It has been proven that the newborn screening programs for congenital hypothyroidism are very important for its early detection and the early treatment of congenital It has been proven that the newborn screening programs for congenital hypothyroidism are very important for its early detection and the early treatment of congenital hypothyroidism can ameliorate and possibly reverse its consequences. Treatment with L-thyroxine is started in case of suspicious hypothyroidism at the first visit. Serum concentration of total and free thyroxine become normal within 1week after start of therapy but TSH values become normal from 2 months to 6 months after L-thyroxine therapy. The possible explanations for prolonged TSH elevation in congenital hypothyroidism are poor compliance for therapy, an inadequate dose of L-thyroxine, elevated threshold for thyrotropin suppression and two novel mutations in the thyrotropin (TSH) receptor gene in a child with resistance to TSH. Authors have experienced two cases of prolonged TSH elevation with normal T3 and T4 levels till 18months and 27 months of age after optimal L-thyroxine therapy and literature were reviewed.
Child ; Compliance ; Congenital Hypothyroidism* ; Humans ; Hypothyroidism ; Infant, Newborn ; Mass Screening ; Thyrotropin ; Thyroxine

PURPOSE: A number of studies have been published on the effect of growth hormone therapy over 1-3 years in children with growth hormone deficiency(GHD) & Familial short stature(FSS). So far final height data are seldomly available. Final heights of GH treated children with GHD & FSS were evaluated. METHODS: 10 Children with GHD and 69 children with with FSS were enrolled for the study. They were treated with GH 0.1IU/kg/daily in 10 GHD and 20 children with FSS. They were grown up and reached adult height. 49 children with FSS were not treated at all. Facors influencing final height were investigated. RESULTS: 1) All patients with GHD(Idiopathic 8 cases, Organic 2 cases) had additional gonadotropin deficiency and had multiple pituitary hormone deficiency. 2) At start of GH treatment boys of idiopathic GHD were 9.8 years old and 12.4 years old in girls and their mean height was 114.8cm(-2.8SDS), 123.0cm(-2.9 SDS)in boys and girls respectively. Boy with orgnaic GHD was 11.1 years and 6.7 years old in girl. Their height were 126.0cm(-1.5SDS) and 104cm(-1.2SDS) respectively. 3) Mean final height of idiopathic GHD was 167.6cm(-0.5SDS) in male and 161.0 cm(0.7SDS) and that of organic GHD was 173.0cm(0.5SDS) in male and 157cm (0SDS) in girl. 4) Mean Final height in untreated children with FSS was 159.8+/-.2cm(-1.6 SDS)in male and 149.6+/-.3cm(-1.4SDS) in female. Mean final height of GH treated in FSS was 162.5+/-.1cm(-1.5SDS) in male and 152.0+/-.4cm(-1.2SDS) in female But there was no statiscally difference between untreated and treated children in final height. 5) The age of onset of menarche was 12.74+/-.78 years old in GH treated group (n=12) and 12.45+/-.16 years old in untreated group(n=34). CONCLUSION: The GH administration in patients with GHD has been confirmed for growth promotion. but in case of FSS there was no significant difference between treated and untreated group. More further studies are needed for the confirmation of the efficacy of GH therapy in patients with FSS.
Adult ; Age of Onset ; Child* ; Female ; Gonadotropins ; Growth Hormone* ; Humans ; Male ; Menarche

The question has been raised whether the medical fee schedule is very low in Korea. However, studies that empirically address this matter on a national scale are rare. This study attempted to determine the level of Korea's medical fees for caesarean section (C-section), cataract, and appendectomy surgeries by comparing and analyzing them with other Organization for Economic Cooperation and Development (OECD) countries' medical cost data obtained from other studies. There are two ways to compare the level of medical fees: one is a direct comparison, which obtains each country's medical fee schedule and compares them with each other. Another is indirect comparison, a method which compares data such as physician income. For direct comparison, fees were calculated using data provided by the OECD and Health Insurance Review and Assessment. For indirect comparison by physician income, data obtained from Korea Employment Information Services were used to represent Korean physician income. When compared with other OECD countries, the results suggest that, overall, the Korean fee schedule could be low, based on the fees for C-section, cataract, and appendectomy surgeries. The study results also confirm that Korean physicians' average earnings ranked relatively low among OECD countries. These results are meaningful in that they empirically support the contention that Korean medical fees could be low. In addition, under what is known as national health insurance, in which the medical fee schedule is determined by a single payer, an empirical analysis on medical fee levels, as in this study, has substantial political implications because it may be utilized for medical fee schedule negotiation in the near future. An attempt to directly research fees and the range of services of OECD countries is still needed in order to provide more established data.
Appendectomy ; Appointments and Schedules ; Cataract ; Cesarean Section ; Employment ; Fee Schedules ; Fees and Charges ; Fees, Medical ; Female ; Information Services ; Insurance, Health ; Korea ; National Health Programs ; Negotiating ; Pregnancy

CD44, an integral membrane glycoprotein expressed by many cell types, serves as the principal transmembrane hyaluronate receptor and may be a determinant of metastatic and invasive behavior in carcinomas. This study was performed to investigate the relationship between CD44 splicing variants v4/5 and v6 expression and histopathologic prognostic factors (depth of tumor invasion, histologic classification, vascular and lymphatic invasion, and lymph node metastasis) in 107 gastric adenocarcinomas. In 107 cases of gastric carcinoma, the immunohistochemical stainining for CD44 v4/5 and CD44 v6 gave the following results. CD44 v4/5 was expressed in 40.2% and CD44 v6 in 67.3% of gastric carcinomas. The expression of CD44 v4/5 was correlated with histologic classification by Lauren (p<0.05), lymphatic invasion (p<0.05), and lymph node metastasis (p<0.004). In contrast, expression of CD44 v6 had no impact on prognostic markers. This study suggests the role of CD44 v4/5 in invasion, metastasis, and its prognostic significance in gastric adenocarcinoma.
Adenocarcinoma* ; Classification ; Immunohistochemistry ; Lymph Nodes ; Membrane Glycoproteins ; Neoplasm Metastasis

PURPOSE: To evaluate morphologic characteristics of the microcalcifications on mammography that were confirmed pathologically. MATERIALS AND METHODS: Forty five cases of microcalcifications on mammography (fifteen cases of benign lesion, thirty cases of maiignancy) were retrospectively reviewed. RESULTS: The number of microcalcifications within 1 cm2 were more than 5 in 22 cases (73%) of 30 malignancy and less than 5 in 11 cases (73%) of 15 benignity. The heterogeneity of microcalcifications were seen in 26 cases of malignancy (87%) and the homogeneity of microcaicifications were 11 cases of benignity (73%). The morphologic characteristics of the microcalcifications were linear-V shape in 9 cases (30%), punctate shape in 8 cases (27%), fine stippled shape in 7 cases (23%), and round dot shape in 6 cases (20%) of malignancy and, round dot shape in 11 cases (73%), punctate shape in 2 cases (13%), and linear-V shape in 2 cases (13%) of benignity. CONCLUSION: Numerous irregular microcalcifications that are heterogenous in size and morphology were strong indicators of malignancy.
Mammography ; Population Characteristics ; Retrospective Studies

PURPOSE: To evaluate the clinical features of infectious keratitis in the western coastal area of Chungcheongnam-do, Korea. METHODS: We performed bacterial and fungal cultures in patients with findings of infectious keratitis. Any correlations between the culture results and the patients' place of residence, occupation, types of ocular trauma, contact lens wear, previous ocular disease, duration of treatment for complete recovery, time between the onset of symptom and beginning of treatment were evaluated. In addition, we assessed the antibiotic susceptibilities of the cultured organisms. RESULTS: We detected 34 (58.62%) among 58 cultures performed in 55 patients that were positive for organisms; 24 for Gram-positive bacteria, 17 for Gram-negative bacteria, 3 for fungi and 9 for polymicrobial infections. Coagulase-negative staphylococci (CNS) was the most frequent infection. The culture positivity rate was significantly higher (P=0.047) in patients with history of previous ocular disease but no correlations were detected with place of residence, type of ocular trauma or the timing of culture. The average treatment period was 33.95+/-30.59 days, which extended as the lesion size increased (P=0.003). CONCLUSIONS: Pseudomonas species are considered to be the most frequent cause of infectious keratitis in Korea. However, in our study, CNS were the most frequent culture-positive organisms and visual prognosis was poorer in the culture-positive group.
Coinfection ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Hypogonadism ; Keratitis ; Korea ; Mitochondrial Diseases ; Occupations ; Ophthalmoplegia ; Prognosis ; Pseudomonas

PURPOSE:Urine examination for microalbuminuria during the clinical silent years can help to identify those patients most likely to progress to overt nephropathy. The normalization of the AER(Albumin Excretion Rate) by alteration of glomerular hemodynamics may be the key to preventing or delaying overt nephropathy. The prognostic and therapeutic implications have led to attempts to identify patients with microalbuminuria as early as possible.Because diagnosis of microalbuminuria has required a 12 or 24 hour urine collection,there has been interested in developing tests that might serve as a first-stage screen for microalbuminuria. Most reports have dealt with the usefulness of either the albumin concentration or the albumin/creatinine ratio in a timed or randomly collected urine specimen. Exercise induced albumin excretion is increased compared to resting and could unmask latent glomerular damage. The purpose of this study is to evaluate diagostic significance of urinary albumin measurement after exercise in children with insulin dependent diabetes. METHODS:Fifty-seven patients with IDDM collected their overnight urine from 22:00 to 6:00 in following morning. Exercised method for urine examination was 100M running and collected 2 hour urine after exercise. The AER and Albumin/ creatinine ratio(ACR) were measured in the urine and compared with before and after exercise. RESULTS:Mean ages of diabetic children was 13.7 yrs old and duration of diabetes was 4.1+/-2.7yrs, HbA1c 8.6+/-1.9%,Systolic BP 107+/-10mmHg and Diastolic BP 67+/-8mmHg. The exercise induced AER was increased compared to before exercise(10.3+/-10.5 vs 18.1+/-16.0 mg/24hr). The exercise induced ACR also increased too(1.4+/-1.5 mg/g.Cr vs 4.1+/-3.6mg/g.Cr)(P<0.01). Two(3.5%) children with IDDM was positive for microalbuminuria in terms of AER before exercise and 8 children(14%) after exercise. No one positive for microalbuminuria in terms of Alb/cr before and after exercise. The charateristics of 8 children with microalbuminuria after exercise was no specific difference between positive and negative microalbuminuria. There was specific correlation between microalbuminuria and HbA1c(P<0.05) but sex, ages, duration of diabetes & blood pressure were not correlated with incidence of microalbuminuria. CONCLUSION: The mean timed urinary albumin excretion after exercise was significantly higher than before exercise. Measurement of timed urinary albumin excretion after exercise will be helpful for detecting microalbuminuria earlier.
Blood Pressure ; Child* ; Creatinine ; Diabetes Complications ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies ; Diagnosis ; Hemodynamics ; Humans ; Incidence ; Insulin ; Running

Adenovirus (AD) is classified into A, B, C, D, E and F subgenera on the basis of neutralization, hemagglutination and DNA homology tests. Six AD subgenera have 51 serotypes. We selected AD types 3, 7, and 11 since they are known to frequently cause respiratory disease, gastrointestinal disease and meningitis, which often require hospitalization of the patients. The purpose of this study was to detect and to evaluate the correlation of AD types 3, 7 and 11 and the diseases. The detection method, used for AD types 3, 7 and 11, was a multiplex polymerase chain reaction (PCR) with HEp-2 cell cultured with clinical samples. The result was as follows: AD 3 (22/62, 35.5%), AD 7 (27/62, 43.5%), and AD 11 (50/62, 80.6%) were detected by the multiplex PCR in 62 clinical samples. AD 3 detection rate in cerebrospinal fluid was relatively higher than in other specimens but its statistical significance was low (p=0.07). AD 11 was detected (50/62, 80.6%) with the highest frequency and appeared to significantly be associated with gastroenteritis, respiratory disease, and meningitis in hospitalized children, and arthritis in adult patients. AD 3, AD 7 and AD 11 types were detected singly in 21/62 (33.9%), doubly in 15/62 (24.2%), and triply in 16/62 (25.8%). The multiplex PCR method using Hep2 cell culture with clinical specimens could detect AD types 3, 7, and 11 in children with meningitis, respiratory infection, or gastroenteritis, and in adults with cancer and arthritis.
Adenoviridae* ; Adult ; Arthritis ; Cell Culture Techniques ; Cerebrospinal Fluid ; Child ; Child, Hospitalized ; DNA ; Gastroenteritis ; Gastrointestinal Diseases ; Hemagglutination ; Hospitalization ; Humans ; Meningitis ; Multiplex Polymerase Chain Reaction*

Viral meningitis and encephalitis are important and serious diseases in young children and adults. There are many causative viruses but it is known that a low percentage of adenovirus (ADV) and parvovirus (PA V) infected individuals develop meningitis or encephalitis. Few reports have been published about central nervous system complications that were rare but fatal. First we used enzyme immunoassay (EIA) with monoclonal antibody to detect ADV antigen (Ag) and PAV Ag in cerebrospinal fluids (CSF) from acute phase of hospitalized adult patients with viral meningitis or viral encephalitis. Second we detected ADV DNA and PAV DNA in the same CSF after cell culture by nested-polymerase chain reaction (PCR). Third we evaluated ADV and PAV dual infection in CSF by EIA and nested-PCR. ADV Ag in CSF by EIA positivity was 42.9% (12l28) and PAV Ag in CSF by EIA positivity was 21.4% (6/28). ADV DNA in CSF by nested-PCR positivity was 89.3% (25/28) and PAV DNA in CSF by nested-PCR positivity was 38.5% (10/26). ADV and PAV dual infection in CSF by 11CSted-PCR was 35.7% (10/28). Detection rate of ADV DNA and PAV DNA in CSF by nested-PCR with viral meningitis or encephalitis adult patients were higher than we expected. Positive detection of nested-PCR was higher than that of EIA with monoclonal antibody for detection of antigens ADV and PAV in CSF with viral meningitis or encephalitis adult patients. Both methods were analnized by the McNemar test.
Adenoviridae* ; Adult* ; Cell Culture Techniques ; Central Nervous System ; Cerebrospinal Fluid ; Child ; DNA ; Encephalitis ; Encephalitis, Viral ; Humans ; Immunoenzyme Techniques* ; Meningitis ; Meningitis, Viral* ; Parvovirus* ; Polymerase Chain Reaction*

BACKGROUND: The incidence of fungal urinary tract infections has increased in the immunocompromized patients. We analyzed urine culture results of St. Mary's Hospital during 28 month period between October 1993 and January 1996 to evaluate the frequency of yeast isolates and to survey the distribution of departments from where yeasts isolated. METHODS: We performed a retrospective analysis of urine culture results. Yeasts were identified by the examination of germ tube production in human serum at 37degrees C and API2OC (BioMerieux, France) yeast strip. RESULT: A total of 1,387 urine cultures were reviewed, of which 164 (11.8%) were isolated as fungi. Candida albicans occurred in 36.5% of the total yeast isolates, C. tropicalis in 35.3%, C. glabrata in 10.9% and Trichosporon beigelii in 0.6%. The incidence of urinary fungal infection increased in 1995 (13.0%) than 1994 (9.1%) (P=0.047). Fifty two percents (85/164) of urinary fungi were isolated from patients in Neurosurgery (NS), where isolation of C. tropicalis was significantly more increased than other departments. In four patients, candiduria progressed to candidemia, which were caused by C. albicans (three patients) and C. glabrata (1 patient). CONCLUSIONS: The isolation rate of yeast species was different in NS and non-NS department. The frequency of isolation of C. albicans increased in non-NS department than NS department, while the frequency of isolation of C. tropicalis increased in NS department than non-NS department. The most common organism was C. albicans and department was Neurosurgery.
Candida albicans ; Candidemia ; Fungemia ; Fungi ; Humans ; Incidence ; Neurosurgery ; Retrospective Studies* ; Trichosporon ; Urinary Tract Infections ; Yeasts