OBJECTIVES: Face-to-face interviews were conducted to investigate the relationship between blood pressure and the impairment of cognitive function in rural elderly (N=932) aged 60-64 in Dalsung County, April to September in 1996 METHODS: Impairment of cognitive function was defined as a score of less than 23 by the Korean version of the Mini-Mental State Examination (MMSEK). Blood pressure was measured once in each subject using a portable automatic sphygmomanometer. RESULTS: By univariate logistic regression on males, no category of systolic blood pressure bore statistical significance. Groups with diastolic blood pressures of, less than 80 mmHg, 90-94 mmHg, and more than 95mmHg had odds ratios of more than one compared with the reference group (80-89 mmHg). This was most significant in the group with blood pressures lower than 80 mmHg, which had a statistically significant odds ratio of 1.68 (95 % confidence interval Cl; 1.02-2.75). No category of blood pressure was statistically significant in females. Multivariate logistic regression for males, with adjustment for age, educational attainment, smoking, alcoholic drinking, body mass index, atherosclerotic disease, and antihypertensive medication use, did not alter the odds ratios significantly in terms of systolic blood pressure. However, the group with diastolic blood pressure of less than 80 mmHg had an increased odds ratio of 2.01 (95 % Cl; 1.15-3.52) compared with the reference group. In females, systolic blood pressure did not alter the odds ratio, but the group with a diastolic blood pressure of less than 80 mmHg had a statistically significant odds ratio of 0.57 (95% Cl; 0.37-0.89). CONCLUSIONS: These results suggest that the relationship between blood pressure and cognitive function status is stronger diastolic than systolic blood pressure and that there is a complex relationship between blood pressure and cognitive function by sex.
Aged ; Alcoholics ; Blood Pressure* ; Body Mass Index ; Drinking ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Smoke ; Smoking ; Sphygmomanometers

PURPOSE: We report a case of congenital accessory punctum and canaliculus in a patient with dry eye, which had not previously been reported in Korea. METHODS: A 56-year old woman presented with dry eye that was more pronounced in the left eye than in the right. An accessory punctum was found in the left medial canthus. Dacryocystogram showed that the accessory punctum had an independent canaliculus which was connected to a normal upper canaliculus. RESULTS: The symptoms were relieved after permanent punctal occlusion of the lower and accessory puncta. CONCLUSIONS: Severe dry eye can be induced by congenital accessory punctum and canaliculus.
Dry Eye Syndromes ; Female ; Humans ; Korea ; Middle Aged

BACKGROUND: Defective adhesion and migration of melanocyte may be involved in pathogenesis of vitiligo. Tenascin, a glycoprotein of the extracellular matrix, has a role in cell adhesion and migration. It has been reported that abundant expression of tenascin in vitiligo lesion may inhibit melanocyte adhesion and migration. OBJECTIVE: To investigate the tenascin expression in vitiligo skin lesions and to compare with clinical findings. METHODS: We studied 9 patients with vitiligo. The expressions of tenascin were studied by immunahistochemieal techniques.
Cell Adhesion ; Extracellular Matrix ; Glycoproteins ; Humans ; Melanocytes ; Skin ; Tenascin* ; Vitiligo*

There is no doubt that the diastolic dysfunction of the left ventricular plays an important role in the pathophysiogy of clinical heart faliure in some patients, if not all, and that many hypertensive subjects manifest diastolic dysfunction of the left ventricle in its early hypertensive stage. But yet, it is not clear which paramenter is most sensitive and/or specific, and consistent with pathophysiologic states. In order to have an insight into the problems, 30 hypertensives and 30 normotensive subjects were studied by phonocardiogram and pulsed Doppler echocardiogram at the left ventricular inflow and then isovolumic relaxation time(A2D time), early diastolic deceleration time(EDDT), early diastolic deceleration rate(EDDR), late diastolic time(LDT), E.A velocity ratio[E/A(v)]and E/A area ratioA(a)] were measured and calculated. And the values of each parameters of different groups were subgrouped according to the severity of the hypertension(Group A:mild, B:moderate and C:severe hypertension) and according to the LV mass(Group D:LVMI<125g/m2, GroupE:LVMI> or =125g/m2) were compared with those of the normal control subjects and also between each subgroups. The results were as follows : 1) In the 30 normotensive subjects, A2D time was averaged out 60.8+/-12.5msec, E/A(v) 1.55+/-0.59, E/A(a) 2.61+/-1.35, EDDT 1.35+/-37.8msec, EDDR8.3+/-4, 6m/sec2 and LDT 151+/-42.2msec. 2) In group A, A2D time was significantly prolonoged(82.5+/-26.0msec, p<0.005) and E/A(v) markedly decreased(1.12+/-0.40, p<0.05) compared to those of normotensive group. 3) In group B, A2D time was significantly prolonged(78+/-20.8msec, p<0.005), and E/A(v)(0.92+/-0.42, p<0.005) and EDDR(4.9+/-1.5m/sec2, p<0.05) were significantly decreased compared to those of the control group. 4) In group C, A2D and EDDT were increased(p<0.005, p<0.05 respectively) while E/A(v) and EDDR decreased(p<0.01, p<0.05 respedtively), while E/A(v) and EDDR decreased(p<0.01, p<0.005 respectively). 5) In group D, A2>D and EDDT were significantly prolonged(p<0.005), while E/A(v), E/A(a) and EDDR wer significantly decreased(p<0.005, p<0.05 respectively). 6) In group E, A2D and EDDT were significantly increased(p<0.005, p<0.05 respectively), while E/A(v) and EDDR significantly decreased(p<0.005, p<0.05 respectively). Above results suggest that diastolic function of the left ventricle can be deteriorated in the hypertensive subjects before systolic dysfunction is apparent even in the mild hypertensives and in the patients devoid of hypertensive hypertrophy of the left ventricle.
Deceleration ; Heart ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy ; Relaxation

OBJECTIVE: To determine the clinical and radiological safety of 15 consecutive patients managed with plate and screw fixation systems applied to the cervical lateral mass. METHODS: 15 patients who underwent posterior cervical and T1 arthrodesis were reviewed from Jan 2002 to Dec 2004. Posterior cervical screw and plate fixation was applied on the lateral mass of the cervical spine. The authors have tried lateral mass screw fixation using a modified Magerl's technique (20 degrees lateral and 20~30 degrees rostral screw trajectory) under preliminary radiological study. The average patient age was 39.73 degrees+/-11.00 years, and the average follow-up period was 9.73 degrees+/-6.77 months. Computed tomography scans taken after surgery were reviewed to confirm the attempted screw trajectory correct and safety. RESULTS: Three of 93 lateral mass screws were malpositioned but clinical damage was not noted. Two of 8 pedicle screws on the T1 vertebrae were not placed on the correct pedicle area. Screw and plate loosening was observed in one case but was not subjected to an additional procedure because of maintained screw position observed during follow-up periods. CONCLUSION: The results of this study indicate that lateral mass screw fixation using the Modified Magerl's technique on the cervical lateral mass may provide safe and effective application on the patients. In addition, the chance of incorrectly placed screws was higher in T1 pedicle screw fixation than in lateral mass screw fixation of the cervical area.
Arthrodesis ; Follow-Up Studies ; Humans ; Spine

Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent ; Dyspnea ; Electrophysiologic Techniques, Cardiac ; Fascia ; Female ; Heart Block ; Humans ; Incidence ; Polyethylene Terephthalates ; Syncope

The only clinically avilable levo-isomer type of beta-recepter blocker is penbutolol sulfate, and it is already accepted as one of beta-receptor blockers for initial antihypertensive drug therapy according to the report of 1988 Joint National Committee on Detection, Evaluation, and Tratment of High Blood Pressure. To evaluate the antihypertensive efficacy, effect on the quqlity of life, and side effects of penbutolol recently introduced into Korea, penbutolol was administered to 29 essential hypertensive(mild 9, moderate10, and severe 10) patients for 12 weeks or longer. The result of the clinical analysis are as follows; 1) The mean age was 50.0+/-10.9(M+/-SD), and the sex distribution between male and female was16:13. 2) The blood pressure lowering effects of penbutolol as a monotherapy were marked in 16, moderate in 6, and insignificant in 2 cases. The systolic blood pressure was significantly decreased from 179.1+/-20.2 to 135.4+/-16.5mmHg(P<0.005), and the diastolic blood pressure from 112.6+/-13.5 to 84.0+/-11.9mmHg(P<0.005)after 12 weeks' penbutolol therapy. 3) The heart rate was significantly decreased from70.3+/-13.3 to 65.5+/-9.1 per minute(P<0.05). 4) The quality of life was improved markely in 5(17.2%) and slightly in 8 cases(29.6%). 5) There were no significant laboratory changes after 12 weeks' penbutolol therapy. 6) Two out of three cases with non-specific ST segment and T wave changes in EKG and two out of 9 cases with EKG were normalized, 2 cases of LAH with strain were improved. 7) The side effects of penbutolol were dizziness in 4, sexual dysfunction in 2, and skin rash in 1 case. 8) Final multifarious assessment of penbutolol therapy showed that it was very useful in 11(37.9%), useful in 4(13.8%) and slightly useful in 7 cases(24.1%). These reult suggest that penbutolol is a first-line antihypertensive agent with an effective antihypertensive action, improving quality of life, with no significant laboratory changes and few side effects.
Blood Pressure ; Dizziness ; Drug Therapy ; Electrocardiography ; Exanthema ; Female ; Heart Rate ; Humans ; Hypertension ; Joints ; Korea ; Male ; Penbutolol ; Pheniramine ; Quality of Life ; Sex Distribution

Sphenoid sinus is adjacent to important intracranial structures, such as major intracranial vessels and some cranial nerves. However isolated sphenoid sinusitis is often misdiagnosed because presenting symptoms are initially subtle. Therefore, if the diagnosis of the isolated sphenoid sinusitis is delayed and complications occur, it will lead to disastrous results. We experienced a rare case in which a 51-year-old male patient developed both brain abscess and abuducens nerve palsy and report this case with a review of the case and related articles.
Abducens Nerve Diseases ; Brain Abscess ; Cranial Nerves ; Humans ; Male ; Middle Aged ; Orbit ; Paralysis ; Sphenoid Sinus ; Sphenoid Sinusitis

The left ventricular hypertrophy(LVH) in the hypertensive patients is known to be associated with relatively higher risk for cardiovascular morbidity and mortality. In this sense the reversal of LVH with blood pressure control, if attained, could yeild an additional benefit of reducing cardiovascular morbidity and/or mortaility associated with hypertension. However pathogenesis of LVH, the attitude of the LVH to regerss with blood pressure control in a particular patient and whether the regression is really beneficial are not clear. In order to see the effect of angiotensin converting enzyme(ACE) inhibitors on LVH and the age group difference of the LVH regresion, if attainable, 26 hypertensive patients with LVH(LVMI:Left Ventricular Mass Index>125g/m2) were treated with enalapril or captopril for more than 12 weeks and the LVMI followed and the regression rates in younger group "A"(less than 50 years of age) and elder group "B" were compared(LVMI, level of blood pressure, kinds and dosage of enalapril or captopril were not different between the two groups). The LVMI was significantly decreased in both groups, in group A from 191.6+/-74.9g/m2 to 139.7+/-52.0g/m2, and in group B from 185.5+/-58.7g/m2 to 163.9+/-58.7g/m2. In group A the percent decrease of LVMI was significantly higher than that of group B(25.3+/-14.9% versus 10.3+/-8.6%, p<0.005). Above results suggest that enalapril and captopril are equally effective in reducing LVMI in hypertensive patients with LVH and the regression of the LVMI is more marked in the younger age group in this relatively short-term treated small population study.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; Blood Pressure* ; Captopril ; Enalapril ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Mortality ; Peptidyl-Dipeptidase A*

Trichomoniasis is a sexually transmitted disease by Trichomonas vaginalis infection that may be associated with preterm delivery and low birth weight in the newborn infants. T. vaginalis may be transmitted to neonates during passage through an infected birth canal and neonatal infection is usually self-limiting course, but rare cases of symptomatic neonatal infection such as vaginitis, urinary tract infection and respiratory infection have been reported. We experienced a case of symptomatic neonatal trichomoniasis which was confirmed by wet mount examination of vaginal discharge and urine specimens in premature baby with intrauterine growth retardation. The patient had complete resolution of symptoms such as vaginal discharge and pyuria after treatment with ornidazole (tiberalR). We report this case with a brief review of the related literatures.
Fetal Growth Retardation ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Ornidazole ; Parturition ; Pyuria ; Sexually Transmitted Diseases ; Trichomonas vaginalis ; Urinary Tract Infections ; Vaginal Discharge ; Vaginitis