Intrathecal administration of methotrexate(IT-MTX) has constituted the standard approach to prophylaxis and treatment of central nevous system(CNS) leukemia. We experienced a quadriplegia and motor aphasia in a 14-year-old boy following repeated IT-MTX for the prophylaxis of meningeal leukemia. He was diagnosed as ALL without CNS involvement and treated by CCG- 1882 protocol. IT-MTX was administered for CNS prophylaxis. The patient began complaining of urinary incontinence, motor aphasia and weakness in his right leg from 12 days after the 5th dose of the IT-MTX therapy. Even though the IT-MTX was discontinued, loss of muscle power progressed upward resulting in quadriplegia. The patient showed slow and partial recovery on right extremities over 3 months. We report this case with brief review of literature.
Adolescent ; Aphasia, Broca* ; Extremities ; Humans ; Leg ; Leukemia ; Male ; Methotrexate* ; Quadriplegia* ; Urinary Incontinence

Ficus carica L. (fig) belongs to the mulberry tree (Moraceae) which is one of the oldest fruits in the world. It has been used as a digestion promoter and a cure for ulcerative inflammation and eruption in Korea. The present study investigated the antimicrobial activity of methanol (MeOH) extract of figs against oral bacteria. The MeOH extract (MICs, 0.156 to 5 mg/ml; MBCs, 0.313 to 5 mg/ml) showed a strong antibacterial activity against oral bacteria. The combination effects of MeOH extract with ampicillin or gentamicin were synergistic against oral bacteria. We suggest that figs could be employed as a natural antibacterial agent in oral care products.
Ampicillin ; Bacteria ; Carica ; Digestion ; Ficus ; Fruit ; Gentamicins ; Inflammation ; Korea ; Methanol ; Morus ; Trees ; Ulcer

Kawasaki disease is an acute vasculitis of unknown causes that occurs predominantly in infants and young children and produces coronary artery aneurysm. We have recently experienced a case of persistent Kawasaki disease in a 24 month-old-girl improved with pulsed doses of methylprednisolone. Even with an administration of intravenous gamma globulin(IVIG), she repeated the course of recovery and aggravation. After four times repeated doses of IVIG, additional intravenous methylprednisolone pulse therapy was tried and resulted in remarkable improvement. We reported the case with a brief review of the related literature.
Aneurysm ; Child ; Coronary Vessels ; Humans ; Immunoglobulins, Intravenous ; Infant ; Methylprednisolone* ; Mucocutaneous Lymph Node Syndrome* ; Vasculitis

PURPOSE: Alternative medicine(AM) is defined as the approaches and techniques that are not included in the curricula of medical schools or residency training at present. This study aimed to evaluate the present status of the use of AM in allergic diseases and to propose an appropriate guide. METHODS: Mailed questionnaires on the patterns of the use of AM were collected during the month of May in 2001. The data was analyzed using SPSS WINDOW 8.0. RESULTS: 1) One hundred and five patients responded. Their mean age was 46.5 years old and the mean duration of the diseases was 67 months. 2) Ninety six(91.4%) out of 105 responders who have allergic diseases experienced AM. Herb medicine(57.3%) was most popular and hot spring(22.9%), immune stimulants(22.9%), nutritional supplements(13.5%), acupuncture(12.5%), breathing exercise, aroma-therapy and foods such as aloe, honey and ginkgo nuts were also tried. 3) The annual mean expenditure for the AM was about 690,000 Won. Severely diseased patients spent more money out of their pocket for AM. 4) Doctors(43.5%), oriental doctors(19.8%), neighbours(27.1%) and mass media played some roles for the distribution of the information about AM. 5) The patients purchased the products for AM from drug store, hospital, market, health care shop and by mail or internet orders. 6) Thirty two patients(33.3%) were satisfied with the AM and 35(36.5%) patients answered that they would recommend the AM to the others. CONCLUSION: Many allergy patients used various kinds of AM without any guidelines. Therefore, doctors' active participation in AM is necessary to confirm the scientific basis, to strengthen patient's education and to filter the informations about AM spreaded by the mass media.
Aloe ; Complementary Therapies* ; Curriculum ; Education ; Ginkgo biloba ; Health Care Sector ; Health Expenditures ; Honey ; Humans ; Hypersensitivity* ; Internet ; Internship and Residency ; Mass Media ; Nuts ; Postal Service ; Surveys and Questionnaires ; Respiration ; Schools, Medical

PURPOSE: The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments. MATERIALS AND METHODS: One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated. RESULTS: At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups. CONCLUSION: Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; Constriction, Pathologic ; Disease-Free Survival ; Drug Therapy ; Epithelial Cells* ; Esophageal Neoplasms ; Fluorouracil ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Assessment

PURPOSE: Off-pump coronary artery bypass (OPCAB) is known to be associated with a lower risk of acute renal failure (ARF) than on-pump method. However, little data is available on ARF in OPCAB. The aim of the present study was to identify the incidence, risk factors, and mortality of ARF in OPCAB. METHODS: Perioperative variables in medical records of 573 patients who had undergone OPCAB from Jan 2000 to June 2004 were evaluated. ARF was defined as a 50% increase in preoperative serum creatinine (over 1.4 mg/dL) within 72 hours after operation, or as the need for postoperative dialysis. RESULTS: The incidence of ARF and ARF requiring dialysis were 9.8% and 2.6%, respectively. The independent risk factors for ARF after OPCAB were the perioperative use of an intra-aortic balloon pump (OR, 4.425; 95% CI, 2.342-8.403), high preoperative serum creatinine (OR 2.099; 95% CI, 1.422-3.098), diabetes (OR, 1.961; 95% CI, 1.078-3.571), and old age (OR, 1.479; 95% CI, 1.034- 2.116). The in-hospital mortality rate was 53.3% for patients requiring dialysis, 19.6% for all ARF patients and 0.8% for patients without ARF (p<0.001). The 3-year cumulative mortality rate was 38.4 % in all ARF patients and 5.2% in patients without ARF (p<0.001). CONCLUSION: ARF was not an uncommon complication in adults who underwent OPCAB. Perioperative hemodynamic instability, preoperative renal dysfunction, diabetes, and age could independently predict the development of ARF after OPCAB and the severity of ARF was related to higher in-hospital and long-term mortality rates.
Acute Kidney Injury* ; Adult ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Creatinine ; Dialysis ; Hemodynamics ; Hospital Mortality ; Humans ; Incidence* ; Medical Records ; Mortality ; Renal Insufficiency ; Risk Factors*

PURPOSE: Number of patients expecting for kidney transplantation and transplantations in foreign countries are rapidly increasing. However, there was a lack of information about clinical progresses and outcomes of kidney recipients, underwent cadaveric kidney transplantation in China. METHODS: We included 44 patients (China group), received cadaveric kidney transplantation in China and have been managed at our institute from Jan 2002 to Jan 2006 and 33 patients (domestic group), received cadaveric kidney transplantation at our institute from Feb 2000 to Jan 2006. We performed retrospective study based on medical records. RESULTS: Duration of pre-transplantation renal replacement therapy and of post-transplantation follow up was longer in domestic group (China group vs. domestic group; 89.9 months vs. 24.6 months, 31.9 months vs. 13.9 months) (p<0.05, p<0.05). Final GFR of China group was lower than domestic group (China group vs. domestic group; 54.97+/-18.92 mL/min vs. 64.26+/-18.23 mL/min) (p<0.05). Infection and rejection rates of China group were higher than domestic group (Incidences/ Pantients *Yr./1000; China group vs. domestic group; infection; 2.05 vs. 0.76, rejection; 1.34 vs. 0.51) (p<0.05). There was no difference of patient and graft survival between two groups. CONCLUSION: Korean recipients of Chinese cadaveric kidneys showed lower final GFR and higher rates of infection and rejection. We should be aware of the possible rejections and complications of kidney recipients undergoing cadaveric kidney transplantation in China. Mutual exchange of information about current status of patients, transplantation indications, donor status and treatment protocols is needed between foreign transplantation centers and our medical centers.
Asian Continental Ancestry Group ; Cadaver* ; China* ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Medical Records ; Renal Replacement Therapy ; Retrospective Studies ; Tissue Donors

Acute humoral rejection after renal transplantation is associated with a higher frequency of allograft dysfunction and graft loss. We report a case of acute humoral rejection which was treated successfully with plasmapheresis and intravenous immunoglobulin. A 31- year-old man developed azotemia after kidney transplantation. Kidney biopsy finding was compatible with antibody-mediated rejection, demonstrated by the infiltration of monocytes and neutrophils and the deposition of C4d on glomerulus and peritubular capillaries. We performed five plasmapheresis with concomitant treatment of intravenous immunoglobulin after each session. With aggressive treatment, there was improvement of oliguric acute renal failure, accompanied by decrease in the percentage of PRA and the titer of donor specific antibodies. Repeated kidney biopsy revealed persistent C4d staining on peritubular capillaries despite disappearance of donor specific antibodies. In conclusion, plasmapheresis and intravenous immunoglobulin are effective in treating acute humoral rejection.
Male ; Humans ; Biopsy

PURPOSE: In spite of medical advances, empyema is a serious complication of pneumonia in children. Vaccination practices and antibiotic prescribing practices promote the change of clinical manifestations of empyema and causative organisms. So we made a nationwide clinical observation of 122 cases of empyema in children from 32 hospitals during the 5 year period from September 1999 to August 2004. METHODS: Demographic data, and clinical information on the course and management of empyema patients were collected retrospectively from medical records in secondary and tertiary hospitals in Korea. RESULTS: One hundred twenty two patients were enrolled from 35 hospitals. The most frequent age group was 1-3 years, accounting for 48 percent of all cases. The male to female sex ratio was 1.2:1. The main symptoms were cough, fever, respiratory difficulty, lethargy and chest pain in order of frequency. Hematologic findings on admission revealed decreased hemoglobin levels (10.4+/-1.6 g/dL) and increased leukocyte counts (16,234.3+/-10,601.8/microliter). Pleural fluid obtained from patients showed high leukocyte counts (30,365.8+/-64,073.0/microliter), high protein levels (522.3+/-1582.3 g/dL), and low glucose levels (88.1+/-523.5 mg/dL). Findings from pleural fluid cultures were positive in 80 cases(65.6 percent). The most common causative agent was Streptococcus pneumoniae. The majority of patients were treated with antibiotics and closed drainage. Some patients needed open drainage (16.4 percent) or decortication (3.3 percent). The mean duration of hospitalization was 28.6+/-15.3 days. CONCLUSION: We analyzed childhood empyema patients during a period of 5 years in Korean children. The most frequent age group was 1-3 years and the most common causative agent was Streptococcus pneumoniaeiae. The majority of patients were treated with antibiotics and close drainage.
Anti-Bacterial Agents ; Chest Pain ; Child ; Cough ; Drainage ; Empyema* ; Female ; Fever ; Glucose ; Hospitalization ; Humans ; Korea* ; Lethargy ; Leukocyte Count ; Male ; Medical Records ; Pneumonia ; Retrospective Studies ; Sex Ratio ; Streptococcus ; Streptococcus pneumoniae ; Tertiary Care Centers ; Vaccination

OBJECTIVE: The purpose of this study was to self-management asthma including symptom, medication, and to prevent the exacerbation of the condition using the Personal Asthma Management System(PAMS) which was developed based on Personal digital Assistant(PDA). METHODS: A development tool of the PAMS was EVC(Microsoft Embadded Visual C++). The system contents referred to workshop report of the Global Initiative for Asthma, on-line lecture of the Korean Society of allergology and Korea Asthma allergy Foundation, asthma-related web-sites. RESULTS: The PAMS was implemented with four main menus: personal information, symptom, medication management, and self care. The patients input their daily condition, and this data will be used in the successful prevention and management of asthma exacerbation. This real-time nature of PAMS is its primary advantage over other retrospective computing system for reducing the effects of forgetting, so this information will be useful in classifying of asthma severity. CONCLUSION: The PAMS can be contributed to aid self-management of asthma and effective treatment by attending physician.
Asthma* ; Education ; Humans ; Hypersensitivity ; Korea ; Retrospective Studies ; Self Care