Tri- and tetra-cyclic antidepressants are known to cause dry mouth among other several major complications. The present study was designed to compare the degree of reduced salivation due to antidepressants and to explore whether intracellular calcium-increasing agents ameliorate the salivation. Effects of antidepressants and agents increasing intracellular calcium on the cholinergic submandibular secretion and blood flow induced by the chorda stimulation or intra-arterial acetylcholine were observed in anesthetized cats. Effects of antidepressants and calcium-mobilizing agents on K+ efflux were also observed in excised gland slices. The results obtained were as follows: 1. Salivary secretion in response to the chorda stimulation (3 V, 20 Hz, 1 msec) was significantly attenuated by antidepressants in a dose-dependent manner, whereas the blood flow was not affected. 2. Salivary secretion and increased blood flow evoked by intra-arterial acetylcholine (20 microgram/kg) were markedly diminished by antidepressants, the magnitude of which was amitryptyline>imipramine >mianserin in order. 3. Cholinergic salivation was significantly decrease by cyclopiazonic acid, a calcium pump inhibitor of the endoplasmic reticulum, or by BAPTA/AM, a specific intracellular calcium chelator. 4. Caffeine and ryanodine potentiated the cholinergic salivation and ameliorated the depressed salivary secreation due to antidepressants. 5. Calcium ionophore A 23187 ameliorated the depressed salivation due to antidepressants. 6. Antidepressants inhibited the K+ efflux, which were restored by caffeine or A 23187. These results suggest that the depressed salivary secreation due to antidepressants is ameliorated by increasing intracellular calcium levels.
Acetylcholine ; Animals ; Antidepressive Agents ; Caffeine ; Calcimycin ; Calcium* ; Cats ; Endoplasmic Reticulum ; Mouth ; Ryanodine ; Salivation*

All-ceramic restorations have become an attractive alternative to porcelain-fused-to-metal crowns. In-Ceram, and more recently IPS Empress 2 were introduced as a new all-ceramic system for single crowns and 3-unit fixed partial dentures. But their strength and marginal fit are still an important issue. This study evaluated the fracture resistance and marginal fit of three systems of 3 unit all-ceramic bridge fabricated on prepared maxillary anterior resin teeth in vitro. The 3 all-ceramic bridge systems were: (1) a glass-infiltrated, sintered alumina system (In-Ceram) fabricated conventionally, (2) the same system with copy-milled alumina cores (copy-milled In-Ceram), (3) a heat pressed, lithium disilicate reinforced glass-ceramic system (IPS Empress 2). Ten bridges of each system with standardized design of framework were fabricated. All specimens of each system were compressed at 55degree at the palatal surface of pontic until catastrophic fracture occurred. Another seven bridges of each system were fabricated with standard method. All of the bridge-die complexes were embedded in epoxy resin and sectioned buccolingually and mesiodistally. The absolute marginal discrepancy was measured with stereomicroscope at x50 power. The following results were obtained: 1. There was no significant difference in the fracture strength among the 3 systems studied. 2. The Weibull modulus of copy-milled In-Ceram was higher than that of In-Ceram and IPS Empress 2 bridges. 3. Copy-milled In-Ceram (112micrometer) exhibited significantly greater marginal discrepancy than In-Ceram (97micrometer), and IPS Empress 2 (94micrometer at P=0.05. 4. The lingual surfaces of the ceramic crowns showed smaller marginal discrepancies than mesial and distal points. There was no significant difference between teeth (incisor, canine) at P=0.05. 5. All-ceramic bridges of three systems appeared to exhibit sufficient initial strength and acceptable marginal fit values to allow clinical application.
Aluminum Oxide ; Ceramics ; Crowns ; Denture, Partial, Fixed ; Hot Temperature ; Lithium ; Tooth

BACKGROUND: Intra-aortic balloon pump (IABP)is well known for its hemodynamic benefit but still has its own complications.Proper use of IABP is the best way t o obt ai n maximum benefit with low complication rate. MATERIALS AND METHOD: Twenty one(men 10,female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital.Eighteen(85.7%)were ischemic heart disease patients.They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications.Their preoperative conditions,intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. RESULT: Nineteen patients(90.5%)were successfully weaned from IABP.There were 2 patients of operative death and the mortality rate was 9.5%.Duration of IABP use was 40.7+/-24.3 hours.There were 2 cases(9.5%)of IABP-related vascular complications that required surgical intervention. CONCLUSION: We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.
Adult ; Hemodynamics ; Humans ; Mortality ; Myocardial Ischemia ; Shock, Cardiogenic* ; Thoracic Surgery

Chronic iron overload is associated with life-threatening complications, such as cardiomyopathy, liver cirrhosis, diabetes, hypothyroidism, hypoparathyroidism and hypogonadism. We experienced a case of secondary hemosiderosis with hepatic fibrosis in a 8-year-old boy who had been transfused 56 pints of packed red blood cells for a supportive therapy of acute myelogenous leukemia for a 27-month period. Intramuscular injection of Desferroxamine (40mg/kg/ day) was done for 9 months, however, there was no sign of improvement in hepatic size, consistency, and in liver biopsy findings. Except for mild thrmobocytopenia which seems to be the result of hypersplenism, the boy remained in remission for 3 2/3 years. We think, the prompt use of Desferroxamine therapy may be needed to avoid iron overload, if patients recieved multiple transfusions and high serum ferritin level.
Biopsy ; Blood Transfusion ; Cardiomyopathies ; Child ; Deferoxamine ; Erythrocytes ; Ferritins ; Fibrosis* ; Hemosiderosis* ; Humans ; Hypersplenism ; Hypogonadism ; Hypoparathyroidism ; Hypothyroidism ; Injections, Intramuscular ; Iron Overload ; Leukemia, Myeloid, Acute* ; Liver ; Liver Cirrhosis ; Male

BACKGROUND: Disordered lactate metabolism which is due to tissue hypoxia and hypoperfusion is frequently encountered in critically ill patients. These patients suffer from a high hospital mortality rate and are at great risk of developing multiple organ failure. The present study was designed to evaluate the prognostic value of blood lactate as a determinant of mortality in comparison with the APACHE II score. METHODS: 29 adult ICU patients participated in this study. Blood lactate concentrations, arterial blood gas analysis, hemodynamic data and APACHE II scores were collected on the first and last days of ICU stay. These data were compared between survivor and non-survivor groups. RESULTS: On the day of admission, blood lactate concentrations and APACHE II scores of non-survivors were 48.5 +/- 27.0 mg/dl and 18.5 +/- 5.9, while those of survivors were 23.7 +/- 12.9 mg/dl and 6.7 3.1. On the day of discharge, arterial blood lactate concentrations and APACHE II scores of non-survivors were 143.2 +/- 54.0 mg/dl and 28.2 +/- 6.0, while those of survivors were 14.9 +/- 7.1 mg/dl and 4.7 +/- 2.2. There was a significant positive correlation between high arterial blood lactate concentration and fatal outcome in critically-ill patients. There was also a significant positive correlation between arterial blood lactate concentration and APACHE II score. Furthermore, decreases in arterial blood lactate levels during the course of ICU stay may indicate a favorable outcome. The mortality increased abruptly in critically-ill patients with an initial arterial blood lactate concentration higher than 40 mg/dl. CONCLUSIONS: The result shows that arterial blood lactate concentration can serve as a reliable prognostic predictor and clinical guide to therapy in critically ill patients.
Adult ; Anoxia ; APACHE* ; Blood Gas Analysis ; Critical Illness* ; Fatal Outcome ; Hemodynamics ; Hospital Mortality ; Humans ; Lactic Acid* ; Metabolism ; Mortality ; Multiple Organ Failure ; Survivors

No abstract available.
Nitric Oxide Synthase* ; Nitric Oxide*

Neonatal lupus erythematous is a rare syndrome, which is characterized by a transient lupus dermatitis, hematologic abnormalities and isolated congenital heart block. We detected the atrioventricular dissociation, bradycardia and pericardial effusion by fetal echocardiography in a female fetus at 25th weeks of gestational age. The baby was born in the 38th week of pregnancy by Cesarean section with 1790 gram of body weight. In spite of atrioventricular dissociation with bradycardia and pericardial effusion, cardiac pacemaker was not needed during neonatal period because she was doing well, no evidence of congestive heart failure and around 80 beat per minute of heart rate. The serologic markers for diagnosis of neonatal lupus are the autoantibodies specific to SS-A/Ro and/or SS-B/La. These antibodies are produced by the mother and passed to the fetus through the placenta. Autoantibodies of cytoplasmic SS-A antigens or SS-B antigen were found in the blood of this patient and her mother. We report a case of neonatal lupus syndrome with congenital atrioventricular dissociation with Rt. Bundle branch block and hematologic abnormality.
Antibodies ; Autoantibodies ; Body Weight ; Bradycardia ; Bundle-Branch Block ; Cesarean Section ; Cytoplasm ; Dermatitis ; Diagnosis ; Echocardiography ; Female ; Fetus ; Gestational Age ; Heart Block* ; Heart Failure ; Heart Rate ; Heart* ; Humans ; Mothers ; Pericardial Effusion ; Placenta ; Pregnancy

Glycogen storage diseases(GSD) are inherited disorders affecting glycogen metabolism and type I GSD is due to the absence or deficiency of glucose-6-phosphatase(G6Pase) enzyme in the liver, kidney, and intestinal mucosa. The defect leads to inadequate hepatic conversion of G6P to glucose and thus make affected individuals susceptible to fasting hypoglycemia, and the accumulation of glycogen occurs in the liver and other organs. Type Ia is the most common form of GSD and clinically growth retardation may manifest of GSD itself rather than growth hormone deficiency(GHD), but we experienced a case of type I GSD with GHD in a 14-year-o1d male. The height was 125 cm, compatible with 50 th percentile of height of 8 years of age. He has doll-like face with fat cheek, relatively thin extremities, and metabolic acidosis, hyperuricemia, hypoglycemia, hyperlipidemia. GH stimulation test with clonidine and L-dopa revealed that the patient had decreased GH secretion. After laboratory work up including liver biopsy, he was diagnosed as type I GSD. Hypoglycemia was managed with frequent feeding with high starch diet(uncooked cornstarch). Metabolic acidosis and hyperuricemia were treated with sodium bicarbonate, allopurinol and probenecid. The patient is being followed at out-patient clinic with clinical improvement after of diet therapy and GH administration.
Acidosis ; Allopurinol ; Biopsy ; Cheek ; Clonidine ; Diet Therapy ; Extremities ; Glucose ; Glycogen Storage Disease* ; Glycogen* ; Growth Hormone* ; Humans ; Hyperlipidemias ; Hyperuricemia ; Hypoglycemia ; Intestinal Mucosa ; Kidney ; Levodopa ; Liver ; Male ; Metabolism ; Outpatients ; Probenecid ; Sodium Bicarbonate ; Starch

Two cases of Kartageneranjx syndrome were presented. They were sisters in the same family and were 15 years and 13 years old respectively. Chief complaints of the first case were chronic cough and expectoration and of the second case were chronic cough, expectoration and nasal stuffiness. Situs inversus, bronchiectasis and paranasal sinusitis were identified in both cases. EKG showed typical findings of mirror image compatible with dextrocardia in all two cases. Administration of antibiotics and postural drainage were performed with good resultin the first case but no remarkable improvement in the second case. A brief review of literatures was made.
Adolescent ; Anti-Bacterial Agents ; Bronchiectasis ; Cough ; Dextrocardia ; Drainage, Postural ; Electrocardiography ; Humans ; Siblings* ; Sinusitis ; Situs Inversus

For evaluating the boosting (anamnestic) effects of the most recent commercially produced plasma derived heat-inactivated hepatitis B vaccine (A. Co.), 117 adults with naturally acquired antibody to hepatitis B surface antigen (anti-HBs) were selected at random. In addition, out of case immunized at zero and 1 month, and boosted at 6 months (primary booting) by conventional vaccine (B.Co), inactivated by pepsin digestion and formalin treatment, 11 cases who showed elevated titer after primary boosting were also submitted to the study. The results were as follows: 1) Out of the 117 subjects with naturally acquired anti-HBs, 6(5.1%) showed isolated anti-HBs and the titers were below 10 ratio units (RU). Negative seroconversion was seen in 4 (3.4%) of the 117 cases at 12 months after the screening and, of these cases, 3 showed isolated anti-HBs below 10 RU (increased GMT, 28.04) at one month after primary booster injection with 3 microgram dose of A. Co. Vaccine at all, but 90% of the other subjects responded. 3) The anti-HBs titers of all the 11 cases who showed a rise of more than 10 RU (increased GMT, 28.04) at one month after primary booster injection by 20 microgram dose of B. Co. vaccine decreased at 19 months after the primary booster. And 3 subjects (27.3%) of the 11 reached negative seroconversion. All of the 11 cases, who had secondary booster injection with 3 microgram dose of A. Co. vaccine at 19 months after primary boosting, showed increased anti-HBs titer at least 20 RU or more (increased GMT, 57.72) at one month after the boosting. According to the above results in the anti-HBs screening survey for the purpose of immunization with hepatitis B vaccine, subjects with isolated anti-HBs below 10 RU should be regarded as being in an unimmunized state. In cases who are in risk circumstances, immunized primarily with a 20 microgram dose of B. Co. vaccine, a secondary booster injection should be given within 2 years after initiation of primary immunization and a 3 microgram booster dose of A. Co. vaccine can be reliably used.
Adult ; Digestion ; Formaldehyde ; Hepatitis B Surface Antigens* ; Hepatitis B Vaccines ; Humans ; Immunization* ; Mass Screening ; Pepsin A ; Plasma