BACKGROUND: Blood pressures rneasured by a nurse at reception room as a part of routine physical examination are oft,en used as a indicator of medical care. Blood pressure at reception room and consultation room are, however, often different to each other and these differences are caused by various factors including difference of white coat effect by nurse and doctor. Thus, this study was performed in order to know whether blood pressure difference really exit, and its associated factors. METHODS: Two hundred ninety one patients who visited to one university hospital farnily practice were enrolled in this study. Blood pressure and pulse rate at reception room and consultation room, waiting t,ime, time interval between reception and consultation, smoking status, and intake of coffee and food were collected. Nine patients were excluded, because blood pressure either at reception room or at consulation room was not recorded. This study was performed by one nurse and two doctors. They defined the guideline for method of blood pressure measurement before the study, and used the same kind of indirect cuff sphygmomanometer. RESULTS: Two hundred eighty two patients were analyzed. The number of men was one hundred twenty five. Systolic blood pressure at consultation room was higher than that at reception room by 1.6+/-11.9mmHg (P<0.05). Sixty five cases(65%) in systolic blood pressure and 111 cases(40%) in diastolic blood pressure showed blood pressure differences more than 5mmHg. The group with systolic blood pressure difference between reception room and consultation room(SBP) in more than 5mmHg is more likely to be hypertensive than the group with SBP in less than 5mmHg(P<0.01). More female patients(66%) and hypertensive patients(59%) were belong to the group whose systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). Twenty four patients(30%) of the group whose systolic blood pressure at reception room were 5mmHg higher than at consultation room had cigarette smoking within 1 hour, and this ratio was significantly higher than the other groups whose systolic blood pressure difference was less than 5rnmHg or systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). There was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site(Overall kappa, 0.747, P<0.01). CONCLUSIONS: Many patients showed blood pressure differences more than 5mmHg between reception room and consultation room. Systolic blood pressure at consultation room was higher than that at reception room, and there was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site, but the adverse effect by misclassification should not be neglected. The importance as well as the limitation of blood pressure measurement at reception room should be considered in screening and treating hypertensive patient. Every time when blood pressure is taken, physicians should keep in mind to consider patients factors which may influence blood pressure level.
Blood Pressure* ; Coffee ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Mass Screening ; Outpatients* ; Physical Examination ; Smoke ; Smoking ; Sphygmomanometers

BACKGROUND: Hypertension is one of the frequent problems for which family physicians are well encountered to manage. Nonpharmacologic measures which include stress relaxation, low salt diet, weight reduction, moderation of alcohol intake, physical activity, tobacco avoidance are used as definitive or adjuvant therapy for hypertension. Family physicians should vigorously encourage their patients to adopt these life style modifications. This study was conducted to know how many nonpharmacologic treat,ment modalities are adopted by hypertensives and to find predicting factors. METHODS: A total of 100 of the hypertensive patients who are followed up via the department of family medicine, Hanyang University Hospital, from September 1995 through November 1995 are included in this study. A trained nurse interviewed patients according to the previously designed structured questionnaire. The overall response rate was 90% and the fill-up rate of the questionnaire was 100%. RESULTS: Sixty three patients were women. The mean age was 57.4 years(range, 20 to 84). Sixty one percent accompanied one or more other diseases, of which diabetes mellitus was the most common disorder. The mean systolic pressure was 143.9 mmHg and the mean diastolic blood pressure was 89.3mmHg. Ninty-three percent of patients received antihypertensives with compliance of 81 to 100%. Twenty four percent of patients adhered to regular exercise, 36 percent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent no smoking. Of those six non-pharmacological treatments, 3.6 behaviors were adhered. Male patients were more attended with the low salt diet. Eleven patients of 2S alcoholics(44.0%) reduced their amount of alcohol intake and 8 of 17 smokers quitted smoking (47.1%) after they were diagnosed as hypertension. The mean BEPSI score was 1.5. Fifty one percent of patients had stress within the last three months, 32 percent had cumulative fatigue. The occupational stress was the most common one. All exercise which patients reported were isotonic. Seventeen percent of the patients took certain herb medicine or folk medicine. CONCLUSIONS: Of those 100 hypertensives who were treated at the department of family medicine, Hanyang University hospital, 24% adhered to regular exercise, 36 per cent weight reduction, 48 percent low salt diet, 79 percent moderate drinking, 81 percent stress relaxation, and 87 percent quit smoking in order. Of those six non-pharmacological treatments, 3.6 behaviors were adhered on the average. Nonpharmacologic treatment should be promoted by family physician as an important strategy for treatment of hypertension.
Antihypertensive Agents ; Blood Pressure ; Compliance ; Diabetes Mellitus ; Diet ; Diet, Reducing ; Drinking ; Fatigue ; Female ; Humans ; Hypertension ; Life Style ; Male ; Medicine, Traditional ; Motor Activity ; Physicians, Family ; Relaxation ; Smoke ; Smoking ; Tobacco ; Weight Loss ; Surveys and Questionnaires

The systemic lupus erythematosus is a self-perpetuating disease with multisystem involvement, i.e.; skin, kidney, serous membrane, nervous system and other organs. The mortality in SLE is determined primarily by the extent of renal involvement and the degree of immunosuppression resulting from the therapy. We experienced two cases of lupus nephritis in SLE with clinical, serologic, immunologic and pathologic evaluations. Renal biopsy revealed focal and segmental proliferative glomerulonephritis and mesangial proliferative glomerulonephritis. Both patients have been improving with prednisolone on follow-up studies.
Biopsy ; Follow-Up Studies ; Glomerulonephritis ; Humans ; Immunosuppression ; Kidney ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Mortality ; Nervous System ; Prednisolone ; Serous Membrane ; Skin

BACKGROUND: Neer type II distal clavicle fractures have the drawback of coracoclavicular instability and insufficient distal bony fragment, thereby making it difficult to achieve adequate fixation. Although various surgical treatments have been described for Neer type II fracture, the optimal treatment remains controversial. This study reports the clinical results and usefulness of anatomical locking plate with additional K-wire fixation. METHODS: A totally of 21 patients with type II distal clavicle fracture were included in the study. The surgical procedure reduced the fracture temporarily; it included insertion of one or two K-wire from the lateral margin of the distal fragment to the proximal fragment through the fracture site, followed by application and fixation of the locking plate. The bony union and migration of K-wire was evaluated in the follow-up radiography. The coracoclavicular distance and acromioclavicular joint arthrosis were assessed at the final follow-up. The Constant Score (CS) and Korean Shoulder Score (KSS) were evaluated for clinical scoring. RESULTS: Bone union was achieved in all cases. At the final follow-up, coracoclavicular distance of the injured shoulder was increased, as compared to the intact shoulder (p=0.002), with no accompanying clinical symptoms. No K-wire migration was observed. At the final follow-up, K-wire irritation was observed in two cases and acromioclavicular arthrosis in one case, with no other adverse effects. Pain visual analogue scale, CS, and KSS were improved in all cases. CONCLUSIONS: The method of anatomical locking plate with additional K-wire fixation could be useful in achieving beneficial clinical results.
Acromioclavicular Joint ; Clavicle* ; Follow-Up Studies ; Humans ; Methods ; Radiography ; Shoulder

No abstract available.
Barium* ; Enema* ; Intussusception*

In Korea, owing to effective vaccination, occurences of poliomyelitis begen to decrease rapidly from 1964 and in recent years less than 10 cases of acute infection are being reported annually. However, patients crippled with poliomyeltis residua, mainly the legacy of the many epidemics of 1950s, and early 1960s, are many and pose a social and national problem as well as a personal and family ordeal. We reviewed 536 patients with residual poliomyelitis admitted and treated at Seoul National University Hospital during the past 18 years, from 1963 to 1980 They were divided into four chronological groups; the first, 1993 to 1968, the second 1968 to 1973, the third, 1974 to 1977, and the fourth, 1978 to 1980, In each group, based on in-patient records, and out-patient records, epidemology, deformities, and treatment were extensively reviewed. The followings are the outcome of this investigation 1. The male-to-female ratio was 53.7%: 46.3%, The male majority, distinct in the first group with 63. 7%, became less conspicuos in the fouth group with 50. 3%. 2. Average age oe admission, which was 10. 7 years in the first group, had increased decidedly to 17. 8 years in the fourth group. 3. The age of onset was most frequent between 1 to 2 years with 45.8% and next frequent between 7 to 12 months with 23. 5%. The ages below 5 years occupied 97. 6% of the cases. 4. The year of onset was most frequent from 1961 to 1963 with 28.7%. The incidence markedly and steadily decreased thereafter. 5. 94. 5% of the cases were unvaccinated. The remaining cases, except one, had had incomplete vaccination. 6. Fever, with 74. 0% was by far the most frequent initial symptom. Vomiting and diarrhea were the next frequent symptoms. 7. Of the 60% of the patients who had had any previous treatment, 25. 9% had operations and 20. 4% had braces and crutches. 8. Average number of admissions per patient were 1. 7 and average number of operations were l. 9. Average length of hospitalization was 39. 2 days. 9. 23. 6% of the patents had hip deformities, of which flexion defermity was most frequent with 4. 7%. Soutter fasciotomy or Campbell operation was employed in order to correct flexion deformity. In the earlier groups, Mustard operation, Sharrard operation, Ober-Barr operation, and pem-berton osteotmy were commonly practiced, whereas in the later groups, Thomas-Thompson-Straub operation, combined Thomas-Thompson-Straub and Ober-Barr operation, Salter osteotomy, Chiari osteotomy, Steel osteotomy were favored. 10. 45.2% of the patients had knee and leg deformities, of which flexion deformit; was most frequent with 14.5%. Flexion-valgus-external rotation deformity and flexion-valgus deformity with 4.6% and 4.5%, respectively, followed next. 11. 83. 9% of the patients had foot and toe deformities, of which equinovarus deformity occupied 6. 5% equinovalgus deformity 6.8%, and clawing of great toe 25. 2%. Triple arthodesis was done most frequently with 45. 9% of the cases, or 282 feet. Jone's operation or its modification, Tendo Achilles lengthening, plantar fasciotomy, and Peroneal tendon transfer were also frequntly performed. 12. There was leg length inequality in 90%. of the cases, Epiphysiodesis and femoral shortening were carried out, except for 4 cases of stapling in the earliest group, and femoral lengthening was done in 3 cases. 13. Spineal deformity was found in 19.7 % Of the cases, of which scoliosis was most freqent with 11. 5%. 7% of the cases had pelevic obliquity. Lumbodorsal fasciotomy, and postrior spinal fusion with Harrington instrument were carried out in order to ameliorate these deformities. 14. Deformities in the upper extremity were found in 3.6% of the patients. Procedures carried out inclulded shoulder fusion, Saha's operation, Steindler's flexorplasty, sternocleidomastold transfer, wrist fusion and opponensplasty, etc. 15. Generally, there was marked improvement of disability after treatment. The patients having moder.ate to severe limping decreased from 41.3%, preoperatively, to 25% after operation.
Age of Onset ; Animals ; Arterial Switch Operation ; Braces ; Clubfoot ; Congenital Abnormalities ; Crutches ; Diarrhea ; Fever ; Foot ; Hip ; Hoof and Claw ; Hospitalization ; Humans ; Incidence ; Knee ; Korea ; Leg ; Leg Length Inequality ; Male ; Osteotomy ; Outpatients ; Poliomyelitis ; Scoliosis ; Seoul ; Shoulder ; Spinal Fusion ; Steel ; Tendon Transfer ; Toes ; Upper Extremity ; Vaccination ; Vomiting ; Wrist

There have been numerous hypotheses about the pathogenesis of idiopathic scoliosis, but it is still unclear. There are some reports that abnormalities of contractile proteins may play a role in the pathogenesis of idiopathic scoliosis. The purpose of this report is to study the quantitative abnormalities of contractile proteins in muscles and nonactivated and activated platelets, and to determine whether or not the abnormalities in contractile proteins may play a role in the pathogenesis of idiopathic scoliosis. The materials were 21 idiopathic scoliosis patients aged from 13 years to 28 years(average 19.2 years) and 20 persons aged from 17 years to 25 years(average 20.1 years) as a control group. The electrophoretic analysis(SDS-PAGE method) was done on platelets both unstimulated and stimulated with thrombin and also on proteins of paraspinal muscles and gluteus maximus of idiopathic scoliosis patient and paraspinal muscles of control group. The results are as follows. 1. The myosin/actin ratios of triton-insoluble fractions to paraspinal muscles in convex sides of main curvatures of scoliosis patients(1.69±0.81) were significantly decreased compared to those of concave sides(2.55±1.28), gluteus maximus muscles(2.56±1.70) and control group(2.61±1.01). 2. There were no significant differences between scoliosis group and control group in the actin/myosin ratios of triton-insoluble fractions of the platelets both nonactivated and activated by thrombin. In conclusion, abnormalities of contractile protein in paraspinal muscles of convex side may play a role in the pathogenesis of idiopathic scoliosis, rather than abnormalities of systemic contractile protein.
Actins ; Blood Platelets ; Contractile Proteins ; Humans ; Muscles ; Myosins ; Paraspinal Muscles ; Scoliosis ; Thrombin

Intra- and extrahepatic bile duct can be invaded by hepatocellular carcinoma (HCC). This is infrequent in HCC, but it can directly affect the clinical manifestation and prognosis. We present eight cases of HCCs with emphasis on the incidence and features of bile duct invassion on computed tomography (CT). Over a period of 22 months, abdominal CT was performed in 186 with HCC patients. Out of these, five cases of bile duct invasion by HCC were confirmed in our hospital and three in other hospitals. The eight cases were evaluated for the type, size and location. CT features of intraductal mass and ductal dilatation were evaluated. The incidence of bile duct invasion in HCC was 2.6%. Infiltrative type of HCC was seen in seven cases and six of these had mass 5-11 cm in size. The characteristic CT findings of bile duct invasion in HCC are mass in common hepatic duct with bulging contour(8/80, multiple intraductal masses in the intrahepatic ducts (5/8), and diffuse dilatation of intrahepatic ducts (7/8).
Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Carcinoma, Hepatocellular* ; Dilatation ; Hepatic Duct, Common ; Humans ; Incidence ; Prognosis ; Tomography, X-Ray Computed

No abstract available.
Humans ; Hypercholesterolemia*

A case of sporotrichosis misdiagnosed as lupus vulgaris was presented. A 56-year-old woman had been to pea sized, nontender pustules and a hypertrophic-scar-like nodule on the right thigh. She denied any trauma before the lesions developed. Histopathologic findings from the lesion showed tuberculosis-like granulomatous changes. And she was diagnosed as lupus vulgaris. She also had pulmonary tuberculosis and had been treated with antituberculous drugs for 1 year. But skin lesions was not cleared. We suspected the lesions as one of deep mycoses and could confirm sporotrichosis by mycologic studies. They showed characteristic gross colonies and microscopic findings of Sporothrix schenckii..
Female ; Humans ; Lupus Vulgaris* ; Middle Aged ; Mycoses ; Peas ; Skin ; Sporothrix ; Sporotrichosis* ; Thigh ; Tuberculosis, Pulmonary