Five ten per cent of asthmatics remain symptomatic despite high-dose treatment. Difficult asthma must be distinguished from severe asthma. Difficult asthma was defined as persistence of symptoms despite treatment at step wise recommended. It is then important in patients with suspected difficult asthma to ensure that the diagnosis is correct, and that if the patient has asthma that the attributed symptoms are indeed all genuinely due to the asthma and not to coexisting physical or psychogenic respiratory conditions. It is also important to be alert to recognize both poor perceivers and over-reactors. Asthma may be difficult for the patient, for the clinician or both because of disease factors, doctor or nurse therapist factors, and/or patient factors. Investigation requires access to the full range of respiratory, imaging and allergy tests. There remains a small number of patients with genuine steroid-resistant asthma, brittle asthma and asthma with airway remodeling. The anti-inflammatory effects of GCs are mediated through receptors that modulate inflammatory gene expression. GC resistance results from an interaction between susceptibility genes, the host's environment, and immunologic factors. The management of these patients requires a systematic approach to rule out underlying conditions that lead to GC resistance or treatment failure, as well as the use of alternative strategies to inhibit tissue inflammation.
Airway Remodeling ; Asthma* ; Diagnosis ; Gene Expression ; Humans ; Hypersensitivity ; Immunologic Factors ; Inflammation ; Treatment Failure

The trends of gastric cancer in Korea are changing, such as an increase of early and minute gastric cancer. The standard treatment of gastric cancer has become more complicated. Endoscopic treatment of gastric cancer is considered to be a useful procedure towards a curative or conservative treatment of early gastric cancer or advanced gastric cancer. Recent advances in endoscopic treatment technique are truly remarkable. The advances allow minimally invasive treatment of diseases that would otherwise require major surgery. New techniques will continue to solve the limitations of endoscopic treatment and their use will also continue to expand accordingly.
Korea ; Stomach Neoplasms* ; Stomach*

No abstract available.
Respiratory System* ; Ventilators, Mechanical*

No abstract available.
Asthma* ; Inhalation* ; Respiratory Therapy*

No abstract available.
Diabetic Nephropathies*

No abstract available.
Endothelial Cells* ; Humans* ; Umbilical Veins*

BACKGROUND: Socio-economic factors, culture, and the health care delivery system are all associated with increased risk of cardiovascular disease (CVD). However, their significance and prevalence in Korea have not been precisely determined. The purposes of this study were to identify factors related to increased CVD risk among Koreans, and compare the results with those of previous studies. METHODS: This study is an analysis of secondary data collected through the Korea National Health and Nutrition Examination Survey. For the purposes of this research, CVD is defined as medically diagnosed hypertension, stroke, angina, and myocardial infarction. Of the 38,746 survey participants, we analyzed 4,727 subjects who suffered from CVD. RESULTS: Before the age of 50, men have a greater risk of CVD than women while a woman's risk of CVD after 50 begins to rise with age. Socioeconomic factors such as education, income, single living pattern, chronic kidney disease (CKD), diabetes mellitus (DM), depression, rheumatic arthritis, chronic obstructive pulmonary disease, body mass index and waist circumference, lipids, physical activity, and diet are all associated with the prevalence of CVD. A multi-variate analysis demonstrated that CKD (odds ratio, OR=5.266, P<0.001) and DM (OR=2.872, P<0.001) are the strongest independent predictors of CVD among Koreans. CONCLUSIONS: The prevalence of CVD among Korean was about 12.2%. While most risk factors had similar influence on the development of CVD, depression, CKD, and DM showed stronger correlations than those seen in studies performed in other countries. Our results show that a greater importance should be placed on strict and early management of these diseases.
Body Mass Index ; Cardiovascular Diseases ; Chronic Disease ; Delivery of Health Care ; Depression ; Diabetes Mellitus ; Diet ; Female ; Health Promotion ; Humans ; Hypertension ; Korea ; Male ; Motor Activity ; Myocardial Infarction ; Nutrition Surveys ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Renal Insufficiency, Chronic ; Rheumatic Fever ; Risk Factors ; Socioeconomic Factors ; Stroke ; Waist Circumference

We report unusual 3 cases of adult coronary arteriovenous fistula(CAVF) diagnosed by coronary arteriography in Soonchunhyang University Hospital. In one patient with mitral stenoinsufficiency, multiple CAVFs originated from left anterior descending and left circumflex coronary areries. In another patient with significant stenosis(90%) in distal right coronary artery, new CAVF was seen in mid right coronary artery during consecutive coronary arteriography. In the remaining one, it was arose from contus branch of right coronary artery. Surgical correction was performed in two cases.
Adult* ; Angiography ; Arteriovenous Fistula* ; Coronary Vessels ; Humans

BACKGROUND: Studies of human coronary plaque specimens have shown that T lymphocytes and macrophages are present in all types of lesions, from fatty streaks to advanced plaques. There is growing evidence for a pathogenic role for immune response in progression of atherosclerosis. This study was designed to investigate cytokine production by mononuclear leukocytes from patients with myocardial infarction. METHOD: We measured the kinetics of secretion of tumor necrosis factor-alpha (TNF-alpha) and interferon-r (IFN-r) by mononuclear leukocytes from 8 control subjects and 12 patients with acute myocardial infarction. Mononuclear leukocytes were isolated and incubated with plant lectin mitogen concanavalin-A for 24 and 48 hours. TNF-alpha and IFN-r secretions were measured by ELISA. RESULTS:There were no significant differences between TNF-alpha and IFN-r secretions by mononuclear leukocytes at and before 24 hours of incubation from both patients and control subjects, but TNF-alpha and IFN-r secretions at 48 hours of incubation were higher (p<0.005, p<0.05) in patients when compared with control subjects. TNF-alpha and IFN-r secretions by mononuclear leukocytes after incubation correlated with the peak level of creatine phosphokinase (CK) and CK-MB. CONCLUSION: Increased cytokine secretory capacity of mononuclear leukocytes may be due to the acute inflammatory response of myocardial infarction. Further trials may be needed to determined the effects of increase in secretory capacity of mononuclear leukocytes before myocardial infarction.
Atherosclerosis ; Creatine Kinase ; Enzyme-Linked Immunosorbent Assay ; Humans ; Kinetics ; Leukocytes, Mononuclear* ; Macrophages ; Myocardial Infarction* ; Plants ; T-Lymphocytes ; Tumor Necrosis Factor-alpha*

BACKGROUND: Most studies of Mycoplasma pneumonia involve a group of admitted patients in hospital, usually with major medical illness. So we investigated the epidemiologic and radiologic features during the course of outbreak of pneumonia in Chunnam coastal area. METHODS: We retrospectively studied the epidemiologic and clinical feature of 105 patients with serologically proven Mycoplasma pneumonia treated at Kwang-Yang Hospital during a epidemic period of Jun. 1993 to Dec. 1993. All cases of pneumonia developed in this period were also reviewed and compared with serologically proven group. RESULTS: 1) There were 63 males and 42 females. 2) More than half(57%) of cases belonged to 5-9 years of age group, and mean age was 6.5 years old. Mean age was steadily decreased as prevalence of Mycoplasma pneumonia had been subsided. 3) A major determinant of the outbreak seemed to .to the population density rather than the population size. 4) The common radiologic features were interstitial in type, and 67 cases was restricted to one lobe. Lobar types are more common in late childhood, and interstitial or diffuse types in early childhood. CONCLUSION: These epidemiologic and radiographic characteristics would contribute to the diagnosis of Mycoplasma pneumonia.
Diagnosis ; Female ; Humans ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Population Density ; Prevalence ; Retrospective Studies