In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.

In 2010, we proposed the first Korean Guidelines for the Prevention of Venous Thromboembolism (VTE). It was applicable to Korean patients, by modifying the contents of the second edition of the Japanese guidelines for the prevention of VTE and the 8th edition of the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. From 2007 to 2011, we conducted a nationwide study regarding the incidence of VTE after major surgery using the Health Insurance Review and Assessment Service (HIRA) database. In addition, we have considered the 9th edition of the ACCP Evidenced-Based Clinical Practice Guidelines, published in 2012. It emphasized the importance of clinically relevant events as opposed to asymptomatic outcomes with preferences for both thrombotic and bleeding outcomes. Thus, in the development of the new Korean guidelines, three major points were addressed: 1) the new guidelines stratify patients into 4 risk groups (very low, low, moderate, and high) according to the actual incidence of symptomatic VTE from the HIRA databases; 2) the recommended optimal VTE prophylaxis for each group was modified according to condition-specific thrombotic and bleeding risks; 3) guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and/or physician advice.
Age Factors ; Anticoagulants/adverse effects/*therapeutic use ; Asian Continental Ancestry Group ; Evidence-Based Medicine ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; *Mechanical Thrombolysis ; Neoplasms/complications/surgery ; Republic of Korea ; Risk Assessment ; Surgical Procedures, Operative/adverse effects ; Venous Thromboembolism/etiology/prevention & control/*therapy

No abstract available.
Angiofibroma ; Carbon ; Carbon Dioxide ; Lasers, Gas

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.
Adult ; Androstanols/*administration & dosage/adverse effects ; Anesthetics, Intravenous/administration & dosage ; Double-Blind Method ; Female ; Histamine H1 Antagonists/*pharmacology ; Humans ; Incidence ; Injections, Intravenous ; Male ; Middle Aged ; Movement/drug effects/physiology ; Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects ; Pain/chemically induced ; Pain Measurement ; Pheniramine/*pharmacology ; Thiopental/administration & dosage

BACKGROUND: Demand of anesthesia for patients with cerebral palsy is more increasing. But there is still lacking in clinical research regarding how BIS and entropy reflect well on sedative and hypnotic state in patients with cerebral palsy. METHODS: Fifteen patients with cerebral palsy (Group CP) and fifteen patients without cerebral palsy (Group NL) scheduled for elective orthopedic surgery were included in the study. Induction of anesthesia was done by having the patient inhale 1 vol% sevoflurane and 100% oxygen using a total fresh gas flow of 8 L/min. Simultaneously BIS, state entropy (SE), response entropy (RE), end-tidal sevoflurane concentration were recorded every 15 seconds till there was no self respiration. When end-tidal sevoflurane concentration had not risen any more for 30 seconds, we increased inhaled sevoflurane concentration in 1 vol% increments. End point of recording was when self respiration was lost or the time sevoflurane concentration reached 8 vol%. RESULTS: No significant differences in RE, SE, BIS at baseline and end point were found between the two groups. No significant difference in the time reach end point was found between the two groups. BIS, SE and RE correlated with end-tidal sevoflurane concentration in the two groups. CONCLUSIONS: The authors found no significant difference in the entropy values between patients with CP and normal patients. Also, the entropy values could be interpreted like BIS in patients with CP. And BIS showed a stronger correlation with end tidal sevoflurane concentrations than entropy.
Anesthesia ; Cerebral Palsy ; Entropy ; Humans ; Methyl Ethers ; Orthopedics ; Oxygen ; Respiration

BACKGROUND: Activation of renin-angiotensin system (RAS) has been an important mechanism of microvascular and macrovascular complications in diabetic patients. It has been reported that RAS blockades reduce the development and progression of diabetic nephropathy. The aim of this study was to evaluate whether valsartan, an angiotensin II receptor blocker (ARB), reduced blood pressure and urinary albumin excretion rate (UAER) in hypertensive type 2 diabetic patients. METHOD: Three hundred forty-seven hypertensive type 2 diabetic patients who had not taken angiotensin converting enzyme inhibitors or ARB for 6 months prior to this study were enrolled. We measured blood pressure and UAER before and after 24 weeks of valsartan treatment. RESULT: Baseline mean systolic and diastolic blood pressure was 143 +/- 15 and 87 +/- 11 mmHg, respectively and the median albumin excretion rate was 27 ug/mg. Reduction in systolic and diastolic blood pressure was 16 mmHg/10 mmHg and the median UAER was 19.3 ug/mg after 24 weeks (P < 0.01, respectively). When we divided the subjects into three groups according to the UAER (normoalbuminuria, microalbuminuria and macroalbuminuria), significant changes were reported in the microalbuminuria and the macroalbuminuria groups. Thirty-eight (42%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria. We found an association between the improvement of blood pressure and UAER (R = 0.165, P = 0.015). CONCLUSION: We concluded that valsartan reduces urinary albumin excretion and blood pressure in hypertensive type 2 diabetic patients.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Humans ; Receptors, Angiotensin ; Renin-Angiotensin System ; Tetrazoles ; Valine ; Valsartan

Pulmonary edema is usually bilateral, but can be uncommonly unilateral. Although unilateral pulmonary edema (UPE) can occur owing to various etiologies, it usually occurs at a patient who has an underlying defect or abnormality in the cardiopulmonary system except a case of negative-pressure pulmonary edema. Especially UPE following general anesthesia is a rare complication in a healthy patient. Re-expansion pulmonary edema (REPE) as a cause of UPE mostly occurs when a chronically collapsed lung is rapidly re-expanded after pneumothorax. There are some reports associated with REPE following one-lung ventilation used to facilitate surgery, in which there is no chronically collapsed lung. There are, however, little reported cases of a more acute form of this complication following re-expansion after atelectasis due to only several minutes of an inadvertent main stem bronchial intubation during operation. A report of the occurrence of UPE in a healthy, young male undergoing two-jaw surgery is described.
Anesthesia, General ; Edema ; Humans ; Intubation ; Lung ; Male ; One-Lung Ventilation ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema

Iatrogenic aortic dissection (IAD) is a life-threatening complication that can occur during open heart surgery, therefore IAD requires early diagnosis and prompt management. We describe here a case of IAD that occurred during mitral valve replacement. The transesophageal echocardiography (TEE) evaluation revealed features indicative of acute aortic dissection and the tear was successfully repaired by interposition of a graft.
Early Diagnosis ; Echocardiography, Transesophageal ; Mitral Valve* ; Thoracic Surgery ; Transplants

We report a case in which epidural anesthesia was successfully administered during a cesarean section of a 35 years old parturient patient with severe congestive heart failure and respiratory insufficiency at 33 weeks of gestation. The patient had a past history of mitral regurgitation and mitral valve prolapse treated by mitral valve replacement ten years prior. When limited motion of the prosthetic mitral valve developed, congestive heart failure recurred and was aggravated by the pregnancy. In addition, the patient presented with symptoms of respiratory insufficiency including NYHA III dyspnea, orthopnea, severe pulmonary hypertension (systolic pulmonary arterial pressure: 112 mmHg) due to severe aortic regurgitation, pleural effusion and pulmonary edema on admission. Four-days after admission, with premature labor pain and fetal distress, the patient underwent an emergency cesarean section. Due to the orthopnea, the patient could not breathe in the supine position, and we chose to give epidural anesthesia at a sitting position for preserving self-respiration and to prevent a ventilation-perfusion mismatch that would possibly develop during general anesthesia. Moreover, we could control postoperative pain and maintain a minimal, gradual hemodynamic change throughout the epidural anesthesia. During surgery, the hemodynamic instabilities were controlled by the use of dopamine, dobutamine, ephedrine and milrinone. We safely finished the cesarean section under epidural anesthesia and the patient was sent to the intensive care unit postoperatively to manage congestive heart failure and respiratory insufficiency.
Adult ; Anesthesia, Epidural* ; Anesthesia, General ; Aortic Valve Insufficiency ; Arterial Pressure ; Cesarean Section* ; Dobutamine ; Dopamine ; Dyspnea ; Emergencies ; Ephedrine ; Estrogens, Conjugated (USP)* ; Female ; Fetal Distress ; Heart Failure* ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Intensive Care Units ; Milrinone ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Obstetric Labor, Premature ; Pain, Postoperative ; Pleural Effusion ; Pregnancy ; Pulmonary Edema ; Respiratory Insufficiency* ; Supine Position

Complex regional pain syndrome (CRPS) is quite difficult to comprehend and manage, of which etiology and pathophysiological mechanisms have not been fully understood. CRPS is classified as either type 1 (without any known nerve injury) or type 2 (with apparent nerve or tissue injury). Spinal cord stimulation is a restorative therapy that currently offers the best chances of obtaining long-term pain relief in CRPS patients with pain that has not responded to other treatments such as physical therapy or analgesic medications. A 45 years old male patient referred to our pain clinic due to uncontrolled pain at the middle finger for 4 years after crushing injury. He was diagnosed with CRPS type 2 and treated with medication, stellate ganglion block, thoracic sympathetic block, and pulsed radiofrequency therapy, but their effects were transient and not satisfactory. A percutaneous spinal cord stimulation (SCS) with a single quadripolar electrode was tried and the patient's finger pain was improved significantly (from VAS 10 to 2). SCS is an effective treatment for CRPS type 2 which results from crushing injury when alternative therapies fail.
Complementary Therapies ; Electrodes ; Fingers* ; Humans ; Male ; Middle Aged ; Pain Clinics ; Spinal Cord Stimulation* ; Spinal Cord* ; Stellate Ganglion