BACKGROUND: Osteoporosis results from bone loss due to menopause [estrogen(E) deficiency] and aging. Initial skeletal effect of menopause is accelerated bone resorption with an increase in seurm calcium(Ca) and compensatory but inadequate bone formation. Secretion of parathyroid hormone(PTH) is suppressed at this time. Postmenopausal osteoporosis results in fractures predominantly of trabecular bone, i.e., vertebra. With aging, secondary hyperparathyroidism by low serum Ca and vitamin D deficiency superim poses. Senile osteoporosis produces hip fractures, area of cortical bone. The aim of this study was to- examine the association of vitamin D[25(OH)D] and intact(i) PTH with bone mineral density(BMD) after controlling for suggested confounding factors, and the possibility of low serum vitamin D and high serum iPTH concentration could impact bone loss in Korean postmenopausal women. METHODS: Data from 188 postmenopausal Korean women aged 42 to 69 were analyzed through BMD, serum 25(OH)D, iPTH, Ca, phosphorus(P), alkaline phosphatase(ALP) and clinical characteristics. Factors affecting BMD was determined by Pearson correlation and the relationship between lumbar and femoral neck BMD and vitamin D[25(OH)D] and iPTH was assessed by multiple regression analysis after adjus- ting for suggested confounding factors. RESULTS: Lumbar and femoral neck BMD, serum Ca, P were decresaed and serum iPTH was increased with aging. In Pearson`s correlation, significant contributing factors to lumbar BMD was age, height, weight, menarche, year since menopause(YSM) and ALP. And significant contributing factors to femoral neck BMD was age, height, weight, menarche, YSM and iPTH. No relationship could be demonstrated between serum vitamin D[25(OH)D] and lumbar and femoral neck BMD. How ever, after controlling for potential confounding factors, a correlation was found between vitamin D[25(OH)D] and both of lumbar (p=0.013) and femoral neck BMD(p=0.077). iPTH was inversely related to femoral neck BMD(p=0.004) only in multiple linear regression. CONCLUSION: Serum vitamin D[25(OH)D] was influencing both of vertebral and femoral neck BMD, which suggests a significant role of vitamin D deficiency in the pathogenesis of postmenopausal osteo- porosis. In age related remodeling and loss of bone, increased serum iPTH might have additive role in cortical bone of femur. These findings suggest that vitamin D is very important for optimal bone health and a deleterious effect of increased iPTH on cortical bone loss. Adequate calcium and vitamin D status have to be maintained to prevent osteoporosis in postmenopausal Korean women.
Aging ; Bone Density* ; Bone Resorption ; Calcium ; Female ; Femur ; Femur Neck ; Hip Fractures ; Humans ; Hyperparathyroidism, Secondary ; Linear Models ; Menarche ; Menopause ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal ; Parathyroid Hormone* ; Spine ; Tolnaftate ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

One family with asymmetric septal hypertrophy was reported. The propositus of this family was 31 years old man who was admitted because of transient syncope. His father and one brother were affected but asymptomatic. His sister was suddenly died at age 21 years. The interventricular septal thickness to left ventricular posterior wall thickness ratios were measured using M-mode echocard ogram. In the affected family, echocardiogram revealed asymmetric septal hypertrophy (1.5:1, 2:1, 1.9:1 respectively). In the propositus, cardiac catheterization and simultaneous biventricular cineangiography were performed. Pressure study revealed mild peak systolic pressure gradient within left ventricular apex and left ventricular outflow tract (4mm Hg respectively). Biventricular cineangiogram showed the septal width increased inferiorly, and left ventricular endocardial surface of the septum was straight, while the right ventricular border convex toward the right ventricle.
Adult ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cineangiography ; Fathers ; Heart Ventricles ; Humans ; Siblings ; Syncope

We report a case of myiasis on the left submandibular area after radiation therapy for squamous cell carcinoma. A 77-year-old man visited our hospital, 7 weeks after complicating a course of radiation therapy, had a 7cm diameter necrotic ulcer on the left submandible. The margin of the lesion were undermined by numerous interlinking passages containing 20 maggots. The maggots were removed by simple extraction and were identified as Calliphoridae Lucilia. The probable origin of the myiasis in this case was attributed to poor environmental condition and general weakness of the patient. Oppotunistic cutaneous myiasis can be prevented by protecting open wounds from flies, wound should not be left without a covering capable of excluding flies, especially in the summer month.
Aged ; Carcinoma, Squamous Cell* ; Diptera ; Humans ; Larva ; Myiasis* ; Ulcer ; Wounds and Injuries

Heorrhage and infarct-like necrosis of anterior lobe of the pituitary gland is one of the characteristic pathologic findings of the autopsied cases of Korean Hemorrhagic Fever (KHF) patients, but there has been rare reports of hypopituitarism in patients with KHF. Recently we have experienced a patient with hyponatremia who had recovered from KHF. He was admitted to our hospital due to nausea, vomiting, and epigastric discornfort. To determine the function of the anterior pituitary gland, hormonal levels of target galnds and pituitary gland were measured, and combined pituitary stimulation test was performed. ACTH, GH, and prolactin deficiency were confirmed by combined pituitary stimulation test in this patient. There was no evidence of hypothalamic or other pituitary diseases by brain MRI. Our experience shows that KHF can be a cause of hypopituitarism and these findings should alert physicians the possibility of hypopituitarisrn in patients who had recovered from KHF.
Adrenocorticotropic Hormone ; Brain ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Hyponatremia ; Hypopituitarism* ; Magnetic Resonance Imaging ; Nausea ; Necrosis ; Pituitary Diseases ; Pituitary Gland ; Pituitary Gland, Anterior ; Prolactin ; Vomiting

BACKGROUND AND OBJECTIVES: Metabolic syndrome and high sensitivity C-reactive protein (hs-CRP) are known to be strong predictors of coronary atherosclerosis. Even though there have been many observations and much research concerning the association of coronary atherosclerosis with CRP and metabolic syndrome, certain problems still need to be resolved in order to produce clear mechanistic illustrations. Therefore, the correlations of metabolic syndrome, hs-CRP and the severity of coronary atherosclerosis were evaluated herein. SUBJECTS AND METHODS: 271 patients, aged between 29 and 87, who had undergone diagnostic coronary angiograms at the National Medical Center, between January, 2004 and June, 2006 were evaluated. Coronary angiograms were performed in patients who complained of typical chest pain and had risk factors associated with coronary atherosclerosis. The correlations of metabolic syndrome, hs-CRP and coronary atherosclerosis were analyzed in these patients. RESULTS: Positive relationships were found between the metabolic syndrome risk factor clustering and an increased level of hs-CRP (p<0.01). The severity of coronary atherosclerosis increased with the increasing number of metabolic syndrome risk factors. As metabolic syndrome risk factor clustering increased, the quantity of 1, 2 and 3 vessel diseases also increased (Odd ratios 1.61, 1.83 and 2.50; p=0.001, <0.001 and <0.001, respectively). In contrast to metabolic syndrome risk factor clustering, no definite relationship between the hs-CRP level and the severity of coronary atherosclerosis was observed. CONCLUSION: The more metabolic syndrome risk factors clustered, the greater the severity of coronary atherosclerosis. The extension of coronary atherosclerosis maybe predicted using evaluation of metabolic syndrome risk factor clustering in patients with angina.
C-Reactive Protein ; Chest Pain ; Cluster Analysis* ; Coronary Angiography ; Coronary Artery Disease* ; Humans ; Metabolic Syndrome X ; Risk Factors*

Menetrier's disease is a rare disease characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss and edema due to gastric protein loss. The 48-year-old male patient was admitted to the Hangang Sacred Heart Hospital with cheif complaints of indigestion and epigastric pain. The diagnosis of Menetriers disease is established by radiologic, endoscopic, and pathologic examination. He was treated with soft diet, antacid, H2- receptor antagonist, and IV albumin. We report a case of Menetriers disease with brief review of literatures.
Diagnosis ; Diet ; Dyspepsia ; Edema ; Gastritis, Hypertrophic* ; Heart ; Humans ; Male ; Middle Aged ; Rare Diseases ; Stomach ; Weight Loss

PURPOSE: The rate of malignancy in the follicular neoplasm (FN) or Hürthle cell neoplasm (HCN) of the thyroid gland is estimated as approximately 20~30%. Fine-needle aspiration biopsy (FNAB) and frozen section examination are restricted in differentiating between benign and malignant. The aims of this study are to compare the differences of clinicopathologic features and to determine the risk factors for malignancy in patients with FN or HCN. METHODS: A retrospective study was conducted of patients with FN or HCN who were diagnosed by FNAB, and underwent surgery at our institution between Jan. 2005 to Jun. 2010. We analyzed the risk factors for malignancy and the differences of clinicopathologic features in patients with FN or HCN. RESULTS: A total of 290 patients were enrolledin this study; 160 (55.2%) patients underwent thyroidectomy, 97 (60.6%) patients had FN, and 63 (39.4%) had HCN. Forty one (25.6%) patients were diagnosed as malignancy of these, 22 (22.7%) patients were FN and 19 (30.2%) were HCN (P=0.29). Two (2.1%) patients with FN and 10 (15.9%) with HCN (P=0.002) comcomitant papillary thyroid carcinoma were indentified by FNAB. Classification of nodules according to ultrasonographic findings in both neoplasms (P<0.05) and galectin-3 in FN (P<0.05) were predictive factors for malignancy. In addition, galectin-3 was a predictive factor for malignancy in indeterminate nodules on ultrasonography (USG) (P=0.028). CONCLUSION: Classification of nodules according to ultrasonographic findings and galectin-3 expression is helpful in predicting carcinoma of patients with FN or HCN.
Biopsy, Fine-Needle ; Classification ; Frozen Sections ; Galectin 3 ; Humans ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography

PURPOSE: Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). MATERIALS AND METHODS: For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to 50% of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. RESULTS: When patients breathed freely, average movement of diaphragm was 12+/-1.9 mm in prone position in contrast to 16+/-1.9 mm in supine position. In prone position, difference in diaphragm movement with and without RRD was 3+/-0.9 mm and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to 22.7% in DVH analysis. CONCLUSION: Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.
Abdomen ; Carcinoma, Hepatocellular* ; Diaphragm ; Humans ; Liver ; Liver Neoplasms ; Prone Position ; Respiration ; Supine Position ; Thorax

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in patients with vocal cord paralysis (VCP). MATERIALS AND METHODS: Total 210 patients with VCP and 236 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text “Walk”. A 2 second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were recorded. And then voice samples were edited, concatenated, and analyzed according to Praat script. Two standardized auditory-perceptual assessment (GRBAS and CAPE-V) were performed by three raters. RESULTS: The VCP group showed higher AVQI, Grade (G) and Overall Severity (OS) values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.904 to 0.926. In ROC curve analysis, cutoff values of AVQI, G, and OS were < 3.79, < 0.00, and < 30.00, respectively, and the AUC of each analysis was over .89. CONCLUSION: AVQI and auditory evaluation can improve the early screening ability of VCP voice and help to establish effective diagnosis and treatment plan for VCP-related dysphonia.
Acoustics* ; Area Under Curve ; Diagnosis ; Dysphonia* ; Humans ; Mass Screening ; ROC Curve ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice ; Voice Quality