29 isoniazid (INH) resistant isolated strains and INH sensitive reference strain (H37Rv) of Mycobacterium tuberculosis were analysed by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) and NciI restriction mapping for the detection of mutations in katG gene and inhA gene. The katG gene was divided into 3 parts (Akat, Bkat, Ckat; each part is about 800 bp) and amplified, inhA gene was amplified as a whole. Each of the amplified 800 bp DNA was digested into small fragments of less than 400 bp with restriction enzymes for the direct PCR-SSCP analysis. Firstly, 10 strains were analysed. All the 10 isolates showed clearly distinct SSCP patterns in Bkat from that of the reference strain, but only two isolates showed distinct SSCP patterns in Akat, and no isolated strain showed any distinct SSCP patterns in Ckat. 10 isolates also showed distinct SSCP patterns in inhA. NciI restriction mapping of Bkat showed mutation in codon 463 in 7 strains among 10 isolated strains. With these results an early detection strategy for the INH resistant M. tuberculosis was applied to the rest of 19 isolated INH resistant strains. Firstly, isolates were screened by Ncsl mapping in Bkat, and 13 strains showed mutations in codon 463. Secondly, the rest of 6 INH resistant isolates were analysed by PCR-SSCP with restriction enzyme digestion (PCR-SSCP-RE) in Bkat, and all the strains showed distinct SSCP patterns from that of the INH sensitive reference strain. This proved our strategy as effective and economic and time saving method in early detection of INH resistant M. tuberculosis.
Codon ; Diagnosis* ; Digestion ; DNA ; Isoniazid* ; Korea* ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymorphism, Single-Stranded Conformational ; Restriction Mapping ; Tuberculosis

Sclerosing hemangioma is a rare, benign neoplasm of the lung, usually presented as a solitary pulmonary nodule in an otherwise asymptomatic middle-aged woman. Cytologically it shows papillary, sheet, and cyst-like arrangements representing three main histologic patterns of papillary, solid, and angiomatous ones, respectively. Herein, we report the fine needle aspiration cytology of 5 cases of sclerosing hemangioma of the lung. The most characteristic finding is cyst-like spaces intimately related to the papillary or solid cell nests. The tumor cells are relatively monotonous, round to oval, small to medium in size. They have small amount of eosinophilic cytoplasm. The nuclei are uniform, round and have small but conspicuous nucleoli. The tumor cells in one of the presenting cases are large with abundant cytoplasm and show moderate nuclear pleomorphism. The nuclear chromatin, however, is fine and even without exception, even in the case showing nuclear pleomorphism. Major differential diagnoses based on the cytologic findings are well-differentiated papillary adenocarcinoma, bronchioloalveolar carcinoma, and carcinoid tumor.
Adenocarcinoma, Bronchiolo-Alveolar ; Adenocarcinoma, Papillary ; Biopsy, Fine-Needle* ; Carcinoid Tumor ; Chromatin ; Cytoplasm ; Diagnosis, Differential ; Eosinophils ; Female ; Histiocytoma, Benign Fibrous* ; Humans ; Lung ; Pulmonary Sclerosing Hemangioma* ; Solitary Pulmonary Nodule

Remarkable progress has recently been achieved in blood pressure (BP) control based on key research findings in the general population. It has been observed that maintaining BP slightly lower than previously recommended goals leads to better clinical outcomes, provided that patients can tolerate it. Previously, BP control targets for dialysis patients were extrapolated from studies conducted on the general population. However, dialysis patients are considered a distinct group with unique characteristics, which makes defining appropriate BP targets a matter of debate. Several observational studies measuring BP in hemodialysis (HD) patients within dialysis units have shown that lower peridialysis BP (pre-, post-, and interdialytic BP) is associated with worse clinical outcomes. However, this association is likely confounded by factors specific to dialysis patients. The relationship between BP and mortality appears to be more linear in patients with fewer underlying cardiovascular diseases and longer survival. Recent studies have indicated that BP measurements taken outside of dialysis sessions, such as standardized BP on nondialysis days, home BP, and ambulatory BP monitoring between HD sessions, are more predictive of clinical outcomes. Due to the varied effects of dialysis-related treatment practices on BP, there is a lack of data from large-scale clinical trials. As a result, it is challenging to provide strong recommendations for BP targets directly applicable to dialysis patients. This review addresses various factors influencing BP in dialysis patients, including the establishment of individualized target BP levels and discussions on maintenance strategies, while incorporating a recent literature review.

OBJECTIVE: To test whether the impact of thyroid-nodule size on the malignancy risk differs according to the ultrasonography (US) patterns of nodules. MATERIALS AND METHODS: This study is a post hoc analysis using data from the Thyroid Imaging Reporting and Data System (TIRADS) multicenter retrospective study which included 2000 consecutive thyroid nodules (≥ 1 cm) with final diagnoses. A total of 2000 consecutive thyroid nodules from 1802 patients (1387 women and 613 men; mean age, 51.2 ± 12.2 years) were enrolled in this study. The malignancy risk of the nodules was assessed according to the nodule size and US patterns (Korean-TIRADS). RESULTS: Overall, the malignancy risk did not increase as nodules enlarged. In high-suspicion nodules, the malignancy rate had no association with nodule size (p = 0.467), whereas in intermediate- or low-suspicion nodules there was a trend toward an increasing malignancy risk as the nodule size increased (p = 0.004 and 0.002, respectively). The malignancy rate of large nodules (≥ 3 cm) was higher than that of small nodules (< 3 cm) in intermediate-suspicion nodules (40.3% vs. 22.6%, respectively; p = 0.001) and low-suspicion nodules (11.3% vs. 7.0%, respectively; p = 0.035). There was a trend toward a decreasing risk and proportion of papillary carcinoma and an increasing risk and proportion of follicular carcinoma or other malignant tumors as nodule size increased (p < 0.001, respectively). CONCLUSION: The impact of nodule size on the malignancy risk differed according to the US pattern. A large nodule size (≥ 3 cm) showed a higher malignancy risk than smaller nodules in intermediate- and low-suspicion nodules.
Carcinoma, Papillary ; Diagnosis ; Female ; Humans ; Information Systems ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

In this case, a successful mitral valve repair was confirmed by transesophageal echocardiography (TEE) at the end of a cardiopulmonary bypass. The left ventricular vent was placed through the mitral valve to remove the air after the TEE examination, and on its way out, the left ventricular vent damaged the anterior mitral leaflet (AML). Re-examination of the valve with TEE detected the new mitral valve insufficiency. The CPB was reinstituted, and tearing of the lateral third part of the anterior mitral leaflet was found. This case emphasizes the importance of TEE in the operating room as a continuous monitor, not only to evaluate the result of the cardiac surgery, but also to detect any unpredictable events during the surgery.
Mitral Valve Insufficiency/*surgery/*ultrasonography ; Mitral Valve/*injuries/surgery ; Middle Aged ; Intraoperative Complications/surgery ; Humans ; Female ; *Echocardiography, Transesophageal ; Cardiopulmonary Bypass/*adverse effects

Adenoid basal carcinoma and adenoid cystic carcinoma of the uterine cervix are rare tumors that have often been regarded as a single entity. But adenoid basal and adenoid cystic carcinomas of the cervix differ from each other in their histology, treatment, and prognosis. We experienced 2 cases of these neoplasms, with 1 case in each category. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late distant metastases. This study reviews the literature and formulates a program for the management of these rare lesions.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Cervix Uteri* ; Female ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

This study assessed the dynamics of morphological and immunophenotypic properties of activated microglia in a 6-hydroxydopamine (6-OHDA) induced Parkinsonian animal model. Neurodegeneration in the substantia nigra pars compacta (SNc) was induced by unilateral injection of 6-OHDA into the medial forebrain bundle. Parkinsonian animal model were sacrificed at 1, 2, 4 and 8 weeks after 6-OHDA injection. Changes in the functional activity of activated microglia were identified using different monoclonal antibodies: OX6 for major histocompatibility complex (MHC) class II, ED1 for phagocytic activity. Phagocytic microglia, characterized by ED1- or OX6-immunoreactivity, appeared in the SNc at 1 week after 6-OHDA injection, activated microglia selectively adhered to degenerating axons, dendrites and dopaminergic neuron somas in the SNc. This was followed by significant loss of these fibers and nigral dopaminergic neurons. Activation of microglia into phagocytic stage was most pronounced at 2 week after 6-OHDA injection and gradually subsided, but phagocytic microglia persisted until 8 weeks after 6-OHDA injection. Taken together, our results indicate that activated microglia is lead to persistently neuron cell death and promotes loss of dopaminergic neuron by degeneration of the dopaminergic neurons.
Animals ; Axons ; Carisoprodol ; Cell Death ; Dendrites ; Dopaminergic Neurons ; Major Histocompatibility Complex ; Medial Forebrain Bundle ; Microglia ; Models, Animal ; Neurons ; Oxidopamine ; Substantia Nigra

PURPOSE: Measles infection in children has been known to have many complications including hepatitis. But there has been no appropriate study about measles hepatitis in children. So we studied to facilitate the understanding of measles hepatitis in children by analyzing their clinical features and laboratory findings. METHODS: We investigated 164 patients who were admitted to the Department of Pediatrics, Seoul Red Cross Hospital due to measles from January 1985 to December 1994. We excluded other factors such as hepatitis A, B, C virus, Epstein-Barr virus and cytomegalovirus which could also result in hepatitis. According to the presence and the absence of coexistent complications 22 measles hepatitis patients were divided into two groups in which clinical characteristics and laboratory findings were analyzed as well. RESULTS: 1)Of total 164 patients there were 26 patients(15.9%) with measles hepatitis. 2)The ratio of male to female was 1.8:1. The range of age distribution was 6 months to thirteen years, and patients from 6 months to 3 years of age occupied 50% of the total patients. 3)The mean values of serum AST and ALT levels were 151+/-17.6 IU/L and 185+/-36.6 IU/L, espectively. And they were detected at 4.4+/-2.4 days after the first symptoms of measles were developed. 4)Major clinical characteristics were diarrhea in 22.7%, vomiting in 13.6%, hepatomegaly in 9.1%, and splenomegaly in 4.5%. Jaundice was not detected. 5)There was no difference between two groups in terms of serum albumin, globulin, bilirubin, AST and ALT(p>0.05). 6)Elevated serum AST and ALT levels returned to normal values within 2 weeks in 87.5%. CONCLUSIONS: Measles hepatitis develops with favorable outcome. Liver function test may well be done in cases of measles infection because hepatic dysfunction does not uncommonly occur in measles infection. Further study for the difference of the incidence of measles hepatitis according to the measles epidemics should be performed.
Age Distribution ; Bilirubin ; Child* ; Cytomegalovirus ; Diarrhea ; Female ; Hepatitis A ; Hepatitis* ; Hepatomegaly ; Herpesvirus 4, Human ; Humans ; Incidence ; Jaundice ; Liver Function Tests ; Male ; Measles* ; Pediatrics ; Red Cross ; Reference Values ; Seoul ; Serum Albumin ; Splenomegaly ; Vomiting

Neuromyelitis optica(Devie's disease) is a demyelinating disorder of unknown etiology that is characterized by bilateral acute optic neuritis, associated with transverse myelitis. The authors experienced a case of Neuromyelitis optica in a 28 year old female who developed acute visual disturbance, sensory loss under the thoracic dermatome 8, and paraplegia, shortly after upper respiratory infection. Bilateral acute optic neuritis was noted with abnormal visually evoked potential. We confirmed this case by neurologic features, magnetic resonance imaging, and cerebrospinal fluid finding, and treated with Corticosteroid "pulse therapy".
Adult ; Cerebrospinal Fluid ; Demyelinating Diseases ; Evoked Potentials ; Female ; Humans ; Magnetic Resonance Imaging ; Myelitis, Transverse ; Neuromyelitis Optica* ; Optic Neuritis ; Paraplegia