Serum Low-Density Lipoprotein Cholesterol Levels and Depressive Mood in Korean Adults: A Nationwide Population-Based Study / 가정의학회지

Background@#The association between serum cholesterol levels and depression has been studied extensively; however, results are inconsistent. This study aimed to investigate the association between low-density lipoprotein cholesterol (LDL-C) levels and depressive symptoms among Korean adults. @*Methods@#This cross-sectional study used data obtained from the 2007–2015 Korea National Health and Nutrition Examination Survey. In total, 40,904 adults were included in the final analysis. Participants were categorized into five groups according to their LDL-C levels, using the Korean guidelines for dyslipidemia. Symptoms of depression were evaluated using a self-reported questionnaire. Weighted logistic regression was used to examine the relationship between LDL-C levels and self-reported depressive symptoms. @*Results@#Compared with the intermediate category, the lowest (<70 mg/dL) and highest (≥160 mg/dL) LDL-C categories were associated with depressive symptoms, after adjusting for potential confounding factors (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.008–1.409; OR, 1.241; 95% CI, 1.073–1.435, respectively). The highest LDL-C category was positively associated with depressive symptoms in those who were middle-aged, female, had a low body mass index, and taking or not taking dyslipidemia medications. @*Conclusion@#A U-shaped association was identified between LDL-C categories and self-reported depressive symptoms. Our findings suggest that LDL-C levels that are too low or too high are associated with self-reported depressive symptoms. Further prospective studies are needed to determine the causal relationship of this association.

Comparison between the International Classification of Primary Care and the International Classification of Diseases Classifications in Primary Care in Korea / 가정의학회지

Background@#The International Classification of Primary Care-2 (ICPC-2) is a classification method designed for primary care. Although previous studies have found that ICPC-2 is a useful tool for demonstrating the relationship between patients’ expectations and health providers’ diagnoses, its utility of ICPC-2 has yet to be fully studied in Korea. This study aimed to evaluate the practicality of ICPC-2 in Korean primary care. @*Methods@#The study was conducted at primary care clinics in Seoul and Gyeonggi areas from October to November 2015. Third-year family medicine residents examined and analyzed the medical records of patients who visited primary care physicians using ICPC-2, and the results were compared with those obtained using the International Classification of Diseases-10 (ICD-10) (Korean version: Korean Standard Classification of Diseases-7). @*Results@#A total of 26 primary care physicians from 23 primary care clinics participated in the study. Furthermore, 2,458 ICD-10 codes and 6,091 ICPC-2 codes were recorded from the data of 1,099 patients. The common disease codes were vasomotor and allergic rhinitis (J30), according to ICD-10, and acute upper respiratory infection (R74) in ICPC-2. Comparing disease status by body systems, the proportion of gastrointestinal disease with ICD-10 codes was significantly higher than that with ICPC-2 codes (P4 diagnoses accounted for 36% of the ICD-10 classifications, whereas those with >4 diagnoses accounted for 4% of the ICPC-2 classifications. @*Conclusion@#Introducing ICPC as a complementary means for diagnosing common diseases could be a practical approach in Korean primary care.

Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Difference of Low Skeletal Muscle Index According to Recommended Protein Intake in Korean

BACKGROUND: Sarcopenia has become a major concern owing to its association with a high risk of fall or fracture and metabolic impairments. There is insufficient evidence to support the role of dietary protein intake in reducing the prevalence of sarcopenia. This study was conducted to investigate the variation in low skeletal muscle index (SMI) with the dietary levels of protein intake.METHODS: This study analyzed data of 3,482 male and 4,838 female aged 50 years or older from the Korean National Health and Nutrition Examination Survey (KNHNES) database (2008–2011). Low SMI was indicated by a value <0.789 in male and <0.512 in female. Multiple logistic regression was performed to analyze the association of SMI with protein intake, whereby it was tested whether the dietary intake of proteins met the estimated average requirement (EAR) or the reference nutrient intake (RNI) as stated in the dietary reference intake (DRI) for Koreans, 2015.RESULTS: Irrespective of sex, the prevalence of low SMI was significantly high when the protein intake did not meet the EAR or RNI. Following adjustment for covariates, the odds ratio (OR) for low SMI in subjects with unmet EARs was 1.63 (1.28–2.09) in male and 1.35 (1.10–1.66) in female. The OR for low SMI in subjects with unmet RNI was 1.74 (1.38–2.18) in male and 1.39 (1.14–1.69) in female.CONCLUSION: The prevalence of low SMI was significantly higher when the protein intake did not meet the EAR or RNI as stated in the DRI for Koreans.

Corrected QT Interval is Associated with Nonalconolic Fatty Liver Disease in Korean Adult Men

BACKGROUND: Recently, the incidence of nonalcoholic fatty liver disease (NAFLD) has been growing rapidly. Corrected QT (QTc) interval prolongation is known to be associated with the risk of coronary heart disease. In this study, our aim was to establish whether NAFLD diagnosed using ultrasonography is associated with QTc intervals in Korean adult men.METHODS: We recruited 1,155 Korean adult men who visited the Gangnam Severance Hospital health promotion center between October 2007 and July 2010. The participants underwent liver ultrasonography according to a standardized protocol, which confirmed the diagnosis of NAFLD. Standard electrocardiography was performed for analysis of the QTc interval.RESULTS: The 1,155 participants had a mean QTc interval of 430.7±21.2 ms. Of them, 366 had a QTc interval ≥440 ms. The values of the QTc interval increased in relation to the severity of NAFLD. After adjustment for confounders, QT interval prolongation was significantly associated with NAFLD in the severe NAFLD group. The odds ratios were 2.102 (95% confidence interval [CI] 1.536–2.877) (model 1), 1.986 (95% CI 1.399–2.819) (model 2), and 1.960 (95% CI 1.347–2.851) (model 3).CONCLUSION: QTc interval prolongation was significantly associated with NAFLD severity in Korean adult men. Depending on the severity of NAFLD, QTc intervals were prolonged. QTc interval length is easily determined and may contribute to cardiovascular risk stratification in male patients with NAFLD.

The Association between the Stress Relief Method and High-Risk Alcohol Drinking: The 2005 Korea National Health and Nutrition Examination Survey

BACKGROUND: The importance of stress relief methods is becoming an important issue in developed societies. However, no studies have examined the effects of stress relief methods on the risk of engaging in high-risk alcohol consumption. Therefore, we aimed to investigate the association between stress relief methods and high-risk alcohol consumption.METHODS: This study included a total of 5,313 subjects who participated in the 2005 Korean National Health and Nutritional Examination Survey. To evaluate high-risk alcohol consumption, we used the alcohol use disorders identification test (AUDIT-K). Regarding the stress relief method, participants were divided into three groups as follows: 1) those who were non-smokers and relieved stress using methods other than smoking (Group A), 2) those who were smokers but relieved stress using methods other than smoking (Group B), and 3) those who relieved stress by smoking (Group C). Multiple logistic regression analysis was conducted to examine the association between the stress relief method and high-risk alcohol consumption.RESULTS: The mean scores of AUDIT-K were 5.7 for Group A, 10.0 for Group B, and 11.4 for Group C (P-value < 0.001). Compared to Group A, the odds ratio and 95% confidence intervals for high-risk alcohol consumption were 3.91 (1.96–7.80) for Group B and 6.26 (2.99–13.10) for Group C after adjusting for age, sex, body mass index, household income, education levels, residential area, marital status, stress levels, hypertension, diabetes, and dyslipidemia.CONCLUSION: We found that the participants who relieved stress by smoking had a significantly higher risk of engaging in high-risk alcohol consumption.

Rapidly Progressive Small Bowel Necrosis in a Previously Healthy Child without Proven Mechanical Obstruction / 대한소아소화기영양학회지

Bowel ischemia is a life-threatening surgical emergency. We report a case of rapidly progressive bowel necrosis in a previously healthy child without proven mechanical small bowel obstruction. The definite diagnosis was established at the time of an exploratory operation. Of note, imaging studies and even a laparotomy did not reveal any evidence of acute appendicitis or mechanical obstruction such as intussusception or Meckel's diverticulum. During hospitalization, since we could not rule out surgical abdomen after inconclusive image findings, we closely followed the patient and repeated physical examinations carefully. Eventually surgical exploration was performed based on changes in clinical condition, which proved to be the right decision for the patient. We propose that in children with suspected strangulation of small bowel obstruction, especially when imaging findings do not provide a conclusive diagnosis, the timely exploratory surgical approach ought to be chosen based on carefully observed clinical findings and other evaluations.

Risk Assessment and Intervention of Ergonomic Risk Factor in Beekeeping / 農村醫學 地域保健

OBJECTIVES@#This study investigated musculoskeletal symptoms in upper limbs according to the working environment (job stress) of dental hygienists and examine their relationship with upper limb functions.@*METHODS@#The subjects include 198 dental hygienists in dental hospitals and dental clinics in Pusan and Gyeongnam. The questionnaire was consisted of general characteristics of the subjects, job stress, musculoskeletal symptoms in upper limbs and function (Disability Measurement Tool for Upper Extremity Disorders-11, DASH-11).@*RESULTS@#The study was analyzed their musculoskeletal symptoms in upper limbs according to their general characteristics and found that the symptoms occurred in the neck (39.4%), the shoulders (54.6%), elbows (14.7%), and the hands (50.0%). Job stress was associated with upper limb functions (DASH-11) (model 3, B=5.210, p=0.012) and repeated elbow bending and spreading posture was associated with DASH-11 (model 3, B=6.561, p=0.029). Elbow symptoms were associated with DASH-11 in the upper limbs (B=10.679, p=0.003).@*CONCLUSION@#Dental hygienists are experiencing limitations of upper limb function due to job stress. In particular, even if the correction of their uncomfortable posture is significantly related to the job stress and upper limb function, in order to improve the upper limb function of the dental hygienist, efforts to reduce the job stress as well as the uncomfortable posture are necessary.

Predictors for Amputation in Patients with Diabetic Foot Wound

PURPOSE: Diabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW. MATERIALS AND METHODS: From January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU). RESULTS: The overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU. CONCLUSION: This study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

Uric Acid Level Has a J-Shaped Association with Arterial Stiffness in Korean Postmenopausal Women / 가정의학회지

BACKGROUND: Uric acid has been reported to function both as an oxidant or antioxidant depending on the context. A previous study in the Korean population reported a positive linear association between serum uric acid level and arterial stiffness in men, but little is known about how serum uric acid level is related to the risk of increased arterial stiffness in Korean postmenopausal women. METHODS: We performed a cross-sectional study of 293 subjects who participated in a health examination program run by the health promotion center of Gangnam Severance Hospital between October 2007 and July 2010. High brachial-ankle pulse wave velocity was defined as a brachial-ankle pulse wave velocity of more than 1,450 cm/s. The odds ratios (ORs) for high brachial-ankle pulse wave velocity were calculated using multivariate logistic regression analysis across uric acid quartiles after adjusting for other indicators of cardiovascular risk. RESULTS: The 293 postmenopausal women were divided into quartiles according to uric acid level. The mean brachial-ankle pulse wave velocity values of each quartile were as follows: Q1, 1,474 cm/s; Q2, 1,375 cm/s; Q3, 1,422 cm/s; Q4, 1,528 cm/s. The second quartile was designated as the control group based on mean brachial-ankle pulse wave velocity value. Multivariate adjusted ORs (95% confidence intervals) for brachial-ankle pulse wave velocity across the uric acid quartiles were 2.642 (Q1, 1.095–6.3373), 1.00, 4.305 (Q3, 1.798–10.307), and 4.375 (Q4, 1.923–9.949), after adjusting for confounding variables. CONCLUSION: Serum uric acid level has a J-shaped association with arterial stiffness in Korean postmenopausal women.

Association between the Eating Family Meal and the Prevalence of Metabolic Syndrome Using Data from Korea National Health and Nutrition Examination Survey (2007–2012) / 가정의학회지

BACKGROUND: Several studies have shown that family meals promote a well-balanced and healthier diet and weight status. Metabolic syndrome is related to eating behavior. This study investigated the association between eating family meals and the prevalence of metabolic syndrome. METHODS: This cross-sectional study included 4,529 subjects who participated in the Korea National Health and Nutrition Examination Survey IV and V (2007–2012). A self-reported questionnaire was used to assess dietary status. Metabolic syndrome was defined according to the guidelines of the modified version of the National Cholesterol Education Program Adult Treatment Panel III. We compared the overall quality of dietary intake in family meal. RESULTS: Nutritional adequacy ratios for energy, protein, calcium, vitamin A, vitamin B₁, vitamin B₂, vitamin C, niacin, and potassium, and the mean adequacy ratio were significantly higher in the family meal group (P<0.05). The prevalence of metabolic syndrome was lower in the family meal group (P<0.05). However, we observed no significant association between eating family meals and the prevalence of metabolic syndrome. CONCLUSION: This study demonstrated that eating family meals appeared to be associated with nutrient adequacy. However, we observed no significant differences in prevalence of metabolic syndrome between the 2 groups.

Hydrocele of the Canal of Nuck in a Female Adult

No abstract available.

Deep Vein Thrombosis in Patients with Pulmonary Embolism: Prevalance, Clinical Significance and Outcome

PURPOSE: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are considered as similar disease entities representing different clinical manifestations. The objectives of this study were: 1) to determine the prevalence and outcome of DVT in patients with PE; 2) to identify additional risk factors for PE-related unfavorable outcome and 30-day all-cause mortality; and 3) to establish the clinical importance of screening for concomitant DVT. MATERIALS AND METHODS: From January 2013 to December 2015, a total of 141 patients with confirmed PE were evaluated. The prevalence and outcome of DVT in patients with PE was determined. Furthermore, the potential risk factors for PE-related unfavorable outcome and 30-day all-cause mortality were also analyzed. RESULTS: The prevalence of concomitant DVT was 45.4%. PE-related unfavorable outcome was observed in 21.9% of all concomitant DVT, with all-cause mortality of 21.9%. There was no significant relationship between the presence of concomitant DVT and the development of PE-related unfavorable outcome or all-cause mortality. Our results indicated that heart rate >100/min and peripheral oxygen saturation <90% were independent predictors for PE-related unfavorable outcome. Regarding all-cause mortality, active malignancy and hypotension or shock were significant risk factors. CONCLUSION: Our findings demonstrate that approximately half of patients with PE possess DVT. However, this study failed to establish any clinical significance of concomitant DVT for PE-related unfavorable outcome and all-cause mortality. Tachycardia and hypoxemia were identified as significant predictors for PE-related unfavorable outcome along with active malignancy and hypotension or shock as significant risk factors of all-cause mortality.

Schwannoma of the Orbit

BACKGROUND: A schwannoma is a benign, slow-growing peripheral nerve sheath tumor that originates from Schwann cells. Orbital schwannomas are rare, accounting for only 1% of all orbital neoplasms. In this study, we retrospectively review orbital schwannomas and characterize clinical, radiologic, and histologic features of this rare entity. METHODS: A retrospective review was performed to identify patients with histologically confirmed orbital schwannoma, among a list of 437 patients who had visited our hospital with soft tissue masses within the orbit as the primary presentation between 2010 and 2014. Patient charts and medical records were reviewed for demographic information, relevant medical and family history, physical examination findings relating to ocular and extraocular sensorimotor function, operative details, postoperative complications, pathologic report, and recurrence. RESULTS: Five patients (5/437, 1.1%) were identified as having histologically confirmed orbital schwannoma and underwent complete excision. Both computed tomography (CT) and magnetic resonance imaging (MRI) studies were not consistent in predicting histologic diagnosis. There were no complications, and none of the patients experienced significant scar formation. In two cases, patients exhibited a mild postoperative numbness of the forehead, but the patients demonstrated full recovery of sensation within 3 months after the operation. None of the five patients have experienced recurrence. CONCLUSION: Orbital schwannomas are relatively rare tumors. Preoperative diagnosis is difficult because of its variable presentation and location. Appropriate early assessment of orbital tumors by CT or MRI and prompt management is warranted to prevent the development of severe complications. Therefore, orbital schwannomas should be considered in the differential diagnosis of slow-growing orbital masses.

Fingernail Configuration

BACKGROUND: A number of conditions can alter a person's fingernail configuration. The ratio between fingernail width and length (W/L) is an important aesthetic criterion, and some underlying diseases can alter the size of the fingernail. Fingernail curvature can be altered by systemic disorders or disorders of the fingernail itself. Although the shape and curvature of the fingernail can provide diagnostic clues for various diseases, few studies have precisely characterized normal fingernail configuration. METHODS: We measured the W/L ratio of the fingernail, transverse fingernail curvature, hand length, hand breadth, and distal interphalangeal joint width in 300 volunteers with healthy fingernails. We also investigated whether age, sex, height, and handedness influenced the fingernail W/L ratio and transverse fingernail curvature. RESULTS: In women, fingernail W/L ratios were similar across all five fingers, and were lower than those in men. The highest value of transverse fingernail curvature was found in the thumb, followed by the index, middle, ring, and little fingers. Handedness and aging influenced transverse fingernail curvature, but not the fingernail W/L ratio. Fingernails were flatter on the dominant hand than on the non-dominant hand. The radius of transverse fingernail curvature increased with age, indicating that fingernails tended to flatten with age. CONCLUSIONS: Our quantitative data on fingernail configuration can be used as a reference range for diagnosing various diseases and deformities of the fingernail, and for performing reconstructive or aesthetic fingernail surgery.

Intercostal Nerve Schwannoma Encountered during a Rib-Latissimus Dorsi Osteomyocutaneous Flap Operation

No abstract available.

Median Nerve Compression by the Feeding Vessels of a Large Arteriovenous Malformation in the Axilla

No abstract available.

The Injury and its Related Factors in the Elderly Using the Data of 2008 Community Health Survey / 農村醫學 地域保健

OBJECTIVE: The objectives were to estimate the rate of the injury in the elderly over the past year and to identify factors related to injury in the elderly in South Korea. METHOD: Using data from the 2008 Community Health Survey, 43,049 elderly persons, aged 65 years and older, were selected as study subjects. Their experience of injury during the past year and other variables, including socio-demographic factors, health-related factors, and diagnosed chronic diseases, were used. The chi-squared test and multiple logistic regression analysis with weighted analysis were conducted and statistical significance was set at p<0.05. RESULT: The rate of injury in the elderly during the past year was 5.1%. The most common types of the injury were falling/slipping down and traffic accidents. Factors related to injury in the elderly were living alone, current drinking, depression, poor self-rated health, stroke, and osteoporosis. Living alone (odds ratio 1.23, 95% CI: 1.05-1.45), current drinkers (OR 1.19, 95% CI: 1.05-1.35), poor self-rated health (OR 1.72, 95% CI: 1.43-2.08), depression (OR 1.23, 95% CI: 1.17-1.68), and history of stroke (OR 1.40, 95% CI: 1.17-1.68), and history of osteoporosis (OR 1.45, 95% CI: 1.26-1.66) were related to an increased risk of injury. CONCLUSIONS: Intervention programs that consider the risk factors related to injury should be developed and implemented to decrease and prevent injuries in the elderly.

Gynecomastia Surgery Is Associated with Improved Nipple Location in Young Korean Patients

BACKGROUND: Gynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia. METHODS: We retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls. RESULTS: Nipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05). CONCLUSIONS: Nipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.

Prevalence and Risk Factors for the Peripheral Neuropathy in Patients with Peripheral Arterial Occlusive Disease

PURPOSE: Peripheral neuropathy (PN) is known as a major contributor of the worsening of ischemic symptoms and the foot ulceration in patients with peripheral arterial occlusive disease (PAOD). However, there are few studies reporting the prevalence and risk factors for PN in PAOD. This study aimed to evaluate these issues for PN and to establish the importance of screening as additional treatment target for PN in PAOD. MATERIALS AND METHODS: A total of 52 limbs with PAOD were enrolled from January 2011 to December 2012. PN was divided into radiculopathy, ischemic PN (IPN), and diabetic PN (DPN), based on electromyographic findings. We investigated the prevalence of overall PN and subtypes of PN and then analyzed the risk factors. RESULTS: The prevalence of overall PN in PAOD was 43 of 52 limbs (82.7%). In terms of subtypes of PN, the prevalence rate of radiculopathy and IPN was 30.8% and 23.1%, respectively. DPN showed in 22 limbs (73.3%) among 30 diabetic limbs. There was no significant correlation between each type of PN and ischemic symptoms. Our analysis showed that coronary artery disease (CAD) was a significant risk factor (P=0.01) for IPN, however, did not identify any significant risk factors for DPN. CONCLUSION: This present study indicated that most patients with PAOD had PN and CAD was a risk factor for IPN. In particular, PAOD with diabetes represented a higher prevalence for DPN. Our study suggests that PN should be evaluated and considered as another treatment target in patients with PAOD.