The main purpose of this study was to describe the differences in health status between urban and rural elders in Korea. The sample consisted of one thousand one hundred non-institutionalized individuals, aged 65 or over, living in three metropolitan cities and two rural provinces. The modified Cornell Medical Index, ADL, IADL, and existing medical diagnosis were used to measure the health status of the elders. Rural elders reported significantly more health problems than urban elders. Differences in ADL and IADL scores were not statistically significant. There was a difference in the types of health problems between the urban and rural elders. While more rural elders reported that they were diagnosed as having neuralgia and arthritis, more urban elders reported that they had diabetes. The results of this study demonstrated that rural elders had significantly more health problems than urban elders even after all the other variables were controlled. However, in Korea, most health care resources available to elders are concentrated in large urban cities. This study suggests that it is important to invest more health care resources in rural areas to meet the needs of all elders in Korea.
Aged ; Aged, 80 and over ; Aging/physiology* ; Comparative Study ; Female ; Health Status* ; Human ; Korea ; Male ; Rural Population* ; Urban Population*

The coexistence of pneumothorax and pneumopericardium in patients with primary lung cancer is a very rare phenomenon. We report one such case, in which squamous cell carcinoma of the lung was complicated by pneumopericardium and pneumothorax. Several explanations of the mechanisms involved will be discussed.
Carcinoma, Squamous Cell/*complications/radiography ; Case Report ; Human ; Lung Neoplasms/*complications/radiography ; Male ; Middle Age ; Pneumopericardium/*complications/radiography ; Pneumothorax/*complications/radiography ; Tomography, X-Ray Computed

The coexistence of pneumothorax and pneumopericardium in patients with primary lung cancer is a very rare phenomenon. We report one such case, in which squamous cell carcinoma of the lung was complicated by pneumopericardium and pneumothorax. Several explanations of the mechanisms involved will be discussed.
Carcinoma, Squamous Cell/*complications/radiography ; Case Report ; Human ; Lung Neoplasms/*complications/radiography ; Male ; Middle Age ; Pneumopericardium/*complications/radiography ; Pneumothorax/*complications/radiography ; Tomography, X-Ray Computed

Alveolar soft-part sarcoma is a rare soft tissue sarcoma of young adults with unknown histogenesis, and the organ most frequently involved in metastasis is the lung. We report the CT findings of three patients of pulmonary metastases of alveolar soft-part sarcoma, which manifested as clearly enhanced pulmonary nodules or masses. On enhanced scans, some of the masses were seen to contain dilated and tortuous intratumoral vessels.
Adult ; Case Report ; Female ; Human ; Lung Neoplasms/blood supply/*radiography/*secondary ; Male ; Sarcoma, Alveolar Soft Part/blood supply/*radiography/*secondary ; *Tomography, X-Ray Computed

OBJECTIVE: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. MATERIALS AND METHODS: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. RESULTS: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). CONCLUSION: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.
Aged ; Carcinoma, Bronchogenic/*complications/radiography ; Female ; Human ; Lung Neoplasms/*complications/radiography ; Male ; Middle Age ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary/*complications/radiography

BACKGROUND: Myocardial ischemia is known to depress systolic and diastolic functions for a prolonged period of time. Dobutamine and epinephrine are frequently administered to improve myocardial function during cardiac surgery. The vascular response to vasopressors might be altered by ischemia and reperfusion, since alterations in vascular control mechanisms have been demonstrated even after a short period of ischemia. The present study was aimed to investigate the effects of dobutamine and epinephrine on regional and global myocardial functions, coronary blood flow (CBF) and myocardial oxygen consumption (MVO2) in normal and stunned myocardium in an open-chest canine model. METHODS: Forty-eight dogs were acutely instrumented under enflurane anesthesia to measure aortic and left ventricular pressures, and pulmonary (cardiac output) and left anterior descending (LAD) blood flows via a Doppler flowmeter, and a subendocardial segment length in the region supplied by the LAD. In series 1, incremental doses of dobutamine (1, 2, 5, 10microgram/kg/min, n = 9) or epinephrine (0.02, 0.04, 0.1, 0.2microgram/kg/min, n = 10) were infused intravenously (IV) for 10 min before (normal) and after 15 min of LAD occlusion and subsequent 1 hr-reperfusion (stunned). In series 2, incremental doses of dobutamine (50, 125, 250, 375 ng/mL of LAD flow, n = 14) or epinephrine (4, 10, 20, 30 ng/mL of LAD flow, n = 15) were infused directly into the LAD (IC) for 3 5 min before (normal) and after myocardial ischemia (stunned). Segment shortening (%SS), as an index of regional myocardial contractility, and the peak segment lengthening rate (dL/dt max), as an index of regional diastolic function, were evaluated. Simultaneous arterial and coronary venous contents of oxygen and lactate were measured to calculate MVO2 and oxygen (EO2) and lactate extraction (Elac) ratios during IV or IC infusions of epinephrine or dobutamine. Effectiveness of metabolic vasodilation was determined from EO2. RESULTS: IV or IC infusions of dobutamine or epinephrine before ischemia resulted in dose-dependent increases in mechanical functions (%SS and dL/dt max) and MVO2. These changes were accompanied by parallel increases in CBF resulting in unaltered EO2 with an infusion of dobutamine, while CBF increased more than MVO2 with epinephrine, resulting in decreased EO2. After the ischemia and reperfusion, %SS and dL/dt max were depressed and Elac was reduced, but similar mechanical responses (%SS and dL/dt max) to both dobutamine & epinephrine were observed. Also, in the stunned myocardium, CBF increased in parallel with mechanical function and MVO2 with either IC or IV dobutamine, resulting in an unaltered EO2. However, IC but not IV epinephrine did not affect EO2, suggesting abolishment of its direct vasodilating effect in stunned myocardium. In addition, IC epinephrine infusion further decreased Elac, while IC dobutamine did not affect it in stunned myocardium. During IV infusions, dobutamine caused a dose-dependent increase in the heart rate but epinephrine did not affect it, despite the comparable increase in cardiac index and mean aortic pressure. CONCLUSIONS: The results indicate that dobutamine and epinephrine exert similar positive inotropic and lusitropic effects in normal and stunned myocardium in dogs. However, epinephrine causes direct coronary vasodilation in normal myocardium, but it does not directly affect coronary vascular tone in stunned myocardium. In addition, epinephrine infusion dose-dependently depresses Elac in stunned myocardium. In contrast, dobutamine affects neither direct coronary vascular tone nor Elac regardless of ischemia and reperfusion injury.
Anesthesia ; Animals ; Arterial Pressure ; Dobutamine* ; Dogs* ; Enflurane ; Epinephrine* ; Flowmeters ; Heart Rate ; Ischemia ; Lactic Acid ; Myocardial Ischemia ; Myocardial Stunning* ; Myocardium ; Oxygen Consumption ; Oxygen* ; Reperfusion ; Reperfusion Injury ; Thoracic Surgery ; Vasodilation ; Ventricular Pressure

BACKGROUND: Intravenous (IV) morphine is commonly used for postoperative pain management. Ketorolac has been proposed as a potent analgesic for treatment of moderate to severe pain. The purpose of this study was to determine the equianalgesic dose of morphine and ketorolac using intravenous patient-controlled analgesia (IV-PCA) system in human volunteers. METHODS: Fourty-five patients undergoing elective total abdominal hysterectomy were randomly assigned to receive either morphine (n=22) or ketorolac (n=23) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Until postoperative pain decreased to 40/100 mm, morphine and ketorolac group received repeated IV boluses of 3 mg of morphine and 18 mg of ketorolac respectively and then followed by a IV-PCA with morphine (basal infusion 0 mg/hr, PCA dose 1 mg/1 ml, lock-out interval 5 min) and ketorolac (basal infusion 0 mg/hr, PCA dose 5 mg/1ml, lock-out interval 5 min). Analgesic efficacy with VAS (0~100 mm), PCA demand ratio and rate, analgesics consumptions, patient satisfaction and side effects were compared. RESULTS: There were no significant differences in VAS, PCA demand ratio and patient satisfaction. Mean 48-hour morphine and ketorolac consumptions were 35 (SEM=2.9) mg and 224 (SEM=16.5) mg, respectively (ratio=1:6.4). Morphine group experienced side effects such as pruritus (45%), nausea and vomiting (41%) and respiratory depression (5%). However, ketorolac group only showed side effects such as nausea and vomiting (26%). CONCLUSION: We concluded the ratio of equianalgesic dose of morphine versus ketorolac using intravenous patient-controlled analgesia (IV-PCA) after total abdominal hysterectomy was 1 versus 6.4.
Analgesia, Patient-Controlled* ; Analgesics ; Healthy Volunteers ; Humans ; Hysterectomy* ; Ketorolac* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Pruritus ; Respiratory Insufficiency ; Vomiting

BACKGROUND: Intravenous (IV) morphine is commonly used for postoperative pain management. Ketorolac has been proposed as a potent analgesic for treatment of moderate to severe pain. The purpose of this study was to determine the equianalgesic dose of morphine and ketorolac using intravenous patient-controlled analgesia (IV-PCA) system in human volunteers. METHODS: Fourty-five patients undergoing elective total abdominal hysterectomy were randomly assigned to receive either morphine (n=22) or ketorolac (n=23) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Until postoperative pain decreased to 40/100 mm, morphine and ketorolac group received repeated IV boluses of 3 mg of morphine and 18 mg of ketorolac respectively and then followed by a IV-PCA with morphine (basal infusion 0 mg/hr, PCA dose 1 mg/1 ml, lock-out interval 5 min) and ketorolac (basal infusion 0 mg/hr, PCA dose 5 mg/1ml, lock-out interval 5 min). Analgesic efficacy with VAS (0~100 mm), PCA demand ratio and rate, analgesics consumptions, patient satisfaction and side effects were compared. RESULTS: There were no significant differences in VAS, PCA demand ratio and patient satisfaction. Mean 48-hour morphine and ketorolac consumptions were 35 (SEM=2.9) mg and 224 (SEM=16.5) mg, respectively (ratio=1:6.4). Morphine group experienced side effects such as pruritus (45%), nausea and vomiting (41%) and respiratory depression (5%). However, ketorolac group only showed side effects such as nausea and vomiting (26%). CONCLUSION: We concluded the ratio of equianalgesic dose of morphine versus ketorolac using intravenous patient-controlled analgesia (IV-PCA) after total abdominal hysterectomy was 1 versus 6.4.
Analgesia, Patient-Controlled* ; Analgesics ; Healthy Volunteers ; Humans ; Hysterectomy* ; Ketorolac* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Patient Satisfaction ; Pruritus ; Respiratory Insufficiency ; Vomiting

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score < 23) and 34 in the control group (MMSEK score > 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).
Aged* ; Alcoholics ; Alzheimer Disease ; Classification ; Dementia* ; Dementia, Vascular ; Education ; Female ; Humans ; Logistic Models ; Male ; Mass Screening ; Motor Activity ; Odds Ratio ; Prevalence*

BACKGROUND: During one-lung ventilation (OLV) for thoracic surgery, hypoxic pulmonary vasoconstriction (HPV) may reduce the venous admixture and ameliorate the decrease in arterial oxygenation by diverting blood from the non-ventilated to the ventilated lung. Volatile anesthetics (halothane, enflurane, isoflurane, desflurane and sevoflurane) have been shown to depress the HPV with essentially the same potency in vitro. However, clinical studies suggest that isoflurane and sevoflurane provide superior arterial oxygenation during OLV over halothane or enflurane. However, these have not been compared with desflurane. This study compared the effects of desflurane with those of isoflurane on oxygenation & shunt during two lung ventilation (TLV) and OLV in human volunteers. METHODS: Twenty adults who needed OLV with minimal trauma to the nonventilated lung (esophageal surgery) were randomly assigned to receive either 1 MAC desflurane (n = 10) or 1 MAC isoflurane (n = 10) with 100% oxygen in separate groups. Systemic and pulmonary hemodynamic data were recorded, and blood gas values were obtained 30 min after TLV and OLV in lateral position. RESULTS: Reductions in PaO2 (445.2 +/- 72.3 to 125.9 +/- 52.5 and 483.2 +/- 86.2 to 110. 2 +/- 39.8 mmHg, in desflurane and isoflurane respectively) and increases in shunt fraction (Qs/Qt%; 17.2 +/- 3.8 to 33.1 +/- 5.7, 13.4 +/- 4.5 to 32.5 +/- 4.1, in desflurane and isoflurane respectively) at 30 min after the start of OLV were observed, but there were no differences between the groups. The other blood gas data (PaCO2, PCO2, pH, Hb, CaO2, CO2) and systemic and pulmonary hemodynamics (mean arterial blood pressure, heart rate, cardiac output, mean pulmonary arterial pressure, central venous pressure) did not change 30 min after the start of OLV in the two groups. CONCLUSIONS: In clinical practice, there was no difference between desflurane and isoflurane for OLV was no difference in the arterial blood oxygenation and the intrapulmonary shunt.
Adult ; Anesthesia* ; Anesthetics ; Arterial Pressure ; Cardiac Output ; Enflurane ; Halothane ; Healthy Volunteers ; Heart Rate ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Isoflurane* ; Lung* ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Vasoconstriction ; Ventilation