PURPOSE: To evaluate the changes and remission of disease activity with changes in inflamed synivial volumes of rheumatoid joints after therapy. MATERIALS AND METHODS: Seven rheumatoid arthritis patients who had been treated with antiinflammatory drugs were followed up. Using NIH imaging and a segmentation technique, pre- and post-enhanced images were measured in subtracted images. Intra- and interobserver variation were evaluated by two radiologists(A and B), using two independent measurements. For comparison, the cases were assigned to one of two groups : remission and non-remission. Changes in ESR and total joint counts(TJC) after therapy were compared with inflamed synovial volumes. RESULTS: Intraobserver variations were 3.2% and 2.7% in A and B, respectively, interobserver variation between A and B was 7.1%. Changes in inflamed synovial volumes correlated well with those in ESR (r=0.88, p<0.009) and TJC (r=0.78, p<0.037) after therapy. Changes between the remission and non-remission group were insignificant, however. CONCLUSION: Changes in inflamed synovial volumes reflect those in the activity of rheumatoid arthritis between pre- and post- treatment. This technique may be used as a tool for predicting therapeutic response in rheumatoid arthritis cases. Changes in inflamed synovial volumes are of limited value, however, in predicting the remission of rheumatoid arthritis after therapy.
Arthritis, Rheumatoid ; Humans ; Joints ; Observer Variation ; Synovial Membrane* ; Synovitis* ; Wrist Joint* ; Wrist*

PURPOSE: To evaluate the changes and remission of disease activity with changes in inflamed synivial volumes of rheumatoid joints after therapy. MATERIALS AND METHODS: Seven rheumatoid arthritis patients who had been treated with antiinflammatory drugs were followed up. Using NIH imaging and a segmentation technique, pre- and post-enhanced images were measured in subtracted images. Intra- and interobserver variation were evaluated by two radiologists(A and B), using two independent measurements. For comparison, the cases were assigned to one of two groups : remission and non-remission. Changes in ESR and total joint counts(TJC) after therapy were compared with inflamed synovial volumes. RESULTS: Intraobserver variations were 3.2% and 2.7% in A and B, respectively, interobserver variation between A and B was 7.1%. Changes in inflamed synovial volumes correlated well with those in ESR (r=0.88, p<0.009) and TJC (r=0.78, p<0.037) after therapy. Changes between the remission and non-remission group were insignificant, however. CONCLUSION: Changes in inflamed synovial volumes reflect those in the activity of rheumatoid arthritis between pre- and post- treatment. This technique may be used as a tool for predicting therapeutic response in rheumatoid arthritis cases. Changes in inflamed synovial volumes are of limited value, however, in predicting the remission of rheumatoid arthritis after therapy.
Arthritis, Rheumatoid ; Humans ; Joints ; Observer Variation ; Synovial Membrane* ; Synovitis* ; Wrist Joint* ; Wrist*

BACKGROUND: Visceral obesity is the most powerful contributor to the development of metabolic syndrome (MetS) and cardiovascular diseases. In light of visceral obesity, however, there is a paucity of data on the appropriate cutoff point of waist circumference (WC) in subjects with type 2 diabetes. The aim of this study was to investigate the optimal cutoff value for WC that signals insulin resistance (IR) and visceral obesity in Koreans with type 2 diabetes. METHODS: We evaluated 4,252 patients with type 2 diabetes (male 2,220, female 2,032, mean age 57.24 years) who visited our clinic between January 2003 and June 2009. WC was measured at the midpoint between the lower rib and the iliac crest, and insulin sensitivity was assessed by the rate constant of plasma glucose disappearance (Kitt %/min) using an insulin tolerance test. Visceral fat thickness was measured using ultrasonography. Statistical analysis was performed using receiver operating characteristic curve. RESULTS: The optimal cutoff points for WC for identifying the presence of IR and visceral obesity, as well as two or more metabolic components, were 87 cm for men and 81 cm for women. Moreover, these cutoff points had the highest predictive powers for the presence of visceral obesity. The MetS defined by new criteria correlated with the increased carotid intima-media thickness in female subjects. CONCLUSION: Our results suggest that the optimal cutoff values for WC in Koreans with type 2 diabetes should be reestablished based on IR and visceral obesity.
Blood Glucose ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Insulin ; Insulin Resistance* ; Intra-Abdominal Fat ; Male ; Obesity, Abdominal* ; Ribs ; ROC Curve ; Ultrasonography ; Waist Circumference*

BACKGROUND: To assess the utility of HRCT in the evaluation of visceral pleural invasion and to determine whether visceral pleural invasion and bronchovascular bundle thickening on the same lobe could be related to the recurrence and survival in non-small cell lung cancer (NSCLC). METHOD: Eighty one patients, which were fulfilled long-term follow-up at least 18 months (maximum 103 months) among which 434 patients had underwent curative surgical resection for NSCLC from 1986 to 1995, were studied. They were analyzed to evaluate whether the prognostic factors such as the recurrence and survival depend on visceral pleural invasion and bronchovascular bundle thickening to the same lobe. Thirty two patients adjacent to a chest wall or a fissure were evaluated for visceral pleural invasion by HRCT. CT criteria included abutting pleura along the chest wall, abutting and/or compressing fissure, crossing fissure, and pleural tail. RESULTS: The positive predictive value and the negative predictive value of crossing fissure were 100% and 100%, respectively. Two patients showing spiculated interface between a mass and abutting fissure were confirmed to have visceral pleural invasion at surgery. Visceral pleural invasion confirmed at surgery was significant to local recurrence and survival (p<.05, p<.05, respectively). Brochovascular bundle thickening to the same lobe on CT scan was significant to survival (p<.05) but was not significant to local and distant recurrence (p>.05). CONCLUSION: Visceral pleural invasion and bronchovascular bundle thickening to the same lobe have a role in predicting prognosis such as recurrence and survival in NSCLC. Therefore, the analysis of visceral pleural invasion on CT scan and the pathological analysis of bronchovascular bundle thickening to the same lobe may be necessary to predict the prognosis in NSCLC.
Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Pleura ; Prognosis ; Recurrence ; Thoracic Wall ; Tomography, X-Ray Computed

Thyrotoxicosis factitia, a syndrome that results from a surreptitious ingestion of excess thyroid hormone, has generally been diagnosed in young or middle-aged women who have psychopathological disturbances. An 18-year-old female was admitted to the hospital 24 hours after taking an overdose of more than 50 tablets of synthyroid (levothyroxine, 5mg). She had taken 6 to 9 tablets of synthyroid daily for 6 months for the purpose of weight reduction even though she was not overweight. Because of her stuporous mental state and an acute respiratory failure, she was intubated and treated in the intensive care unit. After careful history taking and after her plasma thyroid hormone levels were determined, we diagnosed a thyroid storm that was caused by a thyrotoxicosis factitia. The laboratory results were, T3 430.0 ng/dL, free T4 70.0 ng/dL, TSH 0.05 IU/mL. Her symptoms improved after treatment by steroids and propranolol. She was discharged 8days after admission. Cases of thyrotoxicosis factitia have been reported very infrequently and, there has been no reports of a thyroid storm due to thyrotoxicosis factitia in Korea. We now report a case of a thyroid storm that resulted from thyrotoxicosis factitia that was caused by the ingestion of a massive dose of thyroid hormone that was takan daily for 6 months. We also present a brief review of the relevant literature.
Adolescent ; Eating ; Female ; Humans ; Intensive Care Units ; Korea ; Overweight ; Plasma ; Propranolol ; Respiratory Insufficiency ; Steroids ; Stupor ; Tablets ; Thyroid Crisis* ; Thyroid Gland* ; Thyrotoxicosis* ; Weight Loss

PURPOSE: This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy. MATERIALS AND METHODS: One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months). RESULTS: The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 602, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%). CONCLUSION: The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.
Brachytherapy ; Cervix Uteri* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Fractures, Stress ; Humans ; Incidence ; Multivariate Analysis ; Pelvis ; Radiation Oncology ; Radiotherapy* ; Rectum ; Urinary Bladder

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing disease with genetic and environmental background. Many factors may act as triggers and affect the course of the disease. However, little is known about the factors affecting the disease severities in Korean childhood AD. OBJECTIVE: The aim was to document the distinct characteristics of childhood AD in Korea and to determine which manifestations are prone to be present in the settings of different severity of the disease. METHOD: The clinical manifestations, past medical and family history, and inducing or aggravating factors were studied in patients, who participated in the open lectures for childhood AD patients in three provinces of Korea. The severity of the disease was evaluated using the Eczema Area and Severity Index (EASI) and the factors affecting the severity of the disease were determined. Skin prick tests with four allergens, Dermatophagoides pteronyssinus, milk, peanut and egg, were also carried out. RESULTS: Of the 93 patients, 38.7% had the disease onset between the age of three and six, while 17.2% had it between the age of seven and fifteen. Sixty-five percent of the patients had family members with a history of atopic diseases, such as AD, asthma, allergic rhinitis and allergic conjunctivitis. In order of frequency, the patients either had a history of or presently accompanying infantile eczema, allergic rhinitis, asthma or allergic conjunctivitis. Among the patients, 27% took herbal medication. The most frequently involved site was the flexural area. The most common aggravating factors were sweating in hot environment, wool fabric and stress. When AD patients were categorized into mild, moderate and severe groups by EASI, the older onset age, the longer duration, facial distribution, history of taking herbal medication, cholinergic condition, wool fabric and stress were found to be significant factors influencing the severity of the disease. Skin prick test with the four major allergens revealed the highest prevalence in Dermatophagoides pteronyssinus. CONCLUSION: The age of onset of AD was higher than that has been reported. Many suffered from infantile dermatitis and had other accompanying atopic diseases. Aggravating factors should be avoided to minimize the risk of disease aggravation. Based on the fact that late onset age, duration, facial distribution, history of taking herbal medication, cholinergic condition, wool and stress were the statistically significant factors, we may predict the severity or the course of the disease.
Age of Onset ; Allergens ; Antigens, Dermatophagoides ; Asthma ; Conjunctivitis, Allergic ; Dermatitis ; Dermatitis, Atopic* ; Dermatophagoides pteronyssinus ; Eczema ; Humans ; Korea* ; Lectures ; Milk ; Ovum ; Prevalence ; Rhinitis ; Skin ; Sweat ; Sweating ; Wool