Clinical features of 28 acutely toxic hepatitis patients who ingested Dictamnus dasycarpus: A single center clinical experience / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to investigate the clinical features of acutely toxic hepatitis associated with ingesting Dictamnus dasycarpus (D. dasycarpus). METHODS: Between January 2004 and July 2009, 28 patients were enrolled in this study. We reviewed the medical records retrospectively. Acutely toxic hepatitis associated with D. dasycarpus was diagnosed by a Roussel Uclaf Causality Assessment Method Values (RUCAM) score of 6 or above. All patients were tested for viral hepatitis A, B, C, cytomegalovirus, and Epstein-Barr virus. Other tests included anti-nuclear antibody, anti-mitochondrial antibody, and anti-smooth muscle antibody. Abdominal pelvic computed tomography was performed. RESULTS: The incidence was female predominant (64% vs. 36%). The mean patient age was 53.0+/-11 years. The symptoms were jaundice (68%), fatigue (57%), nausea (43%), anorexia (43%), and abdominal pain (24%). The mean RUCAM score was 7.0+/-0.8. The biochemical patterns of hepatotoxicity were hepatocellular (n=23, 82%) and mixed types (n=5, 18%). Radiologic findings were as follows: normal findings (29%), lymphadenopathy (50%), edema of the gall bladder wall (46%), periportal edema (43%), splenomegaly (11%), fatty liver (11%), and ascites (7%). The mean hospitalization period was 21.6+/-11.6 days. The mean duration of recovery from hepatitis was 56.6+/-30.4 days, and all patients recovered completely from the toxic hepatitis. One patient who had severe jaundice developed a complication of pure red cell aplasia during the hospitalization period. CONCLUSIONS: The biochemical pattern of liver injury was hepatocellular predominant. Although the initial manifestations and clinical course were variable, all patients completely recovered with supportive care or steroid treatment. Toxic hepatitis was accompanied by pure red cell aplasia in one patient.

Oxaliplatin and Leucovorin Plus Fluorouracil Versus Irinotecan and Leucovorin Plus Fluorouracil Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Adenocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: We performed retrospective study in order to compare oxaliplatin, leucovorin, and fluorouracil (FOLFOX) versus irinotecan, leucovorin, and fluorouracil (FOLFIRI) in recurred or metastatic gastric adenocarcinoma. METHODS: We investigated 56 patients who were diagnosed with recurred or metastatic gastric adenocarcinoma in a single center during march, 2003 to march, 2008. The patients received either FOLFOX or FOLFIRI chemotherapy. RESULTS: There were no significant difference between the Oxaliplatin group (30 patients) and Irinotecan group (26 patients) in sex, age, and ECOG performance (p>0.05). Oxaliplatin group showed 1 case of CR (3.3%) and 12 cases of PR (40%), making the response rate 43.3%. Irinotecan group showed CR in 2 cases (7.7%) and PR in 10 cases (38.5%), making the response rate 46.2%. The median value of time to progression was 4 months in the oxlaplatin group and 4.5 months in the irinotecan group. The overall survival showed no significant difference (p=0.784), with the irinotecan group (9.7 months) being slightly longer than the Oxaliplatin group (8.3 months). Grade 3/4 neutropenia occurred similarly in both groups (4 cases in the oxalplatin group, 9 in the irinotecan group). CONCLUSIONS: Both combination treatment can be used safely and effectively in recurred or metastatic gastric adenocarcinoma.

Differential Immunohistological Features of Inflammatory Myopathies and Dysferlinopathy

This study was performed in order to characterize the types of the infiltrating cells, and the expression profiles of major histocompatibility complex (MHC) class I and membrane attack complex (MAC) in patients with inflammatory myopathies and dysferlinopathy. Immunohistochemical stains were performed using monoclonal antibodies against several inflammatory cell types, MHC class I, and MAC in muscles from inflammatory myopathies and dysferlinopathy. There was significant difference in the types of infiltrating cells between polymyositis (PM), dermatomyositis (DM), and dysferlinopathy, including significantly high CD4+/CD8+ T cell ratio and B/T cell ratio in DM. In dysferlinopathy, CD4+ T cells were the most abundant and the proportions of infiltrating cell types were similar to those of DM. MHC class I was expressed in muscle fibers of PM and DM regardless of the presence of inflammatory infiltrates. MAC was expressed in necrotic fibers and vessels of PM and DM. One patient with early stage DM had a MAC deposits on endomysial capillaries. In dysferlinopathy, MAC deposit was also observed on the sarcolemma of nonnecrotic fibers. The analysis of inflammatory cells, MHC class I expressions and MAC deposits may help to differentiate dysferlinopathy from idiopathic inflammatory myopathy.

Characteristics of Heart Rate Variability Among Adults with Metabolic Syndrome

OBJECTIVES: The authors tried to investigate the characteristics of Heart Rate Variability(HRV) among the subjects with metabolic syndrome for testing the possibility of clinical application of HRV in evaluating metabolic syndrome. METHODS: We examined the difference of the means of HRV between 122 subjects of metabolic syndrome and 1057 healthy controls using T-test, and the change of means in HRV according to increasing risk factors of metabolic syndrome. Using multiple regression analysis, we examined the association of HRV with the risk factors of metabolic syndrome. RESULTS: The HRV indices including SDNN(Standard Deviation of all normal NN intervals), RMSSD(the square Root of the Mean Squared Differences of successive all normal NN interval), TP(Total Power), LF(Low Freuency), and HF(High Frequency) were significantly lower in the metabolic syndrome group than in the normal control group, and the means of all HRV indices except LF/HF were decreased consistently according to increasing risk factors of metabolic syndrome. The fasting glucose, triglyceride, and waist circumference were dependent factors that contributed significantly to the change of HRV. CONCLUSION: These findings suggest metabolic syndrome adversely affects cardiac autonomic system and HRV could be a useful method for evaluating metabolic syndrome.

Clinical characteristics of 159 cases of acute toxic hepatitis / 대한간학회지

BACKGROUNDS/AIMS: Toxic hepatitis has recently been discovered to be a major cause of acute hepatitis. We studied the clinical features and prognosis of patients diagnosed with toxic hepatitis at a single institution. METHODS: A retrospective analysis was performed using medical records of 159 cases of toxic hepatitis that were diagnosed from March 2003 to March 2008. Patients were selected based on a RUCAM score of 4 or above. RESULTS: The incidence was higher in women (n=97) than in men (n=62). The age (mean+/-SD) of the patients was 51+/-15 years . The major causes of the disease included the use of Korean traditional therapeutic preparations (34.0%), herbal medicines (41.5%), and drugs prescribed by a physician (23.9%). At the time of admission, jaundice was the most common symptom (41.5%), and the results of a liver serum battery were as follows: aspartate aminotransferase, 729.4+/-877.0 IU/L; alanine aminotransferase, 857.1+/-683.0 IU/L; total bilirubin, 6.4+/-6.5 mg/dL; and alkaline phosphatase, 209.8+/-130.0 IU/L. The hospitalization period was 10.0+/-9.5 days, and the duration of recovery from liver injury was 31.0+/-29.5 days. The factors associated with the hospitalization period included the presence of anorexia and the serum levels of albumin and bilirubin at the time of admission (P<0.05). A high serum bilirubin level and a history of alcohol ingestion were associated with a delayed recovery (Plt;0.05). The sex, age, BMI, and duration of medication were not significantly related to the hospitalization and recovery periods. CONCLUSIONS: The main cause of acute toxic hepatitis in the current study was the use of herbal medicines. The severity of liver injury at the time of admission was a major factor significantly associated with the hospitalization and recovery periods.

Efficacy of initial treatment with peginterferon alpha-2a versus peginterferon alpha-2b in combination with ribavirin in naive chronic hepatitis C patients living in Daejeon and Chungcheong Province in Korea: A comparative study / 대한간학회지

BACKGROUNDS/AIMS: Peginterferon alpha-2a or -2b is the standard treatment regimen in chronic hepatitis C. However, there have been few comparative studies of the efficacies of these two types of peginterferon. We evaluated their efficacies in combination with ribavirin as a initial treatment for chronic hepatitis C. METHODS: Ninety-seven patients were treated with peginterferon alpha-2a (180 microgram/week, n=48) or peginterferon alpha-2b (1.5 microgram/kg/week, n=49) plus ribavirin (800 mg/day for 24 weeks in genotype non-1 or 1,000-1,200 mg/day for 48 weeks in genotype 1). Virologic responses including the early virologic response (EVR), end-of-treatment response (ETR), sustained virologic response (SVR), and adverse effects were analyzed retrospectively. RESULTS: The virologic response rates did not differ significantly between peginterferon alpha-2a and -2b: 89.6% and 89.7% for EVR, 79.2% and 79.5% for ETR, 72.9% and 73.5% for SVR, respectively. Analysis of the virologic responses according to genotype also revealed no significant differences in SVR between peginterferon alpha-2a and -2b (59.3% vs. 59.7% for genotype 1 and 90.5% vs. 83.3% for genotype non-1, respectively), or in adverse effects including flu-like symptom, rash, itching, neutropenia, and thrombocytopenia. CONCLUSIONS: We found no significant differences in therapeutic efficacies and adverse effects between the alpha-2a and -2b types of peginterferon as the initial treatment regimen in naive chronic hepatitis C patients.

The effect of curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer / 대한내과학회지

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. METHODS: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. RESULTS: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. CONCLUSIONS: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.

Abnormalities of liver function tests in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: Abnormalities of liver function tests are common in patients with hyperthyroidism and may reflect thyroid hormone status. The aim of our study was to analyze the frequency of abnormal liver function tests in the patients with hyperthyroidism at diagnosis and the association with the thyroid function state after antithyroid therapy. METHODS: Three hundred seventy eight patients with hyperthyroidism who visited Chungnam National University Hospital from June 2004 to May 2005 and had no other causes for abnormal liver function tests were examined. At diagnosis, 272 of 378 patients had various abnormalities seen on the liver function tests. Among 272 patients, 65 were followed up for liver function tests and were analyzed for sex, age, use of an antithyroid drug, and thyroid function tests after administration of an antithyroid drug. We analyzed the frequency of liver function abnormalities and the relevance between abnormalities of liver function and the thyroid function state. RESULTS: Abnormalities in AST, ALT, total bilirubin, alkaline phosphatase and GGT were observed in 16.4%, 31.0%, 3.2%, 48.7% and 26.9% of the 378 patients with hyperthyroidism, respectively. The level of alkaline phosphatase was the most common abnormal parameter. After antithyroid therapy, 48 (73.8%) of 65 patients had normalization of their liver function abnormalities. The normalization rate for AST, ALT, alkaline phosphatase and GGT were higher in the euthyroid status group than the sustained hyperthyoid status group. The normalization rate for ALT was significantly higher in the female group than in the male group, but the effect of antithyroid drug use and age on the normalization rate was not statistically significant. CONCLUSIONS: These findings indicate that abnormalities of liver function tests are common in patients with hyperthyroidism and these abnormalities are strongly associated with thyroid hormone status.

Docetaxel-Cisplatin-5-FU Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.

Surgical orthodontic treatment of skeletal Class III malocclusion using mini-implant: correction of horizontal and vertical dental compensation / 대한치과교정학회지

Treatment of skeletal Class III malocclusion with mini-implant anchorage is discussed in relation to vertical control of the maxillary posterior dentoalveolar region and horizontal control of mandibular anterior teeth. A midpalatal mini-implant provided anchorage for intruding the maxillary posterior teeth. Mandibular mini-implant implants were used to bring about labioversion of mandibular anterior teeth. After mandibular setback surgery, improvement of the facial profile was obtained both horizontally and vertically. Total treatment time was 11 months. Stable occlusion was maintained after 18 months of retention. The effectiveness and efficacy of mini-implants for the treatment of skeletal Class III malocclusion are also discussed.

Effects of Postoperative Patient Controlled Epidural Analgesia in Pediatric Patients Undergoing Lower Extremity Surgery / 대한마취과학회지

BACKGROUND: A limited number of studies have been conducted on postoperative epidural analgesia in pediatric patients. There have been primarily dealt with spinal or abdominal surgeries where multiple dermatomal segments needed to be blocked and morphine was given either through the caudal approach or by direct catheter placement. This study evaluated the safety and efficacy of postoperative continuous patient controlled epidural analgesia (PCEA) in children undergoing lower extremity surgery using a bupivacaine and fentanyl via lumbar approach. METHODS: The patient population consisted of 40 children ranging in age from 5 to 12 years. Patients were randomly divided into two groups according to postoperative pain relief regimen; the control group received an intramuscular injection of ketorolac 1 mg/kg t.i.d. and meperidine 0.5 mg/kg p.r.n., and the epidural group received PCEA (0.1% bupivacaine + fentanyl 2 microgram/ml) through an epidural catheter positioned at the surgical dermatomal level of the spinal cord. In the epidural group the volume of the initial dose was 1 ml/segment in children 10 years of age. The basal infusion rate was 0.1 ml/kg/hr (bolus: 0.05 ml/kg, lockout time: 30 minutes). Pain scores were measured upon arrival at the ward, and 6 and 24 hours thereafter. RESULTS: The epidural group had significantly lower pain scores and minimal side effects. A significant correlation was observed between the bolus number and the incidence of nausea/vomiting in the epidural group. CONCLUSIONS: This study shows that PCEA targeted at the surgical dermatome is a safer and more effective regimen for postoperative pain relief than conventional postoperative pain relief in pediatric patients undergoing lower extremity surgery.

Propofol for Ambulatory Laryngomicrosurgery Using Bispectral Index Monitoring: Nitrous Oxide Does Not Significantly Affect Postanesthetic Recovery and Emetic Sequelae / 대한마취과학회지

BACKGROUND: Although nitrous oxide (N2O) is used commonly during anesthesia, the roles of N2O in postanesthetic recovery and emetic sequelae are not well established in the ambulatory surgery. The goal of this study was to compare outcomes in patients anesthetized with propofol/air versus propofol/N2O using BIS. METHODS: Patients for ambulatory laryngomicrosurgery were randomly allocated to the group of anesthesia with propofol/air (Air, n = 44) or propofol/67% N2O (N2O, n = 44). The target concentration of propofol was controlled to maintain the BIS values between 35 and 40. By the end of surgery, anesthetics were discontinued and the time to eyes-open (TTEO) on verbal command was measured. The BIS values, effect site concentration (ESC), and total propofol doses were measured at eyes-open. Time to first drink (TTD), walk (TTW), and PONV were evaluated by blinded observers in the phase II recovery room. All data were analyzed using the student t-test and the Chi-Square Test. RESULTS: In the Air group, TTEO was significantly shorter than in the N2O group (7.6+/-3.1 min vs 9.5+/-2.3 min) despite the higher ESC of propofol (1.8+/-0.4 mcg/ml vs 1.5+/-0.3 mcg/ml). The propofol doses, BIS scores at eyes-open, TTD and TTW, and the incidence of PONV were no different in the two groups. Females showed faster emergence from anesthesia than males in the operating room, but showed slower recovery in the phase II recovery room. CONCLUSIONS: N2O does not affect significantly postanesthetic recovery and emetic sequelae. Since N2O has no effect on BIS values, propofol doses may be titrated accordingly.

Pulmonary Lobar Collapse after the Induction of Anesthesia: A Case Report / 대한마취과학회지

Although segmental or subsegmental atelectasis may occur during anesthesia, mucous plugging of a mainstem bronchus has been uncommonly reported in anesthetized patients with chronic respiratory disease. However, pulmonary atelectasis following mucous plugging may rarely result normal patients. We report this case of an allegedly healthy patient was developed a left main stem bronchus obstruction, resulting in subsegmental collapse of left lower lung after the induction of general anesthesia.

Analysis and Prediction of Length of Stay in the Postanesthetia Care Unit / 대한마취과학회지

BACKGROUND: Optimal control for the management of the length of stay in the postanesthesia care unit (PACU) following general anesthesia in adults is an important strategy for surgical patients' care. A model to predict the results of the PACU stays could be used to improve the utilization of the PACU and resources of the operating room through a more efficient arrangement. The purpose of this study was to evaluate the performance of the decision tree based analysis using clinical sets of data from adult patients undergoing general anesthesia. METHODS: The decision tree was trained with 351 clinical sets (86% in 409 data sets) using a Chi-squared automatic interaction detection (CHAID) algorithm and validated through independent testing of 58 cases (14%). Twenty-two independent variables were used to find determinant variables and to predict categorical dependent values (lengths of stay in the PACU). RESULTS: The decision tree based analysis correctly predicted in 68% of real situations and identified influencing variables as intubation state, complication in the PACU, and intraoperative transfusion. CONCLUSIONS: We concluded that the decision tree based analysis could provide a useful predictive and classifying model for the optimization of limited resources of the PACU. The decision tree based analysis is an alternative way of classifying, and a predicting method for developing a model for lengths of stay in the PACU with easy interpretation and clear graphical displays of the structure of variables.

Effects of general and locoregional anesthesia on reproductive outcome for in vitro fertilization: a meta-analysis

The objective of this meta-analysis was to evaluate prospective trials of general or locoregional anesthesia on reproductive outcomes (cleavage and pregnancy rate) for in vitro fertilization (IVF). Of 115 published studies retrieved from a search of articles indexed on MEDLINE from 1966 to February 1999, four studies with distinct general and locoregional anesthesia were deemed eligible for meta- analysis. The pooled relative risk and odds ratios were calculated. A test for homogeneity was also performed. The pooled log odds ratio was 1.03 (95% CI 0.90-1.18) in cleavage rate and 0.71 (95% CI 0.47-1.08) in pregnancy rate. Heterogeneity was negative. Cleavage and pregnancy rates were not significantly different in both the general anesthesia and locoregional anesthesia groups. Both anesthetic techniques were favorable to IVF procedure by available published evidence when anesthesia was needed.

Association between the Alleles of the Dopamine D, Receptor and Schizophrenia

The results regarding an association between the polymorphism sites in the dopamine D1 receptor gene and schizophrenia compelled us to study the distribution of the polymorphism in Korean schizophrenia and controls. Eighty-eight schizophrenic patients and normal controls were examined by case-control study for distribution of the polymorphism of the dopamine D1 receptor gene in Korean popualtion to minimize the effect of racial differencies in gene frequencies. The frequencies of the B1 and B2 in schizophrenic patients were 0.11 and 9.89, respectively. And 0.10 and 0.90 in normal control. There was no significant differences in the frequencies in the allele B1 and 2 between schizophrenic patients and normal controls. The author present here the evidence of a lack of alleic association between the polymorphism of the dopamine D1 receptor gene and Korean schizophrenic. The assumption that the dopamine D1 receptor gene has genetic role in the development of schizophrenia was not supported by this case-control study.

Morphological Studies on the Rabbits Ciliary Epithelium by Bunazosin

Bunazosin is a alpha-1 blocker that is more selective and effective than other alpha-1 receptor blockers. Bunazosin has been shown to lower intraocular pressure but it's mechanism is uncertain. The purpose of this study is to know the morphological changes in the ciliary epithelium by bunazosin. 0.1% Bunazosin was instilled on the eye of the rabbits and the eyes were enucleated on 1, 2, 6 and 24 hours after instillation to find out the tissue response under the electronmicroscopy. As a result, widening of the cell membranes and swelling of the mitochondria were observed in the pigmented and non-pigmented epithelium and these changes were recovered with time and seem to be the morphological changes of bunazosin against aqueous formation in the ciliary body.