Cognitive Function in Older Patients with Diabetes Mellitus

BACKGROUND: The relationship between type II diabetes and congnitive function has been explored in several studies. But the result was controversial. The purpose of the study was to determine whether diabetes mellitus in older patients(>or=65 years) is assiciated with cognitive dysfunction and to discover the related factors with th cognitive dysfunction. METHOD: Twenty patients with type 2 diabetes and twenty subjects with non-diabetes are studied with cognitive function test at Hwachun health center and county hospital. Cognitive function was assessed using Mini-Mental State Examination and Clock Drawing test and the score was analyzed. The diabetes groups were subdivided with duration of diabetes, HbAlc, chronic diabetic complications and then analyzed. RESULTS: A total of 6(30%) diabetic subjects scored below 24 on mini-mental state examination, compared with 3(15%) of controls(p=0.2560). The mean socres were 20.1+/-2.7 and 19.0+/-3.5 respectively. Clock drawing test demonstrated that 13(65%) diabetic subjects inconectly placed the numbers and hands, compared with 7(35%) of controls(p=0.0578>0.05). The duration of diabetes mellitus, HbAlc, chronic diabetic com- plications were not associated with cognitive dysfun- ction among diabetic subjects. CONCLUSIONS: The study showed that type 2 diabetes mellitus in the elderly is not associated with cognitive dysfunction, but further study should be done.

Dyspepsia in Korean Population: Who Needs Endoscopy? / 대한소화기내시경학회지

BACKGROUND/AIMS: Dyspepsia is remarkably common in the general population. Although upper gastrointestinal endoscopy is the investigation of choice for dyspepsia, the selection of the patients who need endoscopy is very difficult. This study was aimed to investigate the usefulness of the various parameters for the selection of the patients who need endoscopy in Korean population. METHODS: An analysis of the endoscopic findings was carried out in 141 patients with dyspepsia according to parameters including H. pylori IgG seropositivity, age and alarm signs, such as dysphagia, weight loss, vomiting, anemia, family history of upper gastrointestinal malignancy, hematemesis or melena, abdominal mass and anorexia. RESULTS: The positive rates of stomach cancer and peptic ulcer in patients above 35 years of age were 3% (4/118) and 30% (35/118), respectively. The positive rates of stomach cancer and peptic ulcer in patients with alarm signs were 2% (2/94), 36% (34/94) and the rates in patients with H. pylori IgG seropositivity were 4% (3/70), 37% (26/70), respectively. However, no parameter was useful in the selection of patients with stomach cancer or peptic ulcer. In patients with alarm signs, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 46% (22/48) and 26% (12/46), respectively (p=0.04). In patients under 35 years of age, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 58% (7/12) and 18% (2/11), respectively (p=0.048). CONCLUSIONS: The overall positive rates of stomach cancer or peptic ulcer were significantly higher in patient group with both H. pylori IgG seropositivity and alarm signs, and that under 35 years of age with H. pylori IgG seropositivity. However, there were also considerable number of peptic ulcer in patients who were excluded from those groups. We recommend that those parameters should be used only as a decision aid in selecting the candidates for endoscopy.

Four Cases of Pericardial Tamponade Following Percutaneous Transluminal Coronary Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is a relatively safe and effective procedure in the treatment of coronary artery disease, but complications related to dilating catheters and guide wires such as coronary artery dissection, spasm, rupture, and perforation can be. Pericardial tamponade is a rare complication of cardiac catheterization, and prompt diagnosis and proper management are important in lifesaving. We report 4 patients who developed pericardial tamponade following PTCA, presumably from coronary artery or right ventricular perforation. All 4 patients received heparin during PTCA and temporary pacemaker was placed in the right ventricle. Pericardial tamponade was recognized in the catheterization laboratory in 1 patient, within 3 hours after leaving the laboratory in 3 patients. Emergent pericardiocentesis was performed in all patients. Three patients recovered and one patient died.

Changes in Left Ventricular Diastolic Function after Antihypertensive Treatment in Patients with Hypertension

BACKGROUND: Left ventricular diastolic dysfunction is often observed in hypertensive patients with normal left ventricular systolic function and can cause heart failure symptoms. Doppler echocardiography has become a standard tool for examining left ventricular diastolic function. This study was performed to evaluate the left ventricular diastolic function in hypertensive patients with normal left ventricular systolic function and to determine the changes in left ventricular diastolic function after antihypertensive treatment. METHODS: Mitral inflow and pulmonary venous Row velocities were evaluated by transthoracic pulsed-wave Doppler study in patients with hypertension before antihypertensive treatment(n= 50) and after antihypertensive treatment for 4 months(n=24). The patients were randomly assigned to group I to receive ACE inhibitor or group II to receive other antihypertensive drugs. RESULTS: Before antihypertensive treatment, mitral inflow E/A ratio was 0.94+/-0.27, decele- ration time was 222+/-47 msec, and pulmonary venous flow S/D ratio was 1.62+/-0.42. Follow- up Doppler study was completed in 24 patients after 4 months of antihypertensive treatment. Mitral inflow E/A ratio was significantly increased(0.96+/-0.24 vs. 1.16+/-0.25, p<0.001), but deceleration time showed no significant changes. Pulmonary venous flow S/D ratio was signi- ficantly decreased(1.75+/-0.27 vs. 1.50+/-0.24, p<0.001). There was no significant difference in changes in mitral inflow E/A ratio, deceleration time and pulmonary venous flow S/D ratio between ACE inhibitor group and other antihypertensive group. CONCLUSION: There was some improvement in left ventricular diastolic function in patients with hypertension after 4 months of antihypertensive treatrnent. But, there was no significant difference in changes in diastolic parameters between ACE inhibitor group and other antihy- pertensive group.

Rescue Utilization of Abciximab (ReoPro) for the Thrombus

The presence of pre-existing intracoronary thrombus has consistently been shown to be among the strongest predictors of unsuccessful angioplasty and abrupt vessel closure. Abciximab, platelet glycoprotein IIb/IIIa receptor antagonist, through prevention platelet aggregation and coronary thrombosis, has shown promise in helping to decrease the incidence of complications of PTCA when prophylatically administered in patients presenting with unstable angina or complex lesion morphology for PTCA and in lower risk patients as well. However, the cost of abciximab and its associated increased risk of bleeding may limit its use as a prophylactic treatment. This study was performed to evaluate the effect of the rescue administration of abciximab in seven patients with thrombus containing lesion during angioplasty. Thrombus was disappeared in 4 patients and decreased in 2 patients, and the follow-up angiogram showed normal brisk flow in all 6 patients. There were no death or myocardial infarction on clinical follow-up at a mean of 7 months except one which was developed restenosis at the angioplasty lesion. Dissolution of thrombus and restoration or maintenance of TIMI grade 3 flow were achieved without complications after administration of abciximab when delivered in a rescue manner on thrombus containing lesion during angioplasty. These results showed that failure to give preprocedural proph-ylactic abciximab did not appear to exclude the possibility of a beneficial effect of abciximab, given therapeutically during the early stage of thrombus formation in patients with complicated lesion during angioplasty.