The rupture of ventricular septum complicating acute myocardial infarction requires prompt recognition for the correct management of the patient. The diagnosis of this condition had required right heart catheterization. We performed two-dimensional and Doppler echocardiography in patients with systolic murmur after acute myocardioal infarction. Ventricular septal defect was found at lower interventricular septum by mapping technique of pulsed wave Doppler system and obtained high velocity Doppler tracting by continuous wave Doppler echocardiography. Doppler echocardiography could be useful noninvasive method for detection of ventricular septal rupture after acute myocardial infarction.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography, Doppler ; Heart Septal Defects, Ventricular* ; Humans ; Infarction ; Myocardial Infarction* ; Rupture ; Systolic Murmurs ; Ventricular Septal Rupture ; Ventricular Septum

Compliance of epileptic patients is one of the most important factors for adequate therapy. Recently, it had been shown that the variability of three serial measurement of the serum levels of antiepileptic drug(AED) may be used as an indication of the degree of compliance. Coefficient variation(CV) of serum drug levels calculated by only one AED had been used to determine the compliance in epileptic patients who took multiple AEDs. We attempted to evaluate the CV of AEDs and then find the objective clue of compliance and the compatible therapeutic planing according to CV. Ninety seven epileptic patients of outpatients department of the Gyengsang National University Hospital were entered to this study. All patients were taking medication at least for 6 months without any changes of drug regimen. Patient's information was acquired by reviewing the chart and interview with questionnaire. With these informations, we determined the compliance of the patients. Antiepileptic serum levels were measured three times at intervals of at least two to four weeks apart, and their CV was calculated. We compared the CV between the compliant and non-compliant group in each AED(phenytoin, carbamazepine , valproic acid) and three drugs in the compliant group. The mean CVs of phenytoin, carbamazepine and valproic acid in the compliant group were 18.3+/-13.0, 15.2+/-10.2 and 23.8+/-8.9, respectively(mean+/-SD). The mean of CV in the compliant and the non-compliant group were 17.9+/-10.9 and 38.8+/-27.2, respectively. The CVs of the compliant group were significantly lower than those of the non-compliant group(p<0.05). However, CVs had no significant difference between three antiepileptic drugs. This study showed that CVs of AEDs were not different between each AEDs, even though they possess different pharmacokinetic properties. Therefore, the CV of one AED can be used in determining the compliance of the epileptics who are taking multiple AEDs.
Anticonvulsants ; Carbamazepine* ; Compliance ; Humans ; Outpatients ; Phenytoin* ; Surveys and Questionnaires ; Valproic Acid*

PURPOSETo review evidence-based management of nephropathy in patients with type 2 diabetes.

DATA SOURCESA literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.

DATA EXTRACTIONData and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.

RESULTSHypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions.

CONCLUSIONSDiabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.

Albuminuria ; diagnosis ; therapy ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; epidemiology ; therapy ; Dietary Proteins ; administration & dosage ; Humans ; Hyperlipidemias ; therapy ; Hypertension ; therapy

OBJECTIVES: To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. METHODS: A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. RESULTS: A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. CONCLUSIONS Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.
Child ; Humans ; Esophageal Stenosis/therapy* ; Constriction, Pathologic/complications* ; Dilatation/methods* ; Caustics ; Retrospective Studies ; Treatment Outcome

PURPOSE: The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this diversity in epithelial types. METHODS: According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group I), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group II), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome. RESULTS: None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8 16.9 mmHg and 67.1 21.3 mmHg in group I, and 61.1 22.7 mmHg and 90.0 38.6 mmHg in group II, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group I and from 86.5% to 53.9% in group II, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2 26.1 ml and 2.8 3.3 to 163.3 115.7 ml and 14.7 15.3 in group I (P=0.0001, and <.0001, respectively), and from 77.0 59.5 ml and 4.4 6.8 to 167.3 87.9 ml and 28.7 44.0 in group II (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011). CONCLUSIONS: Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.
Anal Canal* ; Colitis, Ulcerative ; Colonic Pouches* ; Compliance ; Epithelium ; Humans ; Male ; Proctocolectomy, Restorative ; Reflex

PURPOSE:Solitary rectal ulcer syndrome (SRUS) is a poorly understood clinical condition and its scheme of treatment has not been defined yet. The aim of this investigation was to review the clinical spectra and outcome of various surgical treatments in patients with SRUS, thus to define more rational approach to the management of this ambiguous condition. METHODS:The study population was composed of 49 patients, among whom 20 patients (18 females and 2 males; median age, 55) were diagnosed primarily as SRUS histopathologically (=primary SRUS). Reviewing all pathologic reports and slides from specimens resected surgically in patients with rectal prolapse, another 20 cases were diagnosed to be combined with SRUS. Other 9 patients included those who were diagnosed histologically as or to be combined with SRUS after the operation for an indication other than SRUS. The latter 29 cases (26 females and 3 males; median age, 72) were defined as secondary SRUS, and then differences in clinical features and outcome of surgical treatment between 2 groups were reviewed retrospectively. The median follow-up was 24 months (range, 5-49 months). RESULTS:Ulcerative morphology was predominant in primary SRUS (70 percent), whereas erythematous (45 percent) and polypoid (34 percent) in the secondary ones. This difference in morphologic distribution between two groups was significant statistically (P=0.0025). No statistical difference was observed for symptomatologic distributions between two groups. The most common problem associated with evacuation was rectal bleeding in both groups (85 percent and 76 percent, respectively). In primary SRUS, clinical and defecographic studies revealed a rectal prolapse in 5 patients (25 percent), intussusception in 11 patients (55 percent), sigmoidocele (2 degrees) in 4 (20 percent), and paradoxical puborectalis contraction (PPC) in 3 (15 percent) to be combined. Beside rectal prolapse in secondary group, other defecographic findings associated with possible evacuatory problem included sigmoidocele (2 degrees) in 5 (25 percent), rectocele and intussusception in 2 (10 percent), respectively. Clinical improvement after surgery was obtained in 14 of 19 procedures (74 percent) in 17 patients with primary SRUS and 23 of 29 (79 percent) in secondary SRUS, the difference of which was not significant. Though statistically not significant, transabdominal rectopexy was superior to local excision for symptomatic relief in primary SRUS without overt prolapse (86 percent vs. 33 percent). Neither of changes in the percentage of symptoms before and after the operation between two groups showed significance. Clinical and pathologic variables were compared between two treatment result groups of 'improvement' and 'no improvement' and manifestations as tenesmus and digitation correlated with a poorer outcome after surgery (P=0.0065 and 0.02, respectively). CONCLUSIONS:SRUS is rather a clinical condition associated with functional anorectal evacuatory disorders than an independent disorder. This study shows optimistic role of a surgical treatment against underlying functional disorders in the improvement of secondary SRUS. Proper surgical option, however, for treatment in variable clinical spectra of primary SRUS is still not established, which awaits a conclusion from extensive prospective randomized trials.
Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Intussusception ; Male ; Prolapse ; Rectal Prolapse ; Rectocele ; Retrospective Studies ; Ulcer*

OBJECTIVETo investigate the relative effects of degree and distribution of body fat with several cardiovascular disease (CVD) risk factors in elderly Chinese subjects.

METHODSOne hundred and thirty-five elderly Chinese individuals (age range, 60-65 y) without any history of significant renal, hepatic or cardiac disease were recruited. Seated blood pressure, anthropometric and fasting plasma biochemical parameters were measured. Student's t-test was used to compare the differences in biochemical and anthropometric markers between cohorts.

RESULTSMales were heavier (64.6 +/- 8.6, 57.2 +/- 8.2kg, P < 0.001), taller (1.65 +/- 0.06, 1.51 +/- 0.05 m, P < 0.001) and their greater body fat was predominantly deposited centrally (Waist-to- hip ratio, 0.91 +/- 0.06, 0.88 +/- 0.07, P < 0.05). Females were more generally obese with increased body mass index (BMI, 23.8 +/- 4.6, 25.0 +/- 3.5 kg/m2, P < 0.05) and percentage body fat [26.3% (24.5%-28.1%) vs 37.2% (36.0%-38.9%), P < 0.001] than the males. However, despite an 11% higher proportion of body fat in females, no significant differences were identified in blood pressure, lipid profile, indices of insulin resistance or albumin-to-creatinine ratios.

CONCLUSIONIt is likely that central adiposity contributes disproportionately to these metabolic disorders in males even though they are much leaner than elderly Chinese females.

Adult ; Aged ; Body Mass Index ; Cardiovascular Diseases ; etiology ; Female ; Humans ; Male ; Middle Aged ; Obesity ; complications ; Risk Factors

C-C chemokine receptor type 5 (CCR5) regulates the trafficking of various immune cells to sites of infection. In this study, we showed that expression of CCR5 and its ligands was rapidly increased in the kidney after systemic Candida albicans infection, and infected CCR5−/−mice exhibited increased mortality and morbidity, indicating that CCR5 contributes to an effective defense mechanism against systemic C. albicans infection. The susceptibility of CCR5−/− mice to C. albicans infection was due to impaired fungal clearance, which in turn resulted in exacerbated renal inflammation and damage. CCR5-mediated recruitment of NK cells to the kidney in response to C. albicans infection was necessary for the anti-microbial activity of neutrophils, the main fungicidal effector cells. Mechanistically, C. albicans induced expression of IL-23 by CD11c+ dendritic cells (DCs). IL-23 in turn augmented the fungicidal activity of neutrophils through GM-CSF production by NK cells. As GM-CSF potentiated production of IL-23 in response to C. albicans, a positive feedback loop formed between NK cells and DCs seemed to function as an amplification point for host defense. Taken together, our results suggest that CCR5-mediated recruitment of NK cells to the site of fungal infection is an important step that underlies innate resistance to systemic C. albicans infection.

Objective: Data from the surveillance program was collected, to analyze the situation of hospitalization and cases of death with recorded causes, in Shenzhen, from 1995 to 2014. Situation of hospitalization and causes of deaths were studied in Shenzhen which had been a fast-developing city with growing number of immigrants so as to provide reference for decision-making on related prevention and control strategies. Methods: Data on hospitalizations and deaths collected from the surveillance program, were classified by both International Classification of Diseases (ICD)- 9 and ICD-10. A database was constructed with methods on related descriptive and trend analysis. Results: Around 6.3 million inpatients were seen in the past two decades in Shenzhen. The top five diseases for hospitalization were pregnancy childbirth and puerperium complications, respiratory diseases, injury and poisoning, digestive system diseases and circulatory system diseases, that accounting for 68.4% of all the hospitalization burden. The number of inpatients increased annually, with an 11 times increase during the past two decades. Proportions for pregnancy childbirth and puerperium complications, circulatory system diseases and urinary system diseases all showed increasing (χ(2)=53 806.94, 6 893.95 and 15 383.14, P<0.01), while proportions for injuries and poisoning, respiratory diseases, digestive system diseases showed a declining trend (χ(2)=131 480.09,1 711.84 and 11 367.66, P<0.01). Number of cumulative inpatient deaths exceeded 60 000, with the top five causes as malignant tumor, circulatory system diseases, injury and poisoning, respiratory system diseases and digestive system diseases, that accounting for 82.28% of all the inpatient deaths. Deaths due to circulatory system diseases, injury and poisoning increased and then decreased. Malignant tumor and respiratory diseases-induced deaths showed an increasing trend (χ(2)=1 546.48, 309.55, P<0.01), while induced deaths from disease of the other systems showed slight changes. The overall case fatality rate showed an annual decline (χ(2)=4 378.63, P<0.01), from 2.23% in 1995 to 0.74% in 2014, with mortality attribute to tumor, circulatory system disease decreased significantly. Conclusions: Shenzhen had been under an ageing transition, with relatively young population living in the city. Chronic diseases such as tumor gradually had become the major causes for heavy hospitalization burden on the population of Shenzhen.
Cardiovascular Diseases/epidemiology* ; Cause of Death ; China/epidemiology* ; Female ; Global Burden of Disease ; Hospitalization/statistics & numerical data* ; Humans ; Neoplasms/epidemiology* ; Pregnancy ; Pregnancy Complications/epidemiology* ; Respiratory Tract Diseases/epidemiology*

Purinergic P2Y Receptor Antagonists ; Consensus ; Cardiovascular System ; Cardiology ; Asia