BACKGROUND: Although there are improvements of clinical symtoms after bronchodilator inhalation in COPD patients, it has been noted that there was no increase of FEV1 in some cases. FEV1 did not reflect precisely the improvement of ventilatory mechanics after bronchodilator inhalation in these COPD patients. The main pathophysiology of COPD is obstruction of airway in expiratory phase but in result, the load of respiratory system is increased in inspiratory phase. Therefore the improvement of clinical symptoms after bronchodilator inhalation may be due to the decrease of inspiratory load. So we performed the study which investigated the effect of bronchodilator on inspiratory response of vetilatory mechanics in COPD patients. METHODS: In 17 stable COPD patients, inspiratory and expiratory forced flow-volume curves were measured respectively before bronchodilator inhalation. l0mg of salbutamol solution was inhaled via jet nebulizer for 4 minutes. Forced expiratory and inspiratory flow-volume curves were measured again 15 minutes after bronchodilator inhalation. RESULTS: FEV1, FVC and FEV1/FVC% were 0.92 +/-0.34L(38.3+/- 14.9% predicted), 2.5+/-0.81L (71.1 +/-21.0% predicted) and 43.1+/-14.5% respectively before bronchodilator inhalation. The values of increase of FEV1, FVC and PIF(Peak Inspiratory Flow) were 0.15 +/-0.13L(relative increase: 17.0%), 0.58+/-0.38 L(29.0%) and 1.0+/-0.56L/sec(37.5%) respectively after bronchodilator inhalation. The increase of PIF was twice more than FEV1 in average(p<0.001). The increase of PIF in these patients whose FEV1 was not increased after bronchodilator inhalation were 35.0%, 44.0% and 55.5% respectively. CONCLUSION: The inspiratory parameter reflected improvement of ventilatory mechanics by inhaled bronchodilater better than expiratory parameters in COPD patients.
Albuterol ; Humans ; Inhalation ; Mechanics ; Nebulizers and Vaporizers ; Pulmonary Disease, Chronic Obstructive* ; Respiratory System

Surgical results of 59 patients with constant exodeviation having at least 2 months of follow-up were reviewed. Fifty nine cases of constant exodeviation were classified by fixation patterns into alternating exotropia 38 cases and monocular exotropia 21 cases. The final surgical results and success rates were compared between the 2 groups and were analyzed according to the length of postoperative follow-up period. The surgical results were as follows: in alternating exotropia, 63.2% was satisfactory, 28.9% undercorrected and 7.9% overcorrected, in monocular exotropia, 85.7% was satisfactory, 9.5% undercorrected and 4.8% overcorrected. The mean follow-up period was 5.3 months in alternating exotropia and 5.9 months in monocular exotropia. Final surgical results were not affected by the length of postoperative follow-up period in alternating exotropia. However, in monocular exotropia, there was a strong tendency to become exotropic with a long term follow-up period(2-17 months). We suggest that the fixation patterns could have an influence on postoperative stability in exodeviation.
Exotropia* ; Follow-Up Studies ; Humans

Surgical results of 59 patients with constant exodeviation having at least 2 months of follow-up were reviewed. Fifty nine cases of constant exodeviation were classified by fixation patterns into alternating exotropia 38 cases and monocular exotropia 21 cases The final surgical results and success rates were compared between the 2 groups and were analyzed according to the length of postoperative follow-up period. The surgical results were as follows: in alternating exotropia, 63.2% was satisfactory, 28.9% undercorrected and 7.9% overcorrected, in monocular exotropia, 85.7% was satisfactory, 9.5% undercorrected and 4.8% overcorrected. The mean follow-up period was 5.3 months in alternating exotropia and 5.9 months in monocular exotropia. Final surgical results were not affected by the length of postoperative follow-up period in alternating exotropia. However, in monocular exotropia, there was a strong tendency to become exotropic with a long term follow-up period (2-17 months). We suggest that the fixation patterns could have an influence on postoperative stability in exodeviation.
Exotropia* ; Follow-Up Studies ; Humans

The identification of therapeutic target genes that are functionally involved in stemness is crucial to effectively cure patients with metastatic carcinoma. We have previously reported that inhibition of ribosomal protein L9 (RPL9) expression suppresses the growth of colorectal cancer (CRC) cells by inactivating the inhibitor of DNA-binding 1 (ID-1) signaling axis, which is functionally associated with cancer cell survival. In addition to cell proliferation, ID-1 is also involved in the maintenance of cancer stemness.Thus, we aimed in this study to investigate whether the function of RPL9 could correlate with CRC stem cell-like properties. Here, we demonstrated that siRNA silencing of RPL9 reduced the invasiveness and migrative capabilities of HT29 and HCT116 parental cell populations and the capacity for sphere formation in the HT29 parental cell population. CD133+ cancer stem cells (CSCs) were then separated from CD133- cancer cells of the HT29 parental cell culture and treated with RPL9-specific siRNAs to verify the effects of RPL9 targeting on stemness. As a result, knockdown of RPL9 significantly suppressed the proliferative potential of CD133+ colorectal CSCs, accompanied by a reduction in CD133, ID-1, and p-IκBα levels. In line with these molecular alterations, targeting RPL9 inhibited the invasion, migration, and sphere-forming capacity of CD133+ HT29 CSCs. Taken together, these findings suggest that RPL9 promotes CRC stemness via ID-1 and that RPL9 could be a potential therapeutic target for both primary CRC treatment and the prevention of metastasis and/or recurrence.

BACKGROUND: A number of different weaning techniques can be employed such as spontaneous breathing trial, Intermittent mandatory ventilation(IMV) or Pressure support ventilation(PSV). However, the conclusive data indicating the superiority of one technique over another have not been published. Usually, a conventional spontaneous breathing trial is undertaken by supplying humidified O2 through T-shaped adaptor connected to endotracheal tube or tracheostomy tube. In Korea, T-tube trial is not popular because the high-flow oxygen system is not always available. Also, the timing of extubation is not conclusive and depends on clinical experiences. It is known that to withdraw the endotracheal tube after weaning is far better than to go through any period. The tube produces varying degrees of resistance depending on its internal diameter and the flow rates encountered. The purpose of present study is to evaluate the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube. METHODS: We analyzed the result of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube in 18 subjects from June, 1993 to June, 1994. They consisted of 9 males and 9 females. The duration of mechanical ventilation was from 38 hours to 341 hours(mean: 105.9 +/- 83.4 hours). In all cases, the cause of ventilator dependency should be identified and precipitating factors should be corrected. The weaning trial was done when the patient became alert and arterial O2 tension was adequate(PaO2 > 55mmHg) with an inspired oxygen fraction of 40%. We conducted a careful physical examination when the patient was breathing spontaneously through the endotracheal tube. Failure of weaning trial was signaled by cyanosis, sweating, paradoxical respiration, intercostal recession. Weaning failure was defined as the need for mechanical ventilation within 48 hours. RESULTS: In 19 weaning trials of 18 patients, successful weaning and extubation was possible in 16/19(84.2% ). During the trial of spontaneous breathing for 60 minutes through the endotracheal tube, the patients who could wean developed slight increase in respiratory rates but significant changes of arterial blood gas values were not noted. But, the patients who failed weaning trial showed the marked increase in respiratory rates without significant changes of arterial blood gas values. CONCLUSION: The result of present study indicates that weaning from mechanical ventilation following a 60 minutes spontaneous breathing with O2 supply through the endotracheal tube is a simple and effective method. Extubation can be done at the same time of successful weaning except for endobronchial toilet or airway protection.
Cyanosis ; Female ; Humans ; Korea ; Male ; Oxygen ; Physical Examination ; Precipitating Factors ; Respiration* ; Respiration, Artificial ; Respiratory Rate ; Sweat ; Sweating ; Tracheostomy ; Ventilators, Mechanical ; Weaning*

BACKGROUND: The intrapleural instillation of tetracycline for pleural sclerosis had been most commonly used in patients with symptomatic malignant pleural effusion or recurrent pneumothorax for a long time. Unfortunately, at a time of expanding use of this agent, the production of injectable tetracycline hydrochloride used for pleurodesis was discontinued by its sole manufacturer in mid-1991 because the manufacturer was unable to meet US Food and Drug Administration purity standards. So we performed a preliminary study of doxycycline, as a alternative pleural sclerosant on rabbit pleura and compared its efficacy with that of tetracycline. METHOD: Eighteen New Zealand white rabbits weighing 2 to 3kg(mean 2.6kg) were divided into three groups. In each groups, one tetracycline(20 mg/ml/kg) and two doxycycline solutions(7 mg/ml/kg and 20 mg/ml/kg) instillated into the right pleural space through an 18-gauge angiocath with care to prevent pneumothorax. All rabbits were sacrificed after 28 days. RESULTS: 1) In the group of tetracycline 20 mg/ml/kg(six rabbits), five rabbits showed partial pleural symphysis with several fibrous bands, and one rabbit died on 22th day. 2) In the group of doxycycline 7 mg/ml/kg(six rabbits), three rabbits showed partial pleural symphysis and the other three rabbits showed complete pleural symphysis without necrosis of underlying parenchymal lung tissue. 3) In the group of doxycycline 20 mg/ml/kg(six rabbits), two rabbits showed complete pleural symphysis without lung necrosis, another two rabbits showed complete pleural symphysis with lung necrosis, and the other two rabbits died on 4th and 13th day, respectively. CONCLUSION: We concluded that doxycycline is a highly effective sclerosing agent having stronger pleurodesis effect with that of tetracycline by dose base and its optimal dosage was considered as 7 mg/ml/kg with minimal complications.
Doxycycline* ; Humans ; Lung ; Necrosis ; Pleura ; Pleural Effusion, Malignant ; Pleurodesis* ; Pneumothorax ; Rabbits ; Sclerosis ; Tetracycline ; United States Food and Drug Administration

BACKGROUND: Cancer pain impacts the patient and improved pain management increases the quality of life (QOL) for the patient and entire family. One tablet of Ultracet(R) is composed of 37.5 mg of tramadol hydrochloride and 325 mg acetaminophen. Mechanism of action of Ultracet(R) is multiple blocking to pain transmission with 3 synergistic actions. Ultracet(R) shows high performance analgesic efficacy with good tolerability and fast onset in previous studies. METHODS: From February 2003 to January 2004, we treated 97 patients who had cancer pain. Brief pain inventory, WHO QOL-BREF, and EORTC QLQ-C30 were evaluated before, and after median duration of treatment of 17.9 days with Ultracet(R). RESULTS: Among 97 patients, male was 59 (61%) and female was 38 (39%). Mean age was 60.3+/-12.0 (range: 25-81 years). Stomach cancer was in 19, lung cancer in 14, lymphoma in 11, unknown primary carcinoma in 8, colorectal cancer in 7, in order of frequency. Pre/post treatment visual analogue scale (VAS) score was 6.43/4.46 (p=0.000). Mild pain in 11 patients and pre/post treatment VAS score of 2.09/1.91 (p=0.875), moderate pain in 33 and 5.21/3.64 (p=0.000), and severe pain in 53 and 8.09/5.51 (p=0.000). Change of QOL after pain management was significant in emotion (65.9/72.1, p=0.012) in functional scales, and pain in symptom scales (62.0/50.9, p=0.000), sleep disturbance (p=0.018), and constipation (p=0.038) in symptom scales. We compared a QOL scales of 3 groups by response to Ultracet(R); improvement (67), no change (17), and aggravation (13). Global health (p=0.000). fatigue (p=0.019), and sleep disturbance (p=0.003) were statistically different among 3 groups. CONCLUSION: Ultracet(R) is effective in moderate to severe cancer pain and contribute an improvement of quality of life (QOL) of cancer patients.
Acetaminophen ; Analgesics ; Colorectal Neoplasms ; Constipation ; Fatigue ; Female ; Humans ; Lung Neoplasms ; Lymphoma ; Male ; Pain Management ; Quality of Life* ; Stomach Neoplasms ; Tramadol ; Weights and Measures

BACKGROUND/AIMS: Cancer-induced bone pain (CIBP) is one of the most common pains in patients with advanced neoplasms. Because of treatment-associated side effects, more than half of cancer patients are reported to have inadequate and undermanaged pain control. New mechanism-based therapies must be developed to reduce cancer pain. Quetiapine is a commonly used atypical antipsychotic drug. We report a study of the potential analgesic effects of quetiapine in a mouse model of CIBP and examine the mechanism of bone pain by analyzing the expression of various nociceptors. METHODS: Fifteen male C3H/HeN mice were arbitrarily divided into five groups: control and, CIBP with no treatment, quetiapine treatment, opioid treatment, and melatonin treatment. The mice were tested for mechanical hyperalgesia by determining the nociceptive hind paw withdrawal pressure threshold. Tissues from tibia were removed and subjected to quantitative and qualitative evaluations of transient receptor potential vanilloid 1 (TRPV1), TRPV4, acid-sensing ion channel 1 (ASIC1), ASIC2, and ASIC3 expression. RESULTS: Paw withdrawal pressure threshold was improved in the quetiapine treatment group compared with the CIBP group. Expression of TRPV1, TRPV4, ASIC1, ASIC2, and ASIC3 in the CIBP with quetiapine treatment group was significantly lower than that in the CIBP group. CONCLUSIONS: Our results suggest an analgesic effect of quetiapine in the CIBP animal model and implicate TRPV and ASICs as potential targets for cancer pain management.
Animals ; Evaluation Studies as Topic ; Humans ; Hyperalgesia ; Ion Channels ; Male ; Melatonin ; Mice* ; Models, Animal ; Nociceptors ; Pain Management ; Quetiapine Fumarate* ; Tibia

Sarcoidosis is a chronic multisystemic disorder of unknown cause characterized by presence of noncaseating Epithelioid granuloma in affected organ. It was first reported in 1887 by Hutchinson and is relatively common in western countries. But it is not commonly seen in East Asia including Korea. All parts of the body can be affected, but the lung is the most frequently affected organ. Other common site of involvement include lymph node, eye, skin, etc. It is known that 3~9% of all cases of sarcoidos is associated with bone involvement. Bone involvement usually cause no symptom and frequently affect bones in hands an feet. In many cases, it is known to be associated with skin involvement. We recently experienced one case of sarcoidosis which typically showed X-ray finding of sarcoidosis with associated skin lesion(lupus pernio) and report it with review of the literature.
Far East ; Foot ; Granuloma ; Hand ; Korea ; Lung ; Lymph Nodes ; Sarcoidosis* ; Skin

BACKGROUND/AIMS: Acidic saline injections produce mechanical hyperresponsiveness in male Sprague-Dawley rats. We investigated the effect of milnacipran in conjunction with tramadol on the pain threshold in an acidic saline animal model of pain. METHODS: The left gastrocnemius muscle of 20 male rats was injected with 100 microL of saline at pH 4.0 under brief isoflurane anesthesia on days 0 and 5. Rats administered acidic saline injections were separated into four study subgroups. After determining the pre-drug pain threshold, rats were injected intraperitoneally with one of the following regimens; saline, milnacipran alone (60 mg/kg), milnacipran (40 mg/kg) plus tramadol (20 mg/kg), or milnacipran (40 mg/kg) plus tramadol (40 mg/kg). Paw withdrawal in response to pressure was measured at 30 min, 120 min, and 5 days after injection. Nociceptive thresholds, expressed in grams, were measured with a Dynamic Plantar Aesthesiometer (Ugo Basile, Italy) by applying increasing pressure to the right or left hind paw until the rat withdrew the paw. RESULTS: A potent antihyperalgesic effect was observed when tramadol and milnacipran were used in combination (injected paw, p=0.001; contralateral paw, p=0.012). This finding was observed only at 30 min after the combination treatment. CONCLUSIONS: We observed potentiation of the antihyperalgesic effect when milnacipran and tramadol were administered in combination in an animal model of fibromyalgia. Further research is required to determine the efficacy of various combination treatments in fibromyalgia in humans.
Analgesics, Opioid/administration & dosage/*pharmacology ; Animals ; Antidepressive Agents/administration & dosage/*pharmacology ; Behavior, Animal/drug effects ; Cyclopropanes/administration & dosage/*pharmacology ; Disease Models, Animal ; Drug Synergism ; Drug Therapy, Combination ; Fibromyalgia/chemically induced/complications/*prevention & control ; Hydrogen-Ion Concentration ; Hyperalgesia/etiology/*prevention & control ; Injections, Intraperitoneal ; Male ; Pain/etiology/*prevention & control ; Pain Measurement ; Pain Threshold/*drug effects ; Rats ; Rats, Sprague-Dawley ; Sodium Chloride ; Time Factors ; Tramadol/administration & dosage/*pharmacology