OBJECTIVES: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. METHODS: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50+/-13.16 yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=43.67+/-12.11 yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age 44.93+/-12.38 yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=45.87+/-12.44 yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. RESULTS: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1+/-27.1 and 875.8+/-22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4+/-6.6 and 112.8+/-5.4 ms (p=0.022), SDNN index was 57.5+/-5.2 and 87.6+/-4.2 (p<0.001), total power was 11,893.5+/-1,359.9 and 18,097.0+/-1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8+/-1,120.1 and 11,883.8+/-912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2+/-327.8 and 4,351.6+/-266.9 ms2 (p=0.003). CONCLUSIONS: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.
Acceleration ; Anoxia ; Arousal ; Autonomic Nervous System ; Cardiovascular System ; Heart ; Heart Rate ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sympathetic Nervous System

OBJECTIVES: To investigate the factors associated with symptoms from job stress among Korean dental laboratory technicians. METHODS: We collected the data of 786 technicians for life-style, job stressor, social support, self-esteem, personality, and various dimension of stress symptoms included roomatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility by self-administerd questionnaire. Global severity index of dental technician (GSID) was calculated by total sum of sub-dimension. RESULTS: We used 80 percentile as a cut-off point, and got the 81.5 % of sensitivity, 86.1 % of specificity by receiver operating characteristic curve. The odds ratios of various factors in high group of GSID compared with low group were 1,49(95 % Cl 1.00-2.00) for smoker, 1,53 (1.06-2.21) for unhealthy group, 6,69 (4.74-9.44) for work overload, 8.34(5.82-11.97) for work demand, 9.89 (6.76-74.94) for work process, 8.27 (5.80-11,79) for work environment, 5.82 (4.04-8.39) for interpersonal relationship, 8.34 (5.82-11.97) for occupational conflict, 5.70 (4.04-8.04) for labor remuneration, 7.58 (5.37-10.71) for role conflict, but 0.39 (0.27-0.57) for social support, 0.41 (0.29-0.60) for self-esteem. By multiple logistic regression, factors were significantly associated with GSID were age, working area, role overload, work demand, work procedure, physical environment, occupational conflict, role conflict, social support, personality traits. CONCLUSIONS: Factors associated with symptoms from stress were role overload, work demand, work procedure, occupational conflict, interpersonal relationship, labor remuneration and role conflict in Korean dental laboratory technicians. It is suggested that health promotion program to reduce job stress and to enforce social support and self-esteem should be developed.
Anxiety ; Dental Technicians ; Depression ; Health Promotion ; Hostility ; Humans ; Laboratories, Dental* ; Logistic Models ; Odds Ratio ; Questionnaires ; Remuneration ; ROC Curve ; Sensitivity and Specificity

Cytologic findings of pleural effusion in three cases of rhabdomyosarcoma are reported. Case 1 was a pleomorphic rhabdomyosarcoma which had devoped at the chest wall of an elderly male patient and caused pleural effusion. The cytologic features were consistent with pleomorphic rhabdomyosarcoma, that was, showing loose clusters, cellular pleomorphism, and abundant finely vesicular cytoplasm. Cases 2 and 3 were embryonal rhabdomyosarcomas in young adults. Primary site was the oral cavity in case 1, but unknown in case 2 and case 3. The effusion cytology was similar in these cases. Clustered or isolated small round cells with hyperchromatic nuclei and scanty cytoplasm were smeared. The cohesiveness of tumor cells was weak and the cells did not show linear arrangement or nuclear molding. Effusion cytology in a sarcoma patient would be diagnostic when the primary site and the type of sarcoma were already known.
Aged ; Cytoplasm ; Fungi ; Glomerulonephritis* ; Glomerulonephritis, Membranous* ; Humans ; Male ; Mouth ; Pleural Effusion ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal ; Sarcoma ; Thoracic Wall ; Young Adult

BACKGROUND: Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. METHOD AND MATERIALS: The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale(MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index-Side Effect Scale(EISE). RESULTS: A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demographic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group 1.39+/-0.61 ; amitriptyline group 2.00+/-0.85, p<.001). At the 4-PISE. There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. CONCLUSIONS: In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.
Adolescent ; Amitriptyline* ; Depression ; Double-Blind Method ; Drug Therapy ; Dysthymic Disorder* ; Follow-Up Studies ; Humans ; Moclobemide*

Purpose: Some patients who have undergone surgery due to lumbar disc herniation still complain of leg pain and other abnormal sensations. Therefore, the study examined the effects of the neurodynamics on pain and other abnormal nerve sensations in post-operated patients with lumbar disc herniation. Methods: The participants of this study comprised 20 adults (10 males and 10 females) who were diagnosed with lumbar disc herniation. The subjects were classified into two groups of 10 patients each in the lower extremity neurodynamics (LEN) and lumbar stabilization exercise (LSE) groups. Each intervention was applied twice a day for one week and was composed of two different exercise patterns; one was applied by a therapist, and the other was performed by the patients themselves. The data were analyzed using assessment methods of Digital Infrared Thermal Imaging (DITI), Toronto clinical neuropathy scoring system (TCNSS), Sympathetic Skin Response (SSR) test, and Oswestry Disability Index (ODI) scale. Results: Significant differences in TCNSS, DITI, ODI scale were observed between the LEN and LSE group (p<0.01). On the other hand, there was no significant difference in the SSR test between pre and post-treatment (p>0.05). Conclusion The results indicated that neurodynamics treatment is effective in pain reduction and abnormal sensations, such as leg muscle cramps, in post-operated patients with lumbar disc herniation.

Purpose: Some patients who have undergone surgery due to lumbar disc herniation still complain of leg pain and other abnormal sensations. Therefore, the study examined the effects of the neurodynamics on pain and other abnormal nerve sensations in post-operated patients with lumbar disc herniation. Methods: The participants of this study comprised 20 adults (10 males and 10 females) who were diagnosed with lumbar disc herniation. The subjects were classified into two groups of 10 patients each in the lower extremity neurodynamics (LEN) and lumbar stabilization exercise (LSE) groups. Each intervention was applied twice a day for one week and was composed of two different exercise patterns; one was applied by a therapist, and the other was performed by the patients themselves. The data were analyzed using assessment methods of Digital Infrared Thermal Imaging (DITI), Toronto clinical neuropathy scoring system (TCNSS), Sympathetic Skin Response (SSR) test, and Oswestry Disability Index (ODI) scale. Results: Significant differences in TCNSS, DITI, ODI scale were observed between the LEN and LSE group (p<0.01). On the other hand, there was no significant difference in the SSR test between pre and post-treatment (p>0.05). Conclusion The results indicated that neurodynamics treatment is effective in pain reduction and abnormal sensations, such as leg muscle cramps, in post-operated patients with lumbar disc herniation.

PURPOSE: This study aimed to evaluate the changes in dorsiflexion and balance following proximal and distal tibiofibular joint manipulation in individuals with a history of lateral ankle sprain (LAS). METHODS: Fifteen participants with a history of unilateral LAS, exhibiting a restriction in ankle dorsiflexion were included in this study. LAS ankle received a manipulation to the proximal and distal tibiofibular joint, while the opposite control ankle received no manipulation intervention. The outcome measures included ankle dorsiflexion and balance. Ankle dorsiflexion was measured using weight-bearing lunge test. Static and dynamic balances were measured using the overall, anterioposterior, and mediolateral balance index via the biodex balance system. Measurements were obtained prior to and following manipulation. RESULTS: This study showed that ankle dorsiflexion and dynamic balance were improved following the manipulation compared to those prior to the manipulation (p<0.05). There was no significant change in static balance (p>0.05). CONCLUSION: The joint manipulation technique applied to the ankle of those with a history of LAS appears to improve ankle dorsiflexion and dynamic balance. This suggest that a manipulation to the proximal and distal tibiofibular joint could be provided as preliminary data regarding the prophylactic effects of recurrent LAS.
Ankle Injuries* ; Ankle* ; Joints* ; Lung ; Outcome Assessment (Health Care) ; Weight-Bearing

BACKGROUND: First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. METHODS AND MATERIALS: Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months. Twenty-seven patients (84.4%) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional lymphatics with shrinking field technique. All patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had induction chemotherapy with cisplatin and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6%); stage II, 10/32 (31.3%); stage III, 8/32 (25%); stage IV, 9/32 (28.1%). RESULTS: The 5-year overall survival rate of the whole series (32 patients) was 51.7%. The overall survival rate at 5-years was 80% in stage I, 66.7% in stage II, 42.9% in stage III, 25% in stage IV ( p= 0.0958). The 5-year local control rates after radiotherapy were as follows: stage I, 100%; stage II, 60%; stage III, 62.5%; stage IV, 44.4% ( p=0.233). Overall vocal preservation rates was 65.6%, 100% in stage I, 70% in stage II, 62.5% in stage III, 44.4% in stage IV ( p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotherapy, emergent tracheostomy was done. Four patients were died from distant metastsis, : three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival ( p=0.0302). CONCLUSIONS: The role of radiotherapy in the treatment of supraglottic carcinoma is to improve the survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supraglottic carcinomas could be successfully treated with either conservative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.
Appointments and Schedules ; Brain ; Busan ; Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Laryngeal Edema ; Larynx* ; Lung ; Photons ; Radiotherapy* ; Survival Rate ; Thyroid Gland ; Tracheostomy ; Ulcer

OBJECTIVES: This study aims to examine the possible reasons of unmet dental need, considering the relationship between the socioeconomic and oral health status in Korea. METHODS: The study was designed as a cross-sectional study, using the data of the 4th Korea National Health and Nutritional Examination Survey. The samples were selected with a stratified clusters sampling method. The subjects were 8,808 out of 23,478 people, which participated in the health examination survey and the oral examination. Statistical analysis was conducted using SPSS18.0, according to complex sampling design. 26 variables reflecting demographic, social and economic characteristics, and an oral health status, were all examined for a complex sampling frequency analysis. Further, their distributional differences were confirmed by chi-square analysis. RESULTS: About 40% of the subjects failed to receive dental treatment when it was required. 'Financial burden' was the main reason, with the percentage of 39.1%, followed by 'busy with school or work' (22.4%), 'lower on the priority scale' (15.2%) and 'fear of dental treatment' (12.1%). 'Other reasons' were 5.9%. In addition to this, 2.9% of the subjects stated 'there was no one to help with their children', 1.6% was 'dental clinics were too far to go' and 0.8% was due to 'poor mobility and other health problems'. It was observed that younger than 6 years old, especially, seemed to have a high level of fear of dental treatment. The students due to school and the elderly were concerned with financial burden. Moreover, low-level educated and low-level income, also have their financial problems as the main reason. On the other hand, highly educated and those that were better-off, financially, were 'busy with school or work' as the main reason. CONCLUSIONS: The primary reason for unmet dental need was the financial burden in Korea. Also, it was confirmed that there were various reasons, according to the demographic, social and economic characteristics, such as their age, education levels and incomes, rather than oral health status.
Aged ; Cross-Sectional Studies ; Diagnosis, Oral ; Hand ; Humans ; Korea ; Oral Health ; Social Class

To estimate the manganese (Mn, below) exposure of workers in the ferromanganese manufacture factory and to evaluate its health effects, airborne, blood and urine Mn concentration measurements, questionnaire and other neurologic examinations were performed on 80 Mn-handing productive male workers (exposed group), 47 non-Mn-handling productive male workers (internal control group) and 144 productive male workers in other factory (external control group). The results obtained were as follows; The highest airborne Mn fume concentration among the work process was found at charging (0.42 mg/m3), and ferromanganese crushing process (1.14 mg/m3) was the highest in Mn dust. However all of them were below threshold limit value. Mean Mn concentrations in blood and urine of crushing workers were higher than those of other part workers. Among all of them, workers whose urine Mn concentration were exceed normal reference level (10 microgram/l) were 31 (18.5%). There was statistically significant correlation between airborne and urine Mn concentration (r=0.60), and so between airborne and blood Mn concentration (r=0.49), while there was no statistically significant correlation between blood and urine Mn concentration. Mean Mn concentration in airborne (0.60 mg/m3), urine (6.92 microgram/l) and blood (3.16 microgram/dl) in exposed group were significantly higher than those of control groups (p<0.01). Clinical symptoms such as excessive sweating, hypoesthesia, libido change, anosmia, decreased visual acuity and difficulty in writing showed higher positive rate in exposed group. Positive rate of clinical signs such as eye blinking and masked face in exposed group was higher than external control group. However clinical and laboratory findings such as blood pressure, blood chemistry, grip strength in exposed group were not statistically different from those of control groups. The results suggested that further studies were followed to evaluate the workers whose blood Mn concentration were below normal reference level but urine Mn concentrations above normal reference level, and to establish the questionnaire and the diagnostic tools to detect the Mn poisoning workers early.
Blinking ; Blood Pressure ; Chemistry ; Dust ; Hand Strength ; Humans ; Hypesthesia ; Libido ; Male ; Manganese* ; Masks ; Neurologic Examination ; Olfaction Disorders ; Poisoning ; Questionnaires ; Sweat ; Sweating ; Visual Acuity ; Writing