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

No abstract available.
Humans ; Token Economy*

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m^s in both film-screen and DR systems. Three radiologists scored the images by four grades in four categories of 1) contrast between mediastinum and lung, 2) definition of the nodule in the lung, 3) definition of another nodule through the mediastinal shadow, and 4) grainess(noise : assessed only in DR). Additionally, portable chest images were obtained in 10 patients in a intensive care unit by film-screen, standard dose and half dose DR in consecutive days. The same readers scored the images by four grades in six categories of 1) the lungs and hila, 2) the mediastinum, 3) subphrenic area. 4) musculoskeletal shadow, 5) tubes and lines, and 6) grainess (only in DR). The images with superior quality were assessed by paired t-test. RESULTS: In phantom study, the minimum dose of digital images scored 3 or more by all readers was 39% of the standard dose. In patient study, DR was superior to film-screen radiography in all categories except tube and line. Low dose DR was not inferior to standard dose DR in five categories other than grainess to two readers or more. CONCLUSION: In portable chest imaging, storage phosphor DR image was superior to conventional film-screen radiography and half dose DR was comparable to standard dose DR despite of more noise.
Adult ; Humans ; Intensive Care Units ; Lung ; Mediastinum ; Noise ; Radiographic Image Enhancement* ; Radiography ; Thorax*

PURPOSE: To compare image quality of storage phosphor digital radiography(DR) with film-screen radiography in portable chest imaging, and to assess the minimum X-ray dose that can be applied to DR in adults without image degradation, and also to compare image qualities of low dose and standard dose DR. Materials and Methalos: A geometrical phantom similar to the human thorax was imaged by a portable radiographic unit with fixed kVp and variable m^s in both film-screen and DR systems. Three radiologists scored the images by four grades in four categories of 1) contrast between mediastinum and lung, 2) definition of the nodule in the lung, 3) definition of another nodule through the mediastinal shadow, and 4) grainess(noise : assessed only in DR). Additionally, portable chest images were obtained in 10 patients in a intensive care unit by film-screen, standard dose and half dose DR in consecutive days. The same readers scored the images by four grades in six categories of 1) the lungs and hila, 2) the mediastinum, 3) subphrenic area. 4) musculoskeletal shadow, 5) tubes and lines, and 6) grainess (only in DR). The images with superior quality were assessed by paired t-test. RESULTS: In phantom study, the minimum dose of digital images scored 3 or more by all readers was 39% of the standard dose. In patient study, DR was superior to film-screen radiography in all categories except tube and line. Low dose DR was not inferior to standard dose DR in five categories other than grainess to two readers or more. CONCLUSION: In portable chest imaging, storage phosphor DR image was superior to conventional film-screen radiography and half dose DR was comparable to standard dose DR despite of more noise.
Adult ; Humans ; Intensive Care Units ; Lung ; Mediastinum ; Noise ; Radiographic Image Enhancement* ; Radiography ; Thorax*

Os odontoideum is a rare anomaly of the second cervical vertebrae, which is a separated ossicle from the body of the axis. This abnormality of the odontoid process can result in an atlanto-axial instability & subsequent cervical cord compression. In spite of the high prevalence of atlanto-axial instability due to the ligamentous laxity of atlanto-axial joint, the frequency of neurologic symptoms is relatively low in the patient of the Down syndrome. The asymptomatic atlanto-axial instability by trauma may progress to Os odontoideum in Down syndrome population and may cause cervical cord compression. Therefore, early recognition and an appropriate management of patients with atlanto-axial instability can significantly reduce the morbidity and mortality. We report a case of Os odontoideum in a child with Down syndrome, who had an atlanto-axial instability which resulted in the cervical cord compression.
Atlanto-Axial Joint ; Axis, Cervical Vertebra ; Cervical Vertebrae ; Child ; Down Syndrome* ; Dyspnea* ; Female ; Humans ; Ligaments ; Mortality ; Neurologic Manifestations ; Odontoid Process ; Prevalence ; Quadriplegia*

PURPOSE: Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternographic findings of spontaneous intracranial hypotension. MATERIALS AND METHODS: The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. RESULTS: Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30 min. Epidural blood patch was done in 11 patients and headache was improved in all cases. CONCLUSION: The characterstic findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration.
Absorption ; Blood Patch, Epidural ; Diagnosis ; Headache ; Humans ; Intracranial Hypotension* ; Pentetic Acid ; Radioactivity ; Spinal Puncture ; Subarachnoid Space ; Urinary Bladder

PURPOSE: The purpose of this study was to determine the differences in the level of disease related knowledge, compliance of health behavior, and educational needs in relation to time (at discharge and 6 months after discharge) among patients underwent percutaneous coronary intervention (PCI). METHODS: Data were collected from January 1, 2006 to September 30, 2006 and a total of 60 patients participated in the study. The survey was conducted in patients underwent PCI at the time of discharge right after discharge education was provided and at a follow up visit which was 6 months after discharge. RESULTS: The level of disease related knowledge (p<.001), the compliance of health behavior (p<.001), educational need (p=.496), the sub-item of sexual life (p<.001), follow up (p<.001), diet (p=.021), stress (p<.001) in compliance of health behavior, and the sub-item of specific character of disease in educational needs (p=.015) were significantly different between discharge and 6 months after discharge. CONCLUSION: The results of this study suggested that further education should be provided to the patients underwent PCI regarding medication, smoking cessation, daily life and exercise at a time of 6 months after discharge in order to increase patient compliance of health behavior.
Compliance ; Coronary Artery Disease ; Diet ; Follow-Up Studies ; Health Behavior ; Humans ; Patient Compliance ; Percutaneous Coronary Intervention ; Smoking Cessation

No abstract available.

We experienced a case of congenital rubella syndrome manifesting patent ductus arteriosus, petechiae, microcephaly, intrauterine growth retardation, and hepatomegaly in one-day-old female newborn infant. Congenital rubella syndrome was confirmed by positive results of anti-rubella IgM in the sera of patient. Anti-rubella IgM was negative in the sera of mother, while anti-rubella IgG was positive.
Ductus Arteriosus, Patent ; Female ; Fetal Growth Retardation ; Hepatomegaly ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infant, Newborn ; Microcephaly ; Mothers ; Purpura ; Rubella Syndrome, Congenital*

No abstract available.
HIV-1* ; Humans* ; Tumor Necrosis Factor-alpha*