Diet control to achieve euglycemia induces significant loss of heart and liver weight via increased autophagy compared with ad libitum diet in diabetic rats

Intensive glucose control increases the all-cause mortality in type 2 diabetes mellitus (T2DM); however, the underlying mechanisms remain unclear. We hypothesized that strict diet control to achieve euglycemia in diabetes damages major organs, increasing the mortality risk. To evaluate effects on major organs when euglycemia is obtained by diet control, we generated a model of end-stage T2DM in 13-week-old Sprague-Dawley rats by subtotal pancreatectomy, followed by ad libitum feeding for 5 weeks. We divided these rats into two groups and for the subsequent 6 weeks provided ad libitum feeding to half (AL, n=12) and a calorie-controlled diet to the other half (R, n=12). To avoid hypoglycemia, the degree of calorie restriction in the R group was isocaloric (g per kg body weight per day) compared with a sham-operated control group (C, n=12). During the 6-week diet control period, AL rats ate three times more than rats in the C or R groups, developing hyperglycemia with renal hyperplasia. R group achieved euglycemia but lost overall body weight significantly compared with the C or AL group (49 or 22%, respectively), heart weight (39 or 23%, respectively) and liver weight (50 or 46%, respectively). Autophagy levels in the heart and liver were the highest in the R group (P<0.01), which also had the lowest pAkt/Akt levels among the groups (P<0.05 in the heart; P<0.01 in the liver). In conclusion, glycemic control achieved by diet control can prevent hyperglycemia-induced renal hyperplasia in diabetes but may be deleterious even at isocaloric rate when insulin is deficient because of significant loss of heart and liver mass via increased autophagy.

Injury to the Abdominal Aorta from a Seat Belt in a Frontal Motor Vehicle Collision

In traffic accidents, wearing a seatbelt can cause abdominal aortic injury due to an abrupt deceleration. We report a case of abdominal aorta dissection caused by a seat belt in a frontal motor vehicle collision. The initial symptoms and signs were vague or uncertain. However, he complained severe abdominal pain with seat belt sign below the umbilicus. Abdominal computed tomography scans showed an initial flap of the abdominal aorta with hematoma and hazy stranding of the mesentery.

A Case of Acute Motor and Sensory Axonal Neuropathy Following Hepatitis A Infection

Acute motor and sensory axonal neuropathy (AMSAN) are recently described subtypes of Guillain-Barre syndrome characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. A 21-yr-old male was transferred to our hospital due to respiration difficulties and progressive weakness. In laboratory findings, immunoglobulin M antibodies against hepatitis A were detected in blood and cerebrospinal fluid. The findings of motor nerve conduction studies showed markedly reduced amplitudes of compound muscle action potentials in bilateral peroneal, and posterior tibial nerves, without evidence of demyelination. Based on clinical features, laboratory findings, and electrophysiologic investigation, the patient was diagnosed the AMSAN following acute hepatitis A viral infection. The patient was treated with intravenous immunoglobulin and recovered slowly. Clinicians should consider this rare but a serious case of AMSAN following acute hepatitis A infection.

The Impact of Implementing Critical Care Team on Open General Intensive Care Unit / 결핵및호흡기질환

BACKGROUND: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. METHODS: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. RESULTS: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). CONCLUSION: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

Lacunar Infarction Following Recurrent Transient Ischemic Attack During Consecutive Hemodialysis / 대한뇌졸중학회지

The link between hemodialysis and cerebrovascular disease has become more apparent. Several reports have suggested that the incidence of ischemic stroke on hemodialysis patients is greater than that on the general populations. We report a case with lacunar infarction following recurrent transient ischemic attack during consecutive hemodialysis.

Spontaneous left external iliac vein rupture / 대한외과학회지

We report a 72-year-old female patient with spontaneous rupture of the left external iliac vein. She visited our hospital for abdominal and back pain. She had the abnormal finding of hemoperitoneum. We performed an emergency operation with diagnosis of left ovarian cyst rupture though she suffered from spontaneous rupture of the left external iliac vein. This case provides insight to the experience of spontaneous rupture of the left external iliac vein.

A Prospective Study of Prophylatic Antibiotics for Laparoscopic Cholecystectomy

PURPOSE: We wanted to clinically evaluate the antibiotic therapy used from pre- to postlaparoscopic cholecystectomy along with the improved surgical techniques and instruments and the patient nutrition. METHODS: We prospective studied 105 patients who were treated with laparoscopic cholecystectomy for acute and chronic cholecystitis at Busan St. Mary Hospital from March 2007 to January 2008. The two groups were divided as follows: (A) the group was not injected with antibiotics, and the other group (B) was injected with antibiotics. We did not used antibiotics when the patient had no acute aggravating symptoms, and we exclude the patients with old age (<70 years), a past history of diabetes mellitus (DM) or hypertension (HTN), and a past operation history. RESULTS: Between the two group, there was no difference when they were compared for age, BMI (Body Mass Index), the operation time (minute) and the length of the hospital stay: (A) Group 49.3+/-13.0 years, 24.4+/-3.2 kg/m2, 37.9 +/- 10.0 minute and 4.6 +/- 1.3 days, respectively, and (B) Group 55.9+/-15.6 years, 23.5+/-3.5 kg/m2, 43.2 +/- 23.8 minute and 5.5 +/- 2.5 days, respectively. There was a significant different in the leukocyte count and the % of neutrophils: (A) Group 6396microliter(-1) and 53.4%, respectively and (B) Group 9354microliter(-1) and 66.6%, respectively. In (B) group, there were 2 cases of atrial fibrillation, 1 case of diarrhea and 1 case of wound seroma. There were no surgical related complications in group (A). CONCLUSION: For the well nourished chronic cholecystitis patients, the use of the prophylatic antibiotics may be less effective because of the many drug-induced side effects. More studies about the use of prophylactic antibiotics are needed.

Venous Hemodynamic Changes in the Surgical Treatment of Primary Varicose Vein of the Lower Limbs

Venous hemodynamic changes after the surgery of primary varicose veins were evaluated. (Materials and methods) We retrospectively analyzed 1, 211 patients (1, 407 limbs) who underwent surgery for primary varicose veins from 1994 to 2002. The venous hemodynamics were evaluated using air- plethysmography (APG) preoperatively and one month postoperatively in the viewpoints of ambulatory venous pressure (AVP), venous volume (VV), venous filling index (VFI), and ejection fraction (EF). (Results) The surgical modalities included 958 cases of greater saphenous vein high ligation (GSV HL) and stripping with varicosectomy (VS), 222 cases of short saphenous vein (SSV) HL and VS, 143 cases of external banding valvuloplasty of GSV and VS, and 44 cases using VNUS (R) and VS. The reduction rate of VV was 20.9 +/- 14.1% in the GSV stripping group, 12.0 +/-14.7% in the GSV valvuloplasty group, 18.3 +/-16.1% in the VNUS (R) group, and 20.6 +/-15.9% in the SSV group. The reduction rate of VFI was 63.6 +/-20.7% in the GSV stripping group, 38.8 +/-40.9% in the GSV valvuloplasty group, 60.1 +/-23.9% in the VNUS (R) group, and 37.6 +/-30.2% in the SSV group. The increasing rate of EF was 25.0 +/-28.2% in the GSV stripping group, 21.0 +/-30.0% in the GSV valvuloplasty group, 29.4 +/-31.9% in the VNUS (R) group, and 30.0 +/-36.5% in the SSV group. The reduction rate of AVP was 25.4 +/-32.2% in the GSV stripping group, -6.1 +/-58.1% in the GSV valvuloplasty group, 28.4 +/-38.5% in the VNUS (R) group, and 14.1 +/-49.0% in the SSV group. All of the patients showed improvements in venous hemodynamics by showing a decrease in VV, VFI, AVP, and an increase in EF. However, there was no difference in the change of venous hemodynamics according to the type of surgery.

Factors That Affect the Survival Rate of Ruptured Abdominal Aortic Aneurysm

PURPOSE: Ruptured abdominal aortic aneurysm (RAAA) continue to be a significant causes of death. We review 14 patients who underwent repair of RAAA to analyze the factors affecting the mortality rate. METHOD: Fourteen patients who underwent repair of a RAAA at Samsung Medical Center from March 1995 to July 2001 were reviewed retrospectively. The patients were divided two groups as survival and fatal group. Data was analyzed by both univariate and multivariate analysis. RESULT: There were nine patients (64%) in survival group and five patients (36%) in fatal group. The mean age of survival group was 64.67+/-19.59 years and 67.0+/-5.15 years in fatal group. All patients in fatal group were died within 2 days postoperatively. By univariate analysis of various factors associated with the mortality rate, creatinine level, hemoglobin level were statistically significant. Other factors associated with the mortality rate, albumin, initial systolic blood pressure, initial diastolic blood pressure, operation time, prothrombin time and perioperative platelet count were not statistically significant. CONCLUSION: These findings suggest that creatinine level is predictive of death in repair of RAAA. But patients who have RAAA should not be denied therapy on the basis of any specific criteria of preoperative factors.

Clinical Experiences of the Arterial Bypass in Aortoiliac Occlusive Disease

PURPOSE: To analysis of the clinical aspects of axillofemoral (AXFBG) and aortofemoral bypass (AOFBG) for aortoiliac occlusive disease. METHODS: Between June 1996 and May 2001, 23 patients underwent AXFBG or AOFBG for lower extremity ischemia caused by aortoiliac occlusive disease at Samsung Medical Center. The decision to perform AXFBG or AOFBG was based on an assessment of surgical risk and the patient's preference. We retrospectively analyzed the preoperative clinical status, risk factors and distal runoff scores affecting the patency rate as well as the clinical outcome following surgery. RESULTS: We performed 10 AXFBGs and 13 AOFBGs. The mean age was 67.8 years in AXFBG patients and 57.4 years in AOFBG patients. Limb salvage as an indication for surgery included 8 (80%) cases with AXFBG, as compared to 13(100%) cases with AOFBG. The mean follow-up period was 20.7 months in AXFBG and 21.8 months in AOFBG. The clinical improvement following surgery was statistically higher with AOFBG. The one-year and 2-year primary patency rates in AXFBG were 100% and 82% retrospectively. All of the grafts of AOFBG were patent during this follow-up period. CONCLUSION: The clinical improvement was higher with AOFBG as compared to AXFBG. However AXFBG is a safe practice in high-risk patients.