, Honkeun Cho, Si-Hoon Park, Gil Ja Shin, Dong Su Lee, Yang Hee Lim The Measurement of blood pressure by a doctor may trigger a pressor response, so there are marked differences between office and ambulatory or self-measured blood pressure and the subjects may misdiagnosed as hypertensives and receive unneccesary medication. The study is designed to evaluate the charicteristic of white coat hypertension, the degree of white coat effect and the relationship between the white coat hypertension and persistent hypertension.
Thirteen patients with office hypertension receiving no medication, were recruited from 434 patients experienced in ambulatory blood pressure. Past history, physical examination, office blood pressure, 12-channel standard electrocardiography, chest X-ray, plasma lipid battery, echocardiography and 24-hr ambulatory blood pressure monitoring with BP3 MEDIANA were performed.
1) White coat hypertensive patients were 13 of 434 patients(2.99%) who were performed 24-hr ambulatory blood pressure monitoring. The mean age was 45±12 years with 6 men and 7 women and rage of age was 26-65 years.
2) The lipid battery, chest X-ray and 12-channel standard electrocardiographty showed no significant finding.
3) The LV mass index was 90.7±11.0g/m3 but one of 8 who performed echocardiography showed concentric hypertrophty.
4) The LV ejection traction was 60.8±8.7% which normal range.
5) The mitral flow velocity parameters were E velocity 0.71±0.14m/sec, A velocity 0.54±0.24m/sec, E/A ratio 1.6±0.8, mitral valve deceleration time 214±27.6msec and isovolumic relaxation time 104±11.4msec but one of 8 showed LV relaxation abnormality.
6) The mean office systolic blood pressure was 159±13.8mmHg, mean office diastolic blood pressure 101±9.0mmHg, 24-hr mean ambulatory systolic blood pressure 128±4.9mmHg and 24-hr diastolic bliid pressure 82±8.6mmHg.
7) The night day ratio of systolic blood pressure was 0.93±0.06 and the night day ratio of diastolic blood pressure was 0.92±0.06 suggestive of blunted diurnal variation. The Dipper were 5 of 13 patients(38.5%) and the non-Dipper were 8 of 13 patients(61.5%).
8) Two of 13 white coat hypertensives were diagnosed as persistent hypertensives in follow-up periods and antihypertensive drug had been initiated.
White coat hypertension can be diagnosed by 24-hr ambulatory blood pressure monitoring. The influence of white coat effect to cardiovascular system was not established. Sixty-two percent of white coat hypertensives showed blunted diurnal variation in 24-hr ambulatory blood pressure monitoring and two of 13 were diagnosed as persistent hypertensives in our F/U study, so white coat effect cannot be merely innocent and need strict evaluation and regular follow-up.
, Ku Yong Chung, Ho-Seong Han, Yung Man Choi Kimura disease, which was initially described by Kimura et al. in 1948, is a rare entity that occurs primarily in Asian people characterized histopathologically by a lymphofolliculoid granuloma with infiltration of the mass and the surrounding tissue by eosinophils, often with concomitant peripheral blood eosinophilia and elevated serum Ig E. The kimura disease frequentlly involves head and neck region and reraly extrimities. When the disease involvews parotid gland, it is very difficult to differentiate clinically with parotid gland tumor. We have experienced a case of Kimura disease. The lesion was initially diagnosed as a parotid gland due to extensive fibrosis surrounding the mass. So, the mass excision was performed without clear identification of the facial nerve. The Kimura disease usually follows a benign course. But when this disease is confused with parotid gland tumor, there will be a danger of nerve injury due to difficulty in dissection of the extensive fibrotic soft tissue surrounding the parotid gland.
Estrogen replacement is part of the preventive health care of postmenopausal women. The utilization of estrogens for the relief of menopausal complaints, such as atrophic vaginitis and vasomotor symptoms, and the prevention of osteoporosis is well established and may reduce the risk of cononary artery disease.
Despite these benefits, many women are reluctant to use cyclic estrogen/progestin replacement therapy because of the problems of vaginal bleeding and the risk of endometrial cancer.
Furthermore, progestin related side effects such as breast tenderness, headache, nausea, abdominal bloating and depression are additional reasons for patient dissatisfaction, with cyclic therapy.
Continuous regimens of estrogen-progesterone have recently been favored over sequential regimens because of a lower incidence of withdrawal bleeding.
Therefore to determine the effect of different doses of progestin on lipid profiles and bone mineral density, we studied the daily continuous estrogen/progestin therapy in post menopausal vomen during a 1-year prospective trial.
The results were as follows ;
1)The changes of serum cholesterol after hormone therapy in group I,II and III decreased by 1.9%, 6.4%, and 0.2% after one year, but the difference of changes between three groups was not statisitically significant.
2) The changes of serum LDL-cholesterol after hormone therapy in group I,II and III decreased by 22.1%, 19.7%, and 15.5% after one year(p<0.05) but the difference of changes between three groups was not statisitically significant.
3) The changes of serum HLDL-cholesterol after hormone replacement therapy in group I,II and III increased significantly by 16%, 15% and 10% after one year, but the difference of changes between three groups was not statisitically significant.
4) The changes of serum mghecride after hormone replacement therapy in group increased 22%, 6% and decreased about 22% but the difference of changes between three groups was not statisitically significant.
5) The changes of bone mineral density of femur after hormone replacement therapy in three groups was not statisitically significant.
6) The changes of bone mineral density of vertebrae after hormone replacement therapy increased by 2.8%, 1.2%, and 0.2% after one year, but the difference were not statisitically significant.
In ostroarthritis and rheumatoid arthritis, β-glucuronidase activity was measured in body fluid to diagnose this special disease entities.
The β-glucuronidase activity was studied in the urine, serum and joint fluid. The level of this specimens were estimated by statistical sections.
1) The β-glucuronidase activity in urine, serum and joint fluid of osteoarthritis patients were 0.09U/l urine, 0.14U/l serum, 0.06U/l joint fluid. The highest level of activity was in the serum.
2) The β-glucuronidase activity on rheumatoid arthritis was 0.19U/l urine, 0.17U/l serum, 0.07U/l joint fluid. The highest increased level of activity was in the urine.
3) In the joint fluid and serum, there is the no mean of stistical analysis. But in the urine, there is marked meaning of statistical analysis(Male : p=0.0041, Female : p=0.0001).
β-glucuronidase activity was influenced by osteoarthritis and rheumatoid arthritis. Especially in the urine, β-glucuronidase activity was outstanding statistical meaning. According to disease entities, The level of activity was different from each specimen.
, Kyu Man Shin 59 Consequtive patients with cervical disc disease were treated with single or multilevel anterior discectomy and fusion using a modified Smith-Robinson procedure from Sep. 1993 to Dec. 1996.
There were 36 single-level fusions, 19 two-level fusions and 4 three-level fusions.
The most common presenting complaint was radiating pain to upper extremity and the most frequent site was the C5-6 in single level, C5-6-7 in two level, and C3-4-5-6 in three level. Immediate postoperative complications were encountered in 11 cases : graft extrusion in three, hardware failure and loosening in two, donor site pain and hematoma in four, and transient hoarseness in two cases. With an average follow-up of 1 year, the fusion rate was 96.5%(83 of 86 levels). The single-level fusion rate was 100%, the two-or three-level was 94%. Results by clinical examination revealed 32(54%) excellent, 23(39%) good, 1 fair and 3 poor.
There were no significant graft collapse or exrusion and wound infection or neurologic complications. The modified Smith-Robinson procedure for anterior cervical discectomy and fusion has led to the successful treatment of cervical disc disease with improved results and few complications in long-term follow up.
, Dong Been Park Animal models of peripheral nerve ischemia have yielded variable results.
The question of whether postischemia re-estableshment of blood flow to the nerves auguments injury has not been examined.
To study this question, the ipsilateral common iliac and femoral arteries were occluded with arterial snares for 3 hours in rats. C14-butanol tissue distribution was then used to measure blood flow in both sciatic and posterior tivial nerve trunks during occlusion and reperfusion.
Clinical limb function was graded serially, with the undisturbed contralateral limb serving as the study control. Nerve blood flow was reduced throughout the ischemic period and was only 20% of the control value in the posterior tibial nerve. All rats had functional impairment with an average limb function score of 7.5(normal score<2). During reperfusion period, blood flow in the distal sciatic and posterior tibial nerves was approximately double that of control nerbes at 2 hours.
At 21 hours, tibial nerve blood flow was still twice that of the control nerve, but flows in the distal sciatic nerve were unchanged from control levels. Clinically, limb function improved progressively after reperfusion.
It was concluded that nerve ischemia is attended by a relatively prolonged hyperemic flow response during reperfusion.
, Sung-Soo Park Borine pericardial bioprosthesis fixed in glutaraldehyde(GA) is most popular surgical materials but late calcific degeneration is remained to be solved. To prevent the calcific degeneration, we sdded MgCl2 into the GA solution to compete with calcium for bending the free aldehyde from GA solution to compete with calcium for binding to the free aldehyde from GA and posttreated with amino acids to enhance the mitigating effect.
40 pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2 · 6H2O as a control(group 1). 40 pieces fixde in the same condition were posttreated with 4% chitosan(group 2) and the other 40 pieces posttreated with 8% glutamate(group 3). These were implanted into the belly of 40 Sprague-Dawley subdermally and extracted on 1 month, 2 month, 3 month and 6 months after implantation.
We measured the calcium deposited in those pericardia with atomic absorption spectrophotometry and the results were these ; calcium deposition in group 1 on 1 month after implantation was 0.283±0.059mg/g, 1.338±0.732mg/g in group 2 and 0.469±0.215mg/g in group 3, on the 2nd month 0.921±0.342mg/g in group 1, 6.521±1.919mg/g in group 2 and 2.772±1.747mg/g in group 3, on the 3rd month 0.785±0.212mg/g in group 1, 12.223±3.305mg/g in group 2 and 2.655±0.905mg/g in group 3, and on the 6th month 1.621±1.475mg/g in group 1, 9.121±3.373mg/g in group 2 and 2.916±1.461mg/g in group 3, which have statistical significance(p<0.05).
This means posttreatment with with chitosan or glutamate show no calcium mitigation effects on subcutaneously implanted bovine pericardium in the this experiment which is quite different from others.
, Sung Min Chung, Myoung Sil Ju The surgical modalities for treatment of chronic maxillary sinusitis have changed in recent years. The radical Caldwell-Luc operation has been replaced by the more conservative endoscopic sinus surgery(ESS). Good clinical results for the ESS technique have been reported(Wigand, 1978 ; Stammberger, 1991 ; Kennedy, 1992), but only a few papers give detailed data on the symptoms(Kamel, 1989 ; Levin, 1990 ; Lund, 1991). From April 1992 to January 1996, a total of 118 patients(primary ESS 62 patients and ESS after previous nasal surgery 56 patients) who underwent ESS at the department of otolaryngology, Ewha womans university Hospital, were evaluated.
Preoperative nasal symptoms, except for nasal discharge were higher in revision cases. The previous most common nasal surgery was polypectomy accounting for 25(44.6%) of the 56 revision cases. All had preoperative CT scans of the ostiomeatal unit area(OMU CT) and severity of inflammatory disease had been graded by CT. In revision cases, 30(53.6%)cases had complete opacification of one or more major sinuses. But in primary ESS cases, 19(30.6%) had findings limited to the osteomeatal complex. Overall, 43(76.8%) patients benefited from ESS in revieion cases, and 58(93.5%) in primary ESS cases. Synechia was the most common complication in revision and primary FESS cases. The difference of outcomes between primary ESS and ESS after previous nasal surgery is explained by the difference of preoperative state of the sinus mucosa.
The author's review of 118 patients showed that there was significant difference in the postoperartive success rate between the primary ESS and ESS after previous nasal surgery.
The purpose of this study is to investigate the dissociative levels and histories of reported abuse among women psychiatric outpatients.
The author observed the dissociative levels and histories of reported abuse of the 66 women outpatients who visited psychiatric clinics, and compare dissociative symptoms of women who reported the history of physical and sexual abuse and symptoms of the others who did not have such history.
Results are as follows :
1) 54.5% of the other 66 outpatients of psychiatric clinic reported the history of abuse, including 13.6%, 24.2% and 16.7% of them reporting sexual abuse, physical abuse and physical and sexual abuse respectively.
2) Scores on the DES of abuse group was 18.6±16.3 which was significantly higher than DES of the non-abuse group(7.09±7.10).
3) Scores on the DES was highest in sexual abuse group, followed by physical abuse group and then physical and sexual abuse group. The percentile of score on the DES above 25 which was considered the score of dissociative disorder 44.4% of sexual abuse group, 18.8% of physical abuse group, 18.2% of physical and sexual abuse group, and 3.3% of non-abuse group.
4) Scores on the DES was variable according to the age of first abuse. It was highest in 7-11 years old group, followed by 12-16years old group, and then above 16years old group.
Sexual and physical abuse, especially sexual abuse, appears to be responsible for dissociation, or at least to ve a precipitating factor of dissociative experience.
This study purported to evaluate the factor structure of the Korean Family Mental Health test(K-FMHT), which was a self-report questionnaire composed of 67 items and developed for measuring the degree of mental health and psychopathological traits of the families by the comprehensive dimensions.
K-FMHT was administered to 476 married women subjects from normal families. A factor analysis revealed the 10 factor structure to be appropriate which determined by clinical, logical and statistical basis that included the pretest items expected empircally.
1) It was founded that the 10 factors item composition of K-FMHT satisfied the content validity through factor analysis and explained 50.1% of total variances.
2) 10 factors of K-FMHT have sufficient eigenvalues respectably and the factor loadings of total items were significantly high.
3) Factor 1 explainded 18.8% of variance and the other factors 6.4-2.4% of variance.
4) Factor namings were determinded which based the examination of the item contents : factor 1-open heartedness within family, factor 2 - family relationship of emotional disharmony, factor 3 - conflict relationship with mother-in-law and daughter-in-law, factor 4 - sexual relationship of couple, factor 5 - the filial devotion toward parent, factor 6 - openness toward community, factor 7 - patriarchic family, factor 8 - living together of family members, factor 9 - parent attachment toward children, factor 10 -parent unconditional love toward children.
5) Some limitation and future requirements are discussed to increase the validity of the K-FMHT.
It was suggested that factor 5, 10 need to dupplement more items for increasing the validity of K-FMHT though the complimentary work.
This study aims to investigate the domographic characteristics, main clinical problems, diagnoses and treatments of child and adolescent psychiatric outpatients.
The statistical analyses were based on the clinical reports and medical records of 111 child and adolescent psychiatric patients who wisited to the outpatient clinic during current 6 months.
1)The sex ratio(male : female) of these 111 patients was 1.1:1 and the most frequent age group was adolescent period(13-18 years of age). In sibling order, the first born child was more prevalent. Almost all the patients had both parents and was accompanied by a mother on the first visit. The most living place of the patients was in Seoul. 2) The main problems visiting our coinic were in following order : somatic symptoms, learning problems, anxiety, fear & restlessness, attention deficits, conduct problems and substance abuse etc. 3) Diagnostic distribution of the patients was in following order : conduct disorder, mood disorder, organic mental disorder, attention deficit hyperactivity disorder, anxiety disorder etc. 4) The patients who visited to the outpatient coinic above 5 times were more frequent. The more frequently used method for treatments was in the sequence of pharmacotherapy combined with psychotherapy and behavior therapy.
These results suggest that the necessity of the space of special therapy(such as play and behavior therapy) for the children and division of child and adolescent psychiatry is very important in current situation.
Citations
This study was designed to evaluate the ability of the injured trigeminal nerve to regenerate in the bone, and to compare the axonal regeneration following the nerve graft and nerve tubulization with GTR membrane. Fourteen rabbits were divided into 3 groups as follows : not repaired(Gc), Entubulation(G1), and nerve graft(G2) after partial resection of inferior alveolar nerves in the mandibular canals. The neuro-fibrotic tissues regenerated in the nerve gaps were prepared for histomorphologic examination by special staining with Hematoxylin & Eosin, Luxol-fast blue, Bodian's Masson-trichrome. The regenerated axons were examined with Toluidine blue staining and Transmission electronmicroscopy(TEM).
The injured mandibular nerve presented a regenerative capacity across 7 cm defect, and tubular repairs with GTAM produced histomorphologic regeneration of neural axons and mini-fascicles in 16 weeks. This investigation, however, showed a finding that autogenous nerve graft was inferior to tubulization in the histomorphologic assessment. The group of nerve graft disclosed less organized neural tissue(mini-fascicles) with more fibrovascular collagenous tissues.
Nerve injury resulting a gap which cannot be repaired by primary neurorrhaphy needs grafts or intrpositional tubular nerve guides. The e-PTFE membrane or tube can be used as a good conduit or sheath for nerve regeneration without adhesion of connective tissues, while the grafted nerves in the mandibular and bony ingrowth. Electrophydiologic examination and qualification of the regenerated axons are recommended to evaluate the substantial recovery following the nerve repair modalities.
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