BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
Arterial Pressure ; Blood Gas Analysis ; Central Venous Pressure ; Critical Illness* ; Glaucoma ; Humans ; Intraocular Pressure* ; Positive-Pressure Respiration* ; Tonometry, Ocular ; Veins

BACKGROUND: Since recent economic crisis(IMF) in Korea, the number of new homeless is increasing(that is, 'IMF style homeless'). There are only few studies on the health problem of this uniquely formed population. We have attempted to estimate the problem of health behavior and health status of this population. METHODS: Some homeless who agreed to enter the asylum during the winter were taken for medical check-up in Sungbuk Community Health Center from November to December, 1998. The participants filled up a self-reported questionnaire and physical examination, laboratory test, and chest x-ray were performed. RESULTS: Among 'IMF style homeless', the prevalence of hypertension(30.9% in primary screening, 7.3% in secondary screening), diabetes mellitus(9.4% in primary screening, 3.5% in secondary screening), syphilis(7.3%), and hepatitis B antigen carrier(5.3%) was higher than among the general population. But we could not find statistical difference according to the duration of homelessness. We found higher smoking rate and higher alcohol drinking amount per week in homeless than in the general population. The amount of alcohol drinking per week was larger among those who had been homeless for more than 3 months(p< 0.01). CONCLUSION: The prevalence of chronic diseases in homeless was higher than in the general population, but statistical difference according to the duration of homelessness could not be found. The longer the duration of homelessness, the larger the amount of alcohol drinkin was seeng.
Alcohol Drinking ; Chronic Disease ; Community Health Centers ; Health Behavior ; Hepatitis B ; Homeless Persons ; Humans ; Korea ; Mass Screening ; Physical Examination ; Prevalence ; Seoul* ; Smoke ; Smoking ; Thorax ; Surveys and Questionnaires

Brown tumor is a bone disease that arises in the setting of increased osteoclastic activity and fibroblastic proliferation in the involved bone. It is well recognized as serious complication of hyperparathyroidism. Brown tumor is uncommon, and brown tumor with secondary hyperparathyroidism resulting from chronic renal failure has rarely been reported. We recently experienced a case of a 28-year-old Korean woman with chronic renal failure caused by chronic glomerulonephritis, on hemodialysis for nine years. She has been hospitalized with left shoulder pain for two years. Image studies showed multiple cystic masses, and both suspicious marked thinning and partial destruction of the cortex on the head of the left humerus. Histopathologic analysis of the mass lesion showed a fibrotic capsule, hemosiderin pigmentation, and giant cell, all characteristic of brown tumor. A subtotal parathyroidectomy was done without surgery of the bony lesion (brown tumor), with successful results. We report this case with a brief review of the literature.
Adult ; Bone Diseases ; Female ; Fibroblasts ; Giant Cells ; Glomerulonephritis ; Head ; Hemosiderin ; Humans ; Humerus* ; Hyperparathyroidism ; Hyperparathyroidism, Secondary* ; Kidney Failure, Chronic ; Osteoclasts ; Parathyroidectomy* ; Pigmentation ; Renal Dialysis ; Shoulder Pain

We report a case of the functioning long subcutaneous fibrous tract that drained cerebrospinal fluid into peritoneal cavity. A 13 year-old boy whose distal catheter had been removed 10 years before was admitted with intermittent headache and deteriorated mentality. On physical examination, a hard and firm long subcutaneous catheter-like structure was palpable along the tract of the old distal catheter in the neck, anterior chest and abdomen. We could see hydrocephalus on the computed tomography(CT) scan and passage of radioisotope through the long left subcutaneous fibrous tract into abdomen on the shunt function test. After ventriculoperitoneal shunt in the right side, he improved clinically and brain CT scan showed decreased size of ventricles.
Abdomen ; Adolescent ; Brain ; Catheters* ; Cerebrospinal Fluid* ; Headache ; Humans ; Hydrocephalus ; Male ; Neck ; Peritoneal Cavity ; Physical Examination ; Thorax ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt*

No abstract available.
Osteoporosis* ; Spondylitis, Ankylosing*

BACKGROUND: Obesity is not anly one of the risk factors that affects the prevalence and aggravation of chronic diseases, but is also the cause of social unfitness because slimness has become a standard of beauty. We surveyed on the satisfaction about self body image, the factors which are related to it and weight control behavior of the adolescents in a local area of Korea. METHODS: The survey was performed in a high school of Pocheon on August, 1996. Five classes out of 14 classes in 1st and 2nd grade were selected. The body mass index(BMI) was calculated from the measured height and weight. The satisfaction about body image which was estimated by the difference between present body image and wanted body image in 9 graded figures of body image was obtained from the questionnaire. The information about sex, religion, history of being teased about body image, body image of their parents, mean duration of watching TV in a day, body esteem, and binge-eating was obtained from the questiannaire and we evaluated the relationship between all of the above with BMI and body image satisfaction. We also investigated on the interest in education about weight control and efforts made by adolescents from the questionnaire on weight control behavior. RESULTS: Total of 224 students participated in this study and only 14.7% of them were satisfied with their body image. 58.9% wanted weight reduction and 26.4% wanted weight gain. They were more dissatisfied with their body image when they were girls(p<0.01), had the experience of being teased about their body image(p<0.01), had low body esteem(p<0.01), and had high BMl(p<0.01). We could not find statistically significant relationship between body image satisfaction and other factors such as religion, the duration of watching TV in a day, the body image of their parents and binge eating. 64.3% of the subjects tried to control their weight and most(87.5%) tried to lose weight. The selected methods were diet control(65.3%) and exercise(52.1%) and the most preferred method of diet control was skipping meah(45.7%). CONCLUSIONS: Most of adolescents were not satisfied with their body image and this dissatisfaction was related to gender, history of being teased about their body image, BMI, and body esteem. Many of them had tried to lose weight and among the methods of weight reduction, there were behaviors that were injurous to their health and growth
Adolescent* ; Beauty ; Body Image* ; Bulimia ; Chronic Disease ; Diet ; Education ; Humans ; Korea ; Obesity ; Parents ; Prevalence ; Risk Factors ; Weight Gain ; Weight Loss ; Surveys and Questionnaires

BACKGROUND: Venous regurgitation into the infusion line and subsequent occlusion frequently occurs during blood pressure (BP) measurement. The purpose of this study was to obtain the pattern and the actual range of peripheral venous pressure (PVP) change during NIBP measurement before and during enflurane anesthesia. METHODS: Adult size NIBP cuff was placed on the same arm on which IV infusion set was placed. PVP waveforms during BP measurement were recorded from 6 subjects. PVPs were measured before induction and at 30 min after induction of enflurane anesthesia (n=19). As the PVP waveform during NIBP measurement was biphasic in shape, values of baseline PVP (BEFORE), first peak (PEAK1), notch between two peaks (NOTCH), second peak (PEAK2) were measured. Timed control data were obtained from six volunteers. RESULTS: PEAK2 was always higher than PEAK1. Range of peak PVP was 12-130 mmHg (57.6 2.5 mmHg, mean S.E.) and PVP change was augmented during enflurane anesthesia (p<0.05). Enflurane anesthesia accentuated correlationship between mean arterial pressure and PVP. CONCLUSION: Our observation showed that peak PVP occurred during deflation phase and its range of variation was substantial. Changes in the pattern and the autoregulation of PVP by enflurane needs further investigation.
Adult ; Anesthesia* ; Arm ; Arterial Pressure ; Blood Pressure* ; Enflurane* ; Homeostasis ; Humans ; Venous Pressure* ; Volunteers

PURPOSE: The usefulness and radiographic findings of the angiography in cerebral infarction are well known. We attempted to evaluate the anglographic causes, findings, and the usefulness of DSA in cerebral infarction. MATERIALS AND METHODS: The authors reviewed retrospectively DSA images of 51 patients who were diagnosed as having cerebral infarction by brain CT and/or MRI and clinical settings. DSA was performed in all 51 patients, and in 3 patients, conventional anglogram was also done. Both carotid DSA images were obtained in AP, lateral, oblique projections, and one or both vertebral DSA images in AP and lateral. The authors reviewed the patient's charts for symptoms, operative findings and final diagnosis, and analysed DSA findings of cerebral atherosclerosis with focus on 6 major cerebral arteries. RESULTS: Among the 51 patients of cerebral infarction 43 patients(84.3%) had cerebral atherosclerosis, 1 dissecting aneurysm, 1 moyamoya disease and 6 negative in anglogram. DSA findings of cerebral atherosclerosis were multiple narrowings in 42 patients(97,7%), tortuosity in 22(51.2%), dilatation in 14, occlusion in 12, avascular region in 8, collaterals in 7, ulcer in 6, and delayed washout of contrast media in 3. In cerebral atherosclerosis, internal carotid artery was involved in 37 patients(86.0%), middle cerebral artery in 29(67.4%), posterior cerebral artery in 28, anterior cerebral artery in 26, vertebral artery in 22, and basilar artery in 15. Intracranial involvement of cerebral atherosclerosis (64.9%) was more common than extracranial involvement(16.2%). CONCLUSION: In cerebral infarction MRA may be the screening test, but for more precise evaluation of vascular abnormality and its extent, DSA should be considered.
Aneurysm, Dissecting ; Angiography ; Angiography, Digital Subtraction* ; Anterior Cerebral Artery ; Basilar Artery ; Brain ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebral Infarction* ; Contrast Media ; Diagnosis ; Dilatation ; Humans ; Intracranial Arteriosclerosis ; Magnetic Resonance Imaging ; Mass Screening ; Middle Cerebral Artery ; Moyamoya Disease ; Posterior Cerebral Artery ; Retrospective Studies ; Ulcer ; Vertebral Artery

BACKGROUND: Many children and adolescents are exposed to the risk of cardiovascular diseases because of increase in obesity and obesity-related metabolic derangements in children and adolescents. The diagnosis of the metabolic syndrome is useful to identify these children with high cardiovascular risk. In 2007, the International Diabetes Federation (IDF) presented a new defi nition of the metabolic syndrome for children and adolescents. The aim of this study was to estimate the prevalence of the metabolic syndrome using the IDF pediatric defi nition in Korean children and adolescents. METHODS: We used data from 931 participants aged 10-19 years in the Korean National Health and Nutrition Examination Survey 2005. The metabolic syndrome was diagnosed by the new IDF pediatric defi nition. RESULTS: The prevalence of the metabolic syndrome in Korean children and adolescents aged 10-19 years was 2.0 +/- 0.5% (boys: 3.1 +/- 0.8%, girls: 0.8 +/- 0.4%). Approximately 95% of children and adolescents with the metabolic syndrome was classifi ed with obesity and none of the normal-weighted participants were diagnosed with the metabolic syndrome. CONCLUSION: The prevalence of the metabolic syndrome in Korean children and adolescents was 2.0 +/- 0.5%. It is expected that the new IDF pediatric defi nition will help to detect children with high cardiovascular risk early and to manage them properly. However, whether the IDF pediatric defi nition of the metabolic syndrome and cut-off points of its components are appropriate for Korean children and adolescents should be answered through future research.
Adolescent ; Aged ; Cardiovascular Diseases ; Child ; Humans ; Nutrition Surveys ; Obesity ; Obesity, Abdominal ; Prevalence

BACKGROUND: To determine the bone mineral density (BMD), serum soluble receptor activator of the nuclear factors kappa B ligand (sRANKL) and the osteoprotegerin (OPG) levels in patients with ankylosing spondylitis (AS), and to determine their relationship with disease activity indexes. METHODS: The disease activity was evaluated by the Bath Ankylosing Spondylitis Disease Activity Score Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Spondylitis Patient Global Score (BAS-G). The BMD was measured by dual energy X-ray absorptiometry. Serum levels of sRANKL and OPG were measured by the sandwich enzyme-linked immunosorbent assay. RESULTS: Osteoporosis and osteopenia of the femoral neck were found in 33% and 41%, respectively. BMD of femoral neck showed a negative correlation with disease activities. The serum levels of sRANKL were higher in patients with AS than in controls, and the ratio of sRANKL to OPG was also elevated in AS, but had no correlation with disease activity. The sRANKL/OPG ratio tended to be higher in patients with lower BMD. CONCLUSIONS: BMD was reduced in 79% of AS patients and reflected disease status. The sRANKL/OPG ratio was upregulated in patients with AS and it appears to be related to BMD and radiological changes. These results suggest that the imbalance between RANKL and OPG might be involved in the pathogenesis and clinical courses of AS.
Absorptiometry, Photon ; Baths ; Bone Density ; Bone Diseases, Metabolic ; Enzyme-Linked Immunosorbent Assay ; Femur Neck ; Humans ; Osteoporosis* ; Osteoprotegerin ; Spondylitis, Ankylosing*