The empty sella syndrome is characterized by obesity, frequent pregnancy, headache and high blood pressure, but its exact cause remains unknown. Usually the incomplete diaphragmatic sella has been considered as the cause of the empty sella syndrome, but some authors recently have suggested that the antipituitary antibody way be related to development of pituitary atrophy and the pituitary empty sella syndrome, and thus it may be clinically useful as screening test for the empty sella syndrome. We experienced two empty sella syndromes associated Graves disease and applied the antipituitary antibody as the diagnostic tool of the empty sella syndrome. But none of this two patients had antipituitary antibody and we report these cases with reviews of literatures.
Atrophy ; Empty Sella Syndrome ; Graves Disease ; Headache ; Humans ; Hypertension ; Mass Screening ; Obesity ; Pregnancy

Management of unstable angina has evolved progressively. Although coronary angioplasty has recently shown to be relatively safe and effective treatment strategy for unstable angina, aute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty remains to be one of the most common serious complication of this procedure. Intracoronary urokinase has been used to treat flow-limiting intracoronary thrombus accumulation that complicated initial successful percutaneous transluminal coronary angioplasty(PTCA) in unstable angina patient, which made the patient stablilzed. Thus in patient with flow-limiting intracoronary thrombus accumulation complicating PTCA, intracoronary urokinase proved to be highly effective in restoring vessel patency and preventing acute myocardial infarction. We report a case of successful revascularization with intracoronary infusion of urokinase in patient with intracoronary thrombus accumulation that complicated PTCA.
Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Humans ; Myocardial Infarction ; Thrombosis ; Urokinase-Type Plasminogen Activator

The advances in electronic medical records (EMRs) and bioinformatics (BI) represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO) aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population.
Biology ; Computational Biology ; Confidentiality ; Delivery of Health Care ; Electronic Health Records ; Genome ; Human Genome Project ; Humans ; Informatics ; Medical Informatics* ; Pathology, Molecular ; Privacy

PURPOSE: To evaluate the influence of gestational age(GA) and disease on thyroid hormone concentration in preterm neonates(preterm), we measured thyroxine (T4) and thyroid stimulating hormone(TSH) concentrations and analyzed the relation to GA and diseases. Additionally, we calculated the reference ranges of T4 in preterm for future investigation. METHODS: Serum T4 and TSH were measured by radioimmunoassay for 107 preterm who admitted neonatal intensive care unit during 1994. We sampled from preterm on 5th day of life. We analysed the relationship of GA and birth weight with the levels of T4 and TSH, and prospectively compared them with each neonatal disease. RESULTS: Serum T4 concentration correlated positively with GA(r=0.62, P<0.001) and birth weight(r=0.29, P<0.01). After controlling GA, birth weight did not correlate to the levels of T4. But after controlling birth weight, GA had correlation with T4(r=0.58, P<0.001). In preterm less than 32 weeks of GA, there was no difference of T4 level between healthy and the diseased(respiratory distress syndrome, patent ductus arteriosus, sepsis, intraventricular hemorrhage, and cerebral palsy). Group of bronchopulmonary dysplasia had significant lower level of T4 compared control group(P<0.01). The reference range of T4 in GA 32-36 weeks is 5.56-15.58 microgdL (9.82+/-.40 microgdL). CONCLUSION: GA positively correlated with serum T4 in preterm, but not to TSH. The measurement of TSH level, using in most of the neonatal care unit as neonatal thyroid screening test, in Korea, is not an adequate test to diagnosis hypothyroidism early in preterm. We recommend serial follow up of TSH and T4 in preterm.
Birth Weight* ; Bronchopulmonary Dysplasia ; Diagnosis ; Ductus Arteriosus, Patent ; Gestational Age* ; Hemorrhage ; Humans ; Hypothyroidism ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Korea ; Mass Screening ; Parturition* ; Prospective Studies ; Radioimmunoassay ; Reference Values ; Sepsis ; Thyroid Gland* ; Thyroxine

No abstract available.
Anesthesia* ; Intubation, Intratracheal* ; Vocal Cord Paralysis*

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.
Biopsy ; Cholangitis, Sclerosing ; Eating ; Fibrosis* ; Hemorrhage ; Humans ; Inflammation ; Lung ; Mediastinitis ; Orbit ; Retroperitoneal Fibrosis ; Steroids ; Thyroid Gland

The gene for tyrosinase has been mapped to the long arm of chromosome 11 at 11q14-21. The gene is at least 50Kb in length and its coding region is divided into five exons. Until now several mutations of the tyrosinase gene have been identifed in patient with typical oculocutaneous albinism (OCA) who are responsible for tyrosinase negative OCA. It may be possible to determine the types of OCA by measuring the hairbulb tyrosinase activity. Hairbulb tyrosinase activity was examined in a Korean albino to determine the type of OCA. And also tyrosinase assay was carried out in normally pigmented individuals and all members of a Korean albino's family to examine the tyrosinase activities. Five exons of tyrosinase gene from a Korean albino were amplified by polymerase chain reaction. Each amplified exon segments were independently subcloned and DNA sequences of clones were determined. The results obtained were as follows : 1. A Korean albino had no measurable hairbulb tyrosinase activity and was identified as type IA (tyrosinase negative) oculocutaneous albinism. 2. Normally pigmented individuals had different ranges of hairbulb tyrosinase activity. 3. A Korean albino had two single base insertions within exon V (between 337bp and 338bp, 353bp and 354bp) of tyrosinase gene. These insertional mutations might disrupt tyrosinase function and were associated with a total lack of melanin biosynthesis.
Albinism* ; Albinism, Oculocutaneous ; Arm ; Base Sequence ; Chromosomes, Human, Pair 11 ; Clinical Coding ; Clone Cells ; Exons ; Humans ; Melanins ; Monophenol Monooxygenase* ; Polymerase Chain Reaction

Background: Topical steroids are the most commonly prescribed anti-inflammatory agents in dermatology, and patients often experience various adverse events of topical steroid application. Patients’ awareness of adverse effects and understanding of coping strategies for these unwanted events are pivotal elements for the safe use of topical steroids. Objective: This study aimed to assess the prescribing pattern of topical steroids and patient education for safe use by dermatologists and non-dermatology specialists in Korea. Methods: A questionnaire was sent to dermatologists, pediatricians, and other specialists through an online survey.A total of 444 answers were analyzed; then, the numbers were adjusted according to the nationwide proportion of specialists prescribing topical steroids. The total number of respondents was set to 720 after the adjustment. Results: Dermatologists prescribed topical steroids to 49% of their patients, while other specialist doctors prescribed to 6.4% of the patients. Mid-potency steroids were most commonly prescribed (52.9%), followed by low/weak potency (37.6%), in adjusted analysis. Overall, 12.5% of all respondents and 14.5% of dermatologists reported adverse events due to topical steroids within the last month. The physicians spent 2.1 minutes on average (2.0 minutes for dermatologists) for patient education on proper use of topical steroids. The majority (79.1%) of physicians informed patients of the fact that the prescription contained steroids, while some were reluctant to disclose this information because of the negative perception about steroids in the general population. Conclusion This survey provides thorough information on the current status of prescription, counseling condition, doctors’ perception of patients’ knowledge of adverse events, and proper use of topical steroids.

Background: Topical corticosteroids (TCs) are available both as over-the-counter drugs and prescription medicines at pharmacies.Although they are generally safe drugs, inappropriate and excessive use could result in potential side effects. Thus, it is important to have appropriate knowledge regarding the use of TCs. We performed a cross-sectional survey to assess public knowledge and the potential misuse or overuse of TCs. Methods: A cross-sectional and nationwide online survey was conducted among participants who were aware of TCs. The survey items included sources of information, indications, potential side effects, and methods of application of TCs. A comparative analysis was conducted between those with (TC users) and without (TC non-users) an experience of using TCs. Results: Among 3,000 participants, 74.4% were TC users. The mass media was the most common information source of TCs, and only one-third of the surveyed people relied on pharmacists or doctors for information. Regarding indications and application methods, incorrect answer rate was high in some items, but respondents showed adequate knowledge. However, awareness of the safety of TCs was low. Overall, the TC users showed a higher knowledge of TCs than TC non-users. Conclusions Public knowledge of the use of TCs appears to be appropriate. However, we found potential misuse or overuse of some items and a lack of awareness of the side effects concerning TCs. Thus, healthcare professionals’ significant role is required.

We aimed to assess one-year persistence with antihypertensive therapy (AHT) among newly treated uncomplicated hypertensive patients in Korea and to evaluate the effect of initial therapeutic classes on persistence. We retrospectively analyzed a random sample of 20% of newly treated uncomplicated hypertensive patients (n = 45,787) in 2012 from the National Health Insurance claims database. This group was classified into six cohorts based on initial AHT class. We then measured treatment persistence, allowing a prescription gap of 60 days. Adherence to AHT was assessed with the medication possession ratio. Calcium channel blockers (CCB, 43.7%) and angiotensin receptor blockers (ARB, 40.3%) were most commonly prescribed as initial monotherapy. Overall, 62.1% and 42.0% were persistent with any AHT and initial class at one year, respectively, and 64.2% were adherent to antihypertensive treatment. Compared with ARBs, the risk of AHT discontinuation was significantly increased with initial use of thiazide diuretics (hazard ratio [HR], 3.16; 95% confidence interval [CI] 2.96-3.74) and beta blockers (HR, 1.86; CI, 1.77-1.95) and was minimally increased with CCBs (HR, 1.12; CI, 1.08-1.15). In conclusion, persistence and adherence to AHT are suboptimal, but the differences are meaningful in persistence and adherence between initial AHT classes.
Adolescent ; Adrenergic beta-Antagonists/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Antihypertensive Agents/classification/*therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cohort Studies ; Female ; Humans ; Hypertension/*drug therapy ; Male ; Medication Adherence ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Sodium Chloride Symporter Inhibitors/therapeutic use ; Young Adult