Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.

A Case of Graves' Disease Presented as Generalized Seizure Attack

Hyperthyroidism is diagnosed when a patient is presented with typical symptoms, such as weight loss, palpitation, and hand tremor. However, early diagnosis is difficult in elders, because they have no typical symptoms, but only cardiovascular or muscular symptoms. In hyperthyroidism, there are often with neurologic changes, leading to various neurologic symptoms. Generalized or focal seizures are rarely reported in thyrotoxicosis and thyrotoxic crisis. Further, cases of hyperthyroidism presented as generalized seizure attack are extremely rare. We report a case of hyperthyroidism. A patient is presented at the hospital with mental change, as well as generalized seizure, who was finally diagnosed to have Graves' disease. A 56-year-old male was admitted to the hospital because of mental change with generalized seizure attack. Initial neurologic evaluations, including a brain magnetic resonance imaging and electroencephalogram proved to be normal. But, thyroid function test showed abnormal results. We diagnosed him as Graves' disease and prescribed anti-thyroid drug. Thereafter, there has been no recurrence of neurologic symptoms for 12 months.

Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

Radiofrequency ablation is a new non-surgical treatment modality for patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the treatment of benign thyroid nodules and recurrent thyroid cancers using radiofrequency ablation. These recommendations are based on evidence from the current literature and expert consensus.

The Current Status of Multidrug-Resistant Tuberculosis in One Tertiary Hospital in Busan, 2005~2009 / 결핵및호흡기질환

BACKGROUND: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. METHODS: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. RESULTS: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. CONCLUSION: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.

Comparison of the Diagnostic Usefulness of Two Whole-Blood Interferon-Gamma Assays for Extrapulmonary Tuberculosis / 대한내과학회지

BACKGROUND/AIMS: The QuantiFERON-TB Gold (QFT-G) and QuantiFERON-TB Gold in tube (QFT-IT) assays have been studied primarily for the use of diagnosing active pulmonary tuberculosis (TB) or latent TB. The clinical usefulness of these assays for the detection of active extrapulmonary (EP) TB has not been fully defined. The aim of this study was to compare the diagnostic value of these two interferon-gamma assays for EP-TB. METHODS: From June 2007 to August 2010, we evaluated the usefulness of QFT-G (n = 56) and QFT-IT (n = 48) in patients (n = 104) with suspected EP-TB. The diagnostic sensitivity, specificity, postive predictive value (PPV), and negative predictive value (NPV) of QFT-G and QFT-IT, and the cut-off value of QFT-IT were analyzed. RESULTS: EP-TB was diagnosed in 55 (53%) patients. The overall sensitivity, specificity, PPV, and NPV of the QFT-IT assay were 96%, 42%, 62%, and 91%, respectively, and those of the QFT-G test were 81%, 52%, 68%, and 68%, respectively. In subgroup analyses according to infection site, the sensitivity and NPV of QFT-IT were higher than those of QFT-G. Analysis confirmed that the manufacturer's recommended test cut-off value fell within our cut-off value range (0.30-0.45 IU/mL; 95.8% sensitivity, 41.7% specificity). CONCLUSIONS: The QFT-IT assay showed superior sensitivity and NPV, and equivalent specificity, as comparison with the QFT-G test for the detection of Mycobacterium tuberculosis infection. The logistic benefits of the QFT-IT test format should facilitate the diagnosis of EP-TB.

A case of successful posaconazole salvage therapy for rhinocerebral mucormycosis after failure of amphotericin B / 대한내과학회지

A 58-year-old man with uncontrolled type 2 diabetes mellitus developed rhinocerebral mucormycosis. The infection progressed to intracranial extension despite more than 5 weeks of treatment with amphotericin B. The patient then received oral posaconazole, 800 mg/d, in divided doses for 6 months. Salvage treatment with the new azole antifungal posaconazole resulted in dramatic clinical improvement as early as 1 week after the initiation of therapy. Oral posaconazole continued through 24 weeks of treatment, with marked clinical, mycological, and radiological improvements and no adverse events. Here we review the medical literature on rhinocerebral mucormycosis, which is a rapidly progressive and often fatal infection. The treatment of choice is amphotericin B, which failed in our patient. Our case report suggests that posaconazole appears to be a well tolerated and effective salvage treatment option for rhinocerebral mucormycosis, including disseminated disease.

The immunohistochemical study on Ki-67 Expression in epithelial ovarian carcinomas / 대한산부인과학회지

OBJECTIVE: The study was to evaluate the biological significance of Ki-67 expression in common epithelial ovarian carcinomas. We investigated the correlation between Ki-67 expression and clinicopathological parameters. METHODS: One hundred patients with epithelial ovarian carcinomas stage I-IV treated at Department of Obstertrics and Gynecology, Korea University Hospital from January 1994 to December 2004 were used as study group. We determined expression of Ki-67 by immunohistochemistry using MIB-1 monoclonal antibody reactivity. RESULTS: Ki-67 overexpression was higher in high stage (III-IV) than low stage (I-II) (P<0.013). Ki-67 overexpression was higher in serous cystadenocarcinoma (76.3%) than mucinous cystadenocarcinoma (53.6%), endometrioid carcinoma (54.5%) and clear cell carcinoma (58.3%) but it was not statistically significant (P<0.191). Ki-67 expression was higher in high grade but it was not statistically significant (P<0.096). Ki-67 overexpression was not correlated with serum CA-125 level (P<0.172). Overall survival revealed significant survival difference between patients whose tumor showed Ki-67 overexpressions compared with remaining patients. CONCLUSIONS: Ki-67 overexpressions was a poor prognostic indicator in epithelial ovarian carcinomas.

MR Findings of Metaplastic Carcinoma of the Breast: Case Report

We report the dynamic magnetic resonance imaging findings (MRI) of a metaplastic carcinoma of the breast. A 44-year-old woman presented with a 2-month history of a mass in the right breast. The tumor showed a central irregular necrosis that was depicted upon low signal intensity on a T1-weighted image and high signal intensity on a T2-weighted image. The periphery of the tumor showed strong enhancement on a contrast enhanced T1-weighted image. The time-signal intensity curve revealed an early strong contrast enhancement and a delayed washout pattern.

Mammographic and Sonographic Findings of Metaplastic Carcinoma of the Breast

PURPOSE: To demonstrate the mammographic and sonographic appearances of metaplastic carcinoma of the breast. MATERIALS AND METHODS: The mammographic and sonographic findings in eight female patients (aged: 28-78 years, mean: 50.3 years) with pathologically proven metaplastic cancer were analyzed retrospectively by three radiologists. We analyzed the size, density, shape, margin, associated architectural distortion, calcification in the mass and enlarged lymph node at the axilla, on the mammograms. We also analyzed the shape, margin and echogenicity of the lesions on the sonograms. RESULTS: On mammography, irregular (n=4), lobular (n=2) or oval (n=2) shaped high density masses were found. The margins of the masses were indistinct (n=4) or obscured (n=3). There were architectural distortions in three cases and pleomorphic calcifications in two cases. On sonography, irregular (n=5) or oval (n=3) shaped masses with microlobulated margins were found. The echopatterns of the masses were complex (n=5) or hypoechoic (n=3). CONCLUSION: The mammographic and sonographic findings of metaplastic carcinoma of the breast are nonspecific and similar to those of other forms of breast cancer. However, this type of tumor should be included in the differential diagnosis for breast masses which appear as an irregular or oval shape with a microlobulated margin and a complex or hypoechoic echopattern on sonography.

Family physician's roles in health promotion, what patients want

BACKGROUND: Family physicians are interested in health promotion for maintaining one's sound health. But there is little information on what patients think about the practice of health promotion by family physicians. Therefore, we found out whether patients think that it is appropriate for family physicians to be concerned about problems relating to four health risk factors, and the patients' perception both of their own health problems and of the concern actually shown by their family physicians. METHODS: Patients who had visited our two family medicine offices from March to August 1998 was asked to complete a self administered questionnaire. Questions on attitudes to wards and perceptions of family physicians' interest in weight, smoking, drinking, and fitness problems were included. 586 questionnaires with adequate response were analyzed using chi square test and Mantel Haenszel's linear trend test. RESULTS: A total of 586 respondents consisted of 230 men and 356 women. Of the respondents, the proportion of people who thought that family physicians should be concerned about the health risk factors ranged from 83.6% in the case of smoking to 86.5% of fitness, but 76.6% thought their family physicians had in fact been interested in smoking and 72.2% thought so about fitness. There was a significant age group trend in the case of attitudes towards family physician concern for smoking with larger proportions of older patients (p<0.01). Significantly more women than men thought that their family physicians seemed interested in health risk factor with 62.2% to 70.0% in men and 78.6% to 80.9% in women (p<0.001). There were significant age group differences in proportions who thought that their family physicians seemed interested in weight (p<0.001), smoking (p<0.001), and drinking (p<0.05) problems except for fitness problem. 31.6% of the respondents thought that they had a weight problem, 20.5% smoking problem, 14.0% drinking problem, and 28.2% fitness problem. CONCLUSION: These results suggest that many patients thought that most of their family physicians seemed interested in health promotion, but felt the need that they should be come more interested.

The relationship between nutrient intake and bone mineral density by use of a semiquantitative food frequency questionnaire

BACKGROUND: To determine the relationship between nutrient intake and bone mineral density(BMD), we have investigated this issue by the use of a semiquantitative food-frequency questionnaire. METHODS: A total of 312 women aged 33-77 was divided into two groups, 187 premenopausal and 125 postmenopausal women. Dietary intake was assessed with a food-frequency questionnaire. DMD was assessed with dual-energy X-ray absorptiometry at the lumbar spine (lumbar vertebrae 2-4). Pearson correlation and partial correlation coefficients were calculated for each nutrient at the lumbar spine BMD. RESULTS: The mean age of the 312 participants was 48 years, and their mean body mass index (BMI) was 23.7+/-2.8 Kg/m2. Forty percent of the women were in postmenopausal state. The mean lumbar BMD was 1.117g/cm2. Age was negatively correlated with BMD in premenopausal and postmenopausal women, BMI was positively correlated with BMD in postmenopausal women, but smoking and exercise were not correlated with BMD. In premenopausal women, nutrient intakes were not associated with BMD. A significant association was found between intakes of fat, iron, vitamin A, vitamin C and BMD in postmenopausal women, but after adjusting for age, body mass index, energy intake, smoking, exercise, and use of hormone replacement therapy, there was no association. CONCLUSION: There was no significant association between nutrient intakes and BMD of the lumbar spine.

Differentiation of Bone Metastases and Fractures using 24 hour / 3 hour Radio-uptake Ratio in Bone Scintigraphy / 대한핵의학회잡지

PURPOSE: We evaluated the usefulness of 24 hour/3 hour radio-uptake ratio, lesion to non-lesion ratio, in differentiating bony metastases from acute (<2 months) and healing ( 2 months) fractures. MATERIALS AND METHODS: Sixty-three patients (age range: 26-81, 32 males, 31 females) having 90 lesions (30 bone metastases, 30 acute fractures, 30 healing fractures) were included. Bone scans were obtained 3 and 24 hours after administration of 740 MBq of 99mTc-MDP. The ratio of radio-uptake in the lesion to normal area was measured as 24/3 hour radio-uptake ratio ([lesion/non-lesion RUR at 24 hour]/[lesion/non-lesion RUR at 3 hour], 24/3 RUR) and analyzed clinical significance in differentiating bone metastases from acute or healing fractures. RESULTS: Mean 24/3 RUR were 1.22+/-0.18 for bone metastases, 1.25+/-0.14 for acute fractures, and 0.99+/-0.15 for healing fractures. 24/3 RUR values of bone metastases and acute fractures were not significantly different. But 24/3 RUR values of bone metastases and healing fractures, and those of acute and healing fractures were found to be significantly different (p<0.001). When 24/3 RUR of 1.0 was considered as the cut off point separating metastases from fracture, a sensitivity of 100% (30/30) was obtained. The specificity was 0% (0/30) in separating metastases from acute fractures, and 47% (14/30) in separating metastases from healing fractures. When 24/3 RUR of 1.2 was considered as the cut off point, sensitivity of 53% (16/30) in the diagnosis of bone metastasis, and specificity of 37% (11/30) in separating metastases from acute fractures, and 100% (30/30) in separating metastases from healing fractures were obtained. CONCLUSION: 24/3 RUR is useful in differentiating bone metastases from healing fractures, but not in differentiating bone metastases from acute fractures. A 24/3 RUR of less than 1.0 suggests healing fractures. A 24/3 RUR of more than 1.2 suggests bone metastases or acute fractures.