Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called "Whipple's triad" : the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report a adult female patient with insulinoma and the review of literatures briefly.
The tools that classify the severity of patients based on the prediction of mortality include APACHE, SAPS, and MPM. Theses tools rely crucially on the evaluation of patients' general clinical status on the first date of their admission to ICU. Nursing activities are one of the most crucial factors influencing on the quality of treatment that patients receive and one of the contributing factors for their prognosis and safety. The purpose of this study was to identify the goodness-of-fit of CPSCS of critical patient severity classification system(CPSCS) and Glasgow coma scale(GCS) and the clinical usefulness of its death rate prediction. Data were collected from the medical records of 187 neurological patients who were admitted to the ICU of C University Hospital. The data were analyzed through $x^2$ test, t-test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and ROC curve. In accordance with patients' general and clinical characteristics, patient mortality turned out to be statistically different depending on ICU stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Homer-Lemeshow goodness-of-fit tests were CPSCS and GCS and the results of the discrimination test using the ROC curve were $CPSCS_0$, .734, $GCS_0$,.583, $CPSCS_{24}$,.734, $GCS_{24}$, .612, $CPSCS_{48}$,.591, $GCS_{48}$,.646, $CPSCS_{72}$,.622, and $GCS_{72}$,.623. Logistic regression analysis showed that each point on the CPSCS score signifies1.034 higher likelihood of dying. Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.
Recently, as wired and wireless communication services have rapidly developed and multimodal mobile devices which have various characteristics have widely spread, the need for new convergence services increases. The growing population of VoIP technologies and the high communication expense yield that the market of IP based telephony such as WiFi phone and IP phone is substituted for one of the conventional PSTN telephony. With the help of this trend, the wireline network operators desire to find a market in mobile networks. Therefore, they focus on Fixed Mobile Convergence (FMC) service as one of the key factors to accomplish this goal. FMC services are able to provide the mobility of voice services between circuit switched and packet switched networks. IP Multimedia Subsystem (IMS) based Voice Call Continuity (VCC) is one of the schemes to embody FMC services. As Application Server (AS) which has this VCC function provides seamless handover of services between heterogeneous networks, FMC subscribers can communicate seamlessly with others m WiFi domain and COMA domain using WiFi-COMA dual phone. Most of enterprises have already introduced IP network infrastructure and IP-PBX (Private Branch eXchange) for telephony. However, the problems of high communication cost and work inefficiency due to frequent outside jobs or business trips have remained. In order to solve these problems, demands for enterprise FMC services increase. In this paper, we introduce a new IP-PBX based VCC model that can provide seamless handover of voice services between WiFi and COMA networks for enterprise users and we investigate some interworking and security issues between Soft Switch (SSW) and IMS, or between IMSs. In addition, we introduce a new service that can provide the continuity of voice sessions as well as video sessions using Multimedia Session Continuity (MMSC) technology which has evolved from VCC. This service is expected to be one of the next-generation personalized services based on user's context.
I present new near-infrared (NIR) photometry of globular cluster (GC) systems associated to a cD galaxy NGC 4874 in the core of the Coma cluster and 16 early-type galaxies in the Fornax and Virgo clusters of galaxies using the Infrared Channel of the Wide Field Camera 3 (WFC3/IR) on board the Hubble Space Telescope (HST). Combining these high-resolution NIR data with new HST Advanced Camera for Surveys (ACS) optical photometry for NGC 4874 and existing ACS GC catalogs from the ACS Fornax and Virgo Cluster Surveys, I have examined for the first time the GC systems in a statistically significant optical/NIR sample of galaxies spanning a wide range of luminosities and colors. A primary goal of this study is to explore empirically whether the distributions of purely optical and hybrid optical - NIR color indices for extragalactic GCs have different forms and whether the relations between these color indices are nonlinear, indicating that they behave differently with underlying metallicity. I find that some GC systems of large galaxies in our sample show color bimodalities that differ between the optical and optical - NIR colors, in the sense that they have disparate ratios of "blue" and "red" peak GCs, as well as differing ratios in their color dispersions. Consistent with these results, I find empirically that the dependence of hybrid optical-NIR color on purely optical color is nonlinear, with an inflection at intermediate metallicities. These findings underscore the importance of understanding the nature of galaxy-to-galaxy variations in the GC color distributions and color-color relations, as well as the exact forms of the color-metallicity transformations, in interpreting the observational data on GC color bimodality. Our ACS data for NGC 4874 shows that its GC system exhibits a very strong blue tilt, implying a very steep mass-metallicity scaling, and the centroid of this GC system is offset by $4{\pm}1kpc$ from the luminosity center of NGC 4874, in the direction of NGC 4872. Finally, I discuss the asymmetrical GC distribution around a dwarf elliptical galaxy in Coma that has a very high relative velocity with respect to the cluster mean at small clustercentric radius.
Proceedings of the Korea Institute of Fire Science and Engineering Conference
/
2012.04a
/
pp.190-193
/
2012
The tools that classify the severity of patients based on the prediction of mortality include APACHE, SAPS, and MPM. Theses tools rely crucially on the evaluation of patients' general clinical status on the first date of their admission to ICU. Nursing activities are one of the most crucial factors influencing on the quality of treatment that patients receive and one of the contributing factors for their prognosis and safety. The purpose of this study was to identify the goodness-of-fit of CPSCS of critical patient severity classification system(CPSCS) and Glasgow coma scale(GCS) and the clinical usefulness of its death rate prediction. Data were collected from the medical records of 187 neurological patients who were admitted to the ICU of C University Hospital. The data were analyzed through $x^2$ test, t-test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and ROC curve. In accordance with patients' general and clinical characteristics, patient mortality turned out to be statistically different depending on ICU stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Homer-Lemeshow goodness-of-fit tests were CPSCS and GCS and the results of the discrimination test using the ROC curve were $CPSCS_0$,.734, $GCS_0$,.583, $CPSCS_{24}$,.734, $GCS_{24}$,.612, $CPSCS_{48}$,.591, $GCS_{48}$,.646, $CPSCS_{72}$,.622, and $GCS_{72}$,.623. Logistic regression analysis showed that each point on the CPSCS score signifies1.034 higher likelihood of dying. Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.
This following is effect of Buthus martensi Karsch(BMK) extract on dextran-thrombus model, KCN-induced coma, cytotoxicity of brain etc. BMK extract significantly increased number of platelet and fibrogen and significantly shortened the prothrombin time as compared with control group treated with dextran. BMK extract didn't affect the changes of hematocrit as compared with control group treated with dextran. BMK extract induced a significant inhibition of human platelet aggregation induced by thrombin and ADP but did not affect human platelet aggregation induced by collagen. BMK extract showed a protective effect on pulmonary thrombosis induced by collagen and epinephrine. BMK extract prolonged the duration of KCN-induced coma and showed a protective effect on cytotoxicity of PC12 cells induced by amyloid ${\beta}$ protein(25-35) in a dose dependent manner. These results suggested that BMK extract might be usefully applied for prevention and treatment of thrombosis and brain damage.
Park, Kang Min;Shin, Kyong Jin;Ha, Sam Yeol;Park, JinSe;Kim, Si Eun;Kim, Hyung Chan;Kim, Sung Eun
Annals of Clinical Neurophysiology
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v.16
no.1
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pp.15-20
/
2014
Background: Triphasic waves are one of the electroencephalographic patterns that can be usually seen in metabolic encephalopathy. The aim of this study is to compare the clinical and electrophysiologic profiles between patients with and without triphasic waves in metabolic encephalopathy, and reassess the significance of triphasic waves in metabolic encephalopathy. Methods: We recruited 127 patients with metabolic encephalopathy, who were admitted to our hospital. We divided these admitted patients into two groups; those with and without triphasic waves. We analyzed the difference of duration of hospitalization, mortality rate during admission, Glasgow Coma Scale, severity of electroencephalographic alteration, and presence of acute symptomatic seizures between these two groups. Results: Of the 127 patients with metabolic encephalopathy, we excluded 67 patients who did not have EEG, and 60 patients finally met the inclusion criteria for this study. Patients with triphasic waves had more severe electroencephalographic alterations, lower Glasgow Coma Scale, and more acute symptomatic seizures than those without triphasic waves. After adjusting the clinical variables, Glasgow Coma Scale and acute symptomatic seizures were only significantly different between patients with and without triphasic waves. Conclusions: We demonstrated that patients with triphasic waves in metabolic encephalopathy had more significant impairment of the brain function.
Park, Jisoo;Park, Taejin;Ko, Jung-In;Yeo, Woonhyung
Journal of Trauma and Injury
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v.33
no.4
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pp.227-235
/
2020
Purpose: Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication. Methods: In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined. Results: The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score. Conclusions: The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.
Purpose : We investigated the change of spherical and comma aberrations after wearing aspheric soft contact lens (ASCL) in young myopes. Methods : Fifty young myopes ($23.15{\pm}1.70years$, spherical equivalent: $-2.90{\pm}1.75D$) were recruited and refractive errors were corrected using ASCL (Biotrue, Bausch+Lomb, USA). High order aberrations were measured in the 4 mm pupil size using the wavefront analyze and pupil sizes were measured with a pupillometer at the modes of scotopic condition (light off) at 3.5 m in the 100 lx illuminance condition. Results : Spherical aberrations and coma aberration of the 20s myopes were $0.026{\pm}0.031{\mu}m$ and $0.078{\pm}0.039{\mu}m$ respectively, and $0.019{\pm}0.026{\mu}m$ and $0.082{\pm}0.038{\mu}m$ after ASCL wear that spherical aberration was decreased and coma aberration was increased. However, spherical aberration was decreased in the 68% of the subject have positive spherical aberration, and increased in the 11% of the subject have negative spherical aberration. Coma aberration was increased in the 53% of the subject, did not change in the 19% of the subjects, and decreased in the 28% of the subject. Spherical aberration was not different with the refractive errors in low and moderate myopies, however, coma aberrations was higher in the higher myopes. Conclusion : In a scotopic condition without accommodation stimuli, spherical aberration is decreased after wearing ASCL, however in the subject have negative spherical aberration spherical aberration could be increased, and which is thought to be the influence of contact lens design and pupil size.
Jungook Kim;Youngbo Shim;Yoon-Hee Choo; Hye Seon Kim; Young ran Kim; Eun Jin Ha
Journal of Korean Neurosurgical Society
/
v.67
no.4
/
pp.451-457
/
2024
Objective : Exploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients' protein requirements during the application of TTM and coma therapy. Methods : This study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient's treatment period was divided into two phases (phase 1, application and maintenance of coma therapy and TTM; phase 2, tapering and cessation of treatment). In assessing protein requirements, the urine urea nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient's protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed. Results : Out of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84±0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49±0.42 to 2.18±0.60 in phase 2 (p<0.001). Conclusion : Our study revealed a total average protein requirement of 1.84±0.62 g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the severity by disease.
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