BACKGROUND: Established risk factors for coronary artery disease include smoking, hypertension, diabetes mellitus and hypercholesterolemia. However, these account for less than 50% of the actual incidence of coronary artery disease and the importance of other risk factors is being increasingly realized. It has been known that insulin resistance associated with hyperinsulinemia is a pivotal link to several risk factors of coronary artery disease, including hypertension, glucose intolerance, dyslipidemia and obesity. Recently both experimental and clinical studies have produced evidence suggesting that high plasma insulin level may promote the development of atherosclerotic vascular diseasa. Several prospective studies showed independently that high plasma insulin is associated with an increased risk of major coronary artery disease. In our study, plasma glucose, insulin and C-peptide level were determined with oral glucose tolerance test to assess the insulin resistance or hyperinsulinemia as a risk factory of coronary artery disease. METHOD: From September 1993 to April 1995, after excluding patients with hypertension, diabetes mellitus, hypercholesterolemia and obesity, 17 patients with significant coronary artery stenosis and 10 control subjects with normal coronary finding were selected among the 226 patients who undertook coronary angiography. In the 17 cases(M:F=15:2) of coronary artery disease group, the mean age was 54+/-10 years, and in the 10 cases(M:F=8:2) of control group, 51+/-9 years. All were matched for age, gender and body mass index. Blood pressure, lipid and lipoprotein were measured and smoking history was assessed. Glucose, insulin and C-peptide responses to oral glucose tolerance test were also determined. RESULT: 1) There was no significant difference in systolic and diastolic and diastolic blood pressure, total-cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ApoA and smoking history except ApoB between the subjects with coronary artery disease and normal control subjects. 2) In oral glucose tolerance test, the plasma glucose levels were not significantly different in the two groups. plasma insulin and C-peptide levels at 60 and 120 minutes were higher in the patient group than control, but the results lack statistical significance. The area under the insulin curve and C-peptide curve were larger in patient group than control, but the result lack statistical significance also. CONCLUSION: Although our study dose not prove the hypothesis that insulin resistance or hyperinsulinemia is statistically an independent risk factor for coronary artery disease, this study showed the tendency of insulinresistance to be correlated with development of coronary artery disease. As this study has limitations due to small sample size, further study is required to confirm the role of hyperinsulinemia using a larger sample size.
Apolipoproteins A ; Apolipoproteins B ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Peptide ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Dyslipidemias ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hypercholesterolemia ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Lipoproteins ; Obesity ; Plasma ; Prospective Studies ; Risk Factors* ; Sample Size ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Alexithymia refers to a specific disturbance in psychic functioning characterized by difficulties in capacity to verbalize affect and to elaborate fantasies. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. OBJECTIVE: The present study was to evaluate the relationship between the alexithymia and bronchial asthma, and to compare the results with finding from a group of acute infectious illness subjects. MATERIAL AND METHOD: Alexithymia was measured with on Korean translation of the TAS-20 (Toronto Alexithymic Scale-20 Korea version) and the Scored Archetypal 9 Test(SAT9). Thirty patients with bronchial asthma and thirty patients with acute infectious illness completed these tests. The SAT9 and the TAS-20K scores were compared in the both group, considering the age, gender, education level, and duration of illness. RESULT: Bronchial asthma patients had significantly higher score of on the TAS-20K and SAT9 compared with those with infectious illness(p<0.05). The two scales correlated in expected direction. Alexithymia was significantly related to education level(SAT9: r=0.335, TAS-20K: r=-0.376, p<0.01) and duration of illness(asthma group, SAT9: r=-0.383, TAS-20K: r=0.288, p<0.05). CONCLUSION: Bronchial asthma patients had significantly higher alexithymic scores. This finding suggests that psycliathic consultation may be considered for the management of asthmatic patients with alexithyria.
Affective Symptoms* ; Asthma* ; Education ; Fantasy ; Humans ; Korea ; Weights and Measures

Polyarteritis nodosa is systemic necrotizing vasculitis of medium and small-sized arteries and results in variable manifestations due to ischemia of the involving organs. Diagnosis can either be made pathologically by demonstrating necrotizing vasculitis of arteries or angiographycally by demonstrating small arterial aneurysm. We experienced a case of PAN with dilated cardiomyopathy, confirmed by clinical feature, renal biopsy, angiography and echocardiography.
Aneurysm ; Angiography ; Arteries ; Biopsy ; Cardiomyopathy, Dilated* ; Diagnosis ; Echocardiography ; Ischemia ; Polyarteritis Nodosa* ; Vasculitis

Behcet's syndrome has been known as a disease which has the triple symptoms such as recurrent orogenital ulceration and eye inflammation. The syndrome is now recogninized as a multisystem disease involving mucocutaneaous, cardiovascular, central nervous system, renal, articular and gastrointestinal system. The vascular involvement in Behcet's disease has been reported since Mischima first described the case in 1961, four types of vascular lesion are recognized ; arterial occlusion ; aneurysm ; venous occlusion ; and varices. Venous occlusion are frequently observed, most commonly in the inferior or superior vena cava. We report a case of Behcet's disease manifested as superior vena cava syndrome due to thrombus on both brachiocephalic veins.
Aneurysm ; Behcet Syndrome* ; Brachiocephalic Veins ; Central Nervous System ; Inflammation ; Superior Vena Cava Syndrome* ; Thrombosis ; Ulcer ; Varicose Veins ; Vena Cava, Superior*

The purpose of nursing education is to prepare the professional practitioner as nurse who will be interested in the health and the related aspects of community and will assume responsibility for contributing toward the improvement of the health for the all. This means that nursing education must provide opportunities for the development of knowledge, skills, and attitudes which make this possible. Consequently, this approach has relevance for nursing education. Faculty engaged in endless debates about what is to be included, and to what death, and what will be given short shrift as a result. Thus, it can be seen why there is so much confusion and lack of agreement between the emphasis and objectives in nursing. This study attempted to review and identify the curriculum content of child nursing in Korea to build and develop the standard curriculum contents for national board examination for nurses and child's health needs for the coming 21st century. The questionnaire was consisted of items for selection and organization of the knowledge components and type of unit with weigh to be attained in child nursing. Response of 34% of nursing program in university and junior college. Content analysis was done by using consensual validation of essential knowledge for curriculum content to identify what is obvious or trivial. This study pointed out that it is not yet apparent that demographic fact has greatly influenced child nursing curriculum content. In a similar vein the majority of content of child nursing devote little time and weigh to social and epidemically significant to child health. It seems to be needed that the content of child nursing may push the paradigm shift in nursing education such as health promotion and prevention for postretinal roles of child and family. In conclusion, it is time to convoke and content and standardization on job analysis for national board exam for nurses in Korea.
Child* ; Curriculum* ; Education, Nursing ; Health Promotion ; Humans ; Korea* ; Nursing* ; Veins ; Child Health ; Surveys and Questionnaires

PURPOSE: The objective of this study was the development and validation of a scale to measure the self-care of patients with chronic obstructive pulmonary disease(COPD) in Korea. METHOD: Self-care scale was developed based on the self-care activities patients had to carry out in order to manage their COPD. The original scale contained 34 items rated along a five-point Likert scale and was reviewed by 18 professional nurses and 10 Korean patients with COPD for content validity. Subsequently, patients with COPD were asked to complete this 23-item scale and further tests were done with the 125 useable responses. RESULT: Factor analysis identified eight factors- "maintaining a clean air way", "taking medication", "support from family", "preventing infection", "managing symptoms", "breathing exercising", and "taking in nutrition". The internal consistency of the total scale was Cronbach's alpha=0.7226. These eight factors explained 60.8% of total variance. There was correlation among Korean Self-Care Scale score, administration level, and knowledge level but there was no correlation to patients' satisfaction with medical services. CONCLUSION: The 23 item questionnaire positively identified 8 areas defined important for COPD patients. Further studies are required to see how these can be integrated into patient education.

OBJECTIVE: Serologic support is important for the diagnosis of rheumatoid arthritis (RA). Anti-cyclic citrullinated peptide (anti-CCP) has relatively low sensitivity despite of high specificity for the diagnosis of RA. Anti-mutated citrullinated vimentin (anti-MCV) is an indirect solid phase enzyme immunoassay for the quantitative measeurement of IgG class autoantibodies against MCV, a novel serologic marker for an aid in the diagnosis of RA. We investigated a diagnostic value of anti-MCV in comparison with those of anti-CCP, and rheumatoid factors (IgM, IgG, and IgA RFs) in RA patients. METHODS: Cohorts of 48 patients with RA and 50 patients with osteoarthritis (OA) were enrolled. All patients underwent standard examinations, including anti-MCV, anti-CCP, IgM RF, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). We measured IgG RF and IgA RF titers in 21 RA and 50 OA patients. The sensitivities and specificities of anti-MCV, anti-CCP, RFs were determined. Correlations with these markers, ESR and CRP were analyzed. RESULTS: The sensitivity of anti-MCV, anti-CCP, and IgM RF were 89.6%, 89.6%, and 77.1%, respectively. The specificities of them were 96.0%, 96.0%, and 88%, respectively. Combination of two tests such as anti-MCV or anti-CCP positivity increased the sensitivity up to 93.8%. None of these markers showed significant correlation with ESR and CRP. Anti-MCV correlated with anti-CCP (r=0.596, p<0.01) and IgM RF (r=0.301, p=0.038). CONCLUSION: Anti-MCV and anti-CCP showed high sensitivity and specificity for the diagnosis of RA. Combination of these markers increased the sensitivity without significant decrease in the specificity, suggesting they may be promising serologic markers for RA.
Arthritis, Rheumatoid* ; Autoantibodies ; Blood Sedimentation ; C-Reactive Protein ; Cohort Studies ; Diagnosis ; Humans ; Immunoenzyme Techniques ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Osteoarthritis ; Rheumatoid Factor* ; Sensitivity and Specificity ; Vimentin*

The distribution of enkephalin, dynorphin, substance P and neurotensin in the periaqueductal gray[PAG] has been well established by immunohistochemical methods. However, there is little information about the regional distribution of these neuropeptide mRNA-containing neurons in the PAG. The present study was undertaken [1] to elucidate the distribution of these neuropeptide mRNA-containing neurons and to determine of the PAG, [2] to know how peptide expression relates to the proposed functional subdivisions of the PAG and [3] to know how neuropeptide mRNA levels in the PAG change following peripheral neuropathy The results obtained are as follows ; 1. Preproenkephalin[pENK] mRNA-containing neurons are found mostly in the ventrolateral portion at all levels of the PAG. 2. Prodynorphin[pDYN] mRNA-containing neurons are concentrated mostly in the ventrolateral portion at the caudal level of the PAG. 3. Preprotachykinin[pTAK] mRNA-containing neurons are localized mainly in the ventrolateral portion at all levels of the PAG. There is small numbers of pTAK mRNA-containing neurons in the dorsolateral and dorsal portion at all levels of the PAG. 4. Proneurotensin[pNT] mRNA-containing neurons are concentrated mostly in the medial part of ventrolateral portion of the caudal and mid PAG. 5. Peripheral neuropathy induces an increase of pNT mRNA levels in the PAG, while pENK, pDYN and pTAK mRNAs levels show no change. The present results indicate that the pENK, pDYN, pTAK or pNT mRNA-containing neurons are found mainly in the ventrolateral PAG, the area where analgesia is most easily produced and that neurotensin in the PAG may play an important role in modulating chronic neuropathic pain.
Analgesia ; Animals ; Dynorphins ; Enkephalins ; Gene Expression* ; In Situ Hybridization ; Neuralgia* ; Neurons* ; Neuropeptides* ; Neurotensin ; Periaqueductal Gray* ; Peripheral Nervous System Diseases ; Rats* ; RNA, Messenger ; Substance P

The purpose of this project is to implement "Homecare Nursing Network System" using wireless network which was able to manage homecare service efficiently. Therefore, by completing the project of "Homecare Nursing Network System", the research team connected the headquarter and the local homecare service offices over the Internet, and built the database and application programs to operate the offices. Homecare nurses are using the PDA(personal digital assistant) in order to provide homecare nursing service, to record the patients' data, and to send and receive the data in real time. It results in improving the quality of the homecare service through the computerized knowledge-based assess and intervention algorithms. The team also has implemented the homepage to introduce the homecare office and to provide the homecare service information. "Homecare Nursing Network System" allows us to manage homecare nursing service under the computerized environment, to keep track of the homecare nursing document efficiently, to improve the quality of homecare nursing, and to expand its business territory.
Commerce ; Internet ; Nursing Services ; Nursing*

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.
Cerebrovascular Disorders ; Classification ; Education ; Emergencies ; Home Care Services* ; Home Care Services, Hospital-Based ; House Calls ; Humans ; Korea ; Nursing Care ; Nursing Services* ; Nursing* ; Public Health ; Quality Control ; Referral and Consultation ; Respiration ; Seoul ; Skin ; Transportation