PURPOSE: This paper studies the influence of the case-management program on the change of blood sugar, lifestyle, and knowledge level of diabetes mellitus (DM) for medium-sizedenterprise employees suffering from DM. METHOD: Subjects, divided into experimental and control groups, are 59 workers with FBS higher than 126mg/dl or under DM medication treatment in the medium-sized enterprises, being managed by two distinct university hospital group occupational health management service teams. The case management program for DM patients consists of 6 different processes in which each subject is treated. RESULT: FBS decreased in the experimental group after the program, while that of the control group increased significantly. In the experimental group, the amount of smoking, the frequency of drinking and the amount of drinking per week decreased. Also, the knowledge level for DM and the change of nutrition management showed significant increase. In the control group, the amount of smoking increased and the frequency of drinking, the amount of drinking and nutrition level did not change significantly. And the knowledge level for DM decreased. CONCLUSION: We expect that taking this case management program for DM management may significantly improve diabetic patients' overall health.
Blood Glucose ; Case Management ; Diabetes Mellitus ; Drinking ; Humans ; Life Style ; Occupational Health ; Smoke ; Smoking ; Stress, Psychological

No abstract available.
Arnold-Chiari Malformation* ; Diagnosis* ; Prenatal Diagnosis* ; Ultrasonography*

No abstract available.
Elbow*

OBJECTIVES: This study was performed to investigate the relationship between age of onset in late-life depression and T2 hyperintensities observed in the brain MRI, we tried to see part of pathophysiology of late-life depression. METHOD: The subjects consisted of 18 patients whose first depressive episode occurred before age 50, and 20 patients whose first depressive episode occurred after age 50 years, and 20 agematched controls. Depressive patients were diagnosed according to DSM-IV. Established hyperintensity rating systems were used to analyse the T2 weighted images and blood pressure, cholesterol level, DM, EKG were measured to compare the relationships. RESULTS: 1) Signal hyperintensities on T2 weighted image were more severe in late-life depressive patients whose first depressive episode after age 50 (p<0.05) and there is no significant difference between patients whose first episode before age 50 and age-matched control subjects. 2) Mild signal hyperintensities were observed in all elderly depressed patients and control subjects, but severe hyperintensities were observed in late-onset depression. 3) Signal hyperintensities were related to age, hypertension, blood cholesterol level (p<0.05). CONCLUSION: The late onset depressive patients had more white matter hyperintensities on T2 weighted image than early onset depressive patients. this results support previous hypothesis that white matter change is the important biological factor of late-onset elderly depression and old age, hypertension, hypercholesterolemia may be associated with signal hyperintensities.
Age of Onset ; Aged ; Biological Factors ; Blood Pressure ; Brain* ; Cholesterol ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Electrocardiography ; Humans ; Hypercholesterolemia ; Hypertension ; Magnetic Resonance Imaging*

No abstract available.
Syringomyelia*

OBJECTIVE: To document the outcome of the conservative treatment in plantar heel pain patients. Specific objectives included the evaluation the difference of outcome between patients, who revealed the different clinical menifestation, and the evaluation of prognostic factors. METHOD: We devided the plantar heel pain patients to two groups by the location of maximal tenderness on the heel(Group A - localized severe tenderness over the medial calcaneal tuberosity, Group B - diffuse tenderness over the central heel) and performed the conservative treatment according to a standard protocol(relative rest,nonsteroidal anti-inflammatory medications and stretching exercise during initial 2 weeks. And then viscoelastic polymer heel cushion, functional custom-made insole for all patients. Steroid injections were used for the patients of Group A who suffer from pain despite of standard treatment. In order to evaluate the results, we reviewed all charts and conducted the follow-up survey by questionnairs. 21 patients(8 males, 13 females; 26 heels; average age, 47.9 years; 15 group A, 6 group B) were available for review. RESULTS: The average follow-up was 9 months. Clinical results were classified as good(resolution of symptoms) for 3 patients, fair(continued symptoms but no limitation of activity) for 13 patients, poor(continued symptoms limiting activity) for 5 patients. The overall successful improvement(including good and fair) were 76.2% within 2.6 months. There were no significant difference of the successful improvement between two groups, which were 73.3% in group A, 83.3% in group B. The overweight was the only predictive factor of poor result. CONCLUSION: The outcome of a conservative treatment in patients with plantar heel pain is successful. But it is not different in spite of difference of clinical menifestation.
Female ; Follow-Up Studies ; Heel* ; Humans ; Male ; Overweight ; Polymers

OBJECTIVE: To study the relationship between plantar pressure and diabetic foot ulcer and the assessment the usefulness of plantar pressure measurement in diabetic patients. METHOD: The total 94 diabetic patients were enrolled in this study. The plantar pressure was measured by using EMED-SF. And the nerve conduction studies, physical examination, and history taking were done. Patients were divided into 3 subgroups, Group A: without neuropathy and past ulcer history (n=31), Group B: with neuropathy and without past ulcer history (n=44), Group C: with neuropathy and past ulcer history (n=19). RESULTS: 1) There were significant increase in the maximum peak pressure (MPP) and the pressure-time integral (PTI) values in the Group C as compared with the Group A and B (p<0.05). 2) As compared among the groups for each areas, the MPP and the PTI significantly higher in group C for heel, medial fore-foot, and lateral fore-foot area than in another two groups (p<0.05). CONCLUSION: The high plantar pressure was significantly related with diabetic foot ulcer history. The plantar pressure measurement may be useful in diabetic patients as a predictive and management aids of diabetic foot ulcer.
Diabetes Mellitus ; Diabetic Foot ; Heel ; Humans ; Neural Conduction ; Physical Examination ; Ulcer

PURPOSE: Acute lung injury/acute respiratory distress syndrome is common following major trauma, and is one of the most important causes of mortality and morbidity. Compared with gelatine, resuscitation with hydroxyethyl starch (HES) reduces posttrauma capillary leak. Furthermore, hypertonic saline (HTS) is known as a promising fluid resuscitation therapy with the potential to reduce lung injury caused by severe trauma. The aim of this study was to test the hypothesis that resuscitation with mixed fluids, HTS and HES, will reduce inflammation in hemorrhagic shock induced by acute lung injury compared to control (sham injury) or to either fluid alone. METHODS:Spraque-Dawley (SD) rats were divided into five groups randomly: Group I were cannulated but not bled (sham); Group II bled and received Ringer's lactated solution; Group III bled and received 7.5% HTS; Group IV bled and received HES; Group V bled and received a mixeture of HTS and HES (HTS-HES). After anesthetizing the rat, two catheters were inserted into femoral vessels: the femoral artery for monitoring blood pressure and pulse rate; the femoral vein for bleeding and fluid resuscitation. Blood sampling was done for arterial blood gas analysis (ABGA), Tumor necrosis factor-alphaTNF-alpha, Interleukin-6 (IL-6) before shock, after fluid resuscitation and after 48 hours of survival. Bronchoalveolar lavage (BAL) and a lung histology study were conducted in surviving rats. RESULTS: Survival rates were as follows; Group I, 80%; Group II, 100%; Group III, 70%; Group IV, 70%; Group V, 100%. There were no significant between group differences in initial ABGA, hemoglobin, or TNF-alpha TNF-alphaevels postresuscitation were significantly higher in group II compared to groups IV and V. After 48 hours of survival, TNF-alphaas higher in groups IV and V than in group II. After survival, The IL-6 level of group V was significantly lower compared to that of the control group. IL-6 levels in BAL fluid were higher in groups IV and V than in groups I and II. Lung injury histology scores were significantly higher in groups IV and V than in the control group. CONCLUSION: After moderate hemorrhagic shock, lung injury is more severe in rats resuscitated with HTS-HES than in the control groups.
Acute Lung Injury ; Animals ; Blood Gas Analysis ; Blood Pressure ; Bronchoalveolar Lavage ; Capillaries ; Catheters ; Femoral Artery ; Femoral Vein ; Gelatin ; Hemoglobins ; Hemorrhage ; Hetastarch ; Inflammation ; Interleukin-6 ; Lung ; Lung Injury ; Necrosis ; Rats ; Resuscitation ; Saline Solution, Hypertonic ; Shock ; Shock, Hemorrhagic ; Starch ; Survival Rate ; Tumor Necrosis Factor-alpha

We investigated the use of ulinastatin in association with the suppression of polymorphonuclear leukocyte elastase (PMNE), tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6), and its effects on the prognosis of patients with traumatic hemorrhagic shock. Nineteen patients who visited the emergency department for traumatic hemorrhagic shock were enrolled. Eleven patients were randomly selected to receive a total of 300,000 IU of ulinastatin. Measurements of serum PMNE, TNF-alpha and IL-6 were taken before ulinastatin treatment at 24 hr, two days, three days, and seven days after admission. We compared the Systemic Inflammatory Response Syndrome scores, Multiple Organ Dysfunction Syndrome scores and Acute Physiology, age, Chronic Health Evaluation III scores of the control and ulinastatin groups. There were no significant differences in baseline values, laboratory data, treatment or mortality between the two groups. The serum PMNE levels in the ulinastatin group were lower than in the control group on the second hospitalized day. Serum TNF-alpha and IL-6 levels in the ulinastatin group decreased 24 hr after admission but had no significance. It is suggested that ulinastatin treatment could decrease the serum PMNE levels in trauma patients with hemorrhagic shock at 48 hr after treatment.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use ; Female ; Glycoproteins/*therapeutic use ; Humans ; Interleukin-6/blood ; Leukocyte Elastase/blood ; Male ; Middle Aged ; Severity of Illness Index ; Shock, Hemorrhagic/*drug therapy ; Tumor Necrosis Factor-alpha/blood

OBJECTIVES: This study was performed to determine whether the corpus callosum is involved in pathophysiology of schizophrenia and measured corpus callosal areas of first episode, chronic schizophrenic patients and controls. METHODS: We obtained the brain magnetic resonance imaging of 23 schizophrenic inpatients(15 males, 8 females)and 23 controls(11 males, 12 females)with simple headache or dizziness. Among the schizophrenic group, first episode patients were 13, chronic patients were 10. In mid-sagittal plane, the corpus callosum was divided into 7 areas and the cerebral area was measured. This data was analyzed with NIH image 1.60 software. We compared the corpus callosal areas of schizophrenics with controls by t-test and by ANOVA according to sex. Thereafter, ANCOVA was performed with mid-sagittal cerebral area as covariant. Comparison of first episode, chronic schizophrenics and controls was carried out by MANCOVA that was adjusted with age and mid-sagittal cerebral area. RESULTS: The schizophrenics, compared with controls, had smaller corpus callosal areas except for the 3rd, 6th callosal area, but statistical significance was absent. According to sex, male schizophrenics had insignificantly smaller total callosal areas than male controls and female schizophrenics had larger ones. In comparision of first episode, chronic schizophrenic patients and controls, first episode patients had smaller every corpus callosal areas than chronic ones, chronic ones had larger total callosal area than controls and first episode ones had smaller total area than controls, but statistical significances were absent also. CONCLUSION: Our study did not reveal the structural abnormality of corpus callosum in schizophrenic patients, but many controversial results have been reported in other studies. This inter-study inconsistency could be explained by the hypotheses of not only clinical but also biological different phenotypes within the schizophrenia.
Brain ; Corpus Callosum ; Dizziness ; Female ; Headache ; Humans ; Magnetic Resonance Imaging* ; Male ; Phenotype ; Schizophrenia