In order to discover difference that may exist in quantity of medical care services, length of stay and hospital changes between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the groups were studied. The results showed that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.
Cesarean Section* ; Female ; Humans ; Length of Stay ; Pregnancy

OBJECTIVE: To investigate the frequency, type and severity of cardiac abnormalities in the patients with ankylosing spondylitis and undifferentiated spondyloarthopathy. METHODS: A history, clinical examination, standard 12 lead electrocardiography, two dimensional, M mode, and Doppler echocardiographies were performed on 19 patients with ankylosing spondylitis, 15 patients with undifferentiated spondyloarthropathy and 21 normal controls. RESULTS: 1) Cardiac abnormalities were detected in 8 patients(42.1%) with ankylosing spondylitis. 2) Cardiac abnormalities were detected in 8 patients(53.3%) with undifferentiated spondyloarthropathy including 2 patients with aortic valve abnormalities(mild aortic insufficiency, aortic valve thickening. 3) Cardiac abnormalities were detected in one (4. 8%) among normal controls (mild tricuspid regurgitation). 4) There were sinus bradycardias on electrocardiography in 2 patients among patients witn anl;ylosing spond!litis and in 1 patient among undifferentiated spondyloarthropathy. But there was no conduction disturbance in both groups. 5) The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. 6) The mean age, mean disease duration, presence of uveitis, peripheral arthritis, HLA-B27, enthesopathy, Schober test and chest expansion in the patients with ankylosing spondylitis and undifferentiated spondyloarthropathy with cardiac abnormalities were not different from those in the patients without cardiac abnormalities. CONCLUSION: The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. The frequency, type and severity of cardiac involvement in patients with ankylosing spondylitis were not different from those in patients with undifferentiated spondyloarthropathy.
Aortic Valve ; Aortic Valve Insufficiency ; Arthritis ; Bradycardia ; Electrocardiography ; HLA-B27 Antigen ; Humans ; Rheumatic Diseases ; Spondylarthropathies* ; Spondylitis, Ankylosing* ; Thorax ; Uveitis

Percutaneous transluminal coronary angioplasty(PTCA) has been widely applied in patients with coronary artery disease since 1977. Although coronary angioplasty has beeb shown to be safe and effective treatment strategy, acute closure & restenosis remain as major limitations of PTCA. Acute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty is serious complication of PTCA, also, Intracoronary urokinase has been used to treat acute occlusion by intracoronary thrombus that complicated in PTCA and proved to be effective in restoring vessel preventing acute myocardial infarction. We report a case in which embolism of left anterior descending artery was complicated during angioplasty of left circumflex artery and managed with intracoronary infusion of urokinas.
Angioplasty* ; Arteries* ; Coronary Artery Disease ; Embolism ; Humans ; Myocardial Infarction ; Thrombocytosis ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator

On page 76, reference no. 21 was inadvertently omitted.

PURPOSE: We conducted this study to assess the effect of oral application of bovine colostrum on the plasma endotoxin and TNF-alpha following the abdominal surgery. METHODS: 46 patients who underwent the abdominal surgery were evenly enrolled in a prospective, randomized, double blind and placebo-controlled study. The patients were preoperatively managed by oral application of 20 g of a bovine colostrums or placebo (nonfat dried milk) per a day for 3 days. In both groups, endotoxin was sequentially determined pre-, intra- and postoperatively by a modified limulus amebocyte lysate test. TNF-alpha and CRP were also measured. The clinical course was followed and compared in both groups. RESULTS: The colostrum group showed significantly lower level of endotoxin and TNF-alpha compared to the placebo group. CRP did not differ in both groups. Clinical event did not occur in both group until the discharge. Colostrum group tends to have a lower incidence of fever and leukocytosis without statistic significance. CONCLUSION: Prophylactic preoperative oral application of bovine colostrum lower the plasma level of perioperative endotoxin and TNF-alpha. Further studies were needed for the relation of clinical effect and preoperative oral application of bovine colostrum.
Colostrum* ; Endotoxemia* ; Fever ; Horseshoe Crabs ; Humans ; Incidence ; Leukocytosis ; Plasma ; Prospective Studies ; Tumor Necrosis Factor-alpha*

BACKGROUND AND OBJECTIVES: High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. SUBJECTS AND METHODS: A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. RESULTS: Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0+/-15.9% vs. 22.9+/-16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2+/-19.3 vs. 32.6+/-21.4, p=0.020), and higher MBG (2.49+/-0.76 vs. 2.23+/-0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. CONCLUSION: A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.
Acute Coronary Syndrome ; Angina, Stable ; Angioplasty ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Perfusion ; Stents ; Technetium ; Tomography, Emission-Computed, Single-Photon ; Rosuvastatin Calcium

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of > or =0.5 mg/dL or > or =25% above baseline within 72 hours after PCI. RESULTS: The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84+/-22.59% vs. 2.43+/-24.49%, p=0.038; -11.44+/-14.00 vs. -9.51+/-13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026). CONCLUSION: High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS.
Acute Coronary Syndrome ; C-Reactive Protein ; Contrast Media ; Creatinine ; Glomerular Filtration Rate ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Kidney ; Mortality ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Stents ; Rosuvastatin Calcium

Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that mediates cell proliferation, differentiation, migration, and angiogenesis in vivo. However, the roles of S1P on pathogenesis of arthritis have been not completely understood. This study was designed to determine the effects of S1P modulation on collageninduced arthritis (CIA) model. DBA/1J mice were injected with collagen into the tail for induction of CIA model. S1P was administered into the peritoneal cavity every other days from day 1 to day 42 after collagen injection. To determine the degree of damage in CIA, we examined macroscopic findings of CIA. The inflammation and bone destruction of CIA mice were evaluated by histo-patholigy and radiography (CT and microradiography). The expressions of TNF-alpha, IL-6, and RANKL which have important roles in pathogenesis of rheumatoid arthritis and bone destruction were observed by immuno-histochemical staining. After injection with collagen in the DBA/1J mice, CIA was induced by swelling in the knee and ankle joint. Administration of S1P suppressed damages and incidence of arthritis elicited by collagen. In histologic and radiographic studies, S1P strongly suppressed the infiltration of inflammatory cells, the swelling of synovial membrane, erosion, and the destruction of bone on CIA mice. Injection of S1P resulted in down-regulation of the expression of the pro-inflammatory and bone destruction mediators such as TNF-alpha, IL-6, and RANKL on CIA mice. Furthermore, S1P suppressed the differentiation of bone marrow cells into osteoclasts by RANKL. In conclusion, this study suggest that S1P has protective effects on inflammation and bone destruction during pathogenesis of CIA, which indicates S1P can be a new possible therapeutic strategy for rheumatoid arthritis
Animals ; Ankle Joint ; Arthritis ; Arthritis, Rheumatoid* ; Bone Marrow Cells ; Cell Proliferation ; Collagen ; Down-Regulation ; Incidence ; Inflammation* ; Interleukin-6 ; Knee ; Mice* ; Osteoclasts ; Peritoneal Cavity ; Radiography ; Sphingosine ; Synovial Membrane ; Tail ; Tumor Necrosis Factor-alpha