BACKGROUND: Whether the changes of risk factors (hypertension, diabetes mellitus, smoking, alcohol) can precipitate stroke remains unknown, and antecedent infection and psychologic stress are described insufficiently as predisposing risk factors for cerebral infarction. Therefore, we attempted to examine the roles of recent infection, psychologic stress, and the changes of risk factors as potential precipitants in each stroke subtypes. We also tested the temporal relationship between preceding exposure to coldness and stroke onset. METHODS: In this case-control study, 113 consecutive patients with acute cerebrovascular disease (38 small vessel disease, 43 large vessel disease, 11 cardiogenic infarction, 4 infarction of undetermined cause, and 17 intracerebral hemorrhage) and 23 control subjects were evaluated. Changes of the risk factors (and their management) were interviewed. A sign/symptom based questionnaire was used to characterize the prevalence of recent prior infection and exposure to coldness. Psychologic stress was measured with the use of Social Readjustment Rating Scale. RESULTS: The negative change of alcohol drinking was significantly higher in the stroke group. However, there was no significant difference between stroke and control groups in the changes of the other risk factors. The prevalence of previous (within 1 month) infection was significantly higher in the stroke group compared with control subjects (p=0.03). However, there were no significant differences among the stroke subtypes in the prevalence of infection(p=0.08). Upper respiratory tract infections constituted the most common type of infection. The exposure to coldness was significantly higher in the stroke group compared with control subjects (p=0.002). The level of stress within the prior 1 month/1 year was significantly higher in the stroke group than control group (p=0.01). CONCLUSION: Our data suggest that preceding infection, exposure to coldness, psychologic stress, and the negative change of alcohol drinking may be com.
Alcohol Drinking ; Case-Control Studies ; Cerebral Infarction ; Diabetes Mellitus ; Humans ; Infarction ; Prevalence ; Surveys and Questionnaires ; Respiratory Tract Infections ; Risk Factors* ; Smoke ; Smoking ; Stress, Psychological* ; Stroke*

Cervical spinal manipulation is considered to be a safe procedure for treating patients with neck pain and muscle-tension headache. Rarely has acute cervical spinal epidural hematoma after spinal manipulation been reported. Here, we report a 16-year-old healthy male adolescent who presented with progressive weakness in the right extremities following acute neck and shoulder pain after spinal manipulation from Acute cervical spinal epidural hematoma with compression of spinal cord. After emergency surgery the patient had full recovery from the profound neurological deficits.
Hematoma, Epidural, Spinal

PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.
Abdomen, Acute ; Abdominal Pain* ; Diagnosis ; Duodenitis ; Duodenum ; Early Diagnosis ; Endoscopy ; Exanthema* ; Gastrointestinal Hemorrhage ; Hemorrhage ; Nephritis ; Purpura* ; Recurrence ; Sigmoidoscopy ; Skin* ; Ulcer ; Ultrasonography

Implant materials, for examples, plaster of Paris, Bone cement and ceramics which are used experimentally to regain shape and function, act as a scaffold for bone growth and contribute to the healing processes at bone defect developed by trauma, infection and other causes. Therefore, the effect of plastei of Paris on the bone defects of adult rabbits may be an interesting subject, particularly in the orthopedic field. The authors carried out an experiment to study the effect of plaster of Paris on the bone defect, using 30 adult rabbits weighing fmm 3000-3500 gm, which were divided into 3 main gmups. (Each group was composed of 10 adult rabbits.). In Group 1, which was the control group, made a defect at the proximal metaphysis of the tibia, 6 mm×6 mm×6 mm in size, using a drill bit and filled by hematoma spontaneously. In Group II and Group IU, a defect was also made by the same method as in Group I and a piece of Gelfoam or plaster of Paris was inserted into the bone defect respectively. Then we studied the healing processes of the bone defect by sacrifying animals of each group at 6th and 12 th week after operation. The results of this experiment were as follows. 1. New bone formarion in the bone defect was poor in group I and Gmup Il, but it was good in Group III. 2. The plaster of Paris, filling into the defect, was absorbed and removed from the site of implantation continuously and stimulated the new bone formation. 3. The Gelfoam in Group II was more rapidly absorbed than plaster of Paris and didn't stimulate the new bone formation.
Adult ; Animals ; Bone Development ; Calcium Sulfate ; Ceramics ; Gelatin Sponge, Absorbable ; Hematoma ; Humans ; Methods ; Orthopedics ; Osteogenesis ; Rabbits ; Tibia

PURPOSE: The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. METHODS: A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis. RESULTS: The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness. CONCLUSION: The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.
Aged ; Aged, 80 and over ; Attitude ; Diabetes Mellitus, Type 2/*physiopathology/psychology ; Female ; Humans ; Male ; Motor Activity/*physiology ; Personal Satisfaction ; Residence Characteristics ; Self Efficacy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to measure home health resource utilization using a Case-Mix Adjustor Model developed in the U.S. METHOD: The subjects of this study were 484 patients who had received home health care more than 4 visits during a 60-day episode at 31 home health care institutions. Data on the 484 patients had to be merged onto a 60-day payment segment. Based on the results, the researcher classified home health resource groups (HHRG). RESULT: The subjects were classified into 34 HHRGs in Korea. Home health resource utilization according to clinical severity was in order of Minimum (C0) < 'Low (C1) < 'Moderate (C2) < 'High (C3), according to dependency in daily activities was in order of Minimum (F0) < 'High (F3) < 'Medium (F2) < 'Low (F1) < 'Maximum (F4). Resource utilization by HHRGs was the highest 564,735 won in group C0F0S2 (clinical severity minimum, dependency in daily activity minimum, service utilization moderate), and the lowest 97,000 won in group C2F3S1, so the former was 5.82 times higher than the latter. CONCLUSION: Resource utilization in home health care has become an issue of concern due to rising costs for home health care. The results suggest the need for more analytical attention on the utilization and expenditures for home care using a Case-Mix Adjustor Model.
Risk Adjustment ; Middle Aged ; Male ; Korea ; Humans ; Home Care Services/*utilization ; Health Resources/*utilization ; Female ; Aged, 80 and over ; Aged ; Adult

Benign lichenoid keratosis is an asyrnptomatic, isolated, plaque-like lesion frequently mistaken for basal cell carcinoma, Bowens disease, and actinic or seborrheic keratosis because of its variable clinical appearance. We present two cases of benign lichenoid keratosis. The first case was a 44-year-old female who had mild pruritic, ll x15rnrn sized, single, slightly elevated brownish plaque with fine scaling on the right zygornatic area of 5 years' duration. The second case was a 35-year-old female who had mild prutitic, single, pea- sized erythernatous patch on the left ala nasi of one month's duration. On histologic examination, these two cases showed same histologic findings, such as focal parakeratosis, moderate hyperkeratosis, irregular acanthosis and liquefaction degeneration of basal cells in the epidermis and band-like mononuclear infiltration and colloid bodies in the dermis.
Actins ; Adult ; Bowen's Disease ; Carcinoma, Basal Cell ; Colloids ; Dermis ; Epidermis ; Female ; Humans ; Keratosis* ; Keratosis, Seborrheic ; Parakeratosis

The levels of pH,pCO,bicarbonate, and base excess in umbillical venous blood were measured at birth of life in 30 normal term infant and 27 high risk infants. The study group was divided into two categories by clinical evaluation: first group of normal term infant without high risk indication and second group of high risk infants. Following results were obiained. 1) The average level of umbilical venous blood pH in normal group was 7.3260.001 and high risk group was 7.3180.002(7.326 versus 7.318,respecitvely,p>0.05) 2) The average Apgar Score in normal group was 9.30.95 and more acidotic high risk group was 7.42.54 3) The average level of pCO in normal group was 43.361.36mmHg and high risk group was 43.952.36mmHg(43.36 respecitively, p>0.05) 4) The average level of pCo in normal group was 21.550.85mmEq/L and high risk group was 20.030.78mEq/L(21.55 versus 20.03mEq/L respectively,p>0.05) 5) The average level of base excess in normal group was -2.610.76mEq/L and high risk group was -3.060.91mEq/L(-2.61 versus -3.06mEq/L respecitively,p?0.05) 6) Relationship between hP and Apgar Score in normal group was False normal (6.7%),False abnormal(10%) and high risk group was False normal (14.8%) False abonromal(7.4%).
Apgar Score ; Humans ; Hydrogen-Ion Concentration* ; Infant* ; Parturition

BACKGROUND: The aim of this study was to determine an adequate minimal concentration of lidocaine in a stellate ganglion block for decreasing a false positive response to a diagnostic sympathetic blockade determining whether the patient's pain is SMP or SIP. METHODS: This crossover study was performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB using three different concentrations (1%, 0.5% and 0.25%) of 8 ml lidocaine at the sixth cervical vertebral level via an anterior paratracheal approach. The blocks were separately done at one week intervals in random order. The occurrence, onset time and action duration of Horner's syndrome were observed after each SGB. RESULTS: Positive cranial sympathetic blockade (Horner' syndrome) was present in all patients using 1% and 0.5% lidocaine. It was present in 60% of the patients using 0.25% lidocaine. Onset time was not significantly different among the three groups. Action duration of 1% and 0.5% lidocaine groups was significantly longer than the 0.25% lidocaine group. There was no critical side effects, and temporary foreign body sensation was the most common side effect. CONCLUSIONS: The results of this study suggest that 0.5% lidocaine is an adequate minimal concentration for diagnostic SGB. Therefore, we recommend that 0.5% lidocaine instead 1% should be used in diagnostic SGB to decrease a false positive response to a sympathetic blockade.
Anesthetics ; Cross-Over Studies ; Foreign Bodies ; Hearing Loss ; Horner Syndrome ; Humans ; Lidocaine* ; Sensation ; Stellate Ganglion*

We experienced an autopsy case of esophageal atresia with tracheoesophageal fistula and other multiple congenital anomalies in a 4 days old male infant. Esophageal atresia with tracheoesophageal fistula was type C by Gross Classification. Combined anomalies were malrotation of left kidney, one left accessory renal artery form right renal artery and one left accessory renal vein from right renal vein, duodenal atresia and annular pancreas. Until now, the esophageal atresia with tracheoesophageal fistula and other multiple congenital anomalies (7 congenital anomalies) are not reported in the korean literature, except our case. Our autopsy case, it suggests that esophageal atresia with tracheoesophageal fistula has often close relation-ship with other multiple congenital anomalies.
Infant ; Male ; Female ; Humans