BACKGROUNG AND OBJECTIVES: It was reported that low molecular weight heparin (LMWH) was more effective than unfractionated heparin in patients with acute coronary syndrome. Recent studies have shown that the pathophysiology of restenosis in stented lesions was different from those of nonstented lesions. Treatment strategies designed to limit cellular proliferation that were ineffective in nonstented lesions may be efficacious in reducing in-stent restenosis. This study was aimed to compare the clinical and angiographic results of LMWH (nadroparin) after coronary stenting with those of conventional ticlopidine regimen. MATERIALS AND METHODS: Patients were eligible for inclusion if they had angina and/or objective evidence of myocardial ischemia, and a significant (>50%) stenosis that was documented on a recent coronary angiogram. After stenting, prospective randomized comparison study was performed. Patients were randomly assigned to either nadroparin (200 IU/kg, sc, bid) or ticlopidine (250 mg bid) plus aspirin (200 mg qd) treatment groups. Repeat coronary angiography (KERN=*)was performed at 236+/-90days after stenting, and quantitative coronary angiographic analysis (QCA) was done. RESULTS: Intracoronary stent implantation was performed in eighty five lesions in eighty one patients (ticlopidine:40, nadroparin:41). There was no significant difference in any baseline clinical/angiographic variables between the two treatment groups. There were no subacute stent thrombosis, infarction and death in both groups. Six-month event-free survival was 36 (90%) in the ticlopidine group and 35 (85.4%) in the nadroparin group. Follow-up quantitative angiographic data such as late loss (1.35+/-0.70 vs 1.32+/-0.69), loss index (0.53+/-0.70 vs 0.56+/-0.23) and restenosis rate (36% vs 25.8%) were not different between ticlopidine and nadroparin groups. CONCLUSION: Effects of nadroparin were not different from those with ticlopidine therapy in the prevention of restenosis and subacute stent thorombosis after coronary stenting. Clinical outcomes between two strategies were similar. Low molecular weight heparin may be an alternative to ticlopidine in patients that ticlopidine cannot be administered because of severe adverse effects.
Acute Coronary Syndrome ; Aspirin ; Cell Proliferation ; Constriction, Pathologic ; Coronary Angiography ; Disease-Free Survival ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Myocardial Ischemia ; Nadroparin* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine*

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.
Anoxia ; Female ; Humans ; Intubation ; Laryngeal Masks* ; Larynx ; Middle Aged ; Pharynx ; Trachea* ; Tracheal Stenosis ; Ventilation

No abstract available.
Hypoglossal Nerve Diseases* ; Hypoglossal Nerve* ; Paralysis ; Prognosis

BACKGROUND: Propofol increases the risk of bradycardia compared with other anesthetics. This paper reports the heart rate response to intravenous atropine during propofol and enflurane anesthesia. METHODS: Sixty patients undergoing a transabdominal hysterectomy under general anesthesia were randomly assigned to two groups: the propofol group and the enflurane group. All the patients received midazolam 2 mg intramuscularly and were then anesthetized with propofol or enflurane. The blood pressure and heart rate were taken at 1 min intervals for 10 min after a bolus injection of atropine 5microgram/kg. RESULTS: In the enflurane group, the systolic blood pressure and heart rate were increased significantly at 1, 2 and 3 min after the atropine injection (P<0.05). When the two groups were compared, the heart rate in the enflurane group was significantly higher at 1, 2 and 3 min after atropine injection than in the propofol group (P<0.05). CONCLUSIONS: The heart rate response to intravenous atropine during propofol anesthesia is attenuated compared with enflurane anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Atropine* ; Blood Pressure ; Bradycardia ; Enflurane* ; Heart Rate* ; Heart* ; Humans ; Hysterectomy ; Midazolam ; Propofol*

PURPOSE: To improve survival and/or to avoid radiotherapy, high dose chemotherapy (HDCT) with autologous peripheral blood stem cell transplantation (PBSCT) was given to patients with recurrent or high risk medulloblastoma (MB)/primitive neuroectodermal tumor (PNET) as well as patients younger than 3 years of age. METHODS: Six patients (3 recurrent, 1 high risk, 2 younger than 3 years; 5 MBs and 1 PNET) received single or double HDCT and PBSCT with or without immunotherapy using interleukin-2. Chemotherapeutic regimen in the first HDCT included cyclophosphamide (1,500 mg/m2/ day for 4 days) and melphalan (60 mg/m2/day for 3 days). Chemotherapeutic regimen in the second HDCT included carboplatin (400 mg/m2/day for 3 days), thiotepa (250 mg/ m2/day for 3 days), and etoposide (200 mg/m2/day for 3 days). RESULTS: Nine HDCTs were applied in 6 patients. Three double HDCTs were rescued with peripheral blood stem cells collected during single round leukapheresis. Rapid hematologic recovery occurred in 4 patients. Engraft failure occurred in 1 patient and delayed granulocyte recovery and platelet engraft failure occurred in 1 patient. Three patients who had minimal disease before HDCT had event free survival for 7~18 months after HDCT. Tumor relapsed 8 and 12 months after single HDCT in 2 patients among 3 patients with recurrent MB/PNET. One patient with recurrent MB died due to engraft failure and sepsis. CONCLUSION: HDCT with autologous PBSCT is expected to improve survival of patients with poor prognosis MB/PNET including younger patients less than 3 years. Subsequent trials with larger number of patients and long-term follow-up are needed.
Blood Platelets ; Carboplatin ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy* ; Etoposide ; Follow-Up Studies ; Granulocytes ; Humans ; Immunotherapy ; Interleukin-2 ; Leukapheresis ; Medulloblastoma ; Melphalan ; Neural Plate* ; Neuroectodermal Tumors* ; Neuroectodermal Tumors, Primitive ; Peripheral Blood Stem Cell Transplantation* ; Prognosis ; Radiotherapy ; Sepsis ; Stem Cells ; Thiotepa

PURPOSE: To evaluate the outcomes of patients with comminuted subtrochanteric femoral fractures using minimally invasive plate osteosynthesis (MIPO) technique. MATERIALS AND METHODS: Twelve patients with a mean age of 38.2 years, who sustained comminuted subtrochanteric femoral fractures, were treated using MIPO technique. All patients suffered these fractures either from traffic accidents (6) or falls from height (6). Average follow-up was 4.3 years (range, 29~78 months). Patients were assessed radiographically and clinically with regards to time to union, malunion, and complications. According to the Seinsheimer's classification, there were 1 type III, 7 type IV, and 4 type V. Type C fractures were ten according to AO-OTA classification. RESULTS: Union was achieved in 7 of 12 cases, in an average of 23.4 weeks (range, 12~42 weeks). Three definite non-unions with implant failures, needed the procedure of implant change and bone graft. In other two patients, early bone graft was performed for anticipated nonunion of comminuted area. The most common complication was metal failures (2 plate failures and 3 screw breakages). Limb length shortening of 1.5 cm occurred in one patient, and external rotation malunion of 15 degrees was noted in one patient. No patients developed infection. CONCLUSION: Preserving biology of the fracture fragments, the use of MIPO technique using DCS has proven to be less successful in comminuted subtrochanteric fractures, comparing to fractures in other areas. To avoid mechanical failure, the careful and protective weight bearing is needed until the callus-bridging is seen in the commniuted area.
Accidents, Traffic ; Biology ; Classification ; Extremities ; Femoral Fractures ; Femur* ; Follow-Up Studies ; Hip Fractures ; Humans ; Transplants ; Weight-Bearing

BACKGROUND: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. METHODS: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. RESULTS: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. CONCLUSIONS: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.
Analgesics ; Anesthetics, Local ; Arthroscopy* ; Humans ; Hyperalgesia ; Injections, Intra-Articular ; Ketamine* ; Knee Joint ; Knee* ; Pain, Postoperative ; Patient Satisfaction ; Synovial Fluid ; Wounds and Injuries

The goal of this study was to determine whether gypenosides (GPS) exert protective effects against dopaminergic neuronal cell death in a 6-hydroxydopamine (OHDA)-lesioned rat model of Parkinson's disease (PD) with or without long-term 3,4-dihydroxyphenylalanine (L-DOPA) treatment. Rats were injected with 6-OHDA in the substantia nigra to induce PD-like symptoms; 14 days after injection, groups of 6-OHDA-lesioned animals were treated for 21 days with GPS (25 or 50 mg/kg) and/or L-DOPA (20 mg/kg). Dopaminergic neuronal cell death was assessed by counting tyrosine hydroxylase (TH)-immunopositive cells in the substantia nigra and measuring levels of dopamine, norepinephrine, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the striatum. Dopaminergic neuronal cell death induced by 6-OHDA lesions was ameliorated by GPS treatment (50 mg/kg). L-DOPA treatment exacerbated 6-OHDA-induced dopaminergic neuronal cell death; however, these effects were partially reversed by GPS treatment (25 and 50 mg/kg). These results suggest that GPS treatment is protective against dopaminergic neuronal cell death in a 6-OHDA-lesioned rat model of PD with long-term L-DOPA treatment. Therefore, GPS may be useful as a phytotherapeutic agent for the treatment of PD.
3,4-Dihydroxyphenylacetic Acid ; Animals ; Cell Death* ; Dihydroxyphenylalanine ; Dopamine ; Dopaminergic Neurons* ; Homovanillic Acid ; Levodopa* ; Models, Animal* ; Norepinephrine ; Oxidopamine ; Parkinson Disease* ; Rats* ; Substantia Nigra ; Tyrosine 3-Monooxygenase

Lupus myocarditis is usually treated using immunosuppressive agents, such as high-dose corticosteroids, azathioprine and cyclophosphamide. Viral myocarditis and enteroviruses have been identified as the most common causative agents of myocarditis in lupus patients. Although immunosuppressive therapy has an important role in the treatment of lupus myocarditis, it is not recommended in patients with infectious or post-infectious viral myocarditis, and supportive care is very important in these patients. A 25-year old female patient, with systemic lupus erythematosus, was admitted due to severe dyspnea, and diagnosed as having heart failure. She recovered 7 days after supportive care for heart failure, without Immuno-suppression. Her sera neutralized coxsackievirus B3 (CVB3) in neutralization test, with the horse anti-CVB3 antibody (Ab, ATCC V030-501-560) used as a positive control. The titers for the neutralizing Ab in her sera were 4 times higher than that of the standard control ATCC Ab.
Adrenal Cortex Hormones ; Adult ; Azathioprine ; Cyclophosphamide ; Dyspnea ; Enterovirus ; Female ; Heart Failure ; Horses ; Humans ; Immunosuppressive Agents ; Lupus Erythematosus, Systemic* ; Myocarditis* ; Neutralization Tests

PURPOSE: The purpose of this study was to evaluate the responses and toxicities of risk-adapted chemotherapy in pediatric intracranial germ cell tumors(IC-GCT). METHODS: Fourteen patients who were diagnosed as IC-GCT from October 2002 to December 2003 received chemotherapy as an initial treatment modality. The low risk(LR) group was defined as follows: Pure germinoma and normal AFP level. Beta-hCG level 50 mIU/mL or less. The others belonged to the high risk(HR) group. Chemotherapy was composed of cisplatin, cyclophosphamide, etoposide and vincristine. Double doses of cisplatin and cyclophosphamide was used in HR patients. RESULTS: Pathologic confirmation was done in all but one. Median age at diagnosis was 11.6 yr (1.2-18.7 yr), and nine patients belonged to the HR group. Tumor markers were normalized after chemotherapy in all patients whose tumor markers had been elevated. Four LR patients(80 percent) and seven HR patients(77.8 percent) showed complete response(CR) at the end of chemotherapy. An additional two of the three patients with partial response(PR) achieved CR after radiation therapy (RT), and the remaining one relapsed before RT. Four LR and all HR patients experienced infectious episodes that required hospitalization. Four of the nine HR patients(44.4 percent) suffered from tinnitus, three of whom developed sensorineural hearing loss. All but one are surviving, event-free, with a median follow-up of 13.9 mo(8.1-22.3 mo). CONCLUSION: Risk-adapted cisplatin-based chemotherapy was effective even in HR patients, but regimen modification seems to be necessary to avoid an unacceptably high toxicity rate.
Cisplatin ; Cyclophosphamide ; Diagnosis ; Drug Therapy* ; Etoposide ; Follow-Up Studies ; Germ Cells* ; Germinoma ; Hearing Loss, Sensorineural ; Hospitalization ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Tinnitus ; Biomarkers, Tumor ; Vincristine