A retrospective analysis was performed on the 968 cases of fetal or pediatric autopsies over five year period (1990-1994), at the Seoul National University Children's Hospital. Age/mode distribution of cases were artificial abortus(30.6%), spontaneous abortus(12.0%), stillbirth(21.9%), neonates(29%), infants(2.8%) and children(0.9%). Male/female ratio was 1.21. Overall incidence of congenital anomalies was 60.8% and 34.0% of all cases had anomalies involving multiple organ systems. Percentage of cases with any anomaly was 71.6% in artificial abortus, 35.3% in spontaneous abortus, 59% in still births, 65.5% in neonates and 38.9% in infant and children. Common organ systems involved were the cardiovascular system (39.0%), musculoskeletal system (23.6%), nervous system (22.6%), gastrointestinal system (19.9%), and urinary system (14.6%). From these results, we found that the congenital anomalies were most significant diseases of the perinatal period and the cardiovascular anomalies were the most common anomalies of them.
Autopsy* ; Cardiovascular Diseases ; Cardiovascular System ; Child ; Humans ; Incidence ; Infant ; Infant, Newborn ; Musculoskeletal System ; Nervous System ; Parturition ; Perinatal Mortality ; Retrospective Studies ; Seoul*

A retrospective analysis was performed on the 968 cases of fetal or pediatric autopsies over five year period (1990-1994), at the Seoul National University Children's Hospital. Age/mode distribution of cases were artificial abortus(30.6%), spontaneous abortus(12.0%), stillbirth(21.9%), neonates(29%), infants(2.8%) and children(0.9%). Male/female ratio was 1.21. Overall incidence of congenital anomalies was 60.8% and 34.0% of all cases had anomalies involving multiple organ systems. Percentage of cases with any anomaly was 71.6% in artificial abortus, 35.3% in spontaneous abortus, 59% in still births, 65.5% in neonates and 38.9% in infant and children. Common organ systems involved were the cardiovascular system (39.0%), musculoskeletal system (23.6%), nervous system (22.6%), gastrointestinal system (19.9%), and urinary system (14.6%). From these results, we found that the congenital anomalies were most significant diseases of the perinatal period and the cardiovascular anomalies were the most common anomalies of them.
Autopsy* ; Cardiovascular Diseases ; Cardiovascular System ; Child ; Humans ; Incidence ; Infant ; Infant, Newborn ; Musculoskeletal System ; Nervous System ; Parturition ; Perinatal Mortality ; Retrospective Studies ; Seoul*

This study is based on 155 patients of congenital me colon. For the diagnosis, 93 cases were histologically proven and the remaining 63 cases were diagnosed on clinical basis including barium enema or surgical gross findings. On histologic examination, 80 cases(86%) showed typical features of absence of ganglion cell in the myenteric plexus and the 13 cases(14%) had atypical features which were segmental absence Of ganglion cell in one case. There we 127 males(82%) and 28 females(18%). The age at diagnosis was younger than 30 days in 87 cases(56%), I month to 1 year in 39 cases(25%) and older than I year in 29 cases(18%). The levels of aganglionosis were variable: short segment (rectosigmoid) in 134 cases(86%), intermediate segment (more proximal colon) in 14 cases(100%). and 6 cases(4%) had total aganglionosis. Common clinical presentations were abdominal distention, delayed meconium passage or bilious vomiting in neonate, and chronic constipation in infancy or childhood. Following initial colostomy or ileostomy, a definitive procedure was performed in 151 cases(Duhamel type in 150 cases; Soave type in 2 cases; Swenson type in 3 cases). Frequently associated problems after definitive procedure were persistent constipation(ll%) due to septum formation, fecaloma, remnant aganglionic segment and rectal stenosis. Overall mortality rate was 4%, and increased mortality was associated with enterocolitis(14%) which was the most frequent cause of death. The follow-up study longer than 3 months was available in 138 patients who underwent a definitive procedure(mean 2 year 11 months). Seventy-three cases(53%) had normal bowel function, 38cases(27.5%) had occasionally used enema or stool softners, and 27 cases(19.5%) had severe constipation or soiling. The bowel habit improved with time, and were considered normal in 60% of patients after follow-up more than 3 years. The results of definitive procedures for congenital megacolon including Duhamel operation was satisfactory, and long-term follow-up appeared an important and critical component of patients'care.
Child ; Male ; Female ; Infant, Newborn ; Humans ; Mortality ; Follow-Up Studies

Cutaneous larva migrans(creeping eruption) is a rare cutaneous serpiginous erution caused by the accidental invasion of the skin by parasites. We report herein a 27 year-old female with a mild pruritic erythematous serpiginous linear skin lesion located on the patient's back for a month. Histopathologic examination revealed a larva in the dermis with dense iinfiltrates of eosinophils and lymphocytes. After treatment with oral anitiparasitics, the skin lesions resolved with post-inflammatory hyperpigmentation. This is the first case of larva migrans showing the larva on the biopsy specimen in Korea.
Adult ; Biopsy* ; Dermis ; Eosinophils ; Female ; Humans ; Hyperpigmentation ; Korea ; Larva Migrans* ; Larva* ; Lymphocytes ; Parasites ; Skin

We experienced 3 cases of Candida esophagitis in infancy which were diagnosed by esophageal endoscopy. First case, 10 month-old boy with combined immune deficiency had suffered from oral thrush and poor feeding for more than 4 months. Esophageal endoscopy revealed multiple whitish creamy patches on the friable erythematous and necrotic mucosa of the esophagus. He was firstly treated with amphotericin-B but in vain. Then he was treated with fluconazole (5 mg/kg/day) and in a few days oral thrush nearly disappeared and endoscopy after 2 weeks revealed complete healing of the esophagitis. Second case, 6 month-old boy with some cellular immue defect also suffered from oral thrush, poor feeding and intermittent fever. He was treated with fluconazole and oral thrush was imporved. He was discharged without follow up endoscopy. Third case, 4 month-old girl with liver cirrhosis due to infantile cholestasis had Candida sepsis. Esophagitis was found incidentally during the endoscopic examination of esophageal varix. First 2 cases showed multiple small filling defects and decreased motility on esophagography. Candida antigen was not detected in the sera of all 3 cases of candidiasis. We conclude that Candidia esophagitis should be suspected when an infant has been suffering from long-term treatmet-resistant oral thrush and poor feeding and that esophageal endoscopy can be easily performed in infants also and useful in diagnosing esophagitis and assessing the outcome of treatment.
Candida* ; Candidiasis ; Candidiasis, Oral ; Cholestasis ; Endoscopy ; Esophageal and Gastric Varices ; Esophagitis* ; Esophagus ; Female ; Fever ; Fluconazole ; Humans ; Infant ; Liver Cirrhosis ; Male ; Mucous Membrane ; Sepsis

Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. Antitachycardia pacemaker PASAR 4172 (Programmable Automatic Scanning Arrhythmia Reversion, Model 4172, Telectronics) is designed to detect tachycardia automatically and subsequently to deliver programmed one or two extrastimuli to revert to sinus rhythm. We experienced two patients, one paroxysmal supraventricular tachycardia and one paroxysmal ventricular tachycardia, who had had frequent and often prolonged episodes of tachycardia that responded poorly to pharmacologic antiarrhythmic therapy. Each patient underwent a detailed preimplantation clinical electrophysiological study in order to determine the number of stimuli required for termination of tachycardia, the most satisfactory site for electrode placement, and the tachycardia termination zone. During the follow-up period of 7 to 11 months after implantation of PASAR 4172, no patient complained of an episode of sustained tachycardia although they experienced symptoms of an impending attack. We conclude that antitachycardia pacemaker PASAR 4172 is a safe, effective, and well tolerated method for the therapy of drug resistant paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Arrhythmias, Cardiac ; Electrodes ; Follow-Up Studies ; Humans ; Tachycardia ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

A 62-year-old man was transferred to our emergency room because of acute encephalopathy. He was a nondrinker with history of a gastrectomy nineteen years ago. Two weeks before his visit, he had experienced transient poor oral intake due to gastroesophageal reflux (GER). His brain MRI showed definite lesions compatible with Wernicke Encephalopathy (WE). A trivial event like GER can complicate the marginal equilibrium of thiamine and, after a long latent interval following a gastrectomy, may induce delayed-onset WE.
Brain ; Emergencies ; Gastrectomy ; Gastroesophageal Reflux ; Humans ; Middle Aged ; Thiamine ; Wernicke Encephalopathy

BACKGROUND: Reestabilshment of blood flow is a standard therapeutic modality to salvage the myocardium at risk in an acute phase of myocardial infarction. However, there are significant evidences that reperfusion per se may injure the potentially viable myocardium, and a number of pharmacological agents were tried to reduce this reperfusion injury. Adenosine, an endogenous vasodilator, is suggested to reduce repergusion inury. To evaluate the myocardial protective effect of adenosine, magnetic resonance spectroscopy with superscript P was applied to feline model of acute myocardial ischemia-reperfusion, as well as pathological examination. METHODS: Effects of adenosine on the recovery of high energy phosphorous metabolites during 90 minutes of reperfusion period following 90 minutes of left anterior descending coronary artery ligation were assessed by31P spectroscopy in 27 cats(10: control group, 8: adenosine I group, 9: adenosine II group). In adenosine groups 0.2 mg/kg/min of adenosine was infused intravenously for 90 minutes from 30 miniutes before reperfusion in group I, and from just before reperfusion in group II. The experiments were performed on a 4.7 T/30 cm Biospec MRS/MRI system and the MR signals were obtained by using inner-diameter 1.5 cm-sized doubly tuned surface coil. The size of the spectral peaks was measured by area integration method. RESULTS: 1) Phosphocreatine(PCr) decreased rapidly with progression of ischemia, and recovered in reperfusion period in each group. PCr values in the reperfusion period were significantly higher in adenosine group than those in control group, although there was no difference between adenosine group I and II. 2) ATP decreased with progression of ischemia, and recovered in reperfusion period in each group. ATP values in the reperfusion period were significantly higher in adenosine groups than those in control group, byt there was no difference between adenosine group I and II. 3) pH decreased uniformly with progression of ischemia and recovered in reperfusion period, showing no difference between control and adenosine groups. 4) PCr/ATP ratio, representing the potential of oxidative phosphorylation, dereased with progression of ischemia and increased in reperfusion period. PCr/ATP ratio showed no difference between control, adenosine I and II groups. 5) Risk area/left ventricle ratio was not different in control and adenosine groups. Infarct size/risk area and infarct size/left ventricle ratios were smaller in adenosine II than those in control group. Howerver no significant diffence was noticed between adenosine I and control, and between adenosine I and II group. CONCLUSION: Intravenous infusion of adenosine showed the tendency of reducing the infarct size in the feline model of acute myocardial ischemia-reperfusion, and adenosine could improve significantly the recovery of high energy phosphate metabolites. This myocardial pretective effect of adenosine is considered to be present mainly in the reperfusion period.
Adenosine Triphosphate ; Adenosine* ; Coronary Vessels ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Ischemia ; Ligation ; Magnetic Resonance Spectroscopy ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium ; Oxidative Phosphorylation ; Polymerase Chain Reaction ; Reperfusion ; Reperfusion Injury ; Spectrum Analysis

In patients with chronic aortic regurgitation, irreversible left ventricular dysfunction, which is associated poor longterm prognosis, often develops before onset of severe symtoms. To determine whether evidence of left ventricular dysfunction could be detected before it appeared at rest, 48 patients with chronic aortic regurgition were studied using exercise echocardiography, and 25 patients were followed-up for 16.1 months in average by serial echocardiographical and clinical examination to evaluate the prognostic value of exercise-echocardiographic data. Among 41 patients with normal resting ejection fraction, left ventricular ejection fraction increased more than 5% with exercise(big up tri, DeltaEF> or =5%) in 14 patients (Group I), while in 27 patients ejection fraction change with exercise was less than normal (big up tri, DeltaEF <5%) (Group II). In the remaining 7 patients with subnormal resting ejection fraction, the exercise response was also subnormal (big up tri, DeltaEF<5%)(Group III). 1) There was no significant difference in radius-thickness ratio, ejection fraction at rest, work capacity, exercise duration and NYHA functional class between group I, II and III. But left ventricular internal dimension and wall stress were greater in group II than in group I. Group III had the largest left ventricualr internal dimension and stress. 2) Among the 15 patients with left vnetricular end-systolic dimension(LVESD) greater than 55mm, only one patient belong to group I. The other 14 patients belonged to group II(7 patients) and group III(7 patients). In contrast, in 22 patients with LVESD less than 50mm, 13 patients were group I, 9 patients were group II. In 26 patients with LVESD greater than 50 mm, only one patient showed normal exercise response, but the remaining 25 patients showed subnormal response. 3) Serial echocardiographic and clinical follow-up study for average 16.1 months showed group I the best, group II better than group III, group III the poorest clinical course and prognosis. Left ventricular functional status of group II patients seemed to be intermediate stage between group I and group III. 4) Total work duration and work capacity were more reduced in NYHA functional class II and III than in class I. But, using NYHA functional classification there were no differences in left ventricular internal dimension, ejection fraction at rest, exercise change in ejection fraction(big up tri, DeltaEF), wall stress and radius-thickness ratio between class I, II and III. According to the above results the classification based on the resting ejection fraction and big up tri, DeltaE.F., seemed to be useful for identification of patients with different clinical course and prognosis, especially in asymptomatic cases. The consideration of indices obtained by exercise-echocardiography, such as, LVESD, resting ejection fraction, big up tri, DeltaE.F. and wall stress, as well as the clinical status of patient, would be a useful guideline for follow-up and determining the optimal time for surgical intervention in patients with chronic aortic regurgitation.
Aortic Valve Insufficiency* ; Classification ; Echocardiography* ; Follow-Up Studies* ; Humans ; Prognosis ; Stroke Volume ; Ventricular Dysfunction, Left

OBJECTIVE: To investigates the effect of curcumin on proliferation of spinal cord neural stem/progenitor cells (SC-NSPCs) and functional outcome in a rat spinal cord injury (SCI) model.METHODS: Sixty adult male Sprague-Dawley rats were randomly and blindly allocated into three groups (sham control group; curcumin treated group after SCI; vehicle treated group after SCI). Functional recovery was evaluated by the Basso, Beattie, and Bresnahan (BBB) scale during 6 weeks after SCI. The expression of SC-NSPC proliferation and astrogliosis were analyzed by nestin/Bromodeoxyuridine (BrdU) and Glial fibrillary acidic protein (GFAP) staining. The injured spinal cord was then examined histologically, including quantification of cavitation.RESULTS: The BBB score of the SCI-curcumin group was better than that of SCI-vehicle group up to 14 days (p < 0.05). The co-immunoreactivity of nestin/BrdU in the SCI-curcumin group was much higher than that of the SCI-vehicle group 1 week after surgery (p < 0.05). The GFAP immunoreactivity of the SCI-curcumin group was remarkably lower than that of the SCI-vehicle group 4 weeks after surgery (p < 0.05). The lesion cavity was significantly reduced in the curcumin group as compared to the control group (p < 0.05).CONCLUSION: These results indicate that curcumin could increase the expression of SC-NSPCs, and reduce the activity of reactive astrogliosis and lesion cavity. Consequently curcumin could improve the functional recovery after SCI via SC-NSPC properties.
Adult ; Animals ; Curcumin ; Glial Fibrillary Acidic Protein ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries ; Spinal Cord