Hospice Care ; Hospices ; Humans ; Palliative Care ; Renal Dialysis

No abstract available.
Pancreatic Neoplasms

BACKGROUND: Microalbuminuraia is a strong prognostic factor for cardiovascular morbidity and mortality in type I and II diabetics. Recent data suggest that microalbuminuria predicted cardiovascular disease independent of hypertension in one of two large-scale studies performed in non-diabetics. Additional possibilities could be a previously documented association with other major and interconnected cardiovascular risk factors, such as insulin resistance, and elevated cardiac mass, abnormal circulation lipid levels, and overweight. The object of this study os to investigat the incidence of microalbuminuria, and to define the pathophysiologic mechanism of microalbuminuria to contribute coronary heart disease in non-diabetic patients with angiographiclly documented coronary artery disease(CAD). METHODS: The study group comprised 31 patients(M;21, mean age 60+/-30 year) with angiographically documented CAD and 15 normal control(m;9, mean age 62+/-7 year). Urinary albumin excretion, blood pressure, echocardiographic left ventricular mass indes, plasma abdominal/hip circumference ratio, fasting glucose, insulin, and c-peptide were studied. The microalbuminuria was defined urinary albumin more than 20ug/min. RESULTS: 1) Six of 31 patients with CAD(19.4%) and none of 15 normal control had microalbuminuria. Hypertension were documented 13 of 31 patients with CAD, and none of 15 normal control(p<0.01). Five of 6 patients with CAD and microalbuminuria and 8 of 25 patients with non-microalbuminuric aptients had hypertension (p<0.05). 2) In the microalbuminuric subjects with CAD, body mass index(29.0+/-3.2vs 24.8+/-3.5), systolic blood pressure(138+/-31 vs 118+/-15mmHG), lipoprotein(a) (69+/-31vs 32+/-32mg/dl), fastion C-peptide(5.5+/-2.2 vs 2.7+/-1.6ng/ml), and microalbumin(221+/25 vs 9.6+/-7.9mg/day)were significantly greater than in normal control(p<0.05). But no difference in left ventricular mass, lipid profile, and abdominal/hip circumference ratio existed between the microalbminuric patients with CAD and normal control. 3) Between the microalbuminuric patients with CAD and without CAD, no signficant difference were noted excepr lipoprotein(a) lever(69+/-31 vs 29+/-29mg/dl), fasting C-peptide(5.5+/-2.4 vs 2.5+/-1.2ng/ml), and microalbumin(221+/-247 vs 8.6+/-6.7mg/day). CONCLUSION: Microalbuminuria was associated with history of hypertension or concurrent antihypertension therapy and insulin resistance in non-diabetics with CAD. But left ventricular cardiac mass, central obesity inedw, and lipid profile were not related with microalbuminuria. The underlying presence of a major risk factor such as hypertension and insulin resistance might be explain the previously reported predictive value of microalbuminuria for cardiac events.
Blood Pressure ; C-Peptide ; Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Echocardiography ; Fasting ; Glucose ; Humans ; Hypertension ; Incidence ; Insulin ; Insulin Resistance ; Lipoprotein(a) ; Mortality ; Obesity, Abdominal ; Overweight ; Plasma ; Risk Factors

A 18 year-old man presented with dyspnea and a swelling of the neck. On physical examination, maculopapular rashes were noted on the face and the whole body and crepitus was noted at the thorax and upper arms. His chest X-ray showed bilateral interstitial infiltrates of the lung, pneumomediastinum and subcutaneous emphysema. On serologic examination, measles IgM was positive. Under the diagnosis of measles pneumonia, the patient was treated with oral ribavirin, which resulted in a complete resolution of the pneumomediastinum, subcutaneous emphysema, pneumonic infiltrate, and subjective symptoms of dyspnea and swelling of the neck in 7 days. Here we report this case with a brief review of the relevant literature.
Adolescent* ; Arm ; Diagnosis ; Dyspnea ; Exanthema ; Humans ; Immunoglobulin M ; Lung ; Measles* ; Mediastinal Emphysema* ; Neck ; Physical Examination ; Pneumonia* ; Ribavirin ; Subcutaneous Emphysema* ; Thorax

Atotal of 26 patients diagnosed as diffuse axonal injury(DAI) between Nov. 1993 and Dec. 1995, were evaluated retrospectively with special attention given to MRI findings. In clinical aspects, there was male predominance(1.9:1) with the mean age of 28.5 years. The clinical grades based on the Glasgow coma scale(GCS) score were classified as mild(13-15), moderate(9-12) and severe(3-8). The duration of hospitalization and loss of consciousness(LOC) at admission were well correlated with the severity of clinical status. As regards the outcome of patients, twenty patients(77%) recovered as alert, but three patients(12%) died of sepsis. Short duration of LOC less than one day and young age of less than 10 years were good prognostic factors. The MRI findings of DAI were divided into three grades; in grade 1, there was small scattered lesions in the white matter of the cerebral hemisphere, in grade 2, focal lesion in the corpus callosum, and in grade 3, there was an additional focal lesion in the brain stem. The final outcome of grade 3 was poor, but in grade 2, there was wide spectrum between initial clinical status from alertness to semicoma and relative good result.
Axons* ; Brain Stem ; Cerebrum ; Coma ; Corpus Callosum ; Diffuse Axonal Injury ; Hospitalization ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Sepsis

The effects of intravenous Verapamil administration on ventricular function were evaluated using grated radionuclide ventriculography in 15 patients with essential hypertension. Verapamil(0.1mg/kg) was injected as a bolus for 2 minutes followed by an infusion of 0.007mg/kg/min. Heart rate, blood pressure, ejection fraction, peak ejection rate, total filling time, and prak filling rate were assessed before and after Verapamil administration. The results were was as follows ; 1) Verapamil administration increased heart rate from 63+/-5 to 75+/-9 beats/min(p<0.01) and reduced systolic and diastolic blood pressure from 156+/-17/99+/-6mmHg to 139+/-16/88+/-6mmHg(p<0.01). 2) Ejection fraction, peak ejection rate, and total filling time were not changed significantly after Verapamil injection. 3) Right and left ventricular peak filling rate increased significantly only in patients in whom it was subnormal in the basal study) from 1.6+/-0.4 to 2.3+/-1.1 end-diastolic volumes/s, p<0.05 and from 2.5+/-0.6 to 3.1+/-0.8 end-diastolic volumes/s, p<0.05, respectively). In conclusion, it was found that intravenous Verapamil administration enhances ventricular diatolic function in patients with essential hypertension.
Blood Pressure ; Heart Rate ; Humans ; Hypertension* ; Radionuclide Ventriculography ; Ventricular Function ; Ventricular Function, Right* ; Verapamil*

Tissues actively involved in energy metabolism are more likely to face metabolic challenges from bioenergetic substrates and are susceptible to mitochondrial dysfunction, leading to metabolic diseases. The mitochondria receive signals regarding the metabolic states in cells and transmit them to the nucleus or endoplasmic reticulum (ER) using calcium (Ca2+) for appropriate responses. Overflux of Ca2+ in the mitochondria or dysregulation of the signaling to the nucleus and ER could increase the incidence of metabolic diseases including insulin resistance and type 2 diabetes mellitus. Mitochondrial transcription factor A (Tfam) may regulate Ca2+ flux via changing the mitochondrial membrane potential and signals to other organelles such as the nucleus and ER. Since Tfam is involved in metabolic function in the mitochondria, here, we discuss the contribution of Tfam in coordinating mitochondria-ER activities for Ca2+ flux and describe the mechanisms by which Tfam affects mitochondrial Ca2+ flux in response to metabolic challenges.

PURPOSE: Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment. MATERIALS AND METHODS: We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion. RESULTS: According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases). CONCLUSION: Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.
Arm ; Bone Transplantation ; Elbow ; Follow-Up Studies ; Hand ; Humans ; Joints ; Olecranon Process* ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Ulnar Nerve

BACKGROUND: Exercise induced ST-segment depression in patients after coronary angioplasty is frequently observed but the mechanism responsible for exercise induced myocardial ischemia early after successful coronary angioplasty is poorly understoodd. The object of this study is to investigate potential determinants of this phenomenon by analizing the clinical, exercise testing, and angiographic characteristics in patients with exercise induced ST-segment depression. METHODS: The study group comprised 13 patients with exercise induced ST-segment depression(Positive group,M:12, mean age:59+/-9year) and 26 patients without exercise induced ST-segment depression(Negative group, M; 22, mean age; 55+/-13 year) after succeessful coronary angioplasty in single vessel disease. We compared preangioplasty clinical, angiographic, and hemodynamic variables in group with positive and negative results on exercise testing after successful PTCA. RESULTS: 1) Clinical characteristics: The initial diagnosis were acute myocardial infarction in 5, unstable angina in 8 patients at positive group, and 16 and 10 patients at negative group, respectively. There were no significant different in initial diagnosis, risk factor for coronary artery disease, and medication used before exercise test at between two groups. 2) Cornary angiography and PTCA: The maximal ballooning size were significantly smaller in positive group than negative group(2.7+/-0.5 vs 3.1+/-0.4mm, 2.9+/-0.4mm, vs 3.2+/-0.4mm, respectively(p<0.05) but there were no significantly different in ejection fraction, end-diastolic volume, end-systolic volume before PTCA. degree of stenosis of lesion before and after PTCA, total ballooning time, balloon pressure, lesion site and infarction relation of lesion at between two groups. 3) Exercise test: The mean time from angioplasty to the performance of exercise testing were 9.5+/-4.0 days in positive group and 6.1+/-4.5 days in negative group. The mean depression of ST-segment was 1.5+/-0.5mm and was predominantly noted in lateral leads(V4-6)(9/13:69%). There were no significantly different in total exercise time, rate-pressure product, and metabolic equivalents-exercise time at positive and negative group. But positive results at follow up exercise test were significantly higher in positive group(p<0.05). CONCLUSION: There were no definite determinating factors for exercise induced ST-segment depression early after successful coronary angioplasty by analizing the clinical, angiographic, and exercise testing variables. The pathophysiologic mechanism of this findding remain to be elucidated, especially for association of microvascular functional alternation.
Angina, Unstable ; Angiography ; Angioplasty* ; Constriction, Pathologic ; Coronary Artery Disease ; Depression* ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Ischemia ; Risk Factors

Several prognostic factors have been implicated in survival prolongation in patients with metastatic brain tumors. Among these, surgery has been regarded as very significant one with respect to life prolongation and improving the quality of survival in such patients. From August 1982 through July 1996, a series of 31 patients with metastatic brain tumors among 785 patients with operated brain tumors, whose medical records, X-rays and follow-ups were avilable, was studied retrospectively to evaluate the beneficial effects of surgery. Despite the limitations inherent to the retrospective study and limited number of patients, we divided these patients into two groups to find out any statistical differences in terms of survival and quality of survival among them: 1) Conservative group(8 nonoperated patients: 5 patients with biopsy or partial resection): 13, and 2) Surgical treatment group(17 totally resected patients: one patient with subtotal resection): 18. The quality of survival was assessed by Karnofsky performance(KP) scale before and after each treatment. The survival of the patients in the surgical treatment group was longer than the conservative treatment group(14.5 months/10 months), but this was not statistically significant(p value: 0.3305). However, improvement of quality of survival, in terms of KP scale, was significantly higher in the surgical treatment group(p value: 0.0027). Although confounded by the lack of controlled, randomized study and limitations of retrospective study, aggressive surgery can be regarded to have a significant role in improving the quality of survival in patients with metastatic brain tumors.
Biopsy ; Brain Neoplasms* ; Brain* ; Follow-Up Studies ; Humans ; Life Support Care ; Medical Records ; Pheniramine ; Retrospective Studies