Background: Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods: A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results: Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits.Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.

Background: Patient-centered management is becoming increasingly important in gout, but there are limited studies exploring patients' perspectives and preferences. We aimed to investigate patients' perspectives and preferences regarding gout and gout management, and their impacts on adherence to urate lowering therapy (ULT). Methods: A paper-based survey was performed in patients with gout seen at the rheumatology outpatient clinics of 16 tertiary hospitals. The survey included questions regarding demographics, comorbidities, gout attacks, current treatment and adherence, and patients' perspectives and preferences regarding gout and gout management. Multivariate regression analysis was performed to determine the factors associated with ULT adherence. Results: Of 809 surveyed patients with gout, 755 (94.5%) were using ULT. Among those using ULT, 89.1% had ≥ 80% adherence to ULT. Majority of the patients knew management strategies to some extent (94.8%), perceived gout as a life-long disease (91.2%), and were making efforts toward practicing at least one lifestyle modification (89.2%). Most patients (71.9%) obtained information about gout management during their clinic visits.Approximately half of the patients (53.6%) preferred managing their disease with both ULT and lifestyle modification, 28.4% preferred ULT only, and 17.4% preferred lifestyle modification only. Adherence was better in patients with older age (odds ratio [OR], 1.03), those with better knowledge of gout management strategies (OR, 3.56), and those who had preference for ULT (OR, 2.07). Conclusion Patients' perspectives and management preferences had high impacts on adherence to ULT in gout. Consideration of patients' perspectives and preferences is important for achieving the desired clinical outcome in gout.

PURPOSE: Croup is known to have epidemics in seasonal and biennial trends, and to be strongly associated with epidemics of parainfluenza virus. However, seasonal and annual epidemics of croup have not been clearly reported in Korea. This study aimed to examine the seasonal/annual patterns and etiologies of childhood croup in Korea during a consecutive 6-year period. METHODS: Pediatric croup data were collected from 23 centers in Korea from 1 January 2010 to 31 December 2015. Electronic medical records, including multiplex reverse transcription polymerase chain reaction (RT-PCR) results, demographics and clinical information were cross-sectionally reviewed and analyzed. RESULTS: Overall, 2,598 childhood croup patients requiring hospitalization were identified during the study period. Among them, a total of 927 who underwent RT-PCR were included in the analysis. Males (61.5%) predominated, and most (63.0%) of them were younger than 2 years of age (median, 19 months; interquartile range, 11–31 months). Peak hospitalization occurred in 2010 and 2012 in even-numbered years, and parainfluenza virus (PIV, 39.7%) was the most common cause of childhood croup requiring hospitalization, followed by respiratory syncytial virus (14.9%), human rhinovirus (12.5%), Mycoplasma pneumonaie (10.6%), and human coronavirus (7.3%). CONCLUSION: It is concluded that croup hospitalization has a biennial pattern in even-numbered years. PIV may be the most common cause of childhood croup; however, croup epidemics could be attributed to other viruses.
Child ; Coronavirus ; Croup ; Demography ; Electronic Health Records ; Hospitalization ; Humans ; Korea ; Male ; Mycoplasma ; Paramyxoviridae Infections ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Reverse Transcription ; Rhinovirus ; Seasons

BACKGROUND/AIMS: Pain is one of the most troublesome symptoms of pancreatitis. Transdermal fentanyl patches (TFPs) are long-acting analgesics with a reduced risk of dependency. This prospective study evaluated the effect of TFPs on sphincter of Oddi (SO) motility for the management of pain in pancreatitis. METHODS: SO manometry (SOM) was performed using triple-lumen catheters anterogradely inserted through the percutaneous transhepatic route during cholangioscopy in 16 patients. The basal pressure, amplitude, and frequency of the SO were assessed before and after applying a TFP at 24 hour at doses of 25 and 12.5microgram/hr, respectively. RESULTS: Two of 16 patients receiving a 25microgram/hr. TFP were excluded because of adverse side effects (headache and/or nausea). The mean basal pressure, amplitude, and frequency of SOM did not change significantly in the 25microgram/hr TFP group (n=4 patients). Parameters of SO function also did not significantly change in the 12.5microgram/hr TFP group (n=11 patients). CONCLUSIONS: TFPs below a dose of 25microgram/hr may not affect the motility of the SO. Administration of TFPs at lower dosages seems to be a safe analgesic treatment for the pain control of patients with pancreatitis without affecting the function of the SO.
Analgesics ; Catheters ; Dependency (Psychology) ; Fentanyl ; Humans ; Manometry ; Pancreatitis ; Prospective Studies ; Sphincter of Oddi

OBJECTIVE: To find the characteristics of stroke in colorectal cancer patients. METHOD: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. RESULTS: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were observed in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarction were more common in ischemic stroke. CONCLUSION: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors.
Atherosclerosis ; Brain ; Cerebral Infarction ; Colorectal Neoplasms ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Thrombosis

OBJECTIVE: In the present study, we evaluate visual outcomes after surgical removal of craniopharyngiomas and analyze the factors that are considered to affect visual outcomes. METHODS: This study includes 30 patients with craniopharyngioma, who underwent surgery in this clinic during the last 10 years. The changes of visual function (visual acuity and field) of the patients were assessed preoperatively and postoperatively, and paired data of this change were compared. Also, the factors that influence on this change were analysed. RESULTS: Among the 21 patients complaining of decreased vision before the operation, 8 patients were improved (38.0%), and 7 patients were worse (33.3%). However, Four out of 9 patients without any preoperative visual symptoms developed worse vision after the operation (44.4%). The average duration of symptom was 17.2 months in the improved group and 23.6 months in the aggravated group. The tumors recurred in only 5 patients after the gross total resection: Four of them showed the aggravation of visual function after surgical removal and 1 had improvement. CONCLUSION: After removal of craniopharyngiomas, the overall rate of vision improvement, no change and aggravation are 26.6%, 36.7% and 36.7%, respectively. Aggravation of postoperative visual function is higher in males, children and patients with a longer duration of symptom and the tumor recurres more frequently in patients who complained of worsened vision after surgical removal.
Child ; Craniopharyngioma* ; Humans ; Male

We report a case of metastatic hemangiopericytoma to the cervical spine. A 55-year-old female having a history of intracranial cavernous hemangiopericytoma, which was found 78 months ago was admitted to our hospital with posterior neck pain and left arm radiating pain. Magnetic resonance image revealed a tumor invading the C6 and C7 vertebral body and compressing the spinal cord. The histopathologic findings were characteristic of hemangiopericytoma. Extracranial metastases of hemangiopericytoma can occur long after the previous treatment in unexpected sites, especially in skeletal system. Bone scintigraphy is an useful tool to detect osseous metastasis, furthermore single negative scan is not sufficient to exclude bone metastasis.
Arm ; Female ; Hemangiopericytoma ; Humans ; Middle Aged ; Neck Pain ; Neoplasm Metastasis* ; Radionuclide Imaging ; Spinal Cord ; Spine*

We report a case of delayed rupture of pseudoaneurysm after operation for meningionma. A 68-year-old female presented with mild headache and hemiparesis. Magnetic resonance imaging showed a cystic mass lesion with a solid component, which was attached to dura in the right frontal area. The mass was totally removed, and diagnosed to transitional type meningioma with histopathological examination. Postoperatively, almost of preoperative symptoms were impoved. About a month later, she developed sudden onset deterioration of mental state and hemiparesis. Computed tomography disclosed a large intracerebral hemorrhage at the site of the tumor bed. Emergency operation was performed. During the evacuation of hematoma, we found a ruptured pseudoaneurysm, and secured it with circumferential wrappig and clipping. The patient recovered well and became ambulatory. In case of delayed intracerebral hematoma at the postoperative site, a possibility of the rupture of pseudoaneurysm should be considered.
Aged ; Aneurysm, False* ; Cerebral Hemorrhage ; Emergencies ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Paresis ; Rupture

OBJECTIVES: Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. MATERIALS AND METHODS: To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. RESULTS: The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. CONCLUSION: Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.
Body Temperature ; Denervation ; Ganglia, Sympathetic ; Humans ; Hyperhidrosis* ; Incidence ; Medical Records ; Occupations ; Retrospective Studies ; Sweat ; Sweating ; Sympathectomy ; Telephone

Isaacs' syndrome consists of spontaneously occurring muscle activity of peripheral nerve origins. This syndrome arises in association with/without polyneuropathy and rarely with malignancy. A 63-year-old man was admitted to our hospital due to generalized painful muscle stiffness. He complained of difficulty with standing and with finger exten-sion after grasping. Chvostek's and Trousseau's signs were noticed. Electrolytes, calcium, CK, and LDH were in the normal range. Small cell lung cancer was diagnosed by a needle biopsy. Electrophysiological testing revealed normal nerve conduction studies with the exception of a grossly abnormal EMG. Continuous neuromyotonic discharges with firing rates of 120-200 Hz were seen at rest. The amplitude of the response typically waned with 0.5-1.5 seconds of duration. The discharges persisted throughout sleep, after diazepam injection, and with brachial plexus blockage.Muscle stiffness improved with the administration of oral phenytoin. Under chemotherapy and radiotherapy, tumor remission was partially achieved and neurological symptoms markedly improved.
Biopsy, Needle ; Brachial Plexus ; Calcium ; Diazepam ; Drug Therapy ; Electrolytes ; Fingers ; Fires ; Hand Strength ; Humans ; Isaacs Syndrome* ; Middle Aged ; Neural Conduction ; Peripheral Nerves ; Phenytoin ; Polyneuropathies ; Radiotherapy ; Reference Values ; Small Cell Lung Carcinoma*