Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma in a Child: A Case Report

The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is uncommon. Herein, we report a rare case of DSPTC in a 9-year-old girl who initially presented with a painless diffuse goiter. Thyroid peroxidase antibody testing yielded positive results, and the initial clinical diagnosis was Hashimoto's thyroiditis. However, thyroid ultrasonography revealed characteristic findings of DSPTC, which was confirmed through the postoperative histopathological diagnosis. Although thyroid cancers are rare in the pediatric population, DSPTC should be included in the differential diagnosis of goiter in these patients. Moreover, ultrasonography may prevent a diagnostic delay and facilitate the detection of a concomitant malignancy.

Altered Regulation of 11beta-hydroxysteroid Dehydrogenase II in the Kidney of Rats with Experimental Hypertension

The present study was aimed at investigating the role of type II 11beta-hydroxysteroid dehydrogenase (IIbeta- HSD II) in the development of hypertension. Two-kidney, one-clip (2K1C), deoxycorticosterone acetate (DOCA)/salt, or NG-nitro-L-arginine methyl ester (L-NAME) hypertension was induced in male Sprague- Dawley rats. Four weeks later, the expression of 11beta-HSD II mRNA was determined in the kidney by Northern blot analysis. The plasma level of aldosterone was measured by radioimmunoassay. In 2K1C hypertension, the expression of 11beta-HSD II was decreased in the clipped kidney and increased in the non-clipped kidney. The expression was increased in the remnant kidney of DOCA/salt hypertension, while decreased in the kidneys of L-NAME hypertension. The plasma level of aldosterone was increased, decreased, and remained unchanged in 2K1C, DOCA/salt, and L-NAME hypertension, respectively. The down-regulation of 11beta-HSD II may contribute to the sodium retention, thereby increasing the blood pressure in 2K1C and L-NAME hypertension. On the contrary, the up-regulation in DOCA/salt hypertension may play a compensatory role to dissipate the sodium retention.

Expression of Matrix Metalloproteinase (MMP)-1, MMP-3 Nitrotyrosine and Apoptosis in Articular Cartilage of Human Osteoarthritis

BACKGROUND: Matrix metalloproteinase (MMP)-1 and 3 are the most important degradating enzymes of the chondroid matrix. Chondrocytes may undergo apoptosis under various stimuli including nitric oxide (NO). We studied the expression rate and zone of MMP-1, MMP-3, nitrotyrosine, a marker of NO release, and apoptosis in the articular cartilage of human osteoarthritis. METHODS: To investigate the role of nitrotyrosine and apoptosis in the degradation of the chondroid matrix in human osteoarthritis, immunohistochemistry was done for MMP-1, MMP-3, and nitrotyrosine; and the terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) method was performed for apoptosis using a total of 93 articular cartilages from 12 femoral heads and 17 knees obtained from total joint arthroplasty and 7 normal articular cartilages. RESULTS: In the normal control group, the expression rates for MMP-1, MMP-3, nitrotyrosine, and apoptosis were very low; and their expression zones were confined to the superficial layer of the articular cartilage. Their expression rates were low in the early stage of osteoarthritis and were moderate to high in the late stage (P<0.05). Their expression zones were confined to the superficial layer of the articular cartilage in the early stage of osteoarthritis and were expressed throughout the whole layer in the late stage and those of MMP-3 and nitrotyrosine were statistically significant (P<0.05). Their expression rates and zones were significantly correlated with the grade of osteoarthritis (P<0.05). Conclusion : The expression rate and zone of apoptosis and nitrotyrosine correlated well with those of MMP-1 and MMP-3. Therefore, NO and apoptosis may be related to the progression of human osteoarthritis.

Diagnostic Significance of Myelo-Enhanced Computerized Tomography(MECT) in Spinal Stenosis / 대한정형외과학회잡지

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Myelo-enhanced computerized tomography(MECT) has been accepted as especially useful diagnostic method for spinal steonsis after its application in the orthopedic fields. The goal of this study was to analyze the diagnostic accuracy and sensitivity of MECT and to determine the prevalance of stenosis in various regions of lumbar spine. During the period of 3 years, from January 1991 to December 1993, 40 cases of lumbar spinal stenosis were analyzed, all of whom took myelography, computerized tomography and surgical treatment. The results of the study were as follows: 1. The myelographic findings were, respectively, hourglass bilateral defect 15(37.5%), complete block 14(35%) and the unilateral focal defect 5(12.5%). 2. The most prevalent from of spinal stenosis was the combined central-lateral-foraminal stenosis(47.5%) and the degenerative change in the lumbar spine was the principal etiologic factor(55%) by Arnoldi classification. 3. The involved levels were as follows:1 level 18(45%), 2 level 16(40%) and 3 level 6(15%). And among single level, the most frequent level was L5-S1 intervertebral space(30%). The diagnostic accuracies according to operative finding and above results were 83% by myelography and 97.5% by MECT. The MECT showed absolutely superior to myelography or CT and it was especially useful in lateral stenosis and multi-level stenosis.

As a Cause of Myelopathy in the Lower Thracic Spines ): Two Cases Report / 대한정형외과학회잡지

Ossification of the ligamentum flavum (OLF) has been recognised as a definite clinical entity as an ossification of the posterior longitudinal ligament. It has been known that the incidence of OLF is high in Japan and OLF usually occurs in the thoracic and lumbar region. Recently OLF has received considerable attention as a cause of myelopathy. OLF is quite distinct from “hypertrophy” of the ligamentum flvum. We experienced 2 cases of OLF with neurological symptom, which were treated by decompressive laminectomy and removal of the ossified ligamentum flavum. So remarkable symptomatic improvement was obtained.

Clinical Study on Ankylosing Spondylitis / 대한정형외과학회잡지

Ankylosing spondylitis is a chronic inflammatory disease which most frequently affects the sacro-iliac joints of young men, and also the synovial joints of the whole spine. Bony fusion of these joints and ossification along the longitudinal ligaments lead to total immobility of the vertebrae. Sixty-two cases of ankylosing spondylitis treated at the Severance Hospital from June 1980 to June 1986 were analysed clinically and the followings were obtained. 1. The average age was 38 years and the sex ratio between the male and the female was 58: 4(Male=94%). 2. The most frequent location of pain was low back (32%), and the pain was usually bilateral (81%). 3. The main stiff regions were the hip joint (35%) and the lumbar spine (27%). 4. The most frequent joint affected was the hip (44%), and the extraarticular manifestations were pleuropulmonary disease (29%), gastrointestinal disorder (15%), iritis (10%), etc. 5. The characteristic X-ray findings were sacro-iliac changes (72%), facet joint blurring (53%), and syndesmophyte (37%). 6. Laborstory findings showed increased ESR (85%), positive HLA B-27 (97%), negative rheumatoid factor (94%), and the serum immunoglobulins snd complements were not decreased.