BACKGROUND/AIMS: Determination of the optimal radiotherapeutic parameters for radiotherapy of hepatocellular carcinoma (HCC) is still under investigation. The purpose of this study is to identify the risk factors associated with radiation-related morbidity. METHODS: We evaluated one hundred fifty-eight patients, who were given radiotherapy for HCC between January 1992 and March 2000. Radiation-induced liver disease (RILD) was defined as the development of nonmalignant ascites without disease progression and an anicteric elevation of the alkaline phosphatase level by at least twofold. Gastrointestinal toxicity was assessed by using the RTOG-EORTC scale. RESULTS: Six patients (3.8%) displayed RILD. In these patients, three patients had not responded to other previous treatments. Two patients with portal vein thrombosis or huge sized mass, above 10 cm, showed liver toxicity and two other patients presented with Child-Pugh class B liver cirrhosis. Eight patients (5%) had gastro-duodenal ulcers. In one of these 8 patients, the left lobe close to the stomach was involved and two patients had been treated for gastro-duodenal ulcer. In two more patients, the radiation field, with using anterior/posterior radiation ports, covered a significant volume of the gastrointestinal tract. One of eight patients had been irradiated with a large fraction size (250 cGy). CONCLUSIONS: The efforts should be made to reduce the radiation-related complications for hepatocellular carcinoma by considering the volume and the function of remaining liver, the location of tumor, the tumor size and the severity of liver cirrhosis.
Adult ; Aged ; Carcinoma, Hepatocellular/complications/*radiotherapy ; Female ; Humans ; Liver Cirrhosis/diagnosis/*etiology ; Liver Neoplasms/complications/*radiotherapy ; Male ; Middle Aged ; Peptic Ulcer/etiology ; Radiotherapy Dosage ; Risk Factors

OBJECT: Although there is extensive research. on treatment of acute unipolar depression, few studies examined the treatment of acute bipolar depression. This preliminary study was designed to suggest clinical guideline for treatment of bipolar depression through comparing the pharmacological treatment of bipolar depression with that of unipolar depression. METHOD: We studied 19 patients with bipolar depression and 38 patients with unipolar depression, who were admitted to Kyung Hee University Medical Crater from January 1990 to December 1997. The pattern of treatment and the response to treatment of bipolar depression were investigated compared with unipolar depression. RESULTS: The percentage of prescription in bipolar depression was as follows in order : combination of mood stabilizer and an antidepressant 52.6%, mood stabilizers 15.8%, ECT 15.8%, TCAs 5.3%, SSRIs 5.3%, RIMA 5.3%. In unipolar depression : TCAs 47.4%, SSRIs 28.9%, combination of mood stabilizer and an antidepressant 10.5%, others 13.2%. There was no significant difference in response to treatment in bipolar depression and unipolar depression. CONCLUSIONS: These results suggest a mood stabilizer and an antidepressant together or a mood stabilizer alone would be first line in bipolar depression. Among the antidepressants, bupropion, RIMA and SSRls is more recommended in that order rather than TCAs in consideration of the risk of switching into mania.
Antidepressive Agents ; Bipolar Disorder* ; Bupropion ; Depressive Disorder ; Drug Therapy* ; Humans ; Prescriptions

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.
Circadian Rhythm ; Electrocardiography, Ambulatory ; Heart Rate ; Humans ; Hypertension

BACKGROUND AND OBJECTIVES: An anatomic variant of left anterior descending coronary artery (LAD), termed "dual LAD", consists of early bifurcation of the proximal LAD into one early terminating branch (short LAD) which remains in the anterior interventricular sulcus (AIVS) and doesn't reach the apex, and the second (long LAD), which has a variable course outside the AIVS but returns to the distal sulcus and continues to the apex. Its incidence, angiographic features and clinical significance are investigated. MATERIALS AND METHOD: Consecutive 696 coronary angiograms during October 1997 through August 1998 were analyzed. RESULTS: A dual LAD variant was noted in 45 patients (6%) of the 696 patients. Type I, in which the long LAD descends on the left ventricular side of the AIVS before reentering the AIVS, was noted in 24 patients (53%) and type II, in which the long LAD descends on the right ventricular side of the AIVS before reentering the AIVS, in 21(47%). First septal branch was commonly originated from LAD proper in both type (54% vs 52%), but first diagonal branch from LAD proper (63%) in type I, from short LAD (71%) in type II. Presence of dual LAD was recognized before percutaneous coronary intervention (10) or bypass surgery (2) in 12 (63%) of 19 patients. Regional wall motion abnormalities (RWMA) were localized in distal septum or anterolateral wall in 2 patients with short or long LAD obstruction, respectively. CONCLUSION: Recognition of dual LAD is essential to prevent errors of interpretation of the coronary angiogram, to plan optimal strategy for percutaneous coronary intervention or bypass surgery, especially in case of total occlusion, and to understand localized septal or anterolateral RWMA.
Coronary Vessels* ; Humans ; Incidence* ; Percutaneous Coronary Intervention

Plasmapheresis is an emerging treatment for intravenous steroid-resistant neuromyelitis optica (NMO). We present the case of a 16-year-old girl who suffered from intravenous steroid-resistant NMO and whose neurological status improved markedly after treatment with plasmapheresis. This is the first report on the effectiveness of plasmapheresis in NMO in Korea. kwoo@plaza.snu.ac.kr
Adolescent ; Humans ; Korea ; Neuromyelitis Optica ; Plasmapheresis

OBJECTIVE: This retrospective study was designed to compare the drug usage patterns and clinical outcomes of patients who received either risperidone or olanzapine in a naturalistic setting at a university hospital. METHODS: Inpatients with schizophrenia given either risperidone or olanzapine, as a single oral antipsychotic drug during hospitalization were retrospectively investigated. Data on patients' age, sex, efficacy, duration of hospitalization, dosage, use of antiparkisonian drugs, cost of drugs, weight changes, and hepatotoxicity were collected. RESULTS: Sixty patients, 30 patients for each group, were evaluated. No significant differences were observed between groups for age, sex, the duration of hospitalization, the degree to the improvement of Global Assessment of Functioning and weight gain. The mean daily antiparkinsonian medication use expressed in benztropine equivalents was significantly lower (p<0.001) in the olanzapine group (0.8 mg+/-0.9) than in the risperidone group (2.2 mg+/-0.8). For risperidone, the mean daily dose and associated cost at discharge were 5.6 (+/-1.1)mg and 765.6 (+/-144.9) won per day, whereas those for olanzapine were 15.8 (+/-4.0)mg and 1884.2 (+/-470.9) won per day (p<0.001). A mild increase of liver enzymes was found in both groups. CONCLUSION: It appears from this study that both risperidone and olanzapine are relatively safe and effective in inpatients with schizophrenia. While olanzapine group shows a superior profile in the neurological side effects, risperidone group exhibits better profile in the daily cost of drug. Further controlled studies are recommended to confirm these findings.
Benztropine ; Hospitalization ; Humans ; Inpatients* ; Liver ; Retrospective Studies ; Risperidone* ; Schizophrenia* ; Weight Gain

Background: Reduced arterial compliance has recently been reported in patients with diastolic dysfunction and correlated with the severity of diastolic dysfunction. We tried to investigate the relation of arterial compliance to diastolic dysfunction in elderly hypertensive patients. Subjects and Methods: 250 medically treated elderly hypertensive patients without clinical atherosclerotic cardiovascular disease (131 men, 71.5+/-5.1 years) and 15 normotensive controls were enrolled. Using an automated wave form analyzer, the pulse wave velocity(PWV) and augmentation index (AI) were simultaneously measured as indices of arterial compliance. Diastolic function was determined based on Doppler echocardiography. Results: According to conventional Doppler echocardiography of transmitral and pulmonary venous flow, diastolic function was classified as relaxation abnormality in 220 patients and pseudonormal in 30 patients. hfPWV and baPWV were lowest in controls (842.0+/-251.9, 1,463.3+/-265.9 m/sec) and became progressively higher in patients with hypertension and relaxation abnormality (1,171.5 +/-234.5, 1,824.2+/-389.9 m/sec), and pseudonormalization (1,433.3+/-344.4, 2,009.3+/-579.4 m/sec; p<0.001 in both). In patients with diastolic dysfunction, hfPWV and baPWV were related to age (p<0.001), blood pressure (p<0.001), and E/Ea (p< 0.01). hfPWV was directly deceleration time (p=0.01) and Aa (r=0.13, p=0.03). After adjustment for age, sex, blood pressure, parameters of arterial compliance worked as independent predictors of diastolic dysfunction. Conclusions: In elderly hypertensive patients, diastolic function is inversely related with arterial compliance. Arterial compliance is an independent predictor of diastolic dysfunction in elderly patients with hypertension and should be considered a potential target to optimize ventriculo-arterial coupling and cardiac performance in diastolic HF.
Aged* ; Arteries ; Blood Pressure ; Cardiovascular Diseases ; Compliance ; Deceleration ; Diastole ; Echocardiography, Doppler ; Humans ; Hypertension ; Male ; Relaxation ; Vascular Stiffness*

PURPOSE: We examined the effect of the dual EGFR/HER2 tyrosine kinase inhibitor, GW572016, on EGFR/HER2 receptor phosphorylation, inhibition of downstream signaling and radiosensitization in either an EGFR or HER2 overexpressing human breast cancer xenograft. MATERIALS AND METHODS: We established SCID mice xenografts from 4 human breast cancer cell line that overexpressed EGFR or HER 2 (SUM 102, SUM 149, SUM 185, SUM 225). Two series of xenografts were established. One series was established for determining inhibition of the EGFR/HER2 receptor and downstream signaling activities by GW572016. The other series was established for determining the radiosensitization effect of GW572016. Inhibition of the receptor and downstream signaling proteins were measured by the use of immunoprecipitation and Western blotting. For determining the in vivo radiosensitization effect of GW572016, we compared tumor growth delay curves in the following four treatment arms: a) control; b) GW572016 alone; c) radiotherapy (RT) alone; d) GW572016 and RT. RESULTS: GW572016 inhibited EGFR, HER2 receptor phosphorylation in SUM 149 and SUM 185 xenografts. In addition, the p44/42 MAPK (ERK 1/2) downstream signaling pathway was inactivated by GW572016 in the SUM 185 xenograft. In the SUM 225 xenograft, we could not observe inhibition of HER2 receptor phosphorylation by GW572016; both p44/42 MAPK (Erk1/2) and Akt downstream signal protein phosphorylation were inhibited by GW572016. GW572016 inhibited growth of the tumor xenograft of SUM 149 and SUM 185. The combination of GW572016 and RT enhanced growth inhibition greater than that with GW572016 alone or with RT alone in the SUM 149 xenograft. GW572016 appears to act as an in vivo radiosensitizer. CONCLUSION: GW572016 inhibited EGFR/HER2 receptor phosphorylation and downstream signaling pathway proteins. GW572016 modestly inhibited the growth of tumor in the SUM 185 xenograft and showed radiosensitization in the SUM 149 xenograft. Our results suggest that a better predictor of radiation response would be inhibition of a crucial signaling pathway than inhibition of a receptor.
Animals ; Arm ; Blotting, Western ; Breast Neoplasms* ; Breast* ; Cell Line ; Heterografts* ; Humans* ; Immunoprecipitation ; Mice ; Mice, SCID ; Phosphorylation ; Protein-Tyrosine Kinases* ; Radiotherapy ; Tyrosine*

We report the case of a 32-year-old female who developed polymyositis associated with scrub typhus. She exhibited the eschar with high titer of anti-Rickettsia(R)-tsutsugamushi antibody, severe muscle weakness, markedly elevated serum levels of muscle enzymes, EMG changes, and infiltration of macrophages in a muscle biopsy specimen. Initiation of appropriate antibiotic therapy resulted in complete healing of scrub typhus and disappearance of symptoms and signs of polymyositis within 1 month after high dose steroid therapy. We suggest that scrub typhus also be included within the causes of idiopathic inflammatory polymyositis.
Adult ; Biopsy ; Female ; Humans ; Macrophages ; Muscle Weakness ; Polymyositis* ; Scrub Typhus*

BACKGROUND: Heart failure due to diastolic dysfunction rises dramatically with age. Normal aging process is also known to depress left ventricular diastolic performance. It was reported that exercise training prevented diastolic dysfunction in old men and old rats. We investigated the diastolic function after long-term exercise training in old rats using the Millar Pressure-Volume conductance catheter system. MATERIALS AND METHODS: Young and old male Fischer 344 rats were assigned to sedentary controls groups(young control group: YC, old control group: OC), and an exercise training group (old trained group: OT). After 12-week treadmill exercise training (6 mo of age and 25 mo of age, respectively), the cardiac performance at different preloads was assessed using the Millar Pressure-Volume conductance catheter system. RESULTS: Heart rate (HR), mean arterial pressure, LV systolic pressure, maximal slope of the systolic pressure increment (+dP/dt), and maximal slope of the diastolic pressure decrement (-dP/dt) were decreased in OC compared with YC (all p<0.05). However, LV end diastolic pressure, end diastolic volume (EDV), end systolic volume, time constant of LV pressure decay (tau), and the slope of the end-diastolic pressure-volume relation (EDPVR slope) significantly increased in OC compared with YC (all p<0.05). After 12-week exercise training, HR, +dP/dt (p<0.05), and -dP/dt (p=0.07) were increased, but EDV, EDPVR slope (p<0.05), and tau (p=0.1) decreased in OT compared with OC. CONCLUSION: Longterm exercise training in old rats attenuated age-related deterioration in diastolic function. Our findings indicates that in rats, some age-associated changes in diastolic function are reversible and thus may not be intrinsic to aging.
Aging* ; Animals ; Arterial Pressure ; Blood Pressure ; Catheters ; Heart Failure ; Heart Rate ; Humans ; Male ; Models, Animal* ; Rats*