BACKGROUND AND OBJECTIVES: We investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors. SUBJECTS AND METHODS: A total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure. RESULTS: The mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure. CONCLUSION: Large inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.
Adult ; Arm ; Blood Pressure* ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cohort Studies ; Cross-Sectional Studies ; Humans ; Inflammation ; Logistic Models ; Metabolic Diseases ; Obesity ; Posture

Malignant peripheral nerve tumors are very rare and derived from the neurofibromatosis in about 13%. There are two classes of malignant tumors in the peripheral nerve, one those of mesoblastic origin, is far most common and made up of malignant neurofibroma and much common fibrosarcoma, and metastasis in 20% of fibrosarcoma, and the other is neuroepithelial origin. These are characterized by increased cellularity, atypical form of cells, mitoses and invasiveness. The choice treatment is radical removal of the tumor, and not affected the prognosis by radiation or chemotherapy. We have been recently experienced of one case of malignant schwannoma on the cervical roots in a case of von Recklinhausen's disease.
Drug Therapy ; Fibrosarcoma ; Mitosis ; Neoplasm Metastasis ; Neurilemmoma* ; Neurofibroma ; Neurofibromatoses ; Peripheral Nerves ; Peripheral Nervous System Neoplasms ; Prognosis

PURPOSE: Human bronchial smooth muscle cell(HBSMC) plays an important role in the remodeling of the airways in asthma. Vascular endothelial growth factor(VEGF) is a multifunctional cytokine, which induces edema, angiogenesis, vascular remodeling, mucus metaplasia, subepithelial fibrosis, and antigen-induced Th2 inflammation. Transforming growth factor-beta(TGF-beta) is a growth modulator of HBSMC and an important cytokine in airway remodeling. We investigated the effect of dexamethasone on the release of VEGF from HBSMC stimulated with platelet-derived growth factor(PDGF) and TGF-beta. METHODS: HBSMC cultured in 10 percent FCS-DMEM media was growth-arrested in serum-deprived medium for 48 hours. Dexamethasone and TGF-beta were added and incubated for 16 hours before stimulation with PDGF. After 24 hours of stimulation, culture medium was harvested and stored at -80 degrees C until ELISA for VEGF was performed. RESULTS: The release of VEGF was significantly increased after stimulation with PDGF (P<0.01). The production of VEGF pretreated with TGF-beta before stimulation with PDGF was higher than those without TGF-beta pretreatment(P<0.01). Dexamethasone suppressed the release of VEGF in HBSMC stimulated with PDGF(P<0.01), TGF-beta and PDGF(P<0.01). CONCLUSION: PDGF and TGF-beta may be one of the key mediators in inducing airway remodeling and glucocorticoid, and can be used as useful therapies to prevent airway vascular remodeling by modulating the VEGF on airway smooth muscle cells.
Airway Remodeling ; Asthma ; Dexamethasone* ; Edema ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Humans* ; Inflammation ; Metaplasia ; Mucus ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Transforming Growth Factor beta ; Vascular Endothelial Growth Factor A*

PURPOSE: The headache, one of the symptoms of meningitis, is related to abrupt elevation of intracranial pressure(ICP) or stimulation of intracranial nociceptive structure. However, in cases of mild elevation of ICP or normal findings of cerebrospinal fluid(CSF) analysis, patients sometimes complain of headaches. Therefore, other pathways may contribute to the occurrence of headaches in aseptic meningitis or meningismus. We intend to investigate the role of substance P(SP) and calcitonin gene-related peptide(CGRP) in aseptic meningitis or meningismus. METHODS: We measured leukocyte count, the concentration of protein and glucose in CSF and ICP of patients with meningeal irritation sign. We also measured SP and CGRP levels by using immunoassay. We analyzed the relationship between the presence of headache and the value of SP and CGRP. RESULTS: The concentrations of CGRP(18.8+/-10.5 ng/mL) in CSF and ICP(14.8+/-4.5 cmH2O) in aseptic meningitis group were significantly higher than in those(14.1+/-7.4 ng/mL and 12.0+/-5.1 cmH2O, respectively) of the meningismus group(P<0.05). There was no significant difference in the SP levels between the two groups. In the aseptic meningitis group, the concentrations of SP and CGRP were significantly higher in the normal ICP group than in the elevated ICP group(P<0.05). CONCLUSION: Headaches in children with aseptic meningitis or meningismus is considered to be related to the elevation of the CSF levels of SP and CGRP.
Calcitonin ; Calcitonin Gene-Related Peptide ; Child* ; Glucose ; Headache* ; Humans ; Immunoassay ; Leukocyte Count ; Meningism ; Meningitis ; Meningitis, Aseptic ; Neuropeptides* ; Substance P

PURPOSE: Because migraine in children has different characteristics from that in adults, it is inappropriate to apply migraine criteria for adults to children. Recently, the International Headache Society(IHS) revised criteria regarding children's characteristics. Therefore, we reviewed the characteristics of childhood migraines without auras based on the revised criteria and compared the data with the findings of childhood migraine by the previous criteria. METHODS: Among 102 children who visited the outpatient clinic of Kangbuk Samsung Hospital for the chief complaint of headache, we analyzed the clinical findings of 34 patients, who were diagnosed as migraine without aura, and probable migraine based on the revised criteria. RESULTS: Migraines without aura were diagnosed in 27 patients(26.5 percent) and probable migraines were observed in seven patients(6.8 percent). The usual duration of headache attacks over 2 hours was observed in 12 patients(44.4 percent). On the contrary, 15 patients(55.6 percent) usually experienced headaches for one to two hours. According to the location of headaches, there were temporal areas in 14 cases, frontal areas in nine cases, occipital areas in two cases and diffuse areas in two cases. The striking point in probable migraines is that the length of headache was below one hour in five patients. Nine patients were diagnosed as migraine without aura, when the first edition criteria was applied to same patients. CONCLUSION: We found that the prevalence of migraine without aura increased by the revision of IHS criteria. We hope that migraines in children will be diagnosed correctly by the new IHS criteria.
Adult ; Ambulatory Care Facilities ; Child* ; Epilepsy* ; Headache* ; Hope ; Humans ; Migraine Disorders* ; Migraine without Aura ; Prevalence ; Strikes, Employee

PURPOSE: The aim of the study was to determine the factors associated with complicated acute cholecystitis of initial clinical findings during an emergency department (ED) visit, and to use them as a guideline for consideration of early and active surgical intervention, to improve the prognosis of acute cholecystitis. METHODS: Medical records of adult patients diagnosed and treated in the ED as acute cholecystitis were reviewed retrospectively. Clinical findings including demographic data, past medical history, symptoms, physical exam, and laboratory test results were included in the analysis. A case associated with gall bladder empyema, gangrene, perforation, hydrops, or failure of initial laparoscopic approach was defined as complicated acute cholecystitis. Factors showing significance in univariate analyses were included in binary logistic regression analysis for prediction of complicated acute cholecystitis. RESULTS: Age, sex, hypertension history, anorexia, body temperature, white blood cell count (WBC), aspartate aminotransferase, creatinine, total bilirubin, amylase, and lipase were significant in univariate analyses, and included in multivariate analysis. Age (p=0.039), male sex (p=0.004), and WBC (p=0.019) were significant in multivariate analysis. CONCLUSION: Age, sex, and initial WBC of patients diagnosed and treated in the ED as acute cholecystitis were independently associated with complicated acute cholecystitis.
Adult ; Amylases ; Anorexia ; Aspartate Aminotransferases ; Bilirubin ; Body Temperature ; Cholecystitis ; Cholecystitis, Acute* ; Creatinine ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Gangrene ; Humans ; Hypertension ; Leukocyte Count ; Lipase ; Logistic Models ; Male ; Medical Records ; Multivariate Analysis ; Prognosis ; Retrospective Studies

Radiation therapy has been used as adjuvant therapy or primary treatment for inoperable, remnant or recurrent cancer. Many authors reported good palliation effect by external irradiation or interstitial therapy, but the report of intracavitary irradiation for recurrent, inoperable rectal cancer is very rare. We experienced a case of recurrent adenocarcinoma of rectum along fistula tract after laparotomy and postoperative radiotherapy who achieved very good palliation by intracavitary irradiation. Even though we have only good palliation without impressive survival improvement in this case, we hope that this technique may achieve good local control in other similar patients.
Adenocarcinoma* ; Fistula* ; Hope ; Humans ; Laparotomy ; Radiotherapy ; Rectal Neoplasms ; Rectum*

The goals of operation for unstable thoracolumbar spine injuries are decompression of any neural canal compression, restoration of normal anatomic contour of the spine and stabilization. A retrospective analysis on 64 thoracolumbar injured patients treated with internal instrumentation and fusion was performed from January 1991 to December 1996. The purpose of this study was to review the clinical outcome and efficacy of surgical treatment using internal instrumentation, and compare neurological, radiological and functional outcomes between anterior and posterior approach groups. Of these, 42 patients were operated via on posterior approaches and the other 22 patients by anterior approaches. At final follow up evaluation with mean period of 14.5 months, 50 patients(78%) were walking and 47 patients(92%) except 4 patients(A-A, three and C-C one patient) had improved using Frankel's grade in patients with neurological deficits(51 patients). No patient deteriorated. Radiological and functional outcomes were satisfactory in the majority of patients. In a comparison of the clinical outcomes between anterior and posterior approaches, there was no statistically significant difference in neurological outcome(the mean value of up-grade: anterior 1.05+/-.7, posterior 0.95+/-.9, p=0.42), but in radiological outcomes, there were no significant differences between the two groups in amount of restoration of vertebral compression(mean recovery rate: anterior 61.5%, posterior 50.9%), kyphotic deformity(mean recovery rate: anterior 47.9%, posterior 70.0%)(p>0.05), but the only difference was in the restoration of canal narrowing, with the anterior group more improved(recovery rate: anterior 86.4%, posterior 74.3%) (p<0.05). In functional outcomes by Prolo's scale, the anterior group was better than the posterior group(mean economic and functional status: anterior E(4.4), F(4.3); posterior E(3.5),F(3.9)). We conclude that agressive decompression, instrumentation and bone fusion has shown better clinical outcomes of the unstable thoracolumbar injured patients and the choice of surgical approaches depends on the general condition, age, status of bone mineral density, specific injury mechanism, radiological findings, and grade of neural injury at the time of injury of these patients.
Bone Density ; Decompression ; Follow-Up Studies ; Humans ; Neural Tube ; Retrospective Studies ; Spine ; Walking

BACKGROUND AND OBJECTIVES: To investigate age-specific and sex-specific distributions of blood cholesterol in the general Korean population. SUBJECTS AND METHODS: We analyzed data for 8284 men and 9246 women aged > or =10 years who participated in the fifth (2010-2012) Korea National Health and Nutrition Examination Survey. Age-specific means, medians, and selected percentiles were calculated for men, premenopausal women, and postmenopausal women. RESULTS: Median total cholesterol (TC) level increased with age across all age groups, from 147 to 196 mg/dL in males and from 159 to 210 mg/dL in females. Triglyceride (TG) levels increased with age in females; however, in males, TG levels rapidly increased during young adulthood, peaked at 50-54 years, and then decreased. High density lipoprotein-cholesterol (HDL-C) levels were higher in females than in males and decreased with increasing age in both males and females. Low density lipoprotein-cholesterol (LDL-C) levels increased with age across all age groups, from 89 to 127 mg/dL in males and from 82 to 113 mg/dL in females. Lipoprotein-cholesterol fraction (TC/HDL-C, LDL-C/HDL-C, TG/HDL-C, non-HDL-C) levels increased with age in females, but increased more rapidly in males during young adulthood and decreased after middle age. CONCLUSION: Blood cholesterol levels and lipoprotein-cholesterol fractions present different distributions by age, sex, and menopausal status.
Cholesterol* ; Epidemiology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Nutrition Surveys ; Triglycerides

PURPOSE: The purpose of this study is to search for factors which can help in deciding on proper treatment for patients who visit the Emergency department (ED) with symptoms of foreign body ingestion. METHODS: This study was a retrospective review of medical records of ED patients with primary symptoms of foreign body ingestion. The patients' demographic data, elapsed time since the ingestion, type of foreign body, symptoms, and the method of removal were analyzed. Receiver operating characteristic (ROC) curve was used for analysis of whether these factors can be used to decide on proper treatment. RESULTS: Among 321 patients, a foreign body was removed successfully in 285 patients and the foreign body was not found in the remaining 36 patients. Of the successfully treated cases, 76 were removed grossly, 133 were removed using a laryngoscope, 74 were removed with endoscopy, and 2 were removed spontaneously. Comparing the group in which a foreign body was found and the other group, there was a significant difference in elapsed time since the onset of symptoms (p=0.013) and the type of foreign body (p=0.001). There was no significant reliable factor which can predict the existence of a foreign body. CONCLUSION: There was no significant factor which can predict the existence of a foreign body. Considering that the foreign body was found in most suspected patients, and that numerous patients in which a foreign body was not found had shown signs of complications due to foreign body, constructive treatment should be advocated.
Adult* ; Eating* ; Emergencies* ; Emergency Service, Hospital* ; Endoscopes ; Endoscopy ; Foreign Bodies ; Gastrointestinal Tract* ; Humans ; Laryngoscopes ; Medical Records ; Retrospective Studies ; ROC Curve