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The current study reviewed the medical records of those inpatients who were 55 years old at admission and were admitted to Kaohsiung Medical College Hospital between 1983 and 1992. The purpose was to investigate the influences of patient characteristics and disease factor on the length of hospital stay. The long-term goals of these results are to provide a better understanding of the medical needs of aged people, especially the need of hospital beds, and to aid in an effective planning of medical resources for them to maintain their health. 57,009 records were collected. The average length of stay was 14.28 days with a standard deviation of 21.06. Gender, age, condition at discharge, number of diseases diagnosed, year admitted, and whether insured showed significant difference when they were tested by univariate statistical procedures. Multiple regression (MR) analysis was used to test the relative importance of these variables. It showed that whether or not cataracts were diagnosed had the most influence on the length of stay for the pooled samples. Condition at discharge, numbers of admissions, number of diseases diagnosed, and insurance had moderate predictive power. MR on the ten leading diseases separately showed that numbers of admissions, conditions at discharge, and insurance status were the three most important predictors at most models. Number of diseases diagnosed and admission year were also in several of the 10 models. However, gender did not enter any model.

Manidipine hydrochloride (MH) is a new calcium channel antagonist which is not yet available in Taiwan. Thus, a clinical trial was performed. The clinical effects and adverse effects of MH were compared with those of nifedipine hydrochloride retard monotherapies. Sixty-three out-patients with mild to moderate hypertension and no advanced systemic diseases were randomly divided into 2 groups. Twenty patients remained in each group after some patients withdrew from the study. Blood pressure decreased significantly after treatment in both groups (p < 0.01). In the manidipine group, systolic blood pressure (SBP) decreased from 164 +/- 14 to 140 +/- 18 mmHg and diastolic BP (DBP) decreased from 99 +/- 6 to 87 +/- 7 mmHg by the 8th week. In the nifedipine group, SBP decreased from 163 +/- 11 to 134 +/- 17 mmHg and DBP decreased from 101 +/- 10 to 88 +/- 9 mmHg by the 8th week. Pulse rates did not change significantly. Antihypertensive efficacy was 18/20 (90%) and 19/22 (86.4%) in the manidipine and nifedipine groups, respectively. There were a few adverse effects in both groups, the reaction was severe as to lead to the discontinuation of medication in two patients in the nifedipine group. No significant changes in laboratory tests were identified in either group, except for minimal decreases of lactate dehydrogenase and creatine kinase in the nifedipine group. We conclude that MH was equally safe and effective as nifedipine and it may have less severe side effects compared to nifedipine.

To evaluate the clinical efficacy of recombinant human erythropoietin (EPO) and its influencing factors in the treatment of anemia in hemodialysis (HD) patients, 17 chronic stable HD patients (10 males, 7 females; mean age: 46.0 +/- 2.6 years) with severe anemia were enrolled in this study. The study period (ranging from 5 to 11 months) was divided into the initial 12 weeks of correction phase and the subsequent maintenance phase. EPO, 1500 U initially, was administered intravenously twice weekly (BIW group, n = 10) or thrice weekly (TIW group, n = 7) at the end of each HD. Dose was doubled every 4 weeks until up to a maximum dose of 6000 U if increment of hematocrit (Hct) was less than 3%. At the end of correction phase, anemia was markedly improved. Hct and hemoglobin (Hb) increased from 19.3 +/- 0.8 to 28.7 +/- 1.1% and from 6.5 +/- 0.3 to 9.6 +/- 0.4 g/dl, respectively. Fifteen patients (88%) reached to the target Hct of 30% at 13.7 +/- 1.2 weeks. At the end of study, Hct and Hb was maintained at 29.1 +/- 0.7% and 9.6 +/- 0.3 g/dl, respectively. Requirement of EPO dose to reach the target and maintain the stable Hct (greater than or equal to 28%) was 99 +/- 14 and 62 +/- 11 U/kg/week, respectively. Laboratory parameters showed that serum iron, transferrin saturation, sugar and triglyceride decreased significantly and uric acid and aluminum (Al) increased significantly. There was no significant change in predialysis blood pressure, body weight, cardiac ratio, and ECG. Quality of life was markedly improved with the better subjective feelings, physical activity and Karnorfsky index. Common adverse effects included exacerbated hypertension (23%), hyperphosphatemia (18%), hyperkalemia (18%), and flu-like syndrome (12%). All of them could be managed by medical and dialysis treatment. Investigation of influencing factors on response to EPO suggests that 1) TIW group had a better response than BIW group 2) Response was better in patients with more adequate iron status and less severe Al burden. 3) Time to target Hct correlated approximately with basal serum Al levels but did not correlate with basal serum parathyroid hormone levels. In conclusion, low dose of EPO therapy corrects anemia effectively with minimal adverse effects in HD patients. Dosing regimen, iron status, and serum Al will influence the response to EPO.

Continuous ambulatory peritoneal dialysis (CAPD) is a valuable alternative to hemodialysis in treating uremic diabetics, and insulin can be injected directly into dialysate and absorbed intraperitoneally (IP). We evaluated the effect of IP supply of insulin in 9 uremic diabetics undergoing CAPD therapy. The 9 patients included 5 males and 4 females, with a mean age of 57 +/- 12 years old. The study showed that serum biochemistry was stationary during the treatment period except for the variable elevations of serum triglyceride and cholesterol. Hypertension was easily controlled in most patients. The insulin requirements ranged from 50 to 180 (129 +/- 34) units/day, which was 4.2 +/- 1.6 times higher than the subcutaneous doses before dialysis. Insulin added to the dialysate showed a high percentage of adsorption (55% to 65%) onto the plastic bag. The blood glucose levels varied less after an IP supply of insulin. The overall incidence of peritonitis was 8 episodes in 135 patient months (one episode every 16.9 patient months), and the average duration of hospitalization was 14.9 +/- 11.2 days/year. The cumulative survival rates were 89% in the first year and 74% in the second year. Our experience indicates that CAPD is an ideal treatment modality for uremic diabetics, and IP supply of insulin results in a good control of diabetes.

Peritoneal function is the major determinant of the efficiency of peritoneal dialysis. To understand whether diabetes affects the peritoneal function, we performed the peritoneal clearance study in 9 diabetic and 16 nondiabetic patients with end stage renal disease. The ultrafiltration volume tended to be lower in diabetics after infusion of 1.5% Dianeal, although there were no statistically significant differences between them. The same results were obtained after infusion of 4.25% Dianeal. The glucose uptake after infusion of both 1.5% and 4.25% Dianeal was not significantly different between the two groups. The dialysate/plasma(D/P) concentration ratio was also not significantly different between the two groups, however the D/P ratio for BUN and uric acid was slightly higher in the diabetic group. The peritoneal clearance of smaller molecules such as BUN, creatinine, uric acid and phosphate also tended to be higher in diabetics after infusion of 1.5% Dianeal for 4 hours. The peritoneal clearance became higher when more hyperosmotic dialysate were used in both diabetics and nondiabetics. The above results indicated that diabetic patients with end stage renal disease might have a normal peritoneal function compared to nondiabetics.

To assess the time spent and the degree of satisfaction of new clinic patients, one hundred and nine new out-patients from the Internal Medicine Clinic of Kaohsiung Medical College Hospital were studied from January 30th to February 6th, 1985. Both accurate field recording and telephone interviews concerning the time spent for each procedure and satisfaction with the medical personnel and expense in their first visits were carried out. The total time spent was 152 +/- 65 minutes (mean +/- SD) from questionnaire and 126 +/- 56 minutes from field recording. According to field recording, time spent in waiting for registration was 39.8 +/- 42.9 minutes. Most (55%) of study patients spent more than one hour in waiting for consultation. The time spent in waiting for filling prescription was 17 +/- 6 minutes. The accessibility of the paramedical examination units was good. The degree of satisfaction was measured by a five point rating scale for series of questions. The response were "very satisfied" or "satisfied" with professional services but not medical expense and cashier attitude. According to our results, some of our attempts to innovate service have been done including an appointment system, colored directional arrowheads, and changing our schedule to opening 30 minutes earlier.

Albumin excretion rates (AER) of three consecutive days in different urine collection periods were measured in 7 hospitalized microalbuminuric diabetics (Ma DM) and 7 normoalbuminuric diabetics (Na DM). They were divided on the basis of an initial overnight urinary AER below or above 10 micrograms/min. The percentage of variation coefficients (% CV) of 24-hour, overnight 12-hour, and morning one-hour urine collections in Ma DM were 29.9%, 31.8% and 50.9%, respectively; while in Na DM group were 60.0%, 60.3% and 74.5%, respectively. There was no significant difference in the variation of AER among the three different urine collection procedures in both Ma DM and Na DM groups, or for similar urine collection between the two groups. The initial AER was compared to the subsequent two AERs in overnight 12-hour collection. The results were that three Ma DM patients had a subsequent AER below 10 micrograms/min and two Na DM patients had a subsequent AER above 10 micrograms/min on a single occasion. Therefore, the high variability of both groups would be expected to result in category changes. Multiple urine collections are needed to detect the early diabetic nephropathy for the hospitalized diabetics.

A 28 year-old homosexual man had one month history of intermittent high fever, nonproductive cough and progressive shortness of breath. He not only had immunity deficits, with decrease CD4 cells decreased CD8 cells and inverted CD4/CD8 ratio, but also presented with evidence of human immunodeficiency virus infection (positive ELISA antibody tests and Western blot tests). Chest X-ray showed diffuse pulmonary infiltration. The arterial blood gases revealed hypoxemia. The PaO2 was 69 mmHg. Spirometry showed FVC 2.28 L (45% predicted), FEV1 2.21 L (49% predicted), FEV1/FVC 93%, and MMEF 4.41 L/sec (90% predicted). The configuration of the Flow-Volume loop was consistent with a restrictive ventilatory defect. Transthoracic lung biopsy demonstrated pneumocystis carinii pneumonia (PCP). He had inadvertent steroid therapy and showed some clinical, pulmonary function and chest X-ray improvement before the diagnosis was established. Steroids might be as adjunctive therapy for a short period of time in treatment of PCP associated with acquired immunodeficiency syndrome (AIDS) at respiratory failure.