Transient myeloproliferative disorder (TMD), which may mimic acute leukemia, occurs in neonates with Down syndrome along with hepatic fibrosis. TMD is recognized shortly after birth or in the neonatal period and is characterized by leukocytosis and thrombocytopenia, which resolve spontaneously in four to six weeks. And hepatic fibrosis is characterized by diffuse intralobular sinusoidal fibrosis, extramedullary hematopoiesis and hemochromatosis. A newborn male infant with Down syndrome, atrial septal defect and ventricular septal defect is reported. He showed abnormal myelopoiesis accompanying characteristic hepatic sinusoidal fibrosis. Knowing the cellular mechanism of hepatic fibrosis and its modulation by growth factors, a pathogenetic link between transient myeloproliferative disorder and the development of liver fibrosis in Down syndrome neonates, association of this triad no longer appears to be accidental.
Down Syndrome* ; Fibrosis* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hematopoiesis, Extramedullary ; Hemochromatosis* ; Humans ; Infant ; Infant, Newborn ; Intercellular Signaling Peptides and Proteins ; Leukemia ; Leukocytosis ; Liver Cirrhosis ; Male ; Myelopoiesis ; Myeloproliferative Disorders* ; Parturition ; Thrombocytopenia

In central neurons, an excessive or sustained rise in the concentration of free cytoplasmic Ca2+ ions([Ca2+]i) after hypoxia may promote rapid neurodegeneration both in vitro and in vivo. Treating cells with Ca2+ chelating agents may prevent or delay a loss of cellular Ca2+ homeostasis after hypoxic injury and thus constitute an effective strategy for minimizing neuronal damage. Cell-permeant Ca2+ chelators such as 1,2-bis-(2-aminophenoxy) ethrane -N,N,N',N' -tetraacetic acid acetoxymethyl ester(BAPTA-AM) have shown evidence of neuroprotective effect against hypoxic neuronal injury. This study was designed to examine dose response and to estimate therapeutic window of BAPTA-AM for the recovery from hypoxia in vitro. Electrophysiological studies were made in CA1 neurons in rat hippocampal slices which were superfused with artificial cerebrospinal fluid(ASCF) in tissue chamber. Hypoxia was induced by replacement of 95% N2+5% CO2 from 95% O2+5% CO2 for 20min. Recovery from hypoxic injury was evaluated by using a percentage recovery of population spike. BAPTA-AM in concentration of 1, 10 and 50micrometer were administered to the artificial cerebrospinal fluid(ASCF) for 2 hours prior to hypoxia, simultaneous with hypoxia and after hypoxia. The experimental specimens were divided to seven groups and each group was compared to control ASCF group. Recovery of population spike after hypoxia was about 70% in control ASCF group, which was mild type hypoxic injury. BAPTA-AM in 10 micrometer concentration, when given just prior to hypoxia, enhanced recovery of poppulation spikes at 15 and 30min following reoxygenation(p<0.05), in comparison with control ASCF. BAPTA-AM had no neuroprotective acitvity when given after the onset of hypoxia. Also, BAPTA-AM in 1 and 50 micrometer concentration did not accentuate recovery of population spike after hypoxia. Dose response curve was inverted U-shape and the response was maximun in 10 micrometer concentration of BAPTA-AM.
Animals ; Anoxia ; Chelating Agents ; Cytoplasm ; Enflurane ; Homeostasis ; Neurons ; Neuroprotective Agents* ; Rats

A widened mediastinum is not always caused by aortic dissection, which is the default diagnosis among emergency physicians. Other acute aortic syndromes should be included in differential diagnosis, such as penetrating atherosclerotic ulcer (PAU), intraluminal hematoma, aneurismal leak, and traumatic transection. When an ulcerative lesion is found in the atherosclerotic aorta, especially the descending aorta of an elderly, PAU should be considered as the possible cause of widened mediastinum. We present a case of PAU, the diagnosis of which was delayed without the knowledge of PAU even though thoracic computed tomography showed widened mediastinum and suspious pericardial effusion.
Aged ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Rupture ; Chest Pain ; Diagnosis, Differential ; Emergencies ; Hematoma ; Humans ; Mediastinum ; Pericardial Effusion ; Ulcer

OBJECTIVE: The aim of this study was to identify interaction between causative factors of cervical cancer and BARD-1 (BRCA1 associated ring domain-1) polymorphism on cervical carcinogenesis in Korean women. METHODS: We evaluated 1,347 patients composed of women who had cervical cancer (n=337) and cervical intraepithelial neoplasia (n=308) and normal control healthy women (n=702) from October 2000 until November 2001. The single nucleotide polymorphisms (SNPs) of BARD-1 were evaluated from extracted DNA of peripheral blood with automatic DNA sequencer. The difference of each SNP between normal controls and patients was evaluated in the adjusted environmental background. RESULTS: In environmental aspect, the cervical cancer increased in the women who had the lower level of education, smoking history, the younger age of the first sexual intercourse, and the more child-bearing . The women who had BARD V507M (Arg/Arg) showed 1.6 fold increased risk in cervical cancer than the women who had BARD V507M (G/G), (G/A)(p=0.0433). And the risk increased with BARD R378S (C/C) among who have environmental risk factors compared with BARD R378S (G/G), (G/C) allele positive who have no environmental risk factors. CONCLUSION: We found that the level of education, the age at first intercourse, and the number of children were the independent risk factors in cervical carcinogenesis. The specific combination of BARD-1 and gene-environmental interactions were significantly noted in the cervical carcinogenesis in Korean women.
Alleles ; Carcinogenesis ; Cervical Intraepithelial Neoplasia ; Child ; Coitus ; DNA ; Education ; Female ; Humans ; Polymorphism, Single Nucleotide ; Risk Factors ; Smoke ; Smoking ; Uterine Cervical Neoplasms*

PURPOSE: Staphylococcal bacteremia is a major problem in the neonatal intensive care unit. But, there is little data on staphylococcal bacteremia in the neonatal intensive care unit in Korea. We searched for patterns of staphylococcal infection in neonatal intensive care units. METHODS: A retrospective study was conducted on infants who had staphylococcal bacteremia and were in the neonatal intensive care unit between 2001, February and 2007, May. RESULTS: A total of 48 cases were reviewed (mean gestational age 31 wks [23-40], mean birth weight 1689 g [510-3,920]). The vast majority of cases were coagulase-negative staphylococcus (CoNS) (30 cases, 62.5%). Staphylococcus aureus caused 36.1% of staphylococcal bacteremia (17 cases). Methicillin-resistant staphylococcal aureus (MRSA) (14 cases) caused 77.7% of staphylococcal aureus bacteremia. Peripherally inserted central venous catheters were placed in situ in most patients (MSSA: 75%, MRSA: 88.2%, CoNS: 62.1%). Most of the staphylococcal bacteremia in patients were hospital-acquired (81%). Fifteen cases increased levels of C-reactive protein (CRP) (31%). (Mean CRP : MSSA 1.07 mg/dL, MRSA 3.64 mg/dL, CoNS 0.54 mg/dL). Exclusively MRSA had focal complications (osteomyelitis/arthritis: 3 cases). Vancomycin was used in 47.4% in MRSA and 52.6% in CoNS. Four patients (8.3%) died, but all were not directly attributable. CONCLUSION: The staphylococcal bacteremia was generally observed to be a hospital- acquired infection in the neonatal intensive care unit. MRSA caused more elevation of CRP levels and focal complication. To know exactly that what the pattern of staphylococcal bacteremia in Korea is, more research is needed in other neonatal intensive care unit.
Bacteremia ; Birth Weight ; C-Reactive Protein ; Central Venous Catheters ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal* ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Staphylococcal Infections* ; Staphylococcus ; Staphylococcus aureus ; Vancomycin

Parapharyngeal abscess is relatively common but it can cause life-threatening complications like internal jugular vein thrombophlebitis, septic shock, airway obstruction, and mediastinitis. The diagnosis is dependent on physical examination, endoscopic view, and CT and MR imaging. The treatment is antibiotics but sometimes incision and drainage are necessary. Pseudoaneurysm in deep neck space is very rare and mainly caused by trauma, postoperative state of head and neck surgery and radiation therapy. We herein report a case of massive oropharyngeal bleeding from pseudoaneurysm of the superior thyroid artery associated with parapharyngeal abscess with a review of related literature.
Abscess* ; Airway Obstruction ; Aneurysm, False* ; Anti-Bacterial Agents ; Arteries* ; Diagnosis ; Drainage ; Head ; Hemorrhage* ; Jugular Veins ; Magnetic Resonance Imaging ; Mediastinitis ; Neck ; Physical Examination ; Shock, Septic ; Thrombophlebitis ; Thyroid Gland*

In September 2013, we discovered sooty mould growing on kenaf with the extrafloral nectaries in Iksan, Korea and identified the causative fungus as Leptoxyphium kurandae based on morphological characteristics and phylogenetic analyses. This is the first report of sooty mould caused by L. kurandae on kenaf in Korea and globally.
Fungi ; Hibiscus* ; Jeollabuk-do ; Korea ; Virulence

Objective: Discriminating between pulmonary embolism (PE) and pneumonia in the emergency department (ED) is one of the fastidious tasks. Elderly patients are at more risk of PE and pneumonia than younger patients. This study aimed to determine whether the ratio of D-dimer to C-reactive protein (CRP) could be used as an adjunctive method to differentiate between PE and pneumonia in elderly patients. Methods: Medical records of patients visiting the ED diagnosed with PE and pneumonia were examined. Cutoff values of D-dimer (μg/mL) and the ratio of D-dimer to CRP ([μg/mL]/[mg/dL]) of subjects with PE or pneumonia were analyzed. Results: There were a total of 60 patients with PE and 152 patients with pneumonia. In addition, 15 patients had both PE and pneumonia. The cutoff value of D-dimer to differentiate between PE and pneumonia was 4.26 μg/mL (4,260 ng/mL) (area under curve [AUC], 0.861; sensitivity, 80.0%; specificity, 80.3%; 95% confidence interval [CI], 0.805-0.917). The cutoff value of the ratio of D-dimer to CRP to differentiate between PE and pneumonia was 1.24 ([μg/mL]/[mg/dL]) (AUC, 0.919; sensitivity, 84.4%; specificity, 84.2%; 95% CI, 0.878-0.960). Conclusion The ratio of D-dimer to CRP can be used as an adjunctive method to determine whether a computed tomography pulmonary angiography or a ventilation-perfusion scan can be performed to differentiate between PE and pneumonia in elderly patients.

A 62-year-old Korean woman was admitted to our department to evaluate a chronic cough and sputum, which had begun several weeks ago. The patient had been diagnosed with systemic sclerosis in 2004. Autoantibody screening tests were negative for the anticentromere and antitopoisomerase antibodies. She received therapy with combined cyclophosphamide, a calcium channel blocker, D-penicillamine, and low dose steroid. In 2006, a pulmonary function test (PFT) showed a restrictive pattern, and a computed tomography (CT) scan of the lungs revealed interstitial lung disease, but no symptoms were present, so we maintained her on the medication. In October 2008, a chest x-ray and CT scan of the lungs demonstrated aggravation with bilateral basal interstitial infiltrates and hilar lymphadenopathy. Cyclophosphamide pulse therapy was conducted six times during 6 months, but there was no change on her chest CT and PFT, and she had no symptoms, so we decided to follow up. On admission, no significant interval change in the reticular opacity of both lower lungs was observed, but several lymph nodes were enlarged on a chest and neck CT. The skin showed multiple large polygonal-shaped scaled lesions on her upper and lower extremities. Biopsies were taken from the skin of the lower extremities and the left cervical lymph node. Typical non-caseating granulomas corresponding to sarcoidosis were found along with systemic sclerosis findings.
Antibodies ; Biopsy ; Calcium Channels ; Cough ; Cyclophosphamide ; Female ; Follow-Up Studies ; Granuloma ; Humans ; Lower Extremity ; Lung ; Lung Diseases, Interstitial ; Lymph Nodes ; Lymphatic Diseases ; Mass Screening ; Middle Aged ; Neck ; Penicillamine ; Respiratory Function Tests ; Sarcoidosis ; Scleroderma, Systemic ; Skin ; Sputum ; Thorax

Cardiac arrest (CA) is sudden loss of heart function and abrupt stop in effective blood flow to the body. The patients who initially achieve return of spontaneous circulation (RoSC) after CA have low survival rate. It has been known that multiorgan dysfunctions after RoSC are associated with high morbidity and mortality. Most previous studies have focused on the heart and brain in RoSC after CA. Therefore, the aim of this research was to perform serological, physiological, and histopathology study in the lung and to determine whether or how pulmonary dysfunction is associated with low survival rate after CA. Experimental animals were divided into sham-operated group (n=14 at each point in time), which was not subjected to CA operation, and CA-operated group (n=14 at each point in time), which was subjected to CA. The rats in each group were sacrificed at 6 hours, 12 hours, 24 hours, and 2 days, respectively, after RoSC. Then, pathological changes of the lungs were analyzed by hematoxylin and eosin staining, Western blot and immunohistochemistry for tumor necrosis factor α (TNF-α). The survival rate after CA was decreased with time past. We found that histopathological score and TNF-α immunoreactivity were significantly increased in the lung after CA. These results indicate that inflammation triggered by ischemia-reperfusion damage after CA leads to pulmonary injury/dysfunctions and contributes to low survival rate. In addition, the finding of increase in TNF-α via inflammation in the lung after CA would be able to utilize therapeutic or diagnostic measures in the future.
Animals ; Blotting, Western ; Brain ; Eosine Yellowish-(YS) ; Heart ; Heart Arrest* ; Hematoxylin ; Humans ; Immunohistochemistry ; Inflammation ; Lung* ; Models, Animal* ; Mortality ; Rats* ; Survival Rate ; Tumor Necrosis Factor-alpha*