Here we report the case of a 20-year-old female patient previously diagnosed with Hashimoto's thyroiditis and overt hypothyroidism, and who had been taking synthetic thyroxine (100micro/day) for eight months. She experienced intermittent dizziness and generalized weakness, and was diagnosed as having severe autoimmune hemolytic anemia (AIHA). We prescribed prednisolone treatment and continued synthetic thyroxine administration. Two years and five months later, she developed idiopathic thrombocytopenic purpura (ITP) and was diagnosed with Evans' syndrome. Thereafter, laparoscopic splenectomy was performed because her autoimmune hemolytic anemia was refractory and dependent on steroid therapy. The HLA genotypes of the patient were HLA-A*020101/A*2602, HLA-B*270502/B*5401, HLA-Cw*0102/Cw*020202, HLA-DRB1*0404/DRB1*0405, and HLA-DQB1*0302/DQ B1*0401. Hashimoto's thyroiditis is often associated with other nonendocrine autoimmune diseases, and antithyroid antibodies are frequently observed in Evans' syndrome (coexistence of AIHA and ITP). However, there is no report of Evans' syndrome developing in patients with overt hypothyroidism and Hashimoto's thyroiditis. This case suggests that three autoimmune diseases (AIHA, ITP, and Hashimoto's thyroiditis) might share a common immunogenetic pathway in pathogenesis.
Purpura, Thrombocytopenic/blood/*complications ; Humans ; Hashimoto Disease/*complications/radionuclide imaging ; Female ; Anemia, Hemolytic, Autoimmune/blood/*complications ; Adult

OBJECTIVES: The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpatients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. METHODS: The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). RESULTS: Overall, patients showed improvement over the treatment period on psychopathology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9+/-4.0 before training to 12.9+/-4.2 after training(p<0.01) and scores of CGI were improved from 3.7+/-0.9 to 2.8+/-0.8 (p<0.01). However age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with un-awareness of psychosis. CONCLUSION: These results suggest that SMM-B could be a reliable method to improve self-awareness of psychosis in patients with chronic schizophrenia and one of important elements in rehabilitation.
Age of Onset ; Education ; Humans ; Inpatients* ; Psychopathology ; Psychotic Disorders ; Rehabilitation ; Schizophrenia*

No abstract available.
DNA* ; Immunophenotyping*

OBJECTIVES: The purpose of this study was to compare the differences in bone mineral density (BMD), T-scores, and the prevalence of osteopenia and osteoporosis between mountain villagers and seaside villagers. MATERIALS & METHODS: Four hundred fifty-one postmenopausal women (138 women in mountain villagers and 313 women in seaside villagers) were examined, including women > 50 years of age. The study subjects were recruited from the women who had received care at the health examination center of our hospital between January 2005 and September 2009. The BMD was measured at lumbar 1-4 by dual-energy X-ray absorptiometry.
Absorptiometry, Photon ; Aged ; Bone Density ; Bone Diseases, Metabolic ; Female ; Humans ; Osteoporosis ; Prevalence ; Spine

Neuroendocrine cells are distributed throughout the body and they are found in the gastrointestinal tract, pancreas, lung, thyroid, adrenal gland and many other organs, and especially the gastrointestinal tract. As a consequence, neuroendocrine tumors of the colon and rectum are common neoplasm. Several cases of the benign carcinoid tumor and a few cases of the malignant carcinoid tumor of the colon and rectum have been reported. Yet there have been no reports on concurrent malignant carcinoid tumor and benign carcinoid tumor at the same site of the colon. A 60-year-old man presented with an asymptomatic rectal mass. After the mass was evaluated and operated on, it was confirmed to be a concurrent malignant carcinoid tumor and benign carcinoid tumor of the rectum, and metastasis to the liver was also found.
Adrenal Glands ; Carcinoid Tumor ; Colon ; Gastrointestinal Tract ; Humans ; Liver ; Lung ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Cells ; Neuroendocrine Tumors ; Pancreas ; Rectum ; Thyroid Gland

PURPOSE: The association of varicoceles and subfertility has been well documented. Although varicoceles remain the most common surgically correctable cause of male infertility the subjective diagnosis of varicocele, especially the small ones remains a challenge. MATERIALS AND METHODS: We evaluated 40 young men (16 volunteers, 24 varicocele patients) with scrotal blood pool scan using 99mTc RBC. RESULTS: Complete correlation between physical findings and the scrotal scan was found. The postoperative scans of 12 patients with surgically corrected high grade varicoceles demonstrated symmetrical photon accumulation in the scrotum. The technique which most accurately correlated the clinical grade was the varicocele index using total count at Valsalva maneuver. CONCLUSIONS: We believe that the 99mTc RBC scrotal scan with technical refinement is a useful procedure in the objective diagnosis and followup of varicoceles.
Diagnosis ; Follow-Up Studies ; Humans ; Infertility ; Infertility, Male ; Male ; Scrotum ; Valsalva Maneuver ; Varicocele* ; Volunteers

OBJECTIVES: This study was performed to investigate the factors predicting recidivism within 6 months after release in arrested juvenile delinquents for proper screening and intervention of high-risk subjects. METHODS: The subjects consisted of 125 arrested male adolescents who were released after legal procedure in prosecutor office and court. The socio-demographic and crime-related characteristics were evaluated by police records, and the familial, psychopathology and personality characteristics, and the level of moral development measured by the Conflict Tactics Scale(CTS), Family Environment Scale(FES), Parental Behavioral Inventory, Symptom Checklist-90-Revised(SCL-90-R), Beck Depression Inventory, Beck Anxiety Inventory, Korean form of Moral Developmental Inventory for adolescents, and Personality Disorder Questionnaire-Revised(PDQ-R). RESULTS: The recidivism rate within 6 months after release was 44% of the initial sample. Recidivists were younger and had higher scores on Anger-hostility scale of SCL-90-R and lower principle morality score than nonrecidivists. More recidivists had history of physical abuse and antisocial personality disorder on PDQ-R than nonrecidivists. They also showed the crimerelated characteristics of lower percent of violence crime, higher incidence of previous conviction, younger age of the first crime. Among those variables, logistic regression showed that age of first crime, antisocial personality disorder, and history of physical abuse best predicted the recidivism within 6months after release. CONCLUSION: These results of present study suggest that the recidivism rate of arrested male adolescents is very high, and the age of first crime, antisocial personality disorder and history of physical abuse were key factors predicting recidivism. To prevent repeated crime of delinquent adolescents, the development of programs for those high-risk groups to help rehabilitation and adaptation in community would be essential.
Adolescent* ; Antisocial Personality Disorder ; Anxiety ; Crime ; Depression ; Humans ; Incidence ; Logistic Models ; Mass Screening ; Moral Development ; Morals ; Parents ; Personality Disorders ; Police ; Psychopathology ; Rehabilitation ; Violence

BACKGROUND: The reasons for the viral persistence and disease progression of hepatitis B virus (HBV) infection are unknown, but are probably related to host immune factors. Cytokines such as tumor necrosis factor-alpha (TNF-alpha) play significant roles in inflammatory and immune defense. This study was undertaken to investigate the association between HBV infection and polymorphisms of TNF-alpha gene promoter polymorphism. METHODS: We studied 412 Korean patients with chronic HBV infection (72 inactive carriers, 261 chronic hepatitis, 79 liver cirrhosis) and 204 healthy individuals who recovered from HBV infection. We assessed two biallelic polymorphisms in TNF-alpha gene promoter (at position -308, -238) by single base primer extension assay (SNP ITTM). RESULTS: Genotype frequencies of TNF-alpha gene promoter at position -308 and -238 were not different between the clearance and the persistence group in univariate analysis. In multivariate analysis after adjusting age and sex, TNF 308 G/G genotype was associated with HBV persistence (ORs;1.71, p=0.039). Moreover, concerning the haplotype analysis, -308G/ -238G homozygotes showed much higher correlation with HBV persistence (ORs;1.88, p=0.005). Genotype distributions of both gene promoters in inactive carriers were similar to those in patients with chronic progressive liver disease (chronic hepatitis and liver cirrhosis). CONCLUSION: The carriers of -308 G/G genotype and -308G / -238G haplotype homozygotes in the TNF-alpha promoter region have higher risk of persistent HBV infection.
Cytokines ; Disease Progression ; Genotype ; Haplotypes ; Hepatitis ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Homozygote ; Humans ; Immunologic Factors ; Liver ; Liver Diseases ; Multivariate Analysis ; Promoter Regions, Genetic ; Tumor Necrosis Factor-alpha*

OBJECTIVES: The purposes of the study were to assess the unmet needs of the chronic mental ill in low income class living in community and to provide basic data for developing services and programs in community mental health. METHODS: Face to face interviews were done for the subjects (n=320) who were diagnosed as schizophrenia, major depressive disorder, and bipolar I disorder. The Korean version of Camberwell Assessment of Need Short Appraisal Scale (CANSAS) was used as the assessment tool of the needs. Frequencies and rates of met needs and unmet needs of each 22 items of CANSAS were estimated. We classified 22 items into six need areas by operational definition, and then estimated mean percentages of unmet needs and met needs for each 6 need areas. We also classified subjects into 2 groups by the presence of psychiatric care needs, and then estimated mean percentage of unmet needs for other 5 need areas according to psychiatric care needs. RESULTS: Among the respondents, 77.7% of them had no spouses, and 66.4% had the education of six years and over. Of the respondents, 53.8% were males, 46.2% females. And 74.3% used medical aid in social security. Most respondents did not have present occupations and persons who were living with their parents were 48.3% and persons living alone reached 8%. The diagnosis of schizophrenia was 60.9%, major depressive disorder 15.2%, respectively. Most respondents (73.6%) had been admitted to the hospitals, but they hardly used rehabilitation services or programs during the daytimes. In estimating the unmet needs for each 22 items of CANAS, the need of company of others was the highest and that of welfare benefit and daytime activity were next. Information for treatment, intimate relationship, psychological distress, money, and psychotic symptoms follow the order. The mean percentages of unmet needs for each 6 needs area were 29.5% for income needs, 26.9% for social relation needs, 17.0% for physical care needs, 14.2% for psychiatric care needs, 11.6% for daily living skill needs, and 9.6% for residency needs. We classified subjects into 2 groups by the presence of psychiatric care needs: 49% of the subjects had no psychiatric care needs and 51% had psychiatric care needs. The group that had psychiatric care needs also had higher mean percentage of unmet need in 5 other needs areas than group that had no psychiatric care needs. And these results showed statistically significant except residency needs area. CONCLUSION: When preparing services or programs in community mental health, occupational rehabilitation and social support should be included as basic services. Other services such as physical treatment, psychiatric treatment, social skill training, and residency could be considered as optional.
Surveys and Questionnaires ; Depressive Disorder, Major ; Diagnosis ; Education ; Female ; Humans ; Internship and Residency ; Male ; Mental Health ; Mentally Ill Persons* ; Needs Assessment* ; Occupations ; Parents ; Rehabilitation ; Schizophrenia ; Social Security ; Spouses

OBJECTIVES: To investigate the differences in accessing regional hospitals and the utilization rate of hospitals located in other regions for cancer patients by regions. METHODS: Data for the utilization of regional hospitals for cancer patients were obtained from the Korean National Cancer Incidence Databases in 1999 and 2002. We divided the regions into 16 provinces by administrative districts. We using the SAS 9.1.3 to analyze difference of regional self-sufficiency and the Arcview 3.2 to show in a schematize for regional variation of the regional self-sufficiency. RESULTS: There were regional variations in the regional self-sufficiency of cancer patients. Especially, Jeollanam-do(1999 13.6%, 2002 12.8%), Gyeongsangbuk-do(1999 22.0%, 2002 20.7%), and Chungcheongnam-do(1999 27.8%, 2002 27.1%) had low regional self-sufficiency. The regional self-sufficiency in Gyeonggi-do and utilization rate of cancer patients who lived in other regions were increased between 1999 and 2002(regional self-sufficiency: 1999 37.2%, 2002 48.2%). CONCLUSION: The results of this study showed that there were regional variation in utilization of regional hospitals for cancer patients. Accessibility of cancer patients in metropolitan areas was higher than in small size cities, medium size cities, and rural county areas. These results suggested that it should be considered support medical facilities for cancer patients in rural areas where have lower relevance rate.
Gyeonggi-do ; Humans ; Incidence