BACKGROUND: The hemodynamic and metabolic effects of tourniquet application undergoing knee surgery with general anesthesia in elderly patients with hypertension have been rarely reported. We evaluated the hemodynamic and metabolic effects in elderly patients compared with young adults. METHODS: Thirty elderly patients (elderly hypertension group, 71.8 +/- 3.9 years) with chronic hypertension undergoing total knee replacement and 30 young adults (normal group, 33.1 +/- 5.1 years) undergoing knee surgery were studied. Mean arterial pressure (MAP), heart rate, cardiac index (CI) by esophageal doppler method, and systemic vascular resistance index (SVRI) were measured before, during, and after tourniquet application. pH, PaO2, PaCO2, Hb and lactate blood concentrations were also measured. RESULTS: MAP increased 25% and 16% in elderly hypertension and normal groups during inflation, respectively (P < 0.05) and returned to basal values after deflation. CI increased to 30% higher than basal values in both groups after deflation (P < 0.05). SVRI decreased 31% and 19% in elderly hypertension and normal groups after deflation, respectively (P < 0.05). After deflation, PaCO2 and lactate increased (P < 0.05). CONCLUSIONS: Elderly patients with hypertension have the significant hemodynamic changes during and after tourniquet application than before, however, there are no differences compared to normal group. These elderly patients should be needed the active hemodynamic monitoring due to the lower compensatory ability.
Aged* ; Anesthesia, General ; Arterial Pressure ; Arthroplasty, Replacement, Knee ; Heart Rate ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension* ; Inflation, Economic ; Knee* ; Lactic Acid ; Tourniquets* ; Vascular Resistance ; Young Adult

OBJECTIVE: To evaluate the long-term effect of a custom-made rigid foot orthosis (RFO) in children older than 6 years with pes planus (flat foot). METHODS: Medical records of 42 children diagnosed with flexible pes planus who were fitted with RFOs based on the inverted technique and underwent more than four consecutive radiological studies were reviewed. Resting calcaneal stance position (RCSP), anteroposterior talocalcaneal angle, lateral talocalcaneal angle, lateral talometatarsal angle, and calcaneal pitch were initially measured in both feet to evaluate alignment. Followup clinical and radiological evaluations were then performed at 12–18, 24–30, 36–42, and ≥48 months after RFO application. Repeated measures analysis of variance was used to evaluate significant differences. RESULTS: Significant improvements in all radiological indicators and significant progression of RCSP toward the corrective direction were observed after RFO application relative to baseline measurements. CONCLUSION: According to our findings, RFO can induce significant improvements in calcaneus-related radiographic indices and subsequently improve talus-related radiologic indices.
Child ; Flatfoot ; Follow-Up Studies ; Foot Orthoses ; Foot ; Humans ; Medical Records

Background: Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 200l and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 192 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p<0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (l.5% in Off-Pump CABG versus l.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p<0.05), lower rate of usage of inotropics (p<0.05), shorter mean ventilation time (p<0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p<0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.
Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; Coronary Vessels* ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Renal Insufficiency ; Risk Factors ; Stroke ; Transplants ; Ventilation

OBJECTIVES: Given the roles of bcl-2, bax and p53 in apoptosis, we investigated the effect of their expression on the response to cisplatin in order to understand the molecular events of cisplatin-resistance in lung cancers. METHODS: Three parental human lung cancer cell lines (PC9, PC14 and H69) and their in vitro selected cisplatin-resistant sublines were examined. Cells treated with cisplatin were processed for acridine orange and ethidium bromide staining and DNA gel electrophoresis for the morphologic detection of apoptosis. The endogenous levels of bcl-2, bax and p53 protein expression in lung cancer cells were assessed by Western blot analysis and DNA of polymerase chain reaction-amplified exon 5 to 8 of p53 gene was directly sequenced. RESULTS: H69, which had bcl-2 expression, p53 mutation and decreased expression of p53 and bax, was relatively resistant to cisplatin and delayed and reduced apoptosis. Although apoptosis was markedly reduced in cisplatin-resistant sublines compared to their parental cells, there were no significant differences in the expression of p53, bcl-2 and bax. CONCLUSIONS: Cisplatin-resistance was associated with the reduced cellular susceptibility to apoptosis. Cancer cells with the natural expression of bcl-2 and p53 mutation may be more resistant to cisplatin and less susceptible to apoptosis.
Antineoplastic Agents/pharmacology* ; Apoptosis/genetics ; Apoptosis/drug effects* ; Cisplatin/pharmacology* ; Drug Resistance ; Gene Expression ; Genes, bcl-2 ; Genes, p53 ; Human ; Lung Neoplasms/pathology ; Lung Neoplasms/genetics ; Lung Neoplasms/drug therapy ; Proto-Oncogene Proteins/genetics ; Tumor Cells, Cultured

PURPOSE: Nocternal enuresis is a common disorder. Tricyclic antidepressant and desmopressin have been accepted pharmacological treatment for this disorder. We conducted a cooperative study to investigate the efficacy and adverse reactions of imipramine, desmopressin and combination treatment in children with primary monosymptomatic nocturnal enuresis(PMNE). METHODS: Data from a large multicenter study were analysed. In the period of 8 months in 2002, the study comprised of 168 children(78 boys and 90 girls, 5 to 15 years old) with PMNE for imipramine, desmopressin or combination treatment. Before treatment a history, physical examination and laboratory tests were performed and the children were observed for 2 weeks. Response rate, adverse reactions and enuresis episodes after stopping drug administration were evaluated after 12-weeks of imipramine, desmopressin or combination of both. RESULTS: After 4 weeks, the frequency of bed wetting in all treated patients decreased during treatment significantly. Even though a 30-50% reduction in the number of wet nights were 68.6%, 74.4% and 86.1% during 12 weeks treatment by imipramine, desmopressin and both of them respectively, there was no significant difference between them. The most common adverse reaction was decreased appetite from imipramine administration. But no serious drug-related adverse events were reported. CONCLUSION: Efficacy of the combination therapy of imipramine and desmopressin in PMNE appears not to be better than either drug alone. It is necessary to pay attention on account of adverse reactions during imipramine treatment even though imipramine and desmopressin were generally well tolerated.
Appetite ; Child ; Deamino Arginine Vasopressin* ; Enuresis ; Female ; Humans ; Imipramine* ; Nocturnal Enuresis* ; Physical Examination