Thyroid nodule is a common clinical problem and it is important to distinguish benign from malignant nodule. Although features found on history taking, physical examnation and imaging studies help the diagnosis, fine needle aspiration(FNA) has been accepted as an accurate and reliable diagnostic procedure of thyroid nodule. This study was aimed to assess the values of FNA and needle biopsy in the diagnosis of thyroid nodules.

We reviewed the medical records of the 405 patients who underwent FNA and needle biopsy for the diagnosis of thyroid nodule form September 1993 to July 1996.

The 414 fine needle aspiration cytologic specimens were obtained from 405 patients(male : 26, female : 379). 390 cases(94.2%) were adequate for cytologic diagnosis. And the diagnosis showed benign in 357(91.5%), malignancy in 20(5.1%) and suspicious malignancy in 13(3.3%). Among the 357 benign cases, 104 cases were benign cysts, 163 cases were adenomatous goiter and 45 cases were follicular adenoma. 46 patients underwent thyroidectomy after FNA and 21 patients(45.7%) were diagnosed as having carcinoma. The sensitivity and specificity of FNA in diagnosing malignancy were 65% and 82%, respectively, with an accuracy of 74%. Of 46 patients, needle biopsy was done in 41. The sensitivity and specificity of the needle biopsy were 79% and 73%, respectively. And the accuracy was 76%. Hoarseness was developed in one patient after FNA and needle biopsy, and small amount of hemoptysis was developed in another patient after FNA.

Although it had been expected that needle biopsy may increase the diagnostic accuracy, our study didn't show the superiority of needle biopsy as compared with FNA. FNA has limitations in suspicious and nondiagnostic results but it is a safe, simple, reliable and cost-effective means of evaluating thyroid nodules. It is the preferred initial diagnostic method in all patients with thyroid nodule.

The purpose of this study is to establish the normal levels of α-fetoprotein in amniotic fluid between 15 and 22 weeks of gestation.

Amniotic fluid Alpha-fetoprotein(AFAFP)levels were measured by enzyme-immunoassy in pregnant women between 15 and 22 weeks of gestation for variety of indication of amniocentesis from October, 1994 to July, 1996 at Mokdong Hospital Ewha Womans University.

The study group was selected from normal karyotype at prenatal genetic diagnosis and no congenital anomaly of fetus.

The normal level of AFAFP was the highest at 16weeks and then it declined gradually as gestational weeks increased. The mean±SD levels of AFAFP from 15 to 22weeks were 16.9±5.7, 20.4±9.8, 13.8±6.8, 10.9±3.0, 8.1±2.3, 6.9±3.9, 5.6±1.6, 4.7±0.6µg/ml respectively, the median levels of AFAFP from 15 to 22weeks were 14.7, 16.2, 12.3, 11.0, 7.8, 5.5, 5.3, 4.8µg/ml, respectively.

We consider that this preliminary data normal AFAFP levels by each gestation weeks can be used as reference value for screening of anomalies or genetic disorder.

Although various kinds of spine stabilizing instruments have been developed over the past years for the treatment of unstable lumbar spinal disorders, the subject is still controversial and contradictory reports are seen in the literature.

Among such instruments, Graf instrument has attracted much interest because of the originality of the idea as s soft stabilizer.

All patients suffered from intractable symptomatic degenerative disc disease which could be localized to one or more levels.

The results of the 30 consecutive patients using the Graf stabilization system are presented from Jan. 94 to Dec. 95.

I have performed Graf soft fixation system on 30 cases of degenerative lumbar spine diseases for 2 years and more than 3 months of postoperative follow-up.

1) There were 10 males and 20 females.

2) The main preoperative diagnosis and evaluation was a severe back pain caused by degenerative disc disease with instability.

3) The most common operation level was a single level, L4/5 in 8 cases(27%), followed by two levels, L4/5+L5/S1 in 6 case(20%).

4) Out of the 30 operated cases, the follow-up results for low back pain were excellent in 14 cases(47%),good in 10 cases(33%).

Although the follow-up in relatively short, the results from this study are sufficiently encouraging to prompt this report. Compared with conventional instrumented spinal fusion, the advantages of Graf system are less surgical trauma with shorted hospital stay and faster rehabilitation with early normal life, The Graf system instead of rigid implant is highly recommendable in managing unstable lumbar disorders.

The timing of aneurysm surgery has been a topic of major neurosurgical controversy.

Aneurysmal rebleeding is the most cataclysmic and disabling event following initial subarachnoid hemorrhage. Thus, early surgical obliteration of aneurysm eliminates the potential for rebleeding during the highest risk period.

The results of operation for the twenty-three patients who had admitted to neurosurgical departments, Mokdong hospital and undergone surgery within the 24-72 hours after initial rupture of these aneurysms from October, 1993 to August, 1996, were reviewed.

Twenty-three patients underwent craniotomy for clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, and hemodilution therapy. The outcome was excellent in 10(43%), good in 3(13%), poor in 5(22%) and death in 5(22%). The mean age was 57.7 and the ratio of male to female was 13:10. The outcome according to Hunt-Hess(H-H) grade was followings. H-H grade 1 was 2(%) and all excellent outcome, H-H grade 2 24(61%) and the outcome were excellent in 8(35%), good in 1(4%), poor in 2(9%), death in 3(13%), H-H grade 3 was 6(26%) and good in 2(9%), poor in 2(9%), death in 2(9%), and H-H grade 4 was 1(4%) and the outcome was poor in 1(4%). The outcome according to grading system of Fisher was followings. Grade 2 was 6(26%), and the outcome was excellent in 5(22%) and death in 1(4%). The grade 3 was 14(61%) and excellent in 5(22%), good in 2(9%), poor in 3(13%), and death in 1(4%). The grade 4 was 3(31%) and good in (4%) and poor in 2(9%). The variations in anterior communicating complex were followings. The both A₁ equal in 6(26%), left A₁ dominancy was 1(4%), right A₁ atresia was 13(57%) and left atresia was 3(13%).

The most favorable outcomes and lowest mortality rate were patients of H-H grade 1 group. The surgical results of alert patients with early surgery should even further improve as compared to delay surgery. However, patients who present in poor medical condition at the time of operation were still indicated delay surgery.

The aim of this study was to investigate whether or not endothelin-1 content of bronchoalveolar lavage was elevated in allografted lungs during acute rejection.

After single lung allotransplantation, dogs were immunosuppressed with triple standard therapy and divided into 2 groups. Group 1(Immunosupression ; n=4) was maintained on immunosuppression as controls. In group 2(Rejectin ; n=13), triple therapy was discontinued to induce acute rejection from postoperative day 5.

At postoperative day 9, broncholaveolar lavage was done through bronchoscopy in native unoperated lung and transplanted lung in group 1. Bronchoalveolar lavage was repeated in group 2 in the same way. Endothelin-1 content of bronchoalveolar lavage was measured by radiommunoassay.

Endothelin-1 content in transplanted lung of group 2 was compared to that of transplanted lung of group 1 and to that of native unoperated lung of group 2.

Endothelin-1 content of bronchoalveolar lavage in transplanted lung of group 2 was comparable to that of group 1(42.18±26.39 vs 3.08±3.08pg/ml ; p=0.08). Endothelin-1 content of bronchoalveolar lavage in transplanted lung of group 2 was comparable to that of native unoperated lung of group 2(42.18±26.39 vs 3.74±2.62pg/ml ; p=0.07).

Endothelin-1 content of bronchoalveolar lavage in transplanted lung was altered during acute rejection, but without statistical significance.

Experiments were designed to investigate whether there is any correlation between concentration of plasma nitric oxide and pathological severity of acute rejection after lung allograft.

After single lung allograft, dogs were immunosuppressed with triple standard therapy and divided into 2 groups. Group 1(Immunosuppression ; n=4) was maintained on immunosuppression as controls. In group 2(Rejection ; n=15), triple therapy was discontinued to induce acute rejection from postoperative day 5. Plasma concentration of nitric oxide was measured by chemiluminescence method prior to surgery and at postoperative day 9. At postoperative day 9, dogs were sacrificed and rejection was graded pathologically by a working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: lung rejection study group.

Plasma nitric oxide level of day 9 was compared to that of prior to surgery in each group. Correlation between plasma nitric oxide level and pathological grade of acute rejection at day 9 in group 2(Rejection) was examined.

In group 2(Rejection), plasma nitric oxide level fo day 9 was elevated significantly, compared to that of prior to surgery(12.28±2.10 vs 6.46 0.57µM/L ; p<0.05).But plasma nitric oxide level of day 9 didn't significantly correlate with the pathological grades of rejection in group 2(Spearman's coefficient r=-0.2094 ; p>0.05).

Plasma concentration of nitric oxide was elevated during acute rejection, but didn't correlate with the pathological severity of rejection.

Urolithiasis is the most common and important disease in the field of Urology, and recently the incidence of urolithiasis has increasing tendency according to the improvement of living condition in Korea. In the management of urolithiasis, open surgery was done mainly until several years ago. But not with the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, the urolithiasis is easily treated, not surgically.

The author analyzed patients with urolithiasis who had been admitted to Ewha Womans University Hospital from April 1976 to December 1995 to know the change ofoccurrent trend and treatment for urolithiasis for the past 20 years.

The following results were obtained ;

1) During the periods, 3,069 cases were urolithiasis(31.1%) of the 9,868 total admitted patients in urology. The total number and rate of incidence were increased constantly especially until late eighties, but since the year of 1991 those were slightly decreased.

2) The sex ratio of male to female was not changed significantly. The occurrent rate under age of 20 years old was decreased but increased after 6th decades. The seasonal occurrence was the highest in summer until 1985, but after then there was no seasonal difference.

3) The incidence of ureter, bladder and urethral calculi was decreased but that of renal calculi was increased.

4) In the management, the open surgery and expectant therapy were decreased after October 1986, but the rate of nephrectomy was slightly increased. In endourological management, the success rate of ESWL, PNL and URS was 92.8%, 86.6% and 96.7% respectively.

For the past 20 years, the trend of urolithiasis was changed and modalities of treatment were changed, especially since the late of 1980s.

As the number of elderly people rises, the incidence of surgery in elderly patients would become higher. This study was undertaken to examine the changes in pulmonary gas exchange that occurs with advancing age.

Arterial blood gases were analysed in 106 elderly patients over the age of 65 and 40 adult patients(control group) during breathing of room air preoperatively. Alveolar oxygen partial pressure(PAO₂), alveolar-arterial partial pressure gradient for oxygen(AaDO₂), arterial/alveolar oxygen partial pressure(a/A) ratio were calculated using PaO₂ and PaCO₂ and PAO₂ and measured the relationship between the PaO₂ and age.

PaO₂ declined as age increased significantly and the regression equation was PaO₂=103.6-0/332×age(r=0.55). There was no significant difference in PaCO₂ and PAO₂ but AaDO₂ increased and a/A ratio decreased significantly.

As the AaDO₂ and a/A ratio were changed significantly, it is necessary for monitoring of oxygenation during perioperative periods in elderly patients.

This study was performed to assess the factor affecting the distance from skinto epidural space.

The distance from the skin to epidural space(DSES) was measured in 105 patients who received lumbar epidural anesthesia. The relationship between patient factors [age, weight, height, body mass index(BMI : weight/height²), pregnancy] and technical factor(posture) versus DSES was investigated using multiple regression analysis.

The mean DSES was 4.5±0.7cm. DSES correlated positively with weight and BMI in non-obstetrics(including male), and BMI in obstetrics. But, DSES did not correlated with posture.

The patient's weight and BMI in non-obstetrics and BMI in obstetrics but posture during epidural needle placement are important factors influencing DSES.

Axillary block is a common anesthetic technique for operation on the hand and forearm. Many variations of the axillary approach have been described. Therefore we studied the results obtained when the axillary approach to brachial plexus blockade is attempted utilizing peripheral nerve stimulation(PNS).

Axillary brachial plexus block with PNS(0.5mA, 2Hz) was used in 30 adult patients undergoing hand and forearm surgery. 20ml of 1.5% lidocaine and 20ml of 0.375% bupivacaine solution was injected. A pin prick test was performed at 5, 10, 15, 20, 25 and 30 min. and quality of the clock in the distribution of 7 peripheral nerve of the brachial plexs was evaluated.

Block were 28 cases(93.3%) including 6 cases(20%) of incomplete block and total failure were 2 cases. Average number of blocked peripheral nerve of upper extrmity was 4.4±1.7. The order of rate of block was medial cutaneous n. of forearm, ulnar n., medial cutaneous n. of arm, median n., radial n., musculocutaneous n. and axillary n..

We found that a PNS can be utilized to establish blockade of the upper extrimity, but the success rate is not different than other methods, But it is appropriate for blocks established by beginner without complication.

We retrospectively analyzed the clinical and radiologic findings of broncho-pulmonary dysplasia.

We retrospectively studied the chest radiographs of 10 infants, who were clinically diagnosed as bronchopulmonary dysplasia from January, 1994 to December, 1995.

The underlying disease of the cases that has BPD were, there were hyaline membrane disease in 4 cases, repeating apnea in 4 cases, septicemia, peneumonia in 2 cases.

The most common radiological findings were coarse nodular & streaky densities in perihilar region(7/10),emphysematous overdistention(6/10), and other findings such as bubbly pattern (3/10), lace-like pattern with strands of density(2/10) appeared.

Premature and infants with thigh oxygen and intermittent positive pressure ventilation therapy, the chronic persistent pulmonary abnormality in chest X-ray films highly suggests the possibility of bronchopulmonar dysplasia.

Elevation of serum lgE is the most characteristic immune response in helminthic infections. Recently, expression of CD23(FcεRII on B lymphocytes play a major role in lgE production in allergic diseases. However, the mechanisms causing increased lgE production during helminthic infections are poorly understood. In the present study, the expression of CD 23 on splenic B lymphocytes during the course of infection with Paragonimus westermani was examined.

Female, 4-6-week old BALB/c mice were inoculated orally with 20 metacercariae of P. westermani. For detection of CD23 positive B lymphocytes by flow cytometry, splenocytes from infected mice and non-infected age matched controls were stained with FITC-conjugatedrat anti-mouse DB23 and PE-conjugated rat anti-mouse CD45R/B220 mono-clonal antibody. And also, to observe the effect of metacercarial ESP on the expression of CD23 antigen, splenocytes from non-infected mice were incubated in the presence of ESP at 37℃ for 6 h and 24 h.

The frequency of CD23 positive B lymphocytes of infected mice was increased significantly(p<0.05) at two and three weeks after infection(43.4±7.52% and 44.4±2.99%, respectively) and persisted the higher levels at four and six weeks after infection. Expression of CD23 antigen of cultured splenocytes from non-infected mice in the presence of metacercarial ESP was increased significantly(p<0.05) at 24 h after incubation(60.1±7.54%).

These results suggest that the expression of CD23 antigen induced by metacercarial ESP might play a important role in serum lgE production in mice infected with P. westermani.