Recently, the proportion of cardiovascular disease as a cause of death in diabetics is in ever increasing tendency. Present study is designed to evaluate the change of myocardial performance by the effect of microangiopathy of diabetics. The measurements of systolic time intervals were obtained from simultaneous high speed recordings(100mm/sec) of electrocardiography, phonocardiography, and carotid pulse tracing in diabetics(male 26, female 31). 1. As the diabetic retinopathy got severe, shortening of LVET and prologation of PEP were noted, but QS2 showed no significant change. 2. PEP/LVET ratio fo diabetics without diabetic retinopathy was significantly higher than that of normal control(p<0.01). 3. PEP/LVET ratio of diabetics with diastolic blood pressure under 95mmHg was significantly higher than that of normal control group(p<0.01), and PEP/LVET ratio of diabetics with diastolic blood pressure over 96mmHg was significantly higher than that of normal control and that of diabetics with diastolic blood pressure under 95mmHg(p<0.01). 4. PEP/LVET ratio of diabetics with proliperative retinopathy was significantly higher than that of normal control and that of diabetics with mild diabetic retinopathy(p<0.01), but this result was not conclusive because of the small case number.
Blood Pressure ; Cardiovascular Diseases ; Cause of Death ; Diabetic Retinopathy ; Electrocardiography ; Female ; Humans ; Phonocardiography ; Systole*

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Congenital pericardial defect is relatively rare and two different types, partial and complete, of different clinical significance have been recognized. Most reported defects are complete type and left-sided lesion. Most patients are asymptomatic or complain of vague chest pain. Partial pericardial defect can be potentially fatal due to cardiac herniation and strangulation or coronary insufficiency. Plain chest reontgenography shows abnormal prominence along the cardiac border. 2-D echocardiography demonstrates a drop-off of pericardial echo and protruding cardiac chamber through the defect. Because of the potential fatality, surgical repair is recommended for the partial pericardial defect. We report a case of congenital partial left pericardial defect, which was diagnosed by plain chest reontgenography and 2-D echocardiography, with related literatures.
Chest Pain ; Echocardiography ; Humans ; Thorax

For the purpose of elucidating relation between red cell electrolyte concentrations and serum digoxin level, measurement of red cell electrolyte concentrations and seum digoxin level by radioimmunoassay were done in 46 normal controls and 63 patients of CHF including 8 patients with digitalis intoxication. The results obtained were as follows: 1. Red cell sodium concentration and ratio of red cell sodium to red cell potassium concentration in normal males were significantly higher than those of females, and red cell potassium concentration in normal males was significantly lower than that of normal females. 2. Red cell potassium concentration in patients of CHF was significantly higher than that of normal controls, but there was no difference in the red cell sodium concentration between the groups. 3. There was no relation between red cell electrolyte concentrations and serum digoxin level, and red cell electrolyte concentration did not exactly estimate serum digoxin level. 4. Red cell electrolyte concentrations in the patient of CHF were valuable in detecting digitalis toxicity.
Digitalis ; Digoxin* ; Female ; Humans ; Male ; Potassium ; Radioimmunoassay ; Sodium

The antihypertensive effects fo aldactazide and serum electrolytes changes before and after treatment with aldactazide were observed. The followings were obtained: 1. Results of antihypertensive therapy with aldactazide in 23 hypertensive patients revealed good effects in 52.17%, fair in 26.09%, poor in 8.7%, and failure in 13.04% of cases. In 78.26% of cases, good or fair control of blood pressure was obtained. 2. Daily doses of aldactazide ranged from 25mg to 50mg depending upon the level of blood pressure. The antihypertensive effects were appeared after average 11 days of administration. 3. The side effects during treatment with aldactazide were dizziness, weakness, indigestion, headache, and restlessness in 26.28% of cases (6 of 23 cases). 4. No significant changes in serum Na and K values were observed before and after treatment with aldactazide for average 23 days.
Blood Pressure ; Dizziness ; Dyspepsia ; Electrolytes ; Headache ; Humans ; Psychomotor Agitation

No abstract available.
Osteotomy*

Fifty two cases of displacecd supracondylar fractures were divided into three groups according to the methods of fracture stabilization. Cast immobilizations without pin fixation were included to the group 1 (12 cases), fixation with lateral pins to the group 2 (22 cases), and lateral and medial cross pins to the group 3 (18 cases). In each group we attempted a radiological analysis for the stabilization failure through measurements of the horizontal rotation and the mediolateral tilting in their preoperative, postoperative and follow-up X-rays. Stabilization failure during the follow-up period was presumpted to be present in those cases that show (1) a development or increase of the horizontal rotation in follow-up lateral X-ray, and (2) accompanied change in Baumann's angle of more than 5 degrees. The failed stabilizations were in three cases (25%) in the group 1. In the group 2 the horizontal rotations after initial fixation were developed in four fractures. However, only two (9%) of the four cases accompanied significant changes in the Baumann's angle. Loss of the initial fixation in the cross pin group was found in one case. These results demonstrate that the cross pin fixation is the most stable form. Fixation in only lateral side sometimes shows rotational instability, but this method seems to be still useful because singificant coronal tilting develops in only a few occasions of those with horizontal rotation.
Child ; Follow-Up Studies ; Humans ; Humerus ; Methods

PURPOSE: Matrix metalloproteinase-2 (MMP-2) and MMP-7 have been implicated in tumor growth and metastasis. This study aimed to investigate the expressions of MMP-2 and -7 in colorectal cancer and to evaluate their values as prognostic markers. METHODS: Immunohistochemical staining for MMP-2 and -7 was done in 144 resected colorectal cancer specimens. Clinicopathological data and survival results were compared with regard to the expression results. RESULTS: The expression rates of MMP-2 in tumor cells in the tumor center and the tumor border were 16.7% and 38.9%, respectively. That of MMP-2 in stromal cells was 27.8%. MMP-7 immunoreactivities of tumor cells in the tumor center and the tumor border were 6.9% and 23.6%. The expressions of MMP-2 and MMP-7 were correlated. MMP-2 expression in stromal cells was more increased in the distal part of the colorectum: 8.8% in right colon cancer, 29.5% in left colon cancer and 36.4% in rectal cancer. MMP-2 expression of tumor cells in the tumor border was correlated with T-stage. MMP-7 expression of tumor cells in the tumor border was increased in case of infiltrative cancer compared with fungating tumor. The expression patterns of MMP-2 and -7 were not correlated with other clinicopathological factors, including tumor markers, node metastasis, distant metastasis, lymphatic invasion, tumor differentiation, and recurrence. No significant associations between the overall and disease-free survival rates and the MMP-2 and -7 expression patterns were noted. CONCLUSION: The high expression rates of MMP-2 and -7 in tumor borders suggest that MMP-2 and -7 have some role in tumor invasion, but in this study, MMP-2 and -7 did not appear to be significant predictors of prognosis in colorectal cancer.
Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Immunohistochemistry ; Lymphatic Metastasis ; Matrix Metalloproteinase 2 ; Matrix Metalloproteinases ; Neoplasm Metastasis ; Prognosis ; Rectal Neoplasms ; Recurrence ; Stromal Cells ; Biomarkers, Tumor

PURPOSE: The utility of 18-fluordesoxyglucose positron emission tomography ([¹⁸F]-FDG-PET) combined with computer tomography or magnetic resonance imaging (MRI) in gastric cancer remains controversial and a rationale for patient selection is desired. This study aims to establish a preclinical patient-derived xenograft (PDX) based [¹⁸F]-FDG-PET/MRI protocol for gastric cancer and compare different PDX models regarding tumor growth and FDG uptake. MATERIALS AND METHODS: Female BALB/c nuu mice were implanted orthotopically and subcutaneously with gastric cancer PDX. [¹⁸F]-FDG-PET/MRI scanning protocol evaluation included different tumor sizes, FDG doses, scanning intervals, and organ-specific uptake. FDG avidity of similar PDX cases were compared between ortho- and heterotopic tumor implantation methods. Microscopic and immunohistochemical investigations were performed to confirm tumor growth and correlate the glycolysis markers glucose transporter 1 (GLUT1) and hexokinase 2 (HK2) with FDG uptake. RESULTS: Organ-specific uptake analysis showed specific FDG avidity of the tumor tissue. Standard scanning protocol was determined to include 150 μCi FDG injection dose and scanning after one hour. Comparison of heterotopic and orthotopic implanted mice revealed a long growth interval for orthotopic models with a high uptake in similar PDX tissues. The H-score of GLUT1 and HK2 expression in tumor cells correlated with the measured maximal standardized uptake value values (GLUT1: Pearson r=0.743, P=0.009; HK2: Pearson r=0.605, P=0.049). CONCLUSIONS This preclinical gastric cancer PDX based [¹⁸F]-FDG-PET/MRI protocol reveals tumor specific FDG uptake and shows correlation to glucose metabolic proteins. Our findings provide a PET/MRI PDX model that can be applicable for translational gastric cancer research.

OBJECTIVES: The drug utilization review (DUR) system, which checks any conflict event of medications, contributes to improve patient safety. One of the important barriers in its adoption is doctors' resistance. This study aimed to analyze the impacts of doctors' resistance on the success of the DUR system. METHODS: This study adopted an augmented the DeLone and McLean Information System (D&M IS) Success Model (2003), which used doctors' resistance as a socio-technological measure. This study framework is the same as that of the D&M IS Success Model in that it is based on qualities, such as system, information, and services. The major difference is that this study excluded the variable 'use' because it was not statistically significant for mandatory systems. A survey of doctors who used computers to enter prescriptions was conducted at a Korean tertiary hospital in February 2012. RESULTS: This study is very meaningful in that it is the first study to explore the success factors of the DUR system associated with doctors' resistance. Doctors' resistance to the DUR system was not statistically associated with user usefulness, whereas it affected user satisfaction. CONCLUSIONS: The results indicate that doctors still complain of discomfort in using the DUR system in the outpatient clinical setting, even though they admit that it contributes to patient safety. To mitigate doctors' resistance and raise user satisfaction, more opinions from doctors regarding the DUR system have to be considered and have to be reflected in the system.
Drug Utilization Review* ; Humans ; Information Systems ; Medicare Assignment ; Outpatients ; Patient Safety ; Prescriptions ; Tertiary Care Centers