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*

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*

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

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: 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

PURPOSE: Dengue fever occurs in many popular tourist destinations and is increasingly imported by returning travelers in Korea. Since Korea is not an endemic country for dengue fever, pediatricians do not usually suspect dengue fever in febrile children even with typical presentation and exposure history. This study was performed to describe the international travel experiences and dengue fever in Korean children. METHODS: Travel histories were collected based on questionnaires completed by all patients' guardians who visited the pediatric infectious diseases clinic at Samsung Medical Center from January 2008 to December 2008. For patients who were suspected of dengue fever, a serological test was performed. RESULTS: Five hundred and seventeen children visited the pediatric infectious diseases clinic for the first time during this period. About 30% of patients who responded to the questionnaire (101/339) had experienced international travel within the last 2 years. Four patients were diagnosed with dengue fever by serological test. CONCLUSION: Increasing numbers of Korean children visit dengue endemic areas and they may return home with dengue fever. Dengue fever should be suspected in patients who have a travel history to endemic areas.
Child ; Communicable Diseases ; Dengue ; Humans ; Korea ; Surveys and Questionnaires ; Serologic Tests

OBJECTIVE: To provide the off-loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. This study examined the effects of the off-loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals. METHOD: Ten healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity. RESULTS: We found that VMO activity was significantly decreased with application of the off-loading knee brace during squatting and fast walking exercise. However there were no significant differences in VMO activity with application of the off-loading knee brace during slow walking exercise. CONCLUSION: These results suggest that the external moment of the brace which effectively stabilized the patella in the movement in which the knee joints become relatively unstable. The brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Therefore the program of selective muscular strength strengthening for the VMO should be emphasized.
Braces ; Electromyography ; Exercise ; Humans ; Isometric Contraction ; Knee ; Knee Joint ; Leg ; Male ; Muscles ; Osteoarthritis ; Patella ; Quadriceps Muscle ; Walking

PURPOSE: If primitive hematopoietic cells expanded ex vivo can be used in stem cell transplantation, duration for hematologic recovery will be shortened. In this study, CD34 cells were cultured with various hematopoietic growth factors which are known to stimulate proliferation of primitive hematopoietic cells. METHODS: CD34 cells isolated from cord blood were cultured and expanded ex vivo with IL-3, stem cell factor (SCF), flt-3 ligand (FL), thrombopoietin (TPO), granulocyte-colony stimulating factor (G-CSF). To find optimal combination of growth factors, CD34 cells were cultured for 9 days with various combinations of growth factors. To find optimal duration of culture, CD34 cells were cultured for 5, 7, 9, 12 days. To evaluate expansion of primitive hematopoietic cells, the number of CD34 cells, colony forming cells and long-term culture-initiating cells (LTC-IC) were counted by flow cytometry, colony forming cell assay and limiting dilution assay respectively. RESULTS: Primitive hematopoietic cells were successfully expanded from CD34 cells of cord blood. Maximal expansion of LTC-IC and CFU- GEMM were 2.58 and 2.37 fold respectively after 9 days of culture, and were obtained with the combination of IL-3 SCF FL TPO. When CD34 cells were cultured for 5, 7, 9, 12 days with the combination of IL-3 SCF FL TPO, expansion of LTC-IC was maximal (2.95 fold) after 9 days culture. After reaching maximal expansion of LTC-IC, the number of nucleated cells increased, but that of primitive hematopoietic cells decreased. CONCLUSION: Primitive hematopoietic cells can be successfully expanded ex vivo by using hematopoietic growth factors. Duration for hematologic recovery after stem cell transplantation will be shortened by using primitive hematopoietic cells expanded ex vivo.
Fetal Blood ; Flow Cytometry ; Intercellular Signaling Peptides and Proteins* ; Interleukin-3 ; Stem Cell Factor ; Stem Cell Transplantation ; Thrombopoietin ; Transplantation

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