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Usefulness of Tc-99m MIBI Scan in the Postoperative Follow Up Of Well-Differentiated Thyroid Cancer (분화된 갑상선암의 수술후 경과 관찰에서 Tc-99m MIBI 스캔과 다른 추적 지표들의 유용성 비교)

  • You, Kye-Hwa;Song, Jae-Soon;Shinn, Joon-Jae;Lee, Hyun-Kyung;Cha, Wang-Ki;Kim, Do-Min;Kim, Eun-Sil;Kim, Chong-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.3
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    • pp.356-364
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    • 1997
  • 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)]. 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 I-131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.

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Two Patients with Diabetic Gastroparesis Who Showed Improvement in Gastric Motility and Blood Glucose Control through Korean Traditional Medical Therapy (당뇨병성 위마비 환자에 대해 한방치료 후 위 운동성 및 혈당조절이 호전된 2예 보고)

  • Jang, Sun-Young;Eom, Guk-Hyeon;Lee, Seon-Young;Kim, Hyun-Kyung;Lee, Joon-Suk;Ryu, Jong-Min;Kim, Jin-Sung;Ryu, Bong-Ha;Ryu, Ki-Won;Lew, Jae-Hwan;Yoon, Sang-Hyub
    • The Journal of Internal Korean Medicine
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    • v.26 no.1
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    • pp.265-274
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    • 2005
  • Diabetic gastroparesis is a disorder in a diabetic of delayed gastric emptying in the absence of mechanical obstruction. It is estimated that about 20%-50% of diabetics suffer from gastroparesis. Clinical Sympoms include early satiety, bloating, nausea, anorexia, vomiting, abdominal pain, and weight loss. Severe gastroparesis might result in recurrent hospitalization, malnutrition, and even death, but, no exact treatment has yet been established. Electrogastrography has been known to be a simple, non-invasive, and effective method in assessing gastric motility and EGG has been used to diagnosis diabetic gastroparesis and to estimate its prognosis. Recently, two cases of diabetic gastroparesis were observed. For this cases, manual acupucture, electroacupucture, lumbar skin warming and herb medicine were applied. After application of these therapies, gastrointestinal symptoms improved and these therapeutic effects were confirmed in EGG. Moreover, blood glucose control improved, so patients were able to discontinue insulin injection and change to p.o.medication. In light of this encouraging application of oriental medicine, this is reported along with investigation of the literature.

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Recurrent Paravalvular Leakage after Mitral Valve Replacement with Annular Reconstruction for Paravalvular Leakage Due to a Paravalvular Abscess - A case report - (판막주위농양에 의해 발생된 판막주위누출 환자에서 승모판막 치환술과 승모판륜 재건술을 함께 시행한 후 재발된 판막주위누출 - 1예 보고 -)

  • Park, Chan-Beom;Kim, Yong-Han;Kweon, Jong-Bum;Park, Kuhn;Chung, Mee-Young;Jin, Ung;Roh, Tae-Ho;Kim, Chi-Kyung
    • Journal of Chest Surgery
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    • v.41 no.2
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    • pp.268-272
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    • 2008
  • Paravalvular abscess is defined as infective necrosis of the mitral annulus and surrounding tissue that requires debridement of the necrotic tissue and patch reconstruction before valve implantation. Paravalvular abscess is associated with high operative mortality, postoperative complications, and recurrence. We report here a case of a 59-year old woman that had undergone mitral valvular replacement with a mechanical valve 13 years ago. The patient was determined to have paravalvular leakage due to paravalvular abscess as seen during follow-up. The patient underwent repeat mitral valvular replacement with annular reconstruction. However, the patient with mitral annular reconstruction and valvular replacement on the fifteenth postoperative day due to recurrence of paravalvular leakage. The patient is now receiving follow-up eight months after surgery.

Clinical and Molecular Characterization of Korean Patients with Glycogen Storage Type 1b (당원병1b형의 임상양상 및 분자유전학적 특징)

  • Cho, Ja Hyang;Kim, Yoo-Mi;Choi, Jin-Ho;Lee, Beom Hee;Kim, Gu-Hwan;Yoo, Han-Wook
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.15 no.1
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    • pp.18-24
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    • 2015
  • Glycogen storage disease type Ib (GSD Ib) is one of the rare inherited metabolic disease caused by mutation of SLC37A4 gene. Clinical characteristics include hepatomegaly, hypoglycemia, lactic acidosis, hyperlipidemia and high serum uric acid concentration. The authors analyzed clinical and molecular characteristics of three Korean patients (one male and two females) with GSD Ib by retrospective review of medical records. Two patients were diagnosed in toddler period by hypoglycemia and hepatomegaly. One patient was diagnosed by growth retardation and short stature in puberty. c.412T>C (p.Trp138Arg) (3/6 alleles, 50.0%) was most frequently observed, following by p.Leu348Valfs*53 (1 allele), p.Pro191Leu (1 allele), p.Ala148Val (1 allele) in molecular analysis. Uncooked corn starch and allopurinol was administered. Because all three patients had neutropenia and recurrent infections, G-CSF was administered. Two patients had severe osteoporosis needing calcium supplement. The patient who diagnosed at puberty had relatively poor prognosis demonstrated by having severe infection and complications in liver and kidney.

The Treatment for The Intractable Epidural Abscess Using Tensor Fascia Lata Graft and Anterolateral Thigh Free Flap (대퇴근막 이식과 전외측 대퇴 유리 피판을 이용한 난치성 경막 외 농양의 치료)

  • Park, Byung-Chan;Ryu, Min-Hee;Kim, Tae-Gon;Lee, Jun-Ho
    • Archives of Reconstructive Microsurgery
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    • v.18 no.1
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    • pp.23-26
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    • 2009
  • Purpose: Artificial dura maters are commonly used in cranioplasty, but sometimes they can result in serious postoperative infection. Once complications such as epidural abscess or chronic draining ulcer arise, they are very difficult to treat. In this case, reclosure of dura defect using artificial dura mater may give rise to recurrence of infection. We experienced a case of intractable epidural abscess caused by use of artificial dura. To avoid repeated infection, we decided to use autologous tissue for the coverage of dura and soft tissue defect. Therefore, autologous tensor fascia lata graft and anterolateral thigh free flap were harvested at the same donor site incision to cover composite defect on the scalp and dura mater. Methods: A 13 year old male patient, who underwent the decompression cranioplasty and duroplasty, suffered from the intractable infection lesion. Twice, the epidural abscess was removed, both times the infection recurred. And eventually dura mater was exposed through the infected open wound. Nine months after dura exposed, infected aritificial dura mater was removed and extensive debridement was performed. Through a surgical incision on donor thigh, first, tensor fascia lata graft was harvested in process of the anterolateral thigh flap elevation. After the fascia lata graft was fixed over the dural defect, the anterolateral thigh flap was used to fill the dead space as well as the scalp defect. Results: Postoperatively, no recurrent infection and cerebrospinal fluid leakage are observed for a year. After the surgery, on the first and second day, venous congestion of the flap was observed, this problem was solved by thrombectomy and vein reanastomosis. And partial necrosis of flap occurred, but completely healed as conservative treatment for two weeks. Conclusion: Using the autologous tensor fascia lata graft and anterolateral thigh flap, we could obtain satisfactory results as treatment for the intractable infection lesion after duroplasty. Autologous tensor fascia lata in conjunction with anterolateral thigh flap is useful method for covering composite defect of scalp and dura mater.

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Aerodynamic Features and Voice Therapy Interventions of Functional Voice Disorder after Thyroidectomy (갑상선 절제 술 후 기능적 음성장애의 공기역학적 특징과 음성치료 중재)

  • Lee, Chang-Yoon;An, Soo-Youn;Chang, Hyun;Jeong, Hee Seok;Son, Hee Young
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.26 no.1
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    • pp.25-33
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    • 2015
  • Background and Objectives:The objective of this study was to investigate the features of post-thyroidectomy subjective voice disorder by Voice Handicap Index (VHI) and Voice Symptom Scale (VOISS) through aerodynamic analysis and to investigate the appropriate voice therapy intervention. Materials and Methods:Twenty post-thyroidectomy patients who had no recurrent laryngeal nerve paralysis through laryngeal stroboscopy were enrolled for this study. Acoustic and aerodynamic evaluations were performed before operation, 2 weeks and 3 months after operation. Subjective voice evaluation was performed by VHI and VOISS. Aerodynamic evaluation was compared and analysed by maximum phonation time(MPT), phonation threshold pressure(PTP), mean air flow rate(MFR), etc. Subjective voice evaluation was surveyed through VHI and VOISS. To evaluate patients' symptoms related to functional voice disorder, scores on physical domain in VHI and VOISS were selected to be compared for each session. Results: The 10 out of 20 participants who complained of voice symptoms had no significant difference with pre-operation in acoustic evaluation, but all showed higher scores on 2 weeks and 3 months after operation compared to pre-operation, in VHI-physical domain and selected questionnaires in VOISS. They reduced MPT and increased PTP value simultaneously. Laryngeal massage and breathing training were simultaneously treated to them, 5 participants resulting in improvement in MPT and PTP compared to pre-treatment. Conclusion:Patients who complained voice change with no organic damage after thyroidectomy were all shown to have reduced MPT and increased PTP in some by aerodynamic evaluations. Reduced MPT may imply some problem in air flow beneath glottis. Increased PTP suggests much more effort in vocalization mechanism than pre-operation. Comparing aerodynamic evaluations in post-thyroidectomy may provide information on behavioral interventions. Additionally, study on laryngeal massage and breathing training simultaneously treated to patients with such voice disorder is needed to be conducted with larger number of participants.

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A Clinical Analysis of the Thyroid Cancer (갑상선암의 임상적 고찰)

  • Park Ki-Min;Kang Hyung-Kil;Kim Lee-Su;Lee Bong-Hwa
    • Korean Journal of Head & Neck Oncology
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    • v.13 no.2
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    • pp.213-220
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    • 1997
  • Background: Thyroid cancer is a relatively rare neoplasm and its incidence varies geographically and ethnically around the world. Thyroid cancer is the most common endocrine malignancy, but it has a wide spectrum of biologic behavior, histologic appearance, and management. Purpose: The purpose of the study was to analyse and evaluate all aspects of the clinical consideration in thyroid cancer. Method: Between 1986 and 1995, a retrospective analysis of 77 thyrod cancer patients admitted at the Department of Surgery, Hangang Sacred Heart Hospital, Hallym University was made to assess clinical entities. Result: By the pathological classification, the papillary carcinoma was the most common type(83.1%). Male to female ratio was 1 : 5.4 and most prevalent age group was noted from fourth decade to fifth decade(46.8%). The most common duration of illness between the appearance of the symptoms and the treatment was below 6 months(44.2%), and the most common symptom was the palpable mass at the anterior portion of the neck(96.1%). Most cases of the thyroid cancer were appeared as cold nodule in the $^{99m}$Tc-thyroid scan(95.7%). In the site of tumor location, the right and left lobe was distributed similarly. In the extent of tumor, incidence of intrathyroidal location was 41.6%, and that of the metastasis to the cervical lymph nodes was 44.2% and that of the direct capsular invasion was 27.3%, and incidence of both involved case was 13%. Surgical procedures were total thyroidectomy alone in 27 cases(35.1%) or with modified neck dissection in 6 cases(7.8%), or with radical neck dissection in 2 cases (2.6%), near total thyroidectomy alone in 22 cases(28.6%), ipsilateral lobectomy with isthmectomy alone in 12 cases(15.6%) or with modified neck dissection in 1 case(1.3%), and biopsy only in 7 cases(9.1%). The most common postoperative complications were transient hypoparathyroidism(5.2%) and transient unilateral recurrent laryngeal nerve paralysis(5.2%). Conclusion: The major problem of management of thyroid cancer include a wide spectrum of clinical behaviour of this tumor entity, the lack of reliable prognostic factors and lack of an objective assessment of the various treatment modalities. But because of showing the favorable prognosis for most thyroid cancer, appropriate and aggressive management should be recommended.

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Internal Jugular Vein Patency after Modified Radical Neck Dissection (변형적 경부청소술 후 내경정맥의 유지)

  • Cho Jung-Il;Kim Young-Mo;Kim Chul-Ho;Kim Hyung-Jin
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.2
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    • pp.169-174
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    • 1998
  • Background: To avoid the major mobidity associated with bilateral radical neck dissection, modified radical neck dissection has become established as an effective adjunctive procedure in the management of head and neck cancer. But several studies reported early postoperative internal jugular vein(IJV) occlusion in patients who underwent modified radical neck dissection. Objectives: To determine internal jugular vein patency following modified radical neck dessection performed in various head and neck cancer and to identify factors associated with venous occlusion. Materials and Methods: From Aug. 1996 to Oct. 1997, twenty three patients underwent either unilateral or bilateral modified radical neck dissection; 19 males and 4 females, ranging in age from 28 to 75 were retrospectively examined. All patients had a preoperative doppler imaging or CT or both for their initial evaluation. A follow-up examination was obtained(after a minimum postoperative period of 2 months and a maximum one of 4 months). Results: Thirty-four IJVs were examined. All but six IJVs examined were found patent postoperatively. The preservation rate of patency of the IJV in modified radical neck dissection was found to be high(28 of 34 IJVs or 82%). Conclusion: The preservation rate of patency of the IJV in modified radical neck dissection was found to be high. These results favor the use of modified radical neck dissection for IJV preservation, particularly in bilateral neck dissection. A retrospective chart review revealed that trauma of the vessel and extrinsic compression of the vein by the musculocutaneous flap or recurrent carcinoma in the neck may be the cause of the vein occlusion.

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QTLs Identification and Confiirmation of Field Resistance to Leaf Blast in Temperate japonica Rice (Oryza sativa L.)

  • Cho, Young-Chan;Kwon, Soon-Wook;Suh, Jung-Pil;Kim, Jeong-Ju;Lee, Jeom-Ho;Roh, Jae-Hwan;Oh, Myung-Kyu;Kim, Myeong-Ki;Ahn, Sang-Nag;Koh, Hee-Jong;Yang, Sae-Jun;Kim, Yeon-Gyu
    • Journal of Crop Science and Biotechnology
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    • v.11 no.4
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    • pp.269-276
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    • 2008
  • Field resistance is defined as the resistance that allows effective control of a parasite under natural field condition and is durable when exposed to new races of that parasite. To identify the genes for field resistance to rice blast, quantitative trait loci (QTLs) conferring the resistance for races and blast nursery screening in japonica rice cultivars were detected and mapped using SSR markers. QTL analysis was carried out in 190 RILs population from the cross between Suweon365 (moderately resistant) and Chucheong (highly susceptible). Twelve QTLs against nine blast races inoculated were detected on chromosomes 1, 2, 4, 6, 7, 11 and 12. They explained from 5.1% to 34.9% of total phenotypic variation. Eight QTLs against blast nursery screening in four regions for three years were detected on chromosomes 1, 2, 4, 11 and 12. The phenotypic variation explained by each QTL ranged from 4.3% to 37.7%. Three chromosome segment substitution lines (CSSLs) of $BC_2F_6$ by backcross method were developed to transfer the QTLs into the susceptible cultivar Chucheong as a recurrent parent. A CSSL4-1 containing two QTLs qLB6.2 and qLB7 against blast races showed to the reaction of 6 to 7 at blast nursery in two regions for two years. The CSSL4-2 and CSSL93 containing QTLs, qLB11.2 and qLB12.1 of the resistance against leaf blast in blast nursery screening, respectively, had enhanced the resistance for blast nursery screening across two regions and in two years.

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Clinical Observation of Bell's Palsy (침치료(鍼治療)에 의한 말초성(末梢性) 안면신경마비(顔面神經麻痺)의 임상적(臨床的) 관찰(觀察))

  • Kang, Sung-Keel;Kim, Yong-Suk
    • The Journal of Korean Medicine
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    • v.16 no.2 s.30
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    • pp.9-16
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    • 1995
  • Forty four patients with Bell's palsy were treated with acupuncture from onset and clinical observation was carried on from March 1994 through Feburary 1995. Acupuncture treatment was done 3 times per week and the acupuncture points were LI4 Hapkok, ST36 Choksamni, LI20 Yonghyang, BL2 Ch'anjuk, TE17 Yep'ung, ST4 Chich'ang, ST6 Hyopko, GV26 Sugu, CV24 Sungjang, GB14 Yangbaek and Ex-HN4 Oyo. They were inserted to a depth of 0.5 to 1.0 cm. After insertion, manipulation was carried on until the patients felt strong numbness or De Qi sensation induced by rotating or twisting needles. Through-needling in lengths varying from 2.0 to 3.5 cm was also applied from ST4 Chich'ang to ST6 Hyopko, from GV26 Sugu or CV24 Sungjang to ST4 Chich'ang and from GB14 Yangbaek to Ex-HN4 Oyo. The mean age was 39.3 and 63.6% of the patients were women, including one pregnant woman. There was no recurrent palsy in this study. By applying the House-Brackmann facial nerve grading scales, patients were evaluated weekly from the first treatment to judged recovery or the 7th week of the treatment. 86.4% of the patients were recovered completely within 7 weeks and the average healing period was 3.7 weeks.

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