No abstract available.
Autonomic Nervous System* ; Humans ; Kidney Failure, Chronic*

No abstract available.
Agranulocytosis* ; Granulocytes* ; Humans

On the basis of the electrocardiographic ST-T changes, 46 patients with hypertensive heart disease were evaluated with echocardiography and classified into three groups; Those without any ST-T changes(group I, 6 patients) ; those with various nonspecific ST-T changes(group II, 20 patient); and those with full-blown LVh strain pattern (group III, 20 patients). In group III, left ventricular posterior wall thickness (p<0.01). interventricular septal thickness(p<0.05) and cardiac muscle mass(p<0.02) increased significantly and end-systolic dimension(p<0.05), relative wall thickness(p<0.02) also in creased significantly but ejection fraction decreased significantly (p<0.05). These results suggest that LVH strain pattern is associated with left ventricular hypertrophy or thickening, left ventricular dilatation and/or functional deterioration and that left ventricular wall thickness increase progressively even in the stage of LVH strain pattern on electrocardiogram.
Dilatation ; Echocardiography* ; Electrocardiography* ; Heart Diseases* ; Heart* ; Humans ; Hypertrophy, Left Ventricular ; Myocardium

The case is presented a 49-year-old man had several year history with chronic renal failure with hyperlipidemia due to diabetes mellitus. Treatment of hyperlipidemia was started by oral bezafibrate intake 600 mg per day. Several days later, patient noticed muscle weakness and myalgia. The serum CK, LDH, AST levels were remarkably elevated, myoglobulinuria was also noticed The symptoms of the patient were resolved after the drug was discontinued, thus the diagnosis was established as having bezafibrate induced rhabdomyolysis. On the basis of the above description, bezafibrate may induce muscle damage if dose is excess over the renal capacity. Extreme caution is warranted when the patient is placed on bezafibrate and has renal dysfunction.Strict dose adjustment is necessary in taking account of renal function to avoid muscle damage including rhabdomyolysis.
Bezafibrate ; Diabetes Mellitus ; Diagnosis ; Humans ; Hyperlipidemias ; Kidney Failure, Chronic ; Middle Aged ; Muscle Weakness ; Myalgia ; Rhabdomyolysis

PURPOSE: To evaluate the safe triangle within the femoral triangle for the potential space of the true anterior hip approach. MATERIALS AND METHODS: Cadaveric dissections were carried out on 28 femoral triangles from 14 cadavers. This study measured the length of the direct head of the rectus femoris from the anterior inferior iliac spine (AIIS) to the patella upper pole, the AIIS to the lateral border of the femoral nerve, and the entry point of the femoral nerve and vessel branches to the rectus. The safe portion within the risky femoral triangle was analyzed and applied to two clinical situations, a femoral head fracture and septic hip arthritis. RESULTS: The examination showed that there were three terminal branches to the rectus femoris from the femoral nerve. The entry point of the first branch was at the proximal 20.0-28.9% portion of the rectus femoris. The second and the third branch entered at the proximal 22.5-37.5% and 24.9-41.0%, portion, respectively. The vessel entry was at 21.4-37.3%. The length from the AIIS to the femoral nerve was 3.5- 8.0 cm. Using this space, the procedure was easier to perform in the two situations mentioned above. CONCLUSION: The space within the femoral triangle between the proximal 20% of the rectus femoris and iliacus can be used as one of the potential spaces for femoral head fracture fixation and septic hip irrigation in children, and as an arthroscopy portal.
Arthritis ; Arthroscopy ; Cadaver ; Child ; Femoral Nerve ; Fracture Fixation ; Head ; Hip* ; Humans ; Patella ; Quadriceps Muscle ; Spine

BACKGROUND: Bilirubin prevents oxidative modification of low density lipoprotein, and may protect vessels from atherosclerosis. Several studies showed an inverse relationship between serum bilirubin and coronary artery disease. However, there are some needs to clarify the relationship between serum bilirubin and carotid atherosclerosis in type 2 diabetes, especially. METHODS: A total of 346 type 2 diabetic patients, between 35 and 95 years of age (146 men and 200 women), were studied. Subjects with normal serum total bilirubin were divided into two groups, according to their serum total bilirubin levels (group I, total bilirubin > or = 1.0 mg/dL [n = 59]; group II, total bilirubin < or = 0.5 mg/dL [n = 76]). Carotid intima-media thickness (IMT) and plaque scores were measured by ultrasonography. Carotid atherosclerosis was defined by the presence of plaque or more than 1 mm of common carotid IMT. RESULTS: Carotid IMT was positively correlated with age, duration of diabetes and hypertension, high sensitive C-reactive protein (hs-CRP) and fibrinogen, but, it was negatively correlated with bilirubin, gamma glutaryltransferase, albumin, hemoglobin, cystatin C and estimated-glomerular filtration rate (GFR) in all subjects. After controlling for sex, age and levels of hemoglobin, direct bilirubin only was negatively correlated with carotid IMT (r = -0.151, P = 0.034). Low serum total bilirubin group had a lot of female, long duration of diabetes and hypertension, higher hs-CRP, platelet counts, serum creatinine, HbA1c and homeostasis model assessment-insulin resistance, lower albumin, hemoglobin, estimated-GFR and quantitative insulin sensitivity check index. Carotid IMT and plaque scores were significantly greater in low serum bilirubin group (0.785 +/- 0.210 mm vs. 0.678 +/- 0.146 mm, P < 0.01; 1.95 +/- 2.56 vs. 1.03 +/- 1.40, P < 0.05, respectively) than in the high serum bilirubin group. Multivariate logistic regression analysis showed that age, serum albumin and total bilirubin were independent associated factors for carotid atherosclerosis in type 2 diabetic women. CONCLUSION: Total bilirubin is inversely correlated with carotid atherosclerosis in type 2 diabetic patients, and it is an independent associated factor for carotid atherosclerosis in women.
Atherosclerosis ; Bilirubin ; C-Reactive Protein ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Coronary Artery Disease ; Creatinine ; Cystatin C ; Diabetes Mellitus, Type 2 ; Female ; Fibrinogen ; Filtration ; Hemoglobins ; Homeostasis ; Humans ; Hypertension ; Insulin Resistance ; Lipoproteins ; Logistic Models ; Male ; Platelet Count ; Serum Albumin

We have experienced acute hepatitis after general anesthesia. We guess that acute hepatitis is caused by enflurane anesthesia. We will report this case with references. A 34 year old pregnant woman suffered from preeclamsia. She admitted for emergence repeat cesarean-section due to labor pain. In this operation general anesthesia was performanced with enflurane. The preoperative liver enzyme were normal and other tests were within normal range. She developed high fever, marked elevation of serum glutamic oxaloacetic transaminase(SGOT)/serum glutamic pyrubic transaminase(SGPT)/ alkaline phosphatase(ALP)/total bilirunbin(T-B) on the 2nd postoperative day. She recovered gradually and discharged after 13 day's hospitalization. A possible cause of the acute hepatitis in this case were considered to be the enflurane.
Adult ; Anesthesia ; Anesthesia, General* ; Enflurane* ; Female ; Fever ; Hepatitis* ; Hospitalization ; Humans ; Labor Pain ; Liver ; Pregnancy ; Pregnant Women ; Reference Values

BACKGROUND: High-resolution carotid ultrasonography is considered a fundamental technique for the investigation of the vascular system. However, it is still very unclear whether ultrasonographic studies of carotid arteries are useful for the prediction of cardiovascular events in patients with coronary heart disease. We have tried to assess the usefulness of carotid ultrasonography to predict the severity of coronary artery stenosis in the patients with ischemic heart disease. METHODS: We studied in 80 patients(53 men, 27 women) with acute chest pain, mean ages 63.1 10.8 yr(35 to 84 yrs), who underwent both coronary angiography and carotid ultrasonography with 10 MHz transducer. The patients who had received revascularization procedure were excluded. We classified the patients into two groups, the control group without significant coronary stenosis(23 patients) and the coronary artery disease(CAD) group(57 patients) with significant stenosis(>50%). The intima-media thickness (IMT) was measured in the far wall of CCA at 10 mm proximal to carotid bulb and the abnormal IMT was defined when the measurement was greater than mean IMT+2 SD of control group(>0.99 mm). Serum total cholesterolQlC), low density lipoprotein(LDL), high density lipoprotein(HDL), triglyceride(TG) and lipoprotein (a) (LP(a)) were measured and history of hypertension, diabetes mellitus, and smoking were investigated. RESULTS: A significant difference in IMT of the CCA was found between control and CAD group(0.75+/-0.12mm vs. 1.02+/-0.34 mm; p<0.001). Also a significant difference in the existence of plaque(control; 26.1% vs. CAD; 73.7%, p<0.00l) and the number of plaque(control; 0.39+/-0.94 vs. CAD; 2.20+/-1.87 p<0.001) was found. The existence and number of carotid plaque were more conelated with coronary artery stenosis severity than carotid IMT. The sensitivity of IMT for prediction of significant CAD was 42.1%, the specificity 95.7%, the positive predictive value 96%, and the negative predictive value 40%. The sensitivity of plaque presence on the carotid artery for prediction of CAD was 73.7%, the specificity 73.9%, the positive predictive value 87.5% and the negative predictive value 53.1%. Among the risk factors, age and LP(a) were correlated with IMT of CCA, and diabetes, hypertension, age were correlated with the presence of plaque. Smoking and hypertension were correlated with coronary artery disease. CONCLUSION: Carotid atherosclerosis was significantly correlated with severity of coronary atherosclerosis. We therefore suggest that carotid ultrasonography is useful to predict the severity of coronary artery stenosis and that the best index of coronary artery stenosis severity may be carotid plaque rather than carotid intima-media thickness.
Carotid Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoprotein(a) ; Male ; Myocardial Ischemia ; Risk Factors ; Sensitivity and Specificity ; Smoke ; Smoking ; Transducers ; Ultrasonography*

It is well recognized that diabetic patients have small pupil. The most likely cause of the abnormally small pupil in diabetics is decreased funcitor of the autonomic nerves. We measured pupil size in 141 control subjects and 53 diabetic patients (29 cases with symptomatic autonomic neuropathy, 24 cases without symptomatic autonomic neuropathy) with portable pupillometry, PUPILSCAN in darkness. Pupils become smaller in healthy and diabetic subjects with advancing age. (log pupil size = 2.05 - 0.066 X age, r: -0.47, p Aging* ; Autonomic Pathways ; Darkness ; Diabetic Neuropathies ; Early Diagnosis ; Humans ; Miosis ; Pupil*

PURPOSE: To determine the influence of manganese dipyridoxyl diphosphate (Mn-DPDP) on MRI and proton MRS. MATERIALS AND METHODS: In an in-vitro study designed to determine changes in the lipid peak at 1.3 ppm, 4.7T MR equipment was used to obtain proton MR spectrographic images of a lipid solution of varying concentration, with and without Mn-DPDP. Before; at 10, 20, and 30 minutes; and at 1, 2, 4, and 24 hours after the IV injection of Mn-DPDP (10umol, 1ml/kg), the concentration of Mn in liver tissue was measured by atomic absorption spectrometry. At the same intervals, T1-weighted MR images were obtained, the signal intensity ofthe liver was thus determined, and the relative enhancement ratio was calculated. MRS of rabbit liver was performed serially at the same intervals, and the peak areas of metabolites, as well as their peak areas relative to lipids, were calculated. The findings were correlated with tissue Mn concentration. RESULTS: At 1.3 ppm with Mn-DPDP, MRS showed that the peak area of the lipid had decreased. Tissue Mn concentration increased just after Mn-DPDP injection and peaked after 20 minutes, decreasing to a level within the normal range after 24 hours. Serial changes in the signal intensity of the liver, as seen at MRI, showed a similar pattern to that of Mn concentration. There was reverse correlation between serial change in the peak area of lipids at 1.3 ppm and Mn concentration after Mn-DPDP injection. CONCLUSION: At T1-weighted MR imaging, the injection of Mn-DPDP led to the enhancement of liver tissue, and at MRS, the lipid peak at 1.3 ppm decreased. There was close correlation between these effects and tissue Mn concentration.
Absorption ; Liver* ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy* ; Manganese ; Protons* ; Reference Values ; Spectrum Analysis