Shaken baby syndrome develop as a form of child abuse, with the majority of cases occurring during the first year of life. It results from extreme rotational cranial acceleration and deceleration effects induced by violent shaking of an infant. The characteristic injuries include subdural and subarachnoid hemorrhages, and retinal hemorrhages. We experienced three cases of shaken baby syndrome. Although the history of trauma was little known, all of these cases had subdural hemorrhages. We present the cases with a review of related literature.
Acceleration ; Child ; Child Abuse ; Deceleration ; Hematoma, Subdural ; Humans ; Infant ; Retinal Hemorrhage ; Shaken Baby Syndrome* ; Subarachnoid Hemorrhage

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential. METHODS: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours. RESULTS: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035). CONCLUSION: Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.
Cerebral Infarction ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Medical Records ; Neurologic Manifestations* ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator

PURPOSE: To assess the usefulness of three-dimensional Fourier transformation constructive interference in steady state (CISS) for the evaluation of chondromalacia. MATERIALS AND METHODS: In 110 knee joints which underwent both MR imaging and arthroscopy, the findings were retrospectively reviewed. MR imaging sequences included two-dimensional dual-echo turbo spin-echo imaging along the sagittal and coronal planes, two-dimensional fast low-angle shot (FLASH) with magnetization transfer along the axial plane, and three-dimensional CISS along the sagittal plane. After the cartilage surfaces of each joint were divided into eight areas (each medial and lateral area of patellar facets, trochlear surfaces, femoral condyles, and tibial plateaux), a total of 880 areas were assessed. Using both combined two-dimensional (2-D turbo spin-echo and FLASH) and CISS imaging during different sessions, each chondromalacia case was assigned one of five grades. RESULTS: Arthroscopy revealed the presence of chondromalacia in 162 areas. This was first grade in 77 areas, second grade in 38, third grade in 21, and fourth grade in 26. The sensitivity, specificity, and accuracy of 2-D and CISS imaging were 48.1%, 93.7% and 85.3%, and 45.7%, 95.3% and 86.1%, respectively. Agreement between MR and arthroscopic staging occurred in 81.48% of 2-D imaging procedures and 82.16% of CISS procedures. If a difference of one grade was accepted, these proportions rose to 84.32% and 85.22%, respectively, though this increase was statistically insignificant. CONCLUSION: Though CISS imaging was less sensitive than 2-D imaging in the grading of chondromalacia, additional CISS imaging can help improve the accuracy of this grading.
Arthroscopy ; Cartilage ; Cartilage Diseases* ; Fourier Analysis* ; Joints ; Knee Joint* ; Knee* ; Magnetic Resonance Imaging ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: The isolated microscopic hematuria is the most common abnormality detected by school urinary screening, but there is no consensus about the range of investigations and long-term outcomes of isolated hematuria in children yet. This study aims to elucidate the prognosis of hematuria and the range of diagnostic studies by follow-up results. METHODS: Students with isolated hematuria who were referred to the Department of Pediatrics, Asan Medical Center from Aug. 1990 to Feb. 2004 were analysed retrospectively. Cases that presented Through significant proteinuria(>250 mg/day), other symptoms of nephritis or renal dysfunction (creatinine clearance <85 mL/min/1.73m2) were excluded. Follow-up was done every six months with checking urinalysis, serum creatinine, protein and albumin. When albuminuria was detected, 24 hour urine protein was checked. Renal biopsy was done when urine protein was over 500 mg/day. RESULTS: A total of 331 students were enrolled in this study. There were 157 males and 174 females. The mean age at presentation was 9.9+/-2.3 years(7-15 years) and mean follow-up period was 2.2+/-1.6 years(1-10 years). Seventy five(22.7 percent) patients showed the resolution of microscopic hematuria. The mean resolution period was 2.6+/-1.7 years(1-8 years). Eight(2.4 percent) patients developed significant proteinuria and renal biopsy was done in four of them. Two cases of mild IgA nephropathy and two of minimal change were detected. None of them developed hypertension. At the end of the follow-up, renal function had remained stable in all subsets of patients. CONCLUSION: The prognosis of isolated microscopic hematuria was good. This study suggests that invasive studies including renal biopsy are not necessary and a regular follow-up of urinalysis is enough for children with isolated microscopic hematuria.
Albuminuria ; Biopsy ; Child* ; Chungcheongnam-do ; Consensus ; Creatinine ; Female ; Follow-Up Studies* ; Glomerulonephritis, IGA ; Hematuria* ; Humans ; Hypertension ; Male ; Mass Screening* ; Nephritis ; Pediatrics ; Prognosis ; Proteinuria ; Retrospective Studies ; Urinalysis

PURPOSE: Podocytes are critical in maintaining the filtration barrier of the glomerulus and are dependent on the integrity of slit diaphragm(SD) proteins including nephrin, P-cadherin, and others. Diabetic proteinuric condition demonstrates defects in SD molecules as well as ultrastructural changes in podocytes. We examined the molecular basis for this alteration of SD molecules especially on P-cadherin as a candidate regulating the modulation of pathogenic changes in the barrier to protein filtration. METHODS: To investigate whether high glucose and AGE induce changes in SD, we cultured rat GEpC under normal(5 mM) or high glucose(30 mM) and AGE- or BSA-added conditions and measured the change of P-cadherin expression by Western blotting and RT- PCR. RESULTS: We found that administration of high glucose decreased the P-cadherin production significantly in the presence or absence of AGE by Western blotting. In RT-PCR high glucose with or without AGE also significantly decreased the expression of P-cadherin mRNA compared to those of controls. Such changes were not seen in the osmotic control. CONCLUSION: We suggest that high glucose with or without AGE suppresses the production of P-cadherin at the transcriptional level and that these changes may explain the functional changes of SD in diabetic conditions.
Animals ; Blotting, Western ; Cadherins* ; Diabetic Nephropathies ; Filtration ; Glucose* ; Glycosylation* ; Podocytes ; Polymerase Chain Reaction ; Rats ; RNA, Messenger

BACKGROUND: Since various hematology analyzers apply common or different principles in complete blood counting, difference between measured values could developed according to the control material used in external quality assessment. Diagnostic Hematology Subcommittee has been using formalin fixed blood and Liquichek(TM) Hematology-16 (Bio-Rad, USA) as control material of external quality assessment alternately but recently significant difference of test results was found in some analyzers. We intended to select adequate control material showing similar test results in most analyzers. METHODS: Using fresh whole blood, formalin fixed blood, Liquichek(TM) Hematology-16 and CBC-4K (R&D, USA), 5 parameters (WBC, RBC, Hb, Hct, platelet) were measured in 4 hematology analyzers; CELL-DYN sapphire (Abbott Diagnostics, USA), Coulter LH750 (Beckman Coulter, USA), ADVIA 2120 (Siemens Diagnostics, USA) and Sysmex XE-2100 (Sysmex Co., Japan). Linearity, within-run precision and between-day precision of 4 materials for each parameter were evaluated at different analyzers. RESULTS: The between-day precisions for WBC of formalin fixed blood showed very high CVs of 6.5~13.5% in all 4 hematology analyzers. The within-run and between-day precisions for WBC and platelet of Liquichek(TM) Hematology-16 showed high CVs of 9.3%, 16% and 19.8%, 18%, respectively in CELL-DYN analyzer. But, CBC-4K showed a good linearity (r2=0.9953~0.9993) and precision (within-run CVs, 0~1.5% and between-day CVs, 0~2.0%) in all analyzers. CONCLUSIONS: Fresh whole blood, formalin fixed blood and Liquichek(TM) Hematology-16 are not appropriate for standardization of external quality control materials because of some different test results among analyzers. We conclude that CBC-4K with good performance in all hematology analyzer is adequate as external quality control material.
Aluminum Oxide ; Blood Cell Count ; Blood Platelets ; Formaldehyde ; Hematology ; Quality Control

PURPOSE: The natural courses of prenatally diagnosed hydronephrosis(HN) are diverse. Our purpose was to determine if the findings of renal ultrasonography(USG) in patients with prenatal HN at 1 month of age can predict the 1 year follow-up results and determine the guideline of follow-up study. METHODS: Among 462 hydronephrotic patients registered between 1996 and 2004, 153 unilateral hydronephrotic renal units were enrolled in this study, bilateral HN, vesicoureteral reflux and other associated anomaly were excluded. These were classified into four groups respectively, according to anterior posterior pelvic diameter(APPD) or Society for Fetal Urology(SFU) grading by USG findings at 1 month after birth. Renal USG and Tc(99m)-mercaptoacetyl triglycerine(MAG3) scan were done according to a set protocol. RESULTS: Most cases improved or remained stationary. No one underwent an operation SFU grade 1,2 groups and only one case of SFU grade 3 group was operated. Thirty two cases(64 percent) were operated on among the 50 cases of SFU grade 4 group. 0/2(0 percent), 5/11(45.5 percent), 11/17(64.7 percent) and 16/20(80 percent) were operated on in each group with APPD <10, 10-19, 20-29, >30 mm, and the operation risk is higher as the APPD is increased. CONCLUSION: In group with SFU grade below 3 and APPD below 10 mm, we can delay the follow-up study beyond existing set protocol. Operations are recommended immediately if diuretic renogram show the obstructive pattern or decreased renal function in SFU grade 4 group with APPD over 10 mm.
Follow-Up Studies* ; Humans ; Hydronephrosis* ; Parturition ; Ultrasonography* ; Vesico-Ureteral Reflux

PURPOSE: Evaluation of sexual function is an important step for animal studies about sexual function. Male rats could display penile erection in the presence of an inaccessible estrous female. We examined the usefulness of observing non-contact erection (NCE) for the evaluation of sexual function in male rats. MATERIALS AND METHODS: Forty five Long-Evans male rats (8 weeks old) were used in this study. Tests for NCE were conducted in a glass chamber divided in half by 2 wire-mesh screens that prevented direct contact, but the rats freely passed other forms of stimulation. If at least 1 NCE could be observed during 45 minutes, we considered this as a positive response. In case of two or three positive responses in three NCE tests, that was considered as NCE (+). After NCE, copulation observations were noted to evaluate sexual function. If at least two ejaculations could be observed during 45 minutes, we considered that a positive response. In case of two or three positive responses in three copulation observations, that was considered as normal sexual function. RESULTS: Twenty one of 45 male rats (47%) were NCE (+) and 34 of 45 male rats (76%) had normal sexual function. In 21 NCE (+) rats, 20 rats had normal sexual function: only one was impotent. The positive predictive value of the NCE observation for the evaluation of sexual function was 95%. In 11 impotent rats, 10 rats were NCE (-). The specificity of the NCE observation was 91%. CONCLUSIONS: These results indicated that NCE observation could be a useful method for evaluating the sexual function of male rat.
Animals ; Copulation ; Ejaculation ; Female ; Glass ; Humans ; Male* ; Penile Erection ; Rats* ; Sensitivity and Specificity

Allergic asthma is associated with persistent functional and structural changes in the airways and involves many different cell types. Many proteins involved in allergic asthma have been identified individually, but complete protein profiles (proteome) have not yet been reported. Here we have used a differential proteome mapping strategy to identify tissue proteins that are differentially expressed in mice with allergic asthma and in normal mice. Mouse lung tissue proteins were separated using two-dimensional gel electrophoresis over a pH range between 4 and 7, digested, and then analyzed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MS). The proteins were identified using automated MS data acquisition. The resulting data were searched against a protein database using an internal Mascot search routine. This approach identified 15 proteins that were differentially expressed in the lungs of mice with allergic asthma and normal mice. All 15 proteins were identified by MS, and 9 could be linked to asthma-related symptoms, oxidation, or tissue remodeling. Our data suggest that these proteins may prove useful as surrogate biomarkers for quantitatively monitoring disease state progression or response to therapy.
Animals ; Asthma/genetics/immunology/*metabolism ; Comparative Study ; Disease Models, Animal ; Electrophoresis, Gel, Two-Dimensional ; Gene Expression/immunology ; Gene Expression Profiling ; Lung/immunology/metabolism/pathology ; Male ; Mice ; Mice, Inbred BALB C ; Ovalbumin/immunology ; Proteome/*analysis/genetics/immunology ; Proteomics/methods ; RNA, Messenger/genetics/metabolism ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

BACKGROUND: Many Studies regarding hemodynamic changes by various vasodilators, such as nitroprusside, nifedipine, and hydralazine have been reported, however little data are available upon acute hemodynamic change due to captopril, an angiotensin converting enzyme inhibitor especially in chronic regurgitant valvular heart disease. Therefore the aim of this study is to evaluate the acute hemodynamic effects of sublingual captopril in patients with regurgitant valvular heart diseases. METHODS: Among the 9 patients enrolled in this study, 5 patients mitral regurgitation, 2 had aortic regurgitation, and 2 had both. Five had patients were male and 4 were female. Before, 15 minutes and 30 minutes after administration of 25mg of captopril via sublingual route, forward cardiac output was measured three times using Swan-Ganz catheter. Right and left cardiac catheterization were also done at each phase and measurement of pulmonary capillary wedge pressures, pulmonary artery pressures, right atrial pressures, aortic pressures, left ventricular pressures were done. RESULTS: 1) Heart rate, pulmonary capillary wedge pressures, cardiac output and cardiac indices left ventricular end-diastolic pressure, diastolic and mean aortic pressures, and diastolic pulmonary artery pressure showed no significant change after administration of sublingual captopril. 2) Systolic aortic pressure decreased significantly from basal value(130+/-35) to 15 minute value(126+/-39). 3) Systemic vascular resistance at 15 minute showed significant reduction as compared with basal value(from 1743+/-551 to 1642+/-491). Pulmonary vascular resistance at 30 minutes(254+/-193) was significantly lower than basal value(282+/-229). CONCLUSIONS: Reductions of systemic and pulmonary vascular resistance occurred relatively rapidly, however, acute effects on cardiac output and pulmonary capillary wedge pressures were not evident. Clinical implication of sublingual captopril in patients with regurgitant valvular heart diseases is worth evaluationg by more extensive hemodynamic studies.
Aortic Valve Insufficiency ; Arterial Pressure ; Arteries ; Atrial Pressure ; Blood Pressure ; Capillaries ; Captopril* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Catheters ; Female ; Heart Rate ; Heart Valve Diseases* ; Hemodynamics* ; Humans ; Hydralazine ; Male ; Mitral Valve Insufficiency ; Nifedipine ; Nitroprusside ; Peptidyl-Dipeptidase A ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Vascular Resistance ; Vasodilator Agents ; Ventricular Pressure