Association between Healthcare Utilization and Depression in Korean Women with Cardiovascular Conditions

OBJECTIVE: This study aimed to examine the associations between depression and both coronary artery disease (CAD) and cardiovascular risk factors (CVRs) in Korean women. Furthermore, this study sought to determine whether depression was associated with use of healthcare services in women with CAD or CVRs. METHODS: This cross-sectional study was conducted on 26,335 women who were aged 19 years or older, and who participated in the Korean National Health and Nutrition Examination Survey (2007–2014). Associations of prior diagnosis of depression with CAD and CVRs and with nonutilization of healthcare services were investigated. RESULTS: Women with depression had a higher prevalence of CAD and CVRs including obesity, hypertension, dyslipidemia, and metabolic syndrome than those without depression. In addition, depression was significantly associated with nonutilization of healthcare services in women with most CVRs. CONCLUSION: Considering the high rate of comorbid depression with CAD or CVRs and the low lvels of health service utilization in depressed patients, screening for common CVRs, such as obesity, hypertension, and dyslipidemia, should be provided for patients with depression in mental health care settings.

Transcallosal Fibers from Corticospinal Tract in Patients with Cerebral Hemorrage

OBJECTIVE: To investigate the relationship between the transcallosal fibers (TCFs) from the corticospinal tract (CST) and the motor function of the affected extremities in patients with cerebral hemorrhage, using diffusion tensor image tractography (DTT). METHOD: 49 patients with cerebral hemorrhage and 38 controls were recruited. DTT was performed using 1.5 T magnetic resonance imaging. The DTT findings were classified into 3 groups according to targeting location: no TCF from the CST (type A), TCF ended in the corpus callosum or connected to the cortex of the opposite hemisphere (type B), and TCF that descending toward the lesion after passing through the corpus callosum (type C). RESULTS: The TCF originated from the CST of the unaffected hemisphere, and the presence of fiber descending toward the lesion after passing through the corpus callosum were significantly more prevalent in the patients who showed the worse motor function. CONCLUSION: The TCF originated from the unaffected CST toward the lesion in patients with cerebral hemorrhage might play a relevant role in compensating motor deficits in the major corticospinal disruption.

Improved Heat Lamp for Preventing Arterial Spasm after Microvascular Surgery

PURPOSE: Heat therapy by heat lamp after microvascular surgery is being used for preventing blood vessels's contraction and blood-flow's disturbance. As usually, incandescent lamp has been used. But there have been several problems and need for improvement in the existing heat lamp treatment. So we would like to introduce improved heat lamp to keep an appropriate temperature and intensity of illumination. METHODS: The existing heat lamps are the ones of general light stands covered with newspaper, having 60 watt light bulb of incandescence and lampshade made of aluminum. We have tried to improve shortcomings of the existing heat lamps by enlarging the size of aluminum lampshade and attaching a curtain that can block heat and light. We conducted a comparative study between the existing and improved heat lamps. Under the assumption that there are several affected parts, we have also measured the distance from heat lamp to patients' eye region and then intensity of illumination. RESULT: The target temperature of surface was realized in 11 minutes with the maximum temperature reaching at 36.6 degrees C in 28 minutes at the existing heat lamp while the target temperature reached in 7 minutes with the maximum temperature reaching at 39.0 degrees C in 17 minutes at the improved heat lamp. The existing and improved heat lamp showed 38 lx and 0.1 lx of intensity of lumination, respectively. CONCLUSION: Using improved heat lamps, we can keep an appropriate temperature and we think we can make contribution to patients' treatment by making them and their neighbors able to sleep with minimized disturbance thanks to low intensity of illumination secured by blocking light.

Clinical Usefulness of Diffusion Tensor Image Tractography in Stroke Patients: Report of two cases

We report the clinical usefulness of elucidating the state of the corticospinal tract (CST) by the use of diffusion tensor image tractography (DTT) in hemiparetic stroke patients. DTT was performed using 1.5 T magnetic resonance imaging. DTT demonstrated that the CST of the affected hemisphere was preserved in the medial portion of the hematoma in patient 1, but was interrupted by a hematoma in patient 2. DTT seems to be useful for elucidating the status of the CST in hemiparetic stroke patients.

Effect of Aggressive Rehabilitative Treatment on Canalicular Sequestered Lumbar Disc Herniations : Long-term Follow-up Study

OBJECTIVE: To assess long term outcomes of aggressive rehabilitative treatment on canalicular sequestered lumbar disc herniations METHOD: Clinical outcomes of twenty four patients with sequestered disc herniation with symptomatic radicular pain were evaluated prospectively and longitudinally for one year. All patients received aggressive rehabilitative treatment including transforaminal epidural steroid injection, pelvic stabilization exercise, physical therapy, and back school. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry Disability Index (ODI) for back pain before treatment, posttreatment one, three, six, and twelve months. After twelve months, we categorized patients' satisfaction. Four patients were dropp RESULTS: The averages of VAS for lower extremity and back pain reduced significantly from 6.6 and 5.8 at pretreatment to 0.7 and 0.9 at 12 months posttreatment, respectively (p<0.001). The averages of ODI reduced significantly from 73.5% at pretreatment to 22.3% at posttreatment 12 months (p<0.001). Sixteen of twenty patients (80.0%) were satisfied with their current status posttreatment 12 months. CONCLUSION: Sequestered disc herniations could be treated successfully by aggressive rehabilitative treatment. Clinical improvement was achieved from posttreatment one month and persisted for twelve months. Operation might be delayed until aggressive rehabilitation treatment fail to treat sequestered disc herniations.

The Change of Serum and Synovial IGF-I Level in Patients with Knee Osteoarthritis

OBJECTIVE: The purpose of this study was to investigate the serum and synovial IGF-I levels in 30 patients with knee osteoarthritis (OA) and the relationships among the IGF-I level, pain intensity and severity of knee OA. METHOD: Thirty patients who met criteria of knee OA of American Rheumatology Association participated in this study. Samples of serum and synovial fluid were obtained from all patients. The levels of IGF-I were determined by radioimmunoassay (RIA). The intensity of pain was assessed by Pain Rating Score (PRS) and Visual Analogue Scale (VAS). The severity of knee OA was evaluated by Kellgren's grade of knee OA. RESULTS: The mean serum and synovial IGF-I level was 231.66+/-86.15 ng/ml and 122.42+/-37.79 ng/ml, respectively. There was no correlation between pain intensity and IGF-I levels. Neither was there statistically significant correlation between Kellgren's grade and IGF-I levels. CONCLUSION: The serum and synovial IGF-I levels were not related with pain intensity and severity of knee OA.

Change of Serum IGF-l level in Knee Osteoarthritis

BACKGROUND: To examine serum Insulin-like growth factor-I(IGF-I) level in patients with knee osteoarthritis(OA) and to determine the relationship between the serum level of IGF-I with pain intensity and severity of OA knee. METHODS: Serum IGF-I levels measured by standard radioimmunoassay techniques were obtained from 30 knee OA patients and 30 normal controls matched by age and gender. Pain intensity was measured by pain rating scale(PRS) and visual analogue scale (VAS). Kellgren grade also used for assessing the severity of knee OA. RESULTS: No difference was found in serum IGF-I levels between the cases and controls(cases: 279+/-128 ng/dL, controls: 282+/-113 ng/dl). There was no correlation between pain intensity and serum IGF-I levels. There is no significant association between IGF-I level and Kellgren grade. CONCLUSION: Serum IGF-I level does not decrease in knee OA. The serum IGF-I levels can not indicate pain intensity and severity of knee OA.

Radiologic Measurement of Pes Cavus

OBJECTIVE: To determine valuable radiologic criteria in diagnosis of pes cavus. METHOD: Thirty eight healthy subjects and twenty seven pes cavus cases were evaluated by radiologic measurements. We evaluated the criteria for longitudinal arch curve by measuring the calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II. RESULTS: By comparing the pes cavus with the control group, no significant differences in the talocalcaneal angle, metatarsal angle and navicular height I and II were found. Whereas we found a significant difference between the talometatarsal angle and calcaneal pitch. Talometatarsal angle is more sensitive and specific compared to the calcaneal pitch. CONCLUSION: In diagnosis of idiopathic pes cavus, talometa tarsal angle is more reliable in the diagnosis of pes cavus. The ultimate diagnostic value of talometatarsal angle in pes cavus is 6degrees.

Effect of Lateral Heel and Sole Wedges in Patients with Osteoarthritis of Knees

OBJECTIVE: The purpose of this study was to evaluate the effect of lateral heel and sole wedges on osteoarthritis of knees. METHOD: Sixty patients with knee osteoarthritis were enrolled and divided into the control (n=30) and wedge (n=30) groups. The control group received only conventional therapy for 5 weeks, while the wedge group took lateral wedges with 4 mm height in additional to the same conventional therapy. Intensity of pain and funtional activity were assessed by Western Ontario and Mac-Master Universities Osteoarthritis index (WOMAC index) and Lequesne s index. Scanogram was measured to assess femorotibial anglechange. WOMAC index, Lequesne's index and scanogram were measured before and 6 months after the therapy. RESULTS: For the wedge group, WOMAC index and Lequesne's index were significantly lower at the six month follow up compared to the initial indices (p<0.05). The femorotibial angle showed no significant change in both groups. CONCLUSION: Lateral heel and sole wedges can be used as an effective therapeutic modality for long term management of knee osteoarthritis in combination with conventional therapy.

Circadian Variation of Non-Sustained Ventricular Tachycardia

BACKGROUND: Circadian rhythms have been described for many cardiovascular phenomenon, both physiologic and pathologic. However, its frequency of onset in nonsustained ventricular tachycardia(NVT) has rarely been studied. Hence, this study was performed to examine the occurence of circardian rhythm in patients with NVT and to access underlying factors affecting it. METHOD: Among about 2000 patients who had undergone 24-hour Holter recordings between 1988 and August 1992, 46 patients with one or more ventricular tachyardia(VT) episode were selected. In this group, subjects receiving antiarrhythmic drug, including beta blockers were excluded. RESULTS: The frequency of onset of circadian rhythm in NVT peaked between 10 to 11AM and 6 to 7PM. In patiens younger than 60 years, its frequency was highest between 9 AM to 12 noon and 6 to 8 PM, whereas peak occurred around 9 AM in the morning in other age groups. In addition, circadian rhythm was more frequent in female NVT patients between 9 to 11 AM, while peaking between 6 to 8 PM in male patients. Moreover, higher frequency was shown during the day in patients with underlying heart disease, although the peak occurred in 9 AM and 8 PM in patients without any heart disease. CONCLUSION: In NVT patients, the frequency of onset of circadian rhythm varied with time of the day, showing nearly equal peaks in the morning and in the evening. This is similar to rnythms described for acute myocardial infarction and sudden death. Furthmore, the occurrence was affected by age, sex and presence of underlying disease.

Circadian variation in acute myocardial infarction

BACKGROUND: TAn increased occurrence of morning time acute myocardial infarction(AMI) based on subjective self-reports and objective confirmation has been reported in the USA and Europe. We tried to see if the same circadian pattern is found among Korea patients in the regard. We have also studied how various modifying factors such as age, gender, history of congestive heart failure, previous angina pectoris, hypertension and smoking may affect the circadian pattern. METHODS: The onset of chest pain was studied in 471 patients with AMI admitted to four teaching hospitals in Taegu. Korea. We categorized the patients according to the modifying factors described above. RESULTS: The patients with AMI indeed showed bimodal variation at the onset of myocardial infarction with the primary peak between 6 A.M. and 12 noon. The frequency of the onset of pain occurred during this 6 hour period was 1.8 times higher than the average of the remaining period(p<0.001). The secondary peak occurring in the evening was barely noticeable. On the other hand. the sub-group(n=96) with a history of congestive heart failure demonstrated its peak(30%) in the evening(6 pm~12 midnight) and the sub-group with a history of hypertension(n=177) demonstrated its peak(37%) in the afternoon(12noon-6P.M.). However. the rest of the sub-groups smokers, patients with previous angina and patients over the age of 70 revealed typical circadian rhythm with a pronounced primary morning peak. CONCLUSIONS: This study clearly showed that Korean patients with AMI revealed a remarkably similar circadian pattern, primary morning peak of onset of myocardial infarction and that the marked differences in diurnal patterns of myocardial infarction onset occur in sub-groups of patients with modifying factors, particularly previous congestive heart failure and hypertension.