Long-term Survival of a Patient with a Large Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombosis and Spontaneous Tumor Rupture

Optimal treatments for patients with advanced hepatocellular carcinoma (HCC) are still limited and their prognosis remains dismal. Yet, there have been rare cases that have shed light on longer survival in these patients assisted by various treatments. This paper aims to present an extraordinary case of far advanced HCC that had been properly managed in spite of continuous recurrence. A patient visited the hospital with a ruptured large HCC with main portal vein tumor thrombosis but survived longer than 14 years owing to active and prompt interventions.

The Effect and Safety of Dapagliflozin in Patients with Type 2 Diabetes: A Single-Institution Pharmacovigilance Review / 임상당뇨병

BACKGROUND: Dapagliflozin, a selective sodium-glucose co-transporter 2 (SGLT2) inhibitor, lowers blood glucose by reducing glucose reabsorption at the proximal renal tubule in an insulin-independent manner. We aimed to evaluate the efficacy and safety of dapagliflozin and to identify the risk factors of adverse drug events in patients with type 2 diabetes. METHODS: As an institutional pharmacovigilance review activity, we reviewed data from medical records of 455 patients with type 2 diabetes who received dapagliflozin therapy from July 2014 to August 2015 in Seoul National University Hospital. We analyzed the changes in laboratory data and examined the characteristics of dapagliflozin users who showed adverse effects. RESULTS: Mean changes in HbA1c and fasting serum glucose level from baseline to second visit were −0.42% (8.07 ± 1.51% to 7.65 ± 1.31%, P < 0.001) and −22.9 mg/dL (167.8 ± 48.5 mg/dL to 144.9 ± 37.6 mg/dL, P < 0.001), respectively. Adverse drug events observed during this study were lower urinary tract symptoms (7.7%), dehydration-related symptoms (6.1%), ketonuria (3.4%), hypoglycemia (3.4%), and urogenital infection (4.2%). Thiazide use, age, insulin use, number of anti-diabetic drugs, gender and history of urogenital infection were the risk factors for adverse drug events (P < 0.05). CONCLUSION: Dapagliflozin significantly improved hyperglycemia in patients with type 2 diabetes without serious adverse drug events. The incidences of adverse drug events were was similar to those ofthat in the previous studies.

A Patient with Recurrent Dyskinesia and Hyperpyrexia Syndrome

Dyskinesia hyperpyrexia syndrome is a rare medical emergency in Parkinson's disease. It is characterized by continuous dyskinesia associated with hyperthermia, rhabdomyolysis, and alteration of the mental state. We present the case of a 74-year-old woman who presented with recurrent dyskinesia hyperpyrexia syndrome. Although some provocation factors and clinical manifestations seem to be shared with parkinsonism hyperpyrexia syndrome, a clear distinction in management should be considered.

A Case of Atypical Acute Retinal Necrosis Observed Using Ultra-Wide-Field Imaging

PURPOSE: To Report A Case Of Atypical Acute Retinal Necrosis (Arn) Observed Using Ultra-wide-field Imaging. CASE SUMMARY: A 50-year-old male with recurrent oral ulcer presented with visual loss in his right eye. On the initial visit, slit-lamp examination showed inflammatory cells (3+) in the anterior chamber and vitreous of the right eye. Funduscopic examination and ultra-wide-field fundus images showed severe occlusive vasculitis with perivascular hemorrhage. No necrotic lesion was observed at the peripheral retina in the left eye. Under the impression of Behcet's uveitis, immunosuppressive therapies including oral steroid, intravenous cyclophosphamide, anti-tumor necrosis factor (TNF) alpha agent and intravitreal triamcinolone were administered, but without improvement. Subsequently, a necrotic lesion appeared at the far peripheral retina in the right eye and varicella-zoster virus was identified using the polymerase chain reaction test. After the patient was diagnosed with atypical ARN, intravenous acyclovir was administered, resulting in eventual suppression of the necrotic lesion progression. Due to retinal detachment, pars plana vitrectomy with silicone oil infusion was performed in the right eye. At that time, a whitish lesion at the far peripheral retina in the ultra-wide-field photography of the fellow eye was found and 3 intravitreal ganciclovir injections were administered. Finally, the whitish lesion regressed after 1 month. CONCLUSIONS: Ultra-wide-field imaging might be useful for diagnosis and follow-up of atypical ARN patients.

Correlation between Visual Outcomes and Pre-Treatment Factors Including Hyperreflective Foci in Neovascular Age-Related Macular Degeneration

PURPOSE: To investigate the correlation between hyperreflective foci (HF) on spectral domain optical coherence tomography (SD-OCT) at baseline and visual outcomes after intravitreal ranibizumab injection in neovascular age-related macular degeneration (nAMD). METHODS: We retrospectively reviewed the medical records of 44 eyes of 44 nAMD patients. The number of HF was counted according to the location of HF on SD-OCT: neurosensory retinal layer, outer retinal layer, and subretinal layer. Statistical correlations among final visual acuity (VA) and pretreatment OCT parameters including number of HF, foveal thickness (FT), thickness of choroidal neovascularization (CNV), the status of external limiting membrane, and photoreceptor inner and outer segments (IS/OS) were evaluated. RESULTS: The number of HF was reduced in all retinal layers in nAMD patients after treatment. In multivariate regression analysis, final VA was associated with baseline VA, number of subretinal HF, and IS/OS disruption length (p = 0.028, p = 0.046 and p = 0.009, respectively) in nAMD patients. The baseline number of subretinal HF was correlated with final FT and CNV thickness (p = 0.002 and p = 0.009, respectively). CONCLUSIONS: The baseline number of subretinal HF on SD-OCT might predict the final VA after intravitreal ranibizumab treatment in nAMD patients.

Radius Intermedius Stenosis Induced Myocardial Perfusion Defect: Provened by the Fusion Images of Myocardial Perfusion SPECT and 64 Channel CTA / 핵의학분자영상

A 71-year-old woman was assigned to our department for Tc-99m myocardial perfusion SPECT(MPS) and coronary CT angiography. She admitted for substernal pain, via the ER, 2 days ago. The heart was scanned after intravenous injection of 925 MBq of (99m)Tc-sestamibi adenosine-induced stress SPECT using dual head gamma camera (Hawkeye, GE healthcare. USA). The MPS shows decreased tracer uptake in the apical & mid area of anterior & lateral wall and mid & basal inferior wall. Coronary CT angiograph was obtained using Discovery VCT (GE healthcare). 3D angiography portrayed significant stenosis of ramus intermedius(RI) and posterolateral branch of right coronary artery(PLB) with fibrocalcified plaque. Two images were fused using Cardiac IQ fusion softwear package (Advantage workstation 4.4, GE healthcare) The fusion images explain the perfusion defect of anterior, lateral and inferior wall is due to stenosis of the RI and PLB. And 3 days later, coronary angiography was done and revealed the marked stenosis of RI and PLB. Then balloon angioplasty and stent was instituted in RI. Cardiac SPECT/CT fusion imaging provides additional information about hemodynamic relevance and facilitates lesion interpretation by allowing exact allocation of perfusion defects to its subtending coronary artery.1,2)

Three Dimensional Volume Rendering Fusion Images Using F-18 FDG PET/CT in Evaluation of Cholangiocellular Carcinoma / 핵의학분자영상

A 69-year old male with cholangiocellular carcinoma (CCC) was assigned to our department for whole body PET/CT scan. 18F- FDG PET/CT images showed an intense hypermetabolic lobulating mass(SUV(max)= 8.7 / size : 11.4 mm) in the right hepatic lobe with multiple metastatic lung nodules. We made three dimensional volume rendering fusion images by using advantage workstation 4.3 (GE health care) which provide quick anatomic overview and improve the planning process significantly.1)

Comparison of Clinical Usefulness between N-13 Ammonia PET/CT and Tc-99m Sestamibi SPECT in Coronary Artery Disease / 핵의학분자영상

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.

The Differentiation of Malignant and Benign Musculoskeletal Tumors by F-18 FDG PET/CT Studies: Determination of maxSUV by Analysis of ROC Curve / 핵의학분자영상

PURPOSE: We evaluated the standard uptake value (SUV) of F-18 FDG at PET/CT for differentiation of benign from malignant tumor in primary musculoskeletal tumors. MATERIALS AND METHODS: Forty-six tumors (11 benign and 12 malignant soft tissue tumors, 9 benign and 14 malignant bone tumors) were examined with F-18 FDG PET/CT (Discovery ST, GE) prior to tissue diagnosis. The maxSUV(maximum value of SUV) were calculated and compared between benign and malignant lesions. The lesion analysis was based on the transverse whole body image. The maxSUV with cutoff of 4.1 was used in distinguishing benign from malignant soft tissue tumor and 3.05 was used in bone tumor by ROC curve. RESULTS: There was a statistically significant difference in maxSUV between benign (n=11; maxSUV 3.4+/-3.2) and malignant (n=12; maxSUV 14.8+/-12.2) lesions in soft tissue tumor (p=0.001). Between benign bone tumor (n=9; maxSUV 5.4+/-4.0) and malignant bone tumor (n=14; maxSUV 7.3+/-3.2), there was not a significant difference in maxSUV. The sensitivity and specificity for differentiating malignant from benign soft tissue tumor was 83% and 91%, respectively. There were four false positive malignant bone tumor cases to include fibrous dysplasia, Langerhans-cell histiocytosis (n=2) and osteoid osteoma. Also, one false positive case of malignant soft tissue tumor was nodular fasciitis. CONCLUSION: The maxSUV was useful for differentiation of benign from malignant lesion in primary soft tissue tumors. In bone tumor, the low maxSUV correlated well with benign lesions but high maxSUV did not always mean malignancy.

18F-FDG PET/CT Images of Appendiceal Adenocarcinoma / 핵의학분자영상

A 53-year -old man underwent 18F-FDG whole body PET/CT because of the detected liver mass on abdominal CT. The PET/CT showed a huge liver mass (9 x 9 cm, SUV: 12.12 ) in the right lobe and a focally hypermetabolic lesion in the right lower quadrant of abdomen (SUV: 9.12). At first, we suspected that the focal hypermetabolic lesion in RLQ was the physiologic uptake of ureter or a metastatic lesion of small bowel. We repeated the abdominal PET/CT next day. The focally hypermetabolic lesion was identified as the appendiceal mass. He underwent right hemicolectomy and right lobectomy of the liver. It was confirmed that the lesion was appendiceal adenocarcinoma with liver metastasis. Cancer of the appendix is an uncommon disease that is rarely suspected before surgery.1,2) But, we suggest that PET/CT is useful to identify the small lesion like appendiceal malignant mass.

Scintigraphic Evaluation of Inhalation Injury in Fire Victims / 핵의학분자영상

PURPOSE: Conventional chest X-ray and pulmonary function test cannot sensitively detect inhalation injury. Bronchoscopy is known to be the gold standard but it is invasive method. We evaluated whether lung inhalation/perfusion scans can sensitively detect inhalation injury of fire victims. MATERIALS AND METHODS: Nineteen patients (male 9, female 10, mean age 31.6 yr) of fire victims were enrolled in this study. Inhalation lung scan was performed 2 days later after inhalation injury with 99mTc-technegas. Perfusion lung scan was performed 4 days later with 99mTc-MAA (macroaggregated albumin). Follow up lung scans were performed 16 and 18 days later for each. Chest X-ray was performed in all patients and bronchoscopy was performed in 17 of 19 patients at the same period. Pulmonary function test was performed in 9 patients. RESULTS: Four of 19 patients showed inhalation and perfusion defects and one showed inhalation defect but, normal perfusion scan findings. These five patients with abnormal scan findings showed abnormal bronchoscopic findings and severe respiratory symptoms. On chest X-ray, 2 of them had pulmonary tuberculosis and one of them showed pulmonary congestion. FEV1/FVC was abnormal in 3 patients. On the follow up scan, all patients with abnormal initial scan findings showed improved findings and they had improved clinical state. CONCLUSION: Inhalation/perfusion lung scans can detect inhalation burn injury noninvasively in early stage and may be useful in therapeutic decision making and follow up of patients.

The Effect of Attenuation Correction with CT on the Interpretation of Myocardial Perfusion SPECT: in Patients with Normal Coronary Angiogram / 대한핵의학회잡지

PURPOSE: There has been many reports for the effect of attenuation correction on myocardial perfusion SPECT. We studied the effect of attenuation correction with CT (computed tomography) in patients with normal coronary angiography. MATERIALS AND METHODS: Fifteen patients with normal coronary artery on angiography and low likelihood of coronary artery disease were enrolled in this study (male: 6, female: 9, mean age: 58+/-8 year). Myocardial perfusion SPECT was done with Millennium VG with Hawkeye device (GE, SPECT/CT camera). A visual analysis and polar map quantification (Emory tool box) was performed. In quantitative analysis, percent uptake of each myocardial wall on polar map (percent of maximal uptake) was compared between non-corrected (NC) and corrected (AC) images. RESULTS: Visual analysis showed AC images led to an increase of uptake in the inferior wall, but decrease of uptake in the anterior wall, apex and septum. Liver activity is also increased in AC images. In quantitative analysis, the percent uptake is decreased in the anterior wall, apex and septum, but increased in the inferior wall. It is helpful to interpret the images in the inferior wall after AC, but difficult in the apex and anterior wall after AC. CONCLUSION: AC is helpful in the inferior wall. But in the apex or anterior wall, AC must be carefully applied to normal perfused myocardium.

Evaluation of Hemodynamic Failure with Acetazolamide Challenged 123I-IMP Brain SEPCT and PET / 대한핵의학회잡지

PURPOSE: Cerebral blood flow (CBF) reactivity to acetazolamide (ACZ) is useful to select patients with hemodynamic failure. However, it is still a matter of speculation that varying degrees of regional CBF increases after ACZ administration represent the severity or stage of regional hemodynamic failure as assessed by positron emission tomography (PET). We studied to elucidate whether ACZ challenge (123) I-IMP brain single photon emission tomography (SPECT) can accurately grade the severity of regional hemodynamic failure. MATERIALS AND METHODS: Eighteen patients (M: 16, F: 2, average age: 61 years) with unilateral occlusive disease of the internal carotid artery or the trunk of the middle cerebral artery (MCA). Patients underwent (123) I-IMP brain SPECT study with acetazolamide challenge and PET study was carried out within 2 weeks before and after SPECT study. Five healthy volunteers with a mean age of 48 years (range: 28-73 yr, M: 3, F: 2) underwent PET studies to determine normal values. In SPECT study, an asymmetry index (AI) -the percentage of radioactivity of region of interest (ROI) in the occlusive cerebrovascular lesion to the contralateral homologous ROI-was used for numerical evaluation of relative (123) I- IMP distribution. In PET study, regional CBF, oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO2) and cerebral blood volume (CBV) values were measured with (15) O-labeled gas inhalation method and the values were used for comparison with AI (AI during acetazolamide challenge-AI of basal study) on the SPECT study. ROIs were classified by severity into three groups (normal, stage I and stage II). RESULTS: Mean values of AI in areas with normal, stage I and stage II hemodynamic failure were 6.25+/-7.77% (n=107), -10.38+/-10.41% (n=117) and 13.30+/-10.51% (n=140), respectively. AI significantly differed with each groups (p< 0.05). Correlation between AI and CBF, OEF and CBV/CBF in hemisphere with occlusive cerebrovascular lesion was 0.20 (p< 0.01), -0.28 (p< 0.01) and -0.28 (p< 0.01), respectively. CONCLUSION: We concluded that (123) I-IMP brain SPECT with acetazolamide challenge could determine the severity and stage of regional hemodynamic failure as assessed by PET.

Comparison of Ga-67, Tl-201 and Tc-99m MIBI Imaging in Lymphoma Patients / 영남의대학술지

PURPOSE: Ga-67 scintigraphy has been used for the evaluation of tumors, especially lymphoma. Recently, Tl-201 and Tc-99m MIBI were also used to tumor imaging. Tl-201 and Tc-99m MIBI had better physiologic characteristics than Ga-67, so we studied 32 biopsy proven lymphoma patients (male 24, female 8, mean age 46 years) with Ga-67, Tl-201 or Tc-99m MIBI and compared the scan findings. MATERIALS AND METHODS: Twenty-three of 32 patients were injected 74-111 MBq (2-3 mCi) of Tl-201, before chemotherapy and imaged with dual-headed SPECT (Prism 2000, Picker, USA) at 30 minutes after injection. Delayed images were obtained after 3 hr in 8 patients. Twenty seven of 32 patients were injected 740 MBq (20 mCi) of Tc-99m MIBI and imaged at 30 minutes after injection. 111-185 MBq (3-5 mCi) of Ga-67 was injected in 12 patients and imaged at 48 and 72 hours after injection. Twenty eight patients were diagnosed as non-Hodgkin's lymphoma and others were Hodgkin's lymphoma. RESULTS: Twenty patients were positive on Tl-201 scan and 3 patients showed negative findings. One of these 3 patients, Tc-99m MIBI and Ga-67 scan were positive. Twenty two patients were positive on Tc-99m MIBI scan and 5 patients showed negative findings. One of these 5 patients, Tl-201 was positive and 2 were positive on Ga-67 scan. Ten of 12 patients showed positive findings on Ga-67 scan. The sensitivity of these agents were 83.3%, 87.0% and 81.5% for Ga-67, Tl-201 and Tc-99m MIBI, respectively. The sensitivity was highest in Tl-201 scan, but there were no significant differences among three tests. In this study, there was no significant difference of uptake ratios between early and delayed images of Tl-201. CONCLUSION: Scintigraphy with Tl-201 and Tc-99m MIBI in lymphoma patients have similar sensitivity with Ga-67.

Comparison of Thallium-201 Scan and Tc-99m Sestamibi Scan in the Differential Diagnosis of Breast Mass / 대한핵의학회잡지

PURPOSE: We performed this study to compare T1-201 and Tc-99m MIBI scans for the differentiation of malignant from benign breast mass. MATERIALS AND METHODS: Thirty-eight female patients underwent T1-201 breast scan and thirty-two of them also underwent Tc-99m MIBI scan of the breast. After intravenous injection of 74-111 MBq of T1-201, early (10 minutes) and delayed (3 hours) images were obtained. Then, 555-740 MBq of Tc-99m MIBI was injected and images after 30 minutes were obtained. We compared T1-201 and Tc-99m MIBI scans with pathologic RESULTS. RESULTS: Twenty-three patients were confirmed to have infiltrating duct carcinoma and fifteen patients to have benign breast mass by excisonal biopsy. The sensitivity of early and delayed T1-201 scan and Tc-99m MIBI scan in the detection of malignant breast lesion were 100% (23/23), 82% (18/22), and 90% (18/20), respectively. The specificity of early T1-201 scan was significantly higher than that of delayed T1-201 scan (p<0.05). The specificity of early and delayed T1-201 scan and Tc-99m MIBI scan were 73% (11/15), 73% (11/15) and 83% (10/12), respectively (p:not significant). Three patients out of nine with fibroadenoma and one patient with atypical duct hyperplasia were false positive in both early and delayed T1-201 scans. The size of fibroadenoma with false positvie in early and delayed T1-201 scan (4 cases) was larger than that of 11 fibradenoma with true negative scan (p<0.01). Metastatic axillary lymph node involvement was present in fifteen patients. The sensitive to detect metastatic nodes was 38% (5/13) for early T1-201 images, 15% (2/13) for delayed T1-201 images, 58% (7/12) for Tc-99m MIBI planar images and 67% (4/6) for Tc-99m MIBI SPECT. The sensitive of Tc-99m MIBI planar or SPECT was significantly higher than that of delayed T1-201 images (p<0.05). CONCLUSION: Early T1-201 and Tc-99m MIBI scan are useful noninvasive methods to differentiate malignant form benign mass of breast. Tc-99m MIBI scan was sensitive in detecting axillary lymph node metastasis in patients with brease cancer.

Comparison of Double Phase 99mTc-sestamibi Scintigraphy with Evaluation of Hyperparathyroidism / 대한내분비학회지

"BACKGROUND: Between 80 to 85% of patients with hyperparathyroidsm have a solitary adenoma of the parathyroid glands and another 15% have a parathyroid hyperplasia. Preoperative localization of the parathyoid glands is generally accepted as warranted in patients who have failed an initial attempt at parathyroidectomy, ectopic locations and inexperienced surgeons. Different imaging techniques have been used for detection of abnormal parathyroid glands such as high resolution ultrasonography, computerized tomography, arteriography, venous sampling or magnetic resonance imaging and 201Tl/99mTc subtraction scintigraphy. But these methods have had varying rates of success, with low specificity and low sensitivity. Among the several different techniques available for parathyroid radionuclide imaging, the most common is the use of a dualradioisotope procedure combining of Tl with Tc. However, there are some controversies regarding the optimal technical aspects of this procedure, including the relative amount of injected dose of radiotracers, failed detection for small sized and deeper cervical located parathyroids, and not easy procedures. Recently, double phase Tc-sestamibi scintigraphy would be useful to solve these technical limitations, more convenient and have higher sensitivities. The purpose of this study was to compare the diagnostic accuracy of 99mTc-sestamibi with 201Tl/ 99mTc subtraction scintigraphy in the localization of hyperparathyroidism. METHODS: 9 patients with hyperparathyroidism underwent preoperative evaluation with double phase 99mTc-sestamibi scintigraphy and 201Tl/99mTc subtraction scintigraphy for attempted localization of abnormal parathyroid glands and surgical explorations. Imaging results were compared to surgical findings. RESULTS: Of 9 patients, 7 had a solitary parathyroid adenoma, 1 had a carcinoma and 1 had parathyroid hyperplasia. The 201Tl/99mTc subtraction scintigraphy preoperatively localized 8 of 9 patients(sensitivity: S9%) and 99mTc-sestamibi scintigraphy correctly localized all lesions for a sensitivity of 100%. In one case, 201Tl/99mTc subtraction scan show only a hot uptake at left upper parathyroid area, but 99mTc-sestamibi scan was shown the three site of hot uptake at left upper, both inferior parathyroid area. CONCLUSION: In patients with hyperparathyoridism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it show a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands.

Clinical Features of Ectopic Thyroid Gland / 대한내분비학회지

BACKGROUND: Ectopic thyroid gland is relatively rare condition and a developmental anomaly characterized by an aggregated of thyroid tissue in the midline anywhere from the base of the tongue to the mediastinum. The role of ectopic thyroid in the pathogenesis of non-goitrous sporadic cretinism and primary hypothyroidism has been emphasized. 19 cases of ectopic thyroid for 12 years was presented with Tc-pertechnetate or radioactive iodine, which were diagnosed by scintigraphy. METHODS: We wish to report these 19 cases and 12 cases of brief review of literatures on the incidence, etiology and development, symptomatology, diagnosis and treatment of ectopic thyroid gland was done. RESULTS: The most frequent incidental age was between the age 1 year and 29 years. And the frequency of ectopic thyroid was about 7 times more common in female(27 cases) than in male(4 cases). The location of ectopic thyroid were found to be lingual in 18 cases, sublingual in 9 cases, prelaryngeal in 1 case, and combine with lingual and sublingual in 3 cases. In chief complaints, palpable mass was most common and there were foreign body sensation on throat, dysphagia, dysphonia, and hoarseness. In 15 cases of hypothyroidism, l2 cases were taken thyroid hormone replacement therapy, 1 case was removed ectopic thyroid gland. In 2 of 10 cases of euthyroidism, replacement of thyroid hormone were done and 2 cases were removed ectopic thyroid gland, in 6 cases of unknown thyroid function, 1 case was removed ectopic thyroid gland and 131I therapy was done in 1 case, and others were observed with following up thyroid function test. CONCLUSION: These results suggest that the long terms thyroid function test, thyroglossal duct eyst and malignant change in ectopic thyroid tissue when finding the ectopic thyroid in thyroid scintigraphy were recommended highly.

Malaria detection rate of donated blood and blood sample in risky area / 대한수혈학회지

BACKGROUND: Screening of donor blood for malaria has not been activated in Korea yet in spite of the recent break out of tertian malaria. The microscopical and immunological methods, PCR in current use for malaria diagnosis in blood donations. We studied the positive rate of malaria antibody and antigen in army donation blood and samples of risky area (Daesung dong) as a screening method. METHODS: In this study, samples of Daesung dong residing people(n=77) and army donated blood donors(n=44) were screened for malarial antibody by Indirect Fluorescence Antibody (IFA) test and malarial antigen by Polymerase chain reaction(PCR) technique and microscopic exam of Wright Giemsa stain. RESULTS: A total of 6.7% blood donors showed positive result of malaria antibody by IFA test respectively, and 1.7% donors showed the presence of antigen both technique by the PCR and conventional microscopy. CONCLUSIONS: Army donated blood and samples of risky area had a high positive rate of malaria antibody and antigen, there need attention and effort of prevention of tranfusion transmitted malaria in donated blood from risky area.

Diagnostic Value of Serum CYFRA 21-1 in Lung Cancer / 결핵

BACKGROUND: Cytokeratin 19 is 40KD acidic molecule whose distribution is restricted to simple or pseudo-stratified epithelia, such as the epithelial layer of the bronchial tree. Immunohistochemical study have shown that cytokeratin 19 is overexpressed in lung carcinoma tissue. An immunora- diometric assay, CYFRA 21-1 has been developed using two monoclonal antibody, BM 19-21 and KS 19-1, reactive to different epitopes on cytokeratin 19. We studied the diagnostic value of CYFRA 21-1 in lung cancer. METHOD: The serum CYFRA 21-1 level using immunoradiometric kit(ELSA-CYFRA 21-1) was measured in 54 patients who admit to Yeungnam University Hospital from April, 1993 to August, 1994. Lung cancer group was 39 primary lung cancer patients(19 patients with squamous cell carcinoma, 11 patients with adenocarcinoma and 9 patients with small cell carcinoma). Control group was 15 patients with non malignant lung diseases(8 patients with pulmonary tuberculosis, 3 patients with chronic obstructive pulmonary disease, 2 patients with pneumonia and 2 patients with chronic obstructive pulmonary disease combined with pulmonary tuberculosis). RESULTS: The mean serum value of CYFRA 21-1 was 20.2 +/- 4.7ng/ml in squamous cell carcinoma, 7.2 +/- 1.6ng/ml in adenocarcinoma and 15.5 +/- 4.7ng/ml in non-small cell lung cancer. The serum value of CYFRA 21-1 in control group was 1.7 +/- 0.5ng/ml. All of the serum values of 3 histologic types were significantly higher than that of control group(p<0.01). The serum value of CYFRA 21-1 of squamous cell carcinoma was significantly higher than that of adenocarcinoma(p <0.05). Serum value of CYFRA 21-1 in small cell lung cancer was 2.9 +/- 0.9ng/ml and not significantly different compared with control group. Using cut off value of 3.3ng/ml, sensitivity and specificity was 11.1%, 65.2% in small cell lung cancer, 70.0%, 62.5% in non-small cell lung cancer, 73.7%, 75% in squamous cell carcinoma and 63.6%, 78.9% in adenocarcinoma, respectively. CONCLUSION: The serum levels of CYFRA 21-1 may be useful in diagnosis of non-small cell lung carcinoma, especially in squamous cell carcinoma with its high specificity.

Scintigraphic features of choledochal cyst using technetium-99m-DISIDA hepatobiliary scan / 대한핵의학회잡지

No abstract available.