Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma and may lead to acute renal failure secondary to myoglobinuria. The most sensitive marker of muscle cell damage is serum creatine kinase concentration. It was first described by Bywaters and Beall in association with crush injuries during the second world war, and since then it has been recognized as the cause of about 5 % of all cases of acute renal failure. But acute renal failure is extremely rare in diabetic patient with hyperosmolarity irrespective of the frequency of rhabdomyolysis. Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic hyperosmolar state with acute renal failure, secondary to rhabdomyolysis. We reported a case with diabetic hyperosmolar nonketotic coma who developed acute renal failure secondary to rhabdomyolysis and myoglobinuria in a 60 year old patient with review of the literatures.
Acute Kidney Injury* ; Coma* ; Creatine Kinase ; Diuresis ; Glucose ; Humans ; Middle Aged ; Muscle Cells ; Muscle, Skeletal ; Myoglobinuria ; Necrosis ; Plasma ; Rhabdomyolysis* ; World War II

BACKGROUND/AIMS: The early diagnosis of acute hepatitis A (AHA) is hindered because serum IgM against hepatitis A virus (HAV) can yield false-negative results during the window period. This study evaluated the diagnostic accuracy of a polymerase chain reaction (PCR) kit for HAV RNA for the diagnosis of AHA. METHODS: Samples were collected from 136 patients with acute severe hepatitis at their admission to Asan Medical Center between June 2010 and July 2010. Samples were analyzed for serum IgM anti-HAV using an immunoassay test and for qualitative HAV RNA using the Magicplex HepaTrio PCR test kit. The diagnostic accuracies of these methods were tested on the basis of clinical and laboratory diagnoses of AHA. RESULTS: The concordance rate and kappa value between IgM anti-HAV and HAV RNA PCR were 88.2% and 0.707, respectively. For the diagnosis of AHA, the sensitivity and specificity of IgM anti-HAV were 90.7% and 100%, respectively, when an "equivocal" result was regarded as positive; and 79.1% and 100%, respectively, when an "equivocal" result was regarded as negative. The sensitivity and specificity of HAV RNA PCR were 81.4% and 100%, respectively. All four patients with negative IgM anti-HAV and positive HAV RNA PCR results and all four patients with equivocal IgM anti-HAV RNA and positive HAV RNA PCR results were eventually diagnosed with AHA. CONCLUSIONS: The qualitative HAV RNA PCR test has an equivalent diagnostic accuracy for AHA compared to IgM anti-HAV and may be more sensitive during the window period.
Acute Disease ; Adult ; Aged ; Female ; Hepatitis A/*diagnosis ; Hepatitis A virus/genetics/immunology ; Humans ; Immunoassay ; Immunoglobulin M/blood ; Male ; Middle Aged ; *Multiplex Polymerase Chain Reaction ; Prospective Studies ; RNA, Viral/*blood ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

Baicalin is flavonoid and major component of PC-SPES. Flavonoids including baicalin have been reported to not only function as anti-oxidant but also cause cytotoxic effect. Baicalin hydrate has been reported to induce cell death, however the mechanism by which baicalin hydrate induces the apoptosis of cancer cells is still unclear. To evaluate the mechanistic insights of apoptosis by baicalin hydrate, we tested the activities of apoptosis signaling pathway in HeLa cells. The viability of HeLa and HeLa s3 cells was markedly decreased by baicalin hydrate in a dose- and time- dependent method. Baicalin hydrate induced the apoptotic death of HeLa cells, which was characterized by the chromatin condensation of the nuclei and phosphorylation of histone H2AX. Baicalin hydrate increased the sub-G1 DNA content of HeLa cell lines. Baicalin hydrate digested Bid protein, increased Bak protein level and also, induced mitochondrial dysfunction disrupted as shown as the mitochondrial membrane potential. It activated caspase-3, thereby resulted in cleavage of poly (ADP) ribose polymerase (PARP).
Apoptosis ; bcl-2 Homologous Antagonist-Killer Protein ; BH3 Interacting Domain Death Agonist Protein ; Caspase 3 ; Cell Death ; Chromatin ; DNA ; Flavonoids ; HeLa Cells ; Histones ; Humans ; Membrane Potential, Mitochondrial ; Phosphorylation ; Ribose ; Signal Transduction*

Primary adenocarcinoma of the appendix is an extraordinarily rare tumor, with fewer than 500 cases described in the collected world literature. However, it has been shown that the incidence of secondary neoplasm, such as synchronous or metachronous lesions, for primary adenocarcinoma of the appendix is much greater than that for colorectal cancer in general. In the present paper, the authors report a case of a 72-year-old male patient with immunoreactivity for P 53 and DCC protein and a review of the literature, who was operated on for an appendiceal orifice cancer and in whom colonic adenomas, a synchronous colon cancer and an appendiceal mucocele, was incidentally discovered after right hemicolectomy.
Adenocarcinoma ; Adenoma ; Aged ; Appendiceal Neoplasms ; Appendix ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Incidence ; Male ; Mucocele ; Neoplasms, Multiple Primary

PURPOSE: Asthma-related morbidity and mortality are increasing, and the financial burden imposed by this condition will substantially increase. Nevertheless, little information is available regarding the nature and magnitude of the burden due to asthma at the national level. This study was conducted to characterize the financial burden imposed by asthma in the Republic of Korea at the national level. METHODS: The overall prevalence of asthma and the costs of related medical services were determined using data from the National Health Insurance Corporation, which is responsible for the National Health Insurance scheme. Indirect costs, including expenditures on complementary and alternative medicines, and the economic impact of an impaired quality of life (intangible costs) were estimated by surveying 660 asthmatics, and these estimates were transformed to the national level using the prevalence of asthma. RESULTS: The prevalence of asthma and total costs related to the disease in 2004 were 4.19% and $2.04 billion, respectively. Direct costs and indirect costs contributed equally to total costs (46.9% and 53.1%, respectively). However, when intangible costs were included, total costs rose to $4.11 billion, which was equivalent to 0.44% of the national gross domestic product in 2004. CONCLUSIONS: The results provide evidence that asthma is a major health cost factor in the Republic of Korea and that intangible costs associated with asthma are significant cost drivers.
Asthma ; Gross Domestic Product ; Health Care Costs ; Health Expenditures ; National Health Programs ; Prevalence ; Quality of Life ; Republic of Korea

We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved altertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events.
Adolescent ; Child ; Child, Preschool ; Electric Stimulation Therapy/*methods ; Epilepsy/*therapy ; Female ; Humans ; Korea ; Male ; Quality of Life ; Seizures/therapy ; Time Factors ; Treatment Outcome ; Vagus Nerve/*pathology

Endodermal sinus tumor (EST) is a rare malignant germ cell tumor arising usually in the gonads such as the testis or ovary. However, 10-15% of EST cases may arise in the extragonadal sites, such as sacrocoxygeal area, mediastinum, vagina, brain and retroperitoneum in a frequent occurring order. To our knowledge there are only 2 case reports of extragonadal EST, one originating from the omentum in 1998, and another which was localized in the pelvis in 2003. We report one case of extragonadal sinus tumor which arose in appendix and mesentery in the 19-year-old female with a review of the literature.
Appendix* ; Brain ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Gonads ; Humans ; Mediastinum ; Mesentery* ; Neoplasms, Germ Cell and Embryonal ; Omentum ; Ovary ; Pelvis ; Testis ; Vagina ; Young Adult

BACKGROUND: We investigated hepatitis B virus (HBV) infection cases, who were HBsAg negative by radioimmunoassay (RIA) and HBV DNA positive for their clinical characteristics, the S gene mutation of hepatitis B virus (HBV), and usefulness of other HBsAg immunoassay. METHODS: Among the patients requested for HBV DNA quantification, 16 patients positive in HBV DNA but negative in HBsAg RIA (BNIBT HBsAg Kit, China) were enrolled. The "a" determinant of HBV S gene was sequenced and clinical characteristics were reviewed. Additional HBsAg assay was performed using Architect HBsAg kit (Abbott laboratories, USA) employing chemiluminescent immunoassay method. RESULTS: Eleven of the 16 patients showed multiple mutations in the "a" determinant. These patients received liver transplantation several years ago and have been treated with hepatitis B immune globulin (HBIG) and antiviral drugs. G145R mutation was found in 8 patients and G145K, D144G, and D144A were also frequently found. Among 9 of the 11 patients tested for HBsAg by Architect HBsAg kit, 8 showed positive results. Among 4 of the remaining 5 patients, only 2 showed weak positive results (< or =1 IU/mL) in Architect HBsAg kit. CONCLUSIONS: HBV DNA-positive/HBsAg RIA-negative results were mostly observed in the patients treated with HBIG after liver transplantation, in whom HBIG escape mutations were found. Majority of these cases were positive in Architect HBsAg assay, and it is recommended to use other HBsAg immunoassay methods that are more sensitive than RIA in the detection limit as well as in the detection of escape mutant in hospitals performing liver transplantation.
Adolescent ; Adult ; Aged ; Amino Acid Sequence ; Antiviral Agents/therapeutic use ; DNA, Viral/analysis ; Female ; Hepatitis B/*diagnosis/drug therapy/virology ; Hepatitis B Surface Antigens/*analysis/genetics ; Hepatitis B virus/*genetics/isolation & purification ; Humans ; Immunoassay ; Immunoglobulins/therapeutic use ; Immunologic Factors/therapeutic use ; Male ; Middle Aged ; Molecular Sequence Data ; Mutation ; Radioimmunoassay

Background: and Purpose A multifactorial antiepileptic mechanism underlies the ketogenic diet (KD), and one of the proposed mechanisms of action is that the KD inhibits the mammalian target of rapamycin (mTOR) pathway. To test this clinically, this study aimed to determine the efficacy of the KD in patients with pathologically confirmed focal cortical dysplasia (FCD) due to genetically identifiable mTOR pathway dysregulation. Methods: A cohort of patients with pathologically confirmed FCD after epilepsy surgery and who were screened for the presence of germline and somatic mutations related to the mTOR pathway in peripheral blood and resected brain tissue was constructed prospectively. A retrospective review of the efficacy of the prior KD in these patients was performed. Results: Twenty-five patients with pathologically confirmed FCD and who were screened for the presence of detectable somatic mTOR pathway mutations had received a sufficient KD. Twelve of these patients (48.0%) had germline or somatic detectable mTOR pathway mutations. A response was defined as a ≥50% reduction in seizure frequency. The efficacy of the KD after 3 months of dietary therapy was superior in patients with detectable mTOR pathway mutations than in patients without detectable mTOR pathway mutations, although the difference was not statistically significant (responder rates of 58.3% vs. 38.5%, p=0.434). Conclusions A greater proportion of patients with mTOR pathway responded to the KD, but there was no statistically significant difference in efficacy of the KD between patients with and without detectable mTOR pathway mutations. Further study is warranted due to the smallness of the sample and the limited number of mTOR pathway genes tested in this study.

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide