No abstract available.
Estrogens, Conjugated (USP)* ; Heart Failure*

No abstract available.
Drug Therapy* ; Dyslipidemias*

Internet medical counseling is increasing through the recent diffusion of super-high speed network. It provides not only medical information but also substantial Internet counseling(home medical care or telemedicine) that may rander definite diagnosis and treatment on line. But Internet medical counseling is still prohibited since Korean medical law stipulates the principle of facing treatment. Soon if will be possible to deliver Internet medical counseling under the revised bill of Korean medical law on telemedicine and electronic medical record. Therefore, I would like to give some legal information and advice that merit attention when medical personnel deliver Internet medical counseling. First, in case of substantial Internet medical counseling, it would be desirable to allow Internet counseling as the second treatment with the trust between doctor and patient being the first. Internet counseling should replace facing treatment only when the latter is practically not possible. It should be initiated not by physicians??soliutation but by requests from patients themselves. Of course, full explanation about the practice, including any potential disadvantages to the patients, should be provided. Second, counseling contents should be recorded and the hard copies of the Q-and-A should be kept with signature on. Patients privacy should not be infringed. Third, in case of Internet medical counseling, medical personnel has the same responsibility as that in the facing treatment. And it is stipulated in the revised bill of Korean medical law that if there is no definite evidence that acknowledges remote doctor's fault, resident doctor has the responsibility. But this could make a resident doctor hesitate to practice telemedicine, and enough discussion should follow on this. Internet medical counseiling gives a big opportunity to provide highly developed medical techniques overcoming the geographic barrier of distance, but it also might be dangerous enough to threaten patient's life by providing wrong information and cause effluence of private inforamtion. Therefore, it is necessary to facilitate public opinion regarding the Internet medical counseling on its limit and regulation.
Counseling* ; Diagnosis ; Diffusion ; Electronic Health Records ; Humans ; Internet* ; Jurisprudence ; Privacy ; Public Opinion ; Telemedicine

No abstract available.
Cardiovascular Diseases* ; Female ; Hormone Replacement Therapy* ; Humans

No abstract available.
Critical Care* ; Jurisprudence*

In 1814, Monteggia first described a fracture of proximal third of the ulna with a dislocation of radial head. The clinical importance of this fracture is that when the ulna is fractured and shortened, the proximal radioulnar joint dislocate. Despite of its importance the reports of this fracture is relatively rare. The authors reviewed twenty-nine Monteggia fractures that were treated at 15 orthopedic institutes of Honam area over a four-year period (1981 through 1984), with particular emphasis on classification, causes of injury, level of fracture, direction of dislocation, treatment and results. The results were as follows: 1. Total 29 patients were 8 children and 21 adults. 2. The male was affected about 2 times more than female (19: 10). 3. Causes of injury were fall in 12, car accident in 12 and machinery injury in 5. 4. Classification into 4 type by Bado's method disclosed that type 1 accounts for 65.5% of cases, type 2 for 6.9%,type 3 for 13.8%, and type 4 for 13.8%. 5. Treatments of dislocated radial head were closed reduction in 24, open reduction in 3, and excision in 2. 6. Locational incidence of ulnar fracture were upper one third of ulna in 11, junction of upper and middle 1/3 in 2, middle one third in 15, and distal one third in 1. 7. Treatment of fractured ulna was different between child and adult. Eight children fracture were managed by closed reduction in 5 and open reduction with K-wire fixation in 3. Twenty one adult fracture were managed by open reduction and internal fixation in 20 and closed reduction in l. 8. Palsy of posterior interosseous nerve was observed in 3 patients (10.4%) and disappeared completely later. 9. The results (Bruce et al criteria) for the 19 patients followed 6 months and more were 8 excellent, 4 good, 1 fair and 1 poor.
Academies and Institutes ; Adult ; Child ; Classification ; Dislocations ; Female ; Head ; Humans ; Incidence ; Joints ; Male ; Methods ; Monteggia's Fracture ; Orthopedics ; Paralysis ; Ulna

BACKGROUND: Fluid overload prior to continuous renal replacement therapy (CRRT) is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA) can predict outcomes in critically ill patients requiring CRRT. METHODS: A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW) was derived to estimate volume status. RESULTS: A total of 31 patients treated with CRRT were included. There were 18 men (58.1%), and the median age was 67 years (interquartile range, 51 to 78 years). Fourteen patients (45.2%) died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044). Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061). Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92), and this was significant (P = 0.037). CONCLUSIONS: Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.
Body Water ; Critical Illness* ; Electric Impedance* ; Humans ; Intensive Care Units ; Male ; Mortality ; Observational Study* ; Prospective Studies* ; Renal Replacement Therapy* ; Survival Rate ; Water

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are relatively prevalent in clinical situation (20 - 57% of WCH in the hypertensive population). The aim of this study was to analyze the determinant factors of WCE. METHODS: A prospective study was carried out in outpatient clinic in a consecutive hypertensives without receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed following more than two resting blood pressure (BP) determinations carried out with the interval of 1 - 2 weeks by mercury sphygmomanometer. WCE was calculated for systolic and diastolic BP as the difference between a clinic BP (CBP) and an average daytime ambulatory BP (ABP). WCH was defined as;BP in the clinic > or = 140/90 mmHg with a mean daytime BP by ABPM < or =137/< or =89 mmHg. RESULTS: 1) Two hundred thirty-five patients (mean age 49.7 years, females 74%) were studied. Thirty-seven percent in male and forty-six percent in female patients fulfilled WCH criteria. 2) CBP was significantly correlated to daytime ABP (systolic BP;r=.47, p<.001 and diastolic BP;r=.65, p<.001). 3) The magnitude of WCE was greater in the group of WCH (28.9+14.6/19.3+6.9 mmHg) than ambulatory hypertensives (15.1+15.7/13.0+8.2 mmHg) (p<.001). 4) The magnitude of WCE is significantly correlated with female (r2=.12, p<.001) and the stage of CBP according to JNC-V (r2=.23, p<.001) in systolic BP, the stage (r2=.08, p<.001) in diastolic BP, and the stage (r2=.09, p<.001) and weight (r2=.15, p<.01) in mean BP. CONCLUSIONS: The magnitude of WCE in essential hypertension diagnosed at the clinic is significantly correlated with female, the magnitude of clinic BP, and weight.
Ambulatory Care Facilities ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Humans ; Hypertension* ; Male ; Prospective Studies ; Sphygmomanometers ; White Coat Hypertension

Aberrant left-sided pulmonary artery(pulmonary artery sling) is an uncommon anomaly, which may cause significant respiratory abnormality. We report a case of pulmonary artery sling which is combined with persistent left superior vena cava and dextrocardia. This case was identified by esophagogram and CT and confirmed by MRI and angiography. We consider that MRI is a valuable new method for the diagnosis of aberrant left-sided pulmonary artery.
Angiography ; Arteries ; Dextrocardia ; Diagnosis ; Magnetic Resonance Imaging ; Methods ; Pulmonary Artery* ; Vena Cava, Superior

No abstract available.
Extracorporeal Circulation* ; Pulmonary Atresia* ; Ventricular Septum*