Pleuroperitoneal communication-associated pleuritis as an uncommon cause of fever of unknown origin in a child on peritoneal dialysis: a case report

Pleuroperitoneal communication (PPC) is a rare mechanical complication of peritoneal dialysis (PD), which causes dialysate to move from the peritoneal cavity to the pleural cavity, resulting in pleural effusion. Typically, PPC is discovered through pleural effusion in PD patients who are not in volume overload status. A unique characteristic of the pleural effusion caused by PPC is that it is not resolved by increasing ultrafiltration by dialysis. In this report, we present a 7-year-old girl with PD after birth with the history of various infectious PD-related complications, presenting with fever ongoing for 6 months. PPC-associated pleuritis was suspected as the cause of fever, which eventually developed after long-term PD and induced complicated pleural effusion, lung inflammation, and prolonged fever for 6 months.

Assessing Seasonality of Acute Febrile Respiratory Tract Infections and Medication Use / 보건행정학회지

BACKGROUND: Monitoring appropriate medication categories can provide early warning of certain disease outbreaks. This study aimed to present a methodology for selecting and monitoring medications relevant to the surveillance of acute respiratory tract infections, such as influenza. METHODS: To estimate correlations between acute febrile respiratory tract infection and some medication categories, the cross-correlation coefficient (CCC) was used and established. Two databases were used: real-time prescription trend of antivirals, anti-inflammatory drugs, antibiotics using Drug Utilization Review Program between 2012 and 2015 and physicians' number of encounters with acute febrile respiratory tract infections such as influenza outbreaks using the national level health insurance claims data. The seasonality was also evaluated using the CCC. RESULTS: After selecting six candidate diseases that require extensive monitoring, influenza with highly specific medical treatment according to the health insurance claims data and its medications were chosen as final candidates based on a data-driven approach. Antiviral medications and influenza were significantly correlated. CONCLUSION: An annual correlation was observed between influenza and antiviral medications, anti-inflammatory drugs. Suitable models should be established for syndromic surveillance of influenza.

Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose

Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose

Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

BACKGROUND AND OBJECTIVES: Despite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes. METHODS: AMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service. RESULTS: The use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31–0.67; p < 0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71–0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days. CONCLUSION: The use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.

The Trend of Acute Respiratory Tract Infections and Antibiotic Prescription Rates in Outpatient Settings using Health Insurance Data

OBJECTIVE: A significant concern has been raised about the emerging resistance that is largely caused by the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study investigated the trend of respiratory tract infections (RTIs) and the use of antibiotics. METHODS: Utilizing the national level health insurance claims data from 2005 to 2008, we examined encounter days, antibiotic use, and the prescription rate for respiratory tract infections including upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and otitis media in outpatient settings. The antibiotic use was measured as defined daily dose per 1,000 patients per day (DDD/1,000 patients/day). RESULTS: The visit for URTI increased from 141,693,465 in 2005 to 120,717,966 in 2008 and the visit for LRTI decreased from 61,778,718 to 66,930,122. For RTIs, prescription rates of antibiotics decreased from 65.2% to 58.5% for URTIs and 76.9% to 68.3% for LRTIs from 2005 to 2008. The antibiotic use decreased to 20.85 DDD/1,000 patients/day after a significant increase of 22.01 DDD/1,000 patients/day in 2006. Among antibiotics, J01CR had the highest use- 7.93 DDD/1,000 patients/day followed by J01DC of 3.71 DDD/1,000 patients/day and J01FA of 3.2 DDD/1,000 patients/day. One notable trend is that J01FA presented a continuous increase in antibiotic use from 2.3 in 2005 to 3.26 DDD/1,000 patients/day in 2008. CONCLUSION: The use of antibiotics had poor compliance to guidelines for RTIs. Despite decrease in the use of antibiotics, prescription rates for URTIs were still about 50% indicating that the delayed prescribing antibiotics (or wait-and-see) were not observed.

A Qualitative Study of Antibiotic Prescribing Decision of Physicians and Strategy of Antibiotics Prescription

BACKGROUND: Korea has high prescribing rate and rising antibiotic resistance. This study was conducted to understand why primary physicians prescribe antibiotics for acute respiratory infections and to explore the factors that influence antibiotic resistance, and so to suggest strategy to reduce antibiotic resistance. METHODS: A qualitative exploratory approach was used using 4 focus groups composed of physicians from different area. A semi-structured guide was applied in obtaining the physicians' opinions. Common themes were extracted by authors, which were used to gather results and draw conclusion. RESULTS: Participants acknowledged multiple factors such as clinical factor and competitive environment are involved in physicians' decision of antibiotic prescribing. They identified that causes of rising antibiotic resistance were shortage of information, discontinuation of taking antibiotics, and other system factors. CONCLUSION: Participants were certain that less prescribing antibiotics and selecting appropriate antibiotics might be method to reduce antibiotic resistance. To change the prescribing behavior, it should be provided periodically for community physicians with prescribing information and specific guidelines for antibiotics resistance. Patients should be also noticed about antibiotic medication information more accurately. Including prescription incentive policy, improvement of healthcare system will be carried out at the same time.

Inhibitory Effect of Vitamin U (S-Methylmethionine Sulfonium Chloride) on Differentiation in 3T3-L1 Pre-adipocyte Cell Lines

BACKGROUND: S-methylmethionine sulfonium chloride was originally called vitamin U because of its inhibition of ulceration in the digestive system. Vitamin U is ubiquitously expressed in the tissues of flowering plants, and while there have been reports on its hypolipidemic effect, its precise function remains unknown. OBJECTIVE: This study was designed to evaluate the anti-obesity effect of vitamin U in 3T3-L1 pre-adipocyte cell lines. METHODS: We cultured the pre-adipocyte cell line 3T3L1 to overconfluency and then added fat differentiation-inducing media (dexamethasone, IBMX [isobutylmethylxanthine], insulin, indomethacin) and different concentrations (10, 50, 70, 90, 100 mM) of vitamin U. Then, we evaluated changes in the levels of triglycerides (TGs), glycerol-3-phosphate dehydrogenase (G3PDH), AMP-activated protein kinase (AMPK), adipocyte-specific markers (peroxisome proliferator-activated receptor gamma [PPAR-gamma], CCAAT/enhancer-binding protein alpha [C/EBP-alpha], adipocyte differentiation and determination factor 1 [ADD-1], adipsin, fatty acid synthase, lipoprotein lipase) and apoptosis-related signals (Bcl-2, Bax). RESULTS: There was a gradual decrease in the level of TGs, C/EBP-alpha, PPAR-gamma, adipsin, ADD-1 and GPDH activity with increasing concentrations of vitamin U. In contrast, we observed a significant increase in AMPK activity with increasing levels of vitamin U. The decrease in bcl-2 and increase in Bax observed with increasing concentrations of vitamin U in the media were not statistically significant. CONCLUSION: This study suggests that vitamin U inhibits adipocyte differentiation via down-regulation of adipogenic factors and up-regulation of AMPK activity.

Branch-shaped Cutaneous Hypopigmentation and Atrophy after Intralesional Triamcinolone Injection

Cutaneous changes after local corticosteroid administration may include dermal atrophy, hyperpigmentation, alopecia, and hypopigmentation. Linear hypopigmentation and atrophy after intralesional injection of triamcinolone acetonide has been reported in the literature as a very rare side effect. A 30-year-old woman visited our dermatology department for a linear hypopigmented patch with atrophy from her left foot to the lower margin of the knee. The lesion developed after injection of an intralesional corticosteroid. The patient was diagnosed with linear hypopigmentation and atrophy secondary to the triamcinolone injection.

A Case of Ingrown Toenail Associated with Tinea Unguium Treated with K-D(R) Wire / 대한의진균학회지

Ingrown toenail is a common disorder resulting from various etiologies including excessive external pressure, ill-fitting footwear, and improper nail-trimming techniques. Patients commonly present with pain in the affected nail but with progression, drainage, infection and difficulty walking occur. It is often difficult to manage and frequently recurs, despite the multitude of treatment techniques that have been reported. Conservative therapy is a reasonable approach in patients with a mild to moderate ingrown toenail that do not have significant pain, substantial erythema, or purulent drainage from the lateral nail edge. We report a case of ingrown toenail in a 45-year-old female treated with K-D(R) wire, a corrective device. After application of K-D(R) wire for 3 weeks, ingrown toenail healed and the nail deformity was corrected.

A Pilot Study of Q-switched 1064-nm Nd:YAG Laser Treatment in the Keratosis Pilaris

BACKGROUND: Keratosis pilaris (KP) is a keratinization disorder that is characterized by follicular hyperkeratosis, with surrounding erythema. Topical treatments are widely used, but their effects are limited. OBJECTIVE: To evaluate the effectiveness of the Q-switched 1064-nm Nd:YAG laser for the treatment of KP. METHODS: Total of 12 patients with KP were treated with a Q-switched 1064-nm Nd:YAG laser. Ten sessions of laser treatment were delivered once every two weeks. The entire lesions were treated with the following laser settings: 4.0~5.0 J/cm2, 4-mm spot size, and three passes. Two dermatologists' clinical evaluations and patients' satisfaction were assessed between before treatment (baseline) and at 1 month after the last treatment. RESULTS: Eleven of the twelve patients showed more than grade 2 (>25%) improvement in texture and dyspigmentation in KP lesions, respectively. A half of the patients (50%) showed more than 50% improvement in the skin texture. Regarding dyspigmentation, five patients (41.7%) showed more than 50% improvement. Eleven out of twelve participants were satisfied (>25% of the Patients' self assessment) with the procedure. No significant adverse effect was observed. CONCLUSION: Although the Q-switched 1064-nm laser treatment may not be the first line therapy for KP, it might be a new treatment option for the patients with recalcitrant KP.

The Effect of Full Spectrum Light Phototherapy for Patients with Tinea pedis / 대한의진균학회지

BACKGROUND: Tinea pedis is the most common dermatophytosis which is usually treated by antifungal agent. Recently, there has been a resurgence of interest in potential phototherapy for the local treatment of bacterial and fungal infection. OBJECTIVE: The aim of this study is to evaluate the therapeutic effect of full spectrum light (F.S.L) phototherapy for patients with tinea pedis. METHODS: Lesions were irradiated for 20 minutes, 2 times a week for 4 consecutive weeks with F.S.L. emitting wavelengths from 320 nm to 5000 nm. Clinical symptoms were observed and KOH direct smear and fungal culture were done. RESULTS: Global assessment score was improved after the application of eight sessions of F.S.L phototherapy. 18% of total patient were cleared, 45.4% a marked improvement, 27.3% a mild improvement and 9.1% of patients had no effect. And the fungal exams, KOH direct smear and culture, were conversion to negative in 7 out of 11 patients. Significant adverse effects were not observed. CONCLUSION: F.S.L phototherapy might be another treatment option for the tinea pedis patients.

The Therapeutic Efficacy of the Moisturizer APDDR-0801 for Patients with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The patients with atopic dermatitis (AD) show a defective barrier function of the skin and symptoms such as xerosis, pruritus and erythematous lesions with increased transepidermal water loss (TEWL). The choice of topical moisturizer is very significant for AD patients because these symptoms could be relieved by a local moisturizing agent that strengthens the epidermal barrier function. OBJECTIVE: This study was performed to evaluate the effects of the moisturizer APDDR-0801, which contains physiologic lipid granules (DermaON(R)), for relieving the symptoms associated with AD. METHODS: 128 patients (17.8+/-12.1 years) who were suffering from mild to moderate AD topically applied the test moisturizer twice daily for up to 4 weeks. The treatment efficacy was evaluated by the investigator global assessment (IGA) score, the eczema area and severity index (EASI) score, the transepidermal water loss (TEWL), the visual analogue scale (VAS) for pruritus and sleep disturbance, and the level of inflammatory cytokines in the horny layer of the flexural areas. RESULTS: The test moisturizer was well-tolerated and 58.6% of the patients achieved clinical improvements (over moderate) after the application of the test moisturizer for 4 weeks. The significant relief of AD symptoms was observed from 2 week to 4 week in a time-dependent manner. Significant improvements in the signs and symptoms of AD were observed at 4 week, such as the EASI score (37.8% improvement), the TEWL (20.3% improvement in the antecubital fossa lesion), the VAS score for pruritus (26.2% improvement), and VAS score for insomnia (39.7% improvement). CONCLUSION: The moisturizer APDDR-0801 (Atobarrier Cream(R), which contains physiologic lipid granules, effectively relieved the symptoms associated with AD.

HIV-associated Eosinophilic Folliculitis Appearing in a Patient with End-stage AIDS / 대한피부과학회지

HIV-associated eosinophilic folliculitis is characterized by recurrent crops of severely-pruritic follicular papules, pustules and plaques that occur mainly on the face, trunk and upper extremities of AIDS patients. This disease is distinguished from Ofuji's disease by severe pruritus, leukopenia, sparing of the palm and sole and a good response to phototherapy. Up to now, only three such cases have been reported in the Korean literature. A 55-year-old man, who was confirmed as being HIV positive 6 months previously, presented with severely-pruritic, erythematous pinhead to half pea sized papules and nodules on the face, neck and anterior chest. The skin biopsy from a nodular lesion on the face revealed perifolliculitis with a predominant eosinophilic infiltrate.

Clinical Efficacy for 1% Zinc Pyrithione Shampoo for the Treatment of Dandruff / 대한피부과학회지

BACKGROUND: Dandruff is a common complaint, and is suffered by up to 50% of the population at some time. Malassezia yeasts, which comprise part of the normal skin flora, might be a critical factor in this disease, as they have been found in higher proportions in patients with seborrheic dermatitis or dandruff, its milder form. OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of 4 weeks of treatment with 1% zinc pyrithione (ZP) shampoo. METHODS: A randomized, double-blind, 4-week treatment period was preceded by a 1-week run-in period. A total of 30 patients were enrolled in this study. Assessments included the patient's subjective score (PSS) and the investigator's assessment score (IAS), images of the affected scalp area, the severity of sebum production, and the erythema and moisturizing effect of the shampoo. RESULTS: 1% ZP shampoo significantly reduced the extent and severity of scaling, as measured by folliscope imaging on visit 2 (p=0.0391) and visit 3 (p=0.0381), as well as pruritus related to the disease as measured by the grading systems, PSS (p=0.0352) and IAS (p=0.0142). Additionally, the results of this study show that a treatment regimen with 1% ZP shampoo significantly reduced scalp sebum production as measured by a sebumeter. Erythema measured by the chromameter was not as meaningful. The corneometric values were slightly increased in the group treated with 1% ZP shampoo but not in the group treated with ZP-free shampoo. Side effects of the ZP shampoo were quite mild and tolerable, and were observed only in a small group of patients. CONCLUSION: 1% ZP shampoo appears to be both effective and well-tolerated when used for the treatment of dandruff.

A Case of Adult-onset Urticaria Pigmentosa with Bone Involvement / 대한피부과학회지

Urticaria pigmentosa (UP) is the most common variant of cutaneous mastocytosis. Primarily a disease of childhood, in over one-half of the cases onset is before 2 years of age, and in 90%, the disease is confined to the skin. UP precedes the diagnosis of systemic mastocytosis and is more common in adults than in children. Therefore, systemic examination should be performed in patients with UP. We report a case of adult-onset UP with systemic involvement.

A Clinical Study of Androgenic Alopecia (VII) / 대한피부과학회지

BACKGROUND: Androgenic alopecia (AGA) is characterized by the local and gradual transformation of terminal scalp hair into vellus hair, which has a shorter and thinner shaft. It is the most common form of hair loss in people with a genetic predisposition for baldness. OBJECTIVE: The aim of this study was to evaluate the prevalence, AGA type, family history, co-morbidity diseases, stress factors and endocrine factors of AGA patients. METHODS: We examined a total of 432 male and female AGA patients who visited for two years at the Department of Dermatology, School of Medicine, Chung-Ang University. RESULTS: There were 2.06 times more men (291 patients) than women (141 patients) among the study subjects. Most of the men were in their twenties (108, 37.1%), however, most of the women were in their forties (42, 29.7%). In the 291 male patients, Norwood class IIIv was dominant (120 patients, 41.2%). In the 141 female patients, Ludwig class I was dominant (87 patients, 61.7%). 219 (75.2%) of the 291 male patients and 81 (73.6%) of the 141 female patients had a family history of AGA. 224 (76.9%) of the 291 male patients and 101 (53.4%) of the 141 female patients had a co-morbidity disorder. The most common among these disorders in both the male and female patients was seborrheic dermatitis. Stress factors were observed in 162 (55.6%) of the 291 male patients and in 78 (55.3%) of the 141 female patients. The most common stress factor in both the male and female patients was work tasks. The serum testosterone levels was increased in 51 (17.5%) of the 291 male patients and in 20 (14.1%) of the 141 female patients. CONCLUSION: Most of the study results are compatible with those of our previous study. Yet the following results were different: (1) the number of female AGA patients in their forties is increasing; and (2) stress was found to be associated with AGA in both the male and female patients.

A Clinical Study of Androgenic Alopecia (VII) / 대한피부과학회지

BACKGROUND: Androgenic alopecia (AGA) is characterized by the local and gradual transformation of terminal scalp hair into vellus hair, which has a shorter and thinner shaft. It is the most common form of hair loss in people with a genetic predisposition for baldness. OBJECTIVE: The aim of this study was to evaluate the prevalence, AGA type, family history, co-morbidity diseases, stress factors and endocrine factors of AGA patients. METHODS: We examined a total of 432 male and female AGA patients who visited for two years at the Department of Dermatology, School of Medicine, Chung-Ang University. RESULTS: There were 2.06 times more men (291 patients) than women (141 patients) among the study subjects. Most of the men were in their twenties (108, 37.1%), however, most of the women were in their forties (42, 29.7%). In the 291 male patients, Norwood class IIIv was dominant (120 patients, 41.2%). In the 141 female patients, Ludwig class I was dominant (87 patients, 61.7%). 219 (75.2%) of the 291 male patients and 81 (73.6%) of the 141 female patients had a family history of AGA. 224 (76.9%) of the 291 male patients and 101 (53.4%) of the 141 female patients had a co-morbidity disorder. The most common among these disorders in both the male and female patients was seborrheic dermatitis. Stress factors were observed in 162 (55.6%) of the 291 male patients and in 78 (55.3%) of the 141 female patients. The most common stress factor in both the male and female patients was work tasks. The serum testosterone levels was increased in 51 (17.5%) of the 291 male patients and in 20 (14.1%) of the 141 female patients. CONCLUSION: Most of the study results are compatible with those of our previous study. Yet the following results were different: (1) the number of female AGA patients in their forties is increasing; and (2) stress was found to be associated with AGA in both the male and female patients.

Comparison of Therapeutic Effect of High Dose Corticosteroid Pulse Therapy and Combination Therapy of Cyclosporine with Low Does Corticosteroid for Severe Alopecia Areata / 대한피부과학회지

BACKGROUND: Severe alopecia areata (AA) is difficult to treat. Treatment modalities such as topical and systemic immune modulators, corticosteroids and topical sensitizers have been tried. Among them, encouraging RESULTS have been reported with high dose pulse corticosteroid therapy. OBJECTIVE: The aim of this study was to determine the effectiveness of a high dose corticosteroid pulse therapy in patients with severe AA compared with a group treated with oral cyclosporine with low dose corticosteroid. METHODS: A total of 105 patients with severe AA were treated with high dose corticosteroid pulse therapy and 41 patients those were treated with oral cyclosporine (3~5 mg/kg/day) with low dose methylprednisolone (2.5~5 mg/day). RESULTS: Therapeutic effect of high dose corticosteroid pulse therapy was better in shorter disease duration (6~12 months, 52.6%;>13 months, 37.3%) and less extensive type (AA multiplex, 80.0%; alopecia totalis, 41.2%; alopecia universalis, 27.8%). Therapeutic effect of oral cyclosporine with low dose corticosteroid therapy was better in less extensive type (AA multiplex, 75.0%; alopecia totalis, 41.2%; alopecia universalis, 25.0%). Disease duration did not significantly affect treatment response. High dose corticosteroid pulse therapy was more effective method (65.7%) than combination regimen of oral cyclosporine with low dose methylprednisolone (46.3%), especially in the case of shorter disease duration (p<0.05). CONCLUSION: High dose corticosteroid pulse therapy might be a more effective therapy for severe AA than other treatments, especially when in the acute stage (<6 months).

The protective effect of melatonin administration against adriamycin-induced cardiotoxicity in rats

Adriamycin is a commonly used chemotherapeutic agent for cancer, including acute leukemia, lymphoma, and a number of solid human tumors. However, recent studies have recognized severe cardiotoxicity after an acute dose, which are likely the result of generation of free radicals and lipid peroxidation. Therefore, the clinical uses of adriamycin have been limited. Melatonin, the pineal gland hormone known for its ability to modulate circardian rhythm, has recently been studied in its several functions, including cancer growth inhibition, stimulating the immune system, and acting as an antioxidant and radical scavenging effects. In the present study, we evaluated the effect of melatonin administration on adriamycin-induced cardiotoxicity in rat. Heart slices were prepared using a Stadie-Riggs microtome for the measurement of malondialdehyde (MDA) content used as an index of lipid peroxidation and lactate dehydrogenase (LDH) release as an indicator of lethal cell injury. Serious adriamycin-induced lethality was observed in rat by a single intraperitoneal injection in a dose-dependent manner. A single injection of adriamycin (25 mg/kg, i.p.) induced a lethality rate of 86%, with melatonin (10 mg/kg s.c. for 6 days) treatment reducing the adriamycin-induced lethality rate to 20%. The severe body weight loss caused by adriamycin was also significantly attenuated by melatonin treatment. Treatment of melatonin marked reduced adriamycin-induced the levels of MDA formation and LDH release. A cell damage indicated by the loss of myofibrils, swelling of the mitochondria as well as cytoplasmic vacuolization was seen in adriamycin-treated group. Melatonin attenuated the adriamycin-induced structural alterations. These data provide evidence that melatonin prevents adriamycin-induced cardiotoxicity and might serve as a combination with adriamycin to limit free radical-mediated cardiotoxicity.