No abstract available.
Mucopolysaccharidosis II*

No abstract available.
Mucopolysaccharidosis II*

This study investigated the differences in the effect of repetitive transcranial magnetic stimulation (rTMS) between patients with and without the involvement of Broca's area (IBA).The medical records of 20 stroke patients treated with rTMS for non-fluent aphasia were reviewed. Patients completed the Korean version of the Western Aphasia Battery (K-WAB) pre- and post-rTMS. Magnetic resonance T1-weighted images of the brain were analyzed using SPM12 software. Montreal Neurological Institute templates and Talairach coordinates were used to determine Broca's area involvement and segregate patients into 2 groups: IBA and non-IBA (NBA) groups. All statistical analyses were performed using the SPSS software.Twenty subjects were included in the study. The K-WAB scores revealed improvements in the total subjects and IBA and NBA groups. There were no statistical differences between the IBA and NBA groups in the ΔK-WAB scores of aphasia quotient, fluency, comprehension, repetition, and naming. The rTMS was positive for non-fluent aphasia patients, but there was no significant difference in effectiveness depending on the IBA. Further research with a larger number of patients is needed to identify the differences in the effect of rTMS on the IBA.

Pulmonary embolism is a common clinical problem in patients with immobilization, cancer, indwelling central venous catheter and surgery. However, although rare, it may occur in patients with inherited thrombophilia. Protein S deficiency is known to increase the risk of venous thrombosis and pulmonary embolism. There are many reports of venous thrombosis with protein S deficiency, but there are few reports of arterial thrombosis, especially recurrent acute pulmonary embolism. Here, we report a case of recurrent pulmonary embolism associated with type II protein S deficiency.
Blood Coagulation Disorders, Inherited ; Central Venous Catheters ; Humans ; Immobilization ; Protein S ; Protein S Deficiency ; Pulmonary Embolism ; Thrombophilia ; Thrombosis ; Venous Thrombosis

PURPOSE: This study is aimed to find out the incidence of late endocrine complications in children who were treated for childhood cancer. METHODS: We reviewed the medical records of 60 patients who was treated for childhood cancer and evaluated various pituitary hormonal functions after completion of treatment from July 1985 to September 2004 at Kyungpook National University Hospital. RESULTS: Forty-four boys (73.3%) and sixteen girls (26.7%) were involved in the study and their ages ranged from 2 months to 14 years. Twenty-four patients were treated with chemotherapy with cranial irradiation and thirty-six were treated with chemotherapy only. The diagnoses included ALL (n=27, 45.0%), AML (n=2, 3.3%), malignant lymphoma (n=13, 21.7%), brain tumor (n=5, 8.3%), MDS (n=1, 1.7%), and other solid tumor (n=12, 20.2%). Forty-four (73.3%) out of the 60 patients had an additional endocrine abnormality. Growth hormone deficiency (GHD) was identified in 44 children (73.3%). Incidence of GHD was significantly higher among those who had received cranial irradiation (91.6% vs. 61.1%) (P=0.009) but this kind of difference was not found in ALL 27 patients (93.7% vs. 72.7%) (P=0.131). Only one patient was diagnosed as primary hypothyroidism, two patients were diagnosed as primary hypogonadism, and these three patients showed growth hormone deficiency. No patient had abnormalities of ACTH and cortisol. CONCLUSION: We thought that late endocrine complications were very common in childhood cancer survivors. Accordingly, we recommended that we should focus on endocrine abnormalities while treating and following up the patients.
Adrenocorticotropic Hormone ; Brain Neoplasms ; Child ; Cranial Irradiation ; Diagnosis ; Drug Therapy ; Female ; Growth Hormone ; Gyeongsangbuk-do ; Humans ; Hydrocortisone ; Hypogonadism ; Hypothyroidism ; Incidence ; Lymphoma ; Medical Records ; Survivors*

PURPOSE: This analysis was conducted to evaluate the cost-effectiveness of gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patients in an outpatient setting compared with the traditional inpatient setting. METHODS: A cost-effective analysis was conducted from a societal perspective. The effects of treatment, which was measured as an adverse event rate, were abstracted from a published literature search and empirical data from one university hospital. The costs included both direct and indirect costs. Direct costs included hospitalizations, outpatient visits, and lab tests. Pharmaceutical costs were excluded in analysis because they were same for both options. Indirect costs included productivity loss of patients as well as care-givers. In order to determine the robustness of the results, sensitivity analysis on treatment protocol was conducted. RESULTS: Literature search showed no difference in adverse effect rates between inpatient treatment protocol and outpatient treatment protocol. Therefore, this analysis is a cost-minimization analysis. Cost-savings in the outpatient setting was 555,936 won for one treatment cycle. Our sensitivity analysis indicated that the outpatient chemotherapy still showed cost-savings, regardless of changes in treatment protocol. CONCLUSION: The outpatient gemcitabine-cisplatin chemotherapy for non small-cell lung cancer resulted in cost savings compared to inpatient chemotherapy. More importantly, outpatient chemotherapy could improve the utilization of health service resources in terms of available beds.
Antineoplastic Combined Chemotherapy Protocols/*economics/therapeutic use ; Carcinoma, Non-Small-Cell Lung/*drug therapy/*economics ; Cisplatin/*economics/therapeutic use ; Cost Allocation ; Cost-Benefit Analysis ; Deoxycytidine/*analogs & derivatives/economics/therapeutic use ; Humans ; Lung Neoplasms/*drug therapy/*economics ; Outpatients

BACKGROUND: The aim of the present study was to evaluate whether calcium channel blockers pretreatment increase blood potassium level after the administration of succinylcholine in hypertensive patients. METHODS: Eighty hypertensive patients were randomly divided into four groups: group I (saline, n = 20), group II (nicardipine 30 microg/kg, n = 20), group III (diltiazem 0.2 mg/kg, n = 20), group IV (verapamil 0.1 mg/kg, n = 20). The patients had been taking antihypertensive drugs regularly and their blood pressures were well controlled. Anesthesia was induced with thiopental sodium 5 mg/kg and tracheal intubation was facilitated with succinylcholine 1 mg/kg. Saline, nicardipine, diltiazem, and verapamil were administered two minutes before injection of succinylcholine in group I, II, III, and IV, respectively. Blood potassium level was measured prior to induction and 1, 3, 5, 10, 15, 30, 45, 60, 75, 90 minutes after administration of succinylcholine. RESULTS: Blood potassium levels at 5, 10, 15, and 30 minutes after the administration of succinylcholine were significantly increased compared with baseline values in all groups (P < 0.05). Blood potassium level was not different significantly among four groups at all times. CONCLUSIONS: Calcium channel blockers pretreatment did not increase blood potassium level after the administration of succinylcholine. We concluded that succinylcholine and calcium channel blocker can be used safely together in hypertensive patients.
Anesthesia ; Antihypertensive Agents ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Diltiazem ; Humans ; Intubation ; Nicardipine ; Potassium ; Succinylcholine ; Thiopental ; Verapamil

OBJECTIVES: Single-pill combination therapy (amlodipine/atorvastatin) might be more effective than double-pill therapy (amlodipine+atorvastatin) in patients with diabetes and concomitant hypertension requiring statin therapy. We compared the cost-effectiveness of a single-pill with that of double-pill for control of low density lipoprotein cholesterol (LDL-C) levels, with the ultimate goal of cardiovascular disease prevention, in these patients using a cost-effectiveness analysis model that considered medication adherence. METHODS: Effectiveness was defined as the percentage (%) attainment of target LDL-C levels (<100 mg/dL) based on adherence for each therapy. Adherence was defined as compliance to medication (> or =80% proportion of days covered). A systematic review of the literature was conducted to determine the proportion of patients who were adherent and target goal attainment based on adherence level. The annual medication costs were based on the adherence levels for each regimen. The average cost-effectiveness ratio (ACER) was calculated as the cost per % attainment of the target LDL-C level. RESULTS: The ACER for the single-pill regimen was lower than for the double-pill regimen (4,123 vs. 6,062 Korean won per 1% achievement of target goal). Compared with the double-pill, the medication costs were approximately 32% lower with the single-pill. CONCLUSION: A single-pill for reductions in LDL-C is cost-effective compared with double-pill in hypertensive patients with type 2 diabetes.
Acer ; Amlodipine ; Cardiovascular Diseases ; Cholesterol, LDL ; Compliance ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Korea* ; Lipoproteins* ; Medication Adherence ; Atorvastatin Calcium

Background: Osteoporosis is one of the most common diseases of the skeletal system, particularly occurring in older adults. Bisphosphonates are frequently used to treat osteoporosis and prevent bone fractures. Studies evaluating the association between treatment with bisphosphonate and the risk of atrial fibrillation have reported conflicting results. This meta-analysis of observational studies was performed to assess this association. Methods: Databases were searched to find relevant observational studies, and the identified articles were selected according to the selection criteria. Sensitivity and subgroup analysis based on various confounding factors were performed. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of atrial fibrillation were estimated using a random-effects model. Results: We selected 12 studies, including four case-control and eight cohort studies, for the meta-analysis. Assessment of the estimated effect size yielded an OR of 1.171 (95% CI, 1.011–1.356; P=0.035), with substantial heterogeneity (I 2 =84.74%, P<0.001). When the studies were excluded one-after-another, the pooled OR remained unchanged in only six studies. In addition, subgroup analyses found that treatment with bisphosphonates was positively associated with the risk of atrial fibrillation in studies performed in Western countries (OR, 1.263; 95% CI, 1.092–1.462) and lower-quality studies (OR, 1.214; 95% CI, 1.035–1.423). No publication bias was observed. Conclusion This meta-analysis showed that treatment with bisphosphonates may be associated with an increased risk of atrial fibrillation. Therefore, bisphosphonates should be carefully prescribed to patients at a high risk of atrial fibrillation.

Complicating intramural hematoma is an interesting, relatively unusual condition. Various etiologic factors have been described, with the most common being blunt trauma, anticoagulant therapy, Henoch-Sch nlein purpura and blood dyscrasias. Most intramural hematomas resolve spontaneously with conservative treatment, and the prognosis is good. However, if the abdominal pain or obstruction does not resolve with medical management over seven to ten days, complications such as infarction or peritonitis may occur, and surgical intervention might be required. We report a case of intramural hematoma of duodenum treated with percutaneous drainage and embolization of bleeding focus which was complicated with acute pancreatitis after anticoagulation treatment in a patient with recurrent history of deep vein thrombosis. In addition, we reviewed reports of intramural hematoma of the duodenum and treatment strategies.
Adult ; Anticoagulants/therapeutic use ; Catheterization ; *Drainage ; Duodenal Diseases/*diagnosis/*therapy ; Fluoroscopy ; Hematoma/*diagnosis/*therapy ; Humans ; Male ; Thrombolytic Therapy ; Tomography, X-Ray Computed