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

We experienced a case of congenital tuberculosis infected in utero, who had been found to have massive ascites and pleural effusion on routine ultrasonography at the 39 weeks' gestation. The emergency C-section delivered a male neonate weighing 2,050 g with poor condition and in severe respiratory distress. He was the first child born of a 27-year-old woman, who was diagnosed as having tuberculous pleurisy after delivery. Detection of acidfast bacilli in gastric aspirates obtained from the newborn as well as the clinical features and maternal history confirmed the diagnosis of congenital tuberculosis. Though rare, congenital tuberculosis requires early detection and treatment because of its severity and high mortality. A brief review of the relevant literature was made.
Adult ; Ascites* ; Child ; Diagnosis ; Emergencies ; Female ; Humans ; Infant, Newborn ; Male ; Mortality ; Pleural Effusion* ; Pregnancy ; Tuberculosis* ; Tuberculosis, Pleural ; Ultrasonography

When the hypopharynx is examined in the frontal view during modified Valsalva maneuver after barium swallow anoutpouching of the lateral wall of the hypopharynx resembling a deverticulum is commonly observed. Review of theliterature however fails to disclose provious documentation of systematic prospecative observation of this phenomenon. The present study has been undertaken to detemine the incidence and degree of outpouching according tothe age and sex and to assess the clinical implication of the outpouching. The clinical materials consist of 100 consecutive cases of routine upper GI series with a particular effort directed to induce hypopharyngeal out pouching by a modified Valsalva maneuver at the Department of Radiology, St. Mary's Hospital, Catholic Medical College during 6 months period from Jan. 1982. Technically, outpouching was best demonstrated in the erectposition with a slight extension of the neck during the pharyngeal phase of barium swallowing while the subjectwas instructed to blow through the closed lips. Observation were made ofhhte incidence and intensity of theoutpouching by an arbitrary line drawning to measure the depth of outpouchings. Our study revealed thathypopharyngeal outpouchings occure bilaterally in every case studied. There was definite dominancy on the rightside(p<0.01) and the outpouching was greater in intensity in male (p<0.05) and the depth varied from a few to 15mm. And there was no statistically significant difference according to the age. Outpouchings collapsed and disappeared completely after release of Valsalva maneuver and did not appear to produce any clinical symptoms. The reason of right-side dominancy should further be investigated.
Barium ; Deglutition ; Humans ; Hypopharynx ; Incidence ; Lip ; Male ; Neck ; Spectinomycin ; Valsalva Maneuver

Informed consent (IC) should be a form of communication between a physician and patient in which information regarding all options of a medical procedure and the patient's preference is shared. The aim of this study was to create a standard for communication by IC for physicians. The IC standard was developed based on an analysis of a dialogue in our previous experience with a medical communication program and a review of the literature. The dialogue pattern of the IC standard had the following six elements: opening; orientation; disclosure of information; conforming and complementing; shared decision making; and closing. Factors that influenced effective IC-based communication included preparation, attitude, empathy, listening, a psychosocial factor, nonverbal communication, explanation, and understanding. The IC communication standard will be useful in improving the quality of communication between a physician and patient in obtaining IC. It will also be used as a guideline for communication educators and medical students. Innovative strategies and rigorous studies are needed to improve IC counseling to establish effective patient-centered interviews.
Complement System Proteins ; Counseling ; Decision Making ; Disclosure ; Empathy ; Humans ; Informed Consent* ; Nonverbal Communication ; Psychology ; Students, Medical

No abstract available.
Movement Disorders* ; Radiosurgery*

We experienced a case of thanatophoric dwarfism with a relatively large head and shortened limbs. The diagnosis was confirmed by clinical features, radiologic examinations and autopsy. A review of literature was made briefly.
Autopsy ; Diagnosis ; Extremities ; Head ; Thanatophoric Dysplasia

Berry syndrome is a rare association of congenital heart anomalies which consists of a distal aortopulmonary window with aortic origin of the right pulmonary artery and hypoplasia or interruption of the aortic arch. This defect can be corrected only by immediate surgical intervention, so accurate preoperative diagnosis and detailed anatomic depiction of this syndrome are important in prognosis. We experienced a case of Berry syndrome in an 8-day-old male, who had presented with multiple malformation such as syndactyly, high arched palate and brain hemorrhage. The diagnosis was made by two-dimensional echocardiography. The case is presented with a brief review of related literatures.
Aorta, Thoracic ; Diagnosis ; Echocardiography ; Fruit* ; Heart ; Humans ; Intracranial Hemorrhages ; Male ; Palate ; Prognosis ; Pulmonary Artery ; Syndactyly*

It is well known that in studying the effects of hypophysectomy, removal of the pituitary must be essentially complete without injury of the neighboring region of the brain. We devised a new method of total hypophysectomy using microsurgical instruments, and observed the effects on the gonad in the dog. 1. Operative method. The animals were anesthetized with pentobarbital sodium 30 mg/kg body weight and then a wooden bar, about 5 cm in diameter, was inserted in the mouth to displace the mandibular angle anteriodownwardly. After aseptic draping at operative field vertical incision from the midline of the vertex to just behind the mandibular angle was made on the right side of frontotemporal region. Temporal muscles were also incised vertically and retractor was applied to expose the frontotemporal bone. Following wide craniectomy down to the base of middle cranial fossa and careful opening of the dura mater, temporal lobe was retracted upward and medially at the tip of the middle cranial fossa with narrow brain retractor. As the 3rd cranial nerve and internal carotid artery were exposed, arachnoid membrane was torn with microforceps and microscissors, and aspirated the cerebrospinal fluid slowly to obtain wider exposure, then elevated posterior communicating artery to expose the pituitary body and stalk. The stalk was clipped or crushed with microforceps and then sectioned with microscissors, then pituitary body was isolated with microelevator and removed in a piece with microforceps or sucked out with suction. The wound was closed in layers. 2. Postoperative management and the results. Among these experimental animals, 6 dogs were observed for the period of 43-77 days, and in 6 dogs dexamethasone was given intramuscularly for one or two weeks following hypophysectomy, the rest were used as normal control. Following clinical observation, these animals were sacrificed with intracarotid arterial infusion of 0% neutral formalin solution and removed the brain and the gonads, and fixed in 10% neutral formalin solution. The removed brain was examined and pituitary fossa was also scrutinized. The gonads were stained with hematoxylin-eosin. Periodic acid Sciff(PAS) and toluidine blue staining methods. The observed results were as follows: 1) Average diameter of testicular seminiferous tubules was 0.17 mm in normal control group. but became markedly reduced to 0.10 mm following hypophysectomy. With administration of dexamethasone for 1 and 2 weeks, diameter ranged 0.09 mm and 0.13 mm, respectively. 2) Testicular lesions in hypophysectomy group were characterized by marked reduction of spermatogenic activity, representing stage of germ cell aplasia with loss of spermatogonia, spermatocytes and spermatids. But in cases with dexamethasone administration, the pattern resembled various stages of germ cell arrest as with increased mitotic activities of spermatogonia and spermatocytes. 3) Those numerical alternations of spermatogenic cells accompanied secondary histological manifestations which included relative increase of Sertoli cell, mild thickening of basement membrane and Leydig cell hyperplasia. The findings following administration of dexamethasone became modified to reveal less prominent Sertoli cells and rather distinct Leydig cell clustering. Basement membrane thickening remained unchanged. 4) Ovarian changes in hypophysectomized dogs on the other hand, disclosed reduction of overall size accompanying decrease in number and size of Grafian follicles, atrophy of follicular and cortical stremal cells, degeneration of cva and absence of corpus luteum. Follicular and stromal cells appeared responded to administration of dexamethasone relatively in considerable degree. 5) Mast cells normally distributed mainly in the tunica albuginea of both testis, and ovary, increased following hypophysectomy to extend along fibrotic interstitial tissue of testis, but became reduced to the level of normal control group following administration of dexamethasone.
Animals ; Arachnoid ; Arteries ; Atrophy ; Basement Membrane ; Body Weight ; Brain ; Carotid Artery, Internal ; Cerebrospinal Fluid ; Corpus Luteum ; Cranial Fossa, Middle ; Cranial Nerves ; Dexamethasone ; Dogs* ; Dura Mater ; Female ; Formaldehyde ; Germ Cells ; Gonads* ; Hand ; Hyperplasia ; Hypophysectomy* ; Mast Cells ; Membranes ; Mouth ; Ovary ; Pentobarbital ; Periodic Acid ; Seminiferous Tubules ; Sertoli Cells ; Spermatids ; Spermatocytes ; Spermatogonia ; Stromal Cells ; Suction ; Temporal Lobe ; Temporal Muscle ; Testis ; Tolonium Chloride ; Wounds and Injuries

PURPOSE: The function of the neonatal thyroid is affected transiently or consistently by various maternal thyroid diseases, neonatal diseases, drugs, and more as well as thyroid dysgenesis. In this study, we analyzed several factors of neonatal thyroid dysfunction through neonatal screening test and investigated the prognosis. METHODS: From January 1992 to July 1997, we reviewed 66 newborn patients, who showed abnormal thyroid function in neonatal screening test, and analyzed 62 cases except for 3 cases of thyroid dysgenesis and 1 case of TBG deficiency. In the end, we statistically compared the maternal thyroid disease group with umbilical-iodinated disinfection group because the other groups were too small in numbers. RESULTS: Among 62 cases of neonatal thyroid dysfunction, maternal thyroid disease (A) group had 29 cases (46.8%), umbilical-iodinated disinfection (B) group had 22 cases (35.5%), neonatal disease (C) group had 7 cases (11.2%), idiopathic (D) group had 4 cases (6.4%). Group A showed compensated hypothyroidism 79.3%, transient hypothyroidism 13.8% and hyperthyroidism 6.9%, while group B showed compensated hypothyroidism 77.3% and transient hypothyroidism 22.7%. Capillary TSH showed that group B was significantly higher than group A (P<0.05). The serum T4 showed that group B was significantly lower than group A (P<0.05). The incidence of medication showed no significant difference between groups A and B. The duration of normalizing thyroid function showed that group B was significantly longer than group A. CONCLUSOIN: The iodide-containing disinfectant caused transient thyroid dysfunction which was longer and more severe than in the maternal thyroid disease group even though the time of causative exposure differed.
Capillaries ; Disinfection ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Infant, Newborn ; Neonatal Screening ; Prognosis* ; Thyroid Diseases ; Thyroid Dysgenesis ; Thyroid Gland*