No abstract available.
Cystitis* ; Eosinophils* ; Urinary Bladder Calculi* ; Urinary Bladder*

No abstract available.
Echocardiography* ; Humans ; Infant, Newborn*

No abstract available.
Pulmonary Blastoma*

Bezafibrate, a fibric acid derivative related to clofibrate, is being used increasingly in the treatment of hypertriglycemia. It is relatively well tolerated at usual dosage, and has a low incidence of adverse reactions. But we had recently observed a reversible deterioration of renal function requiring hemodialysis, presumed to be caused by bezafibrate treatment in a patient with diabetic nephropathy. A 55 year old man was admitted with complaints of general weakness and painful lower extremities. He had taken bezafibrate (200 mg every 12 hours) for the previous 4 months because of hypertriglycemia. After admission, the drug was withdrawn, and he was treated conservatively management with hydration and diuretics for bezafibrate induced rhabdomyolysis. Nevertheless, his symptom was not improved, so he was taken even hemodialysis. These findings suggested that bezafibrate should be admistered with great caution to patient with renal insufficiency. When it is admistered, CK, LDH, aldolase, and sGOT levels have to be checked for early detection of potential side effect.
Aspartate Aminotransferases ; Bezafibrate* ; Clofibrate ; Diabetic Nephropathies ; Diuretics ; Fructose-Bisphosphate Aldolase ; Humans ; Incidence ; Lower Extremity ; Middle Aged ; Renal Dialysis ; Renal Insufficiency ; Rhabdomyolysis*

Combined resection of the spleen during total gastrectomy for gastric cancer is usually performed to remove the lymph nodes adequately and thereby achieving surgical radicality. However there is still controversy whether a total gastrectomy combined with a splenectomy can improve the survival rate. The authors retrospectively analyzed 557 gastric cancer patients, who underwent total gastrectomy at the Department of Surgery of Yonsei University during the 7-year period between 1987 and 1993, in order to investigate the influence of combined resection of the spleen upon the patients' survival. The patients were followed until March 1996, and the rate of follow up was 90.6%. The number of cases in which the spleen was saved was 101(the spleen conservation group, SC) and the number of cases in which the spleen was resected was 431(the spleen resection group, SR). Twenty-five cases were excluded due to incomplete data. Among the 431 cases for whom splenectomy was done, 343 were cases in which spleen was the only organ removed other than the stomach (SOR). For the other 88 cases, at least 1 more organs were resected along with the stomach and the spleen(Sp combined). There were no significant differences in the clinical characteristics such as age, sex ratio, tumor size, depth of invasion, nodal stage, TNM stage and histological type between SC and SOR group. In terms of the nodes removed during operation, there was significant difference between the SC and the SOR groups. Also, the Sp combined group showed significant differences in terms of tumor size, depth, nodal stage, TNM stage, and removed nodes. The overall 5-yr survival rate for the spleen conservation group(SC, N=101) was 61.2% and the survival rates according to TNM stage were 94.0% for stage I, 94.1% for stage II, 30.0% for III, and 0.0% for stage IV. The overall 5-yr survival rate for the 343 patients with splenectomy(SOR) was 51.9%, and the survival rates according to TNM stages were 88.7% for stage I, 57.0% for II, 44.0% for III, and 10.8% for stage IV. The overall 5-yr survival rate for the 431 patients with splenectomies or with splenectomies and multiple organ resection(SR) was 48.2%, and the survival rates according to the stages were 88.2% for stage I, 60.2% for II, 41.5% for III, and 6.8% for stage IV. The overall 5-yr survival rate was higher in SC group than in the SOR or the SR groups, but there was no statistical significance to this difference (p>0.05). In a compared according to the TNM stage, the SC group showed better survival rates in the relatively early stages (I, II) than the SOR or the SR groups did; in advanced stages (III, IV), the SOR and the SR groups showed better survival rates than the SC group. However, there was no statistically significant differences in survival among the three groups. These results suggest that during a total gastrectomy, it may be better to save the spleen in early stages of gastric cancer and that it may be better to resect the spleen for adquate lymphadenectomy in grossly advanced stages. To identify statistical difference in survival, it might be necessary to perform a randomized prospective study.
Follow-Up Studies ; Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Retrospective Studies ; Sex Ratio ; Spleen* ; Splenectomy ; Stomach ; Stomach Neoplasms* ; Survival Rate

OBJECTIVE: We investigated predictors of insulin resistance in Korean population from the Korean National Health and Nutrition Examination Surveys. METHODS: Adults aged between 30-69 years without anemia were selected for the analysis. Fat mass was measured by dual-energy X-ray absorptiometry, and 24-hour nutritional information was obtained by interview from study subjects. Insulin resistance and beta cell function were calculated from homeostatic model assessment. RESULTS: 6,256 men and 8,003 women were included in the the study. Among participants, 9.8 (standard error [SE] 0.4) % of men and 6.8 (SE 0.4) % of women had diabetes mellitus (DM); moreover, serum ferritin level was higher in the DM patients compared to the non-DM subjects both in men and women (p<0.001). Serum ferritin levels correlated significantly with insulin resistance (age and body mass index adjusted p<0.001) in men, but not in women. Serum ferritin levels also correlated with total body fat (p=0.009), triglyceride levels (p<0.001), alanine aminotransferase (ALT) levels (p<0.001) and leukocyte count (p<0.001), but not with iron or fat intake. Multivariate analysis showed that serum ferritin level was an independent predictor of insulin resistance even after adjusting body fat, ALT levels, triglyceride levels and leukocyte count (beta=0.027, p=0.027). Beta cell function was not associated with ferritin levels both in men and women. CONCLUSION: Elevated serum ferritin was a risk factor for DM by increasing insulin resistance rather than affecting beta cell function. Serum ferritin level was an independent predictor of insulin resistance even after adjusting body fat or systemic inflammation in men.
Absorptiometry, Photon ; Adipose Tissue ; Adult ; Alanine Transaminase ; Anemia ; Body Mass Index ; Diabetes Mellitus ; Female ; Ferritins* ; Humans ; Inflammation ; Insulin Resistance* ; Insulin* ; Iron ; Leukocyte Count ; Male ; Multivariate Analysis ; Nutrition Surveys* ; Risk Factors ; Triglycerides

PURPOSE: This study was designed to evaluate the effects of caudal block or/and local infiltration on postoperative pain control in pediatric patients, and whether the faces pain rating scale (FPS), visual analogue scale (VAS) or sleep disturbance scale (SDS) values were estimator dependent (parents, doctors and nurses). MATERIALS AND METHODS: Thirty four children (average age 2.8+/-2.4 years), undergoing inguinal and scrotal surgery, were randomly allocated to one of three groups; combined caudal block with local infiltration (group I), caudal block only (group II) and neither of the above two (group III). Parents, doctors and nurses assessed the FPS, VAS and SDS before and after surgery, and the side effects were assessed after surgery. RESULTS: The mean SDS, FPS and VAS values in Group III were significantly higher than those in groups I and II at 1 and 3 hours postoperatively. All patients slept with a discontented look 1 hour postoperatively, but gradually improved and normalized 12 hours postoperatively. The mean FPS and VAS values were highest 1 hour postoperatively, and decreased with time in all groups. The mean pain value, as assessed by parents, tended to be higher than those assessed by healthcare professionals - doctors and nurses, but the correlation between the parents and healthcare professionals for the SDS, FPS and VAS assessments was statistically significant (intraclass correlation coefficients; 0.64, p<0.05). There were no side effects in any patient. CONCLISIONS: This study suggests that caudal block with local infiltration may be more useful for postoperative pain control, and all three pain scales are useful for assessing the postoperative pain associated with pediatric urological surgery of the penoscrotal and inguinal regions.
Anesthesia ; Child ; Delivery of Health Care ; Humans ; Pain Measurement ; Pain, Postoperative* ; Parents ; Surgical Procedures, Minor ; Weights and Measures

BACKGROUND: We compared the association between economic status and the prevalence of diabetes mellitus (DM) using large nationwide datasets covering the previous 10 years in Korea. METHODS: We analyzed the association between economic status and DM using Korean National Health and Nutrition Examination Survey (KNHANES) data from 2001 to 2010 weighted to represent the Korean population between 30 and 59 years of age. The economic status of participants was classified into quartiles according to monthly family income with an equivalence scale. RESULTS: In men, the prevalence of diabetes in the lowest income quartile (Q1) was significantly higher than that in the other quartiles in 2008 (age and body mass index-adjusted odds ratio [OR], 1.846; 95% confidence interval [CI], 1.126 to 3.027; P=0.015), 2009 (OR, 1.706; 95% CI, 1.094 to 2.661; P=0.019), and 2010 (OR, 1.560; 95% CI, 1.024 to 2.377; P=0.039) but not in 2001 or 2005. The data indicated that classification in the lowest economic status was an independent risk factor for diabetes even after adjusting for abdominal obesity, dyslipidemia, hypertension and education level in men of KNHANES 2008 to 2010. Although economic status was significantly associated with abdominal obesity, hypertriglyceridemia, and hypertension in women (P<0.001), there was no significant association between economic status and DM in women. CONCLUSION: Korean men between 30 and 59 years of age with the lowest economic status had a significantly higher prevalence of DM in 2008 to 2010 even after adjusting for other risk factors.
Classification ; Dataset ; Diabetes Mellitus* ; Dyslipidemias ; Education ; Female ; Humans ; Hypertension ; Hypertriglyceridemia ; Korea ; Male ; Nutrition Surveys* ; Obesity ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Risk Factors*

The prognoses for the gastric cancer patients treated with total gastrectomies are known to be unsatisfactory due to the low survival rates, the high frequency of postoperative mortality or morbidity, and long-term complications such as nutritional deficiency. The authors evaluated the 5-year survival rates and analyzed the prognostic factors in 557 patients with gastric cancer who underwent total gastrectomies during the period between Jan. 1987 and Dec. 1993. The overall 5-year survival rate was 49.7%, and the survival rates according to the stage were stage Ia, 92.0%; Ib, 85.5%; II 64.1%; IIIa 55.0%; IIIb 26.5%; and stage IV, 6.3%. Postoperative mortality rate was 1.1%. By using univariate analysis to evaluate the prognostic factors, factors such as age, depth of invasion, extent of lymph node metastasis (according to the Japanese rule), number of involved nodes, lymph node ratio, distant metastasis (peritoneal and/or hepatic), size of the tumor, gross type, histological type, the surgical curability and the TNM stage were found to be related with the survival of the patients. In a multivariate analysis using 11 variables, the TNM stage was the single most significant prognostic factor. Besides the TNM, depth of invasion (ratio of risk (R.R)=1.50), extent of lymph node metastasis (R.R=1.83), number of involved nodes (R.R=1.64), lymph node ratio (R.R=1.91), and peritoneal metastasis (R.R=3.11) were found to be independent prognostic factors influencing survival. It was thought that the radicality of surgery could be reflected in the number of removed nodes per specimen. In this study, the average number of removed nodes was 42.3 per case. Hence, it may be said that adequate lymphadenectomy was performed for almost all the grossly curable cancers. The 5-year survival rate in stage IV patients with tertiary node (N3) metastasis and no peritoneal or hepatic metastasis was 16.8%; in patients with peritoneal or hepatic metastasis, the survival rate was 0%. There was a significant survival difference between these two groups (p<0.05). This result suggests that the tertiary node metastasis is a potentially curable factor, and that it should be classified differently in the current TNM system. In conclusion, the overall survival rates in the patients treated with total gastrectomies were favorable compared with the results in other reports. Depth of invasion, extent of lymph node metastasis, number of involved nodes, lymph node ratio were important prognostic factors for survival after a total gastrectomy. The current TNM staging system appears to be a reasonable one, except that the probable curability of tertiary node metastasis may need to be taken into consideration.
Asian Continental Ancestry Group ; Gastrectomy* ; Humans ; Lymph Node Excision ; Lymph Nodes ; Malnutrition ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms* ; Survival Rate

BACKGROUND AND PURPOSE: The receptor for advanced glycation end products (RAGE) may contribute to the development of diabetic neuropathy. To assess its relevance in humans, this study examined the expression of RAGE in the skin biopsy samples of patients with diabetes mellitus, and investigated its correlation with intraepidermal nerve-fiber density (IENFD) and clinical measures of neuropathy severity. METHODS: Forty-four patients who either had type 2 diabetes or were prediabetes underwent clinical evaluation and a 3-mm skin punch biopsy. The clinical severity of their neuropathy was assessed using the Michigan Diabetic Neuropathy Score. IENFD was measured along with immunohistochemical staining for RAGE in 29 skin biopsy samples. The expression of RAGE was also quantified by real-time reverse-transcription PCR in the remaining 15 patients. RESULTS: RAGE was localized mostly in the dermal and subcutaneous vascular endothelia. The staining was more intense in patients with a lower IENFD (p=0.004). The quantity of RAGE mRNA was significantly higher in patients with severe neuropathy than in those with no or mild neuropathy (p=0.003). The up-regulation of RAGE was related to dyslipidemia and diabetic nephropathy. There was a trend toward decreased sural nerve action-potential amplitude and slowed peroneal motor-nerve conduction with increasing RAGE expression. CONCLUSIONS: The findings of this study demonstrate up-regulation of RAGE in skin biopsy samples from patients with diabetic neuropathy, supporting a pathogenic role of RAGE in the development of diabetic neuropathy.
Biopsy* ; Diabetes Mellitus ; Diabetic Nephropathies ; Diabetic Neuropathies* ; Dyslipidemias ; Glycosylation End Products, Advanced* ; Humans ; Michigan ; Polymerase Chain Reaction ; Prediabetic State ; Rage ; RNA, Messenger ; Skin* ; Sural Nerve ; Up-Regulation* ; Advanced Glycosylation End Product-Specific Receptor