Factors associated with Experience of Diagnosis and Utilization of Chronic Diseases among Korean Elderly : Focus on Comparing between Urban and Rural Elderly / 農村醫學 地域保健

OBJECTIVES@#The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea.@*METHODS@#We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data.@*RESULTS@#We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092–1.183) for diagnosis of diabetes, 1.278 (1.278–1.386) for diagnosis of dyslipidemia, 0.940 (0.904–0.977) for diagnosis of arthritis, 0.785(0.736–0.837) for treatment of arthritis, 1.159 (1.116–1.203) for diagnosis of cataracts, and 1.285(1.200–1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p<0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p<0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly.@*CONCLUSION@#Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

Voiding Dysfunction after Stroke and Traumatic Brain Injury: Multi-center Study

OBJECTIVE: Voiding dysfunction after stroke and traumatic brain injury has been known to be a predictive factor of death or severe disability, and an important factor on hospital discharge. Thus we aim to investigate its prevalence, related factors and natural course of brain injury related voiding dysfunction for proper rehabilitation after brain injury. METHOD: Two hundred ten brain injury patients (male 130, female 80) admitted in 5 university hospitals were included. The cognitive function was assessed using the Korean version-Mini mental state examination (K-MMSE), and bladder function was evaluated with the International Prostate Symptom Score (IPSS) and voiding diary. We excluded the patients that had previous urologic and gynecologic problem. RESULTS: Overall, 43.7% of total patients had voiding difficulty and the most common symptom was nocturia (80.6%), which was followed by frequency (72.6%) and urgency (40.3%). Patients with incontinence had lower K-MMSE scores than continent patients. There was no significant difference of rate of incontinence in relation with sex, cause of brain injury, and lesion site. Prevalence of urinary symptoms decreased as the duration after brain injury was longer. The quality of life score showed a high correlation with the total IPSS score (p<0.05). CONCLUSION: The overall results demonstrate that voiding dysfunction after brain injury is influenced by onset time and cognitive function after brain injury.

The Effect of Functional Electrical Stimulation on Gait Function in Children with Cerebral Palsy

OBJECTIVE: To evaluate the effect of functional electrical stimulation (FES) on the motor function and gait in children with cerebral palsy. METHOD: Sixteen ambulant children (8 females, 8 males) with diplegic (n=12) or hemiplegic (n=4) cerebral palsy participated in this study. All were randomly assigned to either the FES (n=8) or control (n=8) group. Both groups received physical therapy based on neurodevelopmental technique for 20 minutes a day, 5 days a week for a period of 6 weeks. The FES group was treated with additional neuromuscular electrical therapy over quadriceps, hamstring, and ankle dorsiflexor on affected legs. Modified Ashworth scale, active range of motion of affected ankle and knee joints, motricity index for strength, gross motor function measure (GMFM), and gait analysis were performed before and after treatments. RESULTS: The strength of lower limbs, section of D (standing), E (walking-running-jumping) and total of GMFM, and maximal range of motion of knee from sagittal kinematic data improved significantly in FES group (p<0.05). In FES group, change values of before and after treatments to the strength of lower limbs, and section of D and total of GMFM were significantly improved compared to control group (p<0.05). There was no serious side effect. CONCLUSION: This study suggests that FES in children with cerebral palsy may be a safe and beneficial therapeutic technique in improving the leg strength and gross motor function. However, we could not find any superior changes then control in gait kinematics of FES group.

A case of Ebstein's anomaly prenatally diagnosed by fetal sonography / 대한산부인과학회잡지

We experienced a case of Ebstein's anomaly prenatally by fetal sonography. Ebstein's anomaly is a rare congenital heart defect characterized by abnormally downward displacement of the septal and posterior leaflets of the tricuspid valve. In the absence of tricuspid regurgitation, this condition may be completely asymptomatic. On the other hand, symptomatic newborns often develop life-threatening congestive heart failure. A 30-year-old multiparous woman was referred for the evaluation of fetal cardiac defect at 26th gestational week from a private clinic. Fetal ultrasonography showed markedly enlarged right atrium and downward displacement of tricuspid valve into the right ventricle. After discussion with the patient, the pregnancy was terminated and Ebstein's anomaly was confirmed by autopsy.

A Case of Hantavirus Pulmonary Syndrome Complicating Pregnancy / 대한산부인과학회잡지

Hantavirus infection occuring during pregnancy is rarely progressing to adult respiratory distress syndrome (ARDS), which is accompanied by thrombocytopenia, leukocytosis, fever, oliguria, aggravation of bleeding, hematuria, lactacedemia. Pregnancy may have an unfavorable impact on the pathophysiologic characteristics of ARDS. The high oxygen demands of pregnancy are unable to be matched by oxygen delivery in ARDS and may predispose the patient to multiple organ failure, as well as fetal oxygen deprivation. We present the case with hantavirus pulmonary syndrome complicating pregnancy.

The clinical experience of LLETZ / 대한산부인과학회잡지

OBJECTIVE: To evaluate how resection margin involvement after LLETZ affect treatment of CIN and microinvasive cervical cancer, and several factors affecting the resection margin involvement. METHOD: Retrospective analysis was performed in 160 patients that underwent LLETZ at Gachon Medical College, Gil Medical Center from March, 1997 to September , 1998. The several factors affecting the resection margin involvement were analyzed. RESULT: The following results were obtained. 1. 127 patients were diagnosized finally with CIN, 30 patients with microinvasive SCC and 3 patients with chronic inflammation. 2. The rate of the negative resection margin involvement was 81% and that of the positive was 19%. 3. No case among 129 cases with the negative resection margin had residual lesion, but 9 cases among 31 cases with the positive resection margin had residual lesion. As a whole, the rate of residual lesion was 6.2%. 4. In CIN, 3 cases of 19 cases with the positive resection margin had residual lesion, but none with the negative resection margin had. 5. The degree of histopathology, glandular involvement, menopause, colposcopic evaluation were correlated with the resection margin involvement but delivery mode and HPV infection not correlated. CONCLUSION: LLETZ is a enough method to reduce unnecessary hysterectomy in the treatment of CIN, if followed up, in spite of the positive resection margin because of low rate of lesidual lesion, and is a effective method in the treatment of microinvasive cervical cancer when the case with negative resection margin and no lymphovascular invasion was followed up.

The effect of the sera from severe preeclamptic patients on endothelial cell viability and endothelin-1 in cultured human umbilical vein endothelial cells / 대한산부인과학회잡지

OBJECTIVES: In order to assess the effects of sera from severe preeclamptic patients on endothelial cell viability in vitro and endothelin-1 synthesis in cultured human umbilical vein endothelial cells. METHODS: The cultured human umbilical vein endothelial cells were incubated with media containing 10% sera from women with either preeclamptic patients or normal pregnancies for 24 hours or 48 hours. After then, their viability was measured by colorimetric MTT{3-(4,5-dimethylthiazol-2yl)2,5-diphenyl tetrazolium bromide} assay and their production of endothelin-1 was measured. We also measured the serum levels of endothelin-1 level in sera obtained from the normal and severe preeclamptic pregnancies. RESULTS: The calorimetric MTT assay revealed that after 24 hours, the absorbances in the media treated with normal pregnancies and severe preeclampsia sera were 0.0718+/-0.0078 and 0.0837+/-0.0129, respectively and after 48 hours, they were 0.1133+/-0.0103 and 0.1268+/-0.0186, respectively. Serum obtained from severe preeclampsia did not affect endothelial cell viability. 2. The serum mean levels of endothelin-1 in normal and severe preeclamptic pregnancies were 22.66+/-8.6 fmol/ml and 48.98+/-25.27 fmol/ml. The mean level in preeclamptic sera was significantly higher than that of normal pregnant women. (P<0.05) 3. After 24 hours, the mean amount of endothelin-1 stimulated by normal pregnant and severe preeclamptic sera were 37.52+/-18.41 fmol/ml and 97.58+/-53.64 fmol/ml, respectively. The mean amount of endothelin-1 in preeclamptic sera-treated cells was significantly higher than that of normal pregnant sera-treated cells. (P<0.05). CONCLUSION: The sera from severe preeclamptic women do not affect cell viability but act selectively on specific activation of their function such as endothelin-1 production. And it is necessary that the identification and isolation of the putative serum factor(s) will be performed to resolve the pathogenesis in future.

Clinical Study on Cesarean Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: To study the prevalence, indications, and outcome of cesarean hysterectomy in women delivered at the Gil Medical Center, Gacheon Medical School. METHOD: This is a retrospective study of all cases of cesarean hysterectomy performed between January 1995 and December 1999. RESULTS: The incidence of cesarean hysterectomy was 0.4% (122/31,481). Cesarean hysterectomy was performed in 100 of 17,829 cesarean sections (0.6%) and in 22 of 13,652 vaginal deliveries(0.2%). The higher the age and the parity of patients, the higher the incidence of cesarean hysterectomy was noted. The most common indication of cesarean hysterectomy was uterine atony(50 cases, 41.9%), followed by 25 cases of placenta previa with adhesive placenta(20.5%), 14 cases of adhesive placenta(11.5%), 11 cases of uterine myoma with pregnancy(9.0%), 9 cases of uncontrolled bleeding with placenta previa(7.4%), 7 cases of uterine rupture(5.7%) and 6 cases of extension of uterine incision(4.9%). All patients who had cesarean hysterectomy received transfusion from 0 pint to 78 pints. Live births were 115 cases(94.3%) and 3 infants were still birth(2.5%). Four infants were dead during early neonatal period(3.3%), so perinatal mortality rate was 5.7%. The postoperative complications were bladder injury, ureteral injury, febrile morbidity, disseminated intravascular coagulopathy, hematoma, wound disruption, postpartum cardiomyopathy, and vaginal stump bleeding. There was two maternal deaths due to acute, severe hemorrhage and DIC. CONCLUSIONS: Cesarean hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. The procedure itself is usually associated with considerable perioperative morbidity. Obstetricians should identify patients at risk and anticipate the procedure and complications.

Factors associated with fetal losses after mid-trimester amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To evaluate factors associated with fetal losses following mid-trimester diagnostic amniocentesis. METHODS: 412 pregnancy outcomes following amniocentesis were analyzed for each variables(maternal age, gestational age, indication for the amniocentesis, placental penetration by aspiration needle, needle touch by the fetus, color of amniotic fluid) with statistical methods(student t-test, chi-square test and multiple logistic regression test). RESULTS: Mean maternal age was 31.8+/-4.9 years, fetal loss rate was increased slightly with the age of the mother. If the indications were abnormally high maternal serum alpha-fetoprotein level, the pregnancy courses after the procedure were worse than other indication groups. In cases of discolored amniotic fluid, the dark brown discoloration made the pregnancy outcome poor. Gestational age at the time of the procedure, penetration of the placenta by the aspirating needle, needle touch during the procedure by the fetus, did not influence the outcomes after the procedure. CONCLUSION: Maternal age, indication as neural tube defect in triple test and dark brown discoloration of amniotic fluid are associated with fetal losses following mid-trimester diagnostic amniocentesis.

Adenoid Basal Carcinoma and Adenoid Cystic Carcinoma of the Uterine Cervix: A Study of 2 Cases / 대한산부인과학회잡지

Adenoid basal carcinoma and adenoid cystic carcinoma of the uterine cervix are rare tumors that have often been regarded as a single entity. But adenoid basal and adenoid cystic carcinomas of the cervix differ from each other in their histology, treatment, and prognosis. We experienced 2 cases of these neoplasms, with 1 case in each category. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late distant metastases. This study reviews the literature and formulates a program for the management of these rare lesions.

A case of retiform sertoli - Leydig cell tumor inn patient with hyperthyroidism family history / 대한산부인과학회잡지

No abstract available.

A case of retiform sertoli - Leydig cell tumor inn patient with hyperthyroidism family history / 대한산부인과학회잡지

No abstract available.