PURPOSE: We performed a study on clinical benefits of Harada's scoring method, problems of present criteria and requirement of the revision of that criteria for intrvenos gamma-globulin (IVGG) treatment of Kawasaki disease (KD) in Korea. METHODS: The patients of 104 cases who visited to Department of Pediatrics of Chungnam National University Hospital and diagnosed as KD were objective group. We classified the patients to high and low risk groups as two methods of Harada's scoring method and present criteria for IVGG treatment of KD in Korea, and analyzed the results after treatment by means of echocardiogram. RESULTS: 1. Characteristics of the patients 1) Duration to diagnosis: Mean duration was 6.0 3.5days after onset of fever. 2) Age of onset and male to female ratio: the patients of 84.6% were the age of 4 years or less, and male to female ratio was 1.8 to 1. 2. Coronary aitery lesion (CAL) abnormalities according to items of Harada's scoring method and classification of risk groups 1) The age of less than 12 months and CRP of 3+ or more were significant predictive factors 2) Classification of risk groups was significantly predictive in CAL development. 3. Classification of total cases The patients reserved to administration for IVGG according to Harada's scoring method and present criteria for IVGG treatment of KD in Korea were 63.5% and 50% respectively. If so in present criteria for IVGG treatment of KD in Korea, 50% of the KD patients were excluded for that application. 4. Outcome after treatment according to selective IVGG use by two methods 1) Selective IVGG use by Harada's scoring method: There was no significant difference in development of CAL between low risk group and high risk group, resulting in 1 case (14.3%) of 7 cases and 5 cases (9.4%) of 53 cases respectively. 2) Selective IVGG use by present criteria for IVGG treatment of KD in Korea: There were more significant cases at low risk group than those at high risk group in development of CAL, resulting in 3 cases (42.9%) of 7 cases and 5 cases (12.2%) of 41 cases respectively. 3) Outcome after treatment in patients not administered IVGG as low risk groups according to two methods: There were more significant cases in low risk group at present criteria for IVGG treatment of KD in Korea than those at Harada's scoring method in the development of CAL, resulting in 3 cases (42.9%) of 7 cases and 1 case (14.3%) of 7 ases respectively. 4) Outcome after treatment in patients administered IVGG as high risk groups according to two methods: There was no significant difference between high risk groups at both methods in the CAL development, resulting in 5 cases (12.2%) of 41 cases at present criteria for IVGG treatment of KD in Korea and 5 cases (9.4%) of 53 cases at Harada's scoring method. CONCLUSIONS: Harada's scoring method had more benefits in clinical application, selection of risk group, and outcome after treatment, So we propose the revision of present criteria for IVGG treatment of KD in Korea, suggesting another method as indication for selective IVGG treatment.
Age of Onset ; Chungcheongnam-do ; Classification ; Diagnosis ; Female ; Fever ; gamma-Globulins ; Humans ; Korea* ; Male ; Mucocutaneous Lymph Node Syndrome* ; Pediatrics ; Research Design* ; Risk Factors

PURPOSE: Aspiration of foreign material into the lungs can cause acute or chronic pulmonary diseases. It is difficult to detect small amounts of aspiration due to the lack of safe, sensitive and specific diagnostic tests. Recently, in animal or human studies, it has been reported that immunochemistry for lactalbumin can be used to detect the minimal aspiration. So, the authors' investigation was designed to determine whether human milk phagocytized alveolar macrophages can be detected in human milk aspirated mice. METHODS: Sixty four male mice, 6-8 weeks old and 30-40 gm weighing, were used for this study. About 0.05 mL of human milk or normal saline were given intranasally once per day for 1 day or 3 days. Under anesthesia with ketamine and xylazine, the trachea of each mouse was cannulated with an 18G Jelco needle and then, each mouse's lungs were lavaged three times with 0.5 mL of phosphate buffer solution at 2, 8, 24, and 48 hours after the last milk or normal saline instillation. Cells in bronchoalveolar lavage fluid were stained with Oil Red O and immunocytochemistry for alpha-lactalbumin. RESULTS: Immunocytochemical reactivity for alpha-lactalbumin or lipid-laden alveolar macrophages were not observed in the normal saline aspirated groups. Immunocytochemical reactivity for alpha- lactalbumin were observed in the human milk aspirated groups. They showed a peak at 8 hours and decreased markedly at 24 hours but persisted even at 48 hours after aspiration. Immunocytochemical stain positive alveolar macrophages were noted similarly in number between single and multiple aspiration groups. CONCLUSION: These observations suggested that alveolar macrophages for lactalbumin could be more easily detected on immunocytochemistry than Oil Red O stain, and immunocytochemistry could be used as a sensitive and specific diagnostic test for the detection of human milk aspiration.
Anesthesia ; Animals ; Bronchoalveolar Lavage Fluid ; Diagnostic Tests, Routine ; Humans* ; Immunochemistry ; Immunohistochemistry ; Ketamine ; Lactalbumin* ; Lung ; Lung Diseases ; Macrophages, Alveolar* ; Male ; Mice* ; Milk ; Milk, Human* ; Needles ; Trachea ; Xylazine

No abstract available.
Alzheimer Disease*

PURPOSE: Chemotherapies for breast cancer generally have strong cellular cytotoxicity and severe side effects. Thus, significant emphasis has been placed on combinations of naturally occurring chemopreventive agents. Silibinin is a major bioactive flavonolignan extracted from milk thistle with chemopreventive activity in various organs including the skin, prostate, and breast. However, the mechanism underlying the inhibitory action of silibinin in breast cancer has not been completely elucidated. Therefore, we investigated the effect of silibinin in MCF-7 human breast cancer cells and determined whether silibinin enhances ultraviolet (UV) B-induced apoptosis. METHODS: The effects of silibinin on MCF-7 cell viability were determined using the MTT assay. The effect of silibinin on PARP cleavage, as the hallmark of apoptotic cell death, and p53 protein expression in MCF-7 cells was analyzed using Western blot. The effect of silibinin on UVB-induced apoptosis in MCF-7 cells was analyzed by flow cytometry. RESULTS: A dose- and time-dependent reduction in viability was observed in MCF-7 cells treated with silibinin. Silibinin strongly induced apoptotic cell death in MCF-7 cells, and induction of apoptosis was associated with increased p53 expression. Moreover, silibinin enhanced UVB-induced apoptosis in MCF-7 cells. CONCLUSION: Silibinin induced a loss of cell viability and apoptotic cell death in MCF-7 cells. Furthermore, the combination of silibinin and UVB resulted in an additive effect on apoptosis in MCF-7 cells. These results suggest that silibinin might be an important supplemental agent for treating patients with breast cancer.
Apoptosis ; Blotting, Western ; Breast ; Breast Neoplasms ; Cell Death ; Cell Survival ; Humans ; MCF-7 Cells ; Milk Thistle ; Prostate ; Silymarin ; Skin

OBJECTIVES: This 6-week, open label randomized, multicenter study was conducted to evaluate the antidepressant effect and safety of milnacipran and fluoxetine in patients with major depression. METHODS: The study was done in patients with major depression diagnosed by DSM-IV who score > or =17 in 17 items Hamilton Rating Scale for Depression (17-item HAM-D) and score > or =25 in Montgomery and Asberg Depression Rating Scale (MADRS). A total of 87 patients were randomized to milnacipran group and fluoxetine group. In cases of the patients taking other antidepressants, 6 weeks of each medication was administered after 7 days of drug excretion period. The evaluation was done using 17 item HAM-D, MADRS, Clinical Global Impression Scale (CGI), and COVI scale after baseline, 1 week, 2 weeks, 4 weeks, and 6 weeks. The side effects that had occurred during the period of our study were put in records by developed/disappeared time, severities, incidences, managements and results. RESULTS: A total of 87 patients were enrolled. 70 (milnacipran group 39;fluoxetine group 31) of them were included for the 6 weeks of research and 17 of them dropped out within the first week, not due to adverse reactions or deficiency of effects. Total 17 item HAM-D scores, total points of MADRS, and CGI showed significant decrease after 1 week in each treatment group and continued decrease after 2 weeks and 4, 6 weeks. But there was no difference between milnacipran group and fluoxetine group in the antidepressant effect. There were no significant changes in vital sign, CBC, chemistry, and EKG in each treatment group. The commonly reported side effects of minlacipran were nausea (25.0%), headache (10.7%), vomiting (7.1%), constipation (7.1%), dizziness (7.1%) and those of fluoxetine were GI trouble (11.1%), diarrhea (11.1%), insomnia (11.1%), agitation (5.6%), and dizziness (5.6%). CONCLUSION: Milnacipran was effective for the improvement of depressive symptoms and was well tolerated and safe in patients with depression.
Antidepressive Agents ; Chemistry ; Constipation ; Depression* ; Diagnostic and Statistical Manual of Mental Disorders ; Diarrhea ; Dihydroergotamine ; Dizziness ; Electrocardiography ; Fluoxetine* ; Headache ; Humans ; Incidence ; Nausea ; Sleep Initiation and Maintenance Disorders ; Vital Signs ; Vomiting

PURPOSE: Few studies have reported ovarian cancer risks in Korean patients with the BRCA1/2 mutation. We investigated the prevalence of ovarian cancer in Korean women at high risk for hereditary breast-ovarian cancer (HBOC) syndrome and reviewed the clinicopathological factors of ovarian cancer. METHODS: Female subjects who were enrolled in the Korean Hereditary Breast Cancer study were included. The questionnaire included a personal and family history of cancer. The BRCA1/2 mutation and CA-125 level were tested at the time of enrollment. A transvaginal ultrasonogram (TVUS) was recommended for subjects with an elevated CA-125 level. RESULTS: A total of 1,689 patients were included. No ovarian cancer was newly diagnosed by CA-125 level or TVUS during the enrollment. The prevalence of ovarian cancer was 1.71% in BRCA1/2 mutation carriers and 0.39% in non-carriers. Among 11 patients with ovarian cancer, five had the BRCA1 mutation and one had the BRCA2 mutation. The most common histopathological type was serous cystadenocarcinoma. No difference in clinicopathological findings between BRCA1/2 mutation carriers and non-carriers was observed. CONCLUSION: The prevalence of ovarian cancer was 58-fold elevated in women at high-risk for HBOC syndrome and 146-fold elevated in the BRCA1 subgroup, compared with the Korean general population. Further investigation with a long-term follow-up is required to evaluate BRCA1/2 gene penetrance.
Female ; Humans ; Breast Neoplasms ; Ovarian Neoplasms

OBJECTIVES: The purpose of this study was to evaluate the long-term efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open label study included 116 schizophrenic patients drawn from 19 university hospitals. After a wash-out period of 1 week, the patients were treated with risperidone for 56 weeks and evaluated at 8 points:at baseline, and the 8th, 16th, 24th, 32nd, 40th, 48th, 56th weeks of treatment. The dose was started at 2mg of risperidone on day 1, and increased to 4mg on day 2, and 6mg on day 3,7 and adjusted to a maximum of 16mg/day according to the individual's clinical response. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: Eighty-seven(75%) of 116 patients completed the 56-week trial of risperidone. Clinical improvement(as defined by a 20% of reduction in total PANSS score at end point) was shown by 92.0% of the patients. The mean dose of risperidone was 5.0mg/day in the 56 week follow-up. PANSS total scores showed significant improvements between consecutive two points at baseline, 8th, 16th, 24th, 32nd, and 48th week of treatment. CGI scores showed significant reductions between consecutive two points at baseline, 8th, 16th, 24th, and 48th week of treatment. Three PANSS factors(positive, negative, general) showed a significant improvement from the 8th week of treatment, and, after then, remained improved in the rest of the study period. ESRS showed no significant change during the 56 week trial. Laboratory parameters showed no significant changes during the course of treatment. CONCLUSIONS: This multicenter long-term open study suggests that risperidone is a antipsychotic drug with long term efficacy and safety in the treatment of schizophrenic patients.
Follow-Up Studies* ; Hospitals, University ; Humans ; Risperidone* ; Schizophrenia* ; Weights and Measures

PURPOSE: Breast reconstruction in patients who have undergone a mastectomy is performed less frequently in Korea than in Western countries. The aim of this study was to investigate the psychosocial problems related to a mastectomy and awareness of reconstruction after a mastectomy in breast cancer survivors. METHODS: From March to April 2010, 252 patients who underwent a mastectomy were recruited for this survey. The questionnaire included sociodemographic characteristics of patients, psychosocial problems related to mastectomy, and reasons not to receive breast reconstruction. RESULTS: Patients had difficulty going to a public bath (70.3%) or going to a swimming pool or the beach (74.6%). More than half of patients answered that their physical activity had decreased due to persistent shoulder or arm pain after the mastectomy. The most common psychological problem that patients experienced was distress over the loss of charm as a woman (66.8%), followed by considering themselves disabled (62.0%), and worries about recurrence (59.4%). The most common reason not to receive a breast reconstruction was the high cost of the operation (59.4%), followed by anxiety about complications (46.7%). Only 16.2% of patients reported that they did not receive enough information about reconstruction from their doctor. Of 229 patients, 43.7% would consider undergoing breast reconstruction in the future. CONCLUSION: Breast cancer survivors who underwent a mastectomy suffered from various psychosocial problems, and high cost was a major reason for not undergoing breast reconstruction. Broader health insurance coverage should be provided for breast reconstruction in breast cancer survivors.
Female ; Humans ; Breast Neoplasms

OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. METHOD: This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points: at baseline, and 1,2,4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. RESULTS: 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action: a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. CONCLUSIONS: This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.
Dyskinesias ; Dystonia ; Electrocardiography ; Hospitalization ; Hospitals, University ; Humans ; Parkinsonian Disorders ; Risperidone* ; Schizophrenia* ; Vital Signs ; Weights and Measures