CORRIGENDUM: Correction of 4th author's name: The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer

In the original publication, the authors found a mistake in 4th author's name. The 4th author's name Younghee Choi is the correct spell rather than Yong Hee Choi.

The Krüppel-like factor (KLF5) as a predictive biomarker in preoperative chemoradiation therapy for rectal cancer

PURPOSE: Preoperative chemoradiation therapy (CRT) has become the standard treatment for patients with locally advanced rectal cancer, 15%–30% of patients still progress while being treated with CRT. The aim of this study was to identify as important biomarker of poor response and evaluate the mechanism associated with CRT resistance. METHODS: This study included 60 human colon tumour pre-irradiation specimens. Expressions of epidermal growth factor receptor (EGFR), p53, Krüppel-like factor 5 (KLF5), C-ern, Ki67 were assessed and correlated with tumor regression grades and complete remission. We added in vitro study with biomarker which has been identified as important biomarker of poor response to evaluate the mechanism associated with CRT resistance. RESULTS: Pathologic complete remission (pCR) was achieved by 9 patients (18%). EGFR and KLF5 were significantly associated with pCR (P = 0.048, P = 0.023, respectfully). And multivariate analysis showed high KLF5 intensity was worse factor for pCR (P = 0.012). In vitro study, radiation or chemotherapy therapy stabilized KLF5 protein levels in a time- and dose-depended manner in HCT116 and Caco-2 cells. KLF5 overexpression in HCT116 stable cell line showed significantly better cell viability by increasing cyclinD1 and b-catenin compared to control cells in MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, suggesting that KLF5 mediates cell survival. CONCLUSION: KLF5 was significantly associated with the presence of KRAS mutations, and KLF5 was an independent poor response predictor of CRT in rectal cancer. Our study is pilot study and more research will be needed in the future.

The Safety Evaluation of a Potent Angiogenic Activator, Synthetic Peptide (SFKLRY-NH2) for the Skin Application

A novel synthetic hexapeptide (SFKLRY-NH2) that displays angiogenic activity has been identified by positional scanning of a synthetic peptide combinatorial library (PS-SPCL). This study was carried out to investigate the irritation of the SFKLRY-NH2 on the skin. The tests were performed on the basis of Korea Food and Drug Administration (KFDA) guidelines. In results, cell toxicity is not appeared for SFKLRY-NH2 in HaCaT cells and B16F10 cells. SFKLRY-NH2 induced no skin irritation at low concentration (10 microM), mild irritation at high concentration (10mM). We consider that this result is helpful for saying about the safety of SFKLRY-NH2 in clinical use.

Surgical Treatment of Acute Arterial Occlusion after Applying the Vascular Closure Device for Hemostasis of Femoral Arteriotomy in Vascular Intervention

Vascular intervention via the femoral artery can cause vascular access complications and complications from closure of the arteriotomic incision site such as bleeding, thrombotic complications and vascular trauma. These types of complications occur in about 2% to 10% of the cases. After removal of the catheter, hemostasis is traditionally achieved by manual compression as a standard method. Many vascular closure devices have been developed in an attempt to improve the patient's comfort and to decrease the time to ambulation. Yet the safety and effectiveness of these vascular closure devices as compared to that of manual compression remains unclear. Herein we report on a case of femoral arterial occlusion due to vascular closure devices and the operative management.

Expression of E-cadherin, Heat Shock Protein 47, Transforming Growth Factor beta1 and C4d in Chronic Allograft Nephropathy / 대한이식학회지

BACKGROUND: Chronic allograft nephropathy (CAN), which causes graft failure, is related to tubular atrophy and interstitial fibrosis. E-cadherin is a well-known epithelial marker and heat shock protein (HSP)-47 is a collagen-specific molecular chaperone that regulates collagen synthesis. Transforming growth factor (TGF)-beta1, a profibrotic cytokine, downregulates E-cadherin and induces expression of mesenchymal markers in an in vitro model. C4d expression is considered a poor prognostic marker for graft survival. This study evaluated the relationship between the expression of E-cadherin, HSP47, TGF-beta1, and C4d with the prognosis for CAN. METHODS: Between March 1991 and August 2007, we performed renal allograft biopsies on 42 recipients with deteriorating renal function. CAN was diagnosed according to the chronic allograft damage index (Banff classification). Renal allograft biopsies were examined for the expression of E-cadherin, HSP47, TGF-beta1, or C4d by immunohistochemistry. The HSP47, TGF-beta1, and E-cadherin staining was scored semiquantitatively by analyzing ten different fields of cortical interstitium and tubules. Biopsies with endothelial C4d staining in peri-tubular capillaries (> or =25%) were designated as C4d-positive. RESULTS: Of 42 recipients, 17 (40.5%) were in the graft survival group (GS) and 25 (59.5%) were in the graft failure group (GF). E-cadherin expression in tubular cells of the GS was much higher than that of the GF (94.1% vs 52%, P=0.04). HSP47 expression in tubular cells and interstitium in the GF was much higher than that in the GS (84% vs 35.3%, P=0.001). TGF-beta1 expression in tubular cells and interstitium in the GF was much higher than that in the GS (72% vs 23.5%, P=0.02). CONCLUSIONS: E-cadherin, HSP47, and TGF-beta1 expression was strongly correlated with the CAN prognosis.

Kaposi's Sarcoma on Mediastinum after Renal Retransplantation

Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.

Comparison of New Onset Diabetes according to the Time of Onset in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset. METHODS: A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose > or =126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM). RESULTS: PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI) CONCLUSIONS: The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.

The Effect of Compliance, Family Support and Graft Function on Quality of Life in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: Previous studies have shown that kidney transplant recipients' quality of life depend on compliance of treatment, family support, socioeconomic status. The purpose of this study was to determine whether estimated glomerular filtration rate (GFR) by Modification of Diet in Renal Disease (MDRD) study as a index of graft function influence recipients' quality of life including above mentioned factors. METHODS: One hundred and ten patients who visited out-patient department at least 3 months after kidney transplantation were included in this study. A structured questionnaire was used to collect data. This tool included; quality of life, compliance and family support scale as well as medical record review. The analysing of data was performed with SPSS version 11.5 (SPSS Inc. Chicago, IL, USA). RESULTS: The mean score of the recipients' quality of life (3.59/5), compliance (3.81/5), the support of family (4.02/5) and GFR (63 ml/min/1.73 m2) were revealed respectively. The quality of life was correlated with compliance (r=.260, P<.001) and family support (r=.377, P<.001) statistically. and compliance and family support also revealed correlation (r=.452, P<.001). Family support was the most explainable factor for the quality of life (R2=.142). however, the quality of life was not correlated with recipients' GFR (r=.013 P=0.819). CONCLUSIONS: Results of this study showed that kidney transplant recipients had a moderate quality of life. These findings suggest that emotional aspect like family support is as important as clinical factors such as GFR or compliance for recipients' quality of life. To optimize post-transplant quality of life, implication for interventional programming should be focused on family support.

Simultaneous Pancreas-kidney Transplantation from Pediatric Donor: A Case Report / 대한이식학회지

Simultaneous pancreas-kidney (SPK) transplantation is a well-established treatment for patients with insulin-dependent DM complicated by ESRD. The current shortage of cadaver donors and the increasing number of diabetic patients on the transplant waiting list has prompted the use of cadaveric organ from pediatric donors. But the lower age limit of the pancreatic donors has not yet been established. We report the successful result using a 10 years old donor for a 36-year-old SPK transplant recipient.

The Clinical Significance of the Hypoxia Inducible Factor-1 alpha and C4d in Implantation Renal Biopsies and Post-transplant Biopsies / 대한이식학회지

PURPOSE: Hypoxia inducible factor-1 alpha (HIF-1 alpha) is induced in response to ischemic states and in turn activates transcription of several growth factors implicated in cell survival. These growth factors have been recognized as role players in the development of chronic allograft nephropathy (CAN). C4d depositions in the peritubular capillaries of renal allografts have been reported to be sensitive markers of acute humoral rejection. The purpose of this study was to determine the effects of HIF-1 alpha expression and C4d deposition in implantation biopsies of renal allografts. METHODS: Implantation biopsies and 22 rejection proven biopsies of 54 renal transplantation recipients (Male:Female=31:23) in Kangdong Sacred Heart Hospital from December 1996 to July 1999 were done. Immunohistochemical studies were performed using mouse monoclonal antibody (1:1000, Novus Biological Inc., Littleton, CO, USA) as the primary antibody and CSA (Catalyzed Signal Amplification System, Dako, Denmark) as the secondary antibody for HIF-1 alpha. Rabbit polyclonal antibody (1:200 Biogenesis, UK) and DAB kit (Dako) were used for C4d detection. Expression of HIF-1 alpha was defined as positive nuclei staining under 10 HPF (high power field) and C4d deposition was defined as 1+ when the pericapillary deposition was under 50% and 2+ when over 50% and 0 when there were no traces of depo sition. RESULTS: HIF-1 alpha was demonstrated in 19 cases (35%) of the 54 implantation biopsy cases. The expression of HIF-1 alpha was statistically higher in the deceased donor group compared to the living donor group. The HIF-1 alpha positive group had a longer mean cold ischemic time than the HIF-1 alpha negative group but was not statistically significant. The age of the donor and HIF-1 alpha expression showed no correlation. Expression of HIF-1 alpha of the implantation biopsies also showed no difference in the rejection group (n=22) compared to the non-rejection group (n=32). There was no significant difference of HIF-1 alpha expression in the graft loss group (n=7) and the graft functioning group (n=47). C4d deposition was detected in one implantation allograft biopsy (1.9%). The C4d positive patient developed acute accelerated rejection on the fourth postoperative day. HIF-1 alpha and C4d were demonstrated in 22 (100%) and 11 (50%) of the 22 rejection biopsies, respectively. In patients who showed rejection, HIF-1 alpha expression was significantly higher in the rejection biopsies compared to the implantation biopsy group. HIF-1 alpha expression of the patients who showed rejection within one month and those with rejection later than three months after engraftment showed no significant difference. CONCLUSION: Expression of HIF-1 alpha in implantation biopsies showed significant correlation with deceased kidney donors. The relation with cold ischemic time was not statistically proven but the HIF-1 alpha positive group showed a tendency of longer cold ischemic time. Biopsies from the renal allografts with rejection showed significantly higher expression of HIF-1 alpha compared to the implantation biopsies. The deposition rate of C4d was extremely low in implantation biopsies that we could not prove any relevance with acute rejection.

Clinical Significance of the Ki-67 Index for Colorectal Cancer

PURPOSE: Monoclonal antibody Ki-67 has been employed to evaluate the growth fraction of various tumors. The purpose of this study is to determin the prognostic value of the Ki-67 index for colorectal cancer. METHODS: The Ki-67 index was investigated by counting the immunohistochemically stained cells. We described this as the permillage. We reviewed the test results of 36 colorectal cancer patients and we compared the Ki-67 index with other clinical factors. RESULTS: There was no correlation between the Ki-67 index and the other established risk factors, and only the number of invaded lymph nodes and their degree of differentiation were related with the Ki-67 index. CONCLUSION: The Ki-67 index is an important marker of the growth fraction of tumor. The pattern of tumor growth is determined not only by the growth fraction, so the discovery of other parameters that can reflect tumor growth and the Ki-67 index can help the patients with respect to their prognosis & treatment.

Paraduodenal Hernia

Internal abdominal hernias are an unusual cause of intestinal occlusion. They are responsible for 2% of all the intestinal obstructions. Various types of hernia have been described. Paraduodenal hernias are relatively rare congenital malformations and result from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia of the small intestine in a 32-year-old man with presentation of intestinal obstruction. The patient suffered from nausea, vomiting and acute abdominal pain for 9 hours. Abdominal CT showed sac-like mass of clustered, dilatated small bowel in the right upper quadrant. At operation, herniation of small intestine into a retroperitoneal space through a defect on right mesocolon was noted. A right paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery except some diarrhea after extensive segmental resectio of strangulated small bowel. Paraduodenal hernia is important as it usually presents as intestinal obstruction, and is often misdiagnosed before laparotomy. Mortality is increased significantly with delays in surgical treatment. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery and also prevents the possible complication of gangrenous bowels.

Deep Vein Thrombosis at Lower Extremities in Severe Burn Patients

PURPOSE: In major burns, deep vein thrombosis (DVT) is frequently diagnosed as a major complication of burns. But the risk factors and prophylaxis remain controversial. This study was designed to evaluate the incidence and risk factors of DVT in major burn patients. METHOD: We reviewed all major burn patients (>40% of TBSA) admitted to our burn center from June 1998 to August 2003 and assessed each affected patients with an in-hospital diagnosis of DVT for DVT risk factors. RESULT: There were 9 symptomatic DVT detected among 606 severe burn patients (1.45% incidence). Patients diagnosed with DVT had no risk factors of morbid obesity, previous DVT, congestive heart failure or neoplastic disease, except one patient who had a polycythemia vera diagnosed incidentally. In eight of 9 patients, DVT occurred in veins draining burned extremities. All patients had burn wound infections as a complication of burns. Eight of 9 patients had longer hospital stays than patients without DVTs. In all patients, DVT was developed after operations for skin graft. CONCLUSION: DVT should be suspected in patients with delayed wound healing and unresolved edema of extrimites. Wound infection, long bed-ridden state and operations are significant risk factors for DVT formation in major burn patients.

A Clinical Analysis of Thyroglossal Duct Cyst and Sinus

PURPOSE: Anomalies in the thyroglossal duct are the most common midline, or paramedian cervical lesions of congenital origin. Presenting as a thyroglossal duct cyst (TGDC) or a thyroglossal duct sinus (TGDS), they are found in all age groups. This clinical study was intended to elucidate the clinical characteristics, and the outcomes, of surgical treatment of these anomalies. METHODS: Between January 1992 and May 2002, 91 patients underwent surgery for a TGDC or a TGDS at 4 hospitals affiliated to Hallym University. The demographics of the patients, the clinical characteristics of the lesions, and the outcomes of the treatments were retrospectively evaluated. These characteristics were evaluated according to age groups; younger than 15 (38 patients) and older than 15 (53 patients) years. RESULTS: The male to female ratio was 1.67: 1 (It is better to give the actual figures.), with the first decade showing the highest incidence in the age distribution (33%). Painless masses (83.6%) were the most common presenting symptom, with most symptoms having been manifest for less than 1 year (67%). TGDCs were 90% and TGDSs were 10%. There were 62 cases of infrahyoid and 18 of suprahyoid lesions, with 80 cases on the midline and 11 on the paramedian within 2 cm from the midline. Of the paramedian lesions, 2 cases were in the younger group and 9 were in the older group. This tendency of laterality in the location by age group showed no statistical significance (p=0.172). All the patients underwent a Sistrunk operation, and one experienced a recurrence. CONCLUSION: This study justified the Sistrunk operation as the treatment of choice for anomalies of the thyroglossal duct. The lateral lesions occurred in the old age groups more frequently. A careful approach is needed with paramedian cervial lesions in adults to avoid the loss of the proper treatment of possible hidden congenital lesions.

Placement of Tunneled Cuffed Hemodialysis Catheters Via Internal Jugular Vein by an Interventional Radiologist and a Vascular Surgeon Together / 대한신장학회잡지

BACKGROUND: The use of dacron-cuffed tunneled double-lumen catheters for hemodialysis has become more common as patients wait for creation and maturation of a permanent access. Placement of the catheters is done by interventional radiologists, vascular surgeons or nephrologists, and the differences in success rates, complications, blood flow rates and the durations of catheter uses are reported. This study evaluated the usefulness, complications, blood flow rates and duration of use of tunneled cuffed hemodialysis catheters implanted via the internal jugular veins by an interventional radiologist and a vascular surgeon together. METHODS: The outcomes were retrospectively analyzed of 31 hemodialysis catheters placed from December 1999 through January 2001. We investigated age, sex, indications and locations of insertion, catheter performance, complications and causes of catheter removal. All the catheters were placed via the internal jugular veins by an interventional radiologist and a vascular surgeon together. RESULTS: Catheter placements were successful in all patients. Procedural complication was limited to clinically unimportant minor local bleeding. No instances of pneumothorax, hemothorax, vessel injury, substantial bleeding, obstruction, malposition or stenosis occurred. The blood flow rate on the first hemodialysis after placement of the catheter was 230+/-35.5 mL/min and that after 1 month was 248+/-18.6 mL/min. Late complications included catheter breakage in two cases (6.5%) and bacteremia in four cases (12.9%). Catheters were removed because of catheter-related bacteremia in four cases (12.9%) and death of patients in three cases (9.7%). In 22 cases (71.0%) the catheters were removed because the A- V vascular accesses were available for hemodialysis. Mean duration of the catheter use before removal was 134+/-96 days. CONCLUSION: Tunneled cuffed catheters inserted via the internal jugular veins are safe and durable vascular accesses for hemodialysis with good blood flow rate and long duration of use, especially placed by the co-operation of an interventional radiologist and a vascular surgeon.

Native Ureterotransplant Ureterostomy for Ureteral Obstruction after Simultaneous Pancreas Kidney Transplantation

Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.

A Murine Model of Toluene Diisocyanate-induced Contact Hypersensitivity

BACKGROUND: Toluene diisocyanate (TDI) can cause contact allergy and occupational asthma, but the mechanism underlying sensitization to this chemical compound remains controversal. Also the correlation of mast cell with contact hypersensitivity (CHS) and the role of mast cell in the TDI-induced CHS is unknown. This issue was investigated by administrating TDI on the skin of genetically mast cell-deficient WBB6F1/J-Kit(W)/ Kit(W-v) (W/W(V)) and congenic normal WBB6F1/J-Kit +/+ (+/+) mice. METHODS: To development of animal model of TDI-induced CHS and to investigate the correlation of mast cell with CHS and the role of mast cell in the TDI-induced CHS, W/W(V) and +/+ mice were sensitized with TDI on the back skin at day 1 and day 8, and then challenged with 1% TDI on the ear at day 15. At 1, 2, 4, 8, and 24 hours after 1% TDI challenge, the ear thicknesses were measured. It was investigated the histologic changes of dermis in the ear of W/W(V) and +/+ mice at 24 hours after 1% TDI challenge. RESULTS: TDI induced a significant ear swelling response in W/W(V) and +/+ mice. TDI induced the significant infiltrations of polymorphonuclear leukocytes and eosinophils in W/W(V) and +/+ mice, but not of mast cells in normal mice. And TDI increased a characteristic extent of mast cell degranulation in normal mice. There were no significant differences in the ear swelling and the infiltrations of polymorphonuclear leukocytes and eosinophils of normal versus W/W(V) mice, either at baseline or after TDI-induced CHS. CONCLUSION: From the above results, TDI can be used as a murine CHS model, and the mast cells may not be essential in TDI-induced CHS.

A Murine Model of Toluene Diisocyanate-induced Contact Hypersensitivity

BACKGROUND: Toluene diisocyanate (TDI) can cause contact allergy and occupational asthma, but the mechanism underlying sensitization to this chemical compound remains controversal. Also the correlation of mast cell with contact hypersensitivity (CHS) and the role of mast cell in the TDI-induced CHS is unknown. This issue was investigated by administrating TDI on the skin of genetically mast cell-deficient WBB6F1/J-Kit(W)/ Kit(W-v) (W/W(V)) and congenic normal WBB6F1/J-Kit +/+ (+/+) mice. METHODS: To development of animal model of TDI-induced CHS and to investigate the correlation of mast cell with CHS and the role of mast cell in the TDI-induced CHS, W/W(V) and +/+ mice were sensitized with TDI on the back skin at day 1 and day 8, and then challenged with 1% TDI on the ear at day 15. At 1, 2, 4, 8, and 24 hours after 1% TDI challenge, the ear thicknesses were measured. It was investigated the histologic changes of dermis in the ear of W/W(V) and +/+ mice at 24 hours after 1% TDI challenge. RESULTS: TDI induced a significant ear swelling response in W/W(V) and +/+ mice. TDI induced the significant infiltrations of polymorphonuclear leukocytes and eosinophils in W/W(V) and +/+ mice, but not of mast cells in normal mice. And TDI increased a characteristic extent of mast cell degranulation in normal mice. There were no significant differences in the ear swelling and the infiltrations of polymorphonuclear leukocytes and eosinophils of normal versus W/W(V) mice, either at baseline or after TDI-induced CHS. CONCLUSION: From the above results, TDI can be used as a murine CHS model, and the mast cells may not be essential in TDI-induced CHS.

Mast Cells in Renal Allografts

PURPOSE: Chronic rejection is the enemy in the battle for long term survival after renal allografts. Interstitial fibrosis is known to be the important finding in renal allografts with chronic rejection. Mast cells secrete a large number of fibrogenic factors and have been involved in chronic inflammation and tissue fibrosis. In this study the authors evaluated the relationship between mast cells and fibrosis in renal allografts with chronic rejection. METHODS: The authors evaluated 42 biopsied specimens of renal allografts. Immunohistochemistry using anti-mast cell tryptase (Dako, 1 : 200) and an LSAB kit (Dako) was applied to detect mast cells. The mean number of mast cells (MNM) per 10 high power fields was counted. RESULTS: MNM of implantation biopsies was 0.640+/-0.537, of acute rejection -1.969+/-1.216, of chronic rejection -6.0+/-3.133 (P0.05). CONCLUSION: Our data show that the number of mast cells in renal allograft was significantly associated with chronic rejection, donor sex and hypercholesterolemia.

Ultrasonogram as a Diagnostic Modality in Thyroid Tumors / 대한내분비외과학회지

PURPOSE: To evaluate the usefulness of ultrasonogram as a preoperative diagnostic tool in thyroid nodular diseases, this study was carried out. METHODS: From January 1998 to December 1999, 51 patients who underwent thyroidectomy were analyzed retrospectively. We compared the finally histopathological results to ultrasonographical findings such as internal consistency, multiplicity of nodules, nodular ehogenicity, nodular capsule or margin, calcification of nodules. RESULTS: There were 47 females and 4 males with 25 benign tumor, 23 malignant tumor and 3 occult carcinoma in histopathological diagnosis. The solid tumors in ultrasonography carried a probability of malignancy as 66.7% (16/24 cases) whereas cystic or mixed tumors as 16.7% (1/6 cases) or 23.8% (5/21cases) (p=0.006). The single nodular diseases carried a high probability of malignancy as 50% (13/26cases) whereas multiple diseases as 28.6% (6/21 cases). The hypoechogenicity of thyroid nodular disease showed a probability of malignancy as 60% (9/15 cases) whereas mixed-echogenicity as 36.4% (4/11 cases). The nodules with poorly-defined margin in ultrasonographic findings showed higher probability of malignancy as 63.6% (7/11cases) than the nodules with well -defined margin as 26.5% (9/34 cases) (p=0.025). The nodules with calcification in ultrasonographic findings were represented to high probability of malignancy as 70.6% (12/17 cases) compared to those without calcification as 29.4% (10/34 cases) (p=0.005). The differency between ultrasonic and histopathological diagnosis was high in solid nodules (33%), 3~4 cm sized nodules (28.6%) and mixed echogenecity (27.3%) whereas low in complex nodules with cystic and solid nature (4.8%), 2~3 cm sized nodules (8.3%) and pooly defined margin (9.1%). The accuracies of sonography in differentiating malignacy from benign thyroid nodules were 7.1% of false positivity, 39.1% of false negativity, 60.9% of sensitivity, 92.9% of specificity and 78.4% of accuracy. CONCLUSION: Sonographic examination was relatively excellent test as a preoperative diagnostic tool in thyroid nodular diseases when detailed checklists were applied such as internal consistency, multiplicity of nodules, nodular ehogenicity, nodular capsule or margin and calcification of nodules.