Background: Fluvastatin is the first entirely synthetic 3-hydroxy-3-methylglutaryl-coenzyme A(HMG-CoA) reductase inhibitor. Clinical data indicate that this agent exhibits the proven efficacy of its class and also has some theoretical advantages in safety for long-term use because of its unique pharmacololgic property consistent with hepatoselectivity(i.e., low systemic exposure). This study is to evaluate efficacy and safety of fluvastatin in hypercholesterolemic patients in Korea. Methods: An open clinical trial with fluvastatin was conducted in 31 subjects who continued to have high blood cholesterol levels of 6.21 mmol/L(240 mg/dl) or greater after 1 month of lipid-lowering diet plus single blind placebo period. Fluvastatin was administered for 8 weeks with the initial dose of 20 mg per day and if serum cholesterol levels did not fall below 5.20 mmol/L(200 mg/dl) after 4 weeks the dose was increased to 40 mg per day for the second 4 weeks. On each visit every 4 weeks they underwent interview and laboratory tests about side effects and tolerability. Results: The mean % changes in plasma total cholesterol and LDL-cholesterol from baseline were
Cholesterol ; Creatine Kinase ; Diet ; Humans ; Hypercholesterolemia ; Korea ; Oxidoreductases ; Plasma ; Sleep Stages ; Triglycerides

BACKGROUND: Although studies on dental fear in relation to sex and age have been conducted, there have been few nationwide studies particularly on the youth sector. In addition, no validity and reliability verifications have been implemented for new research groups on the Korean version of the Dental Fear Survey (K-DFS). Therefore, this study aimed to apply the K-DFS developed in a previous study on Korean youth to draw conclusions on dental fear among the youth.METHODS: This study used the K-DFS, a Korean translation of Kleinknecht's Dental Fear Survey for elementary school, middle school, and high school students. This study selected 2,161 young people of various ages as participants and increased the validity of the research results by expanding nationwide the scope of the study area.RESULTS: Differences in fear levels according to sex were higher in boys fear behavior scores than in girls' regarding dental treatment (P < 0.05). Students with dental fear had higher scores on items associated with dental treatment and fear of dental stimuli compared with students without dental fear (P < 0.05). Differences were observed among the three groups (P < 0.05). However, the results of logistic regression analysis showed no statistically significant differences for dental visits based on sex, grade, and other subcomponents (P > 0.05).CONCLUSION: By verifying the validity of the newly developed K-DFS, this research confirmed its utility as a dental fear questionnaire. Therefore, there can be no objection that the grounds for criticism have been established according to conventional wisdom. In the future, however, developing and studying the limits of K-DFS that overcome the factors of dental fear, especially pain, will help reduce dental fear in adolescents.
Adolescent ; Dental Anxiety ; Humans ; Logistic Models ; Reproducibility of Results ; Surveys and Questionnaires

No abstract available.
Hemorrhage*

BACKGROUND: Thoracoscopic sympathectomy seems to be a safe therapeutic procedure without a severe complication. Hypotension has been often reported as one of postoperative complications, but intraoperative changes in blood pressure (BP) were not studied. However, authors' past experience of thoracic sympathectomy told that intraoperative BP reduction could be observed only when measured in ipsilateral arm. During general anesthesia, BP reduction might be a crucial, which could be associated with complication. Authors conducted this study to establish whether BP reduction is confined to ipsilateral arm, or is systemic phenomenon in thoracoscopic sympathectomy. METHODS: Twenty healthy, male and female patients scheduled for one stage thoracoscopic thoracic sympathectomy were prepared for this study. Without premedication, invasive BP monitoring was taken place in bilateral radial arteries. General anesthesia was induced with low dose of fentanyl, propofol and vecuronium. Endotracheal intubation was done with double lumen tube and anesthesia was maintained with variable concentrations of isoflurane in 100% oxygen. Sympathetomies were done for T2~3 during one lung ventilation. BP and palmar temperature were recorded at arrival, after one lung ventilation, after sympathectomy, 5 min, 10 min, after two lung ventilation. BPs and temperatures were analyzed by time and groups. RESULTS: Concurrent with initiation of sympathectomy, BP was reduced only in ipsilateral radial artery. Mean BP decrement was almost 11% (right side: 80 +/- 11 mmHg -> 71 +/- 15 mmHg; left side: 80 +/- 14 mmHg -> 71 +/- 9 mmHg; both of p<0.05). It was accompanied with ipsilateral palmar temperature elevation (right side: 1.28 degrees C; left side: 1.19 degrees C; both of p<0.05). CONCLUSION: Conclusively, BP reduction in thoracic sympathectomy is a change confined to ipsilateral arm, which seems because of peripheral vasodilation.
Anesthesia ; Anesthesia, General ; Arm* ; Arterial Pressure* ; Blood Pressure ; Female ; Fentanyl ; Humans ; Hyperhidrosis* ; Hypotension ; Intubation, Intratracheal ; Isoflurane ; Lung ; Male ; One-Lung Ventilation ; Oxygen ; Postoperative Complications ; Premedication ; Propofol ; Radial Artery ; Sympathectomy* ; Vasodilation ; Vecuronium Bromide ; Ventilation

BACKGROUND: As evidence-based medicine is getting popular recently, the importance of randomized controlled trial as a research methodology is also getting highlighted. This study was conducted in order to identify the status quo of randomized controlled trial research in major domestic journals and to provide baseline data for constructing Korean clinical trial database such CCTR (Cochrane Clinical Trial Registry). METHODS: Five journals issued by domestic publication industry were selected, out of which 127,560 original articles, equal to 253 volumes, were investigated. The author extracted the articles, which performed prospective clinical trial, targeting human beings. The selected papers were analyzed with experts to single out randomized controlled trial among them. Furthermore, the quality of the re-selected ones were assessed according to Jadad Quaility Assessment Scale. RESULTS: After analysis, it turned out that the number of papers adopting prospective clinical trial were 406 volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s. However, the percentage of prospective clinical trial monographs, introduced during 1980s and 1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115, accounting for 0.9% of total articles. The number of RCT increased to approximately two fold from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers, which won the marks of 4 and 5. CONCLUSION: It was found that domestic randomized controlled trial research was weak both in number and quality. Therefore, it is necessary to activate clinical medicine study with good quality to upgrade the amount and quality of monographs.
Clinical Medicine ; Evidence-Based Medicine ; Humans ; Publications ; Research Design

PURPOSE: Secondary breast reconstruction is defined as a whole reconstructive procedure to correct complications and to improve the aesthetics when a patient is dissatisfied with her initial reconstruction. We would like to present these particular procedures on previously failed breast reconstruction with analysis of unsatisfactory results. METHODS: From June 2002 to August 2008, we performed secondary breast reconstructions for 10 patients with failed breasts. Six patients with implant failure underwent secondary breast reconstructions using free TRAM flaps after the removal of implants. Two patients with partial loss of pedicled TRAM flaps underwent secondary breast reconstruction using Latissimus Dorsi flaps. Two patients with 1 total loss of free TRAM flap and 1 extensive fat necrosis underwent secondary breast reconstruction using implants. RESULTS: The average age of the patients were 36.4 years (26 - 47 years). All flaps survived completely and had relatively good aesthetic results in free TRAM cases. There was breast asymmetry in one patient using cohesive gell implants in total loss of previously free TRAM patient, which was corrected by exchanging the implants and placing dermofat grafts. CONCLUSION: Secondary breast reconstruction differs from primary procedures in several aspects; there are changes in the anatomy and tissue environment of the breasts, and various limitations in choosing reconstruction methods. In addition, the patients may be uncomfortable with previous complication. It is important to consider various factors before deciding to undergo a secondary breast reconstruction carefully with informed consent.
Breast ; Esthetics ; Fat Necrosis ; Female ; Humans ; Informed Consent ; Mammaplasty

BACKGROUND AND OBJECTIVES: Cochlear implantation is regarded as a safe and effective treatment for patients with profound sensorineural hearing loss. However, a few patients, especially with inner ear anomalies, suffer from complications with variable degrees after operation. This study reports various complications encountered in patients with inner ear anomalies undergoing cochlear implantation in 3rd referreral center. SUBJECTS AND METHOD: We retrospectively analyzed 342 patients who had cochlear implantation between April 1999 and December 2005. There were 70 patients with various inner ear anomalies. Immediate and delayed complications were defined according to their onset which happened within or over 1 week. Minor and Major complications were defined according to their severity which needed further operation or management. RESULTS: Among 342 patients, there were 35 cases (10.2%) with various postoperative complications. In patients with inner ear anomalies, the total number of complications was 20 cases (28.6%). There were 4 cases (5.7%) of major complications including facial nerve palsy, recurrent meningitis, device failure, and cerebrospinal fluid leakage. Reimplantation was performed in 3 cases (4.3%). CONCLUSION: Although the rate of postoperative complications in patients with inner ear anomalies was higher than in patients with normal inner ear, most of them were minor and could be managed with conservative treatments. The tolerable rate of major complications suggests that cochlear implantation is a safe operation even for patients with inner ear anomalies.
Cerebrospinal Fluid ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner* ; Equipment Failure ; Facial Nerve ; Hearing Loss, Sensorineural ; Humans ; Meningitis ; Paralysis ; Postoperative Complications* ; Replantation ; Retrospective Studies

BACKGROUND: Laryngoscopy and endotracheal intubation often provoke an undesirable increase in blood pressure and heart rate. This response may be exaggerated in patients with essential hypertension. We compared the effect of administration of remifentanil and alfentanil on the hemodynamic responses to endotracheal intubation in patients with essential hypertension. METHODS: Forty patients with essential hypertension were allocated into two groups. The remifentanil group received 0.5micro g/kg remifentanil followed by an infusion of 0.25microg/kg/min remifentanil. The alfentanil group received 10microg/kg alfentanil intravenously. Anesthesia was induced with thiopental and vecuronium, and was maintained with 2 vol% sevoflurane with 100% oxygen. Laryngoscopy and tracheal intubation were performed 3 min after vecuronium administration. Arterial blood pressure and heart rate were measured in patients after arrival at the operating room and before and after intubation. RESULTS: The systolic and mean blood pressure after intubation showed significantly higher values in the alfentanil group of patients than in the remifentanil group of patients. There was no significant difference in blood pressure measured at baseline and after intubation in the remifentanil group of patients, but blood pressure showed significantly higher values after intubation in the alfentanil group of patients. Heart rate showed significantly higher values after intubation than at baseline in each group of patients. CONCLUSIONS: These results show that the administration of 0.5micro g/kg remifentanil followed by an infusion of 0.25microg/kg/min remifentanil attenuated the pressor response to endotracheal intubation more significantly than the administration of 10microg/kg alfentanil in patients with essential hypertension.
Alfentanil ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Methyl Ethers ; Operating Rooms ; Oxygen ; Piperidines ; Thiopental ; Vecuronium Bromide

PURPOSE: The purpose of this study was to evaluate the dental fear experienced among Korean adolescents and to identify the relevant factors. MATERIALS AND METHODS: In order to compare the level of dental fear depending on the subjects' previous experience, descriptive statistical analysis was performed. Gender- and grade-dependent evaluation was performed according to the presence of their previous dental visit and dental fear. Subjective oral health status was also investigated. In order to determine the factors affecting dental fear, logistic regression analysis was performed. RESULT: Among the total of 333 subjects who had experienced dental fear, females were found to experience 1.766 times greater dental fear than males (P=0.007). The worse subjective perception of their oral health was associated with increase in the experience of dental fear by 1.245-fold (P=0.047). CONCLUSION: The dental fear was likely to be formed during the visit to the dentist's office or through previous experience of dental treatment. Therefore in order to reduce the fear associated with dental treatment in adolescents, establishemnt of a proper environment in the dental clinic and a patient management program are necessitated.
Adolescent* ; Dental Anxiety* ; Dental Clinics ; Female ; Humans ; Logistic Models ; Male ; Oral Health

PURPOSE: Accurate diagnosis of group A streptococcal(GAS) pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae and to reduce the improper use of antibiotics. Because the clinical presentation of pharyngitis does not reliably predict the etiologic agent, when GAS infection is suspected, diagnosis should be based on the result of a throat swab culture or antigen-detection test with culture back-up. METHODS: We reviewed retrospectively the medical records of children diagnosed as GAS pharyngitis by throat swab culture from Jan. 1995 to Jul. 2000. Since Nov. 1998, specimens were also tested with the Abbott's Testpack+plus Strep A Kit. RESULTS: 121 patients were confirmed as GAS pharyngitis by throat culture. GAS pharyngitis predominantly occurred from 3 to 7 years of age with the peak incidence at 4 and 5 years of age. The disease was more frequent in late fall, winter and spring. Clinical manifestations were as follows; fever(89.9%), abnormal pharynx(94.3%), of which exudate in 33.6%, sore throat(85.3%), headache(78.1%), cervical lymphadenopathy(67.5%), abdominal pain(64.3%), and nausea or vomiting (55.0%). The sensitivity and specificity of rapid antigen test compared to throat culture were 96.4% and 95%, respectively. CONCLUSION: GAS pharyngitis occurred every year, and more frequently in late fall, winter and spring. It occurred with the greatest frequency in preschool children. The rapid antigen test can be a basis for clinicians to decide how to treat their patients before the culture results are proven, and can be helpful to judicious use of antibiotics as well.
Anti-Bacterial Agents ; Child ; Child, Preschool ; Diagnosis ; Exudates and Transudates ; Humans ; Incidence ; Medical Records ; Nausea ; Pharyngitis ; Pharynx ; Retrospective Studies ; Sensitivity and Specificity ; Vomiting