PURPOSE: Hyperhomocysteinemia has been identified as an independent risk factor in arterial and venous thrombosis. Mutations in genes encoding methylenetetrahydrofolate reductase (MTHFR), involved in the metabolism of homocysteine, may account for reduced enzyme activity and elevated plasma homocysteine levels. In this study, we investigated the interrelation of MTHFR C677T genotype and level of homocysteine in patients with arterial and venous thrombosis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 146 patients who were diagnosed as having arterial and venous thrombosis. We excluded patients diagnosed with atrial fibrillation. We examined routinely the plasma concentration of total homocysteine level and MTHFR C677T polymorphism for evaluation of thrombotic tendency in all patients. Screening processes of MTHFR C677T polymorphism were performed by real-time polymerase chain reaction. RESULTS: Investigated groups consisted of thrombotic arterial occlusion in 48 patients and venous occlusion in 63 patients. The distribution of the three genotypes was as follows: homozygous normal (CC) genotype in 29 (26.1%), heterozygous (CT) genotype in 57 (51.4%), and homozygous mutant (TT) genotype in 25 (22.5%) patients. There were no significant differences among individuals between each genotype group for baseline characteristics. Plasma concentration of homocysteine in patients with the TT genotype was significantly increased compared to the CC genotype (P<0.05). CONCLUSION: We observed a significant interaction between TT genotypes and homocysteine levels in our results. The results might reflect the complex interaction between candidate genes and external factors responsible for thrombosis.
Atrial Fibrillation ; Genotype ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Mass Screening ; Medical Records ; Metabolism ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Plasma* ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Risk Factors ; Thrombosis ; Venous Thrombosis

PURPOSE:This study was carried out to evaluate the relationship with other clinicopath ologic factors and prognostic significance of tumor microvessel density in colorectal car cinoma. MATERIAL AND METHODS: 71cases of primary colorectal carcinoma (Modified Astler-Coller stage B and C) were analysed retrospectively who underwent curative resection at Wonkwang university hospital from September, 1991 to September, 1993. Male was 39cases. Age under 60 years was 31cases. 5 year survival rates were 80% (50 cases) in stage B and 52.4% (21 cases) in stage C. Tumor microvessels were stained by immuno histochemical method using anti-CD31 on paraffine embedded tissues, and were counted within 10x objective field (about 0.74 mm2) in the area of the most intense neovascu larization. RESULTS: Mean microvessel Density (MVD) was 56.3+/-18.0 (range 19~128). MVD was 55.2 in 11 cases of nonrecurrent group and 73.5 in 10 cases of recurrent group in stage C (p=0.012). There was no significant association between MVD and other parameters such as age, sex, tumor location and size, CEA, lymph node metastasis, and survival. The 5 year survival rates of 33 cases of MVD< or =56 and 38 cases of MVD>56 were 84.9 and 60.5% respectively(p<0.05). 5 year survival rates of MVD< or =56 groups adjusted for age, sex, tumor location, differentiation, and recurrence were higher than those of >56 groups. 5 year survival rates of MVD < or =56 and >56 groups in stage C were 100% (5 cases) and 37.5% (16 cases) (p<0.05). CONCLUSION:Tumor microvessl density may have somewhat prognostic significance in colorectal carcinoma.
Colorectal Neoplasms* ; Humans ; Lymph Nodes ; Male ; Microvessels* ; Neoplasm Metastasis ; Paraffin ; Recurrence ; Retrospective Studies ; Survival Rate

We studied the age of onset, occupation, inducing or aggravating factors, distribution of skin lesions in 153 patients and recall antigen test in 15 patients of seborrheic dermatitis. The results were as follows : l. Seborrhic dermatitis occurred most frequently at the third decade and the number of patients was 1(0.7%) in the first decade, 41(26.8%) in the second decade, 58(37.9 %) in the third decade, 29(l9.0%) in the fourth decade, 12(7.8%) in the fifth decade, 5(3.3%) in the sixth decade, 4(2.6%) in the seventh decade, and 3(1.9%) in the eighth decade 2. There was family history of seborrheic dermatitis in 40 patients(26.1%) 3. Of the occupations, 48 patients(31.4%) were clerks or office workers, 42 patients (27.5%) were housewives, 23 patients(15.0%) were laborers or factory workers, ll patients(7.2%) were students, 9 patients(5.9%) were managers, and 6 patients(3.9%) were drivers. 4. Inducing or aggravating factors were emotional stress in 75 patrents(49.0%), seasonal change in 53 patients(34.6%), sunlight in 23 patients(15.0%), foods in 15 patients(9.8%), upper respiratory tract infection in 14 patients(9.2%), menstruation in 9 patients(5.9%), and drinking of slcohol in 9 patients(5.9%). 5. I,esions occurred on the scalp in 128 patients(83.7%), on the face in 115 patients (75.2,l6), on the neck in 42 patients(27.5%), on the trunk in 29 patients(19.096), on the intertriginous areas in 12 patients(7.8%), and on the extremities in 6 patients(3.996), 6. The intensity and rate of delayed hypersensitivity reaction in 15 patients of seborrhic dermatitis(1.62+/-0.92mm, 28.67+26.4596) were not significantly decreased than those of control group(1.99+1.08mm, 39.23+/-22.34%) (p>0.05). Anergy and hypoergy were found in 10 patients(6796) with seborrheic dermatitis in contrast to 6 persons(4096) in control group.
Age of Onset ; Dermatitis ; Dermatitis, Seborrheic* ; Drinking ; Extremities ; Female ; Humans ; Hypersensitivity, Delayed ; Menstruation ; Neck ; Occupations ; Respiratory Tract Infections ; Scalp ; Seasons ; Skin ; Stress, Psychological ; Sunlight

BACKGROUND: Induced hypotension is effective in decreasing blood loss and providing better visibility in the surgical field. Extensive epidural block to T4 with intravenous infusion of low-dose epinephrine allows mean arterial pressure to 50 mmHg. We investigated the effects of hypotensive epidural anesthesia comparing with normotensive epidural anesthesia during total hip arthroplasty. METHODS: 40 patients scheduled for total hip arthroplasty under epidural anesthesia were randomly divided into two groups. In hypotensive group, 0.5% bupivacaine 20cc was injected into L1-2 epidural space and if sensory block reached to T4, then epinephrine 1~5 g/min was intravenously injected with continuous infusion pump. As a result, mean arterial pressure was maintained 50 mmHg, and heart rate, 55~80bpm. In normotensive group, 0.5% bupivacaine 20cc was injected into L4-5 epidural space, and sensory block reached to T8. Therefore blood pressure was maintained within 20% of preoperative baseline. RESULTS: There was apparent difference in blood loss between two groups (hypotensive group: 259 +/- 75 ml, normotensive group: 803 +/- 144*ml) (*:p<0.05). In addition, in the case of hypotensive epidral group, transfusion was not required and CVP, heart rate were not changed postoperatively. Cardiac, renal, and cerebral function were preserved too. CONCLUSIONS: Hypotensive epidural anesthesia with low dose of epinephrine infusion is safely lowering mean arterial pressure to 50 mmHg. This technique is associated with low blood loss, reduction in perioperative transfusion requirements, and has no side effects on CNS, liver, kidney and heart function.
Anesthesia, Epidural* ; Arterial Pressure ; Arthroplasty, Replacement, Hip* ; Blood Pressure ; Bupivacaine ; Epidural Space ; Epinephrine ; Heart ; Heart Rate ; Humans ; Hypotension ; Infusion Pumps ; Infusions, Intravenous ; Kidney ; Liver

BACKGROUND: Although drug eruption refers to a common dermatologieal condition, there are numerous setbacks in the diagnosis. In addition there are no annual average prevalence rates of drug eruptions according to time sequence in Korea. OBJECTIVE: This study attempts to detme the clinical features and causative drugs of drug eruptions, the diagnostic value of various skin tests and to evaluate the dome,stic annual average prevalence rate of drug eruptions according to time sequence. METHOD: 270 patients with drug eruptions were reviewed clinically. In 103 patients, intradennal, patch and scratch-patch tests were performed using suspected drugs. The annual average prevalence rate of drug eruptions was calculated from 10 different general hositals in Korea. RESULT: Exanthematous eruptions(49.3), fixed drug eruptions(30.1), and urticaria(10.0%) were the common types of drug eruptions. The common causative agents were antibiotics/antimicrobials, antipyretics(NSAIDs, and CNS depressants. 52 patients out of 103 had positive results after at least one skin test with suspected drugs. CONCLUSION: In our study, we were ahle to obtain somewhat meaningful results basnl on data from the combination of various skin tests. As a result, physicians need to prescrible drugs with care.
Central Nervous System Depressants ; Diagnosis ; Drug Eruptions* ; Humans ; Korea ; Prevalence ; Skin Tests* ; Skin*

BACKGROUND: The chemiluminescent assay(CLA) is a new in vitro non-radioactive modification of the radioallergosorbent test(RAST). The CLA permits quick, siultaneous detection of total and specific IgE in human serum up to 35 different allergens, as well as their semiquantitative concentrations into classes from 0(negative) to 4(very high). The CLA has shown sensitivity, specificity, and a good correlation with the RAST and also with skin pick testing. OBJECTIVE: The purpose of this study was to find the causatix llergens and to evaluate the clinical significance of CLA comparing the results of tbe CLA wi! h hose of the prick test in patients with chronic urticaria. METHODS: We performed the CLA with 35 allergens(MAST immunosunosystems, Inc., California, America) and the prick test with 51 allergens(Bencard Ltd., Bricantord, England) in 70 patients with chronic urticaria. The CLA detects the allergen-IgE reactic say the use of an enzyme-labeled anti-IgE and a coupled photoreagent mixture. lhe amount of the luminescent energy is measured by exposing a polarcid film and then semiquantitation is a sessed by using a densitometer. RESULTS: Except for those over the age of 60, all age-groups ealed a similar positive reaction to the CLA and prick test, but the positive reaction rate o the prick test(91.4%) was higher than that of the CLA(38.6%). The positive reaction rate oringle allergen and compound allergens was 10.0% and 28.6% in the CLA, but 10.0% and 81.4% in the prick test, respectively. In the CLA, the rate of positive reaction was 17(24.3%) in Dermatophagoides(D.) farinae, 15(21.4% ) in D. pteronyssinus, 5(7.1% ) in house dust, an 13(4.3%) in shrimp in that order. In the prick test, the rate of positive reaction was 39(55.7%) in house dust, 35(50.0%) in D. farinae, 29(41.4%) in D. pteronyssinus, and 21(30.0%) in haydrst(30.0%) in that order. The results of the CLA to 3 comrnon allergens showed a concordance rare of 67.6%, sensitivity of 34.3%, and specificity of 97.3% compared with those of the prick case. The levels of total IgE and eosinophils were elevated in 59(n=70, 843%) and in 5(n=56, 84.3%), respectively. CONCLUSION: The results of this study suggest that the CLA may be used as an alternative method for the diagnosis of chronic urticaria because it is and coiomic, safe, simple procedure with very high specificity and trelative low sensitivity, and is sirnilt. neously capable of testing to multiple allergens.
Allergens ; California ; Diagnosis ; Dust ; Eosinophils ; Humans ; Immunoglobulin E ; Luminescent Measurements* ; Sensitivity and Specificity ; Skin ; Urticaria*

There is room for debate in appropriate diagnosis and treatment due to physiological and anatomical differences in pediatric facial bone fractures from that of adult's. The objectives of this article is to analyze for our clinical cases and to suggest the appropriate management of facial bone fracture in children. The study included 56 children who had treatment for the craniofacial fractures form March, 1990 to February, 1998. Their ages ranged from 3 to 15. There were 38 males and 18 females. Physical examination, simple x-rays, ultrasonograms and routine CT scans were used for diagnosis. Materials were classified into 28 nasal bone fractures, 4 nasoethmoidal fractures, 6 orbital fractures, 8 mandible fractures, and 10 zygoma fractures. Patients were treated with conservative treatment in 9 cases, with closed reduction in 28 cases and open reduction only, and 14 patients with open reduction and internal fixation using microplates and screws. 3 patients needed autogenous calvarial bone graft. Plates and screws were removed in postoperative 3-6 months. All patients had successful union of fractured bones without no specific complications, and normal bony growths were noticed during the 7 years follow up. We conclude that surgeons should be careful in diagnosis and management for the pediatric facial fracture due to anatomical variations and differences in fracture aspects. First, it is mandatory for surgeous to get accurate diagnosis and identify children's fracture and displacement through routine CT check up along with physical examination. Second, it is important to perform the minimally invasive technique or conservative treatment for the children with mild displacement so that it reduces the incidence of growth retardation which may be caused by extensive operation. However, application of rigid fixation is necessary in case of extensive bony displacement or bony defects because of poor coorporation in postoperative care. Third, plates and screws which were used for the internal fixation should be removed at 3-6 months after the surgery. Fourth, if bone graft is needed, it is better to use autogenous graft than allogeneous graft. Fifth, care for dentition and follow up for growth are necessary for growing children.
Child ; Dentition ; Diagnosis ; Facial Bones* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mandible ; Nasal Bone ; Orbital Fractures ; Physical Examination ; Postoperative Care ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography ; Zygoma

No abstract available.
Endoscopy ; Gastrointestinal Hemorrhage*

Microsurgical reconstruction is necessary for children to correct severe trauma and congenital or acuqired deformity. The aim of this study was to evaluate whether or not microsurgical reconstruction is a safe and reliable operation in children and to analyze the differences of microsurgical reconstruction in children compared to adults. The study included 12 children who underwent 13 microsurgical reconstructions among a total of 251 cases of microsurgical reconstruction from May, 1986 to August, 1998. Their ages ranged from 24 months to 14 years and 8 months. There were 7 males and 6 females. The involved sites were 9 legs, 3 hands and 1 face. The causes of microsurgical reconstruction were 9 traumas, 2 congenital anomalies, 1 acquired deformity and 1 cancer. The applied flaps were 4 scapular flaps, 2 rectus abdominis muscle flaps, 1 de-epithelized groin flap, 1 lateral arm flap, 1 forearm tendocutaneous flap, 1 forearm tendocutaneous flap, 1 latissimus dorsi muscle flap, 1 fibula flap, 1 second toe transfer, and 1 wrap-around flap. All patients have had normal growth of the donor and recipient sites without specific complications during an average 2 years follow-up. We concluded that microvascular reconstruction is a very useful and reliable procedure in children if it is performed in consideration of each child's specific characteristics and conditions.
Adult ; Arm ; Child ; Congenital Abnormalities ; Female ; Fibula ; Follow-Up Studies ; Forearm ; Groin ; Hand ; Humans ; Leg ; Male ; Rectus Abdominis ; Superficial Back Muscles ; Tissue Donors ; Toes

Drowning is a leading cause of accidental deaths worldwide, but its pathological diagnosis remains a challenge for forensic pathologists owing to a lack of pathognomonic findings in drowning deaths and inconclusive autopsy findings caused by postmortem changes. The aim of the present study was to investigate the pathway taken by inhaled drowning medium through the airway after death in a variety of experimental conditions, including underwater pressurization. We used methylene blue dye to monitor the spread of drowning medium to the lungs. Results of theses experiments demonstrated that it is possible for a significant amount of downing medium to enter the airway during immersion after death. Our results suggest that autopsies of immersed bodies and interpretation of these findings should be performed with special care.
Animal Experimentation* ; Animals* ; Autopsy ; Diagnosis ; Drowning* ; Immersion ; Inhalation* ; Lung ; Methylene Blue* ; Postmortem Changes