Explanations

PURPOSE: To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. MATERIALS AND METHODS: To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. RESULTS: Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. CONCLUSION: In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation.

Sensitivity of Ictal Spect and Variables to affect this in the Presurgical Evaluation of Medically Intractable TLE Patients

BACKGROUND & OBJECTIVE: We did this study to evaluate the sensitivity of ictal SPECT in the presurgical evaluation of medically intractable TLE patients and 1,o know the variables to affect the results of ictal SPECT. METHODS: Ictal SPECT studies were performed in 49 medically intractable TLE patients and the results compared to the final anterior temporal lobectomy sites. Also, we have evaluated the effect of injection time of 99m7c-HMPAO and the presence of secondary generalization on the result of ictal SPECT. Results : In 43/49 (87.8%) patients, increased temporal perfusion of ictal SPECT was concordant to the estimated side of seizure origin. But in 6/49 (12.2%) patients, ictal SPECT studies were incorrect (2 patients - contralateral temporal increased perfusion, 1 patient - bilateral temporal increased perfusion, 1 patient ipsilateral but frontal increased perfusion, 2 patients - no significant perfusion change) Forty-two of forty-four (95.5%) patients in whom true ictal studies were done showed increased temporal perfusion in the final surgery sites. But only one of five patients with postictal injection correctly identified the site of focus. In all eight patients with secondary generalized convulsion and ictal injection, the ictal SPECT studies showed Increased temporal perfusion concordant to the final surgery site. Conclusions : Ictal SPECT studies were very sensitive and useful in the presurgical evaluation of medically intractable TLE patients especially when they were done during the ictal state. Whether generalization occurred or not did not seem to affect the ictal SPECT findings. And this study suggests that if ictal SPECT are used appropriately along with video-EEG monitoring, brain MRI, and other noninvasive studies, many patients can avoid invasive studies.

MR Finding in Subarachnoid Hemorrhage

In an effort to determine the value of the magnetic resonance imaging(MRI) in patients with subarachnoid hemorrhage(SAH), we compared MR findings with CT findings in 34 patients of aneurysmal SAH who taken MRI either preoperatively or postoperatively. MRI was taken in 8 patients and postoperatively in 31 patients. Preoperative abnormal MR findings were cisternal space obliteration(in one case), subacute hematoma in cisternal space(in one case), and visualization of turbulent signal void of aneurysm(in 3 cases). In 31 patients, MRI was taken postoperatively without any problem in spite of their intracranial aneurysm clip(in 9 patients among them, MRI was taken in high(2.0T) magnetic field). And characteristic MR artifact, with sausage shaped central low signal and surrounding high signal in T2WI, appeared in postoperative MRI scans. Their dimension were about 2+4cm in T2WI axial and T2WI sagittal scans. Findings of infarction were detected in 3 cases in both MRI scans and CT scans which were taken within 3dyas interval, postoperatively 1 in total 9 cases. But findings of the hemorrhagic infarction(3 cases) and subacute hemorrhage(2 cases) were detected only in MRI scans.