The Positive Rate of Serum Rheumatoid Factor in Health Screening Subjects and Related Factors

BACKGROUND: This study was done to estimate the prevalence of Rheumatoid Factor (RF) positive rate in adult Korean population and to investigate the association between rheumatoid factor positive rate and related factors. METHODS: The database from 4,678 subjects, who visited a general health screening center of an university hospital during 1 year period were surveyed. RF was tested using a commercial latex test kit, HBsAg by RIA of 3rd generation, anti-HCV by EIA of 3rd generation and serum AST, ALT by enzyme kinetic method. Syphilis was checked using RPR test and TPHA. Lung diseases (tuberculosis, IPF) were screened using chest X-ray. Flukes was checked by sedimentation method and cestodes was by direct method in stool tests. Smokers were based on history on health screening. RESULTS: 1) The positive rate of RF was 4.4%, HBsAg was 5.9%, anti-HCV was 1.5% and ALT>35 IU/L was 18.4%. The number of syphilis subjects was 19, lung diseases was 119, parasitic diseases was 43, and smokers was 1,299. 2) RF positive rate of males was 4.0%, females was 5.3%. Therefore, the positivity of females was higher than males and RF positivite rate was increased in the higher age groups. 3) RF positive rate in HBsAg (+) subjects was 18.1% and HBsAg (-) was 3.6% and in anti-HCV (+) subjects was 10.3% and anti-HCV (-) was 4.3%. 4) RF positive rate of subjection both positive reactions of RPR test and TPHA, namely, syphilis tests was 21.1%. 5) RF positive rate of parasitic diseases was 4.7%, lung diseases was 2.5% and smokers was 4.2%. 6) RF positive rate was highly associated with HBsAg, syphilis, anti-HCV, female sex, age in order of sequence. CONCLUSION: The positive rate of RF in healthy Korean adults can be estimated to be 4.5% and shows high association with hepatitis B and C virus infection in addition to syphilis, age and sex.

A Case of Hematogenous Tuberculosis of Skeletal Muscle / 대한내과학회지

Tuberculosis infection of skeletal muscle is rare even in countries in which tuberculosis is a relatively common disease. Because tuberculosis of muscle is almost always secondary to underlying tuberculosis of the bone or adjacent joint, hematogenous tuberculosis of skeletal muscle is extremely rare. Therefore, We report a case of hematogenous tuberculosis of skeletal muscle with the review of literatures. A 79-year-old man presented with a history of left shoulder pain, edema, fever and chill. MRI showed inflammatory changes of infraspinatus and deltoid muscle. The histopathology of skeletal muscle showed granulomas surrounded by epithelioid cells and Langhans' giant cells. Mycobacterium tuberculosis was grown from the specimens of sputum, pleural fluid and muscle tissue. The patient improved on anti-tuberculosis treatment.

A Case of Bartter's Syndrome in an Adult / 대한신장학회잡지

Bartter's syndrome is characterized by hypokalemia and secondary hyperaldosteronism without edema or hypertension. Its pathogenesis is obscure and the characteristic renal potassium wastage is difficult to treat. We experienced a case of Bartter's syndrome in 47 year-old diabetic female. She had felt dizziness, muscle weakness and cramping for about two years. During diagnostic evaluation, hypokalemic metabolic alkalosis and hyperreninemic hyperaldosteronism were discovered. The patient denied ingestions of laxatives, diuretics, licorice and she had no nausea, vomiting, diarrhea or edema. She had normal blood pressure. The patient improved with potassium supplements and spironolactone therapy along with oral hypoglycemic agent. So we report this case with the review of literature.

Comparison of I-131 Scintigraphy , T1-201 Scintigraphy , and Serum Thyroglobulin in the Postoperative Follow-Up of Differentiated Thyroid Cancer / 대한핵의학회잡지

To evaluate the utility of I-131, T1-201 scintigraphy, and serum thyroglobulin(Tg) in the follow-up of differentiated thyroid cancer, we compared retrospectively the data from 33 patients who underwent total or subtotal thyroidectomy. I-131 scintigraphy was performed after optimal endogenous TSH stimulation (TSH>50microgram/ml). Total 41 cases of I-l3l and T1-201 scintigraphy pairs were examined. Concomitant serum thyroglobulin levels were measured for 41 pairs of scan. Tg-off levels(that measured after discontinuation of the thyroid hormone) higher than 40ng/ml were considered positive, and Tg-on levels(that measured during the thyroid hormone replacement) higher than 5ng/ml were considered positive. The concordance rates between I-131 therapeutic scintigraphy and T1-201 scintigraphy was 48% in the 38 case of total scan pairs(59% in the 17 cases of postoperative preablation group, and 38% in the 21 cases of postoperative postablation group), Of 17 studies before the I-131 ablation therapy (preablation group), 7 showed positive I-131 therapeutic scintigraphy despite of negative T1-201 scintigraphy. Among patients with negative I-131 therapeutic scintigraphy, no patients had abnormal T1-201 uptake. However, of 21 studies which were done after radioiodine therapy(postablation group) 6 had abnormal uptake on T1-201 scintigraphy which were not seen on I-131 therapeutic scintigraphy, and Tg-off levels also elevated in this 4 of 6 cases. As a result, I-131 therapeutic scintigraphy showed highest positive rate at postoperative preablation follow-up study in differentiated thyroid cancer patients. T1-201 scintigraphy may be useful in postablation studies, and the use of the combined modalities(T1-201 and Tg levels) provides a higher diagnostic yield.

Usefulness of Tc-99m MIBI Scan in the Postoperative Follow Up Of Well-Differentiated Thyroid Cancer / 대한핵의학회잡지

To evaluate the clinical utility of Tc-99m MIBI scan in the detection of residual thyroid tissue or metastatic lesion in postoperative thyroid cancer patients, we compared Tc-99m MIBI scan with I-131 diagnostic and therapeutic scan in 30 postoperative well-differentiated thyroid cancer patients. Thyroglobulin levels of both on and off thyroid hormone medication and antithyroglobulin antibody were tested [Tg(on), Tg(off)l Positive rates for I-131 diagnostic and Tc-99m MIBI scan were 81% and 68% respectively. Concordance between I-131 diagnostic and Tc-99m MIBI scan was observed in 15 cases; 12 positive and 3 negative respectively Among the 6 cases with negative I-131 diagnostic scan and positive Tc-99m MIBI scan, 4 were positive in the therapeutic I-131 scan. We concluded that Tc-99m MIBI scan maybe a useful complementary modality to the currently established method of I131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.