No abstract available.
Central Venous Catheters* ; Prospective Studies* ; Thrombophlebitis*

A 52-year-old women, suffering from generalized pruritus due to intrahepatic and common hepatic duct stones, was treated with astemizole, 30mg daily. Sixty one days later, convulsions and syncope developed suddenly during hospitalization. She had no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. As another case, a 44-year-old man suffering from pruritus due to liver cirrhosis, was treated with astemizole, 30mg daily. Thirty two days later, palpitations and syncope also developed suddenly during hospitalization. He was diagnosed liver cirrhosis, 3 years ago and there was no history of arrhythmia, heart disease, electrolytes imbalance, or CNS disorders. Administration of astemizole was stopped immediately. The laboratory investigations revealed the normal range of serum potassium, calcium and magnesium in both cases. The ECG finding showed the prolongation of QTc interval, frequent VPCs and intermittent polymorphic drugs. On 1st and 3rd day, after discontinue of astemisole, the ECG abnormalities disappeard. It is suggested that astemizole overdose can induce prolongation of QTc interval and torsade de pointes, especially in the patient with liver disease.
Adult ; Arrhythmias, Cardiac ; Astemizole* ; Calcium ; Electrocardiography ; Electrolytes ; Female ; Heart Diseases ; Hepatic Duct, Common ; Hospitalization ; Humans ; Liver Cirrhosis ; Liver Diseases ; Magnesium ; Middle Aged ; Potassium ; Pruritus ; Reference Values ; Seizures ; Syncope ; Torsades de Pointes*

PURPOSE: The current organ shortage in renal transplantation underscores the importance of optimizing long- term graft survival. Despite the significant improvement in the results of renal transplantation since the introduction of cyclosporine, graft loss after fist year of transplantation remains a significant and unresolved problem. This study showed renal function at 1 month after transplantation as a prognostic factor influencing long-term renal graft survival. METHODS: The results of 683 cases of renal transplantations performed from 1978 to 2001 in our center were analysed. We divided into 3 groups according to the serum creatinine level (group 1: <1.5, group 2: 1.5~2.0, group 3: 2.0<) at first month of transplantation. And risk factors such as donor age (<60 or >60), donor sex, donor type (related, unrelated, cadevaric), recipient age (<60, or >60), recipient sex, HLA matching, acute rejection, delayed graft function were also analysed. RESULTS: The acute rejection rates in each group were 17.1%, 40.6%, 71.7% retrospectively (P=0.000). The frequencies of delayed graft function were 3.9%, 9.0%, 36.2% retrospectively (P=0.000). There was significant difference of graft survival between each group (P=0.000). In addition, graft survival in group with acute rejection showed significant difference according to creatinine level at 1 month. CONCLUSION: We can predict long-term graft survival and early renal function through serum creatinine levels after transplantation. Therefore, serum creatinine level at first month of transplantation was prognostic factor in predicting long-term graft survival.
Creatinine* ; Cyclosporine ; Delayed Graft Function ; Graft Survival ; Humans ; Kidney Transplantation ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants*

No abstract available.
Nevus

The purpose of this study was to evaluate the effect of thickness, filling methods and curing methods on the polymerization of dual cured core materials by means of microhardness test. Two dual cured core materials, MultiCore Flow (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Bis-Core (Bisco Inc., Schaumburg, IL, USA) were used in this study. 2 mm (bulky filled), 4 mm (bulky filled), 6 mm (bulky and incrementally filled) and 8 mm (bulky and incrementally filled)-thickness specimens were prepared with light cure or self cure mode. After storage at 37degrees C for 24 hours, the Knoop hardness values (KHN) of top and bottom surfaces were measured and the microhardness ratio of top and bottom surfaces was calculated. The data were analyzed using one-way ANOVA and Scheffe multiple comparison test, with alpha = 0.05. The effect of thickness on the polymerization of dual cured composites showed material specific results. In 2, 4 and 6 mm groups, the KHN of two materials were not affected by thickness. However, in 8 mm group of MultiCore Flow, the KHN of the bottom surface was lower than those of other groups (p < 0.05). The effect of filling methods on the polymerization of dual cured composites was different by their thickness or materials. In 6 mm thickness, there was no significant difference between bulk and incremental filling groups. In 8 mm thickness, Bis-Core showed no significant difference between groups. However, in MultiCore Flow, the microhardness ratio of bulk filling group was lower than that of incremental filling group (p < 0.05). The effect of curing methods on the polymerization of dual cured composites showed material specific results. In Bis-Core, the KHN of dual cured group were higher than those of self cured group at both surfaces (p < 0.05). However, in MultiCore Flow, the results were not similar at both surfaces. At the top surface, dual cured group showed higher KHN than that of self cured group (p < 0.05). However, in the bottom surface, dual cured group showed lower value than that of self cured group (p < 0.05).
Acrylic Resins ; Composite Resins ; Hardness ; Light ; Methacrylates ; Polymerization ; Polymers ; Polyurethanes

PURPOSE: The main purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. MATERIAL AND METHODS: A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current payment rates of individual services. RESULTS: The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12- 2.55 times lower in total body irradiation. CONCLUSION: We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.
Classification* ; Fee-for-Service Plans ; Hospital Costs ; Humans ; Radiation Oncology* ; Whole-Body Irradiation

PURPOSE: Takayasu's arteritis is a chronic disease characterized by nonspecific inflammation of the aorta and its branches, and cerebral ischemia has been considered to be the most life-threatening complication of this disorder. METHOD: We performed a retrospective review of 13 patients who underwent 16 procedures between 1996 and 2006 secondary to cerebrovascular symptoms in Takayasu's arteritis (median follow-up=52.5 months). RESULT: Study subjects included 10 females and 3 males, with a median age of 36.5 years. Procedures included 7 bypasses (2 aorto-bicarotid artery, 1 axillo-axillary artery, 2 subclavian-common carotid artery, 1 common carotid-internal carotid artery, and 1 axillo-vertebral artery), 4 carotid endarterectomies (CEA), and 5 stents (4 common carotid artery [1 for the treatment of re-stenosis of CEA] and 1 vertebral artery). All patients were relieved of their cerebral ischemic symptoms and remained stroke-free during the follow-up period. Re-stenosis was seen in two cases of stenting. Occlusion or stenosis of arterial reconstruction occurred more frequently in patients who had elevated erythrocyte sedimentation rates (ESR) preoperatively (P<0.05). CONCLUSION: Surgical treatment was effective in stroke prevention and elimination of cerebrovascular symptoms. The patency of the reconstruction was related to the progression of the disease as indicated by elevated ESR and [18F]fluorodeoxyglucose positron emission tomography, which are useful tools for evaluating disease activity.
Aorta ; Arteries ; Blood Sedimentation ; Brain Ischemia ; Carotid Arteries ; Carotid Artery, Common ; Cerebrovascular Disorders ; Chronic Disease ; Constriction, Pathologic ; Endarterectomy, Carotid ; Female ; Follow-Up Studies ; Humans ; Inflammation ; Male ; Positron-Emission Tomography ; Retrospective Studies ; Stents ; Stroke ; Takayasu Arteritis

Obturator nerve block has been used for analgesia of hip pain, relaxation of adductor muscle spasm related to cerebral palsy or paraplegia and in urologic surgery to prevent inadvertent obturator activity during lateral wall cystoscopy. Recently, ultrasound guidance has gained popularity in the field of peripheral nerve block and have been reported in some benefits. We describe here successfully performed both obturator nerve block under ultrasound guidance.
Analgesia ; Cerebral Palsy ; Cystoscopy ; Hip ; Humans ; Muscles ; Obturator Nerve ; Paraplegia ; Peripheral Nerves ; Relaxation ; Spasm ; Thigh

OBJECTIVE: the enzymes cyclooxygenase(COX)-1 and -2 are necessary for the synthesis of prostaglandins. COX-2 is usually absent in normal cells and is upregulated and expressed as a product of the "immediate early" gene during inflammatory processes. In previous studies, the expression of COX-2 has been shown to be induced by prointlammatory cytockines, and suggestions have been made that overexpression of COX-2 supresses apoptosis and is directly related to tumor growth. We the authors have attempted to determine a relationship between the tumor invasion and metastasis of uterine cervical cancer and COX and apoptosis by comparing the protein expression of apoptosis and COX-I and COX-2 in tumor tissues confirmed with cytokeratin, and therefe determine the clinicopathologic risk factors. MATERIALS AND METHODS: The subjects were 18 patients who were FIGO stage IB uterine cervical cancer patients who underwent surgery at the Ajou University Medical Center. The 18 cases were comprised of 12 cases of squamous cell carcinoma, 3 cases each of adenocarcinoma and adenosquamous carcinoma. There were 9 cases with lymph node or prarametrial involvement and 13 cases with lymphvascular space involvement. All tissues obtained from the cases were subject to immunohistochemical staining for COX-1, -2 and TUNEL method for apoptosis detection, and the following results were obtained. RESULTS: Tumor tissues confirmed by cytokeratin wae separated into tumor surface, tumor stroma, and invasion site portions, and in which increased apoptosis was observed in the tumor surface and tumor stmma, but not in the invasion sites. COX-2 expression was observed in all tumor tissues, which was especially strong in the tumor invasion site. Therefore, it is suggested that COX-2 expression may supress cell apoptosis at the site of tumor invasion. When COX-2 expression was investigated when the cases were divided into groups with regard to the presence or absence of lymph node or parametrial involvement, there was statistically significant (Mann-Whitney U test) COX-2 expression seen microscopically in the tumor stroma (p-value=0.028) and tumor invasion site (p-value=0.040) compared to the tumor surface (p-value=0.499). In other words, in surgically treated stage IB cervical cancer patients, COX-2 was significantly expressed when lymph node or parametrial involvement was present. CONCLUSIONS: These results suggest that the expression of COX-2 in stage IB cervical cancer patients may downregulate apoptosic processes and thus enhances tumor invasion and metastasis.
Academic Medical Centers ; Adenocarcinoma ; Apoptosis ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Humans ; In Situ Nick-End Labeling ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis* ; Prostaglandin-Endoperoxide Synthases* ; Prostaglandins ; Risk Factors ; Uterine Cervical Neoplasms*

Blunt trauma to the chest may result in various cardiac injuries. But traumatic myocardial infarction with coronary artery fistula as a complication of chest trauma has been reported in very few cases. The etiology of myocardial infarction is not entirely clear. A 40 years old male was admitted after a traffic accident. He complained of acute retrosternal pain of about one hours duration. There was an area of contusion over the right sternal border. The ECQ showed deep Q wave and elevated ST segments in leads 2, 3 and aVF. There was a considerable increase in creatine kinase(CK) peak level and a CK-MB fraction. Coronary angiography revealed a total proximal occlusion of the right coronary that communicated directly with the right atrium. The left ventridulogram showed hypokinesia of the inferior wall. He was managed with conservative treatments and has remained well sebsequently. We reported a middle aged man who developed an acute transmural inferior wall myocardial infarction associated with coronary artery fistula secondary to blunt cheat trauma in an automobile accident.
Accidents, Traffic ; Adult ; Automobiles ; Contusions ; Coronary Angiography ; Coronary Vessels* ; Creatine ; Fistula* ; Heart Atria ; Humans ; Hypokinesia ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Thorax*