The Correlation between Carotid Intima-Media Thickness and Neutrophil to Lymphocyte Ratio in Prediabetes Patients / 가정의학회지

Background@#Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients. @*Methods@#From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT. @*Results@#In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT. @*Conclusion@#NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

The Impact of Depression on Cardiovascular Disease: A Nationwide Population-Based Cohort Study in Korean Elderly / 가정의학회지

Background@#Depression is suggested to be associated with cardiovascular disease, including ischemic heart disease and cerebrovascular disease. This study investigated the impact of depression on cardiovascular disease in the elderly population in Korea. @*Methods@#This retrospective cohort study was performed using the Senior Cohort database released by the Korean National Health Insurance Services from January 1, 2008 to December 31, 2012, or January 1, 2009 to December 31, 2013. The study group constituted participants newly diagnosed with depression, but not cardiovascular disease. The control group constituted participants with no past history of depression or cardiovascular disease, and were not diagnosed with depression during the follow-up period. During the 5-year follow-up period, development of ischemic heart disease or cerebrovascular disease was assessed. Depression and cardiovascular disease were identified using the International Classification of Diseases, 10th revision, Clinical Modification codes. The data was analyzed using Cox proportional hazards model. @*Results@#The hazard ratio (HR) between depression and ischemic heart disease was 1.38 (95% confidence interval [CI], 1.23 to 1.55) and the HR between depression and cerebrovascular disease was 1.46 (95% CI, 1.32 to 1.62), after adjusting all confounding variables. @*Conclusion@#Independent of other cardiovascular risk factors, depression increased the risk of ischemic heart disease by 38% and cerebrovascular disease by 46% among older adults in Korea. Since depression may increase the risk of cardiovascular disease, future research should focus on the diagnosis and prevention of cardiovascular disease in people with depression.

Survival Analysis of Patients with Alzheimer’s Disease: A Study Based on Data from the Korean National Health Insurance Services’ Senior Cohort Database / 가정의학회지

Background@#Korea’s rapidly aging population has experienced a sharp rise in the prevalence of dementia. Patients with Alzheimer’s disease (AD), which is estimated to be about three-quarters of all patients with dementia, tend to have higher mortality rates compared with patients without Alzheimer’s disease. In this study, a survival analysis of patients with AD was conducted in order to provide knowledge to those who provide medical care to these patients. @*Methods@#Data on individuals over 65 years old in 2004 were extracted from the Korean National Health Insurance Services’ Senior Cohort database (2002–2013). The subjects were 209,254 patients, including 2,695 who were first diagnosed with AD (the AD group) and 206,559 that had not been diagnosed with the disease (non-AD group). To investigate the independent effect of AD on survival, the Cox proportional-hazards model, hazard ratios (confidence interval of 95%), and the Kaplan-Meier method were used. @*Results@#Mean survival time in the AD group was 5.3±3.3 years, which was about 2.5 years shorter than that in the non-AD group (7.8±2.4 years). The mortality rate in the AD group (66.3%) was higher than that in the non-AD group (26.3%). The adjusted hazard ratio in the AD group was 2.5 and, therefore, it was found that the AD group had a 2.5-fold higher risk of death than the non-AD group. @*Conclusion@#Overall, AD has a large, independent impact on survival. Survival time was shorter, and the mortality rate and risk were generally higher in the AD group, compared with the non-AD group.

The Impact of Depression on Fracture in Elderly: A Nationwide Population-Based Retrospective-Cohort Study

BACKGROUND: Fractures should be actively prevented in the elderly because recovery from the damage of fractures is slow and fractures can cause both physical and psychological pain in the elderly. Previous studies have reported that depression is related to falls or low bone mineral density (BMD). This study aimed to evaluate the risk of fracture according to the depression status among the elderly.METHODS: This study used the National Health Insurance Corporation cohort data to examine 96,188 elderly people aged >65 years who were examined in 2007 and 2008. The chi-square test was used to determine the general characteristics and fracture incidence in patients with depression and healthy controls, and the hazard ratio was calculated using the Cox proportional hazards model corrected for general characteristics. The Kaplan-Meier method predicted the risk of fracture in two groups during the observation period.RESULTS: In the depressed group, 23.2% (441 of 1,904) of the patients had a fracture during the 5-year follow-up period; however, in the control group, only 17.5% (16,470 of 94,284) had a fracture (P < 0.001). In addition, multivariate analysis of the adjusted variables showed that the risk of fracture in the depressed group was 1.34 times higher than that in the control group. The risk of fracture in women was 1.71 times higher than that in men, and the risk of fracture increased with age.CONCLUSION: The risk of fracture in the elderly who were depressed was significantly higher than that in the elderly who were not depressed.

Night Shift Work and Risk of Depression: Meta-analysis of Observational Studies

This study aimed to assess whether night shift work is associated with the risk of depression by using a meta-analysis of observational studies. We searched PubMed and EMBASE in August, 2016 to locate eligible studies and investigated the association between night shift work and the risk of depression, reporting outcome measures with adjusted odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs). In the meta-analysis of a total of 11 observational studies with 9 cross-sectional study, 1 longitudinal study, and 1 cohort study, night shift work was significantly associated with an increased risk of depression (OR/RR, 1.43; 95% CI, 1.24–1.64; I² = 78.0%). Also, subgroup meta-analyses by gender, night shift work duration, type of occupation, continent, and type of publication showed that night shift work was consistently associated with the increased risk of depression. The current meta-analysis suggests that night shift work is associated with the increased risk of depression. However, further large prospective cohort studies are needed to confirm this association.

Pro Re Nata Prescription and Perception Difference between Doctors and Nurses / 가정의학회지

BACKGROUND: Pro re nata (PRN) prescription is a frequently used prescription method in hospitals. This study was conducted to investigate actual condition of PRN prescription and whether administration error occurred because of perception difference between doctors and nurses. METHODS: From May to July 2012, a survey was conducted among 746 doctors and nurses (88 doctors and 658 nurses) working at 5 hospitals located in Seoul, Gyeong-gi, and Gangwon Province. Doctors generating PRN prescription responded to actual conditions of PRN prescription and both doctors and nurses reported whether administration error occurred due to perception difference. RESULTS: Average number of PRN prescription of surgical residents was 4.6 +/- 5.4, which was larger than that of medical residents (1.7 +/- 1.0). Surgical residents more frequently recorded maximum number of daily intake (P = 0.034) and, although not statistically significant, more often wrote exact single dosage (P = 0.053) and maximum dosage per day (P = 0.333) than medical residents. Doctors expected nurses to notify them before the administration of medication; however, nurses were more likely to conduct PRN administration by their own decision without informing doctors. In addition, some doctors and nurses experienced administration errors because of it. CONCLUSION: Standard prescription methods need to be established since there is a perception difference in PRN prescription between doctors and nurses and this could be related to administration errors.

Polypharmacy in Older Patients Admitted to a General Hospital

BACKGROUND: The elderly population is rapidly growing in numbers in Korea. According to the high prevalence of chronic disease in older persons, the issue of polypharmacy becomes one of the main problems in geriatric care. In this study, we tried to investigate the current status of inappropriate multiple drug prescriptions in older patients who were admitted to general hospital. METHODS: From July 1st 2010 to July 31th 2010, a total of 163 patients of 65 years of age or over who were admitted to one general hospital were investigated. Subjects were examined with a structured questionnaire survey. They were reviewed with medical records, and all medications taken by patients were analyzed. Inappropriate prescriptions were evaluated by Beers criteria and drug-drug interactions guidelines. RESULTS: Among the 163 participants, 146 patients took daily medication in the previous week, and the average numbers of pills taken by these patients were 7.95. 24 cases (16.4%) of inappropriate prescriptions were identified by Beers criteria, and 19 cases (13.0%) manifested a potential risk for drug-drug interaction. A total 7 cases (4.8%) of overlapping prescription of similar efficacy were also identified. Also, the risk of inappropriate prescription increased, when older patients visited 2 or more physicians (p<0.01). CONCLUSION: A considerable number of cases of prescriptions probable to cause adverse events in older patients were identified, which suggests physicians need to be thoughtful and alert for the harmful effects of polypharmacy, and the necessity of a well-structured drug monitoring system for older persons. A dedicated personal physician system for older patients should also be considered, to reduce inappropriate prescriptions.

Correlation between Frailty Level and Adverse Health-related Outcomes of Community-Dwelling Elderly, One Year Retrospective Study / 가정의학회지

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.

Inpatient Smoking Cessation Program and Its Success Rate for Abstinence among Korean Smokers / 가정의학회지

BACKGROUND: Inpatient smoking cessation programs have been known to be quite effective for smoking cessation, but it was rarely conducted among Koreans. This study was to investigate the effect of inpatient smoking cessation program among Korean smokers. METHODS: From March 1 to April 30, 2008, we carried out a randomized controlled trial for inpatient smoking cessation program among 70 smokers who were 18 years of age or over and admitted to a university hospital in Seoul, Korea. For the intervention group, a trained doctor conducted the systematic educational program for smoking cessation of 30 minutes to an hour. For the control group, they were advised with a 3-minute explanation for smoking cessation. We assessed the abstinence rates of study participants at 1 week, 1 month, and 3 months after discharge. RESULTS: In 3 months after the discharge, the abstinence rate for the intervention group was 37.1% while that of the control group was 14.3%. In simple logistic regression analysis, the smokers among the intervention group were 3.5 times more likely to abstain than those in the control group. After controlling for confounding factors, the smokers among the intervention group was 11.4 times more likely to abstain than those in the control group. CONCLUSION: For Korean smokers, the inpatient smoking cessation program showed a higher success rate of abstinence compared to simple advice and limited counselling.

Correlation between Frailty Level and Disability of the Elderly and Frailty Related Factors / 가정의학회지

BACKGROUND: Frailty is a wasting syndrome that presents loss of physiological function by aging, lowering of reserve capacity, and disability of body system. It is currently being considered an important issue in geriatrics. This study examined frailty level of Korean elderly in community and whether frailty can be meaningful a predictive factor for functional disability. METHODS: Demographic characteristics, the number of chronic diseases and medications, cardiovascular health study (CHS) frailty index, study of osteoporotic fractures (SOF) frailty index, activities of daily living, Instrumental activities of daily living, depression, mini-mental state examination (MMSE) and fall history were examined for 302 men and women over 65 years old who visited the three community seniors welfare centers from February 2008 to June 2008. RESULTS: There were definite differences of frailty status by age, educational level, marital status, monthly income, body mass index, the number of chronic diseases, the number of medications, depression, MMSE and fall history (P < 0.05), except in gender (P < 0.432). In logistic regression analysis for functional disability with frailty status defined by SOF frailty index, odds ratio to dependency of instrumental activities of daily living (IADL) from the healthy to the prefrail stage increased 6.84 times while from the healthy to the frail stage increased 130.87 times. These effects still increased after covariate adjustment. Also, the CHS frailty index showed the same result although there was some difference in odds ratio. CONCLUSION: There were meaningful correlations of frailty with functional disability when dividing Korean elderly's frailty levels into the healthy, the prefrail and the frail stages.

Polypharmacy and Inappropriate Drug Prescription in Community-dwelling Elderly

BACKGROUND: Due to rapidly growing elderly population, there are increasing numbers of older persons with multiple chronic disorders and geriatric problems arising from polypharmacy. In this study we tried to find out the state of polypharmacy and inappropriate drug prescription and their related factors in community-dwelling elderly by review of drugs taken by older persons visiting a day health center. METHODS: From April 2007 to July 2007, 80 subjects of 65 year-old or over with chronic illness who visited a elderly-wellness and health care center were randomly sampled. All of them were surveyed by structured questionnaires, medical records review, pill counts about all medications they are taking and experience of adverse drug reactions. And all the prescribed medications were reviewed or their drug prescription's appropriateness for each elderly according to Beers criteria. Data results were evaluated by frequency and correlation analyses. RESULTS: The average counts of drugs taken by elderly with chronic disorders were 7.23, minimum 1 to maximum 27 drugs a day. Patients experienced more adverse effects significantly when more prescribed medications were taken (P=0.005), and patients with lack of information about their drugs had taken increased number of medications (P<0.001). Referred to Beers criteria, inappropriate cases of prescription were observed in 26 persons. Those drugs were NSAIDs including aspirin in 17 subjects (21%), amitrityline in 3 (4%), short-acting benzodiazepines in 3 (4%), long acting benzodiazepines in 2 (3%), and anticholinergic antihistamine in 1 (1%). CONCLUSION: Polypharmacy is very common in community-dwelling elderly with chronic disorders. More medications were related to more adverse drug reactions and lack of information about their drugs related to increased number of drug taking. High proportion of inappropriate drug prescriptions was observed in the elderly, which may have resulted from poor education concerning geriatric care of the medical personnels.

Results of 'Short-Form Comprehensive Geriatric Assessment' Application to Elderly Outpatients

BACKGROUND: The importance of comprehensive geriatric assessment(CGA) for the frail elderly can not be overemphasized. Recently, with increasing elderly population and patients, there are increasing need for simplified CGA tool for evaluation of general health and functional status during the limited time in outpatient clinic. This study was conducted to estimate the effectiveness of the 'Short-form Comprehensive Geriatric Assessment' for detecting hidden medical problems beside preexisting diseases. METHODS: 78 outpatients aged 65 or more who revisited to outpatient clinic in a Social Welfare Center answered questionnaires and were examined of the 'Short-form Comprehensive Geriatric Assessment. This screening tool included vision, hearing, arm and leg function, urinary incontinence, nutrition, mental status, depression, ADL, IADL and social support. These results were compared with patients' previous medical records. RESULTS: Among the total 78 subjects, visual difficulty was detected in 63(80.8%)(Rt. eye)/67(85.9%)(Lt. eye). Right hearing difficulty was shown in 8(10.3%) subjects and left hearing difficulty was shown in 4(5.1 %) subjects. There were 2(2.6%) upper extremities dysfunctions and 25(32.1%) lower extremities dysfunctions. 24(30.8%) subjects had depression. The geriatric depression and age and number of disease showed positive correlations. These problems found by assessment tool were not identified on previous medical records. CONCLUSION: Using the 'Short-form Comprehensive Geriatric Assessmen', we could find the new medical problems besides preexisting disease. These findings stress effectiveness and importance of routine application of screening 'Short-form Comprehensive Geriatric Assessment' on daily outpatient clinical practice to improve quality of medical care for the elderly patients.

Is the Pass/Fail System Applicable to a Medical School in Korea? / 보건의료교육평가

To determine whether a pass/fail system is more appropriate for medical education instead of a grade-based system, a survey of medical students and faculty members of Hallym University, Korea, was taken. A questionnaire was delivered to 54 junior students and 36 faculty members from a medical school in Korea and analyzed. Of these participants, 37.7% of students and 36.1% of faculty agreed to the pass/fail system, while 28.3% of students and 52.8% of faculty objected to it. The most frequent reason for objection was the potential decrease in learning achievement. A pass/fail system should be considered after persuasion of the students and faculty to think positively of this system.

Motivation and Time to Apply for Family Medicine Resident

BACKGROUND: As of 2006, the residents of family medicine occupies about 9 percent among the total. However, expansion of more general practice doctors is in demand to conduct desirable general practice. Accordingly, this study was conducted to survey the motivation to apply for family medicine residency and the actual situation. METHODS: A questionnaire survey of 862 residents of nationwide family medicine from June 2006 to July 2006 was performed via e-mails. Hospital, size, years, gender, age, university, career, time and motivation to apply, and existence and nonexistence of lecture in medical school or clinical practice of family medicine for students were reviewed. RESULTS: Among the total, 415 (48.14%) residents from 72 training hospitals answered. For the motivation, 'the necessity to diagnose and treat various patients' was 53.49%, 'advantageous to start practice' was 21.93%, and 'relatively short training period' was 11.33%. For the time, during 'intern' was 49.40%, 'on getting a job' 16.63%, and as a 'student' 15.42%. When they had lectures of family medicine in medical school, decision made as a student was 19.93%, and during clinical practice was 21.61%. CONCLUSION: Among the reasons that motivated to apply for family medicine, 'the necessity to diagnose and treat various patients' was the biggest, which conforms to the training goal of Academy of Family Physicians. Since there is a tendency to select family medicine residency earlier when they are exposed to lectures of family medicine or clinical practices in medical school, the effort to expand substantial lectures and clinical practices is needed.

The Prevalence of Hematuria and Proteinuria in School Children in Seoul

BACKGROUND: Since 1998, mass urinary screening tests have been conducted in Korean school children. We analyzed the urinary screening test data gathered from the metropolitan city, Seoul, to identify the prevalence of persistent urine abnormalities. METHODS: The students were tested for hematuria and/or proteinuria using dipstick urinalysis. If the results were positive, the students were asked to visit a medical clinic to recheck urinalysis and in report their results. RESULTS: Among 1,337,210 students, who were screened with initial urinalysis, 10,871 students (proteinuria, 3,626 (0.27%); hematuria, 7,634 (0.57%); both, 389) were recommended to undergo second urinalysis in which 8,819 students (81.1%) did. Among them, 851 had persistent proteinuria and 2,618 had persistent hematuria. The results of the first urinalysis were scored based on the severity of hematuria and proteinuria from +1 to +4. Among all students 24.7% of the students who scored +1 and 40.4% who scored +3 proteinuria on the first test had persistent proteinuria, and 56.4% with both proteinuria and hematuria had persistent proteinuria on the second test. For hematuria, the more positive in the first test showed more prevalence of persistent hematuria. And 61.6% of students with both proteinuria and hematuia had persistent hematuria on the second test. CONCLUSION: The presence of both hematuria and proteinuria seemed to be a powerful predictor for persistent abnormal urine finding. And the more positive response in the first test was related to persistent abnormal finding. Therefore we should follow up closely for those students with positive findings.

The Difference of Smoking Rates before and after Hospital Admission

BACKGROUND: The harmfulness of smoking is well known, but the smoking rate of adult males in Korea is still high. Therefore, we wanted to find out the factors related to smoking cessation among patients who had been admitted to hospital and to make an effective smoking cessation program. METHODS: We reviewed the medical records of patients who had been admitted to the department of internal medicine or orthopedic surgery of an hospital from January 25, 2005 to June 15, 2005. We enrolled 104 male patients who were smokers and gave them telephone interviews. Among them, 74 patients answered (71.2%). RESULTS: Among the subjects, 10 patients quit smoking and 64 smoked continuously. Age, duration and amount of smoking, past experiences of smoking cessation were not significantly different between the two groups. The patients who were admitted to the department of internal medicine (P=0.047) and advised from doctors to quit smoking (P=0.010) showed a high smoking cessation rate. The patients who were advised by doctors showed a higher rate of planning for smoking cessation, even though they were still smoking (P=0.001). CONCLUSION: For smoking cessation in admission patient's, doctor's advice to quit smoking was important.

A Selection and Translation of Evidence Based Clinical Practice Guidelines for Primary Care Physician in Respiratory Disease Field

BACKGROUND: One method for achieving medical practice to be more evident, especially in the field of primary care, is to encourage the use of clinical guidelines. If development of guidelines is difficult because of time and cost, an evidence based foreign guidelines can be selected and translated into Korean for application. METHODS: A team was formed, consisting of 11 family physician experts on evidence based medicine and clinical practice guidelines. We selected six respiratory diseases requiring clinical guidelines because of variability in practice. We searched several clinical practice guideline databases and selected one guideline according to currency, scope of guideline, whether it was evidence based, and its feasibility in the field of primay care. We translated selected guideline's full-texts or summaries which were done by authorized organization into Korean. RESULTS: The selected respiratory diseases were chronic obstructive pulmonary disease, asthma, pneumonia, sinusitis, rhinitis, and influenza. According to criterion, we selected GOLD (Global Initiative for Chronic Obstructive Lung Disease) for chronic obstructive lung disease, GINA (Global initiative for asthma) for asthma, CDC (Center for disease control) guideline for influenza, IDSA (Infectious Diseases Society of America) guideline for pneumonia, AAP (American Academy of Pediatrics) guideline for sinusitis, and JCAAI (Joint Council of Allergy, Asthma and Immunology) for rhinitis. CONCLUSION: We selected six common respiratory diseases and the most appropriate evidence based guidelines for those particular diseases.

Comparison of Artificial Synthetic Material and Antibacterial Ointment for Treatment of Partial Thickness Skin Burn

BACKGROUND: Burn is one of the most common illness in primary care. Most burns are partial skin thickness burns. The purpose of this study was to evaluate the use ofSilvadene (silver sulfadiazine) ointment (antibacterial agent) and DuoDERMR (artificial syntheticmaterial). METHODS: The subjects of this study were 46 patients with partial skin thickness burns who had visited a general hospital burn clinic from May 1, 2002 to June 30, 2002. They were randomly assigned to the silvadine ointment or DuoDERMR group. The patients were evaluated for pain, the number of dressing change, the ease of dressing application and removal, limitation of activity, comfortableness, satisfaction with the appearance, sleep disturbance, treatment cost, and the number of days for complete epithelialization. RESULTS: DuoDERMR treated burns had a fewer dressing change (3.19 times vs 5.36 times), less time for dressing change (4.13 min vs 6.26 min) and less cost (P<0.01). But there was no statistical difference in the number of days for complete epithelialization (P=0.197) and it depended on the size of the wounds (P=0.005). The cost of treatment was related with the number of dressing change (P=0.000). CONCLUSION: Treatment methods had no effect on duration of treatment but artificial synthetic material was shown to reduce the time for dressing and the cost.

Causes and characteristics of the chest pain(in the chest-pain clinic)

BACKGROUND: Ischemic heart disease is the most important cause of the chest pain, and its frequency is increasing enormously. The purpose of this study is to find out the way of early detection and/or ruling out the cardiogenic chest pain by history taking. METHODS: From July 1996 to December 1999, 248 patients visited the chest-pain clinic and took the questionnaire about characteristics of the chest pain. And we found out the diagnosis that caused the chest pain. 46 patients of them were excluded because of the unreliable responses or uncertain diagnosis. So, we compared the characteristics of the chest pain with causes for 202 patients. RESULTS: The sex ratio of patients was 1.43:1(male:female). The average age was 41.8+/-14.0 for male and 47.3+/-14.8 for female. The causes of the chest pain were cardiogenic(23.2%), musculo-skeletal(19.3%), psychogenic (14.8%), gastrointestinal(12.4%), and pulmonary disease(6.9%). Patients with the past history of diabetes, hypertension, alcohol intake, or angina were more likely to have cardiac disease. Choking (O.R=2.19, C.I.=1.08-4.44), splitting(O.R=3.38, C.I.=1.24-9.21), or exploding pain (O.R=2.65, C.I=1.02-6.88) was more likely to be originated from cardiac disease. And patients with cardiogenic chest pain aggravated their symptoms by climbing the stairs(O.R=3.47, C.I= 1.52-7.90). But, pricking pain(O.R=0.18, C.I.= 0.04,-0.82) or chest pain associated with dyspepsia(O.R.=0.16, C.I.=0.04-0.69) was less likely to be originated from cardiac disease. CONCLUSION: For detection and/or ruling out the cardiogenic chest pain, we have to check out characteristics of the pain, but also factors that associated with the pain or aggravating the pain.

The Effect of Saponin on the Vascular Contractility of the Rabbit Aortic Ring

PURPOSE: There have been conflicting reports on vascular response to Panax ginseng. The conflicting reports may be due to difference of ingredient of Panax ginseng. The aim of the present study was to investigate the effect of saponin, the main ingredient of Panax ginseng, on the vascular contractility. METHODS: The rabbit aortic rings were cut and mounted on the force transducer to record an isometric tension on polygraph. To elucidate the mechanism of saponin effect on vascular smooth muscle, the contractility of the vascular smooth muscle were measured under varying experimental condition. RESULTS: 1) When the aortic rings were precontracted with norepinephrine, saponin caused biphasic(initial relaxation-sustained contraction) dose-response in the endothelium dependent manner. But saponin had no effect on the resting tension. 2) When EDRF inhibitors such as methylene blue(10(-5)M), hemoglobin(10(-5)M), N-omega-nitro-L-arginine(100microM) were added to precontracted ring with norepinephrine, the initial relaxation caused by 2mg% saponin was inhibited. 3) When Ca(2+)-channel blocker, nifedipine(5x10(-7)M), was added to precontracted rings with norepinephrine, the sustsined contraction by saponin was inhibited. 4) When hemoglobin(10(-5)M) was added to precontracted rings with norepinephrine, the contractility by norepinephrine was increased and this effect was further augmented by 2mg% saponin. CONCLUSIONS: From the above results, it may be concluded that saponin stimulated the release of both an endothelium-dependent relaxing factor and endothelium-dependent contracting factor.