Effect of a self-help program for mothers of hemophilic children in Korea

Mothers of hemophilic children are under stressful situations because of the characteristics of disease and inheritance. The purpose of this study was to evaluate the effect of the self-help group program for the mothers of hemophilic children. Fifty one mothers of hemophilic children were participated. The experiment group (n = 24) participated in the self-help group program for 5 weeks, while the control group (n = 27) received a self-help booklet only. Knowledge, self-efficacy, depression, parenting stress, and quality of life were evaluated using questionnaires. Data were analyzed using χ(2) -test, t-test, and analysis of covariance (ancova). The experiment and control groups were homogeneous in general characteristics and depending variables except knowledge (P < 0.05; P > 0.05, respectively). Knowledge, self-efficacy, and quality of life in the experiment group were increased after the program (P < 0.001). Especially, the knowledge in the experiment group was lower than the control group in pretest, but higher in the posttest (P < 0.001). Depression and parenting stress were reduced in the experiment group compared to the control group (P < 0.001). It is suggestive that the self-help group program can be a useful opportunity for mothers of hemophilic children to improve knowledge and self-efficay of child care and quality of life of themselves; to decrease depression and parenting stress. Extended application of the program to fathers or all family members may be needed to investigate in the future.

Profiling of differentially expressed genes in haemophilia A with inhibitor

Inhibitor development is the most significant complication in the therapy of haemophilia A (HA) patients. In spite of many studies, not much is known regarding the mechanism underlying inhibitor development. To understand the mechanism, we analysed profiles of differentially expressed genes (DEGs) between inhibitor and non-inhibitor HA via a microarray technique. Twenty unrelated Korean HAs were studied: 11 were non-inhibitor and nine were HA with inhibitor (≥5 BU mL(-1)). Microarray analysis was conducted using a Human Ref-8 expression Beadchip system (Illumina) and the data were analysed using Beadstudio software. We identified 545 DEGs in inhibitor HA as compared with the non-inhibitor patients; 384 genes were up-regulated and 161 genes were down-regulated. Among them, 75 genes whose expressions were altered by at least two-fold (>+2 or <-2) were selected and classified via the PANTHER classification method. The expressions of signal transduction and immunity-related genes differed significantly in the two groups. For validation of the DEGs, semi-quantitative RT-PCR (semi-qRT-PCR) was conducted with the six selected DEGs. The results corresponded to the microarray data, with the exception of one gene. We also examined the expression of the genes associated with the antigen presentation process via real-time PCR. The average levels of IL10, CTLA4 and TNFα slightly reduced, whereas that of IFNγ increased in the inhibitor HA group. We are currently unable to explain whether this phenomenon is a function of the inhibitor-inducing factor or is an epiphenomenon of antibody production. Nevertheless, our results provide a possible explanation for inhibitor development.

Body mass, tobacco smoking, alcohol drinking and risk of cancer of the small intestine--a pooled analysis of over 500,000 subjects in the Asia Cohort Consortium

BACKGROUND

The evidence for a role of tobacco smoking, alcohol drinking, and body mass index (BMI) in the etiology of small intestine cancer is based mainly on case-control studies from Europe and United States.

SUBJECTS AND METHODS

We harmonized the data across 12 cohort studies from mainland China, Japan, Korea, Singapore, and Taiwan, comprising over 500,000 subjects followed for an average of 10.6 years. We calculated hazard ratios (HRs) for BMI and (only among men) tobacco smoking and alcohol drinking.

RESULTS

A total of 134 incident cases were observed (49 adenocarcinoma, 11 carcinoid, 46 other histologic types, and 28 of unknown histology). There was a statistically non-significant trend toward increased HR in subjects with high BMI [HR for BMI>27.5 kg/m2, compared with 22.6-25.0, 1.50; 95% confidence interval (CI) 0.76-2.96]. No association was suggested for tobacco smoking; men drinking>400 g of ethanol per week had an HR of 1.57 (95% CI 0.66-3.70), compared with abstainers.

CONCLUSIONS

Our study supports the hypothesis that elevated BMI may be a risk factor for small intestine cancer. An etiologic role of alcohol drinking was suggested. Our results reinforce the existing evidence that the epidemiology of small intestine cancer resembles that of colorectal cancer.

Altered cardiovascular responses to tracheal intubation in patients with complete spinal cord injury: relation to time course and affected level

BACKGROUND

We determined cardiovascular responses to tracheal intubation in relation to the time since injury in patients with different levels of spinal cord injury.

METHODS

Two hundred and fourteen patients with complete cord injury were studied. They were either quadriplegics (>C7, n=71) or paraplegics (<T5, n=143), and were subdivided into six groups each according to the time since injury: <4 week (acute), 4 week-1 yr, 1-5, 5-10, 10-20, and >20 yr. Twenty patients with no cord injury served as controls. Systolic arterial pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined.

RESULTS

Intubation did not affect SAP in the quadriplegics regardless of the time post-injury, but it significantly increased SAP in all paraplegics. Moreover, the pressor response was enhanced in the paraplegics who were 10 yr or more since injury (P<0.05). HR increased significantly in all groups; the magnitude of the increase was less only in acute quadriplegics compared with controls. Plasma concentrations of norepinephrine increased in every group except for the quadriplegics within 4 weeks of injury. The maximum increases in SAP, HR, and norepinephrine from awake baseline values were smaller in the quadriplegics than in the paraplegics (P<0.01).

CONCLUSIONS

The cardiovascular and catecholamine responses to intubation change as a function of the time elapsed and the level of the cord injury. In this study, the pressor response to tracheal intubation was abolished in the quadriplegics but not in paraplegics; indeed, it was enhanced at 10 yr or more since injury in this group.

Fatal cerebral hemorrhage associated with autonomic hyperreflexia during surgery in the prone position in a quadriplegic patient: a case report

Intracerebral hemorrhage is an unusual complication of autonomic hyperreflexia (AHR), which can be fatal if massive bleeding occurs with subsequent brain herniation. Episodes of AHR are most often triggered by bladder and rectal distention. We present a case of a 45-year-old quadriplegic male who suffered left basal ganglia and thalamic hemorrhage associated with AHR during surgery for pressure sore defects in the prone position under local anesthesia. Early recognition and removal of triggering factors of AHR failed to bring his blood pressure under control. The patient continued to deteriorate neurologically and died 9 days after the attack. A preventive measure rather than episodic treatment of AHR may be of paramount importance to avoid life-threatening complications, especially when a patient with a history of AHR is undergoing surgery in the prone position.

Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approach

BACKGROUND

The intensity of nociceptive stimuli reflects the severity of tissue injury. The anaesthetic requirement and stress hormonal responses were determined to learn whether they differ according to different surgical approaches (anterior vs. posterior) during the spinal surgery.

METHODS

Patients undergoing lumbar spine surgery without neurological deficits were divided into two groups: one having posterior (n=13) and the other having anterior fusion (n=13). The end-tidal sevoflurane concentrations (ET(SEVO)) required to maintain the bispectral index score at 40-50 were determined. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), serum osmolality and plasma concentrations of catecholamines, cortisol and vasopressin (AVP) were measured.

RESULTS

There were no differences in MAP, HR, CVP and serum osmolality between the groups. ET(SEVO) was higher in the anterior than in the posterior group (P<0.05). The plasma concentrations of norepinephrine and cortisol increased in both groups during the surgery, whereas those of epinephrine remained unchanged. AVP concentrations increased during the surgery in the anterior group, and remained unaltered in the posterior group. The anterior group needed more analgesics (P<0.01) during the first 1 h after the operation.

CONCLUSIONS

The anterior approach required a deeper level of anaesthesia while undergoing spinal surgery and more use of post-operative analgesics than the posterior approach. It was also associated with a more pronounced AVP release during the surgery.

Chronological Alterations of P2X3 Receptor Expression in the Trigeminal Ganglion after Ischaemic Insult in the Mongolian Gerbil

P2X receptors play a role in the transduction of sensory signals like pain. Few studies have been undertaken on altered P2X(3) receptor (P2X3) expression in sensory neurones after peripheral nerve injury. In the present study, we investigated chronological alterations in P2X3 immunoreactivity and its protein content in the trigeminal ganglion after ischaemic insult in the Mongolian gerbil. In the sham-operated group, P2X3-immunoreactive neurones were found abundantly in small- and medium-sized neurones. From 1 day after ischaemic insult, the number of P2X3-immunoreactive neurones decreased significantly. At 5 days after ischaemic insult, P2X3 immunoreactivity was observed in few neurones, but its immunoreactivity was weak. However, the number of cresyl violet-positive neurones was unchanged throughout this period in all groups. These results suggest that transient trigeminal ganglion ischaemia may provoke a decrease of P2X3 expression and its protein content, and that this down-regulation of P2X3 may be related to the altered pain and thermal sensation without being associated with a transient ischaemic insult.

Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture

A cross-sectional study evaluated the prevalence of and the risk factors for hepatitis C and B viruses among 700 adults above the age of 40 years in a rural area of South Korea. Seropositivity for hepatitis C virus antibody (11.0%, 95% confidence interval: 8.7-13.6) was higher than that for hepatitis B surface antigen (4.4%, 95% confidence interval: 3.0-6.2). Anti-hepatitis C virus seropositivity was associated with a history of repeated acupuncture (odds ratio=2.1, 95% confidence interval: 1.1-4.0), and blood transfusion (odds ratio=5.5, 95% confidence interval: 1.6-19.3) before 1992 when hepatitis C virus screening in blood donors became mandatory. Hepatitis C virus 2a was the most prevalent genotype, followed by 1b. Hepatitis C virus risk attributable to acupuncture was 38% (9% for men and 55% for women). Safer acupuncture practice has become a priority for hepatitis C virus prevention in South Korea.

Hemodynamic and catecholamine responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injuries

BACKGROUND

Endotracheal intubation in patients undergoing general anesthesia often causes hypertension and tachycardia, which may be altered when the efferent sympathetic fiber to the cardiovascular system is interrupted. The aim of the current study was to investigate the effects of different levels of spinal cord injury on the cardiovascular responses to intubation.

METHODS

Fifty-four patients with traumatic complete cord injuries requiring tracheal intubation were grouped into quadriplegics (above C7; n = 22), high paraplegics (T1-T4, n = 8), and low paraplegics (below T5, n = 24) according to the level of injury. Twenty patients without spinal injury served as controls. Arterial pressure, heart rate, and rhythm were recorded at intervals for up to 5 min after intubation. Plasma concentrations of catecholamines were also measured.

RESULTS

The intubation increased the systolic blood pressure similarly in control, high-paraplegic, and low-paraplegic groups (P < 0.05), whereas it did not alter the blood pressure in the quadriplegic group. Heart rate was significantly increased in all groups; however, the magnitude was more pronounced in the high-paraplegic group (67%) than in the control (38%) and quadriplegic (33%) groups. Plasma concentrations of norepinephrine were significantly increased after intubation in all groups; however, values were lower in the quadriplegic group and higher in the low-paraplegic group compared with those in the control group. Incidence of arrhythmias did not differ among groups.

CONCLUSIONS

The cardiovascular and plasma catecholamine changes associated with endotracheal intubation may differ according to the affected level in patients with complete spinal cord injuries.

Synergistic effects between intrathecal clonidine and neostigmine in the formalin test

Spinal alpha-2 adrenoceptors and cholinergic receptors are involved in the regulation of acute nociception and the facilitated processing. The aim of this study was to examine the pharmacological effect of an intrathecal alpha-2 agonist and a cholinesterase inhibitor on the facilitated pain model induced by formalin injection and to determine the nature of drug interaction using an isobolographic analysis. Both intrathecal clonidine and neostigmine dose-dependently suppressed the flinching during phase 1 and phase 2. Intrathecal pretreatment with atropine reversed the antinociceptive effects of clonidine and neostigmine in both phases. Pretreatment with intrathecal yohimbine attenuated the effect of clonidine. The antinociception of clonidine and neostigmine was not reversed by mecamylamine. Isobolographic analysis showed that intrathecal clonidine and neostigmine acted synergistically in both phase 1 and 2. Intrathecal pretreatment with atropine and yohimbine antagonized the effect of the mixture of clonidine and neostigmine in both phases, but no antagonism was observed with mecamylamine pretreatment. These data indicate that spinal clonidine and neostigmine are effective to counteract the facilitated state evoked formalin stimulus, and these two drugs interact in a synergistic fashion. In addition, the analgesic action of intrathecal clonidine is mediated by spinal muscarinic receptors as well as alpha-2 adrenoceptors.

Relationship between the Val158Met polymorphism of catechol O-methyl transferase and breast cancer

A case-control study was performed to assess the potential influence of catechol O-methyl transferase (COMT) genotype on the risk of breast cancer in Korean women. One hundred and sixty-three histologically confirmed incident breast cancer cases and 163 age- and menopausal status-matched control individuals with no present or previous history of cancer were selected as study subjects. COMT genetic polymorphism was determined by gel electrophoresis after NlaIII enzyme digestion of amplified DNA. Odds ratios and 95% confidence intervals were estimated by unconditional logistic regression after adjustment for known or suspected risk factors of breast cancer. Women with at least one COMT lower enzyme activity associated allele (COMT-L) were at elevated risk for breast cancer (OR = 1.7, 95% CI = 1.04-2.78) compared with those homozygous for high enzyme activity associated COMT-H alleles. Among women with low (> or = 23.1) body mass index the COMT-L allele containing genotypes posed a marginally significant increased risk of breast cancer compared to the COMT-HH genotype (OR = 1.8, 95% CI = 0.95-3.48). Women with at least one COMT-L allele who had experienced a full-term pregnancy when aged over 30 years or were nulliparous had 2.7-fold increased risk; however, this increase did not reach statistical significance (OR = 2.7, 95% CI = 0.64-11.35). Furthermore, never-drinking and never-smoking women with at least one COMT-L allele were at increased risk of breast cancer compared to those with COMT-HH genotype with ORs of 2.0 (95% CI = 1.23-3.38) and 1.7 (95% CI = 1.04-2.62), respectively. These results are consistent with studies showing that COMT genotype of lower enzyme activity might be related to increase in risk of breast cancer, and extend this finding to Korean women.

The effects of opioids on isolated human pregnant uterine muscles

We determined the effects of fentanyl, sufentanil, morphine, and meperidine on the spontaneous contractility of isolated human pregnant uterine muscle strips. Uterine specimens were obtained from normal full-term parturients undergoing elective lower-segment cesarean delivery. Longitudinal muscle strips were prepared and mounted vertically in tissue chambers to record their isometric tension. Opioid concentration-response curves were constructed after rhythmic contractions were established. The responses were also examined in the presence of opioid receptor blocker, nitric oxide synthase inhibitor, beta-adrenoceptor blocker, or cyclooxygenase inhibitor. Fentanyl and meperidine inhibited uterine contractility in a concentration-dependent manner, their concentration that inhibited 50% being 2.3 x 10(-6) and 1.0 x 10(-3)M, respectively. Sufentanil and morphine had no significant effects on uterine contractility. Pretreatment with either naloxone, N(G)-nitro-L-arginine methyl ester, atenolol, or indomethacin did not affect the uterine responses to opioids. These results demonstrate that fentanyl and meperidine may have direct inhibitory effects on the contractility of the human uterus, though at supraclinical concentrations.

IMPLICATIONS

Opioids do not have a significant effect on spontaneous contractions of gravid human uterine muscle at their clinically relevant concentrations.

Association of serum lipids and glucose with the risk of colorectal adenomatous polyp in men: a case-control study in Korea

Previous studies on life style for colorectal cancer risk suggest that serum lipids and glucose might be related to adenomatous polyps as well as to colorectal carcinogenesis. This case-control study was conducted to investigate the associations between serum lipids, blood glucose, and other factors and the risk of colorectal adenomatous polyp. Male cases with colorectal adenomatous polyp, histologically confirmed by colonoscopy (n=134), and the same number of male controls matched by age for men were selected in hospitals in Seoul, Korea between January 1997 and October 1998. Serum lipids and glucose levels were tested after the subjects had fasted for at least 12 hr. Conditional logistic regression showed that there was a significant trend of increasing adenomatous polyp risk with the rise in serum cholesterol level (Ptrend=0.07). Increasing trend for the risk with triglyceride was also seen (Ptrend=0.01). HDL-cholesterol and LDL-cholesterol had increasing trends for the risk, which were not significant. In particular, it was noted that higher fasting blood glucose level reduced the adenomatous polyp risk for men (Ptrend=0.001). This study concluded that both serum cholesterol and triglyceride were positively related to the increased risk for colorectal adenomatous polyp in Korea. Findings on an inverse relationship between serum glucose and the risk should be pursued in further studies.

Prevalence of lower urinary tract symptoms in Korean men in a community-based study

OBJECTIVE

The prevalence of lower urinary tract symptoms was determined in Korean men aged 50 and over.

METHODS

A community-based, epidemiologic study was performed in Yonchon County, Korea. The Korean version of the International Prostate Symptom Score (I-PSS) was used to assess the severity of urinary symptoms in a representative sample of 514 men.

RESULTS

Nocturia and weak stream were the most prevalent symptoms and urgency was the least. Overall, 23.2% of the men were moderately to severely symptomatic: 17.7% in the age group of 50-59 years, 23.3% in that of 60-69 years and 35.3% in that of 70 years and over. The proportion of severely symptomatic men approximately doubled with each decade of age. The 'quality of life' score showed a high correlation with the I-PSS. Our estimation indicated that in 1995 approximately 800,000 Korean men had moderate to severe lower urinary tract symptoms that were likely to be associated with benign prostatic hyperplasia.

CONCLUSIONS

The prevalence of moderate to severe lower urinary tract symptoms in Korean men is substantially similar to that in Caucasians.

Alcohol consumption, glutathione S-transferase M1 and T1 genetic polymorphisms and breast cancer risk

To evaluate the potential association between GSTM1 and GSTT1 genotypes and development of breast cancer, a hospital based case-control study was conducted in a South Korean study population consisting of 189 histologically confirmed incident breast cancer cases and their 189 age-matched control subjects with no present or previous history of cancer. A multiplex polymerase chain reaction method was used for the genotyping analyses and statistical evaluations were performed by unconditional logistic regression model. The GSTM1 null genotype was significantly associated with breast cancer risk in premenopausal women [odds ratio (OR) = 2.0, 95% confidence interval (CI) = 1-3.7], but not in the postmenopausal women (OR = 0.9, 95% CI = 0.5-1.9), nor in all women grouped together (OR = 1.3, 95% CI = 0.8-1.1). The GSTT1 null genotype posed a similar risk of breast cancer with an OR of 1.6 (95% CI = 1.0-2.5) for the total breast cancer group, OR of 1.7 (95% CI = 0.9-3.2) for pre-menopausal women, and OR of 1.3 (95% CI = 0.6-2.8) for post-menopausal women. The breast cancer risk associated with concurrent lack of both GSTM1 and GSTT1 genes was 2.2 (95% CI = 1.1-4.5), and the risk increased as the number of null genotype increased (P for trend = 0.03). When the data were stratified by the known risk factors of breast cancer, a significant interaction was observed between the GSTM1 genotypes and alcohol consumption (P for interaction = 0.03). An especially remarkable risk of breast cancer was observed for alcohol-consuming premenopausal women lacking both the GSTM1 and GSTT1 genes (OR = 5.3, 95% CI = 1.0-27.8) compared to those with both of the genes. Our findings thus suggest a novel gene-environment interaction which plays an important role in the individual susceptibility to breast cancer. p6

Synergistic effect of angiotensin-converting enzyme and angiotensinogen gene on cardiac hypertrophy

AIMS

There are controversies concerning the association of angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism with left ventricular hypertrophy (LVH), and the unclear association between angiotensinogen (ATG) M235T polymorphism and LVH. We investigated both the separate and interactive effects of these two genes on LVH in patients (N=396) with cardiovascular disease and normal healthy volunteers (N=133).

RESULTS

Frequency of DD genotype of ACE gene was significantly (P<0.05) higher in patients with LVH than patients without LVH or normal controls. Frequency of IT genotype of ATG gene in patients with LVH was significantly (P<0.01) greater than that in normal controls or marginally (P=0.1) higher than that in patients without LVH. These findings were also observed in normotensive patients and normal controls after excluding hypertensive patients. Only in patient group, the frequency of DD genotype in the highest quartile of LVMI was significantly greater than that in the lowest quartile (P<0.05). The higher tendency of TT genotype in the highest quartile patients compared with that in the lowest, did not reach statistical significance. In combined genotype analysis, there was a remarkable difference in LVMI between the two extreme double homozygotes only in patient group (156+/-25 versus 109+/-25 g/m2 for TT+DD versus MM+II) (P<0.01). In ANCOVA, the interaction term composed of ACE and ATG genotype was a significant independent variable for LVMI only in the male patient group (P<0.01).

CONCLUSION

The D-allele of ACE and T-allele of ATG gene exert a synergistic effect on cardiac hypertrophy in male patients with cardiovascular diseases, but not in normal healthy population.

Variant angina is not associated with angiotensin I converting enzyme gene polymorphism but rather with smoking

BACKGROUND

Angiotensin converting enzyme (ACE) perhaps plays roles in regulating coronary vasomotor tone by producing angiotensin II and degrading bradykinin.

OBJECTIVES

We sought to investigate the role of ACE gene polymorphism in the pathogenesis of variant angina and to compare it with that of other clinical risk factors for male patients with variant angina and age-matched and sex-matched control subjects.

METHODS

We studied 78 male patients with variant angina who exhibited spontaneous or provoked coronary spasms during coronary angiography and compared prevalences of ACE gene genotype (deletion D and insertion I) and other risk factors between this group of patients with variant angina and age-matched and sex-matched control subjects whose angiograms were normal and in whom the ergonovine test did not cause spasms (n = 80).

RESULTS

Smokers were more prevalent in the group of patients with variant angina (P < 0.05). Genotype and allele prevalences of the group of patients with variant angina (0.14, 0.53 and 0.33 for DD, DI and II and 0.41 and 0.59 for D and I, respectively) were no different from those of the control group (0.16, 0.49 and 0.35 for DD, DI and II and 0.40 and 0.60 for D and I). Multiple logistic regression analysis showed that smoking was a significant risk factor for variant angina (odds ratio 2.61, 95% confidence interval 1.03-6.66) whereas ACE genotype was not.

CONCLUSIONS

Variant angina is associated with an environmental factor, such as smoking, rather than a genetic factor, such as ACE gene polymorphism.

Reproductive factors related to the risk of colorectal cancer by subsite: a case-control analysis

The authors hypothesized that reproductive factors of colorectal cancer, which are probably mediated by endogenous hormones, would differ according to colonic subsite. Information on reproductive factors was obtained from 372 female colorectal cancer cases (113 proximal colon, 126 distal colon, 133 rectum) and 31,061 cancer-free controls at the Aichi Cancer Center Hospital, Japan, between 1988 and 1995. Multiple logistic analysis showed that late age at interview, family history of colorectal cancer among first-degree relatives, menstrual regularity, late age at menopause, late age at first pregnancy and late age at first full-term pregnancy were significantly associated with the risk of colorectal cancer. None of the risk factors were significantly dissociated between colon and rectal cancer. In polytomous logistic regression analysis, particularly noteworthy was the fact that the odds ratios for age at menarche (P-value for heterogeneity of odds ratios = 0.010), age at first pregnancy (P = 0.016) and age at first full-term pregnancy (P = 0.028) were significantly higher for distal than for proximal colon cancer. This study supports the hypotheses that there might be an association between reproductive factors and risk of colon cancer, and that the carcinogenesis of colon cancer, by subsite, might show aetiologic distinctions.

Intracoronary propofol attenuates myocardial but not coronary endothelial dysfunction after brief ischaemia and reperfusion in dogs

We have investigated the effects of propofol on recovery of regional mechanical and coronary endothelial function and on lipid peroxidation in post-ischaemic myocardium in dogs. The animals were assessed for 180 min during reperfusion after 15-min of occlusion of the left anterior descending coronary artery (LAD). They were treated with intracoronary (i.c.) propofol 5 or 20 micrograms/ml of coronary flow or vehicle (control group) for 60 min, beginning 30 min before LAD occlusion. Propofol significantly enhanced recovery of regional contractile function (70% and 81% of baseline segment shortening in the propofol 5 and 20 micrograms ml-1 groups, respectively, compared with 51% in controls at 3 h of reperfusion). However, LAD flow responses to i.c. acetylcholine were similarly attenuated regardless of treatment with propofol throughout reperfusion. The increase in malondialdehyde induced by ischaemia-reperfusion was significantly suppressed by both doses of propofol. These results demonstrated that in vivo, propofol ameliorated dysfunction of the myocardium but not of the coronary endothelium resulting from brief ischaemia and reperfusion; the protection may be related, at least in part, to its ability to reduce lipid peroxidation.

Prevalence estimation of dementia in a rural area of Korea

OBJECTIVES

A cross-sectional survey was conducted to estimate prevalence of dementia and to determine factors related to dementia among residents in a rural area, Yonchon county, Korea, in 1993.

PARTICIPANTS

Of the study population more than 65 years of age (n = 2171), 1674 persons participated in the cross-sectional survey using the Korean version of the Mini-Mental State Examination (MMSE-K).

DESIGN

Subjects were defined as having dementia according to NINCDS-ADRDA criteria through direct interview by psychiatrists. A total of 436 subjects were selected randomly according to MMSE-K scores, and cases were confirmed as having either Alzheimer's or vascular dementia.

RESULTS

The adjusted prevalence of dementia was estimated at 9.5%. The prevalence of total dementia was 8.8% for men and 9.9% for women. The prevalence of Alzheimer's disease was 3.2% for men and 5.3% for women and that of vascular dementia 3.1% and 2.1%, respectively. Age-standardized prevalence of Alzheimer's disease was 4.5%, whereas that of vascular dementia was 2.5%. Using DSM-III-R criteria to stratify dementia patients according to severity showed the prevalence of mild, moderate, and severe Alzheimer's disease was 3.4%, 0.7%, and 0.5%, respectively.

CONCLUSION

These results showed that the prevalence of dementia in Korea was similar to its presence in Western countries but different from that previously reported in other Asian countries, e.g., China and Japan.

Female sex hormones and body mass in adolescent and postmenopausal Korean women

A cross-sectional study was conducted to evaluate the relationship between body mass and serum level of female sex hormones among 153 adolescent girls, and 153 postmenopausal women in Korea. Information on lifestyles, and both menstrual and reproductive factors was collected by personal interview. Serum total estradiol (E2), progesterone (Pg), and sex hormone binding globulin (SHBG) concentrations were measured by radioimmunoassay. Multiple linear regression analysis was used to determine whether the hormonal levels would be affected by the obesity indices. Body weight and body mass index (BMI) were inversely related to SHBG level in both premenopausal (p<0.005) and postmenopausal women (p<0.005) after adjusting for age. E2 levels during any phase in premenopausal girls were not related to BMI, whereas heavier girls had significantly higher levels of late luteal-phase Pg (p<0.05). Taller postmenopausal women had lower E2 levels (p<0.05). Results on the association between SHBG and BMI are consistent with previous results in Caucasian women, and might suggest the potential role of bioavailable estradiol in breast carcinogenesis in pre- and post-menopausal women. The finding that progesterone might be related to body mass in premenopausal women should be pursued in further studies.

Hepatitis B vaccination and reduced risk of primary liver cancer among male adults: a cohort study in Korea

BACKGROUND

Primary liver cancer is an important health problem in Korea, where hepatitis B virus (HBV) infection is prevalent. The authors conducted a prospective cohort study to evaluate the protective effect of HBV vaccination against liver cancer in adults.

METHODS

A total of 370,285 males aged > or = 30 comprised the study population. They were clinically free of liver diseases, and had not been vaccinated against HBV at enrolment. The results of HBV surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) marker positivity and those of the vaccination programme which took place during 1985 were used for the construction of the cohort. About 5% (n = 18,914) were HBsAg positive, 78,094 were anti-HBs positive, and 273,277 were negative for both. Among the candidates for HBV vaccination (n = 273,277), 35,934 (13.2%) people had been vaccinated against HBV during 1985. Cases of liver cancer were ascertained by record linkage and from medical records covering 1986-1989. A multivariate log-linear model was used to test statistical significance and to estimate relative risks (RR).

RESULTS

The total follow-up period was 1,404,566 person-years, with an average of 3 years and 10 months. A total of 302 incident cases were ascertained. The overall incidence rate of liver cancer was 21.7 per 100,000 person-years. With reference to the incidence level among the unvaccinated and uninfected, the RR of primary liver cancer among the chronically infected and that of the unvaccinated and infected was 18.1 (95% CI: 14.2-22.9) and 0.34 (95% CI: 0.19-0.60), respectively. The RR among the vaccinated group was 0.58 (95% CI: 0.31-1.09).

CONCLUSIONS

This study suggested that artificial immunization through HBV vaccination, even in adulthood, reduces the risk of liver cancer. It might also offer a practicable means of primary prevention, especially in areas with hyperendemicity of HBV infection.

Risk factors for the development of NIDDM in Yonchon County, Korea

OBJECTIVE

To determine the risk factors for the development of NIDDM in Yonchon County of Korea.

RESEARCH DESIGN AND METHODS

We studied 1,193 Korean nondiabetic subjects at baseline who participated in a 2-year follow-up study on diabetes in Yonchon County. A 75-g oral glucose tolerance test was performed 2 years after the baseline examination. Age, sex, and anthropometric and metabolic characteristics at baseline were analyzed simultaneously as potential predictors of conversion to NIDDM. We also designed a nested case-control study to determine the role of hyperinsulinemia and/or hyperproinsulinemia in the conversion to NIDDM in patients with newly developed diabetes and control subjects matched for age, sex, BMI, and waist-to-hip-ratio.

RESULTS

At 2 years, 67 subjects developed diabetes, as defined by World Health Organization criteria. The age-adjusted incidence was significantly higher in men (6.4%) than in women (3.0%), and the incidence increased as age increased in both sexes. Multiple logistic regression analysis revealed age, male sex, and fasting and 2-h glucose levels to be significant risk factors for the development of NIDDM, whereas waist-to-hip ratio and BMI were not. In a nested case-control study, baseline proinsulin but not insulin levels were significantly higher in subjects who progressed to NIDDM than in those who did not.

CONCLUSIONS

In the Korean population, beta-cell dysfunction, as measured by high proinsulin levels, seems to be associated with subsequent development of NIDDM, whereas regional and general obesity and fasting insulin levels, which may be a surrogate for insulin resistance, were not.

Risk factors associated with uterine cervical cancer in Korea: a case-control study with special reference to sexual behavior

OBJECTIVE

A hospital-based case-control study was conducted to identify characteristics of women at high risk of developing cervical cancer with special reference to sexual behavior in Korea.

METHODS

Histologically confirmed cases of invasive cervical cancer were selected from the Department of Gynecology, Seoul National University Hospital between September 1992 to May 1995 (n = 203). Women with normal pap smear tests and women free of past history of any malignancies were regarded as controls (n = 827). Information on risk factors were collected by both a self-administered questionnaire and a direct interview.

RESULTS

Uterine cervical cancer risk was higher in women with a less educated spouse (Ptrend = 0.0003), women with a family history of cervical cancer (adjusted odds ratio [OR] = 2.20., 95% confidence interval [CI] 1.21-4.01), women of shorter height (Ptrend = 0.02), women with early age at first full term pregnancy (Ptrend = 0.0005), and women who have had multiple full term pregnancies (Ptrend = 0.006) by the multiple linear logistic analysis. Particularly noteworthy was a significant decreasing trend in the adjusted OR with the age at first sexual intercourse increasing (Ptrend = 0.002) after adjusting the number of sexual partners. The husband's indecent sexual history showed a borderline significance (Ptrend = 0.07).

CONCLUSIONS

This study confirmed that the risk factors of cervical cancer in Korea are similar with those found in other countries.

Breast cancer risk factors according to combined estrogen and progesterone receptor status: a case-control analysis

Breast cancers demonstrate a gradient of responsiveness to endocrine therapy according to hormone receptor status, with tumors positive for both estrogen and progesterone receptors responding most favorably. The authors hypothesized that reproductive risk factors, which are probably mediated by endogenous hormones, would also differ according to receptor status, and that tumors positive for both receptors would exhibit the highest risk. Information on risk factors was obtained from 1,154 breast cancer cases and 21,714 cancer-free controls at the Aichi Cancer Center Hospital, Nagoya, Japan between 1988 and 1992. Receptor status was known for 40% of cases. For a given risk factor, odds ratios with respect to the common control group for breast cancers of differing receptor status were compared using multiple polytomous logistic regression. Risk factors did not differ significantly according to estrogen receptor status. However, age at diagnosis/interview, occupation, age at menarche, menstrual regularity at ages 20-29 years, and cigarette smoking differed significantly or borderline significantly in effect according to progesterone receptor status. Stratification of cases according to joint estrogen and progesterone receptor status indicated that estrogen receptor status did not modify this difference in effect. This study did not support the hypothesis of a gradient of risk for reproductive factors according to hormone receptor status. The authors recommend that the finding that some risk factors differ according to progesterone receptor status should be pursued in further studies.

Prevalence and risk factors for perennial allergic rhinitis in Korea: results of a nationwide survey

A nationwide survey on the prevalence and risk factors for perennial allergic rhinitis in Korea was conducted by means of physical examination by otolaryngologists from July to October 1991. The total number of subjects examined was 9069 and they were drawn from 2899 households in 60 different districts throughout the country. The overall prevalence of perennial allergic rhinitis was 1.14%. For the evaluation of risk factors for perennial allergic rhinitis, a case-control analysis was carried out. The prevalence was influenced by age and urban or rural province. Risk factors such as current urban residence, urban birth place, overcrowding, higher educational attainment, nasal septal deformity and chronic sinusitis with nasal polyposis, indicated an increased risk of perennial allergic rhinitis. Other factors such as smoking and personal factors showed little influence on prevalence.

Menstrual and reproductive factors related to the risk of breast cancer in Korea. Ovarian hormone effect on breast cancer

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.

Prevalence and risk factors of chronic sinusitis in Korea: results of a nationwide survey

From July through October 1991, a nationwide survey was conducted on the prevalence and risk factors of chronic sinusitis in Korea, using medical and family histories as well as physical examination. In all, 9,069 subjects were examined from 2,899 households residing in 60 different areas throughout the country. The overall prevalence of sinusitis was 1.01%. Casecontrol analysis was performed to determine possible risk factors for sinusitis. No significant differences were found in age groups or sexes. A significant geographic difference was seen in prevalence in the different provinces studied. Economic activity, crowding and allergy were significant risk factors. Other factors such as urban or rural residence, birth place, maternal and paternal age at birth, marriage, smoking history, education, social class, prior trauma, height and weight, and nasal septal deformities did not correlate with the occurrence of sinusitis.

Nationwide incidence estimation of lung cancer in Korea

The aim of this paper is to estimate the nationwide incidence rate of lung cancer in Korea. The potential incident cases were identified by hospital visiting and mailing, based on the ICD-9 diagnostic codes on the claims as one of the following: ICD-9 162-165 (malignant neoplasms of the respiratory system), 212 (benign neoplasm), 231 (carcinoma in situ), 511 (pleurisy), or 195-199 (malignant neoplasms with uncoded sites) in beneficiaries data of the Korea Medical Insurance Corporation from January, 1988 to December, 1989. Thereafter, the identified cases were confirmed by an oncologist (Dr. DS Heo). When adjusted with age distribution of the Korean population based on the 1985 Population Census, the incidence rate was 22.3 per 100,000 in males (95% CI: 21.70-23.01) and 8.37 (95% CI: 7.97-8.78) in females in 1989. And the age-adjusted rate for the world population was 39.63 in males and 9.95 in females.

Dietary factors and stomach cancer: a case-control study in Korea

BACKGROUND

Stomach cancer is the most common cancer among Koreans. There is wide agreement that dietary factors are important in gastric carcinogenesis, but the role of many Korean food items remains unknown.

METHODS

A case-control investigation involving 213 incident cases of histologically confirmed stomach cancer and an equal number of controls, matched by age (within 2 years) and sex, was conducted from June 1990 to October 1991.

RESULTS

An increased risk of stomach cancer was noted among those with high consumption of stewed foods such as soybean paste stew and hot pepper-soybean stew, broiled fish, and those who liked salty food. However, mung bean pancake, tofu (soybean curd), cabbage, spinach, and sesame oil decreased the risk of stomach cancer. Stratified analysis by salt in combined foods, such as stewed foods and pickled vegetables, disclosed salt as being an important risk factor. Analysis of cooking methods showed that broiling and salting increased the risk of stomach cancer, but that frying tended to decrease the risk. These results suggest that the cooking method might modify the gastric carcinogenicity of foods. As non-dietary factors, smoking and a family history of stomach cancer increased the risk, but use of a refrigerator decreased the risk of cancer.

CONCLUSIONS

Heavy salt consumption and cooking methods like broiling and salting seem to play a major role in gastric carcinogenesis among Koreans.

Incidence estimation of female breast cancer among Koreans

The authors conducted a nationwide survey to estimate the incidence rates of female breast cancer among Korean women in 1990-1991. We identified potential breast cancer cases based on the claims sent by medical care institutions throughout Korea to the Korea Medical Insurance Corporation (KMIC) from January 1988 to December 1989, whose diagnoses in the claims included one of the following diagnostic codes; ICD-9 174-175 (malignant neoplasms of the breast), 217 (benign neoplasms of the breast), 610-611 (benign mammary dysplasia and other disorders of the breast), 233 (carcinoma in situ of the breast and genito-urinary system), or 195-199 (malignant neoplasms with uncoded sites). In order to collect the final diagnosis of the potential cases, abstracting medical records was performed through visiting or mailing an abstracting format to the corresponding medical institutions. Thereafter oncologists reviewed the abstracting formats and confirmed the incident cases of female breast cancer among the potential breast cancer cases. Using these data from the KMIC, the incidence patterns of female breast cancer among Korean women were estimated as of July 1, 1988 to June 30, 1989. The incidence rate of female breast cancer adjusted for the Korean population was estimated to be 9.9 (95% confidence interval: 9.5-10.4). The cumulative rates for the ages 0-64 and 0-74 were 0.85% and 1.0%, respectively. The standardized rate for the world population was 10.9, which was lower than those of any other Asian country including China and Japan in 1983-1987.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence and risk factors of chronic otitis media in Korea: results of a nation-wide survey

A nation-wide survey on the prevalence and risk factors of chronic otitis media (COM) in Korea was conducted by means of physical examination by otolaryngologists from July to October, 1991. Total subjects examined were 9,321, who were drawn from 2,899 households residing in 60 different areas throughout the country. The overall prevalence rate of OM was 2.85% whereas that of COM was 2.19%. For the study of risk factors of COM, a case-control analysis was made. The prevalence of chronic OM did not vary by sex, nor by urban-rural difference. However, the risk increased with aging. There was a significant geographic variation by provinces. General risk factors such as crowding, economic activity, childhood home, marital status, maternal or paternal age, body weight, smoking habits, age of first otorrhea, preauricular fistula, canal atresia and cleft anomaly imply an increased risk of COM. Other factors such as residency, education, social class, height, history of breast feeding, microtia, nasal septal deviation, nasal polyposis and nasal allergic symptoms showed little influence on COM.

Prevalence of otitis media and allied diseases in Korea--results of a nation-wide survey, 1991

A nation-wide survey was conducted to estimate the prevalence of otitis media and allied diseases through physical examination by otolaryngologic doctors from July to October, 1991. A sample study population was selected from a panel to be representative of the Korean population by multistage clustered and stratified random sampling method based on the National Census Data, 1990. Total number of subjects undertaken were 9,321, Which were drawn from 2,899 households residing in 60 different areas throughout the country. The overall prevalence of otitis media was 2.85% (3.10% of males and 2.61% of females). Prevalence of each subtype was as follows; acute otitis media, 0.02%; middle ear effusion, 0.60%; chronic otitis media, 2.19%, respectively. The prevalence of otitis media did not vary by sex, nor by urban-rural difference. There was an increasing tendency of the prevalence of otitis media by age. However, the prevalence of both middle ear effusion and acute otitis media showed a decreasing pattern by age. Particularly noteworthy was a significant geographic variation in the prevalence of otitis media by provinces. The prevalence rate of septal deviation was 21.93% and the presence of septal deviation was significantly related to that of otitis media (p < 0.05). The prevalence rates of nasal allergic symptoms, nasal polyposis and evident cleft palate were 1.14%, 1.00% and 0.07%, respectively. The presence of otitis media was significantly correlated with both nasal allergic symptoms (P < 0.1) and evident cleft palate (P < 0.05), but not with that of nasal polyposis.

A hospital-based case-control study of breast-cancer risk factors by estrogen and progesterone receptor status

It has been proposed that breast cancers may differ in their pathogenesis and etiology according to their estrogen receptor (ER) and progesterone receptor (PR) status. This hospital-based case-control study in Japan assessed the relationship between known and suspected breast-cancer risk factors and ER and PR status. Information on risk factors was collected from histologically confirmed breast-cancer cases (n = 519) and from cancer-free controls (n = 9,506). Of 160 cases with known ER status, 58 percent were ER-positive; 38 percent of 157 cases with known PR status were PR-positive. No statistically significant differences were found between ER-positive cf ER-negative cases. However, statistically significant differences between PR-positive cf PR-negative cases were observed for number of full-term pregnancies (P = 0.01), menstrual regularity as a teenager (P = 0.024), and occupation as housewife (P = 0.036). Borderline differences were observed for age at menopause (P = 0.074), and age at menarche (P = 0.083). This study provides some evidence that etiologic distinctions may be greater between PR-positive and PR-negative breast cancers than between ER-positive and ER-negative breast cancers.

Independent protective effect of lactation against breast cancer: a case-control study in Japan

A case-control study was carried out to assess the risk of breast cancer associated with breast feeding in Japan. The data were obtained in a hospital-based case-control study of 521 women with breast cancer and 521 controls from January 1988 to December 1989. Statistical adjustment for potential confounders as well as a likelihood ratio test for linear trend was done by unconditional logistic regression. Compared with parous women who had never breast-fed, women with a positive history of breast feeding had an odds ratio of breast cancer of 0.62 (95% confidence interval 0.37-1.04). The trend of decreasing risk with increasing average months of breast feeding was statistically significant (chi 2 trend = 4.5, p less than 0.05), while it was was nonsignificant for the number of breast-fed children borne. Among premenopausal women, a significant linear relation with a log-transformed term of average months of breast feeding was noted, regardless of the age of the woman at first full-term pregnancy and parity (chi 2 trend = 5.3, p less than 0.05). The risk was the lowest among premenopausal women who had ever lactated for 7-9 months (adjusted odds ratio = 0.39, 95% confidence interval 0.15-0.97). These findings suggest that lactation has an independent protective effect against breast cancer in Japanese women.

Association between childhood rhabdomyosarcoma and maternal history of stillbirths

A case/control study of childhood rhabdomyosarcoma (RMS) was conducted utilizing information from birth records. Cases among Connecticut residents age 19 and younger diagnosed between 1960 and 1988 were identified from the Connecticut Tumor Registry files. Connecticut birth certificates were located for 103 of the 130 cases identified. A random sample of control birth certificates was frequency-matched to the cases by year of birth, sex, and ethnic origin, with a control:case ratio of 2:1. Information abstracted from birth certificates included birth weight, length of pregnancy, plurality, birth order, mother's prior stillbirths, mother's age, father's age, and father's occupation. Data were analyzed by conditional logistic regression. The major finding was an association between RMS and the mother having had one prior stillbirth or more (odds ratio = 3.7; 95% confidence interval = 1.5 to 8.9). Particularly noteworthy was the observation that 6 mothers of cases, but no mothers of controls, had had 2 or more prior stillbirths. The trend for increasing risk of RMS with increasing number of mother's prior stillbirths was highly significant (p = 0.0004). This association suggests that RMS and a class of stillbirths share a common etiologic factor. This factor may be genetic or may involve in utero exposure to an exogenous or endogenous agent.

A reconstructed cohort study on the hepatitis B virus infection as a risk factor of liver cancer in Korea

A stable cohort (n = 369,725) was reconstructed to test the association of hepatitis B virus (HBV) infection with subsequent occurrence of liver cancer in a healthy Korean population. The cohort consisted of male beneficiaries of the Korea Medical Insurance Corporation over 30 years of age, living nationwide. The HBV infection was tested by the reversed passive hemagglutination method for the HBsAg and by the passive hemagglutination method for the anti-HBs at the time of recruitment in 1984. Admissions due to liver diseases were identified through a computerized system for reimbursements on medical insurance claims from January 1, 1985 to December 31, 1987. For a more valid estimate of incidence, a sample survey was carried out, obtaining correction coefficients against misclassification of the diagnosis, as well as those for duplicate claims in a year. The incidence rate of liver cancer steadily increased with age (kappa 2 TREND = 51.1, df = 1, p = 0.00).(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence estimation of leukemia among Koreans

This study was undertaken in order to estimate the incidence of leukemia among Koreans. Medical records were studied of patients with diagnoses of either ICD-9 038 (septicemia), or 204-208 (leukemias), or 284 (aplastic anemia), or 289 (other diseases of the blood and blood-forming organs) in the claims sent in by medical care institutions throughout the country to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987. These records were abstracted in order to identify and confirm new cases of leukemia among the beneficiaries of KMIC, which covers about 10% of the whole Korean population. Using these data from the KMIC, the incidence rates of leukemia among Koreans were estimated as of July 1st, 1986 to June 30, 1987. The crude incidence rate of all types of leukemia among Koreans is estimated to be 3.45 (95% CI; 0.77-9.55) and 2.29 (95% CI; 0.28-7.81) per 100,000 in males and females, respectively. The cumulative rate for the age span 0-64 is 0.25% in males and 0.18% in females, and for the age span 0-74, 0.35% in males and 0.23% in females. The adjusted rates for the standard world population are 3.90 and 2.48 per 100,000 in males and females, respectively. The relative frequencies by type are 51.5% for AML, 21.6% for ALL, 20.2% for CML, and only 1.5% for CLL. The incidence patterns of various types of leukemia, of which this is the first report in Korea, are analyzed and presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence estimation of thyroid cancer among Koreans

The medical records of inpatients with diagnoses of either ICD-9 193(malignant neoplasm of the thyroid gland) or 226(benign neoplasm of the thyroid gland) in the claims sent in by medical care institutions throughout the country, to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987 were abstracted. These records were abstracted in order to identify and confirm new cases of thyroid cancer among the beneficiaries of the KMIC. Using these data, the incidence rate of thyroid cancer among Koreans was estimated as of July 1, 1986 through June 30, 1987. The crude rates were estimated to be 0.76(95% Cl: 0.63-0.87) and 3.87(95% Cl: 3.60-4.14) per 100,000 in males and females, respectively, and the cumulative rates for the age spans 0-64 and 0-74 in males were 0.06% and 1.10%, respectively. In females, those were equally 0.35%. The age-adjusted rate for the world population was 0.93 per 100,000 in males, which is one of the lowest levels in the world. However, the adjusted rate in females was 3.96 per 100,000, which is an average level and very similar to that of the Chinese in Singapore and Shanghai. A similar tendency was shown in the case of the truncated rates for the age group of 35-64, which was 1.91 per 100,000 in males and 8.82 per 100,000 in females.

Incidence estimation of stomach cancer among Koreans

A series of incidence estimation studies of cancers among Koreans through a nationwide survey has been undertaken by authors since 1988. The medical records were studied of inpatients with diagnoses of either ICD-9 151 (malignant neoplasm of the stomach), or 197 (secondary malignant neoplasm of the respiratory and digestive systems), or 211 (benign neoplasm of other parts of the digestive system) in claims sent in by medical care institutions throughout the country to the Korea Medical Insurance Corporation (KMIC) during the period from January 1, 1986 to December 31, 1987. These records were abstracted in order to identify and confirm the new cases of stomach cancer among the beneficiaries of the KMIC, which covers about 10% of whole Korean population. Using these data from the KMIC, the incidence patterns of stomach cancer among Koreans were estimated as of July 1, 1986 to June 30, 1987. The crude incidence rates of stomach cancer among Koreans are estimated to be 36.2 (95% tonfidence interval; 35.3-36.9) and 21.0 (95% CI; 20.3-21.6) per 100,000 in males and females, respectively. The cumulative rates for age spans 0-64 and 0-74 are 3.8% and 7.3% in males, respectively. In females they are 1.8% and 3.0%. The adjusted rates for the world population are 57.9 in males and 25.1 in females, which are similar to those of Shanghai, China '78-'82 but lower than those of Osaka, Japan. The truncated rates for ages 35-64 years, however, are 108.3 in males and 49.1 in females, which may be the highest in the world. Among Koreans in Korea, an increased risk of stomach cancer in this age group is the notable finding. Incidence patterns of stomach cancer by age, sex, and area, which are the first report in Korea, are analyzed and presented.

Incidence rate of hepatitis B: results of a record linkage study among healthy Korean males

A stable, liver disease-free cohort of 369,725 was reconstructed as of 1984 for the study of hepatitis B virus seromarkers and liver diseases. The cohort consisted of male beneficiaries of the Korea Medical Insurance Corporation (KMIC) over 30 years of age and living nationwide. Subjects who were both negatives for HBsAg and anti-HBs (N = 274,037) were selected for incidence of hepatitis B. Data on test results of HBsAg and anti-HBs in 1984 and on hepatitis B occurrence during 1985-1986 were collected from the files of the KMIC. Linkage was done between these two data sets to measure the incidence rate through a longitudinal observation of the male population. Correction against misclassification error and duplicate claims was done by a sample survey and verification procedures. The incidence rate of hepatitis B was 17.13 per 100,000 person-years for acute viral hepatitis B and 15.74 for chronic hepatitis B, respectively. An increasing age-dependent pattern for acute hepatitis B was not so prominent in this population. However, the incidence rate of chronic hepatitis B steadily increased with age. The relative risk, estimated by a log-linear model for rate and constant hazard, was significantly higher in the over-60 age group than in the others. The incidence rate in the lower socioeconomic class was higher than in the others, although statistically not significant.

Influence of intracerebroventricular phenoxybenzamine on the renal action of intracerebroventricular morphine

Renal function is under regulatory influence of the central nervous system, either through mediation of humoral agents or by way of renal nerves, with the sympathetic nerve playing the most important role. As it was recently shown that morphine and enkephalin, when administered intracerebroventricularly (icv), affect renal function in the rabbit, indicating that the opiate receptors are also involved in the central regulation of renal function, it was attempted to clarify whether the central adrenergic system participates in the center-mediated renal action of morphine, employing phenoxybenzamine (PBZ). Morphine, 10 micrograms/kg icv, produced profound and long-lasting antidiuresis and antinatriuresis. PBZ, 250 micrograms/kg icv, elicited marked diuresis with natriuresis and kaluresis, along with significant increases of osmolar clearance and free-water reabsorption, and these effects were not related to a transient increase in glomerular filtration. When PBZ was given 10 min after morphine, the morphine antidiuresis immediately disappeared and the renal action of PBZ unfolded itself undiminished. Also, when morphine was given after PBZ, the PBZ-diuresis developed fully, unaffected by morphine. These observations indicate that the central adrenergic system is involved in the regulation of renal function through central opiate receptors.