Hyperthyroidism is a well known cause of atrial fibrillation. It is also known that control of hyperthyroidism can usually curb thyrotoxic atrial fibrillation and restore sinus rhythm. In this study, 282 patients with hyperthyroidism were investigated to quantify the incidence of atrial fibrillation, and to identify the vulnerable groups. In addition, we compared two groups of subjects with atrial fibrillation-one group with hyperthyroidism and the other group without
Aged ; Atrial Fibrillation ; Female ; Follow-Up Studies ; Heart Diseases ; Humans ; Hyperthyroidism ; Incidence ; Male ; Sex Ratio ; Thyroid Gland

Since Green et al has introduced a new technique of retrograde intramedullary nail, the use of retrograde interlocking intramedullary nails has been recommended as one of the treatment options for the distal femoral fracture. However there are some disadvantages that an arthrotomy is required for insertion and the knee joint could often be violated. Authors present a simple, arthroscopically assisted method using the retrograde intramedullary nailing for distal femoral fractures with minimal invasiveness to the knee. From March 1995 to March 1997, the retrograde intramedullary nail was used to treat 9 distal femoral fractures. Five of 9 patients were fractured at the distal shaft of the femur and others were fractured at the supracondylar region of the femur. Only one of the fractures was open injury(Gustilo-Anderson grade II). Significant concomitant knee joint injuries were revealed through the arthroscopy in 3 patients. Eight of 9 fractures healed by 5 months, but one fracture was not healed and required bone grafting. Average knee range of motion was 130. Complications included 1 nonunion and 1 hardware failure. There were no patellofemoral problems and no posttraumatic arthritis of the knee joint. This arthroscope-assisted method have some potential benefits that include decreased risk of damage to the knee joint, early evaluation and treatment of the associated knee joint injuries, and accurate placement of the nail.
Arthritis ; Arthroscopy* ; Bone Transplantation ; Femoral Fractures* ; Femur ; Fracture Fixation, Intramedullary ; Humans ; Knee ; Knee Joint ; Range of Motion, Articular

PURPOSE: The purpose of this study is to verify the effect of basic psychological needs of learners on student engagement in medical school. METHODS: A total of 91 first-year and second-year medical students participated in this study. Their basic psychological needs were determined. Student engagement scales were utilized to determine their engagement. Correlation and multiple regression analyses were conducted. RESULTS: Basic psychological needs showed a total explanatory power of 13% for student engagement (F=5.27, p < 0.01). Competence (β=0.295, p < 0.01) had statistically significant effect on student engagement. CONCLUSION: Results of the present study verified that student engagement could be determined by learner's traits. Among psychological traits of learners, student engagement was significantly affected by competence. Thus, medical school should provide various experiences to satisfy competence as a basic psychological need of learners.
Humans ; Mental Competency ; Schools, Medical* ; Students, Medical ; Weights and Measures

This study reports the outcomes of a collaborative program between dialysis clinics and a referral hospital, which consisted of clinical monitoring and supplementary routine surveillance, for improving the quality of vascular access care. Methods: This retrospective observational study was performed at five dialysis clinics as part of a 2-year collaborative program (2019–2020) in conjunction with a hospital-based dialysis access management center. A total of 392 hemodialysis patients (arteriovenous fistula [AVF], n = 339 and arteriovenous graft [AVG], n = 53) were included. Outcome measures included the prognosis of vascular access, clinic satisfaction, and referral rate to the hospital. Results: Increased vascular access flow was observed and critical flow events decreased from the first to the second year (AVF: 18.3% vs. 12.7%, p < 0.001; AVG: 26.2% vs. 20.1%, p = 0.30). There were fewer percutaneous transluminal angioplasty events in the AVG group (0.77 per person-year vs. 0.51 per person-year, p = 0.005). New AVF or AVG creation events also remained low. All dialysis clinics were satisfied with the program. The overall referral rate from the participating clinics increased (65.7% vs. 72.0%) during the study period independently of the physical distance between the dialysis clinic and the hospital. Conclusion: The collaboration between dialysis clinics and a referral hospital for improving the quality of vascular access care was successful in this study, and the model can be used by other clinics and hospitals looking to improve care coordination in dialysis patients.

PURPOSE: To investigate the beneficial effect of ginkgo biloba (Ginexin(R)) on ischemic retina model by retinal vein occlusion after photodynamic injury. METHODS: Ginkgo biloba 20 mg/kg/day, 100 mg/kg/day or carboxymethyl cellulose as a control group was administrated orally from 1week before the retinal vein occlusion to 2weeks after. After rose bengal was injected through vein of tail, retinal vein was occluded with argon laser. And then venous occlusion was confirmed by fluorescein angiogram. Rats were examined by using an indirect ophthalmoscopy and fluorescein angiography to detect reperfusion and new vessels. Eyeballs were enucleated for histological examination, retinal ganglion cell count and intravitreal glutamate level. RESULTS: The reperfusion of occluded vein was faster in the ginkgo biloba-treated group than the control group. In the ginkgo biloba-treated group, damage of the inner retina and TUNEL-positive cells were smaller than the control group on histologic examination. The concentration of retinal ganglion cells in the control group was lower than in the ginkgo biloba-treated group. CONCLUSIONS: Ginkgo biloba has protective effects in experimental ischemic retina after vein occlusion.
Animals ; Argon ; Carboxymethylcellulose Sodium ; Fluorescein ; Fluorescein Angiography ; Ginkgo biloba* ; Glutamic Acid ; Ophthalmoscopy ; Rats ; Reperfusion ; Retina ; Retinal Ganglion Cells ; Retinal Vein Occlusion ; Retinal Vein* ; Rose Bengal ; Veins

BACKGROUND: Ambulatory surgery has the advantages of reduced demand for postoperative medications, faster recuperation, less disruption to personal life and reduced hospital costs. At present, 60-70% of surgery in North America is performed on an ambulatory basis. DSC (day-surgery center) was opened on March 1995 in our hospital. We want to introduce an experience in anesthesia for ambulatory surgery. METHODS: Ambulatory surgeries were reviewed from March 1995 to July 1996. Total ambulatory surgeries were 5,593 cases. The medical records of 1,816 patients who were anethetized by anesthesiologists for ambulatory surgery were an alyzed retrospectively (3,777 patients who were operated under local anesthesia were excluded). RESULTS: The rate of utility was 14.1% on March 1995 and 27.7% on January 1996. The mean rate of utility was 22.2% per month in DSC. The overall mean rate of delayed discharge for the period was 2.9% and the overall mean rate of admission for the period was 1.9%. The principal reasons for the both were requestion by surgeons without surgery and anesthesia-related complications. CONCLUSIONS: The increase of demands of patients for ambulatory surgeries, new technological developements for surgery and anesthesia and increased experiences of surgeons will stimulate the utility of day surgery center.
Ambulatory Surgical Procedures* ; Anesthesia* ; Anesthesia, Local ; Hospital Costs ; Humans ; Medical Records ; North America ; Retrospective Studies

To find out the predictors of nocturnal arterial oxygen desaturation in patients with respiratory diseases, transcutaneous oxygen saturation(StcO2) monitoring studies using a pulse oximeter were performed during sleep in 20 patients. StcO2 was decreased more than 4% from the baseline value in 18 patients(90%) and more than 10%('Desaturator') in 8(40%). Five of the seven patients(71.4%) with awake PaO2<60mmHg and three of the thirteen patients(23.1%) with awake PaO2≥60mmHg were 'desaturators'. The awake PaO2/FIO2 and PaO2/PAO2 could distinguish 'desaturator' from 'nondesaturator, and PaO2, SaO2 or StcO2 could not. These results suggest that the nocturnal oxygen desaturation depends on the severity of the underlying disease rather than the baseline PaO2. Anthropomorphic and lung function factors could not separate between 'desaturator' and 'non-desaturator', and about a quarter of patients with a wake PaO2≥60mmHg developed significant desaturation. Therefore, it is necessary to monitor the nocturnal arterial oxygen saturation in patients with respiratory diseases regardless of their severity of airflow obstruction or awake PaO2.
Humans ; Lung ; Oxygen*

BACKGROUND: Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure. METHODS: ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results. RESULTS: Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 +/- 19.7 mm Hg and 79.0 +/- 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 +/- 0.009 to 0.389 +/- 0.047 and office systolic blood pressure was also decreased from 144.7 +/- 32.7 mm Hg to 125.3 +/- 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively). CONCLUSIONS: The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Edema ; Female ; Humans ; Hypertension ; Male ; Renal Dialysis

Renal malakoplakia (RM) with secondary hepatic involvement is extremely rare. There are only two cases reported in literature. We report the first case of RM with secondary hepatic extension in Korea. A 70-year-old woman had a history of long-term oral steroids intake. A radical nephrectomy and a segmental hepatectomy were performed under the clinical impression of a renal cell carcinoma with hepatic extension on the dynamic liver computed tomography. The gross specimen revealed a lobulated yellowish-tan, soft mass (9 X 8 X 5 cm) with hepatic involvement in the upper pole of the right kidney. The hematoxylin and eosin, Prucian blue and von-Kossa stainings, and electron microscopy demonstrated the classical histologic features of malakoplakia with Von Hansemann histiocytes containing Michaelis-Gutmann bodies. The patient is well 5 months after surgery. This case emphasizes that initial diagnoses can be difficult because of the rare occurrence of RM and its resemblance to renal cell carcinoma with hepatic extension.
Aged ; Carcinoma, Renal Cell ; Diagnosis ; Eosine Yellowish-(YS) ; Female ; Hematoxylin ; Hepatectomy ; Histiocytes ; Humans ; Kidney ; Korea ; Liver ; Malacoplakia* ; Microscopy, Electron ; Nephrectomy ; Steroids

Interleukin-1b (IL-1β), a proinflammatory cytokine, regulates the innate immune responses against bacterial infection. Mature IL-1β is produced from pro-IL-1β by activated caspase-1, which in turn is activated by the inflammasome complex formation. In this study, we compared the inflammasome mRNA expression induced by S. sanguinis, S. oralis, F. nucleatum and P. intermedia. Among the tested bacteria, S. sanguinis induced the highest IL-1β secretion. S. oralis, F. nucleatum and P. intermedia induced very weak IL-1β secretion. S. sanguinis mostly induced the NLRP3 mRNA expressions. Although F. nucleatum did not induce high IL-1β secretion, it induced high expression levels of AIM2, NLRP2, and NLRP3. No specific inflammasomes were induced by S. oralis and P.intermedia. Studying the inflammasome complex activation induced by oral bacteria may thus enhance our understanding of the pathogenesis of oral diseases.
Bacteria ; Bacterial Infections* ; Immunity, Innate ; Inflammasomes* ; Interleukin-1beta ; Real-Time Polymerase Chain Reaction ; RNA, Messenger