Spontaneous coronary artery dissection is a rarely identified entity whose exact incidence, etiology, pathogenesis, medium-term evolution and optimal treatment have not yet been firmly estabilished. The cause of spontaneous disection remains unclear but theories of etiology include a medial eosinophilic angiitis, pregnancy induced degeneration of collagen and rupture of the vasovasoum. Most paients die suddenly, but a clinical spectrum is seen including and unstable angina, myocardial infarction and cardiogenic shock. We experienced 4 cases with spontaneous coronary artery dissection found angiographically which caused myocardial infarction and unstable angina. Our patients were treated medically.
Angina, Unstable ; Collagen ; Coronary Vessels ; Eosinophils ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia* ; Pregnancy ; Rupture ; Shock, Cardiogenic ; Vasculitis

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

It is known that radiation can induce various kind of mutations, cancers and congenital malformations. Day 9 rats embryos were cultured by whole embryo culture method and irradiated 0.1, 0.5, 2 and 5 Gy at day 10 to study the effect of radiation on the development of rat embryos. Haversting after 48 hours culture, the morphological changes and apoptosis were investigated. In addition, we assessed the expression patterns of p53, WAF1, Bcl -2, Bcl -x and Bax. Compared to the control group, no remarkable morphological changes were observed in the low dosage group (0.1 and 0.5 Gy). But at high dosage group (2 and 5 Gy), growth was retarded and the heart beats were weak. The crown rump length, the number of somites, and branchial arch were decreased and the rotation of embryo and development of otic pit and lens pit, and upper limb bud was delayed significantly. Especially in the 5 Gy group the most of external morphology were difficult to discriminate. In histological observations, high dosage group showed marked increase in the number of apoptotic bodies in the optic cup, trigeminal ganglion, pharyngeal arches, heart and small intestine. In western blot analysis, Bcl -x and Bax were not expressed in all groups. Expression level of Bcl -2 was constant regardless of the amount of radiation. Expression level of p53 and WAF1 increased significantly in accordance with the increasing amount of radiation. Especially, WAF1 was expressed 7.2, 6.3, 9.9 and 11.3 folds more than the control groups when embryos were exposed to 0.1, 0.5, 2 and 5 Gy, respectively. Considering WAF1 arrests cell cycle, we concluded that cell cycle was affected most sensitively to radiation injury. From these results, radiation showed growth retardation, decrease in protein synthesis, increase in apoptosis and expression of related genetic materials. These results may be used as a standard to test the effect of drugs for reducing and protecting agents against deterious effect of radiation in developing embryo and fetus.
Animals ; Apoptosis ; Blotting, Western ; Branchial Region ; Cell Cycle ; Crown-Rump Length ; Embryonic Structures* ; Fetus ; Heart ; Intestine, Small ; Radiation Injuries ; Rats ; Somites ; Trigeminal Ganglion ; Upper Extremity

In order to understand the effect of retinoic acid (RA) on the craniofacial pattern formation during embryogenesis, we injected RA intraperitoneally into the pregnant female rat on day 11 post coitum (p.c.) and then embryos of day 13 to day 17 p.c. were isolated consequently. The overall morphology and the differential gene expression patterns were analyzed by the microscopic and (DD) RT-PCR methods, respectively. For the morphological study, the retardation of craniofacial region, the shortage of crown rump length and limbs were analyzed in the RA-treated embryos. In the RA-treated embryos of day 17, it was observed that the palatogenesis was completely finished just like in the normal embryos. However, the cleft plate was observed in 36 out of 52 total samples with the distance of cleft palate being 0.80+/-0.36 mm in average. The temporal expression pattern of Hox genes through RT-PCR revealed that the expression of Hoxa7 reached its peak on day 13 then slowly declined in the normal embryos. Whereas in the RA-treated embryos, the expression peak was observed on day 15, then declined subsequently. With the Hoxc8 gene, its expression was low in all stages until the day 16 of normal embryogenesis. On the other hand, Hoxc8 gene expression was detected slightly early on day 15 in the RA-treated embryos. In the study of Bcl-2 family genes, uniformly strong expression of anti-apoptotic and pro-apoptotic genes was observed from day 13 to day 17 of normal embryos, whereas anti-apoptotic gene expressions were decreased after day 16 in the RAtreated embryos. Additionally, a dramatic decline of pro-apoptotic gene expression was observed from day 13 to day 15 of the RA-treated embryos. Therefore, we believe that RA is a potential factor that is actively involved in the cleft palate formation. Moreover, it is profoundly linked with the regulation of Hox and Bcl-2 family gene expression pattern that leads to the embryonic malformation.
Animals ; Cleft Palate ; Crown-Rump Length ; Embryonic Development* ; Embryonic Structures ; Extremities ; Female ; Gene Expression ; Genes, Homeobox ; Hand ; Humans ; Palate* ; Pregnancy ; Rats* ; Tretinoin*

BACKGROUND AND OBJECTIVES: The transposition of the facial nerve is an essential procedure to obtain optimal surgical field and to remove the lesion completely when the tumor is located medial to the facial nerve. However, we frequently encounter postoperative facial palsy after transposition. The aim of the study is to find out how to treat the facial nerve in order to reduce the incidence and the degrees of postoperative facial palsy after anterior transposition of the facial nerve. MATERIAL AND METHODS: Facial nerve function after anterior transposition of the facial nerve were analyzed retrospectively in 10 cases with skull base tumor using the House-BracKJCann grading system. The minimum follow-up period was 12 months. RESULTS: Favorable outcome was noted when the fallopian canal was exposed as widely as possible, and soft tissues were preserved at stylomastoid foramen. Postoperative facial palsy was recovered completely when the facial nerve was not involved by disease. The final House-BracKJCann grades were I, II, III in three cases in which tumor was involved with the facial nerve. The immediate postoperative function of the facial nerve is influenced by surgical procedure and surgeon's skill, and the final status of the facial nerve function depends on the involvement of tumor in the nerve. CONCLUSION: In order to obtain favorable postoperative facial nerve function, no attempt was made to dissect the facial nerve, and all the soft tissue that were attached to the facial nerve through the stylomastoid foramen were sharply elevated and traspositioned together with the facial nerve.
Facial Nerve* ; Facial Paralysis ; Follow-Up Studies ; Incidence ; Retrospective Studies ; Skull Base

Amputation neuroma can cause very serious, intractable pain. Many treatment modalities are suggested for painful neuroma. Pharmacologic treatment shows a limited effect on eliminating the pain, and surgical treatment has a high recurrence rate. We applied pulsed radiofrequency treatment at the neuroma stalk under ultrasonography guidance. The long-term outcome was very successful, prompting us to report this case.
Amputation ; Catheter Ablation* ; Neuroma* ; Pain, Intractable ; Pulsed Radiofrequency Treatment ; Recurrence ; Ultrasonography*

Mutation of the ATRX gene leads to X-linked alpha-thalassemia/mental retardation (ATR-X) syndrome and several other X-linked mental retardation syndromes. We report the first case of ATR-X syndrome documented here in Korea. A 32-month-old boy came in with irritability and fever. He showed dysmorphic features, mental retardation and epilepsy, so ATR-X syndrome was considered. Hemoglobin H inclusions in red blood cells supported the diagnosis and genetic studies confirmed it. Mutation analysis for our patient showed a point mutation of thymine to cytosine on the 9th exon in the ATRX gene, indicating that Trp(C), the 220th amino acid, was replaced by Ser(R). Furthermore, we investigated the same mutation in family members, and his mother and two sisters were found to be carriers.
Amino Acid Substitution ; Body Dysmorphic Disorders/complications ; Child, Preschool ; DNA Mutational Analysis ; Epilepsy/complications ; Exons ; Hemoglobin H/*genetics ; Humans ; Male ; Mental Retardation/complications ; Mental Retardation, X-Linked/complications/diagnosis/genetics ; Point Mutation ; Republic of Korea ; alpha-Thalassemia/complications/diagnosis/genetics

PURPOSE: Kawasaki disease (KD) is a systemic vasculitis, a leading cause of pediatric acquired heart disease. Histopathological findings of coronary artery lesion (CAL) in KD indicate destruction of the coronary artery wall with diffuse vasculitis. Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) might play central roles in this process. Special attention to MMP-9 has recently been emerging. This study was performed to investigate the clinical significance of MMP-9 and its inhibitors, TIMP-1 and TIMP-2, in KD. METHODS: We compared 47 KD patients with 14 febrile controls. Serum MMP-9 and TIMP-1, TIMP-2 were measured by ELISA and compared according to clinical stages and coronary involvement. RESULTS: In acute stage, MMP-9 and TIMP-1 were significantly higher, whereas TIMP-2 was lower, in KD than those in febrile controls (p<0.05). The elevated MMP-9 levels in acute phase significantly decreased during the subacute and convalescent phases (p<0.05). During acute phase, the MMP-9, TIMP-1, and MMP-9/TIMP-2 levels in the CAL group were lower than those in the non-CAL group, but they increased significantly in the subacute phase (p<0.05). MMP-9 has a positive correlation with TIMP-1 in the acute and subacute phases, and negative correlation with TIMP-2 in the subacute and convalescent phases (p<0.05). CONCLUSION: These results suggest that MMP-9, TIMP-1, and the imbalance in MMP-9 and TIMP-2 might play important roles on the pathophysiology of KD and especially on the development of CAL. However, further larger studies are needed.
Coronary Vessels ; Enzyme-Linked Immunosorbent Assay ; Heart Diseases ; Humans ; Matrix Metalloproteinase 9 ; Matrix Metalloproteinases ; Mucocutaneous Lymph Node Syndrome ; Systemic Vasculitis ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Tissue Inhibitor of Metalloproteinases ; Vasculitis

BACKGROUND: Extracardiac pericardial-flap lateral tunnel Fontan operation has theoretical advantage of growth potentiality of the extracardiac tunnels. The mid-term results of this technique and morphologic change of the lateral tunnel were studied. MATERIAL AND METHOD: Clinical data was reviewed in 42 patients who underwent extracardiac pericardial-flap lateral tunnel Fontan operation between November 1993 and December 2004. The age was 2.8+/-1.5 years and the body weight was 12.3+/-3.2 kg. Extracardiac tunnel was constructed using the pedicled pericardium with the base undetached. By reviewing the follow-up cardiac angiograms, the diameter and the cross-sectional area of the lateral tunnel was compared to those of inferior vena cava. RESULT: There were four operative mortality cases (9.8%) and the causes of death were low cardiac output for all four cases. Postoperatively, five patients had prolonged pleural effusion longer than two weeks and one patient required a permanent pacemaker due to complete heart block. Follow-up was possible in 37 patients and the follow up duration was 3.8+/-2.2 years. During that period, one patient died, of upper gastrointestional bleeding combined with heart failure and one patient died a sudden death of unknown cause. Two patients required reoperation due to subaortic stenosis and anastomosis site stenosis between inferior vena cava and lateral tunnel. In one patient, bradyarrhythmia was anew but there was no thromboembolic complication. The lateral tunnel showed growth in proportion to the size of the inferior vena cava. CONCLUSION: Extracardiac pericardial-flap lateral tunnel Fontan operation is relatively simple and safe. The mid-term result was favorable and the extracardiac tunnel showed potential for growth.
Body Weight ; Bradycardia ; Cardiac Output, Low ; Cause of Death ; Constriction, Pathologic ; Death, Sudden ; Follow-Up Studies ; Fontan Procedure* ; Heart Block ; Heart Defects, Congenital ; Heart Failure ; Hemodynamics ; Hemorrhage ; Humans ; Mortality ; Pericardium ; Pleural Effusion ; Reoperation ; Vena Cava, Inferior

BACKGROUND: The drug-resistant tuberculosis has recently decreased in Korea, but it is still one of the major obstacles in the treatment of pulmonary tuberculosis. Unfortunately there are no reliable ways to figure out the drug sensitivity pattern of the M. tuberculosis in the starting point of treatment. At least several months which is critical for the success of treatment have to be passed away before getting the report of drug-sensitivity test. The aim of this study was to find out the clinical and radiological parameters that make it possible to predict the drug-resistant pulmonary tuberculosis and to make a correct decision on the antituberculosis drug regimens. METHOD: We studied 253 pulmonary TB patients with sputum and/or bronchial washing fluid culture-positive diagnosed at the Chung-Ang University Young-San Hospital in the period of 1989-1994. The differences in the clinical and raiological variables between the drug-sensitive and the drug-resistant tuberculosis patients were evaluated. RESULTS: In 66 out of 253 patients(26.1%), drug resistant tuberculosis to at least one antituberculosis drug were found. Patients with retreatment showed higher resistance rate than those with initial treatment (30/69,43.5% vs 36/184, 19.5%, p<0.01). Patients with cavitary TB showed higher resistance rate than those with non-cavitary TB( (24/54, 44.4% vs 42/199, 21.1%, p<0.05). Among patients with initial treatment, those with far-advanced TB showed a higher drug resistance rate than those with minimal lesion(9/23, 36.9% vs 10/82, 12.5%, p<0.05). Patients with culture positive only in the bronchial washing fluid showed lower resistance rate than those with sputum culture positive(7/63, 11.1% vs 59/190, 31.1%, p<0.05) CONCLUSION: Prior treatment history for pulmonary tuberculosis, the presence of cavity & far advanced tuberculosis in the radiologic exam, sputum rather than solely bronchial washing culture positivity would be the related factors to the drug resistance. So in the patients with such characteristics, it is needed to try to find out the drug sensitivity pattern of the infecting tuberculosis organism as soon as possible.
Drug Resistance ; Humans ; Korea ; Retreatment ; Sputum ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*