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.

Impairment of diastolic function in newly diagnosed non-insulin-dependent diabetes mellitus / 대한내과학회지

BACKGROUND: Heart failure is one of the major cause of premature mortality and morbidity in diabetes mellitus. It has been well recognized that left ventricular diastolic dysfunction caused by autonomic neuropathy, hyperinsulinemia, hyperlipidemia might be a preceding underlying mechanism of heart failure in diabetes. Also, an impairment of diastolic function in early diabetic patients has been reported in some literature. So, we evaluated the diastolic function in newly diagnosed diabetics with echocardiography. METHODS: All patients with newly diagnosed NIDDM in Pundang Cha general hospital from December 1996 to June 1998 were enrolled (n=20). The 20 healthy volunteers comparable for age, sex, body surface area were enrolled as a control group. The echocardiography was performed in all patients before any treatment. Blood pressure, pulse rate, fasting and postprandial sugar and insulin level, serum total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol were also checked in all patients. RESULTS: There were no significant difference in blood pressure, pulse rate, total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol level between both groups. E and A ratio of mitral inflow and peak diastolic velocity of pulmonary vein flow were significantly decreased in NIDDM group compared with control group (p<0.01). But there were no significant difference in left ventricular mass index, isovolumic relaxation time, deceleration time and peak atrial reversal velocity. CONCLUSION: This study demonstrates that an impairment of left ventricular diastolic function occurs early in the NIDDM and investigation of diastolic function should be performed in the clinical evaluation of early diabetic patients.

Clinical Efficacy of Carvedilol in Patients with Moderate to Severe Congestive Heart Failure

BACKGROUND: Clinical trials have shown that b-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate congestive heart failure. Carvedilol is a mild b1-selective adrenergic blocking agent with vasodilating properties due to a blocker and antioxidant and anti-proliferative properties. This study assessed the efficacy and safety of carvedilol in patients with moderate to severe congestive heart failure caused by idiopathic dilated cardiomyopathy. METHODS: We enrolled 27 patients with moderate to severe congestive heart failure with a left ventricular ejection fraction of 35% by MUGA scan. Each patient was randomly assigned to either control (n-9) or carvedilol (n-18, target dose 25 mg bid) for 6 months while background therapy with digoxin, diuretics, and ACE inhibitor remained constant. RESULTS: Compared to the control group, patients in the carvedilol group showed significant increase of left ventricular ejection fraction (p<0.05). In addition, patients in the carvedilol group had a tendency to show a decrease in left ventricular end-diastolic dimension and heart rate. Also, the carvedilol group had a greater frequency of symptomatic improvement than the control group. There was neither serious side effects nor hospitalization. CONCLUSION: These finding indicate that carvedilol produces important clinical benefits in patients with moderate to severe heart failure treated with digoxin, diuretics, and ACE inhibitor without serious side effects.

A Case of Hemochromatosis / 대한내과학회지

Idiopathic hemochromatosis is hereditary hemochromatosis without secondary cause. Hereditary hemochromatosis is a common disorder of iron metabolism with a prevalence of 1 case per 250-300 persons. Affected individuals absorb excessive amounts of dietary iron for a long time and tissue iron deposition results in skin discoloration, arthropathy, hepatic cirrhosis, heart cirrhosis, heart failure, diabetes mellitus and impotence. Early diagnosis and institution of phlebotomy treatment will prevent these manifestations and normalize life expectancy. We report a case of hemochromatosis in 65-year-old male of no transfusion and iron ingestion history who was anti-HCV(+), chronic alcoholic, hepatic iron index>2.24.

Rahnella Aquatilis Bacteremia in a Hemodialysis Patient / 대한신장학회잡지

Rahnella aquatilis, an infrequently isolated gram-negative rod, is the only species of the genus Rahnella within the Enterobacteriaceae family. The organism's natural habitat is water, from which most isolates have been recoverd. Infecions in humans have only occasionally been reported, especially in immunocompromised patients. We reort a case of bacteremia caused by this organism in a hemodialysis patient.

Clinical Report of Effects of Pre and Post-partum Thyroiditis (PPT) / 대한내분비학회지

BACKGROUND: Excessive iodine intake increases the occurrence of autoimmune thyroid disorders by enhancing immunogenecity of iodine-rich thyroglobulin, In Korea, most of postpartum women take a large amount of iodine-rich seaweed. Although the excessive iodine intake may affect the thyroid function, only a few reports were available concering iodine intake, especially on postpartum period. METHODS: A prospective study was undertaken in 146 of normal delivered postpartum women. Dietary intake and urinary excretion of iodine, serum T3, T4, TSH, anti-TPO Ab and anti-Tg Ab were measured before and 1, 6, 12 and 24 weeks after delivery. Iodine intake was analyzed by one-to-one interview using 24hr recall and food frequency questionnaire. RESULTS: 1. PPT was occurred in 6 (10.3%) postparturn women, It presented as hypothyroidism alone in 1 (16.7%), transient thyrotoxicosis followed by hypothyroidisrn in 3 (50.0%), and thyrotoxicosis alone in 2 (33.3%) of the follwed-up patients. 2. During pregnancy, no difference was found in age, serum T3, T4 and TSH between PPT and normal thyroid function group. 3. In PPT group, anti-TPO and anti-Tg Ab were significantly higher than those of normal thyroid function group during pregnancy, and their sensitivity for PPT was 40% and 33%, respectively. But there was no correlation between dietary iodine intake and the titer of thyroid auto-antibodies. 4. There was no correlation between pre and post-partum dietary iodine intake and occurrence of PPT. CONCLUSION: In Korea, the incidence of PPT was slightly higher than other nations. The sensitivity of thyroid auto-antibodies was too low to use for prediction of PPT. Pre and post-partum iodine intake had no effect on the occurrence of PPT and post-partum thyroid function.

A Case of Pulmonary Siderosis / 대한내과학회지

Pulmonary siderosis is one kind of pneumoconiosis caused by the long term inhalation of iron dust. Iron is deposited in the lungs, usually in the form of iron oxides. Iron oxides are relatively inert particles with a minimal fibrotic response. It occurs in a number of occupations including welding, steel rolling and grinding, casting, iron ore mining and oxyacetylene cutters. We have experienced the first case of pulmonary siderosis in Korea. A 42-year-old woman who had engaged in a metalware manufacturing factory as a manager for 7 years was admitted because of dyspnea on exertion. A pulmonary function test disclosed a mildly obstructive ventilatory defect. Open lung biosy revealed deposition of iron-laden macrophages in most alveolar spaces by which confirmed the diagnosis of pulmonary siderosis. We report a case of pulmonary siderosis with a review of the literature.

Bone Mineral Density and Markers of Bone Turnover in Patients with End-Stage Renal Failure on Starting Hemodialysis / 대한신장학회잡지

Renal osteodystrophy is well recognized complication of end stage renal disease(ESRD) and is associated with a marked morbidity. To evaluate bone loss in renal osteodystrophy, we measured bone mineral density(BMD) in distal radius by quantitative computed tomography in 43 ESRD patients on starting hemodialysis(HD) and in 84 healthy controls matched for age and sex. We also measured intact parathyroid hormone(iPTH), serum total alkaline phosphatase(T-ALP), osteocalcin(OC) and urine deoxypyridinoline(U-DPD) as bone turn-over markers. 1) The mean age of ESRD patients and control groups were 49.8 and 49.7 years. M:F ratio were 1:1.1 and 1:1.3 on each groups. There was no significant differences on each groups. 2) Serum T-ALP and OC were 263.9+/-264.5U/L, 43.5+/-27.6ng/mL in ESRD patients and 167.4+/-46.6U/ L, 8.8+/-3.9ng/mL in control groups. These were significantly higher in ESRD patients(P<0.001, P< 0.001), while U-DPD were not significant difference on each groups(5.3+/-4.1 vs 5.4+/-1.9nM/mM. Cr.). 3) Serum iPTH and aluminum were 296.8+/-263.4pg/mL, 10.1+/-11.6ng/mL in ESRD patients. 4) Total density, trabecular density and cortical density were 340.4+/-83.6, 172.9+/-48.4, 477.2+/-123.5mg/ cm3 in ESRD patients and 393.2+/-49.1, 210.6+/-32.9, 541.3+/-76.2mg/cm3 in control groups. BMD was statistically significantly reduced in ESRD patients (P<0.001, P<0.001, P<0.001, respectively). Z score of total density and trabecular density were -0.62+/-1.12, -0.91+/-0.95 in ESRD patients and 0.19+/-0.68, 0.06+/-0.59 in control groups. It was significantly reduced in ESRD patients(P<0.001, P<0.001, P<0.001, respectively). 5) In ESRD patients, serum T-ALP, iPTH, OC, U-DPD were not correlated with BMD and Z score. But in control groups, serum OC was correlated inversly with BMD, and U-DPD was only correlated inversely with trabecular density. 6) In ESRD patients(n=22) who were having iPTH above 300pg/mL, serum OC and U-DPD were significantly higher than in ESRD patients(n=21) who were having iPTH below 300pg/mL(52.6+/-28.8ng/ mL, 6.8+/-5.1nM/mM.Cr. vs. 33.9+/-23.3ng/mL, 3.7+/-1.9 nM/mM.Cr. P<0.05, P<0.05 repectively). But serum aluminum, and T-ALP were not significant difference on each groups. BMD and Z score were also not difference on each groups. 7) In ESRD patients who were having iPTH above 300pg/mL, iPTH and serum OC were inversely correlated with BMD but U-DPD were only inversely correlated with trabecular density. In ESRD patients who were having iPTH below 300pg/mL, bone turn-over markers were not correlated with BMD. In ESRD patients on starting HD, BMD were significantly reduced, but serum T-ALP, OC, iPTH and U-DPD were not correlated with BMD. In ESRD patients who were having iPTH above 300 pg/mL, BMD were significantly inversely correlated with serum OC, iPTH.

Midazolam as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.

Anticardiolipin Antibodies in Patients with Behçet's Disease

Anticardiolipin antibodies(ACA) were assayed by an enzyme-linked immunosorbent assay (ELISA) in 68 patients with Behçet's disease. Twenty seven (39.7 %) patients showed levels of ACA five standard deviations above the value of the control group. The frequency of ACA isotype IgM was found to be significantly increased in these patients. However, ACA was not found to have a significant association with clinical activity, thrombosis, positive Venereal Disease Research Laboratory(VDRL) test or antinuclear antibodies (ANA).

An Immunolhistochemical Study of Extramammary Paget's Disease: Adenokeration , Carcinoembryonic Antigen and Involucrin Expression in Extramammary Paget's Disease / 대한피부과학회지

The origin of Paget cells in extramammary Pagets disease is uncertain, however, some ultrastructural surveys revealed differentistion of Paget cells toward sweat gland apparatus. This is supported by recent immunohistochemical studies that Paget cells are irnmunohistochemically shown to react with antikeratin monoclonal antibodies specific to simple epithelia. In this siudy, seven cases of extramammary Pagets disease were immunohistochemically investigated with adenokeratin, carcinoembryonic antigen(CEA), involucrin by peroxidase-antiperoxidase(PAP) techniques. The results were as follow : l. Epidermis, hair follicies and sebaceous glands revealed negative immunoreacativity for adenokeratin in all cases. Sweat glands(6/7), Paget cells(6/7) and underlying adenocarcinoma revealed positive immunoreactivity for adenokeratin. 2. Epidermis, hair follicles and sebaceous glands(6/7) revealed negative immunoreactivity for CEA. Sweat glands, Paget cells and underlying adenocarcinoma revealed positive immunoreactivity for CEA in all cases. 3. Lower epidermis, sweat glands(6/7), Paget cells and underlying adenocarcinorna revealed negative irnmunoreactivity for involucrin. Upper epidermis, hair follicles and sebaceous glands(5/7) revealed positive immunoreactivity far involucrin. Based on these results, Paget cells of extramammary Pagets disease are considered to be derived from the sweat glands.

A Case of Lymphocytic Infiltration of the Skin ( Jessner ) / 대한피부과학회지

Lymphocytic infiltration of the skin(LIS), first described in 1953 by Jessner and Kanot is relatively uncommon disorder, characterized clinicaily by the presence of erythemat.ous peripherally enlarging papules or plaques which may show central clearing. Histologically, the lesions show patch, perivascular and periadnexal lymphocytic infiltrates. We have experienced a case of 30-year old male who had multiple erythematous nodules and plaques on the face and dorsum of the right wrist with 5 years history. He had first noted erythematous plaques on the cheek and these lesions were gradually increasing in size and spreading to the forehead and forearm. He had transiently improved by medication at the drug store, but recurred after discontinuation.

A Case of Inflammatory Linear Verrucous Epidermal Nevus Combined with Generalized Pasoriatic Eruption / 대한피부과학회지

A 5- year old female patient visited our clinic due to linear erythernatous and verrucous patches on the left extremities of 3 years duration, She was born with a small erythematous macule on the lateral side of left little finger. This macule, over 2 years, developed into pruritic, linear, and verrucous patches stretching from left little finger to lefr, axillai y area, and also erythematous, linear patches on the left thigh. On follow-up visit on October 1986, she has generalized psoriatic eruption with aggravation of originnl skin lesions. Digriosis was based on the clinical features and histopathnlogic findings of the skin lesions.