PURPOSE: Neuronal damage induced by febrile seizure(FS) has been implicated in the pathogenesis of medial temporal sclerosis, the pathologic hallmark of temporal lobe epilepsy. Recent data indicate that prolonged FSs induce transient structural changes of some hippocampal pyramidal neurons and long-term functional changes of hippocampal circuitry. In this study we have investigated the expression of brain-derived neurotrophic factor(BDNF) in the hippocampal formation after FSs with in situ hybridization histochemistry using riboprobe. METHODS: FSs were induced in 21 day-old male Sprague-Dawley rats(five rats for each group), which had a mean weight of about 100g. Exposure to hyperthermia was achieved by maintaining the water in the beaker at a temperature of 45 degrees C by pacing it in a temperature-controlled water bath. The rats were decapitated at appropriate times(0 hr, 30 min, 1 hr, 2 hr, 3hr, 6 hr, 12 hr and 24 hr) after FSs. In situ hybridization histochemistry was performed. The probe used in these studies were riboprobe complementary to the sequence 641-729 of rat BDNF. RESULTS: The induction of BDNF mRNA was observed in the dentate gyrus at 30 min after FSs. The expression in the dentate gyrus was gradually increased, peaked at 3 hr after FSs, and almost returned to basal level at 24 hr after FSs. The significant induction of BDNF mRNA was also observed in the CA3 area of hippocampus from 2 hr to 3 hr after FSs. CONCLUSION: These observations suggest that BDNF is the gene whose expression can be altered by FSs and these gene might be related to pathologic alterations after FSs.
Animals ; Baths ; Brain-Derived Neurotrophic Factor* ; Dentate Gyrus ; Epilepsy, Temporal Lobe ; Fever ; Hippocampus* ; Humans ; In Situ Hybridization ; Male ; Neurons ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger* ; Sclerosis ; Seizures, Febrile* ; Water

Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.
Analgesia ; Analgesics, Opioid ; Constipation ; Deep Sedation ; Humans ; Morphine ; Nausea ; Pneumonia ; Pruritus ; Respiratory Insufficiency

PURPOSE: Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in western countries but it has been reported rarely in Korea. The purpose of this study was to evaluate the clinical characteristics, treatment responses and prognosis of the patients with CLL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 17 patients with CLL diagnosed at the Catholic University of Taegu-Hyosung & Kyungpook National University Hospital from Jan. 1986 to Mar. 1996. RESULTS: There were 9 males and 8 females and the mean age was 55 years. The majority of patients had systemic symptoms (77%) and advanced clinical stage (Binet stage C, 70%) at the time of diagnosis. The bone marrow histology was reviewed in 13 cases and patients were subdivided into those with a diffuse (9cases) and nondiffuse (4cases) pattern of bone marrow histology. In patients with advanced clinical stage, diffuse pattern was predominated and showed poor survival. 14 patients were treated with chlorambucil/steroid or combination chemotherapy. Among the 13 evaluable patients, 1 (8%) achieved a complete response and 7 (54%) achieved partial responses, and median survival duration was 18months. 11 patients died after 2~18 months of follow-up and infection was the main cause of death. CONCLUSION: Poor prognostic factors, such as high blood lymphocyte counts, diffuse bone marrow involvement pattern & advanced clinical stage, are common in our patients at presentation & showed poor survival.
Bone Marrow ; Cause of Death ; Diagnosis ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Humans ; Korea ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Lymphocyte Count ; Male ; Medical Records ; Prognosis ; Retrospective Studies

BACKGROUND: Heat shock proteins (HSP), especially the HSP 70 family, may play certain roles in the immunophysiology of some skin diseases such as psoriasis, pemphigus, and lichen planus. HSPs generally induce down-regulation of the process of apoptosis that is considered to be one of the acantholysis-producing pathways in pemphigus. OBJECTIVE: We planned to examine possible roles of HSPs 70/105 in the blistering process in pemphigus vulgaris (PV) and pemphigus foliaceus (PF), in connection with the detection results of apoptosis in local tissue specimens. METHODS: Immunohistochemical stainings and Western blot analysis were performed for the detection and semiquantitation of HSPs 70/105 in skin specimens from lesional, nonlesional, and normal control sites. Hoechst 33342 staining was simultaneously carried out to examine features of apoptosis in lesional skin specimens. RESULTS: The findings on expression of HSP were as follows. In PV, the expression of HSP 70 was minimum or negative; however, in PF, the expression was obvious and recognizable in lesional and perilesional normal skin. In contrast, HSP 105 was not detected in all cases of PV and PF. The features of apoptosis were evident at the lesional skin of all cases of pemphigus with acantholytic changes. CONCLUSION: PV and PF had different relative intensities of HSPs in lesional tissue stainings, especially in cases with HSP 70. This suggests that there may be subtle differences in the mechanisms causing acantholysis between PV and PF.
Acantholysis ; Apoptosis ; Benzimidazoles ; Blister ; Blotting, Western ; Down-Regulation ; Heat-Shock Proteins ; Hot Temperature ; HSP70 Heat-Shock Proteins ; Humans ; Lichen Planus ; Pemphigus ; Psoriasis ; Skin ; Skin Diseases

OBJECTIVE: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors. METHOD: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories. RESULTS: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin. CONCLUSION: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP.
Atrophy ; Brain ; Cerebral Infarction ; Cerebral Palsy* ; Humans ; Infant, Newborn ; Korea ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging ; Meningitis ; Myelin Sheath ; Neuronal Migration Disorders ; Risk Factors ; Twins

PURPOSE: We aimed to compare the detection of breast cancer using full-field digital mammography (FFDM), FFDM with computer-aided detection (FFDM+CAD), ultrasound (US), and FFDM+CAD plus US (FFDM+CAD+US), and to investigate the factors affecting cancer detection. METHODS: In this retrospective study conducted from 2008 to 2012, 48,251 women underwent FFDM and US for cancer screening. One hundred seventy-one breast cancers were detected: 115 invasive cancers and 56 carcinomas in situ. Two radiologists evaluated the imaging findings of FFDM, FFDM+CAD, and US, based on the Breast Imaging Reporting and Data System lexicon of the American College of Radiology by consensus. We reviewed the clinical and the pathological data to investigate factors affecting cancer detection. We statistically used generalized estimation equations with a logit link to compare the cancer detectability of different imaging modalities. To compare the various factors affecting detection versus nondetection, we used Wilcoxon rank sum, chi-square, or Fisher exact test. RESULTS: The detectability of breast cancer by US (96.5%) or FFDM+CAD+US (100%) was superior to that of FFDM (87.1%) (p=0.019 or p<0.001, respectively) or FFDM+ CAD (88.3%) (p=0.050 or p<0.001, respectively). However, cancer detectability was not significantly different between FFDM versus FFDM+CAD (p=1.000) and US alone versus FFDM+CAD+US (p=0.126). The tumor size influenced cancer detectability by all imaging modalities (p<0.050). In FFDM and FFDM+CAD, the nondetecting group consisted of younger patients and patients with a denser breast composition (p<0.050). In breast US, carcinoma in situ was more frequent in the nondetecting group (p=0.014). CONCLUSION: For breast cancer screening, breast US alone is satisfactory for all age groups, although FFDM+ CAD+US is the perfect screening method. Patient age, breast composition, and pathological tumor size and type may influence cancer detection during screening.
Breast Neoplasms* ; Breast* ; Carcinoma in Situ ; Consensus ; Diagnosis, Computer-Assisted ; Early Detection of Cancer ; Female ; Humans ; Information Systems ; Mammography* ; Mass Screening* ; Methods ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Mammary

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.
Adolescent ; Blood Pressure ; Capsid Proteins ; Cardiomyopathies ; Central Venous Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Cough ; Creatinine ; Digoxin ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Enterovirus ; Ergonovine ; Female ; Fever ; Furosemide ; Heart Failure ; Heart-Assist Devices* ; Hemodynamics ; Horses ; Hospitalization ; Humans ; Immunohistochemistry ; Myocarditis* ; Neutralization Tests ; Pharyngitis ; Prognosis ; Pulmonary Edema ; Shock ; Spasm ; Tachycardia, Sinus ; Thrombosis ; Troponin T

PURPOSE: Tc-99m labeled diethylenetriaminepentaacetic acid (DTPA) -coupled galactosylated human serum albumin (GSA) is a currently used imaging agent for asialoglycoprotein receptor (ASGPR) of the liver, but, it has several shortcomings. Recently a new ASGPR imaging agent, (99m) Tc-lactosylated human serum albumin (LSA), with simple labeling procedure, high labeling efficiency, high stability was developed. In order to assess the feasibility of the (99m) Tc-LSA as a ASGPR imaging radiopharmaceuticals, we performed biodistribution study of the tracer in liver injured mice model and the results were compared with histolgic data. MATERIALS AND METHODS: To induce hepatic damage in ICR mice, diethylnitrosamine (DEN) (60 mg/kg/week X 5 time, low dose or 180 mg/kg/week X 2 times, high dose) and thioacetamide (TAA) (50 mg/kg X 1 time) were administrated intraperitoneally. Degree of liver damage was evaluated by tissue hematoxilin-eosin stain, and expression of asialoglycoprotein receptor (ASGPR) was assessed by immunohistochemistry using ASGPR antibody. (99m) Tc-LSA was intravenously administrated via tail vein in DEN or TAA treated mice, and biodistribution study of the tracer was also performed. RESULTS: DEN treated mice showed ballooning of hepatocyte and inflammatory cell infiltration in low dose group and severe hapatocyte necrosis in high dose group, and low dose group showed higher ASGPR staining than control mice in immunohistochemical staining. TAA treated mice showed severe hepatic necrosis. (99m) Tc-LSA Biodistribution study showed that mice with hepatic necrosis induced by high dose DEN or TAA revealed higher blood activity and lower liver activity than control mice, due to slow clearance of the tracer by the liver. The degree of liver uptake was inversely correlated with the degree of histologic liver damage. But low dose DEN treated mice with mild hepatic injury showed normal blood clearance and hepatic activity, partly due to overexpression of ASGPR in mice with mild degree hepatic injury. CONCLUSION: Liver uptake of (99m) Tc-LSA was inversely correlated with degree of histologic hepatic injury in DEN and TAA treated mice. These results support that (99m) Tc-LSA can be used to evaluate the liver status in liver disease patients.
Animals ; Asialoglycoprotein Receptor ; Diethylnitrosamine* ; Hepatocytes ; Humans ; Immunohistochemistry ; Liver Diseases ; Liver* ; Mice* ; Mice, Inbred ICR ; Necrosis ; Radiopharmaceuticals ; Serum Albumin* ; Thioacetamide* ; Veins

BACKGROUND: The blood processing works are composed of phlebotomy, donor testing, manufacturing, storage, transportation, and quality control. Among these, storage, transportation and quality control are done partially at the blood collection centers and finally accomplished at the hospital blood banks. We tried to analyze blood processing costs in hospital blood banks. METHODS: Blood processing costs are divided into physician works, practice expenses, and professional liability insurance according to RBRVS (Resource-Based Relative Value Scale). Physician works were analyzed according to the study of the 'Physician work RBRVS committee of the Korean society for laboratory medicine'. For the practice expenses, three university hospital blood banks data were analyzed. The costs for the blood supply of small clinics or hospitals without blood banks were investigated by questionnaire. RESULTS: Comprehensive works of physician were such as laboratory administration, quality control, preparation of procedure manual, education, quality improvement control. Specific works of physician were such as supervision over technologists, analysis of quality control data, management of blood inventory, storage and issue, blood utilization review, management of adverse transfusion reaction, blood return and disposal. As for one unit of blood, the standard labor time of technologists was 28.8 minutes (which is equivalent of 7,680 won) and the mean equipment cost was 592 won. The mean cost of small clinics or hospitals for blood supply was 12,150 won. CONCLUSION: The reimbursement of blood processing cost for the hospital blood bank would contribute to stable blood bank administration, stable blood supply and safe transfusion.
Blood Banks* ; Blood Group Incompatibility ; Education ; Humans ; Insurance ; Liability, Legal ; Organization and Administration ; Phlebotomy ; Quality Control ; Quality Improvement ; Tissue Donors ; Transportation ; Utilization Review ; Surveys and Questionnaires

BACKGROUND: Spitz nevus and malignant melanoma have common features clinically and histologically, and in some cases it is impossible to distinguish between the two. Heat shock proteins (HSPs) serve to protect cells, and are activated by cell injury. Some HSPs are shown to be elevated in many types of cancers. Previous studies have reported the expression of heat shock protein in association with melanoma; however, a similar relationship with Spitz nevi has never been investigated. OBJECTIVE: This study was designed to measure the expression pattern of HSP 105 in both Spitz nevi and melanomas. METHODS: The specimens of 4 of Spitz nevi and 10 of malignant melanomas were analyzed for heat shock protein 105 expression through immunohistochemical staining. RESULTS: Immunohistochemical examination of HSP 105 showed strong expression in malignant melanoma specimens. On the other hand, weak expression was observed in Spitz nevus specimens. The degree of expression of HSP 105 showed a statistically significant difference (p<0.05). CONCLUSION: These findings provide the possibility of using HSP 105 as a effective marker for differentiating between Spitz nevi and malignant melanomas. In support of this, HSP 105 is considered to be a tumor-associated antigen of malignant melanoma.
Hand ; Heat-Shock Proteins ; Melanoma ; Nevus ; Nevus, Epithelioid and Spindle Cell