Minoxidil is a potent direct-acting peripheral vasodilator indicated in the management of severe or refractory hypertension. Well-known adverse effects include reflex tachycardia, fluid retention and hypertrichosis. This drug has also been reported to cause pericardial effusion in about three percent of nondialyzed patients with compromised renal function and to cause cardiac tamponade less frequently. Many studies have reported that the mean duration of therapy that caused pericardial effusion was about 8 months (range 1 month-53 months). We report a case of cardiac tamponade in nondialyzed patient with chronic renal failure receiving minoxidil for 10 years. A 58-year-old female was admitted to our hospital with dyspnea of NYHA III. She was a chronic renal failure patient without dialysis treatment and received kidney transplantation from cadaver donor and was dignosed chronic rejection in 1994. Minoxidil 10mg has been used for past 10 years. Lasix has been used for past 2 years, with dosage of 40mg to 240mg. On admission, blood pressure was 90/60mm Hg. Cardiomegaly was seen on chest radiograph. The two-dimensional echocardiogram showed a large amount of pericardial effusion. Emergency treatment with pericardiocentesis removed 2500ml of straw- colored pericardial fluid and resulted in marked improvement of dyspnea and stabilized blood pressure. The minoxidil was discontinued. The evidence of pericardial effusion was not seen for 12 months after minoxidil had been discontinued.
Blood Pressure ; Cadaver ; Cardiac Tamponade* ; Cardiomegaly ; Dialysis ; Dyspnea ; Emergency Treatment ; Female ; Furosemide ; Humans ; Hypertension ; Hypertrichosis ; Kidney Failure, Chronic* ; Kidney Transplantation ; Middle Aged ; Minoxidil* ; Pericardial Effusion ; Pericardiocentesis ; Radiography, Thoracic ; Reflex ; Tachycardia ; Tissue Donors

No abstract available.
Factor V Deficiency* ; Factor V*

We have constructed several panels of MAbs which specifically recognize B-subunit of HCG (BHCG). Splenocytes from Balb/c mice immunized with B-subunit of HCG were fused with SP2/o-Ag14 myeloma cells by PEG method. Fifteen different hybridorna clones (individually named as mG10.127, mG10.61, mG9.5, mG9.18, rnG9.20, mG6.3, mG6.36, mG6.8, mG7.31, mG7.79, mG9.11, mG9.51.6, mG9.51.12, mH4.17, and mH4.4) were obtained by indirect ELISA screening and three to five successive cloning procedures. The distinct features of these MAbs were determined by specificity, western blot, isotyping, and isoelectrofocusing. All of the MAbs except mG9.20 and mG6.8 specifically bind to BHCG without cross- reaction with B-subunit of LH (BLH). In western blot analysis, all of the MAbs bind to non-denatured form of BHCG suggesting that the MAbs recognize conformation-dependent epitope of BHCG. This new panels of MAbs to BHCG should be useful for developing diagnostic reagent such as pregnancy, choriocarcinoma, Down's syndrome as well as for the fine quantitation of serum or urinary HCG.
Animals ; Antibodies, Monoclonal* ; Blotting, Western ; Choriocarcinoma ; Chorionic Gonadotropin* ; Clone Cells ; Cloning, Organism ; Down Syndrome ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans* ; Mass Screening ; Mice ; Pregnancy ; Sensitivity and Specificity

Fumarase catalyzes the conversion of fumarate to malate in the Krebs cycle. Fumarase deficiency is a rare inborn error of metabolism and is inherited in an autosomal recessive manner. It causes mitochondrial encephalomyopathy. The symptom is characterized by developmental delay and hypotonia. We report here a case of a 32-month-old child who was initially refered because of spastic quadriplegia, delayed development and poor feeding.
Child ; Child, Preschool ; Citric Acid Cycle ; Fumarate Hydratase* ; Humans ; Metabolism ; Mitochondrial Encephalomyopathies ; Muscle Hypotonia ; Muscle Spasticity* ; Quadriplegia*

The purpose of this study was to investigate the ability of cultured chondrocytes to prevent formation of bony bridge and possibly to repair of the damaged growth plate. Growth cartilage cells were obrained from the new born canine epiphyseal plates and was culture-expanded in high density. It took 14 days until formation of micro mass of cartilage cells which was easily removable from the culture flask. Twenty dogs were divided into two groups: group I (10), the medial side of growth plate of right proximal tibia was destroyed and cultured chondrocytes were homografted into the defect: and group II (10), the medial side of growth plate of right proximal tibia was destroyed and was left as it was. Left leg was served as a control. Serial radiological and histological observation were made until 16 weeks after homografting to determine the growth parrern. Following results were obtained. 1. In group I, 8 of 10 dogs had near normal growth with little angular deformity of the tibia, averaging 8° at post-op 16 weeks. Two dogs had 20° angulation at 16 weeks post-surgery. In contrast in group II, angular deformity was obvious at 4 weeks post-surgery, reaching 31° at 16 weeks post-surgery. 2. In group II, bony bridge was consistently formed on the medial side of the proximal tibia. In group I, the cultured chondrocytes initially appeared to be an amorphous cartiagenous mass, which, however, remained to contribute to matrix formation as time went on. 3. This study showed the ability of cultrued chondrocytes to prevent formation of bony bridge and possibly to repair the damaged growth plate. To prove the effectiveness of homografting of the growth cartilage cells for reconstruction of the growth plat, further studies should be followed.
Allografts ; Animals ; Cartilage ; Chondrocytes ; Congenital Abnormalities ; Dogs ; Growth Plate ; Leg ; Tibia ; Transplantation, Homologous

OBJECTIVE: To determinate the reference values of residual latencies of motor nerves and to evaluate the early diagnostic value of residual latency. METHOD: The subjects were 129 diabetes mellitus patients and 60 controls with no known neurological disorders. The patients were divided into two groups based on the conventional nerve conduction study: Group 1, 75 patients without neuropathy; Group 2, 54 patients with neuropathy. The group 2 patients were subdivided into 4 sub- groups on the basis of conduction velocity and residual latency of the median nerve. Residual latencies were measured in all subjects and glycosylated hemoglobin percentages (HbA1c) were measured in the diabetes patients. In group 2, each nerve conduction parameter was correlated with the duration of diabetes and HbA1c. The duration of diabetes, HbA1c, and amplitude of median nerve response were compared between the subgroups of group 2 patients. RESULTS: Motor residual latencies obtained from the controls were 1.93+/-0.28 msec, 1.53+/-0.24 msec, 2.46+/-0.43 msec, 2.21+/-0.53 msec in median, ulnar, deep peroneal and posterior tibial nerves, respectively. In group 1, motor residual latencies of median & deep peroneal nerves were significantly delayed compared with those of the controls. In group 2, motor residual latencies of median, ulnar, deep peroneal and posterior tibial nerves were significantly delayed more than those of the controls and group 1. In group 2, increased HbA1c correlated to the decreased conduction velocities of median, deep peroneal, posterior tibial nerves but not to the residual latencies. In the subgroup of group 2 (2-D), the nerve involved more distally showing lower compound muscle action potential and higher HbA1c. CONCLUSION: Residual latency measurement can be a useful diagnostic method for the early detection of diabetic neuropathy.
Action Potentials ; Diabetes Mellitus ; Diabetic Neuropathies* ; Diagnosis* ; Hemoglobin A, Glycosylated ; Humans ; Median Nerve ; Nervous System Diseases ; Neural Conduction ; Peroneal Nerve ; Reference Values ; Tibial Nerve

BACKGROUND: Anemia is a major contributor to morbidity and mortality in chronic renal failure patients. The benefits of anemia correction using recombinant human erythropoietin (Epo) are well established but because of high cost, several studies increasing the efficacy of it were described. The objective of this study was to evaluate the efficacy of an anemia management protocol using subcutaneous Epo and intravenous iron therapy. METHODS: We enrolled seventy-eight maintenance hemodialysis patients for at least 3 months from January 2000 to November 2002. They received a practice of anemia correction in two other settings. One (control) group performed an irregular administration of Epo and iron, the other (protocol) group performed a regular administration according to anemia management protocol. Clinical and laboratory parameters were analyzed. Dosage of Epo and IV iron were compared. RESULTS: Thirty-one patients in control group and forty-seven patients in protocol group were enrolled. There were no significant differences between two groups in age, gender, existence of diabetic mellitus, vintage of hemodialysis, use of angiotensin-converting enzyme inhibitor, BUN, prealbumin, parathyroid hormone and Kt/Vurea. Mean arterial pressure, creatinine and albumin were significantly lower and hematocrit was significantly higher and well-maintained on the target level in protocol group. There were no significant differences in serum iron, transferrin saturation, ferritin but total iron binding capacity was significantly lower in protocol group. Doses of erythropoietin and IV iron showed no significant differences between two groups. CONCLUSION: The protocol based erythropoietin administration was more efficient in achieving target hematocrit without increment of dosage of erythropoietin and intravenous iron and side effect of hypertension.
Anemia ; Arterial Pressure ; Creatinine ; Erythropoietin* ; Ferritins ; Hematocrit ; Humans ; Hypertension ; Iron ; Kidney Failure, Chronic ; Mortality ; Parathyroid Hormone ; Prealbumin ; Renal Dialysis* ; Transferrin

Nonocclusive mesenteric ischemia (NOMI) is known to occupy about 25+ACU- to 60+ACU- of intestinal infarction. NOMI has been reported to be responsible for 9+ACU- of the deaths in the dialysis population and the postulated causes of NOMI include intradialytic hypotension, atherosclerosis and medications, such as diuretics, digitalis and vasopressors. Clinical manifestations, such as fever, diarrhea and leukocytosis, are nonspecific, which makes early diagnosis of NOMI very difficult. Case: A 66-year-old woman on maintenance hemodialysis for 5 years was admitted with syncope, abdominal pain and chilly sensation. Since 7 days prior to admission, blood pressure on the supine position during hemodialysis had frequently fallen to 80/50 mmHg. Four days later, she complained of progressive abdominal pain. Rebound tenderness and leukocytosis (WBC 13900/mm3) with left shift were noted. Stool examination was positive for occult blood. Abdominal CT scan showed a distended gall bladder with sludge. Under the impression of acalculous cholecystitis, she was operated on. Surgical and pathologic findings of colon colon were compatible with NOMI. Because of recurrent intradialytic hypotension, we started midodrine 2.5 mg just before hemodialysis and increased the dose up to 7.5 mg. After midodrine therapy, blood pressure during dialysis became stable and the symptoms associated with hypotension did not recur. CONCLUSION: As NOMI may occur within several hours or days after an intradialytic hypotensive episode, abdominal pain should be carefully observed and NOMI should be considered as a differential diagnosis. In addition, we suggest that midodrine be considered to prevent intradialytic hypotensive episodes.
Aged ; Case Report ; Colectomy ; Colon/surgery ; Colon/blood supply ; Female ; Human ; Ischemia/therapy ; Ischemia/pathology ; Ischemia/etiology+ACo- ; Kidney Failure, Chronic/therapy ; Mesentery/blood supply+ACo- ; Midodrine/administration +ACY- dosage ; Renal Dialysis/methods ; Renal Dialysis/adverse effects+ACo- ; Treatment Outcome ; Vasoconstrictor Agents/administration +ACY- dosage

Congenital syphilis occurs when Treponema pallidum crosses the placenta during pregnancy or from contact with an infectious genital lesion during delivery. Cutaneous manifestations of congenital syphilis are relatively common, occurring in approximately 30% to 70% of patients. Maculopapular lesions, vesiculobullous lesions, condylomata lata lesions, annular lesions, and erythema multiforme-like targetoid lesions have been reported. We report on a premature newborn with congenital syphilis who presented with generalized bullous and pustular eruption and desquamation at birth.
Blister ; Erythema ; Humans ; Infant, Newborn ; Parturition ; Placenta ; Pregnancy ; Syphilis ; Syphilis, Congenital ; Treponema pallidum

PURPOSE:Present evidences suggest that Ureaplasma urealyticum is a cause of pneumonia, septicemia, and bronchopulmonary dysplasia (BPD) in newborn infants, particularly those born prematurely. The purpose of this work was to examine the relationship between Ureaplasma urealyticum in the tracheal aspirates and adverse outcomes, such as BPD and early onset neonatal sepsis in premature infants. METHODS:A polymerase chain reaction (PCR) was performed on tracheal aspirates collected within 24 hour after birth in 176 premature infants less than 35 weeks of gestation and admitted to the neonatal intensive care unit of Bundang CHA Hospital. RESULTS:U. urealyticum was detected in 37 of 176 preterm infants (21.0%). Gestational age (29+5+/-2+5 wk vs. 30+6+/-2+5 wk, P=0.013) and birth weight (1.39+/-0.44 kg vs. 1.59+/-0.55 kg, P=0.037) were lower in the U. urealyticum-positive group compared to the control group. The incidence of early onset neonatal sepsis (16.2% vs. 6.5%, P=0.045) and BPD (45.9% vs. 29.5%, P=0.047) was higher in the U. urealyticum-positive group compared to the control group, but the severity of BPD was not different between two groups. However, multiple logistic regression analysis revealed that the presence of U. urealyticum was not independently related to the development of early onset neonatal sepsis and BPD. CONCLUSION:The results suggest that colonization of the lower respiratory tract by U. urealyticum might not be related to the development of neonatal sepsis and BPD directly in preterm infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Colon ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Logistic Models ; Parturition ; Pneumonia ; Polymerase Chain Reaction ; Pregnancy ; Respiratory System ; Sepsis ; Ureaplasma ; Ureaplasma urealyticum