BACKGROUND: Fentanyl, which is a potent synthetic micron-opioid receptor agonist, is one of the most widely used opioids in anesthesia and pain control. However, the pharmacodynamics of fentanyl show wide inter-individual variability. Therefore, this study was conducted to evaluate the influence of the blood-brain barrier transporter protein, p-glycoprotein, and micron-opioid receptor genetic polymorphism on fentanyl pharmacodynamics. METHODS: Seventy-nine patients who underwent posterior lumbar interbody fusion (PLIF) were included in this study. Postoperatively, the patients received fentanyl via an intravenous patient controlled analgesia device. The cumulative fentanyl doses and other pharmacodynamic data were then recorded at 2 h, 6 h, 12 h, 24 h and 48 h after the operation. In addition, genomic DNA was isolated from the patient's peripheral leukocytes and then evaluated for the presence of OPRM1 A118G and ABCB1 C3435T genetic polymorphism using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The results of this study indicated that ABCB1 C3435T genetic polymorphism may be related to the cumulative fentanyl requirement for postoperative pain control. However, these findings were not statistically significant (P = 0.09). In addition, no relationship was observed between OPRM1 A118G and the cumulative postoperative fentanyl requirement. However, the cumulative postoperative fentanyl requirement was lower in the TTAA group (ABCB1 3435 TT, OPRM1 118 AA) than in the CCGG group (ABCB13435 CC, OPRM1 118 GG). CONCLUSIONS: The ABCB1 C3435T polymorphism may affect fentanyl pharmacodynamics. However, further studies are required to confirm the relationship between p-glycoprotein and fentanyl.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Anesthesia ; Blood-Brain Barrier ; DNA ; Fentanyl ; Humans ; Leukocytes ; P-Glycoprotein ; Pain, Postoperative ; Pharmacogenetics ; Polymorphism, Genetic

BACKGROUND: Advanced chronic obstructive pulmonary disease is characterized by progressive pulmonary hypertension leading to right heart dysfunction, which plays a important role in clinical evaluation but remains difficult and challenging to quantify. The noninvasive doppler echocardiographic value referred to as the Tei index has been suggested as a simple, reproducible and reliable parameter of the right ventricular function. The purpose of this was to assess the right ventricular function in patients with chronic obstructive pulmonary disease using the Tei index and to evaluate its relationship with the pulmonary functional status. METHODS: The study population comprised of 26 patients with chronic obstructive pulmonary disease and 10 normal control subjects. The Tei index was obtained by dividing the sum of the isovolumetric contraction and the relaxation tines by the ejection time using a pulsed-wave doppler. It was compared with the other available Doppler echocardiographic parameters of systolic or diastolic and with the pulmonary function of the patients. RESULTS: The Tei indices of the patients with COPD were significantly higher than those of normal subjects (0.45±0.17 vs. 0.27±0.03, p<0.01). The isovolumetric contraction time/ejection time(0.32±0.08 vs. 0.25±0.05, p<0.05), the isovolumetric relaxation time/ejection time(0.29±0.16 vs. 0.15±0.08, p<0.05) and the preejection period/ejection time (0.46±0.10 vs. 0.38±0.06, p<0.05) were prolonged and the ejection time (255.2±32.6 vs. 314.2±16.5 msec, p<0.05) was significantly shortened in patients with COPD compared to normal subjects. The tei indices were inversely correlated with the FEV1(r=-0.46, p=<0.05) and were prolonged significantly in patients with a severe obstructive ventilatory dysfunction(less than 35% of predicted FEV1) compared to those with a mild and moderate ventilatory dysfunction. The tei indices showed an inverse correlation with the ejection time (r=-0.469), the isovolumetric contraction time/ejection time(r=0.453), the isovolumetric relaxation time/ejection time(r=0.896) and the preejection period/ejection time(r=0.480). CONCLUSION: The tei index appeared to be a useful noninvasive means of evaluating the right ventricular function. It revealed a significant correlation with the pulmonary function in patients with COPD.
Echocardiography* ; Heart ; Humans ; Hypertension, Pulmonary ; Pulmonary Disease, Chronic Obstructive* ; Relaxation ; Ventricular Function, Right*

No abstract available.
Titanium*

OBJECTIVE: Spasticity has been reported to be one of the common complications in patients with spinal cord injury. The purposes of this study were to investigate the proper dosage, the therapeutic and undesirable effects of clonidine with combined used of baclofen for the management of spasticity. METHOD: A prospective study was performed for 17 patients with spinal cord injury who did not improve spasticity with 80 mg baclofen administration. The degree of spasticity was assessed in the more-affected knee by modified Ashworth scale, pendulum test at pre-treatment and at 7 days after receiving clonidine. We also investigated the complications and subjective satisfaction. RESULTS: Seven of 13 patients with spinal cord injury showed subjective improvement in spasticity. We found significant improvement in the relaxation index by pendulum test after administration of more than 0.3 mg of clonidine. There was no significant difference between the subgroups depending on the extent of spinal cord injury. We didn't find any serious complication in adjuvant clonidine therapy. CONCLUSION: Adjuvant clonidine therapy can be effective in spasticity of spinal cord injured patients without serious complication.
Baclofen ; Clonidine* ; Humans ; Knee ; Muscle Spasticity* ; Prospective Studies ; Relaxation ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: To assess the clinical and radiographic results of the Elmslie-Trillat-Marquet procedure used to treat recurrent patellar subluxation or dislocation with patellar malalignment. MATERIALS AND METHODS: A total of 15 knees in 14 patients were evaluated at an average of 54.5 months (12 to 106) following the Elmslie-Trillat-Marquet procedure; carried out between May 1993 and March 2000. The evaluation included subjective, objective and radiographic assessments. RESULTS: The causes of recurrent patella dislocation were patella alta (11 knees), tight lateral retinaculum (8 knees), patella dysplasia (7 knees), femoral condyle dysplasia (13 knees) and joint hyperlaxity (1 case). The average preoperative Q-angle was 28.5degrees and the postoperative angle 13 degrees. Subjective evaluation using Cox's criteria showed excellent or good results in 13 knees (87%), and the objective evaluation using Fulkerson's functional knee score showed excellent or good results in 14 knees (93%). The mean anterior tibial tubercle displacement was 8 mm (7-11 mm), and the patella congruence angle and Insall-Salvati index were significantly corrected (p<0.001). Lateral subluxation and patellar tilt angle were corrected in all cases. The only complication was an irritation due to nonabsorbable suture material. There were no redislocations, infections, nonunions, or fractures of the transferred tibial tubercle during the follow-up period. CONCLUSION: The Elmslie-Trillat-Marquet procedure for recurrent patellar subluxation or dislocation can basically correct malalignment tridimensionally.
Dislocations* ; Follow-Up Studies ; Humans ; Joints ; Knee ; Patella ; Sutures

Primary malignant fibrous histiocytoma (MFH) of the chest wall is extremely rare and is characterized by aggressive features, including a high incidence of local recurrence and distant metastasis. Surgical resection of the chest wall is the primary modality of management. However, surgical treatment is not generally recommended in patients with evidence of distant metastasis. Here, we present a case of chest wall MFH along with a schwannoma mimicking distant metastasis in the right upper arm. The patient was treated by radical en bloc resection and survived for more than 9 years without recurrence.
Arm ; Histiocytoma, Malignant Fibrous ; Humans ; Incidence ; Neoplasm Metastasis ; Neurilemmoma ; Positron-Emission Tomography ; Recurrence ; Thoracic Wall ; Thorax

OBJECTIVE: This study aimed to evaluate the kinematic data and energy consumption of domestic swing and stance phase (SNS) control knee assembly in transfemoral amputees. METHOD: Five male transfemoral amputees took prosthetic training of more than one week and evaluated with random applying 3 types of knee assembly; mechanical type, pneumatic type, and domestic SNS type. Kinematic data was obtained by the VICON 370 system (Oxford Metrics Ltd., UK.). Energy consumption was measured using a KB1-C (Aerosport Inc, U.S.A). RESULTS: Domestic SNS type showed a significantly increased walking speed, cadence and step length compared with mechanical type and pneumatic type (p<0.05). Domestic SNS type showed a significantly increased maximal hip flexion and extension compared with mechanical type and pneumatic type (p<0.05). Domestic SNS type showed decreased peak knee flexion at swing phase and significantly increased peak knee extension at stance phase compard with mechanical type and pneumatic type (p<0.05). In energy consumption, the domestic SNS type tended to show a lower O2 cost and faster walking speed than the mechanical type and pneumatic type at free-walking. CONCLUSION: We concluded the domestic SNS type had more tendency toward a normal gait pattern and lower energy consumption compared with mechanical type and pneumatic type.
Amputees ; Gait ; Hip ; Humans ; Knee* ; Male ; Prostheses and Implants ; Walking

Primary malignant fibrous histiocytoma (MFH) of the chest wall is extremely rare and is characterized by aggressive features, including a high incidence of local recurrence and distant metastasis. Surgical resection of the chest wall is the primary modality of management. However, surgical treatment is not generally recommended in patients with evidence of distant metastasis. Here, we present a case of chest wall MFH along with a schwannoma mimicking distant metastasis in the right upper arm. The patient was treated by radical en bloc resection and survived for more than 9 years without recurrence.

The kinetics of cytokine mRNA expression was studied in porcine alveolar macrophages using an RT-PCR assay. The expression levels of IFN- gamma, IL-2, IL-4, IL-6, GM-CSF, IL-12 p35, and IL-12 p40 were examined after 2, 4, 14, 24, 48, and 72 h of incubation in unstimulated control and LPS-stimulated cells. The expression contents of IFN-gamma, IL-2, and IL-4 were not detected in both unstimulated and LPS-stimulated cells. On the other hand, the expression levels of IL-6, GM-CSF, and IL-12 in LPS-stimulated cells were almost always higher than those in control cells. Among those cytokines, IL-6 exhibited the predominant expression, and GM-CSF, IL-12 p40, and IL-12 p35 followed in the descending order. The times to reach the peak expression levels for IL-6, and GM-CSF, IL-12 p35, and IL-12 p40 were 14, and 24 h, respectively. After reaching the peak expression point, the expression levels of IL-6, GM-CSF, and IL-12 p40 reduced to the baseline by 72 h after stimulation, however, IL-12 p35 still kept a substantial expression by the same time. This study demonstrates that porcine alveolar macrophages primarily respond to express IL-6, GM-CSF, and IL-12 by LPS-stimulation and have a cytokine-specific expression profile during the stimulation time.
Animals ; Cells, Cultured ; Cytokines/*genetics ; Female ; Gene Expression Profiling ; Gene Expression Regulation/*drug effects ; Granulocyte-Macrophage Colony-Stimulating Factor/genetics ; Interferon Type II/genetics ; Interleukins/genetics ; Kinetics ; Lipopolysaccharides/*pharmacology ; Macrophages, Alveolar/*drug effects/*metabolism ; RNA, Messenger/genetics/metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Sensitivity and Specificity ; Swine/*genetics

BACKGROUND: Although osteoporosis is increasing in the elderly population, attempts to analyze the patterns of medical service utilization for osteoporosis are currently not sufficient. The medical services and treatment patterns were investigated using Korea's National Health Insurance claims data, which includes all of the Korean population. METHODS: Through the patient identification algorithm developed by using the administrative claims data in 2007, the adult patients (between 50-100 years) with osteoporosis were identified. The age and gender of the patients who used medical service for osteoporosis were described, in relation with six dichotomous variables. The medical service use patterns such as the type of medical institution and conducting bone mineral density measurement were investigated. RESULTS: The number of patients who used medical service were 1,230,580 (females 89.9%). Sixty one point six percent of the patients were prescribed osteoporosis medicine (indicated for osteoporosis only), and 12.9% of the patients had experienced osteoporotic fracture. The primary medical institutions for treatment were clinics (54.3%), while hospitals were mainly used among the patients with a history of fracture and disease or drug use that may induce secondary osteoporosis. The number of visited medical institutions was 6.4 (as an outpatient) and 0.2 (as admissions) during 6 months. The proportion of patients who conducted bone mineral density measurements within one year before and after the diagnosis of osteoporosis was 66.7% and DXA was the most frequently used densitometry (46.3%). The average number of days for the prescriptions for osteoporosis medicine was 70 days. CONCLUSION: In order to prevent further osteoporotic fractures, appropriate management and treatment should be implemented for osteoporosis patients. To do this, we need to understand the current state of medical service utilization and the treatment of osteoporosis using the National Health Insurance claims data.
Adult ; Aged ; Bone Density ; Densitometry ; Humans ; National Health Programs ; Osteoporosis ; Osteoporotic Fractures ; Prescriptions