The efficacy and side effects associated with anticancer drugs have attracted an extensive research focus. Onconephrology is an evolving field of nephrology that deals with the study of kidney diseases in cancer patients. Most renal diseases in cancer patients are unique, and management of renal disease can be challenging especially in the presence of continuing use of the nephrotoxic drugs. Cisplatin is one of the most important chemotherapeutic agents used in the treatment of various malignancies, such as head, neck, ovarian, and cervical cancers. The major limitation in the clinical use of cisplatin is its tendency to induce adverse effects, such as nephrotoxicity. Recently, plant-derived phytochemicals have emerged as novel agents providing protection against cisplatin-induced renal cytotoxicity. Owing to the diversity of phytochemicals, they cover a wide spectrum of therapeutic indications in cancer and inflammation and have been a productive source of lead compounds for the development of novel medications. Of these agents, the effectiveness of triterpenoids, isolated from various medicinal plants, against cisplatin-induced renal cytotoxicity has been reported most frequently compared to other phytochemicals. Triterpenes are one of the most numerous and diverse groups of plant natural products. Triterpenes ameliorate cisplatin-induced renal damage through multiple pathways by inhibiting reactive oxygen species, inflammation, down-regulation of the MAPK, apoptosis, and NF-κB signaling pathways and upregulation of Nrf2-mediated antioxidant defense mechanisms. Here, we reviewed recent findings on the natural compounds with protective potential in cisplatin-induced renal cytotoxicity, provided an overview of the protective effects and mechanisms that have been identified to date, and discussed strategies to reduce renal cytotoxicity induced by anticancer drugs.

PURPOSE: On November 23, 2010, Yeonpyeong Island was under artillery fire and mass civilian casualties developed. Incheon West-sea regional emergency medical center, dispatched a disaster team to deal with the casualties. The purpose of this study was to review the regional disaster response of this team to improve the operations of the National Disaster Medical System, Disaster Medical Assistance Team, and the Mobile Emergency Support Unit in case of future emergencies. METHODS: We retrospectively reviewed the disaster response upon bombardment of the Yeonpyeong Island and analyzed medical records of patients who treated by the disaster team at Yeonpyeong island. RESULTS: The disaster team and EMS were activated after the bombardment. Disaster team included two doctors, three emergency medical technicians, and one ambulance driver. The bombardment occurred at 14:34, and lasted for 30 minutes. The disaster team was dispatched at 16:40, and arrived in Incheon port at 17:07 and departed for Yeonpyeong Island with a fire engine and ambulance at 21:48. Our team reached the island the next morning and started to treat a patient. A total of 30 patients were participated in this study. The mean age of the patients was 49.4(+/-14.2) yrs old. Most of he patients are a mild case. Diagnosis was multiple contusion, acute stress reaction, cerebral concussion, rupture of tympanic membrane. Also: It may help to include data/analyses showing that there were inadequacies and problems with the system (time lag, insufficient medical training or supplies, etc.) CONCLUSION: This article is the first to report on the efficacy of the National Disaster Medical System after bombardment. From our analysis, the National Disaster Medical System contains many problems including access to the island, the equipment of communication, and the security of disaster team. This report shows that a review of our National Disaster Medical System is necessary to plan for future disaster scenarios.
Ambulances ; Brain Concussion ; Contusions ; Disasters ; Emergencies ; Emergency Medical Technicians ; Equipment and Supplies ; Fires ; Humans ; Medical Assistance ; Medical Records ; Retrospective Studies ; Rupture ; Tympanic Membrane

BACKGROUND: Early defibrillation is the treatment of choice in out-of-hospital cardiac arrests (OHCA) with initial shockable rhythms. However, the relationship between the frequency of defibrillation and neurological outcome was not clear. In this study, the frequency of defibrillation and other factors related to neurological outcome were investigated. METHODS: Records of 255 adult patients, who were admitted to the hospital after resuscitation from OHCA between November 2008 and March 2012, were retrospectively reviewed. 6 months after the return of spontaneous circulation, patients were divided into two groups based on the cerebral performance category (CPC) score for neurologic prognosis. The frequency of defibrillation during resuscitation and other variables were analyzed between the two groups. RESULTS: In the study group, initial rhythm was divided into two groups, non shockable rhythm (200, 78.4%) and shockable rhythm (55, 21.6%). The frequency of 1-7 defibrillations was significantly associated with good neurological outcome (OR 3.05, 95% CI 1.328-6.850). In addition, shockable initial rhythm (OR 4.520, 95% CI 1.953-10.459), arrest caused cardiac origin (OR 2.945, 95% CI 1.334-6.500), time to BLS (OR 1.139, 95% CI 1.033-1.256) and lower APACHII score (OR 1.095, 95% CI 1.026-1.169), which were associated with good neurological outcomes, independently. CONCLUSIONS: In those patients who survived from OHCA, adequate defibrillation was important to improve the neurological outcome, whether the initial rhythm was shockable or not. Frequency of 1-7 times defibrillation was associated with good neurological outcome.
Adult ; Humans ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Resuscitation ; Retrospective Studies ; Survival Rate

Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11 month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16 days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.
Adolescent ; Adult ; Aged ; Child ; Coma ; Heart Arrest ; Humans ; Hypnotics and Sedatives ; Hypothermia ; Hypothermia, Induced ; Hypoxia-Ischemia, Brain ; Infant ; Out-of-Hospital Cardiac Arrest ; Pediatrics ; Rewarming ; Ventricular Fibrillation

Spontaneous hemothorax vary in cause and are rare for hemothorax induced osteochondroma. Sometimes hemothroax is reported due to osteochondroma induced injury of diaphragm, lung, pericardium, heart, or pleura. We report a patient with diaphragm laceration due to osteochondroma.
Diaphragm* ; Heart ; Hemothorax* ; Humans ; Lacerations* ; Lung ; Osteochondroma* ; Pericardium ; Pleura ; Ribs*