This is the first case report of myasthenia gravis with cosxisting hyperthyroidism and thymic hyperplasia in Korea. Thirty two year-old man visited in the clinic with exthophalmos, ptosis, dysarthria and dysphagia. Serum anti-acetylcholine receptor and anti-microsomal antibodies was increased significantly. The chest CT showed a large soft tissue mass at the anterior mediastinum. The anti-thyroid drug, glucocorticoid, cholinesterase inhibitor and intravenous immunoglobulin was given as a treatment. After thyroid function is normalized, thymectomy will be done.
Antibodies ; Cholinesterases ; Deglutition Disorders ; Dysarthria ; Hyperthyroidism* ; Immunoglobulins ; Korea ; Mediastinum ; Myasthenia Gravis* ; Thymectomy ; Thymus Hyperplasia* ; Thyroid Gland ; Tomography, X-Ray Computed

BACKGROUND: As prostate cancer in men is increasing in Korea, the need for early detection by mass screening has become an important issue. Screening tests for early detection of prostate cancer are digital rectal examination, transrectal ultrasonography (TRUS) and prostate specific antigen (PSA) test. PSA test has been mainly used for prostate cancer screening in health promotion centers. However, PSA has a high sensitivity but low specificity. Therefore, PSA concentration can be increased not only in prostate cancer, but also in several benign prostate diseases such as benign prostate hyperplasia (BPH), prostatitis, and prostate ischemia. Also, PSA concentration can increase in the elderly. Therefore, we investigated the results of follow-up PSA tests, in the cases of increased PSA concentration on screening. METHODS: In 538 cases, the PSA concentration were increased over 2.5 ng/ml among total 17,302 males checked up on screening test at Ajou University Hospital from January 1999 to December 2001. Two hundred and four cases followed up with TRUS or prostate biopsy were chosen. We investigated 89 cases who performed follow- up PSA test. On the basis of the results of biopsy or TRUS, the subjects were classified into non-disease group, benign prostate disease group and prostate cancer group (possible or confirmed prostate cancer group). RESULTS: The mean age of non-disease group was 35.5 5.9 years, which was significantly lower than that of benign prostate disease group and prostate cancer group (P<0.05). Compared to the mean age of prostate cancer group (60.6 10.4 years) and non-prostate cancer group (53.1 12.3 years), prostate cancer group was significantly older than non prostate cancer group (P=0.005). When the lower limit of age was set to 40 years (mean-2SD), confirmed prostate cancer group was significantly older than other groups (p<0.001). The PSA concentration of confirmed prostate cancer group (11.33 7.58 ng/ml) was significantly higher than that of non-prostate disease group (4.35 2.22 ng/ml) and possible prostate cancer group (4.44 2.29 ng/ml) (P<0.05). The follow-up PSA level of confirmed prostate cancer group (10.13 6.13 ng/ml) was significantly higher than that of non-prostate disease group (2.55 0.97 ng/ml), BPH group (4.33 3.80 ng/ml), prostatitis group (3.61 2.17 ng/ml), prostate cyst group (3.00 1.86 ng/ml) and possible prostate cancer group (3.81 2.82 ng/ml) (P<0.05). CONCLUSION: It is recommended that screening test for prostate cancer be performed after the age of 40. While follow-up PSA test is needed when the PSA is increased up to less than 10 ng/ml, prostate biopsy may be desired in the PSA value of 10.0 ng/ml or greater.
Aged ; Biopsy ; Digital Rectal Examination ; Follow-Up Studies ; Health Promotion ; Humans ; Hyperplasia ; Ischemia ; Korea ; Male ; Mass Screening ; Multiple Endocrine Neoplasia Type 1 ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Prostatitis ; Sensitivity and Specificity ; Ultrasonography

BACKGROUND: Childhood and adolescent obesity, not only increases the risk of obesity into adulthood but also is a significant culprit affecting health in general. The purpose of this study was to examine the trend in body mass index (BMI) and to investigate the prediction of adolescence overweight from childhood weight status by retrospectively tracking for seven years. METHODS: The subjects, 520 adolescents aged 14 and 15 years, were recruited from a junior high school that is located in Guri-city. The subjects' height and weight measurements were extracted from the school records of annual physical examination. We assessed their BMI over a period of seven years starting at age seven. Other baseline data were obtained by questionnaires which were completed by both the subjects and their parents in 2001. RESULTS: The prevalence of overweight, according to the Korean Pediatric Society guideline, increased at age 7 through 14. The overweight adolescents of age 14 were more likely to have an obese mother. The results showed that 84% of males and 47% of females who were overweight in childhood continued to remain overweight in adolescence. Compared to the non-overweights, the relative risk of becoming an overweight adolescent among overweight boys was 5.7 (95% CI: 4.1~8.1) and among overweight girls was 6.3 (95% CI: 3.4~11.4). CONCLUSION: Approximately 70% of the overweight children continued to remain overweight as adolescents. Therefore, prevention and effective management of obesity during childhood and adolescence are essential.
Adolescent* ; Body Mass Index* ; Child* ; Female ; Humans ; Male ; Mothers ; Obesity ; Overweight* ; Parents ; Pediatric Obesity ; Physical Examination ; Prevalence ; Retrospective Studies* ; Surveys and Questionnaires

BACKGROUND: Smoking is well known as an important preventable risk factor contributing to mortality and morbidity. Telephone counseling might be one of adjunctive interventions for smoking cessation. We evaluated whether telephone counseling performed by a nurse could improve smoking cessation rate. METHODS: Study subjects were 152 male smokers who visited family practice in one tertiary hospital between November 2001 and January 2002 and agreed to participate in this study. After completing a self- administered questionnaire, the subjects received self-help materials and were randomly assigned into either an intervention or control group. A well-trained nurse provided telephone counseling only to experimental group at 8th and 17th week of follow-up. The 25-week smoking cessation rates were checked in both groups by telephone call. RESULTS: There were no significant differences in socio- demographic and smoking-related characteristics between intervention, control, and non-participants groups. Intention-to-treat smoking cessation rate at 25th-week of follow- up was 21.1% in control, 25.0% in intervention group and was not statistically different from each other. Smoking cessation rate according to the baseline stage of change toward quit smoking was not statistically different from each other. CONCLUSION: The telephone counseling performed by a nurse was not significantly effective for improving smoking cessation rate in this study.
Counseling ; Family Practice ; Follow-Up Studies ; Humans ; Male ; Mortality ; Risk Factors ; Smoke* ; Smoking Cessation ; Smoking* ; Telephone* ; Tertiary Care Centers ; Surveys and Questionnaires

BACKGROUND: Errors during measurement of blood pressure can cause over diagnosis or under diagnosis of hypertension, which can result in inappropriate management of hypertension and follow up consultation. The aim of this study was to investigate the factors affecting the accuracy of blood pressure measurement, which may serve as means to improve the accuracy of blood pressure measurements. METHODS: Among the 123 interns who work at Asan Medical Center, we selected 90 persons who agreed to join the study. Three interns were excluded because of their incomplete response to the questionnaire. Questionnaire for the survey concerning blood pressure measurement was created by selecting 5 case problems from a total of 34 cases provided within the blood pressure measurement CD ROM, which apply the Korotkoff sound technique. The factors that might affect the measurement were analyzed by multiple logistic regression. RESULTS: Fifteen (17.2%) interns failed to accurately measure blood pressure provided by the CD program. They showed a difference of greater than 10 mmHg between the actual and the measured systolic blood pressure. A discrepancy of greater than 5 mmHg was noted in the measurement of diastolic blood pressure. From the total sample of 87 interns, 15 (16.1%) interns showed digit preference (0 or 5), when measuring blood pressure. The discrepancy between the measured and the actual blood pressure was greater among those who had a digit preference (95% CI 1.055~17.770). CONCLUSION: Digit preference was the most important factor that affected the accuracy of blood pressure measurement taken by conventional sphygmomanometry. Effort to correct digit preference would improve the quality of blood pressure measurements.
Blood Pressure* ; Chungcheongnam-do ; Diagnosis ; Humans ; Hypertension ; Logistic Models ; Surveys and Questionnaires

BACKGROUND: Vascular endothelial dysfunction (VED) plays a pivotal role in the pathogenesis of atherosclerosis and is associated with insulin resistance and with visceral obesity. Therefore, in this study the predicting factor of vascular endothelial dysfunction was investigated in healthy premenopausal obese women by pulse-wave analysis (PWA) combined with provocative pharmacological testing. METHODS: Thirty three obese women (BMI> or =25), aged 20~45 y and 25 age-matched control subjects (BMI; 18.5~22.9) were examined. All women were sedentary (<1 hr/wk of physical activity), non-smoker and were excluded if they had type 2 diabetes melitus, hypertension, hyperlipidemia, cardiovascular disease, or acute inflammatory disease and were studied in folicullar phase of the cycle, within the first week after cessation of menstrual bleeding. They underwent determination of anthropometric measurements, metabolic variables, adipose tissue regional distribution, and endothelial function by performing pulse-wave analysis (PWA) combined with provocative pharmacological testing. RESULTS: Augmentation Index (AIx) fell significantly after the administration of salbutamol, which causes endothelium-dependent vasodilatation, but response was significantly reduced in obese women compared with controls (10.28 6.72% vs 17.2 6.84%, P=0.0003). The change in after Nitroglycerin, which causes endothelium-independent vasodilatation, did not differ significantly (30.86 9.67% vs 30.6 10.11%, P=0.9172). In our obese subjects, visceral adipose tissue area was independently a significant predictor of vascular endothelial dysfunction (beta= 0.1381, P=0.0038, Adj-R2=0.348). CONCLUSION: Increased abdominal adiposity is a powerful independent predictor of VED in obese healthy women. Future studies of vascular endothelial function should account for the independent effects of abdominal fat.
Abdominal Fat ; Adipose Tissue ; Adiposity ; Albuterol ; Atherosclerosis ; Cardiovascular Diseases ; Female ; Hemorrhage ; Humans ; Hyperlipidemias ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Nitroglycerin ; Obesity, Abdominal ; Vasodilation

BACKGROUND: Which component of physician's interviewing process affects the patient- physician relationship and clinical outcomes can be studied by videotaping conversations in an exam room. The purpose of this study was to record resident physicians' conversations, describe the frequency and the content of the observed patient- centered utterances in interviews, and analyze the correlation between the presence of observed patient- centered utterances and the level of satisfaction. METHODS: Ten interactions for each of the 6 resident physicians were videotaped. The utterances of physicians were coded directly from video tapes and transcribed partially. Uttering to explore a patient's standpoint, uttering emotionally to mention directly about patient's feeling, and uttering to counsel a patient for coping skills were considered as indicators of patient- centered conversations. RESULTS: The average number of physician's utterances per interaction was 32 (range 9~67). The mean time of an interaction was 8 minutes and 23 seconds (range: 1 min and 55 sec~20 min and 20 sec). Among the total 1,792 physicians' utterances, there were 29 social talks, 1,228 utterances for diagnosis, 376 utterances for treatment, 147 directive utterances, and 12 family-centered utterances. Among the utterances for diagnosis or treatment, there were 88 patient-centered utterances including 59 utterances for exploring a patient's standpoint, 23 emotional utterances, and 6 utterances for counseling. Fifty two patients responded to a questionnaire to assess satisfaction after an interaction. Sixteen respondents (30.8%) were very satisfied, 26 respondents (50.0%) were satisfied, 6 respondents (11.5%) were little satisfied, one respondent (1.9%) was unsatisfied, and 3 respondents (5.8%) were reserved to respond. There was no significant correlation between the presence of observed patient- centered utterances and the level of satisfaction (P>0.05). CONCLUSION: Most of the resident physicians' utterances consisted of asking physician-centered questions and offering informations. The patient-centered utterances were observed 1~2 times per interaction in average, and they were brief. This study reveals that the presence of patient-centered utterances in interviews was not correlated with the level of patients' satisfaction.
Adaptation, Psychological ; Counseling ; Surveys and Questionnaires ; Diagnosis ; Humans ; Patient-Centered Care ; Personal Satisfaction ; Physicians, Family*

In early May 2003, a small group of four, including three family physicians and a media person, visited various family medicine education and training facilities in Edmonton, Alberta, Canada. This paper is a brief discussion of what knowledge and insight was gained during this trip.
Alberta* ; Canada* ; Education ; Humans ; Physicians, Family

No abstract available.
Urinary Bladder*

No abstract available.
Aging* ; Hormone Replacement Therapy*