Anterior Commissure - Posterior Commissure Revisited

OBJECTIVE: The anterior commissure (AC) and posterior commissure (PC) are the two distinct anatomic structures in the brain which are difficult to observe in detail with conventional MRI, such as a 1.5T MRI system. However, recent advances in ultra-high resolution MRI have enabled us to examine the AC and PC directly. The objective of the present study is to standardize the shape and size of the AC and PC using a 7.0T MRI and to propose a new brain reference line. MATERIALS AND METHODS: Thirty-four, 21 males and 13 females, healthy volunteers were enrolled in this study. After determining the center of each AC and PC, we defined the connection of these centers as the central intercommissural line (CIL). We compared the known extra- and intra-cerebral reference lines with the CIL to determine the difference in the angles. Additionally, we obtained horizontal line from flat ground line of look front human. RESULTS: The difference in angle of the CIL and the tangential intercommissural line (TIL) from the horizontal line was 8.7 +/- 5.1 (11 +/- 4.8) and 17.4 +/- 5.2 (19.8 +/- 4.8) degrees in males and females, respectively. The difference in angle between the CIL and canthomeatal line was 10.1 in both male and female, and there was no difference between both sexes. Likewise, there was no significant difference in angle between the CIL and TIL between both sexes (8.3 +/- 1.1 in male and 8.8 +/- 0.7 in female). CONCLUSION: In this study, we have used 7.0T MRI to define the AC and PC quantitatively and in a more robust manner. We have showed that the CIL is a reproducible reference line and serves as a standard for the axial images of the human brain.

Effect of 8-week Therapy with Rabeprazole on Presenting Symptoms in Korean Patients with Gastroesophageal Reflux Disease

BACKGROUND: Gastroesophageal reflux diease (GERD) is common in Western civilization and comprise 75% of esophageal diseases. However, there are only few studies of GERD in Korea. The aim of the study was to evaluate the clinical symptoms of GERD in Koreans and the effect of rabeprazole on the symptoms. METHODS: The study subjects were included 353 patients who were diagnosed endoscopically with reflux esophagitis (316) or non-erosive reflux disease who have complained of intermittent heartburn during the past 3 months or more. All patients received rabeprazole 20 mg daily for 8 weeks. Symptoms according to 8 symptom categories of GERD were evaluated. Patients recorded the severity of GERD associated symptoms at baseline, 4 weeks and 8 weeks after treatment. Presenting symptoms in Korean, frequency and severity of each symptom was evaluated. Efficacy of Rabeprazole treatment was analysed. RESULTS: The most common symptoms of GERD were regurgitation (60.9%), heartburn (52.7%), epigastric pain/ soreness (49.6%) and other epigastric discomfort (47.0%). Symptom severity was rated in order of epigastric pain/ soreness, epigastric discomfort, and heartburn. The proportion of all symptoms, except for heart burn and cough, increased in relation to the severity of endoscopic grading, but the severity of symptoms was not significantly different between subgroups according to endoscopic findings. Symptoms, except for hoarseness, globus sensation and cough, significantly improved in 4 weeks after treatment. Cough did not improve after 4 weeks irrespective of smoking status, All symptoms significantly improved after 8 weeks. CONCLUSION: Regurgitation was more common, and epigastric symptoms were more severe than heartburn in Koreans. The 8-week rabeprazole treatment was effective on all symptoms associated with GERD.

Factors related to postpartum weight retention / 대한산부인과학회지

OBJECTIVE: Pre-pregnancy weight and excess weight gain during pregnancy were associated with obstetric outcomes and plasma leptin was reported to have association with postpartum weight retention. The purpose of this study was to examine the relationships between pregnancy related factors including plasma leptin and weight gain during pregnancy and postpartum weight retention. METHODS: Seventy-five women were observed through pregnancy and 6 months postpartum. First trimester, third trimester and postpartum leptin were measured by radioimmunoassay. Weight gain categories were based on the Institute of Medicine recommendations. Relationships between pregnancy related factors and leptin were examined. And relationship between leptin and postpartum weight retention was also examined. RESULTS: Among subjects, 44.0% of women had concerns for postpartum weight retention and 18.9% had diet controls for postpartum weight management. Initial BMI categories by IOM classification were underweight, 29 (38.7%), normal, 37 (49.3%), and overweight group, 9 (12.0%). Underweight group was largely below IOM weight gain recommendation and overweight group was largely over IOM weight gain recommendation (P=0.013). First trimester leptin was correlated with pregravid BMI (r=0.678, P=0.000), maternal weight at term (r=0.547, P=0.006) and postpartum BMI (r=0.608, P=0.002), but not correlated with weight gain during pregnancy and postpartum weight retention. Third trimester leptin was not correlated with above variables. Initial BMI categories by IOM were significantly correlated with first trimester leptin, leptin at 5 weeks postpartum, maternal weight at term (0.741, P=0.000), weight at 5 weeks postpartum (r=0.728, P=0.001) and weight at 6 months postpartum (r=0.684, P=0.002). CONCLUSION: These results suggest that first trimester plasma leptin may predict maternal weight at term and initial BMI categories may be a predictor of maternal weight at 5 weeks postpartum and 6 months postpartum. However, weight gain during pregnancy was not correlated with postpartum weight retention.

Case Report of a Crushing Injury of Hand by Telemedicine

Crushing injury is a common in work place and require early judgment and assessment. However during shipping, it is impossible that patient is rapidly taken care in hospital. But in this case, crushed handed patient during shipping was early assessment and sutured by telemedicine. A healthy 28-year-old man had crushed hand during working. But this patient was on the sea, so could not use medical facilities. Using e-mailing and telephone by satellite, report-ed to the doctor that patient status. In order to doctor 's pre-scription, patient hand was sutured and prescribed medicines. So patient preserved good hand function and rapidly recovered. In the future, telemedicine will be useful and economic medical field in isolated areas to medical facilities or shipping.

The Correlation between Vitamin C Intake and Plasma High-Sensitive C-reactive Protein Concentration

BACKGROUND: There are several reports that vitamin C is one of antioxidants and can be used to protect cardiovascular diseases. Inflammation plays a major role in atherosclerosis, and the measurement of inflammatory markers such as high-sensitivity C-reactive protein (hs- CRP) may provide methods for risk prediction and reveal independent risk factors of cardiovascular diseases. The purpose of our study was to assess the correlation between vitamin C intake and plasma hs-CRP concentration. METHODS: The study subjects consisted of 2,012 individuals who underwent periodic health examination in a university hospital in Busan from June 2002 to January 2003. The subjects were questioned concerning their past medical history, alcohol intake, smoking status, physical activity. Body mass index, abdominal circumference, blood pressure, fasting glucose, lipid profile, general blood test, and hs-CRP were measured. The exclusive responsible dietitian evaluated the average calorie intake and vitamin C intake by food frequency questionnaire. To quantify the correlation between vitamin C intake and plasma hs-CRP concentration, Pearson correlation coefficient and Spearman correlation coefficient were presented. RESULTS: The vitamin C index (r=-0.051, P<0.05) and the vitamin C intake per calorie intake (r=-0.075, P<0.01) showed a significant correlation with the plasma hs-CRP level. The vitamin C intake and the vitamin C intake per calorie intake were significantly correlated with the plasma hs-CRP level after adjusting for sex, age, body mass index and smoking status. CONCLUSION: These findings suggest that there was a significant correlation between the vitamin C intake and the hs-CRP concentration. Therefore, inflammatory status is higher in a person who takes small amount of vitamin C than a person who takes it plentifully. The former is presumed to have a higher risk of cardiovascular diseases thereafter.

The Effects of Brief Diet Education in Office on Body Weight and Blood Pressure in Olders

BACKGROUND: It is one of the important strategies to maintain a appropriate body weight and blood pressure by diet and exercise for the elderly. But there is some difficulties to perform the specific diet therapy continuously at the primary medical environment. The purpose of this study was to examine the effect of the brief diet education by physician on body weight and blood pressure for the elderly at the out patient clinic. METHOD: A retrospective design reviewing medical record with elderly(60 and over 60 years) men and women(N=110) from who had complete medical record when they visited first and revisited. 70 samples(education group) attended at the diet education with physician, 40 samples were non education group. For education group, we performed general diet principal, and investigated the change of body weight, diastolic blood pressure and systolic blood pressure at the first visit, one month, and three month. RESULT: there was significant difference on the both group's body weight, diastolic blood pressure and systolic blood pressure according to diet education. Body weight, diastolic blood pressure and systolic blood pressure were decreased average 0.98+/-2.01 kg, 10.33+/-15.60mmHg, 4.97+/-9.16 mmHg on education group, but there is no significant difference on non education group. CONCLUSION: A brief diet education can be a very useful method for management of body weight and blood pressure for the elderly in the way of cost-effectiveness. Also we can obtain more higher educational effect with regular practice.

Change of Body Weight and Body ComPosition after Smoking Cessation in Males

BACKGROUND: There are very few studies on change in body composition after smoking cessation. The purpose of our study was to assess the change in body composition as well as body weight after smoking cessation in men. METHODS: The subjects were 203 men who had received health examination from May in 2000 to April in 2001 on their first visit, and then from May in 2001 to May in 2002 on their second visit, at the department of family medicine of a university hospital. They were divided into groups of non-smokers, current smokers, and former smokers by smoking status. Their past medical history, obesity indexes, smoking status, physical activity, and nutrition intake were reviewed. Body composition of the study subjects was assessed by bioelectrical impedance analysis. RESULTS: After adjustment for age, nutrition intake, and physical activity as confounding factors, former smokers' body weight was significantly increased by 1.8+/-0.4 kg on second visit compared to non-smokers and current smokers. There was a significant difference in body muscle change between first and second visit, but not in body fat change among former smokers. Former smokers' body fat and muscle were significantly increased by 0.9+/-0.3 kg and 0.8+/-0.4 kg, respectively, compared to non-smokers. Former smokers' waist circumference was significantly increased by 2.5+/-0.7 cm on second visit compared with non-smokers and current smokers. CONCLUSION: In former smokers, body weight was increased by 1.8 kg after smoking cessation, which was attributed to increase of body muscle as well as body fat. Compared with non-smokers, former smokers' body muscle and fat were significantly increased on second visit.

Gastrointestinal Stromal Tumor in a Patient Complaining about Less Decreasing Abdominal Obesity

The gastrointestinal stromal tumor was finded in a female patient complaining continous abdominal obesity without any gastrointestinal symptoms. The tumor was sized 5.5 7 10 cm and expanded from stomach to the space between stomach and pancreas. The surgical resection was carried out for treatment. This case means that careful physical examinations should be done when there are no gastrointestinal complains in a abdominal obesity patient.

Clinical Usefulness of the Two-site Semmes-Weinstein Monofilament Test for Detecting Diabetic Peripheral Neuropathy

The present study was done to validate the two-site Semmes-Weinstein (SW) monofilament test in identifying patients at risk of lower-extremity complications in clinical setting. The SW monofilament test and nerve conduction study were conducted on type 2 diabetic patients (n=37) at Pusan National University Hospital in Korea. As the duration of diabetes mellitus was longer, neuropathy identified by nerve conduction study and complications of diabetes were more severe (p<0.01). The number of sites unable to perceive SW monofilament (p<0.001) was larger in patients with lower-extremity neuropathy symptoms than those without symptoms. Sensitivity and specificity at two sites (the third and fifth metatarsal head sites) were 93% and 100%, respectively. In conclusion, the two-site SW monofilament test was a sensitive, specific, simple, and inexpensive screening tool for identifying diabetic peripheral neuropathy in clinical setting.

Effect of Dehydroepiandrosterone Sulfate on Cardiovascular Risk Factors / 대한남성과학회지

PURPOSE: Morbidity and mortality from cardiovascular disease have increased in Korea. Some studies have suggested that dehydroepiandrosterone sulfate(DHEAS) may play an important role in the pathogenesis or prevention of cardiovascular disease. However, insufficient data are available for Korean subjects, and the results of the available studies are controversial. We conducted this study to investigate the relationship between DHEAS and cardiovascular risk factors. MATERIALS AND METHODS: We evaluated 621 men who visited Health Promotion Center at the National University Hospital in Pusan from March 2001 to June 2002 and checked their plasma DHEAS concentration, body mass index, plasma lipid profile, blood pressure, and body fat percent. We assessed the effect of plasma DHEAS concentration on these factors. RESULTS: Plasma DHEAS concentration decreased with age. The mean concentration was 210.6microgram/dl. The values were positively correlated with body mass index, body fat percent, waist circumference, hip circumference, and blood pressure(p<0.05). Serum triglyceride correlated positively with serum DHEAS concentration(r=0.0924; p<0.05), and increasing HDL-cholesterol was related to higher serum DHEAS after adjustment for age and body mass index(beta= 0.060; p<0.05). CONCLUSIONS: This study suggests that the plasma DHEAS concentration can impact HDL-cholesterol, which has a protective effect against cardiovascular disease. However, other studies show different results, and most such studies are cross-sectional. Large well-controlled studies are necessary to prove any effect of plasma DHEAS concentration on cardiovascular disease risk factors.

The Experience of Brief Survey for Teaching Journal Writing by Medical Students in a Clinical Curriculum of Family Medicine / 한국의학교육

PURPOSE: This study was to report our experience of the brief survey for teaching journal writing by medical students in a clinical curriculum of family medicine. METHODS: Brief surveys performed by medical students in clinical clerkship of department of family medicine from 1998 to 2000. Medical students determined theme without rein for brief surveys. Lecture about meaning and process of survey was given for sufficient understanding of students, and then surveys were conducted. The subjects of survey were outpatients, nursing person, medical students, nursing students, and other general persons. The subjects of theme were classified to 17 chapters 7 components by international classification of primary care(ICPC). RESULTS: In analysis of brief surveys according to ICPC, the reasons for surveys by components were diagnostic, screening prevention(89.0%), treatment, procedures, medication(5.7%), symptoms, complaints(5.3%). By chapters, there were social(64.6%), psychological(12.6%), metabolic and endocrine(6.5%). Among social problems, there were other social problem(35.4%), health care system/access(20.9%), problem with education(13.9%), relation problems partner(12.7%). Majority of medical students had affirmative response for survey conduction. In conclusion, our finding suggest that teaching journal writing as brief survey seems to be useful in understanding of journal writing of medical students.

The Association of Prostate Volume with Obesity Index

BACKGROUND: The purpose of this study as to assess the impact of obesity on prostate volume by estimating prostate volume using transrectal ultrasonography in men without obesity related metabolic diseases. METHODS: The study sample consisted of 135 men (age 51.8+/-8.0 y) in whom trans-rectal ultrasonography was performed to estimate the prostate volume at an university hospital in Pusan from March 2001 to April 2002. The subjects with obesity-related diseases, such as diabetes, impaired fasting glucose, hypertension, and dyslipidemia were excluded. Subjects were divided into three groups -normal, overweight, and obese- according to body mass index (BMI) and also classified into two groups -normal, central obese- according to abdominal circumference. Differences in means of prostate volume in three groups divided by BMI and two groups by abdominal circumference, respectively, were tested using ANOVA with Sheffe posthoc test and two-sample t test. The correlation between prostate volume and age, obesity index, male hormone and lifestyle factors were assessed using Pearson and Spearman correlation coefficients. Multiple logistic analysis were used to evaluate the independent factor associated with prostatic hyperplasia defined as volume more than 20 cc. RESULTS: The mean prostate volume was significantly larger in obese group than normal group (P<0.05) and in central obese group than normal group (P<0.05). The prostate volume correlated with BMI, abdominal circumference after adjusting for age. Central obesity was an independent factor affecting prostatic hyperplasia (OR=4.3, P<0.05). CONCLUSION: There was significantly larger prostate volume in both obese and central obese group than normal group after excluding for obesity related metabolic diseases. Although both BMI and abdominal circumference were positively correlated with the prostate volume, central obesity was the only independent factor affecting prostate hyperplasia. We suggest central obesity to be a risk factor of prostatic hyperplasia.

The Association between Blood Pressure and Bone Mineral Loss in Perimenopausal Women; A Cross Sectional Study

BACKGROUND: The risk factors of bone mineral loss are known widely. Recently, the results were reported that high blood pressure is associated with abnormalities in calcium metabolism and sustained calcium loss may lead to increased bone mineral loss in people with high blood pressure. Therefore, we investigated the cross sectional association between blood pressure and bone mineral loss in domestic perimenopausal women. METHODS: Among 306 women who visited a university hospital in Busan for health exam from July 1999 to March 2001, we selected 150 women excluding those who received hormone replacement therapy or anti-osteoporotic medications, and have had vertebral surgery. We measured body weight, body mass index, daily calcium uptake, blood pressure (BP), and bone mineral density (BMD). The SPSS statistical program was used for statistical analysis and the test for correlation and partial correlation adjusted for age was used. RESULTS: The total subjects consisted of 88 premenopausal and 62 postmenopausal women. In premenopausal women, after controlling for age, body weight (gamma=0.222, Por=140 mmHg or diastolic BP >or=90 mmHg) after controlling for age, menopausal status, body weight, and spinal BMD was negatively correlated with systolic BP (gamma= 0.321, P=0.03). CONCLUSION: These results suggest that BP was not associated with bone mineral loss in perimenopausal women. In perimenopausal women with high abnormal BP, systolic BP was negatively correlated with BMD at the lumbar vertebrae.

Incidence of Influenza-like Illness after Influenza Vaccination in the Elderly

BACKGROUND: The purpose of our study was to assess the efficacy of influenza vaccination against influenza-like illness and the common cold in the elderly. METHODS: A total of 62 subjects, aged 60 years or older, were evaluated, who visited the Un-bong Welfare center, Bansong, Pusan. Attack rate of influenza-like illness and the common cold during winter, before and after influenza vaccination, was assessed by means of interview. RESULTS: After influenza vaccination, the attack frequency of influenza-like illness during winter was 0.07 0.31. This differed with 0.81 1.17 before vaccination (P<0.000). After influenza vaccination, the attack frequency of the common cold during winter was 1.22 1.61. This differed with 2.71 2.35 before vaccination (P<0.000). After influenza vaccination, the attack rate of influenza-like illness during winter was 45.2%. This differed with 4.8% before vaccination (P<0.000). After influenza vaccination, the attack frequency of common cold during winter was 87.1%. This differed with 48.4% before vaccination (P<0.000). The only side effect of influenza vaccination was pain (1.6%). CONCLUSION: In the elderly, influenza vaccination may reduce the incidence of influenza-like illness and the common cold during winter.

Treatment Behavior for the Eradication of Helicobacter Pylori in Peptic Ulcer

BACKGROUND: Helicobacter pylori (H. pylori) infection is an important etiological factor in development of pep-tic ulcer. Eradication of H. pylori improves the cure rate of peptic ulcer and decreases the recurrence rate of these disease. However, the eradication success results have proven variable, and the factors influencing effec-tiveness of therapy are unclear. We performed this study to know treatment behavior for the eradication of H. pylori in peptic ulcer. METHODS: We studied 214 patients retrospectively from medical records. All visited depart-ment of family medicine in one university hospital from August 1997 to May 2001 and were confirmed H. pylori infection by a positive Compylobacter like organism (CLO) test. Of 214 patients studied, 181 patients were treat-ed omeprazole 20 mg bid, amoxicillin 1 g bid, clarithromycin 500 mg bid daily for 7-14 days. CLO test or his-tology or urea breath test were used to determine H. pylori eradication at 4 weeks later after eradication treat-ment. RESULTS: Only 52 of 188 patients who took a eradication treatment were confirmed of the presence of eradication at 4 weeks later after treatment. The success rate of H. pylori eradication was 94.9%. Ulcer stage after therapy was improved. CONCLUSION: Our retrospective study showed that only 28.7% patients were con-firmed of the presence of eradication, but overall eradication rate of confirmed patients was 94.9%.

The pattern of urinary deoxypyridinoline and serum osteocalcin across menopausal transition in women

BACKGROUND: Biochemical markers have been proposed as sensitive indicators of high bone turnover and for monitoring response to osteoporosis treatment. We conducted a retrospective study to investigate the pattern of biochemical markers of bone metabolism (urinary deoxypryridinoline(D PYD), serum osteocalcin) across menopausal transition in women. METHODS: We measured the urinary excretion of D PYD, serum osteocalcin and BMD in 44 premenopausal and age matched 44 postmenopausal women who visited a tertiary hospital from May 1, 1997 to July 31, 1997. Each values between premenopausal and postmenopausal women were anaysed with paired t-tests. Pearson's correlation coefficients were performed to assess the relationships between the three values. RESULTS: Urinary excretion of D-PYD in postmenopausal women (12.103+/-2.27 nM/mM creatinine) was higher than in premenopausal women (9.322+/-2.53 nM/mM creatinine) (P<0.05). Serum osteocalcin in postmenopausal women (12.8698+/-3.1 ng/ml) was higher than in premenopausal women (9.0949+/-2.7 ng/ml) (P<0.01). BMD in postmenopausal women (0.9979+/-0.1863 g/cm2) was lower than in postmenopausal women (1.1845+/-0.1591 g/cm2) (P<0.01). The serum osteocalcin level was positively correlated with D-PYD (r=0.547, p<0.01). Urine excretion of D-PYD was negatively correlated with BMD (r= 0.36, p<0.01). Serum osteocalcin was negatively correlated with BMD (r= 0.427, P<0.01). CONCLUSION: Urinary D-PYD excretion and serum osteocalcin were increased, but BMD was decreased significantly in postmenopausal women. Urinary D-PYD, serum osteocalcin, and BMD were significantly correlated with each other in women.