BACKGROUND: Biochemical bone markers have been suggested to reflect postmenopausal high bone turnover. These markers could be useful in following response to hormone replacement therapy (HRT). But we have few studies about the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, and it is unclear whether women with early menopause have different response to HRT from women with normal menopause. The aims of the present study were to see the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, to examine whether a single baseline biochemical bone marker or a change in biochemical bone marker could predict subsequent bone mass, and to determine the difference of response to HRT between women with early menopause and women with normal menopause. METHODS: Postmenopausal women (n=21) were divided with into three groups according to their age at menopause (AAM): the first group with AAM < or = 43 years (early menopause group, n=7), the second group with 43 years < or = AAM < or = 50 years (n=4), and the third group with AAM > or = 50 years (normal menopause group, n=10). For the HRT, conjugated estrogen (0.625mg per day) and continuous or cyclic medroxyprogesterone (2.5-10mg per day) were administered. Bone mineral density (BMD) was measured at baseline and 12 months and biochemical bone markers were measured at baseline and 3, 6, and 12 months during HRT. RESULTS: Deoxypyridinoline, type 1 collagen N-telopeptide, bone alkaline phosphatase, and osteocalcin were significantly decreased at 3 months, and mean percent changes from baseline of bone resorption markers were larger than those of bone formation markers. At 12 months, BMD was significantly increased at lumbar spine and Ward's triangle. But BMD was not significantly increased at femur neck and femur trochanter. Two baseline bone markers (bone alkaline phosphatase and type 1 collagen N-telopeptide) correlated with changes of BMD but any changes of bone markers at 3, 6 months didn't correlate with changes of BMD. In early menopause group, changes of bone markers and BMD were larger than those in normal menopause group, but the difference between the two groups was not significant. CONCLUSION: All four bone markers showed significant reduction at 3 months, but bone resorption markers were decreased more markedly and rapidly, and some baseline bone markers can predict the change of BMD after HRT. The difference of response to HRT between early menopause group and normal menopause group was not significant.
Alkaline Phosphatase ; Bone Density* ; Bone Resorption ; Collagen Type I ; Estrogens ; Female ; Femur ; Femur Neck ; Hormone Replacement Therapy* ; Humans ; Medroxyprogesterone ; Menopause ; Osteocalcin ; Osteogenesis ; Spine

BACKGROUND: QT dispersion(QTd) has been shown to be ventricular electrical instability, especially predictor of ventricular arrythmia and indicator of antiarrythmic effect. It was reported that there was a relationship between acute myocardial infarction and increased QTd in that QTd is dependent of the degree of reperfusion as well as the site and size of infarction. In this study, we intended to verify a significant association between myocardial ischemia and QTd by comparing the changes in QTd with or without chest pain in patients with unstable angina who had proven myocardial ischemic changes. METHOD: We studied 20 patients (12 men and 8 women : mean age, 58+/-3.4 years) with unstable angina who had proven myocardial ischemic changes and perfusion defect by 24 hour Holter monitoring, Treadmill test, or coronary angiography. Each case was measured QTd during chest patin and resting state 24 hours after chest pain. All standard 12-lead ECGs were recorded at a speed of 25 mm/sec and examined retrospectively by one observer. QTd corrected for heart rate (QTcd) was calculated by Bazett's formula. The difference of QTd was assessed by comparing by paired t-test. RESULTS: The mean values of QTd were 117.9+/-49.9 msec and 69.7+/-30.2 msec with existence and the absence of chest pain. There was significant increment of QTd when the paients with unstable angina had chest pain(p<0.01). QTcd also significantly increased with the mean value of 119.7+/-57.1 and 74.9+/-36.6 msec (p=0.015). CONCLUSIONS: The results of this study clarified the change of QTd with myocardial ischemia. We expect QTd using a single, noninvasive method to indicate that the chest pain is induced by myocardial ischemic changes. For the furture, it may be possible to study as to the significance of QTd as a predictor of cardiovascular accidents in patients with unstable angina by measuring the serial QTd.
Angina, Unstable ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography* ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Electrocardiography, Ambulatory ; Exercise Test ; Female ; Heart Rate ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardial Ischemia ; Perfusion ; Reperfusion ; Retrospective Studies ; Thorax

OBJECTIVE: To evaluate the effectiveness of CC+FSH or CC+hMG in intrauterine insemination (IUI) cycles for the treatment of infertility. METHOD: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days followed by hMG or FSH. A single IUI was performed at 36 h after hCG. Clinical pregnancy was classified if a gestational sac or fetal cardiac activity was seen on ultrasound. RESULTS: The overall clinical pregnancy rate was 19.1% per cycle (17/89) and 21.5% per patient (17/79). More clinical pregnancies were recorded in CC+FSH (23.1%, 6/26) than CC+hMG cycles (17.5%, 11/63), but this difference was not statistically significant. No differences were found in age, duration of infertility, follicle size, levels of estradiol (E2) on the day of hCG injection and total motile sperm counts between pregnant and non-pregnant groups. However, more ampules of gonadotropins were used in pregnant group than non-pregnant group (p<0.05). CONCLUSION: Combination of CC and hMG may economically be more effective to induce ovulation for IUI compared to CC and FSH.
Clomiphene* ; Estradiol ; Female ; Gestational Sac ; Gonadotropins ; Humans ; Infertility ; Insemination* ; Ovulation ; Pregnancy Rate* ; Pregnancy* ; Sperm Count ; Ultrasonography

OBJECTIVE: This study was designed to evaluate the effects of endogenous LH surge, GnRH agonist (GnRH-a) or human chorionic gonadotropin (hCG) as ovulation trigger on pregnancy rate by intrauterine insemination (IUI). METHOD: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days stating on the third day of the menstrual cycle followed by human menopausal gonadotropin (hMG) for ovulation induction. Follicles larger than >16 mm in diameter were present in the ovary, frequent LH tests in urine were introduced to detect an endogenous LH surge. Final follicular maturation and ovulation were induced by GnRH-a 0.1 mg (s.c.) or hCG 5,000~10,000 IU (i.m.) administration except natural ovulation. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. RESULTS: There were no differences in age, duration of infertility and follicle size, but more ampules of hMG were used in GnRH-a group compared to hCG 10,000 IU treated group (p<0.05). Lower level of estradiol (E2) on the day of hCG or GnRH-a injection was observed in hCG 10,000 IU group than other treatment groups (p<0.01). The overall clinical pregnancy rate was 19.8% per cycle (32/162) and 22.2% per patient (32/144). Pregnancy rate was higher in natural-endogenous LH surge group (37.5%, 9/24) than GnRH-a (18.8%) or hCG treated group (20.9% & 13.9%), but this difference was not statistically significant. No patient developed ovarian hyperstimulation. Abortion rate was 22.2% (2/9) in hCG 5,000 IU group. Delivery or ongoing pregnancy rate was 37.5% (9/24), 18.8% (3/16), 16.3% (7/43) and 13.9% (11/79) in endogenous LH surge, GnRH-a, hCG 5,000 IU and hCG 10,000 IU treatment groups, respectively. CONCLUSION: These results support the concept that use of natural-endogenous LH surge in stimulated cycles may be more effective to obtain pregnancies by IUI than GnRH-a or hCG administration.
Abortion, Induced ; Chorionic Gonadotropin ; Clomiphene ; Estradiol ; Female ; Gestational Sac ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Infertility ; Insemination* ; Menstrual Cycle ; Ovary ; Ovulation Induction ; Ovulation* ; Pregnancy Rate* ; Pregnancy* ; Ultrasonography

BACKGROUND: Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. METHODS: Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. RESULTS: 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. CONCLUSION: Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.
Burns ; Diabetic Neuropathies ; Diagnosis* ; Follow-Up Studies ; Foot ; Humans ; Mass Screening ; Neural Conduction ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Prevalence ; Sensation ; Sensitivity and Specificity ; Surveys and Questionnaires

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

This study was conducted to investigate the supplementary effects of Suwon 464 developed by Rural Development Administration, which has over two times of dietary fiber content compared with normal rice (Ilpum), on lipid metabolism in diabetic mice. We supplied 5 kinds of experimental diets (corn starch diet as a control (CO), Ilpum polished rice diet (IP), Ilpum brown rice diet (IB), polished rice diet (SP) and brown rice diet (SB) of Suwon 464) to diabetic mice for 8 weeks, after analyzing dietary fiber contents of 5 experimental diets. Diet intake, body weight, organ weights, and lipids levels of serum, liver and feces were measured. The dietary fiber contents in CO, IP, IB, SP, and SB diets were 1.0, 1.2, 1.4, 1.4, and 2.0% respectively. Body weight and liver and epididymal fat pad weights were lower in SB group than the other groups though there was no significant difference in diet intake among experimental groups. The concentrations of serum triglyceride was lower in SP and SB groups than CO and IP groups. The levels of hepatic total lipid and total cholesterol were significantly lower in SP and SB groups than CO group, and the level of hepatic triglyceride was lower in IB, SP and SB groups than CO group. The levels of total lipid and triglyceride excreted in feces were higher in IB, SP and SB, and the level of total cholesterol in feces was higher in SP and SB groups than CO group. These results suggested that the high dietary fiber rice (Suwon 464) decrease the triglyceride or total cholesterol concentrations of serum and liver by increasing of fecal lipid excretion in diabetic mice.
Adipose Tissue ; Animals ; Body Weight ; Cholesterol ; Diet ; Dietary Fiber* ; Feces ; Gyeonggi-do ; Lipid Metabolism* ; Liver ; Mice* ; Organ Size ; Social Planning ; Starch ; Triglycerides ; Weights and Measures

This study was carried out to investigate the supplementary effects of Suwon 464, which has over two times of dietary fiber content compared with normal rice (Ilpum), on blood glucose in diabetic mice. We supplied 5 kinds of experimental diets (corn starch diet as a control (CO), Ilpum polished rice diet (IP), Ilpum brown rice diet (IB), polished rice diet (SP) and brown rice diet (SB) of Suwon 464) to diabetic mice for 8 weeks, after analyzing dietary fiber contents of 5 experimental diets. Diet intake, body weight and contents of blood glucose, hemoglobin A(1c) and insulin were measured. The dietary fiber contents in CO, IP, IB, SP, and SB diets were 1.0, 1.2, 1.4, 1.4, and 2.0% respectively. Body weight was lower in SB group than the other groups though there was no significant difference in diet intake among experimental groups. The concentration of blood glucose in diabetic mice was lower in SB group than the other groups during the supplementary period of experimental diets. The hemoglobin A(1c) and serum insulin levels were lower in SP and SB groups. These results suggested that the brown rice of Suwon 464 with high dietary fiber can control diabetes in diabetic mice by reducing the blood glucose and hemoglobin A(1c).
Animals ; Blood Glucose* ; Body Weight ; Diet ; Dietary Fiber* ; Gyeonggi-do ; Insulin ; Mice* ; Starch

BACKGROUND: Little is known about the relative contribution of long-term glycemic variability to the risk of macrovascular complications in type 2 diabetes. This study was conducted to evaluate the effect of A1C variability on the progression of carotid artery intima-media thickness (IMT) in type 2 diabetic patients. METHODS: Among type 2 diabetic patients who visited Hallym University Sacred Heart Hospital from March 2007 to September 2009, 120 patients who had carotid artery IMT measured annually and A1C checked every three months for at least one year were analyzed. Individual A1C variability was defined as the standard deviation (SD) of five A1C levels taken every three months for approximately one year. Change in IMT was defined as an increase in IMT on follow-up measurement. The association between the SD of A1C and changes in IMT was evaluated. RESULTS: With greater A1C variability, there was a greater increase in the mean IMT (r = 0.350, P < 0.001) of the carotid artery. After adjusting for confounding factors that may influence IMT, A1C variability was significantly associated with the progression of IMT (r = 0.222, P = 0.034). However, the SD of A1C was not a significant independent risk factor for the progression of IMT in multiple regression analysis (beta = 0.158, P = 0.093). CONCLUSION: Higher A1C variability is associated with IMT progression in type 2 diabetic patients; however, it is not an independent predictor of IMT progression. Overall glycemic control is the most important factor in the progression of IMT.
Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases ; Diabetes Mellitus, Type 2 ; Follow-Up Studies ; Heart ; Humans ; Risk Factors

OBJECTIVES: Liver biopsy is an essential tool to confirm suspected diagnosis and to guide specific therapy in patients with liver disease. But, the standard percutaneous needle biopsy is contraindicated in patients with coagulopathy and large amount of ascites. The transjugular approach has been developed for these problem cases, but its efficacy and safety has not been adequately tested in korea. METHODS: We retrospectively analysed 21 transjugular liver biopsy cases, and the success rate of procedure, the adequacy of obtained specimen for diagnosis and procedure related complications were reviewed. RESULTS: The major reasons for trasjugular liver biopsy were coagulopathy(71%) and massive ascites(19%). Liver tissue was obtained successfully in 20 of 21 cases. The mean number of specimens was 3.4+/-1.1 per case and the mean size of specimen was 1.8+/-0.7mm. Pathologists reviewed and judged as adequate for diagnosis in 13 cases(65%), helpful in 6 cases(30%), and inadequate in 1 case. Minor complications such as neck pain, hematoma at puncture site, or transient fever occurred in 5 cases (23.8%) but there was no major complication or procedure-related mortality. CONCLUSION: Transjugular liver biopsy is a safe and valuable technique that provides adequate diagnostic informations in about two thirds of patients for whom conventional percutaneous biopsy is contraindicated.
Ascites ; Biopsy* ; Biopsy, Needle ; Diagnosis ; Fever ; Hematoma ; Humans ; Korea ; Liver Diseases ; Liver* ; Mortality ; Neck Pain ; Punctures ; Retrospective Studies