In evaluating the early state of shock patients and their response to treatment, generally vital signs or additional hemodynamic values were used. Vital signs are easily obtained and repetitious values or continous monitoring is possible, whereas it cannot evaluate the patient's status properly nor is it a good prognostic factor. Meanwhile, additional hemodynamic values are obtained from pulmonary artery catheterization. But this procedure is difficult to proceed in the emergency room. Since central venous oxygen saturation has the advantage of being easily obtained and acts as a good prognostic factor for shock patients, we intended to prove its efficacy. From 1997 May to October, 50 patients admitted to Yonsei University Young Dong Severance Hospital in shock state, with systolic blood pressure below 90mmHg, were evaluated. Central venous catheter was inserted to obtain central venous oxygen saturation, serum lactate, base excess value, and its' initial value compared with the prognosis. The central venous oxygen saturation and base excess were low, while serum lactate value was high in the nonsurvival group. And in ROC(relative operating characteristic) curve, the AUC(area under curve) of central venous oxygen saturation was larger than the others. In comparing the MOF(multi-organ failure) group with the non-MOF group, the MOF group had a lower central venous oxygen saturation and base excess, and a higher serum lactate level, whereas in ROC curve, the AUC of base excess was larger than the others. Therefore, in estimating the prognosis of shock patients, the early central venous oxygen saturation proved to be a good prognostic factor.
Area Under Curve ; Blood Pressure ; Catheterization, Swan-Ganz ; Central Venous Catheters ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Lactic Acid ; Oxygen* ; Prognosis ; ROC Curve ; Shock* ; Vital Signs

In contrast to the nodular renal blastema which is defined by nests of primitive metanephric cells after 36 weeks of gestation, the nephroblastomatosis is characterized by neoplastic proliferation of the primitive cells. This lesion is presumed to be closely related to the development of Wilms' tumor. We report a case of bilateral nephroblastomatosis associated with Wilms' tumor in a child. This 4 1/2 year-old girl was admitted because of a 10 cm-sized round mass in the right kidney, and smaller nodules in the left kidney and the lung. After three cycles of chemotherapy and subsequent disappearance of the nodules in the left kidney and lung, she underwent a right nephrectomy and a wedge resection of the left kidney. A round Wilms' tumor mass was seen in the lower pole of the right kidney. Remaining right renal cortex showed multiple, slightly depressed gray-white nodules associated with multiple samll cysts. They were comprised of multifocal subcapsular nests of primitive nephrogenic cells with focal tubular or glomerular differentiation. They resembled fetal renal tissue. In the left kidney, similar nests of primitive cells were also noted. These lesions were interpreted as multifocal perilobar type of nephroblastomatosis.
Child ; Male ; Female ; Humans

No abstract available.
ACTH Syndrome, Ectopic* ; Wilms Tumor*

No abstract available.
Ischemia* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Survival time of patients with multiple myeloma has been reported to be closely related to the cytology of bone marrow smears and the histologic features of bone marrow biopsies. However, there have been many differences in morphological criteria applied by various authors. In this study, we evaluated the prognostic relevance of bone marrow features in patients with multple myeloma by investigation of the cytologic feature and the histologic patterns. MATERIALS AND METHODS: One hundred and seven previously untreated patients with multiple myeloma, admitted to Asan Medical Center, between 1989 and 1997, were studied. Bone marrow aspirations and biopsies were analyzed according to the criteria such as cytologic differentiation, volume of infiltration, pattern of infiltration, degree of hematopoiesis, and presence of fibrosis. RESULTS: 64 cases (59.8%) of 107 patients with multiple myeloma were plasmacytic type and 43 cases (40.2%) were plasmablastic type. Each median survival time was 35.0 months and 18.0 months (P<0.05). The patients with more than 25% of plasmablasts showed shorter median survival time than those with 1ess than 25% (18 months vs 38.9 months, P<0.05). The patients with nodular or packed marrow pattern revealed poorer prognosis than those with interstitial or interstitial/nodular pattern (P<0.05). The patients of plasmablastic type disclosed larger volume of myeloma cell infiltration and more packed marow pattern than those of plasmacytic type. CONCLUSIONS: The cytologic differentiation, the volume of infiltration and the patterns of infiltration were reliable predictors of survival in myeloma patients. Thus, for the prognostic evaluation and therapeutic plans, the descriptions for cytologic differentiation (especially percentage of plasmablasts), volume of infiltration and pattern of infiltration should be included in the bone marrow interpretation of multiple myeloma.
Aspirations (Psychology) ; Biopsy ; Bone Marrow* ; Chungcheongnam-do ; Fibrosis ; Hematopoiesis ; Humans ; Multiple Myeloma* ; Prognosis

OBJECTIVE: To evaluate the change of abnormal spontaneous activities according to the clinical and radiologic findings, and to the time course after onset in hemiplegic upper limb. METHOD: We scored abnormal spontaneous activities of hemiplegic upper limb muscles (infraspinatus, deltoid, extensor carpi radialis, abductor pollicis brevis, abductor digiti minimi) in 100 hemiplegic patients without peripheral neuropathy. The abnormal spontaneous activities were evaluated according to their radiologic findings and to Brunnstrom stage and the presence of reflex sympathetic dystrophy (RSD), and the time course after the onset (A cross-sectional study). In addition we repeatedly examined 40 hemiplegic patients until 12 weeks after the onset to define the pattern of change (A prospective study). RESULTS: There was no significant difference in the score of abnormal spontaneous activities according to the radiologic findings. The score of abnormal spontaneous activities decreased while Brunnstrom stage progressed. In both the cross-sectional and prospective studies, we found that the abnormal spontaneous activities decreased according to the time course after the onset in the limb without RSD, but sustained in the limb with RSD. CONCLUSION: Abnormal spontaneous activities decreased according to the progression of Brunnstrom stages. The hemiplegic patients with RSD showed more profuse and sustained abnormal spontaneous activities at needle EMG study of hemiplegic upper limb than the patients without RSD.
Extremities ; Humans ; Muscles ; Needles ; Peripheral Nervous System Diseases ; Prospective Studies ; Reflex Sympathetic Dystrophy ; Upper Extremity*

The introduction and practice of smallpox(cowpox) vaccination was officially done in 1879 by Chi Seok-young, but we know that already in 1835 Cheong Yak-yong, a great scholar and politician of the late period of Chos?n, got a small pamphlet about cowpox vaccination named New Treatise on the Smallpox Vaccination from Beijing. The second edition of the pamphlet was published in 1828 in Beijing. According to Kim Du Jong and Miki Sakae, Cheong Yak-yong might have got it through Korean Roman Catholic group corresponding with the French Catholic Missionary in Beijing but hided it secretly for the official oppression to the Catholicism. Cheong was a member of the group of young scholars that introduced Catholicism into Korea in 1784 and leaded this movement for a time, but officially betrayed his faith since 1791. So there is little historical documents to support the claim that two conflicting groups of scholars continue to debate. One group argues that Cheong betrayed his faith completely and left the Church since the persecution of Sinyu year(1801), but the other claims that he remained as believer in heart, only to hide his faith for the fear of official oppression. In such a horror of terrible persecution did he really communicate with Catholic group who often went to Beijing? We don't know what really was. Therefore the purpose of this article is to collect the circumstantial evidences for the assumption about 'the introduction of smallpox vaccination by Catholic group' and to evaluate the possibility. From the documents of the Church of that time we can know that a few of Catholic believers actively communicated with missionaries in Beijing for the employment of priests. The agents of Korean Catholic Church visited Beijing almost annually disguised in the official diplomatic visit, where they met French missionaries, discussed their route to Korea, sent letters, and traded of the bibles, holy books and religious materials from 1828(the publication year of the pamphlet) to 1835(the year Cheong Yak-yong died). It was a most active period in the History of Korean Catholic Church. Especially Cheong Ha-sang, nephew of Cheong Yak-yong, was the central figure leading this movement with Yu Jin-kil who was an official translator in a high position and a very erudite man. They often visited Beijing, and where they could have seen the pamphlet about smallpox vaccination and taken it to Cheong secretly. The Church of that time valued medical activity as an effective mean of their mission, which is well illustrated in the letters and documents of the missionary in Korea. Smallpox was a very severe health problem in Korea and the mortality of children was extremely high. The first Korean priest Father Kim asked the missionary in Beijing to send a prescription for smallpox. Cheong Yak-yong had a great interest in medicine, especially in smallpox, wrote some books devoting this subject. He also asserted continual study and introduction of new knowledge, which we can know from the statement that he rewrote MagwaHoetong for seven times. He knew and trusted the Western science and technology as other Korean Roman Catholics. It can not be completely confirmed that he really reacted religious practices after returned from his 18 year exile as the claim of Church, but at least he recorded the history of Korean Catholic Church and was interested in the affairs of it, that known from the notes of Bishop Daveluy who preached gospel in Korea, to be martyred in 1866. He said repeatedly in the notes and letters that Cheong wrote and provided the basic material necessary to construct the history of Korean Catholic Church. On the basis of that information Bishop Daveluy tried to edit the History, but the task was finally accomplished by his successor Father Dallet, who wrote History of Korean Catholic Church(1874). From his statement Cheong hided his records of Korean Catholic Church and showed it to very few number of selected people, small group of friends and relatives. The similar situation is shown in the statement of Yi Kyu-kyoung, a scholar of Silhak school of 19th century, about smallpox vaccination in Korea in mid 19th century. He said Cheong had a book of the vaccination but hided it and showed to some limited people. Cheong also wrote secretly memorial addresses for some of his friends died in Sinyu Persecution. His son Hak-sang was baptized too. From those facts we can assume that Cheong Yak-yong was not totally disconnected from the Church as officially documented but continued works relating with it secretly under the severe persecution. In this small pamphlet the phrases suggesting its own origin from the West were carefully erased, which might have disguised its relation with the Catholicism. Yi Kyu-kyoung also said he had heard about smallpox vaccination from Nam Sang-kyo, who was a sincere catholic. It is suggested that small group of Roman Catholics knew the method but it could not be widely practiced. Because it seemed to be strange and odd to general Korean people and the Catholic believers were generally isolated in the deep mountain valley or so from the general population to escape the persecution. Chos?n government rigorously prohibited the import of foreign(Western) books and materials from China for protecting the country from the invasion of 'Western barbarians' since late 18th century. The ones committing this regulation were destined to get severe punishments. So were the related. Thousands of people were tortured and sentenced to death under the accusation of "believing foreign superstition and betraying his mother country". In such a condition who dared to get foreign materials and expose it except Catholics? We can think other routes. For example Hong Seok-joo, a high ranking official of the Chos?n government, secretly asked a Chinese official to get some books including Western books when he visited Beijing in 1831. He was an editor of MabangTonghwi, medical book about smallpox edited on the base of MagwaHoetong of Cheong. It is possible that he introduced New Treatise on the Smallpox Vaccination to Cheong. He was a relative of Cheong and some of Catholic martyrs, so he might have understanding of Catholicism. If he did, it was also done in the context of Western culture imported by Korean Catholic Church. Considering the above facts we can suggest the higher possibility of the introduction of smallpox vaccination through Catholic groups with Cheong Yak-yong. Of course other routes could have been available, but its possibility seems to be comparatively low.

Respiration has been well known as a basic phenomenon of life since the ancient times, but the explanation of which was varied. In most theories the respiration and the body heat of animal had been different phenomena until the early 19th century. After the Lavoisier's experiments in the late 18th century, combustion and respiration came to be considered as the same phenomenon. Through many discoveries and efforts of scientists in the field of chemistry, physics and biology, Justus Liebig, a German organic chemist, established the modern theory of the respiration of animal in the mid 19th century, where respiration was viewed as the origin of all energy of animal. The more detailed biochemical mechanisms were found in the 20th century.

OBJECTIVE: In adhesive capsulitis, assessment of the mobility of the shoulder are likely to have intrinsic error because of the altering scapulohumeral rhythm and extrinsic error. For more objective and the precise assessment of shoulder mobility in adhesive capsulitis, we observed proper glenohumeral movement, the change of scapulohumeral angle, the scapulohumeral rhythm were evaluated with radiography and compared with clinical measurement of shoulder range of motion (ROM). METHOD: The subjects were 19 patients (21 shoulder) with adhesive capsulitis of the shoulder and undertook combination treatment of distention arthrography, per os medication of non-steroid anti- inflammatory drug, stellate ganglion block, physical therapy including exercise. We assessed change in visual analogue scale (VAS), joint space capacity, shoulder mobility by measurement of ROM, and scapulohumeral angle in active shoulder abduction under the fluroscopy. RESULTS: All the subjects experienced pain relief, increased shoulder mobility and restoration of scapulohumeral rhythm. The improvement of the shoulder extension and scapulohumeral angle is well correlated with the change of VAS and joint capacity. However, the improvement of the shoulder flexion, abduction, external rotation and internal rotation were poor correlated with them. CONCLUSION: We propose the measurement of scapulohumeral angle with active shoulder abduction in shoulder AP view as an assessment method for shoulder mobility in adhesive capsulitis.
Adhesives* ; Arthrography ; Bursitis* ; Humans ; Joints ; Radiography* ; Range of Motion, Articular ; Shoulder* ; Stellate Ganglion ; Treatment Outcome*

Cerebral Salt Wasting Syndrome (CSWS) is defined as the development of extracellular volume depletion due to a dysfunction of the renal sodium transport system. Differentiation of CSWS from the Symdrome of Inappropriate Secretion of Antidiuretic Hormone in patients with intracranial disease is difficult because both syndromes include hyponatremia and concentrated urine with natriuresis. However, distinguishing between these two syndromes is very important because the treatment options differ. We report a 41 year-old Asian woman who presented initially with hyponatremia, and was finally diagnosed with CSWS after an operation for an acoustic neuroma. Based on this case, we discuss a possible mechanism and disclose insights about differential diagnosis thereof.
Acoustics ; Asian Continental Ancestry Group ; Cerebrum ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia ; Natriuresis ; Neuroma ; Neuroma, Acoustic ; Sodium ; Wasting Syndrome