Background and objectives: Carvedilol is a cardiovascular drug, beta- and alpha1-adrenoceptor antagonist, currently approved for the treatment of hypertension, angina, congestive heart failure by FDA. Carvedilol has been shown to attenuate oxygen free radical-initiated lipid peroxidation and to inhibit neointimal formation of aorta following vascular injury by balloon angioplasty. We have investigated the effect of carvedilol on DNA synthesis of vascular smooth muscle cells (VSMC) stimulated by platelet-derived growth factor (PDGF)-BB. MATERIALS AND METHOD: Rat aortic smooth muscle cells were obtained by the combined collagenase and elastase methods. Cells between the 4th and 8th passages were used for the experiments. Incorporated radioactivity of [3H]-thymidine was measured by liquid scintillation spectrometry. RESULTS: PDGF-BB (1 nM) increased [3H]-thymidine incorporation about 70-100% over basal value in cultured VSMC. PDGF-stimulated increase in DNA synthesis was significantly suppressed by simultaneous administration of carvedilol. In contrast, propranolol did not significantly affect 3[H]-thymidine uptake in rat aortic VSMC. CONCLUSION: The present study demonstrate that carvedilol significantly inhibits the proliferation of vascular smooth muscle cell in our condition. These results indicate that carvedilol may be effective in the treatment of cardiovascular diseases principally associated with abnormal vascular smooth muscle growth.
Angioplasty, Balloon ; Animals ; Aorta ; Cardiovascular Diseases ; Cell Proliferation ; Collagenases ; DNA ; Heart Failure ; Hypertension ; Lipid Peroxidation ; Muscle, Smooth, Vascular* ; Myocytes, Smooth Muscle ; Oxygen ; Pancreatic Elastase ; Platelet-Derived Growth Factor ; Propranolol ; Radioactivity ; Rats ; Spectrum Analysis ; Vascular System Injuries

Malocclusion is a serious complication of open reduction surgery for facial fractures. It is often caused by the lack of adequate consideration for the occlusal relationship before the trauma and intermaxillary fixation during the operation. This is a case report of postoperative malocclusion that occurred in a patient with a midfacial complex fracture.
Fracture Fixation ; Humans ; Jaw ; Malocclusion* ; Postoperative Complications

PURPOSE: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. METHODS: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. RESULTS: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. CONCLUSIONS: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.
Epiretinal Membrane ; Eye ; Humans ; Prospective Studies ; Retinaldehyde ; Tomography, Optical Coherence ; Vitrectomy

BACKGROUND: Atherosclerosis is a diffuse disease process that produce thickening of the vascular wall because of intimal deposition of lipid, fibrous tissue, and calcific material. Nowadays it is possible to evaluate atherosclerotic changes of carotid arteries accurately by developed noninvasive techniques such as ultrasonography. Left ventricular hypertrophy (LVH) is known to be an important risk factor for cardiovascular events in hypertension. The purpose of this study was to establish whether the carotid intimal - medial thickness (IMT) correlates with the severity of LVH. METHOD: We measured intimal-medial thickness (IMT) for 12 sites in carotid arteries (near and far walls in common carotid, bifurcation, and internal carotid arteries of both sides) by B-mode ultrasonography in both 38 normotensive and 72 hypertensive patients. Left ventricular measurements were made according to the recommendations of the American Society of Echocardiography. Left ventricular mass was derived from the formula described by Devereux et al. and each left ventricular mass value was indexed to body surface area. And then we have investigated whether hypertensive patients have significant changes of carotid IMT and IMT correlates with left ventricular mass index (LVMI). RESULTS: (1) Most hypertensive patients had diffuse thickening of the carotid artery and some had focal or multiple plaques. (2) In general, mean IMT was widest in the carotid bifurcation. (3) The mean IMT of all 12 segments increased about 40% in hypertensive patients compared with normal control group. (4) LVMI significantly correlates with IMT of carotid artery, especially bifurcation site and mean all 12 segments. CONCLUSION: The mean IMT may serve as a useful marker of the severity of atherosclerosis in hypertensive patients. The significant association between carotid IMT and LVMI suggests a simultaneous correlation of carotid atherosclerosis with left ventricular hypertrophy in hypertension.
Atherosclerosis ; Body Surface Area ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Artery, Internal ; Echocardiography ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Risk Factors ; Ultrasonography

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.
Biopsy ; Bone Marrow ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Radiotherapy ; Survival Rate ; Testis ; Vinblastine

BACKGROUND: Recently, balanced anesthesia (BA: halogenated volatile anesthetics + remifentanil) has been useful for abdominal surgery. The authors therefore performed a retrospective study about the difference in the dose of vasoactive drugs and rocuronium according to the general anesthesia type. METHODS: BA was compared with inhalational anesthesia (IA: halogenated volatile anesthetics + N2O) and total intravenous anesthesia (TIVA: propofol + remifentanil). The records of a total of 415 patients (IA : TIVA : BA = 126 : 157 : 132) who received open gastrectomy between 2004 to 2010 were analyzed. The types of vasoactive drugs and dosage as well as infusion time were calculated. The total amounts of vasoactive drugs were scored by two different methods. Infusion drugs were scored as 30 points, whereas bolus drugs were scored as 5 points. Drug score is the total sum of each score, where each drug score point split either into Plus or Minus. Plus means raising the blood pressure whereas Minus means the opposite. For rocuronium dosage, a total of 286 patients (IA : TIVA : BA = 89 : 78 : 119) who met the criteria were enrolled, and this formula was used (total rocuronium/weight/time, microg/kg/hr). RESULTS: The BA group showed a lower (P = 0.01) Minus score (1.8 +/- 4.0) compared to the IA group (3.6 +/- 5.2). Less amount of rocuronium (P = 0.001) was administered in the BA (327 +/- 72 microg/kg/hr), compared to the IA (368 +/- 93 microg/kg/hr) and TIVA (356 +/- 81 microg/kg/hr). CONCLUSIONS: BA seems to require less hypotensive agent and rocuronium compared with IA and TIVA for open gastrectomy. But, well-designed prospective studies are required.
Androstanols ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics ; Balanced Anesthesia ; Blood Pressure ; Gastrectomy ; Humans ; Piperidines ; Propofol ; Retrospective Studies

BACKGROUND: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. METHODS: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. RESULTS: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. CONCLUSIONS: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.
Anesthesia ; Anesthesia, General* ; Anesthetics, Local ; Blood Pressure ; Epinephrine* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Postural Balance ; Prospective Studies ; Retrospective Studies*

BACKGROUND: Vitiligo is an acquired depigmentary disorder of the skin and hair. The etiology is unknown, however an autoimmune hypothesis is favored. OBJECTIVE: We performed this study to develop a better understanding of the clinical features of vitiligo patients. METHOD: We evaluated clinical manifestations of 1203 vitiligo patients(556 males and 647 females). RESULTS AND CONCLUSIONS: 1. The mean age of onset and that of the first visits made by patients were 22.9+/-18 and 27.9+/-19 years, respectively. 2. The face(37.4%) was the most common site of initial involvement. In decreasing order of frequency, the common sites of involvement were the face and neck(65.9%), thorax and abdomen(42.9%), upper extremities(42.3%). 44.5% of the cases had the vulgaris type, 26.1% the focal type, and 21.1% the segmental type. During the three months before a visit, 44% of patients experienced progression of disease. Within one year, about 75% of patients reported that the disease had progressed. 3. Precipitating or aggravating factors such as trauma(13.1%), psychological stress(9.2%), sun light (2.8%) and pregnancy(2.5%), were found in 30.9% of patients. Thyroid disease was the most common associated disease.
Age of Onset ; Hair ; Humans ; Male ; Skin ; Solar System ; Thorax ; Thyroid Diseases ; Vitiligo*

BACKGROUND AND PURPOSE: The cerebrospinal fluid (CSF) biomarkers play an important supportive role as diagnostic and predictive indicators of Alzheimer's disease (AD). About 30% of controls in old age show abnormal values of CSF biomarkers and display a higher risk for AD compared with those showing normal values. The cut-off values are determined by their diagnostic accuracy. However, the current cut-off values may be less accurate, because controls include high-risk groups of AD. We sought to develop models of patients with AD, who are homogenous for CSF biomarkers. METHODS: We included participants who had CSF biomarker data in the Alzheimer's Disease Neuroimaging Initiative database. We investigated the factors related to CSF biomarkers in patients with AD using linear mixed models. Using the factors, we developed models corresponding to CSF biomarkers to classify patients with mild cognitive impairment (MCI) into high risk and low risk and analyzed the conversion from MCI to AD using the Cox proportional hazards model. RESULTS: APOE ε4 status and age were significantly related to CSF Aβ1-42. CSF t-tau, APOE ε2 status and sex were significant factors. The CSF p-tau181 was associated with age and frequency of diagnosis. Accordingly, we modeled the three CSF biomarkers of AD. In MCI without APOE ε4, our models were better predictors of conversion. CONCLUSIONS: We can interpret CSF biomarkers based on the models derived from the data obtained from patients with AD.
Alzheimer Disease* ; Apolipoproteins E ; Biomarkers ; Cerebrospinal Fluid ; Diagnosis ; Humans ; Methods* ; Mild Cognitive Impairment* ; Neuroimaging ; Proportional Hazards Models ; Reference Values

A patient, who underwent partial masseter muscle resection and mandibular angle reduction at a plastic surgery clinic, visited this hospital with major complaints of trismus and dysesthesia. A secondary angle formation due to a wrong surgical method was observed via clinical and radiological examinations, and the patient complained of trismus due to the postoperative scars and muscular atrophy caused by the masseter muscle resection. The need for a masseter muscle resection in square jaw patients must be approached with caution. In addition, surgical techniques must be carefully selected in order to prevent complications, and obtain effective and satisfactory surgery results.
Cicatrix ; Humans ; Jaw ; Masseter Muscle* ; Methods ; Muscular Atrophy ; Paresthesia ; Surgery, Plastic ; Trismus*