BACKGROUND: The high concentration of plasma total homocysteine is recently considered an independent risk factor for atherosclerosis. The purpose of this study was to provide reference ranges for plasma homocysteine levels and to investigate the relationship between plasma homocysteine and cardiovascular risk factors in healthy Korean men. METHODS: Anthropometric parameters, alcohol intake, cigarette use and nutrient intake were determined in 166 healthy men within a wide age range(30-69 yr). Serum levels of lipids, glucose and insulin levels during oral glucose tolerance test(OGTT), plasma amino acid concentrations and levels of antioxidant nutrients and enzymes were also measured. Hyperhomocysteinemia was defined as plasma homocysteine levels above the 90th percentile(> or =15micromol/L) of respective plasma homocysteine distribution in study subjects. Characteristics of hyperhomocysteinemic men(n=16) were compared to normohomocys- teinemic men(n=16) matched for age and body mass index. RESULTS: Plasma total homocysteine values ranged from 2.4 to 38.1micromol/L, a skewed, right-tailed distribution. The homocysteine levels of 25th, 50th and 75th percentile were 7.02, 9.61 and 12.4micromol/L, respectively. The mean concentration of plasma total homocysteine was 10.7micromol/L. Plasma total homocysteine level was positively correlated to body mass index, serum cholesterol and triglyceride levels and alcohol intake, but negatively correlated to serum bata-carotene concentration. In multivariate analysis, serum triglyceride level was the strongest determinant of plasma total homocysteine concentration. There were no significant differences between two groups in waist to hip ratio, alcohol intake, cigarette use, blood pressure and serum levels of glucose and insulin during OGTT. Hyperhomocysteinemic men had significantly higher mean values of serum triglyceride(258mg/dl), total cholesterol(226mg/dl), and LDL-cholesterol(140mg/dl) than normohomocysteinemic men. Hyperhomocysteinemic men showed a decrease in lipid corrected values of serum bata-carotene and alpha-tocopherol and plasma concentrations of serine and taurine, when compared to normohomocysteinemic men. The mean intakes of vitamin B6, folate, vitamin B12 and bata-carotene tended to decline by 25-30% in hyper- homocysteinemic group, when compared to normohomocysteinemic group. CONCLUSION: Our results indicate that healthy Korean men with hyperhomocys- teinemia show signs of hyperlipidemia and decreased antioxidants nutrients and these factors increase risk for coronary artery disease. In addition, hyperhomocysteinemia may affect amino acid metabolism related to homocysteine.
alpha-Tocopherol ; Antioxidants ; Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cholesterol ; Coronary Artery Disease ; Folic Acid ; Glucose ; Glucose Tolerance Test ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Hyperlipidemias ; Insulin ; Male ; Metabolism ; Multivariate Analysis ; Plasma* ; Reference Values ; Risk Factors* ; Serine ; Taurine ; Tobacco Products ; Triglycerides ; Vitamin B 12 ; Vitamin B 6 ; Waist-Hip Ratio

BACKGROUND AND OBJECTIVES: The identification of a specific etiology of effusive pericardial disease is difficult because of the limited yield of cytologic and microbiologic pericardial fluid analysis. We performed retrospective study to find out whether pericardial biopsy was superior to pericardial fluid analysis in search of the etiology of pericardial effusion. MATERIALS AND METHOD: We reviewed 76 cases of moderate to severe pericardial effusion on which we performed surgical pericardial biopsy from Sep. 1986 to Sep. 1996. The results of pericardial fluid analysis, clinical manifestation, pericardial biopsy were compared retrospectively. RESULTS: 1)Clinical diagnosis of pericardial effusion were as follow:neoplastic disease (7.9%), tuberculosis (72.4%), constrictive pericarditis (17.1%), and others (2.6%). 2)By the percutaneous pericardial biopsy, we confirmed 19 cases (25%). Etiology of 4 cases (5.3%) were malignancy and 15 cases (19.7%) tuberculosis. Fifteen out of 76 patients who were diagnosed by biopsy as tuberculous pericarditis and 28 patients who were suspected as tuberculous pericarditis clinically were treated with antituberculous medications. Ten patients (66.7%) of pathologically diagnosed patients and 18 patients (69.2%) of clinically diagnosed patients showed complete resolution of pericarditis. CONCLUSION: By pericardial biopsy, we only confirmed 19 cases (25.0%). It means that pericardial biopsy is not superior to pericardial fluid analysis in searching of etiology of pericardial effusion. Moreover, it is not sufficient for final diagnosis of pericardial effusion.
Biopsy* ; Diagnosis ; Humans ; Pericardial Effusion ; Pericarditis ; Pericarditis, Constrictive ; Pericarditis, Tuberculous ; Retrospective Studies ; Tuberculosis

PURPOSES: Staphylococcus epidermidis is a causative agent of bacterial keratitis and the authors performed an epidemiologic study to identify the risk factors, clinical features and treatment results. METHODS: Epidemiologic study on Staphylococcus epidermidis keratitis, which were confirmed by cultures in 6 university hospitals, was performed prospectively under the identical protocol. RESULTS: Seventeen cases of Staphylococcus epidermidis keratitis were diagnosed by culture with corneal scraping and comprised 4.1% of 401 cases of confirmed bacterial keratitis. Male patients were affected more than female patients and the highest prevalent age was in the seventies. Most of their occupation was farming. The most prevalent season was fall and it mostly occurred after corneal trauma. CONCLUSIONS: Staphylococcus epidermidis keratitis usually occurred in a relatively old age group followed by corneal trauma. Its prevention along with early and proper antimicrobial therapy based on sensitivity results is important.
Epidemiologic Studies ; Epidemiology* ; Female ; Hospitals, University ; Humans ; Keratitis* ; Male ; Occupations ; Prospective Studies ; Risk Factors ; Seasons ; Staphylococcus epidermidis* ; Staphylococcus*

BACKGROUND: Changes in body fat distribution and antioxidant status can be shown in patients with coronary heart disease (CHD) and these changes may be more pronounced in CHD patients with than those without diabetes. This study was undertaken to determine the discrimination of body fat distribution, hormones and antioxidants among healthy male and CHD male patients with and without diabetes. METHODS: An oral glucose tolerance test was performed in 64 healthy males and 56 CHD male patients. CHD group was subdivided into patients with and without diabetes. Adipose tissue and muscle areas were calculated from computed tomography scans made at four body levels, L1, L4 and mid portion of thigh and calf. Fasting serum levels of lipids, hormones and antioxidants and plasma level of homocysteine were determined. RESULTS: 28% of healthy males, 33% of CHD patients without diabetes and 15% of CHD patients with diabetes were current smokers. 56% of healthy males, 30% of CHD patients without diabetes and 46% of CHD patients with diabetes supplemented their diet with synthetic vitamin preparation. There were no differences among groups in means of age, body mass index and blood pressure. While CHD patients without diabetes showed an increase in visceral fat area at only L1 level, CHD patients with diabetes showed an increase at both L1 and L4 levels, compared with healthy males. CHD patients with diabetes showed the lowest mean value of HDL-cholesterol and testosterone. The mean response areaof insulin and C-peptide during OGTT was higher in CHD patients without diabetes than healthy males. CHD patients with and without diabetes showed higher plasma level of homocysteine and lower serum levels of IGF-1, superoxide dismutase (SOD) and beta-carotene, compared with healthy males. Serum levels of cryptoxanthin and lycopene were lower in CHD patients with diabetes than healthy males. CONCLUSION: Visceral fat accumulation, an increase in insuline and homocysteine levels and a decrease in IGF-1, SOD and beta-carotene levels in CHD patients indicate a difference in body fat distribution, hormones and antioxidant systems between CHD patients and healthy males. In addition, a further increase in visceral fat and a decrease in the serum levels of HDL-cholesterol, testosterone and carotenoids in CHD patients with diabetes show the increased risk in the simultaneous presence of CHD and diabetes. Thus, the lifestyle modification of these CHD patients such as quitting smoking, reducing abdominal fat and taking antioxidant-rich foods is recommended.
Abdominal Fat ; Adipose Tissue* ; Antioxidants ; beta Carotene ; Blood Pressure ; Body Fat Distribution* ; Body Mass Index ; C-Peptide ; Carotenoids ; Coronary Disease* ; Diet ; Discrimination (Psychology) ; Fasting ; Glucose Tolerance Test ; Homocysteine ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Intra-Abdominal Fat ; Life Style ; Male ; Plasma ; Smoke ; Smoking ; Superoxide Dismutase ; Testosterone ; Thigh ; Vitamins

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

In this paper, the title was described incorrectly.

BACKGROUND: We performed this study to evaluate the long-term clinical prognosis, the effects of anti-anginal medicines on angina, and the factors on recurrence of angina in patients with angina and insignificant coronary artery stenosis (CAS). METHODS: The study population was consisted of 372 patients with angina and normal or minimal (less than 50 % stenosed) CAS out of 2475 consecutive patients who were performed coronary angiogram for 3.5 years. We reviewed the medical record of the study population. RESULTS: Myocardial infarction was developed in 2 cases (0.5%), recurrence of angina 59 cases (16%), and no death during mean 19 months follow-up period out of 372 patients. Patients with normal coronary artery (n=66) were younger (mean 54 yrs vs 59 yrs, p<0.001), had less incidence of diabetes (5% vs 13%, p<0.01), hypertension (19% vs 29%, p<0.05), recurrent angina (15% vs 18%, not significant), and myocardial infarction (0.4% vs 0.9%, not significant) than patients with minimal lesion (n=06). Anti-anginal medicine did not show benefits in relieving recurrent angina. Furthermore, in case of taking nitrates in patients with normal coronary artery, there was more frequent recurrence of angina (23% vs 13%, p<0.01) than not taking nitrates. There were no affecting factors to the recurrent angina among age, sex, ischemic changes on electrocardiogram, smoking, hypertension, diabetes, and hyperlipidemia. CONCLUSION: The long-term clinical outcomes in patients with insignificant CAS were good. Although there were no definite factors for recurrence of chest pain, administration of nitrates may cause more frequent angina in patients with normal coronary angiography.
Chest Pain ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Medical Records ; Myocardial Infarction ; Nitrates ; Prognosis ; Recurrence ; Smoke ; Smoking

No abstract available.
Ear* ; Fascia* ; Temporal Muscle* ; Transplants*

No abstract available.
Lupus Erythematosus, Systemic*

Squamous cell carcinoma is a rare complication of chronic osteomyelitis. Squamous cell carcinoma of extremity campromises approximately 1 to 2% of all squamous cell carcinoma and of these 2.5 to 4.5% are secondary to chronic osteomyelitis. Biopsy of squamous cell carcinoma, which arises in the proliferating edge of the cutaneous ulcer and invades the bone, should include tissues from all portion of sites of ulcer including bone marrow spaces. But histological diagnosis may be difficult becasue of preexisiting and coexisisting metaplasia and pseudo-epitheliomatous hyperplasia. With prompt and aggressive surgical treatment, the prognosis for patient with squamous cell carcinoma secodary to chronic osteomyelitis is good. Routine regional lymphadenectomy at site of amputation seems unnecessary. This case report represets an unusual bone marrow involvement of squamous cell carcinoma which was complicated by femur fracture.
Amputation ; Biopsy ; Bone Marrow ; Carcinoma, Squamous Cell ; Diagnosis ; Epithelial Cells ; Extremities ; Femur ; Humans ; Hyperplasia ; Lymph Node Excision ; Metaplasia ; Osteomyelitis ; Prognosis ; Ulcer