OBJECTIVE: The purpose of this study was to evaluate hemodynamics for diabetes mellitus (DM) by transcranial Doppler sonography (TCD) and to evaluate the influences of risk factors to cerebral hemodynamics in DM. METHOD: We examined 54 normal persons, 17 patients with DM without risk factors, and 15 patients with DM and risk factors. The risk factors were hypertension, smoking, and hyper lipidemia (total cholesterol >240 mg/dl, low density lipoprotein >160 mg/dl). Mean blood flow velocity (MBFV) was also analyzed by Angiodine 2 Doppler system operating at 2 MHz frequency from each subjects. RESULTS: There was a significant decrease of MBFV in the diabetes in comparison to control groups (p<0.05). There was a significant decrease of MBFV in the diabetic risk group as compared to diabetic non-risk group (p<0.05). There was significantly increased total cholesterol, low density lipoprotein, low density lipoprotein/high density lipoprotein ratio in the diabetic risk group as compared to diabetic non-risk group (p<0.05). MBFV significantly decreased with increasing concentration of HbA1C and duration of DM (p<0.05). CONCLUSION: We suggest that transcranial Doppler sonography can be used as one of the useful screening tests for early detection of cerebrovascular diseases in DM.
Blood Flow Velocity ; Cholesterol ; Diabetes Mellitus* ; Hemodynamics* ; Humans ; Hyperlipidemias ; Hypertension ; Lipoproteins ; Mass Screening ; Risk Factors ; Smoke ; Smoking ; Ultrasonography, Doppler, Transcranial*

OBJECTIVE: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups. METHOD: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions. RESULTS: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p<0.01). The differences in the median sensory latency (p<0.01), amplitude (p<0.05) and the change of wrist-palm segmental conduction velocity (p<0.01) were statistically significant between the diabetes and the normal control. CONCLUSION: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.
Adult ; Carpal Tunnel Syndrome ; Diabetes Mellitus* ; Humans ; Median Nerve* ; Wrist Joint ; Wrist*

Osteochondritis dissecans of the capitellum is a condition which causes pain and limitation of motion in the elbow joint. Conservative management can be done in the early stage, but operative method is indicated when conservative treatment failed or loose bodies causing symptoms developed. The authors experienced 20 cases of osteochondritis dissecans of the capitellum, which received satisfatory surgical treatment, such as 1) removal of loose body, 2) removal of loose body, curettage, and multiple drilling, 3) curettage and multiple drilling at the Department of Orthopedic Surgery, National Police Hospital, from January, 1985 to August 1989. Following results were obtained. 1. The occupations were baseball players in 5 cases (25%), gymnast in 4 csses (20%), tennis player in 1 case (5 %), which implicates repetitive trauma or excessive use of the elbow joint as a cause of osteochondritis dissecans of the capitellum. 2. The main symptoms were pain in all cases(100%), limitation of range of moiton(70%), locking(25%), swelling of the joint, and clicks on range of motion in decreasing order. 3. Of the 20 cases, removal of loose bodies was performed in 13 cases(65%), removal of loose bodies, curettage, and multiple drilling in 4 cases (20%), and curettage and multiple drilling in the remaining 3 cases (15%), And follow-up results were excellent in 16 cases (80%), good in 3 cases (15%), and moderate in 1 case (5%). So, we concluded that the above surgical measurements are good enough to give satisfactory results for osteochondritis dissecans of the capitellum.
Baseball ; Curettage ; Elbow Joint ; Follow-Up Studies ; Humans ; Joints ; Methods ; Occupations ; Orthopedics ; Osteochondritis Dissecans ; Osteochondritis ; Police ; Range of Motion, Articular ; Tennis

No abstract available.
Edema* ; Hydrops Fetalis*

OBJECTIVE: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients. METHOD: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI). RESULTS: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p<0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p<0.05). CONCLUSION: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.
Diabetic Neuropathies ; Foot Ulcer* ; Foot* ; Heel ; Humans ; Metatarsal Bones ; Neuralgia ; Polyneuropathies ; Reading ; Skin

BACKGROUND: Bronchial asthma is characterized by a reversible airway obstruction, airway hyperresponsiveness, and eosinophilic airway inflammation. The bronchodilator response(BDR) after short acting beta agonist inhalation and PC20 with methacholine inhalation are frequently used for diagnosing bronchial asthma, However, the relationship between the presence of a bronchodilator response and the degree of airway hyperresponsiveness is uncertain. Therefore, the availability of a eosinophil cationic protein(ECP) and a correlation ECP with a bronchodilator response and airway hyperresposiveness was investigated. METHOD: A total 71 patients with a moderate to severe degree of bronchial asthma were enrolled and divided into two groups. 31 patients with a positive bronchodilator response and 38 patients with a negative bronchodilator response were evaluated. In both groups, the serum ECP, peripheral blood eosinophil counts, and total IgE level were measured and the methacholine bronchial provocation test was examined. RESULTS: There were no differences observed in age, sex, atopy, and baseline spirometry in both groups. The peripheral eosinophil counts showed no difference in both groups, but the ECP level in group 1 (bronchodilator responder group) was higher than in group 2(non-bronchodilator responder group) (22.4±20.7 vs 14.2±10.4, mean±SD). The PC20 in group 1 was significantly lower than in group 2 (1.14±1.68 vs 66±2.98). There was a significant positive correlation between the BDR and ECP, and a negative correlation between the bronchial hyperresponsiveness and ECP. CONCLUSION: The bronchodilator response significantly correlated with the bronchial hyperresponsiveness and serum ECP in the moderate to severe asthma patients. Hence, the positive bronchodilator response is probably related with active bronchial inflammation and may be used as a valuable index in treatment, course and prognosis of bronchial asthma.
Airway Obstruction ; Asthma ; Bronchial Provocation Tests ; Eosinophil Cationic Protein* ; Eosinophils ; Humans ; Immunoglobulin E ; Inflammation ; Inhalation ; Methacholine Chloride ; Prognosis ; Spirometry

BACKGROUND: Low dose dobutamine echocardiography has recently been introduced for use in identification of viable myocardium in patients with acute myocardial infarction and prediction of the response of dysfunctioning myocardial segments to coronary angioplasty. The aim of this study was to evaluate wheter tihs test could be used to predict the early response of dysfunctioning myocardial segements to coronary artery bypass grafting(CABG). METHODS: We studied in 23 patients with multi-vessel disease during CABG. Myocardial segments were monitored by intraoperative transesophageal echocardiography(TEE) in the transgastric short-axis view at papillary muscle level. The left ventricle was divided into five segments and sixty eight myocardial segments in 23 patients were analyzed. Percentage of systolic wall thickening(PSWT) was calculated in each segment for three times: at basline(early after pericardiectomy);before bypass during dobutamine infusion(3-5ug/kg/min);and after seperation from cardiopulmonary bypass. Segments showing baseline PSWT >_30% were considered normal and those < 30% were dysfunctional. Segments showing an increase in PSWT >_10% during dobutamine infusion were considered responders and those < 10% nonresponders. RESULTS: AT baseline, 24%(36%) of 68 segments had PSWT > 30%(normal) and 44(68%) had PSWT < 30%(dysfuctioning segments). During dobutamine infusion, 21(47.7%) among 44 dysfunctional segments showed increase in PSWT >_10%(from 12.3+/-7.2% to 33.5+/-11.8%, p<0.01 ; responder segments), and 23(52.3%) showed increase in PSWT < 10%(from 14.7+/-6.5% to 17.4+/-7.4%, p=NS ; nonresponder segments). After CABG, responder segments showed a significant increase in PSWT in comparison with baseline values(from 12.3+/-7.2% to 32.1 +/-11.0%,p<0.01). Segments not responded to dobutamine showed no significant changes in PSWT after CABG(from 14.7+/-6.5% to 16.0+/-8.2%, p=NS). Twenty-four normal segments (PSWT 41.9+/-6.2%) showed a slight but significant reduction in PSWT both during dobutamine infusion(38.7+/-6.9%;p<0.05) and after CABG(38.9+/-6.3%, p<0.05), suggesting that compensatory hyperfunction was present at baseline. Estimation of clinical accruacy of low dose dobutamine TEE yieded to 69% sensitivity, 93.9% specificity, 95.2% positive predictive value, 60.9% negavive predictive value, and 77.3% overall accuracy. In both responders and nonresponders of dysfunctioning segments, there was a correlation between PSWT during dobutamine infusion and that after CABG(r=0.61, r=0.63, respectively). CONCLUSION: Low dose dobutamine TEE test well predicts the early response of dysfunctioning myocardial segments to CABG.
Angioplasty ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Dobutamine* ; Echocardiography* ; Heart Ventricles ; Humans ; Myocardial Infarction ; Myocardium ; Papillary Muscles ; Sensitivity and Specificity

OBJECTIVES: Visualization of the left atrial appendage(LAA) by the transesophageal echocardiography(TEE) is excellent, but it is difficult to visualize the LAA by the modified parasternal short-axis view(MPSA) in transthoracic echocardiography(TTE). We studied to determine the usefulness of the apical horizontal view(AHV) abtained by the apical rotation method of the transducer for the detection of the LAA. METHODS: We studied the MPSA and AHV in 602 patients, The LAA was observed during diastole of the LAA. We obtained an apical horizontal view by 45 degree clockwise rotation of the transducer from the apical 2 chamber view and compared with the visualization of the LAA in AHV and MPSA. RESULTS: Among 602 patients, LAA could not be visualized in 88(14.6%) because of a poor echo-window. LAA was more clearly visualized in 222 patients by the AHV than the MPSA and 56 patients by the MPSA than the AHV. LAA was same degree visualization in patients by the AHV and MPSA. In male and female, more than 55 ages and less than 55 ages, visualization of inner margin of the LAA by the AHV was more clear than by the MPSA. CONCLUSION: The AHV was a useful, noninvasive and reproducible method for the visualization of the LAA.
Atrial Appendage* ; Diastole ; Female ; Humans ; Male ; Transducers*

BACKGROUND AND OBJECTIVES: The degree of diastolic dysfunction may explain the difference in clinical symptoms between patients with similar degrees of systolic dysfunction. Pseudonormal mitral filling pattern with increased left ventricular filling pressure is a transitional stage of diastolic dysfunction and is difficult to distinguish from normal. Preload is one of factors affecting the diastolic filling patterns and mitral flow patterns may be influenced by changes in preload in the absence of changes in the left ventricular pressure-volume curve. The changes in the mitral flow velocities caused by preload reduction may be useful in distinguishing patients with a pseudonormal pattern from those with normal. The aim of this study was to establish whether the effect of changes in pulmonary venous flow pattern by preload reduction may be useful in distinguishing pseudonormal pattern from normal. MATERIALS AND METHODS: This study included 40 patients (men 25, female 15, average age 51.0+/-11.2 years) underwent left side cardiac catheterization among patients with normal or pseudonormal patterns. All patients with pseudonormal group had increased LVEDPr (>15 mmHg). The Doppler mitral inflow & pulmonary venous flow parameters at baseline and during reduction of preload using Valsalva maneuver were recorded. RESULTS: 1) There were no difference in sex, diabetes mellitus, hypertension and lipid profiles between both groups. The left ventricular systolic function was better and mean age was younger in normal than pseudonormal group (p<0.05). The incidence of coronary artery disease was more frequent and LV mass was more increased in pseudonormal than normal group (p<0.05). 2) E and A velocities were significantly decreased but E/A ratio was still <0A65B> 1.0 during Valsalva maneuver in normal group (p<0.05). In pseudonormal group, E velocity was significantly decreased but A velocity was not significantly changed and the E/A ratio was <1.0 during Valsalva (p<0.05). Therefore the change revealed masked LV relaxation abnormality pattern. 3) S and D velocities of pulmonary venous flow were significantly decreased and S/D ratio was significantly increased in both groups (p<0.05). The % changes before and after Valsalva maneuver showed that S velocity was less decreased, D velocity was more decreased and S/D ratio was more significantly increased in pseudonormal than normal group (p<0.05). That revealed masked LV relaxation abnormality pattern. CONCLUSIONS: The Valsalva maneuver for preload reduction is a relatively simple, easily applicable, safe and reproducible method of acutely reducing venous return. The assessment of changes in pulmonary venous flow pattern by preload reduction may be helpful in distinguishing pseudonormal and normal diastolic function in addition to changes in mitral inflow pattern.
Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Diabetes Mellitus ; Female ; Humans ; Hypertension ; Incidence ; Masks ; Relaxation ; Valsalva Maneuver

Anticonvulsant hypersensitivity syndrome(AHS) is an uncommon, but potentially fatal, multi-systemic disorder that occurs after exposure to phenytoin, carbamazepine, phenobarbital. Clinical features and laboratory data are diverse and variable. The multi-systemic reaction presents as fever, skin eruptions, lymphadenopathy, hematologic abnormality, and hepatitis. It is postulated that this mechanism can cause deficient enzymatic reduction by epoxide hydrolase. The diagnosis of AHS is made by reviewing the history of drug exposure and clinical course. It is important to discontinue use of the offending drug suspected for AHS and to closely observe patients with anticonvulsant therapy. We experienced a case of anticonvulsant hypersensitivity syndrome developed by carbama-zepine, presented with pseudolymphoma in lymph node biopsy and improved by discontinuing the drug and implementing steroid treatment. We report this case with pathologic findings and a brief review.
Biopsy ; Carbamazepine* ; Diagnosis ; Fever ; Hepatitis ; Humans ; Hypersensitivity* ; Lymph Nodes ; Lymphatic Diseases ; Phenobarbital ; Phenytoin ; Pseudolymphoma* ; Skin