No abstract available.
Intra-Abdominal Fat*

BACKGROUND: Circardian variation in the onset of cardiovascular events includig sudden cardiac death, myocardial infarction and ventricular arrhythmias has been discribed. The frequency of ventricular premature complexes has also been reported to demonstrate a pattern consisting of a daytime peak and nightime nadir. We tried to see if the same circardian pattern is found in dilated cardiomyopathy patients. We have also studed how various modifying factors such as left ventricular ejection fration and ACE inhibitor use may affect the circardian pattern. METHOD: 24-hour ambulatory electrocaridiographic monitorings were performed in 50 dilated cardiomyopathy patients and 20 control subjects. Patients were prospectively divided in 2 groups based on LVEF and ACE inhibitor use. RESULTS: In dilated cardiomyopathy patients, the expected morning increase in VPC frequency is absent and show a peak in evening. This pattern is not correlated with heart rate. Evening peak is more prominent in low LVEF group and ACE inhibitor non-user group. CONCLUSION: In dilated cardiomyopathy patients, VPC frequency show a peak in the evening.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Heart Rate ; Humans ; Myocardial Infarction ; Prospective Studies ; Ventricular Premature Complexes*

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.
Adult ; Anesthesia* ; Blood Pressure ; Bradycardia ; Ephedrine* ; Heart Rate ; Hemodynamics* ; Humans ; Intubation ; Propofol* ; Syringes ; Vital Signs

There are many procedures described for the treatment of acromioclavicular joint dislocation. Most of them, however, have elther technical difficulties or many complications following the operation. Dewar and Barrington procedure was described originally for the old dislocation of the acromio-clavicular joint. However, we have had applied it for the fresh dislocation of the acromioclavicular joint as well as for old one. So far, we have treated 18 cases of fresh dislocations of the acromioclavicular joint together with 3 case of old dislocations from March 1976 to June 1979. The brief summary of the observatlons made are as follows: 1. Among 21 cases, all were grade III by Allman. The age distribution was from 19 to 65 years old. The most common cause of the injury was a traffic accident and the most frequent mechanism of injury was a direct blow. 2. All were treated with Dewar and Barrington procedure and 11 excellent, 7 good, 2 fair and one poor cases were observed in the end result. 3. The impression was that Dewar and Barrington procedure was a excellent procedure for the treatment of fresh acromioclavicular joint dislocation as well as old one.
Accidents, Traffic ; Acromioclavicular Joint ; Age Distribution ; Dislocations ; Joints

PURPOSE: Acute kidney injury is a critical complication in patients intensive care unit (ICU) and shows high mortality. After development of continuous renal replacement therapy (CRRT), there were many conflicting data for patient survival. We want to find out which parameter shows strong correlation in the survival of patients undergoing CRRT in intensive care unit. METHODS: Total 85 patients were enrolled who had been treated with CRRT in ICU. We compared the differences in clinical parameters between survivors with non-survivors. RESULTS: Mean age of the patients was 62.0+/-15.6 and 57 patients were male (67.1%). Out of 85 patients, 39 patients survived (45.9%). Mean duration of CRRT was 103.5+/-178.8 hours and mean Acute Physiology And Chronic Health Evaluation (APACHE) III score was 90.6+/-22.6. There were significant differences between survivors and non-survivors in APACHE III score (p=0.004), time to initiation of CRRT (p=0.05), systolic blood pressure at initiation of CRRT (p=0.001), arterial [H+] (50.18 vs. 84.19, p=0.001), respectively. But there was no difference in the age, sex, the level of pre CRRT blood urea nitrogen, duration of ICU admission, hypoxemia and hemoglobin level. CONCLUSION: Earlier initiation of CRRT and protection from metabolic acidosis were strongly associated with the survival of the patient with acute kidney injury in ICU.
Acidosis ; Acute Kidney Injury ; Anoxia ; APACHE ; Blood Pressure ; Blood Urea Nitrogen ; Hemodiafiltration ; Hemoglobins ; Humans ; Intensive Care Units ; Male ; Prognosis ; Renal Replacement Therapy ; Survivors

Authors reviewed 39 cases of proximal or distal fracture which had been managed with Ender flexible intramedullary nails to identify the proper region of tibial fracture for the nail and acceptable indication of retrograde nailing relevant to our clinical experiences. The results were as followings; l. Incidence of malunion with more than 10° of angulation was higher in the fracture of proximal 1/3 tibia than that of distal 1/3. Especially this phenomenon was more significant in case of combination with segmental fracture. 2. As all segmental fractures combined with proximal tibial fracture within 9cm from the plateau were malunited with angulation of 10° or more, another method of internal fixation should be considered. 3. Although degree of angulation was relatively larger in distal tibial fracture within 10cm from the plafond than that beyond 10cm and 2 cases of malunion with angulation of 10° or more were also found within 10cm from tibial plafond, there was no statistically significant difference. 4. Retrograde nailings were performed for 5 cases of proximal 1/3 fractures and 1 case of poor skin condition on the proximal entry. Clinical relevance: Suitable region of tivial fracture managed with Ender-flexible intreamedullary nail was fracture which occurred from 9cm distal to tibial plateau to 10cm proximal to tibial plafond.
Incidence ; Methods ; Skin ; Tibia ; Tibial Fractures

In patients undergoing hemodialysis, spontaneous bleedings have been reported in locations such as mediastinum, subdural space, retroperitoneum, pericardial and pleural cavities. A 61 year-old woman had been treated three times a week with maintenance hemodialysis via tunnelled cuffed central venous catheter for 4 months. She had a sudden onset of severe pain on right chest wall 24 hours after maintenance hemodialysis. We found that her right upper chest wall was swollen. Urgent computed tomography revealed a soft tissue mass with high density in right chest wall. The lesion was enhanced by contrast but was not clearly marginated in arterial phase. We did emergent hemodialysis, and did transfusion of packed red blood cells and fresh frozen plasma and compressed locally on her right chest wall. Hematoma was spontaneously resolved only after supportive care. Therapeutic approaches to uremic patients with bleeding disorders include angiography, hemodialysis, peritoneal dialysis, transfusion of packed red cells and fresh frozen plasma, infusion of erythropoietin, desmopressin, conjugated estrogen, etc. In this case, spontaneous bleeding without trauma history can occur in patients with endstage renal disease who underwent hemodialysis using catheter. Therefore, immediate treatment should be followed when evidence of bleeding is found.
Angiography ; Catheters ; Central Venous Catheters ; Deamino Arginine Vasopressin ; Erythrocytes ; Erythropoietin ; Estrogens ; Female ; Hematoma ; Hemorrhage* ; Humans ; Kidney Failure, Chronic ; Mediastinum ; Middle Aged ; Peritoneal Dialysis ; Plasma ; Pleural Cavity ; Renal Dialysis* ; Subclavian Artery* ; Subdural Space ; Thoracic Wall

Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR <15mL/min per 1.73m2) and 40 patients with stage 4 CKD (eGFR 15 to 30mL/min per 1.73m2) who had a total CO2 less than 22mEq/L were assigned into the bicarbonate treatment group or control group for 12 months. In stage 4 CKD, there were significant differences in the changes of eGFR during the study between the treatment group and the control group (-2.30+/-4.49 versus -6.58+/-6.32mL/min/1.73m2, p<0.05). However, in stage 5 CKD, there were no significant differences in the change of eGFR during the study between the two groups (-2.10+/-2.06 versus -3.23+/-1.95mL/min/1.73 m2).There were no significant differences in the changes of nutritional indices such as albumin, prealbumin, transferrin, total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.
Acidosis ; Alkalies ; Glomerular Filtration Rate ; Humans ; Lymphocyte Count ; Malnutrition ; Nutrition Assessment* ; Prealbumin ; Renal Insufficiency, Chronic* ; Sodium Bicarbonate ; Transferrin

A 12-year-old female with histiocytosis X accompanied by autoimmune hemolytic anemia. During the episode of hemolysis, the hemoglobin level fell to 5.2 g/dL. The direct antiglobulin test was weakly positive. The anti-C and anti-e were identified in her serum. The Rh subgroup of her family(father, mother and brother) including the patient, were all same as DCe. The antibodies which showed anti-C and anti-e specificity were confirmed autoanti-Ce(non-separable) using the serum absorbed with various known Rh phenotyped RBCs. Two packed RBCs phenotyped as DeE were transfused for correction of anemia. Acute and delayed hemolytic transfusion reactions were not noted after transfusion. Identification of blood group specific autoantibodies may be benificial in such case for blood transfusion.
Anemia ; Anemia, Hemolytic, Autoimmune* ; Antibodies ; Autoantibodies ; Blood Group Incompatibility ; Blood Transfusion ; Child ; Coombs Test ; Female ; Hemolysis ; Histiocytosis, Langerhans-Cell ; Humans ; Mothers ; Sensitivity and Specificity

The authors report a case of monostotic eosinophilic granuloma which occured in the skull. A 37 year-old woman was presented with headache and soft mass in the occipital region. Plain skull X-ray showed a "punched out" osteolytic lesion in the right paramedian posterior parietal bone. Computed tomography shows a soft tissue mass and irregular bone destruction in corresponding region. On magnetic resonance image, the mass was of high signal intensity, with subgaleal extension and looks like a shirt stud or "collar button" on T2-weighted image. Total excision of the tumor and postoperative radiotherapy(1000cGy) were performed. The woman had no headache complains nor showed any focal neurologic deficit during the six months follow-up period. We report a case of monostotic eosinophilic granuloma of the skull with review of the pertinent literatures.
Adult ; Eosinophilic Granuloma* ; Eosinophils* ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parietal Bone ; Skull*