No abstract available.
Child* ; Hand* ; Humans ; Silver-Russell Syndrome*

Vascular leak syndrome(VLS) is characterized by endothelial damage, which causes extravasation of plasma proteins and fluid from capillaries into the extravascular space. It has been suggested that the increased vascular permeability is the result of an IL-2-induced suppression of endothelin-1 secretion by endothelial cells, an IL-2-induced activation of the complement cascade or TNF-alpha release from IL-2-activated T-cells. A 13-year-old male patient visited our hospital with abdominal pain. He was diagnosed with acute lymphoblastic leukemia(T cell type) by bone marrow study on his 2 nd day in hospital. On the 3 rd day of induction chemotherapy(prednisone, L-asparaginase, vincristine, intrathecal methotrexate), pulmonary edema and pleural effusion, ascites and generalized edema developed and lasted for 53 days without responding to supportive care. The laboratoy finding was that TNF-alpha was increased without evidence of infection and hypoalbuminemia was noted. It was suggested that the patient's clinical feature was induced by VLS.
Abdominal Pain ; Adolescent ; Ascites ; Blood Proteins ; Bone Marrow ; Capillaries ; Capillary Permeability ; Complement System Proteins ; Edema ; Endothelial Cells ; Endothelin-1 ; Humans ; Hypoalbuminemia ; Induction Chemotherapy* ; Male ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Pulmonary Edema ; T-Lymphocytes ; Tumor Necrosis Factor-alpha ; Vincristine

The authors accessed the effects of heart rate and age to echocardiographic right ventricular systolic time intervals in 27 cases with normal pulmonary artery pressure and correlation of pulmonary hemodynamic parameters with echocardiographic right ventricular systolic time intervals in 76 cases with congenital and acquired valvular heart diseases. The results were as follows; 1) As heart rate increased there was a diminution of the length of right ventricular ejection time(RVET)(r=0.642), but no significant changes in the length of right ventricular pre-ejection period(RVPEP) and the ratio of RVPEP/RVET were found. 2) As age increased there was an increase in the ratio of RVPEP/RVET(r=0.46), but no significant changes in the length of RVPEP and RVEF were found. 3) In patients with the RVPEP/RVET of 0.3 or more this ratio can predict that pulmonary artery systolic pressure is >30mmHg(sensitivity : 83%, specificity : 96%, accuracy 88%), pulmonary artery mean pressure >20mmHg(sensitivity : 87%, specificity : 96%, accuracy 90%), and pulmonary artery diastolic pressure >15mmHg(sensitivity : 86%, specificity : 90%, accuracy : 88%). 4) In patients with the RVPEP/RVET of 0.4 or more this ratio can predict that pulmonary artery systolic pressure is >50 mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary artery mean pressure >40mmhg(sensitivity : 93%, specificity : 96%, accuracy : 96%), pulmonary artery diastolic pressure >25mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary vascular resistance >6 units(sensitivity : 70%, specificity : 96%, accuracy : 89%), and Rp/Rs >0.25(sensitivity : 86%, specificity : 95%, accuracy : 93%). In conclusion, pulmonary hypertension, increased pulmonary vascular resistance and pulmonary arteriolar obstructive disease can be predicted by echocardiographic measurement of RVPEP/RVET.
Blood Pressure ; Echocardiography* ; Heart Rate ; Heart Valve Diseases ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery* ; Sensitivity and Specificity ; Systole ; Vascular Resistance*

STUDY DESIGN: A retrospective study. OBJECTIVES: We assessed the intraobserver and interobserver reliability of TLICS classification in the thoracolumbar injuries, which had been evaluated in our hospital. It was compared with that of the older, McAfee classification and discussed for clinical validation. SUMMARY OF LITERATURE REVIEW: Among the numerous literatures regarding the thoracolumbar injury, there is no consensus on the most useful classification, and there is nothing comparing the McAfee classification with the TLICS classification. MATERIALS AND METHODS: Among the 230 patients that were treated with conservative care or operation from January 1, 2005 to January 1, 2010 in our hospital, 185 patients with initial CT and MRI images were assessed. Five orthopedic surgeons reviewed histories, plain film, CT and MRI of the 185 thoracolumbar injury cases, respectively. Each case was classified and scored according to the McAfee classification and the TLICS classification. The case assessment was recorded and the orthopedic surgeons repeated the assessment 1 month later. Intraobserver and interobserver reliability were assessed by statistical analysis. The actual management of each case was compared with the treatment recommended by TLICS classification to calculate the validity of the indexes. RESULTS: Intraobserver and interobserver reliability in TLICS were higher than those in the McAfee classification. Agreement of the TLICS classification for treatment recommendation was 81.7%, comparing with the actual management of previous McAfee classification. Validity indexes were satisfactory in therapeutic decision making, especially specificity. CONCLUSIONS: TLICS classification has a relative high K-value, when compared with that of the McAfee classification for intraobserver and interobserver reliability. Through clinical studies, including prospective observational analysis, TLICS classification can be applied and adjusted more adequately.
Consensus ; Decision Making ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Injuries

A major limiting factor in the use of cyclosporine A (CsA) is nephrotoxicity, but the mechanisms of nephrotoxicity are not fully understood. In order to elucidate the pathogenesis of CsA tubulotoxicity, we examined mechanisms (DNA synthesis, necrosis and apoptosis) of cellular injury induced by CsA in cultured LLC-PK1 renal tubular cell line. The possible role of Fas antigen in the mediation of CsA-induced cell death and the hypothesis that CsA-mediated injury activates the glucose transporter GLUT1, a stress response gene in renal tubular cells were also investigated. CsA treatment for 24 hours in LLC-PK1 cells showed significantly decreased 3H-thymidine uptake in a dose dependent manner (0.1 microgram/ml to 1 mg/ml), indicating that DNA damage is a sensitive indicator of CsA induced nephrotoxicity. A dose of 10 microgramml CsA caused a significant increase in LDH release (M+/-S.D., 11.0+/-3.0% vs 27.0+/-9.8, p<0.05). On flow cytometric analysis, 9.9 4.2% of control cells appeared in a region of decreased forward light scatter and increased side scatter, respectively. Both indices representing characteristics of apoptotic cell death. Compared to control, treatment with 10 ng/ml of CsA for 24 hours significantly increased the proportion of cells in apoptotic region to 38.9 13.5%. This finding was supported by electrophoretic analysis of the DNA extracted from CsA-treated cells, where a series of bands corresponding to integer multiples of 180 to 200 base pairs was visualized. CsA (0.1 microgram/ml) treatment for 24 hours was seen to cause a significant elevation in the expression of the 45 kD Fas protein by Western blot analysis. In addition, the exposure to CsA was also associated with an increase of GLUT1 protein levels up to 2.2 fold (mean) on Western blot analysis. In conclusion, CsA is directly toxic to tubular cells with inhibiting DNA synthesis and inducing cell death in the form of necrosis or apoptosis. Fas antigen-ligand system and glucose transporter GLUT1 may play roles in mediating CsA induced tubular cytotoxicity.
Animals ; Antigens, CD95 ; Apoptosis* ; Base Pairing ; Blotting, Western ; Cell Death ; Cell Line ; Cyclosporine* ; DNA ; DNA Damage ; Epithelial Cells* ; Glucose Transport Proteins, Facilitative ; Glucose Transporter Type 1 ; LLC-PK1 Cells ; Necrosis ; Negotiating ; Swine

A major limiting factor in the use of cyclosporine A (CsA) is nephrotoxicity, but the mechanisms of nephrotoxicity are not fully understood. In order to elucidate the pathogenesis of CsA tubulotoxicity, we examined mechanisms (DNA synthesis, necrosis and apoptosis) of cellular injury induced by CsA in cultured LLC-PK1 renal tubular cell line. The possible role of Fas antigen in the mediation of CsA-induced cell death and the hypothesis that CsA-mediated injury activates the glucose transporter GLUT1, a stress response gene in renal tubular cells were also investigated. CsA treatment for 24 hours in LLC-PK1 cells showed significantly decreased 3H-thymidine uptake in a dose dependent manner (0.1 microgram/ml to 1 mg/ml), indicating that DNA damage is a sensitive indicator of CsA induced nephrotoxicity. A dose of 10 microgramml CsA caused a significant increase in LDH release (M+/-S.D., 11.0+/-3.0% vs 27.0+/-9.8, p<0.05). On flow cytometric analysis, 9.9 4.2% of control cells appeared in a region of decreased forward light scatter and increased side scatter, respectively. Both indices representing characteristics of apoptotic cell death. Compared to control, treatment with 10 ng/ml of CsA for 24 hours significantly increased the proportion of cells in apoptotic region to 38.9 13.5%. This finding was supported by electrophoretic analysis of the DNA extracted from CsA-treated cells, where a series of bands corresponding to integer multiples of 180 to 200 base pairs was visualized. CsA (0.1 microgram/ml) treatment for 24 hours was seen to cause a significant elevation in the expression of the 45 kD Fas protein by Western blot analysis. In addition, the exposure to CsA was also associated with an increase of GLUT1 protein levels up to 2.2 fold (mean) on Western blot analysis. In conclusion, CsA is directly toxic to tubular cells with inhibiting DNA synthesis and inducing cell death in the form of necrosis or apoptosis. Fas antigen-ligand system and glucose transporter GLUT1 may play roles in mediating CsA induced tubular cytotoxicity.
Animals ; Antigens, CD95 ; Apoptosis* ; Base Pairing ; Blotting, Western ; Cell Death ; Cell Line ; Cyclosporine* ; DNA ; DNA Damage ; Epithelial Cells* ; Glucose Transport Proteins, Facilitative ; Glucose Transporter Type 1 ; LLC-PK1 Cells ; Necrosis ; Negotiating ; Swine

No abstract available.
Cryptorchidism* ; Humans ; Infant* ; Male

BACKGROUND: Tracheal intubation and skin incision are potent stimuli that can induce increased sympathetic activity, tachycardia and hypertension. The purpose of this study is to evaluate whether the epidural clonidine pretreatment reduce the sympathetic activity and cardiovascular response. We compared the hemodynamic changes and catecholamine concentration before, during and after general anesthesia with epidural clonidine pretreatment. METHODS: Forty patients undergoing lower abdominal surgery were randomly allocated into the two groups. In Group 1, 10 ml of 0.9% normal saline was administered epidurally 15 minutes before induction of anesthesia as control. In Group 2, 3 microgram/kg clonidine diluted in 10 ml normal saline was administered epidurally 15 minutes before induction of anesthesia. We measured the blood pressure, heart rate and plasma catecholamine concentration at preinduction, 1 minute after intubation (T1), 1 (T2) and 30 minutes after skin incision (T3), 1 (T4) and 2 (T5) hours after arrival at recovery room and the results were compared between group 1 and group 2. RESULTS: There was statistically significant difference in systolic pressure at T1 and T2 between the two groups. Heart rate was statistically significant difference at T1 and T4 between the two groups. There was statistically significant difference in epinephrine and norepinephrine concentration at T1 and T2 between the two groups. CONCLUSION: The elevation of blood pressure, heart rate and plasma catecholamine concentration accompanying tracheal intubation and skin incision may be reduced by administration of epidural clonidine.
Anesthesia ; Anesthesia, General* ; Blood Pressure ; Clonidine* ; Epinephrine ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Norepinephrine ; Plasma* ; Recovery Room ; Skin ; Tachycardia

A survey was conducted to determine the extent of intestinal parasite infection in Bat Dambang, Cambodia in March 2004. A total of 623 fecal specimens was collected from kindergarten and schoolchildren and examined using the formalin-ether sedimentation technique. The overall infection rate of intestinal parasites was 25.7% (boys, 26.2%; girls, 25.1%), and the infection rates of intestinal helminthes by species were as follows: Echinostoma sp. 4.8%, hookworm 3.4%, Hymenolepis nana 1.3%, and Rhabditis sp. 1.3%. The infection rates of intestinal protozoa were; Entamoeba coli 4.8%, Giardia lamblia 2.9%, Iodamoeba butschlii 1.4%, Entamoeba polecki 1.1%, and Entamoeba histolytica 0.8%. There were no egg positive cases of Ascaris lumbricoides or Trichuris trichiura. All children infected were treated with albendazole, praziquantel, or metronidazole according to parasite species. The results showed that intestinal parasites are highly endemic in Bat Dambang, Cambodia.
Adolescent ; Age Factors ; Animals ; Cambodia/epidemiology ; Child ; Feces/parasitology ; Female ; Helminthiasis/*epidemiology ; Helminths/isolation & purification ; Humans ; Intestinal Diseases, Parasitic/*epidemiology ; Male ; Protozoa/isolation & purification ; Protozoan Infections/*epidemiology

Recently Korean Food and Drug Administration approved Hypericum perforatum preparations (St. John's wort) as an over-the-counter drug. The authors reported a case of Hypericum perforatum induced mania in a patient with major depressive disorder and reviewed. A seventy-five years old female patient was diagnosed as major depression 5 years ago, and had been admitted in the psychiatric ward twice and had received regular outpatient treatment. Since October 1998, she took paroxetine 20 mg, and bromazepam 1.5 mg constantly. But all of a sudden, she stopped taking the drugs on June 20th 2000, and took Hypericum perforatum 300 mg three times daily. Ten days after, she became abruptly talkative, irritable, hyperactive, and euphoric. She was diagnosed as Hypericum perforatum-induced mania. Manic symptoms came down after several days by discontinuation of taking Hypericum perforatum. Since then she has been got a continuous treatment with paroxetine 20 mg, and she is in full remission state now. Hypericum perforatum is one of herb extracts, which is known to have the antidepressant effect like traditional and newer antidepressants. The side effects of Hypericum perforatum are gastrointestinal disturbance, allergy reaction, fatigue, photosensitivity. And more serious side effect is drug-drug interaction due to it's inducing effect of cytochrome P450 and P-glycoprotein. It is possible to switch from depression to manic episode as was in this case. Although it was approved as an over-the-counter drug in Korea, the use of Hypericum perforatum need to be thoroughly examined to prevent misused if not fully understood.
Antidepressive Agents ; Bipolar Disorder* ; Bromazepam ; Cytochrome P-450 Enzyme System ; Depression* ; Depressive Disorder, Major ; Fatigue ; Female ; Humans ; Hypericum* ; Hypersensitivity ; Korea ; Outpatients ; P-Glycoprotein ; Paroxetine ; United States Food and Drug Administration