PURPOSE:The natural course of Hashimoto' thyroiditis (HT) is so dynamic that the disease progresses to overt hypothyroid or spontaneous recovery. The authors reviewed the clinical course of this disease and analysed the possible predicting factors regarding remission. METHODS:Thirty nine patients with HT (38 girls and 1 boy) were studied retrospectively. Of these patients, 30 were followed for more than 2 years. The possible remission factors were analyzed at initial diagnosis and during follow-up period. RESULTS:The mean age at the diagnosis was 11.8+/-.1 years. Initial thyroid function was euthyroid in 38.5%, compensated hypothyroid in 35.9%, overt hypothyroid in 23.1%, and hyperthyroid in 2.6% of patients. Antithyroglobulin antibody (ATA) was positive in 94.7%, and antimicrosomal antibody (AMA) was positive in 74.4%. The overall remission rate was 53.3% during the follow-up period (51+/-7 months). Initial goiter size, thyroid function status, and autoantibody titer had no relation to the remission rate statistically. Follow-up autoantibody titers in remission group were marginally lower than those in nonremission group (P<0.1), and follow-up AMA titer was significantly higher than initial titers in nonremission group (P<0.05). CONCLUSION: We could not find any predictable remission factors from the initial clinical and autoantibody status. But, during follow-up period, patients with lower autoantibody titers showed slight higher remission, and those with increasing AMA titer showed less remission. Above results suggest that we should monitor antithyroid antibody titer as well as thyroid function regularly.
Adolescent* ; Child* ; Diagnosis ; Female ; Follow-Up Studies ; Goiter ; Humans ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis*

BACKGROUND: Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. METHOD: We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group (clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine (10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram (lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. RESULTS: Clonidine group showed significant decrease of heart rate after pretreatment (p<0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group (p<0.05). The time required for resuscitation was shorter in clonidine group than control group (p<0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group (p<0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. CONCLUSIONS: Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation.
Analgesia ; Animals ; Arterial Pressure ; Bupivacaine ; Clonidine* ; Dogs* ; Electrocardiography ; Epinephrine ; Heart Arrest ; Heart Massage ; Heart Rate ; Injections, Intravenous ; Resuscitation* ; Seizures ; Thoracotomy ; Vecuronium Bromide ; Vital Signs

No abstract available.
Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Korea*

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization with Staphylococcus aureus (S. aureus). Superantigens produced by S. aureus and their specific IgE antibodies are thought to be important precipitating factors of AD, but there are few reports evaluating these 2 factors at the same time, particularly in adult AD patients. OBJECTS: Our purpose was to investigate the differences in the culture degree of S. aureus from the lesion, non-lesion, and control group of child and adult AD patients, to research the correlation between the exotoxin production, total IgE, anti-SEA IgE and the disease severity by SCORAD index, to ascertain the differences between child and adult AD patients. METHODS: The clinical severity of 30 child (2 to 15 years of age) and 30 adult patients (16 to 40 years of age) with AD was evaluated by using SCORAD index. S. aureus was isolated from lesional and non-lesional skin of AD patients, and from healthy controls. Staphylococcal exotoxins were detected by using reversed passive latex agglutination toxin detection kits. Anti-SEA IgE antibody was determined by using AlaSTATt assay RESULTS: S. aureus colonizations were found in 11 (36.7%) of the lesional skin, in 5 (16.7%) of the non-lesional skin of 30 child AD patients, and in 26 (86.7%), in 20 (66.7%) of 30 adult AD patients, respectively. The colonization rates of S. aureus in child patients were much lower than those in adult patients, both form lesional skin and non-lesional skin. Staphylococcal exotoxins were detected in 5 (45.5%) of the 11 colonizations from lesional skin, in 2 (40%) of the 5 colonizations from non-lesional skin of children, and in 10 (38.5%) of the 26 colonizations, in 9 (45%) of the 20 colonizations of adults, respectively. Staphylococcal enterotoxin A (SEA) was most frequently detected in both groups. S. aureus colonization was correlated with the severity of AD in childhood, but not in adulthood. However, there were no statistical significances between severity of AD and others such as exotoxin production, and the level of total IgE and anti-SEA IgE in both groups. CONCLUSION: The colonization of S. aureus was more common in adult AD patients than child AD patients. Anti-SEA IgE level was much higher in adult AD patients than in child AD patients. It is tempting to speculate that the colonization of S. aureus and exotoxin production might be related to the disease. duration rather than clinical severity of AD.
Adult ; Agglutination ; Antibodies ; Child ; Colon ; Dermatitis, Atopic* ; Enterotoxins* ; Exotoxins* ; Humans ; Immunoglobulin E* ; Latex ; Precipitating Factors ; Skin ; Staphylococcus aureus ; Strikes, Employee ; Superantigens

The deliberate hypotension with esmolol or sodium nitroprusside(SNP) was provided subsequently in random order with six dogs. Anesthesia was maintained with 0.8 vol% halothane, end-tidal, in N2O/O2, 50: 50, with vecuronium. Mean arterial pressure was reduced 30-35% to 70 mmHg, with use of SNP or esmolol. Mean arterial pressure, heart rate, mean pulmonary arterial pressure, arterial blood gas analysis, and cardiac output were measured both prior to the deliberate hypotension and at 70 mmHg of mean arterial pressure induced with esmolol or SNP. The following results were observed; 1) The mean doses required were 725+/-250 ug/kg/min in esmolol and 12+/-2 ug/kg/min in SNP. 2) Esmolol was associated with a decrease in cardiac output (from 2.13+/-0.23 to 1.27+/-0.23 L/min), in heart rate (from 128+/-14 to 91+/-11/min), and an increase in central venous pressure (from 9.2+/-3.27 to 11.60+/-3.21 mmHg)(p<0.05). 3) SNP decreased systemic vascular resistance from 41111+/-484 to 2175+/-451 dynessec/cm5 (P<0.05), trended to increase heart rate. 4) A change in arterial blood gas analysis before and during deliberate hypotension with esmolol or SNP was not significant. As to mechanism of hypotensive effect, SNP caused decrease in systemic vascular resistance by 47% but esmolol significantly reduced cardiac output by 40% and heart rate by 29%. The result of present study suggests that when moderately deliberate hypotension with only esmolol was done, the potential for marked myocardial depression must be recognized. The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may be provide a pharmacologic profile superior to either agent alone.
Anesthesia ; Animals ; Arterial Pressure ; Blood Gas Analysis ; Cardiac Output ; Central Venous Pressure ; Depression ; Dogs* ; Halothane ; Heart Rate ; Hemodynamics* ; Hypotension* ; Nitroprusside* ; Sodium* ; Vascular Resistance ; Vecuronium Bromide

BACKGOUND: The purpose of this study was to examine the effect of various levels of positive end-expiratory pressure (PEEP) on the intraocular pressure in the patients receiving positive pressure ventilation. METHODS: Twenty, critically ill sedated and hemodynamically stable patients without history of glaucoma were placed on controlled positive pressure ventilation. Measured variables included intraocular pressure (IOP), mean arterial pressure (MAP), central venous pressure (CVP), peak inspiratory pressure (PIP) and arterial blood gas analysis (ABGA), and were recorded at zero end-expiratory pressure (ZEEP), and at 5, 10, 15, 20 cmH2O PEEP, applied in random order. RESULTS: IOP increased significantly from 13+/-3 to 16+/-3 mmHg at 15 cmH2O PEEP and from 14+/-4 to 17+/-6 mmHg at 20 cmH2O PEEP. CVP increased significantly from its corresponding ZEEP measurements at all PEEP levels and from 14+/-4 cmH2O at 5 cmH2O PEEP to 21+/-4 cmH2O at 20 cmH2O PEEP. There was a positive correlation between PEEP levels and PIP or CVP but no relationship between PEEP levels and IOP was observed. CONCLUSIONS: The application of PEEP levels > or = 15 cmH2O resulted in a significant increase in the IOP of patients with normal basal ocular tonometry. This study suggests that further increase in IOP may occur in the mechanically ventilated patients with already increased IOP or normal-tension glaucoma, when higher levels of PEEP are used.
Arterial Pressure ; Blood Gas Analysis ; Central Venous Pressure ; Critical Illness* ; Glaucoma ; Humans ; Intraocular Pressure* ; Positive-Pressure Respiration* ; Tonometry, Ocular ; Veins

No abstract available.
Child ; Femoral Fractures ; Humans

PURPOSE: To compare the diagnostic accuracy between fine needle and large cutting needle biopies. METHODS & MATERIALS: Chest lesion was biopsied consecutively by 19 G or 22 G fine needle and 14 G large cutting needle with interval of 10-20 min. 119 patients confirmed by operation or clinical follow-up were evaluated. RESULTS: There were 65 patient confirmed as malignant lesion and 54 confirmed as benign lesions. Diagnostic accuracy was 87.7%(57/65) for malignancy and 85.2%(46/54) for benign lesion with fine needle. With large cutting needle, it was 90.8%(59/65) for malignancy and 88.9%(48/54) for benign lesion. In the benign lesion, specific diagnostic accuray was 48.1%(26/54) with fine needle, and 64.8%(35/54) with large cutting needle biopsy, respectively. Complications were hemoptysis(n=13, 10.9%), pneumothorax(n=7, 5.9%) and mild to moderate chest pain. Although, it is impossible to compare the complications by the two types of biopsy on same lesion, 10 cases of immediate hemopytsis and more severe chest pain occurred when large cutting needle biopsy was done. CONCLUSION: No significant difference in diagnostic accuracy between fine needle and large cutting needle biopsies was observed in malignant lesion. In benign lesions, larger sample volume may increase the chance of obtaining a specific diagnosis but has no influence on overall diagnostic accuracy of benignity. Thus, we believe that fine needle aspiration biopsy is an accurate, safe, and more tolerable means to be performed as first step for diagnosis of chest lesions.
Biopsy* ; Biopsy, Fine-Needle* ; Biopsy, Needle ; Chest Pain ; Diagnosis ; Follow-Up Studies ; Humans ; Needles* ; Thorax

Bradycardia is recognized as an acute complication of cervical cord injury. The etiology of such a phenomenon is believed to be due to an imbalance in the autonomic nervous system imposed on the heart by a cervical cord injury. The majority of the episodes of bradycardia degrees Ccurred either with tracheal suctioning or with changes in position. We experienced a case of severe bradycardia and hypotension when turning the patient with acute cervical spinal cord injury to the prone position, which was reversed by administration of intravenous atropine and ephedrine.
Anesthesia, General* ; Atropine ; Autonomic Nervous System ; Bradycardia* ; Ephedrine ; Heart ; Humans ; Hypotension* ; Prone Position ; Spinal Cord Injuries* ; Spinal Cord* ; Suction

BACKGROUND: Atopic dermatitis (AD) in children may profoundly affect their quality of life (QOL), in addition to familial life plus cause financial burden. OBJECTIVE: The aim of this study was to show how AD affects children's QOL, family life and contributes to financial burden, and to evaluate this relationship with severity of AD. METHODS: The target population comprised of children aged 0~6 years with AD who visited our out-patient department between May 2004 and October 2005. The Infants' Dermatologic Quality of Life Index (IDQOL), the Dermatitis Family Impact questionnaire (DFI) and the Financial Impact questionnaire (FI) were used to quantify the impact of AD on each area. Eczema severity was assessed using the Eczema area and severity index (EASI) score. The student' T-test and simple linear regression were used for statistical analysis. RESULTS: A total of 101 children completed all the questionnaires. The mean score for IDQOL was 11.50, DFI was 10.05 and FI was 16.10. The highest scoring question for IDQOL was itching and scratching, the lowest one was family activities. For the DFI they were main carer's life effect and shopping. The mean score of EASI was 8.81 and this was linearly related with IDQOL (R2=0.126, p<0.001), DFI (R2=0.154, p<0.001) and FI (R2=0.145, p<0.001), but not as highly. CONCLUSION: We have shown that children's quality of life, family life and financial burden are related to the severity of AD. The IDQOL, DFI and FI may potentially be of value to help guide appropriate management of AD and can be used as an added parameter in clinical trials involving AD management.
Child* ; Dermatitis ; Dermatitis, Atopic* ; Eczema ; Health Services Needs and Demand ; Humans ; Linear Models ; Outpatients ; Pruritus ; Quality of Life* ; Surveys and Questionnaires