Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well know through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.
Antipsychotic Agents* ; Benzodiazepines ; Bone Marrow ; Carbamazepine ; Clozapine ; Cytochrome P-450 Enzyme System ; Cytochromes ; Delirium ; Drug Interactions* ; Fluoxetine ; Fluvoxamine ; Half-Life ; Humans ; Isoenzymes ; Metabolism ; Parents ; Paroxetine ; Respiratory Insufficiency ; Risperidone ; Schizophrenia ; Smoke ; Smoking

The brachial plexus injury causes a catastrophic loss of functions of the corresponding upper extremity. However, for a long time, it must have been treated by conservative methods. Recently, with the development of the microsurgery, the brachial plexus lesions were begun to be treated by surgical means, such as neuroiysis, interfascicuiar nerve graft, or neurotization. We experienced seven cases, managed by interfaseicular nerve graft under the operating microscope, and here we presented four cases with the over-one-year results after operations.
Brachial Plexus ; Microsurgery ; Nerve Transfer ; Transplants ; Upper Extremity

The finger flexor injuries are very difficult to treat satisfactorily. It is usually said that the earlier the treatment performed, the better result obtained. But the delicasy of the hand anatomy and its function as well as the absence of the hand surgeon in the first aid care make the problem more complex. Even if we made the primary treatment to the flexor tendon injuries, some disabilities are often remained. We have treated fifty eight cases of old flexor tendon injuries in forty eight patients, the results can be summarized as follows. 1. The cause of the tendon damage is due to the laceration injury in the majorities of the cases. T,he tendon injuries are especially common between the late second and the early third decade. 2. In the injury of the Zone II with pulley distortion, the pulley reconstruction using palmaris longus or fascia from other sites will prevent bowstring and help the tendon function. 3. The Zone II can be subdivided into two subspecific areas. The proximal area is from the distal palmar crease to the midoprtion of porximal phalanx and the distal one is from the midportion of the proximal phalanx to the insertion of the sublimis tendon. In the proximal area one can repair the injured tendon directly after removal of the A1 and about proximal half of the A2 pulley without any subsequent bowstring if the tendon and its tunnel is relatively well preserved. Thus one can convert this proximal portion of Zone II to Zone III. So the proximal area of the Zone II should be differentiated from the remaining distal part of the Zone II. 4. At six months after the operation the result of the operation was analyzed by the percentage of the recovery, which was calculated by the postoperative active range of the interphalangeal joints divided by one hundred seventy five degrees that means the available total range of motion of normal interphalangeal joints. Excluding the cases with the tenodesis or arthrodesis, the total result revealed good or excellent in about ninty percentages with this method. 5. There were two fingers that showed a postoperative lumbrical plus state in Zone II, which were recovered spontaneously within three to four months postoperatively. So it is considered that the relative shortening of the lumbrical muscles can be treated and overcome conservatively by the active use of the fingers, and there is no need to perform an lumbrical tenotomy to correct this kind of muscle imbalance.
Arthrodesis ; Fascia ; Fingers ; First Aid ; Hand ; Humans ; Joints ; Lacerations ; Methods ; Muscles ; Patella ; Patellar Ligament ; Range of Motion, Articular ; Tendon Injuries ; Tendons ; Tenodesis ; Tenotomy ; Tibia

A case of multiple myeloma with massive pleural effusion is reported. A 53 year-old previous known multiple myeloma patient vistited our hospital complaining of cough with sputum. Radiologic study revealed multiple osteolytic bony lesions and left side pleural effusion. The effusion were bloody exudates containing numerous atypical plasma cells. The tumor cells showed pleomorphism, eccentric nuclei, prominent nucleoli, perinuclear halo, multincleation, and chromatin patterns of occasional cart-wheel appearance. The cytological examination of pleural fluid established the malignant nature of the effusion with multiple myeloma.
Biopsy* ; Chromatin ; Cough ; Enzyme Assays* ; Exudates and Transudates ; Glycogen Storage Disease* ; Glycogen* ; Humans ; Lung ; Lymphoma, T-Cell, Peripheral ; Middle Aged ; Multiple Myeloma ; Plasma Cells ; Pleural Effusion ; Sputum

PURPOSE: The optimal surgical technique for inguinal hernia repair continues to be debated. This study was designed to investigate optimal surgical procedures in inguinal or femoral hernia. METHOD: We analyzed 153 cases of herniorrhaphy on inguinal or femoral hernias between August 1996 and November 2000. We divided patient into four groups according to the methods of hernia repair, i.e., 1) 78 cases of laparoscopic herniorrhaphy, 2) 42 cases of Lichtenstein herniorrhaphy, 3) 24 cases of Bassini herniorrhaphy and 4) 9 cases of McVay herniorrhaphy. RESULTS: The patient in the laparoscopic and Lichtenstein herniorrhaphy groups needed shorter hospital stays than those in the Bassini or McVay herniorrhaphy groups. The severity of pain was assessed by the total amount and duration of nonsteroidal anti-inflammatory drug injections, which was minimal in the laparoscopic group. There were no differences in complications between the groups. One patient in the laparoscopy group had a hernia recurrence and was reoperated with Lichtenstein herniorrhaphy. We compared two tension-free herniorrhaphies with each other. The numbers of patients not needing analgesic injections were more in the laparoscopic than the Lichtenstein herniorrhaphy group, reflecting less pain in the former group. Hospital stays were also shorter in the laparoscopic than the Lichtenstein herniorrhaphy group. CONCLUSION: We concluded that tension-free herniorrhaphy is superior to tension herniorrhaphy in terms of postoperative pain & recovery. Of the tension-free herniorrhaphies, laparoscopic herniorrhaphy is associated with less postoperative pain and shorter hospital stays than Lichtenstein herniorrhpahy.
Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Laparoscopy* ; Length of Stay ; Pain, Postoperative ; Recurrence

PURPOSE: L-arginine is a precursor of nitric oxide(NO). It was reported that administration of L-arginine increases immune reaction in some studies. Also it is known that NO was involved in antitumor effect of BCG therapy on bladder carcinoma. So we tried to know if antitumor effect of intravesical BCG instillation on murine bladder cancer could be potentiated by oral L-arginine administration. MATERIALS AND METHODS: N-butyl-N-(4-hydroxybutyl) nitrosamine(BBN) was fed to Fisher 344 rats for 20 weeks to induce bladder carcinoma. We instilled intravesically normal saline in group I, BCG in group II, and BCG together with oral ingestion of L-arginine in group III once a week from the 8th week to the 19th week, respectively. Urinary NO secretion was measured. The rats were sacrificed at the 20th week. The expression of inducible nitric oxide synthase(iNOS) as well as the incidence, size and number of bladder tumor was evaluated in the murine bladder. RESULTS: Urinary NO secretion increased significantly in group II and III compared to group I. The incidence of carcinoma showed no difference among the three groups. The tumors in group II and III were smaller and fewer than those in group I. iNOS was more strongly expressed in group II and III than that in group I. But there was no statistical difference between group II and III on the urinary secretion of NO, the incidence, size and number of the tumor, and the expression of iNOS. CONCLUSIONS: Our results suggest that ingestion of L-arginine neither enhances production of NO nor potentiates antitumor effect of BCG immunotherapy against bladder carcinoma in this animal model study.
Animals ; Arginine* ; Eating* ; Immunotherapy ; Incidence ; Models, Animal ; Mycobacterium bovis* ; Nitric Oxide ; Rats* ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: Through our previous studies on the antitumor mechanism of BCG therapy for bladder carcinoma, we become to consider a nitric oxide(NO)-mediated process as one of its mechanisms. Briefly describing, intravesical BCG stimulates T helper cells to secrete INF-gammaand also stimulates macrophages to secrete TNF-alpha and IL-1. The cytokines induce expression of inducible NO synthase(iNOS) in the macrophages, the epithelium, and the tumor cells of the bladder , which results in longstanding abundant secretion of NO in those cells and results in apoptosis of tumor cells. Our theory of NO-mediated antitumor mechanism confronts a question; Can E. coli replace BCG because E. coli also induce NO production To reply to the question this study was done. MATERIALS AND METHODS: N-butyl-(4-hydroxybutyl) nitrosamine was fed in rats. Normal saline in group I, E. coli in group II, and BCG in group III were intravesically instilled weekly for 12 times, respectively. Urinary nitrite concentration was measured in the 3 groups. Observed were histological findings including iNOS expression ,incidence ,size and number of the tumors in the excised bladder at the 20th week. RESULTS: Urinary nitrite concentration in group III was significantly higher than that in group I and II. iNOS expression was relatively strong in the epithelium and the tumor of group II and III, but weak in those of group I. No statistically significant difference was found in the incidence of tumor among the three groups. Induced tumors were fewer in group II and III than in group I. And the tumors were smaller in group III than in group II. CONCLUSIONS: Intravesical E. coli instillation showed less significant secretion of NO in the bladder than BCG instillation. Intravesical E. coli might weakly suppress tumor growth in the rats. On the other hand, intravesical BCG instillation induces strong iNOS expression and significant NO production in the bladder tissue and seems to suppress tumor growth.
Animals ; Apoptosis ; Cytokines ; Epithelium ; Hand ; Incidence ; Interleukin-1 ; Macrophages ; Mycobacterium bovis* ; Nitric Oxide ; Rats* ; T-Lymphocytes, Helper-Inducer ; Tumor Necrosis Factor-alpha ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Recently therapeutic efficacy of stomach cancer was greatly improved due to early diagnosis and irnproved diagnostic and therapeutic modalities. Especially in early gastric cancer, 5 year survival rate is near 100%. Recarrence of early gastric cancer after curative surgery is rarely reported. Recently authors experienced one case of recurrent stomach cancer arising from remmnant stomach 14 years after gastrectomy of EGC type I(m), so we reports it here with review of literatures.
Early Diagnosis ; Gastrectomy* ; Stomach Neoplasms* ; Stomach* ; Survival Rate

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p<0.05), diastolic blood pressure from 98.52.4 mmHg to 87.51.3 mmHg (p<0.05). Peak E/A ratio was increased from 0.75+/-0.04 to 0.82+/-0.04 (p<0.05). LV mass was decreased from 267.5+/-15.8 g to 235.6+/-12.6 g (p<0.05), and LV mass index from 166.8+/-8.0 g/m2 to 146.9+/-6.0 g/m2 (p<0.05). However, there were no significant change in PWV (from 7.18+/-0.10 m/sec to 7.23+/-0.30 m/sec, p>0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.
Angiotensin II* ; Angiotensins* ; Aorta, Thoracic ; Arterial Pressure ; Blood Pressure ; Compliance ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertrophy ; Losartan* ; Peptidyl-Dipeptidase A ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Ventricular Function, Left*

PURPOSE: Mutations of the p53 gene are currently the most commonly recognized genetic mutations in human cancer. In some tumors, p53 gene mutations are associated with aggressiveness of the tumor and poor prognosis. There is wide variation in the reported incidence of p53 mutation in renal cell carcinoma, and little is known about its prognostic significance. To detect whether the expression of p53 could be correlated with clinical characteristics, we perfomed immunohistochemical stain on renal cell cancer samples. MATERIALS AND METHODS: Paraffin-embedded nephrectomized specimens collected from 25 patients were immunostained for p53 using the DO-1 monoclonal antibody. We evaluated the relation between p53 staining and known prognostic factors such as tumor size, pathologic stage, lymph nodal involvement, presence of metastasis, nuclear grade and cell types. RESULTS: Positive staining for p53 was detected in 32%(8/25). The staining for p53 was not statistically significant in relation with the prognostic factors such as pathologic stage(stageI&II; positive staining 6/18, 33%, stage III&IV; 2/7, 29%), lymph nodal involvement(positive 1/3, 33%, negative 7/22, 32%), distant metastasis(positive 2/6, 33%, negative 6/19, 32%), nuclear grade(nuclear gradeI&II; positive 5/18, 28%, nuclear grade III&IV; 3/7, 43%) and cell types(p>0.05). CONCLUSIONS: p53 gene mutations of the renal cell carcinoma are infrequent and show no relation to tumor size, pathologic stage, lymph nodal involvement, presence of metastasis, nuclear grade and tumor cell type in this study.
Carcinoma, Renal Cell* ; Genes, p53 ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis