The Study of Risk Factors for Symptomatic Knee Osteoarthritis in Korea / 대한류마티스학회지

OBJECTIVE: To investigate the risk factors for symptomatic knee osteoarthritis (OA) in Koreans METHODS: A total of 1,194 persons consisting of 588 men and 606 women (mean age+/-SD, 48.9+/-14.0 years) were enrolled in rural and urban areas or in a hospital of Korea between september 2000 and august 2001. All participants were interviewed about symptoms of knee OA and possible risk factors including age, sex, occupation, body mass index (BMI), smoking, age of menarche, menopause and hormone replacement therapy and examined. Knee radiograph was obtained in all participants with knee symptoms. Symptomatic knee OA was defined according to clinical criteria or clinical and radiographic criteria for classification of osteoarthritis of the knee by Altman. RESULTS: Of 1,194 participants, symptomatic knee OA was found in 189 persons (15.8%) and multivariate analysis showed that female (OR=5.66, 95% CI 3.42~9.38), aging (OR=1.10, 95% CI 1.08~1.12), living in rural area (OR=3.83, 95% CI 2.27~6.45) and BMI over 25 kg/m(2) (OR=2.26, 95% CI 1.42~3.59) were risk factors. Age (older than 70 years, OR=1.08, 95% CI 1.04~1.12) and living in rural area (OR=5.39, 05% CI 1.94~14.96) were associated with symptomatic knee OA in men and age (older than 40 years, OR=1.11, 95% CI 1.07~1.16), living in rural area (OR=2.46, 95% CI 1.17~5.17), and BMI over 25 kg/m(2) (OR=3.45, 95% CI 1.63~7.29) in women. CONCLUSION: The risk factors for symptomatic knee OA were aging, female, living in rural area and high BMI in Koreans.

Effect of Pulsed Electromagnetic Fields in the Treatment of Knee Osteoarthritis. Report of Double-blind, Placebo-controlled, Randomized Trial / 대한류마티스학회지

OBJECTIVE: To determine the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of knee osteoarthritis (OA). MEHTODS: In this randomized, placebo-controlled, double-blind trial, 51 patients with knee OA, diagnosed according to the criteria of the American College of Rheumatology, were treated with PEMF or placebo. Eleven patients failed to attend after screening and were excluded from analysis. Treatment consisted of 3 half-hour periods of exposure per week over 6 weeks in a specially designed cylindrical device that emits low-frequency pulsed electromagnetic fields (25 gauss, 12 Hz). The primary outcome measure was reduction in pain on movement using a 10 cm visual analog scale. Secondary outcome measures included joint swelling and tenderness, the Lequesne index, and overall evaluations of improvement by the patient and examining physician. Evaluations were made at baseline, 3 week and 6 week during treatment and 4 weeks after finishing treatment. RESULTS: There were no significant differences between PEMF and placebo groups in respect of any outcome measures after treatment. Range of motion and knee swelling tended to be improved in the PEMF group. There were no clinically relevant adverse effects attributable to PEMF treatment. CONCLUSION: These results suggest that the PEMF treatment has no clinically significant benefits in patients with knee OA resistant to conventional treatment. The larger studies are needed to confirm the efficacy of PEMF therapy in knee OA.

Job Stress and Organizational Effectiveness of Dental Technicians / 대한산업의학회지

OBJECTIVES: To investigate the relationship between job stress and the variables associated with the organizational effectiveness of dental technicians. METHODS: The job stresses were divided into the following six components; somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility. The organi-zational effectiveness variables in this study included job satisfaction, occupational commitment, organizational commitment and intent to leave. The sample used in this study consisted of 248 dental technicians working in hospitals and dental laboratories. The data were collected with self-administered questionnaires between March 16 and April 29 in 2002, and the results analyzed with ANOVA and multiple regression analysis. RESULTS: Firstly, job stress of dental technicians was found to be significantly different in relation to the number of workers at the workplace and the working hours. The level of job stress was the highest when the number of workers were more than 10, or when the daily working hours were over 12. Secondly, of the six variables of job stress, five variables of somatization, interpersonal sensitivity, depression, anxiety, and hostility were found to have significant negative correlations with job satisfaction. Thirdly, all six job stress variables were found to have significant negative correlations with the occupational and organizational commitments of the dental technicians. Finally, depression was the only job stress variable found to have a significant effect on the dental technicians' intent to leave. CONCLUSIONS: The results of this study indicate that personal and organizational efforts are very important to improve the organizational effectiveness in reducing work related stress. Organizational support, especially for managing the depression of dental technicians is recommended.

Prevalence of Osteoarthritis and Rheumatoid Arthritis in Two Communities in Korea / 대한류마티스학회지

OBJECTIVE: To estimate the prevalence of osteoarthritis (OA) and rheumatoid arthritis (RA) in Korean. METHODS: Those who participated arthritis/allergy field study in Icheon, Kyunggi Province and Goesan, Chungbuk Province in 2001 were evaluated for the prevalence of arthritis. Diagnosis of OA and RA were made using American College of Rheumatology criteria. RESULTS: Among the 983 participants (mean age+/-SD, 49.9?14.0 years), 498 participants were male (mean age 49.9+/-13.1 years) and 485 participants were female (mean age 49.9+/-15.0 years), and there was no difference of mean age between male and female. There were 153 cases of OA (15.6%, mean age, 61.6+/-9.5), which consisted of 44 male cases (mean age, 58.9+/-10.7) and 109 female cases (mean age, 62.7+/-9.5). Prevalence of OA was significantly higher in female compared to male (22.5% vs 8.8%, p<0.0001). Prevalence of OA in the 4th to the 8th decade was 1.1, 7.5, 19.4, 34, 37.2%, respectively and showed increasing trend in the ascending order of age in decade (p<0.001). Localization of OA was knees (77.1%), knees and hands (17.6%), and hands (5.2%). RA was detected in 14 cases (1.4%, mean age, 58.8+/-14.6, male to female 1:13). Prevalence of RA was significantly higher in female compared to male (2.7% vs 0.2%, p<0.01). CONCLUSION: The prevalence of knee or hand OA and RA were 15.6% and 1.4% in Korean, respectively. The prevalence of OA was significantly higher in female and aged individuals. The prevalence of RA was also significantly higher in female.

A Case of Gastrointestinal Amyloidosis Presenting with Hematochezia / 대한소화기내시경학회지

Amyloidosis is a disorder of protein metabolism that leads to extracellular deposition of amyloid in tissues and organs. Multiple organ dysfunction can be induced by deposition of amyloid. Diagnosis is established by histologic demonstration of amyloid protein in involved tissue using Congo red staining. A 72 year-old woman was admitted due to mild abdominal pain, diarrhea and hematochezia. Duodenoscopic and colonoscopic findings were nonspecific, however, multiple biopsies showed amyloid deposits characterized by green birefringence under polarized light. The findings of small bowel series and abdominal CT were compatible with amyloidosis. We experienced a case of amyloidosis with involvement of the whole bowel.

Plasmodium vivax Infection in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Malaria was rarely reported in patients with systemic lupus erythematosus (SLE). We report a case of P. vivax infection in a patient with SLE. A 42-year-old woman was admitted to the hospital because of fever, anemia, and severe thrombocytopenia and had transfusion of multiple blood products including 16 units of red blood cells (RBC). The patient was diagnosed as having SLE complicated with antiphospholipid syndrome. From the 96th hospital day, the patient had cyclic high fever for 4~5 hours, myalgia and shaking chills, follwed by generalized diaphoresis and resolution of fever. Examination of her peripheral blood smear showed gametocytes of P. vivax. She received hydroxychloroquine of a total dose of 25 mg/kg orally over 3 days and then oral primaquine 15 mg/day for 14 days. Blood donors were traced retrospectively. The 13 RBC products were negative for malaria but other three RBC products could not be checked on P. vivax. The patient was presumed to have acquired malaria from infected blood products. Relapse did not occur 1 year later. In conclusion, malaria should be considered in the differential diagnosis of persistent fever in a patients with SLE who received multiple blood products in Korea.

Clinical Result of Excimer Laser Photoastigmatic Refractive Keratectomy Using VISX 20/20 B VisionKeyTM with Version 4.01 Software

Photoastigmatic refractive keratectomy (PARK) using VISX 20/20 B excimer laser with version 4.01 software was performed in 205 consecutive eyes of compound myopic astigmatism to assess the efficacy, predictability, and safety of excimer laser treatment of compound myopic astigmatism between September 1994 and June 1996. The mean preoperative manifest spherical equivalent refraction was -6.95+/-2.52D (range -1.13 to -15D) and the mean preoperative manifest cylindrical refraction was -1.25+/-0.76D (range -0.5 to -4.50D). The patients were followed from 6 months to 1 year (mean 9.19 months). At 1 year, 82(75.2%) of all 109 eyes receiving PARK were within 1D of plano refraction, and 88(80.7%) of all 109 eyes achieved uncorrected visual acuity of 20/30 or better. Postoperative refractions were stable after 3 months without significant early overcorrection. Mean postoperative astigmatism was -0.29+/-0.40D at 6 months and -0.24+/-0.42D at 12 months. Overall improvement of astigmatism was 75% at 6 months and 82% at 12 months by vector analysis using Alpins` method. In conclusion, PARK using VISX 20/20 B VisionKeyTM excimer laser with version 4.01 software appears to be effective in the treatment of compound myopic astigmatism with a relatively high degree of accuracy and safety. The predictability and stability of the postoperative refraction during the first 12 months seem to be quite reliable.

Assessment of Mitral Valve Area in Patients with Mitral Stenosis and Atrial Fibrillation

BACKGROUND: In mitral stenosis with atial fibrillation, it is known that there is a significant linear correlation between end-diastolic mitral pressure gradient(EDMG) in cardiac catheterization and the corresponding RR interval. And using this, the equations to calculate the mitral valve area(MVA) in several heart retes has been inducing. However, as cardiac catheterization has a limitation not to be practiced repeatedly in all patients due to invasive procedure. In this study, using transthoracic doppler echocardiography, we tried to investigate the correlation of EDMG, RR interval and MVA and we tried to get the nomogram to predict MVA in different heart rates using it. METHODS: We made 9 patients an abject of this study whose measured MVA is from 0.5cm2 to 1.55cm2 by pressure half time(PHT) method among patients who have no any valvular heart disease except mitral stenosis with atrial fibrillation and whose condition is stable. We investigated the linear correlation between EDMG and RR interval, RR interval=a×EDMG+b(a ; slope, b ; intercept), using doppler echocardiography. We got the equation and nomogram to make an estimate of MVA with multiple regression analysis using the relation of measured MVA, slope and intercept. RESULTS: There was a linear correlation between EDMG and RR interval in all the patients. There was a mutual correlation of slope=53.0×(measured MVA)−101.2 between measured MVA and slope. There was a negative correlation of intercept=1,497−470×(measured MVA) between measured MVA and intercept. Using these, we could get multiple regression analysis equation, estimated MVA=0.0113×slope−0.0007×intercept+2.2497 and nomogram to estimate MVA. CONCLUSION: We could get the nomogram to estimate MVA easily using doppler echocardiography in mitral stenosis with atrial fibrillation.

Influences of White-Coat Hypertension and White-Coat Effect on the Left Ventricular Mass and Diastolic Function

BACKGROUND: Overstimation of blood pressure(BP) by clinic measurements occur in about 20 to 30% of subjects(white-coat hypertension) who may, consequently, be misdiagnosed as hypertensives and received unnecessary medications. The clinical significance of white-coat hypertension and its effects on the cardiovascular wystem have not been studied systematically.This study was designed to evaluate the influences of white-coat hypertension and white-coat effect, defined as difference between clinic and ambulatory BP, on the LV mass and diastolic function. METHODS: LV mass index was calculated and LV systolic and diastolic function were assessed by the analysis of mitral and pulmonary venous flow velocity in 45 untreated essential hypertensives and 20 normotensives(NT). Ambulatory BP monitoring classified hypertensives as white-coat hypertensives(WCHT,n=20) and sustained hypertensives(SHT, n=25). RESULTS: 1) Left ventricular systolic indices were not different among the three groups. 2) Left ventricular mass inedx of WCHT(114.5+/-36.3g/m2) was similar to that of SHT(115.6+/-34.9g/m2) and was significantly greater than that of NT(86.5+/-37.7g/m2)(p<0.05). 3) Some of left ventricular diastolic parameters(isovolumic relaxation time, E/A ratio, A velocity, pulmonary systolic fraction, ratio of systolic to diastolic forward flow velocity) of WCHT and SHT were significantly different from those of NT(p<0.05), but there were no differences between two hypertensive groups. 4) Even though both systolic and diastolic white-coat effect in WCHT were significantly greater than those of SHT(o<0.05),white-coat effect did not influence on the left ventricular mass or function in both groups. CONCLUSION: An increased left ventricular mass and diastolic dysfunction in WCHT suggests that white-coat hypertension could not be considered as an entirely innocuous clinical condition.