No abstract available.
C-Peptide* ; Child* ; Diabetes Mellitus* ; Histocompatibility Testing* ; Humans ; Insulin* ; Islets of Langerhans*

No abstract available.
Carcinoma, Squamous Cell* ; Epithelial Cells* ; Porokeratosis*

The angiotensin-converting enzyme (ACE) gene DD homozygote has been suggested to be a significant risk factor for the progression of diabetic nephropathy. We analyzed clinical parameters and ACE genotype distribution between type 2 diabetic patients at the extremes of renal risk, i.e. an end-stage renal failure (ESRF) group (n = 103, group 1) who were on dialysis therapy due to progression of diabetic nephropathy, and a no progression group (n = 88, group 2) who had maintained normal renal function and normoalbuminuria for more than 15 years. There were no significant differences in age, sex, body mass index, HbA1c level, or lipid profiles between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of hypertension [group 1: 82.5% (85/103) vs. group 2: 50.0% (44/88), p < 0.05] and diabetic retinopathy [group 1: 103/103 (100%) vs. group 2: 28/88 (31.8%), p < 0.05] than group 2. Daily urinary albumin excretion was also higher in group 1 than in group 2 [group 1: 2873 +/- 2176 mg/day vs. 12 +/- 7 g/day, p < 0.05]. The frequencies of the DD, ID, and II genotypes of the ACE gene in group 1 and group 2 were 26.2%, 47.6%, and 26.2%, and 7.9%, 57.9%, and 34.2%, respectively. The ACE genotype frequencies between the two groups were significantly different according to a chi-square test with Bonferroni's correction (p = 0.004). The presence of the DD genotype increased the risk of ESRF 4.286-fold compared to the II genotype [odds ratio 4.286, 95% CI 1.60- 11.42, p = 0.005]. The frequency of the D-allele was higher in both male and female patients in group 1 compared to group 2, but reached statistical significance only in males [male, group 1: 50.8% vs. group 2: 35.0%, p = 0.018, female, group 1: 48.8% vs. group 2: 39.5%, p = 0.231]. This study, although limited by sample size, showed that type 2 diabetic ESRF patients more frequently expressed the DD genotype. These findings may substantiate the previously noted relationship between the ACE DD genotype and the progression of diabetic nephropathy in Korean type 2 diabetic patients.
Renal Dialysis ; *Polymorphism, Genetic ; Peptidyl-Dipeptidase A/*genetics/metabolism ; Middle Aged ; Male ; Kidney Failure, Chronic/diagnosis/*genetics ; Humans ; Homozygote ; Gene Frequency ; Female ; Diabetic Nephropathies/diagnosis/*genetics ; Diabetes Mellitus, Type 2/diagnosis/*genetics ; Aged

Etanercept is widely used to treat autoimmune rheumatic, digestive, and dermatologic diseases such as psoriasis. It acts as a competitive inhibitor of tumor necrosis factor (TNF)-alpha and has acceptable safety and tolerability profiles. However, patients occasionally experience serious adverse effects such as infection, malignancy, cardiovascular events, and pulmonary disease. A 43-year-old man with a 10-year history of psoriasis presented with cough and exertional dyspnea that had developed 4 months after the initial etanercept administration. His symptoms continued to aggravate, and chest radiography and high-resolution computed tomography showed a diffuse reticulonodular infiltrate and ground-glass attenuation. As these clinical and radiologic findings suggested drug induced interstitial lung disease, we withdrew etanercept and initiated oral prednisolone treatment. The patient showed gradual improvement of the disease. Interstitial lung disease, although rare, is a potentially fatal adverse effect of TNF-alpha inhibitor treatment. Therefore, we recommend considering the possibility of interstitial lung disease in patients suffering from pulmonary symptoms who are taking TNF-alpha inhibitors.
Adult ; Cough ; Dyspnea ; Humans ; Immunoglobulin G ; Lung Diseases ; Lung Diseases, Interstitial ; Prednisolone ; Psoriasis ; Receptors, Tumor Necrosis Factor ; Stress, Psychological ; Thorax ; Tumor Necrosis Factor-alpha ; Etanercept

This study was performed to investigate the effects of fentanyl in epidural bupivacaine anesthesia for Cesarean section. 45 patients were enrolled in this study. The patients in group I(N=15) received 0.9% NaC1 2ml mixed with 20ml of bupivacaine 0.5%, group II(N=15) received 0.9% NaC1 1ml and fentanyl 50 ug mixed with 20 ml of bupivacaine 0.5%, and group IlI(N =15) received fentanyl 100ug mixed with 20 ml of bupivacaine 0.5%. The time of onset, segmental spread of analgesia, duration of analgesia, changes in arterial blood pressure and heart rate, the incidence of side effects, Apgar score and early neonatal neurobehavioral scale were observed after epidural anesthesia. The results were as follows 1) The time of onset and segmental spread of analgesia were very significantly shorter in group III compared to group I and group lI. 2) The spread of sensory blockade at 30 minutes after epidural injection showed no significant differences among the three groups. 3) The mean duration of analgesia was significantly longer in group IlI compared to group I and II. 4) There were no significant differences in the occurence of side effects among the three groups. 5) There were no significant differences in the Apgar score and early neonatal neurobehavioral scale among the neonates of the three groups. The above results suggested that fentanyl 100ug can be used as a good adjuvant for epidural anesthesia with bupivacaine for Cesarean section.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Apgar Score ; Arterial Pressure ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Heart Rate ; Humans ; Incidence ; Infant, Newborn ; Injections, Epidural ; Pregnancy

This study was performed to investigate the effects of fentanyl in epidural bupivacaine anesthesia for Cesarean section. 45 patients were enrolled in this study. The patients in group I(N=15) received 0.9% NaC1 2ml mixed with 20ml of bupivacaine 0.5%, group II(N=15) received 0.9% NaC1 1ml and fentanyl 50 ug mixed with 20 ml of bupivacaine 0.5%, and group IlI(N =15) received fentanyl 100ug mixed with 20 ml of bupivacaine 0.5%. The time of onset, segmental spread of analgesia, duration of analgesia, changes in arterial blood pressure and heart rate, the incidence of side effects, Apgar score and early neonatal neurobehavioral scale were observed after epidural anesthesia. The results were as follows 1) The time of onset and segmental spread of analgesia were very significantly shorter in group III compared to group I and group lI. 2) The spread of sensory blockade at 30 minutes after epidural injection showed no significant differences among the three groups. 3) The mean duration of analgesia was significantly longer in group IlI compared to group I and II. 4) There were no significant differences in the occurence of side effects among the three groups. 5) There were no significant differences in the Apgar score and early neonatal neurobehavioral scale among the neonates of the three groups. The above results suggested that fentanyl 100ug can be used as a good adjuvant for epidural anesthesia with bupivacaine for Cesarean section.
Analgesia ; Anesthesia ; Anesthesia, Epidural* ; Apgar Score ; Arterial Pressure ; Bupivacaine* ; Cesarean Section* ; Female ; Fentanyl* ; Heart Rate ; Humans ; Incidence ; Infant, Newborn ; Injections, Epidural ; Pregnancy

Aseptic subcutaneous abscesses are characterized by deep, round lesions histologically consisting of neutrophils, without evidence of microorganisms on culture. Although these are sometimes reported in healthy individuals, most are reported in patients with inflammatory bowel disease, including Crohn's disease and ulcerative colitis. A 79-year-old man without underlying disease presented with multiple skin-colored nodules and masses on his face and extremities 4 years ago. All of the microbiology studies for bacteria and fungi were negative and he did not respond to antibiotics. However, the lesions improved markedly after systemic prednisolone treatment. We diagnosed his lesions as aseptic subcutaneous abscesses. Further studies to evaluate inflammatory bowel disease were negative. Here, we report a case of multiple aseptic subcutaneous abscesses without an underlying disease.
Abscess* ; Aged ; Anti-Bacterial Agents ; Bacteria ; Colitis, Ulcerative ; Crohn Disease ; Extremities ; Fungi ; Humans ; Inflammatory Bowel Diseases ; Neutrophils ; Prednisolone

No abstract available.
Cicatrix* ; Lasers, Dye* ; Sarcoidosis*

BACKGROUND AND OBJECTIVES: To determine appropriate counseling time for the first hearing aids user, we measured the effectiveness of first counseling time limit of 20 minutes for those who need hearing aids and collected predictive parameters during history taking. SUBJECTS AND METHOD: We reviewed the medical records of 956 patients (age 66.5±12.1) with hearing impairment who needed hearing aids. We divided patients into two groups, those who had counseling time limited to 20 minutes and others who had no time limitation. Job status, working condition of noise status, social activity and audiological variables were analyzed as probable predicting factors influencing the purchasing of the hearing aid (penetration rate). RESULTS: Of the total 956 patients, 48.64% of subjects decided to purchase hearing aids at first counseling. The two groups showed no significant difference (p=0.396): 49.81% of the group without time limitation purchased the hearing aid and 47.04% of those with time limitation purchased the aid. The social status, right side pure tone threshold and right side tinnitus were significant for calculating the explanation power (64.15%) in the hearing aid uptake probability equation. CONCLUSION: The level of social activity, hearing threshold and tinnitus were predictive variables obtained during the counseling. The time limitation of 20 minutes did not affect the rate of decision to purchase hearing aids. These results might help hearing clinics improve efficient time management at hearing aid clinics.

It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.
Adult ; Blood Pressure ; Brain ; Brain Edema ; Craniocerebral Trauma* ; Emergencies ; Emergency Service, Hospital ; Fractures, Multiple ; Glasgow Coma Scale ; Head* ; Heart Rate ; Hemoperitoneum ; Hemorrhage ; Humans ; Intracranial Pressure ; Joints ; Methods ; Motorcycles ; Multiple Trauma ; Neurosurgery ; Oxygen ; Pupil ; Rehabilitation ; Respiratory Rate ; Splenectomy* ; Subarachnoid Hemorrhage ; Trauma Centers ; Ultrasonography ; Vital Signs