OBJECTIVE: A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. METHODS: Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. RESULTS: Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of 7.25+/-1.5 and 2.0+/-1.4, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. CONCLUSION: The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.
Cadaver ; Fractures, Compression ; Hematoma ; Humans ; Kyphoplasty ; Needles ; Retrospective Studies ; Vertebroplasty

PURPOSE: This study aimed to investigate the effects of vasopressin and desmopressin on the contractile and relaxative responses of rabbit cavernosal smooth muscle. MATERIALS AND METHODS: Isometric tension studies were conducted to investigate the effects of vasopressin(10(-14)-10(-8)M) and desmopressin(10(-14)- 10(-8)M) on the contraction and relaxation responses of rabbits cavernous muscle strips in an organ bath. The effects of pretreatment with phenylephrine(10(-5)M), L-NAME(10(-5)M) and indomethacin(10(-5)M) on the contraction and relaxation responses of the vasopressin and desmopressin were also investigated. The statistics were analyzed by Student's t-test and ANOVA. RESULTS: Vasopressin contracted the strips in a dose-dependent manner, while desmopressin did not. The phenylephrine-induced contraction was dose-dependently increased by vasopressin, but it was dose-dependently relaxed by desmopressin. L-NAME pre-treatment did not block the relaxation response, but indomethacin pre-treatment did. Vasopressin- induced contraction occurred the via V(1) receptor, while desmopressin- induced relaxation occurred via the V(2) receptor. CONCLUSIONS: Vasopressin, in pathophysiological circumstances, would worsen erectile dysfunction. On the contrary, desmopressin, which may induce an endothelium-dependent relaxation of the cavernous smooth muscles, would be good for erectile function.
Baths ; Caves ; Contracts ; Deamino Arginine Vasopressin ; Erectile Dysfunction ; Indomethacin ; Male ; Muscle, Smooth ; Muscles ; NG-Nitroarginine Methyl Ester ; Rabbits ; Relaxation ; Vasopressins

Scrub typhus is a acute febrile illness by Orientia tsutsugamushi that is endemic in Asian-Pacific areas. But it is difficult to found this disease in pregnant woman. As yet, many clinicians have difficulty in making choice of appropriate and safe drugs to pregnant women with scrub typhus, because the drugs such as tetracycline (doxycycline) and chloramphenicol which have been used are proven harmful to fetus and neonates. We experienced a case of successfully treated scrub typhus with azithromycin in pregnant woman, and report it with references.
Azithromycin* ; Chloramphenicol ; Female ; Fetus ; Humans ; Infant, Newborn ; Orientia tsutsugamushi ; Pregnant Women* ; Scrub Typhus* ; Tetracycline

Valproic acid is available as an antiepileptic therapy and has been used treat bipolar disorder and migraine headaches. In the setting of accidental or intentional ingestion of valproic acid overdose, serious toxicitis have been reported including leukopenia, thrombocytopenia, hemodynamic compromise, respiratory failure, cerebral edema, renal failure, hepatotoxicitiy, and coma. The optimal therapy for life-threatening case of acute valproic acid overdose has not been clearly established. A 34-year-old man developed coma and shock after suicidally ingesting large amount of valproic acid (45,000 mg). The peak serum valproic acid concentration on admission was 1400 micro gram/mL (therapeutic range 50~100 micro gram/mL). His hypotension was refractory to crystalloid and pressor infusions, but resolved during concurrent hemoperfusion and hemodialysis to enhance elimination of valproic acid. After serial hemoperfusion and hemodialysis, serum valproic acid level decreased to 680 micro gram/mL, coincident with improvement in clinical status. Concurrent hemoperfusion and hemodialysis, in series, should be considered in hemodynamically unstable patients with valproic acid poisoning whose clinical condition is worsening in spite of aggressive supportive care.
Adult ; Bipolar Disorder ; Brain Edema ; Coma ; Eating ; Hemodynamics ; Hemoperfusion* ; Humans ; Hypotension ; Leukopenia ; Migraine Disorders ; Poisoning ; Renal Dialysis* ; Renal Insufficiency ; Respiratory Insufficiency ; Shock ; Thrombocytopenia ; Valproic Acid*

Statin-induced rhabdomyolysis is a frequent complication in renal transplant recipients receiving cyclosporine, but incidences are different between different types of statins. Statins have different pharmacokinetic properties. Atorvsatatin, simvastatin, lovastatin, and cerivastatin are all metabolized by the cytochrome P450 isoenzyme 3A4 and co-administration of cyclosporine which may inhibit cytochrome P450 isoenzyme 3A4, increases statin levels and therefore increases the risk of rhabdomyolysis. Fluvastatin is metabolized by cytochrome P450 isoenzyme 2C9 and no clinically significant interactions with cyclosporine have been reported. Atorvastatin with co-administration of cyclosporine in renal transplant patients may induce drug interactions, therefore we recommend the routine monitoring of muscle enzymes, in these cases. Here, we reported a case of rhabdomyolysis in a patient who received atorvastatin and cyclosporine with the review of the literature.
Cyclosporine ; Cytochrome P-450 Enzyme System ; Drug Interactions ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Lovastatin ; Rhabdomyolysis* ; Simvastatin ; Transplantation* ; Atorvastatin Calcium

PURPOSE: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn`t duplicate the result. the purpose of this study was to evaluate the relative efficacy&toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. MATENRIALS AND METHODS: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/m2 IV for 1~5 days), adriamycin (20 mg/m2 IV for 1~5 days) and cisplatin (20 mg/m2 IV for 1~5 days) and Twenty-eight patients receieved ELF chemotherapy:etoposide (100 mg/m2 IV for 1~3 days), leucovorin (20 mg/m2 IV for 1~5 days) and 5-FU (500 mg/m2 IV for 1~5 days). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient: ELF means 4.1 cycles per patient RESULTS: Total respones rates were 5.4% in the ELF group and 3.6% in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value>0.05), and the median overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis&hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: 27.6% in ELF vs 54% in EAP-II; Leukopenia: 8.5% in ELF vs 19% in EAP-II; nausea&vomiting: 45.9% in ELF vs 67.8% in EAP-II. CONCLUSION: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer.
Anemia ; Appointments and Schedules ; China ; Cisplatin ; Developed Countries ; Developing Countries ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination ; Etoposide* ; Fluorouracil ; Hand ; Humans ; Incidence ; Japan ; Korea ; Leucovorin* ; Leukopenia ; Mortality ; Prognosis ; Retrospective Studies* ; Stomach Neoplasms*

PURPOSE: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn`t duplicate the result. the purpose of this study was to evaluate the relative efficacy&toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. MATENRIALS AND METHODS: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/m2 IV for 1~5 days), adriamycin (20 mg/m2 IV for 1~5 days) and cisplatin (20 mg/m2 IV for 1~5 days) and Twenty-eight patients receieved ELF chemotherapy:etoposide (100 mg/m2 IV for 1~3 days), leucovorin (20 mg/m2 IV for 1~5 days) and 5-FU (500 mg/m2 IV for 1~5 days). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient: ELF means 4.1 cycles per patient RESULTS: Total respones rates were 5.4% in the ELF group and 3.6% in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value>0.05), and the median overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis&hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: 27.6% in ELF vs 54% in EAP-II; Leukopenia: 8.5% in ELF vs 19% in EAP-II; nausea&vomiting: 45.9% in ELF vs 67.8% in EAP-II. CONCLUSION: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer.
Anemia ; Appointments and Schedules ; China ; Cisplatin ; Developed Countries ; Developing Countries ; Doxorubicin* ; Drug Therapy ; Drug Therapy, Combination ; Etoposide* ; Fluorouracil ; Hand ; Humans ; Incidence ; Japan ; Korea ; Leucovorin* ; Leukopenia ; Mortality ; Prognosis ; Retrospective Studies* ; Stomach Neoplasms*

BACKGROUND: Hypertension is the most important, and yet modifiable, risk factor for cardiovascular diseases. But in many countries, hypertension remains poorly controlled. Moreover, sleep apnea syndrome has shown that it is correlated with hypertension. The purpose of this study was to investigate the prevalence, awareness and control of hypertension among the Korean people and to evaluate the relationship between hypertension and snoring. METHODS: A total of 640 subjects living in Ansan, a regional city in Korea, were selected randomly, and trained nursing students investigated their age, sex, medical history, blood pressure, body mass index (BMI) and snoring score. Blood pressures were measured three times with a 10 - minute interval and then averaged. The degree of snoring was estimated using a questionnaire. We divided the subjects into hypertensive (BP> OR =140/90 mmHg) versus normotensive group and snorer versus non-snorer group, and correlated hypertension with snoring. RESULTS: Of 640 subjects, 311 were male. The mean age was 39.7+/-14.6 years (18-77 years), the mean BMI (body mass index) was 22.4+/-3.0 kg/m2. The mean systolic and diastolic blood pressure was 121+/-15.7 mmHg and 79.5+/-11.6 mmHg. The prevalence and awareness of hypertension were 22.2% and 16.9%, respectively, and the prevalence of snoring was 35.2%. With the increment of age, in the male, the prevalence of hypertension and snoring were higher, and the snorer group showed a higher risk of hypertension than the non-snorer group (Odds ratio 2.32, CI=1.56-3.39, p=0.0001). CONCLUSION: In Korea, the prevalence of hypertension was similar to that in the western countries, but the awareness of hypertension was much lower compared with western countries. The prevalence of hypertension was higher in the snorer group, so more research on the correlation between the two conditions should be advanced in the future.
Adolescent ; Adult ; Age Distribution ; Aged ; Comorbidity ; Comparative Study ; Confidence Intervals ; Cross-Sectional Studies ; Female ; Human ; Hypertension/diagnosis/*epidemiology ; Korea/epidemiology ; Male ; Middle Age ; Odds Ratio ; Prevalence ; Probability ; Risk Assessment ; Sex Distribution ; Snoring/diagnosis/*epidemiology

No abstract available.
Skull Fracture, Depressed*

BACKGROUND/AIMS: The aim of this study was to ascertain the effects of two week treatment of omeprazole (O) and clarithromycin (C) with and without metronidazole (M), and one week treatment of omeprazole, clarithromycin and metronidazole, for the eradieation of Helicobacter pylori (H. pylori) in patients with peptic ulcer disease in double-blind, randomly controlled groups. METHODS: The H. pylori infection determined in patients whose results were positive in a rapid urease test or in those who exhibited histology in antrum and body, The OC14 group received O 40 mg qd and C 500 mg t.i.d. for 2 weeks; the OCM14 group received O, C, and M 250 mg t.i.d for 2 weeks, and the OCM7 group received O, C, M for 1 week, respectively. H. pylori eradication was assessed 4 weeks after the end of treatment. The H. pylori eradication was determined as all negative for the rapid urease test and histology on both the antrum and body.
Clarithromycin* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metronidazole* ; Omeprazole* ; Peptic Ulcer* ; Urease