BACKGROUND: To predict the therapeutic efficacy of osteoporosis, one or two years is needed to evaluate the therapeutic effect by the measurement of bone mineral density(BMD), whereas three to six months is sufficient with bone markers. Using this information, we can change therapeutic plan or modulate drug dosage if necessary. This approach would provide appropriate therapy for osteoporosis. The purpose of this study is to evaluate the association between the percentage change of BMD which was measured by peripheral quantitative computed tomography(pQCT), and bone markers after 1 year of hormone replacement therapy(HRT) in healthy postmenopausal women. METHODS: Bone mineral density of nondominant distal forearm in 89 postmenopausal women was measured by pQCT. We measured serum alkaline phosphatase(ALP) and intact osteocalcin(iOC, Novocalcin) as bone formation markers, urinary deoxypyridinoline(dPyr, PyriLinks-D(TM)) as bone resorption marker by using enzyme immunoassay. After 1 year of HRT, 54 subjects dropped out and 33 subjects were reevaluated. RESULTS: After 1 year of HRT, the drop-out rate was 61%. There was no significant difference in age, age of menopause, years since menopause, initial BMD, initial bone markers between remained and drop out groups. But osteocalcin level was significantly high in remained group(p=0.02). ALP(-27.6 %), iOC(-29.9%), dPyr(-25.2%) were significantly decreased after 1 year of HRT(p<0.001). Trabecular BMD was increased by 2.4%(p=0.003), but the percentage change of total and cortical BMD was not significant(p>0.05). The levels of BMD and bone markers between before and after was significantly correlated, demonstrating the homogeneity of response to HRT. The percentage change of trabecular BMD was negatively correhted with the percentage change of dPyr after HRT(r=-0.45, p=0.01). The variance of the percentage change of dPyr contributed to the percentage change of trabecular BMD by 20%. There was no correlation between the percentage change of total BMD or cortical BMD and the change of ALP, iOC, or dPyr after HRT. CONCLUSIONS: After 1 year of HRT in postmenopausal women, all biochemical bone markers were decreased significantly, whereas only trabecular BMD measured by pQCT was increased significantly. This result suggests that bone markers was more sensitive than BMD to monitor the therapeutic efficacy of HRT. The percentage change of trabecular BMD was correlated with the change of dPyr after HRT only. dPyr might be the most sensitive marker among bone markers tested. Therefore, we can predict the change of BMD after HRT through monitoring the levels of dPyr.
Bone Density* ; Bone Resorption ; Female ; Forearm ; Hormone Replacement Therapy* ; Humans ; Immunoenzyme Techniques ; Menopause ; Osteocalcin ; Osteogenesis ; Osteoporosis

Polycystic ovary syndrome is characterized by symptoms of oligomenorrhea, amenorrhea, infertility, hirsutism and obesity. It is known that the women with such diseases would have higher risks to coronary heart diseases, hypertension, DM and endometrial cancer later on, Known risk factors of endometrial cancer are nullipara, late menopause, obesity, DM, unopposed estrogen, tamoxifen treatment, and atypical endometrial hyperplasia ect. 75% of endometrial cancer occurs in age over 50 and 4% of endometrial cancer occurs in age under 40. Particulary endometrial cancer concurrent polycystic ovary syndrome occurs usually in people under age 40 and is commonly well differentiated cell type and is related to good prognosis. We experienced a case of endometrial cancer with polycystic ovary syndrome, who was early dignosed, presented with infertility and got an operation in our hospital, and report this case with a brief review of literature.
Amenorrhea ; Coronary Disease ; Endometrial Hyperplasia ; Endometrial Neoplasms* ; Estrogens ; Female ; Hirsutism ; Humans ; Hypertension ; Infertility ; Menopause ; Obesity ; Oligomenorrhea ; Polycystic Ovary Syndrome* ; Prognosis ; Risk Factors ; Tamoxifen

Patients treated by extracorporeal shock wave lithotripsy are usually evaluated by excretory urography within 1 month after treatment to determine the clearance of stone debris and rule out asymptomatic obstruction. In an attempt to obtain more precise functional information, we used 99m-Tc-DTPA renal scan as the initial follow-up study after ESWL in 10 patients. GFR checked by renal scan shows no difference in pre and post ESWL. Our experience suggests that follow up after ESWL by radionuclide renal imaging studies provides specific functional information and also particular value in the management of patients with obstructing stone debris and diminished renal function. Radionuclide renal imaging studies may also reveal unexpected obstruction and functional impairment after ESWL of stones, and is recommended as routine follow-up study after ESWL.
Follow-Up Studies* ; Humans ; Lithotripsy* ; Shock* ; Urography

BACKGROUND: Continuity is very important in primary care, and in most studies continuous care has been reported to have a good effect on the result of care. So we studied the factors influencing the continuity of patient care by physician in charge, especially in case of out-patient department in a university hospital. METHODS: We posed questionnaires to 55 persons who had visited continually to Paik Hospital in Pusan for at least 6 months. We classified them into three groups according to the degree of continuity using 'Modified Continuity Index', and compared the lower group (18 patients) with the higher group(18 patients). RESULTS: The incame of the higher continuity group was significantly less than that of the lower continuity group(P=0.042). But there were no significant differences between the two groups according to sex, age, the type of family, marital status, job and the level of education. The higher continuity group agreed more significantly than the lower continuity group with the question whether it is important to be treated continually from physician in charge(P=0.005). About the reasons for visiting to other doctors instead of the physician in charge, most of them in both group replied that they could not keep appointment. And there were no significant differences in the care pattern of disease between the groups. CONCLUSIONS: To improve the continuity of patient care by physician in charge, it is necessary to instruct the importance of continuous care to the patients and to motivate them through various methods.
Busan ; Continuity of Patient Care* ; Education ; Family Practice* ; Humans ; Marital Status ; Outpatients ; Primary Health Care ; Surveys and Questionnaires

Transitional cell carcinoma of the bladder in children is rare, low grade, noninvasive and rarely recurrent. A l2-year old boy with painless gross hematuria showed a 1.5cm sized papillary mass on cystoscopy. Histologic examination showed grade I transitional cell carcinoma without muscle invasion. Three months postoperative cystoscopy and urine cytology were negative but adjacent vesical biopsy revealed carcinoma in situ. We report a case of transitional cell carcinoma of the bladder in a child and treated with transurethral resection and intravesical BCG therapy.
Biopsy ; Carcinoma in Situ ; Carcinoma, Transitional Cell* ; Child ; Cystoscopy ; Hematuria ; Humans ; Male* ; Mycobacterium bovis ; Urinary Bladder*

BACKGROUND: Although maximal exercise stress tests are widely used in the athletic and medical fields, studies on professional soccer players are few. The purpose of our study is to observe the cardiopulmonary response to maximal exercise loading and the AT in professional soccer players. METHODS: Maximal exercise stress tests were carried out by a ramp protocol using a treadmill on 20 professional soccer players with a mean age of 25.2 years and with over 10 career years. The tests were also done on 21 college students majoring in physical education with a mean age of 19.4 years, which served as the control group. The AT was determined by the V-slope method. RESULTS: In the players, the VO2 max, VCO2 max and O2 pulse max were significantly larger than those in the control group, and the HR max was smaller for their ages. The VE max, VT max and RP max showed not much difference between the 2 groups but the VE max/VO2 max and VE max/VCO2 max were significantly lower in the players. The AT was larger in the players but the AT/VO2 max was essentially similar to that of the control group. CONCLUSION: Our study reveals that the professonal soccer players, despite their mean ages were approximately 6 years older than the subjects in the control group, had larger VO2 max and VCO2 max, and smaller HR max for their ages. The VE max was similar in both groups. This suggests that the players have higher aerobic capacity than the control group and exchange respiratiory gases more efficiently.
Architectural Accessibility ; Child ; Exercise Test ; Gases ; Humans ; Physical Education and Training ; Soccer* ; Sports

The hemangiopericytoma originated from the greater omentum is a very rare vascular tumor and grows to a large mass without symptoms for a long period. The diagnosis can be made on ultrasonogram, CT or MRI and angiogram with the findings of well circumscribed, solitary mass with hypervascularity in the abdominal cavity especially retroperitoneal cavity. The surgical treatment is recommended due to its possibility of malignant potential and metastasis on diagnosis. The evaluation of differential diagnosis to rule out this tumor is obligatory if a large solitary movable mass being palpated in abdomen. We experienced a case of hemangiopericytoma of greater omentum which was diagnosed as a left ovarian tumor preparatively, and we report the case with brief review of the literatures.
Abdomen ; Abdominal Cavity ; Diagnosis ; Diagnosis, Differential ; Hemangiopericytoma* ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Omentum* ; Ultrasonography

The hemangiopericytoma originated from the greater omentum is a very rare vascular tumor and grows to a large mass without symptoms for a long period. The diagnosis can be made on ultrasonogram, CT or MRI and angiogram with the findings of well circumscribed, solitary mass with hypervascularity in the abdominal cavity especially retroperitoneal cavity. The surgical treatment is recommended due to its possibility of malignant potential and metastasis on diagnosis. The evaluation of differential diagnosis to rule out this tumor is obligatory if a large solitary movable mass being palpated in abdomen. We experienced a case of hemangiopericytoma of greater omentum which was diagnosed as a left ovarian tumor preparatively, and we report the case with brief review of the literatures.
Abdomen ; Abdominal Cavity ; Diagnosis ; Diagnosis, Differential ; Hemangiopericytoma* ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Omentum* ; Ultrasonography

BACKGROUND: The patency of arteriovenous access is important for stable and effective hemodialysis, and long-term technical survival is best achieved with a native arteriovenous fistula (AVF). However, maintaining AVF patency remains a challenge. This study was designed to determine the independent prognostic factors for AVF patency according to hemodialysis duration. METHODS: The primary study end point was unassisted patency of the AVF, which was defined as the time from the first fistula surgery to the first AVF failure. AVF failure was defined as an event that required percutaneous intervention or surgery to revise or replace the fistula, which occurred at least 2 months after fistula formation. RESULTS: We enrolled 478 patients with a mean age of 55.5+/-14.0 years, and mean duration of dialysis was 2.5+/-2.1 years. There were 109 cases (22.8%) of AVF failure. The factors related to AVF patency differed according to hemodialysis duration. Using a Cox-adjusted model, we observed a significant correlation between the incidence of AVF failure and diabetes within the initial 12 months of hemodialysis. Uncontrolled hyperphosphatemia (mean serum phosphorus>5.5 mg/dL during hemodialysis) was associated with patency loss of AVF after 1 year of hemodialysis. CONCLUSION: Various factors were associated with the development of patency loss of AVF as hemodialysis duration differed, and a preventive role of hyperphosphatemia control in AVF survival needs further clinical study.
Arteriovenous Fistula* ; Dialysis ; Fistula ; Humans ; Hyperphosphatemia* ; Incidence ; Renal Dialysis*

Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)X100/initial PTH(%),deltaPTH during oral calcitriol therapy for 3 and 6 months(group I ; delta PTH >30%, group II ; delta PTH <30%). RESULT: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22Mg and during 6month 0.43 0.24Mg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7+/-196.5 vs. 871.0+/-478Apglml, 6.2+/-2.6 vs. 13.1+/-5.2mm, 5.0+/-1.3 vs. 5.7+/-1.3mg/dl, 93.7+/-4L1 vs. 171.9+/-137.6IU/L, 40.1+/-34.9 vs. 73.5+/-37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1+/-266.6 vs. 889.7+/-485.4pg/ml, 6.4+/-2.7 vs. 14.5+/-5.1mm, 107.9+/-80.1 vs. 180.7+/-121.5IU/L, 40.5+/- 32.9 vs. 81.8+/-35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between deltaPTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.
Absorption ; Alkaline Phosphatase ; Calcitriol* ; Calcium ; Creatinine ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary* ; Hyperphosphatemia ; Hypertrophy ; Parathyroid Glands ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Phosphorus ; Retrospective Studies ; Risk Factors ; Ultrasonography