Canalith repositioning maneuver is effective to treat benign paroxysmal positional vertigo(BPPV). This case showed complicated form of the BPPV such as changes of canalolithiasis to cupulolithiasis, involvement of one canal to two canals and from unilateral to bilateral involvement during the reposition maneuver. This patient was diagnosed as left lateral canalolithiasis at first. After left barbecue maneuver, the type was changed to the right posterior cupulolithiasis. Semont maneuver was performed and then the type of BPPV was changed to combined type with right posterior canalolithiasis and left lateral canalolithiasis. We performed left barbecue maneuver and right Epley maneuver. Then the type of BPPV was changed to left lateral cupulolithiasis. After Brandt-Daroff maneuver and left barbecue maneuver, nystagmus and dizziness disappeared finally.
Dizziness ; Humans

No abstract available.
Humans ; Infant, Newborn*

No abstract available.
Hemorrhage* ; Humans ; Infant* ; Infant, Very Low Birth Weight*

No abstract available.
Humans ; Infant, Newborn*

No abstract available.
Humans ; Infant, Newborn*

Patient death with a functioning graft(DFG) has been a predominant cause of graft loss. According to conventional graft survival(C-GS) analysis, DFG is considered as a graft failure. However, such survival analysis may obscure immunologic graft loss and distort the overall graft results as well as risk factors affecting the graft survivals. In functional graft survival(F-GS) analysis, the DFG is considered as censored data(in which the graft survived until patient death) which is more closely related with the immunologic graft loss. We designed our study to identify the differences and significance of F-GS compared to C-GS. From April 1984 to October 1995, 1242 living donor kidney transplantations under cyclosporine were performed at Yonsei University Medical Center. At least a 1-year follow-up was possible in all the patients. The graft survival rate was calculated by both C-GS and F-GS analyses. The recipient's and the donor's ages, the donor-recipient relationship, the degree of HLA matching, the degree of ABO blood type matching, the episodes of acute rejection within 1 year, and the presence of diabetes mellitus were monitored as risk factors affecting the graft survival in the two analysis methods. Univariate and multivariate analyses for risk factors were done by the Kaplain-Meier method and the Cox proportional harzard model. The C-GS rate were 96.3% at 1 year, 81.8% at 5 years, and 58.4% at 10 years compared to 98.5%, 88.1%, and 67.9%, respectively in the F-GS analysis. Elderly recipients(> or =50), elderly donors(> or =50), presence of acute rejection within 1 year post-transplant, ABO blood type minor mismatching, and diabetic recipients were risk factors affecting long-term graft survival in the C-GS analysis. However, elderly recipients and diabetic recipients were no longer considered as risk factors in the F-GS analysis. In fact, elderly recipients or diabetic recipients showed equal or even better graft survivals in the F-GS analysis compared with younger or non-diabetic recipients. The differences between the C-GS and the F-GS analyses in such subgroups suggests that the primary cause of graft loss in these groups was non-immunologic. Death with functioning graft(DFG) needs to be considered in analyzing kidney-transplant outcomes. Hence, we propose that all transplant graft survival data be presented in two ways, by conventional and functional graft analyses.
Academic Medical Centers ; Aged ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Graft Survival* ; Humans ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Risk Factors ; Transplants*

PURPOSE: Proliferation, migration, and the accumulation of extracellular matrix (ECM) protein of vascular smooth muscle cells (VSMC) play roles for transplant arteriosclerosis. We have previously reported that carvedilol (CA) inhibits the proliferation and the migration of VSMCs. The present study examined the effects of CA on platelet-derived growth factor (PDGF)-induced collagen synthesis in VSMC and the roles of reactive oxygen species (ROS), extracellular signal- regulated protein kinase (ERK), and p38 mitogen-activated protein kinase (p38 MAPK). METHODS: Primary cultured rat VSMCs were obtained from aorta of Sprague-Dawley rats. Growth arrested and synchronized cells were pretreated with CA (10 nM~10micrometer) at 1 hour before the addition of PDGF 10 ng/ml. Collagen synthesis was measured by 3[H]-proline incorporation, ROS by flow cytometry using ROS-sensitivedichlorofluorescein (DCF) dye, and the activation of ERK andp38 MAPK by Western blot analysis. RESULTS: PDGF significantly increased collagen synthesis by 2.0-fold, intracellular ROS by 1.6-fold, the activation of ERK 1/2 and p38 MAPK by 4.2-fold and 3.9-fold compared to control, respectively. CA above 1micrometer inhibited PDGF-induced collagen synthesis. CA also inhibited DCF-sensitive ROS and the activation of ERK and p38 MAPK. All pharmacological inhibitors of ROS, ERK, and p38 MAPK effectively inhibited PDGF-induced collagen synthesis. CONCLUSION: These data suggest that CA inhibit PDGF-induced collagen synthesis possibly through inhibiting intracellular ROS and ERK 1/2 and p38 MAPK activation.
Animals ; Aorta ; Arteriosclerosis ; Blotting, Western ; Collagen* ; Extracellular Matrix ; Flow Cytometry ; Muscle, Smooth, Vascular* ; p38 Mitogen-Activated Protein Kinases ; Platelet-Derived Growth Factor ; Protein Kinases ; Rats* ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Signal Transduction*

PURPOSE: Hepatoprotective effect of prostaglandin E1 (PGE1) has been verified in numerous animal experiments but not so apparent in clinical trials. Although the reason for this discrepancy in clinical results is still unknown, one possible explanation is the instability of PGE1. In this study, the hepatoprotective effect of lipo-PGE1, which is known to be stable during pulmonary circulation and have more targeting effect, was investigated in canine partial liver allotansplantation. In order to reckon in the possible injury during harvest of partial liver, lipo-PGE1 was infused from the start of living graft harvest procedure. METHODS: Mongrel dogs weighing about 25 kg were divided into control (n=6) and lipo-PGE1 (n=6) group. Partial liver allotransplantation was performed. In lipo-PGE1 group, lipo-PGE1 was slowly infused through splenic venous cannulation during the donor liver harvesting procedure (50 mg) and continuously infused (60 mg/day) for 48 hrs after reperfusion. The aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were monitored. RESULTS: The AST and ALP levels of the lipo-PGE1 group were significantly lower than that of the control group at both 1 hour and 48 hours after reperfusion. The LDH level in lipo-PGE1 group was lower at 1 hour and 48 hours after reperfusion, but no significant differences were shown between two groups. CONCLUSION: This study demonstrated the hepatoprotective effect of the lipo-PGE1 against ischemia-reperfusion injury in canine partial liver allotransplantation.
Alkaline Phosphatase ; Allografts* ; Alprostadil* ; Animal Experimentation ; Animals ; Aspartate Aminotransferases ; Catheterization ; Dogs ; Humans ; L-Lactate Dehydrogenase ; Liver Transplantation ; Liver* ; Pulmonary Circulation ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Transplants

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the characteristics of gentamicin-induced vestibulotoxicity of otolith organs and preventive effect of low power laser to vestibulotoxicity by assessing the result of earth vertical and the off vertical axis rotation tests. MATERIALS AND METHODS: Twenty guinea pigs were grouped into two groups, laser and no laser group. Vestibulotoxicity was induced by intratympanic injection of gentamicin. Prevention of the vestibulotoxicity was studied by irradiation of low power laser. Off vertical axis rotation tilted 30 degree relative to the earth vertical axis was applied to evaluate the otolithic function. Results and CONCLUSION: Gentamicin induced vestibulotoxicity was confirmed by gain decreasing in slow harmonic acceleration test and modulation decreasing in the off vertical axis rotation test. Prevention effect of low power laser to gentamicin induced vestibulotoxicity was confirmed by modulation maintaining in the off vertical axis rotation test and gain maintaining in the earth vertical axis rotation.
Acceleration ; Animals ; Axis, Cervical Vertebra ; Gentamicins ; Guinea Pigs* ; Guinea* ; Low-Level Light Therapy* ; Otolithic Membrane

There are numerous reasons for the failure of anterior cruciate ligament (ACL) reconstruction. Among them, surgical technical failure and wrong femoral tunnel location are the most common. The authors focused on the results of ACL revision using two anteromedial portals. Sixteen patients were selected with two anteromedial portals that were designed to decrease the femoral tunnel slope in sagittal plane. Clinical analysis was carried out based on Lysholm score, Tegner score and International Knee Documentation Committee (IKDC). For anterior stability test, Lachman test, KT-2000 arthrometer were used. pivot shift test was measured for rotatory stability test. Preoperative Lachman test and pivot shift test showed positive finding in all cases, however, postoperative Lachman with 10 cases (62.5%) and pivot shift test with 10 cases (62.5%) were negative. The difference of anterior displacement with the non-affected side using KT 2000 arthrometer showed 6.57 mm (range: 4.0-12.0 mm) preoperatively and 2.20 mm (range: 1.0-4.0 mm) postoperatively on average. Score of Tegner and Lysholm improved from 4.86 (range: 2.0-7.0), 46.14 (range: 33-52) preoperatively, to postoperative score of 8.14 (range: 7.0-9.0), 83.43 (range: 74-89) at the final follow up. IKDC result also showed improvement. ACL reconstruction method using two anteromedial tunnels that is desgined to decrease femoral tunnel slope at sagittal plane is an effective technigue for revision surgery after initial ACL reconstruction failure. This technigue allows superior femoral tunnel selection, firm fixation of grafts and also shows excellent clinical results with stability.
Anterior Cruciate Ligament ; Anterior Cruciate Ligament Reconstruction ; Displacement (Psychology) ; Follow-Up Studies ; Humans ; Knee ; Transplants