BACKGROUND AND OBJECTIVES: Pioglitazone has been known for its anti-atherogenic effects. We compared the effects of pioglitazone in reducing atherosclerosis progression and neointima volume in type 2 diabetic patients. SUBJECTS AND METHODS: This was a prospective, randomized single-blinded, 8-month follow-up study. Patients with significant coronary artery stenosis were randomly assigned to either pioglitazone (n=19) or placebo (n=18) following zotarolimus-eluting stent (ZES) implantation. Intravascular ultrasonography of the culprit vessel was performed from 20 mm distal and proximal to the stent at baseline. and at 8-month, and volumetric analysis was performed. Changes in inflammation markers, insulin resistance and lipid profile were compared. RESULTS: Changes in atherosclerosis progression from baseline in the pioglitazone group was significantly lower than that of the placebo group (0.06+/-0.73 vs. 1.16+/-1.41 mm3/mm, p=0.024, respectively), and neointima volume was significantly lower in the pioglitazone group compared to the placebo group (1.74+/-0.93 vs. 2.42+/-1.98 mm3/mm, p=0.007, respectively). Homeostatic model assessment-index, interleukin-6, and tumor necrosis factor-alpha levels were significantly lower in the pioglitazone group at 8 months. Adiponectin levels increased significantly only in the pioglitazone group. No significant differences in retinol binding protein-4 levels between the 2 groups were seen during the 8-month follow-up period. CONCLUSION: Compared to placebo, pioglitazone was associated with significant reduction in atherosclerosis progression and neointima formation in type 2 diabetic patients with ZES implantation.
Adiponectin ; Atherosclerosis ; Coronary Stenosis ; Diabetes Mellitus ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Inflammation ; Insulin Resistance ; Interleukin-6 ; Neointima ; Prospective Studies ; Stents ; Thiazolidinediones ; Tumor Necrosis Factor-alpha ; Ultrasonography, Interventional ; Vitamin A

Hypokalemia is a frequent problem in patients on continuous ambulatory peritoneal dialysis (CAPD) and is affected by multiple factors. To evaluate factors associated with hypokalemia, we studied 68 patients on maintenance CAPD treatment for at least six months. In univariate analysis, patients with hypokalemia were associated with older age and the presence of diabetes mellitus. Serum albumin, calcium-phosphate product, triglyceride, body mass index, protein nitrogen appearance, and lean body mass assessed by creatinine kinetics were significantly lower as compared to those without hypokalemia. Serum C-reactive protein was significantly higher in the patients with hypokalemia. Multivariate stepwise linear regression analysis revealed that the serum albumin level and the ultrafiltration volume at the peritoneal equilibration test were independent factors associated with hypokalemia. This suggests that the serum potassium level may be an important nutritional marker in CAPD patients. Further longitudinal investigation is needed to clarify this relationship.
Body Mass Index ; C-Reactive Protein ; Creatinine ; Diabetes Mellitus ; Humans ; Hypokalemia* ; Kinetics ; Linear Models ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Potassium ; Serum Albumin ; Triglycerides ; Ultrafiltration

Sweet's syndrome is acute febrile neutrophilic dermatosis. It frequently involves upper and lower limbs, head and neck. The dermatologic symptom of Sweet's syndrome is elevated plaque, pain, and skin erythema. We have experienced a case of Sweet's syndrome which involved auricle and have needed to differentiate it from perichondritis. For the cases of assumed perichondritis that do not improve symptoms with treatment compatible for perichondiritis, Sweet's syndrome could be the etiology.
Ear, External ; Erythema ; Head ; Lower Extremity ; Neck ; Paraneoplastic Syndromes ; Skin ; Sweet Syndrome*

PURPOSE: The purpose of this study was to estimate the operating status of existing medical education management units in medical colleges and to define the roles of these units to provide basic information to medical schools contemplating to establish similar management units. METHODS: A structured questionnaire survey was conducted via mail. The survey 41 medical colleges across the nation and was done during September 2003 and March 2005. The assessment instrument included six items assessing the organizational structure, composition, major activities, self-satisfaction with performance, administration and financial aspects and the need for further development in the medical education unit for medical colleges with a medical education management unit. There were only two items assessing demand for establishment of a medical education management unit, prerequisite conditions for establishment, the expected role of such a system for medical colleges without a medical education management unit. RESULTS: Of 41 medical colleges, 18 had a medical education management unit as of September 2003 and 32 as of March 2005. The major activities of these 18 management units included curriculum development(26.7%), faculty development(26.7%), support for PBL(16.0%) and OSCE(12.0%). Recently, these units have become involved in enhancing clinical clerkship as well as improving teaching skills. To have a medical education-related unit run smoothly, at least two tenured faculty members majoring in education and medical education were needed. And a compensation systems was required for those professors working in the unit as a second post but without pay. CONCLUSION: This study underscored the importance of professional faculty members, and administrative and financial supports in having a medical education management unit meet its objectives. The role of the dean of medical college seems crucial in deciding how the unit is operated.
Clinical Clerkship ; Compensation and Redress ; Curriculum ; Education ; Education, Medical* ; Financial Support ; Korea* ; Postal Service ; Schools, Medical ; Surveys and Questionnaires

OBJECTIVE: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. METHODS: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. RESULTS: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. CONCLUSION: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.
Disease-Free Survival ; Follow-Up Studies ; Gynecology ; Hospital Records ; Humans ; Mesentery ; Multivariate Analysis ; Neoplasm, Residual ; Obstetrics ; Ovarian Neoplasms ; Prognosis ; Retrospective Studies ; Survival Rate ; Vital Signs

BACKGROUND: The revised version of the Hasegawa Dementia Scale (HDS-R) is a useful dementia screening tool with a test for frontal lobe function and is relatively less influenced by education level and linguistic ability. We developed a Korean version of HDS-R (K-HDS) by translating the HDS-R to screen dementia patients in the Korean elderly. METHODS: The basic structure of the HDS-R was preserved but some questions were modified for lingual and cultural difference. It was administrated along with the Korean version of the MMSE, Korean Dementia Screening Questionnaire, Short form Samsung Dementia Questionnaire and Clinical Dementia Rating (CDR) scales, to 151 patients (55 Alzheimer's disease, 73 vascular dementia, 23 others) with mild to moderate dementia and to 225 elderly control subjects. To screen dementia, the optimal cut-off score was estimated by receiver operating characteristic (ROC) curve analysis. By comparing the Area Under the Curve, the diagnostic efficiency of K-HDS was compared with that of K-MMSE. RESULTS: The K-HDS had good internal consistency (Crohnbach's alpha coefficient=0.66), inter-rater reliability (r=0.95), and test-retest reliability (r=0.92). K-HDS was well correlated with the K-MMSE (r=0.84) and CDR (r=-0.67), which confirms the validity of this test. The optimal cut-off score was different according to educational level. In patients with an educational level less than 10 years, the cut-off score was 20 with the sensitivity of 87.0% and the specificity of 83%. With an educational level of 10 years or more, the cut-off score was 22 with the sensitivity of 93.0% and the specificity of 89.6%. The overall diagnostic efficiency of K-HDS was superior to that of K-MMSE especially in patients with an educational level of less than 10 years. CONCLUSIONS: The K-HDS is a reliable, valid and useful tool to screen dementia in the Korean elderly.
Aged ; Alzheimer Disease ; Dementia* ; Dementia, Vascular ; Education ; Frontal Lobe ; Humans ; Linguistics ; Mass Screening ; Surveys and Questionnaires ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity ; Translating ; Weights and Measures

Apert syndrome or acrocephalosyndactyly is a rare developmental deformity with a sporadic or autosomal dominant trait characterized by coronal craniosynostosis, midface hypoplasia, exorbitism, typical symmetrical syndactyly of both hands and feet with varying degrees of mental retardation. It results from a mutation of the fibroblast growth factor receptor type-2 (FGFT2) gene. In the absence of family history, prenatal diagnosis may be difficult based on ultrasonographic findings alone. The original description was presented by Apert in 1906 with nine cases. Since then more than 200 cases have been reported in the world. We report a case of Apert syndrome diagnosed prenatally by ultrasonogram in the third trimester and subsequently was terminated, with a brief review of prenatal sonographic findings in 11cases reported in literature.
Acrocephalosyndactylia* ; Congenital Abnormalities ; Craniosynostoses ; Female ; Foot ; Hand ; Humans ; Intellectual Disability ; Pregnancy ; Pregnancy Trimester, Third ; Prenatal Diagnosis ; Receptors, Fibroblast Growth Factor ; Syndactyly ; Ultrasonography

Pericarotid syndrome is the combination of a postganglionic Horner's syndrome and ipsilateral head and facial pain, which is caused by diverse pathologic processes in and around the internal carotid artery. We report a case of peri-carotid syndrome which presented Horner's syndrome and ipsilateral periodic severe hemicrania associated with malig-nant lymphma lapping internal carotid artery. After surgical removal of the mass and chemotherapy, miosis, ptosis, and ipsilateral hemicrania improved.
Carotid Artery, Internal ; Drug Therapy ; Facial Pain ; Head ; Headache ; Horner Syndrome ; Lymphoma* ; Miosis ; Pathologic Processes

Tuberculomas of the lung are rare in children and one of the more common lesions presenting a solitary pulmonary nodule roetgenorgraphically. We are reporting of a 3-year-old child with a tuberculoma in left upper lobe. The patient was initially diagnosed as the benign mediastinal tumor but in the end as tuberculoma in left uper lobe. Wedge resection including the mass was done. The tumor had brown smooth external surfaces on sectioning including the mass was done. The tumor had brown smooth external surfaces on sectioning show pale gray and soft cut surface was shown. In light electromicroscopy chronic granulomas with multinucleated giant cells and central caseous necrosis were observed which are the characteristics of tuberculoma. The postopeative course was smooth and uneventful and patient has been well for 4 months postoperatively.
Child* ; Child, Preschool* ; Giant Cells ; Granuloma ; Humans ; Lung ; Necrosis ; Solitary Pulmonary Nodule ; Tuberculoma*

It is well known that the status epilepticus induced by the administration of pilocarpine to lithium-pretreated rats is a role model to study for the cholinergic system in epileptogenesis and the pathogenesis of status epilepticus. Although the researches for the expression of the c-fos proto-oncogene in seizure models have been studied, the exact role of the c-fos expression is still uncertain. To evaluate the characteristics of lithium-pilocarpine seizure model, we designed this study by following three steps; (1) the analysis of clinical manifestations by video, and electroencephalogram through implanted cortical electrodes during the course of status epilepticus induced by intraperitoneal administration of lithium chloride (5 mEq/kg) followed by pilocarpine(50 mg/kg) in Sprague-Dawley rats, (2) Fos expression and the time course of Fos appearance by the immunocytochemistry, (3) Neuropathologic change by cresyl violet stain. The presentation of clinical manifestations were cholinergic symptoms and signs, stereotyped behaviour, motor seizures, and status epilepticus in order. Electroencephalographic findings showed five patterns : (I) discrete seizure with interictal slowing; (ii) merging seizures with waxing and waning ictal discharges; (iii) continuous ictal discharges; (iv) continuous ictal discharges with flat periods; and (v) periodic epileptiform discharges on a flat background. The neuroanatomical sites of Fos expression were the taenia recta, anterior olfactory nucleus, olfactory tubercle, piriform cortex, entorhinal cortex, amygdala, septum, accumbens, caudate-putamen, hippocampus, dentate gyrus, thalamus, and cerebral neocortex. The Fos immunostaining appeared first in the taenia tecta, anterior olfactory nucleus, olfactory tubercle, and piriform cortex at 1 hour after pilocarpine injection, and was maximal in the most areas of cerebral cortex and limbic area between 4 and S hours. The thalamus and the caudate-putamen became stained after 4 hours. In the hippocampal formation, firstly, the Fos was stained maximally in the dentate gyrus at 3 hours followed by in the CA1, CA2, and CA3 regions. The Fos was disappeared in the dentate gyrus and CA2 region of hippocampus within 18 hours, but became stained sustainly in the CA3 and CA1 regions of hippocampus at 24 hours. Llght microscopic findings revealed widespread brain damage. The neuropathological changes were found within the anterior olfactory nucleus, piriform cortex, entorhinal cortex, thalamus, hippocampal formation, amygdaloid complex, lateral septum, neocortex and substantia nigra. There were only swollen and edematous change of neurons at 1 hour, but severely shrunken and darkened neuronal degeneration and neuronal loss at 72 hours. The neuronal degeneration and loss in hippocampal formation appeared severe in the CA1 and hilum, moderate in CA2, and mild in CA3 and dentate gyrus. In conclusion, it was suggested that cholinergic system (muscarinic receptor) played an important role in the induction of the seizure because Fos was expressed in the brain areas containing muscarinc receptor and the lithium-pilocarpine seizure was a good model to study for the status epilepticus.
Amygdala ; Animals ; Brain ; Cerebral Cortex ; Dentate Gyrus ; Electrodes ; Electroencephalography* ; Entorhinal Cortex ; Genes, fos ; Hippocampus ; Immunohistochemistry ; Lithium Chloride ; Neocortex ; Neurons ; Olfactory Pathways ; Pilocarpine ; Rats ; Rats, Sprague-Dawley ; Seizures* ; Status Epilepticus ; Substantia Nigra ; Taenia ; Thalamus ; Viola