BACKGROUND AND OBJECTIVES: Preoperative identification of intimal tear site in acute type A dissection will help procedural planning. The objective of this study was to determine the key findings of computed tomography (CT)-based prediction for tear site and compare the accuracy between radiologists and surgeons. SUBJECTS AND METHODS: Multi-detector CT (MDCT) images from 50 patients who underwent surgical repair of type A aortic dissection were retrospectively reviewed by 4 cardiac surgeons with limited experience or by 3 radiologists specialized in cardiovascular imaging. Surgical findings of intimal tear site were used as references. RESULTS: In surgical findings, the locations of intimal tear that were identified in 43 patients included aorta (n=25), ascending with arch (n=7), and arch only (n=11). The rest were retrograde dissections from the tear of descending aorta. Key CT findings that were most frequently found were defect in the intimal flap shadow (30.0+/-4.0 patients/reviewer, accuracy 87.0+/-11.7%) and differential filling of false lumen by phase and location (9.4+/-2.9 patients/reviewer, 84.8+/-10.4%). Surgeons predicted tear site (75.0+/-7.7% vs. 86.7+/-1.2%, p=0.055) and specified flap defect (80.5+/-10.3% vs. 95.7+/-7.4%, p=0.073) with lower accuracy than radiologists. CONCLUSIONS: With MDCT imaging, well-educated surgeons could be accurate in three fourths of cases. There was room for improvement through experience. Considering the substantial possibility of inaccuracy, critical decisions on CT images should be made through thorough reviewing by as many experienced radiologists and surgeons as possible.
Aorta ; Aorta, Thoracic ; Humans ; Retrospective Studies ; Tears*

BACKGROUND/AIMS: We aimed to evaluate the efficacy and safety of peginterferon plus ribavirin for chronic hepatitis C (CHC) patients under real life setting in Korea. METHODS: We retrospectively analyzed the medical records of 758 CHC patients treated with peginterferon plus ribavirin between 2000 and 2008 from 14 university hospitals in the Gyeonggi-Incheon area in Korea. RESULTS: Hepatitis C virus (HCV) genotype 1 was detected in 61.2% of patients, while genotype 2 was detected in 35.5%. Baseline HCV RNA level was > or =6x10(5) IU/mL in 51.6% of patients. The sustained virological response (SVR) rate was 59.6% regardless of genotype; 53.6% in genotype 1 and 71.4% in genotype 2/3. On multivariate analysis, male gender (p=0.011), early virological response (p<0.001), genotype 2/3 (p<0.001), HCV RNA <6x10(5) IU/mL (p=0.005) and adherence to the drug >80% of the planned dose (p<0.001) were associated with SVR. The rate of premature discontinuation was 35.7%. The main reason for withdrawal was intolerance to the drug due to common adverse events or cytopenia (48.2%). CONCLUSIONS: Our data suggest that the efficacy of peginterferon and ribavirin therapy in Koreans is better in Koreans than in Caucasians for the treatment of CHC, corroborating previous studies that have shown the superior therapeutic efficacy of this regimen in Asians.
Asian Continental Ancestry Group ; Genotype ; Hepacivirus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Hospitals, University ; Humans ; Male ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Ribavirin ; RNA

PURPOSE: Flexible bronchoscopy is effectively used in the diagnosis and treatment of respiratory diseases in children. This report attempted to analyze the indication, effectiveness, and complications of bronchoscopy in children who visited a single tertiary care, university-based hospital in Korea. METHODS: A retrospective review was conducted of the medical records of a total of 100 cases of flexible bronchoscopy that were performed at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary's Hospital from April 8, 2007 to June 16, 2010. RESULTS: A total of 85 patients (48 males and 37 females) were involved in the study. The range in age was 5 days old to 18 years old. Eighty cases were for diagnosis, 7 cases for treatment, and 13 cases for both. The purpose of flexible bronchoscopy was accomplished in 67 of 100 cases. In 60 cases where bronchoalveolar lavage was provided, microbial organisms were identified in 38 cases. Minor complications were observed in 12 cases. CONCLUSION: Pediatric flexible bronchoscopy is shown to be an effective and safe diagnostic and interventional tool, even in young or immunocompromised hosts. This study also found that children under one year of age were more frequently treated with bronchoscopy and that the detection rate in microbiological diagnosis was improved due to the introduction of the virus polymerase chain reaction method.
Bronchoalveolar Lavage ; Bronchoscopy ; Child ; Humans ; Immunocompromised Host ; Korea ; Male ; Medical Records ; Pediatrics ; Polymerase Chain Reaction ; Retrospective Studies ; Tertiary Healthcare ; Viruses

Although various derivatives of caffeic acid have been reported to possess a wide variety of biological activities such as protection of neuronal cells against excitotoxicity, the biological activity of 1-docosanoyl cafferate (DC) has not been examined. The objective of the present study was to evaluate the anti-inflammatory effects of DC, isolated from the stem bark of Rhus verniciflua, on lipopolysaccharide (LPS)-stimulated BV2 microglial cells. Pretreatment of cells with DC significantly attenuated LPS-induced NO production, and mRNA and protein expression of iNOS in a concentration-dependent manner. DC also significantly suppressed LPS-induced release of cytokines such as TNF-alpha and IL-1beta . Consistent with the decrease in cytokine release, DC dose-dependently and significantly attenuated LPS-induced mRNA expression of these cytokines. Furthermore, DC significantly suppressed LPS-induced degradation of IKB, which retains NF-kB in the cytoplasm. Therefore, nuclear translocation of NF-kB induced by LPS stimulation was significantly suppressed with DC pretreatment. Taken together, the present study suggests that DC exerts its anti-inflammatory activity through the suppression of NF-kB translocation to the nucleus.
Caffeic Acids ; Cytokines ; Cytoplasm ; Neurons ; NF-kappa B ; Rhus ; RNA, Messenger ; Tumor Necrosis Factor-alpha

BACKGROUND: We applied the pediatric risk of mortality (PRISM) III score to study patients in a pediatric intensivecare unit (PICU), where children with various kinds of diseases were hospitalized. We analyzed whether this scoring system was useful to predict patient mortality in the PICU. METHODS: We retrospectively analyzed the medical records of patients hospitalized in a 5-bed PICU at a tertiary general hospital. Children who were transferred to other hospitals and remained under pediatric intensive care were excluded from this study. RESULTS: We studied a total of 105 children, which included 63 boys (60%) and 42 girls (40%). The mean age was 4.2 years (range 0-17 years). The children were admitted to the PICU for various conditions, including respiratory disease (31 children), neurological disease (30 children), congenital anomaly or neonatal disease (11 children), hemato-oncological disease (10 children), accident or poisoning (7 children), cardiovascular disease (5 children), sepsis (2 children), and the other miscellaneous diseases (9 children). The mean period of PICU stay was 9 days (range 2-66 days). Out of the 105 patients, 94 survived and 11 died. Thus, the mortality rate was calculated as 10.5%. PRISM III scores of the patients were between 0 and 38, with a mean +/- SD of 5.0 +/- 6.7. In comparison with previous studies on PICU patients with similar PRISM scores, the patients included in our study exhibited a higher mortality. The area under the curve for the prediction of mortality by PRISM III was 0.107. Among the variables included in PRISM III, Glasgow coma scale, pupillary light reflex, and platelet counts were associated with patient mortality. CONCLUSIONS: In a PICU with a wide spectrum of diseases, PRISM III was not a useful predictor of patient mortality.
Cardiovascular Diseases ; Child ; Glasgow Coma Scale ; Hospitals, General ; Humans ; Critical Care ; Intensive Care Units ; Light ; Medical Records ; Platelet Count ; Reflex ; Retrospective Studies ; Sepsis

Exposure to early stressful adverse life events such as maternal and social separation plays an essential role in the development of the nervous system. Adolescent Sprague-Dawley rats that were separated on postnatal day 14 from their dam and litters (maternal social separation, MSS) showed hyperactivity and anxiolytic behavior in the open field test, elevated plus-maze test, and forced-swim test. Biologically, the number of astrocytes was significantly increased in the prefrontal cortex of MSS adolescent rats. The hyperactive and anxiolytic phenotype and biological alteration produced by this MSS protocol may provide a useful animal model for investigating the neurobiology of psychiatric disorders of childhood-onset diseases, such as attention deficient hyperactive disorder.
Adolescent ; Animals ; Astrocytes ; Humans ; Models, Animal ; Nervous System ; Neurobiology ; Phenotype ; Prefrontal Cortex ; Rats ; Rats, Sprague-Dawley

The internal stipe necrosis of cultivated mushrooms (Agaricus bisporus) is caused by the bacterium Ewingella americana, a species of the Enterobacteriaceae. Recently, Ewingella americana was isolated from cultivated white button mushrooms in Korea evidencing symptoms of internal stipe browning. Its symptoms are visible only at harvest, and appear as a variable browning reaction in the center of the stipes. From these lesions, we isolated one bacterial strain (designated CH4). Inoculation of the bacterial isolate into mushroom sporocarps yielded the characteristic browning symptoms that were distinguishable from those of the bacterial soft rot that is well known to mushroom growers. The results of Gram stain, flagellal staining, and biochemical tests identified these isolates as E. americana. This was verified by pathogenicity, physiological and biochemical characteristics, and the results of an analysis of the 16S rRNA gene sequences and the fatty acids profile. This is the first report of the isolation of E. americana from cultivated white button mushrooms in Korea.
Agaricales ; Enterobacteriaceae ; Fatty Acids ; Genes, rRNA ; Humans ; Korea ; Maillard Reaction ; Necrosis ; Sprains and Strains

Calyptella capula is reported for the first time in Korea. It was found in spring in Chungcheongbuk-do, central Korea, growing in a dead stalk of Sesamum indicum. A description and molecular phylogenetic analyses are reported.
Korea ; Sesamum

PURPOSE: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performingLATG for the gastric cancer located in the upper or middle portion of the stomach. MATERIALS AND METHODS: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. RESULTS: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago- jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was 212+/-67 minutes. The mean total number of retrieved lymph nodes was 28.9+/-10.54 (range: 12~64) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the BMI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.
Body Mass Index ; Conversion to Open Surgery ; Gastrectomy ; Hand ; Humans ; Jejunostomy ; Korea ; Laparoscopy ; Learning Curve ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Patient Selection ; Prospective Studies ; Stomach Neoplasms

PURPOSE: Despite known advantages of laparoscopy-assisted distal gastrectomy (LADG) over open surgery, including less blood loss, less pain, faster recovery, and shorter hospital stays, many surgeons still hesitate to perform LADG in overweight patients due to concerns about increased perioperative morbidity. We investigated whether surgical outcomes in LADG differ in overweight patients and normal patients, as well as the influence of surgical experience. METHODS: Between April 2004 and December 2006, 331 consecutive patients underwent LADG for preoperatively diagnosed early gastric cancer. Using the definition of overweight by western criteria, patients were classified into a low (n = 187, BMI < 25 kg/m(2)) and a high (n=144, BMI > 25 kg/m(2)) group. We retrospectively analyzed surgical outcomes, including operation time, retrieved lymph nodes, hospital courses, and postoperative complications. RESULTS: The only differences in overweight and normal patients were longer operation time, incision length, and fewer retrieved lymph nodes. As our surgical team accumulated experience (after 250 cases in our study), there were no differences at all between the two groups. CONCLUSION: Technical difficulty in overweight patients could hamper some surgical outcomes but didn't worsen the post- operative courses or complications. Moreover, those difficulties can be overcome as the surgical team accumulates experience.
Body Mass Index ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Obesity ; Overweight ; Retrospective Studies ; Stomach Neoplasms