Objective This study reports the early and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac artery. Methods From December 1994 to February 2000, we performed iliac artery angioplasty and primary intravascular stent placement in 42 vessel of 31 patients (23 men and 8 women; mean age, 70.5 years). A total of 44 self expanding Wallstents ( Boston Schneider, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Results Clinical follow up was available for all patients at a mean of (36?13) months. All patients with clinical ischemic category (claudication or rest pain) were improved. Angiographic follow up with completed data are available for 20 of 31 patients at a mean follow up of (10?5) months. The iliac artery restenosis rate was 2%(1/42). The patients again underwent balloon angioplasty successfully. Conclusions PTA and primary stenting of the iliac arteries are effective and safety for treating iliac arterial stenosis,and should be the method of first shoice.

Adult polycystic kidney disease (APKD) accounts for 2% of end-stage renal disease in Singapore and is a major indication for kidney transplantation. We report synchronous nephrectomy with unilateral cadaveric dual kidney transplantation (DKT) in a patient with APKD. Simple nephrectomy of the right native 27-cm polycystic kidney was performed to provide adequate space for unilateral DKT. Right donor kidney transplantation was performed at the site of native nephrectomy. End-to-side anastomosis of the right donor renal vein to the distal inferior vena cava and the right donor artery to the common iliac artery were performed. Left donor kidney was transplanted below the right kidney, with its vessels anastomosed to the right external iliac vessels. Ureter anastomosis was performed after perfusion of both kidneys. Lich-Gregoir anastomosis of the left donor ureter to the bladder and direct right donor ureter to native ureter anastomosis was established. This case illustrates that synchronous nephrectomy with DKT is feasible to facilitate implantation on the same side.
Adult ; Anastomosis, Surgical ; Humans ; Kidney ; surgery ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Male ; Middle Aged ; Nephrectomy ; methods ; Polycystic Kidney, Autosomal Dominant ; surgery ; Tomography, X-Ray Computed ; Ureter ; surgery

No abstract available.

No abstract available.
Ear, Middle*

Objective To assess the efficacy and safety of percutaneous transluminal stenting for patients with carotid artery stenosis.Methods Selective percutaneous transluminal stenting was performed for patients with symptomatic carotid artery stenosis(luminal narrowing ≥ 70%).Success rates and complications associated with the procedures were observed.During six months of follow-up,both recurrent symptom and restenosis rates were recorded.Results There were 17 bifurcating lesions among 27 stenoses in 26 patients,of whom 18 had concomitant coronary artery diseases.The acute procedural success rate was 96.3%(26/27),and the degree of stenosis was reduced from 88.6% ± 8.9%(range 70 - 100)to 0.4% ± 2.0%(range 0 - 10).Six patients developed severe bradycardia and hypotension,and 3 experienced transient loss of consciousness during balloon dilatation.During hospitalization,2 patients experienced loss of consciousness and convulsion,respectively,due to hyperperfusion,and both recovered 12 hours later.There were 2 minor stroke cases (7.4%)but no cases of major stroke or death.At the 6-month follow-up,there were no cases of TIA or new onset of stroke.There was no restenosis detected in 16 cases using angiography and in 10 cases using MRI in 6 to 16 months of follow-up. Conclusions Percutaneous transluminal stenting for patients with carotid artery stenosis has a high procedural success rate with few and acceptable complications.Few patients suffered from recurrent symptoms or showed restenosis in long-term follow-up.

GTPrS-dependent phospholipase D activity in human neutrophils was investigated using exogenous phospholipid as a substrate. Both cytosolic and membrane- associated phospholipase D activities were identified. The previously described 50 kDa cytosolic activating factor was resolved chromatographically from the cytosolic phospholipase D. Using exogenous phospholipid as substrate along with chromatographically resolved 50 kDa factor and recombinant ADP-ribosylation factor 1, plasma membrane was required for activity, indicating that the activity which was previously seen using endogenous phospholipid substrate was due to a phospholipase D located in the plasma membrane. In addition, ADP-ribosylation factor and the 50 kDa factor activated synergistically. Using neutrophil plasma membranes, a third regulator of neutrophil membrane phospholipase D was identified from bovine brain cytosol. This factor was resolved from ADP-ribosylation factor and Rho A by successive column chromatographies. The brain factor showed a synergistic effect with the 50 kDa neutrophil activator but an additive effect with recombinant ADP- ribosylation factor. Whether or not ADP-ribosylation factor or the brain factor were present, high activities were seen only when the 50 kDa factor was present, indicating that the 50 kDa cytosolic factor is a major activating factor for the neutrophil plasma membrane phospholipase D.
ADP-Ribosylation Factor 1 ; ADP-Ribosylation Factors* ; Brain* ; Cell Membrane ; Chromatography ; Cytosol* ; Fibrinogen ; Humans ; Membranes ; Neutrophils* ; Phospholipase D* ; Phospholipases*

A questionnaire on a variety of ophthalmic topics was made up and sent to 150 members of the Korean Society of Cataract and Refractive Surgery-[KSCRS] in May, 1996. Forty percent [60/150] responded within the deadline in June, 1996. As the contents of the questionnaire were almost identical to the ones prepared in the USA [1994, 1995] and in Japan [1994], the answer to the questionnaire could be compared with those gathered from the USA and Japan. Over half of the respondents [57%] were in their forties. The average number of operations done per month was 26. Cataract operation accounted for over 60% of the total operations in 34% of KSCRS members. And more than 76% of the cataract operation were done using phacoemulsification technique in 31% of the respondents. There were no difference in the preferred method of local anesthesia for the cataract surgery in Korea compare to the USA or Japan. And there was less likelihood of using peribulbar anesthesia and no suture technique in Korea compared to the USA. Sixty-one percent of the Korean ophthalmic surgeon implanted the intraocular lenses even before the patients were younger than 20 years old whereas, 82% of ophthalmic surgeon in Japan did only when the patients were older than 20 years of age. For radial keratotomy as a means of correcting myopia, 91% of the Korean respondents were not performing the procedure any more, while 45% of the American respondents abandoned it. Fifty four percent of the Korean respondents and 46% of the American respondents have been doing excimer laser photorefractive keratectomy. There was no statistical difference between the two. From the answers to the qustionnaire, we found that our results did not differ significantly from those of the USA or Japan and we believe that these results reflect the present trends of cataract and refractive surgeries in Korea.
Anesthesia ; Anesthesia, Local ; Cataract* ; Surveys and Questionnaires ; Humans ; Japan ; Keratotomy, Radial ; Korea ; Lasers, Excimer ; Lenses, Intraocular ; Myopia ; Phacoemulsification ; Photorefractive Keratectomy ; Refractive Surgical Procedures* ; Suture Techniques ; Young Adult

The application of appropriate rules for drug–drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed.
Drug Utilization Review ; Drug-Related Side Effects and Adverse Reactions ; Fatigue ; Humans ; Inpatients ; Prescriptions ; Tertiary Care Centers*

PURPOSE: To develop a profiling tool which accurately assigns a patient to the appropriate attitudinal cluster for the management of asthma. METHODS: Attitudinal data from an online survey of 2,467 patients with asthma from 8 Asian countries/region, aged 18-50 years, having had ≥2 prescriptions in the previous 2 years and access to social media was used in a discriminant function analysis to identify a minimal set of questions for the Profiling Tool. A split-sample procedure based on 100 sets of randomly selected estimation and validation sub-samples from the original sample was used to cross-validate the Tool and assess the robustness of its predictive accuracy. RESULTS: Our Profiling Tool contained 10 attitudinal questions for the patient and 1 GINA-based level of asthma control question for the physician. It achieved a predictive accuracy of 76.2%. The estimation and validation sub-sample accuracies of 76.7% and 75.3%, respectively, were consistent with the tool's predictive accuracy at 95% confidence level; and their 1.4 percentage-points difference set upper-bound estimate for the degree of over-fitting. CONCLUSIONS: The Profiling Tool is highly predictive (>75%) of the attitudinal clusters that best describe patients with asthma in the Asian population. By identifying the attitudinal profile of the patient, the physician can make the appropriate asthma management decisions in practice. The challenge is to integrate its use into the consultation workflow and apply to areas where Internet resources are not available or patients who are not comfortable with the use of such technology.
Asia ; Asian Continental Ancestry Group ; Asthma* ; Discriminant Analysis ; Disease Management ; Humans ; Internet ; Prescriptions ; Social Media

PURPOSE: Respiratory syncytial virus is the primary cause of pneumonia and bronchiloitis in young children and infants. RSV infection is also known to be very important to asthma patient, because previous RSV infection increases the frequency of the asthma development and RSV infection may cause airway hyperresponsiveness. Natural RSV infection does not provide complete immunity and reinfection occurs throughout life. Several strategies have recently been used in RSV vaccine development, including the generation of formalin inactivated RSV(FI-RSV), peptides, recombinant vaccine viruses (rVV), and DNA based vaccines. Previous studies in mice primed with RSV G protein enhanced lung pathology resulted from a Th2 host immune response against the viral G protein. We studied for the evaluation of protective immunity, effect on airway hyperesponsiveness, and influence on lung pathology after pND G immunization. METHODS: BALB/c mice were injected with pND G(50g in 1 g/l PBS), pND G-HA (50 g), pND(50 g) FI-RSV(10 6PFU) i.d.at 0, 2, 4 weeks. Four weeks later, mice were challenged with RSV(10 6PFU). Mice were sacrificed on postchallenge day 4 and their lungs were removed for RT-PCR and viral titration. The other mice were sacrificed on postchallenge day 6 for bronchoalveolar lavage, serum and histologic examination. Airway responsiveness was assessed by using a single chamber whole body plethysmography on post challenge day 5. RESULTS: 1) Vaccination with pND-G reduced the Mch(methacholine) induced airway hyperresponsiveness after RSV infection(P<0.05). 2) Viral titers are decreased in pND-G group and FI-RSV group(P<0.05) and complete protection from RSV infection was 9/12(75%) in pND-G group. 3) Serum anti-G IgG antibody is more increased in pND-G group than RSV group(P<0.05). 4) IFN-/IL-5 ratio is increased in pND-G group(0.59) and decreased in FI-RSV group(P<0.036). 5) Inflammatory response in BAL after RSV infection was decreased by pND-G vaccination(P>0.05). CONCLUSION: In this study, immunization with pND encoding G protein induced decrease in airway hyperresponsiveness, and protection against RSV infection of the lower respiratory tract infection and also induced virus neutralizing antibody and decrease in lymphocytic inflammation. pND G immunization elicited balanced pulmonary Th1/Th2 cytokine response without atypical pulmonary inflammatory responses.
Animals ; Antibodies, Neutralizing ; Asthma ; Bronchoalveolar Lavage ; Child ; DNA* ; Formaldehyde ; GTP-Binding Proteins ; Humans ; Immunization* ; Immunoglobulin G ; Infant ; Inflammation ; Lung ; Mice ; Pathology ; Peptides ; Plethysmography, Whole Body ; Pneumonia ; Respiratory Syncytial Viruses* ; Respiratory Tract Infections ; Vaccination ; Vaccines