Long term use of steroid induces multiple side effects and morbidity. However, SW has been reported to be associated with increased incidence of acute and chronic rejection, and subsequently reduced graft outcome. MMF inhibits the proliferation and functions of lymphocytes, decreases the incidence of acute rejection in organ transplants, and therefore may decrease the graft rejection associated with SW. We tried to withdraw steroid from 21 renal transplants treated with prednisolone and cyclosporine, who had clinically significant steroid induced side effects. Reasons for SW were diabetes in 15 patients (pre-transplant DM 4 and post-transplant 11), moon face 4 and avascular necrosis of femur 2. Prednisolone was tapered at a rate of 2.5mg every 2 weeks and was discontinued. MMF, 1.0-2.0g/day, was initiated at the beginning of SW. The time interval between transplantation and SW was 26+/-5 (1.5-67) months. Mean age was 48(28-61). Two patients developed MMF-induced GI side effects, and were returned to previous immuno- suppressants. In 1 patient, serum creatinine increased during SW, and steroid was re-administered with the restoration of renal function. In 18(86%) of 21 patients, therefore, steroid was successfully with-drawn. At the follow up of 17+/-1(13-24) months after SW, 1 patient with drug incompliance developed chronic rejection. The rest showed stable renal function. Steroid can be safely withdrawn from renal transplants by simultaneous administration of MMF. The long-term safety, however, needs to be evaluated by prolonged follow up studies.
Creatinine ; Cyclosporine ; Femur ; Follow-Up Studies ; Graft Rejection ; Humans ; Incidence ; Kidney Transplantation ; Lymphocytes ; Necrosis ; Prednisolone ; Transplants

Systemic lupus erythematosus, an autoimmune disease with multisystem involvement, has been reported to be associated with a number of gastrointestinal complications and symptoms such as nausea, vomiting, and abdominal pain. However, acute pancreatitis only rarely has been reported as a complication of SLE. We report a case of SLE presenting drug unrelated acute pancreatitis as a initial manifestation.
Abdominal Pain ; Autoimmune Diseases ; Lupus Erythematosus, Systemic* ; Nausea ; Pancreatitis* ; Vomiting

No abstract available.
Antibodies, Neutralizing* ; Feces* ; Rotavirus*

Purpose: Trochanteric fixation nail advanced (TFNA) was modified to compensate for the shortcomings of proximal femoral nail antirotation-II (PFNA-II). The clinical and radiological outcomes of surgeries us-ing the PFNA-II and TFNA for femoral intertrochanteric fractures were compared. Materials and Methods: Eighty-two patients who underwent surgeries using PFNA-II or TFNA were analyzed. Only those who were followed up for more than a year were enrolled. Bone union, shortening of the femoral neck, and the tip–apex distance of the intramedullary nail were compared in the radiological findings. Clinical outcomes, including the frequency of complications and gait ability (Koval score), were also assessed. Results: The mean follow-up periods were 22 and 19 months for the PFNA-II and TFNA groups, re-spectively. In the PFNA-II group, two cases of femoral head cut-out and one case of varus collapse were observed. In the TFNA group, only one case of femoral head cut-out was observed; however, there was no significant difference in the frequency of complications between the two groups (p=0.37). Ad-ditionally, both the shortening of the femoral neck and the decrease in gait ability after surgery showed relative improvement in the TFNA group compared to the PFNA-II group; however, there was no sig-nificant difference between the two groups. Conclusion The use of both TFNA and PFNA-II was associated with satisfactory outcomes. In patients who underwent surgeries using TFNA, the recovery of gait ability, frequency of complications, and short-ening of the femoral neck were not significantly different from PFNA-II, suggesting that both are suitable instrument choices for intertrochanteric fracture treatment. However, the clinical significance must be further assessed using a larger group of patients over a longer follow-up period in future studies.

PURPOSE: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. METHODS: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. RESULTS: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. CONCLUSION: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.
Acetylcysteine* ; Amanita ; Humans ; Liver Transplantation ; Mortality ; Penicillins* ; Poisoning* ; Retrospective Studies ; Silymarin* ; Treatment Outcome

No abstract available.
Humans ; Prevalence* ; Renal Dialysis*

BACKGROUND: Fatigue is a common problem in medical students and is thought to be related to poor academic performance. Fatigue is expected to be highly related to dietary habits, but previous research was not enough. Therefore, the aims of this study were to investigate the relationship between dietary habits and the prevalence of fatigue and also to give an update on basic research data for improving academic performance in medical students. METHODS: The study group consisted of 170 healthy second-year medical students attending three university school of medicine in Busan. They completed a questionnaire dealing with fatigue (Fatigue Severity Scale), dietary habits, lifestyle, and academic performance. RESULTS: On multivariate logistic regression analyses, skipping breakfast (completely skipping breakfast everyday versus having breakfast everyday; odds ratio 7.23; 95% confidence interval, 2.07 to 25.28; P = 0.002) was positively correlated with the complaints of fatigue. CONCLUSION: Skipping breakfast was associated with the complaints of fatigue in medical students.
Breakfast ; Fatigue ; Food Habits ; Humans ; Life Style ; Logistic Models ; Odds Ratio ; Prevalence ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: Fatigue is a common problem in male workers as they have responsibilities in both role in home and in work place. The use of functional food has been one of the popular choices for fatigue recovery. This study was conducted to investigate the prevalence of functional food usage and its relationship with fatigue in male workers. METHODS: The study subjects were male workers seen for health check up at a university hospital in Busan from May to July 2009. They completed a questionnaire including social factor, occupational factor, life style, functional food usage and disease status. The subjects were divided into groups according to fatigue severity. RESULTS: Among 770 subjects, 267 (34.7%) consumed functional food daily. Most of them used functional food to recover fatigue as a supplement nutrition by their wife's or surrounding person's recommendation. There were significant difference between fatigue and non-fatigue group in age, occupation satisfaction, alcohol drinking, and insomnia. The prevalence of fatigue was 37.8%. The functional food usage significantly increased with fatigue severity scale (P < 0.001). CONCLUSION: Fatigue is common problem in male workers. The functional food usage is relation with fatigue severity.
Alcohol Drinking ; Fatigue ; Functional Food ; Humans ; Hypogonadism ; Life Style ; Male ; Mitochondrial Diseases ; Occupations ; Ophthalmoplegia ; Prevalence ; Sleep Initiation and Maintenance Disorders ; Workplace ; Surveys and Questionnaires

BACKGROUND: A mixture of local anesthetics such as lidocaine and bupivacaine has frequently been used in clinical practice. The rationale behind this is to take advantage of lidocaine's rapid onset and bupivacaine's perpetuation in anesthesia. The purpose of this study was to examine the changes in the onset and recovery of nerve blocking action exerted by the different combinations of these two in the mixture. METHODS: Isolated sciatic nerve preparations obtained from adult male Sprague-Dawley rats were used in this study. Recordings of A-fiber compound action potentials (A-CAPs) were made at the end of the isolated nerve while single pulse stimuli (0.5 msec, supramaximal intensity, 2 Hz) were applied to the opposite end of the nerve. Seven different composition of lidocaine-bupivacaine mixtures were prepared (0 : 6, 1 : 5, 2 : 4, 3 : 3, 4 : 2, 5 : 1, 6 : 0 vol./vol.), where basal concentrations of lidocaine and bupivacaine were 0.2% and 0.05%, respectively. Amplitudes of A-CAPs were measured before, during and after perfusion of mixture solution. The time needed for A-CAPs amplitude to decrease to 10% of the basal value after starting perfusion (onset time) and that needed to reach to 50% of the basal value after ceasing the perfusion (recovery time) were measured. RESULTS: With increasing concentration ratios of lidocaine to bupivacaine in the mixture as mentioned above, the following onset and recovery times were obtained (6.0 +/- 0.3, 5.6 +/- 0.3, 6.0 +/- 0.5, 8.3 +/- 0.5, 7.3 +/- 0.6, 7.8 +/- 0.3, and 10.8 +/- 0.8, minutes; 38 +/- 4, 63 +/- 12, 87 +/- 19, 100 +/- 13, 104 +/- 18, 137 +/- 27, and 157 +/- 18 minutes, respectively). CONCLUSION: Onset times were, in general, exponentially decreased with the increase in the lidocaine concentration. However, recovery times were lineary increased with the increase in the bupivacaine concentration. So, it should be kept in mind that rapid onset can only be obtained with the expense of substantial reduction in the duration of local anesthetic effect of the mixture, and vice versa.
Action Potentials ; Adult ; Anesthesia ; Anesthetics ; Anesthetics, Local ; Bupivacaine ; Humans ; Lidocaine ; Male ; Nerve Block ; Neural Conduction* ; Perfusion ; Rats, Sprague-Dawley ; Sciatic Nerve

Antipyschotics have been frequently reported being associated with hyponatremia. We have experienced two cases of severe hyponatremia with neurological symptoms in patients with acute schizophrenia who were treated with risperidone. Case 1 was a 33-year-old female who developed hyponatremia (Na+114 mEq/L) at 17 days after initiation of treatment with risperidone. Case 2 was a 41-year-old female who developed hyponatremia (Na+107 mEq/L) 5 months after treatment with risperidone. In both cases, polydipsia was not obvious. The exact cause of hyponatremia was uncertain, but we suggest that syndrome of inappropriate secretion of antidiuretic hormone due to risperidone may be the mechanism of hyponatremia in both cases. Although there have been many recent studies about the pathophysiology of hyponatremia among psychiatric patients, the exact mechanism remains unclear. There have been many case reports in the literature of hyponatremia associated with antipsychotics. We suggest that risperidone may be a potential drug that can cause hyponatremia and lead to life-threatening neurological symptoms in the early stage treatment, and that clinicians should monitor patients on a regular basis.
Adult ; Antipsychotic Agents ; Coma ; Female ; Humans ; Hyponatremia ; Morphinans ; Organothiophosphorus Compounds ; Polydipsia ; Risperidone ; Schizophrenia