The purpose of this study was to investigate the compliance and need for diet therapy among diabetics and their caregivers. A total of 625 respondents participated in this survey. Appropriate management for long-term blood glucose control and difficult-to-manage cases appeared to be diet therapy, physical activity, medical treatment and folk remedies, in that order. The most important educational avenues for diet therapy were books, magazines and TV. Most respondents were educated in diet therapy within a year after diagnosis and had practiced diet therapy for over four years. The most common diet therapy practices were food selection and quantity control. Of the specific problems in practicing diet therapy, time and labor, taste, and meal planning appeared to be equally difficult factors. The prevailing diet therapy skills were controlling food amounts at breakfast and supper, and selecting food for lunch and refreshments. Respondents practicing both skills were about 20% of the participants; this shows the need to improve the current situation. The nutrients most frequently considered in diet therapy practice were simple sugars (sugar and sweet foods), total fats and cholesterol. Since the perception of the role of dietary fiber among respondents was very low, nutrition education about the importance of dietary fiber and food sources of dietary fiber was needed. Diabetics seemed to be concerned about diabetic menus. Three difficult problems in planning diabetic menus were daily menu planning, patient's preferences, and the calculation of calories. As a means of nutrition counseling, they preferred interviews. The higher the educational status and the lower the age, the higher the preference was for internet or PC counseling. Therefore, it is necessary to develop nutrition educational programs so that diabetics can obtain practical knowledge of diet therapy. Furthermore, it is also necessary to develop additional means of informing diabetics about menu planning, while still considering Korean dietary behavior.
Blood Glucose ; Breakfast ; Carbohydrates ; Caregivers* ; Cholesterol ; Compliance* ; Counseling ; Surveys and Questionnaires ; Diagnosis ; Diet Therapy* ; Diet* ; Dietary Fiber ; Education ; Educational Status ; Fats ; Food Preferences ; Humans ; Internet ; Lunch ; Meals ; Medicine, Traditional ; Menu Planning ; Motor Activity ; Periodicals as Topic

Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent ; Dyspnea ; Electrophysiologic Techniques, Cardiac ; Fascia ; Female ; Heart Block ; Humans ; Incidence ; Polyethylene Terephthalates ; Syncope

The only clinically avilable levo-isomer type of beta-recepter blocker is penbutolol sulfate, and it is already accepted as one of beta-receptor blockers for initial antihypertensive drug therapy according to the report of 1988 Joint National Committee on Detection, Evaluation, and Tratment of High Blood Pressure. To evaluate the antihypertensive efficacy, effect on the quqlity of life, and side effects of penbutolol recently introduced into Korea, penbutolol was administered to 29 essential hypertensive(mild 9, moderate10, and severe 10) patients for 12 weeks or longer. The result of the clinical analysis are as follows; 1) The mean age was 50.0+/-10.9(M+/-SD), and the sex distribution between male and female was16:13. 2) The blood pressure lowering effects of penbutolol as a monotherapy were marked in 16, moderate in 6, and insignificant in 2 cases. The systolic blood pressure was significantly decreased from 179.1+/-20.2 to 135.4+/-16.5mmHg(P<0.005), and the diastolic blood pressure from 112.6+/-13.5 to 84.0+/-11.9mmHg(P<0.005)after 12 weeks' penbutolol therapy. 3) The heart rate was significantly decreased from70.3+/-13.3 to 65.5+/-9.1 per minute(P<0.05). 4) The quality of life was improved markely in 5(17.2%) and slightly in 8 cases(29.6%). 5) There were no significant laboratory changes after 12 weeks' penbutolol therapy. 6) Two out of three cases with non-specific ST segment and T wave changes in EKG and two out of 9 cases with EKG were normalized, 2 cases of LAH with strain were improved. 7) The side effects of penbutolol were dizziness in 4, sexual dysfunction in 2, and skin rash in 1 case. 8) Final multifarious assessment of penbutolol therapy showed that it was very useful in 11(37.9%), useful in 4(13.8%) and slightly useful in 7 cases(24.1%). These reult suggest that penbutolol is a first-line antihypertensive agent with an effective antihypertensive action, improving quality of life, with no significant laboratory changes and few side effects.
Blood Pressure ; Dizziness ; Drug Therapy ; Electrocardiography ; Exanthema ; Female ; Heart Rate ; Humans ; Hypertension ; Joints ; Korea ; Male ; Penbutolol ; Pheniramine ; Quality of Life ; Sex Distribution

In cases of atherosclerotic occlusion of coronary artery, is it appropriate to conclude that myocardial infarction is the true cause of death? More sensitive and specific diagnostic methods for the postmortem diagnosis of myocardial infarction are sometimes necessary because macroscopic or microscopic changes associated with early-phase acute myocardial injuries or myocardial infarct are sometimes absent in sudden cardiac death. Postmortem biochemical assessment of cardiac markers may help to evaluate the pathological cardiac status in sudden unexpected death without obvious cause. However, forensic pathologists are generally interested only in the macroscopic and microscopic findings for postmortem diagnosis of myocardial diseases and hesitate to use postmortem biochemical data because of the risk of postmortem changes. There are several clinically useful cardiac markers antemortem cardiac events such as myocardial injuries, infarct, or heart failure and postmortem data on cardiac markers in autopsy cases of sudden death have been reported. This review of postmortem data on cardiac markers in blood, other body fluids, and myocardial tissue will serve to introduce the recent international research trends and provide a foundation for a new field in postmortem biochemistry.
Autopsy ; Biochemistry ; Body Fluids ; Cardiomyopathies ; Coronary Vessels ; Death, Sudden ; Heart Failure ; Myocardial Infarction

Scabies is a skin disease caused by the parasite Sarcoptes scabiei var. hominis, primarily transmitted via direct skin or sexual contact or, less commonly, via contact with infested fomites. In Korea, the incidence of scabies has decreased from approximately 50,000 people/yr in 2010 to approximately 30,000 people/yr in 2021. However, outbreaks have been consistently observed in residential facilities, such as nursing facilities, particularly among the older population. The clinical manifestations of scabies vary depending on a patient’s age, health status, number of mites, and transmission route. Typical clinical presentations of classic scabies include intense nocturnal pruritus and characteristic skin rashes (burrows and erythematous papules), with a predilection for the interdigital web spaces, inner wrists, periumbilical areas, axillae, and genital areas. Unlike classic scabies, older adults with immunodeficiency or neurological disorders exhibit hyperkeratotic scaly lesions or an atypical distribution with mild-to-non pruritus (crusted scabies). Diagnosis of scabies is based on clinical symptoms and results of diagnostic tests aimed at identifying the presence of the parasite. Although a close contact history and characteristic clinical findings are suggestive of scabies, confirmation of diagnosis requires detection of scabies mites, eggs, or scybala.This can be achieved through light microscopy of skin samples, non-invasive dermoscopy, and other high-resolution in vivo imaging techniques.

For all suspected, clinical, or confirmed cases of scabies, treatment should be initiated. Affected patients should be adequately isolated, and high-risk groups with close contact histories should be treated irrespective of their symptoms. Optimal treatment strategies can be selected based on age, clinical subtype, and patient’s health status. In Korea, commercially available preparations for scabies treatment include topical 5% permethrin, topical 10% crotamiton, and oral ivermectin. Topical 5% permethrin is the first-line selective treatment for both classic and crusted scabies. Alternative treatments are topical 10% crotamiton and oral ivermectin. Following treatment completion, a follow-up visit at 2 and 4 weeks is recommended to monitor therapeutic response. Treatment failure is considered when scabies mites or burrows are detected, upon development of new clinical characteristics, or upon aggravation of pruritus. Scabies itch should be adequately managed with emollients, oral antihistamines, and topical corticosteroids. Preventive measures, including personal hygiene, patient education, and environmental control should be rendered to reduce the transmission of scabies.

PURPOSE: Chronic constipation is not uncommon even in children. Recently biofeedback treatment (BT) is considered as a useful modality in the treatment of various types of constipation. The aim of this study was to evaulate the effectiveness of BT in children with chronic constipation. METHODS: We reviewed 24 cases of childhood constipation (17 boys, 7 girls) who visited the Jinju Hakmoon colorectal surgery clinic and GNUH1 between April, 2001 and September, 2002. Balloon-mediated anorectal manometry system was used for BT. The effects of therapy was assessed by bowel movement, defecation time, fecal soiling and balloon evacuation test in the early course of therapy. The long term follow up survey was done by telephone interview at January 2003 and the effects of therapy was assessed by bowel movement, defecation time, fecal soiling and parents' satisfaction. RESULTS: Patients received the BT for the three times on average, and as the result of the therapy, 20 patients experienced disappearance of symptoms (87%) or at least improvement of symptoms. In terms of manometric values, the mean resting pressure was 113.4 mmHg before the BT, but decreased to 86.3 mmHg after the BT (P=0.0012). Mean pushing pressure dropped to 85.98 mmHg from 130.45 mmHg (P=<0.0001). Mean sensitivity decreased from 55 ml to 35 ml (P=0.0053). Mean compliance decreased from 20.28 H2O/cm to 4.21 H2O/cm (P=0.0015). 13 patients (76%) showed disappearance or improvement of symptoms in the long term follow up. CONCLUSIONS: The Balloon mediated biofeedback therapy is effective in children with chronic constipation. It is safe, easy to administer and also improve symptoms and objective parameters of anorectal function. Balloon mediated biofeedback therapy could be the first-line therapy in child patient with chronic constipation who failed conservative management.
Biofeedback, Psychology* ; Child* ; Colorectal Surgery ; Compliance ; Constipation* ; Defecation ; Follow-Up Studies ; Gyeongsangnam-do ; Humans ; Interviews as Topic ; Manometry ; Soil

Background/Aims: Tegoprazan is a novel potassium-competitive acid blocker that has beneficial effects on acid-related disorders such as gastroesophageal reflux and peptic ulcer diseases.This study aimed to validate the effect of tegoprazan on endoscopic submucosal dissection (ESD)-induced artificial ulcers. Methods: Patients from 16 centers in Korea who underwent ESD for gastric neoplasia were enrolled. After ESD, pantoprazole was administered intravenously for 48 hours. The patients were randomly allocated to either the tegoprazan or esomeprazole group. Tegoprazan 50 mg or esomeprazole 40 mg were administered for 4 weeks, after which gastroscopic evaluation was performed. If the artificial ulcer had not healed, the same dose of tegoprazan or esomeprazole was administered for an additional 4 weeks, and a gastroscopic evaluation was performed. Results: One hundred sixty patients were enrolled in this study. The healing rates of artificial ulcers at 4 weeks were 30.3% (23/76) and 22.1% (15/68) in the tegoprazan and esomeprazole groups, respectively (p=0.006). At 8 weeks after ESD, the cumulative ulcer healing rates were 73.7% (56/76) and 77.9% (53/68) in the tegoprazan and esomeprazole groups, respectively (p=0.210). Delayed bleeding occurred in two patients in the tegoprazan group (2.6%) and in one patient in the esomeprazole group (1.5%). Other adverse events were negligible in both groups. Conclusions Tegoprazan showed similar effects on post-ESD artificial ulcer healing in comparison with esomeprazole.

OBJECTIVE: Anterior abdominal wall defects are classified into three basic types: omphalocele, gastroschisis and bodystalk anomaly. Its incidence and prognosis are different according to each type of anomaly. We aimed at investigating its demographic characteristics and risk factors. METHODS: From Jan. 1996 to Jun. 2002, 20 cases of anterior abdominal wall defects were diagnosed by prenatal ultrasonography and all ultrasonographic findings and delivery records were reviewed. RESULTS: We had experienced 13 cases of omphalocele, 5 cases of gastroschisis and 2 cases of bodystalk anomaly. Mean maternal age was 29.9 (+/-5.5) years in omphalocele, 25.6 ( +/- 1.7) in gastroschiss, 32 ( +/- 4.2) in bodystalk anomaly. The median gestational weeks at the time of diagnosis was 17.6 for omphalocele, 20 for gastroschisis, 14.5 for bodystalk anomaly. Live born cases were 3 in omphalocele, 1 in gastroschisis and none in bodystalk anomaly. Of the 13 cases of chromosomal analyses, there was one case of trisomy 18 in omphalocele. Multiple anomalies were found in all bodystalk anomalies including kyphoscoliosis, facial defect, central nervous system defects. 54% of associated anomalies were found in omphalocele and no associated anomaly in gastroschisis. CONCLUSION: Omphaloceles were most frequently detected in abdominal wall defects and the gastroschisises were the next. Our results suggested that the pathogenesis of anterior abdominal wall defect might be different one another, but we could not find out definite risk factors for the individual type of defect.
Abdominal Wall* ; Central Nervous System ; Diagnosis ; Gastroschisis ; Hernia, Umbilical ; Incidence ; Maternal Age ; Prognosis ; Risk Factors ; Trisomy ; Ultrasonography, Prenatal

BACKGROUND AND OBJECTIVES: The coronary sinus (CS) is a small tubular structure just below the tricuspid valve. The dilatation of the coronary sinus as well as the inferior vena cava and the hepatic vein may provide echocardiographic signs of systemic congestion. The aim of this study was to evaluate the correlation of size of coronary sinus that had abnormal echocardiographic findings with or without congestive heart failure. SUBJECTS AND METHODS: Echocardiographic examinations of coronary sinus were performed on 58 patients (M : F=20 : 38) who had abnormal echocardiographic findings with current or previous symptoms or signs of congestive heart failure (group 1), and on 63 patients (M:F=27:36) who had abnormal echocardiographic findings but that had never had symptoms or signs of heart failure(group 2) and 94 healthy volunteers (control group, M:F=52:42). The CS was mesured using a two-dimensional echocardiogram in the right ventricular inflow view (5-10 mm below the Thebesian valve at end-systolic phase). RESULTS: In the normal control group, the median size of the CS was 6.2+/-1.2 mm, and showed no difference between gender and age. The sizes of the CS in groups 1 and 2 were 9.0+/-2.3 and 6.4+/-1.3 mm, respectively. There were differences between groups 1 and the normal control group (p<0.001), and between groups 1 and 2 (p<0.001), but a slight change between group 2 and the normal control group. In group 1, the size of the coronary sinus was related with the duration of heart failure (r=0.32, p=0.016), but no correlations to body surface area, left ventricle dimension and TR peak velocity were shown. In the presence of heart failure, as diagnosed according to the size of the CS, the predictive value was high when the size of the CS exceeded 8.0 mm, with an accuracy of 84%. In heart failure, the median size of the IVC was 16.6+/-5.4 mm, the variation rate of the IVC during the respiratory cycle was 0.40+/-0.13, and the variation rate of the CS during cardiac cycle was 0.31+/-0.20. The size of the CS was not related with the size of the IVC, but there was an inverse correlation between the size of the IVC and its variation rate (r=-0.434, p=0.037). The size of the IVC was inversely correlated with the variation rate of the CS (r=-0.490, p=0.024). There was a correlation between the variation rate of the CS and that of the IVC (r=0.411, p=0.021). Comparing the groups with and without systolic flow reversal into the CS in congestive heart failure patients with tricuspid regurgitation, in the former there wrer distensions of the CS, IVC and LA dimensions and reductions in the variation rates of the CS. CONCLUSION: The measurement of the size of the CS and the variation rate of CS may provide valuable information concerning the presence and duration of congestive heart failure.
Body Surface Area ; Coronary Sinus* ; Dilatation ; Echocardiography ; Estrogens, Conjugated (USP) ; Healthy Volunteers ; Heart Failure* ; Heart Ventricles ; Heart* ; Hepatic Veins ; Humans ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Vena Cava, Inferior