Association of Resting Heart Rate and Dyslipidemia and Diabetes in 2018 National Health and Nutrition Examination Survey

Background@#As a risk factor for diabetes, there are many evidences for physical characteristics and lifestyle habits. There are studies showing that resting heart rate is also related, but evidence is still lacking. Therefore, this study attempted to determine the effect of resting heart rate on diabetes. @*Methods@#The subject of this study was analyzed with 6,622 people who had fasting blood glucose test data out of a total of 7,993 people who participated in the 7th National Health and Nutrition Survey. Fasting blood glucose above 126 mg/dL was defined as a diabetic group and a multiple logistic regression analysis was used. General characteristics, lifestyle and blood chemistry test results were adjusted to investigate the association with diabetes according to the resting heart rate level in the subjects. @*Results@#The risk of diabetes according to the resting heart rate level was 1.434 times in the 2nd quartile, 1.714 times in the 3rd and 1.785 times in the 4th, compared to the 1st quartile. In model 4, except for the 2nd, which was not significant the analysis with all related variables adjusted for the risk rate in the 3rd and 4th order showed that the risk rate increased to 2.364 times and 3.477 times, respectively as the resting heart rate increased. @*Conclusions@#This study shows that high resting heart rate is associated with increased diabetes, and suggests that high heart rate, along with other known risk factors, may be a useful tool in predicting diabetes risk.

A Case of Diaphragmatic Eventration Complicated with Contralateral Traumatic Diaphragmatic Paralysis / 대한흉부외과학회지

Diaphragmatic eventration is a rare disease and is caused by congenital etiology. We operated on a patient who had had preexisting left diaphragmatic eventration which was complicated by a right diaphragmatic paralysis and a persistent respiratory insufficiency due to a traffic accident. This was a very rare case and there has not yet been any case reports worldwide. We were able to abtain good surgical results from plication of left diaphragm in this case and thus report it.

Coexistence of Bronchial Atresia and Bronchogenic Cyst: A Case of Report / 대한흉부외과학회지

We report very rare case of concurrent bronchial atresia and bronchogenic cyst. Morphologic apical segment of right upper lobe directly stemmed from right main bronchus. Bronchogenic cyst was communicating with atretic segmental bronchus and both were filled with mucus. The etiology is not well known, however it is likely that a single insult arround the 5th~6th week causes both malformations.

Availability of Cardiac Troponin T as a Marker for Detecting Perioperative Myocardial Damage in Patients with Open Heart Surgery / 대한흉부외과학회지

It is well known that troponin T (below TnT) is present in the myocardial cells and released during myocardial damage, so it`s very specific enzyme to myocardium. Availability of cardiac specific TnT in assessing perioperatively myocardial damage was evaluated from 34 open heart surgery patients. They consisted of 11 ischemic heart, 13 acquired valvular heart and 10 congenital heart cases. Patients were divided into two groups, group A (patients with myocardial damage) and group B (patients without myocardial damage), according to the symptom of chest pain suspecting angina and the ECG findings of ST segment and T wave changes which show myocardial ischemia and injury. Serum TnT levels were measured by enzyme immunoassay method preoperatively, immediately postoperatively, postoperative day 1, day 2, day 3, and day 7. We observed and analyzed the changes of serum TnT levels in two groups and compared the serum TnT levels with CK-MB levels measured at the same time. In group A, serum TnT levels showed 1.37+/-0.26microgram/L, 3.16+/-0.66microgram/L, 2.39+/-0.74microgram/L, 2.49+/-0.76microgram/L, and 1.23+/-0.60microgram/L, immediate postoperatively, postoperatively day1, day2, day3, and day7, respectively. It was observed there were significant differences compared with those of group B (0.38+/-0.04microgram/L, 0.34+/-0.05microgram/L, 0.25+/-0.03microgram/L, 0.24+/-0.04microgram/L, and 0.11+/-0.03microgram/L) during identical periods (p<0.01). Serum CK-MB level in group A significantly elevated to 145.04+/-35.08 IU/L on the postoperative day 1 compared to group B (31.28+/-5.87 IU/L, p<0.05), However, it stiffly decreased from day 2 and returned to preoperative level at day 3. When serum TnT level more than 1.0microgram/L is thought to reflect myocardial damage, serum TnT had 100% of sensitivity and 87% of specificity in diagnosing the postoperative myocardial damage (p<0.01). I conclusion, serum TnT levels increased significantly at very early stage of myocardial damage and persisted much longer period than CK-MB. This suggests that serum TnT has more advantage and availability in assessing the perioperatively myocardial damage than any other tests.

Surgical Treatment of Loculated Empyema: Closed Rib Resectional Drainage / 대한흉부외과학회지

BACKGROUND: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. MATERIALS AND METHODS: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. RESULTS: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis (8 cases) or chest tube drainage (10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases (42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, alpha-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1~4 (mean 1.78+/-1.00). Operating time was relatively short, about 55~140 mins (mean 102.8+/-30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3~42 days (mean 11.4+/-11.5) and 6~36 days (mean 12.9+/-8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3~6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. CONCLUSIONS: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

Efficacy of mechanical pleurodesis for the treatment of spontaneous pneumothorax with VATS: A comparison of short-term recurrence according to the intensities of pleural abrasion / 대한흉부외과학회지

BACKGROUND: With the advent of thoracoscopy, there has been increasing interest in less invasive surgical bullectomy and pleurodesis. The recurrence rate, however, has been reported higher in surgery with thoracoscopy than with open thoracotomy and it is thought to be caused by inappropriate mechanical pleurodesis during thoracoscopic surgery. MATERIALS AND METHODS: We compared the short-term recurrence rates according to the intensities of pleural abrasion in 62 patients who underwent VATS for treatment of spontaneous pneumothorax from April 1996 to August 1997. The patients were divided into 2 groups: group A (n=32) included patients who received relatively weak pleural abrasion using Endo-forcep instrument for grasping the gauze, and group B (n=30) received strong pleural abrasion using conventional instrument wrapped tightly with gauze. Each intensity of pleural abrasion allowed petechia on the parietal pleura in group A, and some tearing and bleeding in group B. RESULTS: Indications for operation, sex distribution, and age were comparable in both groups. There were no differences in chest tube indwelling time (3.78+/-3.35 vs 3.80+/-2.49 days), hospital stay (4.72+/-1.87 vs 4.67+/-2.20 days), and the amount and duration of analgesics required postoperatively. Persistent air-leak more than 7 days after surgery occurred in 4/32 (12.5%) and 2/30 (6.7%) in group A and B, respectively. No bleeding-related complication occured. Pneumothorax recurred 12.5% (4/32) and 0% (0/30) of patients at a mean follow-up of 9.7 and 9.6 months in group A and B, respectively, and it was statistically significant (p<0.05). CONCLUSIONS: Proper intensity of pleural abrasion is very important factor to reduce recurrence after VATS for spontaneous pneumothorax. During short-term follow-upafter surgery, we could achieve excellent result in reducing recurrence rate with VATS and strong pleural abrasion which is comparable to thoracotomy.

Cardiac Rupture after Blunt Chest Trauma / 대한흉부외과학회지

A clinical evaluation was performed on 11 cases of the cardiac rupture by blunt chest trauma at the department of thoracic and cardiovascular surgery, Yeungnam University Hospital during the period from July, 1993 to May, 1995. The results were as follows ; The sex distribution was 8 mem and one women, and mean age was 41 years old. The causes of accident was traffic accident in most cases. And then one case was cultivator accident and another one was fall down. The average times from trauma to admission was 139 minutes and the patients that transferred via other hospitals have relatively long average times to 227 minutes. The average times from admission to operation was 117 minutes and we consumed 25 minutes for the preoperative preparation. The sites of injury were 7 cases in the right heart and 3 cases in the left heart. There were symptoms and signs of the cardiac tamponade (dyspnea, chest pain, nausea/vomitus, neck vein distention & hypovolemic shock) at admission and in most of them typical symptoms and signs of a tamponade appeared. Surgical approach was performed with median sternotomy in 10 cases. Subxiphoid pericardial window was created in one case. Another case which was very difficult in surgical procedure was operated under cardiopulmonary bypass and the result was good.

Thymic carcinoid tumor: a case report / 대한흉부외과학회지

No abstract available.

Responses of vasopressin release in patients with cardiopulmonary bypass anesthetized with enflurane and morphine

Changes in plasma level of arginine vasopressin (AVP), arterial pressure, and urine flow were studied before, during and after cardiopulmonary bypass (CPB) in 11 patients with congenital heart disease. Anesthesia was induced with thiopental sodium (3-5 mg/kg) and was maintained with enflurane (1.0-1.5%), 50% N2O in O2 and morphine (0.5 mg/kg). Concentration of plasma AVP increased slightly from 3.8 +/- 1.5 pg/ml after induction and increased 3-fold after sternotomy. Plasma AVP level increased to 132 +/- 26 pg/ml and 218 +/- 54 pg/ml after 5 and 60 min on CPB, respectively. When the circulation returned to normal, plasma AVP level decreased gradually but was still significantly higher at 24 hr (13.4 +/- 2.5 pg/ml). Marked osmolar diuresis was induced with mannitol in the priming solution used during the CPB: increases in urine flow, Na excretion and osmolar clearance. Possible mechanisms of marked increase in AVP release and differences of AVP responses during CPB reported by other investigators are discussed.