Thirty patient with essential hypertension were administered Manidipine, a new calcium antagonist, 10~20mg once daily to evaluate the hypotensive efficacy and safety for 8 weeks. And the followings were the result. 1) Patients were consists of 14 male, 16 female, aged 53 in average and classified as mild in 21 and moderate in 9 patients. 2) Optimum intial dose was 10mg and 10 to 20mg were the doses recommended. 3) Blood pressure dropped after 8 weeks 24/13mmHg in average, rewarding 80% effectiveness and normalized in 87%. 4) Most frequent side reaction was facial flushing in 5 patiens followed by palpitation and dizziness, all of which did not disturb the continuation of medication. 5) Most of routine laboratory parameter were normal and unchanged between before and after the trial. 6) Overall rating of usefulness was 77%. In conclusion, Manidipine 10 to 20mg once daily regimen is well tolerated and effective in the treatment of mild to moderate essential hypertension.
Blood Pressure ; Calcium ; Dizziness ; Female ; Flushing ; Humans ; Hypertension* ; Male ; Reward

To evaluate the reproducibility of the Ambulatory Electrocardiography (AECG), we examined the consistency rates of premature beats between the baseline AECG's and the repeat AECG's in 23 patients who underwent AECG's times within 1 year. 12 patients were male and 11 patients were female. Their mean age was 48 years. (Range ; 20 years-75 years) The time interval between both AECG's was 1 month 20 days. (Range ; 1 day-9months) They did not take any antiarrhythmic druge during the observation period except 4 patients who were taking calcium channel blockers or beta receptor blockers for hypertensive heart disease or ischemic heart disease. The consistency rate of both frequency and complexity of ventricular premature beats was 52%. The consisency rate of both frequency and complexity of supraventicular premature beats was 35%. These consistency rates seemed to vary as the time interval between both AECG's differed. In the case of ventricular premature beats, the consistency rates of 1 day, 8 days and 5 months as the time interval were 100%, 38% and 14% respectively. In the case of supraventricular premature beats, the consistency rates were 50%, 25% and 29%. We concluded that the reproducility of the AECG was low and this reproducibility became lower as the time interval between both AECG's became longer and that hese facts had to be considered when the effect of the antiarrhythmic drugs was evaluated.
Anti-Arrhythmia Agents ; Calcium Channel Blockers ; Cardiac Complexes, Premature ; Electrocardiography, Ambulatory* ; Female ; Heart Diseases ; Humans ; Male ; Myocardial Ischemia

The antihypertensive effects and serial changes of serum lipids were observed in 17 patients with essential hypertension, administered daily 30-60mg dose of Tripamide(Tripamol(R)) for 8 weeks. The results were as follows ; 1) After 8 weeks treatment, there is no change of serum total cholesterol, serum triglyceride and HDL-cholesterol were decreased by 3.2mg/dl(-1.9%) and 0.9mg/dl(-2.8%) respectively. The changes were not significant statistically. 2) After 8 weeks treatment, mean systolic and diastolic blood pressure were decreased by 11.2mmHg(-6.8%) and 7.7mmHg(-7.3%). 3) No significant side effect was observed during treatment except of 2 patients of mild headache and insomnia.
Blood Pressure ; Cholesterol ; Headache ; Humans ; Hypertension* ; Sleep Initiation and Maintenance Disorders ; Triglycerides

BACKGROUND: Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). METHODS: The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. RESULTS: Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT>37℃ 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. CONCLUSION: Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.
Aged* ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Early Diagnosis ; Fever ; Follow-Up Studies ; Hemoptysis ; Humans ; Lung Diseases, Obstructive ; Lung Neoplasms ; Medical Records ; Mortality ; Pneumonia ; Retrospective Studies ; Seoul ; Sputum ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary*

BACKGROUND: The importance of pro-inflammatory cytokines, especially tumor necrosis factor α(TNF-α) and interleukin-1β(IL-1β), have been extensively documented in the generation of inflammatory lung disease. Lung epithelial cells are also actively involved in initiating and maintaining inflammation by producing pro-inflammatory mediators. Understanding the mechanism of pro-inflammatory cytokine expression in lung epithelial cells is crucial to the development of new therapeutic modalities for inflammatory lung disease. Transcription of most pro-inflammatory cytokines is dependent on the actiation of NF-κB. However, the relationship between pro-inflammatory cytokine expression and NF-κB/IκB pathway in lung epithelial cells is not clear. METHODS: BEAS-2B, A549, NCI-H719 cells were stimulated with IL-1β or TNF-α at various times, and then IL-8 and TNF-αmRNA expressions were assayed by Northern blot analysis. IL-1β or TNF-α-induced NF-κB activation was assessed by the nuclear translocation of p65 NF-κB subunit. The degradation of IκBα and IκBβ by IL-1βor TNF-α stimulation was assayed by Western blot analysis. The phosphorylation of IκBαwas evaluated by Western blot analysis after pre-treating cells with proteasome inhibitor followed by IL-1β or TNF-α stimulation. The basal level of IKKα expression was evaluated by Western blot analysis. RESULTS: IκBαand IκBβ was repidly degraded after 5 minutes of incubation with IL-1β or TNF-α in BEAS-2B, A549, and NCI-H157 cells. The activation of NF-κB and the induction of IL-8 and TNF-α mRNA expressions were observed by IL-1β or TNF-α stimulation in these cells. In contrast, neither the changes in NF-κB/IκB pathway nor IL-8 and TNF-α mRNA expression was induces by IL-1β or TNF-α stimulation in NCI-H719 cell. IL-1β and TNF-α-induced IκB phoshorylation was observed in BEAS-2B, A549, and NCI-H157 cells, but not in NCI-H719 cells. The basal level of IKKα expression was not different between cells. CONCLUSION: NF-κB/IκB pathway plays an important role in the ixpression of pro-inflammatory cytokine in most lung epithelial cells. The absence of the effect on NF-κB/IκB pathway in NCI-H719 cells seems to be due to the defect in the intracellular signal transduction pathway upstream to IKK.
Blotting, Northern ; Blotting, Western ; Cytokines ; Epithelial Cells* ; Inflammation ; Interleukin-8 ; Lung Diseases ; Lung* ; Phosphorylation ; Proteasome Inhibitors ; RNA, Messenger ; Signal Transduction ; Tumor Necrosis Factor-alpha

Emphysematous gangrene of the lower extremity in a diabetic patient due to minor trauma is being presented. The gas originating from the extremity extended along to fascial planes into the pelvic cavity, scrotal region, retroperitoneal space, and abdominal wall. CT demonstrated the pathways of upward extension of emphysematousgangrene. Anatomic pathways of the spread of the disease are insertions of the iliopsoas, piriformis and obturator internus muscles, and their fascial investments, and the endopelvic fascia. Anatomic pathways on CT and the roleof CT are discussed.
Abdominal Wall ; Extremities ; Fascia ; Gangrene* ; Humans ; Investments ; Lower Extremity* ; Muscles

BACKGROUND: This randomized, controlled study was designed to compare the effects of recruitment maneuvers (RMs) with a 15 cmH₂O positive end-expiratory pressure (PEEP) on the systemic oxygenation and lung compliance of patients with healthy lungs following robot-assisted laparoscopic prostatectomy (RALP). METHODS: Sixty patients undergoing a RALP with an intraoperative 15 cmH₂O PEEP were randomly allocated to an RM or a Control group. The patients in the RM group received a single RM through the application of a continuous positive airway pressure of 40 cmH₂O for 40 s 15 min after being placed in the Trendelenburg position. The arterial oxygen tension (PaO₂, primary endpoint) and the pulmonary dynamic and static compliances (secondary endpoints) were measured 10 min after the anesthetic induction (T1), 10 min after establishment of the pneumoperitoneum (T2), 10 min after establishment of the Trendelenburg position (T3), 10 min after the RM (T4), 60 min after the RM (T5), and 10 min after deflation of the pneumoperitoneum in the supine position (T6). RESULTS: The intergroup comparisons of the PaO₂ showed significantly higher values in the RM group than in the Control group at T4 and T5 (193 ± 35 mmHg vs. 219 ± 33 mmHg, P = 0.015, 188 ± 41 mmHg vs. 214 ± 42 mmHg, P = 0.005, respectively). However, the PaO₂ at T6 was similar in the two groups (211 ± 39 mmHg vs. 224 ± 41 mmHg, P = 0.442). Moreover, there were no statistical differences between the groups in the dynamic and static compliances of the lungs at any time point. CONCLUSIONS: The arterial oxygenation of the patients with a healthy lung function who had undergone a RALP with intraoperative 15 cmH₂O PEEP was improved by a single RM. However, this benefit did not last long, and it did not lead to an amelioration of the lung mechanics.
Continuous Positive Airway Pressure ; Head-Down Tilt ; Humans ; Lung ; Lung Compliance ; Mechanics ; Oxygen* ; Pneumoperitoneum ; Positive-Pressure Respiration* ; Prostatectomy* ; Supine Position

The cause of Moyamoya disease remains unknown, and theories of inflammatory and immunologic pathophysiological mechanisms remain unproven. Moyamoya disease characterized by angiographic findings of intracranial carotid artery stenosis and occlusion, resulting in brain hemorrhage. We experienced that a 32-year-old female patient whose complaint was a suddenly developed occipital headache, decreased vision and visual field defect, and performed transfemoral 4-vessel angiography and magnetic resonance image (MRI). It was defined as Moyamoya disease. So we report a case of Moyamoya disease with right homonymous hemianopsia.
Adult ; Angiography ; Carotid Stenosis ; Female ; Headache ; Hemianopsia* ; Humans ; Intracranial Hemorrhages ; Moyamoya Disease* ; Visual Fields

Sarcopenia-related falls and fractures are increasing worldwide due to the aging population. The purpose of this study was to 1) evaluate anthropometric characteristics related to hip fracture in Korean patients, 2) investigate sarcopenia prevalence in hip fracture (HF) and non-hip fracture (NF) groups, and 3) investigate the correlation between sarcopenia and osteoporosis. This case-control study examined 359 HF and 1,614 NF normal populations using Korea National Health and Nutrition Examination Survey data. We performed whole-body dual energy X-ray absorptiometry to analyze body composition using the skeletal muscle mass index (SMI: lean mass/height2) and bone mineral density (BMD). In the HF group, using the AWGS definition, the prevalence of sarcopenia in women and men was 44.3% and 68.2%, respectively; in the NF group, it was 7.1% and 16.1%, respectively. Lower appendicular SMI (P < 0.001), leg muscle mass (P < 0.001), and higher prevalence of sarcopenia (P < 0.001) were observed in the HF group after adjustment for age and gender. In multivariate analysis, sarcopenia (OR = 6.52; 95% CI = 4.67-9.09), age (OR = 1.15; 95% CI = 1.13-1.17), and osteoporosis (OR = 1.87; 95% CI = 1.35-2.58) were associated with the occurrence of a hip fracture. This study showed a higher prevalence of sarcopenia in patients with hip fractures compared with a normal population, and higher prevalence of sarcopenia in men.
Absorptiometry, Photon ; Accidental Falls ; Aging ; Body Composition ; Bone Density ; Case-Control Studies* ; Female ; Hip Fractures ; Hip* ; Humans ; Korea ; Leg ; Male ; Multivariate Analysis ; Muscle, Skeletal ; Nutrition Surveys ; Osteoporosis ; Prevalence* ; Sarcopenia*

Antiphospholipid syndrome (APS) is a noninflammatory autoimmune disorder characterized by the association of arterial and/or venous thrombosis, recurrent fetal loss and elevated titres of antiphospholipid antibodies, namely lupus anticoagulant (LAC) and/or anticardiolipin antibodies (aCL). It can either occur as a free-standing condition (primary APS) or be associated with another autoimmune disease (secondary APS), mainly systemic lupus erythematosus. The precise pathogenesis of thrombosis in APS in unknown. For children with unexplainable venous or arterial thrombosis, APS should be considered. The diagnosis of APS in children requires a clinical event including venous or arterial thrombosis or immune thrombocytopenia and a laboratory abnormality including positive LAC test or positive aCL antibody test, moderate or high titer IgG. The laboratory abnormality should persist for at least 2 months. We report a 7-year-old girl who had pulmonary embolism and multiple arterial thrombosis caused by primary APS. The laboratory abnormality was positive LAC and beta2-glycoprotein I. She was treated successfully with low molecualr weight heparin (LMWH). After recovery, she was continuously treated with subcutaneous LMWH for another 3 months and switched to oral warfarin. She was symptom-free through 3 years of follow-up.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Autoimmune Diseases ; beta 2-Glycoprotein I ; Child ; Diagnosis ; Female ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Immunoglobulin G ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Pulmonary Embolism ; Pulmonary Infarction* ; Thrombocytopenia ; Thromboembolism* ; Thrombosis ; Venous Thrombosis ; Warfarin