We experienced two cases of congenital adrenal hyperplasia(CAH), complicated by true precocious puberty with early maturation of the hypothalamic-pituitary-gonadal axis in a boy and a girl. The boy was diagnosed as CAH at 8 years of age, when he showed pseudoprecocity with adrenal rest tumor. The girl was diagnosed at neonate, when she showed ambiguous genitalia and salt-losing symptom. They developed precocious puberty during steroid treatment. Clinically they showed precocity, advanced bone age, and decreased predicted adult height, even though they showed partial gonadotrophin response to luteinizing hormone releasing hormone (LHRH) stimulation test. They were treated with LHRH analogue(leuprolide depot) resulting no further progression of precocity.
Adrenal Hyperplasia, Congenital* ; Adrenal Rest Tumor ; Adult ; Axis, Cervical Vertebra ; Disorders of Sex Development ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Infant, Newborn ; Male ; Puberty, Precocious*

PURPOSE: It is not clear that the development of glomerular injury and aggravation by tumor necrosis factor alpha (TNF-alpha) is related to intrarenal or serum concentration of TNF-alpha. So, we studied the relationship between the concentration of TNF-alpha and aggravation of glomerular damage in the Henoch-Schonlein nephritis(HSN) and idiopathic nephrotic syndrome(INS). METHODS: We collected the sera and urines of 21 patients with Henoch-Schonlein purpura(HSP) and 22 patients with INS visited Chungbuk National University hospital from March 1998 to March 2001. The concentration of TNF-alpha in the sera and urines were measured by sandwich ELISA. RESULTS: Serum TNF-alpha levels in the HSP patients with renal involvement were significantly higher than those without renal involvement(P=0.009). But urine TNF-alpha levels have no correlation with renal involvement(P=0.088). In the HSN patients, proteinuria have a significant correlation with serum TNF-alpha levels(P=0.004) but less correlation with urine TNF-alpha levels(P=0.053). Otherwise, proteinuria have no correlation with serum TNF-alpha levels(P=0.763) but have a significant correlation with urine TNF-alpha levels(P=0.007) in INS. CONCLUSION: These result suggest that the serum concentration of TNF-alpha would be important to glomerular involvement in HSP. And, it is interesting that proteinuria shows a significant relation with serum TNF-alpha levels in the HSN, but with urine TNF-alpha levels in the INS. This means the major production of TNF-alpha may be originated by extrarenal inflammation in the HSN and by intrarenal tubulo-interstitial damage due to proteinuria in the INS.
Chungcheongbuk-do ; Enzyme-Linked Immunosorbent Assay ; Humans ; Inflammation ; Nephritis* ; Nephrotic Syndrome* ; Proteinuria* ; Tumor Necrosis Factor-alpha*

One of the goals of anesthesia is complete, comfortable and rapid recovery without sequelae from anesthesia. We compared the recovery pattern between anesthesia with propofol and thiopental/isoflurane. The fifty patients undergoing emergency appendectomy were allocated randomly to receive one of the anesthesia with propofol or thiopental/isoflurane. All of the patients were also given fentanyl, atracurium in equivocal dosage per weight and 50% N2O. Group 1(patient No; 25) was received anesthesia with fentanyl, atracurium, N2O and continuous injection of 6~12 mg/kg/hour of propofol. Group 2(patient No; 25) was received anesthesia with thiopental, fentanyl, atracurium, N2O and 1~2 MAC(minimal alveolar concentration) of isoflurane. We studied the duration of return of self respiration from discontinuation of anesthetics and recovery pattern in time sequence. The results were as following; The group 1 compared with group 2 at early recovery phase. 1) The duration of return of self respiration from discontinuation of anesthetics retured more rapid. 2) Emergence time was more rapid. 3) Postoperative sequelae(nausea, vomiting, sedation, drowsiness, memory dysfunction, pain) rate was less severe. But at recovery phase after 24 hours, there were no significant difference in postoperative sequelae and recovery condition in both groups. Therefore, we concluded that propofol is better than thiopental/isoflurane for anesthesia of emergency appendectomy in view of early recovery pattern.
Anesthesia* ; Anesthetics ; Appendectomy ; Atracurium ; Emergencies ; Fentanyl ; Humans ; Isoflurane ; Memory ; Propofol* ; Respiration ; Sleep Stages ; Thiopental ; Vomiting

Injury of diaphragm mainly occur in penetrating, crush and blunt injuries to the lower chest or upper abdomen, and it is most often secondary to automobile accidents. Diaphragmatic rupture is most frequent in blunt chest trauma and the rate is below 1% of them. Traumatic rupture of the diaphragm is responsible for the herniation of abdominal viscera. Physical finding and radiographic sign of diaphragmatic hernia is nonspecific and misreading. Therefore, the diagnosis of traumatic rupture of diaphragm may be difficult during the early period after the injury, especially when clinical features are dominated by associated injuries. Emergency surgical management is necessary when it is complicated with serious complication. We experienced the case of traumatic diaphragmatic hernia detected after the operation of femur fracture. The patient was injured by motor vehicle accident 6 days before the operation of the femur fracture. There was no specific symptom and sign and the manifestation of the diaphragmatic hernia. in radiographic studies until operation of the femur fracture was done. Diaphragmatic hernia was confirmed by chest X-ray and arterial blood gas analysis after operation of the femur fracture. The repair of the diaphragmatic hernia was directly performed after the diagnosis. The prognosis was favorable, and she was discharged to ward from intensive care unit after 1 day of operation. We must consider the possibility of traumatic diaphragmatic hernia in the patient who have the history of blunt chest or abdominal trauma.
Abdomen ; Analgesia, Patient-Controlled* ; Automobiles ; Blood Gas Analysis ; Diagnosis ; Diaphragm ; Emergencies ; Femur* ; Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Intensive Care Units ; Morphine* ; Motor Vehicles ; Prognosis ; Rupture ; Thorax ; Viscera ; Wounds, Nonpenetrating

PURPOSE:Autonomic neuropathy in adult diabetics is known to be common and poor in prognosis. Cardiac autonomic neuropathy increases sudden cardiac death and is present before apparant cardiac symptoms. Subclinical diabetic peripheral neuropathy is common with type 1 diabetes. In children, few studies for subclinical peripheral neuropathy and cardiac autonomic neuropathy were reported but the results were inconsistent. The authors investigated subclinical cardiac and peripheral neuropaties and evaluated correlation between nerve conduction velocity(NCV) and cardiac autonomic function(CAF) test in type 1 diabetic children and adolescents METHODS:Over 5 years from 1997 to 2002, 27 IDDM without clinical neuropathy were registered. Total 57 CAF and NCV were tested every 2 or 3 years. Duration of diabetes, average HbA1c during 1 year prior to the test, and urinary microalbumin excretion for 24 hours were assessed. Diabetic autonomic nervous function was evaluated by cardiovascular reflex test:falling systolic blood pressure in response to standing, heart rate changes in response to standing, beat-to-beat rate variation during deep breathing, RR interval change during and after Valsalva maneuver. Subclinical peripheral neuropathy was evaluated by NCV in both upper and lower extremities. Correlation of parameters according to NCV abnormality and microalbuminuria were analyzed. RESULTS:The age, duration of diabetes and microalbuminuria were not statistically different between children with normal and abnormal NCV. The level of HbA1c was associated with NCV abnormality. In a multivariate logistic model for NCV abnormality, level of HbA1c showed statistical significance after controlling the effects of age, duration of diabetes, and urinary microalbumin level, and the odd ratio was 1.532. The degree of CAF abnormality was marginally significant in the logistic model. Children with microalbuminuria showed older age and longer duration of diabetes than those without microalbuminuria. However, mean HbA1c level was not significantly different between the two groups. Degree of CAF abnormality was not significantly associated with microalbuminuria, either. In a general linear model including urinary albumin level as the dependent variable, none of independent variables was statistically significant. CONCLUSION: Therapy against neuropathy should be considered in patients with high HbA1c and abnormal CAF test even without clinically apparent neuropathy.
Adolescent ; Adult ; Blood Pressure ; Child* ; Death, Sudden, Cardiac ; Diabetes Mellitus, Type 1 ; Diabetic Neuropathies ; Heart Rate ; Humans ; Linear Models ; Logistic Models ; Lower Extremity ; Neural Conduction ; Peripheral Nervous System Diseases ; Prognosis ; Reflex ; Respiration ; Valsalva Maneuver

Effects of diallyl sulfide (DAS) on thioacetamide-induced hepatotoxicity and immunotoxicity were investigated. When male Sprague-Dawley rats were treated orally with 100, 200 and 400 mg/kg of DAS in corn oil for three consecutive days, the activity of cytochrome P450 (CYP) 2E1-selective p-nitrophenol hydroxylase was dose-dependently suppressed. In addition, the activities of CYP 2B-selective benzyloxyresorufin O-debenzylase and pentoxyresorufin O-depentylase were significantly induced by the treatment with DAS. Western immunoblotting analyses also indicated the suppression of CYP 2E1 protein and/or the induction of CYP 2B protein by DAS. To investigate a possible role of metabolic activation by CYP enzymes in thioacetamide-induced hepatotoxicity, rats were pre-treated with 400 mg/kg of DAS for 3 days, followed by a single intraperitoneal treatment with 100 and 200 mg/kg of thioacetamide in saline for 24 hr. The activities of serum alanine aminotransferase and aspartate aminotransferase significantly elevated by thioacetamide were protected in DAS-pretreated animals. Likewise, the suppressed antibody response to sheep erythrocytes by thioacetamide was protected by DAS pretreatment in female BALB/c mice. Taken together, our present results indicated that thioacetamide might be activated to its toxic metabolite(s) by CYP 2E1, not by CYP 2B, in rats and mice.
Alanine Transaminase ; Animals ; Antibody Formation ; Aspartate Aminotransferases ; Biotransformation ; Blotting, Western ; Corn Oil ; Cytochrome P-450 CYP2E1* ; Cytochrome P-450 Enzyme System ; Erythrocytes ; Female ; Humans ; Male ; Mice ; Rats ; Rats, Sprague-Dawley ; Sheep ; Thioacetamide

PURPOSE: The aim of this study was to evaluate the normal values of regional cerebral blood flow (rCBF) and cerebrovascular reserve (CVR) in normal children to aged volunteers using Tc-99m HMPAO. MATERIALS AND METHODS: Thirty four right-handed normal volunteers (20 males, 14 females, mean age 40.3+/-24.9 years, range 4 to 82 years) were underwent rest/acetazolamide (ACZ) brain SPECT using Tc-99m HMPAO and the sequential injection and subtraction method. rCBF was estimated on the basis of a semiquantitative approach by means of right/left ratio, region/cerebellum and region to whole brain ratios in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalami, and cerebellum. CVR was measured by means of % perfusion increase calculated as % mean count change compared to rest rCBF in each regions. RESULTS: Mean values of right to left ratios range from 1.004 to 1.018. rCBF was highest in cerebellum and lowest in basal ganglia and thalami. Frontal and temporal rCBF decreased while occipital and thalamic rCBF increased according to age. No sexual difference of rCBF was noted. Mean CVR was 29.9+/-12.9%. Mean CVR significantly increased to late teens, and declined thereafter. After 6th decade, CVR in both frontal lobes, left parietal lobe and right basal ganglia decreased significantly with advancing age. There was no sexual difference of CVR. CONCLUSION:: Quantitative assessment of CVR was possible by ACZ Tc-99m HMPAO brain SPECT. It revealed that rCBF and CVR changed according to age in normal Korean volunteers. There was no sexual difference.
Acetazolamide ; Adolescent ; Basal Ganglia ; Brain* ; Cerebellum ; Child ; Female ; Frontal Lobe ; Healthy Volunteers ; Humans ; Male ; Occipital Lobe ; Parietal Lobe ; Perfusion ; Rabeprazole ; Reference Values ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon* ; Volunteers

Human astrovirus (HAstV) is a major cause of acute diarrhea among children, resulting in outbreaks of diarrhea and occasionally hospitalization. Improved surveillance and application of sensitive molecular diagnostics have further defined the impact of HAstV infections in children. These studies have shown that HAstV infections are clinically milder (diarrhea, vomiting, fever) than infections with other enteric agents. Among the 8 serotypes of HAstV identified, serotype 1 is the predominant strain worldwide. In addition to serotype 1, the detection rate of HAstV types 2 to 8 has increased by using newly developed assays. HAstV is less common compared with other major gastroenteritis viruses, including norovirus and rotavirus; however, it is a potentially important viral etiological agent with a significant role in acute gastroenteritis. A better understanding of the molecular epidemiology and characteristics of HAstV strains may be valuable to develop specific prevention strategies.
Child ; Diarrhea ; Disease Outbreaks ; Gastroenteritis ; Hospitalization ; Humans ; Mamastrovirus ; Molecular Epidemiology ; Norovirus ; Pathology, Molecular ; Sprains and Strains ; Vomiting

Human astrovirus (HAstV) is a major cause of acute diarrhea among children, resulting in outbreaks of diarrhea and occasionally hospitalization. Improved surveillance and application of sensitive molecular diagnostics have further defined the impact of HAstV infections in children. These studies have shown that HAstV infections are clinically milder (diarrhea, vomiting, fever) than infections with other enteric agents. Among the 8 serotypes of HAstV identified, serotype 1 is the predominant strain worldwide. In addition to serotype 1, the detection rate of HAstV types 2 to 8 has increased by using newly developed assays. HAstV is less common compared with other major gastroenteritis viruses, including norovirus and rotavirus; however, it is a potentially important viral etiological agent with a significant role in acute gastroenteritis. A better understanding of the molecular epidemiology and characteristics of HAstV strains may be valuable to develop specific prevention strategies.
Child ; Diarrhea ; Disease Outbreaks ; Gastroenteritis ; Hospitalization ; Humans ; Mamastrovirus ; Molecular Epidemiology ; Norovirus ; Pathology, Molecular ; Sprains and Strains ; Vomiting

Pharmacokinetic interaction of chrysin, a flavone present in honey, propolis and herbs, with caffeine was investigated in male Sprague-Dawley rats. Because chrysin inhibited CYP1A-selective ethoxyresorufin O-deethylase and methoxyresorufin O-demethylase activities in enriched rat liver microsomes, the pharmacokinetics of caffeine, a CYP 1A substrate, was studied following an intragastric administration with 100 mg/kg chrysin. In addition to the oral bioavailability of chrysin, its phase 2 metabolites, chrysin sulfate and chrysin glucuronide, were determined in rat plasma. As results, the pharmacokinetic parameters for caffeine and its three metabolites (i.e., paraxanthine, theobromine and theophylline) were not changed following chrysin treatment in vivo, despite of its inhibitory effect on CYP 1A in vitro. The bioavailability of chrysin was found to be almost zero, because chrysin was rapidly metabolized to its sulfate and glucuronide conjugates in rats. Taken together, it was concluded that the little interaction of chrysin with caffeine might be resulted from the rapid metabolism of chrysin to its phase 2 metabolites which would not have inhibitory effects on CYP enzymes responsible for caffeine metabolism.
Animals ; Biological Availability ; Caffeine* ; Cytochrome P-450 CYP1A1 ; Drug Interactions ; Honey ; Humans ; In Vitro Techniques ; Male ; Metabolism ; Microsomes, Liver ; Pharmacokinetics ; Plasma ; Propolis ; Rats* ; Rats, Sprague-Dawley ; Theobromine