Background
: Gastrointestinal (GI) symptoms are believed to be common in the general population, and constipation is one of the most representative GI symptoms. However, the prevalence and risk factors of functional constipation are not well known in Korea. We aimed to study the prevalence of, and risk factors for, constipation in the elderly.

Methods : We randomly selected 852 among 854 (excluded by cancer and dementia) subjects, ages 65 yr and older, in three different geriatric welfare facilities in December, 2003. The prevalence of functional constipation was based on the Rome II criteria and the survey on risk factors for constipation was performed.

Results : Functional constipation had a prevalence of 26.6% and there was no difference between men and women. Exercise, fluid·fruit·vegetable intake, anal diseases and age related risk factors were associated with constipation.

Conclusion : In the elderly, constipation is a common complaint. Further studies are now required for risk factors of constipation.

Background
: Although many studies have focused on the association of hyperuricemia with components of metabolic syndrome, there are only few studies of independent relation between uric acid and metabolic syndrome itself. In this study, we evaluated healthy subjects and assessed the relationship of serum uric acid with metabolic syndrome.

Methods : Between January and February of 2005, we evaluated 164 healthy patients who visited a health evaluation center. Patients were evaluated for metabolic syndrome and risk factors were assessed using a questionaire, blood test and physical examination.

Results : Metabolic risk factors significantly increased as uric acid level markedly increased (P＜0.05). Even after limiting the variables such as age, sex, smoking, exercise, total cholesterol, low-density lipoprotein cholesterol, and LogCRP, the group with metabolic syndrome had markedly increased uric acid levels than those without metabolic syndrome [Odds ratio 1.494 (95% CI, 1.072∼2.084)].

Conclusion : The number of components of metabolic syndrome increased according to serum uric acid level. Uric acid level was significantly higher in metabolic syndrome than normal. Even after considering health behavior variables such as smoking, alcohol status, and exercise, they showed an independent relationship. Further massive prospective studies on whether collecting serum uric acid level can be used as a screening test or predictor of mortality for early metabolic syndrome and cardiovascular disease will be needed.

Background
: Angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker is usually recommended for hypertensive patients with diabetes mellitus. No reports have been made on antihypertensive agents prescribed for these patients in private practice.

Methods : During a one month period of December 2004, 169 hypertensive patients with diabetes mellitus on their prescribed antihypertensive agents by ten family physicians were analyzed. The influencing factors for such prescriptions were analyzed by directly visiting each physicians who prescribed them.

Results : A total of 21 antihypertensive agents were prescribed by these family physicians. Single calcium channel blocker therapy was the most common with 55 cases (32.5%), followed by 20 cases (11.8%) of single angiotensin converting enzyme inhibitor therapy and 16 cases of single therapy of Angiotensin II type 1 receptor blocker. The low frequency of prescribing the Angiotensin II type 1 receptor blocker was due to insufficient effect (7), lack of information (5), resistance from the patients from changing the medications (4) and expensive costs (4).

Conclusion : In prescribing antihypertensive agents for patients with diabetes mellitus, angiotensin converting enzyme inhibitor or Angiotensin II type 1 receptor blocker were chosen less. In order to decrease the incidence of complications in these patients, such agents should be prescribed more.

Background
: It is reported that many types of psychiatric disorders, including anxiety disorder, are related with abnormal brain wave activity, and neurofeedback is associated with clinical improvement in generalized anxiety, OCD, phobic disorder, and PTSD. But in panic disorder, previous studies with neurofeedback are very lacking. Therefore, in this study, the author applied neurofeedback to patients with panic disorder, refractory to cognitive- behavioral therapy and medication.

Methods : From March 2 to May 15 in 2005, six patients with a panic disorder had received 20 sessions of neurofeedback training. The author evaluated the treatment effect by using the alteration of K-APPQ score, the frequency of panic attack, medication and individual handicap.

Results : All 6 patients completed 20 sessions of neurofeedback training. At the end, the score of total APPQ, agoraphobia, and interoceptive fear was decreased (P= 0.028) and the frequency of panic attack, medication, and individual handicap was also decreased.

Conclusion : Neurofeedback training was successful in reducing panic symptom severity, frequency and individual handicap. A controlled study on a larger population is strongly recommended.

Background
: Hospitals provide programs for routine screening health examination to meet the needs of people who take keen interest in the prevention of cancer and chronic diseases. But current programs do not reflect individual characteristics such as age, sex, occupation, and risk factors. Expensive diagnostic tests not based on evidence raise a continued issue of controversy. We evaluated on the scientific evidence of screening tests in these programs.

Methods : Internet home pages were searched for screening test provided by 6 major hospitals and by National Health Insurance Corporation. Screening tests were arranged by target diseases which were chosen by the authors. We reviewed the guidelines of several organizations and compared the scientific evidence of each test by the recommended guidelines.

Results : Excessive investigation, such as tumor markers, abdominal ultrasonography, anti-HCV Ab, and VDRL were routinely administered against recommended guidelines. Screening tests lacking sufficient evidence for recommendation were included. Furthermore, selection of the screening tests options and time interval was based on the clients' economic state and non-expert preference.

Conclusion : Screening tests were uniformly administered in excess with insufficient evidence. Tailored screening program should be administered considering individual characteristics and risk factors.

Background
: It is known that various subtypes of obesity exist and there has been a growing interest in the various subtypes of obesity, especially in the unique "metabolically healthy but obese" subtype. The purpose of this study was to analyze the features of obese adults without metabolic complications and to provide data which can be used in strategy formation for the effective treatment of obesity.

Methods : A total of 4,561 obese adults with a BMI greater than or equal to 25 kg/m², were recruited from a health promotion center of a university hospital. Sociodemographic and life style information were gathered by self- questionnaire. We classified them into 2 groups - one having no features (metabolically healthy obese; MHO) and the other having 1∼5 features (metabolically unhealthy obese; MUHO) - using the ATP III definition for metabolic syndrome, and used the multiple logistic regression analysis to examine the association between various factors and MHO.

Results : Age and BMI were related with MHO independently. Adjusted odds ratio for the MHO men was 2.17 compared with women (P＜0.001). Adjusted odds ratio for the MHO regular exercise group was 1.66 compared with the no exercise group (P＜0.007). Additionally, those who exercised more had a greater probability of being in the MHO group. Adjusted odds ratio for the MHO in the large income group was 1.88 (P=0.007) compared with those in the small income group. As was seen with exercise, there was a direct relationship between higher income and the probability of being in the MHO group.

Conclusion : Men compared with women, large income compared with small income, and regular exercise compared with no exercise were features of obese adults which increased their probability of being categorized as "metabolically healthy but obese".

A 59 year old woman visited the hospital complaining of sore throat, chill, myalgia and whole body skin rash. There was abnormal finding of fever, sinus tachycardia, increased lactic dehydrogenase and elongation prothrombin time. We started treatment with acetaminophen and fluid because she had not specific history of visiting to the mountain or field, etc. After treatment increased aspartate aminotransferase/alanine aminotransferase and thrombocytopenia appeared without symptomatic improvement so that we investigated tsutsugamushi antibodies and diagnosed her condition as Tsutsugamushi disease with polyuria. But the clinical manifestation in our case showed atypical symptom which had polyuria. There is no report on that in Korea and over the world therefore the author et al. report of case of Tsutsugamushi disease with polyuria, atypical symptom.