Sleep disordered breathing is highly prevalent in the elderly and affects older men and women similarly. Nocturia, cardiovascular diseases, cognitive impairment, traffic accidents and repeated falls are common manifestations of sleep apnea in the elderly and sleep study may be indicated in these patients. When a sleep study is planned, reliable markers of respiratory efforts and a tibial EMG should be included because central sleep apneas and periodic leg movements are common in the elderly patients. Although cardiovascular morbidity and mortality seem to be lower in the elderly than in middle-aged adults, these may not be as low as commonly believed. Excessive daytime sleepiness, cognitive dysfunction and nocturia can be improved by effective treatment with continuous positive airway pressure and a therapeutic trial should be recommended to all symptomatic patients. It is still unclear whether sleep apnea in older adults is a specific entity or the same disease as in younger adults. Further clinical research is warranted.
Accidents, Traffic ; Adult* ; Aged ; Cardiovascular Diseases ; Continuous Positive Airway Pressure ; Female ; Humans ; Leg ; Male ; Mortality ; Nocturia ; Sleep Apnea Syndromes* ; Sleep Apnea, Central

This study was a part of large scale of a prospective study on attitudes of professional students in medicine, nursing and teaching toward population related issues in Korea. The study was first conducted in May 1974 and then in May 1975 for the 1974 class cohot using a questionnaire consisted of attitude scales and other items developed by Lee. The purpose of study was two hold, namely, to determine the difference in students among specializations on one hand and between the first and second years in the 1974 class cohot regarding the subject matter. A one-way analysis of variance was used for attitude scale, and absolute and relative frequency were computed for the analysis of non-attitude scale items by employing Fishers' Ratio and Duncan's multiple range test at 5% level and chi square test at 5% level as significance tests. The hypothesis "students in health profession are more likely to have positive attitudes toward population related issues progressively as class year advances than students in teaching profession" was tested and the following results were obtained: 1) Nursing students were more likely to display favorable attitudes toward family planning than medical or teaching students although the class cohot showed slightly improved attitudes in the second year. 2) Respondents in general perceived national family planning program as a means of population control and this tendency was more true among nursing students as the class year advances than two other professional groups of students. Students in teaching profession appeared to perceive it more as a means to improve individual family welfare while health students were likely to see as to improve maternal and child health. This tendency was progressively improved as the class year advanced. 3) The majority of students regardless of their respective specializations believed that family planning program should be directed toward the improvement of individual family welfare. No progressive changes in the class cohot were observed. 4) About the plan to use contraceptives in future, no significant differences were observed among different specializations nor in different class years. However, the majority was confirmed to have a plan to use contraceptives in future. An increasing proportion of the undecided category was observed, as class year advanced among health students. 5) Students in health profession were found to be more favorable about "more leisure opportunities" as motive for limiting number of children whereas education students indicated the reasons as "facilitate ambitions" and "economic base". The progressive changes toward positive direction in both groups were observed as the class years advanced. 6) Attitudes toward induced abortions of the health student were observed to be positively related to class years while an inverse relationship was found in teaching students who showed much less favor in the subject matter than health students. This phenomenon may be due to the different exposure to learning environments unique to respective specializations. 7) Health students were found to have more favorable attitudes toward population education in general than the teaching students. The teaching students appeared to have changed more to the negative direction when they became the second year while no such development was observed in health students. The teaching students seemed to hold a very conservative position with regard to sex education on schools. 8) About the equality of sexes, the nursing group was found to be most favorable while the reverse was true in the teaching group. 9) About questions related to fertility values-the 10 percent of respondents regardless of specialization indicated that they would maintain their single status in future, however no change was observed in the second year. The desired number of children was found to be two by the majority of students in nursing, medicine and teaching in order of high proportion. No changes in a different class year were observed. The childless marriage was seen by nursing students as a problem more than other students, but a slight change in positive direction was found when the nursing students became the second year. In summing, as data supported in the above, students in health profession demonstrated more favorable attitudes toward population related issues than the teaching students were more conscious about the health aspect of population and family planning program while the teaching students gave more attention the socioeconomic aspect. The sex variable seemed to have operated in the item related to the equality of sexes. In conclusion, as data presented in the above, the hypothesis of this study was accepted except in the few items. It should be noted that the limitation of this study is the short duration of the observation in measuring the possible attitude changes. It should include curriculum analysis for the respective specializations in order to identify the area of curriculum impact on students in future study.
Abortion, Induced ; Child ; Child Health ; Contraceptive Agents ; Curriculum ; Surveys and Questionnaires ; Education ; Family Planning Services ; Female ; Fertility ; Hand ; Health Occupations ; Humans ; Korea* ; Learning ; Leisure Activities ; Marriage ; Nursing ; Population Control ; Prospective Studies* ; Surveys and Questionnaires ; Sex Education ; Students, Nursing ; Weights and Measures

BACKGROUND: Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation far febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. METHODS: This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. RESULTS: The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symptoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67 mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria (91.6%), and hematuria (83.3%). CONCLUSION: As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory finding of thrombocytopenia, and renal dysfunction were suggestive of HFRS.
Azotemia ; Bilirubin ; Cough ; Diagnosis ; Exanthema ; Fever ; Flank Pain ; Headache ; Hematuria ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospirosis ; Leukocytosis ; Myalgia ; Occupations ; Proteinuria ; Retrospective Studies ; Rural Population* ; Scrub Typhus ; Skin ; Sputum ; Thorax ; Thrombocytopenia

No abstract available.
Colorectal Neoplasms*

OBJECTIVES: Several studies suggest that nocturia may be related to obstructive sleep apnea syndrome (OSAS). The mechanism by which OSAS develops nocturia has not been determined. The present study aimed to determine the prevalence of nocturia among adults with OSAS and to identify factors that may be predictive in this regard. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the sleep clinics of the St. Paul's Hospital between 2009 and 2012. The urinary symptoms were assessed on the basis of the International Prostate Symptom Score (IPSS). Pathologic nocturia was defined as two or more urination events per night. OSAS was defined as apnea-hypopnea index (AHI) > or =5. A multivariate analysis using logistic regression was performed to examine the relationship between polysomnographic variables and the presence of pathologic nocturia, while controlling for confounding factor. RESULTS: A total of 161 men >18 years of age (mean age 46.7+/-14.1), who had been referred to a sleep laboratory, were included in the present study. Among these, 27 patients with primary snoring and 134 patients with obstructive sleep apnea were confirmed by polysomnography. Nocturia was found in 53 patients with OSAS (39.6%) and 8 patients with primary snoring (29.6%). The AHI was higher in patients with nocturia than in those without nocturia (p=0.001). OSAS patients with nocturia had higher arousal index (p=0.044), and lower nadir oxyhemoglobin saturation (p=0.001). Multiple regression analysis showed that age (beta=0.227, p=0.003), and AHI (beta=0.258, p=0.001) were associated with nocturia, and that the presence of pathologic nocturia was predicted by age (OR 1.04 ; p=0.004) and AHI (OR 1.02 ; p=0.001). CONCLUSION: Nocturia is common among patients with OSAS. The strongest predictors of nocturia are age and AHI in patients with OSAS.
Adult ; Arousal ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Nocturia* ; Oxyhemoglobins ; Polysomnography ; Prevalence* ; Prostate ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Snoring ; Urination

The cathepsin D is a lysosomal protease secreted in excess by breast cancer cells. The function of this enzyme is degradation of the extracellular matrix and proteoglycan. It is induced by estrogens in estrogen receptor positive breast cancer cell lines. On the basis of this, cathepsin D expression in breast cancer cells seems to be correlated with the prognosis. But there is debates in its prognostic significance. Relationship between cathepsin D expression and other prognostic factors of breast cancer was studied. We investigated 51 cases of invasive ductal cell carcinoma of breast removed by open biopsy or mastectomy. All cases were fixed in formalin and embedded in paraffin. We used 46-KD intermediate form of the enzyme for cathepsin D expression on immunohistochemical stain. We observed no significant correlation with age, stage, histologic grade, lymphatic invasion, and estrogen receptor status. Cathepsin D may be an independent factor which is not related with other prognostic factors, especially estrogen receptor status.
Biopsy ; Breast Neoplasms

No abstract available.
Chorion* ; Chorionic Villi Sampling* ; Chorionic Villi* ; Female ; Pregnancy

Cervical plexus block has been evaluated clinically for surgery of the anterior neck in 13 patients during the 10 months(from July 1981 to April 1982) at the Department of Anesthesiology in Capital Armed Forces General Hospital. We have assessed CPB for technique, onset, anesthetized area, duration, complication and supplimentary agents, and reviewed the anatomical aspects of cervical plexus. The distribution of injected local anesthetics was demonstrated under radiography using Urographin. We experienced incomplete block in 9 cases which needed substitution with Thalamonal. The incidence of complications was few and most significant complication seen in this study was respiratory difficulty. However, There was no evidence for phrenic nerve paralysis. Cervical plexus block was performed safely and effectively for surgery of the anterior neck.
Incidence

OBJECTIVES: The Berlin Questionnaire (BQ) has been used to help identify patients at high risk of having sleep apnea in primary care. But it has not been validated in a sleep clinic for Korean patients. The aim of this study is to evaluate the usefulness of the BQ as a screening tool for obstructive sleep apnea (OSA) for Korean patients in a sleep clinic. METHODS: The BQ was prospectively applied to 121 subjects with OSA suspicion who visited to our sleep clinic. All subjects performed overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) > or =5. We investigated the sensitivity, specificity, positive and negative predictive values of the BQ according to severity by AHI. RESULTS: In 121 subjects, 73.6% were males, with a mean age of 48.8+/-13.0 years. Twenty-five (20.6%) patients did not have OSA (AHI<5), 30 (25%) patients had mild OSA (AHI> or =5 and <15), 26 (21.4%) had moderate (AHI> or =15 and <30), and 40 (33%) had severe OSA (AHI> or =30). The BQ identified 69.4% of the patients as being at high risk for having OSA. The sensitivity and specificity of the BQ were 71.9% and 40%, for AHI> or =5, 75.8% and 38.2% for AHI> or =15, 77.5% and 34.6% for AHI> or =30, respectively. The positive and negative predictive values of the BQ were 82.1% and 27.0% for AHI> or =5, respectively. Positive and negative likelihood ratios were 1.2 and 0.7, and the overall diagnostic accuracy of the BQ was 65.3%, using an AHI cut-off of 5. CONCLUSION: Due to modest sensitivity and low specificity, the BQ does not seem to be an appropriate tool for identifying patients with obstructive sleep apnea in a sleep clinic population.
Berlin ; Humans ; Male ; Mass Screening ; Polysomnography ; Primary Health Care ; Prospective Studies ; Surveys and Questionnaires ; Sensitivity and Specificity ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

The clinical and pathological features of a paraganglioma arising in the cauda equina is described and compared with previous reports. The right microscopic fetures were similar to those of paragangliomas from other sites, with a 'Zellballen' pattern of cells containing arzyrophil granules. Immunohistocytochemical stains for neurone specific enolase, S-100 protein, cytokeratin were positive, but stains for glial fibrillary acidic protein were negative. Electron microscopy showed densely staining membrane-bound granules, cilia like structures and fibros bodies in the cytoplasm. The last two features only occur in paragangliomas from this site. The pathological findings suggest that paragangliomas in this site arise from pre-existing paraganglia, possibly of the visceral autonomic group.