No abstract available.
Family Practice* ; Humans ; Internship and Residency*

No abstract available.
Gestational Age* ; Mortality

PURPOSE: The purpose of this study was to analyze the relationship among life style, body composition and Bone Mineral Density (BMD) in community dwelling Korean adults. METHODS: Data were collected from 140 adults who participated in a health check-up program at community health departments in D city, Choong-chung providence. Subjects' life style was assessed with a structured interview survey. Body composition analyses were performed by the bioimpedence method and BMD was measured by peripheral dual energy X-ray absorptionmetry. RESULTS: Among the subjects, 39.3% showed normal BMD values, 50.7% were osteopenic and 10% were assessed as osteoporotic. BMD was significantly different by gender, age, education, economic status and BMI. Subjects who had three or more meals/day had higher BMD then who had less than three meals (t=-2.273, p=.026). BMD was not influenced by regular exercise, alcohol consumption, or smoking. In terms of body composition, there was a significant relationship between fat free mass and BMD (r=.172, p=.043). CONCLUSION: Implementing an osteoporosis prevention program would be warrented considering the significant proportion of osteopenic or osteoporotic subjects. Regular eating habit with three meals for adequate nutrition need to be emphasized to prevent further bone loss in this population. Among the body composition, fat free mass seem to be the mostly predicting factor for BMD.
Adult ; Alcohol Drinking ; Body Composition ; Bone Density ; Eating ; Humans ; Life Style ; Meals ; Osteoporosis ; Smoke ; Smoking

PURPOSE: To evaluate the treatment results and prognostic factors after radiotherapy in stage IIB uterine cervix cancer. MATERIALS AND METHODS: We retrospectively analyzed the records of 90 patients with stage IIB uterine cervix cancer who received radiotherapy between 9/94 and 12/99. Age was ranged from 28 to 79 years (median 57). Tumor size was > or = 4 cm in 64 patients. Preteatment SCC level was measured in 76 patients. Twenty nine patients received conventional radiotherapy (QD) and the others received modified hyperfractionated radiotherapy (BID). Only 7 patients in BID had tumor size <4 cm. All patients received high dose rate brachytherapy (4 Gy x 7 or 5 Gy x 6). No patient received concurrent chemotherapy during radiotherapy. Follow up period was ranging from 9 to 76 months (median 38). RESULTS: The 5-year overall and disease free survival rates were 73.4% and 71.6%, respectively. Local recurrences occurred in 10% of patients, and distant metastasis in 18.9%. There was a significant correlation between OS/DFS and tumor size (<4 cm; OS 95.2%, DFS 91.4%, > or = 4 cm; OS 63.4%, DFS 63.4%). Pretreatment SCC level was one of prognostic factors only in univariate analysis. CONCLUSION: With modified hyperfractionated radiotherapy, there was very low local recurrence rate (6.6%) and high 5-year overall and disease free survival rate (75.4% and 70.5%), which is comparable to results after concurrent chemoradiotherapy in bulky, locally advanced stage IIB uterine cervix cancer.
Brachytherapy ; Cervix Uteri* ; Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies

No abstract available.
Congenital Hypothyroidism* ; Diagnosis* ; Prognosis*

BACKGROUND: The mechanically ventilated patient's stay in the emergency department (ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications far the ventilated patient. So, sedation is necessary to reduce these complications. METHODS: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level (Ramsay's sedation score: 2-5 points, Glasgow coma score scathe : 8-11 points). RESULTS: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. CONCLUSION: A short-term continuous infusion of midazolam was a safe and erective method for sedation of ventilated patients in ED.
Anxiety ; Blood Pressure ; Coma ; Dihydroergotamine ; Emergency Service, Hospital ; Heart Rate ; Humans ; Midazolam* ; Respiratory Rate

BACKGROUND: Vasoconstrictors have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an 2-receptor agonist has been shown to prolong the duration of spinal anesthesia following intrathecal administration. Bupivacaine has been used for spinal anesthesia and compared with tetracaine in recent studies. We have undertaken this study to further evaluate the effect of clonidine in hyperbaric 0.5% bupivacaine spinal anesthesia. METHODS: Thirty patients who were scheduled for lower limb or urologic operation were divided into 2 groups: Group A (hyperbaric bupivacaine 13 mg, 2.6 ml + N/S 1 ml), Group B (hyperbaric bupivacaine 13 mg, 2.6 ml + clonidine 150 g, 1 ml). We used standardized techniques and injected above drugs to group A and B intrathecally for spinal anesthesia. We investigated the onset and the duration of spinal anesthesia along with hemodynamic changes (blood pressure and heart rate) in patients. RESULTS: There were no significant differences in the onset of spinal anesthesia and hemodynamic changes between two groups. The time taken to recover from the nerve block was more prolonged in the group B (touch 225, pain 262, foot dorsiflexion 271, knee flexion 290 minutes) than group A (touch 154, pain 188, foot dorsiflexion 198, knee flexion 216 minutes). There were no significant differences in sedation, and in experiencing dry mouth and other side effects between two groups. CONCLUSION: Intrathecal clonidine 150 g has been proved to prolong the duration of hyperbaric 0.5% bupivacaine spinal anesthesia without neurotoxicity or dangerous hemodynamic depression. Therefore, clonidine can be used as an effective adjunct in hyperbaric bupivacaine spinal anesthesia.
Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Clonidine* ; Depression ; Foot ; Heart ; Hemodynamics ; Humans ; Knee ; Lower Extremity ; Mouth ; Nerve Block ; Tetracaine ; Vasoconstrictor Agents

BACKGROUNDS: This study was performed to determine the onset time and dose of intranasal midazolam used for preanesthetic sedation in children. METHODS: The children were randomly allocated to recieve one of three medications via the nasal route in a double blind manner. Group I: patients were given normal saline 0.2 ml/5kg, Group II: patients were given midazolam 0.2 mg/kg, Group III: patients were given midazolam 0.3 mg/kg. RESULTS: The cardiovascular and SpO2 changes were not significantly different among the patients of the three groups. The sedation score was greater in group II compared with group I from 5 minute after administration (1.9 vs 2.7, p<0.05). postanesthetic recovery score (PARS) was not significantly different among the three groups. CONCLUSIONS: It is suggested that intranasal midazolam (0.2 mg/kg) produces anxiolysis and sedation in children with rapid onset.
Child* ; Humans ; Midazolam*

BACKGROUND: Papillary thyroid cancer has a high frequency of lymph-node metastasis, but the methods for detecting and treating of lymph-node metastases remains controversial. We reviewed clinical analyses for lymph-node metastases. METHODS: Were retrospectively reviewed charts of 120 patients with papillary thyroid cancer who were treated from July 1994 to February 1997. Clinical aspects and the relationship between age, sex, tumor size, extracapsular invasion, multicentricity of the tumor and lymphadenopathy and the rate of lymph-node metastasis were investigated. RESULTS: Modified neck dissection was done in 97 patients, and lymph node metastases were detected in 72 patients (74.2%). Lymph-node meatastases were detected in 3 patients during routine central compartment neck dissection. The overall lymph-node metastasis was 62.5% (75 of 120). The mean number of metastastic nodes was 5.67, and the most frequent site was level VI. Lymph-node metastases were more frequent at a young age and for large sized tumors, extracapsular invasion and preoperatively palpable lymphadenopathy. CONCLUSIONS: The lymph-node metastatic rate is high for preoperatively palpable lymph node, tumor sizes over 4 cm, and extracapsular invasion (p<0.05). To reduce the recurrence rate, the surgeon shoud do a modified neck dissection on such above patients.
Humans ; Lymph Nodes* ; Lymphatic Diseases ; Neck Dissection ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. METHODS: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gentry. When the blind loop was fecund at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-aspen-diceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. RESULTS: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by US, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tenderness on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tenderness were observed far 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. CONCLUSIONS : In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an actuate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal Cf scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.
Abdomen ; Abdominal Pain ; Abscess ; Appendicitis* ; Appendix ; Diagnosis ; Early Diagnosis* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Laparoscopes ; Laparotomy ; Physical Examination ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography*