PURPOSE: Cerebral palsy or hearing disability of hyperbilirubinemic complication was reduced by blood exchange transfusion(BET) and phototherapy(PT). But in spite of these treatment, abnormal Auditory Brainstem evoked Response(ABR) finding after BET or PT and neurodevelopmental defect due to chronic bilirubin encephalopathy were observed. So we have studied risk factors and outcome of chronic bilirubin encephalopathy after BET, and treatment of hyperbilirubinemia. METHODS: We have analyzed clinical characteristics, the finding and change of ABR after BET in 17 hyperbilirubinemic neonates, and in 8 hyperbilirubinemic neonates who were treated by phototherapy and 15 normal control neonates. RESULTS: 1) Mean bilirubin concentraion were 27.5+/-4.1mg/dL in BET group and 22.1+/-2.3 mg/dL in PT group. There were no difference of clinical findings between BET and PT group. 2) Change of ABR (1) Wave I loss resulted in 4 neonates, wave III loss in 3 neonates, and wave V loss in 2 neonates in BET group(P<0.05). (2) Wave I peak latency and hearing threshold in BET group were significantly increased more than normal control group(P<0.01). 3) In 10 neonates(58.8%) among 17 BET group, 4 neonates(50%) in 8 PT group were observed abnormal initial ABR finding after jaundice treatment. Age at treatment and duration of jaundice(interval between onset of jaundice and treatment) in abnormal ABR group were significant prolongation compared with normal ABR group(P<0.05). 4) Chronic bilirubin encephalopathy(CBE) was observed in 3 neonates(17.6%) among 17 BET group and showed higher of bilirubin level than normalized group after BET (31.1mg/dL vs 26.6mg/dL), other clinical findings showed no significant differences. CONCLUSION: Bilirubin level was significantly elevated in CBE more than in BET group and duration of jaundice, age at treatment were longer in abnormal ABR group than in normal ABR group. So not only bilirubin level but also duration of jaundice shoud be considered at jaundice treatment, and ABR has a potential utility in detection of acute brain toxicity of bilirubin and follow up evaluation of bilirubin encephalopathy.
Bilirubin ; Brain ; Brain Stem ; Cerebral Palsy ; Follow-Up Studies* ; Hearing ; Humans ; Hyperbilirubinemia ; Infant, Newborn* ; Jaundice ; Kernicterus ; Phototherapy* ; Risk Factors

No abstract available.
Chiroptera* ; Hemorrhagic Fever with Renal Syndrome* ; Korea*

BACKGROUND: Scuba diving has become increasingly popular in Korea. Medical problems are common with dives, especially decompression sickness(DCS). This study was performed to obtain an useful information of hyperbaric oxygen therapy in DCS in Korea. METHOD: We reviewed the 62 cases of Korean divers, who were diagnosed as DCS and received recompression therapy according to U.S. Navy Standard Recompression Treatment Table at Ocean and Underwater Medical Research and Training Center of ROK Navy, for 6 years from Jan. 1993 to Nov. 1998. RESULT: 1) the mean no-decompression limit excess time between type I DCS group(72.7 min.) and type II DCS group(92.8min.) showed significant difference. 2) The rate of symptoms appeared on surfacing and within 10min. after surfacing of type I and type II DCS were 41.4%and 72.7% respectively. 3) The cure late of type I and type II were 75.9%and 42.4% respectively. In type II DCS group, the cure rate of the group within 12 hour-delayed recompression treatment and the group above 12 hour-delayed treatment were 64.3%and time 26.3% respectively, and in type I DCS group, 100% and 66.7% respectively. CONCLUSION: These findings suggest that the education of safety, the strict observance of the standard decompression table, and the avoidance of excessive repeated diving are important for reducing the risk of diving related disease. And to offer proper management of DCS, there should be more multiplace hyperbaric oxygen chambers, the suitable transport system, and the specialist of diving medicine or hyperbaric medicine in Korea.
Decompression Sickness* ; Decompression* ; Diving ; Education ; Hyperbaric Oxygenation* ; Korea ; Oxygen ; Specialization

Dieulafoy lesion is very small and easily overlooked as a course of massive, often recurrent hemorrhage that results from the crosion of a submucosal artery, typically in the gastric cardia or fundus. The clinical picture of Dieulafoy lesion is quite uniform: patients commonly present with massive hemorrhage and melena without any relevant history. The diagnostic procedure of choice in patients with severe gastrointestinal bleeding is emergency endoscopy. The lesion is rare but potentially life threatening source of upper gastrointestinal bleeding. Before the endoscopic era, the prognosis for patients with these lesions was quite poor. However, recent reports have described the success of endoscopic therapy in the management of Dieulafoy lesion. We performed emergency endoscopy in 3 patients who had massive or recurrent episode of upper gastrointestinal bleeding, identified to the Dieulafoy lesion. We tried to Endoscopic "0" band ligation, successfully in hemostasis and prevention of recurrence.
Arteries ; Cardia ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Melena ; Prognosis ; Recurrence

A 12-year-old boy developed cholestatic hepatitis with Steven-Johnson syndrome following the use of amoxicillin. The skin lesion and general condition were improved over 2 weeks, but jaundice was gradually aggrevated. We performed liver biopsy, on 30th hospital day, which showed cholestatic hepatitis. The patient improved gradually and liver function was normalized 5 months later.
Amoxicillin ; Biopsy ; Child ; Hepatitis* ; Humans ; Jaundice ; Liver ; Male ; Skin

No abstract available.
Diagnosis* ; Hemoglobinuria*

The complications of bile duct stone are cholangitis, pancreatitis, obstructive jaundice, liver abscess, and secondary biliary cirrhosis. Liver abscess may produce pyothorax, peritonitis, subphrenic abscess, and pyogenic pericarditis. The case studies of pyogenic pericarditis secondary to pyogenic liver abscess are rarely reported. Stones greater than 20mm in diameter are difficult or impossible to remove with a standard basket or balloon after sphincterotomy. There are several nonsurgical treatment options for large bile duct stone: mechanical lithotripsy, endoprosthesis, extracorporeal shock-wave lithotripsy (ESWL), electrohydraulic lithotripsy, contact dissolution therapy, and laser lithotripsy. We experienced a case of large bile duct stone which complicated by pyogenic pericarditis, liver abscess, and pyothorax. He treated with antibiotics, closed thoracostomy, partial pericardiectomy, and removal of bile duct stones by extracorporeal shock-wave and mechanical lithotripsy after endoscopic sphincterotomy and nasobiliary drainage.
Anti-Bacterial Agents ; Bile Ducts* ; Bile* ; Cholangitis ; Drainage ; Empyema ; Empyema, Pleural* ; Jaundice, Obstructive ; Lithotripsy ; Lithotripsy, Laser ; Liver Abscess* ; Liver Abscess, Pyogenic ; Liver Cirrhosis, Biliary ; Liver* ; Pancreatitis ; Pericardiectomy ; Pericarditis* ; Peritonitis ; Sphincterotomy, Endoscopic ; Subphrenic Abscess ; Thoracostomy

Endoscopic injection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been aceepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications. (continue...)
Esophageal and Gastric Varices* ; Hemorrhage* ; Ligation* ; Varicose Veins

BACKGROUND: To standardize the histocompatibility testing among different laboratories, we have developed and performed a proficiency survey (external quality control) program in HLA typing with participation of nationwide HLA laboratories in Korea. METHODS: During a two-year period, four trials of proficiency survey were performed with 35-39 participating laboratories. Test number and items included in each survey were 3 HLA class Iantigen typings, 2 class II DNA typings, and 6 HLA crossmatch tests (3 cells x 2 sera). RESULTS: HLA class I serological typing was performed on a total of 12 whole blood specimens representing 7 HLA-A and 17 HLA-B antigens. More than 90% of the laboratories correctly identified 7 HLA-A (A2, A3, A11, A24, A26, A30, A33) and 13 HLA-B antigens (B7, B8, B13, B14, B27, B35, B48, B51, B52, B54, B58, B60, B61). Lower consensus (<90%) was obtained for B62, B67, B75, and B15 (B*1511). Considerable difference in antigen detection rate was observed between different commercial trays used. HLA class II DNA typing was performed on a total of 8 DNA specimens representing 13 HLA-DRB1 and 11 DQB1 alleles. For HLA-DRB1 typing (16-26 laboratories), correct assignment rate was very high (98%) for generic level, but lower (80%) for allele level. For DQB1 typing (5-8 laboratories), 100% consensus was obtained for allelic level. With respect to HLA crossmatching, detection rate of incompatibility was very low in the 1st trial. HLA crossmatch workshop on the standardization of typing methods was performed after the 1st trial, and thereafter the number of laboratories using sensitive methods were increased and the detection rate of incompatible crossmatch was much improved (1st 29-46%, 2nd 78-97%). CONCLUSIONS: Through these HLA typing proficiency surveys, standardization of test methods and improvement of typing results were obtained. A continuous survey program would play an important role for improving success rate of organ transplantations in Korea.
Alleles ; Consensus ; DNA ; DNA Fingerprinting ; Education ; Histocompatibility Testing* ; HLA-A Antigens ; HLA-B Antigens ; HLA-DRB1 Chains ; Korea* ; Organ Transplantation ; Transplants

No abstract available.
Biomarkers* ; Leukemia, Myeloid, Acute*