Efficacy and Safety of Entacapone in the Patients with Parkinson's Disease Experiencing Wearing-off Phenomenon: Multicenter Randomized Placebo-controlled Double Blind Study

BACKGROUND: The purpose of this study was to assess the efficacy and safety of entacapone, a catechol-O-methyltransferase (COMT) inhibitor in Parkinson's disease (PD) patients with wearing-off phenomenon. METHODS: A total of 197 PD patients were included in this 2-month multi-center, randomized, placebo-controlled, double blind, parallel-group study. After a 2-week screening period, each patient was randomly allocated to receive either entacapone (n=98) or placebo (n=99) as an adjunct to levodopa. The efficacy was evaluated with the changes of "on" and "off" time percentage while awake, the reduction of the levodopa dose, Unified Parkinson's Disease Rating Scale (UPDRS), and the clinical global impression (CGI) by the examiner. RESULTS: The percentage of "on" time increased by 9.4 +/- 18.0% in the entacapone group, 7.4 +/- 15.6% in the placebo group. The percentage of "off" time was reduced by 8.6 +/- 16.9% in the entacapone group, 6.6 +/- 18.2% in the placebo group. These parameters did not show a statistical significance between the two groups. However, the levodopa dose was significantly reduced in the entacapone group (51.6 +/- 154.5 mg/day) compared with the placebo group (0.7 +/- 130.0 mg/day) (p=0.009). The total and motor scores of the UPDRS were significantly decreased in the entacapone group (p=0.039, p=0.017, respectively). The most common adverse drug reactions in the entacapone group were urine discoloration (22%), dyskinesia (13%), dizziness (7%). CONCLUSIONS: Entacapone was a safe and well-tolerated drug. Although the changes of "on" and "off" time were not significant, entacapone showed an overall significant beneficial effect in the PD patients with wearing-off phenomenon.

Sensory Symptoms in Amyotrophic Lateral Sclerosis

Objective & BACKGROUND: It has been recognized that sensory symptom is one of the important exclusion criteria for diagnosis of ALS. However, sensory symptoms are occasionally complained of by some patients with ALS and there have been several reports on pathologic evidence of degeneration in sensory pathways. Therefore the authors performed the study to evaluate the sensory symptoms in patients with ALS and to analyze the cause of sensory abnormalities. Method : The clinical and laboratory data of seventy-seven ALS patients were obtained including history, neurologic examination, cervical magnetic resonance imaging, and electrophysiologic study. We evaluated the nature of subjective sensory symptoms and analyzed underlying causes for these abnormalities. Result : The onset age of 77 patients was between 19 and 75 years(mean age=49.5).. Twenty-five of 77 subjects (32.5%) complained of sensory symptoms such as paresthesia and tingling sensation. On neurologic examination Four patients (5.2%) had objective sensory change such as hypesthesia, decreased vibration sense. Five of 25 patients with sensory symptoms had superimposed underlying disease : cervical radiculopathy in 4, peripheral neuropathy in 1. Four of 37 patients showed central conduction defect on sensory evoked potential studies. Therefore in some patients, abnormalities in central sensory pathways are thought to be responsible for their sensory symptoms. Conclusion : The patients with ALS may have sensory abnormality although objective findings are rarely noted. Therefore coexistence of sensory symptoms does not exclude ALS. The presence of cervical radiculopathy, peripheral neuropathy and degeneration on central sensory pathways were thought to be the possible causes of their sensory symptoms.

Natural History of MSA-Clinical Evidence for Single Disease entity

BACKGROUND & OBJECT10NS: Multiple system atrophy(MSA) is a heterogenous system disorder affecting extrapyramidal, cerebellar and autonomic nervous system. Clinical spectrum is broad, and depending on the system affected, patients are classified into striato-nigral degeneration (SND), olivo-ponto-cerebellar atrophy (OPCA) and Shy-Draper syndrome (SDS). However, evolution of symptoms during follow-up usually occurs, stirring up a debate between "lumpers" and "splitters". Recent pathological documentation of intracytoplasmic inclusions support "lumpers" that MSA is a specific disease entity with specific pathology. The study was done to analyze the natural course of MSA, and examine whether they are separate or part of the same disease. METHOD: We obtained the clinical data of patients with clinically probable MSA by the criteria of Quinn (1994). In addition to review of medical records, all patients were phone-interviewed or examined personally. RESULTS: Forty four patients were included in the study (male 23, female 21). Mean onset age 52.9 years, and mean follow-up period 19.7 months. Nine patients died during follow-up (mean disease duration 5.2 years). The initial predominant features were parkinsonism in 40% (14/35), cerebellar dysfunction in 25.7% (9/35), autonomic dysfunction in 17.1% (6/35) and others in 17.1%. At the latest follow-up, parkinsonism were noted in 77.1%, cerebellar dysfunction in 88.6% and autonomic dysfunction in 80%. With progression, all the patients showed mixed clinical manifestations, the most common being combination of all 3(60%). CONCLUS10N: The data supports that SND, OPCA and SDS are part of the same disease process.

Experimental study of laser assisted microvascular anastomosis(lama) using the Nd:YAG laser contact laser

No abstract available.

Treatment of traumatic gap in long bones / 대한정형외과학회잡지

Recently there has been a noted increase in the incidence of traumatic bony gap in long bones due to accidents in industry, high speed traffic accidents and common gunshot accidents. There are several methods to treat traumatic bony gap such as bone graft (autogenous, homogenous and heterogenous), bone transplantation, periosteal osteogenesis and reinplantation of the extruded bone etc. The authors studied 26 patients of traumatic bony gap in the long bones which had been treated by autogenous bone grafting. The results of the clinical observation were as following; 1 The causes were shotgun accidents, vehicle accidennts and explosive accidents. 2 There was bony gap involved in 10 upper extremities and 16. lower extremities. The radius was the most common site in the upper extremity and the femur in the lower extremity. 3. The largest bony gaps were 10.5cm. in the tibia and next were 10.6cm. in ulna and 9.0cm. im humerus. 4. The period of the bony union in these cases was prolonged 1.5~3 times the usual healing period of simple fractures. 5. It was very important to prevent and control infection of the open fractures and to decide the correct time for bone grafting operation after healing of the infected wounds. We did the bone grafting sugery 2 or 3 months later after the infected wounds had been healed. 6 The authors could avoid some complications such as delayed union, shortening of the affected limbs and stiffness of the joints of the affected limbs etc.

Clinical Study on Recurrent Dislocation of the Shoulder: Treated with Putti-Platt Operation / 대한정형외과학회잡지

The clinical study on recurrent dislocation of the shoulder was performed on fourteen cases who were treated by Putti-Platt operation from July 1967 to November 1968. The cases studied were treated at the 17th Army Hospital in Kwang-ju and U.S. 121st Evacuation Hospital in Bu-pyung. Ages in initial dislocation were varied from 11 to 25 with an average of 18 years. Five cases of them were recurred over ten times prior to operation. On radiological findings, Hill-Sachs lesion has been revelaed in 57.1%. On pathological finding, Bankart lesion was seen in 78.5% and detachment of the glenoid labrum with capsular separation in 28.6%. No recurrence has been encountered in this s ries, and average rarige of abduction was gained upto 165 and external rotation 30°.