There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.
Amiodarone ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Arrhythmia Agents ; Bupropion ; Calcium Channel Blockers ; Cardiovascular Agents ; Chlorpromazine ; Cholesterol ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes ; Digoxin ; Diltiazem ; Diuretics ; Drug Interactions ; Drug Toxicity ; Fluvoxamine ; Haloperidol ; Lithium ; Psychotropic Drugs ; Quinidine ; Serotonin Uptake Inhibitors ; Triazoles ; Verapamil ; Warfarin

Any type of urticaria may affect as many as 20% person during their lifetimes, yet the causes of this disorder is established in no more than 20% of cases. So, 308 patients with urticaria(acute ; 73, factitial; 120, chronic;115) were evaluated for results of historical and laboratory tests. The results were summerized as follows,' 1. The disesse primarily affected 2nd % 3rd decade(46.2%) with predominance of woman than man (M: F=1: 1.4). 2. Ninety-seven(31.5%) had at least one abnormal finding in the laboratory tests but, may be twenty-three(7.5%) would have causal relationship. 3. We sought serologic markers of Hepatitis B virus infection in serum from 8(14%) of 57 patients with urticaria. Of these, 4 were found to have abnormal liver function. 4. Sixty-five had taken at least one sort of drug previously or just before urticaria developed, but, may be forty-six(14.9%) would have a causal relationship and the predisposing drugs were analgesics, antibiotics, common cold medication & vitamin etc. 5. The predisposing conditions were as follows ; pulmory tuberculosis, viral hepatitis, hyperthyroidism, tonsillitis & ascariasis, etc. Of these, eleven(3.6%) of this patients were newly found to have underlying diseases. 6. This study showed inciting factors of urticaria in 27.2%(84/308).
Analgesics ; Anti-Bacterial Agents ; Ascariasis ; Common Cold ; Female ; Hepatitis ; Hepatitis B virus ; Humans ; Hyperthyroidism ; Liver ; Palatine Tonsil ; Tonsillitis ; Tuberculosis ; Urticaria* ; Vitamins

A 16-year-old girl developed pyoderma gangrenosum without underlying disease at first. She was treated with local cutaneous dressing and systemic oral prednisolone and minocycline for 10 months, imtermittently. After that, acute leukemia, which was undeterminated type, was developed 4 years after first onset. Since pyoderma gangrenosum may be a preindication of underlying disease, continual follow up check for systemic disease is required.
Adolescent ; Bandages ; Female ; Follow-Up Studies ; Humans ; Leukemia* ; Minocycline ; Prednisolone ; Pyoderma Gangrenosum* ; Pyoderma*

The clinical state with EEG pattern similar to interval discharge of epileptics is named as latent epilepsy, which does not necessarily mean that the patient will develop epilepsy later. However, since there is possibility of developing epilepsy on later date, antiepileptic mainly dilantin was tried to control the abnormal EEG. Since January to October 1985, total 580 headache cases with more than moderately abnormal EEG visited the Neurology Clinic. Among them 162 cases with interval seizure pattern (ISP) of epilepsy were selected for the study. The main ISP was 1. diffuse theta and/or delta bursts and 2. spikes. Since the study in only analysis of clinical treatment of 162 cases without previous planning based on financial aid, about 30% of the patients did not return after the 1st EEG examination, in 42% failed to follow the EEG after the treatment and only remaining 28% of the cases were studied. Among 29 patients who were treated with Dilantin 100mg tid po, 16 improved and 13 not. Of the 13, 4 showed partial improvement and partial progression. Case1. In 4 weeks of antiepileptic therapy (AR), spikes disappeared but in 2 months developed bursts. Case2. In 17days of AR, spikes and bursts disappeared but in 3 months bursts reccured. Case3. In 1 week of AR, bursts disappeared but spikes developed. Case4. In 3 months of AR, no change of spikes and bursts and she discontinued the AR. In 6 months she developed grandma seizure. Eighteen cases, treated with other drugs except antiepileptics, all showed improvement. The other drugs were vincaprol, polygammalon, aronamin, ATP and hydergine. The improved cases had spikes more often than theta bursts. In view of the small number of the cases due to dropping most patients out of present study, it is considered meaningless to perform statistical analysis. Further well planned study with more patients is to be expected.
Adenosine Triphosphate ; Anticonvulsants ; Electroencephalography ; Epilepsy* ; Ergoloid Mesylates ; Headache ; Humans ; Neurology ; Phenytoin ; Seizures

No abstract available.
Bone Plates* ; Spine*

At first, we review a sample size estimation method for log-rank test in survival analysis. Although it is widely used these days, it has a weakness for practical use. We propose a modification method to avoid the weakness.
Sample Size*

BACKGROUND: A fully automated enzyme-immunoassay (EIA) analyzer, Enzymun System, ES-300 (Boehringer Mannheim, Germany) uses streptavidin technology and performs single test or panels of up to 12 tests per run. We evaluated the results of ES-300 for anti-HCV by comparing the results with microplate-EIA, radioimmunoassay (RIA), and confirmatory test. METHODS: Total 79 sera (51 positive, 24 negative, 4 indeterminate results confirmed by Lucky HCD Confirm) were analysed. ES-300 with Enzymun-Test(R) Anti-HCV (Boehringer Mannheim, Germany) and microplate-EIA (Green Cross Center Innotest HCV 3.0(R)) were used. Fifty one sera were examined additionally by 2nd-generation RIA method, NANBDINE 125C(General Biologicals Corp., R.O.C.). And all results were compared to the results of Lucky HCD Confirm. RESULTS: The overall concordance rate of ES-300 and Innotest(R) was 72/79 (91.1%). The results of Lucky HCD Confirm on seven discrepant samples were five negative and two indeterminate. The results of ES-300 and NANBDINE 125C showed concordance rate of 90.2%. The sensitivity and specificity of ES-300 with regard to Lucky HCD Confirm were 94.5%, and 87.5%, respectively, and that of Innotest(R) were 98.2% and 66.7%, respectively. Clear distinction of positive and negative results by signal/cut off ratio was available in both EIAs. The positive predictive values of ES-300 and Innotest(R) were 94.5%, and 87.1%, respectively. CONCLUSIONS: ES-300 showed relatively good results in sensitivity and positive predictive value with regard to confirmatory test. In EIA-positive persons, however, follow-up study would be necessary for reliable evaluation of HCV infection.
Humans ; Radioimmunoassay ; Sensitivity and Specificity ; Streptavidin

No abstract available.
Bowen's Disease*

Wilms' tumor is one of the most common primary malignant tumors of the kidney during infancy and childhood and is known to be originated from the primitive cells of metanephric blastema. It presents difficulties when encountered in deciding the presence of anaplasia or in differentiating it from other renal tumors of childhood with different biologic behavior because of its diverse histologic patterns and varying degrees of differentiation. Evaluation of clinical and histopathologic features in terms of prognostication was done of 32 cases of Wilms' tumor which were surgically resected and diagnosed in the period from January 1979 through June 1992. Immunohistochemical reaction for cytokeratin, vimentin, actin and desmin was also analysed on all cases of Wilms' tumor in conjunction with clear cell sarcoma of the kidney(CCSK), malignant rhabdoid tumor of the kidney(MRTK) and congenital mesoblastic nephroma(CMN) to assess the validity of immunohistochemistry in differentiating Wilms' tumor from these renal tumors. Twenty four(75%) cases were diagnosed before the age of 5 and 40.7% were under 2 years old. Mixed type was most common(62.5%), followed by epithelial, blastemal and stromal predominant type in descending order of frequency. Anaplasia was observed in 3 cases(9.4%), two of which were epithelial predominant type and one blastemal predominant type. Treatment modality and presence of anaplasia were significantly correlated with 5 year survival rate of patients. Immunohistochemical stain revealed that all epithelial component of Wilms' tumor were positive for cytokeratin and 56.3% of Wilms' tumor had blastemal component which were positive for both cytokeratin and vimentin. Twenty cases(62.5%) of Wilms' tumor had blastemal component which were positive for cytokeratin with a proportion of more than 5% of reactive cells. Stromal component of Wilms' tumor generally did not show differentiation into the specialized type of tissue and all revealed positive reactions for vimentin among which some revealed positive reactions for actin. Only 3 out of 6 cases with rhabdomyoblastic differentiation were positive for desmin. CCSK, MRTK and CMN which have different biologic behavior and treatment modality compared to Wilm's tumor showed positivity only for vimentin and/or actin. In summary, treatment modality and presence of anaplasia are significantly correlated with patients' survival and the immunohistochemical stain for cytokeratin is very helpful in confirming the presence of blastemal component and useful in the differential diagnosis of Wilms' tumor from other kinds of pediatric renal tumors.
Child ; Male ; Female ; Humans ; Diagnosis, Differential

Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.