• Journal of Chest Surgery
• /
• v.36 no.1
• /
• pp.30-34
• /
• 2003

As classical acute aortic dissection, atherosclerotic penetrating ulcers and intramural hematoma have different pathophysiology and natural history, treatment strategy should be different and, therefore, accurate differential diagnosis is necessary. However, these three aortic diseases may be indistinguishable by clinical observation and even by various diagnostic modalities such as cardiac echocardiography, CT and MRI. The patients was a 71-year-old female with chief complaints of anterior chest pain, nausea and vomiting which occurred suddenly 3 days before admission. CT angiographic with 3 dimensional reconstruction shows intramural hematoma in ascending aorta, aortic arch, descending thoracic aorta and right brachiocephalic trunk, heompericardium, and blood in mediastinum and both pleural cavities. The CT angiographic finding of focal out-bulging in the ascending thoracic aorta was diagnosed as penetrating atherosclerotic ulcer. The patient underwent emergency operation under a preoperative diagnosis of penetrating atherosclerotic ulcer with a sign of aortic rupture. In the intraoperative findings, however, intimal tear was seen in the anterior portion of the ascending aorta about 1cm below the brachiocephalic trunk and falselumen appeared after hematoma was removed from the layer of tunica media. We report a case of type A aortic dissection which mimicked clinical and diagnostic features of penetrating atherosclerotic ulcer.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.14 no.4
• /
• pp.1728-1736
• /
• 2013

The purpose of this study is to identify prognostic predictors of postoperative acute renal failure(ARF) for the patient undergoing cardiac surgery. Retrospectively review the electronic hospital database at a A hospital from Jan 2008 to Dec. 2011. 483 patients were included in this study. They were divided into a occurrence of ARF group(n=59) and a non occurrence of ARF group(n=424). ARF occurred in 59 cases (12.2%). Multi-variable logistic regression analysis identified that preoperative risk factors include creatinine(OR 3.92, p=<.001), advanced age(OR 2.142, p=.015), female(OR 2.165, p=.015), hypertension(OR 2.513, p=.005), NYHA(New York Heart Association) class II(OR 3.081, p=.003), and III(OR 6.759, p=.004), and intraoperative risk factor includes blood transfusion(OR 3.753, p=<.001), and postoperative factors include bilirubin(OR 4.541, p=.028), creatine(OR 8.554, p=.003), and cardiac output(OR 0.214, p=.033) as a prognostic predictors. The development of postoperative ARF could be a reason for increase in rate of complication and mortality after cardiac surgery. therefore the prevention of ARF is of paramount importance and treatment strategies are urgently needed.

• Journal of Preventive Medicine and Public Health
• /
• v.17 no.1
• /
• pp.259-268
• /
• 1984

The Korean government launched the medicaid program for the poor people as a wing of the social development and welfare programs beginning in 1977 when the fourth 5-year national economic development program started. The charts of the medicaid recipients who visited Jonglo-Gu Health Center for the period from 1981 to 1983 were reviewed and analysed. Major findings from the analysis are as follows. 1. The medicaid recipients occupied 5.19% in 1981, 2.90% in 1982 and 2.00% among the total residents of Jonglo district in 1983, respectively. 2. The mean number of physician visits per person year of medicaid recipients who visited the Jonglo-Gu Health Center was 4.73 in 1981, 4.90 in 1982 and 4.41 in 1983, respectively. 3. The consultation/referral rate at the Jonglo-Gu Health Center was 2.65% in 1981, 1.77% in 1982 and 2.18% in 1983 while the rate at the department of family practice, Seoul National University Hospital was 3.18% in 1983. 4. Classifying into 17 major categories, the pattern of diseases of the poor outpatients who visited the Hallym College Medical Center both in 1981 and 1982 showed a statistically similar pattern of the 5,169 medicaid patients who visited the Jonglo-Gu Health Center in 1981 and 401 patients in 1983. 5. Classifying into 17 major categories, the disease of outpatient visits at the department of family practice, Seoul National University Hospital from 1st May, 1983 to 31s1 Oct., 1983 revealed statistically significant similarity with both the 5,169 medicaid patients in 1981 and the 401 patients sampled in 1983. 6. Classifying into 17 major categories, the diseases of community diagnosis at the Ihwa Dong, Jonglo-Gu also showed a statistically significant similarity with the 5,169 medicaid patients who visited the Jonglo-Gu Health Center in 1981. 7. Classifying into 17 major categories, the diseases of 5,169 medicaid patients at Jonglo-Gu Health Center in 1981 showed a statistically significant similar distribution with that of the 401 sampled medicaid patients at this center in 1983. 8. Among the medicaid patients who utilized the Jonglo-Gu Health Center in 1983, 401 sampled patients who are practicable routine urinalysis composed of 131 indigent group and 270 low-income group. The sample composed of 127 males and 274 females. There were more old patients than the young ones among the 401 sampled patients. 9. Age-adjusted prevalence rate of the hypertension computed by the direct method using estimated of midyear population of 1980 year as the standard is the highest in the Yonsei area and the lowest in the Shindongmyun. Furthermore age-adjusted prevalence rate was higher for males than that of females. 10. The group of hypertension patients using routine urinalysis profile composed of pyuria, hematuria, proteinuria and glycosuria is the most statistical significant, the pyuria alone is very significant, hematuria is significant and proteinuria is also significant.

• The Journal of Korean Medicine
• /
• v.18 no.1
• /
• pp.72-81
• /
• 1997

The causes of stroke are presumed hypertension, atherosclerosis,. cardiac disease, diabetes mellitus and old age and risk factors of stroke are suggested hypertension, hyperlipidemia. obesity, smoking and drinking etc. Especilly, hypertension is one of the most important cause and risk factor of stroke, therfore without therapy hypertension leads to stroke. The frequence of hypertension is significantly higher in hemorrhage patients of intracranial hemorrhage and subarachnoid hemorrhage. Antihypertensive therapy has an impact not only on the primary prevention of stroke but also on stroke recurrence and the declining of stroke motality has been attributed to the widespread availability and use of antihypertensive therapy. The goals of antihypertensive therapy decrease the complications and motalitv of cardiovascular system and prevent the promoting arteriosclerosis. In this study, we observed the blood pressure change of cb-hemorrhagic patients with hypertension who were hospitalized from 1996. 3. 1 to 1997. 2 .26 in Wonkwang Oriental Hospital. These patients had no antihypertensive therapy and were supplied herb med(Jaum sikpoongtang, Chungrijagamtang, Gojinumja) in medication. Our results suggested as follows. 1. Systolic and diastolic average BP at admission is $150.71{\pm}15.61mmHg$ and $95.00{\pm}8.8mmHg$ and this is hypertension state defining WHO 2. During one week in admission, the blood pressure demostrated a marked declination by SBP 8.97mmHg and DBP 6.22mmHg. 3. During two week in admission, the declination of SBP was significant in paired t-test(p<0.05) but, the declination of DBP was non-significant in paired t-test. 4. The blood pressure during third and fourth weeks gradually declined but, non-significant in test. According to the above results, we suggested that the BP declination Was affected by $Jamyang{\cdot}Jaum$ prescriptions in acute stage of cerebral hemorrhage.

• Korean Journal of Occupational Health Nursing
• /
• v.4
• /
• pp.84-101
• /
• 1995

The periodic health examination have been shown the important role on early detection, early treatment and prevention of disease. Until now, there have been many studies that showed the effectiveness of the periodic health examination on the early detection and early treatment of disease to some extent. But there are few studies about primary prevention before health problem arise. In this case-control study, 29 newly detected hypertensive cases, 31 liver disease cases and 65 controls which are all available for 6-year data in the periodic health examination of a occupational field were compared to investigate the significant increase trend of health status between the groups. The results will be used for the occupational health nurses to provide appropriate primary prevention to the employees. The hypertensive and liver disease cases were divided observation-needed group and treatment-needed group. The data on systolic blood pressure, diastolic blood pressure, Body Mass Index and Broca Index in hypertensive cases and SGOT, SGPT, Body Mass Index and Broca Index in liver disease cases were analyzed by t-test and ANOVA. The specific findings are summarized as follows. 1. In the comparison between the hypertensive cases and controls, SBP and DBP of the observation-needed group and the treatment-needed group were significantly higher than the data of the controls for past 6 years. It was 2-3 years ago showing increase over 140/90mmHg of blood pressure in the hypertensive cases before they are categorized as hypertensive cases. In the observation-needed group and the treatment-needed group, the trend of the blood pressure for 6 years were significantly higher than the one of the controls. 2. In the comparison between the liver disease cases and controls, SGOT and SGPT of the observation-needed group and the treatment-needed group were significantly higher than the data of the controls for past 6 years. It was 2 years ago showing increase within upper normal limit of SGOT and 5 years ago of SGPT in the liver disease cases before they are categorized as liver disease cases. In the observation-needed group and the treatment-needed group, the trend of the liver enzyme for 6 years were significantly higher than the one of the controls. With these results, the author proposed that intervention for the primary prevention such as continuous follow-up, health education and weight control to the population who has over 140/90mmHg of blood pressure and upper normal limit of AST and ALT.

• Journal of Sasang Constitutional Medicine
• /
• v.19 no.2
• /
• pp.127-142
• /
• 2007

1. Objectives We studied the characteristics of pulse wave variables in hypertensive patients and healthy subjects and would develope the program diagnosing Sasang Constitution. 2. Methods Healthy subjects and hypertensive patients were measured with pulse analyzer. In each of healthy and hypertensive group, means of pulse analyzer variables were compared among Constitution. On these bases of these results, decision tree composed of several rules were developed. 3. Results and Conclusions Decision tree with 72.13% accuracy were developed. (1) if h5(Cheok) < 2.325 & Wm/t(Cheok) < 0.238281 then class = Soeumin (2) if h5(Cheok) < 2.325 & Wm/t(Cheok) ${\ge}$ 0.238281 then class = Taeumin (3) if h5(Cheok) ${\ge}$ 2.325 & t1(Chon) ${\ge}$ 0.143 then class = Soyangin (4) if h5(Cheok) ${\ge}$ 2.325 & t1(Chon) < 0.143 & h3/h1(Cheok) ${\ge}$ 0.963601 then class = Soyangin (5) if h5(Cheok) ${\ge}$ 2.325 & t1(Chon) < 0.143 & h3/h1(Cheok) < 0.963601 & sum of pulse pressure(SPP) of Gwan ${\ge}$ 618 then class = Taeumin (6) if h5(Cheok) ${\ge}$ 2.325 & t1(Chon) < 0.143 & h3/h1(Cheok) < 0.963601 & sum of pulse pressure(SPP) of Gwan < 618 & t3(Chon) < 0.209 then class = Soeumin (7) if h5(Cheok) ${\ge}$ 2.325 & t1(Chon) < 0.143 & h3/h1(Cheok) < 0.936601 & sum of pulse pressure(SPP) of Gwan < 618 & t3(Chon) ${\ge}$ then class = Taeumin From above results, we concluded that pulse analyzer is useful instrument to decide Sasang Constitution.

• The Korean Journal of Pain
• /
• v.6 no.2
• /
• pp.231-236
• /
• 1993

Clonidine, a centrally-acting antihypertensive agent known to reduce central sympathetic outflow and modulate presynaptic transmitter's release, has shown to suppress central noradrenergic hyperactivity induced by immobilization stress in animals, by decreasing the MAC of halothane and the dose of narcotics required to prevent reflex cardiovascular response to noxious stimuli, and to have potent analgesic properties in humans. These characteristics suggest that clonidine might be a useful adjunct to the anesthetic management of patients with preexisting hypertension. Accordingly, we determined the clinical efficacy and safety on analgesia, sedation and hemodynamic stability in the perioperative period. Thirty patients(ASA physical status II-III) with a history of arterial hypertension, scheduled for elective orthopedic surgery were randomly assigned to two groups. We applied CPA-clonidine patch($6.9\;mg/cm^2$, 0.2 mg delivered daily) or placebo patch to each groups, 48 hours prior to induction of anesthesia. Antihypertensive medication was continued until the morning of the scheduled surgery. All patients received premedication of atropine and lorazepam, and induced anesthesia with thiopental and succinylcholine, and maintained with enflurane and 50% nitrous oxide, while sustaining the BP and pulse rate at acceptable range. For the relief of pain postoperatively, diclofenac and fentanyl were administered intramuscularly on demand. The results were as follows: 1) The change of hemodynamic responses in clonidine group was less compared to the placebo group. 2) Intraoperative anesthetic requirement for enflurane in clonidine group were significantly lower than placebo group. 3) Postoperative analgetic requirement in clonidine group were significantly lower than placebo group. In clonidine group, 5 cases out of 15 cases were required no analgetics, and the incidence of administration of additional fentanyl was decreased to 5 cases, comparing with 10 cases in placebo group.

• Korean Journal of Health Education and Promotion
• /
• v.21 no.2
• /
• pp.215-231
• /
• 2004

The purpose of this study was to examine what factors affected patients who suffered from essential hypertension compliance with health behaviors, to help build a successful strategy to step up their compliance with health behaviors, and to seek effective ways to implement health education programs for patients with chronic disease. The subjects in this study were 60 people selected from among the patients who were diagnosed by physicians as having essential hypertension in S General Hospital in the city of P from April 10 through July 30, 2000, after health education was provided four times a month. The quasi- experimental design based on a control group pretest-posttest design was employed. The subjects were divided into three groups of 20 patients each： one was an experimental group to receive education in one-to-one interview, another was an experimental group to receive education as a group, and the third was a control group. The two experimental groups learned the same material through different methods, and the control group was given the same teaching materials and asked to comply with health behaviors on their own without instruction. After the three-week education was implemented in different ways, their compliance with health behaviors was measured. Collected data was analyzed by t-test, paired test, one-way analysis of variance, correlation analysis and regression analysis procedures. The findings of this study were as follows： 1. Concerning the effective type of health education, the group education produced the best results, followed by the one-to-one interviews and the sole use of print media. 2. Regarding the effect of compliance with health behaviors, the group- educated group got the highest score in compliance with health behaviors, but blood pressure lowered more significantly in the individual interview group. And the compliance with health behaviors had a significant negative correlational relationship with both systolic and diastolic blood pressure. 3. Parameter that had most significant correlational relationship with compliance with health behaviors was health locus of control, followed by self-efficacy and health perception. But there was no significant correlational relationship between compliance with health behaviors and knowledge of hypertension. 4. As a result of analyzing the impact of knowledge of hypertension, health locus of control, self-efficacy and health perception on compliance with health behaviors, self-efficacy was found to exercise most influence. Above-mentioned findings suggested that group education or one- to-one discussion would be more effective for health care for hypertension in koreans, as they could serve to have patients realize their own responsibility for health and to motivate their compliance with health behaviors, and there was a need to more positively utilize educational intervention for patients with chronic diseases, which could elevate not only compliance with health behaviors but self-efficacy.

• Korean Journal of Community Nutrition
• /
• v.11 no.5
• /
• pp.661-672
• /
• 2006

This study was performed to determine the dietary risk factors associated with hypertension. The hypertensive group were composed of 112 hypertensive patients (male 53, female 59) who first visited the hypertension clinic and had been diagnosed as having primary hypertension ($SBP{\ge}140mmHg\;or\;DBP{\ge}90mmHg$). The regular visitors or the subjects on special diets or medical therapies were excluded. The normal group consisted of as subjects (male 41, female 54) matched with age and socioeconomic levels. The subjects having higher intakes (above the 75 percentile) in energy, protein, iron, vitamin A or C showed significantly higher hypertension risk estimated with odds ratio after the covariance factors (age, sex and BMI) were adjusted. More than 2400 mg of sodium (6 g of salt) intake was associated with significantly higher risk of hypertension (odds ratio: 1.773, CI: 1.014-3.014 for $SBP{\ge}140mmHg$; odds ratio: 2.373, CI: 1.359-4.215 for $DBP{\ge}90mmHg$). Hypertensive group showed significantly increased intakes of vegetables and fish and shell fish compared to the normal group. When the vegetable intakes were classified into Kimchi, fresh vegetables and cooked vegetables with seasoning, the hypertensive group was observed as having higher intakes of Kimchi and cooked vegetables with seasoning. The intakes of highest quartile for vegetables (${\ge}327g/day$) (odds ratio: 3.164, CI: 1.740-5.752), fish and their products (${\ge}102g/day$) (odds ratio: 2.756, CI: 1.486-5.109), grains(${\ge}311g/day$) (odds ratio 2.393, CI: 1.186-4.832), meats and their product (${\ge}106g$) (odds ratio: 2.210, CI: 1.225 - 3.987) compared to the lower were significantly associated with the higher risk of hypertension estimated with DBP (${\ge}90mmHg$) after covariance factors were adjusted. In conclusion, our findings confirm that higher intake of energy or sodium are associated with the increased risk of hypertension. Because increased intake of vegetable or fish was associated with the higher risk of hypertension, in contrast with the finding of western countries, choosing or preparation of vegetables or fish with reduced salt is recommended.

• Journal of Digital Convergence
• /
• v.13 no.5
• /
• pp.277-288
• /
• 2015

This study aims to identify determinants affecting on geographic variations in the prevalence of arthritis in Korean women using data mining. Data from Korean Community Health Survey 2012 with 249 small districts were analyzed. Socio-demographic, health behavior and status, and morbidity status measures were analyzed using conventional regression model and convergence analysis method such as decision tree for convergence analysis. Rate of workers in agriculture, forestry, and fishing, salaried workers, persons higher than high school graduates, non-treatment of needing care, non-treatment of care because of economic reason, obesity, heavy drunkers, complaining persons of chewing difficulty, persons with experiencing depression, persons with perceiving stress, and persons with diagnosing hypertension and angina pectoris were variation determinants of prevalence of arthritis in 249 small districts and these districts were classified 10 area groups by decision tree model. Our finding suggest that the approach based characteristics by small area groups rather than national wide or individual level would be effective to reduce in variations of prevalence of arthritis.