BACKGROUND: Although lack of exercise is well known to be a risk factor of osteoporosis, it is unclear whether weight-bearing exercise has different effects on bone mineral density compared to non weight-bearing exercise, and the amount of exercise needed to prevent osteoporosis is not clearly defined. This study was performed to clarify the relations between the type and the amount of exercise with BMD. METHODS: This was a cross-sectional study of 3,661 women who had undertaken health screening including BMD measurement at Health Promotion Center of SNUH between May 1997 and March 1999. Information on sociodemographic characteristics, menarche, childbirth andexercise were gathered by means of self-reported questionnaire, and BMD was measured using DEXA. RESULTS: The number of women with lumbar osteoporosis were 601 (16.4%) and femoral neck osteoporosis 372 (10.2%). Lumbar osteoporosis occurred more frequently with increasing age and age at menarche, and in menopausal women, but less frequently with increasing fat-free mass in multiple logistic regression analysis. When adjusted for age, age at menarche, menopause and fat-free mass, lumbar osteoporosis was less common in women who exercised, but the type and the amount of exercise had no bearing. Especially, lumbar osteoporosis was least common in women engaging in moderate amount of exercise. Femoral neck osteoporosis decreased significantly only in weight-bearing exercise group and in women engaging in high amount of exercise. CONCLUSION: The results of this study suggest that lumbar osteoporosis can be prevented through exercise regardless of its type and amount, and high amount or weight- bearing exercise is most effective to prevent femoral neck osteoporosis.
Adult* ; Body Composition ; Bone Density* ; Cross-Sectional Studies ; Female ; Femur Neck ; Health Promotion ; Humans ; Logistic Models ; Mass Screening ; Menarche ; Menopause ; Osteoporosis ; Parturition ; Risk Factors ; Weight-Bearing ; Surveys and Questionnaires

Between 1989 and 1995, 14 patients with Kienbock's disease were treated with radial shortening or a radial wedge osteotomy. Clinical and radiological changes were classified according to Lichtman's stages and ulnar variance. Seven patients were male and seven were female. The mean age was 45 years, ranging from 29 to 64. The average follow-up period was 29 months, ranging from 12 to 61. Of the ten patients with negative ulnar variance who were treated by radial shortening, two cases were in Lichtman's stage II, six cases were stage III-a and two cases were stage III-b. Of the four patients with zero or positive ulnar variance who were treated by a radial wedge osteotomy, one case was stage 11 and three cases were stage III-a. The results were evaluated in terms of diminished wrist pain, increased grip strength, increased range of wrist motion and radiologic changes of the lunate. Wrist pain had diminished in all patients and grip strength had increased on average from 54% to 70% in the unaffected side. The range of arc of the wrist had increased on average from 59degrees preoperatively to 93 postoperatively. Sclerosis of the lunate improved in 43% of cases, cystic changes of the lunate improved in 57%, fragmentation of the lunate improved in 36% and the carpal height ratio increased in 50%. Of the 14 patients, 13 patients (93%) showed satisfactory results. One patient had an unsatisfactory result, according to Lichtman's criteria. These results suggest that radial shortening or a radial wedge osteotomy is recommended in patients with stage ll, III-a or III-b Kienb ck's disease, according to the ulnar variance. Early wrist pain reduction, increased range of motion and grip strength and improved avascularity of the lunate are all positive outcomes attainable with these treatment methods.
Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Osteonecrosis* ; Osteotomy* ; Range of Motion, Articular ; Sclerosis ; Wrist

Inability to tolerate discontinuation of mechanical ventilation or the need for reintubation has been reported .s much as 20% in mechanically ventilated patients. Many factors may be responsible for the .nsuccessful weaning outcome such as hypoventilation secondary to decreased respiratory c,nter output, respiratory muscle fatigue, impaired pulmonary gas exchange and excessive ventilatory requirements. We experienced a patient who was very difficult to wean from long term mechanical ventilation. The patient was 36 years old male with Guillain Barre syndrome. After 7 days admission, tracheostomy was taken and mechanical ventilation continued to 332 days. There was not any chance of pneumonia during the 11 months ventilation. His respiratory parameter improved to TV of 350 ml and VC of 1300 ml and he was able to breath himself without mechanical ventilator during day time. But he could not sleep without ventilator for fear of dying during sleep. We made him sleep with diazepam injection and carefully observed the patient with pulse oximetry and Sara capnography. We tried this method many times and the patient got the confidence that he cauld alive during sleep without mechanical ventilator. We could wean from long term mechanical ventilation during sleep by carefully observing patients respiratory pattern. Therefore we report here this successful weaning from long term ventilator in anxious and nervous patient.
Adult ; Capnography ; Diazepam ; Fatigue ; Guillain-Barre Syndrome ; Humans ; Hypoventilation ; Male ; Oximetry ; Pneumonia ; Pulmonary Gas Exchange ; Respiration, Artificial* ; Respiratory Muscles ; Tracheostomy ; Ventilation ; Ventilators, Mechanical ; Weaning*

Acute intermittent porphyria(AIP) is a rare hepatic disorder resulting from defects in the synthesis of heme. This occurs in approximately 0.01% of the general population and is even rare in black and orientals. Acute episode of this disease can be triggered by surgery, certain drug, pregnancy, mensturation, fasting and etc. We report a porphyrinogenic neuropathy occured after general anesthesia in a oriental woman who presented with abdominal pain and other typical sign and symptom. 56 year-old female patient was diagnosed as acute appendicitis for 2 days of constipation and abdominal pain and appendectomy was performed under general anesthesia at local clinic. Anesthesia was induced with penthothal and maintained with halothane, and she was recovered from anesthesia without event. After operation she experienced difficult swallowing and generalized weakness which were aggrevated day by day. Therefore she was transferred to our hospital on fourth postoperative day. Physical examination revealed Grade II motor weakness of Gxtremities and decreased deep tendon reflex. Neostigmine test and Jolly test were done under impression of myasthenia gravis but revealed negative. Guillian-Barre syndrome was difficult to rule out in this patient, but urinalysis revealed increased delta aminolevulinic acid and urine color changed dark under light. Therefore we diagnosed her as AIP. 6 days after appendectomy she complained severe dyspnea with vital capacity 350 ml and arterial blood gas analysis revealed PO2 of 56 mmHg and PCO2 of 44 mmHg under nasal oxygen 5 1/min inhalation. Therefore we diagnosed this peripheral neuropathy as AIP and report here with references.
Abdominal Pain ; Aminolevulinic Acid ; Anesthesia ; Anesthesia, General ; Appendectomy ; Appendicitis ; Blood Gas Analysis ; Constipation ; Deglutition ; Dyspnea ; Fasting ; Female ; Halothane ; Heme ; Humans ; Inhalation ; Middle Aged ; Myasthenia Gravis ; Neostigmine ; Oxygen ; Peripheral Nervous System Diseases ; Physical Examination ; Porphyrias ; Pregnancy ; Reflex, Stretch ; Urinalysis ; Vital Capacity

Adult Respiratory Distress Syndrome(ARDS) is defined as a syndrome of acute respiratory failure characterized by noncardiogenic pulmonary edema with severe hypoxemia caused by right to left intrapulmonary shunting secondary to atelectasis and air space filled with edema fluid. On the past respiratory failure was thought to be the most common cause of mortality of ARDS in the past but recent research suggests the importance of non-pulmonary organ failure. And this has been increasingly recognized as a major cause of death in patients who develope a acute lung injury. Therefore the prognosis of ARDS depends on the associated clinical disorders. But there are very few reports about the prognosis and predisposing factor of ARDS in korea. We performed a retrospective study on ARDS in association with sex prevalance, in 103 ARDS patients. Age distribution, associated disease and prognosis. The results were as follows l) ARDS occurred more frequantly in male.(male female=1.9: 1) 2) Common clinical disorders associcated with development of ARDS were sepsis(26%), pneumonia(16%), gastric aspiration(12%) and etc. 3) Overall mortality was 54%, but the mortality was high in trauma patient with 80%. 4) Mortality of ARDS increased by age.
Acute Lung Injury ; Adult* ; Age Distribution ; Anoxia ; Causality* ; Cause of Death ; Edema ; Humans ; Korea ; Mortality ; Prognosis* ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Retrospective Studies

The retrograde microorganismal colonization in the pharynx from stomach may cause the nosocomial pneumonia and that may be more likely when the gastric pH is relatively high. We tried to find out the relationships between the gastric pH and the incidence of nosocomial pneumonia with twenty patients intubated for longer than 48 hours at ICU. We achieved following results: 1) The incidence of the nosocomial pneumonia was twenty percent. 2) All the patients developed nosocomial pneumonia showed the gastric pH above 4.0. 3) In the patients intubated for longer than 5 days, the incidence of nosocomial pneumonia was 33.3% in contrast to 9.0% for less than 5 days. 4) With the sputum culture, the incidence of colonization was higher in the patients with gastric pH above 4.0 than that in the patients with gastric pH below 4.0(84.6% vs 58.1%). 5) With regard to the duration of intubation, the incidence of colonization was higher in the patients intubated for longer than 4 days than that in the patients intubated for less than 4 days(90% vs 50%). 6) The most common pathognomic organisms were astreptoccus and Pseudomonas aeroginosa. It is conculded that the nosocmial pneumonia might develop more frequently in the patients with gastric pH above 4.0 than in the patients with gastric pH below establishment of the relationship between the treatment of the stress ulcer and the nosocomial pneumonia.
Colon ; Humans ; Hydrogen-Ion Concentration* ; Incidence ; Intubation ; Pharynx ; Pneumonia* ; Pseudomonas ; Sputum ; Stomach ; Ulcer

No abstract available.
Adenocarcinoma* ; Female* ; Humans ; Urethra*

No abstract available.
Appendix* ; Carcinoid Tumor*

PURPOSE: The acute respiratory distress syndrome(ARDS), an acute form of severe alveolar-capillary injury evolving after a direct or indirect lung insult is thought to be a common cause of respiratory failure though not many clinical studies on the subject have been made yet. METHODS: Between January 1992 and December 2001, we conducted a retrospective study on 33 children who fulfilled the definition of the ARDS recommended by the American-European Consensus Conference in 1994. RESULTS: A total of 33 patients(20 boys and 13 girls) were selected. Their age ranged from 4 months to 12 years with seven children younger than 1 year. The overall mortality rate was 78.8% and no significant difference was noted based on age or sex. Concerning seasonal variation, incidence of the ARDS increased in spring, especially in May(21.2%). Pneumonia(66.7%) was found to be the most common risk factor of the ARDS followed by sepsis(24.2%) and aspiration(3.0%). In immune ompromised children(six cases), including a recipient of bone marrow transplantation, the mortality rate was 100%. Compared with children with multiple organ failure recording a 83.3% mortality rate, those with isolated respiratory failure, showed a lower mortality rate of 33.3%, although stastistically insignificant. Between survivor and non-survivor groups, significant differences were shown in hematocrit, PaO2, PaCO2, PEEP, and PaO2/FiO2 on the seventh day after the onset of the ARDS. CONCLUSION: According to our study, respiratory failure proved to have a great effect on mortality rate in the ARDS. More aggressive intervention and further studies on this subject should be done to improve the survival rate.
Child ; Male ; Female ; Humans ; Incidence ; Mortality ; Risk Factors ; Bone Marrow Transplantation

No abstract available.
Humans* ; Placenta* ; Pregnancy*