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

PURPOSE: To evaluate the additional effect of internal limiting membrane (ILM) peeling in patients with idiopathic macular epiretinal membrane (ERM) who underwent ERM removal without ILM peeling. METHODS: The subjects were those patients with idiopathic macular ERM who underwent pars plana vitrectomy, whose ERM was completely removed without peeling of the ILM. Additional ILM peeling was carried out randomly in some patients. Anatomical outcomes, functional results, recurrence, and complications were compared between the eyes with and without ILM peeling. Anatomical outcome included the macular thickness from optical coherence tomography (OCT). Functional results included the change in best-corrected visual acuity (BCVA) and the responses from multifocal electroretinograms (mfERG). RESULTS: Postoperative BCVA improved and macular thickness decreased in both groups but there were no statistically significant differences between the two groups. There was no recurred case in either group. Furthermore, in comparison of P1 amplitudes and peak times in mfERG, there were no differences between the two groups. CONCLUSIONS: The additional ILM peeling in patients with complete ERM removal without ILM peeling doesn't affect the postoperative results in visual acuity, macular thickness, recurrence, and complications.
Epiretinal Membrane* ; Humans ; Membranes* ; Recurrence ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy

BACKGROUND: Prolonged extracorporeal circulation entails tremendous threats of red cell lysis, severe bleeding problems due to platelet injury and activation, and endothelial damages by sequestered leukocytes. In consideration of these problems, a new centrifugal pump was developed and tested clinically to evaluate its effectiveness. METHODS: We compared the effects of a centrifugal pump with those of a roller pump on hematological responses during cardiopulmonary bypass (CPB) in 20 coronary artery bypass surgery patients. The patients were divided into two groups of 10 each. The studied parameters included WBC counts, platelet counts, plasma Hb and D-dimer. Blood samples were taken after sternotomy, at 60 min, 120 min and 180 min after CPB start, and at 2 hr after CPB stop. RESULTS: No differences between the groups were found in bypass time, aortic cross clamp time, extracorporeal circulation flow and hematocrit. The centrifugal pump group demonstrated less platelet depletion (p<0.05), hemolysis (plasma Hb, p<0.05) and fibrinolysis (D-dimer, p<0.05). These differences were CPB time dependent and became statistically significant after 120 min bypass. CONCLUSION: We conclude that roller pump still can be safely used for standard cardiac procedures with bypass time less than 120 minutes and the centrifugal pump has significant potential to be safely applied to CPB for long ypass time in order to avoid postperfusion syndrome.
Blood Platelets ; Cardiopulmonary Bypass* ; Coronary Artery Bypass ; Extracorporeal Circulation ; Fibrinolysis ; Hematocrit ; Hemolysis ; Hemorrhage ; Humans ; Leukocytes ; Plasma ; Platelet Count ; Sternotomy

PURPOSE: To evaluate the effects of photodynamic therapy for subfoveal recurrences of juxtafoveal or extrafoveal choroidal neovascularization (CNV), previously treated with argon-laser photocoagulation. METHODS: Seven eyes, previously treated with argon-laser photocoagulation for juxtafoveal or extrafoveal choroidal neovascularization, received photodynamic therapy for subfoveal recurrence. Changes in visual acuity and fluorescein angiographic findings were analyzed. RESULTS: The average time of appearance of recurrent CNV after laser photocoagulation was 43.14+/-29.62 months (range, 2-77 months). After photodynamic therapy, fluorescein leakage and neovascular lesion size decreased in all patients on fluorescein angiography. Visual acuity was stabilized or improved in 5 of 7 eyes. CONCLUSIONS: Photodynamic therapy was effective in patients with subfoveal recurrences of juxtafoveal or extrafoveal choroidal neovascularization previously treated with argon-laser photocoagulation.
Choroid* ; Choroidal Neovascularization* ; Fluorescein ; Fluorescein Angiography ; Humans ; Light Coagulation* ; Photochemotherapy* ; Recurrence ; Visual Acuity

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

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