No abstract available.
Humans ; Male*

No abstract available.
Animals ; Binding Sites* ; Carbon Monoxide* ; Carbon* ; Rats* ; Serotonin*

BACKGROUND: After multiple trauma, blood coagulation activity is enhanced and fibrinolytic activity is suppressed by overproduction of plasminogen activator inhibitor-1 (PAI-1). Intermittent sequential pneumatic compression (ISPC) is an effective method to prevent deep vein thrombosis. Its action is explained by the mechanical effect on blood flow, as well as by the enhancement of fibrinolysis by the reduction of PAI-1. The aim of this study was to determine the effects of ISPC on coagulation and fibrinolysis after multiple trauma. METHODS: Thirty-nine trauma patients were either treated with ISPC (ISPC group, 20 patients) or without ISPC (control group, 19 patients). We measured the plasma levels of the thrombin antithrombin III complex (TAT), the plasmin alpha 2 plasmin inhibitor complex (PIC), the tissue plasminogen activator (t-PA), and the plasminogen activator inhibitor-1 (PAI-1) on admission and at 1, 2, 3, 6, 12, and 24 hours after admission. RESULTS: The TAT was higher than normal in both groups, with no significant difference between the two groups throughout the study period. The PIC level of ISPC group was significantly higher than that of the control group. In the ISPC group, the PIC level increased gradually, reaching a peak at 3 hours and decreasing thereafter. In the control group, the PIC level increased to a peak level at 2 hours. The TAT/PIC ratio dropped in the first two hours and increased at 3 hours, dropping again thereafter. In the ISPC group, the ratio dropped gradually without an intermittent fluctuation. At 3 and 6 hours, the control group showed a significantly greater ratio compared to the ISPC group. PAI-1 was higher than normal in bothgroups, with a significantly lower level in the ISPC group from 2 hours to 24 hours. For the t-PA level, no difference was noted between the two groups, with the peak level occurring at 1 hour. The PAI-1/t-PA ratio was significantly greater in the control group from 2 hours to 12 hours than in the ISPC group, but the difference was not significant at 24 hours. CONCLUSIONS: In multiple trauma patients, ISPC does not seem to affect coagulation, but enhances fibrinolysis through suppressed PAI-1 production. This effect of ISPC may be maintained for 12 hours.
alpha-2-Antiplasmin ; Antithrombin III ; Blood Coagulation ; Fibrinolysin ; Fibrinolysis* ; Humans ; Multiple Trauma* ; Plasma ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Thrombin ; Tissue Plasminogen Activator ; Venous Thrombosis

OBJECTIVES: Considerable variations in the contents of clinical practice are the natural consequences of the fact that so many factors can have influences on each clinical decision making processes in the psychiatric treatment, let alone the pharmacotherapy of schizophrenia. To attain the goal of rational treatment, it is needed to examine the actual contents of clinical practices and the degree of variations among diverse hospitals. In addition, it is also needed to look into the unique situations in which each hospital is situated. For this purpose, this study tried to investigate the degree of variations in several aspects of the treatment of schizophrenia with atypical antipsychotics currently practiced in Korea. METHODS: This study is based on the data from RODOS (Risperidone Olanzapine Drug Outcome Study) in Korea. This study had been designed as a multi-center naturalistic study, therefore, had many advantages for the survey study of actual clinical practices. The subjects of the study were the in-patients who had been given risperidone or olanzapine for the control of their psychotic symptoms. Clinical data had been gathered by retrospective chart review. The degree and the characteristics of the variations were examined by comparing the patient-characteristic variables and the treatment-related variables among each hospital. RESULTS: The differences in the baseline characteristics of the patients including the duration of illness and the past history of psychiatric treatment were substantial among each hospital, and these differences seemed to explain a great portion of the variations in the contents of treatment. The variations in the dosage of risperidone and olanzapine were not conspicuous among each hospital. However, the variations in other treatment-related variables, including duration of admission, proportion of combined therapy with other antipsychotics, usage of anticholinergics, detection rate of extrapyramidal symptoms, remained statistically significant after adjusting the baseline patient characteristics as covariates. Although no significant correlation among each variable was found, a couple of unique practice patterns common to several hospitals could be observed. CONCLUSIONS: Considerable variations in the diverse treatment-related variables were observed in the treatment of schizophrenic patients with risperidone and olanzapine. It seemed that the major portion of these variations could be explained by the characteristic of patient group. However, the possibility remained that the other factors including the socio-cultural environment of the community and the disposition of the clinician themselves were still the major contributing factors to these variations. It is expected that the future clinical practice surveys like this study can help the clinicians to reevaluate their current practices, and can help to accumulate the basic data needed to establish the more rational and customized treatment practices.
Antipsychotic Agents ; Cholinergic Antagonists ; Decision Making ; Drug Therapy ; Humans ; Korea ; Linear Energy Transfer ; Retrospective Studies ; Risperidone* ; Schizophrenia

Though exercise T1-201 myocardial perfusion-scintigraphy is an important test in the diagnosis and evaluation of coronary artery disease, this test is limited in cases with poor physical conditions and unstable angina and the physical characteristics of thallium are not ideal for nuclear imaging of the myocardium. Recently, technetium-99m-labelled agent(99mTc-MIBI) has been developed to improved the quality of imaging and for easy usage in myocardial perfusion scan. Therefore, we performed dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 25 subjects who were suspeced to have coronary artery disease and the results obtanined were as follows ; 1) The overall diagnostic sensitivity of dipyridamole 99mTc-MIBI perfusion scintigraphy was 73.4%, while specificity was 66.7%. 2) Per vessel sensitivity for coronary artery disease diagnosis by the test was 71.4% and a per vessel specificity for coronary artery disease was 95.7%. 3) In all 75 coronary arteries, LAD had a sensitivity of 66.7%(10/15) and a specificity of 100%(10/10); RCA had a sensitivity of 75%(6/8) and a specificity of 82.4%(14/17); LCX had a sensitivity of 60%(3/5) and a specificity of 100%(20/20). 4) After infusion of dipyridamole, the most frequent adverse effect was chest pain which was seen in 8 cases(32%). The headache was seen in 7 cases(28%). Most of the symptoms were mild in severity and subsided spontaneously but 3 subjects were severe enough to require intravenous administration of aminophylline. In conclusion, dipyridamole 99m2011-06-17Tc-MIBI myocardial perfusion scintigraphy is a useful and safe test for diagnosis of coronary artery disease.
Administration, Intravenous ; Aminophylline ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Headache ; Myocardial Perfusion Imaging* ; Myocardium ; Perfusion ; Perfusion Imaging ; Sensitivity and Specificity ; Thallium

An intra-articular fracture of the distal tibia or a fracture of the tibial plafond is a relatively uncommon but the most difficult fracture to manage. There are many treatment options and many authors have reported good results after open reduction and rigid internal fixation to restore the length with articular surface and bone-graft followed by early motion and prolonged non-weight bearing. But in the fractures with severe comminution or with severe soft tissue injury, tries for internal fixation with plate and screws in the distal tibia will result in extensive soft tissue stripping of the wound with precarious blood supply, high rates of wound breakdown, superficial and deep infection, and osteomyelitis. The purpose of this study is to evaluate the results of treatment of severely open (open type III-A and more by Gustilo and Anderson) or comminuted plafond fractures (fracture type III and more by Ovadia and Beals) with an Ilizarov method with a minimum follow up of one year (average: 27.9 months) and we have reviewed 12 cases from December 1990 to October 1995. The results were as follows. 1. The average time of bone union were 17.5 weeks (range: 6-42weeks). 2. The radiological results of the treatment were excellent in 4 patients (33.3%), good in 4 patients (33.3%) and poor in 4 patients (33.3%) by radiological assessment of Crutchfield and the clinical results of the treatment were excellent in 4 patients (33.3%), good in 5 patients (41.7%) and poor in 3 patients (25.0%) by functional rating scaie of Crutchfield. 3. It seems that prognosis depends on severity of comminution at the time of injury. 4. The complications were bony collapse of the distal tibia in 2 patients, nonunion in 1 patient, degenerative arthritis of the ankle joint in 2 patients and chronic osteomyelitis in 2 patients. 5. Ilizarov technique is an useful method in the management of severely open or comminuted plafond fracture of the tibia and it would be preferable to apply buttress plate or bone graft after improvement of skin condition to prevent the late collapse.
Ankle Joint ; Follow-Up Studies ; Humans ; Ilizarov Technique* ; Intra-Articular Fractures ; Osteoarthritis ; Osteomyelitis ; Prognosis ; Skin ; Soft Tissue Injuries ; Tibia ; Transplants ; Wounds and Injuries

OBJECTIVES: Auditory verbal hallucination (AVH) is knoun for its high prevalence and difficulty in evaluation. Authors hypothesized that it may be possible to find useful dimensions of AVH that reflect the clinical status of schizophrenic patients by assessing the multi-dimensional changes and linguistic forms' of AVH during antipsychotic treatment. METHODS: 33 schizophrenic patients with AVH were selected and periodically assessed with the 11 items of hallucinations subscale of 'The Psychotic Symptom Rating Scales (PSYRATS)'. In addition, to assess the linguistic forms observed in the AVH, the evaluations of sentence structure of AVH reported by the patients were conducted. RESULTS: PSYRATS showed the multidimensionality inherent in AVH. The changes in the quantitative dimensions did not correlate well with patients' subjective distress. However, qualitative changes in the cognitive and emotional dimensions showed more favorable correlation with clinical course of the patient. The sentence structures of AVH showed tendency to change from "sentence" to "non-sentence" type with overall improvement during treatment. CONCLUSION: Multi-dimensional approach to AVH can give us more information about the changing patterns of multi-faceted structure of AVH and clinical status of patients than one-dimensional or categorical approach.
Hallucinations* ; Humans ; Linguistics ; Prevalence ; Weights and Measures

OBJECTIVES: Auditory verbal hallucination (AVH) is knoun for its high prevalence and difficulty in evaluation. Authors hypothesized that it may be possible to find useful dimensions of AVH that reflect the clinical status of schizophrenic patients by assessing the multi-dimensional changes and linguistic forms' of AVH during antipsychotic treatment. METHODS: 33 schizophrenic patients with AVH were selected and periodically assessed with the 11 items of hallucinations subscale of 'The Psychotic Symptom Rating Scales (PSYRATS)'. In addition, to assess the linguistic forms observed in the AVH, the evaluations of sentence structure of AVH reported by the patients were conducted. RESULTS: PSYRATS showed the multidimensionality inherent in AVH. The changes in the quantitative dimensions did not correlate well with patients' subjective distress. However, qualitative changes in the cognitive and emotional dimensions showed more favorable correlation with clinical course of the patient. The sentence structures of AVH showed tendency to change from "sentence" to "non-sentence" type with overall improvement during treatment. CONCLUSION: Multi-dimensional approach to AVH can give us more information about the changing patterns of multi-faceted structure of AVH and clinical status of patients than one-dimensional or categorical approach.
Hallucinations* ; Humans ; Linguistics ; Prevalence ; Weights and Measures

The management of penetrating injuries of zone II of the neck presents a difficult problem. The difficulties are due to the close anatomical relationships between the many vital structures in the neck and to the insidious nature in which some of the injuries may present themselves, for example, esophageal lacerations. If a significant injury is overlooked, the consequences may be dire with severe complication and mortality. Two management strategies have been developed for coping with these difficult injuries : (1) mandatory exploration of all injuries penetrating the platysma, and (2) a selective approach with neck exploration being performed based on clinical and investigative findings. The aim of this study was to review the clinical characteristics of and the various treatment protocols for II penetrating injuries of the neck. We reviewed retrospectively the medical records of 38 patients who were admitted to and treated at Yongdong Severance Hospital, College of Medicine, Yonsei University, due to penetraing injuries of the neck from Jan. 1990 to Dec. 1996. Twenty-three of the 38 patients (60.5%) underwent immediate operative exploration. In 13 of these patients, the exploration produced positive findings (56.5%), and in 10, the exploration produced negative findings (43.5%). Following neck exploration, 13 patients presenting acutely were found to have 21 injuries. The predominant injuries were vascular followed by neurologic and then respiratory. Eight of the 11 patients (73%) with positive clinical findings were found to have injuries at exploration, and 5 of the 12 patients (42%) with no clinical signs were found to have injuries (p=0.0432). Three of 4 patients (75%) with positive CT scan findings were found to have injuries at exploration and 4 of the 8 patients (50%) with no CT scan findings were found to have injuries (p=0.0455). The complication rate and the performance rate of CT scan were not statistically different between patients with a negative neck exploration and patients with conservative management. The duration of hospitalization was an average of 6.2 days for those patients with a negative neck exploration and 4.1 days for those patients with conservative management (p=0.0022). There was no mortality. In conclusion, it is possible, by careful physical examination and CT scan, it will be possible to reduce the rate of negative neck exploration without risk to those patients who need immediate surgery.
Clinical Protocols ; Hospitalization ; Humans ; Lacerations ; Medical Records ; Mortality ; Neck Injuries* ; Neck* ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed ; Wounds, Penetrating

STUDY OBJECT: Clozapine has been known to induce variety of side effects. Amongst of all, the hematological abnormalities, especially agranulocytosis, has prohibited the wide-spread use of this drug. There have been a lot of efforts to predict the hematological abnormalities based upon the demographical and clinical characteristics. In addition, although only a few, prediction by the initial hemodynamic change was also attempted. This study was carried out as an attempt to find a reliable predictor of clozapine-induced hematological abnormalities based upon the baseline hematological status and the initial hemodynamic change by clozapine. METHOD: Regardless of the diagnosis, the complete blood count data of every patient who had received clozapine in Seoul National University Hospital from 1996 to the present were analyzed. The risk group was defined as the patient whose absolute neutrophil count(ANC) had dropped below 1500mm3 equal or more than 3 times during the one year after clozapine trial. The occurrences of future clozapine-induced hematological abnormalities were predicted by the baseline ANC and the initial ANC change. RESULT: The baseline ANC immediately before clozapine trial, the degree of ANC declining during the first week, and that of ANC rising during the 2nd and 3rd week all showed significant difference between the risk group and the safe group. The likelihood ratio of risk was 7.75(95% confidence interval: 2.77-21.3) implying significant risk of hematological abnormalities when the baseline ANC was below 2000mm3, and the likelihood ratio of risk was 0.372(0.159-0.798) when the baseline ANC was above 4000mm3. In likewise manner, the interval likelihood ratios of risk associated with the ANC rising during the first 3 weeks were calculated. These two predictor variables contributed mutually independent information in predicting future hematological abnormalities. CONCLUSION: The baseline ANC and the initial hemodynamic change after clozapine trial could help predicting future clozapine-induced hematological abnormalities. If the more reliable predictors can be found, prescreening high risk patients using these predictors and the close hematological monitoring of these patients may not only decrease the risk associated with clozapine usage, but also widen the indication of clozapine by relieving much of the burden currently imposed upon the doctors.
Agranulocytosis ; Blood Cell Count ; Clozapine ; Diagnosis ; Hemodynamics* ; Humans ; Neutrophils ; Schizophrenia ; Seoul