No abstract available.
Fetal Death*

OBJECTIVE: Cognitive symptoms are an important component of depression and the Perceived Deficits Questionnaire-Depression is one of only a few instruments available for the subjective assessment of cognitive dysfunction in depression. Thus, the present study aimed to validate a Korean version of the PDQ-D (K-PDQ-D) using patients with major depressive disorder (MDD). METHODS: This study included 128 MDD patients who were assessed at study entry and 86 of these patients were then completed 12 weeks of antidepressant monotherapy. All subjects were assessed with the K-PDQ-D, the Montgomery-Asberg Depression Rating Scale (MADRS), the Sheehan Disability Scale (SDS), the EuroQol-5 dimensions questionnaire (EQ-5D), and the number of sick leave days taken in the previous week. The internal consistency, Guttman's split-half and test-retest reliabilities, factorial analyses, and concurrent and predictive validities of the K-PDQ-D were investigated. RESULTS: The K-PDQ-D exhibited excellent internal consistency and reliabilities, and was composed of four factors with high coefficients of determination. The concurrent validity analyses revealed that the K-PDQ-D scores were significantly correlated with the MADRS, SDS, and EQ-5D scores and the number of sick leave days taken. The K-PDQ-D scores at study entry significantly predicted changes in sick leave days and EQ-5D score from study entry to the 12-week endpoint. CONCLUSION: The newly developed K-PDQ-D is a reliable and valid instrument for the evaluation of subjective cognitive symptoms in MDD patients. The K-PDQ-D may assist in the gathering of unique information regarding subjective cognitive complaints, which is important for the comprehensive evaluation of patients with MDD.
Depression ; Depressive Disorder, Major* ; Humans ; Neurobehavioral Manifestations ; Sick Leave

Polymicrobial peritonitis is a relatively uncommon complication and it's clinical characteristics, risk factor and optimal managernent remain controversial. To identify indications for catheter removal in polymicrobial peritonitis, we reviewed the 340 episodes that occured in 168 patients of CAPD peritonitis during past 7 years to identify those. Polymicribial peritonitis was the 18 epoisodes in 18 patients of all peritonitis. First, 18 patients with polymicrobial peritonitis (P-P) did not show significant differences in the demographic features compared to 130 patients with single organism peritonitis (S-P). In contrast to Staphylococcus in S-P, the most common causative organisrn in P-P was pseudomonas (23%). Also sgnificantly more catheters were removed in P-P than S-P (P=0.001). Second, we cornpared group I, the patients responded to antibiotics only, and group II, those who needed catheter removal. The group I was 7 (39%) and the group II was 11 (61%). No patient of group I died and two patients of group II died. Between group I and group II, there were no significant differences in the demographic features. However, patients whose dialysate-WBC counts were below 100 at 3rd day after start of antibiotics were more significantly frequent in group I than group II. Among combination of causative organisms in P-P, most of Pseudornonas (6/9) and fungus (4/4) were treated by catheter removal. In conclusion, more catheters were removed in P-P than S-P. When dialysate WBC at 3rd day after start of antibiotics were over 100 and causative organism included pseudomonas or fungus in P-P, catheter removal was needed. We suggest that the kinds of organisms isolated and early response to antibiotics influence on the outcome of polymicrobial peritonitis.
Anti-Bacterial Agents ; Catheters* ; Fungi ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Risk Factors ; Staphylococcus

No abstract available.
Humans ; Nephritis, Interstitial* ; Nephrotic Syndrome*

To evaluate the possibility that the ginseng saponins could be developed as an anti-arteriosclerotic agent, we examined the inhibitory effects of ginseng saponins (total saponin(TS), panaxatriol(PT), panaxadiol(PD)) on the expression of c-fos mRNA and the proliferation of cultured rat aortic vascular smooth muscle cells (VSMCs) stimulated by angiotensin II (Ang II). TS and PT (1.0 mg/ml) suppressed c-fos mRNA induction in VSMCs stimulated by 10-5 M Ang II. The order of inhibitory potency was PT>TS. Ginseng saponins (0.01~1.0 mg/ml) inhibited the proliferation of VSMCs stimulated by Ang II in a concentration dependent manner, the inhibitory potency was TS> PT> PD at 0.1~1.0 mg/ml. These results suggest that ginseng saponins may suppress Ang II-stimulated proliferation of aortic VSMCs which can be seen in atherosclerosis, hypertension and restenosis.
Angiotensin II* ; Angiotensins* ; Animals ; Atherosclerosis ; Hypertension ; Muscle, Smooth, Vascular* ; Panax* ; Rats* ; RNA, Messenger* ; Saponins*

BACKGROUND: A low dose of ketamine can be an effective preemptive analgesic by preventing central sensitization when administered before surgical trauma. In this study, we assessed the preemptive analgesic effect of low-dose ketamine administered intravenously to patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection. METHODS: This randomized, double-blinded study included fifty-six patients scheduled for elective arthroscopic rotator cuff repair. Normal saline (group C) or 0.5 mg/kg of ketamine (group K) was injected intravenously before the skin incision. An intra articular injection using 20 ml of 0.75% ropivacaine was performed in both groups just before wound closure by the surgeon at the end of the surgery. Postoperative pain was assessed by the numeric rating scale (NRS) in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. The total dose of fentanyl consumption and side effects were recorded. RESULTS: There were no significant differences between the C and K groups for the NRS of pain in the PACU and at 12, 24, and 48 hours after the surgery. In addition, there was also no significant difference in total fentanyl consumption between the two groups. CONCLUSIONS: Preemptive ketamine did not reduce preemptive pain scores and fentanyl consumption in patients who underwent arthroscopic rotator cuff repair with intra articular local anesthetic injection. Therefore, more aggressive and multimodal pain control is required in patients undergoing arthroscopic shoulder surgery regardless of the use of preemptive intravenous ketamine injection.
Central Nervous System Sensitization ; Fentanyl ; Humans ; Ketamine* ; Pain, Postoperative* ; Rotator Cuff* ; Shoulder ; Skin ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: The aims of this study were to establish a reliable model of chronic mitral regurgitation (MR) in rats and verify the pathophysiological features of this model by evaluating cardiac function using serial echocardiography and a pressure-volume analysis. MATERIALS AND METHODS: MR was created in 37 Sprague-Dawley rats by making a hole with a 23 gauge needle on the mitral leaflet through the left ventricular (LV) apex under the guidance of transesophageal echocardiography. RESULTS: Serial echocardiograms revealed that the LV began to dilate immediately after the MR operation and showed progressive dilation until the 14th week (LV end-systolic dimension at 14 weeks, 4.71+/-0.25 mm vs. 6.81+/-0.50 mm for sham vs. MR, p<0.01; LV end-diastolic dimension, 8.32+/-0.42 mm vs. 11.01+/-0.47 mm, p<0.01). The LV ejection fraction tended to increase immediately after the MR operation but started to decrease thereafter and showed a significant difference with the sham group from the 14th week (70.0+/-2.2% vs. 62.1+/-3.1% for sham vs. MR). In a pressure-volume analysis performed at the 14th week, the LV end-systolic pressure-volume relationship and +dp/dt decreased significantly in the MR group. A serial treadmill test revealed that exercise capacity remained in the normal range until the 14th week when it began to decrease (exercise duration, 406+/-45 seconds vs. 330+/-27 seconds, p<0.01). A pathological analysis showed no significance difference in interstitial fibrosis between the two groups. CONCLUSION: We established a small animal model of chronic MR and verified its pathophysiological features. This model may provide a useful tool for future research on MR and volume overload heart failure.
Animals ; Echocardiography ; Exercise Test ; Fibrosis ; Heart Failure ; Mitral Valve Insufficiency ; Models, Animal ; Needles ; Rats ; Rats, Sprague-Dawley ; Reference Values ; Salicylamides ; Ventricular Remodeling

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/diagnosis/*mortality ; Comorbidity ; Coronary Angiography/*statistics & numerical data ; Coronary Stenosis/mortality/radiography ; Female ; Humans ; Incidence ; Kidney Diseases/*diagnosis/*mortality ; Kidney Function Tests/*statistics & numerical data ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*statistics & numerical data

Infliximab is a chimeric anti-tumor necrosis factor-alpha monoclonal antibody. Infusion related reactions and infection are well known side effects of infliximab; however, renal complications have not been well recognized. We report on a patient with late onset-acute tubulointerstitial nephritis (ATIN) after treatment with infliximab and mesalazine for Crohn's disease. A 25-year-old woman was admitted with a purpuric rash on both lower extremities and arthralgia. She had been diagnosed with Crohn's disease 5.6 years previously and had been treated with mesalazine and infliximab. Serum creatinine level, last measured one year ago, was elevated from 0.6 mg/dL to 1.9 mg/dL. Results of urinalysis, ultrasound, and serologic examinations were normal. With a tentative diagnosis of Henoch-Schonlein purpura, oral prednisolone was given, and serum creatinine decreased to 1.46 mg/dL, but was elevated to 2.6 mg/dL again at two months after discontinuation of prednisolone. Renal biopsy indicated that ATIN was probably induced by drug, considering significant infiltration of eosinophils. Concomitant use of infliximab with mesalazine was supposed to trigger ATIN. Oral prednisolone was administered, and serum creatinine level showed partial recovery. Thus, ATIN should be suspected as a cause of renal impairment in Crohn's disease even after a long period of maintenance treatment with infliximab and mesalazine.
Adalimumab/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Creatine/blood ; Crohn Disease/*drug therapy ; Drug Therapy, Combination ; Eosinophils/immunology ; Female ; Humans ; Infliximab/*adverse effects/*therapeutic use ; Kidney/pathology ; Mesalamine/*adverse effects/*therapeutic use ; Nephritis, Interstitial/*diagnosis/drug therapy/*etiology ; Prednisolone/therapeutic use

Thrombotic thrombocytopenic purpura(TTP) is a clinical syndrome of unknown etiology and characterized by microangiopathic hemolytic anemia, thrombocytopenia, fluctuating neurological status, renal dysfunction and fever. Systemic lupus erythromatosus(SLE) is also multisystemic disease that some of clinical features may mimic TTP. Therefore both diseases have led to diagnostic confusion. We experienced two cases with SLE who subsequently or initially developed TTP. In case 1, a 44-year old woman had 1-year previous history of SLE and presented with dyspnea. After diagnosis of thrombotic microangiopathy by renal biopsy, she was managed with steroid, cyclophosphamide pulse therapy, fresh frozen plasma infusion and plasmapheresis. She was treated by aggressive treatment; nevertheless, she died on 15th admission day. In case 2, a 22-year old man was admitted because of nausea and vomiting. SLE with TTP was diagnosed by ARA criteria and the finding of microangiopathic hemolytic anemia. He was treated with plasmapheresis, fresh frozen plasma infusion and steroid therapy. He showed clinical response to the therapy, and has shown no recurrence of disease until now on. In conclusion, we suggest that early diagnosis and prompt therapy such as plasmapheresis and plasma infusion are very important in SLE with TTP.
Adult ; Anemia, Hemolytic ; Biopsy ; Cyclophosphamide ; Diagnosis ; Dyspnea ; Early Diagnosis ; Female ; Fever ; Humans ; Nausea ; Plasma ; Plasmapheresis ; Purpura, Thrombocytopenic* ; Purpura, Thrombotic Thrombocytopenic ; Recurrence ; Thrombocytopenia ; Thrombotic Microangiopathies ; Vomiting ; Young Adult