The objectives of this study are two-fold : to identify geographic variations in the rate of tonsillectomy and adenoidectomy(T and A) and appendectomy and analyze the socioeconomic variables and health resources which affect geographic variation in the rate. The nationwide three month's cases of the two surgical procedures in 1991 are obtained from the record of the National Federation of Medical Insurance. The analysis shows two to ten-fold variations in the regional rates for the performance of two common procedures such as T and A and appendectomy. T and A shows a bigger regional variations than appendectomy. As a result of multiple regression, the factor of bed supply has been found significant for the dependent variable of the rate of T and A. The findings of large variations in the rate of surgical procedures throughout the country would have important implications for allocating scarce resources and managing quality of care. Further analysis is needed for the elaboration of the above implications.
Appendectomy* ; Health Resources ; Insurance ; Korea* ; Tonsillectomy*

No abstract available.
Humans ; Lymph Nodes* ; Lymphoscintigraphy* ; Uterine Cervical Neoplasms*

One of the moot important goals of modem gynexologic oncology is the adequate management of ocarian cancer. This includes early detection and differenciation of recurrence or residurd turnur. A promising method is availaible today with the use of mctabolic suubstrates used by tumor cells that are labeled with positron emittillg isotopes and a special instrument capable of detecting the radiations in vivo. Measuring tumor metabolic characteristics appear also to diffnencinte tumor recurrence or reeidual tumor from surgical or irradiation changes which is important since this wil1 not be defferentiaited by other modalities such ac CT or MRI. The goal of this study was to rletennine the potential utility uf whole-body PET using the giucose malogue 2-(18F)-fluoro-2-deoxy-D-glucoae(F-18-FDO for the detection of primey, metastatic, and recurrent ovarian cancer. Six patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET(Positron Emission Tomogrnphy) scans were done with an ECAT 921(Emission Computed Axial Tomograpy 921, Sieinens/CTI. The result of this study show good correla- tion between PET nnd pathological findirs. The tumor detection rate of CT, MRI, CA-125, PET for ocarian cancer was 50%, 75%, 25%, 100% respectively. In summary, this work indicates that PET may be useful in the rnanagement of patients with ovwrian cancers by idengying occult foci of rnetabolically active tumor that do not appear on morphological studies.
Electrons* ; Humans ; Isotopes ; Laparotomy ; Magnetic Resonance Imaging ; Modems ; Ovarian Neoplasms ; Recurrence

One of the moot important goals of modem gynexologic oncology is the adequate management of ocarian cancer. This includes early detection and differenciation of recurrence or residurd turnur. A promising method is availaible today with the use of mctabolic suubstrates used by tumor cells that are labeled with positron emittillg isotopes and a special instrument capable of detecting the radiations in vivo. Measuring tumor metabolic characteristics appear also to diffnencinte tumor recurrence or reeidual tumor from surgical or irradiation changes which is important since this wil1 not be defferentiaited by other modalities such ac CT or MRI. The goal of this study was to rletennine the potential utility uf whole-body PET using the giucose malogue 2-(18F)-fluoro-2-deoxy-D-glucoae(F-18-FDO for the detection of primey, metastatic, and recurrent ovarian cancer. Six patients had imaging studies prior to laparotomy for suspected ovarian cancer. PET(Positron Emission Tomogrnphy) scans were done with an ECAT 921(Emission Computed Axial Tomograpy 921, Sieinens/CTI. The result of this study show good correla- tion between PET nnd pathological findirs. The tumor detection rate of CT, MRI, CA-125, PET for ocarian cancer was 50%, 75%, 25%, 100% respectively. In summary, this work indicates that PET may be useful in the rnanagement of patients with ovwrian cancers by idengying occult foci of rnetabolically active tumor that do not appear on morphological studies.
Electrons* ; Humans ; Isotopes ; Laparotomy ; Magnetic Resonance Imaging ; Modems ; Ovarian Neoplasms ; Recurrence

By using antegrade pyelography which was modified from Casey and Goodwin technique, we examined nine patients in whom accurate roentgenographic diagnosis could not be made by excretory or retrograde pyelography. Diagnosis established were three cases of hydronephrosis due to ureteral calculi, three of pyonephrosis due to renal tuberculosis, one of pyonephrosis due to carcinoma of the ureter, one case of pyonephrosis due to carcinoma of the uretero-pelvic junction and one of pyonephrosis due to ureteral obstruction This is the first report of antegrade pyelography in cases of pyonephrotic renal tuberculosis. No complications occurred during or after examinations. In selected cases of hydronephrosis and pyonephrosis, antegrade pyelography is a safe and new diagnostic procedure to other accepted methods of urography.
Diagnosis ; Humans ; Hydronephrosis ; Pyonephrosis ; Tuberculosis, Renal ; Ureter ; Ureteral Calculi ; Ureteral Obstruction ; Urography*

BACKGROUND: The purpose of this study is to empirically find out the affecting factors on the willingness to platelet apheresis. METHODS: Data were collected from 505 platelet apheresis donors and college students of major cities in Korea using the self-administered questionnaire. RESULTS: First, the level of positive cognition and affectivity to platelet apheresis donation and satisfaction for service during donation process among platelet apheresis donors were significantly higher than that among students only experiencing whole blood donation and students never experiencing blood donation. Second, valence for external and internal reward and knowledge of platelet apheresis among platelet apheresis donors were significantly higher than that among students only experiencing whole blood donation and students never experiencing blood donation. Third, platelet apheresis donors and students experiencing whole blood donation were more sound in character and more active in volunteer works, and had healthier behavior than students never experiencing blood donation. Fourth, the results of multiple regression analysis showed a statistically significant positive relationship between the willingness to platelet apheresis and valence for internal and external reward, satisfaction for service during donation process, and health behavior. CONCLUSIONS: These findings suggest that strategy for effective public relation and improvement of blood donor satisfaction should be developed in order to enhance willingness to platelet apheresis.
Blood Component Removal* ; Blood Donors ; Blood Platelets* ; Cognition ; Health Behavior ; Humans ; Korea ; Reward ; Tissue Donors ; Volunteers ; Surveys and Questionnaires

PURPOSE: There are differences between Standard Uptake Value (SUV) of CT attenuation corrected PET and that of 137Cs. Since various causes lead to difference of SUV, it is important to know what is the cause of these difference. Since only the X-ray CT and 137Cs transmission data are used for the attenuation correction, in Philips GEMINI PET/CT scanner, proper transformation of these data into usable attenuation coefficients for 511 keV photon has to be ascertained. The aim of this study was to evaluate the accuracy in the CT measurement and compare the CT and 137Cs-based attenuation correction in this scanner. METHODS: For all the experiments, CT was set to 40 keV (120 kVp) and 50 mAs. To evaluate the accuracy of the CT measurement, CT performance phantom was scanned and Hounsfield units (HU) for those regions were compared to the true values. For the comparison of CT and 137Cs-based attenuation corrections, transmission scans of the elliptical lung-spine-body phantom and electron density CT phantom composed of various components, such as water, bone, brain and adipose, were performed using CT and 137Cs. Transformed attenuation coefficients from these data were compared to each other and true 511 keV attenuation coefficient acquired using 68Ge and ECAT EXACT 47 scanner. In addition, CT and 137Cs-derived attenuation coefficients and SUV values for 18F-FDG measured from the regions with normal and pathological uptake in patients' data were also compared. RESULTS: HU of all the regions in CT performance phantom measured using GEMINI PET/CT were equivalent to the known true values. CT based attenuation coefficients were lower than those of 68Ge about 10% in bony region of NEMA ECT phantom. Attenuation coefficients derived from 137Cs data was slightly higher than those from CT data also in the images of electron density CT phantom and patients' body with electron density. However, the SUV values in attenuation corrected images using 137Cs were lower than images corrected using CT. Percent difference between SUV values was about 15%. CONCLUSION: Although the HU measured using this scanner was accurate, accuracy in the conversion from CT data into the 511 keV attenuation coefficients was limited in the bony region. Discrepancy in the transformed attenuation coefficients and SUV values between CT and 137Cs-based data shown in this study suggests that further optimization of various parameters in data acquisition and processing would be necessary for this scanner.
Brain ; Fluorodeoxyglucose F18 ; Positron-Emission Tomography and Computed Tomography* ; Water

BACKGROUND: Recurrence of ovarian carcinoma is difficult to diagnose by current diagnostic modalities. Positron emission tomography(PET) might be useful for detecting recurrence of ovarian carcinoma by producing images which reflect biochemical change of tissues rather than their physical characteristics using a positron emitting glucose analog, 2-[18F]-fluoro-2-deoxy-D-glucose(FDG), because glycolysis is increased in malignant tissue. OBJECTIVE: To determine if PET is sensitive for the detection and demonstration of recurrence of ovarian carcinoma and to compare detectability of PET to that of serum CA-125 and CT/MRI. MATERIALS & METHODS: Whole body PET scan was performed in thirty patients with epithelial ovarian carcinoma from March, 1996 to March, 1998 in Seoul National University Hospital. All patients received cytoreductive surgery and combination chemotherapy. The recurrence of ovarian carcinoma was declared by surgico-pathologic evidence or abnormal elevation of serum CA-125 level. CTI/Siemens scanner was used for PET. Ten mCi(370 MBq) of FDG was injected intravenously before whole body scan was obtained from the head to the lower leg. Regional transmission and emission scan was also obtained for areas of tumor. Serum CA-125 levels and CT/MRI findings by the time of PET were matched with PET results. Correlation analysis was performed between each diagnostic modalities and the recurrence of ovarian carcinoma. RESULTS: Ovarian carcinomas were recurred in twelve out of thirty patients. FDG PET detected the recurrence of ovarian carcinoma in ten patients(sensitivity = 66.7%; specificity = 86.7%; contingency coefficient, CC = 0.48; p = 0.003), and better than CA-125(sensitivity = 75.0%; specificity = 75.0%; CC = 0.28; p > 0.05) and CT/MRI(sensitivity = 38.5%; specificity = 57.1%; CC = 0.01; p > 0.05). CONCLUSION: FDG PET accurately predicted the recurrence of ovarian carcinoma and is a useful adjunctive diagnostic method. A prospective case-control study with more patients might be needed in the future.
Case-Control Studies ; Drug Therapy, Combination ; Electrons* ; Glucose ; Glycolysis ; Head ; Humans ; Leg ; Positron-Emission Tomography* ; Recurrence ; Sensitivity and Specificity ; Seoul ; Whole Body Imaging

PURPOSE: We evaluated hemodynamic significance of stenosis on magnetic resonance angiography (MRA) using acetazolamide perfusion single photon emission computed tomography (SPECT). MATERIALS AND METHODS: Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated. RESULTS: Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56+/-7.91 in grade 0, -1.81+/-6.66 in grade 1 and -1.18+/-5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (kappa=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively). CONCLUSION: A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients.
*Acetazolamide ; Adult ; Aged ; Aged, 80 and over ; Brain/blood supply/radionuclide imaging ; Carotid Artery, Internal/physiopathology/radionuclide imaging ; Carotid Stenosis/physiopathology/*radionuclide imaging ; *Cerebrovascular Circulation ; Constriction, Pathologic ; Diuretics ; Female ; *Hemodynamics ; Humans ; Hypertension/physiopathology ; Iodine Radioisotopes ; *Magnetic Resonance Angiography ; Male ; Middle Aged ; *Radiopharmaceuticals ; Tomography, Emission-Computed, Single-Photon/*methods

BACKGROUND AND OBJECTIVES: The extent of weight gain and its association with clinical factors in patients undergoing radioiodine therapy for differentiated thyroid cancer remain unclear. We analyzed clinical factors related to sustained weight gain after serum thyroid-stimulating hormone (TSH) stimulation for radioiodine (I-131) therapy. MATERIALS AND METHODS: The study population included 301 adult patients who underwent total thyroidectomy followed by radioiodine therapy and visited the thyroid clinic regularly. Group 1 received a single radioiodine therapy treatment, while group 2 received multiple radioiodine treatment. Data on transient weight gain, defined as weight gain that resolved (±5%) within 1 year after radioiodine therapy, were collected from medical records. Sustained weight gain was defined as body mass index after treatment (BMI(post)) - BMI before treatment (BMI(pre)) ≥2 kg/m2 more than 1 year following radioiodine therapy. Subjective symptoms were scored by questionnaire. Logistic regression analysis was performed using various clinical and laboratory factors to identify risk factors associated with sustained weight gain. RESULTS: Two hundred and fifty-nine (86%) patients showed transient weight gain and 23 (8%) patients showed sustained weight gain. TSH at therapy and T4-on TSH differed significantly in all patients and in the patients in group 1 with sustained weight gain. The proportion of patients with basal BMI≥25 kg/m2 in group 1 with sustained weight gain also differed significantly. Univariate analysis revealed that high serum levels of TSH at therapy (≥100 µIU/mL) and hypercholesterolemia were associated with sustained weight gain in group 1. Multivariate analysis showed that TSH at therapy levels ≥100 µIU/mL was associated with sustained weight gain in group 1. Of 283 patients remaining after excluding those with insufficient TSH suppression during follow-up, T4-on TSH levels were lower in the sustained weight gain group compared to those without sustained weight gain. TSH at therapy levels ≥100 µIU/mL were significantly associated with sustained weight gain in multivariate analysis. CONCLUSION: Most patients (86%) had transient weight gain after TSH at therapy, while 8% of patients showed sustained weight gain. Univariate and multivariate analysis revealed relatively high TSH levels (≥100 µIU/mL) to be a risk factor for patients that received a single dose of radioiodine therapy. Insufficient T4 dose was not associated with sustained weight gain.
Adult ; Body Mass Index ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Logistic Models ; Medical Records ; Multivariate Analysis ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin* ; Weight Gain*