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Rapid economic development resulted in urbanization of Korea, since 1960s. Seoul is the center of politics, finance, education and culture of Korea. Mostly young people have migrated to large cities, such as Seoul and Pusan. For instance, the population in Seoul city was 2.5 million in 1960 but increased to 10 million in 1990. Presently, total population of Seoul and Pusan, second largest city, composed of approximately 50% of whole national population. The economic distribution among urban people became extremely uneven creating a large gap between low and high income group. As a consequence, both under and over nutritional problems coexist. According to the national nutrition survey data, animal food, such as meat, fish and dairy products have been consumed about 6 times more, and cereal consumption was far less in higher income group. In terms of nutrients intake, 28% of total caloric intake comes from lipids and 15-17% of total caloric intake from protein. This was found in higher income group, while low income group consumed more than 80% of total caloric intake from carbohydrate. The trends of major causes of death in Korea have changed. The degenerative diseases, cerebral disorder, high blood pressure became leading cause of death in recent years. Malignant neoplasm and diabetes followed second leading cause of death in Korea. Undernutrition and nutritional insufficiencies, anemia and low growth rate continue to exist among low income group. According to the annual death rate by age group, the age between 34-54 was the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Urban nutritional problems of Korea. 134 61

In a comparative study of tropical chronic pancreatitis (TCP) and alcoholic chronic pancreatitis (ACP) occurring in the same population, we analyzed the clinical profile of 50 patients of ACP seen over the past 3 years at our centers and compared this with the profile of our TCP patients. A majority (75%) of patients in both groups belonged to Tamil Nadu and 90% had never consumed cassava. Whereas TCP occurred in young subjects of both sexes, ACP patients were all males and presented at an older age. The frequency of pain, diabetes, and pancreatic calcification was similar in the two groups. Patients in both groups were lean, but signs of severe malnutrition were rare. Prediabetic patients had normal body mass index. There were striking differences in radiological appearance of pancreatic calculi in TCP and ACP. Malignancy of the pancreas was present in three patients with TCP. Benign bile duct stenosis was seen in three patients with ACP but not in TCP. Compared to ACP seen in the West, our ACP patients had a shorter duration of symptoms in spite of having advanced disease. TCP and ACP have distinct clinical profiles and it is possible that some environmental factors may hasten the progress of ACP in the tropics.
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PMID:Comparative study of the clinical profiles of alcoholic chronic pancreatitis and tropical chronic pancreatitis in Tamil Nadu, south India. 155 46

Pancreatic adenocarcinoma occurred in 22 of 266 patients with tropical pancreatitis presenting over an 8-yr period (8.3%). We compared the data on three groups: group 1, patients with tropical pancreatitis (benign, n = 82); group 2, tropical pancreatitis with super-imposed malignancy (n = 22), and group 3, those with de novo cancer (n = 76). Factors associated with high risk for cancer in tropical pancreatitis were age greater than 40 yr, short symptom duration, weight loss, mass on ultrasound, and ductal block on endoscopic retrograde cholangiopancreatography. Tropical pancreatic cancers had distinct differences from de novo cancers: younger mean age (47 vs. 61 yr), calculi in all (vs. none in group 3), diabetes in 16 of 22 (73%) versus 18 of 76 (24%), and tumors in body and tail in 16 of 22 (73%) versus 26 of 76 patients (34%). In group 2, survival was poorer (10 vs. 17 months, p less than 0.01) than in group 3 (those with de novo cancer). Two of five resected specimens in group 2 showed features of dysplasia, in addition to cancer. Tropical pancreatitis has a high association with cancer. Malignancy occurring in tropical pancreatitis is distinct from de novo cancer. When considered in the light of the low incidence of pancreatic cancer in southern India, the above evidence suggests a possible etiological relationship.
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PMID:Is tropical pancreatitis premalignant? 164 1

The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.
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PMID:The effects of age, gender, race and concomitant disease on postoperative complications. 769 33

We had already made a report on outcome of schizophrenia (1986). The patients, 129 typical schizophrenia, were continuously observed over 30 years in the Kawagoe Dojinkai Hospital. Recently, we again evaluated their prognoses according to the same criteria as adopted in the first report, and divided them into the following five groups. [symbol: see text]: completely remitted group (21 persons, 16.3%), [symbol: see text]: almost remitted cases now holding jobs (23 persons, 17.8%), [symbol: see text]: Slightly remitted group showing good adjustment at home or hospital (41 persons, 31.8%), [symbol: see text]: maladjusted cases always showing an unfavorable condition (25 persons, 19.4%), x : incurable cases (19 persons, 14.7%). 1) In the last 8 years, there were 30 persons (23.3% of the whole patients) who showed prognostic changes (10 persons improved, 20 persons worsen). While the second group ([symbol: see text]) has seen fewer persons (12 persons down) than previous study, the third group ([symbol: see text]) has seen more persons (9 persons up). Each three groups, that is, the first two groups ([symbol: see text] + [symbol: see text], 44 persons, 34.1%), the third group ([symbol: see text], 41 persons, 31.8%), and the forth and fifth groups ([symbol: see text] + x, 44 persons, 34.1%) accounted for a third of the whole patients. It is after 32 years on the average (extending from 21 to 50 years) from the onset of illness that they showed prognostic changes. 2) Generally speaking, catatonic patients had favorable prognoses, hebephrenic patients unfavorable ones, and paranoid patients medium ones. But 4 improved persons in the forth and fifth groups were all hebephrenic type. 3) 17 among the 30 persons who showed prognostic changes were unstable type. They took a wave-like course. 4) 27 of all the 129 patients were dead. 25 were dead from disease mentioned below. Malignancy (8 persons), Cerebral vascular disease, Pneumonia and Diabetes (3 persons), Heart-failure (2 persons), Ileus, Myocardial infarction, Hepato-cirrhosis, Gastric ulcer, Tuberculosis and Natural death (1 person). 2 persons committed suicide. 5) Outcome of 45 patients who discontinued our medical therapy became clear as follows. [symbol: see text] + [symbol: see text]: 18 persons (40.0%), [symbol: see text]: 9 persons (20.0%), [symbol: see text] + x : 18 persons (40.0%). A smaller percentage of the patients belongs to the third group ([symbol: see text]) than that of our patients who were continuously followed by us.
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PMID:[Outcome of schizophrenia--extended observation (more than 30 years) of 129 typical schizophrenic cases [III]]. 773 53

The clinical characteristics of 234 amputees admitted to the National Taiwan University Hospital during a 10-year period were analyzed. Diabetes mellitus accounted for 37.2% (87 cases) of the amputations and was the most commonly associated disease. Malignancy was the second cause of amputation (16.2%). Traffic accidents and atherosclerosis (without diabetes mellitus) each accounted for about 13% of the amputations. Below-knee amputation was the most commonly performed procedure among the diabetics, while above-knee, below-knee and ray amputations were roughly equally performed among non-diabetic patients. Reamputations were done in 16 diabetic and 12 non-diabetic patients, mostly within a short period of time after the first amputation. Four of the diabetic reamputations and nine of the non-diabetic reamputations were performed on the same side as the first amputation. The mean +/- standard error of admission days and total expenses for each episode of amputation were 36.2 +/- 2.7 days and 116.5 +/- 1.7 thousand New Taiwan dollars for the non-diabetics and 41.3 +/- 4.0 days and 134.0 +/- 16.0 thousand New Taiwan dollars for the diabetics, respectively. We concluded that: 1) diabetes mellitus was the main cause of amputation; 2) diabetes mellitus was associated with a higher rate of reamputations of the contralateral legs; and 3) a multidisciplinary foot-care team is essential for the management of lower leg amputations.
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PMID:Ten-year clinical analysis of diabetic leg amputees. 792 77

A total of 806 primary coronary artery bypass graft operations were performed between January 1984 and December 1989. Excluding eight hospital deaths (1.0%) and three patients lost in follow-up, a total of 795 patients were contracted, with a follow-up rate of 99.6%. The mean follow-up period was 53.6 months, the longest being 92 months. Of the patients 42 died in late follow-up. Malignant neoplasm was the major cause of death (n = 17, 40% of total late deaths), which far exceeded the number of cardiac deaths (n = 6, 14%). The actuarial survival, excluding the initial hospital deaths, was 95% at 5 years and 91% at 7 years by the Kaplan-Meier method. By multivariate logistic analysis, four clinical variables were identified as significant in influencing the late survival, in the following order: (1) presence or absence of diabetes mellitus (P = 0.00008); (2) age > or = 65 years or < 65 years (P = 0.002); (3) left ventricular function with ejection fraction < 45% or > or = 45% (P = 0.014); and (4) use or non-use of left internal mammary arteries to bypass the left anterior descending artery (P = 0.016). Sex (male versus female), severity of anginal symptoms (mild versus severe) and number of diseased vessels (single and double versus triple vessel and left main trunk disease) did not significantly influence the late survival of the patients.
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PMID:Late results of coronary artery bypass surgery with maximal follow-up of 7 years: analysis of determinants affecting late survival. 807 71

Course, prognosis and mortality in Japanese elderly diabetes mellitus were studied using a 7 year follow-up study of 424 elderly diabetics whose ages were 60 years old or more (mean age: 72.6 +/- 6.2, 144 males: 280 females) at baseline. The relationships between clinical findings at baseline and prognosis, causes of death and onset of ischemic heart disease during the follow-up period were also studied. A total of 133 (31%) deaths were observed during the follow-up period. Risk factors present at baseline which significantly influenced the patients' prognosis included age, male gender, previous cerebro-vascular disease, body mass index, pharmacological treatment of diabetes and persistent proteinuria. These factors were also related to the causes of death among the patients. Cardio-vascular disease deaths (n = 66, 50%) tended to increase in patients with a relatively higher age, male gender, previous ischemic heart disease and persistent proteinuria. Malignant neoplasm deaths (n = 28, 21%) tended to increase in patients with relatively higher age and previous cerebrovascular disease. Furthermore, infectious deaths (n = 16, 12%) were relatively increased in patients with a relatively higher age, male gender, previous cerebro-vascular disease, relatively lower body mass index and higher fasting plasma glucose levels. Among various causes for cardio-vascular disease deaths, ischemic heart disease (n = 40) was the leading cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Course, prognosis and mortality in Japanese elderly diabetes mellitus--a seven year follow-up study]. 831 45

Death certificates filed between 1987 and 1990 at the Kaohsiung Medical College Hospital (KMCH) were reviewed to investigate causes of diabetic death. During this period, 1,383 patients expired at KMCH, of which 151 had diabetes mellitus. The major causes of death in these 151 diabetic patients were infection in 25.8%, cardiovascular disease in 18.5%, cerebrovascular disease in 11.3%, uremia in 8.6% and diabetic ketoacidosis in 1.3%, while diabetes was reported as the contributory or underlying cause of death. Malignancy in 12.0%, liver disease in 5.3%, trauma in 1.3% and upper gastroenteral bleeding in 0.7%, likewise, were among the leading causes of death irrespective of underlying diabetes. However, cause of death in 15.2% of these diabetic patients was undetermined. Our analysis revealed that infection and cardiocerebrovascular disease were the leading problems contributing to diabetic death. Therefore, reducing the risk of infection by strict glycemic control, intensive medical intervention in infection and the proper prevention of diabetic angiopathy-related risk factors and complications are imperative for the reduction of diabetic mortality in our patients.
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PMID:Major causes of diabetic death at one hospital. 868 42

Within a 6-year period from January 1991 to December 1996, 249 patients of salmonellosis admitted to Kaohsiung Medical College Hospital were enrolled for clinical and microbiological analysis. The number of patients increased by year from 1991 (14 patients) to 1996 (79 patients), especially in the case of nontyphoid salmonellosis. There were 57 different serotypes isolated during these period. Salmonella typhimurium was the most common clinical serotype of human origin in southern Taiwan, followed by S. choleraesuis, S. schwanzengrund, and S. derby. Fever (81.1%), diarrhea (68.9%), and anorexia (44.6%) were the most common manifestations of human salmonellosis. Relative bradycardia was a more important feature in S. typhi group (100%) than nontyphoid salmonellosis. Leukocytosis, especially lymphocytosis, was found especially in nontyphoid, but not in typhoid salmonellosis. Elevated liver function tests were found in the most severe patients, such as S. choleraesuis and S. typhi infections. Malignancy (8.8%), especially hematological malignancy (5.2%), gastrointestinal diseases (8.8%), and diabetes mellitus (6.4%) were the common underlying diseases. Case fatality rate of human salmonellosis was 8% (20/249), especially high in S. choleraesuis group. The severity of underlying diseases may be the major cause in S. choleraesuis group. There was no fatal case with typhoid fever. Very high resistance rate to commonly used antimicrobial agents in nontyphoid Salmonella was noted in southern Taiwan with overall rates of resistance to ampicillin, 67.9%, chloramphenicol, 66.7%, and TMP/SMZ, 42.2%. The emergence of ciprofloxacin-resistant and multiresistant strains was also a major therapeutic problem in this study.
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PMID:Epidemiological study of human salmonellosis during 1991-1996 in southern Taiwan. 1022 36


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