Retrospective Cohort Study on the Administration of Sedative for Delirium in Terminally Ill Cancer Patients and Survival Time / 한국호스피스완화의료학회지

PURPOSE: This study analyzed the difference in survival time of patients with delirium according to sedative medication. METHODS: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. RESULTS: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=−3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). CONCLUSION: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.

Effects of Tempol on Blood Pressure and Tissue Oxidative Stress in DOCA-alt and L-AME-nduced Hypertension / 대한신장학회잡지

BACKGROUND: Effects of oxidative stress on the development of deoxycorticosterone acetate (DOCA)-salt or N(G)-nitro-L-arginine (L-NAME) hypertension were examined. METHODS: Male Sprague-awley rats were treated with DOCA (200 mg/kg, subcutaneous)-salt or L-NAME (40 mg/L in daily drinking water) for 4 weeks. To reduce the oxidative stress, 4-hydroxyl-2,2,6,6-tetramethylpiperidine-1-oxyl (Tempol, 3 mM/L) was cotreated in drinking water. The expression of endothelial nitric oxide synthase (eNOS) and nitrotyrosine proteins was determined in the renal cortex and thoracic aorta. RESULTS: Tempol prevented the development of DOCA-salt hypertension, whereas it was without effect on L-NAME hypertension. In DOCA-salt hypertension, the eNOS expression in the renal cortex was increased, the degree of which was attenuated by Tempol. The renal expression of nitrotyrosine was decreased, which was further decreased by Tempol. In the aorta, the expression of both eNOS and nitrotyrosine was decreased, which was not further affected by Tempol. In L-NAME hypertension, the renal expression of eNOS was significantly increased, which was blocked by Tempol. The expression of eNOS in the aorta was slightly decreased, and was not further affected by Tempol. The renal expression of nitrotyrosine was not significantly altered. However, its expression was significantly decreased in the aorta, and was further reduced by Tempol. CONCLUSION: The blockade of oxidative stress may attenuate the development of hypertension and provide tissue protection in DOCA-salt hypertension. The blockade of oxidative stress may also contribute to a tissue protection in L-NAME hypertension.

Urinary Transforming Growth Factor-beta-inducible Gene-h3 in Patients with Glomerular Diseases / 대한신장학회잡지

BACKGOUND: Transforming growth factor-beta (TGF-alpha) has been implicated in the pathogenesis of a number of kidney diseases. However, TGF-alpha is secreted in a latent form requiring extracellular modification to become biologically active. Recently, the activity of TGF-alpha has been assessed by the measurement betaig-h3, a novel TGF-alpha induced gene product. Thus we evaluated the pattern of urinary betaig-h3 expression in various glomerular diseases. METHODS: 64 patients with biopsy-proven primary glomerulonephritis (FSGS 6, HSPN 16, IgAN 20, MPGN I 7, and MesPGN 15), 10 patients with nephrotic syndrome and 12 healthy controls were enrolled in the study. A total 86 subjects (51 males, 59.3% and 35 females, 40.7%, mean age 13.9+/-4.28 years) constituted study population. First morning urine were collected and betaig-h3 in the urine was determined by indirect competitive ELISA (Regen Biotech Inc, Seoul, Korea). RESULTS: betaig-h3 excretion was significantly higher in the urine from patients with HSPN (27.5+/-6.46, p=0.002), with IgAN (40.83+/-12.27, p=0.026), with MPGN I (21.64+/-7.29, p=0.042), MesPGN (26.42+/-6.68, p=0.007). In patients with FSGS (21.65+/-17.12) and minimal change nephrotic syndrome (6.26+/-2.18), mean urinary betaig-h3 excretion was not significant higher than that in control group (3.56+/-0.78). CONCLUSION: Urinary betaig-h3 excretion was high in proliferative renal diseases. However, betaig-h3 excretion was not high in non-proliferative renal diseases.

The Bone Regenerative Effect of Calcium Sulfate- chitosan Complex Powder and Chitosan Microsphere Encapsulating Growth Hormone on Bone Formation in Bone Defect of Rabbits

This study was carried out on 32 New Zealand white rabbits, each weighing 3-3.5kg. Eight rabbits were allocated into each of four groups. The groups were a control group(I), hyaluronic acid group(II), chitosan microsphere encapsulating growth hormone group(III), calcium sulfate-chitosan powder group(IV). After a 1cm sized ostectomy was made on the tibial body with the periosteum preserved, artificial bone substitutes were implanted. Except group I, 1ml of hyaluronic acid were implanted in group II, 1ml of chitosan microsphere encapsulating growth hormone in group III, 1ml of manufactured calcium sulfate-chitosan complex powder in group IV. Results were evaluated using radiographic study every week, bone mineral density test and histologic examination at 2, 4, 6 weeks and three point bending test at 6 weeks after implantation. In the radiographic study, the formation and corticalization of callus were seen similarly in group III, IV and much more and earlier than group I, II. In the bone mineral density test and three point bending test to contralateral normal tibia in 6 weeks, the values in groups III and IV were statistically significantly higher than in group I and II(p<0.05). In histologic examination, group III and IV have more abundant and faster new boner formation than group I and II. In conclusion, calcium sulfate-chitosan complex powder and chitosan microsphere encapsulating growth hormone facilitates the formation of new bone. They will be used effectively as a bone substitute on defected bone in clinical situations.

Wound Healing Effect of the Chitosan Sponges Containing the T-CAM or Regenin

Tetra cell adhesion molecule(T-CAM) is a new recombinant mixture of fibronectin and ig-h3. Fibronectin and ig-h3 are extracellular matriprotein involved in each phase of wound healing, and the combination of these materials may generate a synergistic effect in wound healing. Regenin is easily attainable from protein recombination. It can be developed as wound healing material, and also it has a good effect in cell adhesion and proliferation. We combined the chitosan with regenin or T-CAM at different concentration, which are gene recombination material. They were applied to the artificial wound of white rabbit to compare the healing effect in each group. Round full thickness skin defects, 3 cm in diameter, were made bilaterally on the dorsolateral aspect of New Zealand white rabbit. Experimental group was divided into 6 groups, according to concentration of T-CAM and regenin with chitosan-based dressing materials as followings; Group C: control group - oint material dressing, Group Ch: chitosan base only, Group T1: chitosan base in combination with 25 microgram/ml of T-CAM, Group T2: chitosan base in combination with 625 microgram/ml of T-CAM, Group R1: chitosan base in combination with 25 microgram/ml of Regenin, Group R2: chitosan base in combination with 625 microgram/ml of Regenin. Gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area were compared with surface tracing of the remained wound area at the time of 7, 14, 21 days after wound formation. Wound biopsy were performed at the time of 7, 14, 21 days after wound formation. T1, T2 group and R1, R2 groups have less infiltration of inflammtory cell, fast appearance of new vessels, fibroblast, increased volume of collagen fiber comparing to C and Ch group. there's more statistical significance between T1 and T2 group. The same results were shown in Regenin group. In conclusion, our results suggest that T-CAM and Regenin have good effect in wound healing and higher concentration of T-CAM and Regenin is more effective in wound healing than lower concentration. In addition, comparision of same concentration of T-CAM and Regenin group presented almost same results.

Comparison of Wound Healing Effect of Different Forms of Chitosan

This study is to compare the effect of wound healing using three different types of chitin, which include the shapes of sponge, velvet, thick non-woven fabrics, and thin non-woven fabrics. The sponge type had more capacity to absorb the first discharge of a wound than the velvet type and the two non-woven fabrics types. Instead of absorbing the discharge effectively, the velvet type showed a difficulty to take off the dressing stuff from a wound since it was solidly stuck to the wound. The sponge type showed less infiltration of inflammatory cells, producing angiogenesis and fibroblast faster than any other types. Next, the thick non-woven fabrics type was a little more effective than the thin non-woven fabrics type: However, there was no difference between two types. The velvet type sustained the infiltration of inflammatory cells for the longest duration, producing slower angiogenesis and fibroblast. In wound contraction and wound healing, the sponge type was most effective with statistical significance than any other types(p0.05). In conclusion, the sponge type showed the best effectiveness to absorb the early discharge, facilitating the progress of inflammatory phase to increase the healing rate. It induced an early healing of wound caused by wound contraction rather than by wound epithelization.

The Clinical Significance of Elevated Troponin in Patients with Acute Coronary Syndrome with Normal Electrocardiogram

BACKGROUND AND OBJECTIVES: The level of cardiac specific troponin (cTn) may be important in patients with acute coronary syndrome (ACS), but with normal electrocardiography (ECG). SUBJECTS AND METHODS: Three hundred and nineteen patients (61+/-11 years, M:F=212:107), with ACS and normal ECG, who underwent a diagnostic coronary angiogram (CAG), between July 2000 and June 2001, were analyzed according to their cTn level. The clinical characteristics, initial CAG findings and major adverse cardiac events (MACE), during a one-year clinical follow-up, were compared between positive and negative cTn groups. RESULTS: Of the enrolled patients, 191 had a negative cTn (group A, 61+/-10 years, M:F=131:60), and 128 a positive cTn (group B, 60+/-11 years, M:F=81:47), and 176 (55.2%) were shown to have significant coronary artery stenosis on CAG. There were no significant differences in risk factors between the two groups. The mean left ventricular ejection fraction was 64+/-9%, and was lower in group B than in group A (59+/-10% vs. 67+/-7%, p<0.05). cTn positivity was associated with the percentage of significant coronary artery stenosis present (88% vs. 32%, p<0.05), a smaller minimal luminal diameter (1.09+/-0.44 mm vs. 2.68+/-0.33 mm, p<0.05) and a larger diameter of stenosis (68+/-6% vs. 44+/-6%, p<0.05). A multi-vessel lesion was more common in group B than in group A (58.3% vs. 30.3%, p<0.05). During the one-year follow-up period, 36 patients developed MACE, resulting in 3 deaths, 7 acute myocardial infarctions and 34 patients with restenosis. MACE was observed in 9 patients of group A and in 27 of group B (4.7% vs. 21.1%, p<0.05). CONCLUSION: The troponin levels are valuable for the early diagnosis, and prediction of the long-term prognosis, in patients with ACS and a normal ECG.

The long-term clinical effect of cutting ballon angioplasty for coronary in-stent restenosis / 대한내과학회지

BACKGROUND: Coronary stent implantation reduced the restenosis rate after percutaneous coronary intervention (PCI) but, still coronary in-stent restenosis (ISR) remains the major problem after PCI. Cutting balloon angioplasty is one of the method for ISR treatment. The purpose of this study is prospectively comparing the effect of cutting balloon angioplasty (CBA) with plain old balloon angioplasty (POBA) for the ISR. METHODS: A total of 50 patients with ISR, who underwent PCI (randomized CBA or POBA for ISR) from January to December 2001 at Chonnam National University Hospital, were divided into two groups: Group I (n=25: 58.4+/-7.9 years, male 88%) with CBA and Group II (n=25: 58.1+/-8.7 years, male 92%) with POBA. The early luminal gain, late luminal loss, major adverse cardiac event and angiographic restenosis rate were compared. RESULTS: There were no differences in baseline clinical characteristics of sex, age, ejection fraction, cardiac enzyme, risk factors of atherosclerosis, number of coronary artery lesions, and type of ISR between the groups. The minimal luminal diameters of before and after PCI were 0.83+/-0.34 mm, 2.10+/-0.55 mm in group I and 0.93+/-0.58 mm, 2.08+/-0.79 mm in group II. There were no differences in early luminal gain. All patients underwent follow-up coronary angiogram and the restenosis rate was 32% (8/25) in group I and 28% (7/25) in group II, and late luminal loss were 0.60+/-0.40 mm in group I and 0.65+/-0.61 in group II (p=NS). The major adverse cardiac events during 6-month follow-up developed in 3 cases of group I and 4 cases of group II (p=NS). CONCLUSION: There were no differences in early and long-term clinical effects after CBA and POBA for the treatment of ISR.

The Effect of Cyclic Compressive Strain on the Differentiation of Osteoblast-Like Cells (MC3T3-E1) in 3-D Scaffold / 대한정형외과연구학회지

We examined the effect of an applied cyclic compressive strain on the growth and differentiation of MC3T3-E1 cultured in a three-dimensional chitosan scaffold. The specially designed testing apparatus for mechanical stimulus was developed for uniaxial cyclic compressive strain. Cyclic compressive strain was applied over a period of 17 days with 150 cycles per day at a frequency of 0.5hz. Strain magnitude was 2.5% of the scaffold length. Control group and mechanically stimulated group were incubated and harvested at the indicated times. (day 3, 7, 10, 14, 17) The total amount of protein and alkaline phosphatase activity were examined. The total amount of protein of the control group was higher than that of the mechanically stimulated group. This was due to cell death for the nodule formation and calcium deposit of the mechanical stimuli group which resulted in cell differentiation. The alkaline phosphatase activity increased slightly in the control group. However, in the mechanical stimuli group, it increased significantly and reached its peak level on day 7 and subsequently its activity dropped to a level that was higher than the level at day 4(p < 0.05). Conclusively, it can be noted that the mechanical stimulus significantly accelerated the differentiation of MC3T3-E1 cells.

Ultrasonography and Plain Film Versus Intravenous Urography in Urinary calculi

BACKGROUND: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative. METHODS: We undertaken study to see if this approch can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experence. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard. RESULTS: Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was positive, leaving three false negative KUB plus USG. Thus the sensitivity of KUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%. CONCLUSIONS: Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessa.ry.

Average Value of Margin Limbal Distance in Koreans

The measurement of levator muscle function is the most important step in the evaluation of patients with blepharoptosis and also the most important factor in the choice of operation for blepharoptosis. There are two methods in measuring the levatormuscle function; one is Berke's method and the other is margin limbal distance(MLD). When the levator muscle resection procedure is indicated in blepharoptotic patients, preoperative MLD value is the clue to determine the amount of levator muscle to be resected by the MLD formula. MLD was measured in 419 normal Koreans who were examined in the Depart ment of Ophthalmology, Keimyung University School of Medicine from October 1987 to August 1988. The results were as follows: 1. The average value of MLD was 6.3 +/- 1.2mm. 2. The average value of MLD in males was 6.3 +/- 1.3mm and 6.2 +/- 1.2mm in females. 3. The average value of MLD in both eyes was 6.3 +/- 1.2mm. 4. The average value of MLD in different age groups was 5.7 +/- 1.0mm in the below 10 age gruop, 6.0 +/- 1.1mm in the 11-20 age group, 6.8 +/- 1.2mm in the 21-30 age group, 6.8 +/- 1.3mm in the 31-40 age group, 6.4 +/- 1.2mm in the 41-50 age group, 6.1 +/- 1.3mm in the 51-60 age group and 6.3 +/- 1.1mm in the above 60 age group, respectively. The average value of MLD was significantly different in the different age groups(p<0.01). Thus, the average value of MLD in normal Koreans was 6.3 +/- 1.2mm, which is significantly different from the 9mm of Putterman's. So we must consider 6.3 +/- 1.2mm as the normal value of MLD when determining the amount of levator muscle resection by the MLD formula.

Bilateral Microcornea with Cornea Plana in a Family

Microcornea is a condition characterized by a small cornea in an otherwise normal eye and can be defined when corneal diameter is less than 11.00mm. Microcornea may occur as an isolated abnormality or accompany other anterior segment anomalies like aniridia and anterior chamber cleavage abnormalities. Microcornea is part of nanophthalmos, a condition in which a reduction in global dimensions is the only structural abnormality, as well as microphthalmos, a term generally, used to signify a small, abnormal globe. Microcornea is a rare anomaly and its etiology is probably a primary aberration of the growth of the ectoderm of the optic cup. Both autosomal dominant and autosomal recessive patterns of inheritance occur, but it may appear sporadically. Cornea plana is usually seen in association with microcornea wherein the corneal curvature is less than normal. It is often associated with diffuse opacities of the cornea stroma. Cornea plana might be caused by a deep developmental arrest in the fourth month, at which time the cornea begins to increase its curvature relative to the sclera. The authors experienced a case of bilateral microcornea with cornea plana in a family which seemed to transmit as the dominant trait.

Bilateral Microcornea with Cornea Plana in a Family

Microcornea is a condition characterized by a small cornea in an otherwise normal eye and can be defined when corneal diameter is less than 11.00mm. Microcornea may occur as an isolated abnormality or accompany other anterior segment anomalies like aniridia and anterior chamber cleavage abnormalities. Microcornea is part of nanophthalmos, a condition in which a reduction in global dimensions is the only structural abnormality, as well as microphthalmos, a term generally, used to signify a small, abnormal globe. Microcornea is a rare anomaly and its etiology is probably a primary aberration of the growth of the ectoderm of the optic cup. Both autosomal dominant and autosomal recessive patterns of inheritance occur, but it may appear sporadically. Cornea plana is usually seen in association with microcornea wherein the corneal curvature is less than normal. It is often associated with diffuse opacities of the cornea stroma. Cornea plana might be caused by a deep developmental arrest in the fourth month, at which time the cornea begins to increase its curvature relative to the sclera. The authors experienced a case of bilateral microcornea with cornea plana in a family which seemed to transmit as the dominant trait.

A Clinical Study on A and V Patterns

A and V patterns are manifest by a horizontal change of alignment of the eyes that occurs on midline upgaze and downgaze as the eyes are moved from the primary position. A and V patterns may be associated with orthophoria, esodeviation, or exodeviation in the primary position. Compensatory head postures are frequently found in patients having A and V patterns. A great deal has been written about the etiology, however, no single etiologic factor can explain all A and V patterns. A and V patterns are revealed by prism and alternate cover midline measurements, comparing 30 degrees upgaze, primary position, and 30 degrees downgaze. A difference of 15 delta between up and down measurements in V patterns and 10 delta in A patterns is necessary for a valid diagnosis. Some surgical methods were described to correct the A and V patterns, only two methods receive widespread acceptance: vertical transposition of the insertions of the horizontal rectus muscles and weakening of the oblique muscles. The authors studied clinically 8 cases of V patterns and 1 case of A pattern in 118 strabismic patients. The results were as follows; 1) The prevalence of A and V patterns was about 8%(9/118). 2) In V patterns, weakening procedures on the inferior oblique muscles with surgery on the horizontal rectus muscles corrected 7 delta to 12 delta between primary position and upgaze. And combining vertical transposition of horizontal rectus muscles corrected an additional 17 delta to 28 delta of V patterns between up and downgaze. 3) In A pattern, resecting inferior rectus muscle with surgery on the horizontal rectus muscles corrected 6 delta of A pattern.

Typical and A typical Brown's Syndrome

The superior oblique tendon sheath syndrome was first described by Brown(1950). The essential feature is a limitation of elevation in adduction caused by a short or inadequately mobile anterior segment of the superior oblique tendon and its sheath, which restricted passive elevation in the fully adducted position. Brown has subdivided the entity into true and simulated Brown's syndrome. True Brown's syndrome may be typical or atypical. Typically, there is no significant co-existing limitation of the homolateral superior rectus muscle; atypically there is a significant limitation. Numerous surgical techniques have been advocated to treat Brown's syndrome. Of these, a tenectomy of the homolateral superior oblique has emerged as the most effective method. The authors experienced two cases of Brown's syndrome, one is typical in 5 year old male patient, the other is atypical in 27 year old male patient. Excellent result was obtained in typical Brown's syndrome who underwent a tenectomy of the superior oblique, including the sheath.