Thyroid Cancer and Radiation / 대한갑상선학회지

Epidemiological studies have reported an increasing incidence of thyroid cancer worldwide. This phenomenon is unclear whether it is apparent increase or true increase. In Korea, the incidence rate of thyroid cancer in both men and women showed abrupt increase from 1999 through 2011. The possible reason of this increase is suggested as improved screening with sensitive diagnostic procedures. If the incidence increase is real, there are risk factors such as ionizing radiation, obesity, diabetes mellitus, genetic predisposition, hormones, iodine diet, Hashimoto's thyroiditis, and pollutants contributing to this increased incidence. Exposure to ionizing radiation is a well-known risk factor for thyroid cancer. This was verified by epidemiological studies from survivors after Hiroshima and Nagasaki and the Chernobyl accident. The studies demonstrated that the dose-response relationship seems to be linear. However, a statistically significant increase has hardly been described with exposure to low dose radiation (<100 mSv). In addition, with respect to the data on adult exposure, there was no proven radiation related increase of the thyroid cancer incidence. Therefore, a clear understanding for the pathogenesis of radiation induced thyroid cancer is essential. Like other cancers, there are several gene alterations thought to be involved in pathogenesis of sporadic thyroid cancer. Whereas, the exact pathogenesis of radiation induced thyroid cancer by genetic alteration has not been demonstrated until now. Recently, gene expression profiling by microarray analysis has been applied to investigate the possible pathogenesis.

Use of Screening Dose to Evaluate the Work-relatedness of Cancers Occurring among Korean Radiation Workers / 대한산업의학회지

OBJECTIVES: To propose a screening dose based on the probability of causation (PC) to simplify the evaluation procedure for the work-relatedness of the cancers occurring among Korean radiation workers. METHODS: Under the PC uncertainty distribution, the screening dose was defined in which the maximum PC is equivalent to 50% for single exposure to radiation, after which the values were calculated according to three significance levels: 90%, 95%, and 99%. By using the screening doses for each cancer, we also predicted the number of compensations for the occupational cancers among the current Korean radiation workers to determine a reasonable criterion for the significance level. RESULTS: If the cumulative dose received by a radiation worker with cancer is less than the screening dose, then PC can not be greater than 50%, i.e., the case can not be awarded as an occupational disease. The numbers of compensation cases for a future decade were predicted to be 3-5, 4-6, and 6-10 at the significance levels of 90%, 95%, and 99%, respectively. CONCLUSIONS: The procedure to evaluate the occupational disease was greatly simplified by using the screening dose for evaluation. A criterion of 95% was recommended as the PC upper limit following consideration for the results of the predicted cases for compensation and the economic circumstances in Korea.

Incidence and Risk Factors of Insulin Resistance Syndrome in 20-59 Year-Old Korean Male Workers

We investigated the incidence of insulin resistance syndrome (IRS) according to the criteria of diagnoses suggested by the American College of Endocrinology/ American Association of Clinical Endocrinologists and the risk factors associated with the development of IRS. Among 2,048 subjects without a history of/or drug treatment for hypertension, diabetes, dyslipidemia with normal findings at baseline, 1,578 subjects aged 20-59 yr were followed prospectively for 2 yr. The incidence of IRS was 6.9 per 100 persons/year. The relative risk (RR) due to age was 1.03 (95% CI: 1.00-1.05) with every one-year increase in age. The RR associated with an abnormal waist-hip ratio group (> or =0.9) was increased by 1.74 (95% CI: 1.17-2.58) compared to the normal group ( or =35 IU/L) by 1.70 (95% CI: 1.20-2.41) compared to the normal group ( or =160 mg/L) by 1.70 (95% CI: 1.19-2.44) compared to the normal LDL cholesterol (<160 mg/L). Lastly, the RR of current smokers was increased by 1.63 (95% CI: 1.09-2.42) compared to that of non-smokers. It is necessary to develop methods of prevention and therapeutic approach to manage the integrated risk factors as opposed to individual factors.

Comparison of Urine Iodine/Creatinine ratio between Patients following Stringent and Less Stringent Low Iodine Diet for Radioiodine Remnant Ablation of Thyroid Cancer / 핵의학분자영상

A low iodine diet (LID) for 1~2 weeks is recommended for patients who undergoing radioiodine remnant ablation. However, the LID educations for patients are different among centers because there is no concrete recommendation for protocol of LID. In this investigation, we compared two representative types of LID protocols performed in several centers in Korea using urine iodine to creatinine ratio (urine I/Cr). METHODS: From 2006, April to June, patients referred to our center for radioiodine remnant ablation of thyroid cancer from several local hospitals which had different LID protocols were included. We divided into two groups, stringent LID for 1week and less stringent LID for 2 weeks, then measured their urine I/Cr ratio with spot urine when patients were admitted to the hospital. RESULTS: Total 27 patients were included in this investigation (M:F=1:26; 13 in one-week stringent LID; 14 in two-week less stringent LID). Average of urine I/Cr ratio was 127.87+/-78.52 microgram/g in stringent LID for 1 week, and 289.75+/-188.24 microgram/g in less stringent LID for 2 weeks. It was significantly lower in stringent LID for 1 week group (p=0.008). The number of patients whose urine I/Cr ratios were below 100 microgram/g was 6 of 13 in stringent LID for 1 week group, and 3 of 14 in less stringent LID for 2 weeks group. CONCLUSION: Stringent LID for 1 week resulted in better urinary I/Cr ratio in our investigation compared with the other protocol. However it still resulted in plenty of inadequate range of I/Cr ratio, so more stringent protocol such as stringent LID for 2 weeks is expected more desirable.

The Prevalence and Risk Factors of Osteopenia and Osteoporosis in 40-59 year-old male workers / 대한산업의학회지

OBJECTIVES: This study was conducted to investigate the prevalence and risk factors of osteopenia and osteoporosis in 40-59 year-old male workers working at nuclear power plants. METHODS: Bone density, body composition, and anthropometry data were analyzed for 2,073 subjects were carried out from March 2004 to July, 2004. Educational level, smoking status, drinking status and frequency of physical activity were investigated by self-reported questionnaires through internet to identify lifestyles related to bone mass density. Bone mass density was measured by EXE-3000 of Osteosys Co. and body fat percentage, and waist-to-hip ratio by Inbody 3.0 of Biospace Co. RESULTS: The prevalence of ostepeniaosteopenia and osteoporosis was 22.8% and 3.0%, respectively. According to multinominal multinomial logistic regression analysis, age, smoking status (current smoker and former smoker), low body mass index (< 25 kg/m2), and frequency of physical activity were significantly associated with osteopenia and osteoporosis. CONCLUSIONS: The prevalence of osteopenia and osteoporosis wasseemed high for the, when it was inferred from subjects' age compared to the results of previous studies. The This study results suggeststhat it is necessary for 40-59 year-old male workers to stop smoking, and exercise regularly in order to prevent osteopenia and osteoporosis.

Radioresistance of Dendritic Cells / 대한핵의학회잡지

PURPOSE: To evaluate radiation sensitivity of dendritic cells in comparison with lymphocytes. MATERIALS AND METHODS: T lymphocytes captured from peripheral blood were irradiated by 0 Gy, 10 Gy, 30 Gy. Apoptosis was measured by flowcytometry for staining of Annexin V 4 hours after irradiation. Immature and mature dendritic cells processed from blood hematopoietic stem cell were irradiated by 0 Gy, 10 Gy, 30 Gy, 100 Gy respectively and apoptosis was measured by flowcytometry with time difference as 4h, 24h and 48h after irradiation. Morphometric analysis by percent nucleus was measured in three cell groups, also. RESULTS: Lymphocytes showed radiation sensitivity by increasing apoptotic fraction according to radiation dose. However, both mature and immature dendritic cells showed consistent fraction of apoptosis in spite of increasing radiation dose. Percent nucleus ratio is significantly higher in lymphocytes than that of mature or immature dendritic cells. Stimulation of T-cell by dendritic cells was not changed after irradiation. CONCLUSION: Dendritic cells showed radioresistance which was associated with small size of nucleus in comparison with lymphocytes and this result would be used as a basal data of radio-labelling for the cellular trafficking studies in nuclear medicine fields.

The History of Radiation Accidents

While the use of radioactive materials around the world offers a wide range of benefits in medicine, industry and research, radiation accidents also occur in world-wide. The objective of this article is to provide useful information about radiation accidents to the medical personnel. For this, I attempted to document the circumstances leading to the accident and the subsequent medical treatment and health consequences of the victims. Radiation accidents described in this article are Chernobyl nuclear power plant accident, nuclear weapon accident in bikini atoll, major industrial accidents (Ir-192 Peruvian accident, Ir-192 internal contamination accident in Korea, Tokaimura accident in Japan) and Cs-137 contamination accident in Brazil. After reviewing major radiation accidents, I summarized the lessons to be learned from these accidents and presented the helpful institutes that can offer useful helps when radiation accident occurs.

Three Cases of Autoimmune Thyroid Disease in a Family through Three Generation / 대한내분비학회지

According to recent studies, the immunogenetic factors are thought to be account for a part of the etiopathogenesis of autoimmune thyroid disease. In Korea, there was one report on the relationship between HLA DR5, DR8, B13 and autoimmune thyroid disease. There were also several reports on a familial hereditary transmission of autoimmune thyroid disease in other countries but not in Korea. We describe the occurrence of autoimmune thyroid disease that affected three members of a family through three generations. This is the first report on familial hereditary transmission of autoimmune thyroid disease in Korea. We report on an 80-year-old woman who presented with Hashimoto's thyroiditis, her 53-year-old daughter who had Graves' disease, and her 29-year-old grand-daughter who had Graves' disease. In order to identify the immunogenetic influence in these cases, HLA haplotypes & thyroid autoantibody were studied. HLA DRB3*02 was obseved in each of the patents. HLA DQB1*0301, DR11, DQB1*05031 and DR14 were observed in the two cases. However, HLA B13, DR5 and DR8 were not observed. The patients are currently undergoing follow-up using PTU, methimazole and synthyroid medication.

Influence of Neuropathy and Ischemia in the Development and Treatment of the Diabetic Foot / 대한정형외과학회잡지

PURPOSE: To investigate the influence of sensory impairment and vascular insufficiency on the development and treatment of diabetic foot lesions. MATERIALS AND METHODS: From July 1995 to June 1997, 25 subjects with diabetic foot lesions were treated with an average follow-up of 19.6 months (range, 12-35 months). Sensory evaluation was performed with the Semmes-Weinstein monofilaments and a 256 cycles-per-second tuning fork, Vascular testing was performed with IMEXLAB 9,000 workstation in 24 of 25 subjects. RESULTS: In 22 of 25 patients, they could not perceive 5.07 monofilament and also could not feel vibration. In 6 patients, the vascular flow was normal, and there were mild insufficiency in 10 patients and severe insufficiency in 8 patients. The degree of vascular insufficiency correlated with the severity of the lesion (Wagner classification) and also with the result of the treatment. Despite severe vascular insufficiencies, foot lesions could be treated by forefoot amputations in 7 of 8 patients. Overall there were 9 recurrences after initial healing. CONCLUSIONS: This study shows that it is essential to educate patients on taking care of their foot because most of them do not have protective sensation. Vascular insufficiency may be related to the severity of the lesions and the result of treatment. We have to pay continuous attention to these patients for early detection of recurrence after initial treatment of the foot lesions.

Comparison of Thallium-201, Tc-99m MIBI and I-131 Scan in the Follow-up Assessment after I-131 Ablative Therapy in Differentiated Thyroid Cancer / 대한핵의학회잡지

PURPOSE: We conducted a comparative study to evaluate the diagnostic values of Tl-201, Tc-99m MIBI and I-131 scans in the follow-up assessment after ablative I-131 therapy in differentiated thyroid cancer. MATERIALS AND METHODS: The study population consisted of 20 patients who underwent surgical removal of thyroid cancer and ablative radioactive iodine therapy, and followed by one or more times of I-131 retreatments (33 cases). In all patients, Tl-201, Tc-99m MIBI, diagnostic and therapeutic I-131 scans were performed and the RESULTS were analyzed retrospectively. Also serum thyroglobulin levels were measured in all patients. The final diagnosis of recurrent or metastatic thyroid cancer was determined by clinical, biochemical, radiologic and/or biopsy findings. RESULTS: Positive rates (PR) of Tc-99m MIBI, Tl-201, diagnostic and therapeutic I-131 scans in detecting malignant thyroid tissue lesions were 70% (19/27), 54% (15/28), 35% (17/48) and 63% (30/48), respectively. The PR in the group of 20 cases (28 lesions) who underwent concomitant Tl-201 and I-131 scans were in the order of therapeutic 131 scan 71%, Tl-201 scan 54% and diagnostic I-131 scan 36%. There was no statistically significant difference between Tl-201 and diagnostic I-131 scans (p>0.05). In the group of 20 cases (27 lesions) who underwent concomitant Tc-99m MIBI and I-131 scans, the PR were in the order of Tc-99m MIBI scan 70%, I-131 therapeutic scan 52% and I-131 diagnostic scan 33%. The PR of Tc-99m MIBI was significantly higher than that of diagnostic I-131 scan (p<0.05). CONCLUSION: Tc-99m MIBI scan is superior to diagnostic I-131 scan in detecting recurrent or metastatic thyroid cancer following ablation therapy in patients with differentiated thyroid cancer. Tl-201 scan did not showed significantly higher positive rate than diagnostic I-131 scan. Instead of diagnostic I-131 scan before the I-131 retreatment, Tc-99m MIBI scan without discontinuing thyroid hormone replacement would be a prudent and effective approach in the management of these patients.

The Study of the Dry Cough Incidence Rate about Imidapril, the Angiotensin Converting Enzyme Inhibitor

BACKGROUND AND OBJECTIVES: Imidapril, one of the ACE inhibitor, has been used to treate hypertension, congestive heart failure, diabetes mellitus and renal disease. ACE inhibitor, however often causes dry cough and this adverse effect affects the compliance rate negatively. This report aimed to examine the incidence rate of coughing caused by Imidapril treat-ment. And we compared the results with the incidence and tendency of dry cough caused by the other ACE inhibitors. MATERIALS AND METHOD: This study enrolled 38 patients who followed up at internal medicine and took Imidapril from the period of May 9, 1997 to December 17, 1997. We tested its effectiveness, safety and tolerance. The initial dosage of it was 5mg/day and the maximum dosage according to blood pressure was 10mg/day for 8 weeks. The tendency and the incidence of dry cough have been analyzed and compared with recently published Korean reports. RESULTS: The 5 mg dosage of Imidapril showed 68.1% in lowering blood pressure rate and it went up to 81.8% during the 8 weeks treatment perriod. The blood pressure regularity rate was 36.3% after the 8 weeks treatment. The overall rate of adverse effect occurrence was 26.1% (6/23) and 8.7% of them were likely to cough. One of the patients who showed nausea stopped medication. The recent articles reported that the incidence of dry cough had been reduced: Enalapril (33.8%), Fosinopril (16%), Ramipril (15%), Imidapril (7.8 - 8.7%), Losartan (4.3%). CONCLUSION: Imidapril is as safe and effective as other ACE inhibitors. Various ACE inhibitors that were newly developed show their effectiveness in lessening incidence rate of dry cough, and Imidapril is thought to be an excellent drug for this matter. Even though Losartan shows the lowest incidence rate of dry cough, it needs to more regular usages since it is still on the stage of its medical adaptation.

Comparison of I-131 Scintigraphy , T1-201 Scintigraphy , and Serum Thyroglobulin in the Postoperative Follow-Up of Differentiated Thyroid Cancer / 대한핵의학회잡지

To evaluate the utility of I-131, T1-201 scintigraphy, and serum thyroglobulin(Tg) in the follow-up of differentiated thyroid cancer, we compared retrospectively the data from 33 patients who underwent total or subtotal thyroidectomy. I-131 scintigraphy was performed after optimal endogenous TSH stimulation (TSH>50microgram/ml). Total 41 cases of I-l3l and T1-201 scintigraphy pairs were examined. Concomitant serum thyroglobulin levels were measured for 41 pairs of scan. Tg-off levels(that measured after discontinuation of the thyroid hormone) higher than 40ng/ml were considered positive, and Tg-on levels(that measured during the thyroid hormone replacement) higher than 5ng/ml were considered positive. The concordance rates between I-131 therapeutic scintigraphy and T1-201 scintigraphy was 48% in the 38 case of total scan pairs(59% in the 17 cases of postoperative preablation group, and 38% in the 21 cases of postoperative postablation group), Of 17 studies before the I-131 ablation therapy (preablation group), 7 showed positive I-131 therapeutic scintigraphy despite of negative T1-201 scintigraphy. Among patients with negative I-131 therapeutic scintigraphy, no patients had abnormal T1-201 uptake. However, of 21 studies which were done after radioiodine therapy(postablation group) 6 had abnormal uptake on T1-201 scintigraphy which were not seen on I-131 therapeutic scintigraphy, and Tg-off levels also elevated in this 4 of 6 cases. As a result, I-131 therapeutic scintigraphy showed highest positive rate at postoperative preablation follow-up study in differentiated thyroid cancer patients. T1-201 scintigraphy may be useful in postablation studies, and the use of the combined modalities(T1-201 and Tg levels) provides a higher diagnostic yield.

Usefulness of Tc-99m MIBI Scan in the Postoperative Follow Up Of Well-Differentiated Thyroid Cancer / 대한핵의학회잡지

To evaluate the clinical utility of Tc-99m MIBI scan in the detection of residual thyroid tissue or metastatic lesion in postoperative thyroid cancer patients, we compared Tc-99m MIBI scan with I-131 diagnostic and therapeutic scan in 30 postoperative well-differentiated thyroid cancer patients. Thyroglobulin levels of both on and off thyroid hormone medication and antithyroglobulin antibody were tested [Tg(on), Tg(off)l Positive rates for I-131 diagnostic and Tc-99m MIBI scan were 81% and 68% respectively. Concordance between I-131 diagnostic and Tc-99m MIBI scan was observed in 15 cases; 12 positive and 3 negative respectively Among the 6 cases with negative I-131 diagnostic scan and positive Tc-99m MIBI scan, 4 were positive in the therapeutic I-131 scan. We concluded that Tc-99m MIBI scan maybe a useful complementary modality to the currently established method of I131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.

Utility of measurement of GFR using 99mTc-DTPA in patients with increased ECF volume / 대한내과학회지

No abstract available.

Histopathological changes of the liver after praziquantel treatment in Clonorchis sinensis infected rabbits

The rabbits were infected with Clnorchis sinensis and were treated with praziquantel at the dose of 50 mg/kg x 2 x 2 days afer 1, 2, 4, 8 weeks and 7 months from the infection. Their livers were observed histopathologically 1, 4 and 12 weeks after treatment. The findings are summarized as below: The changes of the liver in control rabbits were relatively mild until 2 weeks after infection. However, widening and thickening of bile ducts, proliferation of biliary epithelium and periductal fibrosis were moderate after 4 weeks from infection and those changes were severe after 8 weeks and 7months. Goblet cell metaplasia was found after 8 weeks from infection. The mild changes of 2-week infection group were completely recovered by 4 weeks after the treatment. In the groups of 4 or more weeks after infection, the changes of bile ducts became milder in the degree after the treatment, but were still found 12 weeks after the treatment. As the infection duration was passed, more severe changes were observed after the treatment. In this context, it is concluded that the liver changes of acute clonorchiasis in the early two weeks are reversible by treatment while chronic biliary epithelial changes are irreversible. Therefore, early treatment should be recommended as possible to minimize the remaining histopathological changes of liver in clonorchiasis.

Treadmill Exercise Testing in Hypertensives

Fourteen healthy persons and 43 hypertensives were subjected to treadmill exercise testing to see responses of variable influenced by various degrees of hypertension. The hypertensive were subclassified into 3 groups, mild hypertension(diast. BP<104mmHg), moderate hypertension(diast. BP<129mmHg). 1) The attainability of maximal heart rate was inversely related with levels of basal blood pressure;92.8% of normal control group attained the maximal heart rate, 87.5% of mild hypertension, 69.2% of moderate hypertension and 66.7% of moderately severe hypertension. 2) As the exercise was geaded up, the rate of increase of heart rate was lower in higher blood perssure groups than in lower blood pressuer groups. 3) The rate and extent of rise in systolic pressure was inversely related with basal systolic pressure, the systolic pressure response being least in the group with highest pressure, that is, moderately severe hypertension group. The diastolic pressure seemed to decrease somewhat in early phase of exercise only to return back to basal level at the late phase of exercise. 4) Seven of 43 hypertensive showed significant ST depression during exercise, which may be due to imbalance between oxygen demand and supply caused sither by left ventricular hypertrophy or ischemic heart disease. 5) A case was characterized by very sluggish response in increase of heart rate despite progress in exercise grade and he fell into collase 12 minutes after the interruption of exercise. The tardy response in heart rate may be a hitherto unsuspected risk predictor in exercise test.

Differential Diagnosis in Cases Showing Poor R-Wave Progression on EKG by Vectorcardiography

The vectorcardiography was performed on 34 cases with PRWP of precordial leads. We have studied the vectorcardiographic finding for the differential diagnosis of disease entities were obtrained; 1) Poor R-Wave progression of precordial leads has simply considered as suggestion of anterior myocardial infarction, ischemic heart disease, chronic lung disease and normal variant. 2) The sensitivity and specificity of myocardial infarction criteria were 85.8% and 63.0% respectively in left sagittal plane and 85.8% and 66.7% respectively in horizontal plane. 3) The seneitively and specificity of more than 90 QRS-T vector angle in left sagittal plane were 100.0% and 62.5% respectively in ischemic heart disease and myocardial infarction. 4) The sensitively and specificity of chronic lung disease criteria were 85.7% and 51.9% respectively. 5) Vectorcardiographic study was considered as effective differentiating method for patients with PRWP in EKG.