Doxorubicin(Adriamycin(R)) is effective in the treatment of various solid tumors and hematologic malignancies. Because of dose-related cardiotoxicity, however, early inappropriate discontinuation of doxorubicin therapy may minimize its therapeutic efficacy in many patients. Consequently, clinically sensitive tests are needed to select patients in whom treatment must be stopped early. Various techniques have been used for early detection of subclinical doxorubicin-induced cardiotoxicity, including electrocardiography, systolic time intervals, echocardiography, radionuclide angiography and endomyocardial biopsies. Most studies of doxorubicin cardiotoxicity have dealt with systolic function of the left ventricle and effects on diastolic function have not been reported. In order to determine whether impaired diastolic function may be an early sign of doxorubicin cardiotoxicity, a retrospective study was performed in 12 patients who had undergone serial radioangiography and were found to have left ventricular ejection fractions(LVEF)> or =55% prior to doxorubicin treatment and during follow-up. Average rapid filling velocity(RFV) and slow filling velocity(SFV) were both significantly reduced after doxorubicin treatment. RFV fell from 5.17+/-1.52 units/second to 4.18+/-0.96(P<0.01) and SFV fell from 2.20+/-1.32 units/second to 1.42+/-0.62(P<0.05). There were no significant changes in filling volume ratio, total diastolic time and diastolic time ratio. Since a change in left ventricular diastolic function can occur before ejection fraction falls to subnormal levels, diastolic function as well as systolic function should be examined in the early detection of doxorubicin cardiotoxicity.
Biopsy ; Doxorubicin* ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Hematologic Neoplasms ; Humans ; Radionuclide Angiography ; Retrospective Studies ; Systole

No abstract available.
Acne Vulgaris*

OBJECTIVES: The multiple sleep latency test (MSLT) is commonly used as a valid objective measure of sleepiness. The procedure of MSLT is well standardized but the sleep onset criterion is somewhat variable. One epoch of stage 1 sleep is the most commonly used criterion, and the criterion of three epochs of stage 1 sleep is also used. The purpose of this study was to compare the two criteria used to determine sleep onset. METHODS: We retrospectively analyzed 60 consecutive MSLT that were performed according to a standaridized protocol. We scored each test using the two different criteria for sleep onset and then statistically analyed the results. RESULTS: Using the different criteria, 20 patients among 60 showed changes in mean sleep latency (33.3%). The extent of change ranged from 1.3% to 38.5% (mean 15.9%). Non-narcoleptic patients showed a significantly higher incidence of change than other sleep disorder patients. CONCLUSION: Changes in mean sleep latency occurred according to the different criteria of sleep onset. But the difference arising from different criteria was statistically not significant in patients with moderate to severe sleepiness. Considering that 1 epoch criterion for sleep onset is more sensitive in detecting clinically significant sleepiness, the authors suggest that the 1 epoch criterion is more reliable than the 3 epochs criterion.
Humans ; Incidence ; Retrospective Studies

No abstract available.
Immunoglobulins* ; Tetanus Toxoid* ; Tetanus* ; Vaccination*

OBJECTIVES: The objective of this study was to develop evidence- and consensus-based clinical safety usage guidelines for sedative hypnotics using the Delphi technique. METHODS: A group of 15 sleep experts from Korean Academy of Sleep Medicine were chosen for this study comprising a three-round web-based Delphi survey. The first round survey was composed of 39 questions to identify problems with sedative hypnotics usage in Korean clinical practice and the result roughly outlined what should be included in the guidelines. The second round survey was composed of 21 questions to collect specific opinions of experts on clinically important issues in prescribing sedative hypnotics, and its result provided the basis for the guidelines. A third round survey aimed to evaluate the reliability and validity of the established guidelines. RESULTS: In the third round, all 17 items showed a median of 4 or more, with an average of 4.12 and a standard deviation of 0.32. Thus we present safety usage guidelines with 13 propositions for prescription, maintenance, and withdrawal of sedative hypnotics. CONCLUSION The safety usage guidelines on sedative hypnotics developed from this study could lead to safe and effective prescription of hypnotics in clinical practice, especially for the non-experts in sleep medicine. Furthermore, the guidelines will help to improve the quality of insomnia treatment by contributing to the establishment of a safe regime for sedative hypnotics without excessive use of drugs.

Lipoma arborescens is a rare intra articular lesion consisting of a villous lipomatous proliferation of the synovial lining and occurs mainly in the knee joint. It is mostly found in older patients with joint trauma, meniscal lesions or chronic synovitis. The authors describe one case of a 29-year-old male with multiple lipomas in the right knee joint who has a history of joint trauma. He had joint effusion, pain, giving way and restricted terminal extension of the right knee. Histology and gross findings are consistent with the lipoma arborescens. After arthroscopic excision of the masses, symptom was relieved completely and the patient had gained full range of motion of the right knee joint.
Adult ; Humans ; Joints ; Knee Joint* ; Knee* ; Lipoma* ; Male ; Range of Motion, Articular ; Synovitis

OBJECTIVES: This study was carried out to measure the urinary cotinine concentrations of Korean tobacco harvesters with green tobacco sickness (GTS). METHODS: We conducted a questionnaire survey and measured the urinary cotinine concentrations among the cases who visited six health subcenters and the emergency room in the Health Center and County Hospital after harvesting tobacco leaves in Cheongsong-gun, from Jul 15 to Aug 15, 2002. Ten suspected GTS cases were compared to 10 controls matched for residence, age, and sex. Urinary cotinine was analyzed with a reverse-phase high performance liquid chromatography (HPLC) system and expressed as geometric mean and standard deviation. The data collected were evaluated using the SPSS/win statistical package and the urinary cotinine concentrations between the two groups were analyzed by Mann-Whitney U test. RESULTS: In both the 10 cases and controls, there were 3 males and 7 females. Ages ranged from 22 to 70 years old. Half of the cases were reported within the 6 hours between 12:00 pm and 17:59 pm. The median time from starting work to initially feeling ill was 4.3 hours (min. 2.5; max. 11.0). The GTS symptoms reported were nausea in 10 cases (100.0%), dizziness in 9 (90.0%), weakness in 8 (80.0%), headache in 7 (70.0%) and other symptoms. The geometric mean of urinary cotinine concentrations was significantly higher (p<0.01) in cases at 497.6 +/- 2.5 ng/ml (min. 73.1; max. 2,574.3) than in controls at 32.7 +/- 1.8 ng/ml (min. 13.3; max. 76.9). CONCLUSIONS: Our study suggests that many tobacco harvesters may suffer from GTS in Korea. Therefore, it is very important for doctors to diagnose exactly the GTS. Also we must develop the methods which can prevent GTS, and simple methods of analysis for urinary cotinine.
Aged ; Chromatography, Liquid ; Cotinine* ; Dizziness ; Emergency Service, Hospital ; Female ; Headache ; Hospitals, County ; Humans ; Korea ; Male ; Nausea ; Nicotine ; Questionnaires ; Tobacco*

No abstract available.
Histiocytosis, Langerhans-Cell*

There are widely recognized unusual remote neurological manifestations of internal malignancy. However, as far as the author's knowledge, the generalized myokymia associated with myokymic discharge has not been reported as paraneoplastic syndrome earlier. The patient was a 63-year-old female with generalized myokymia and paresthesia for 4months. The nerve conduction study revealed mild sensorimotor polyneuropathy and EMG study showed the generalized myokymic discharges, which were not changed by sleeping or brachial plexus block. The carbamazepine reduced the amount of myokymia and myokymic discharges but not the benzodiazepine. The diagnosis of lung cancer was confirmed by needle aspiration biopsy, and the cell types of lung cancer were mixed undifferentiated and small cell type. By the administration of anti-cancer drugs including cisplatin, the myokymia and myokymic discharges were completely disappeared. The patient died at 8 months after the diagnosis.
Benzodiazepines ; Biopsy, Needle ; Brachial Plexus ; Carbamazepine ; Cisplatin ; Diagnosis ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Myokymia* ; Needles ; Neural Conduction ; Neurologic Manifestations ; Paraneoplastic Syndromes ; Paresthesia ; Polyneuropathies

Radiation effect on mammals, especially on hematologic changes, has been studied since discovery of x-ay. Various experimental animals were tried for radiobiological studies. 72 hybrid mice with conventional ffaction (5X/week), large abdominal field (2 x3cm, from symphysis pubic to xyphoid process) were used. Body weight was declined gradually by increasing irradiation doses, nadir was about 29.7% in male ; 30.4% in female at 6000 rad irradiation group. Hemoglobin value was nearly normal throughout entire treatment. Significant dropping of WBC count was noted to 40-0% of pretreatment values by only 1000 rad irradiation. Change of differential count was interesting; lymphocyte proportion showed gradual reduction, instead of gradual increasing of segmented neutrophil. Those proportion were reversed after 6000 rad irradiation. Urinary protein tests showed + - +++, showing no correlation with dosage. Application. of our study in clinical combination therapy (radiation + chemotherapy) was discussed.
Animals ; Body Weight* ; Female ; Humans ; Lymphocytes ; Male ; Mammals ; Mice* ; Neutrophils ; Radiation Effects*