Great Toenail Dystrophy: A Single-Center Experience and Review of the Literature / 가정의학회지

BACKGROUND: There have been a few reported cases of congenital great toenail dystrophy (GTND), described as a congenital malalignment of the great toenails. However, acquired GTDN is rare, and has not been documented extensively. This study aimed to describe the clinical features of 21 patients with acquired GTND. METHODS: Twenty-one patients with acquired GTND who visited Yeouido St. Mary's Hospital between June 2005 and August 2012 were retrospectively reviewed. RESULTS: The mean patient age was 43.1 years (range, 17 to 88 years), and the cohort predominantly comprised women (18/21). In our experience, all acquired GTND patients presented with yellow or yellow-brownish chromonychia, onychotrophy, and onycholysis. Conservative treatment with tape methods and grinding, as well as nail extraction, was provided and yielded little improvement in any case. CONCLUSION: This study provides initial data on the nail changes affecting the great toenail, such as yellowish chromonychia, onychomadesis, and onycholysis. These data may help physicians to distinguish various nail disorders, including onychomycosis, congenital malalignment of the great toenails, and yellow nail syndrome.

Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma Arising in a Patient with Hypersensitivity to Mosquito Bites / 가정의학회지

Hypersensitivity to mosquito bites is defined as the appearance of intense skin reactive lesions and systemic symptoms subsequent to mosquito bites. Most cases of hypersensitivity to mosquito bites reported thus far have been associated with chronic Epstein-Barr virus infection or natural killer cell leukemia/lymphoma. In this study, we describe the case of an 18-year-old Korean boy who had hypersensitivity to mosquito bites associated with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. After a mosquito bite, the patient developed a progressive cutaneous nodule on his left lower leg and regional lymphadenopathy in the left inguinal area. The histopathological and immunohistochemical findings suggested anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Positron emission tomography-computed tomography revealed increased fluorodeoxyglucose uptake in the left T4 vertebrae, left external iliac lymph nodes, left inguinal lymph nodes, and lateral subcutaneous region of the left lower leg. According to the clinical, histopathological, and immunohistochemical findings, as well as the imaging data, the patient was diagnosed with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Consequently, the patient received a total of 6 cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone chemotherapy at 3-week intervals, after which the lesions regressed.

Analysis of Heavy Metals in the Hair of Children with Attention-Deficit Hyperactivity Disorder and Tourette's Syndrome

OBJECTIVES: The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). METHODS: Study participants included 27 children diagnosed with ADHD (9.9+/-2.9 years of age), 21 diagnosed with Tourette's disorder (10.7+/-2.2 years of age), and 45 normal control children (9.6+/-0.5 years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. RESULTS: The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. CONCLUSION: We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.

Dietary supplement use by South Korean adults: Data from the national complementary and alternative medicine use survey (NCAMUS) in 2006

There has been little data on the prevalence of supplement use and the characteristics of the dietary supplement users in the Republic of Korea. This study presents the prevalence and the details of any dietary supplement use and the characteristics of the adults who use dietary supplements in the Republic of Korea. Between May 18 and June 16, 2006, nationwide and population-weighted personal interviews with 6,201 adult aged from 30 to 69 years were conducted and the final sample consisted of 3,000 people with a 49.8% response rate. We examined the prevalence and details of the use of dietary supplements and the characteristics of those who use the dietary supplement among adults. About sixty two percent of adults had taken any dietary supplement during the previous 12-month period in 2006. The most commonly reported dietary supplement was ginseng, followed by multivitamins, glucosamine, probiotics, and vitamin C. Female (versus male), an older age group, a higher family income, those living in metropolitan cities, those with marital experience, those with a higher level of education, and those having medical problems had a greater likelihood of reporting the use of any dietary supplements. The particular relationships differed depending on the type of supplement. The most Korean adults took one more dietary supplement and the dietary supplement users had different demographic and health characteristics compared to those of the nonusers. Research on diet supplements by the medical community is needed in the future.

Bone Mineral Density According to Exercise and Physical Activity in Premenopausal Women / 대한골다공증학회지

OBJECTIVES: Exercise and physical activity may increase bone mineral density (BMD), especially in premenopausal women. However, previous studies have concentrated on postmenopausal women. This study was conducted to evaluate the independent associations of exercise and physical activity with BMD in premenopauseal women. MATERIAL & METHODS: One hundred premenopausal women were recruited from outpatient clinics and a health promotion center in a university hospital located in Seoul. We measured the BMD of lumbar spine and hip using dual energy X-ray absoptiometry. Data on sociodemographic characteristics and exercise status were obtained from self-reported questionnaires. The Stanford questionnaire was used to assess physical activity. RESULTS: Age and body mass index-adjusted ANCOVA revealed that the mean BMD at the spine and hip was not significantly associated with exercise time. The mean BMD at the spine was significantly higher in women who exercised regularly > or =3 a week than in women who exercised or =3 times every week had significantly higher spine BMDs. The increase in physical activity was significantly associated with higher BMD at the spine and femur neck.

Psychiatric Disorder in Two Siblings with Hallervorden-Spatz Disease

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.

The Use of Complementary and Alternative Medicine in a General Population in South Korea: Results from a National Survey in 2006

The purpose of this survey was to obtain information on the prevalence, costs, and patterns of use of complementary and alternative medicine (CAM) in a general population in the Republic of Korea. In 2006, we conducted nationwide and population- weighted personal interviews with 6,021 adults ranging from 30 to 69 yr of age; the final sample consisted of 3,000 people with a 49.8% response rate. In addition to their general socio-demographics, the respondents were asked about their use of CAM during the previous 12-month period, costs, sources of information, and reasons for use. The prevalence of use overall was 74.8%, while biologically based CAM therapies were the most likely type of use (65.4%). The median annual out-of-pocket expenditures for CAM therapies was about US$203. The primary reason for using CAM was for disease prevention and health promotion (78.8%). The main source of advice about CAM therapies use was most likely to be from family and friends (66.9%). Our study suggests that CAM use has been and continues to be very popular in South Korea. Conventional western medical doctors and governments should obtain more evidence and become more interested in CAM therapies.

Diagnosis and Management of Attention Deficit Hyperactivity Disorder

No abstract available.

Perception and Experience of CAM Education for Family Practice Residents by Family Practice Training Faculty in South Korea

BACKGROUND: Complementary and alternative medicine (CAM) use is popular and current trend suggests a demand for CAM education during residency training. Our objective was to assess perception, the need and experience of CAM education for family practice residents by training faculty. METHODS: A questionnaire was administered to family physicians (n=262) who were registered in the Korean Academy of Family Medicine as residency training faculty between February and May 2006. RESULTS: One hundred and seven (40.8%) of 262 faculty completed the questionnaires. Eighty three (77.6%) respondents recognized the need of CAM education during residency training and fifty two (46.8%) respondents have already educated some kind of CAM. Thirty nine (36.4%) respondents replied that partial CAM educational contents were given out at conferences. Seventy eight (72.9%) respondents recognized the need for educating residents on the general outlines of CAM along with education on verified CAM. Sixty six (61.7%) respondents replied that the Korean Academy of Family Medicine should host such education. CONCLUSION: Most family practice training faculty recognized the need for providing CAM education for family practice residents during residency training, but about an half of family practice training faculty did not have experiences of CAM education.

Clinical Application of Mind-body Medicine: An Evidence-Based Approach

No abstract available.

Effects of Aerobic Exercise on Heart Rate Variability(HRV)

BACKGROUND: This study was conducted to find out the difference of heart rate variability between practicing Tai Chi and walking at 6 km/hr. METHODS: Twelve healthy volunteers aged 25 to 35 were recruited through advertisement. All the subjects gave their informed consent, and the study was approved by the Institutional Review Board of the Catholic Medical Center Research Foundation. The subjects either practised Tai Chi or walked at 6 km/ hr on a treadmill machine, maintaining 5-minute rest, 20-minute exercise, and 30-minute rest. After 1 week, they switched and performed the other form of exercise. During the exercise, beat-to-beat HRV data was recorded by Polar S-810. We calculated HRV indices using Matlab software program and analyzed the mean value of HRV indices. RESULTS: The differences of the mean value of HRV indices of pre-exercise resting period were not significant. However, repeated ANOVA revealed that there were significant differences of change in the mean of SDNN (-14.27+/-13.03 ms, -33.67+/-20.23 ms; P=0.023), RMSSD (-10.17+/-9.59 ms, -21.90+/-12.60 ms; P=0.087), and STIDX (171.60+/-196.84, 1003.49+/-812.56; P=0.003) between practising Tai Chi and walking. The differences of change in mean heat rate, LF/HF ratio, LF, HF and TP were not significant. The differences of the mean value of HRV indices of the post-exercise resting period were not significant compared to the pre- exercise period. CONCLUSION: The result of this study suggest that exertional intensity of practising Tai Chi is similar to that of walking. Moreover, practising Tai Chi may be more profitable than walking in the aspect of HRV.

The Relationship between Autonomous Function and Fatigue Rating in Patients with Fatigue

BACKGROUND: This study was conducted to find out the relationship between autonomous function and fatigue rating. The subjects were patients with complaints of fatigue who visited the department of family medicine in a general hospital. METHODS: We conducted this study from April to December 2002 in patients complaining of fatigue. The subjects were categorized into low, intermediate, and high fatigue groups. Heart rate variability was measured for five minutes at rest, followed by a five minute mental arithmetic test. We analyzed the relationship between fatigue ratings and autonomous function with SPSS 10.0. RESULTS: There was a statistically significant increase in the mean heart rate variability in the all three groups at rest and with stress. There was a statistically significant increase in LF norm increase in the low and high fatigue groups. HF norm showed a statistically significant decrease in the intermediate and high fatigue group. The variation in LF norms was highest in the low fatigue group and lowest. With the mental arithmetic test, the low fatigue group showed decreased rMSSD, HF and HF norm values compared to the intermediate group. The above values showed decrease in the high fatigue group compared to the low group. CONCLUSIONS: Overactivity of the sympathetic nervous system was observed as fatigue ratings increased. The cadiovascular autonomic response tended to decrease as fatigue ratings increased.

The Segmented Regional Volumes of the Cerebrum and Cerebellum in Boys with Tourette Syndrome

Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.

Bone Acquisition Related Health Behavior Factors and Nutritional Uptake in High School Girl Student

BACKGROUND: The adolescent years are a window of opportunity to influence lifelong bone health. Bone acquisition is accelerated within the genetic potential by lifestyle choices. But some adolescent girls do not care about healthy lifestyle and nutrient uptake. Therefore, we investigated the nutrition and health behavior relating to bone acquisition. METHODS: A cross-sectional study was administered to high school girl students from 4 general and 4 commercial high schools in Uijongbu, Incheon, Suwon, and Yongin. The data was gathered from 378 girls by self-reported questionnaire, which included age, height, weight, health behavior relating to bone acquisition and food-frequency. Nutrient uptake was assessed by DIET PLUS 3.0 program. RESULTS: Girls with bone acquisition inhibiting health habits were reported. Among subjects, 12.2% had regular alcohol intake, 21% smoked daily, 77.7% did not exercise regularly, 58% had light-activity, 42.2% experienced weight reduction trial, 30% had low body weight and 72.8% had less than 2 meals a day. In nutrient uptake, 33.1% of subjects took less calcium uptake and 4% less protein uptake than recommended daily allowance. Comparing general and commercial high schools, commercial students had more bone acquisition inhibiting health habits. CONCLUSION: There were many high school girl students with bone acquisition inhibiting health and eating habits. Family physicians need to promote and educate good health habits with a balanced meal associated with bone acquisition in girls, especially commercial high school students.

Femoral and vertebral bone mineral density and physical fitness factors in postmenopausal women of precticing Tai Chi

BACKGROUND: It is widely accepted tht Tai Chi has been suited for whole aged people, especially old aged women and improves bone mineral density and physical fitness levels. To investigate the efficacy of Tai Chi in postmenopausal women, we compared the bone mineral density and physical fitness levels between Tai Chi and control groups. METHODS: The study subjects were 10 Tai Chi and 18 control group who were postmenopausal women aged 40 years and older. Bone mineral density(BMD) was measured at the lumbar spine and femoral area using dual energy x-ray absorptiometry and maximal O2 intake, flexibility, grip strength, sit up, broad jump, balance, side-to-side step were checked for assessment of fitness levels. Other data was gathered from the questionnaire. RESULTS: The BMD of lumbar spine and Ward's triangle was significantly higher in control group(P<0.05) and the results of maximal O2 intake(P<0.05), grip strength(P<0.05), sit up(P<0.05), balance(P<0.01) were significantly higher in the control group. Logistic regression analysis showed that the results of grip strength, sit up, balance were significantly higher in the control group(P<0.05). CONCLUSIONS: Tai Chi improve physical finess levels and bone mineral density and can be a useful exercise type for menopausal women.

The relationship between grip strength and femoral and vertebral bone mineral density in peri-and postmenopausal women

BACKGROUND: It is widely acepted that muscle strength and bone mineral density have a significant positive correlation and most previous literature focus on the association between specific muscle groups and adjacent bones. This study examined the association of grip strength with bone density at distant sites, such as spine and femur area in peri- and postmenopausal women. METHODS: The study subjects were 30 perimenopausal and 108 post menopausal women aged 40 years older. Bone mineral density was measured in both the dominant and nondominant hands using a dynamometer. Other data was gathered from the questionnaire. RESULTS: Significant negative correlations were noted between spinal and femoral bone mineral density and age and post menopausal duration, and significant positive correlations were fiund between spinal and femoral bone mineral density and body wweight, height, body mass index and both grip strength. Those who exercised had significantly higher spinal bone mineral density than those who did not and smokers had significantly lower spinal bone density than nonsmokers. There was no significant difference in bone mineral density by estrogen and calcium use. The multiple regression analysis examined the associatrion of grip strength in the dominant hand to a bone mineral density after adjustment for the confounding covariates. CONCLUSION: Weak grip strength in the dominant hand is a marker for lower bone mineral density in peri- and postmenopausal women. Grip strength can be a useful index of osteoporosis.

Validity analysis of for exercise tests in assessing aerobic capacity of young men

BACKGROUND: Assessment of aerobic capacity (VO2max) is one of the essential components in exercise prescription for health promotion and maintenance. This study was conducted to compare the validity of four exercise tests to assess aerobic capacity in young adult male subjects by comparing them to the values measured from maximal ergometer exercise test (criterion VO2max). METHODS: Twenty young healthy adult males (M+/-SD=21.1+/-1.5 years) volunteered as subjects. Criterion VO2max was calculated and printed out automatically by computerized analysis system of expired air samples collected during maximal ergometer exercise test. VO2max was estimated for each subject from heart rate at submaximal workloads on the cycle ergometer using the Astrand-Rhyming nomogram(A/R) and Fox protocol(FOX) and the computerized multiple extrapolation method (XTP). The score got from Havard step test(H/S) was used to compare the validity. The validity of the procedures was based on the evaluation of the predicted VO2max (from A/R, FOX, XTP, and H/S) versus the criterion VO2max via the calculation of constant error (CE=mean difference for predicted minus criterion VO2max), r value, standard error of the estimate[SEE=SD(1-r2)(1/2)], total error [TE=(sigma(predicted VO2max - criterion VO2max)(2)/n)(1/2)]. RESULTS: In relation to criterion VO2max, the XTP and A.R underpredicted (XTP: 40.8 ml/kg/min SD=4.1; A/R: 37.3 ml/kg/min SD=5.0) and the H/S and FOX overpredicted (H/S: 48.0 ml/kg/min SD=5.9: FOX 46.3 ml/kg/min SD=5.5). Dunnett post-hoc procedures revealed that there were significant (P<0.05) mean differences (CE) for VO2max from A/R versus criterion. The validity coefficients for VO2max derived from XTP, H/S, A/R, and FOX were 0.68, 0.53, 0.50, and 0.49, respectively. TE of the XTP, FOX, H/S and A/R, which accounts for the effects of both the CE and SEE, were 5.73, 6.13, 6.75, and 8.87, respectively. CONCLUSIONS: These results suggest that the XTP is recommended first for estimation VO2max in young adult males. It is also considered that further studies about female and other age groups are necessary.

The effects of different exercises on regional bone density in young adult female athletes

BACKGROUND: Previous studies have suggested that regular exercise may increase bone mineral density. However, the effects on bone mineral density are different depending on the types of exercises and recent studies on the effects of different exercises on bone mineral density are insufficient. This study was conducted to assess the effects of 2 different exercises(Judo, Taekwondo) and physical fitness(back muscle strength, grip strength, broad jump, vertical jump, flexibility, sit ups) on regional BMD. METHODS: Subjects were healthy adults female volunteers aged 19 to 22 years and consisted of eight Judo athletes, twelve Taekwondo athletes, and eight nonathletic controls. We measured their bone mineral density of lumbar spine, femoral neck, femoral greater trochanter, Wards triangle, femoral shaft and distal radius using dual energy X ray absorptiometry and assessed their physical fitness. We investigated the mean differences of regional bone mineral density between the groups and the relationships between physical fitness and regional bone mineral density. RESULTS: ANCOVA revealed that there were significant differences in the regional bone mineral density between the groups. The Judo athletes group had significantly higher bone density of greater trochanter, femoral shaft, distal radius, femoral neck and lumbar spine than the control group and had significantly higher bone density of greater trochanter, femoral shaft and distal radius.than the Taekwondo atheletes group. There were no significant differences of bone density in all the regions between the Taekwondo atheletes and the control groups. Partial correlation coefficients between the back muscle strength and the bone density of Wards triangle, greater trochanter, distal radius, femoral neck, femoral shaft, and lumbar were 0.581, 0.570, 0.526, 0.502, 0.424, and 0.418, Respectively (P<0.05). Correlation coefficients between the broad jump and the bone density of femoral neck, greater trochanter, and femoral shaft were 0.577, 0.539, and 0.457, respectively(P<0.05). Correlations of the grip strength, flexibility, sit ups and vertical jump with bone density of all regions were not high(r< or=0.5). CONCLUSIONS: Different types of exercises showed different effects of bone density. The back muscle strength among the physical fitness factors was considered to be the most important predictor of bone density. In the future, further studies are necessary for the effects of other exercises on bone density.

Relations between peri and postmenopausal symptoms and vertebral bone mineral density

BACKGROUND: Menopause leads to rapid bone loss, mainly as a result of estrogen deficiency and peri and postmenopausal symptoms are related with estrogen deficiency. We investigated the relationship between peri and postmenopausal symptoms and vertebral bone mineral density(BMD). METHODS: Study subjects were women aged above 40 years underwent a vertebral bone density measurement with dual energy x-ray absorptiometry(DEXA). We examined the relationship between the menopausal symptoms by Kupperman index including vasomotor symptom and vertebral BMD in 74 perimenopausal and 205 postmenopausal women. RESULTS: On the basis of vertebral fracture threshold, 169 subjects were osteoporotic group and the others were nonosteoporotic group. Menopausal index was significantly high in osteoporotic group. And the osteoporotic one also complained of vasomotor symptom more severely. These findings were more definite during perimenopausal and early postmenopausal periods than late period. CONCLUSIONS: The results suggest that menopausal symptoms of peri and early menopausal period are significantly related with vertebral bone loss and helpful in predicting the vertebral osteoporosis.

Comparative Validity Study of Body Fat Assessment Methods Available in the Work Places / 대한산업의학회지

No abstract available.