BACKGROUND: Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. METHODS: One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia (PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. RESULTS: Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. CONCLUSION: We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching.
Abdominal Pain ; Analgesia ; Analgesia, Patient-Controlled ; Cesarean Section* ; Diclofenac* ; Dizziness ; Female ; Humans ; Incidence ; Meperidine* ; Morphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis* ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Urinary Retention

Objectives: Subjective-objective discrepancy of sleep (SODS) is a common symptom and one of the major phenotypes of insomnia. A distorted perception of sleep deficit might be related to abnormal brain reactivity to insomnia-related stimuli. We aimed to investigate differences in brain activation to insomnia-related stimuli vs. general anxiety-inducing stimuli among insomnia patients with SODS, insomnia patients without SODS, and healthy controls (HCs). Methods: All participants were evaluated for subjective sleep status using a sleep diary and questionnaires; occult sleep disorders and objective sleep status were assessed using polysomnography and actigraphy. Task functional magnetic resonance imaging was performed during insomnia-related stimuli (Ins) and general anxiety-inducing stimuli (Gen). Brain reactivity to Ins versus Gen was compared among insomnia with SODS, insomnia without SODS, and HC groups, and a combined insomnia disorder group (ID, insomnia with and without SODS) was also compared with HCs. Results: In the insomnia with SODS group compared to the insomnia without SODS group, the right precuneus and right supplementary motor areas showed significantly increased BOLD signals in response to Ins versus Gen. In the ID group compared to the HC group, the left anterior cingulate cortex showed significantly increased BOLD signals in response to Ins versus Gen. Conclusion The insomnia with SODS and ID groups showed higher brain activity in response to Ins versus Gen, while this was not observed in the insomnia without SODS and HC groups, respectively. These results suggest that insomnia patients with sleep misperception are more sensitive to sleep-related threats than general anxiety-inducing threats.

BACKGROUND: The causes of hepatic dysfunction after exposures to the halogenated inhaled anesthetics may be free radical, metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total hepatic blood flow. The present study was performed to comparison of estimated hepatic blood flow and systemic hemodynamic changes between the general anesthesia with enflurane and thoracic epidural anesthesia in rabbits. METHODS: In general anesthesia group with enflurane, anesthesia was performed with enflurane 2vol% and 100% oxygen for 60 minutes. In thoracic epidural anesthesia group, epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by clearance of indocyanine green according to the constant infusion method before and 30, 60 minutes after anesthesia. Heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were measured at the same time in both groups. RESULTS: Heart rate was decreased significantly in thoracic epidural anesthesia group and mean arterial pressure and central venous pressure were decreased significantly in both groups at 30, 60 minutes. Hepatic blood flow was decreased at 30, 60 minutes in both groups. Splanchnic vascular resistance was increased significantly 30, 60 minutes in thoracic epidural anesthesia group. There were significant differences in mean arterial pressure and splanchnic vascular resistance between two groups. There was no difference in hepatic blood flow between two groups. CONCLUSIONS: The decreased hepatic blood flow was caused by decreased mean arterial pressure in general anesthesia group with enflurane and by increased splanchnic vascular resistance in thoracic epidural anesthesia group.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Anesthetics ; Arterial Pressure ; Central Venous Pressure ; Enflurane ; Heart Rate ; Hemodynamics* ; Indocyanine Green ; Lidocaine ; Oxygen ; Rabbits ; Vascular Resistance

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.
Adenosine Diphosphate Ribose ; Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Humans ; Ovarian Neoplasms* ; Paclitaxel ; Celecoxib

OBJECTIVE: There are some evidences that some epithelial ovarian cancer cells respond to hormonal therapy. And in vitro studies have revealed that treatment of various human cancer cell lines with selective cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to evaluate the effects of tamoxifen and celecoxib, a selective COX-2 inhibitor, on the ovarian cancer cells and the benefits of combining these agents in the management of ovarian cancer. METHODS: SK-OV-3 epithelial ovarian cancer cells were exposed to increasing concentration of tamoxifen (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 h of continuous exposure. Concomitant treatment of SK-OV-3 cells with tamoxifen and celecoxib induced significant increase in apoptosis, comparing with single drug exposure. The pattern of apoptosis induced by these agents on SK-OV-3 cells seemed to be caspase-3 dependent. CONCLUSION: Our data suggest that combining tamoxifen with selective COX-2 inhibitor seems to have at least an additive tumoricidal effect. A more definitive role for this combination therapy in clinical settings in ovarian cancer will need to be defined through the conduct of clinical trials.
Adenosine Diphosphate Ribose ; Apoptosis ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Humans ; Ovarian Neoplasms* ; Tamoxifen* ; Celecoxib

Localized tenosynovial giant cell tumor (TGCT) usually occurs in the hand and foot regions. However, localized TGCT with extensive cartilaginous metaplasia is rare, especially in the tendon sheath of the toe. Here, we report a case of localized TGCT with cartilaginous metaplasia in a 57-year-old man. The tumor presented as a lobular mass measuring 2.2 cm in its greatest dimension and arose in the flexor digitorum tendon sheath of the right 2nd toe. Clinically, the mass was palpable 1 year ago and brought pain during walking. Microscopically, the mass was composed of focal conventional TGCT and cartilaginous components. The conventional TGCT areas consisted of mononuclear cells, multinucleated giant cells, and hemosiderin deposition. The chondroid areas were extensive and comprised more than 90% of the whole tumor. In this case, the mononuclear cells in the conventional TGCT areas showed focal immunohistochemical staining for podoplanin and S100 protein as well as diffuse staining for CD68, which is consistent with the staining pattern of conventional TGCT. The mononuclear cells in the chondroid areas were focal positive for podoplanin and diffuse positive for S100 protein. Chondroid metaplasia in diffuse TGCT has been reported in 10 cases involving the temporomandibular, elbow, and hip joints. However, there has been no report of a localized form of chondroid TGCT involving an extra-articular region.
Elbow ; Foot ; Giant Cell Tumors* ; Giant Cells ; Hand ; Hemosiderin ; Hip Joint ; Humans ; Metaplasia ; Middle Aged ; Staphylococcal Protein A ; Tendons ; Toes* ; Walking

Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric DNA onto the ends of chromosomes. thereby preventing the replication-dependent shortening of these ends. Telomerase activity is detected in a wide range of cancers of various tissues, and its expression may be a critical step in tumor progression. Our objective was to determine if detection of telomerase activity may be an indicator for diagnosis of breast cancer and any association between telomerase activity and prognostic factors of breast cancer. Using a polymerase chain reaction-based telomerase activity assay, we examined telomerase activity in 30 breast cancer specimens (2 ductal carcinoma in situ, 28 invasive ductal carcinoma), 25 benign lesions (14 fibroadenomas, 11 fibrocystic diseases) and 24 normal breast tissues (13 adjacent to malignancy, 11 adjacent to benign lesion). Among surgically resected samples, telomerase activity was detected in 23 (77%) of 30 breast cancers. While telomerase activity was not detected in any of 11 specimens of fibrocystic disease and 11 adjacent normal tissues to benign lesion, surprisingly low levels of telomerase activity were detected in 5 (36%) of 14 fiboadenomas and 1 (7%) of 13 adjacent normal tissues to malignancy. There was no significant difference in expression of telomerase among prognostic factors of breast cancer. In summary, telomerase activity in breast cancer may be useful in diagnosis of breast cancer. We found no correlation between telomerase activity and stage, tumor size or LN status. Mechanisms of telomerase expression are still under investigation; therefore, the significance of telomerase expression in malignant tumors and their progression remains to be determined.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; DNA ; Fibroadenoma ; Humans* ; Ribonucleoproteins ; Telomerase*

Proton-pump inhibitors (PPIs) are effectively used to treat acid-related diseases, including gastroesophageal reflux disease (GERD); however, many unmet medical needs still exist. As a new treatment option, potassium-competitive acid blockers (P-CABs), such as tegoprazan, have been developed. This study was performed to compare the pharmacokinetics (PKs) between two formulations (test and reference drugs) of tegoprazan 100 mg tablets. A randomized, single oral dose, two-treatment, two-period, two-sequence study was conducted with 12 healthy subjects. Each subject received the test drug or reference drug in the first period and the alternative treatment in the second period. For PK evaluation, blood samples were collected up to 48 hours post-dose in each period. The plasma concentrations of tegoprazan and its active metabolite (M1) were measured by liquid chromatography-tandem mass spectrometry. PK parameters, including maximum plasma concentration (C(max)) and area under the concentration-time curve from zero to the last measurable time (AUC(last)), were estimated using a non-compartmental method. The plasma concentration-time profiles of the two formulations were comparable. The geometric mean ratios [90% confidence intervals (CIs)] of the test drug to the reference drug for C(max) and AUC(last) were 0.98 (0.85–1.12) and 1.03 (0.93–1.13), respectively. The corresponding values of M1 were 0.99 (0.89–1.11) and 1.01 (0.93–1.09), respectively. The two formulations of tegoprazan exhibited comparable PK profiles, fulfilling the regulatory criteria for bioequivalence.
Gastroesophageal Reflux ; Healthy Volunteers ; Humans ; Male ; Mass Spectrometry ; Methods ; Pharmacokinetics ; Plasma ; Tablets ; Therapeutic Equivalency

BACKGROUND: Intraoperative low dose dobutamine test with transesophageal echocardiography may offer a simple, cost effective and widely available mean of detecting contractile reserve in coronary artery disease. The purpose of this study was to determine the effect of low dose dobutamine infusion on ventricular function in patients undergoing coronary artery bypass graft and to predict the post-pump response of dysfunctional myocardial segments to surgical revascularization. METHODS: This study was performed in 23 patients undergoing coronary artery bypass graft. After transesophageal echocardiographic images of transgastric left ventricular short axis view at mid-papillary muscles level were obtained, the percentage of systolic wall thickening(PSWT) was evaluated. The ejection fraction by modified Simpson's method and hemodymic changes were measured simultaneously. RESULTS: The clinical accuracy of intraoperative low dose dobutamine test for PSWT was followed; Sensitivity-76%, specificity-94.7%, positive predictive value-95%, negative predictive value-75% and overall accuracy-84.1%. Ejection fraction increased from 49.0 13.1% to 56.3 11.5%(dobutamine infusion) and 59.5 12.1%(post-pump) significantly(P<.05). During dobutamine infusion and post-pump, cardiac index increased significantly(P<.01). CONCLUSIONS: Intraoperative low dose dobutamine by transesophageal echocardiography is a potentially useful test for prediction of the post pump response of regional systolic function and global ventricular function to coronary revascularization.
Axis, Cervical Vertebra ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Dobutamine* ; Echocardiography ; Echocardiography, Transesophageal* ; Heart ; Humans ; Muscles ; Transplants ; Ventricular Function

OBJECTIVE: The provision of care for elderly people with dementia by healthy elderly caregivers is one of the new health-care paradigms in South Korea. The aim of this study was to determine whether this type of care, which includes cognitive stimulation, would improve the cognitive function of dementia patients and the quality of life of the healthy elderly caregiver. METHODS: Totals of 132 dementia patients and 197 healthy elderly caregivers participated in this study. We evaluated the cognitive function of the dementia patients at baseline and after providing the program for 6 months using the Korean version of the Consortium to Establish a Registry for Alzheimer's disease, 1st Edition (CERAD-K). We also evaluated the quality of life of the healthy elderly caregivers using the World Health Organization Quality of Life-Short Version (WHOQOL-BREF) at baseline and after 6 months. RESULTS: The word-list memory results of CERAD-K for the included dementia patients improved after 6 months (Z=-2.855, p=0.004). The WHOQOL-BREF score among the elderly caregiver also improved significantly (Z=-2.354, p=0.019). CONCLUSION: These data suggest that dementia care is associated with improvements in both the cognitive function of dementia patients and the quality of life of the healthy elderly caregivers.
Aged* ; Alzheimer Disease ; Caregivers* ; Cognition ; Dementia* ; Humans ; Korea ; Memory* ; Quality of Life* ; World Health Organization