The association between vitamin D levels and nonalcoholic fatty liver disease (NAFLD) has been recognized. However, few studies showed independent associations between vitamin D deficiency and NAFLD after a sex-related adjustment for metabolic factors. We aimed to study whether vitamin D deficiency is an independent risk factor of NAFLD even after controlling for metabolic syndrome and visceral fat in both sexes. In this cross-sectional study, 7,514 Korean adults (5,278 men, 2,236 women) participated in a health check-up program. They underwent blood tests, abdominal computed tomography (CT) of the visceral fat area, and ultrasonography for NAFLD screening. Multiple logistic regression analysis was used to investigate the association of vitamin D deficiency with NAFLD according to the sex differences. Vitamin D deficiency is associated with NAFLD. The adjusted odds ratio (aOR) for NAFLD increased sequentially with decreasing vitamin D level, even after adjusting for metabolic syndrome and visceral fat. The subjects in the vitamin D sufficiency group (20–30 ng/mL) had an aOR for NAFLD of 1.18 (95% CI, 1.00–1.39), whereas the deficiency group (< 20 ng/mL) had an aOR of 1.29 (95% CI, 1.10–1.52). However, we have detected a significant sex-related interaction when analyzing the results. A significant relationship between vitamin D deficiency and NAFLD was found in men (aOR, 1.33; 95% CI, 1.11–1.60) but not in women.
Adult ; Cross-Sectional Studies ; Female ; Hematologic Tests ; Humans ; Intra-Abdominal Fat ; Logistic Models ; Male ; Mass Screening ; Metabolic Syndrome X ; Non-alcoholic Fatty Liver Disease* ; Odds Ratio ; Risk Factors* ; Sex Characteristics ; Ultrasonography ; Vitamin D Deficiency ; Vitamin D* ; Vitamins*

PURPOSE: Since the revised Cancer Act of October 2006, cancer registration was reactivated, based on the Statistics Law. MATERIALS AND METHODS: The incidence of cancer during 2002 was calculated on the basis of the information available from the National Cancer Incidence Database. Crude and age-standardized rates were calculated by gender for 18 age groups (0~4, 5~9, 10~14, every five years, 85 years and over). RESULTS: The overall crude incidence rates (CRs) were 269.2 and 212.8 per 100,000 for males and females, and the overall age-standardized incidence rates (ASRs) were 287.8 and 172.9 per 100,000, respectively. Among males, the five leading primary cancer sites were stomach (CR 62.4, ASR 65.7), lung (CR 45.4, ASR 51.0), liver (CR 43.2, ASR 43.7), colon and rectum (CR 30.7, ASR 32.7), and prostate (CR 8.0, ASR 9.6). Among females, the most common cancer sites were breast (CR 33.1, ASR 26.9), followed by stomach (CR 32.8, ASR 26.0), colon and rectum (CR 23.1, ASR 18.5), thyroid (CR 19.1, ASR 15.7), and uterine cervix (CR 18.2, ASR 14.7). In the 0~14 age group, leukemia was the most common cancer for both genders. For males, stomach cancer was the most common cancer in the 15~64 age-group, but lung cancer was more frequent in men 65 or older. For females, thyroid cancer among the 15~34 age-group, breast cancer among 35~64 age-group and stomach cancer in women 65 years or older were the most common forms of cancer for each age group. The quality indices for the percentage of deaths, by death certificate only, were 4.7% for males and 4.5% for females. CONCLUSIONS: Since the National Cancer Incidence Database was started, the annual percent change of cancer cases increased by 4.8% (4.1% for males, 5.7% for females) during 1999~2002. This value reflects the increase in prostate cancer for males and breast and thyroid cancer in females during 2002. The timely reporting of improved quality of cancer registration is needed for evidence-based decisions regarding cancer control in Korea.
Breast ; Breast Neoplasms ; Cervix Uteri ; Colon ; Death Certificates ; Female ; Humans ; Incidence* ; Jurisprudence ; Korea* ; Leukemia ; Liver ; Lung ; Lung Neoplasms ; Male ; Prostate ; Prostatic Neoplasms ; Rectum ; Stomach ; Stomach Neoplasms ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: The first Korean national population- based cancer registry using nationwide hospital-based recording system and the regional cancer registries provided the source to obtain national cancer incidences for the period 1999~2001. MATERIALS AND METHODS: The incidence of cancer in Korea was calculated based on the Korea Central Cancer Registry database, data from additional medical record review survey, the Regional Cancer Registry databases, site-specific cancer registry databases, and cancer mortality data from the Korea National Statistical Office. Crude and age-standardized rates were calculated by sex for 18 age groups. RESULTS: The overall crude incidence rates (CR) were 247.3 and 188.3 per 100, 000 for men and women and the overall age-standardized incidence rates (ASR) were 281.2 and 160.3 per 100, 000, respectively. Among men, five leading primary cancer sites were stomach (CR 58.6, ASR 65.6), lung (CR 42.1, ASR 50.9), liver (CR 41.9, ASR 44.9), colon and rectum (CR 24.2, ASR 27.3) and bladder (CR 7.7, ASR 9.2). Among women, the most common cancers were stomach (CR 30.8, ASR 25.8), breast (CR 25.7, ASR 21.7), colon and rectum (CR 19.6, ASR 16.7), uterine cervix (CR 18.4, ASR 15.5), and lung cancer (CR 15.1, ASR 12.4). In 0~14 age group, leukemia was most common for both sexes. For men, stomach cancer was most common in 15~64 age group, but lung cancer was more frequent for over 65 age group. For women, thyroid cancer in 15~34 age group, breast cancer in 35~64 age group, and stomach cancer in over 65 age group were most common for each age group. The proportions of death certificate only were 7.5% for men and 7.4% for women. CONCLUSION: This is the first attempt to determine the national cancer incidence and this data will be useful to plan for research and national cancer control in Korea.
Breast ; Breast Neoplasms ; Cervix Uteri ; Colon ; Death Certificates ; Female ; Humans ; Incidence* ; Korea* ; Leukemia ; Liver ; Lung ; Lung Neoplasms ; Male ; Medical Records ; Mortality ; Rectum ; Registries ; Stomach ; Stomach Neoplasms ; Thyroid Neoplasms ; Urinary Bladder

PURPOSE: Acute appendicitis is the most common disease requiring abdominal surgery, but for atypical clinical findings, a preoperative diagnosis is difficult and the frequency of a false positive and false negative diagnosis is high. The authors compared the diagnostic accuracy of a Technetium-99m-ciprofloxacin scan with that of the other diagnostic tools and evaluated its potential for clinical applications. METHODS: Seventeen patients were among those patients who visited the emergency room due to right lower quadrant (RLQ) pain were selected for this study. The decision for primary treatment was based on the clinical findings (RLQ pain, nausea, tenderness, rebound tenderness, leukocytosis, etc) and the radiological findings (abdominal ultrasonogram, abdominal computed tomography, etc). The 99mTc-ciprofloxacin scan was conducted regardless of the decision above. For the patients who underwent surgery, the final diagnosis of acute appendicitis was based on the pathologic result and for patients who did not undergo surgery, the final diagnosis was determined by the clinical course. RESULTS: Seventeen patients were enrolled in this study (7 males, 10 females). The patient's age ranged from 8 to 71 years and the average age was 29.2 years. The diagnostic accuracy of acute appendicitis is presented in order of the clinical findings, the radiological findings and the 99mTc- ciprofloxacin scan as follows: The sensitivity was 100%, 90.9% and 100%; the specificity rates was 33.3%, 50% and 67%; the positive predictive value was 87.5%, 90.9% and 93%; the negative predictive values was 100%, 50% and 100%; the false positive rate was 66.7%, 50% and 33.3%; the false negative rate was 0%, 9% and 0%. The respective p-values for the correlation between these results and the final diagnosis were 0.021, 0.049 and 0.002. CONCLUSION: A 99mTc-ciprofloxacin scan can decrease the false positive and the false negative rate and increase the diagnostic accuracy of acute appendicitis patients.
Appendicitis* ; Ciprofloxacin ; Diagnosis* ; Emergency Service, Hospital ; Humans ; Leukocytosis ; Male ; Nausea ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute* ; Acute Kidney Injury ; Aged* ; Aging ; Appendicitis ; Cardiovascular Diseases ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Diverticulitis, Colonic ; Emergencies ; Gastrointestinal Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Mortality ; Postoperative Complications ; Retrospective Studies ; Vascular Diseases

PURPOSE: In surgical treatment for the elderly patients with the acute abdomen, the high morbidity and mortality rate become a serious problem because of the difficulty of the initial diagnosis. This study, therefore, aims at analyzing the clinical presentation of the elderly patients with the acute abdomen in order to reduce the high mortality rate for the elderly patients. METHODS: This study included 114 elderly patients who underwent the emergency operation due to the acute abdomen from May 2000 to May 2002. The age of the elderly patients was over 65 years old. The clinical characteristics of these patients were investigated retrospectively in this study. RESULTS: The most two common diseases were the acute appendicitis(25.4%) and the acute cholecystitis (21.9%) for the elderly patients. Then comes the intestinal obstruction, the gastrointestinal cancer, the colonic diverticulitis, and the gastrointestinal vascular disease in that order. The accuracy of the initial diagnosis was 79%, but the correlation between the accuracy and age significantly decreased as the age of the elderly patients increased. The postoperative complication rate was 26.3%, and the most common cause of the complications was the postoperative infection. The postoperative mortality rate was 11.4%, and the common causes of the death were the sepsis(61.5%), the postoperative bleeding, the acute renal failure, and the cardiovascular disease in order of frequency. It was found that there was a significant correlation between the complication rate and old age(p=0.021). In addition, there was a significant correla- tion between the mortality rate and old age p=0.012). CONCLUSION: In this study, it was found that the acute appendicitis and the cholecystitis were the common diseases for the elderly patients with the acute abdomen. The accuracy of the initial diagnosis was 79%; however, it decreased with the aging process. For aged people, that caused the increase of the complication and the mortality rate. It thus appears that elderly patients with the acute abdomen should be treated carefully and systematically.
Abdomen, Acute* ; Acute Kidney Injury ; Aged* ; Aging ; Appendicitis ; Cardiovascular Diseases ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Diverticulitis, Colonic ; Emergencies ; Gastrointestinal Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Mortality ; Postoperative Complications ; Retrospective Studies ; Vascular Diseases

PURPOSE: An increased incidence of gallstones has been widely reported in patients who had undergone a gastrectomy. But, there has been little information about the pathophysiologic mechanism for the occurrence of gallstones after gastric surgery. Many investigators have considered the cause to be decreased gallbladder motility due to vagal denervation. We observed higher increase in the incidence of gallbladder stones in patients who underwent a Billroth II gastrojejunostomy than in those who underwent a Billroth I gastrojejunostomy after radical subtotal gastrectomy. METHODS: We prospectively studied the change in the motility of the gallbladder after a gastrectomy. The gallbladder ejection fraction (EF) was compared pre- and postoperatively by using gallbladder scintigraphy with 2,6-diisopropyl-iminodiacetic acid (DISIDA). RESULTS: Twenty patients underwent a Billroth(B) I anastomosis and twelve patients underwent a B-II anastmosis after the gastrectomy. The means of the EF of the B-I group were 75.9%, 46.4%, 68.1% at the preoperative period, at 1 month and 6 months after the gastrectomy respectively. Those of B-II group were 78.2%, 45.3%, 56.3%, respectively. There was no statistically significant difference of EF between the two groups at postoperative 1 month, but the difference at postoperative 6months was statistically significant. The differences of EF between preoperative period and postoperative 1 month, 6 months were significant in the B-I group andthe B-II group. CONCLUSION: At 6 months postoperative period, there was more recovered gallbladder motility after a gastrectomy with B-I anastomosis than with B-II anastomosis.
Denervation ; Gallbladder* ; Gallstones ; Gastrectomy* ; Gastric Bypass ; Gastroenterostomy ; Humans ; Incidence ; Postoperative Period ; Preoperative Period ; Prospective Studies ; Radionuclide Imaging ; Research Personnel

Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is generally recognized as a rare complication of continuous ambulatory peritoneal dialysis (CAPD), and the prognosis is very poor. The causes of SEP are multifactorial, including acetate in dialysate, recurrent peritonitis and dialysate con tamination with antiseptics containing chlorhexidine. Patients experience the characteristic symptoms and signs of nausea, vomiting, abdominal pain, and partial or intermittent bowel obstruction, and weight loss and malnutrition develop in severe case. We performed bowel resection on two patients with SEP, one idiopathic, and the other from CAPD. We briefly review the literature, and discuss the pathophysiology and the management of SEP.
Abdominal Pain ; Anti-Infective Agents, Local ; Chlorhexidine ; Humans ; Malnutrition ; Nausea ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis* ; Prognosis ; Vomiting ; Weight Loss

Computed tomography (CT) seems to be the best imaging modality to diagnose an enterovesical fistula, but is not always able to demonstrate enterovesical fistula itself. In this case report, we present Tc-99m HMPAO white blood cell (WBC) scintigraphic findings of an enterovesical fistula complicating Crohn's disease. A 22 year-old male presented with a one-month history of urinary symptoms such as dysuria, hematuria, and frequency. The patient had intermittent right lower quadrant pain, diarrhea and hematochezia. Enterovesical fistula was highly suggestive in pelvic CT which showed air density in the urinary bladder, but cystoscopy failed to find an opening of the fistula. Tc-99m HMPAO WBC scintigraphy for evaluation of inflammatory bowel disease incidentally demonstrated enterovesical fistular tract. Crohn's disease was later confirmed by histologic examination of the surgical specimen. In our patient, Tc-99m HMPAO WBC imaging was helpful in determining the location of the fistula as well as assessing the disease activity and extent of the Crohn's disease.
Crohn Disease* ; Cystoscopy ; Diarrhea ; Dysuria ; Fistula* ; Gastrointestinal Hemorrhage ; Hematuria ; Humans ; Inflammatory Bowel Diseases ; Leukocytes* ; Male ; Radionuclide Imaging* ; Technetium Tc 99m Exametazime* ; Urinary Bladder ; Young Adult

Retroperitoneal fibrosis is a slowly progressing syndrome that is a part of a systemic fibrosing disease. Most causes are idiopathic, whereas the remainder are associated with methysergide ingestion, malignancy, or aneurysm of abdominal aorta. The pathogenesis is unclear, but the evidences supporting systemic autoimmune process are present, i.e. the apprearance of autoimmune antibodies, especially antinuclear antibody, positive direct or indirect Coombs' test, and the association with immune thrombocytopenia. Effective treatment with corticosteroid is another suggestion of autoimmune nature of this disease. We experienced a case of retroperitoneal fibrosis with immune thrombocytopenic purpura and positive antinuclear antibody. A 44-years old man who was in splenectomy state due to immune thrombocytopenic purpura for 15 years visited us for obstructive uropathy caused by retroperitoneal fibrosis. He was treated with double J catheter insertion in both ureters, and oral medication of corticosteroid and tamoxifen. Renal failure and thrombocytopenia was improved after treatment and the retroperitoneal fibrotic mass size decreased.
Adult ; Aneurysm ; Antibodies ; Antibodies, Antinuclear ; Aorta, Abdominal ; Autoimmune Diseases ; Catheters ; Coombs Test ; Eating ; Humans ; Methysergide ; Purpura, Thrombocytopenic, Idiopathic* ; Renal Insufficiency ; Retroperitoneal Fibrosis* ; Splenectomy ; Tamoxifen ; Thrombocytopenia ; Ureter