No abstract available.
Cause of Death* ; Humans ; Kidney Failure, Chronic* ; Renal Dialysis* ; Survival Rate*

BACKGROUND AND OBJECTIVES: Heart rate variability (HRV) illustrates the autonomic integration of the heart. Depressed HRV has been proven to be associated with an increased risk of cardiac death, whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity and it was recently introduced as another noninvasive tool for risk stratification. The aim of this study was to determine the relationship between the HRT and HRV parameters in Korean adults with a structurally normal heart. SUBJECTS AND METHODS: We studied 61 adults (males: 31) who showed ventricular premature complexes on 24 hour Holter recording and who were found to have normal hearts on full noninvasive investigation. We calculated the mean heart rate (RR interval), the number of VPBs, the time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (To) and turbulence slope (Ts). RESULTS: Ts showed a strong correlation with the HRV parameters (LF/HF ratio: r=0.35, p=0.006; VLF: r=0.32, p=0.013; LF: r=0.27, p=0.035; SDNN: r=0.28, p=0.029; SDANN: r=0.32, p=0.012), but To showed no significant correlation with the HRV parameters. CONCLUSION: The HRT parameters, and especially Ts, correlate strongly with the HRV parameters; therefore, Ts should be considered as a parameter that reflects the overall cardiac autonomic tone.
Adult* ; Baroreflex ; Death ; Heart Rate* ; Heart* ; Humans ; Ventricular Premature Complexes

Objective: We analyzed the number of deaths due to poisoning by pesticides over 38 years through vital statistics published annually by the Ministry of Health, Labour and Welfare of the Japanese government, from 1968 through 2005. Materials and Methods: Data not published as vital statistics were obtained from the Ministry of Health, Labour and Welfare Statistics and Information Department. The vital statistics provide the numbers of deaths with individual causes of death classified by sex and 5-year age group. We also calculated age-adjusted death rates by this classification, using a direct method based on the 1985 Japanese model population. Results: Deaths from pesticide poisoning increased rapidly beginning in 1982, reached a peak in 1986 (death rate per 100,000 population: 2.6 in males and 1.7 in females) and declined gradually thereafter. In the most recent several years, these figures have declined to levels previously unseen (death rate per 100,000 population: 0.4 in males and 0.3 in females). A difference in death rates between the sexes was observed at every age level, with death rates of males approximately 1.1-1.5-fold those of females. In the 1985-1987 data, these figures were highest in the three prefectures of northern Kanto (Tochigi, Gunma, and Ibaraki Prefectures; crude death rates per 100,000 population: 6.8, 6.8, 6.2, respectively), followed by that in Kagoshima Prefecture (5.0). In the 2003-2005 data, the figure was highest in southern Kyushu (Miyazaki Prefecture; crude death rate per 100,000 population: 1.9), followed by Tochigi (1.6), Ibaraki (1.4), and Kagoshima (1.4). Conclusions: Deaths from pesticide poisoning were extremely well correlated to the history of paraquat. Through the 1985 Advisory Resolution on Paraquat Regulations by the Japanese Association of Rural Medicine and other public health-oriented efforts, the concentration of highly fatal paraquat formulations was reduced, leading to discontinuation of its production, customer identification was strictly enforced when purchasing pesticides, and people's safety consciousness regarding pesticides improved. We regard and these developments as having had the greatest contribution to the reduction in deaths from pesticide poisoning.
Pesticides ; Death Rate ; seconds ; Vital Statistics ; Poisoning aspects

OBJECTIVES: We studied the circadian rhythm of nonlinear heart rate dynamics in healthy subjects. BACKGROUND: The frequency of sudden cardiac death increases in the morning. The relationship between decreased complexity of heart rate dynamics and sudden cardiac death has been documented. An understanding of the circadian variation in the complexity of cardiac dynamics may be important and to predict and prevent this sudden cardiac death. METHODS: Dynamic 24-hour electrocardiographic recordings were obtained from 30 healthy ambulant subjects aged 41 to 50 years and the digitized data was partitioned into sections of 30 minutes' duration. For each section, four indexes obtained from separate algorithms of nonlinear dynamics of RR interval - correlation dimension, Lyapunov exponent, approximate entropy, and fractal dimension - were calculated. Normalized low- (0.04-0.1 hertz) and high-frequency (>0.15 hertz) components were also calculated. RESULTS: All the four indexes of nonlinear dynamics showed a remarkably similar circadian rhythm: a prominent morning dip preceded by a steep decline during the late night, a recovery during the evening and a peak around midnight. In the morning, the low frequency component rose rapidly with concomitant withdrawal of the high frequency component. CONCLUSION: The complexity of cardiac dynamics decreases significantly in the morning, and this may contribute to the ominously increased rate of cardiac death in the morning hours.
Circadian Rhythm* ; Death ; Death, Sudden, Cardiac ; Electrocardiography ; Entropy ; Fractals ; Heart Rate ; Nonlinear Dynamics

Carcinoembryonic antigen (CEA) levels were determined in peritoneal washings from 42 patients who recieved explo-laparatomies from Jan. to Dec. 1995, and these were compared with blood CEA and peritoneal cytology. The patients consisted of 9 patients with benign diseases, 11 with gastric cancer without serosal invasion, 15 with gastric cancer with serosal invasion, and 7 with gastric cancer with visible peritoneal dissemination. Positive values (> 100 ng/g of protein) of peritoneal CEA were observed in 15 cases (45.5%) among 33 gastric cancer patients: 6 (85.7%) of the 7 patients with gastric cancer with visible dissemination, 7 (46.7%) of the 15 patients with serosal invasion without peritoneal dissemination, and 2 of the 11 patients with no serosal invasion, however, no elevation was observed in the 9 patients with benign diseases. The blood CEA and the peritoneal cytology were positive in 8 (24.2%) and 3 (10%) out of the 33 gastric cancer patients, respectively. The sensitivity for peritoneal dissemination was better in peritoneal CEA than in blood CEA and peritoneal cytology. The 1-year survival rates for the patients with and without elevations of the CEA levels were 46.7% and 94.4%, respectively (p < 0.001). The cause of death in 7 (87.5%) of the 8 patients with elevated CEA level in their peritoneal washings could be a sensitive detector of peritoneal dissemination as well as a new predictor for the postoperative prognosis of gastric cancer and an indication for intraperitoneal chemotherapy of hyperthermia.
Carcinoembryonic Antigen* ; Cause of Death ; Drug Therapy ; Fever ; Humans ; Prognosis ; Stomach Neoplasms* ; Survival Rate

STUDY DESIGN: This is a retrospective study analyzing survivorship of pedicle screw fixation in various spinal lesions. OBJECTIVES: To determine the survivorship of pedicle screw fixation and to assess the risk factors for the death of system. SUMMARY OF LITERATURE REVIEW: The previous reports of ten years survival rate of pedicle screw instruments was about eighty percent and the factors which influenced were bone quality, strength of instruments, design of instruments and compliance of patients. MATERIALS AND METHODS: Three hundred and thirty-eight patients(178 males and 160 females), treated by pedicle screw fixation from May 1988 to Dec. 1997, were analysed. Follow-up averaged 26.8months(3 to 116 months). The survival rates according to spinal lesions which caused spinal fixation, types of instruments, level of fusion and methods of fusion were predicted by life table method. The criteria of death were 1)breakage of screw or rod 2)gross bending of screw >5 degree 3)screw pullout and 4)dissociation of rod-screw coupling mechanism. RESULTS: Death of instrumentation was identified in twenty-six patients(7.7%). Of the 1,827 screws used, forty-three screws(2.4%) in twenty patients had broken(28) or bent(15). Thirty-nine Cotrel-Dubousset screws(3.5%) and four Diapason screws(1.6%) had involved. Four patients showed pullout of screws and two had dissociation of rod and screw. There was no rod broken. Life table calculations predicted the survivorship of instrumentation would be 88.7% at 10 years of follow-up. Single segment fixation showed higher survival rate than more than three segments fixation(93.3% vs 83.4%). Fracture had the lowest survival rate(78.3%). Screw failure was not influenced by the method of fusion. Suspected causes of death were collapse of disc space(12 patients), increased kyphosis(6), forceful reduction of fracture(3), infection(2), nonunion(2) and trauma(1). CONCLUSIONS: Ten year survival rate of pedicle screw fixaion was 88.7%. The survival rate was influenced by 1)number of fixed segments 2)cause of fixation .
Cause of Death ; Compliance ; Follow-Up Studies ; Humans ; Life Tables ; Male ; Retrospective Studies ; Risk Factors ; Survival Rate*

OBJECTIVETo establish a stable and modified mouse model of brain death (BD) and to share our experiences in BD induction and maintenance.

METHODSTotally 35 C57BL/6 male mice were randomized into BD group (n=25) or sham control group (n=10). BD was induced by inserting a 2F Fogarty catheter connected to a syringe pump after trepanation of the left frontoparietal area and injecting volume at the speed of 6 μl/min until spontaneous respiration ceased. BD was diagnosed by electroencephalogram, apnea testing,as well as testing of brain stem reflexes. Mechanical ventilation was performed by orotracheal intubation. Right carotid artery was intubated by a PE-10 cannula for the continuous monitoring of mean blood pressure (MAP) and heart rate (HR). The right external jugular vein was catheterized for volume resuscitation.The sham control group underwent the same procedure with catheter insertion but without balloon inflation.Livers were removed and fixed in paraffin to evaluate the histological alterations with the light microscopy.

RESULTSMouse models of BD were successfully established about 20 minutes after balloon inflation, and the mean balloon volume at the time of BD was (105.77 ± 21.57)μl. The MAP and HR rapidly increased on occurrence of BD and the peak value was (128.28 ± 17.16) mmHg and (434.16 ± 55.75) beat/min, respectively, which were significant higher than those in the sham control group at the same time point (P=0.000). During the 4-hour follow-up time, MAP and HR in 72% (18/25) of BD animals remained haemodynamically stable. No animal died due to anesthesia and surgical operation.Hepatic tissues in BD mice showed mild focal ischemic damages (cellular edema, congestion, and inflammatory infiltration), which were slighter and fewer in sham control group.

CONCLUSIONThe mouse model of BD was successfully established with lower surgical difficulty and can be performed in a standardized, reproducible and successful way.

Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164~167)
Bradycardia ; Death, Sudden ; Hand ; Heart Rate ; Humans ; Hypokalemia ; Magnesium ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes*

Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods : from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7 : 1 to 2.1 : 1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.
Birth Rate ; Cause of Death ; Classification ; Female ; Humans ; Infant, Newborn* ; Male ; Mortality* ; Patient Care ; Prenatal Diagnosis

Cancer has been the leading cause of death in Korea for the last 30 years. Cancer patients' 5-year survival rate between 2005 and 2009 was 62.0%, representing a highly advanced standard of care, as much as developed countries in the EU and the US. The Korean government formulated its first 10-year plan for cancer control in 1996 and has been carrying out a second 10-year plan for cancer control since 2006. But despite the Korean government's efforts, the cancer burden in Korea continues to increase. Many separate laws have gone into effect concerning the management of carcinogen exposure. However, there are no integrated regulatory laws or management systems against carcinogen exposure in Korea. Dead zones remain where carcinogen exposure cannot be controlled properly in Korea. In this paper, we suggest the need to establish a national carcinogen list based on international harmonization as a prerequisite for a paradigm shift in cancer control policy from treatment to primary prevention.
Cause of Death ; Developed Countries ; Jurisprudence ; Korea* ; Primary Prevention ; Standard of Care ; Survival Rate