BACKGROUND AND OBJECTIVES: The incidence and prevalence of hyperthyroidism has been reported to be 0.2-0.9/1000 population/year and 5-10/1000 population in foreign countries, respectively. However, there has been no nationwide survey to evaluate them in Korea. Therefore, this study was conducted to investigate the incidence and prevalence of hyperthyroidism in Korea using medicare claims data provided by the Health Insurance Review and Assessment Service. Preference for its therapeutic modalities and its change were also analyzed. MATERIALS AND METHODS: This study was performed in 308,584 (men 86,460, women 222,124) Korean patients with hyperthyroidism treated from January 2006 to June 2012. Patients with past history of hyperthyroidism were not included. RESULTS: The incidence of hyperthyroidism was 0.72/1000 population/year (men 0.40, women 1.03), and its prevalence was 3.40/1000 population (men 2.09, women 4.70) in Korea. Its peak prevalence was detected between 45 and 49 years of age. Among 177,487 patients with hyperthyroidism treated from 2007 to 2011, anti-thyroid drugs were prescribed in 97.9%, and radioiodine therapy and surgery were finally performed in 8.2% and 0.9%, respectively. The prescription of propylthiouracil (PTU) has been reduced from 63.3% in 2007 to 42.9% in 2011, but the use of methimazole (MMI) increased from 33.9% in 2007 to 54.8% in 2011. Primary physicians preferred PTU to MMI, but physicians in general hospitals preferred MMI to PTU. CONCLUSION: This is the first nationwide report to investigate the incidence and prevalence of hyperthyroidism in Korea.
Female ; Hospitals, General ; Humans ; Hyperthyroidism ; Incidence ; Insurance, Health ; Korea ; Medicare ; Methimazole ; Prescriptions ; Prevalence ; Propylthiouracil

OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

PURPOSE: Restaging after neoadjuvant treatment is done for planning the surgical approach and, increasingly, to determine whether additional therapy or resection can be avoided for selected patients. MATERIALS AND METHODS: Local restaging after neoadjuvant chemoradiation therapy (nCRT) was performed in 270 patients with locally advanced (cT3or4 or N+) rectal cancer. Abdomen and pelvic computed tomography (APCT) was used in all 270 patients, transrectal ultrasound (TRUS) in 121 patients, and rectal magnetic resonance imaging (MRI) in 65 patients. Findings according to imaging modalities were correlated with pathologic stage using Cohen's kappa (κ) to test agreement and intra-class correlation coefficient α to test reliability. RESULTS: Accuracy for prediction of ypT stage according to three imaging modalities was 45.2% (κ=0.136, α=0.380) in APCT, 49.2% (κ=0.259, α=0.514) in rectal MRI, and 57.9% (κ=0.266, α=0.520) in TRUS. Accuracy for prediction of ypN stage was 66.0% (κ=0.274, α=0.441) in APCT, 71.8% (κ=0.401, α=0.549) in rectal MRI, and 66.1% (κ=0.147, α=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (κ=0.238, α=0.401). CONCLUSION: APCT, rectal MRI, and TRUS are unreliable in restaging rectal cancer after nCRT. We think that multimodal assessment with rectal MRI and TRUS may be the best option for local restaging of locally advanced rectal cancer after nCRT.
Abdomen ; Hand ; Humans ; Magnetic Resonance Imaging ; Neoadjuvant Therapy ; Neoplasm Staging ; Rectal Neoplasms* ; Ultrasonography

A narrow internal auditory canal (IAC) with duplication is a rare anomaly of the temporal bone. It is associated with congenital sensorineural hearing loss. Aplasia or hypoplasia of the vestibulocochlear nerve may cause the hearing loss. We present an unusual case of an isolated narrow IAC with duplication that was detected by a CT scan. In this case, the IAC was divided by a bony septum into an empty stenotic inferoposterior portion and a large anterosuperior portion containing the facial nerve that was clearly delineated on MRI.
Child ; Ear, Inner/*abnormalities/radiography ; Female ; Hearing Loss, Sensorineural/*congenital ; Humans ; Tomography, X-Ray Computed

PURPOSE: Although there are more than a hundred techniques, including the transabdominal and the perineal approaches, for the repair of the rectal prolapsed, none of them is perfect. The best repair should be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The aim of this retrospective review is to evaluate clinical outcomes of the Delorme's procedure for the management of the complete rectal prolapse. METHODS: A total of 19 patients (13 females and 6 males) with complete rectal prolapses were treated by using the Delorme's procedure in St. Vincent's Hospital, The Catholic University of Korea, from February 1997 to February 2007. Postoperative anal incontinence was evaluated using the Cleveland Clinic Incontinence Score. RESULTS: All 19 patients had incontinence to liquid stool, solid stool, and/or flatus preoperatively. Three (15.8%) patients reported recurrence of the rectal prolapse (at 6, 18, 29 months, respectively, after the operation). Information on postoperative incontinence was available for 16 of the 19 patients. Twelve of the 16 patients (75%) reported improved continence (5 [31.3%] were improved and 7 [43.7%] completely recovered from incontinence) while 4 patients had unchanged incontinence symptoms. One (6.3%) patient who did not have constipation preoperatively developed constipation after the operation. CONCLUSION: The Delorme's procedure is associated with a marked improvement in anal continence, relatively low recurrence rates, and low incidence of postoperative constipation. This allows us to conclude that this procedure still has its own role in selected patients.
Constipation ; Fecal Incontinence ; Female ; Flatulence ; Humans ; Incidence ; Korea ; Prolapse ; Rectal Prolapse ; Recurrence ; Retrospective Studies

The increase in size of lymph node on Ct scan is the single most important finding of lymphadenopathy. The purpose of this study was to evaluate the size of mediastinal lymph nodes in patients with idiopathic pulmonary fibrosis with no evidence of malignancy or current infection. CT scans of 70 patients (16 with conventional CT and 54 with high-resolution CT) were assessed for lymph node size and locations. The duration of symptoms, and the extent and patterns of the parenchymal lung disease on CT scans were correlated with lymph node enlargement. In 54 of 70 patients, more than one lymph nodes were larger than 1-1.5cm. The prevalence of mnode enlargement increased significantly with a longer duration of symptom (p=0.001), larger extent of the disease (p=0.043), and with a greater proportion of honeycomb pattern (p=0.0344). Right paratracheal, subcarinal, right tracheobronchial, and paraesophageal nodes were the most common sites of nodes enlargement. In conclusion, mediastinal lymph node enlargement is common in patients with idiopathic pulmonary fibrosis and is more frequently seen in patients with a longer duration of clinical symptoms, greater extent of the disease, and with a larger proportion of honeycomb pattern.
Humans ; Idiopathic Pulmonary Fibrosis* ; Lung Diseases ; Lymph Nodes* ; Lymphatic Diseases ; Prevalence ; Tomography, X-Ray Computed*

PURPOSE: Thoracic ultrasonography (US) is an emerging tool for diagnosing pneumothorax (PTX), and the possible application of color Doppler to ultrasonography is another new development. The aim of this study is to analyze the possible contribution of color Doppler to thoracic US and to the estimation of pneumothorax volume. METHODS: Patients who were admitted to emergency department underwent chest X-ray and thoracic US with color Doppler. They were also evaluated by computed tomography, if needed, US was performed at four chest sites by emergency medicine faculty and resident, and concordance between color Doppler and lung sliding was analyzed. The number of sites with abnormal findings was correlated with the volume of PTX at each sites. Statistical analysis was performed with Pearson correlation. RESULTS: Sixty-three of 151 PTX cases were included in our study. The sensitivity of US was for PTX detection was 92.1% (58 of 63), and the concordance between color Doppler and lung sliding was 99.4%. The number of sites per patient with abnormal findings increased with the average volume of the PTX. The average PTX volume in the 5 cases with normal findings was 7.0%, which is a smallsized PTX. CONCLUSION: The use of color Doppler is not more accurate than lung sliding, but it may helpful in diagnosing PTX. The volume of a PTX is proportional to a patient's number of sites with abnormal US findings.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Lung ; Pneumothorax* ; Thorax ; Ultrasonography

PURPOSE: We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and we wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. MATERIALS AND METHODS: Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. RESULTS: For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter (p<0.001) and the Myo/Cr ratio in both the gray and white matter (p<0.01) were significantly elevated compared with those in the control subjects. For the patients with CRF after hemodialysis, their Cho/Cr ratios were significantly reduced in both the gray and white matter compared with that before hemodialysis (p<0.05). There was a significant positive correlation between the Cho/Cr ratio and serum Cr in the gray matter of CRF patients after hemodialysis (r=0.54, p<0.05). The cerebral metabolite ratios were not significantly correlated with the duration after starting the initial hemodialysis. CONCLUSION: The cerebral metabolite patterns are significantly different between the patients with CRF and who are undergoing hemodialysis and the normal controls. The cerebral metabolite ratios are not significantly correlated with the duration after starting the initial hemodialysis.
Creatine ; Dialysis ; Healthy Volunteers ; Humans ; Kidney Failure, Chronic* ; Magnetic Resonance Spectroscopy* ; Protons* ; Renal Dialysis*

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

No abstract available.
Coronary Vessels* ; Electrocardiography* ; Spasm*