Usefulness of Thallium-201 Scintigraphy for Differentiating Benign and Malignant Thyroid Nodules in Inconclusive Cases with Fine Needle Aspiration / 대한내분비학회지

BACKGROUND: Although fine needle aspiration(FNA) is recognized as the most accurate procedure in the differential diagnosis of thyroid nodules, about 20~30% of nodules remain inconclusive in FNA. Therefore, we assessed the usefulness of Thallium-201 scintigraphy in differentiating benign from malignant thyroid nodules in patients with inconclusive diagnosis by FNA. METHODS: We studied 43 patients with inconclusive diagnosis(29 of follicular neoplasm, 11 of cystic change and 3 of inadequate) by FNA, with the results being confirmed histopathologically by operation. Thallium-201 scintigraphy was performed at 15 minutes(early scan) and 2-3 hours(late scan) after the intravenous administration of 37 MBq of thallium-201. Malignant nodules were defined by the retention of Thallium-201 on delayed images. RESULTS: In the 43 patients with inconclusive FNA diagnosis, Thallium-201 scan had a sensitivity of 75.0%, specificity of 62.9% and accuracy of 65.1%. The positive and negative predictive values were 31.6% and 91.7%, respectively. In the 29 patients with follicular neoplasm by FNA, Thallium-201 scan had a sensitivity of 83.3%, specificity of 60.9% and accuracy of 65.5%. The positive and negative predictive values were 35.7% and 93.3%, respectively. CONCLUSION: In particular, Thallium-201 scintigraphy demonstrated a high negative predictive value, Therefore, for patients with inconclusive FNA findings, Thallium-201 scintigraphy might be useful in differentiating between benign and malignant thyroid nodules, and has the potential to reduce the rate of unnecessary operations in benign nodules.

Infection Control Activity in Hallym University Medical Center / 병원감염관리

No Abstract available.

Effects of Brief Symptom Management Module on Inpatients with Chronic Schizophrenia: A Preliminary Study / 신경정신의학

OBJECTIVES: The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpatients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. METHODS: The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). RESULTS: Overall, patients showed improvement over the treatment period on psychopathology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9+/-4.0 before training to 12.9+/-4.2 after training(p<0.01) and scores of CGI were improved from 3.7+/-0.9 to 2.8+/-0.8 (p<0.01). However age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with un-awareness of psychosis. CONCLUSION: These results suggest that SMM-B could be a reliable method to improve self-awareness of psychosis in patients with chronic schizophrenia and one of important elements in rehabilitation.

Two Cases of Ectopic Gallstones Treated by Endoscopic Therapy / 대한소화기내시경학회지

Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.

Donor Specific Transfusion 24 Hours Prior to(-24h DST) Living Donor Renal Transplantation / 대한신장학회잡지

The goal of the immunologic maneuvering for organ transplantation may be the donor specific immune tolerance rather than non-specific immunosuppression. Although DST is one of the most extensively studied methods for donor specific immune hyporesponsiveness, it is not widely used in recent years because of possible sensitization and overall improvement of graft survival without DST. Several human and animal studies showed that -24h DST with concomitant cyclosporine administration improved graft survival. -24 DST may not induce adverse sensitization that preclude subsequent transplantation and the procedure is simple and does not delay the operation in living donor transplantation. Between Feb. 1994 and Jan. 1997, 33 patients received 100-200ml of fresh whole blood from the kidney donor 1 day before transplantation. Twenty donors were living related and 13 donors were non- related. Mean age was 40(22-52). Two patients was diabetic. All but one received primary allograft. Cyclosporine and prednisolone were the primary immunosuppressants that started 2-3 days before transplantation. Acute rejection occurred in 11 recipients(33.3%). Acute rejection tended to occur earlier. Eight of 11 first episodes were within 3 days post- transplant, which were all recovered by either steroid pulse or OKT3. Mean follow up was 35 months. Two patients died with functioning graft. Three-year graft survival rate was 93.9%. There was no immunologic graft loss. We conclude that -24h DST may be a valuable option of immune modulation for renal transplantation with no demonstrable adverse reaction. It's beneficial effect needs to be confirmed by a larger controlled study.

A Case of Granulocytic Sarcoma causing Spinal Cord Compression in Chronic Myelogenous Leukemia / 대한혈액학회지

Granulocytic sarcoma is a localized tumor mass composed of immature cells of the granulocytic series. It can develope in patients with acute myelogenous leukemia or impending blast crisis of chronic myelogenous leukemia. Granulocytic sarcoma during the course of chronic myelogenous leukemia has beeen noted to occur in lymph node, bone, skin, breast, peritoneum, testis, ovary, gastrointestinal tract, kidney, brain. We reported a case of granulocytic sarcoma causing spinal cord compression in chronic myelogenous leukemia with a brief review of literature.

Risk Factors and Clinical Characteristics of Post-Renal Transplant Diabetes Mellitus / 대한신장학회잡지

To investigate the risk factors and clinical characteristics of postrenal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients (10.7%) developed PTDM at 5.0+/-7.8 (1-52) months; 9 (47%) of these within 1 month. PTDM patients were older than nondiabetic renal transplants (42+/-2 vs 37+/-1 years, P<0.05). Body mass index tended to be higher in PTDM (23.5+/-1.0 vs 21.8+/-0.3kg/m2, P=0.09). Number of acute rejections (0.6+/-0.2 vs 0.5+/-0.1) and serum creatinine at 1 year after transplantation (1.2+/-0.8 vs 1.3+/-0.3mg/dL) were not different. Fasting (103.6+/-10.4 vs 84.4+/-1.6mg/dL, P<0.05) and postprandial (189.2+/-24.8 vs 118.6+/-2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350+/-34 vs 279+/-8ng/mL, P<0.05). Fasting serum insulin was significantly higher (28.2+/-12.2 vs 7.3+/-2.0 microunit/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients (6.3+/-1.6 vs 3.8+/-0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7+/-6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.

A Case of Leukemic Transformation in Essential Thrombocythemia Treated with Hydroxyurea / 대한혈액학회지

Essential thrombocythemia is a myeloproliferative disorder, characterized by marked thrombocytosis and marrow megakaryocytic hyperplasia. Although the major causes of morbidity and mortality are bleeding and thromboembolic events, the long-term prognosis is favorable and leukemic transformation is rare. We report a case of acute leukemia following treatment of Philadelphia chromosome-negative essential thrombocythemia with hydroxyurea for 4 years with a brief review of literature.