BACKGROUND: Glycemic profile has traditionally been with the use of HbAlc over a 2 to 4 month period. Recently, serum fructosamine is highly sensitive to acute metabolic deterioration(period 2 to 3 weeks), and is suitable for automation, allowing multiple assays with minimal effort. In some report, despite evidence suggesting a reduction in serum albumin level with increasing age, serum fructosamine was strongly correlated with HbAlc in elderly diabetic patients. This study was conducted to define the correlation between fructosamine and other parameters in elderly diabetic patients. METHODS: The study group consisted of 56 elderly patients(age range : 66-85 years, group A) and 58 adult patients(age range: 18-64 years, group B), who were stable over recent 2 months in fasting glucose values and serum albumin levels. Fructosamine was measured in 114 diabetic patients. The measured levels were related to HbAlc and fructosamine/albumin index(FAI). RESULTS: 1) There was significant correlation between HbAlc and fructosamine in all diabetic patients(r=0.705, p=0.0001). The correlation between HbAlc and fructosamine was stronger in group A than in group B [group A: r=0.831, group B: r=0.367, p=0.0001](p<0.05). 2) The correlation between HbAlc and FAI was significantly stronger compared to that between HbAlc and fructosamine in elderly diabetic patients(p<0.05). 3) Glycation ratio provides a vector-like insight into the recent trend of glycemia, and Glycation ratio was stable in all diabetic patients. CONCLUSIONS: Our study suggests that correlation between HbAlc and fructosamine in elderly daibetic patients was significantly lower in adult diabetic patients. Further studies are needed to determine the ultimate values of this test in the clinical management of elderly patient with diabetes.
Adult ; Aged* ; Automation ; Fasting ; Fructosamine* ; Glucose ; Humans ; Serum Albumin

A 68 year-old male was admitted with complaint of dyspnea and nonproductive cough which developed 6 hours after accidental inhalation of nitrogen dioxide. On admission, acute pulmonary edema and severe hypoxemia were found. With oxygen and bronchodilator therapy, diffuse alveolar consolitation and his dyspnea were improved from the following day. He was discharged at 8th hospital day with prednisolone 30mg daily for prevention of bronchiolitis obliteraus. During 6 weeks of follow up, there was no evidence of bronchiolitis obliterans.
Aged ; Anoxia ; Bronchiolitis ; Bronchiolitis Obliterans ; Cough ; Dyspnea ; Follow-Up Studies ; Humans ; Inhalation* ; Male ; Nitrogen Dioxide* ; Nitrogen* ; Oxygen ; Prednisolone ; Pulmonary Edema*

BACKGROUND: Heart Rate Variability help us to diagnose the impairment of autonomic nervous system in patients with diabetes, hypertension, ischemic heart disease, chronic renal disease, and arrhythmia. Change of autonomic nervous system is related to circadian rhythm, stress, physical activity, and so on. Especially, impairment of vagal nervous system with age help us to expect sudden cardiac death, myocardial infarction, and arrhythmia. So we survey heart rate variability by using 24 hours holter monitoring to expect impairment of autonomic nervous system in elderly hypertensive patients. METHODS: In order to assess 24 hours heart rate variability, we use Del Mar Avionics 563 holter monitoring on 11 elderly hypertensive patients( > or =65 years), 12 younger hypertensive patients( <65 years), and 15 normal subjects. RESULTS: 1) Standard deviation of mean R-R interval, LF(low frequency), HF(high frequency), TPSD(total power spectral density) are more decreased in elderly hypertensive patients than in younger hypertensive patients in 24 hours health rate variability analysis(t-test p<0.05). 2) According to age, elderly control group had lower LF power spectral parameter than younger control group had, but other parameters were not decreased, and elderly hypertensive group had lower LF, HF, TPSD, SD of mean R-R interval than younger hypertensive group did(p<0.05). 3) In circardian rhythm, normal subjects had high HF power spectral parameter and low LF power spectral parameter at evening and night. On the other hand, elderly hypertensive group had constant low level of LF, HF power spectral parameter during the day and night. CONCLUSIONS: On heart rate variability analysis using by 24 hours Holter monitoring, heart rate variability was decreased, and impairment of autonomic nervous system was accelerated in elderly hypertensive patients.
Aged* ; Arrhythmias, Cardiac ; Autonomic Nervous System ; Circadian Rhythm ; Death, Sudden, Cardiac ; Electrocardiography, Ambulatory ; Hand ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Motor Activity ; Myocardial Infarction ; Myocardial Ischemia ; Nervous System ; Renal Insufficiency, Chronic

OBJECTIVE: Pattern with essential hypertension generally shows the same circadian pattern as the normothensive person with a night-time reduction or "DIP" in blood pressure in sleep. The definition of "Dipper" and "Non-dipper" are assigned according to arbitrary criteria e.g. a night time average blood pressure which is at least 10% less than the average daytime blood pressure. Prospective evidence that the absence of an overnight dip is a strong adverse prognostic indicator for target organ damage .Thus we investigate circardian rhythm of blood pressure, related target organ damage, its frequency & drug in hypertensive subjects. Method : 24hr ambulatory blood pressure monitoring, history taking, physical examination, fundoscopy, ECG, chest X ray, dipstick urinanlysis, serum creatinine level are performed in essential hypertensive subjects. Exclusion criteria are duration of hypertension over 5 years, DM, renovascular hypertension & heart failure. RESULTS: Total 42 patients performed study.17 subjects classify dipper group,25 subjects classify non-dipper group. Between dipper & non-dipper group shows no significantly difference at stroke history, C/T ratio over 0.5 in chest X-ray, left ventrcular hypertrophy in ECG,ST-T change in ECG, proteinuria & serum creatinine level. Non-dipper group shows significantly difference to dipper group in frequency of hypertensive retinopathy and number of combined drug used subjects. CONCLUSION: Number of hypertensive retinopathy is significantly frequency in non-dipper group. Hypertensive retinopathy is atherosclerotic complication, thus we predict other target organ damage, therefore non-dipper type circardian rhythm of blood pressure is adverse prognostic factor for target organ damage of hypertensive subjects.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Creatinine ; Electrocardiography ; Heart Failure ; Humans ; Hypertension ; Hypertension, Renovascular ; Hypertensive Retinopathy ; Hypertrophy ; Physical Examination ; Prospective Studies ; Proteinuria ; Stroke ; Thorax

PURPOSE: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. METHODS: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. RESULTS: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. CONCLUSION: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Dialysis ; Humans ; Kidney Failure, Chronic ; Medical Records ; Percutaneous Coronary Intervention ; Reperfusion ; Retrospective Studies ; Survival Rate ; Transplants

The use of erythropoietin for correction of anemia in maintenance hemodialysis patients affects dialyzer reuse, dialysis efficacy and other clinical parameters. This study showed the change of Kt/Vurea, nPCR, pre-dialysis BUN, body weight, ultrafiltration volume, pre-dialysis blood pressure, heparin dosage, the number of dialyzer reuse caused by the administration of erythropoietin in reuse(n=11) and first use(n=9) patients who were started erythropoietin since January, 1995. 1) In 20 all patients, hematocrit increased significantly after EPO treatment 20.7+/-0.8%, 27.8+/-0.7%, ultrafiltration volume increased from 2.0+/-0.3L to 2.5+/-0.2L(P<0.05). However no significant changes were noted in Kt/Vurea, nPCR and other parameters 2) In patients of dialysis reuse, the number of reuse was not affected by EPO treatment(8.4+/-1.7, 9.6+/-1.5, P=0.67). No significant differences were observed in all parameters except hematocrit in case of first use and reuse. 3) Entire patients were reclassified into low baseline protein intake group(nPCR<1.0g/kg/day) and high baseline protein intake group(nPcR>1.0/kg/ day) and then pretreatment versus posttreatment nPCR, pre-dialysis BUN and ultrafiltration volume were compared. In low baseline protein intake group, significant increases of ultrafiltration volume, nPCR were observed. However, pre-dialysis BUN were not changed significantly. In high protein intake group, nPCR, pre-dialysis BUN, ultrafiltration volume were changed without significance. In conclusion, EPO treatment did not affect Kt/Vurea, dialyzer reuse, nPCR, predialysis blood pressure, heparin dosage. But ultrafiltration volume increased significantly after EPO treatment. Maybe increased appetite in low baseline protein intake group caused the increased posttreatment ultrafiltration volume.
Anemia ; Appetite ; Blood Pressure ; Body Weight ; Dialysis* ; Erythropoietin* ; Hematocrit ; Heparin ; Humans ; Renal Dialysis ; Ultrafiltration