No abstract available.

BACKGROUND: In Korea, the proportion and absolute number of old people are increasing very rapidly. And the concern about the quality-of-life of elderly is to increase more and more among health care workers. The quality-of-life of elderly is affected by chronic medical conditions in some part. The purpose of this study is to evaluate the association between eight chronic medical conditions and health-related quality of life among the community-based elderly. METHODS: Target areas were 22 dongs in Dong-gu,Kwangju and 2 dongs in Buk-gu. Six hundreds subjects were randomly sampled from target ares. Interview survey was performed for chronic medical conditions by check list and health-related quality of life by COOP chart. Actual subjects were 568 elderlies. RESULTS: The results are followed ; 1) Compared with other domains of health-related quality of life, overall health was the most associated with chronic medical conditions, and social activity the least associated. 2) Stroke were significantly associated with every domain. And also back problems/joint problems were except the domain of social activity. Compared with other disease, stroke was the most associated with health-related quality of life except the domain of pain. 3) Migraine/chronic headache, gastroduodenal problems, and heart conditions were significantly associated with overall health, bodily pain, and one or two domains. 4) Hypertension and diabetes mellitus were signi ficantly associated with only one domain; overall health 5) Asthma and chronic bronchitis was not associated with any domains. CONCLUSION: Generally, health-related quality of life was highly associated with mobility limiting diseases such as back problems/joint problems stroke. And also moderately associated with pain relation disease such ans migraine/chronic headache, gastroduodenal problems, and heart condition.
Aged ; Asthma ; Bronchitis, Chronic ; Chronic Disease* ; Delivery of Health Care ; Diabetes Mellitus ; Headache ; Heart ; Humans ; Hypertension ; Korea ; Quality of Life* ; Stroke

BACKGROUND: Adequate depth of anesthesia requires a sufficient amount of the agent to secure unconsciousness and other components of anesthesia as needed for that particular surgical procedure, without jeopardizing vital organ functions. To evaluate the relationship of depth of anesthesia to EEG, we studied the effects of increasing minimum alveolar concentration (MAC) of isoflurane (arousal, 1, 1.3, 1.5 MAC) on power spectral analysis of the EEG. METHODS: To determine 1 MAC, we studied sixty patients undergoing general anesthesia who were randomly allocated to receive isoflurane at several predetermined end-tidal concentration. A minimum of 15 min was allowed between induction and skin incision to allow steady state condition. Patients were observed for gross purposeful movement for 60 seconds after incision. The MAC was calculated using maximum likelihood solution to a logistic regression model. Another forty patients were randomly allocated to have their EEGs recorded. General anesthesia was induced with oxygen and isoflurane only. After loss of consciousness, succinylcholine 1.5 mg/kg was given and intubation followed. The EEG was recorded awake and after 15 min at steady state conditions of 1, 1.3 and 1.5 MAC isoflurane had been achieved. Spectral edge frequency 95% (SEF95), median spectral frequency (MSF), total power (TP) and relative power in the delta, theta, alpha and beta band were calculated. RESULTS: The MAC of isoflurane was 1.21 vol% (20 - 40 years) and 1.09 vol% (40 - 60 years). The distribution of spectral EEG indices of the EEGs were established and compared. The threshold value of SEF95 14 Hz to differentiate between arousal and 1.3 and 1.5 MAC had a sensitivity of 60.5% (1.3 MAC), 71% (1.5 MAC) and specificity of 74.4% (1.3 and 1.5 MAC) and that of MSF 5 Hz had a sensitivity of 71% (1.3 MAC), 81.5% (1.5 MAC) and specificity of 48% (1.3 MAC), 48.8% (1.5 MAC). CONCLUSIONS: With regard to the dose-related decrease in SEF95 and MSF under increasing end- expiratory concentrations of isoflurane as described in the present study, future studies may have todetermine whether EEG feedback control of volatile anesthetic administration may be used successfully. It seems that if neglected parts by MSF and SEF95, which are really true values are considered in the future studies, those would increase the sensitivity and specificity of EEG could be used as tool for determining depth of anesthesia.
Anesthesia ; Anesthesia, General ; Arousal ; Electroencephalography* ; Humans ; Intubation ; Isoflurane* ; Logistic Models ; Neurofeedback ; Oxygen ; Sensitivity and Specificity ; Skin ; Succinylcholine ; Unconsciousness

BACKGROUND: Acute variceal bleeding is a serious complication of liver cirrhosis, which has an attendant mortality of approximately 60% over two years, and a variety of treatments, such as balloon tamponade, endoscopic varix ligation, sclerotherapy, histoacryl injection and vasoactive drugs, have been used. The aims of the present trial were to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding. METHODS: Forty-three cirrhotic patients, with endoscopically proven acute variceal bleeding, were included in this trial. Both drugs were given as continuous intravenous infusions for 48 hours. Twenty patients received the somatostatin (250 mcg per hr after a bolus of 50 mcg) and twenty-three the vasopressin (0.4 units per min). RESULTS: There were no significant differences between the two groups in relation to age, sex, etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding, within 6 hours after beginning of therapy, was regarded as failure to control initial bleeding, and was observed in 3 (13.0%) of the patients who received vasopressin and in 1 (5.0%) treated with somatostatin (p> 0.05). Five patients in both the somatostatin (25.0%) and vasopressin (21.7%) groups rebled during the first 5 days following the initial therapy (p> 0.05). Meaningful complications related to the use of vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin), but no complications were associated with the use of somatostatin (p< 0.05). The mortalities during hospitalization were similar in both the treatment groups. Two of the vasopressin and 1 of the somatostatin group died due to the uncontrolled rebleeding, and 1 of the vasopressin group died due to hepatic failure (2 weeks later after theropy). CONCLUSION: This study showed no differences in the effectiveness of somatostatin and vasopressin, but the somatostatin group had a lower risk of the complications.
Comparative Study ; Esophageal and Gastric Varices/*drug therapy/etiology ; Female ; Gastrointestinal Hemorrhage/*drug therapy/etiology ; Hemostatics/*administration & dosage/adverse effects ; Human ; Infusions, Intravenous ; Liver Cirrhosis/*complications/mortality/therapy ; Male ; Middle Aged ; Prospective Studies ; Somatostatin/*administration & dosage/adverse effects ; Treatment Outcome ; Vasopressins/*administration & dosage/adverse effects

BACKGROUND: Acute variceal bleeding is one of serious complications of liver cirrhosis that has an attendant mortality of approximately 60% during two years and a variety of treatments like balloon tamponade, sclerotherapy and vasoactive drugs have been used. The aim of the present trial was to compare the effectiveness and complications of somatostatin and vasopressin in the treatment of acute variceal bleeding. METHODS: Fourty-three cirrhotic patients with endoscopically proven acute variceal bleeding were included. Both drugs were given as continuous intravenous infusions for 48 hour. Twenty patients received somatostatin (250 mcg per hour after a bolus of 50 mcg) and twenty-three recieved vasopressin (0.4 units per min). RESULTS: There was no significant difference between two groups in relation to age, sex and etiology of cirrhosis, Child-Pugh classification, characteristics of bleeding episode, laboratory findings before randomization and units of transfused blood during therapy. Rebleeding within 6 hour after beginning of therapy, that is failure of initial control of bleeding, was observed in 3 (13.0%)patients receiving vasopressin and in 1 (5.0%) of those treated with somatostatin (p>0.05). Five patients (25.0%) in the somatostatin group and 5 (21.7%) in the vasopressin group rebled during 5 days after initial therapy (p>0.05). The meaningful complications related with vasopressin were observed in 5 patients (chest pain or abdominal pain requiring nitroglycerin) but serious complications of somatostatin were not found. Mortalities during hospitalization were similar in both treatment groups. Two of the vasopressin group and one of the somatostatin group died because of the uncontrolled rebleeding and one of the vasopressin group died due to hepatic failure. CONCLUSION: This study shows that the effectiveness of somatostatin and vasopressin was not different but somatostatin had a lower risk of the complication than vasopressin.
Abdominal Pain ; Balloon Occlusion ; Classification ; Esophageal and Gastric Varices* ; Fibrosis ; Hemorrhage ; Hospitalization ; Humans ; Infusions, Intravenous ; Liver Cirrhosis* ; Liver Failure ; Liver* ; Mortality ; Prospective Studies* ; Random Allocation ; Sclerotherapy ; Somatostatin* ; Varicose Veins ; Vasopressins*

BACKGROUND AND OBJECTIVES: Some chronic sinusitis patients complain that voice change, which occurs during surgeries such as endoscopic sinus surgery (ESS), can lead to changes in the vocal organ. The purpose of this study is to analyze the effect of ESS on voice by questionnaire and voice analysis. SUBJECTS AND METHOD: Thirty patients (male 15, female 15) who had underwent ESS were enrolled. All patients had sinusitis confirmed by preoperative CT scan. We analyzed subjective voice impairment by way of questionnaire (Korean-Version of Voice Handicap Index, KVHI) and objective voice impairment by Computerized Speech Laboratory one day preceding and at one month following the surgery. Finally, the subjective impairment of voice was analyzed by subjective questionnaire at postoperative 6 months. In objective analysis, we analysis 11 ESS cases on the formant frequencies of five vowels (/a/, /i/, /u/, /e/, /o/) and three nasal consonants (/namu/, /nuna/, /umma/). RESULTS: In the questionnaire (KVHI), there was a little change in the functional, physical and emotional field but the results were not statistically significant (p>0.05). In the voice analysis, the first formant frequencies of /a/, /u/, the third formant frequency of /o/ of vowel and /a/ of /namu/ of nasal consonant were significantly increased postoperatively compared to those of the preoperative status (p<0.05). However, there was no major change. There was no subjective voice impairment at 6 months after operation. CONCLUSION: After ESS, some voice impairment were observed in KVHI and some formant frequencies were increased in the objective voice analysis but without serious major voice changes. We conclude that ESS is relatively safe from voice point of view; however, for some professional voice users, particular attention needs to be paid regarding fine voice changes.
Acoustics ; Endoscopy ; Female ; Humans ; Surveys and Questionnaires ; Sinusitis ; Voice

BACKGROUND AND OBJECTIVES: Many people have been concerned about the voice change after uvulopalatopharyngoplasty (UPPP). A number of studies reported acoustic changes after UPPP. However, there have not been any reports regarding the association of anatomic changes and acoustic results after UPPP. The purpose of this study is to analyze changes of the voice and changes in the vocal tract after UPPP and to evaluate whether the anatomical changes of vocal tract have an effect on the voice change or not. SUBJECTS AND METHOD: By using computerized speech laboratory (CSL), we analyzed fourteen UPPP cases on the formant frequencies of six vowels (/a/, /i/, /u/, /o/, /e/) and three nasal consonants (/eom/, /eoung/, /kin/). By using MR image, we analyzed the changes of vocal tract four weeks after UPPP with preoperative findings in one case. RESULTS: In acoustic analysis, the second formant frequencies of /i/ and /u/ phonation were significantly reduced postoperatively compared to those of preoperative status. In imaging study of /i/ and /u/, the soft palate were contracted along with the widening of the oropharynx and the tongue was shifted toward posterior pharyngeal wall to compensate. CONCLUSION: UPPP reduced the second formant of /i/ and /u/, which did not result in serious voice change.
Acoustics ; Contracts ; Oropharynx ; Palate ; Palate, Soft ; Phonation ; Sleep Apnea, Obstructive ; Tongue ; Voice

BACKGROUND AND OBJECTIVES: The survival rate of laryngeal cancer has improved in recent day. But in case of advanced cancer, radical destructive surgery is required for survival. So early detection of laryngeal cancer prevent from this disastrous condition. In this point of view, mass screening test for early detection of laryngeal cancer is necessary. Screening tests using voice has many advantages of being simple, non invasive, and requiring less space. In this system, the most important factor is the selection of acoustic parameters to be used in voice analysis. Thus authors studied the acoustic parameters that can differentiate normal, benign, malignant laryngeal diseases by an acoustic analyzing system and we also checked the availability of parameters. MATERIALS AND METHODS: We evaluated the voice analyzed data from 25 laryngeal malignancy patients, 33 benign laryngeal disease patients, 35 normal control who visited PNUH otolaryngology department from October 1996 to May 1998. A computerized speech lab. 4300B (CSL) was used to carry out the analysis of each voice sample and statistical analysis, ANOVA. Canonical analysis and cumulative frequency curve were used. RESULTS: The statistically significant parameters that can differentiate normal and malignant laryngeal disease groups were 15 parameters and can differentiate normal and benign laryngeal disease group were 9 parameters and that can differentiate benign and malignant laryngeal disease group were 7 parameters. CONCLUSION: We consider that these parameters and detection programs may be effective in development of a screening system using voice only. Developing diagnostic tools and programs would need further study of phonetics and voice engineering.
Acoustics* ; Diagnosis, Differential* ; Fibrinogen ; Humans ; Laryngeal Diseases ; Laryngeal Neoplasms ; Mass Screening ; Otolaryngology ; Phonetics ; Survival Rate ; Voice*

OBJECTIVES: Signal-averaged electrocardiography (SAECG) has been found to be a useful noninvasive technique for identifying patients at risk for life-threatening ventricular tachycardia. Delayed and fragmented activation of abnormal myocardial tissues causes the occurrence of high frequency low amplitude (HFLA) electocardiographic signals or late potentials. Generally, there are two methods in analyzing signal-averaged electrocardiography. Late potentials in the time domain analysis do not provide sufficient diagnostic power with regard to life-threatening Ventricular tachycardia. Buckingham et al. (1989) reported a time-domain sensitivity of 62%, a specificity of 75%. Spectral turbulence analysis (STA) of the signal-averaged ECG is the most recent frequency domain technique to improve the time domain sensitivity and specificity. So, We designed the study to compare the efficacy of Time Domain Analysis and Spectral Turbulence Analysis among five groups (Normal control, QRS widening, Postmyocardial infarction, Frequent VPC's with group beats, Nonsustained ventricular tachycardia). METHODS: 88 patients were selected from the patients who had been admitted between January 1994 and October l994, at National Medical Center. Patients were divided into five groups, which were respectively, Group A: Normal control group (n=33), Group B: QRS widening group (n=14), Group C: Postmyocardial infarction group (n=10), Group D: Frequent VPC's with group beats (n=22), Group E: Nonsustained VT group (n=9). We compared Spectral Turbulence Analysis and Time Domain Analysis of Signal-Averaged Electrocardiogram by 24 hours-Holter monitoring. RESULTS: 1) In normal control group(Group A), 9.1%(3 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence Analysis. 2) In QRS widening group (Group B), 71.4%(10 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence Analysis. 3) In postmyocardial infarction group (Group C), 309o were positive by Time Domain Analysis, and 10% were positive by Spectral Turbulence Analysis. 4) In frequent VPC's group (Group D), 22.7% (5 patients) were positive by Time Domain Analysis, and, 4.5%(1 patient) was positive by Spectral Tur-bulence Analysis. 5) In Nonsustained VT group (Group E), 33.3% (3 patients) were positive by Time Domain Analysis, and 11.1% (1 patient) was positive by Spectral Turbulence Analysis. CONCLUSIONS: In Time Domain Analysis, abnormal results were presented at Group R (QRS widening group) by 71.4%, which was markedly higher than other groups. But, in Spectral Turbulence Analysis, abnormal results were not presented at Group A and Group B. In Group A and Group B, Spectral Turbulence Analysis shows less false positive results than Time Domain Analysis.
Electrocardiography* ; Electrocardiography, Ambulatory* ; Humans ; Infarction ; Sensitivity and Specificity ; Tachycardia, Ventricular

BACKGROUND: Interleukin-12 (IL-12) can induce antitumor effects in vivo. This antitumor effect is associated with T cell infiltration but the effect of IL-12 on the steps of T cell migration into the tumor tissue has not been fully elucidated. This study focused on the effect of IL-12 on the tumor growth and the metastasis and on the expression of E-selectin, an adhesion molecule which is activated endothelial specific in its expression. In addition, we studied whether the expression of E-selectin is associated with the TNF-alpha, a cytokine that its production is increased by IL-12 and has functions inducing a variety of adhesion molecules. METHODS: Mice of C57BL/6 strain were injected with Lewis lung cancer cells followed by either IL-12, TNF-alpha, or normal saline by intraperitoneal route. Twenty eight days after tumor cell inoculation, metastatic nodules of lung were enumerated and immunohistochemical staining of the subcutaneous tumors were performed with monoclonal antibodies to CD4, CD8, CD16, and E-selectin. RESULTS: In IL-12 treated mice, the subcutaneously implanted Lewis lung tumors were decreased in size and the metastases were also decreased in number compared to control mice. On tumor tissues, increased infiltration of CD4+, CD8+, and CD16+ cells were observed in IL-12 treated mice compared to control mice. In control mice, E-selectin was absent on tumor vessels, but the expression of E-selectin was increased on tumor vessels of IL-12 treated mice. Administration of TNF-alpha increased not only the expression of E-selectin but also infiltrations of CD4+, CD8+, and CD16+ cells on tumor tissues. CONCLUSIONS: These results demonstrate that IL-12 inhibits tumor growth and metastases through infiltrations of inflammatory cells in mouse model of Lewis lung carcinoma and E-selectin may play a role in inflammatory cell recruitment on tumor tissue following IL-12 administration. Also, TNF-alpha may have a role as a mediator responsible for the IL-12 induced expression of E-selectin.
Animals ; Antibodies, Monoclonal ; Carcinoma, Lewis Lung* ; Cell Movement ; E-Selectin* ; Interleukin-12* ; Lung ; Lung Neoplasms ; Mice* ; Neoplasm Metastasis ; Tumor Necrosis Factor-alpha